NURS 380 EX 3 Evolve

11. A 33-yr-old patient has recently been diagnosed with stage II cervical cancer. Which statement by the nurse best explains the diagnosis? a. "The cancer is found at the point of origin only." b. "Tumor cells have been identified in the cervical region." c. "The cancer has been identified in the cervix and the liver." d. "Your cancer was identified in the cervix and has limited local spread."

ANS: D Stage II cancer is associated with limited local spread. Stage 0 denotes cancer in situ or at the point of origin only; stage I denotes tumor limited to the tissue of origin with localized tumor growth. Stage III denotes extensive local and regional spread. Stage IV denotes metastasis such as to the liver.

9. The nurse is teaching a patient about the application of a topical medication. What should the nurse include in the instruction for the patient? a. Avoid applying medications directly onto dressings. b. Use a tongue blade whenever the patient's skin integrity allows. c. Avoid covering skin areas where a topical medication has been applied. d. Apply a layer of medication that is just thick enough to ensure coverage.

ANS: D Topical medication should be applied in a thin film to clean skin and spread evenly in a downward motion in the direction of hair growth. Medications may be applied directly on to secondary dressings, and regions with medications may be covered. A tongue blade is not normally used for the application of a thin coat.

11. Which patient diagnosis or treatment is most consistent with prerenal acute kidney injury (AKI)? a. IV tobramycin b. Incompatible blood transfusion c. Poststreptococcal glomerulonephritis d. Dissecting abdominal aortic aneurysm

ANS:D A dissecting abdominal aortic aneurysm is a prerenal cause of AKI because it can decrease renal artery perfusion and therefore the glomerular filtrate rate. Aminoglycoside antibiotic administration, a hemolytic blood transfusion reaction, and post-streptococcal glomerulonephritis are intrarenal causes of AKI.

4. The primary protective role of the immune system related to malignant cells is a. surveillance for cells with tumor-associated antigens. b. binding with free antigen released by malignant cells. c. production of blocking factors that immobilize cancer cells. d. reacting to a new set of antigenic determinants on cancer cells. 4.

Correct answer: a Rationale: Cancer cells may display altered cell surface antigens as a result of malignant transformation. These antigens are called tumor-associated antigens (TAAs). One of the functions of the immune system is to respond to TAAs.

9. The first nursing intervention for the patient who has been sexually assaulted is to a. treat urgent medical problems. b. contact support person for the patient. c. provide supplies for the patient to cleanse self. d. document bruises and lacerations of the perineum and the cervix. 9.

Correct answer: a Rationale: In the care of a victim of sexual assault, shock and other urgent medical problems (e.g., head injury, hemorrhage, wounds, fractures) are treated first.

1. Trends in the incidence and death rates of cancer include the fact that a. lung cancer is the most common type of cancer in men. b. a higher percentage of women than men have lung cancer. c. breast cancer is the leading cause of cancer deaths in women. d. African Americans have a higher death rate from cancer than whites. 1.

Correct answer: d Rationale: Cancer incidence and death rates are disproportionately higher among African Americans than among other minority groups and white people.

5. The nurse is caring for a 59-year-old woman who had surgery 1 day ago for removal of a malignant abdominal mass. The patient is awaiting the pathology report. She is tearful and says that she is scared to die. The most effective nursing intervention at this point is to use this opportunity to a. motivate change in an unhealthy lifestyle. b. teach her about the seven warning signs of cancer. c. instruct her about healthy stress relief and coping practices. d. let her communicate about the meaning of this experience. 5.

Correct answer: d Rationale: While the patient is waiting for diagnostic study results, you should be available to actively listen to the patient's concerns, and you should be skilled in techniques that can engage the patient and the family members or significant others in a discussion about their cancer-related fears.

8. Postoperative nursing care for the woman with a gynecologic fistula includes (select all that apply) a. bed rest. b. bladder training. c. warm sitz baths. d. perineal hygiene. e. use of stool softeners. 8.

Correct answers: c, d Rationale: Postoperatively, perineal hygiene is important to prevent infection. Warm sitz baths should be taken three times daily if possible.

11. A patient has had a cystectomy and ileal conduit diversion performed. Four days postoperatively, mucous shreds are seen in the drainage bag. The nurse should a. notify the physician. b. notify the charge nurse. c. irrigate the drainage tube. d. document it as a normal observation. 11.

correct answer: d Rationale: Patients with an ileal conduit have mucus in the urine. The mucus is secreted by intestinal mucosa, which is used to create the ileal conduit, in response to the irritating effect of urine.

Evolve Online Questions 1. In a patient admitted with cellulitis of the left foot, which clinical manifestation would the nurse expect to find on assessment of the left foot? a. Redness and swelling b. Pallor and poor turgor c. Cyanosis and coolness d. Edema and brown skin discoloration

ANS: A Cellulitis is a diffuse, acute inflammation of the skin. It is characterized by redness, swelling, heat, and tenderness in the affected area. These changes accompany the processes of inflammation and infection.

23. The postoperative patient has dry skin and complains of pruritus on both legs. What nursing actions can help stop the itch-scratch cycle (select all that apply.)? a. Moisturize the skin on the legs. b. Provide a warm blanket and room. c. Administer antihistamines at bedtime. d. Vigorously rub the patient's legs after bathing. e. Cleanse the legs with a saline solution twice daily.

ANS: A,C Moisturizing the skin to decrease the dryness and the itch sensation and bedtime antihistamines to decrease a potential allergic reaction and provide some sedation will help the patient sleep since pruritus is often worse at night and the patient needs sleep for healing. Using nonallergic sheets may also help. Anything causing vasodilation, such as warmth or rubbing, should be avoided. Saline solution would only further dry the skin, so it should not be used on the patient's legs.

11. A patient with a history of tonsillitis reports difficulty breathing. Which patient assessment data warrants emergency interventions by the nurse? a. Bilateral erythema of especially large tonsils b. Temperature 102.2°F, diaphoresis, and chills c. Contraction of neck muscles during inspiration d. β-hemolytic streptococcus in the throat culture

ANS: C Contraction of neck muscles during inspiration indicates that the patient is using accessory muscles for breathing and is in serious respiratory distress. The reddened and enlarged tonsils indicate pharyngitis. The increased temperature, diaphoresis, and chills indicate an infection, which could be β-hemolytic streptococcus or fungal infection, but not an emergency situation for the patient.

