Exam 1
The health care provider orders a liver and spleen scan for a patient who has been in a motor vehicle crash. Which action should the nurse take before this procedure? a. Check for any iodine allergy. c. Administer prescribed sedatives. b. Insert a large-bore IV catheter. d. Assist the patient to a flat position.
Assist the patient to a flat position.
The complete blood count (CBC) indicates that a patient is thrombocytopenic. Which action should the nurse include in the plan of care? a. Avoid intramuscular injections. c. Check temperature every 4 hours. b. Encourage increased oral fluids. d. Increase intake of iron-rich foods.
Avoid intramuscular injections.
The nurse examines the lymph nodes of a patient during a physical assessment. Which assessment finding would be of most concern to the nurse? a. A 2-cm nontender supraclavicular node b. A 1-cm mobile and nontender axillary node c. An inability to palpate any superficial lymph nodes d. Firm inguinal nodes in a patient with an infected foot
A 2-cm nontender supraclavicular node
By which route of administration will prednisone be administered to a patient with asthma? A. By mouth (PO) B. Intravenous (IV) C. Metered-dose inhaler (MDI) D. Nebulizer
A. By mouth (PO)
Apatient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect? a. Hematocrit of 46% b. Hemoglobin of 13.8 g/dL c. Elevated reticulocyte count d. Decreased white blood cell (WBC) count
Elevated reticulocyte count
A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure? a. Elevate the head of the bed to 45 degrees. b. Have the patient lie on the left side for 1 hour. c. Apply a sterile 2-inch gauze dressing to the site. d. Use a half-inch sterile gauze to pack the wound.
Have the patient lie on the left side for 1 hour.
The nurse is reviewing laboratory results and notes a patient's activated partial thromboplastin time (aPTT) level of 28 seconds. The nurse should notify the health care provider in anticipation of adjusting which medication? a. Aspirin c. Warfarin b. Heparin d. Erythropoietin
Heparin
A patient's complete blood count (CBC) shows a hemoglobin of 19 g/dL and a hematocrit of 54%. Which question should the nurse ask to determine possible causes of this finding? a. "Have you had a recent weight loss?" b. "Do you have any history of lung disease?" c. "Have you noticed any dark or bloody stools?" d. "What is your dietary intake of meats and protein?"
"Do you have any history of lung disease?"
The nurse assesses a patient who has numerous petechiae on both arms. Which question should the nurse ask the patient? a. "Are you taking any oral contraceptives?" b. "Have you been prescribed antiseizure drugs?" c. "Do you take medication containing salicylates?" d. "How long have you taken antihypertensive drugs?"
"Do you take medication containing salicylates?"
Which phrase describes the mechanism of action for trimethoprimsulfamethoxazole? A. Kills bacteria B. Dilates bronchioles C. Relaxes smooth muscle D. Increases pulmonary blood flow
A. Kills bacteria Trimethoprim-sulfamethoxazole kills bacteria. It is an antibiotic that is effective for the treatment of mild to moderate acute exacerbations of chronic bronchitis (AECBs) from infectious causes. Trimethoprim-sulfamethoxazole does not dilate bronchioles, relax smooth muscle, or increase pulmonary blood flow.
Which drug is most appropriate for a patient experiencing an acute asthma attack? A. Albuterol B. Epinephrine C. Tiotropium D. Theophylline
A. Albuterol Albuterol is the first choice for treating a patient experiencing an acute asthma attack. Albuterol promotes cyclic adenosine monophosphate (cAMP) production and enhances bronchodilation. Epinephrine is a nonselective sympathomimetic that is used for acute bronchospasm caused by anaphylaxis from an allergic reaction. It is used in emergency situations to restore circulation and increase airway patency. Tiotropium is an anticholinergic drug used for maintenance therapy of chronic asthma and treatment of bronchospasm associated with chronic obstructive pulmonary disease (COPD). Theophylline is used for maintenance therapy in patients with chronic stable asthma and other COPD conditions when other drugs have failed to show improvement.
Which respiratory disorder may contribute to wheezing? A. Asthma B. Emphysema C. Bronchiectasis D. Chronic bronchitis
A. Asthma Asthma is an inflammatory disorder associated with the airway walls, and it is characterized by bronchospasm, wheezing, mucus secretions, and dyspnea. Emphysema and bronchiectasis may include all of the same symptoms except wheezing. Likewise, the symptoms of chronic bronchitis do not include wheezing.
Which physiologic effect would the nurse anticipate occurring following the administration of formoterol to a patient with COPD? A. Bronchodilation B. Suppressed release of histamine C. Decreased bronchiole inflammation D. Loosened mucus in the airways
A. Bronchodilation Formoterol causes bronchodilation. Thus the nurse would anticipate bronchodilation occurring following the administration of formoterol to a patient with COPD. Leukotriene modifiers supress the release of histamine and reduce inflammation. Expectorants loosen the mucus in airways.
