PrepU Comprehensive Exam Questions and Areas to Study

Fat embolism

A ___ ______ (FE) is a piece of intravascular fat that lodges within a blood vessel and causes a blockage of blood flow. These commonly occur after fractures to the long bones of the lower body, particularly the femur (thighbone), tibia (shinbone), and pelvis.

A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should anticipate which laboratory test result? 1.) serum sodium level of 124 mEq/L 2.) serum creatinine level of 0.4 mg/dl 3.) hematocrit of 52% 4.) serum blood urea nitrogen (BUN) level of 8.6 mg/dl

Answer: 1.) serum sodium level of 124 mEq/L Explanation: In SIADH, the posterior pituitary gland produces excess antidiuretic hormone (vasopressin), which decreases water excretion by the kidneys. This, in turn, causes the body to retain too much water and reduces the serum sodium level, causing hyponatremia, as indicated by a serum sodium level of 124 mEq/L. In SIADH, the serum creatinine level isn't affected by the client's fluid status and remains within normal limits. A hematocrit of 52% and a BUN level of 8.6 mg/dl are elevated. Typically, the hematocrit and BUN level decrease.

A school-age child with glomerulonephritis reports a headache and blurred vision. What immediate action should the nurse take? 1.) Put the client to bed. 2.) Obtain the child's blood pressure. 3.) Notify the health care provider (HCP). 4.) Administer acetaminophen.

Answer: 2.) Obtain the child's blood pressure. Explanation: Hypertension occurs with acute glomerulonephritis. The symptoms of headache and blurred vision may indicate an elevated blood pressure. Hypertension in acute glomerulonephritis occurs due to the inability of the kidneys to remove fluid and sodium; the fluid is reabsorbed, causing fluid volume excess. The nurse must verify that these symptoms are due to hypertension. Calling the HCP before confirming the cause of the symptoms would not facilitate his treatment. Putting the client to bed may help treat an elevated blood pressure, but first the nurse must establish that high blood pressure is the cause of the symptoms. Administering acetaminophen for high blood pressure is not recommended.

After a car accident, a client is admitted to an acute care facility with multiple traumatic injuries, including a fractured pelvis. For 24 to 48 hours after the accident, the nurse must monitor the client closely for which potential complication of a fractured pelvis? 1.) compartment syndrome 2.) fat embolism 3.) infection 4.) Volkmann's ischemic contracture

Answer: 2.) fat embolism Explanation: Fat embolism is a relatively rare but life-threatening complication of pelvis and long-bone fractures, arising 24 to 48 hours after the injury. It occurs when fat droplets released at the fracture site enter the circulation, become lodged in pulmonary capillaries, and break down into fatty acids. Because these acids are toxic to the lung parenchyma, capillary endothelium, and surfactant, the client may develop pulmonary hypertension. Signs and symptoms of fat embolism include an altered mental status, fever, tachypnea, tachycardia, hypoxemia, and petechiae. Compartment syndrome and infection may complicate any fracture and aren't specific to a pelvis fracture. Volkmann's ischemic contracture is a potential complication of a hand or forearm fracture.

For a client with asthma, the health care provider (HCP) prescribes albuterol, two puffs twice a day via a metered-dose inhaler (MDI), and beclomethasone, two puffs twice a day via MDI. How should the nurse instruct the client to administer these drugs? 1.) "Take the medications 1 hour apart, two times a day." 2.)"Take the albuterol first and follow with beclomethasone two times a day." 3.) "Take the albuterol on awakening and alternate the medications every 4 hours." 4.) "Take the beclomethasone inhaler first and follow with albuterol."

Answer: 2.)"Take the albuterol first and follow with beclomethasone two times a day." Explanation: The nurse instructs the client to administer the bronchodilator first (the beta-2 agonist always leads) in order to open the airway and allow for improved delivery of the corticosteroid to the lung tissue, which follows after 1 minute between puffs. Using a spacer device with an MDI provides the best delivery of medication to the lungs.

When starting the client's intravenous infusion line, the nurse applies a tourniquet and selects the site for inserting the needle. When should the nurse remove the tourniquet? 1.) when the skin has been cleansed 2.) as soon as the needle is in the vein 3.) as soon as the needle is positioned under the skin 4.) when the needle has been secured with tape

Answer: 3.) as soon as the needle is positioned under the skin Explanation: When starting an IV infusion, the nurse should remove the tourniquet as soon as the needle is in the vein. Until then, the tourniquet keeps the vein distended so that it is more visible and easier to enter.