20. The nurse is teaching about skin cancer prevention at the community center. Which person is most at risk for developing skin cancer? a. A 67-yr-old bald-headed man with psoriasis and type 2 diabetes mellitus b. A 76-yr-old Hispanic man who has a latex allergy and numerous acrochordons c. A 55-yr-old woman with fair skin and red hair who has a family history of skin cancer d. A 62-yr-old woman with chronic kidney disease who has blond hair with dry, pale skin

ANS: C Risk factors for skin cancer include having fair skin (with red hair) and a family history of skin cancer. Allergies, acrochordons (skin tags), psoriasis, type 2 diabetes mellitus, and chronic kidney disease are not risk factors associated with the development of skin cancer.

23. The patient has osteosarcoma of the right leg. The unlicensed assistive personnel (UAP) reports that the patient's vital signs are normal, but the patient says he still has pain in his leg and it is getting worse. Which question would best determine treatment measures for the patient's pain? a. "Where is the pain?" b. "Is the pain getting worse?" c. "What does the pain feel like?" d. "Do you use medications to relieve the pain?"

ANS: C The UAP told the nurse the location of the patient's pain and the patient reports worsening of pain (pattern). Asking about the quality of the pain will help in planning further treatment. The nurse should already know if the patient is using medication to relieve the pain or can check the patient's medication administration record to see if analgesics have been administered. The intensity of pain using a pain scale should also be assessed.

6. The nurse is caring for a patient with a tracheostomy. What is the priority nursing assessment for this patient? a. Electrolyte levels and daily weights b. Assessment of speech and swallowing c. Respiratory rate and oxygen saturation d. Pain assessment and assessment of mobility

ANS: C The priority assessment in the care of a patient with a tracheostomy focuses on airway and breathing. These assessments supersede the nurse's assessments that may also be necessary, such as nutritional status, speech, pain, and swallowing ability.

19. The patient with suspected pancreatic cancer is having many diagnostic studies done. Which one can be used to establish the diagnosis of pancreatic adenocarcinoma and for monitoring the response to treatment? a. Spiral CT scan b. A PET/CT scan c. Abdominal ultrasound d. Cancer-associated antigen 19-9

ANS: D Rationale: The cancer-associated antigen 19-9 (CA 19-9) is the tumor marker used for the diagnosis of pancreatic adenocarcinoma and monitoring the response to treatment. Although a spiral CT scan may be the initial study done and provides information on metastasis and vascular involvement, this test and the positron emission tomography (PET)/CT scan or abdominal ultrasonography does not provide additional information.

4. The nurse is scheduled to administer seasonal influenza vaccinations to the residents of a long-term care facility. What would be a contraindication to the administration of the vaccine to a resident? a. Hypersensitivity to eggs b. Age older than 80 years c. History of upper respiratory infections d. Chronic obstructive pulmonary disease (COPD)

ANS: A Although current vaccines are highly purified and reactions are extremely uncommon, a hypersensitivity to eggs precludes vaccination because the vaccine is produced in eggs. Advanced age and a history of respiratory illness are not contraindications for influenza vaccination.

3. The nurse assesses a 76-yr-old man with chronic myeloid leukemia receiving chemotherapy using a kinase inhibitor medication. Which question is most important for the nurse to ask? a. "Have you had a fever?" b. "Have you lost any weight?" c. "Has diarrhea been a problem?" d. "Have you noticed any hair loss?"

ANS: A An adverse effect of kinase inhibitors is neutropenia. Infection is common in neutropenic patients and is the primary cause of death in cancer patients. Patients should report a temperature of 100.4° F or higher. The other options are possible while undergoing chemotherapy but do not represent the highest priority for assessment.

Evolve Online Questions 1. The nurse is teaching a wellness class to a group of women at their workplace. Which findings represent the highest risk for developing cancer? a. Body mass index of 35 kg/m2 and smoking cigarettes for 20 years b. Family history of colorectal cancer and consumes a high-fiber diet c. Limits fat consumption and has regular mammography and Pap screenings d. Exercises five times every week and does not consume alcoholic beverages

ANS: A Cancer prevention and early detection are associated with the following behaviors: limited alcohol use, regular physical activity, maintaining a normal body weight, obtaining regular cancer screenings, avoiding cigarette smoking and other tobacco use, using sunscreen with SPF 15 or higher, and practicing healthy dietary habits (e.g., reduced fat and increased fruits and vegetables).

Evolve Online Questions 1. The nurse observes clear nasal drainage in a patient newly admitted with facial trauma with a nasal fracture. What is the nurse's priority action? a. Test the drainage for the presence of glucose. b. Suction the nose to maintain airway clearance. c. Document the findings and continue monitoring. d. Apply a drip pad and reassure the patient this is normal.

ANS: A Clear nasal drainage suggests leakage of cerebrospinal fluid (CSF). The drainage should be tested for the presence of glucose, which would indicate the presence of CSF. Suctioning should not be done. Documenting the findings and monitoring are important after notifying the health care provider. A drip pad may be applied, but the patient should not be reassured that this is normal.

18. An older adult patient living alone is admitted to the hospital with a diagnosis of pneumococcal pneumonia. Which clinical manifestation, observed by the nurse, indicates that the patient is likely to be hypoxic? a. Sudden onset of confusion b. Oral temperature of 102.3 o F c. Coarse crackles in lung bases d. Clutching chest on inspiration

ANS: A Confusion or stupor (related to hypoxia) may be the only clinical manifestation of pneumonia in an older adult patient. An elevated temperature, coarse crackles, and pleuritic chest pain with guarding may occur with pneumonia, but these symptoms do not indicate hypoxia.

16. The laboratory reports that the cells from the patient's tumor biopsy are grade II. What should the nurse know about this histologic grading? a. Cells are abnormal and moderately differentiated. b. Cells are very abnormal and poorly differentiated. c. Cells are immature, primitive, and undifferentiated. d. Cells differ slightly from normal cells and are well-differentiated.

ANS: A Grade II cells are more abnormal than grade I and moderately differentiated. Grade I cells differ slightly from normal cells and are well-differentiated. Grade III cells are very abnormal and poorly differentiated. Grade IV cells are immature, primitive, and undifferentiated; the cell origin is difficult to determine.

19. A patient admitted with heart failure is also diagnosed with herpes zoster and draining vesicles. Which action, if observed by the nurse, would require additional teaching for that individual? a. The dietitian wears a mask when entering the patient's room. b. The patient keeps the draining vesicles covered with a dressing. c. The student nurse who takes prednisone requests a different patient assignment. d. The nursing assistant washes hands frequently and wears gloves when in the room.

