test5
A student under a great deal of stress develops a severe tension headache and goes to the school clinic. What strategy should the nurse teach the student for dealing with the onset of headaches in the future? a. Aerobic exercise b. Relaxation exercises c. Use of vitamin C and zinc d. Use of distraction techniques
B
While collecting data the nurse suspects a patient is experiencing manifestations of Addison's disease. What observations did the nurse make to come to this conclusion? (Select all that apply.) a. Ankle edema b. Bronzing of the skin c. Blood pressure 90/55 mm Hg d. Bruises over the upper chest and arms e. Weight loss 10 lbs from last examination
B,C,E
The LPN is caring for a patient with diabetes insipidus and obtains a urine specific gravity reading of 1.002. Which response by the LPN is most important? a. Document the results. b. Advise the patient to drink less water. c. Report the reading to the RN because therapy is ineffective. d. Report the reading to the RN because the patient may be receiving too much medication.
C
The nurse is assisting with teaching a patient about tension headaches. Which explanation of tension headaches should the nurse provide? a. "Tension headaches result from release of pain mediators in the periphery." b. "Tension headaches are caused by stress, which causes cerebral vessel constriction." c. "Tension headaches are a result of stress and sustained muscle contraction of the head and neck." d. "Tension headaches are caused by blood sugar fluctuations that result from excessive stress."
C
The nurse is caring for a patient who has had a stroke (brain attack). The patient is unable to understand what the nurse is saying and appears frustrated. What term should the nurse use to document this finding? a. Dysphagia b. Confusion c. Receptive aphasia d. Expressive aphasia
C
The nurse notes that a patient with a head injury has a widening pulse pressure. Which action should the nurse take at this time? a. Give an extra dose of diuretic. b. Lay the bed flat and check pupil response. c. Raise the head of the bed and notify the registered nurse (RN). d. None; this is an expected finding after a head injury.
C
The physician prescribes intravenous mannitol for a patient who has a head injury and increased intracranial pressure (ICP). Which assessment finding indicates to the nurse that the patient is having a therapeutic response to the mannitol? a. Return of the gag reflex b. Increased blood glucose c. Increased urinary output d. Decreased Glasgow Coma Scale (GCS) score
C
When the nurse shines a light in a patient's left pupil, both of the pupils constrict. What type of response should the nurse document? a. Direct b. Abnormal c. Consensual d. Accommodation
C
The nurse is assisting with discharge of a patient with Addison's disease following an adrenal crisis. Which instruction is most important for the nurse to reinforce? a. The need for a well-balanced diet b. How to monitor blood glucose levels c. The importance of 30 minutes of exercise each day d. The importance of taking steroid replacements as prescribed
D
The nurse is assisting with teaching family members about a patient's epidural bleed. Which information about an epidural bleed should guide the nurse's teaching? a. It is usually venous and absorbs in time. b. It is within the brain tissue, so residual effects are likely. c. It usually causes quadriplegia, and rehabilitation will be necessary. d. It is usually arterial and may lead to death without rapid intervention.
D
The nurse is assisting with the administration of a Tensilon test. What response to the test causes the nurse to suspect that the patient has myasthenia gravis? a. Dyspnea develops b. Muscle cramps develop c. Muscles become very weak. d. Ptosis is temporarily improved.
