Exam 2
A 23 year old patient with cystic fibrosis says to the nurse "My future mother in law has cystic fibrosis but my children will be safe because my fiancé does not have the disease" What would be the nurses best response? A. Your children will not have the disease but they could be carriers. B. Your children have a 50% chance of having the disease. C. If your fiancés mother has the disease your fiancé has a 50% chance of being a carrier. D. Your children have a 25% chance of being carriers.
B
A Seven year old has been diagnosed with having Cystic fibrosis. Chest physiotherapy Has been ordered. When should the chest percussion be performed? A. Before postural drainage. B. 30 minutes to 1 hour before meals. C. Before an aerosol treatment. D. After suctioning.
B
Bilirubin is a by-product of the destruction of which aged cells? A. Platelets B. Protein C. Leukocytes D. Erythrocytes
D
A nurse cares for a client who has obstructive jaundice. The client asks, "Why is my skin so itchy?" How should the nurse respond? A. "Bile salts accumulate in the skin and cause the itching." B. "Toxins released from an inflamed gallbladder lead to itching." C. "Itching is caused by the release of calcium into the skin." D. "Itching is caused by a hypersensitivity reaction."
A
A nurse cares for a client with acute pancreatitis. The client states, "I am hungry." How should the nurse reply? A. "Is your stomach rumbling or do you have bowel sounds?" B. "I need to check your gag reflex before you can eat." C. "Have you passed any flatus or moved your bowels?" D. "You will not be able to eat until the pain subsides."
A
A patient in the clinic with cystic fibrosis (CF) reports increased sweating and weakness during the summer months. Which action by the nurse would be most appropriate? A. Have the patient add dietary salt to meals. B. Teach the patient about the signs of hypoglycemia. C. Teach the patient about the sweat test. D. Instruct the patient about pancreatic enzyme replacements.
A
Functions of the Myelin sheath are (Select all that apply) a. Protect the axon of the nerve b. Speed conduction of nerve impulses c. Coordinate impulse messages d. Insulate the Neuro axon e. Generate neuro transmitters
A,B,D
What medications would the nurse expect to find in an RSI kit? (Select all that apply) a. Vecuronium b. succinylcholine c. Atropine d. Epinephrine e. Versed
ALL CORRECT
A young adult female patient with cystic fibrosis (CF) tells the nurse that she is not sure about getting married and having children some day. Which initialresponse by the nurse is best? A. "Are you aware of the normal lifespan for patients with CF?" B. "Do you need any information to help you with that decision?" C. "Many women with CF do not have difficulty conceiving children." D. "A genetic specialist can explain your chances of getting pregnant"
B
The health care provider has prescribed the following collaborative interventions for a patient who is taking Methylprednisolone for systemic lupus erythematosus. Which order will the nurse question? a. Draw anti-DNA blood titer. b. Administer varicella vaccine. c. Naproxen (Aleve) 200 mg BID. d. Famotidine (Pepcid) 20 mg daily.
B
Which pancreatic enzyme is responsible for the breakdown of carbohydrates? A. Trypsin B. Amylase C. Lipase D. Chymotrypsin
B
Which of the following signs and symptoms would indicate a need for cystic fibrosis genetic testing? (Select all that apply) A. Asymmetrical weakness and sensory loss B. Malnutrition C. Frequent pneumonia D. Failure to thrive E. Fetal Macrosomia
B,C,D
A new clinic patient with joint swelling and pain is being tested for systemic lupus erythematosus. Which test will provide the most specific findings for the nurse to review? a. Rheumatoid factor (RF) b. Antinuclear antibody (ANA) c. Anti-Smith antibody (Anti-Sm) d. Lupus erythematosus (LE) cell prep
C
A nurse prepares to assess the emotional state of a client with end-stage pancreatic cancer. Which action should the nurse take first? A. Bring the client to a quiet room for privacy. B. Pull up a chair and sit next to the client's bed. C. Determine whether the client feels like talking about his or her feelings. D. Review the health care provider's notes about the prognosis for the client.
