Final Test Questions NPRO2100

The nurse cares for a client with severe pain and a resp rate of 32 breaths/min. Which acid-base imbalance does the nurse expect to find with sustained tachypnea? a) Respiratory alkalosis b) Metabolic acidosis c) Metabolic alkalosis d) Respiratory acidosis

A

When assessing a female client with a disorder of the hematopoietic or the lymphatic system, which assessment is most essential? a) Health history, such as bleeding, fatigue, or fainting b) Menstrual history c) Age and gender d) Lifestyle assessments, such as exercise routines

A

Which of the following is most critical for respiration to occur? a. Low levels of oxygen b. Low levels of CO2 c. Functioning inspiratory muscles d. An actively functioning autonomic system

C

A patient is to receive doxorubicin as treatment for leukemia. The nurse would instruct the patient that the typical cycle would be repeated at which frequency? a) Every 3 weeks b) Every week c) Every other week d) Every 4 weeks

A

Which of the following clinical manifestations occur in cardiogenic shock? a) Blood pressure falls b) Urine output increases c) Skin is dry d) Quick capillary refill

A

2: which of the following are complications of MODS associated with septic shock? Select all: A. ARDS B. AKI/ATN C. DIC D. Cirrhosis and ascites E. Necrotic bowel/ bowel infection

A,B,C,E

8. Select all the task you could delegate to a nursing assistant as the RN: A. Wound dressing change B. IV flush C. Collecting vital signs D. Weighing a patient E. Mouth care F. Suctioning a patient G. Applying oxygen to a patient H. Connecting a patient to their IV fluids I. Assisting a patient with a bath J. Applying denture paste to dentures

Answers C, D, E, I and J. These are all tasks the RN could delegate to a nursing assistant.

2. As the registered nurse, which tasks below should you NOT delegate to the LPN? A. Performing an assessment on a new admission B. Collecting a urine sample from an indwelling Foley catheter C. Developing a plan of care for a patient who is admitted with Guillain-Barré Syndrome D. Educating a patient about how to monitor for side effects associated with Warfarin E. Auscultating lung and bowel sounds F. Starting a blood transfusion G. Administering IV Morphine 2 mg for pain H. Providing wound care to a stage 3 pressure injury

Answers are A, C, D, F, G these are all out of the scope of practice for an LPN. Remember anything that deals with assessments, educating, evaluating, developing a plan of care, IV medications, unstable patients, or invasive/complex procedures where there is unpredictability the RN is responsible for doing it, and these tasks can't be delegated. An LPN can perform a focused assessment by listening to lung or bowel sounds and report the findings to the RN but a comprehensive assessment is done by the RN. In addition, the LPN can perform standard procedures that are predictable on stable patients like wound care for a pressure injury, Foley catheter insertion, obtaining an EKG, obtaining blood glucose level etc.

7. Which patients below are best assigned to the LPN? A. A 30-year-old male patient with active GI bleeding that requires multiple blood transfusions. B. A 78-year-old female with osteoporosis who needs assistance performing range of motion exercises and ambulating with a walker. C. A 29-year-old male patient who is post-op day 6 from a colostomy placement that is on a clear liquid diet. D. A 55-year-old male patient who reports chest pain and has ST segment elevation on his EKG.

Answers are B and C. LPNs should be assigned STABLE patients with predicable outcomes and cases that don't require critical thinking or complex analysis. The patients in options A and D are unstable and require constant care with decisions being based on how to interpret patient findings.

6. An RN has a critical patient that needs constant monitoring. However, the RN also has other patients in need of care. Which tasks below could the RN delegate to the LPN to help continue the process of patient care? A. Admitting and assessing the new admission B. Completing the discharge teaching to a patient going home C. Updating and evaluating the patient's plan of care D. Administering subcutaneous Heparin E. Obtaining a routine 12-lead EKG F. Collecting a stool specimen G. Flushing a central line with normal saline

Answers: D, E, and F these are all tasks an LPN can perform. They are routine procedures that usually have predictable outcomes. RNs are responsible for performing assessments on new admissions, teaching, evaluating, flushing and maintain central lines, and updating the patient's plan of care.

10. A nurse continues START Triage of a 50 y/o welder with partial amputation of RLE at the ankle. No radial pulses are noted. RR 28/min. How should the nurse tag this patient? a) Tag black b) Tag Red c) Tag yellow d) Tag green

B

3: the nursing instructor determines that teaching about adrenergic agonists for the treatment of sepsis has been successful when the class identifies the drug as also being called: A. Anticholinergic agents B. Sympathomimetic agents C. Cholinergic agents D. Sympatholytic agents

B

7. The nurse should assess the patient who is receiving Lorazepam [Ativan] for an extreme anxiety episode for development of which of these adverse effects? a) Ataxia b) Respiratory depression c) Euphoria d) Tachypnea

B

8: a nursing student asks the instructor to explain why serum lactate rises in sepsis and is used as an indicator of microvascular tissue hypoperfusion. Which of the following would be the most appropriate response by the instructor? A. Kidney hypo perfusion alters absorption and excretion of H+ creating acidosis B. Anaerobic metabolism (glycolysis+ no oxygen) produces H+ (lactate) +2 units of ATP C. Carbon dioxide builds up in the blood due to hypo profusion creating respiratory acidosis D. Aerobic metabolism (glycolysis+ O2) +H2O and 38 molecules of ATP

B

A client asks the nurse why the chemotherapy is often administered in cycles. Which response by the nurse would be most appropriate? a) "The drugs are highly toxic, so the body needs time to recover." b) "We want to attack the cells that might be dormant or moving into a new phase." c) "The cycles are the only way to guarantee a cure for the cancer." d) "The cycles help to prevent the drugs from destroying the healthy cells."

B

HIV selectively enters which of the following cells? a. B clones b. Helper T cells c. Suppressor T cells d. Cytotoxic T cells

B

6. You receive a patient who has experienced a burn on the right leg. You note the burn contains small blisters and is extremely pinkish red and shiny/moist. The patient reports severe pain. You document this burn as: A. 1st Degree (superficial) B. 2nd Degree (partial-thickness) C. 3rd Degree (full-thickness) D. 4th Degree (deep full-thickness)

B These are the classic characteristics of a 2nd degree (partial-thickness) burn.

A patient is admitted to the hospital with a possible common bile duct obstruction. What clinical manifestations does the nurse understand are indicators of this problem? (Select all that apply.) a) Amber-colored urine b) Clay-colored feces c) Pruritus d) Jaundice e) Pain in the left upper abdominal quadrant

B,C,D

1. You're providing an in-service to a group of nurses about the different types of kidney stones. You explain to the attendees that the most common type of kidney stone is made up of: A. Cholesterol B. Calcium and oxalate C. Calcium and phosphate D. Uric acid

B. The most common type of kidney stone composite is calcium and oxalate.

21. A patient who is being treated for partial thickness burns on 60% of the body is now in the acute phase of burn management. The nurse assesses the patient for a possible Curling's Ulcer. What signs and symptoms can present with this condition? A. Swelling and pain on the area distal to the burn B. Burning, gnawing sensation pain in the stomach and vomiting C. Dark red or gray sores on the soles of the feet D. Difficulty swallowing and gagging

B. This is a type of ulcer that occurs in the stomach, duodenum, due to a high amount of stress on the body from a burn. The blood supply to the factors that help protect the stomach lining from gastric erosion decreases and this allows for ulcers to form.

16. You're providing education to a group of local firefighters about carbon monoxide poisoning. Which statement is correct about the pathophysiology regarding this condition? A. "Patients are most likely to present with cyanosis around the lips and face." B. "In this condition, carbon monoxide binds to the hemoglobin of the red blood cell leading to a decrease in the ability of the hemoglobin to carry oxygen to the body." C. "Carbon monoxide poisoning leads to a hyperoxygenated state, which causes hypercapnia." D. "Carbon monoxide binds to the hemoglobin of the red blood cell and prevents the transport of carbon dioxide out of the blood, which leads to poisoning."

B. This is the only correct statement about carbon monoxide poisoning.

10: a pt complains of lethargy, fever, cough with return of thick green phlegm and recent confusion. He has a h/o leukemia being treated with oral chemotherapy. His temp is 101.2 F, HR 118, and BP is 92/50 and he complains of dizziness upon rising. Which of the following would be the HIGHEST priority sepsis bundle interventions by the nurse? A. Administer an antipyretic B. Insert an indwelling Foley catheter C. Initiate rapid, aggressive IV fluid resuscitation with crystalloids D. Assist with insertion of an endotracheal tube

C

10: a pt has the following ABG values: : pH 7.52; PaO2 50; PaCO2 28 HCO3- 24. Based on the pts PaO2 values which of the following conclusions would be accurate? A. The O2 level is low but poses no risk for the pt B. The PaO2 is within normal range C. The pt is severely hypoxic D. The pt requires oxygen therapy w 2L nasal cannula

C

2: Which of the following interventions should the nurse anticipate in a pt diagnosed with ARDS? A. Use of a nasal cannula to administer O2 B. Use of inhalers to open the airways C. Insertion of an endotracheal tube (EET) and mechanical ventilation D. Insertion of a chest tube

C

5: which of the follow teaching interventions would be most likely to prevent the development of ARDS? A. Teaching signs of hypercapnia B. Teaching signs of hypovolemia C. Teaching cigarette smoking cessation D. Teaching sign of hypoglycemia

C

6: the nurse interprets which of the following as an early sign of ARDS? A. Severe, unexplained electrolyte balance B. Decreased carbon dioxide levels C. Severe dyspnea and rapid onset of non-cardiac pulmonary edema D. Metabolic alkalosis

C

8. A nurse is assigned to triage at a factory where an explosion has taken place. According to the START Triage, when assessing pulses, the nurse would check: a) Femoral pulses b) Carotid pulses c) Radial pulses d) Pedal pulses

C

9: a pt has the following ABG values: pH 7.52; PaO2 50; PaCO2 28 HCO3- 24. Based on these values which of the following conclusions would be accurate? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Respiratory acidosis

C

A group of community nurses sees & plans care for various clients with different types of problems. Which of the following clients would they consider the MOST VULNERABLE to PTSD? a) A 40-year-old widower who has recently lost his wife to cancer b) A wife of an individual with a severe substance abuse problem c) A 20-year-old college student with DM who experienced date rape d) An 8-year-old boy with asthma who has recently failed a grade in school

C

A nurse cares for a client who is post op open cholecystectomy and has a T-tube in place. Which clinical situation will the nurse notify the health care provider about as a possible complication of the surgery? a) Absence of blood or serous fluid in the T-tube. b) Greater than 250 mL bile output from the T-tube in 24 hours. c) Significantly reduced bile output from the T-tube. d) Finding the T-tube placed below the level of the incision.

C

A nurse is observing the client's rhythm strip on the cardiorespiratory monitor when the P wave suddenly disappears. The nurse interprets this to mean that: a) The ventricle is no longer contracting. b) Only the left ventricle is contracting. c) The atria are not contracting. d) The client's heart is no longer ejecting blood.

C

Adverse effects associated with adrenergic agonists are related to the generalized stimulation of the SNS and could include a. slowed heart rate. b. constriction of the pupils. c. hypertension. d. increased GI secretions.

C

27. After receiving report on a patient receiving treatment for severe burns, you perform your head-to-toe assessment. On arrival to the patient's room you note the room temperature to be 75'F. You will: A. Decrease the temperature by 5-10 degrees to prevent hyperthermia. B. Leave the temperature setting. C. Increase the temperature to a minimum of 85'F.

C. Patients with severe burns can NOT regulate their temperature and are at risk for hypothermia. The room temperature should be a minimum of 85'F.

2. Which type of hemoglobin is present in a patient who has sickle cell anemia? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS C. Hemoglobin AC

C. SCA is homozygous and the patient must have two abnormal alleles present to have sickle cell anemia. The patient receives each abnormal allele for each parent (hence one from each parent which is Hemoglobin SS). If a patient has Hemoglobin AS (normal allele (A) and abnormal allele (S)) this is known as sickle cell trait, which most patients with this don't present with signs and symptoms of the disease...it's rare because they usually have just enough hemoglobin A to prevent the RBCs from sickling.

A 35-year-old male is admitted to the hospital reporting severe headaches, vomiting, and testicular pain. His blood work shows reduced numbers of platelets, leukocytes, and erythrocytes, with a high proportion of immature cells. The nurse caring for this client suspects a diagnosis of what? a) AML b) CML c) MDS d) ALL

D

A client presents to the emergency department (ED) complaining of severe right upper quadrant pain. The client states that his family doctor told him he had gallstones. The ED nurse should recognize what possible complication of gallstones? a) Acute pancreatitis b) Atrophy of the gallbladder c) Gallbladder cancer d) Gangrene of the gallbladder

D

A client who is undergoing chemotherapy for AML reports pain in the low back. What is the nurse's first action? a) Refer the client to a chiropractor. b) Place heating pads on the client's back. c) Administer pain medication, as ordered. d) Assess renal function.

D

Blood calcium levels are increased by a) aldosterone b) antidiuretic hormone c) calcitonin d) parathyroid hormone

D

You're precepting a nursing student who is assisting you care for a patient on mechanical ventilation with PEEP for treatment of ARDS. The student asks you why the PEEP setting is at 10 mmHg. Your response is:* A. "This pressure setting assists the patient with breathing in and out and helps improve air flow." B. "This pressure setting will help prevent a decrease in cardiac output and hyperinflation of the lungs." C. "This pressure setting helps prevent fluid from filling the alveoli sacs." D. "This pressure setting helps open the alveoli sacs that are collapsed during exhalation."