ANS: A Herpes zoster, commonly known as shingles, is spread by contact with fluid draining from the vesicles (not by coughing, sneezing, or casual contact). Shingles is not contagious before the vesicles appear or after the vesicles have crusted over. The risk of a person with shingles spreading the virus is low if the rash is covered. Wearing a mask would not prevent the spread of infection. Until the rash develops crusts, the patient should not have contact with an immunocompromised person (e.g., a person taking prednisone). Frequent hand washing helps to prevent the spread of varicella zoster virus.

8. The nurse should recognize that which patient is likely to have the poorest prognosis? a. A patient who is being treated for stage IV malignant melanoma b. A patient diagnosed with nodular ulcerative basal cell carcinoma c. A patient who has been diagnosed with late squamous cell carcinoma d. A patient whose biopsy has revealed superficial squamous cell carcinoma

ANS: A Late detection of malignant melanoma is associated with a poor outcome. Basal cell carcinomas often have very effective treatment success rates. Although late squamous cell carcinoma (SCC) has worse outcomes than superficial SCC, these are both exceeded in mortality rates by late-stage malignant melanoma.

16. A patient has been diagnosed with tinea unguium (onychomycosis) under the nails but does not like the oral antifungal medication. What is the best alternate treatment the nurse should describe for her? a. Nail avulsion b. Antifungal cream c. Thinning of fingernails d. Soaking nails in salt water

ANS: A Nail avulsion is the best alternate treatment to the oral antifungal medication. Antifungal cream is minimally effective. Thinning fingernails is not needed if the tinea unguium is under her toenails. Soaking the nails will not be helpful.

2. The nurse would assess a patient admitted with cellulitis for what localized manifestation? a. Pain b. Fever c. Chills d. Malaise

ANS: A Pain, redness, heat, and swelling are all localized manifestation of cellulitis. Fever, chills, and malaise are generalized, systemic manifestations of inflammation and infection.

10. Previous administrations of chemotherapy agents to a cancer patient have resulted in diarrhea. Which dietary modification should the nurse recommend? a. A bland, low-fiber diet b. A high-protein, high-calorie diet c. A diet high in fresh fruits and vegetables d. A diet emphasizing whole and organic foods

ANS: A Patients experiencing diarrhea secondary to chemotherapy or radiation therapy often benefit from a diet low in seasonings and roughage before the treatment. Foods should be easy to digest and low in fat. Fresh fruits and vegetables are high in fiber and should be minimized during treatment. Whole and organic foods do not prevent diarrhea.

11. Eight months after the delivery of her first child, a 31-yr-old woman sought care for occasional incontinence when sneezing or laughing. Which measure should the nurse recommend first? a. Kegel exercises b. Use of adult incontinence pads c. Intermittent self-catheterization d. Dietary changes including fluid restriction

ANS: A Patients who experience stress incontinence frequently benefit from Kegel exercises (pelvic floor muscle exercises). The use of incontinence pads does not resolve the problem, and intermittent self-catheterization would be a premature recommendation. Dietary changes are not likely to influence the patient's urinary continence.

12. A patient with a persistent cough is diagnosed with pertussis. What treatment does the nurse anticipate administering to this patient? a. Antibiotic b. Corticosteroid c. Bronchodilator d. Cough suppressant

ANS: A Pertussis, unlike acute bronchitis, is caused by a gram-negative bacillus, Bordetella pertussis, which must be treated with antibiotics. Corticosteroids and bronchodilators are not helpful in reducing symptoms. Cough suppressants and antihistamines are ineffective and may induce coughing episodes with pertussis.

Evolve Resources Online Questions 1. The nurse is caring for a woman recently diagnosed with viral hepatitis A. Which individual should the nurse refer for an immunoglobulin (IG) injection? a. A caregiver who lives in the same household with the patient b. A friend who delivers meals to the patient and family each week c. A relative with a history of hepatitis A who visits the patient daily d. A child living in the home who received the hepatitis A vaccine 3 months ago Incorrect

ANS: A Rationale: IG is recommended for persons who do not have anti-HAV antibodies and are exposed as a result of close contact with persons who have HAV or foodborne exposure. Persons who have received a dose of HAV vaccine more than 1 month previously or who have a history of HAV infection do not require IG.

16. The patient with cirrhosis is being taught self-care. Which statement indicates the patient needs more teaching? a. "If I notice a fast heart rate or irregular beats, this is normal for cirrhosis." b. "I need to take good care of my belly and ankle skin where it is swollen." c. "A scrotal support may be more comfortable when I have scrotal edema." d. "I can use pillows to support my head to help me breathe when I am in bed."

ANS: A Rationale: If the patient with cirrhosis experiences a fast or irregular heart rate, it may be indicative of hypokalemia and should be reported to the health care provider because this is not normal for cirrhosis. Edematous tissue is subject to breakdown and needs meticulous skin care. Pillows and a semi-Fowler's or Fowler's position increase respiratory efficiency. A scrotal support may improve comfort if there is scrotal edema.

10. A patient with type 2 diabetes and cirrhosis asks the nurse if it would be acceptable to take silymarin (milk thistle) to help minimize liver damage. The nurse responds based on what knowledge? a. Milk thistle may affect liver enzymes and thus alter drug metabolism. b. Milk thistle is generally safe in recommended doses for up to 10 years. c. There is unclear scientific evidence for the use of milk thistle in treating cirrhosis. d. Milk thistle may elevate the serum glucose levels and is thus contraindicated in diabetes.

ANS: A Rationale: Scientific evidence indicates there is no real benefit from milk thistle to protect liver cells from toxic damage in the treatment of cirrhosis. Milk thistle does affect liver enzymes and thus could alter drug metabolism. Therefore, patients will need to be monitored for drug interactions. It is noted to be safe for up to 6 years, not 10 years, and it may lower, not elevate, blood glucose levels.

6. Which patient has the highest risk of developing malignant melanoma? a. A fair-skinned woman who uses a tanning booth regularly b. An African American patient with a family history of cancer c. An adult who required phototherapy as an infant for the treatment of hyperbilirubinemia d. A Hispanic man with a history of psoriasis and eczema that responded poorly to treatment

ANS: A Risk factors for malignant melanoma include a fair complexion and exposure to ultraviolet light. Psoriasis, eczema, short-duration phototherapy, and a family history of other cancers are less likely to be linked to malignant melanoma.

7. The nurse is teaching a patient regarding her medications. With which mediation should the nurse be sure to inform the patient to avoid prolonged sun exposure? a. Tetracycline b. Ipratropium c. Morphine sulfate d. Oral contraceptives

ANS: A Several antibiotics, including tetracycline, may cause photosensitivity. This is not the case with ipratropium, morphine, or oral contraceptives.