D
The nurse is caring for a patient brought to the emergency department after an automobile accident. The patient is fully conscious. For what early signs of increased intracranial pressure (ICP) should the nurse be alert? a. Bradycardia b. Hypothermia c. Pinpoint pupils d. Decreased level of consciousness
D
The nurse is caring for a patient with an exacerbation of multiple sclerosis (MS). What should the nurse include when teaching the patient about risk factors for exacerbation? a. Vegetarian diet b. Exposure to sun c. Sedentary lifestyle d. Urinary tract infection
D
The nurse is contributing to a teaching plan. What should the nurse emphasize as being the most effective method known to control the spread of HIV infection? a. Premarital serological screening b. Prophylactic exposure treatment c. HIV screening for pregnant women d. Education about preventive behaviors
D
The nurse is explaining the transmission of nerve impulses to a patient with a spinal cord injury. What should the nurse explain as the structure that carries nerve impulses at synapses? a. Cell membrane b. Depolarizations c. Schwann's cells d. Neurotransmitters
D
A patient is newly diagnosed with acromegaly. Which nursing diagnosis should the nurse identify as being appropriate for this patient? a. Imbalanced Nutrition b. Body Image Disturbance c. Ineffective Airway Clearance d. Risk for Complications related to fluid imbalance
B
A patient asks for the best way to prevent contracting a sexually transmitted infection (STI). What response should the nurse make to this patient's question? a. Abstinence b. Oral contraceptives c. Condom with spermicide d. Prophylactic oral antibiotics
A
Human papillomavirus (HPV) produces verrucous growths. What term should the nurse use to describe these lesions to the patient? a. Warts b. Rashes c. Blisters d. Papules
A
A patient with suspected hyperthyroidism is scheduled for a radioactive iodine uptake test. What symptoms of hyperthyroidism should the nurse note on the medical record? (Select all that apply.) a. Fatigue b. Tremor c. Weight loss d. Constipation e. Buffalo hump f. Cold intolerance
A,B,C
A patient is admitted to the hospital with new-onset diabetes insipidus. Which nursing diagnoses should the nurse include in the plan of care? (Select all that apply.) a. Risk for Deficient Fluid Volume b. Risk for Injury related to fractures c. Risk for Injury related to hypertension d. Knowledge Deficit related to disease process e. Impaired Gas Exchange related to decreased oxygenation
A,D
A patient enters the emergency department in adrenal crisis. The patient is lethargic and vital signs are blood pressure 85/52 mm Hg and pulse 88 beats/min. Which event in the patient's week most likely precipitated this crisis? a. Eating a high-fat diet b. Being laid off from a job c. Taking Tylenol for a headache d. Maintaining usual exercise of walking each night
B
The LPN admits a well-known patient to the clinic and notes that the patient's face and features seem broader and coarser. Which laboratory test should the nurse expect to be prescribed for this patient? a. Cortisol b. Growth hormone c. Glucose tolerance test d. Vanillylmandelic acid (VMA)
B
A patient diagnosed with genital warts asks how they developed. Which pathogen should the nurse explain as causing genital warts? a. Sarcoptes scabiei b. Hepatitis A and B c. Human papillomavirus d. Chlamydia trachomatis
C
A nurse is approached by a neighbor who has a neck growth that appears to be a goiter. What should the nurse do? a. Advise the neighbor to switch to iodized salt when cooking. b. Palpate the neighbor's thyroid gland for enlargement or nodules. c. Ask if the neighbor has numbness or tingling in the hands or lips. d. Question the neighbor about symptoms of hypothyroidism or hyperthyroidism.
D
While doing volunteer health screenings at a local mall a patient with a large growth on the neck approaches the nurse. What finding should alert the nurse to send the patient to the physician immediately? a. The patient seems depressed. b. The growth is difficult to conceal with clothing. c. The patient complains of being very tired lately. d. The patient makes a funny high-pitched sound with each breath.
D
A patient is prescribed to ingest a high-calcium diet. What foods should the nurse instruct the patient to ingest? (Select all that apply.) a. Chicken b. Potatoes c. Beef and pork d. Sardines, salmon e. Milk, cheese, and yogurt f. Whole grain breads and cereals
D,E
The nurse is contributing to a teaching plan. What information should the nurse include that identifies the methods in which HIV can be transmitted? (Select all that apply.) a. Urine b. Sweat c. Saliva d. Semen e. Breast milk f. Vaginal secretions
D,E,F
The nurse is caring for a patient with amyotrophic lateral sclerosis (ALS). Which assessment findings should the nurse anticipate? (Select all that apply.) a. Hemiparesis b. Bradykinesia c. Pill-rolling tremor d. Ascending paralysis e. Progressive weakness f. Decreased coordination of extremities
E,F
A patient develops hyperparathyroidism related to a benign tumor. What laboratory result should the nurse expect to see? a. Elevated serum calcium b. Decreased serum calcium c. Elevated serum potassium d. Decreased serum potassium
A
A patient is demonstrating manifestations of a pheochromocytoma. Which intervention is the most important for the nurse to implement? a. Provide a calm, quiet environment. b. Encourage frequent intake of fluids. c. Offer distraction such as television or music. d. Assist with ambulation at least three times a day.