The nurse is caring for a child with hemophilia who is actively bleeding from the leg. What should the nurse should apply to the site? 1.) direct pressure, checking every few minutes to see if the bleeding has stopped 2.) ice to the injured leg area several times a day 3.) direct pressure to the injured area continuously for 10 minutes 4.) ice bag with elevation of the leg twice a day

Answer: 3.) direct pressure to the injured area continuously for 10 minutes Explanation:

The nurse is planning care for a toddler with a seizure disorder. Which item in the care plan should the nurse revise? 1.) padded side rails 2.) oxygen mask and bag system at bedside 3.) padded tongue blade at the bedside 4.) lorazapam for seizure lasting longer than 5 minutes

Answer: 3.) padded tongue blade at the bedside Explanation: The nurse should revise a care plan that includes padded tongue blades. Nothing should be placed in the mouth during a seizure. Padded side rails will protect the child from injury during a seizure. The bag and mask system should be present in case the child needs oxygen during a seizure. Most seizures resolve in under 5 minutes. If they do not, then a dose of lorazapam can be administered. The healthcare provider will prescribe the correct dosage for weight and the parameters for administering.

The nurse is performing triage in the emergency department. Which client should be seen first? 1.) the client with flank pain radiating to the groin 2.) the client who has an open fracture of his radius 3.) the client with burns to the chest and neck with singed nasal hair 4.) a primipara who is 39 weeks pregnant having contractions every 15 minutes

Answer: 3.) the client with burns to the chest and neck with singed nasal hair Explanation: The client with burns to the chest and neck has the potential to develop decreased lung expansion. Singed nasal hair indicates an inhalation injury, which may lead to the development of respiratory distress syndrome. Flank pain that radiates to the groin is an indication of renal calculi, but this would not take precedence over a client with an obstructed airway. The fracture is not life-threatening and would not take precedence over the client with airway problems. The primipara still has time before the baby comes.

A nurse is providing in-home management instructions to the parents of a child who is receiving desmopressin acetate (DDAVP). What is the most important instruction for the nurse to include? 1.) Give DDAVP only when urine output begins to decrease. 2.) Cleanse skin with alcohol before application of the DDAVP dermal patch. 3.) Increase the DDAVP dose if polyuria occurs just before the next scheduled dose. 4.) Call the healthcare provider if the child has an upper respiratory infection or allergic rhinitis.

Answer: 4.) Call the healthcare provider if the child has an upper respiratory infection or allergic rhinitis. Explanation: Excessive nasal mucus, associated with upper respiratory infection or allergic rhinitis, may interfere with DDAVP absorption because it is given intranasally. Parents should be instructed to contact the health care provider for advice in altering the hormone dose during times when nasal mucus may be increased. The DDAVP dose should remain unchanged, even if the child is experiencing polyuria just before the next dose to avoid over medicating the child.

A client who is receiving acetaminophen for osteoarthritis reports continuing pain. The healthcare provider prescribes celecoxib. What important information regarding this medication, should the nurse share with this client? 1.) report black and tarry stools to the health care provider 2.) use a stool softener or fiber laxative daily to prevent constipation 3.) if you miss a dose, take a double dose the next day 4.) don't take the medication with dairy products

Answer: 1.) report black and tarry stools to the health care provider Explanation: Black and tarry stools are a sign of gastrointestinal (GI) bleeding, and may necessitate a medication change. Dairy products can help reduce GI irritation. The celecoxib dose should never be doubled. Constipation isn't an adverse effect of this medication.

The nurse advises a mother with a 2-year-old child to avoid encouraging excessive milk consumption by the toddler because excess milk consumption can lead to which problem? 1.) vitamin C deficiency 2.) iron deficiency 3.) biotin deficiency 4.) folate deficiency

Answer: 2.) iron deficiency Explanation: Excessive milk consumption can lead to the displacement of iron-rich foods in the diet. This can result in iron deficiency anemia. Drinking excess milk will not cause vitamin C, biotin, or folate deficiencies.

Celecoxib

This medication is a nonsteroidal anti-inflammatory drug (NSAID), specifically a COX-2 inhibitor, which relieves pain and swelling (inflammation). It is used to treat arthritis, acute pain, and menstrual pain and discomfort. The pain and swelling relief provided by this medication helps you perform more of your normal daily activities.

Volkmann's ischemic contracture

Volkmann contracture (or Volkmann ischemic contracture) is a permanent shortening (contracture) of forearm muscles, usually resulting from injury, that gives rise to a clawlike deformity of the hand, fingers, and wrist. It is more common in children. This is a potential complication of a hand or forearm fracture

The health care team determines that the family of an infant with failure to thrive who is to be discharged will need follow-up care. Which approach would be the most effective method of follow-up? 1.) daily phone calls from the hospital nurse 2.) enrollment in community parenting classes 3.) twice-weekly clinic appointments 4.) weekly visits by a community health nurse

Answer: 4.) weekly visits by a community health nurse Explanation: The most effective follow-up care would occur in the home environment. The community health nurse can be supportive of the parents and will be able to observe parent-infant interactions in a natural environment. The community health nurse can evaluate the infant's progress in gaining weight, offer suggestions to the parents, and help the family solve problems as they arise.