14. The patient with a stage IV pressure ulcer on the coccyx will need a skin graft to close the wound. Which postoperative care should the nurse expect to use to facilitate healing? a. No straining of the grafted site b. The wound will be exposed to air. c. Soft tissue expansion will be done daily. d. The pressure dressing will not be removed.

ANS: A Straining or stretching of the grafted site must be avoided to allow the graft to be vascularized and fixed to the new site for healing. The wound may or may not be exposed to air depending on the type of graft, and the donor site will be covered with a protective dressing to prevent further damage. Soft tissue expansion and pressure dressings will not be used after this wound's skin graft.

3. Which nursing intervention would be most helpful in managing a patient newly admitted with cellulitis of the right foot? a. Applying warm, moist heat b. Wrapping the foot snugly in blankets c. Keeping the foot at or below heart level d. Limiting ambulation to three times daily

ANS: A The application of warm, moist heat speeds the resolution of inflammation and infection when accompanied by appropriate antibiotic therapy. It does this by increasing local circulation to the affected area to bring macrophages to the area and carry off cellular debris. Immobilization and elevation is also used. Snug blankets would not be helpful and could decrease circulation to this sensitive tissue.

8. A 71-yr-old patient with a diagnosis of benign prostatic hyperplasia (BPH) has been scheduled for a contact laser technique. What is the primary goal of this intervention? a. Resumption of normal urinary drainage b. Maintenance of normal sexual functioning c. Prevention of acute or chronic renal failure d. Prevention of fluid and electrolyte imbalances

ANS: A The most significant signs and symptoms of BPH relate to the disruption of normal urinary drainage and consequent urine retention, incontinence, and pain. A laser technique vaporizes prostate tissue and cauterizes blood vessels and is used as an effective alternative to a TURP to resolve these problems. Fluid imbalances, impaired sexual functioning, and kidney disease may result from uncontrolled BPH, but the central focus remains urinary drainage.

21. A patient with a gunshot wound to the right side of the chest arrives in the emergency department exhibiting severe shortness of breath with decreased breath sounds on the right side of the chest. Which action should the nurse take immediately? a. Cover the chest wound with a nonporous dressing taped on three sides. b. Pack the chest wound with sterile saline soaked gauze and tape securely. c. Stabilize the chest wall with tape and initiate positive pressure ventilation. d. Apply a pressure dressing over the wound to prevent excessive loss of blood.

ANS: A The patient has a sucking chest wound (open pneumothorax). Air enters the pleural space through the chest wall during inspiration. Emergency treatment consists of covering the wound with an occlusive dressing that is secured on three sides. During inspiration, the dressing pulls against the wound, preventing air from entering the pleural space. During expiration, the dressing is pushed out and air escapes through the wound and from under the dressing.

4. During discharge teaching for an older adult patient with chronic obstructive pulmonary disease (COPD) and pneumonia, which vaccine should the nurse recommend that this patient receive? a. Pneumococcal b. Staphylococcus aureus c. Haemophilus influenzae d. Bacille-Calmette-Guérin (BCG)

ANS: A The pneumococcal vaccine is important for patients with a history of heart or lung disease, recovering from a severe illness, age 65 years or older, or living in a long-term care facility. A Staphylococcus aureus vaccine has been researched but not yet been effective. The Haemophilus influenzae vaccine would not be recommended as adults do not need it unless they are immunocompromised. The BCG vaccine is for infants in parts of the world where tuberculosis is prevalent.

18. What is the nurse's priority when changing the appliance for a patient with an ileal conduit? a. Keep the skin free of urine. b. Inspect the peristomal area. c. Cleanse and dry the area gently. d. Affix the appliance to the faceplate.

ANS: A The priority is to keep skin free of urine because peristomal skin is at high risk for damage from urine if it is alkaline. Peristomal area will be assessed; gently cleaned & dried, and appliance affixed to faceplate if one is being used, but these are not as much of a priority as keeping the skin free of urine to prevent skin damage.

12. A patient with type 2 diabetes is reporting a second urinary tract infections(UTI)within the past month. Which medication should the nurse expect to be ordered for the recurrent infection? a. Ciprofloxacin b. Fosfomycin c. Nitrofurantoin Incorrect d. Trimethoprim-sulfamethoxazole

ANS: A This UTI is a complicated UTI because the patient has type 2 diabetes, and the UTI is recurrent. Ciprofloxacin would be used for a complicated UTI. Fosfomycin, nitrofurantoin , and trimethoprim-sulfamethoxazole should be used for uncomplicated UTIs.

10. Which nursing diagnosis is priority when caring for a patient with renal calculi? a. Acute pain b. Risk for constipation c. Deficient fluid volume d. Risk for powerlessness

ANS: A Urinary stones are associated with severe abdominal or flank pain. Whereas deficient fluid volume is unlikely to result from urinary stones, constipation is more likely to be an indirect consequence rather than a primary clinical manifestation of the problem. The presence of pain supersedes powerlessness as an immediate focus of nursing care.

3. When initially teaching a patient the supraglottic swallow after a radical neck dissection, with which food or fluid should the nurse begin? a. Cola b. Applesauce c. French fries d. White grape juice

ANS: A When learning the supraglottic swallow, it may be helpful to start with carbonated beverages because the effervescence provides clues about the liquid's position. Thin, watery fluids should be avoided because they are difficult to swallow and increase the risk of aspiration. Nonpourable pureed foods, such as applesauce, decrease the risk of aspiration.

10. A 33-yr-old patient noticed a painless lump and heaviness in his scrotum during testicular self-examination. The nurse should provide the patient information on which diagnostic test? a. Ultrasound b. Cremasteric reflex c. Doppler ultrasound d. Transillumination with a flashlight

ANS: A When the scrotum has a painless lump, scrotal swelling, and a feeling of heaviness, testicular cancer is suspected, and an ultrasound of the testes is indicated. Blood tests will also be done. The cremasteric reflex and Doppler ultrasound are done to diagnose testicular torsion. Transillumination with a flashlight is done to diagnose a hydrocele.

19. A school nurse is providing information to high school students about influenza prevention. What should the nurse emphasize in teaching to prevent the transmission of the virus (select all that apply.)? a. Cover the nose when coughing. b. Obtain an influenza vaccination. c. Stay at home when symptomatic. d. Drink noncaffeinated fluids daily. e. Obtain antibiotic therapy promptly.

ANS: A, B, C Covering the nose and mouth when coughing is an effective way to prevent the spread of the virus. Obtaining an influenza vaccination helps prevent the flu. Staying at home helps prevent direct exposure of others to the virus. Drinking fluids helps liquefy secretions but does not prevent influenza. Antibiotic therapy is not used unless the patient develops a secondary bacterial infection.