A
A patient is diagnosed with a parasitic infection caused by close contact with another person's genitals. For which infection should the nurse plan care? a. Phthirus pubis b. Treponema pallidum c. Neisseria gonorrhoeae d. Chlamydia trachomatis
A
A patient with chronic obstructive pulmonary disease develops Cushing's syndrome related to long-term steroid use. The physician writes an order to discontinue the steroids. Which action by the nurse is most appropriate? a. Question the order. b. Monitor the patient's weight daily. c. Monitor the patient's blood glucose level. d. Instruct the patient to report worsening respiratory symptoms.
A
It is documented in the medical record that a patient has gummas. For which sexually transmitted infection should the nurse plan care? a. Syphilis b. Gonorrhea c. Chlamydia d. Genital herpes
A
The nurse is caring for a 76-year-old retired man who is undergoing evaluation for dementia. What would be an important part of the man's history to report to the physician? a. The patient has a history of syphilis. b. The patient was exposed to Chlamydia. c. The patient has a history of hepatitis B. d. The patient has a history of genital warts.
A
The nurse is caring for a patient following a thyroidectomy. Which postoperative assessment activity is most important to detect the development of thyrotoxic crisis? a. Monitor vital signs. b. Monitor the surgical dressing. c. Assess for confusion and delirium. d. Assess hand grips and foot presses.
A
The nurse is caring for a patient with a history of asthma who is newly diagnosed with hyperthyroidism. What assessment finding should the licensed practical nurse (LPN) report immediately to the registered nurse (RN)? a. Heart rate 112 beats/min b. Temperature 97.2°F (36.2°C) c. Blood pressure 112/73 mm Hg d. Respiratory rate 20 breaths/min
A
The nurse is caring for a patient with exophthalmos secondary to Graves' disease. What nursing interventions are appropriate for this patient? a. Myotic eyedrops and privacy b. Television and other diversionary activities c. An accepting attitude and lubricating eyedrops d. Reassurance that the symptoms will resolve when the Graves' disease is under control
A
The nurse is identifying ways for a young adult to reduce the risk of contracting a sexually transmitted infection (STI). What should the nurse teach about the relationship between consumption of alcohol and immediate risk of contracting an STI? a. Alcohol may reduce inhibitions. b. Alcohol increases risk for liver disease. c. Alcohol lowers the body's resistance to infection. d. Alcohol impairs the integrity of the mucous membranes, providing a portal of entry for infection.
A
The nurse is planning care for a patient with an intracerebral hemorrhage. What should be identified as a goal for this patient? a. Maintain blood pressure below 120/80 mm Hg b. Resume activities of daily living as soon as possible c. Expect to experience transient numbness and tingling d. Receive thrombolytic medication therapy within an hour
A
The nurse is providing care for an 87-year-old woman who is recovering from a cerebral vascular accident. Which precaution should the nurse take after noting the patient has a positive Romberg test? a. Institute fall-risk precautions. b. Provide small, frequent meals. c. Request a footboard and splints. d. Darken the room and reduce stimuli.
A
The vital signs for a client with a possible head injury were on admission: blood pressure 128/72 mm Hg, pulse 90 beats/min, and respirations 66 breaths/min. Which vital sign assessment conducted four hours later most likely indicates the presence of increased intracranial pressure (ICP)? a. Blood pressure 172/68 mm Hg, pulse 42 beats/min, respirations 10 breaths/min b. Blood pressure 160/90 mm Hg, pulse 112 beats/min, respirations 16 breaths/min c. Blood pressure 130/72 mm Hg, pulse 50 beats/min, respirations 24 breaths/min d. Blood pressure 100/70 mm Hg, pulse 120 beats/min, respirations 30 breaths/min
A
After frequent examinations a patient is diagnosed with amyotrophic lateral sclerosis (ALS). Which test results should the nurse review as confirmation of this diagnosis? (Select all that apply.) a. Nerve biopsy b. Electroencephalogram c. Nerve conduction velocity d. Analysis of cerebrospinal fluid e. CT scan of the brain and spinal cord
A,B,C,D
The nurse is reinforcing teaching on the rising incidence of HIV in adults over the age of 50 with a group of senior community members. Which factors should the nurse include? (Select all that apply.) a. Older adults are less likely to use condoms than younger at-risk adults. b. At-risk individuals over the age of 50 are less likely to be tested for HIV. c. Society continues to age with larger numbers of people entering this age group. d. A decline in the function of the immune system increases the risk of HIV infection. e. Decreased vaginal dryness and friability of tissues increases the risk of HIV in older women. f. Treatments for erectile dysfunction have increased the number of older individuals who are sexually active.