C
The mother of a 2 year old with cystic fibrosis tells the nurse that the family is planning their first summer vacation. She wants to know if there are any special precautions needed because he has cystic fibrosis. For which condition will the nurse explain that the child is particularly susceptible? a. Severe sunburn b. Infectious diarrhea c. Heat exhaustion d. Respiratory allergies
C
The nurse is teaching a client with cystic fibrosis. What activity does the nurse teach as the priority? A. Taking daily antibiotics B. Having genetic screening C. Maintaining good nutrition D. Exercising daily
C
The nurse will teach a patient with chronic pancreatitis to take the prescribed pancrelipase (Viokase) A. at bedtime. B. in the morning. C. with each meal. B. for abdominal pain.
C
What gene is responsible for the development of the chloride channels? A. Beta gene B. Levi C. CFTR D. babbl
C
A decrease in bone density has been detected in a patient with Cystic Fibrosis. What would be the most essential action for the nurse to take? A. increase vitamin D dose B. Increase protein intake C. Increase calcium intake D. develop an exercise regimen
D
A patient tells the nurse "I am losing control of my body and my mind. Isn't there anything I can do about this?" What is the best way for the nurse to respond to this question? a. No b. The body can only repair myelin of peripheral nerves. MS is demyelination of the nerves in the Central nervous system. c. Corticosteroids will bring back a percentage of your strength and dexterity d. An important part of maintaining or improving those abilities is to follow a physical and mental exercise regimen.
D
A two year old with cystic fibrosis is admitted to the hospital. The child is small for his age. What dietary suggestions can the nurse recommend to the child's mother to enhance his growth? a. Low fat, low residue and high potassium diet. b. Low carbohydrate, soft diet with not sugar products. c. High carbohydrates high fat diet with extra water between meals. d. High protein, a high calorie meal with snacks between meals.
D
The nurse is admitting a client diagnosed with R/O SLE. Which assessment data observed by the nurse supports the diagnosis of SLE? a. Pericardial friction rub and crackles in the lungs b. bradykinesia c. Hirsutism and clubbing of the fingers d. Somnolence and weight gain.
a
The nurse is completing discharge teaching to a patient with a new diagnosis of multiple sclerosis (MS). What does the nurse recommend about diet? a. Focus on maintaining a weight as close as possible to what is recommended for the patient's height and weight. b. Increase fats and lower carbohydrates. c. Include foods that are easy to swallow since dysphagia is a problem seen in the early stages of the disease. d. Basically remain the same, as there are no nutritional changes in the MS patient.
a
A 26 year old client is complaining of a low grade fever, arthralgia's, fatigue, and a facial rash. Which laboratory tests (HCP) to order if SLE is suspected? a. Complete metabolic panel (CMP) and liver function tests. b. Complete blood count and antinuclear antibody testing. c. Cholesterol and lipid profile d. Blood urea nitrogen and glomerular filtration rate.
b
A 5-year-old boy with a fractured Radius with sluggish cap refill and weak radial pulse distal the injury. The child is alert and oriented sitting on his mother's lap. a. Green b. Yellow c. Red d. Black
b
A nurse is teaching a client with multiple sclerosis who is prescribed cyclophosphamide (Cytoxan) and methylprednisolone (Medrol). Which statement should the nurse include in this client's discharge teaching? a. "Take warm baths to promote muscle relaxation." b. "Avoid crowds and people with colds." c. "Relying on a walker will weaken your gait." d. "Take prescribed medications when symptoms occur."
b
The nurse in an emergency department has admitted five clients in the last two hours with complaints of fever and gastrointestinal distress. Which question is most appropriate for the nurse to ask each client to determine if there is a bioterrorism threat? a. Was there a caped man flying nearby that looked like a bird or a plane? b. Where were you immediately before you got sick? c. Can you write down everything you ate today? d. What other health problems do you have?