24. The nurse is caring for a patient with a nursing diagnosis of hyperthermia related to pneumonia. What assessment data does the nurse obtain that correlates with this nursing diagnosis (select all that apply.)? a. A temperature of 101.4°F b. Heart rate of 120 beats/min c. Respiratory rate of 20 breaths/min d. A productive cough with yellow sputum e. Reports of unable to have a bowel movement for 2 days

ANS: A, B, D A fever is an inflammatory response related to the infectious process. A productive cough with discolored sputum (which should be clear) is an indication that the patient has pneumonia. A respiratory rate of 20 breaths/min is within normal range. Inability to have a bowel movement is not related to a diagnosis of pneumonia. A heart rate of 120 beats/min indicates that there is increased metabolism due to the fever and is related to the diagnosis of pneumonia.

23. The nurse is caring for a patient with an alteration in airway clearance. What nursing actions would be a priority to promote airway clearance (select all that apply.)? a. Maintain adequate fluid intake. b. Maintain a 30-degree elevation. c. Splint the chest when coughing. d. Maintain a semi-Fowler's position. e. Instruct patient to cough at end of exhalation.

ANS: A, C, E Maintaining adequate fluid intake liquefies secretions, allowing easier expectoration. The nurse should instruct the patient to splint the chest while coughing. This will reduce discomfort and allow for a more effective cough. Coughing at the end of exhalation promotes a more effective cough. The patient should be positioned in an upright sitting position (high Fowler's) with head slightly flexed.

26. The nurse is admitting a patient with a diagnosis of pulmonary embolism. What risk factors is a priority for the nurse to assess (select all that apply.)? a. Obesity b. Pneumonia c. Malignancy d. Cigarette smoking e. Prolonged air travel

ANS: A, C,D,E An increased risk of pulmonary embolism is associated with obesity, malignancy, heavy cigarette smoking, and prolonged air travel with reduced mobility. Other risk factors include deep vein thrombosis, immobilization, and surgery within the previous 3 months, oral contraceptives and hormone therapy, heart failure, pregnancy, and clotting disorders.

19. The urinalysis of a patient reveals a high microorganism count. What data should the nurse use to determine which part of the urinary tract is infected (select all that apply.)? a. Pain location b. Fever and chills c. Mental confusion d. Urinary hesitancy e. Urethral discharge f. Postvoid dribbling

ANS: A, E Although all the manifestations are evident with urinary tract infections (UTIs), pain location is useful in differentiating among pyelonephritis, cystitis, and urethritis because flank pain is characteristic of pyelonephritis, but dysuria is characteristic of cystitis and urethritis. Urethral discharge is indicative of urethritis, not pyelonephritis or cystitis. Fever and chills and mental confusion are nonspecific indicators of UTIs. Urinary hesitancy and postvoid dribbling may occur with a UTI but may also occur with prostate enlargement in the male patient.

25. During admission of a patient diagnosed with non-small cell lung carcinoma, the nurse questions the patient related to a history of which risk factors for this type of cancer (select all that apply.)? a. Asbestos exposure b. Exposure to uranium c. Chronic interstitial fibrosis d. History of cigarette smoking e. Geographic area in which he was born

ANS: A,B, D Non-small cell carcinoma is associated with cigarette smoking and exposure to environmental carcinogens, including asbestos and uranium. Chronic interstitial fibrosis is associated with the development of adenocarcinoma of the lung. Exposure to cancer-causing substances in the geographic area where the patient has lived for some time may be a risk but not necessarily where the patient was born.

25. The patient and his family are upset that the patient is going through procedures to diagnose cancer. What nursing actions should the nurse use first to facilitate their coping with this situation (select all that apply.)? a. Maintain hope. b. Exhibit a caring attitude. c. Plan realistic long-term goals. d. Give them antianxiety medications. e. Be available to listen to fears and concerns. f. Teach them about the types of cancer that could be diagnosed. Incorrect

ANS: A,B, E Maintaining hope, exhibiting a caring attitude, and being available to actively listen to fears and concerns would be the first nursing interventions to use as well as assessing factors affecting coping during the diagnostic period. Providing relief from distressing symptoms for the patient and teaching them about the diagnostic procedures would also be important. Realistic long-term goals and teaching about the type of cancer cannot be done until the cancer is diagnosed. Giving the family antianxiety medications would not be appropriate.

22. When caring for a patient with a biliary obstruction, the nurse will anticipate administering which vitamin supplements (select all that apply.)? a. Vitamin A b. Vitamin D c. Vitamin E d. Vitamin K e. Vitamin B

ANS: A,B,C,D Rationale: Biliary obstruction prevents bile from entering the small intestine and thus prevents the absorption of fat-soluble vitamins. Vitamins A, D, E, and K are all fat soluble and thus would need to be supplemented in a patient with biliary obstruction.

26. Patients may reduce the risk of developing cancer using health promotion strategies. Identify strategies which can reduce the risk of developing cancer (select all that apply.). a. Control weight b. Genetic testing c. Immunizations d. Use sunscreen e. Stop smoking f. Limit alcohol intake

ANS: AB,C,D,E,F Changing a person's lifestyle can limit cancer promotors, which is key in cancer prevention. Immunizations such as human papilloma virus (HPV) can prevent cervical cancer. Use of sunscreen (SPF 15 or greater) can prevent cell damage and development of skin cancer. Cigarette smoke can initiate or promote cancer development. Alcohol intake combined with cigarette smoking can promote esophageal and bladder cancers. Management of weight can reduce the risk of cancer. Genetic testing (i.e., APC gene) identifies the predisposition of colorectal cancer.

11. A male patient complains of fever, dysuria, and cloudy urine. What additional information may indicate that these manifestations may be something other than a urinary tract infection (UTI)? a. E. coli bacteria in his urine b. A very tender prostate gland c. Complaints of chills and rectal pain d. Complaints of urgency and frequency

ANS: B A tender and swollen prostate is indicative of prostatitis, which is a more serious male reproductive problem because an acute episode can result in chronic prostatitis and lead to epididymitis or cystitis. E. coli in his urine, chills and rectal pain, and urgency and frequency are all present with a UTI and not specifically indicative of prostatitis.

22. The nurse educates a patient with chronic kidney disease about several interventions to reduce pruritus associated with dry skin and uremia. Which statement, if made by the patient to the nurse, indicates further teaching is required? a. "I will avoid taking hot showers." b. "I can rub my skin instead of scratching." c. "Menthol can be used to numb the itch sensation." d. "A lubricating lotion right after bathing will help."