A,B,C,D,F
The nurse is teaching a patient with myasthenia gravis how to recognize a cholinergic crisis. What manifestations should the nurse include in this teaching? (Select all that apply.) a. Diarrhea b. Salivation c. Vomiting d. Difficulty speaking e. Abdominal cramping f. Increased bronchial secretions
A,B,C,E,F
A 56 year old female client asks why the nurse is assessing her for a stroke. Which manifestations did the nurse use to make this assessment decision? (Select all that apply.) a. Nausea b. Hiccups c. Itchy skin d. Chest pain e. Palpitations
A,B,D,E
The nurse suspects that a patient is experiencing increasing intracranial pressure. What observations did the nurse make to come to this conclusion? (Select all that apply.) a. Headache b. Rising temperature c. Decreasing systolic pressure d. Dilated pupil on affected side e. Decreasing level of consciousness (LOC)
A,B,D,E
The nurse notes that a patient is diagnosed with vulvovaginitis. What should the nurse expect when assessing this patient? (Select all that apply.) a. Vaginal edema b. Vaginal discharge c. Areas of ecchymosis d. Dark brown vaginal bleeding e. Complaints of vaginal itching and burning
A,B,E
The nurse is involved in a blood pressure clinic in the community, and an individual with possible stroke symptoms is brought for evaluation. Which findings in the F.A.S.T. assessment indicate the need to call emergency personnel? (Select all that apply.) a. The patient sways when asked to stand still with eyes closed. b. The patient is unable to follow directions during the assessment. c. The patient is unable to repeat a stated phrase exactly as it was stated. d. The patient's face shows signs of uneven symmetry when asked to smile. e. When asked to close the eyes and hold arms straight in front, one arm drifts downward.
A,C,D,E
The nurse has been discussing actions to prevent AIDS-related wasting syndrome with a patient being treated for AIDS. Which patient statements indicate an understanding of this teaching? (Select all that apply.) a. Eat a low-residue diet. b. Drink liquids before meals. c. Enjoy food odors to stimulate appetite. d. Numb painful oral sores with ice or popsicles. e. Eat three high-calorie, high-protein meals a day, plus snacks. f. Increase consumption of caffeine-containing foods and fluids.
A,D
The nurse is caring for a patient who is being tested for possible myasthenia gravis (MG). Which early symptoms of myasthenia gravis should the nurse document in the medical record? (Select all that apply.) a. Ptosis b. Nausea c. Tremor d. Confusion e. Weakness f. Numbness of the extremities
A,E
A patient is admitted to the hospital with a severe headache and photophobia. A lumbar puncture confirms a bleeding aneurysm. What nursing interventions should the nurse anticipate assisting with to prevent increased intracranial pressure (ICP) during the acute phase of illness? a. Morphine, dark glasses, and expectorants b. Quiet room, head of bed up, and stool softeners c. Coughing and deep breathing exercises and tranquilizers d. Range of motion exercises, bedside commode, and suctioning as needed
B
A patient is incontinent during a seizure and sleeps for several hours afterward. What type of seizure did the patient most likely experience? a. Absence b. Tonic-clonic c. Simple partial d. Status epilepticus
B
A patient is scheduled for a thymectomy. For which peripheral nervous system disorder should the nurse plan care for this patient? a. Multiple sclerosis (MS) b. Myasthenia gravis (MG) c. Guillain-Barré syndrome (GBS) d. Amyotrophic lateral sclerosis (ALS)
B
A patient tells the nurse that at times it seems like the mouth muscles do not want to work and the patient's speech is slurred. What should the nurse realize that the patient is describing? a. Diplopia b. Dysarthria c. Dysphagia d. Dysrhythmia
B
The nurse is assisting in a teaching plan for the family of a patient with HIV. Which explanation about the transmission of HIV should the nurse include in this plan? a. HIV is spread by casual contact with others. b. HIV spreads by contact with infected blood. c. HIV can be spread by sharing eating utensils. d. HIV is commonly transmitted by tears or saliva.