Which action will the nurse include in the plan of care for a patient admitted with multiple myeloma? a. Monitor fluid intake and output. b. Administer calcium supplements. c. Assess lymph nodes for enlargement. d. Limit weight bearing and ambulation.
ANS: A A high fluid intake and urine output helps prevent the complications of kidney stones caused by hypercalcemia and renal failure caused by deposition of Bence-Jones protein in the renal tubules. Weight bearing and ambulation are encouraged to help bone retain calcium. Lymph nodes are not enlarged with multiple myeloma. Calcium supplements will further increase the patient's calcium level and are not used
An appropriate nursing intervention for a patient with non-Hodgkin's lymphoma whose platelet count drops to 18,000/µL during chemotherapy is to a. check all stools for occult blood. b. encourage fluids to 3000 mL/day. c. provide oral hygiene every 2 hours. d. check the temperature every 4 hours.
ANS: A Because the patient is at risk for spontaneous bleeding, the nurse should check stools for occult blood. A low platelet count does not require an increased fluid intake. Oral hygiene is important, but it is not necessary to provide oral care every 2 hours. The low platelet count does not increase risk for infection, so frequent temperature monitoring is not indicated.
Which information obtained by the nurse assessing a patient admitted with multiple myeloma is most important to report to the health care provider? a. Serum calcium level is 15 mg/dL. b. Patient reports no stool for 5 days. c. Urine sample has Bence-Jones protein. d. Patient is complaining of severe back pain.
ANS: A Hypercalcemia may lead to complications such as dysrhythmias or seizures, and should be addressed quickly. The other patient findings will also be discussed with the health care provider but are not life threatening.
A patient who has acute myelogenous leukemia (AML) is considering treatment with a hematopoietic stem cell transplant (HSCT). The best approach for the nurse to assist the patient with a treatment decision is to a. discuss the need for insurance to cover post-HSCT care. b. ask whether there are questions or concerns about HSCT. c. emphasize the positive outcomes of a bone marrow transplant. d. explain that a cure is not possible with any treatment except HSCT.
ANS: B Offering the patient an opportunity to ask questions or discuss concerns about HSCT will encourage the patient to voice concerns about this treatment and will allow the nurse to assess whether the patient needs more information about the procedure. Treatment of AML using chemotherapy is another option for the patient. It is not appropriate for the nurse to ask the patient to consider insurance needs in making this decision.
Which action will the admitting nurse include in the care plan for a patient who has neutropenia? a. Avoid intramuscular injections. b. Check temperature every 4 hours. c. Omit fruits or vegetables from the diet. d. Place a "No Visitors" sign on the door.
ANS: B The earliest sign of infection in a neutropenic patient is an elevation in temperature. Although unpeeled fresh fruits and vegetables should be avoided, fruits and vegetables that are peeled or cooked are acceptable. Injections may be required for administration of medications such as filgrastim (Neupogen). The number of visitors may be limited and visitors with communicable diseases should be avoided, but a "no visitors" policy is not needed.
A patient who has acute myelogenous leukemia develops an absolute neutrophil count of 850/µL while receiving outpatient chemotherapy. Which action by the outpatient clinic nurse is most appropriate? a. Discuss the need for hospital admission to treat the neutropenia. b. Teach the patient to administer filgrastim (Neupogen) injections. c. Plan to discontinue the chemotherapy until the neutropenia resolves. d. Order a high-efficiency particulate air (HEPA) filter for the patient's home.
ANS: B The patient may be taught to self-administer filgrastim injections. Although chemotherapy may be stopped with severe neutropenia (neutrophil count <500/µL), administration of filgrastim usually allows the chemotherapy to continue. Patients with neutropenia are at higher risk for infection when exposed to other patients in the hospital. HEPA filters are expensive and are used in the hospital, where the number of pathogens is much higher than in the patient's home environment.
Several patients call the outpatient clinic and ask to make an appointment as soon as possible. Which patient should the nurse schedule to be seen first? a. A 44-yr-old with sickle cell anemia who says his eyes always look sort of yellow b. A 23-yr-old with no previous health problems who has a nontender lump in the axilla c. A 50-yr-old with early-stage chronic lymphocytic leukemia who reports chronic fatigue d. A 19-yr-old with hemophilia who wants to learn to self-administer factor VII replacement
ANS: B The patient's age and presence of a nontender axillary lump suggest possible lymphoma, which needs rapid diagnosis and treatment. The other patients have questions about treatment or symptoms that are consistent with their diagnosis but do not need to be seen urgently.
A patient who has acute myelogenous leukemia (AML) asks the nurse whether the planned chemotherapy will be worth undergoing. Which response by the nurse is appropriate? a. "If you do not want to have chemotherapy, other treatment options include stem cell transplantation." b. "The side effects of chemotherapy are difficult, but AML frequently goes into remission with chemotherapy." c. "The decision about treatment is one that you and the doctor need to make rather than asking what I would do." d. "You don't need to make a decision about treatment right now because leukemias in adults tend to progress slowly."