D

You're teaching a class on critical care concepts to a group of new nurses. You're discussing the topic of acute respiratory distress syndrome (ARDS). At the beginning of the lecture, you assess the new nurses understanding about this condition. Which statement by a new nurse demonstrates he understands the condition? * A. "This condition develops because the exocrine glands start to work incorrectly leading to thick, copious mucous to collect in the alveoli sacs." B. "ARDS is a pulmonary disease that gradually causes chronic obstruction of airflow from the lungs." C. "Acute respiratory distress syndrome occurs due to the collapsing of a lung because air has accumulated in the pleural space." D. "This condition develops because alveolar capillary membrane permeability has changed leading to fluid collecting in the alveoli sacs."

D

3. A nurse has been observing a patient closely in the Emergency Department who has been displaying aggressive behaviors. The nurse observes that the behavior displayed by the patient is escalating. Which nursing intervention is LEAST HELPFUL for this client at this time? a) Position oneself so that there is a path of easy escape in case the behavior becomes violent b) Acknowledge the patient's behavior c) Assist the patient to an area that is quiet d) Maintain a safe distance from the patient e) Initiate confinement behaviors and four-point restraints

E

Which are changes that can be indicative of substance abuse? a. Irritability b. Forgetfulness c. Social isolation d. Change in physical appearance e. All of the above

E

TRUE OR FALSE A primary nursing diagnosis for a patient with acute leukemia is impaired nutritional intake due to pain and discomfort associated with mucositis and stomatitis

True

TRUE OR FALSE Chronic lymphocytic leukemia is the most common form of leukemia and may require no treatment in the early stages

True

True or False Protease inhibitors are effective by blocking the protease activity within HIV.

True

1: which of the following interventions is NOT PART of the early goal directed sepsis bundle to be accomplished during the first hour after a pts admission? A. Prepare to administer IV hydrocortisone B. Initiate aggressive fluid resuscitation C. Draw a serum lactate D. Draw blood cultures prior to administration of appropriate antibiotics

A

5. When planning the care of a patient who is experiencing PTSD, the nurse identifies which of the following as the MOST APPROPRIATE goal? The client will report: a) A decrease in flashbacks and nightmares b) Having less energy c) Spending more time on ritualistic behavior d) A decrease in hearing voices

A

5: A 65-year-old pt with a history of recent abd surgery arrives at the ER complaining of foul smelling drainage from his incision site. On arrival his vital signs were: T100.9f; HR 115; RR 28; BP 92/48. His serum WBC count was 12.6. the nurse would appropriately identify that the pt is severely ill and likely exhibiting symptoms of what disease state? A. Sepsis (SIRS+ sign of infection) B. AKI C. Septic shock D. SIRS without sign of infection

A

6: which of these adrenergic agonists is considered the first line vasopressor to be utilized as part of bundled goal directed therapy for treatment of septic shock? A. Norepinephrine B. Vasopressin C. Hydrocortisone D. Epinephrine

A

8. A patient is being tested for sickle cell disease. As the nurse, you know the ________ will assess for abnormal hemoglobin on the red blood cell, but will not differentiate between sickle cell disease and sickle cell trait. Therefore, the patient will need to have what other test to determine this? A. dithionite test; hemoglobin electrophoresis B. hemoglobin electrophoresis; sickledex C. edrophonium test, dithionite test D. sickledex; edrophonium test

A

9. A nurse is assigned to continue triage at a factory where an explosion has taken place. According to the START Triage what should the nurse do FIRST when finding a patient who is not breathing? a) Open airway, tag red if he starts to breath b) Don't waste time with tagging process and proceed to next patient c) Tag black and rapidly go to next patient d) Tag red, hopefully he will begin to breath shortly

A

9: the nurse would determine that a client being treated for sepsis is improving when which of the following is assessed? A. Fluid resuscitation requirements diminish B. Urine output increases to 30ml/hour C. Blood culture results are normal D. Blood pressure stabilizes within normal limits

A

A client at the scene of an MVA seems somewhat anxious and has clammy skin. The client's BP has dropped to 90 mm Hg. What stage of shock is this client most likely experiencing? a) decompensation stage b) compensation stage c) irreversible stage d) cardiogenic shock

A

A client discharged after a laparoscopic cholecystectomy calls the surgeon's office reporting severe right shoulder pain 24 hours after surgery. Which statement is the correct information for the nurse to provide to this client? a) "This pain is caused from the gas used to inflate your abdominal area during surgery. Sitting upright in a chair, walking, or using a heating pad may ease the discomfort." b) "This pain is caused from your incision. Take analgesics as needed and as prescribed and report to the surgeon if pain is unrelieved even with analgesic use." c) "This may be the initial symptoms of an infection. You need to come to see the surgeon today for an evaluation." d) "This pain may be caused by a bile duct injury. You will need to go to the hospital immediately to have this evaluated."

A

A client experienced hemorrhage following a gunshot to the chest and received massive amounts of fluids. The client is now stable. The nurse assesses abdominal pressure as 12 mm Hg. The most immediate nursing intervention is to a) Raise the head of the client's bed. b) Turn the client every 2 hours. c) Insert a rectal tube for decompression. d) Begin measurements of abdominal girth.

A

A client is evaluated for severe pain in the right upper abdominal quadrant, which is accompanied by nausea and vomiting. The physician diagnoses acute cholecystitis and cholelithiasis. For this client, which nursing diagnosis takes top priority? a) Acute pain related to biliary spasms b) Deficient knowledge related to prevention of disease recurrence c) Anxiety related to unknown outcome of hospitalization d) Imbalanced nutrition: Less than body requirements related to biliary inflammation

A

A client is scheduled for a cholecystogram for later in the day. What is the nurse's understanding on the diagnostic use of this exam? a) It visualizes the gallbladder and bile duct. b) It visualizes the liver and pancreas. c) It shows the sizes of the abdominal organs and detects any masses. d) It visualizes the biliary structures and pancreas via endoscopy.

A

A client receives alteplase (t-PA). It is most important for the nurse to intervene when a) The client's Glasgow Coma Score changes from 15 to 13. b) A small amount of bleeding occurs at venous puncture sites. c) The client reports joint pain in the knees and elbows. d) The client's cardiac rhythm changes to normal sinus with few PVCs.

A

A client who is 24 hours post op from laparoscopic cholecystectomy calls the nurse and reports pain in the right shoulder. How should the nurse respond to the client's report of symptoms? a) "Apply a heating pad to your shoulder for 15 minutes hourly as needed." b) "Come into the emergency room as soon as possible." c) "Take an over the counter analgesic as needed." d) "Place your shoulder in a sling to avoid moving it."

A

A client with acute myeloid leukemia has been receiving mitoxantrone IV as part of the chemotherapeutic regimen. When assessing the client for the effects of bone marrow suppression, the nurse should perform what assessment? a) Assessment of the client's activity tolerance and energy level b) Assessment of the client's respiratory rate and oxygen saturation c) Monitoring the client's urine output, blood urea nitrogen, and creatinine levels d) Monitoring the client's potassium, sodium, and chloride levels

A

A client with cholelithiasis has a gallstone lodged in the common bile duct. When assessing this client, the nurse expects to note: a) yellow sclerae. b) light amber urine. c) circumoral pallor. d) black, tarry stools.

A

A client with leukemia is being treated with a combination of antineoplastics, including methotrexate. The client's most recent laboratory results indicate the client is experiencing bone marrow suppression. What is the nurse's priority action? a) Ensure that all staff and visitors adhere to infection control precautions. b) Space out the client's care to preserve energy and prevent fatigue. c) Encourage the client to limit physical activity in order to reduce the risk of bleeding. d) Provide small quantities of food several times per day, as tolerated.

A

A male client is receiving parenteral cytotoxic medications in the home. Adjunct therapy may include what substance? a) Erythropoietin b) Heparin c) Normal saline 0.9% intravenously d) Antidiuretic hormone

A

A nurse administers ondansetron to a client receiving chemotherapy for which reason? a) Reduce vomiting b) Prevent hypersensitivity c) Relieve inflammation d) Decrease secretions

A

A nurse cares for a client who is post op open cholecystectomy. Upon assessment, the nurse notes the client's abdomen feels firm to palpation. What is the nurse's priority action? a) Contact the health care provider b) Auscultate the bowel sounds c) Ask the client the last bowel movement date d) Prepare to insert a nasogastric tube to intermittent suction

A

A nurse is performing discharge teaching with a client who will soon return home. The client will continue taking imatinib for the foreseeable future, and the nurse is teaching the client about the safe administration of this drug. How should the nurse instruct the client to take imatinib? a) With food and a large glass of water b) On an empty stomach c) Thirty minutes before breakfast and in the early evening, at least 2 hours after dinner d) With a glass of grapefruit or cranberry juice

A

A nurse is preparing to administer imatinib to a client. The nurse expects to administer this drug by which route? a) Oral b) Subcutaneous c) Intramuscular d) Intravenous

A

A nurse is providing preoperative teaching to a client undergoing a cholecystectomy. Which topic should the nurse include in her teaching plan? a) Increase respiratory effectiveness. b) Eliminate the need for nasogastric intubation. c) Improve nutritional status during recovery. d) Decrease the amount of postoperative analgesia needed.

A

A nurse prepares a client for a bone marrow biopsy who is suspected of having acute myeloid leukemia. What results from the bone marrow biopsy does the nurse expect? a) Excess of immature leukocytes b) Excess of immature erythrocytes c) Deficiency of neutrophils d) Deficiency of erythrocytes

A

A patient has been stung by a bee. The patient's blood pressure drops. Which part of the nephron will release a substance to increase the patient's blood pressure? a) juxtaglomerular apparatus b) medulla c) loop of Henle d) countercurrent mechanism

A

A patient has just received the first dose of imatinib and the nurse on the oncology unit is amending the patient's care plan accordingly. What nursing diagnosis is most appropriate in light of this addition to the patient's drug regimen? a) Risk for Infection related to bone marrow suppression b) Risk for Acute Confusion related to adverse neurological effects of imatinib c) Risk for Impaired Skin Integrity related to exaggerated inflammatory response d) Risk for Deficient Fluid Volume related to changes in osmotic pressure

A

A patient who will begin chemotherapy voices concern to the nurse about the accompanying nausea and vomitting. What is the best response by the nurse? a) "We can relieve your nausea and vomiting with antiemetic drug therapy. You should ask for these medications whenever you need them." b) "We can relieve your nausea and vomiting with drugs but you can have them only before and after the chemotherapy." c) "Nausea and vomiting are an unfortunate side effect of the chemotherapy. We will do what we can but you may have it anyway." d) "Not everyone has nausea and vomiting. Just wait to see how you will react to the chemotherapy."

A

A patient with a diagnosis of acute myeloid leukemia (AML) is being treated with induction therapy on the oncology unit. What nursing action should be prioritized in the patient's care plan? a) Protective isolation and vigilant use of standard precautions b) Provision of a high-calorie, low-texture diet and appropriate oral hygiene c) Including the family in planning the patient's activities of daily living d) Monitoring and treating the patient's pain

A

A patient with acute lymphoblastic leukemia (ALL) is receiving imatinib on an inpatient basis. When planning the care of this patient, what assessment should be specified in the patient's plan of nursing care? a) daily weights b) assessment of deep tendon reflexes c) bilateral blood pressures d) pupillary response

A

After teaching a group of students about the release of aldosterone, the instructor determines that the teaching was successful when they identify which as stimulating the hormone's release? a) High potassium levels b) Parasympathetic stimulation c) Angiotensin II d) Natriuretic hormone

A

An oncology nurse is preparing to administer cytotoxic chemotherapy medications. Which measure best protects the nurse from harm related to the chemotherapy? a) wearing protective equipment b) performing thorough hand hygiene c) mixing medication in a 1000-mL bag d) administering medication intramuscularly whenever possible

A

Bicarbonate is stored in which structure when the body needs a buffer? a) Renal tubule b) Loop of Henle c) Bowman's capsule d) Glomerulus

A

Clinical manifestations of common bile duct obstruction include all of the following except: a) Amber-colored urine b) Clay-colored feces c) Pruritus d) Jaundice

A

In describing the action of alkylating agents, what would the nurse include? a) React chemically with portions of RNA, DNA, and other cellular proteins. b) Inhibit DNA production by replacing the natural substances for cell function. c) Block DNA synthesis to interfere with the cell's ability to divide. d) Insert itself between base pairs in the DNA chain to disrupt DNA synthesis.

A

Sodium ions are actively reabsorbed in which location? a) Proximal convoluted tubule b) Loop of Henle c) Ascending loop of Henle d) Distal convoluted tubule

A

The health care provider prescribes a vasoactive agent for a patient in cardiogenic shock. The nurse knows that the drug is prescribed to increase blood pressure by vasoconstriction. Which of the following is most likely the drug that is ordered? a) Levophed b) Dobutrex c) Nipride d) Adrenalin

A

The nurse cares for a client with cholecystitis with severe biliary colic symptoms. Which nursing intervention best promotes adequate respirations in a client with these symptoms? a) Place the client in semi-Fowler's position. b) Encourage the client to deep breathe and cough. c) Instruct the client on the proper use of an incentive spirometer. d) Encourage the client to ambulate frequently.