b
Which result for a 30-year-old patient with systemic lupus erythematosus (SLE) is most important for the nurse to communicate to the health care provider? a. Decreased C-reactive protein (CRP) b. Elevated blood urea nitrogen (BUN) c. Positive antinuclear antibodies (ANA) d. Positive Anti-Smith antibody (Anti-Sm)
b
A patient is undergoing diagnostic testing for possible cystic fibrosis. Which non-pulmonary assessment findings does the nurse expect to observe in a patient with CF? Select all that apply. a. Peripheral edema b. Abdominal distention c. Steatorrhea d. Constipation e. Gastroesophageal reflux f. Malnourished appearance
b. Abdominal distention c. Steatorrhea e. Gastroesophageal reflux f. Malnourished appearance
. A patient is admitted to the emergency department (ED) after falling through the ice while ice skating. Which assessment will the nurse obtain first? a. Heart rate b. Breath sounds c. Airway patency d. Level of consciousness
c
A 30 year old female client is admitted with complaints of numbness, tingling and double vision which have occurred two times in the last month. Which question is the most important for the nurse to ask the client? a. Have you experienced any difficulty with your menstrual cycle? b. Have you noticed a rash across the bridge of your nose? c. Do you get tired easily and sometimes have trouble swallowing? d. Are you taking birth control pills to prevent conception?
c
A 33-yr-old patient with multiple sclerosis (MS) is to begin treatment with glatiramer acetate (Copaxone). Which information will the nurse include in patient teaching? a. Recommendation to drink at least 4 L of fluid daily b. Need to avoid driving or operating heavy machinery c. How to draw up and administer injections of the medication d. Use of contraceptive methods other than oral contraceptives
c
A 45 year old male in and out of consciousness with an upper extremity severed at the elbow. The man has been attempting to hold pressure on the injury site which is actively spurting blood. a. Green b. Yellow c. Red d. Black
c
A nurse assesses a client with early-onset multiple sclerosis (MS). Which clinical manifestation should the nurse assess for? a. Hyperresponsive reflexes b. Excessive somnolence c. Nystagmus d. Heat intolerance
c
25-year-old female patient with systemic lupus erythematosus (SLE) who has a facial rash and alopecia tells the nurse, "I never leave my house because I hate the way I look." An appropriate nursing diagnosis for the patient is a. activity intolerance related to fatigue and inactivity. b. impaired social interaction related to lack of social skills. c. impaired skin integrity related to itching and skin sloughing. d. social isolation related to embarrassment about the effects of SLE.
d
A 27 year old female with a metal pipe penetrating her Left temple and exiting her right temple. She was found in a large pool of blood with her 2 year old child in arms. She is unresponsive with fixed pupils and a weak thready pulse and no obtainable Blood pressure. a. Green b. Yellow c. Red d. Black
d
A nurse cares for a client who presents with an acute exacerbation of multiple sclerosis (MS). Which prescribed medication should the nurse prepare to administer? a. Baclofen (Lioresal) b. Interferon beta-1b (Betaseron) c. Dantrolene sodium (Dantrium) d. Methylprednisolone (Medrol)
d
A nurse prepares a client for prescribed magnetic resonance imaging (MRI). Which action should the nurse implement prior to the test? a. Implement nothing by mouth (NPO) status for 8 hours. b. Withhold all daily medications until after the examination. c. Administer morphine sulfate to prevent claustrophobia during the test. d. Place the client in a gown that has cloth ties instead of metal snaps.
d
. Which signs/symptoms should the nurse attribute to possible anthrax exposure via the skin? a. A scabby clear fluid filled vesicle b. Pruritis and a 2 cm ulcerated vesicle c. irregular brownish pink spots around the hairline d. Tiny purplish spots flush with the surface of the skin
A
A newborn with delayed meconium is going to have a sweat test done. The mother shows accurate interpretation of the test literature she was provided when she makes which of the following statements? A. "This test will see how much chloride is in her sweat" B. "This test will tell us if my baby is sweating to much" C. "This test will detect Jaundice before the skin appears yellow" D. "The Lab Technician will do a heal stick to get the blood for the test"
A
A nurse is teaching a patient with multiple sclerosis (MS) and the patient says "I thought I was allergic to milk but I didn't know allergies would give me MS" Which statement would be the best response to this statement? a. You are probably Lactose intolerant which is not an allergy. b. Milk does not cross the blood brain barrier so it can not cause MS c. MS is caused by lymphocytes crossing the blood brain barrier not with systemic allergies d. If you stop drinking Milk your MS may go away.