ANS: B This response uses therapeutic communication by addressing the patient's question and giving accurate information. The other responses either give inaccurate information or fail to address the patient's question, which will discourage the patient from asking the nurse for information.
Which laboratory test will the nurse use to determine whether filgrastim (Neupogen) is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy? a. Platelet count c. Total lymphocyte count b. Reticulocyte count d. Absolute neutrophil count
ANS: D Filgrastim increases the neutrophil count and function in neutropenic patients. Although total lymphocyte, platelet, and reticulocyte counts are also important to monitor in this patient, the absolute neutrophil count is used to evaluate the effects of filgrastim.
A patient who has non-Hodgkin's lymphoma is receiving combination treatment with rituximab (Rituxan) and chemotherapy. Which patient assessment finding requires the most rapid action by the nurse? a. Anorexia c. Oral ulcers b. Vomiting d. Lip swelling
ANS: D Lip swelling in angioedema may indicate a hypersensitivity reaction to the rituximab. The nurse should stop the infusion and further assess for anaphylaxis. The other findings may occur with chemotherapy but are not immediately life threatening
Following successful treatment of Hodgkin's lymphoma for a 55-yr-old woman, which topic will the nurse include in patient teaching? a. Potential impact of chemotherapy treatment on fertility b. Application of soothing lotions to treat residual pruritus c. Use of maintenance chemotherapy to maintain remission d. Need for follow-up appointments to screen for malignancy
ANS: D The chemotherapy used in treating Hodgkin's lymphoma results in a high incidence of secondary malignancies; follow-up screening is needed. The fertility of a 55-yr-old woman will not be impacted by chemotherapy. Maintenance chemotherapy is not used for Hodgkin's lymphoma. Pruritus is a clinical manifestation of lymphoma but should not be a concern after treatment.
Which range reflects a normal theophylline level? A. 5 - 10 mg/mL B. 5 - 15 mcg/mL C. 5 - 15 mg/mL D. 5 - 10 mcg/mL
B. 5 - 15 mcg/mL A normal theophylline level is 5 - 15 mcg/mL. Normal levels are measured in mcg/mL, and can go above 10 mcg/mL.
Which drug class would a nurse anticipate administering to an emergency department patient with acute bronchospasms caused by anaphylaxis? A. Alpha1-adrenergic agonist B. A nonselective sympathomimetic C. Beta2-adrenergic agonist D. Cyclic adenosine monophosphate (cAMP)
B. A nonselective sympathomimetic The nurse would expect to administer a nonselective sympathomimetic, such as epinephrine, to treat acute bronchospasms caused by anaphylaxis. A nonselective sympathomimetic would promote bronchodilation and raise the blood pressure. An alpha1-adrenergic agonist would cause vasoconstriction. A beta2-adrenergic agonist would be used to cause bronchodilation, but would not alter the blood pressure. Cyclic adenosine monophosphate (cAMP) is a cellular signaling molecule that is responsible for maintaining bronchodilation; sympathomimetics increase cAMP, causing dilation of the bronchioles.
Which condition is treated by aminophylline-theophylline? A. Allergic rhinitis B. Asthma exacerbation C. Exercise-induced bronchospasm D. Chronic obstructive pulmonary disease (COPD)
B. Asthma exacerbation Aminophylline-theophylline is a combination drug used to treat asthma exacerbation.
Which condition would the nurse anticipate being treated with trimethoprim-sulfamethoxazole? A. Allergic rhinits B. Bronchitis exacerbation C. Newly diagnosed asthma D. Exercise-induced asthma
B. Bronchitis exacerbation Trimethoprim-sulfamethoxazole kills bacteria. It is an antibiotic that is effective for the treatment of mild to moderate acute exacerbations of chronic bronchitis (AECBs) from infectious causes.
Which inhalant used for asthma control is categorized as an adrenergic? A. Fluticasone B. Salmeterol C. Cromolyn D. Mometasone furoate
B. Salmeterol Salmeterol is an inhaled adrenergic agent used for asthma control. Fluticasone, cromolyn, and mometasone furoate are antiinflammatory agents used for asthma control.
A patient with pancytopenia of unknown origin is scheduled for the following diagnostic tests. The nurse will provide a consent form to sign for which test? a. Bone marrow biopsy b. Abdominal ultrasound c. Complete blood count (CBC) d. Activated partial thromboplastin time (aPTT)
Bone marrow biopsy
Which long-acting beta2-adrenergic agonist would be prescribed to prevent exercise-induced bronchospasm? A. Metaproterenol B. Levalbuterol C. Salmeterol D. Ephedrine
C. Salmeterol Salmeterol is a long-acting beta2-adrenergic agonist used for maintaining bronchodilation. It would be prescribed for the prevention of exercise-induced bronchospasm. It is not effective for treating acute bronchospasm, and it has a 12-hour-long duration of action. Metaproterenol is used for acute bronchospasm, asthma, and COPD. Levalbuterol is used for acute bronchospasm and prevention of exercise-induced asthma; it is absorbed rapidly and is short-acting. Ephedrine is an alpha and beta-adrenergic agent used for acute bronchospasm
Which condition would a nurse make about a patient who is receiving combination therapy with fluticasone furoate and vilanterol? A. The patient is receiving this therapy to use as needed when asthma symptoms occur B. The patient's liver enzymes should be monitored closely C. The patient is on long-term maintenance therapy for bronchitis or emphysema D. The patient is likely to suffer from diarrhea and weight loss as drug side effects
C. The patient is on long-term maintenance therapy for bronchitis or emphysema Fluticasone furoate and vilanterol form a combination drug composed of a glucocorticoid and a beta-2 adrenergic agonist. They are used for the long-term maintenance of COPD, including bronchitis or emphysema and asthma. Thus the nurse would conclude that the patient is on long term maintenance therapy for bronchitis or emphysema.