ANS: B Any activity that causes vasodilation, such as rubbing or bathing and showering in hot water, should be avoided because vasodilation leads to increased itching. Menthol in skin products provides a sensation that may distract the patient from the sensation of itchiness. Applying lotion right after bathing helps retain moisture in the skin.

7. A patient whose tracheostomy was inserted 30 minutes ago is recovering in the postanesthesia recovery unit when the tracheostomy tube is expelled by coughing. What is the priority action by the nurse? a. Suction the tracheostomy opening. b. Maintain the airway with a sterile hemostat. c. Use an Ambu bag and mask to ventilate the patient. d. Insert the tracheostomy tube obturator into the stoma.

ANS: B As long as the patient is not in acute respiratory distress after dislodging the tracheostomy tube, the nurse should use a sterile hemostat to maintain an open airway until a sterile tracheostomy tube can be reinserted into the tracheal opening. The tracheostomy is an open surgical wound that has not had time to mature into a stoma. If the patient is in respiratory distress, the nurse will use an Ambu bag and mask to ventilate the patient temporarily.

20. The patient is receiving an IV vesicant chemotherapy drug. The nurse notices swelling and redness at the site. What should the nurse do first? a. Ask the patient if the site hurts. b. Turn off the chemotherapy infusion. c. Call the ordering health care provider. d. Administer sterile saline to the reddened area.

ANS: B Because extravasation of vesicants may cause severe local tissue breakdown and necrosis, with any sign of extravasation, the infusion should first be stopped. Then the protocol for the drug-specific extravasation procedures should be followed to minimize further tissue damage. The site of extravasation usually hurts, but it may not. It is more important to stop the infusion immediately. The health care provider may be notified by another nurse while the patient's nurse starts the drug-specific extravasation procedures, which may or may not include sterile saline.

12. After a vasectomy, what instruction should be included in discharge teaching? a. "Some secondary sexual characteristics may be lost after the surgery." b. "Use an alternative form of contraception until your semen is sperm free." c. "Erectile dysfunction may be present for several months after this surgery." d. "You will be uncomfortable, but you may safely have sexual intercourse today."

ANS: B Because vasectomies are usually done for sterilization purposes, to safely have sexual intercourse, the patient will need to use an alternative form of contraception until semen examination reveals no sperm. Hormones are not affected, so there is no loss of secondary sexual characteristics or erectile function. Most men experience too much pain to have sexual intercourse on the day of their surgery, so this is not an appropriate comment by the nurse.

16. A patient has a tracheostomy tube after reconstructive surgery for invasive head and neck cancer. What is most important for the nurse to assess before performing tracheostomy cannula care? a. Level of consciousness b. Quality of breath sounds c. Presence of the gag reflex d. Tracheostomy cuff pressure

ANS: B Before performing tracheostomy care, the nurse will auscultate lung sounds to determine the presence of secretions. To prevent aspiration, secretions must be cleared either by coughing or by suctioning before performing tracheostomy cannula care.

5. A 73-yr-old male patient admitted for total knee replacement states during the health history interview that he has no problems with urinary elimination except that the "stream is less than it used to be." The nurse should give anticipatory guidance regarding what condition? a. A tumor of the prostate b. Benign prostatic hyperplasia c. Bladder atony because of age d. Age-related altered innervation of the bladder

ANS: B Benign prostatic hyperplasia is an enlarged prostate gland because of an increased number of epithelial cells and stromal tissue. It occurs in about 50% of men older than age 50 years and 80% of men older than age 80 years. Only about 16% of men develop prostate cancer. Bladder atony and age-related altered innervations of the bladder do not lead to a weakened stream.

22. The nurse instructs a patient with a pulmonary embolism about administering enoxaparin after discharge. Which statement by the patient indicates understanding about the instructions? a. "I need to take this medicine with meals." b. "The medicine will be prescribed for 10 days." c. "I will inject this medicine into my upper arm." d. "The medicine will dissolve the clot in my lung."

ANS: B Enoxaparin is a low-molecular-weight heparin that is administered for 10 to 14 days and prevents future clotting but does not dissolve existing clots. Fibrinolytic agents (e.g., tissue plasminogen activator or alteplase) dissolve an existing clot. Enoxaparin is administered subcutaneously by injection into the abdomen.

18. The nurse is caring for a patient admitted for uncontrolled seizures who is also diagnosed with impetigo on the face and neck. Which action is appropriate for the nurse to take? a. Put on a protective gown before entering the room. b. Wash hands for 1 to 2 minutes when leaving the room. c. Wear gloves to leave a diet menu on the patient's table. d. Wear a particulate mask when within 3 feet of the patient.

ANS: B Impetigo is a bacterial skin infection with group A β-hemolytic streptococci or staphylococci. Meticulous hygiene (including hand washing) is essential to prevent the spread of infection. A particulate mask or a gown would not be necessary to prevent the spread of impetigo. Gloves would not be needed to make a delivery to the room.

5. Which task can the registered nurse (RN) delegate to unlicensed assistive personnel (UAP) in the care of a stable patient who has a tracheostomy? a. Assessing the need for suctioning b. Suctioning the patient's oropharynx c. Assessing the patient's swallowing ability d. Maintaining appropriate cuff inflation pressure Incorrect

ANS: B Providing the individual has been trained in correct technique, the UAP may suction the patient's oropharynx. Whereas assessing the need for suctioning should be performed by an RN or licensed practical nurse, swallowing assessment and the maintenance of cuff inflation pressure should be performed solely by the RN.

3. The nurse is caring for a 55-yr-old man patient with acute pancreatitis resulting from gallstones. Which clinical manifestation would the nurse expect? a. Hematochezia b. Left upper abdominal pain c. Ascites and peripheral edema d. Temperature over 102o F (38.9o C)

ANS: B Rationale: Abdominal pain (usually in the left upper quadrant) is the predominant manifestation of acute pancreatitis. Other manifestations of acute pancreatitis include nausea and vomiting, low-grade fever, leukocytosis, hypotension, tachycardia, and jaundice. Abdominal tenderness with muscle guarding is common. Bowel sounds may be decreased or absent. Ileus may occur and causes marked abdominal distention. Areas of cyanosis or greenish to yellow-brown discoloration of the abdominal wall may occur. Other areas of ecchymoses are the flanks (Grey Turner's spots or sign, a bluish flank discoloration) and the periumbilical area (Cullen's sign, a bluish periumbilical discoloration).

20. When providing discharge teaching for a patient after a laparoscopic cholecystectomy, what information should the nurse include? a. Do not return to work or normal activities for 3 weeks. b. A lower-fat diet may be better tolerated for several weeks. c. Bile-colored drainage will probably drain from the incision. d. Keep the bandages on and the puncture site dry until it heals.