A

The nurse is caring for a client with suspected chronic pancreatitis. Which diagnostic test or imaging does the nurse recognize as the most useful in diagnosing this condition? a) ERCP b) MRI c) CT d) Ultrasound

A

The nurse is caring for a patient with chronic myeloid leukemia (CML) who is taking imatinib mesylate (Gleevec). In what phase of the leukemia does the nurse understand that this medication is most useful to induce remission? a) Chronic b) Transformation c) Accelerated d) Blast crisis

A

The nurse is caring for as 78-year-old client with extensive cardiovascular disease. Which type of shock is the client most likely to develop? a) Cardiogenic shock b) Neurogenic shock c) Septic shock d) Anaphylactic shock

A

The nurse is planning care for a client following an incisional cholecystectomy for cholelithiasis. Which intervention is the highest nursing priority for this client? a) Assisting the client to turn, cough, and deep breathe every 2 hours b) Teaching the client to choose low-fat foods from the menu c) Performing range-of-motion (ROM) leg exercises hourly while the client is awake d) Assisting the client to ambulate the evening of the operative day

A

The nurse knows that the client with cholelithiasis can have a nutritional deficiency. The obstruction of bile flow due to cholelitiasis can interfere with the absorption of a) Vitamin A b) Vitamin B6 c) Vitamin B12 d) Vitamin C

A

The nurse may be asked to administer which medications to a client to counteract the increase in uric acid and subsequent hyperuricemia resulting from the metabolic waste buildup from rapid tumor lysis? a) allopurinol b) amifostine c) mesna d) leucovorin

A

The pituitary hormone that causes reabsorption of water in the kidneys is: a) antidiuretic hormone (ADH) b) oxytocin c) prolactin (PRL) d) adrenocorticotropic hormone (ACTH)

A

This hormone is released by the pituitary when the sodium concentration of blood rises. a) ADH b) FSH c) aldosterone d) calcitonin

A

Upon receiving the dinner tray for a client admitted with acute gallbladder inflammation, the nurse will question which of the following foods on the tray? a) Hot roast beef sandwich with gravy b) Mashed potatoes c) White rice d) Vanilla pudding

A

What is the effect of insufficient antidiuretic hormone (ADH) on the process of fluid retention? a) Distal tubules and collecting ducts of the kidney to become less permeable b) Sodium retention is decreased c) The countercurrent mechanism is not stimulated d) Hypertonic urine is produced

A

What is the expected outcome when the glomerular membrane is damaged? a) The filtration of fluid from the blood into the kidney's nephron tubule is impaired b) The kidney's ability to regulate the concentration of urine is impaired c) The reabsorption of substances from the renal tubule back into the vascular system is altered d) The chemical reaction that results in the formation of sodium bicarbonate is impaired

A

What is the focus of the renal system's renin-angiotensin- aldosterone system? a) The regulation of blood pressure b) Keeping body fluids in balance c) The regulation of red blood cell production d) Maintaining serum calcium levels in balance

A

What occurs as a result of a defect in the renal system's countercurrent mechanism process? a) Electrolyte imbalance b) The descending loop of Henle cells are permeable to water c) Sodium is actively reabsorbed into peritubular tissue d) The ascending loop of Henle cells are impermeable to water

A

What should the oncology nurse understand when administering a cell cycle-nonspecific chemotherapeutic agent about its effect? a) The drug will be effective through all phases of the cell cycle. b) The drug will be effective through specific areas of the cell cycle. c) The drug is ineffective throughout all phases of the cell cycle. d) The drug has intermittent effectiveness throughout the cell cycle.

A

When describing the mechanism for blood pressure control by the kidneys, which occurs first when oxygenation to the nephron is decreased? a) Renin release b) Activation of angiotensinogen c) Vasoconstriction due to angiotensin II d) Release of aldosterone

A

When describing the various effects of antineoplastic agents, the nurse explains that antineoplastic drugs primarily affect human cells that are rapidly multiplying, going through the cell cycle quickly. The nurse would identify which cells as an example? a) Skin b) Breast c) Testicles d) Ovaries

A

Where is the majority of potassium that is filtered at the glomerulus reabsorbed? a) Bowman's capsule b) Descending loop of Henle c) Ascending loop of Henle d) Distal convoluted tubule

A

Which agents would be considered cancer non-cell cycle specific agents? a) alkylating agents b) antimetabolites c) mitotic inhibitors d) protein tyrosine kinase inhibitors

A

Which enzyme would a nurse identify as being responsible for the reabsorption of sodium ions? a) Carbonic anhydrase b) Acetylcholinesterase c) Angiotensin converting enzyme d) Monoamine oxidase

A

Which of the following would be most appropriate for a client who is experiencing biliary colic? a) Ensure that the client rests. b) Ensure that the client has eaten a full meal. c) Avoid administering antispasmodics. d) Avoid administering analgesics.

A

Which substance acts to increase blood pressure by inducing vasoconstriction? a) angiotensin II b) erythropoietin c) ADH d) atrial natriuretic peptide

A

Which would a nurse identify as responsible for causing the release of antidiuretic hormone? a) Falling blood volume b) Parasympathetic stimulation c) Decreasing sodium levels d) Increasing potassium levels

A

You are caring for a client in the compensation stage of shock. You know that in this stage of shock adrenaline and noradrenaline are released into the circulation. What positive effect does this have on your client? a) Increases myocardial contractility b) Decreases blood return to the heart c) Decreases carbon dioxide exchange d) Contracts bronchioles

A

You're providing care to a patient who was just transferred to your unit for the treatment of ARDS. The patient is in the exudative phase. The patient is ordered arterial blood gases. The results are back. Which results are expected during this early phase of acute respiratory distress syndrome that correlates with this diagnosis?* A. PaO2 40, pH 7.59, PaCO2 30, HCO3 23 B. PaO2 85, pH 7.42, PaCO2 37, HCO3 26 C. PaO2 50, pH 7.20, PaCO2 48, HCO3 29 D. PaO2 55, pH 7.26, PaCO2 58, HCO3 19

A

3. As the nurse providing care to a patient who experienced a full-thickness electrical burn you know to monitor the patient's urine for: A. Hemoglobin and myoglobin B. Free iron and white blood cells C. Protein and red blood cells D. Potassium and Urea

A Patients who've experienced a severe electrical burn or full-thickness burns are at risk for acute kidney injury. This is because the muscles can experience damage from the electrical current leading them to release myoglobin. In addition, the red blood cells will release hemoglobin. These substances will collect in the kidneys leading to acute tubular necrosis (hence leading to AKI). Therefore, the nurse should monitor the patient's urine for these substances.

18. What are some patient priorities during the emergent phase of burn management? A. Fluid volume B. Respiratory status C. Psychosocial D. Wound closure E. Nutrition

A and B. This phase starts from the onset of the burn and ends with the restoration of capillary permeability. Wound closure, and nutrition would be during the acute phase, and would continue into the rehabilitative phase. Psychosocial would be in the rehab phase.

10. An 18 year-old male is taking Hydroxyurea for treatment of sickle cell anemia. Which option below indicates this medication is working successfully? A. The patient needs fewer blood transfusions. B. The patient experiences diuresis. C. The patient experiences an increase in fetal hemoglobin (Hbg F). D. The patient experiences a decrease in hemoglobin S.

A and C. This medications actually treats cancer, but it will help with SCA in that it will help create fetal hemoglobin hgb F (this helps decrease sickling episodes) and helps with anemia (decreasing the need for so many blood transfusions).

15. A patient arrives to the ER due to experiencing burns while in an enclosed warehouse. Which assessment findings below demonstrate the patient may have experienced an inhalation injury? A. Carbonaceous sputum B. Hair singeing on the head and nose C. Lhermitte's Sign D. Bright red lips E. Hoarse voice F. Tachycardia

A, B, D, E, and F. These are all signs of a possible inhalation injury. Bright red lips and tachycardia are present in carbon monoxide poisoning as well.

14. A patient arrives to the ER with full-thickness burns on the front and back of the torso and neck. The patient has no spinal injuries but is disoriented and coughing up black sooty sputum. Vital signs are: oxygen saturation 63%, heart rate 145, blood pressure 80/56, and respiratory rate 39. As the nurse you will: A. Place the patient in High Fowler's positon. B. Prep the patient for escharotomy. C. Prep the patient for fasciotomy. D. Prep the patient for intubation. E. Place a pillow under the patient's neck. F. Obtain IV access at two sites. G. Restrict fluids.

A, B, D, and F. After reading this scenario the location of the burns and the patient's presentation should be jumping out at you. The patient is at risk for circumferential burns due to the location of the burns and the depth (full-thickness....will have eschar present that will restrict circulation or here in this example the ability of the patient to breathe in and out). Based on the patient's VS, we see that the respiratory effort is compromised majorly AND that there is a risk of inhalation injury since the patient is coughing up black sooty sputum. Therefore, the nurse should place the patient in high Fowler's position to help with respiratory effort (unless contraindicated with spinal injuries), prep the patient for escharotomy (this will cut the eschar and help relieve pressure and allow for breathing) and prep for intubation to help with the respiratory distress. In addition, obtain IV access in at least two sites for fluid replacement....remember the first 24 hours after a burn a patient is at risk for hypovolemic shock.

7. A 6 year-old is admitted with sickle cell crisis. The patient has a FACE scale rating of 10 and the following vital signs: HR 115, BP 120/82, RR 18, oxygen saturation 91%, temperature 101.4'F. Select all the appropriate nursing interventions for this patient at this time? A. Administer IV Morphine per MD order B. Administer oxygen per MD order C. Keep NPO D. Apply cold compresses E. Start intravenous fluids per MD order F. Administer iron supplement per MD order G. Keep patient on bed rest H. Remove restrictive clothing or objects from the patient

A, B, E, G, and H. When a patient is in sickle cell crisis, the abnormal RBCs are sickling and sticking together, which blocks blood flow. To help alleviate the RBCs from clumping together and sickling, oxygen and hydration are priority. This will help dilute the blood (hence decrease the sticking of RBCs) and help supply oxygen to the RBCs (remember abnormal RBCs with hemoglobin S are very sensitive to low oxygen levels and will sickle when there is low oxygen). In addition, pain needs to be addressed. Opioid medication is the best on a scheduled basis rather than PRN (as needed). Avoid keeping patient NPO unless needed (remember patient needs hydration). Avoid cold compresses (can lead to more sickling) but instead use warm compresses. The patient will need FOLIC ACID supplements to help with RBC creation rather than iron (iron can actually build up in the body and collect in the organs in patients with sickle cell disease). Patients definitely need to be on bedrest, and restrictive clothing or objects (blood pressure cuff etc.) should be removed to help blood flow.

28. You are about to provide care to a patient with severe burns. You will don: A. gloves B. goggles C. gown D. N-95 mask E. surgical mask F. shoe covers G. hair cover

A, C, E, F, and G. Before providing care to a patient with severe burns the nurse would want to wear protective isolation apparel like: gloves, gown, surgical mask, shoe covers, and hair cover. This protects the patient from potential infection.

Which would be included when describing the site for most calcium reabsorption? a) Ascending loop of Henle b) Proximal convoluted tubule c) Descending loop of Henle d) Distal convoluted tubule e) Loop of Henle f) Bowman's capsule

A,B

The nurse assesses a patient in compensatory shock whose lungs have decompensated. What clinical manifestations would the nurse expect to find? (Select all that apply.) a) A heart rate >100 bpm b) Crackles c) Lethargy and mental confusion d) Respirations <15 breaths/min e) Compensatory respiratory acidosis

A,B,C

The nurse is caring for a client with a central venous line in place for the treatment of shock. Which nursing interventions are essential for the nurse to complete in order to reduce the risk of infection? Select all that apply. a) Maintain sterile technique when changing the central venous line dressing. b) Always perform hand hygiene before manipulating or accessing the line ports. c) Apply clean gloves before accessing the line port. d) Perform a 10-second "hub scrub" using chlorhexidine and friction in a twisting motion on the access hub. e) Instruct the client to wear a face mask and gloves while the central venous line is in place.

A,B,C

When a patient in shock is receiving fluid replacement, what should the nurse monitor frequently? (Select all that apply.) a) Urinary output b) Mental status c) Vital signs d) Ability to perform range of motion exercises e) Visual acuity

A,B,C

1. A 65 year old male patient has experienced full-thickness electrical burns on the legs and arms. As the nurse you know this patient is at risk for the following: Select all that apply: A. Acute kidney injury B. Dysrhythmia C. Iceberg effect D. Hypernatremia E. Bone fractures

A,B,C Electric burns are due to an electrical current passing through the body that leads to damage to the skin but also the muscles and bones that are underneath the skin. The patient is at risk for AKI (acute kidney injury) because when the muscles become affected they release myoglobin and the red blood cells release hemoglobin in the blood, which can collect in the kidneys leading to injury. In addition, the heart's electrical system can become damaged leading to dysrhythmia. The iceberg effect can present as well because the extent of damage is not clearly visible on the skin (there can be severe damage underneath). In addition, if the electrical current is strong enough it can lead to bone fractures (specifically cervical spine injuries) due to the severe contraction of the muscles involved.