Which dose of montelukast is the correct dose for an adult? A. 2mg B. 4mg C. 5mg D. 10mg
D. 10mg Montelukast is a leukotriene receptor antagonist. It is used for the treatment of asthma, bronchoconstriction, and mucus production. The usual dose of montelukast for an adult is 10mgg to be administered in the evening or 2 hours before exercise, depending on the indication.
Which drug is used for long-term maintenance therapy of chronic obstructive pulmonary disease (COPD) but is ineffective for treatment acute bronchospasm? A. Metaproterenol B. Albuterol C. Terbutaline sulfate D. Arformoterol tartrate
D. Arformoterol tartrate Arformoterol tartrate is used for long-term maintenance therapy of COPD because it has a long duration of action. It is not effective for treating acute bronchospasm. Metaproterenol sulfate is used to treate acute bronchospasm, asthma, and COPD. Albuterol is used to treat acute and chronic asthma, bronchitis, and exercise-induced bronchospasm. Terbutaline sulfate is used to treat reversible airway obstruction caused by asthma, acute bronchospasm, and COPD.
Which condition is treated using a phosphodiesterase-4 inhibitor? A. Asthma B. Allergic rhinitis C. Exercise-induced bronchospasm D. Chronic obstructive pulmonary disease (COPD)
D. Chronic obstructive pulmonary disease (COPD) Phosphodiesterase-4 inhibitors, such as roflumilast, are used to treat COPD.
Which disorder affects the thoracic muscular wall? A. Scoliosis B. Emphysema C. Bronchiectasis D. Myasthenia gravis
D. Myasthenia gravis Myasthenia gravis affects the thoracic muscular wall and may be a cause of restrictive lung disease. Scoliosis is a thoracic deformity that may cause restrictive lung disease. Emphysema affects the alveolar walls. In bronchiectasis, the bronchi and bronchioles are dilated as a result of infection and inflammation.
Which adverse reaction would the nurse include in patient teaching regarding the use of albuterol? A. Hypoglycemia B. Drowsiness C. Hypotension D. Tachycardia
D. Tachycardia Albuterol is a beta-agonist bronchodilator that stimulates the beta receptors of the sympathetic nervous system, resulting in tachycardia. This the nurse would include tachycardia in patient teaching regarding the use of albuterol. Hypoglycemia, drowsiness, and hypotension are not expected to occur with albuterol therapy.
The nurse assesses a patient with pernicious anemia. Which assessment finding would the nurse expect? a. Yellow-tinged sclerae c. Numbness of the extremities b. Shiny, smooth tongue d. Gum bleeding and tenderness
Numbness of the extremities `
The nurse is caring for a patient who is being discharged after an emergency splenectomy following a motor vehicle crash. Which instructions should the nurse include in the discharge teaching? a. Check often for swollen lymph nodes. b. Watch for excess bleeding or bruising. c. Take iron supplements to prevent anemia. d. Wash hands and avoid persons who are ill.
Wash hands and avoid persons who are ill.
A nurse reviews the laboratory data for an older patient. The nurse would be most concerned about which finding? a. Hematocrit of 35% b. Hemoglobin of 11.8 g/dL c. Platelet count of 400,000/µL d. White blood cell (WBC) count of 2800/µL
White blood cell (WBC) count of 2800/µL
When planning health care teaching to prevent or detect early head and neck cancer, which people would be the priority to target (select all that apply)? a. 65-year-old man who has used chewing tobacco most of his life b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle c. 21-year-old college student who drinks beer on weekends with his fraternity brothers d. 78-year-old woman who has been drinking liquor since her husband died 15 years ago e. 22-year-old woman who has been diagnosed with human papilloma virus of the cervix
a. 65-year-old man who has used chewing tobacco most of his life b. 45-year-old rancher who uses snuff to stay awake while driving his herds of cattle d. 78-year-old woman who has been drinking liquor since her husband died 15 years ago e. 22-year-old woman who has been diagnosed with human papilloma virus of the cervix
It is important for the nurse to assess for which manifestation(s) in a patient who has just undergone a total thyroidectomy (select all that apply)? a. Confusion b. Weight gain c. Depressed reflexes d. Circumoral numbness e. Positive Chvostek's sign
a. Confusion d. Circumoral numbness e. Positive Chvostek's sign
A 59-yr-old man scheduled for a herniorrhaphy in 2 days reports that he takes ginkgo daily. What is the priority intervention? a. Inform the surgeon, since the procedure may have to be rescheduled. b. Notify the anesthesia care provider, since this herb interferes with anesthetics. c. Ask the patient if he has noticed any side effects from taking this herbal supplement. d. Tell the patient to continue to take the herbal supplement up to the day before surgery.
a. Inform the surgeon, since the procedure may have to be rescheduled.