B
The nurse is caring for a patient with diabetes insipidus. What type of IV fluid should the nurse expect to be ordered for fluid replacement? a. Isotonic b. Hypotonic c. Hypertonic d. Parenteral nutrition
B
The nurse is planning care for a patient with diabetes insipidus. What data should the nurse to monitor this patient? a. Pupil responses and hand grasps b. Intake and output and daily weight c. Bowel sounds and abdominal girth d. Blood glucose before meals and at bedtime
B
The nurse is preparing a patient for an electroencephalogram (EEG). What information should be given to the patient? a. Little needles will be stuck into the scalp. b. The hair must be clean and dry before the test. c. The hair at the temporal area will have to be shaved. d. The patient must withhold fluids and food for 12 hours before the test.
B
The nurse is preparing a patient with myasthenia gravis to undergo plasmapheresis. Which laboratory tests should the nurse verify and place on the medical record before the procedure? a. Urine analysis, urine protein, BUN, and creatinine b. Complete blood count, platelets, and clotting studies c. Creatinine phosphokinase, blood type, and electrolytes d. Electrolytes, blood urea nitrogen (BUN), creatinine, and albumin
B
The nurse is providing post-procedure care for a patient recovering from a lumbar puncture. Which order should the nurse anticipate for this patient? a. Keep the patient NPO for 4 hours. b. Have the patient lie flat for 6 hours. c. Monitor the patient's pedal pulses every 4 hours. d. Keep the head of the bed elevated 30 degrees for 8 hours.
B
While assisting with care, the nurse counsels the patient diagnosed with a sexually transmitted infection (STI) about notification of sexual partners. Which patient statement indicates the need for further teaching? (Select all that apply.) a. "I can contact my sexual partners myself." b. "Reporting regulations are the same throughout the country." c. "A report form will be completed in my chart that includes a list of my sexual contacts." d. "The public health authority can notify a list of sexual contacts without including my identity."
B
While walking to the bathroom a patient begins having a generalized tonic-clonic seizure. What should the nurse do first? a. Reduce external stimuli. b. Maintain the patient's airway. c. Maintain the patient's privacy. d. Perform a brief neurological assessment.
B
A patient diagnosed with syndrome of inappropriate antidiuretic hormone is scheduled for surgery in a few days. What should the nurse expect to be prescribed for this patient to help manage the symptoms until surgery? (Select all that apply.) a. Salt restriction b. Fluid restriction c. Furosemide (Lasix) d. Conivaptan (Vaprisol) e. Hypertonic saline infusion
B,C,D,E
The nurse is caring for a patient scheduled for a lumbar puncture. Which actions should the nurse anticipate providing? (Select all that apply.) a. Position the patient prone on the bed. b. Check the puncture site for swelling or drainage. c. Ensure that the patient has given informed consent to the procedure. d. Keep the patient on bedrest with the head of the bed flat for 6 hours after the procedure. e. Limit fluid intake. f. Assess movement and sensation of lower extremities frequently for several hours after the procedure.
B,C,D,F
A 24-year-old woman diagnosed with Chlamydia has been prescribed doxycycline. What should be included in the nurse's teaching about the drug treatment? (Select all that apply.) a. "Take this drug with a meal." b. "Do not take with dairy products." c. "Avoid unnecessary exposure to sunlight." d. "Abstain from alcohol for at least 48 hours after treatment." e. "Use birth control methods to ensure you do not become pregnant."
B,C,E
The nurse is preparing to provide education related to HIV transmission at a local community health fair. Which statements should the nurse recommend for inclusion in the teaching? (Select all that apply.) a. Use oil-based lubricants. b. Use a new condom for each sex act. c. Use condoms that are not made of latex. d. Fit condom tightly over the tip of the penis. e. Check condom package for expiration date. f. Apply the condom before touching partner with the penis.