When describing the process of tubular reabsorption, which substances would the instructor include as being reabsorbed regularly? (Select all that apply.) a) Water b) Vitamins c) Glucose d) Sodium bicarbonate e) Lipids f) Proteins

A,B,C,D

Which cytoprotective agents can be given along with antineoplastic drugs to help prevent or lessen certain adverse effects? (Select all that apply.) a) Allopurinol (Zyloprim) b) Amifostine (Ethyol) c) Leucovorin (Wellcovorin) d) Mesna (Mesnex) e) Dexrazoxane (Zinecard)

A,B,C,D,E

A nurse should understand which adverse effects of antineoplastic drugs are related to the death of rapidly growing cells? (Select all that apply.) a) Alopecia b) Leukopenia c) Stomatitis d) Cardiotoxicity e) Thrombocytopenia

A,B,C,E

7: what are the signs and symptoms of SIRS? Select all: A. Temp greater than 100.0f B. Systolic blood pressure less than 100mmHg C. Urine output less than30cc/hour D. HR greater than 100 E. Leukocytosis with greater than 10% bands F. Elevated serum lactate

A,B,D,E

A nurse is providing care to all of the following clients. Which would be at increased risk for anaphylactic shock? Select all that apply. a) The client who is in the first 15 minutes of receiving 1 unit of PRBCs b) The 55 year-old client with spina bifida c) The client who is scheduled for a repeat CT scan of the abdomen d) The client with an infection who is prescribed intravenous vancomycin e) The client who reports an allergy to peanuts that causes throat swelling

A,B,E

Incidence of PTSD is higher in which of the following cultural/societal/social groups? [Select all that apply] a) Victims of childhood abuse or domestic abuse b) Victims of Hurricane Katrina/Joplin Category 5 tornado/California wildfires c) Minneapolis college students d) Firefighters/EMTs/Paramedics who responded to 9/11 attacks e) Victims of violent crimes, assault, torture, hostage situation f) Military veterans/Combat veterans

A,B,E,F

4: the student nurse is preparing a presentation on the causes of ARDS. Which risk factors/insults would the student nurse identify as correct direct or indirect causes of ARDS? Select all: A. Inhalation injuries/inhaled gases B. Sickle cell C. Near drowning (salt or fresh water) D. Sepsis and DIC E. Aspiration pneumonia

A,C,D,E

A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply. a) Administer pain-relieving medication b) Administer a low-fat diet c) Administer electrolytes d) Administer plasma e) Assist the client to a semi-Fowler position

A,C,D,E

A nurse discusses risk factors of cholelithiasis with a client. Which risk factors will the nurse include in the teaching? Select all that apply. a) Changes in weight b) Sickle cell disease c) Cystic fibrosis d) Diabetes e) Obesity

A,C,D,E

The nurse is preparing to administer a client's prescribed chemotherapy. The client has developed bone marrow suppression during treatment. What should the nurse include in the client's plan of care? Select all that apply. a) Implement falls prevention measures b) Administer anticoagulants as prescribed c) Place the client on protective isolation d) Monitor the client's laboratory values closely e) Allow sufficient time for rest between scheduled activities

A,C,D,E

The client was admitted to the hospital following a myocardial infarction. Two days later, the client exhibits a blood pressure of 90/58, pulse rate of 132 beats/min, respirations of 32 breaths/min, temperature of 101.8°F, and skin warm and flushed. Appropriate interventions include (Select all that apply) a) obtaining a urine specimen for culture b) maintaining the IV site inserted on admission c) instituting vital signs every 4 hours d) administering pantoprazole (Protonix) IV daily e) monitoring urine output every hour

A,D,E

8. A 58 year old female patient has superficial partial-thickness burns to the anterior head and neck, front and back of the left arm, front of the right arm, posterior trunk, front and back of the right leg, and back of the left leg. Using the Rule of Nines, calculate the total body surface area percentage that is burned? A. 63% B. 81% C. 72% D. 54%

A. Anterior head and neck (4.5%), front and back of the left arm (9%), front of the right arm (4.5%), posterior trunk (18%), front and back of the right leg (18%), back of the left leg (9%) which equals 63%.

5. You're providing care to a patient with a uric acid kidney stone that is 2 mm in size per diagnostic imaging. The patient is having severe pain and rates their pain 10 on 1-10 scale. The physician has ordered a treatment plan to assist the patient in passing the kidney stone. What nursing intervention is PRIORITY for this patient based on the scenario? A. Administer pain medication B. Encourage fluid intake of 2-4 liters per day C. Massage the costovertebral area D. Implement a high protein diet

A. Controlling the patient's pain is priority. Option B is another important part of the patient's plan of care to help assist the passage of the kidney stone, but it is not priority at the moment until the patient's pain is controlled. Option C and D are not recommended for the treatment of uric acid kidney stones. You would never massage the costovertebral area, and a high protein diet will further increase uric acid levels, therefore, should be avoided.

12. A mother brings in her 8 month-old child to the ER. The mother reports the baby has recently started being extremely fussy, has a fever, and swelling in the hands and feet. The child is diagnosed with sickle cell disease. As the nurse you know that the swelling in the hands and feet in the infant is termed? A. Dactylitis B. Erythromelaglia C. Dyshidrotia D. Phalitis

A. Dactylitis (also called hand-foot syndrome) occurs mainly in infants who are newly diagnosed with sickle cell anemia.

10. A patient has a burn on the back of the torso that is extremely red and painful but no blisters are present. When you pressed on the skin it blanches. You document this as a: A. 1st degree (superficial) burn B. 2nd degree (partial-thickness) burn C. 3rd degree (full-thickness) burn D. 4th degree (deep full-thickness) burn

A. These are the classic characteristics of a 1st degree, superficial burn.

24. A patient has full-thickness burns on the front and back of both arm and hands. It is nursing priority to: A. Elevate and extend the extremities B. Elevate and flex the extremities C. Keep extremities below heart level and extended D. Keep extremities level with the heart level and flexed

A. This position will decrease edema, which will help prevent compartment syndrome.

9. A 30 year old female patient has deep partial thickness burns on the front and back of the right and left leg, front of right arm, and anterior trunk. The patient weighs 63 kg. Use the Parkland Burn Formula: What is the flow rate during the FIRST 8 hours (mL/hr) based on the total you calculated? A. 921 mL/hr B. 938 mL/hr C. 158 mL/hr D. 789 mL/hr

A: 921 mL/hr....First calculate the total amount of fluid needed with the formula: Total Amount of LR = 4 mL x BSA % x pt's weight in kg. The pt's weight 63 kg. BSA percentage: 58.5%...Front and back of right and left leg (36%), front of right arm (4.5%), anterior trunk (18%) which equals 58.5%. ......4 x 58.5 x 63 = 14,742 mL......Remember during the FIRST 8 hours 1/2 of the solution is infused, which will be 14,742 divided by 2 = 7371 mL......Hourly Rate: 7371 divide by 8 equals 921 mL/hr

3. On your unit there are two RNs: one is a new RN while the other is an experienced RN. In addition, there are three LPNs and two nursing assistants. Which tasks delegated to one of the nursing assistants by the new RN needs to be re-evaluated? A. Apply hydrocortisone cream to eczema on skin after giving the patient a bath. B. Assist the patient with administering a Fleet Enema. C. Empty an ostomy bag. D. Collect and record patient's blood pressure, heart rate, temperature, oxygen saturation, respirations, and pain rating. E. Assist a patient with ambulating.

Answers: A and B Option A is a task for an LPN or RN...hydrocortisone cream is a medication and the nursing assistant can't administer medications. Option B: is a task for an LPN or RN....it is a procedure. Option C, D, and E are all delegated tasks a nursing assistant can perform.

A client has been prescribed treatment with antineoplastic drugs, which have a depressing effect on the bone marrow. What pre-administration assessment should the nurse perform for this client with respect to the depressing effect of the bone marrow? a) Emotional response to the disease b) Complete blood count c) Fluid intake and output d) Client understands therapy

B

A client has had a laparoscopic cholecystectomy. The client is now reporting right shoulder pain. What should the nurse suggest to relieve the pain? a) Aspirin every 4 to 6 hours as prescribed b) Application of heat 15 to 20 minutes each hour c) Application of an ice pack for no more than 15 minutes d) Application of liniment rub to affected area

B

A client is admitted to the unit with acute cholecystitis. The health care provider has stated that surgery will be scheduled in 4 days. The client asks why the surgery is being put off for a week when he has a "sick gallbladder." What rationale would underlie the nurse's response? a) Surgery is delayed until the client can eat a regular diet without vomiting. b) Surgery is delayed until the acute symptoms subside. c) The client requires aggressive nutritional support prior to surgery. d) Time is needed to determine whether a laparoscopic procedure can be used.

B

A client taking an ACE inhibitor is scheduled for surgery. The nurse should a. stop the drug. b. alert the surgeon and mark the client's chart prominently. c. cancel the surgery and consult with the prescriber. d. monitor fluid levels and make sure the fluids are restricted before surgery.

B

A client who had developed jaundice 2 months earlier is brought to the ED after attending a party and developing excruciating pain that radiated over the abdomen and into the back. Upon assessment, which additional symptom would the nurse expect this client to have? a) Hypertension b) Bile-stained vomiting c) Warm, dry skin d) Weight loss

B

A client who has been having recurrent attacks of severe abdominal pain over the past few months informs the physician about a 25-pound weight loss in the past year. The nurse attributes which factor as the most likely cause of this weight loss? a) Vomiting after heavy meals b) Skipping meals out of fear of painful attacks c) Ingesting a low-fat diet to prevent abdominal pain d) Malabsorption

B

A client with AML has pale mucous membranes and bruises on the legs. What is the primary nursing intervention? a) Assess the client's skin. b) Assess the client's hemoglobin and platelets. c) Assess the client's pulse and blood pressure. d) Check the client's history.

B

A client with calculi in the gallbladder is said to have a) Cholecystitis b) Cholelithiasis c) Choledocholithiasis d) Choledochotomy

B

A nurse in the ED is caring for a client who is experiencing acute respiratory failure. Which of the following lab findings should the nurse expect? A. SaO2 92% B. PaO2 58mm Hg C. Arterial pH 7.50 D. PaCO2 25mm Hg

B

A nurse is assessing a client who has HIV. Which of the following findings should cause the nurse to suspect that the client's diagnosis has progressed to AIDS? A. CD4-T-cells decreased to 750 cells/mm3 B. Small, purple-colored skin lesions C. Persistent, generalized lymphadenopathy D. Fever and diarrhea lasting longer than 1 month

B

A nurse is charged with administering a fatal dose of morphine to a patient on hospice. In which type of court would this nurse be charged? a) Civil b) Criminal c) Administrative d) None of the above

B

A nurse is providing discharge teaching for a client who is HIV-positive. Which of the following instructions should the nurse include in the teaching? A. Work in the garden for exercise B. Discard beverages that have been unrefrigerated for 1hr C. Clean bathroom surfaces with full strength bleach D. Wash laundry soiled with a body fluid in warm water

B

A patient is being evaluated for a diagnosis of chronic myeloid leukemia (CML). The nurse understands that a diagnostic indicator is: a) An enlarged liver. b) A leukocyte count >100,000/mm3. c) Lymphadenopathy. d) Increased number of blast cells.

B

A patient is diagnosed with gallstones in the bile ducts. What laboratory results should the nurse review? a) Serum ammonia concentration of 90 mg/dL b) Serum albumin concentration of 4.0 g/dL c) Serum bilirubin level greater than 1.0 mg/dL d) Serum globulin concentration of 2.0 g/dL

B

A patient with acute myeloid leukemia (AML) is having hematopoietic stem cell transplantation (HSCT) with radiation therapy. In which complication do the donor's lymphocytes recognize the patient's body as foreign and set up reactions to attack the foreign host? a) Acute respiratory distress syndrome b) Graft-versus-host disease c) Remission d) Bone marrow depression

B

An older adult woman has been diagnosed with acute lymphoblastic leukemia (ALL) and her care team has identified potential benefits of imatinib. Which characteristic of this patient's current health status may preclude the use of imatinib? a) The patient has type 2 diabetes mellitus that is controlled using diet and oral antihyperglycemics. b) The patient has chronic heart failure resulting in significant peripheral edema. c) The patient experienced a mild ischemic stroke several years ago and had transient ischemic attacks last year. d) The patient had a total knee arthroplasty several months earlier.

B

During the exudative phase of acute respiratory distress syndrome (ARDS), the patient's lung cells that produce surfactant have become damaged. As the nurse you know this will lead to?* A. bronchoconstriction B. atelectasis C. upper airway blockage D. pulmonary edema

B

Locally active antiviral agents can be used to treat a. HIV infection. b. warts. c. RSV. d. CMV systemic infections.

B

The nurse anticipates that an immunosuppressed client is at greatest risk for which type of shock? a) Neurogenic b) Septic c) Cardiogenic d) Anaphylactic

B

The nurse is caring for a client who has just returned from the ERCP removal of gallstones. The nurse should monitor the client for signs of what complications? a) Pain and peritonitis b) Bleeding and perforation c) Acidosis and hypoglycemia d) Gangrene of the gallbladder and hyperglycemia

B

The nurse is describing the need to maintain the acidity of urine based on the understanding that this is necessary to: a) maintain fluid balance. b) destroy any bacteria that may enter. c) prevent loss of sphincter control. d) maintain peristaltic movement.