A patient with chronic obstructive pulmonary disease is taking the leukotriene antagonist montelukast. The nurse is aware that this medication is given for which purpose? a. Maintenance treatment of asthma b. Treatment of acute asthmatic attack c. Reversing bronchospasm associated with chronic obstructive pulmonary disease d. Treatment of inflammation in chronic bronchitis
a. Maintenance treatment of asthma
A 17-yr-old patient with a leg fracture who is scheduled for surgery is an emancipated minor. She has a statement from the court for verification. Which intervention is most appropriate? a. Witness the permit after the surgeon obtains consent. b. Call a parent or legal guardian to sign the permit since the patient is under 18. c. Notify the hospital attorney that an emancipated minor is consenting for surgery. d. Obtain verbal consent since written consent is not necessary for emancipated minors.
a. Witness the permit after the surgeon obtains consent.
The best method for determining the risk for aspiration in a patient with a tracheostomy is to a. consult a speech therapist for swallowing assessment. b. have the patient drink plain water and assess for coughing. c. ask the patient to rate the perceived degree of swallowing difficulty. d. assess for sputum changes 48 hours after the patient drinks small amount of blue dye.
a. consult a speech therapist for swallowing assessment.
When caring for a patient with thrombocytopenia, the nurse instructs the patient to a. dab his or her nose instead of blowing. b. be careful when shaving with a safety razor. c. continue with physical activities to stimulate thrombopoiesis. d. avoid aspirin because it may mask the fever that occurs with thrombocytopenia.
a. dab his or her nose instead of blowing.
The nursing care for a patient with hyponatremia and fluid volume excess includes a. fluid restriction. b. administration of hypotonic IV fluids. c. administration of a cation-exchange resin. d. placement of an indwelling urinary catheter.
a. fluid restriction.
Nursing care for a patient immediately after a bone marrow biopsy and aspiration includes (select all that apply) a. giving analgesics as needed. b. preparing to start a blood transfusion. c. giving preprocedure and postprocedure antibiotic medications. d. having the patient lie still to keep the sterile pressure dressing intact. e. monitoring vital signs and assessing the site for excess drainage or bleeding.
a. giving analgesics as needed. d. having the patient lie still to keep the sterile pressure dressing intact. e. monitoring vital signs and assessing the site for excess drainage or bleeding.
The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load. c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.
a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load.
Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply) a. instructions for high-iron diet. b. taking vital signs every 8 hours. c. monitoring stools for occult blood. d. teaching self-injection of erythropoietin. e. administration of cobalamin (vitamin B12) injections.
a. instructions for high-iron diet. c. monitoring stools for occult blood.
Significant information from the patient's health history that relates to the hematologic system includes a. jaundice. b. bladder surgery. c. early menopause. d. multiple pregnancies.
a. jaundice.
When reviewing laboratory results of an older patient with an infection, the nurse would expect to find a. mild leukocytosis. b. decreased platelet count. c. increased hemoglobin and hematocrit levels. d. decreased erythrocyte sedimentation rate (ESR).
a. mild leukocytosis.
The nursing management of a patient in sickle cell crisis includes (select all that apply) a. monitoring CBC. b. optimal pain management and O2 therapy. c. blood transfusions if needed and iron chelation. d. rest as needed and deep vein thrombosis prophylaxis. e. administration of IV iron and diet high in iron content.
a. monitoring CBC. b. optimal pain management and O2 therapy. c. blood transfusions if needed and iron chelation. d. rest as needed and deep vein thrombosis prophylaxis.
During administration of a hypertonic IV solution, the mechanism involved in equalizing the fluid concentration between ECF and the cells is a. osmosis. b. diffusion. c. active transport. d. facilitated diffusion.
a. osmosis.
Priority nursing actions when caring for a hospitalized patient with a new-onset temperature of 102.2°F (39°C) and severe neutropenia include (select all that apply) a. starting the prescribed antibiotic STAT. b. drawing peripheral and central line blood cultures. c. ongoing monitoring of the patient's vital signs for septic shock. d. taking a full set of vital signs and notifying the physician immediately. e. administering transfusions of WBCs treated to decrease immunogenicity.
a. starting the prescribed antibiotic STAT. b. drawing peripheral and central line blood cultures. c. ongoing monitoring of the patient's vital signs for septic shock. d. taking a full set of vital signs and notifying the physician immediately.