ANS: B Rationale: Although the usual diet can be resumed, a low-fat diet is usually better tolerated for several weeks after surgery. Normal activities can be gradually resumed as the patient tolerates. Bile-colored drainage or pus, redness, swelling, severe pain, and fever may all indicate infection. The bandage may be removed the day after surgery, and the patient can shower.

18. A patient with sudden pain in the left upper quadrant radiating to the back and vomiting was diagnosed with acute pancreatitis. Which intervention should the nurse include in the patient's plan of care? a. Immediately start enteral feeding to prevent malnutrition. b. Insert an NG and maintain NPO status to allow pancreas to rest. c. Initiate early prophylactic antibiotic therapy to prevent infection. d. Administer acetaminophen (Tylenol) every 4 hours for pain relief.

ANS: B Rationale: Initial treatment with acute pancreatitis will include an NG tube if there is vomiting and being NPO to decrease pancreatic enzyme stimulation and allow the pancreas to rest and heal. Fluid will be administered to treat or prevent shock. The pain will be treated with IV morphine because of the NPO status. Enteral feedings will only be used for the patient with severe acute pancreatitis in whom oral intake is not resumed. Antibiotic therapy is only needed with acute necrotizing pancreatitis and signs of infection.

13. The patient with right upper quadrant abdominal pain has an abdominal ultrasound that reveals cholelithiasis. What is the nurse's priority? a. Prevent all oral intake. b. Control abdominal pain. c. Provide enteral feedings. d. Avoid dietary cholesterol.

ANS: B Rationale: Patients with cholelithiasis can have severe pain, so controlling pain is important until the problem can be treated. NPO status may be needed if the patient will have surgery but will not be used for all patients with cholelithiasis. Patients with pancreatitis may be NPO. Enteral feedings should not be needed, and avoiding dietary cholesterol is not used to treat cholelithiasis.

4. The nurse is caring for a group of patients. Which patient has the highest risk for developing pancreatic cancer? a. A 38-yr-old Hispanic woman who is obese and has hyperinsulinemia b. A 72-yr-old African American man who has smoked cigarettes for 50 years c. A 23-yr-old man who has cystic fibrosis-related pancreatic enzyme insufficiency d. A 19-yr-old patient who has a 5-year history of uncontrolled type 1 diabetes mellitus

ANS: B Rationale: Risk factors for pancreatic cancer include chronic pancreatitis, diabetes mellitus, age, cigarette smoking, family history of pancreatic cancer, high-fat diet, and exposure to chemicals such as benzidine. African Americans have a higher incidence of pancreatic cancer than whites. The most firmly established environmental risk factor is cigarette smoking. Smokers are two or three times more likely to develop pancreatic cancer compared with nonsmokers. The risk is related to duration and number of cigarettes smoked.

6. A 54-yr-old patient admitted with diabetes mellitus, malnutrition, osteomyelitis, and alcohol abuse has a serum amylase level of 280 U/L and a serum lipase level of 310 U/L. Which diagnosis does the nurse expect? a. Starvation b. Pancreatitis c. Systemic sepsis d. Diabetic ketoacidosis

ANS: B Rationale: The patient with alcohol abuse could develop pancreatitis as a complication, which would increase the serum amylase (normal, 30-122 U/L) and serum lipase (normal, 31-186 U/L) levels as shown.

2. When caring for a patient who is 3 hours postoperative laryngectomy, what is the nurse's highest priority assessment? a. Patient comfort b. Airway patency c. Incisional drainage d. Blood pressure and heart rate

ANS: B Remember the ABCs with prioritization. Airway patency is always the highest priority and is essential for a patient undergoing surgery surrounding the upper respiratory system. Comfort, drainage, and vital signs follow the ABCs in priority.

16. A 22-yr-olds BP during pre-employment physical exam 110/68 mm Hg. During a health fair 2 months later, BP 154/96 mm Hg. What renal problem could contribute to this rise in blood pressure? a. Renal trauma b. Renal artery stenosis c. Renal vein thrombosis d. Benign nephrosclerosis

ANS: B Renal artery stenosis contributes to abrupt rise in BP, especially in people younger than 30 or older than 50 yo. Renal trauma usually has hematuria. Renal vein thrombosis causes flank pain, hematuria, fever, or nephrotic syndrome. Benign nephrosclerosis usually occurs in adults 30 to 50 years of age and is a result of vascular changes resulting from hypertension.

9. The nurse is developing a plan of care for a patient with metastatic lung cancer and a 60-pack-year history of cigarette smoking. For what should the nurse monitor this patient? a. Cough reflex b. Mucociliary clearance c. Reflex bronchoconstriction d. Ability to filter particles from the air

ANS: B Smoking decreases the ciliary action in the tracheobronchial tree, resulting in impaired clearance of respiratory secretions and particles, chronic cough, and frequent respiratory infections.

21. A patient reports to the clinic nurse a ring-like itchy rash on the upper leg, low-grade fever, nausea, and joint pain for the past 3 weeks. What question is important for the nurse to ask the patient? a. "Is the itching worse at night?" b. "Have you had a tick bite recently?" c. "Have you been exposed to pubic lice?" d. "Have you had unprotected sexual contact?"

ANS: B Symptoms are consistent with Lyme disease caused by the organism Borrelia burgdorferi, which is transmitted by a tick bite. The itching would not necessarily be worse at night. Exposure to pubic lice would cause itching in the genital area and not fever, nausea, and joint pain. Unprotected sexual contact would not cause an isolated itchy rash on the upper leg.

24. Which patient is statistically and medically at the highest risk of developing cancer? a. A 68-yr-old white woman who has BRCA-1 gene and is obese Incorrect b. A 56-yr-old African American man with hepatitis C who drinks alcohol daily c. An 18-yr-old Hispanic man who eats fast food once per week and drink alcohol d. An 80-yr-old Asian woman with coronary artery disease on blood pressure medication.

ANS: B The combination of statistically identified risk factors in addition to current liver disease (hepatitis C that is linked to the development of liver cancer) and the added promotor of alcohol makes this patient at the highest risk. Second is the white woman with the gene for breast cancer and the added promotor of obesity. The majority of cancer cases are diagnosed in individuals older than 55 years of age. The overall incidence of cancer is higher in men than women. Cancer incidence is higher in African Americans, then whites, and then people from other cultures.

15. The nurse in the occupational health clinic prepares to administer the influenza vaccine by nasal spray to an employee. Which question should the nurse ask before administration of this vaccine? a. "Are you allergic to chicken?" b. "Could you be pregnant now?" c. "Did you ever have influenza?" d. "Have you ever had hepatitis B?"