B

What function does the kidney perform to assist in maintaining acid-base balance within the necessary normal range? a) Excrete acid in the lungs b) Return bicarbonate to the body's circulation c) Return acid to the body's circulation d) Excrete bicarbonate in the urine

B

When a patient develops renal failure and the production of erythropoietin drops, the patient will develop: a) Hypertension b) Anemia c) Leukemia d) Diabetes

B

When describing the fluid in the ascending loop of Henle, what would be most accurate? a) Highly concentrated b) Hypotonic c) Hypertonic d) Osmotically balanced

B

When the patient has lost the ability to compensate for the insult, vital organs begin to show signs of dysfunction. Which of the following is one of the first signs of organ failure? a) Respiratory alkalosis b) Myocardial depression c) Rapid, shallow respirations d) Lethargy and confusion

B

Which blood pressure (BP) reading would result in a pulse pressure indicative of shock? a) 120/90 mm Hg b) 90/70 mm Hg c) 130/90 mm Hg d) 100/60 mm Hg

B

Which foods should be avoided following acute gallbladder inflammation? a) Cooked fruits b) Cheese c) Coffee d) Mashed potatoes

B

Which is a clinical manifestation of cholelithiasis? a) Epigastric distress before a meal b) Clay-colored stools c) Abdominal pain in the upper left quadrant d) Nonpalpable abdominal mass

B

Which is the strongest influence on potassium loss in the kidney? a) Angiotensin b) Aldosterone c) Renin d) Antidiuretic hormone (ADH)

B

Which of these ions plays an important role in pH homeostasis? a) potassium b) bicarbonate c) chloride d) sodium

B

Which positioning strategy should be used for a client diagnosed with hypovolemic shock? a) Supine b) Modified Trendelenburg c) Prone d) Semi-Fowler

B

Which type of shock is caused by an infection? a) Cardiogenic b) Septic c) Hypovolemic d) Anaphylactic

B

Which vasodilator medication is used in the treatment of shock? a) Dopamine b) Nitroglycerin c) Norepinephrine d) Dobutamine

B

You are caring for a client with shock. You are concerned about hypoxemia and metabolic acidosis with your client. What finding should you analyze for evidence of hypoxemia and metabolic acidosis in a client with shock? a) Serum thyroid level findings b) Arterial blood gas (ABG) findings c) Red blood cells (RBCs) and hemoglobin count findings d) White blood cell count findings

B

which of the following nursing interventions would BEST promote effective airway clearance in a pt with ARDS? A. Turn pt every 12hours B. Suctioning out pts breathing tube if cough is ineffective in clearing secretions C. Administering O2 every 12 hours D. Administering sedatives to promote rest

B

4. Select the patient below who is at MOST risk for complications following a burn: A. A 42 year old male with partial-thickness burns on the front of the right and left arms and legs. B. A 25 year old female with partial-thickness burns on the front of the head and neck and front and back of the torso. C. A 36 year old male with full-thickness burns on the front of the left arm. D. A 10 year old with superficial burns on the right leg.

B When thinking about which patient will have the MOST complications following a burn think about: percentage of the total body surface area that is burned (use the rule of nine to calculate), depth of the burn, age, location of the burn, and patient's medical history. The patient in option B has 40.5% TSBA burned (option A 27%, C: 4.5%, D: 9%). Remember that the higher the total of the body surface area that is burned the higher the risk of complications due to an increase in capillary permeability (swelling, hypovolemic shock etc.). In addition, the location of the burn is a major issue with the patient in option B. The burns are on the head and neck and front and back of the torso. Therefore, with head and neck burns always think about respiratory issues because the airway can become compromised due to swelling or an inhalation injury. And with torso burns that are on the front and back, the patient is at risk for circumferential burns that can lead to further respiratory compromise. The other options have burns that are isolated.

The nurse cares for a client with acute myeloid leukemia with severe bone pain. What pathophysiological concept does the nurse understand is the reason for the client's pain? a) Abnormal blood cells deposit in small vessels. b) Bone marrow expands. c) Lymph nodes expand. d) Abnormal blood cells crystalize.

B In acute myeloid leukemia, bone pain is caused when the bone marrow expands.

9. Your patient arrives back to their room after having extracoporeal shock wave lithotripsy (ESWL) for treatment of a kidney stone. What will be included in the patient's plan of care? SELECT-ALL-THAT-APPLY: A. Keep the patient in bed B. Encourage fluid intake of 3-4 liters per day C. Maintain nephrostomy tube D. Strain urine E. Keep dressing dry and intact

B and C. Extracoporeal shock wave lithotripsy (ESWL) is NONINVASIVE (no incisions...no dressings or nephrostomy tubes are placed). Shockwaves are created to penetrate though the skin and body tissue. Shockwaves will hit the stone and break it down into grain of sand like particles which will be passed out by the patient. Option A is wrong because the patient should be kept mobile (as tolerated) to assist the passage of the kidney stone fragment.

13. The nurse notes a patient has full-thickness circumferential burns on the right leg. The nurse would: select all that apply A. Place cold compressions on the burn and elevate the right leg below the heart level B. Assess the distal pulses in the right extremity C. Elevate the right leg above the heart level D. Place gauze securely around the leg to prevent infection

B and C. The patient has burns that completely surround the front and back of the right leg. This can lead to compartment syndrome where the edema from the burn compromises circulation to the distal extremity. The nurse should elevate the extremity ABOVE heart level to decrease swelling and assess distal pulses in the extremity to confirm circulation is present.

6. A 14 year-old female has sickle cell anemia. Which factors below can increase the patient's risk for developing sickle cell crisis? Select all that apply: A. Shellfish B. Infection C. Dehydration D. Hypoxia E. Low altitudes F. Hemorrhage G. Strenuous exercise

B, C, D, F and G. Sickle cell crisis can occur when the body experiences low amounts of oxygen in the body (so think about something that increases the body's need for oxygen or affects how oxygen is being transported). Therefore, infection (especially respiratory infections), dehydration, hypoxia, HIGH (not low) altitudes, hemorrhage (blood loss), or strenuous exercise can lead to a sickle cell crisis.

The nurse caring for the patient in shock recognizes which physiologic responses that are common to all shock states? (Select all that apply.) a) Increased intravascular volume b) Activation of the inflammatory response c) Hypoperfusion of tissues d) Must produce energy through anaerobic metabolism e) Increase in cellular Activity

B,C,D

Which antineoplastic drugs are classified as alkylating agents? (Select all that apply.) a) Bleomycin (Blenoxane) b) Chlorambucil (Leukeran) c) Vinblastine (Velban) d) Cyclophosphamide (Cytoxan) e) Ifosfamide (Ifex)

B,D,E

4. The physician orders a 24-hour urine collection on a patient with recurrent kidney stones. As the nurse you know that the specimen should be? A. Kept at room temperature B. Kept on ice or refrigerated C. Sent to the lab every four hours D. Kept at a temperature between 98.6 'F to 99.3'F

B. 24-hour urine collection specimens should be kept refrigerated or on ice (ice bath). If specimen is not kept cold it can alter the test results.

10. You are providing pre-op teaching to a patient scheduled for a percutaneous nephrolithotomy. Which statement by the patient demonstrates the patient understood the pre-op teaching? A. "During the procedure the surgeon will move the stone down the ureter, so I can pass the stone in the urine. B. "I may have a nephrostomy tube after the procedure." C. "A scope is inserted through the urinary system from the urethra to the kidneys to assess the kidney stone." D. "This procedure is noninvasive and no incision is required."

B. A percutaneous nephrolithotomy is an INVASIVE procedure that can be used to remove large kidney stones. An incision is made on the back where the kidney is located. A nephroscope is then insert through the incision and used to remove the stone. Generally, the surgeon is able to remove the stone or break it up, therefore, the patient doesn't have to pass it naturally as with other procedures. A nephrostomy tube is sometimes placed after the procedure to drain urine and fragments of the stone out of the kidney.

25. A patient has an emergency escharotomy performed on the right leg. The patient has full-thickness circumferential burns on the leg. Which finding below demonstrates the procedure was successful? A. The patient can move the extremity. B. The right foot's capillary refill is less than 2 seconds. C. The patient reports a new sensation of extreme pain. D. The patient has a positive babinski reflex.

B. Escharotomy is performed when a full-thickness burn, due to eschar (which is burned tissue that is hard), is compromising blood flow to the distal extremity. The eschar is cut and this relieves pressure and allows blood to flow to the extremity.

23. You're assisting the nursing assistant with repositioning a patient with full-thickness burns on the neck. Which action by the nursing assistant requires you to intervene? A. The nursing assistant elevates the head of the bed above 30 degrees. B. The nursing assistant places a pillow under the patient's head. C. The nursing assistant places rolled towels under the patient's shoulders. D. The nursing assistant covers the patient with sterile linens.

B. If a patient has severe burns to the neck (head as well) a pillow should NOT be used under the head because this can cause wound contractions. Instead rolled towels should be placed under the shoulders.

4. A 25 year-old pregnant female and her partner both have sickle cell trait. What is the percentage that their offspring will develop sickle cell anemia? A. 50% B. 25% C. 75% D. 100%

B. If both parents have the sickle cell trait it means they each have normal hemoglobin A and abnormal hemoglobin S on their RBCs....so both present with hbg AS. Remember they don't have sickle cell disease just the abnormal gene that can be passed to their child. Sickle cell anemia is autosomal recessive, therefore there is a 25% chance their child will obtain both abnormal genes (the Hbg S) from EACH parent and develop sickle cell anemia.

7. You're developing a nursing care plan for a patient with a kidney stone. Which of the following nursing interventions will you include in the patient's plan of care? A. Restrict calcium intake B. Strain urine with every void C. Keep patient in supine position to alleviate pain D. Maintain fluid restriction of 1-2 Liter per day

B. It is vital the nurse strains every void and assesses the urine very closely for stones. This is crucial so it can be determined what type of kidney stone is causing the problem, therefore, appropriate treatment can be ordered. Restricting calcium intake is no longer recommended unless the patient has a metabolic or renal tubule problem. It is important to avoid placing the patient in the supine position for long periods because this impedes the flow of urine and the patient's ability to pass the stone. Fluid should not be restricted (unless the patient has a condition that requires it like heart failure etc.) because this concentrates the urine...hence increases the chances of another stone developing.

29. While collecting a medical history on a patient who experienced a severe burn, which statement by the patient's family member requires nursing intervention? A. "He takes medication for glaucoma". B. "I think it has been 10 years or more since he had a tetanus shot." C. "He was told he had COPD last year." D. "He smokes 2 packs of cigarettes a day."

B. Patients who have had burns need a tetanus shot if they have not had a vaccine within the past 5 to 10 years.

3. Which type of hemoglobin is present in a patient who has sickle cell TRAIT? A. Hemoglobin AA B. Hemoglobin AS C. Hemoglobin SS D. Hemoglobin AC

B. Sickle cell TRAIT is heterozygous, which means the patient has one NORMAL allele (which is Hemoglobin A...this is NORMAL hemoglobin) and one ABNORMAL allele (which is Hemoglobin S).....this is the abnormal hemoglobin that leads to the abnormal construction of the RBC). However, most patients with sickle cell trait don't show signs and symptoms related to sickle cell anemia because they have just enough of the normal hemoglobin A to prevent sickling of the RBC.

5. You're assisting a physician with sickle cell anemia screening. As the nurse you know that which patient population listed below is at risk for sickle cell disease? A. Native Americans B. African-Americans C. Pacific Islanders D. Latino

B. Sickle cell anemia is most common in African-Americans along with Middle Eastern, Asian, Caribbean, and Eastern Mediterranean. WHY? According to the CDC, 1 in 12 African-Americans have the sickle cell trait, so it can easily be passed to their offspring. Remember if both parents have sickle cell trait there is a 25% chance they will pass it to their child.

30. A patient is presenting with bright red lips, headache, and nausea. The physician suspects carbon monoxide poisoning. As the nurse, you know the patient needs: A. Oxygen nasal cannula 5-6 Liters B. 100% oxygen via non-rebreather mask C. Continuous Bipap D. Venturi mask 6 L oxygen

B. This is the treatment for carbon monoxide poisoning.

11. You're providing education to a patient with sickle cell anemia who is taking Hydroxyurea. You will make it priority to tell the patient to? A. Consume foods high in calcium and potassium B. Avoid sick people and maintain strict hand hygiene C. Take this medication with at least 8 oz of water D. Monitor your blood glucose level daily

B. This medication can lower the white blood cell count. Therefore, the nurse should make it priority to tell the patient to avoid infection by avoiding sick people and performing hand hygiene regularly.

17. A patient experienced a full-thickness burn 72 hours ago. The patient's vital signs are within normal limits and urinary output is 50 mL/hr. This is known as what phase of burn management? A. Emergent B. Acute C. Rehabilitative

B. This phase starts when capillary permeability has returned to normal and the patient's vitals are within normal limits and ends with wound closure. The phase after this is rehabilitative.

22. During the acute phase of burn management, what is the best diet for a patient who has experienced severe burns? A. High fiber, low calories, and low protein B. High calorie, high protein and carbohydrate C. High potassium, high carbohydrate, and low protein D. Low sodium, high protein, and restrict fluids to 1 liter per day

B. This type of diet promotes wound healing and meets the caloric demands of the body.

3: The nurse has placed an intubated pt with ARDS in the prone position. The family asks why the pt is lying face down. What would be an appropriate response for the nurse to make? A. Prone positioning will decrease work of pt heart B. Prone positioning will prevent pressure ulcers C. Prone will help recruit alveoli and improve O2 D. Prone will decrease O2 needs of pt

C

A client is suspected of having an insufficient antidiuretic hormone level (ADH). The functioning of which structure should be assessed? a) Pancreas b) Adrenal c) Hypothalamus d) Prostate

C

A client is treated for gastrointestinal problems related to chronic cholecystitis. What pathophysiological process related to cholecystitis does the nurse understand is the reason behind the client's GI problems? a) Contractile spasms of the gallbladder decreases appetite and leads to malnutrition. b) Inflammation of the gallbladder causes pain and impacts gastric motility. c) Reduced or absent bile as a result of obstruction impacts digestion. d) Increased bile as a result of inflammation leads to indigestion.

C

A deficiency in antidiuretic hormone (ADH) would be primarily associated with which condition? a) Kidney necrosis b) Hypotension c) Fluid imbalance d) Abnormal sodium levels

C

A nurse is preparing a client for surgery. During preoperative teaching, the client asks where is bile stored. The nurse knows that bile is stored in the: a) Cystic duct b) Duodenum c) Gallbladder d) Common bile duct

C

A nurse is providing discharge education to a client who has undergone a laparoscopic cholecystectomy. During the immediate recovery period, the nurse should recommend what foods? a) High-fiber foods b) Low-purine, nutrient-dense foods c) Low-fat foods high in proteins and carbohydrates d) Foods that are low-residue and low in fat

C

An adrenergic agent being used to treat shock infiltrates into the tissue with intravenous administration. Which action by the nurse would be most appropriate? a. Watch the area for any signs of necrosis and report it to the physician. b. Notify the physician and decrease the rate of infusion. c. Remove the IV and prepare phentolamine for administration to the area. d. Apply ice and elevate the arm.