An overweight patient (BMI 28.1 kg/m2) is scheduled for a laparoscopic cholecystectomy at an outpatient surgery setting. The nurse knows that a. surgery will involve multiple small incisions. b. this setting is not appropriate for this procedure. c. surgery will involve removing a part of the liver. d. the patient will need special preparation because of obesity.
a. surgery will involve multiple small incisions.
A complication of the hyperviscosity of polycythemia is a. thrombosis. b. cardiomyopathy. c. pulmonary edema. d. disseminated intravascular coagulation (DIC).
a. thrombosis.
An older woman is admitted to the medical unit with GI bleeding. Assessment findings that indicate fluid volume deficit include (select all that apply) a. weight loss. b. dry oral mucosa. c. full bounding pulse. d. engorged neck veins. e. decreased central venous pressure.
a. weight loss. b. dry oral mucosa. e. decreased central venous pressure.
The patient tells the nurse in the preoperative setting that she has noticed she has a reaction when wearing rubber gloves. What is the most appropriate action? a. Notify the surgeon so that the surgery can be cancelled. b. Ask additional questions to assess for a possible latex allergy. c. Notify the OR staff at once so they can use latex-free supplies. d. No action is needed because the patient's rubber sensitivity has no bearing on surgery.
b. Ask additional questions to assess for a possible latex allergy.
A patient with chronic obstructive pulmonary disease has an acute bronchospasm. The nurse anticipates that the health care provider will prescribe which medication? a. Zafirlukast b. Epinephrine c. Dexamethasone d. Beclomethasone
b. Epinephrine
If a lymph node is palpated, what is a normal finding? a. Hard, fixed nodes b. Firm, mobile nodes c. Enlarged, tender nodes d. Hard, nontender nodes
b. Firm, mobile nodes
Fluticasone propionate and salmeterol combination inhalation is ordered for a patient with chronic obstructive pulmonary disease. What does the nurse know about this medication? (Select all that apply.) a. It can be used to treat an acute attack. b. It is delivered as a dry-powder inhaler. c. It contains a beta1 agonist and cromolyn. d. It is taken as one puff two times a day. e. It promotes bronchodilation.
b. It is delivered as a dry-powder inhaler. d. It is taken as one puff two times a day. e. It promotes bronchodilation.
While in the recovery room, a patient with a total laryngectomy is suctioned and has bloody mucus with some clots. Which nursing interventions would apply? (select all that apply) a. Notify the health care provider at once. b. Place the patient in semi-Fowler's position. c. Use a bag-valve-mask (BVM) and begin rescue breathing for the patient d. Instill 10 mL of normal saline into the tracheostomy tube to loosen secretions. e. Continue patient assessment, including O2 saturation, respiratory rate, and breath sounds.
b. Place the patient in semi-Fowler's position. e. Continue patient assessment, including O2 saturation, respiratory rate, and breath sounds.
An anticoagulant such as warfarin that interferes with prothrombin production will alter the clotting mechanism during a. platelet aggregation. b. activation of thrombin. c. the release of tissue thromboplastin. d. stimulation of factor activation complex.
b. activation of thrombin.
The nurse expects the long-term treatment of a patient with hyperphosphatemia from renal failure will include a. fluid restriction. b. calcium supplements. c. magnesium supplements. d. increased intake of dairy products.
b. calcium supplements.
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would ask the patient about a. folic acid intake. b. dietary intake of iron. c. a history of gastric surgery. d. a history of sickle cell anemia.
b. dietary intake of iron.
A patient who normally takes 40 units of glargine insulin (long acting) at bedtime asks the nurse what to do about her dose the night before surgery. The best response would be to have her a. skip her insulin altogether the night before surgery. b. get instructions from her surgeon or HCP on any insulin adjustments. c. take her usual dose at bedtime and eat a light breakfast in the morning. d. eat a moderate meal before bedtime and then take half her usual insulin dose.
b. get instructions from her surgeon or HCP on any insulin adjustments.
A person who lives at a high altitude may normally have an increased Hgb and RBC count because a. high altitudes cause vascular fluid loss, leading to hemoconcentration. b. hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis. c. the function of the spleen in removing old RBCs is impaired at high altitudes. d. impaired production of platelets leads to proportionally higher red cell counts.
b. hypoxia caused by decreased atmospheric O2 stimulates erythropoiesis.
When reviewing a patient's hematologic laboratory values after a splenectomy, the nurse would expect to find a. RBC abnormalities. b. increased WBC count. c. decreased hemoglobin. d. decreased platelet count.
b. increased WBC count.
A patient is receiving intravenous aminophylline. The nurse checks the patient's laboratory values and sees the serum theophylline level is 32 mcg/mL. What action should the nurse take? a. Assess the patient's breath sounds for improvement. b. Increase the dosage per sliding scale directions. c. Notify the health care provider of the level. d. Have the laboratory collect another sample to verify the results.
c. Notify the health care provider of the level.