MS is caused by lymphocytes crossing the blood brain barrier not with systemic allergies
Patient A: The ED triage nurse has an ambulance enroute with ETA of less that 10 minutes. One ambulance is transporting a the driver of a pickup truck that was involved in an MVC. Patient had seat belt in place and airbags deployed. The patient's lower right arm was trapped between the back of his seat and the rear cab wall. EMS used pry bars to free the patients trapped arm. Assessment of the right arm reveals Edema to lower right arm with no palpable radial pulse. Digits are pale and cool with no cap refill. Pt rates arm and hand pain at 8 on a 0 to 10 scale. 4mg of morphine was administered iv push. The patient is alert and orient x 3. Lungs are clear. O2 sat 100% on 3L O2 per nc. RR-24, HR-110, BP-144/90. Patient B: A second ambulance is enroute with an unresponsive patient. The patient has no spontaneous pulse or respirations and CPR is in progress. The patient's son witnessed the patient collapse 7 minutes ago and started CPR immediately. Telemetry was interpreted as asystole in two leads. ETA is 8 minutes. The patient has been intubated and respirations are now being delivered per ambu bag at a rate of 15 resps per minute. The patient has received Epinephrine IV push per ACLS protocol. Patient C: A patient arrive at the ED triage room and stated that his sexual partner has been diagnosed with syphilis. Denies any symptoms at this time. Patient D: Mother reports her seven-year-old child has had a head injury 4 hours ago at school. The school nurse reported the child had no LOC. The child has a bum on his forehead. Is alert orient x3. PERL. Moves all extremities with strength bilaterally equal. The child vomited x 1 30 minutes ago after eating fish sticks. Denies nausea at this time. Which of the above patients should be the ED's highest priority? Patient A Patient B Patient C Patient D
Patient B
A 24 year old male with a partial thickness burn to the left lower anterior forearm. The man is hysterical and yelling in a loud voice for his wife and daughter. a. Green b. Yellow c. Red d. Black
a
A 30-year-old nurse who works on a busy medical-surgical unit has been diagnosed with multiple sclerosis (MS). What should the nurse identify as a priority for self-care? a. Apply for nursing positions that are less stressful and demanding. b. Work as hard as possible now because it may not be possible later. c. Continue to work as scheduled without making changes. d. Leave employment as a nurse due to the need for complete bed rest.
a
A woman who has multiple sclerosis (MS) asks the nurse about risks associated with pregnancy. Which response by the nurse is accurate? a. "MS symptoms may be worse after delivery" b. "Women with MS frequently have premature labor." c. "MS is associated with an increased risk for congenital defects." d. "Symptoms of MS are likely to become worse during pregnancy."
a
The nurse knows that the best way to achieve slower progression of MS symptom severity over the life span would be to a. Decrease severity and frequency of exacerbations. b. Make sure the patient is following the prescribed exercise regimen. c. Keep the patient on a restrained maintenance dose of corticosteroids. d. Shorten the span of the patient life.
a
Which finding for a patient who is taking hydroxychloroquine (Plaquenil) to treat rheumatoid arthritis is likely to be an adverse effect of the medication? a. Blurred vision b. Joint tenderness c. Abdominal cramping d. Elevated blood pressure
a
The nurse should suspect spinal cord injury for any of the following patient. (Select all that apply) a. A patient that fell from a ladder and has a hematoma to back of the head. b. A patient involved in an MVC. His car was struck in the rear by a truck going 25mph. c. A patient with a 3" laceration after punching a glass door. d. A patient that fell while ice skating and hit the back of his head. e. A patient that suffered an electric shock.