B,E,F
A patient enters the emergency department with right-sided weakness and vision changes. What assessment finding should be communicated to the registered nurse (RN) or HCP immediately? a. Blood glucose 150 mg/dL b. Blood pressure 148/92 mm Hg c. Onset of symptoms occurred 90 minutes ago d. History of transient ischemic attack (TIA) 3 months ago
C
A patient is newly diagnosed with diabetes insipidus. Which medications should the nurse anticipate being prescribed for long-term patient management? a. Mithramycin b. Inderal (propranolol) c. Desmopressin acetate d. Calcium and vitamin D
C
A patient recovering from a thyroidectomy is being assessed for tetany. What is the most likely cause of tetany after this surgery? a. Swelling of the incisional area b. Overdose of preoperative antithyroid medication c. Accidental removal of the parathyroid glands during surgery d. Excess circulating thyroid hormone released during manipulation of the gland during surgery
C
A patient scheduled for diagnostic tests for hypothyroidism. Which symptoms should the nurse expect to observe in a patient with this disorder? a. Tremor and oily skin b. Anxiety and tachycardia c. Dry skin and slowed heart rate d. Increase in appetite and diarrhea
C
A patient scheduled for diagnostic tests for hypothyroidism. Which symptoms should the nurse expect to observe in a patient with this disorder? a. Tremor and oily skin b. Anxiety and tachycardia c. Dry skin and slowed heart rate d. Increase in appetite and diarrhea
C
A patient with a cerebrovascular accident (stroke) has left-sided flaccidity and is unable to speak but seems to understand everything the nurse says. Which term should the nurse use to document the patient's communication impairment? a. Sensory aphasia b. Motor dysphagia c. Expressive aphasia d. Receptive dysphagia
C
A patient with a newly diagnosed brain tumor receives dexamethasone (Decadron) IV, which completely relieves the patient's symptoms. What should the nurse explain to the family about the patient's response to the medication? a. "The brain is such a unique organ; we never really know what will happen." b. "By dilating the arteries in the brain, blood flow is improved and symptoms improve." c. "The Decadron works to reduce swelling in the brain caused by the tumor; we often see remarkable improvement." d. "Decadron regenerates neurons in the central nervous system, so the patient should continue to get even better over the next week or so."
C
A patient with a newly diagnosed seizure disorder is being prepared for discharge. What medication should the nurse anticipate will be prescribed for the patient to prevent recurrent seizures? a. Selegiline (Eldepryl) b. Haloperidol (Haldol) c. Gabapentin (Neurontin) d. Dexamethasone (Decadron)
C
A patient with hyperparathyroidism asks why ambulation three times per day is necessary because it is so difficult to do so. Which response by the nurse is best? a. "Walking is good for you; I walk three times a day." b. "Walking is important for preventing cardiovascular disease." c. "Walking will keep the calcium where it belongs—in your bones." d. "Walking is important to maintaining adequate serum calcium levels."
C
A teen is experiencing a headache and dizziness after falling of a bicycle and hitting the head. The physician diagnoses a concussion. What explanation should the nurse provide to the patient's mother? a. The patient may lose consciousness before beginning to recover. b. The patient has had some intracranial bleeding but should recover in time. c. The patient has had a minor head trauma and should recover spontaneously. d. The patient may need to have surgery to relieve increased intracranial pressure.
C
The nurse is caring for a hospitalized patient who has had a stroke and is waiting to be transferred to a rehabilitation facility. What nursing action can best maximize the patient's rehabilitation potential while awaiting the transfer? a. Teach the patient what to expect at the rehabilitation facility. b. Keep the patient on bedrest to conserve energy for rehabilitation. c. Call the physical therapist for bedside rehabilitation until the transfer. d. Turn the patient every 2 hours to prevent pressure ulcers and contractures.
C
The nurse is caring for a patient with HIV. For which common opportunistic infection should the nurse observe when caring for this patient? a. Toxoplasmosis b. Cryptococcosis c. Candida albicans d. Cryptosporidiosis
C
The nurse is caring for a patient with lung cancer who develops syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which assessment findings should the nurse expect? a. Fatigue and weakness b. Poor skin turgor and polyuria c. Weight gain and concentrated urine d. Truncal obesity and thin extremities
C
The nurse is caring for a young woman who is newly diagnosed with genital warts. She states, "I heard you can get cancer from STIs. Is that true?" Which response by the nurse is correct? a. "No, you cannot get cancer from STIs." b. "Yes, most STIs can lead to cancerous changes if not treated promptly." c. "Yes, some STIs have been linked to cancer, so adequate treatment is very important." d. "No, that is not true, but a diagnosis of cancer does increase the risk of contracting an STI."
C
The nurse is notes that a patient recovering from a craniotomy has a pink spot with a yellow ring around it on the pillow. What should the nurse do? a. Change the patient's pillowcase. b. Do a basic neurological assessment. c. Notify the charge nurse immediately. d. Change the patient's cranial dressing.