Appropriate discharge teaching for the patient with a permanent tracheostomy after a total laryngectomy for cancer would include (select all that apply) a. encouraging regular exercise such as swimming. b. washing around the stoma daily with a moist washcloth. c. encouraging participation in postlaryngectomy support group. d. providing pictures and "hands-on" instruction for tracheostomy care. e. teaching how to hold breath and trying to gag to promote swallowing reflex.
b. washing around the stoma daily with a moist washcloth. c. encouraging participation in postlaryngectomy support group. d. providing pictures and "hands-on" instruction for tracheostomy care.
Which patient is at greatest risk for developing hypermagnesemia? a. 83-year-old man with lung cancer and hypertension b. 65-year-old woman with hypertension taking β-adrenergic blockers c. 42-year-old woman with systemic lupus erythematosus and renal failure d. 50-year-old man with benign prostatic hyperplasia and a urinary tract infection
c. 42-year-old woman with systemic lupus erythematosus and renal failure
The health care provider's progress note for a patient states that the complete blood count (CBC) shows a "shift to the left." Which assessment finding will the nurse expect? a. Cool extremities c. Elevated temperature b. Pallor and weakness d. Low oxygen saturation
c. Elevated temperature
The nurse notes pallor of the skin and nail beds in a newly admitted patient. The nurse should ensure that which laboratory test has been ordered? a. Platelet count c. Hemoglobin level b. Neutrophil count d. White blood cell count
c. Hemoglobin level
A patient is prescribed aminophylline-theophylline. For what adverse effect should the nurse monitor the patient? a. Drowsiness b. Hypoglycemia c. Increased heart rate d. Decreased white blood cell count
c. Increased heart rate
The typical fluid replacement for the patient with a fluid volume deficit is a. dextran. b. 0.45% saline. c. lactated Ringer's solution. d. 5% dextrose in 0.45% saline.
c. lactated Ringer's solution.
While assessing the lymph nodes, the nurse should a. apply gentle, firm pressure to deep lymph nodes. b. palpate the deep cervical and supraclavicular nodes last. c. lightly palpate superficial lymph nodes with the pads of the fingers. d. use the tips of the second, third, and fourth fingers to apply deep palpation.
c. lightly palpate superficial lymph nodes with the pads of the fingers.
You are taking care of a male patient who has the following laboratory values from his CBC: WBC 6.5 × 103/μL, Hgb 13.4 g/dL, Hct 40%, platelets 50 × 103/μL. What are you most concerned about? a. The patient is neutropenic. b. The patient has an infection. c. There is an increased risk for bleeding. d. Fall risk precautions are needed due to anemia.
c. There is an increased risk for bleeding.
The nurse should be alert for which manifestations in a patient receiving a loop diuretic? a. Restlessness and agitation b. Paresthesias and irritability c. Weak, irregular pulse and poor muscle tone d. Increased blood pressure and muscle spasms
c. Weak, irregular pulse and poor muscle tone
DIC is a disorder in which a. the coagulation pathway is genetically altered, leading to thrombus formation in all major blood vessels. b. an underlying disease depletes hemolytic factors in the blood, leading to diffuse thrombotic episodes and infarcts. c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage. d. an inherited predisposition causes a deficiency of clotting factors that leads to overstimulation of coagulation processes in the vasculature.
c. a disease process stimulates coagulation processes with resultant thrombosis, as well as depletion of clotting factors, leading to diffuse clotting and hemorrhage.
A patient is seen at the clinic with fever, muscle aches, sore throat with yellowish exudate, and headache. The nurse anticipates that the interprofessional management will include (select all that apply) a. antiviral agents to treat influenza. b. treatment with antibiotics starting ASAP. c. a throat culture or rapid strep antigen test. d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible cause.
c. a throat culture or rapid strep antigen test. d. supportive care, including cool, bland liquids. e. comprehensive history to determine possible cause.
A patient is seen in the clinic for a nosebleed, which is controlled by placement of anterior nasal packing. During discharge teaching, the nurse teaches the patient to a. use aspirin for pain relief. b. remove the packing later that day. c. avoid vigorous nose blowing and strenuous activity. d. insert more packing into the nose if rebleeding occurs.
c. avoid vigorous nose blowing and strenuous activity.
In a severely anemic patient, the nurse would expect to find a. cyanosis and cardiomegaly. b. pulmonary edema and fibrosis. c. dyspnea at rest and tachycardia. d. ventricular dysrhythmias and wheezing.
c. dyspnea at rest and tachycardia.
A patient with multiple myeloma becomes confused and lethargic. The nurse would expect that these clinical manifestations may be explained by diagnostic results that indicate a. hyperkalemia. b. hyperuricemia. c. hypercalcemia. d. CNS myeloma.
c. hypercalcemia.
The nurse is aware that a major difference between Hodgkin's lymphoma and non-Hodgkin's lymphoma is that a. Hodgkin's lymphoma occurs only in young adults. b. Hodgkin's lymphoma is considered potentially curable. c. non-Hodgkin's lymphoma can manifest in multiple areas. d. non-Hodgkin's lymphoma is treated only with radiation therapy.
c. non-Hodgkin's lymphoma can manifest in multiple areas.