a,b,d,e
Which action will the nurse plan to take for a patient with multiple sclerosis who has urinary retention caused by a flaccid bladder? a. Encourage a decreased evening intake of fluid. b. Teach the patient how to use the Credé method. c. Suggest the use of adult incontinence briefs for nighttime only. d. Assist the patient to the commode every 2 hours during the day.
b
Which nursing action can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) who are assisting with the care of a patient with scleroderma? a. Monitor for difficulty in breathing. b. Document the patient's oral intake. c. Check finger strength and movement. d. Apply capsaicin (Zostrix) cream to hands.
b
Which statement by a patient with systemic lupus erythematosus (SLE) indicates that the patient has understood the nurse's teaching about the condition? a. "I will exercise even if I am tired." b. "I will use sunscreen when I am outside." c. "I should take birth control pills to keep from getting pregnant." d. "I should avoid aspirin or nonsteroidal antiinflammatory drugs."
b
The emergency room physician has diagnosed a patient in the ER with smallpox. The nurse understands that which of the following will take place in response to this diagnosis.(Select all that apply) a. The patient will be sent home with instructions to avoid crouds b. The patient will be placed in strict isolation c. The health authority will be notified immediately d. all persons that have been in contact with the patient will be vaccinated. e. A mass worldwide vaccination will be implemented.
b,c,d
A nurse assesses a client with multiple sclerosis after administering prescribed fingolimod (Gilenya). For which adverse effect should the nurse monitor? a. Peripheral edema b. Black tarry stools c. Bradycardia d. Nausea and vomiting
c
A patient is admitted to the emergency department (ED) suffering an allergic reaction to peanuts. When assessing the patients airway, the nurse finds the tongue blocking the airway. What should the nurse do next? a. Check the patient's pulse b. Auscultate lungs. c. Place an oral or nasal airway d. Immobilize C spine.
c
A patient is to receive a HHN treatment of Ipratropium. The nurse knows that this medication will a. Cause bronchodilation via parasympathetic stimulation b. Cause bronchodilation via sympathetic stimulation c. Cause bronchodilation by blocking the parasympathetics d. Cause bronchodilation by blocking the sympathetic nervous system.
c
On returning from having an EEG the patient with MS asks the nurse how staring at that picture can determine if She has MS. The nurse correctly explains to the patient a.Your pupil response will be sluggish and asymmetrical if you have MS. b. We can tell if you have retinal damage by the wave forms c. We can tell if you have slowed impulse conduction by the wave forms. d. The test tells us if your myelin can regenerate.
c
The client diagnosed with an acute exacerbation of SLE is prescribed high dose steroids. Which statement best explains the scientific rationale for using high-dose steroids in treating SLE? a. The steroids will increase the body's ability to fight the infection b. The steroids will decrease the chance of the SLE spreading to other organs c. The steroids will depress tissue inflammation, which will reduce damage to other organs. d. The steroids will prevent scarring of tissues associated with SLE.
c
The client with an acute exacerbation of MS is placed on high-dose IV injections of corticosteroids. Which nursing intervention should be implemented? a. Discuss discontinuing the proton inhibitor with the HCP. b. Hold the medication until all blood cultures have been obtained. c. Monitor the client's serum blood glucose levels frequently. d. Provide supplemental dietary sodium with the client's meals
c
The nurse is developing a care plan for a client with SLE. Which goal is priority for this client? a. The client will maintain reproductive ability b. The client will verbalize feeling of body-image changes c. The client will have no deterioration of organ function d. The client's skin will remain intact and have no irritation
c
Which information about a 60-yr-old patient with multiple sclerosis indicates that the nurse should consult with the health care provider before giving the prescribed dose of dalfampridine (Ampyra)? a. The patient walks a mile each day for exercise. b. The patient complains of pain with neck flexion. c. The patient has an increased serum creatinine level. d. The patient has the relapsing-remitting form of MS.
c