C
While assisting a health care provider (HCP) conduct a pelvic examination, the patient complains of severe pain during the bimanual examination. For which health problem should the nurse suspect this patient is going to need care? a. Syphilis b. Gonorrhea c. Pelvic inflammatory disease d. Human papillomavirus infection
C
A patient asks, "What is the main purpose of these medications I take for my HIV?" Which response should the nurse make? a. "They encapsulate the virus-infected cells." b. "They mark the virus for natural killer cells to destroy." c. "They attract macrophages to the cells making the virus." d. "They inhibit enzymes to interfere with viral production."
D
A patient comes into the emergency department with symptoms of a stroke. Which medication should the nurse expect may be given to the patient if diagnostic testing confirms an ischemic stroke? a. Heparin b. Clopidogrel (Plavix) c. Warfarin (Coumadin) d. Tissue-type plasminogen activator (tPA)
D
A patient is prescribed levothyroxine (Synthroid) for hypothyroidism. Which statement should the nurse include when teaching the patient about this medication? a. "If you do not take your medication, you will retain water and begin to see swelling in your feet and legs." b. "Cushing's syndrome is a complication of severe hypothyroidism, so you need to take this medication regularly." c. "Thyrotoxicosis results from too little thyroid hormone, so you should monitor your temperature every day." d. "Worsening hypothyroidism can result in a condition called myxedema coma, so it is important to take this medication."
D
A patient is recovering from an epidural bleed. In which part of the brain should the nurse explain to the family that this bleed occurred? a. Circle of Willis b. Spinal meninges c. Space below the dura d. Space between the dura and the skull
D
A patient is scheduled for a lumbar puncture. Which action should the nurse take when preparing this patient? a. Remove all metal jewelry. b. Administer enemas until clear. c. Remove the patient's dentures. d. Assist the patient into a side-lying position.
D
A patient newly diagnosed with Parkinson's disease is prescribed carbidopa/levodopa (Sinemet). Which patient statement indicates teaching about the medication has been effective? a. "The medication causes urinary retention and a dry mouth." b. "Sinemet reduces inflammation in the central nervous system." c. "I should take this medication when my hand tremors bother me." d. "This medication converts to dopamine in the brain so my symptoms should improve."
D
A patient recovering from surgery to remove a brain tumor is found jerking rhythmically in the bed and unresponsive to verbal stimuli. What should the nurse do first? a. Call the physician. b. Find another nurse to assist. c. Hold the patient firmly to keep the patient from injuring someone. d. Protect the patient from injury and observe the sequence of events.
D
A patient who has HIV asks the nurse why blood work has to be done so frequently. Which response should the nurse make to the patient? a. "B-lymphocyte levels increase if you have an acute infection." b. "Phagocytes are decreased when the disease is in an active phase." c. "Neutrophil counts help the doctor titrate medication levels to keep you healthy." d. "CD4+ lymphocyte counts are monitored to determine the progression of the disease."
D
A patient with chronic obstructive pulmonary disease prescribed corticosteroid therapy asks what the medication does. What should the nurse respond to the patient? a. "It is an anti-infective and helps kill bacteria." b. "The medication causes your airways to dilate." c. "The medication is an expectorant that helps you cough up secretions." d. "It is an anti-inflammatory agent that reduces the swelling in your airways."
D
The nurse is assisting in the preparation of a teaching seminar for adolescents to prevent the development of a sexually transmitted infection (STI). Which nonsexual activity should the nurse teach that may transmit a sexually transmitted infection (STI)? a. Sharing a cigarette b. Borrowing a hairbrush c. Coughing and sneezing d. Sharing intravenous drug equipment
D
The nurse is caring for a patient with an exacerbation of multiple sclerosis. Which medication should the nurse anticipate administering to this patient? a. Thyrotropin b. Pyridostigmine (Mestinon) c. Diphenhydramine (Benadryl) d. Adrenocorticotropic hormone (ACTH)
D
The nurse is reinforcing teaching on transmission of HIV for a family of a patient diagnosed with HIV. Which explanation by the nurse would be correct? a. "HIV can be spread by casual contact." b. "HIV lives for long periods outside the body." c. "HIV is most commonly transmitted via tears and saliva." d. "HIV enters the body through breaks in the skin or mucous membranes."
D
The results of a carotid Doppler study indicate that a patient has stenosis of the left carotid artery. For which diagnostic test should the nurse prepare the patient to have completed next? a. MRI b. CT scan c. Echocardiogram d. Carotid angiography
D