Preoperative considerations for older adults include (select all that apply) a. using only large-print educational materials. b. speaking louder for patients with hearing aids. c. recognizing that sensory deficits may be present. d. providing warm blankets to prevent hypothermia. e. teaching important information early in the morning.
c. recognizing that sensory deficits may be present. d. providing warm blankets to prevent hypothermia.
Which nursing action would be of highest priority when suctioning a patient with a tracheostomy? a. Auscultating lung sounds after suctioning is complete b. Giving antianxiety medications 30 minutes before suctioning c. Instilling 5 mL of normal saline into the tracheostomy tube before suctioning d. Assessing the patient's oxygen saturation before, during, and after suctioning
d. Assessing the patient's oxygen saturation before, during, and after suctioning
A patient is scheduled for surgery requiring general anesthesia at an ambulatory surgical center. The nurse asks him when he ate last. He replies that he had a light breakfast a couple of hours before coming to the surgery center. What should the nurse do first? a. Tell the patient to come back tomorrow, since he ate a meal. b. Have the patient void before giving any preoperative medications. c. Proceed with the preoperative checklist, including site identification. d. Notify the anesthesia care provider of when and what the patient last ate.
d. Notify the anesthesia care provider of when and what the patient last ate.
The most common type of leukemia in adults in western countries is a. acute myelocytic leukemia. b. acute lymphocytic leukemia. c. chronic myelocytic leukemia. d. chronic lymphocytic leukemia.
d. chronic lymphocytic leukemia.
Cancer arising from granulocytic cells in the bone marrow will have the primary effect of causing a. risk for hemorrhage. b. altered oxygenation. c. decreased production of antibodies. d. decreased phagocytosis of bacteria.
d. decreased phagocytosis of bacteria.
Because myelodysplastic syndrome arises from the pluripotent hematopoietic stem cell in the bone marrow, laboratory results the nurse would expect to find include a(n) a. excess of T cells. b. excess of platelets. c. deficiency of granulocytes. d. deficiency of all cellular blood components.
d. deficiency of all cellular blood components.
A priority nursing intervention to aid a preoperative patient in coping with fear of postoperative pain would be to a. inform the patient that pain medication will be available. b. teach the patient to use guided imagery to help manage pain. c. describe the type of pain expected with the patient's particular surgery. d. explain the pain management plan, including the use of a pain rating scale.
d. explain the pain management plan, including the use of a pain rating scale.
The nurse would expect that a patient with von Willebrand disease undergoing surgery would be treated with administration of vWF and a. thrombin. b. factor VI. c. factor VII. d. factor VIII.
d. factor VIII.
The nurse is unable to flush a central venous access device and suspects occlusion. The best nursing intervention would be to a. apply warm moist compresses to the insertion site. b. try to force 10 mL of normal saline into the device. c. place the patient on the left side with the head down. d. have the patient change positions, raise arm, and cough.
d. have the patient change positions, raise arm, and cough.
A patient with allergic rhinitis reports severe nasal congestion; sneezing; and watery, itchy eyes and nose at various times of the year. When teaching the patient about how to control these symptoms, the nurse teaches the patient to a. avoid all intranasal sprays and oral antihistamines. b. limit the usage of nasal decongestant spray to 10 days. c. use oral decongestants at bedtime to prevent symptoms during the night. d. keep a diary of when the allergic reaction occurs and what precipitates it.
d. keep a diary of when the allergic reaction occurs and what precipitates it.
A patient has the following arterial blood gas results: pH 7.52, PaCO2 30 mm Hg, HCO3− 24 mEq/L. The nurse determines that these results indicate a. metabolic acidosis. b. metabolic alkalosis. c. respiratory acidosis. d. respiratory alkalosis.
d. respiratory alkalosis.
During the postoperative care of a 76-year-old patient, the nurse monitors the patient's intake and output carefully, knowing that the patient is at risk for fluid and electrolyte imbalances primarily because a. older adults have an impaired thirst mechanism and need reminding to drink fluids. b. water accounts for a greater percentage of body weight in the older adult than in younger adults. c. older adults are more likely than younger adults to lose extracellular fluid during surgical procedures. d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults.
d. small losses of fluid are significant because body fluids account for 45% to 50% of body weight in older adults.
Multiple drugs are often used in combinations to treat leukemia and lymphoma because a. there are fewer toxic and side effects. b. the chance that one drug will be effective is increased. c. the drugs are more effective without causing side effects. d. the drugs work by different mechanisms to maximize killing of cancer cells.
d. the drugs work by different mechanisms to maximize killing of cancer cells.
Complications of transfusions that can be decreased by using leukocyte depletion or reduction of RBC transfusion are a. chills and hemolysis. b. leukostasis and neutrophilia. c. fluid overload and pulmonary edema. d. transmission of cytomegalovirus and fever.
d. transmission of cytomegalovirus and fever.