C

From the following profiles of clients, which client would be most likely to undergo the diagnostic test of cholecystography? a) Steven, suspected of having a tumor in the colon b) Andrew, suspected of having esophageal abnormalities c) Mark, suspected of having stones in the gallbladder d) Sandra, suspected of having lesions in the liver

C

The ICU nurse is required to closely monitor four clients diagnosed with shock. During the shift assessment, the nurse documents the following values for the clients. Which client is most stable? a) Client A: Heart rate 70 beats per minute, systolic blood pressure (BP) 100 mm Hg, urine output 30 mL/hour b) Client B: Capillary refill time between 7 and 10 seconds, urine output 35 mL/hour c) Client C: Heart rate 115 beats per minute, systolic BP 129 mm Hg, urine output 60 mL/hour d) Client D: Capillary refill time between 5 and 6 seconds, urine output 30 mL/hour

C

The nurse is caring for a client at risk for impending shock. The nurse is assessing the vital signs frequently. What systolic blood pressure (BP) value would indicate impending shock? a) 122 mm Hg b) 114 mm Hg c) 91 mm Hg d) 79 mm Hg

C

The partner of a client with disseminated intravascular coagulopathy (DIC) approaches the nurse with concern because the client has been placed on heparin therapy. The partner states, "I thought the problem was too much bleeding. Doesn't heparin make a person bleed more?" The best response by the nurse is which of the following? a) "I understand your concern but the doctors know what they are doing." b) "Let me make sure I have not misread the doctor's orders." c) "The drug is being used to stop abnormal clotting in the capillaries and arterioles." d) "Please talk to the physician about why this drug is being used."

C

The pathophysiology instructor is talking to the pre-nursing students about hypovolemia and the kidneys. The instructor points out that when the blood pressure is low due to dehydration the body will compensate by secreting: a) Antidiuretic hormone b) Aldosterone c) Renin d) Angiotensin

C

The student nurse is being precepted in the ICU. The student is caring for a client in the compensatory stage of shock who is hypovolemic. Which compensatory mechanism is most important in the re absorption and retention of fluid in the body? a) Activation of renin-angiotensin-aldosterone system b) Secretion of epinephrine and norepinephrine c) Production of antidiuretic hormone and corticosteroid hormones d) Release of catecholamines

C

The type II cells of the walls of the alveoli function to a. replace mucus in the alveoli. b. produce serotonin. c. secrete surfactant. d. protect lungs from bacterial invasion.

C

Which would lead to a release of aldosterone? a) Low potassium levels b) Parasympathetic stimulation c) Angiotensin III d) Natriuretic hormone

C

You are talking with the family of a client who is in the irreversible stage of shock. They ask you why the physician has told the family that the client is going to die. What would you explain to this family? a) The client has lost too much blood. b) The client is brain dead. c) The client is not responding to medical interventions. d) The client has given up.

C

5. The _____________ layer of the skin helps regulate our body temperature. A. Epidermis B. Dermis C. Hypodermis D. Fascia

C This layer contains fatty tissue, veins, arteries, nerves and helps insulate the muscles, bones, organs and helps REGULATE our body temperature.

1. You're making the patient assignments for the next shift. On your unit there are three LPNs, two RNs, and two nursing assistants. Which patients will you assign to the LPNs? A. A 68 year-old male patient who is expected to be discharged home with IV antibiotic therapy. B. A 25 year-old female patient newly admitted with diabetic ketoacidosis. C. A 75 year-old male patient with dementia who has an ileostomy and scheduled tube feedings. D. A 65 year-old female patient who has a order to remove the Foley catheter.

C and D. Option A: An RN is the best for this patient because the patient will need discharge teaching AND the nurse will need to teach the patient how to self-administer antibiotics. Option B: This is a new admission and the patient is UNSTABLE. Most patients with DKA (diabetic ketoacidosis) require insulin drips along with close monitoring of the blood glucose levels, which requires critical thinking and interpretation. Options C and D are best for the LPNs: these are standard routine procedures the LPN can perform and these patient cases are stable.

A client is unstable and receiving dopamine (Inotropin) to increase blood pressure. Which of the following are interventions that the nurse administering dopamine would employ? Select all answers that apply. a) Administer through an intact peripheral line. b) Assess vital signs every hour. c) Use an intravenous controller or pump. d) Verify dosage and pump settings with another RN. e) Measure urine output every hour.

C,D,E

When planning the discharge of a patient with PTSD, a nurse selects goals that promote a safe environment at home. The appropriate goals should focus on which of the following? [Select all that apply] a) Ignoring feelings of stress and anxiety b) Eliminating all relationships and new social connections c) Identify anxiety and stress producing situations and experiences d) Continued contact with a therapist or counselor e) Medication and alternative therapy plan to increase sleep hygiene

C,D,E

11. A patient has experienced full-thickness burns to the face and neck. As the nurse it is priority to: A. Prevent hypothermia B. Assess the blood pressure C. Assess the airway D. Prevent infection

C. Due to the location of the burns (face and neck), the patient is at major risk for respiratory issues due to damage to the upper airways and the risk of an inhalation injury.

3. A patient is scheduled for an intravenous pyelogram (IVP) to assess for kidneys stones. Which finding below requires the nurse to contact the physician? A. Patient reports flank pain that radiates downward B. Patient has hematuria C. Patient is allergic to shellfish D. Patient has cloudy urine

C. During an IVP a special dye, which is iodine based, will be given through an IV. Then x-ray images will be taken to assess the kidneys, bladder, ureters, and urethra. It is very important to make sure the patient isn't allergic to iodine or shellfish, pregnant, nursing, has impaired renal function, or is taking Metformin. All the other options are typical signs and symptoms that can occur with a kidney stone.

2. Which patient below is at MOST risk for developing uric acid type kidney stones? A. A 53 year old female with recurrent urinary tract infections. B. A 6 year old male with cystinuria. C. A 63 year male with gout. D. A 25 year old female that follows a vegan diet and report eating high amounts of spinach and strawberries on a regular basis.

C. Patients with gout experience high uric acid levels which can lead to the development of uric acid kidney stones. In option A, the patient is at risk for struvite kidney stones. In option B, the patient is at risk for cystine kidney stones, and in option C, the patient is at a small risk for calcium oxalate stones due to the high consumption of foods with oxalates.

14. You're educating the parents of a 12 year-old, who was recently treated for sickle cell crisis, on ways to prevent further sickle cell crises in the further. Which statement by the parents demonstrates they understood your instructions? A. "We will limit fluid intake during the day to 1-2 L a day." B. "Cold showers are best to help with pain associated with sickling." C. "We will avoid traveling to high altitude locations." D. "It is important we refuse all future vaccinations unless absolutely necessary."

C. Remember sickle cell crisis can be caused by blood loss, illness (it's important the patient is up-to-date with all vaccinations), high altitudes, stress, dehydration, elevated temperature, or extreme cold temperatures. All options are wrong except C.

1. Which statement about how sickle cell anemia is passed to offspring is CORRECT? A. This disease is an x-linked recessive disease. B. Sickle cell anemia is an autosomal dominant disease. C. This condition is an autosomal recessive disease. D. Sickle cell anemia is rarely passed to offspring and is an autosomal x-linked dominant disease.

C. SCA is an autosomal recessive disease in that the offspring must receive TWO hemoglobin S genes (one for each parent). The parents usually don't have the disease but are carriers. For the disease to occur in the offspring they must receive both of those genes (Hbg SS). On the contrary, with autosomal dominant the offspring has to only receive an abnormal gene from one parent, who probably has signs and symptoms of the disease too.

26. Your patient with severe burns is due to have a dressing change. You will pre-medicate the patient prior to the dressing change. The patient has standing orders for all the medications below. Which medication is best for this patient?* A. IM morphine B. PO morphine C. IV morphine D. Subq morphine

C. The best route that is predictable and easily absorbed is via the IV route in burn victims.

12. A patient is in the acute phase of burn management. The patient experienced full-thickness burns to the perineum and sacral area of the body. In the patient's plan of care, which nursing diagnosis is priority at this time? A. Impaired skin integrity B. Risk for fluid volume overload C. Risk for infection D. Ineffective coping

C. The patient is now in the acute phase where fluid resuscitation was successful and ends with wound closure. Therefore, during this stage diuresis occurs (so fluid volume deficient could occur NOT overload) and INFECTION. The location of the burns increases the risk of infection because these areas naturally harbor bacteria. Therefore, this takes priority because during this phase wound healing is promoted.

6. A patient with a kidney stone explains that the pain he is experiencing is intense, sharp, and wavelike that radiates to the scrotum. In addition, he explains it feels like he has to void but a small amount of urine is passed. Based on the patient's signs and symptoms, where may the kidney stone be located? A. Renal Calyx B. Renal Papilla C. Ureter D. Urethra

C. The patient's description of the pain is known as ureteral colic. The kidney stone may be in the ureter. On the other hand, another type of pain that can be reported is renal colic. This is a dull, deep aching in the flank/costovertebral area and the kidney stone may be in the renal pelvis.

7. Based on the depth of the burn in figure 1 (picture is above), you would expect to find: A. report of sensation to only pressure B. blanching C. anesthetization to feeling D. extreme pain

C. This is a 3rd degree to 4th degree burn (full-thickness) and the nerves that detect pain are destroyed. The patient would have no feeling or experiences an extreme decrease sensation to pain.

4: septic shock is classified as what type of shock? A. Cardiogenic B. Anaphylactic C. Hypovolemic D. Distributive

D

7: a pt has the following ABG values: pH 7.28; paO2 50; PaCO2 58; HCO3- 24. Based on these values which of the following conclusion would be accurate? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory alkalosis D. Respiratory acidosis

D

8: which ONE of the following assessment is the MOST APPROPRIATE for determining correct placement of an endotracheal tube in a mechanically ventilated pt? A. Monitor pts respiratory rate B. Assessing pts skin color C. Monitoring pts BP and pulse D. Auscultating breath sounds bilaterally

D

A client's chest x-ray indicates ARDS. Which pathophysiological process does the nurse recognize is the underlying cause of this condition? a) Decreased blood flow in the pulmonary vessels b) Increased retention of serum carbon dioxide c) Decreased compliance of the lungs d) Increased permeability of pulmonary capillaries

D

A female client will soon begin targeted therapy as a component of her treatment plan for chronic leukemia. The nurse is conducting health education about this new aspect of the client's drug regimen and the client has asked about the potential side effects of treatment. How should the nurse best respond? a) "Chemotherapy causes a lot of unpleasant side effects, and the advantage of targeted therapies is that these are all avoided." b) "Targeted therapies are often more effective than traditional chemotherapy, but the downside of this effectiveness is that adverse effects are more common and severe." c) "The adverse effects to targeted therapies are most often a result of the client's cancer, not the drugs themselves." d) "Both classes of drugs have adverse effects, but targeted therapies tend to have less of an effect on healthy body cells."

D

A nurse cares for a client who is post op cholecystectomy due to the development of cholesterol stones. The client asks the nurse, "Why did I develop these stones?" What is the nurse's best response? a) "The stones formed from pigments in the bile and are caused by an infection of the biliary tract." b) "The stones formed from a component in the bile and are caused by excessive fat in the bloodstream." c) "The stones formed from pigments in the bile and are cause by fatty molecules that deposit in the gallbladder." d) "The stones formed from a component in the bile and are caused by bile acid and fat abnormalities in the bloodstream."

D

A nurse is providing care to all of the following clients. Which client would be most at risk for septic shock? a) The client with pneumonia in the left lower lobe of the lung b) The client with a BMI of 25 who has lost 3 pounds as the result of vomiting c) The 45-year-old client with a sudden onset of frequent premature ventricular contractions (PVCs) d) The client with testicular cancer who is receiving intravenous chemotherapy

D

A nurse manager is providing workplace violence training for her new nursing staff members. Which of the following is an accurate statement regarding risk factors for assault? a) Assaults are usually perpetrated by offenders that do not know their victims b) Exposure to violence in the media is not a factor in aggressive behavior escalation c) Living outside of the city limits places the HC worker at the highest risk for assault d) Intense frustration, being prevented from reaching a highly desired goal and ongoing mental health imbalances may contribute to a sudden violent, aggressive outburst that ends in assault

D

A patient is admitted to the hospital with possible cholelithiasis. What diagnostic test of choice will the nurse prepare the patient for? a) X-ray b) Oral cholecystography c) Cholecystography d) Ultrasonography

D

A patient is experiencing respiratory failure due to pulmonary edema. The physician suspects ARDS but wants to rule out a cardiac cause. A pulmonary artery wedge pressure is obtained. As the nurse you know that what measurement reading obtained indicates that this type of respiratory failure is NOT cardiac related?* A. >25 mmHg B. <10 mmHg C. >50 mmHg D. <18 mmHg

D

A patient is in the irreversible state of shock and is unresponsive. The family requests to stay with the patient during this time. What is the best response by the nurse? a) "You don't want to remember your family member this way." b) "We have specific visiting hours that must be adhered to." c) "I will make arrangements for your family to be able to stay with the patient." d) "The healthcare team needs room to do procedures to help your family member, so it would be best if you stayed in the waiting area."

D

A patient with a diagnosis of chronic myeloid leukemia has met with the oncologist, who has recommended treatment with the kinase inhibitor imatinib. What route of administration will the client receive? a) Daily intramuscular injections throughout the course of treatment b) Peripheral IV administration three times a day for 7 to 10 days c) Weekly IV infusions over 6 to 8 hours through a central line d) Oral administration of imatinib in a home setting

D

A patient with acute myeloid leukemia (AML) has a neutrophil count that persists at less than 100/mm3. What should the nurse cautiously monitor this patient for? a) Abdominal cramps b) Hypotension c) Seizure activity d) Infection

D

Countercurrent focuses on what mechanism to regulate fluid and electrolyte balance a) Regulating vitamin D activation b) Clearing nitrogen wastes c) Managing carbonic anhydrase secretion d) Regulating sodium absorption

D

During preshock, the compensatory stage of shock, the body, through sympathetic nervous system stimulation, will release catecholamines to shunt blood from one organ to another. Which of the following organs will always be protected? a) Liver b) Kidneys c) Lungs d) Brain

D

In a patient who loses bicarbonate from the body, how does it get replaced? a) The renal tubules secrete new bicarbonate into the urine. b) The juxtaglomerular cells secrete new bicarbonate into the blood. c) The juxtaglomerular cells generate new bicarbonate. d) Renal tubular cells generate new bicarbonate.

D

The nurse determines that a patient in shock is experiencing a decrease in stroke volume when what clinical manifestation is observed? a) Increase in diastolic pressure b) Decrease in respiratory rate c) Increase in systolic blood pressure d) Narrowed pulse pressure

D

The nurse is caring for a client admitted with cardiogenic shock. The client is experiencing chest pain and there is an order for the administration of morphine. In addition to pain control, what is the main rationale for administering morphine to this client? a) It promotes coping and slows catecholamine release. b) It stimulates the client so he or she is more alert. c) It decreases gastric secretions. d) It dilates the blood vessels.

D

When describing the signs and symptoms associated with renal failure, what would be mostimportant for a nurse to keep in mind? a) A small number of nephrons usually are affected when manifestations develop. b) Most signs and symptoms are unrelated to nephron damage. c) Renal failure reflects injury to the protective layers of the kidneys. d) Renal failure suggests that extensive kidney damage has already occurred.

D

Which electrolyte filters through the glomerulus and enters the renal tubule? a) Potassium b) Magnesium c) Calcium d) Sodium

D

Which electrolyte promotes the movement of sodium out of the cell? a) Magnesium b) Calcium c) Potassium d) Chloride

D

Which hormone is released in response to fluid overload or hemodilation? a) Carbonic anhydrase b) Aldosterone c) Antidiuretic hormone (ADH) d) Natriuretic

D

Which intervention should be included in the plan of care for a client who has undergone a cholecystectomy? a) Placing the client on NPO (nothing by mouth) status for 2 days after surgery b) Clamping the T-tube immediately after surgery c) Placing the client in the semi-Fowler position immediately after surgery d) Assessing the color of the sclera every shift

D

Which is not an intentional tort? a) False imprisonment b) Defamation of character c) Invasion of privacy d) Negligence

D

Which of the following is the primary pacemaker for the myocardium? a) Atrioventricular junction b) Bundle of His c) Purkinje fibers d) Sinoatrial node

D

Which precautions should a nurse include in the care plan for a client with leukemia and neutropenia? a) Have the client use a soft toothbrush and electric razor, avoid using enemas, and watch for signs of bleeding. b) Put on a mask, gown, and gloves when entering the client's room. c) Provide a clear liquid, low-sodium diet. d) Eliminate fresh fruits and vegetables, avoid using enemas, and practice frequent hand washing.

D

Which substance stimulates the reabsorption of calcium in the distal convoluted tubule? a) Aldosterone b) Antidiuretic hormone c) Vitamin D d) Parathyroid hormone

D

13. You're providing seminar teaching to a group of nurses about sickle cell anemia. Which of the following is NOT a treatment for this condition? A. Blood transfusion B. Stem cell transplant C. Intravenous fluids D. Iron supplements E. Antibiotics F. Morphine

D. Iron supplements are not prescribed (rather Folic Acid) because this type of anemia is not caused by low iron levels, and patients who take iron supplements with sickle cell disease are at risk for building up too much iron in the body, which will damage the organs.

9. During an outpatient well visit with a patient who has sickle cell anemia, you make it PRIORITY to assess the patient's? A. hemoglobin A1C level B. heart rate C. reflexes D. vaccination history

D. Patients will sickle cell anemia are at risk for infection because of spleen compromise. Many patients with SCA experience splenomegaly because blood flow is compromised to the spleen due to sickling of RBCs and the spleen is overworked from recycling the old RBCs (remember a patient with sickle cell anemia does NOT have long-living RBCs...the RBCs tend to die in 20 days rather than 120 days). Therefore, vaccination history is very important. The patient should be up-to-date with the flu, pneumococcal, and meningococcal vaccines.

8. You're providing discharge teaching to a patient who was hospitalized for the treatment of a kidney stone. The type of kidney stone the patient experienced was a uric acid type stone. What type of foods will you educate the patient to avoid? A. Cabbage, spinach, tomatoes, strawberries B. Ice cream, milk, pork, cheese C. Beans, potatoes, corn, peas D. Liver, scallops, anchovies, sardines, pork

D. The patient should avoid foods high in purine and foods high in animal proteins. Foods that are high in purine or animal proteins breakdown into uric acid. Foods high in purine are any type of organ meats (liver), most seafood (scallops, anchovies, sardines), pork, red meats, beer etc.

20. A patient is receiving IV Lactated Ringers 950 mL/hr post 18 hours after a receiving a severe burn. The patient urinary output is 20 mL/hr. As the nurse your next nursing action is to: A. Increase the IV fluids B. Continue to monitor the patient C. Decrease the IV fluids D. Notify the physician of this finding

D. The patient's urinary output is too low and needs more fluids. It should be at least 30 mL/hr. Therefore, the nurse must notify the physician for further orders. The nurse can NOT increase or decrease IV fluids without a physician's order.

19. During the emergent phase of burn management, you would expect the following lab values: A. Low sodium, low potassium, high glucose, low hematocrit B. High sodium, low potassium, low glucose, high hematocrit C. High sodium, high potassium, high glucose, low hematocrit D. Low sodium, high potassium, high glucose, high hematocrit

D. Think about the increase in the capillary permeability that happens with severe burns, which causes the plasma to leave the intravascular system and enter the interstitial tissue: Low sodium..why: sodium leaves with the plasma to the interstitial tissue and drops the levels in the blood; High potassium...why? damaged cells lysis and leak potassium which increases the leave in the blood; high glucose...why? stress response leads the liver to release glycogen and this increases levels; low hematocrit...why? when the plasma leaves the intravascular system (the fluid) it causes the blood to become more concentrated so hematocrit increases (this will decrease when the patient's fluid is replaced).

5. True or False: An RN delegates to the LPN to administer a scheduled tube feeding to a patient. The RN has now transferred full accountability to the LPN for the task getting done, and the RN is no longer accountable for the task. True False

FALSE: The RN can delegate this task to the LPN BUT the RN is still ACCOUNTABLE for the task getting done even though the RN is not the one performing it.

TRUE OR FALSE A nurse who lobbies for changes in evidence-based nursing practice is using a reactive approach to policy setting.

False

TRUE OR FALSE Cholecystitis is when a patient has calculi in the gallbladder.

False

TRUE OR FALSE Contusion is a temporary loss of neurologic function with no apparent structural damage to the brain.

False

TRUE OR FALSE In neutropenia, all of the cell lines are affected, resulting in anemia, thrombocytopenia, and agranulocytosis.

False

TRUE OR FALSE Osmosis is the movement of a substance from an area of higher concentration to one of lower concentration.

False

2. True or False: A patient who experiences an alkali chemical burn is easier to treat because the skin will neutralize the chemical rather than with an acidic chemical burn. A. True B. False

False: Alkali burns are harder to treat than acidic chemical burns because the skin will neutralize the acidic burn.

4. When delegating you know that as an RN you must follow the 5 Rights of Delegation to make sure you are delegating properly. Select all the 5 Rights of Delegation: A. Right Credentials B. Right Direction/Communication C. Right Supervision D. Right Experience E. Right Task F. Right Person G. Right Patient H. Right Circumstance I. Right Time J. Right Order

The answers are: B, C, E, F, and H. The 5 Rights of Delegation are: Right Task, Right Circumstance, Right Person, Right Direction/Communication, and Right Supervision.

A client with leukemia has developed a cough and increased fatigue. What is the primary nursing intervention? a) Evaluate the client for potential infection. b) Administer an antitussive. c) Place a cooling blanket on the client. d) Medicate the client to relieve pain.

A

A nurse is caring for a client who is post-op and has a RR of 9/ min secondary to general anesthesia effects and incisional pain. Which of the following ABG values indicates the client is experiencing respiratory acidosis? A. pH 7.30, PO2 80mm Hg, PaCO2 55mm Hg, HCO3- 22 mEq/L B. pH 7.30, PO2 90 mmHg, PaCO2 35 mm Hg, HCO3- 20 mEq/L C. pH 7.50, PO2 95mm Hg, PaCO2 25 mm Hg, HCO3- 22mEq/L D. pH 7.50, PO2 87 mm Hg, PaCO2 35 mm Hg, HCO3- 30 mEq/L

A

A client has completed induction therapy and has diarrhea and severe mucositis. What is the appropriate nursing goal? a) Address issues of negative body image. b) Place the client in reverse isolation. c) Administer pain medication. d) Maintain nutrition.

A

The nurse is caring for a client whose heart rate suddenly becomes irregular. When notifying the physician, the nurse anticipates an order for what diagnostic study? a) Electrocardiogram b) Echocardiogram c) Cardiac catheterization d) Thallium stress test

A

The nurse is providing teaching to a client diagnosed with chronic myeloid leukemia (CML). Which statement will the nurse include in the teaching on the pathophysiology of the disease? a) "Uncontrolled growth of blood cells causes the marrow to expand to organs." b) "Uncontrolled growth of blood cells causes occlusion in the vessels and tissues." c) "Abnormally-shaped blood cells cause malfunction of the marrow." d) "Abnormally-shaped blood cells cause thickening of the vessels and leads to necrosis of tissue."

A

The nurse will explain the risk factors for disseminated intravascular coagulation (DIC) to the family of the client who has experienced which of the following? a) Trauma b) Urinary tract infection c) Cellulitis d) Otitis media

A

What assessment finding best indicates that the client has recovered from induction therapy? a) Neutrophil and platelet counts within normal limits b) Vital signs within normal ranges c) No evidence of edema d) Absence of bone pain

A

Which of the following is the only curative treatment for chronic myeloid leukemia (CML)? a) Allogeneic stem cell transplant b) Imatinib c) Cytarabine d) Idarubicin

A

_________________ is a clinical syndrome that is characterized by a progressive decline in cognitive, behavioral, and motor functions as a direct result of HIV infection: a) Cryptococcal meningitis b) Neuropathy c) Progressive multifocal leukoencephalopathy d) HIV encephalopathy

D

A young athlete collapsed & died due to hypertrophic cardiomyopathy. The parents ask the nurse how it is possible that their child had no symptoms of this disorder before experiencing sudden cardiac death. The nurse responds with which of the following? a) "Exercise causes the heart to contract more forcefully & can lead to changes in heart's rhythm or outflow of blood." b) "It is likely that your child had symptoms of disorder but may not have thought them important." c) "During exercise, the heart may not be able to meet body's demands for blood & oxygen." d) "Cardiomyopathy results in destruction & scarring of cardiac muscle cells. As result, ventricle may rupture, causing sudden death."

A

An ICU nurse monitors a client with sepsis. Lab values include decreased hemoglobin, hematocrit, fibrinogen, and platelet levels. Which complication does the nurse suspect? a) Disseminated intravascular coagulation b) Systemic inflammatory response syndrome c) Hypovolemic shock d) Bone marrow depression

A

Nursing interventions for the patient receiving antiviral drugs for the treatment of HIV probably would include a. monitoring renal and hepatic function periodically during therapy. b. administering the drugs just once a day to increase drug effectiveness. c. encouraging the patient to avoid eating if GI upset is severe. d. stopping the drugs and notifying the prescriber if severe rash occurs.

A

On assessing sinus bradycardia at a rate of 45 bpm, nurse should do which of following? a) Assess mental status & blood pressure. b) Assess peripheral pulses on all four extremities. c) Determine whether apical-radial pulse deficit is present. d) Prepare to administer IV atropine

A

A 48-year-old female recently diagnosed with leukemia presents with increased immature lymphocytes, decreased granulocytes, and normal erythrocytes. The client most likely has which type of leukemia? a) Chronic lymphocytic leukemia b) Acute lymphocytic leukemia c) Acute myelogenous leukemia d) Chronic myelogenous leukemia

A Clients with CLL are typically older than 40 years of age, have increased immature lymphocytes, normal or decreased granulocytes, but erythrocyte and platelet counts may be normal or low. Clients with ALL are younger than 5 years of age; uncommon after 15 years of age. Clients with AML have a decrease in all myeloid formed cells: monocytes, granulocytes, erythrocytes, and platelets. Clients with CML are similar to those with AML but greater number of normal cells than in acute form.

A 12-year-old girl on the oncology unit at children's hospital tells the nurse that she has discovered that there are several different kinds of leukemia. The child asks the nurse to explain what makes them all "leukemia." What should the nurse reply? a) The different leukemias all have unregulated proliferation of white blood cells. b) The different leukemias all have unregulated proliferation of red blood cells. c) The different leukemias all have decrease in production of white blood cells. d) The different leukemias all have decrease in production of red blood cells.

A Leukemia commonly involves unregulated proliferation of white blood cells. Decreased production of red blood cells is associated with anemias. Decreased production of white blood cells is associated with leukopenia.

A nurse prepares teaching for a group of clients with chronic myeloid leukemia (CML). When planning the teaching on medication adherence, which factors associated with lower oral therapy adherence will the nurse keep in mind? Select all that apply. a) Living alone b) Low socioeconomic status c) Not participating in a clinical trial d) Taking medication independent of meals e) Lower self-report of functional status

A,B,C,D Adherence to the oral medication therapeutic regimen is critical to optimal client outcomes. Various factors lead to lower adherence rates to the oral medication therapeutic regimen. These may include: living alone, low socioeconomic status, not participating in a clinical trial, and taking medication independent of meals. A higher self-report of functional status

A nurse has established for a client the nursing diagnosis of risk for infection. Which of the following interventions would the nurse include in the plan of care for this client? Select all answers that apply. a) Assess skin and mucus membranes every shift. b) Auscultate lung sounds every shift and prn. c) Place fresh flowers on a shelf on the opposite wall from the client. d) Encourage the client to take deep breaths every 4 hours while awake. e) Provide oral hygiene once daily.

A,B,D

Which information does the nurse include when providing teaching to a female client with HIV who wants to get prego? Select all that apply. a) "The baby might not be born HIV-positive." b) "Your partner is at risk while not using barrier birth control." c) "Stop taking antiretroviral drugs during pregnancy." d) "The baby could be exposed to HIV during birth." e) "You will need to have a C-section."

A,B,D

A nurse provides discharge instructions to a client with AIDS. Which instructions does the nurse provide? Select all that apply. a) "Sexual partners should be tested for HIV" b) "Avoid being around individuals with symptoms of contagious infections" c) "Avoid sharing drinks or utensils with healthy family members" d) "Do not share your shaving razor or nail clippers with anyone" e) "Use condoms consistently and correctly for vaginal or anal sex"

A,B,D,E

The renin-angiotensin system is associated with which of the following? a. Intense vasoconstriction and BP elevation b. Blood flow through the kidneys c. Production of surfactant in the lungs d. Release of aldosterone from the adrenal cortex e. Retention of sodium and water in the kidneys f. Liver production of fibrinogen

A,B,D,E

A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply. a) "This type of leukemia primarily impacts older adults." b) ''This type of leukemia does not appear to have familial predisposition." c) "This type of leukemia is rarely seen in certain ethnicities." d) "This type of leukemia primarily impacts pediatric adults." e) "This type of leukemia is rarely aggressive."

A,C

You are caring for a patient with acute respiratory distress syndrome. As the nurse you know that prone positioning can be beneficial for some patients with this condition. Which findings below indicate this type of positioning was beneficial for your patient with ARDS?* select all that apply: A. Improvement in lung sounds B. Development of a V/Q mismatch C. PaO2 increased from 59 mmHg to 82 mmHg D. PEEP needs to be titrated to 15 mmHg of water

A,C

A nurse cares for a client suspected of having ARDS. Which assessment data supports this suspected diagnosis? Select all that apply a) Confusion b) Slow onset c) Tachypnea d) Crackles e) Metabolic alkalosis

A,C,D

When explaining to a client the reasoning behind using combination therapy in the treatment of HIV the nurse would include which of the following points? a. The virus can remain dormant within the T cell for a very long time; it can mutate while in the T cell. b. Adverse effects of many of the drugs used to treat this virus include immunosuppression, so the disease could become worse. c. The drugs are cheaper if used in combination. d. The virus slowly mutates with each generation. e. Attacking the virus at many points in its life cycle has been shown to be most effective. f. Research has shown that using only one type of drug that targeted only one point in the virus life cycle led to more mutations and more difficulty in controlling the disease.

A,D,E,F

Appropriate nursing diagnoses related to the drug therapy for a patient receiving combination antiviral therapy for the treatment of HIV infection would include the following: a. Disturbed sensory perception (kinesthetic) related to the CNS effects of the drugs. b. Imbalanced nutrition: More than body requirements related to appetite stimulation. c. Heart failure related to cardiac effects of the drugs. d. Adrenal insufficiency related to endocrine effects of the drugs. e. Acute pain related to GI, CNS, or dermatological effects of the drugs. f. Deficient knowledge regarding drug therapy.

A,E,F

A nurse is providing teaching to a client who will undergo chemotherapy and radiation prior to hematopoietic stem cell transplantation (HSCT) for acute myeloid leukemia (AML). What statement will the nurse use to describe the purpose of the chemotherapy and radiation? a) "These therapies shrink your tumor to ensure the stem cell transplant is more effective." b) "These therapies destroy the ability of your body to produce blood cells inside your bone marrow." c) "These therapies destroy the bone marrow in an effort to shrink it and decrease your pain." d) "These therapies decrease your immune system to decrease the risk of allergic reaction."

B

A patient is brought to the ER with complaints of lethargy, an oral temp 101.2F, HR115, RR 28 and feeling "weaker than usual." The client has a history of leukemia that has been treated recently with oral chemotherapy. Which of the following orders would receive the highest priority by the nurse? a) Administer an antipyretic. b) Initiate intravenous therapy. c) Administer intravenous antibiotics. d) Obtain complete blood count with differential (CBC).

B

A patient is on mechanical ventilation with PEEP (positive end-expiratory pressure). Which finding below indicates the patient is developing a complication related to their therapy and requires immediate treatment?* A. HCO3 26 mmHg B. Blood pressure 70/45 C. PaO2 80 mmHg D. PaCO2 38 mmHg

B

The baroreceptors are the most important factor in continual control of BP. The baroreceptors a. are evenly distributed throughout the body to maintain pressure in the system. b. sense pressure and immediately send that information to the medulla in the brain. c. are directly connected to the sympathetic nervous system. d. are as sensitive to oxygen levels as to pressure changes.

B

The nurse counsels a client who has tested negative HIV after a recent exposure to contaminated blood. Which instruction does the nurse provide? a) "This indicates that you are not contagious" b) "You will need to repeat the test in 6 months." c) "This indicates that you have HIV." d) "The test shows that you are not infected with HIV."

B

The nurse is assessing a patient admitted with a heart block. When placed on a monitor, the patient's electrical rhythm displays as progressively longer PR durations until there is a nonconducted P wave. Which type of heart block does the nurse expect that this patient has? a) First degree b) Second degree, type I c) Second degree, type II d) Third degree

B

The nurse is aware that chronic lymphocytic leukemia (CLL), a common malignancy in those older than 60, has an early stage and a late stage. The nurse assesses a patient for late stage CLL by looking for: a) Lymphadenopathy. b) Thrombocytopenia. c) Hepatomegaly. d) Splenomegaly.

B

The nurse is caring for a client who is diagnosed with shock. For which type of shock will the nurse provide interventions if the client presents with SIRS, infection, widespread vasodilation and decreased peripheral resistance? a) Cardiogenic shock b) Septic shock c) Hypovolemic shock d) Obstructive shock

B

The nurse is educating a patient taking imatinib mesylate (Gleevec) for treatment of leukemia. What should the nurse be sure to include when educating the patient on the best way to take the medication to optimize absorption? a) Take the medication with a source of vitamin C to enhance absorption. b) Take antacids if needed for gastrointestinal (GI) upset 2 hours after taking Gleevec. c) Take the medication with food to enhance absorption. d) Take the medication with acetaminophen to prevent decreased absorption and GI upset.

B

The nurse is teaching a client about to be discharged after undergoing detoxification from chronic alcohol abuse. The client asks the nurse about complications or risk for any heart problems related to alcoholism. The nurse teaches the client that which of the following heart diseases is possible for the alcoholic client? a) Valve stenosis b) Dilated cardiomyopathy, reversible c) Restrictive cardiomyopathy d) Mitral regurgitation

B

The nurse recognizes second-degree AV block, type II, & intervenes appropriately by: a) Recording the finding on chart. b) Preparing for temporary pacemaker insertion. c) Administering class 1B antidysrhythmic drug. d) Placing client in Fowler's position.

B

Virus infections have proved difficult to treat because they a. have a protein coat. b. inject themselves into human cells to survive and to reproduce. c. are bits of RNA or DNA. d. easily resist drug therapy.

B

What is a major indicator of extracellular FVD? a) Full and bounding pulse b) Drop in postural blood pressure c) Elevated temperature d) Pitting edema of lower extremities

B

When a substance-abuse problem is suspected, what is the cause for immediate confrontation? a. If the employee is defensive b. If the employee may pose a risk to clients c. If it is not possible to gather sufficient evidence

B

While assessing a client with chronic HIV, the nurse notes several violet-colored raised lesions on the client's arms and neck. What action does the nurse take? a) Assess the client for further signs of physical abuse. b) Notify the health care provider of the finding. c) Obtain a CBC d) Instruct the client to keep the lesions covered

B

A client with acute myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury. What is the nurse's best understanding of the pathophysiological reason behind the client's injury? a) The majority of the disease process occurs in the tissue of the kidneys. b) Chemotherapy causes an increase in kidney stone formation. c) Chemotherapy causes destruction of the nephrons in the kidney. d) The majority of the disease process occurs in the vessels of the kidneys.

B Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. This causes an increase in uric acid levels, potassium, and phosphate (also known as tumor lysis). The increase in uric acid predisposes the client to the development of kidney stones and increases the risk for renal injury.

A nurse would question the order for an adrenergic agonist for a patient who is also receiving which of the following: a. Anticholinergic drugs b. Halogenated hydrocarbon anesthetics c. Beta-blockers d. Benzodiazepines e. MAOIs f. TCAs

B,C,E,F

A patient has been hospitalized in the ICU for a near drowning event. The patient's respiratory function has been deteriorating over the last 24 hours. The physician suspects acute respiratory distress syndrome. A STAT chest x-ray is ordered. What finding on the chest x-ray is indicative of ARDS?* A. infiltrates only on the upper lobes B. enlargement of the heart with bilateral lower lobe infiltrates C. white-out infiltrates bilaterally D. normal chest x-ray

C

Client presents to ER with symptoms of orthopnea, paroxysmal nocturnal dyspnea, peripheral edema, & ascites. Physician suspects cardiomyopathy. Which of following types of myopathy does nurse suspect this client is experiencing? a) Restrictive cardiomyopathy b) Hypertrophic cardiomyopathy c) Dilated cardiomyopathy d) Hypotrophic cardiomyopathy

C

Nurse is caring for client with history of renal failure, new myocardial infarction & dysrhythmias. Nurse is reviewing laboratory results, & would call physician to report which of following results? a) Potassium of 5.0 mEq/L b) Sodium level of 145 mEq/L c) Calcium level of 7.0 mg/dL d) Digoxin/digitalis level of 0.8 ng/mL

C

The clinic nurse is caring for a client diagnosed with leukopenia. What does the nurse know this client has? a) Too many erythrocytes b) A decrease in granulocytes c) A general reduction in all white blood cells d) A general reduction in neutrophils and basophils

C

The nurse would determine that a client being treated for sepsis is improving when which of the following is assessed? a) Blood pressure stabilizes within normal limits. b) Urine output increases to 30 mL/hour. c) Fluid resuscitation requirements diminish. d) Blood culture results are normal

C

Which ion channels allow cardiac muscle to fire without a stimulus? a) Na+ b) K+ c) Ca++ d) Cl−

C

Which of the following accurately describes why nurses are at increased liability for malpractice suits? a) Their realm of responsibility has decreased. b) Fewer nurses have liability insurance. c) Nurses are making more money. d) Nurses currently have less independence in decision making.

C

Which patient below is at MOST risk for developing ARDS and has the worst prognosis?* A. A 52-year-old male patient with a pneumothorax. B. A 48-year-old male being treated for diabetic ketoacidosis. C. A 69-year-old female with sepsis caused by a gram-negative bacterial infection. D. A 30-year-old female with cystic fibrosis.

C

You're providing care to a patient who is being treated for aspiration pneumonia. The patient is on a 100% non-re breather mask. Which finding below is a HALLMARK sign and symptom that the patient is developing acute respiratory distress syndrome (ARDS)?* A. The patient is experiencing bradypnea. B. The patient is tired and confused. C. The patient's PaO2 remains at 45 mmHg. D. The patient's blood pressure is 180/96.

C

A client is suspected of having leukemia and is having a series of laboratory and diagnostic studies performed. What does the nurse recognize as the hallmark signs of leukemia? Select all that apply. a) Diarrhea b) Nausea and vomiting c) Frequent infections d) Fatigue from anemia e) Easy bruising

C,D,E

As the nurse you know that acute respiratory distress syndrome (ARDS) can be caused by direct or indirect lung injury. Select below all the INDIRECT causes of ARDS:* A. Drowning B. Aspiration C. Sepsis D. Blood transfusion E. Pneumonia F. Pancreatitis

C,D,F

A nurse is assessing a client who has ARDS. Which of the following findings should the nurse report to the provider? A. Decreased bowel sounds B. O2 stats 92% C. CO2 24 mEq/L D. Intercostal retractions

D

A nurse is caring for a client who had HIV. Which of the following lab findings should suggest to the nurse that med therapy is effective? A. Lymphocyte 1,400/mm3 B. WBC count 3,500/mm3 C. Low CD4/CD8 ratio D. Decreased viral load

D

Diagnostic testing has resulted in a diagnosis of acute myeloid leukemia (AML) in an adult patient who is otherwise healthy. The patient and the care team have collaborated and the patient will soon begin induction therapy. The nurse should prepare the patient for which of the following? a) Daily treatment with targeted therapy medications b) Radiation therapy on a daily basis c) Hematopoietic stem cell transplantation d) An aggressive course of chemotherapy

D

The nurse is carefully monitoring a postpartum client who experienced abruptio placentae for which of the following signs of disseminated intravascular coagulation (DIC)? a) Pain and swelling in the leg b) Rapid clotting times c) Increased platelet levels d) Petechiae, oozing from injection sites, and hematuria

D

True or False An HIV-infected person can only transmit the virus when symptoms are present and the antibody test is positive.

False