ANS: B The live attenuated influenza vaccine (LAIV) is given by nasal spray and approved for healthy people age 2 to 49 years. The LAIV is given only to nonpregnant, healthy people. The inactivated vaccine is given by injection and is approved for use in people 6 months or older. The inactivated vaccine can be used in pregnancy, in people with chronic conditions, or in people who are immunosuppressed. Influenza vaccination is contraindicated if the person has a history of Guillain-Barré syndrome or a hypersensitivity to eggs.

4. A patient is admitted with a diagnosis of cellulitis of the left leg and has been placed on antibiotics. Which laboratory result is the best indicator that the treatment is having a positive outcome for the patient? a. WBC of 2900/μL b. WBC of 8200/μL c. WBC of 12,700/μL d. WBC of 16,300/μL

ANS: B The normal white blood cell count is generally 4000 to 11,000/μL. For this reason, the patient's level would be returning to normal if it was 8200/μL, indicating recovery from cellulitis. The 2900/µL is too low and indicates another problem is occurring. The 12,700/µL and 16,300/µL are evidence of continuing infection.

6. After admitting a patient from home to the medical unit with a diagnosis of pneumonia, which physician orders will the nurse verify have been completed before administering a dose of cefuroxime to the patient? a. Orthostatic blood pressures b. Sputum culture and sensitivity c. Pulmonary function evaluation d. Serum laboratory studies ordered for AM

ANS: B The nurse should ensure that the sputum for culture and sensitivity was sent to the laboratory before administering the cefuroxime because this is community-acquired pneumonia. It is important that the organisms are correctly identified (by the culture) before the antibiotic takes effect. The test will also determine whether the proper antibiotic has been ordered (sensitivity testing). Although antibiotic administration should not be unduly delayed while waiting for the patient to expectorate sputum, orthostatic blood pressures, pulmonary function evaluation, and serum laboratory tests will not be affected by the administration of antibiotics.

13. Which statement by the nurse most facilitates patient cancer prevention during the promotion stage of cancer development? a. "Exercise every day for 30 minutes." b. "Follow smoking cessation recommendations." c. "Following a vitamin regime is highly recommended." d. "I recommend excision of the cancer as soon as possible."

ANS: B The promotion stage of cancer is characterized by the reversible proliferation of the altered cells. Changing the lifestyle to avoid promoting factors (dietary fat, obesity, cigarette smoking, and alcohol consumption) can reduce the chance of cancer development. Cigarette smoking is a promoting factor and a carcinogen. Daily exercise and vitamins alone will not prevent cancer. Surgery at this stage may not be possible without a critical mass of cells, and this advice would not be consistent with the nurse's role.

17. The nurse is caring for a patient with a nephrostomy tube. The tube has stopped draining. After receiving orders, what should the nurse do? a. Keep the patient on bed rest. b. Use 5 mL of sterile saline to irrigate. c. Use 30 mL of water to gently irrigate. d. Have the patient turn from side to side.

ANS: B With a nephrostomy tube, if tube is occluded & irrigation is ordered, nurse should use 5 mL or less sterile saline to gently irrigate it. Patient w/ ureteral catheter may be kept on bed rest after insertion, but this is unrelated to obstruction. Only sterile solutions are used to irrigate any type of urinary catheter. With a suprapubic catheter, the patient should be instructed to turn from side to side to ensure patency.

18. A patient is being discharged from the emergency department after being treated for epistaxis. In teaching first aid measures in the event the epistaxis would recur, what measures should the nurse suggest (select all that apply.)? a. Tilt patient's head backwards. b. Apply ice compresses to the nose. c. Tilt head forward while lying down. d. Pinch the entire soft lower portion of the nose. e. Partially insert a small gauze pad into the bleeding nostril.

ANS: B, D, E First aid measures to control epistaxis include placing the patient in a sitting position, leaning forward. Pinching the soft lower portion of the nose or inserting a small gauze pad into the bleeding nostril should stop the bleeding within 15 minutes. Tilting the head back or forward does not stop the bleeding but rather allows the blood to enter the nasopharynx, which could result in aspiration or nausea or vomiting from swallowing blood. Lying down also will not decrease the bleeding.

18. The patient at the clinic complains of abdominal bloating, depression, and irritability related to premenstrual syndrome. What should the nurse recommend initially (select all that apply.)? a. Take diuretics. b. Exercise regularly. c. Take antidepressants. d. Take antianxiety agents. e. Increase pork, chicken, and milk intake. f. Consider psychological counseling to resolve symptoms.

ANS: B, E The nurse can recommend regular exercise to help manage stress, elevate the mood, and have a relaxing effect. Eating foods rich in vitamin B6 (pork, milk, and legumes) and tryptophan (dairy and poultry) will promote serotonin production and improve symptoms. Diuretics, antidepressants, and antianxiety agents are not prescribed unless symptoms persist or interfere with daily functioning. Psychological counseling does not address physiological symptoms, but it may improve coping mechanisms.

21. The nurse is aware of potential complications related to cirrhosis. Which interventions would be included in a safe plan of care (select all that apply.)? a. Provide a high-protein, low-carbohydrate diet. b. Teach the patient to use soft-bristle toothbrush and electric razor. c. Teach the patient to avoid vigorous blowing of nose and coughing. d. Apply gentle pressure for the shortest possible time after venipuncture. e. Use the smallest gauge needle possible when giving injections or drawing blood. f. Instruct the patient to avoid aspirin and nonsteroidal antiinflammatory (NSAIDs).

ANS: B,C,E,F Rationale: Using the smallest gauge needle for injections, using a soft bristle toothbrush and an electric razor will minimize the risk of bleeding into the tissues. Avoiding straining, nose blowing, and coughing will reduce the risk of hemorrhage at these sites. The nurse should apply gentle but prolonged pressure to venipuncture sites to minimize the risk of bleeding. Aspirin and NSAIDs should not be used in patients with liver disease because they interfere with platelet aggregation, thus increasing the risk for bleeding. A low-salt, low-protein, high-carbohydrate diet may be recommended.

16. A female patient is recovering from rectocele repair surgery. Which interventions should be included in the plan of care (select all that apply)? a. Maintain complete bed rest. b. Administer a stool softener. c. Provide a cleansing enema. d. Apply ice to the perineal area. e. Urinary catheter care twice a day. f. Sitz bath may be used in a few days.

ANS: B,D,E,F Administering a stool softener will reduce straining and disruption of the surgical repair. Ice will reduce pain and swelling at the surgical site. Urinary catheter care is provided twice a day to reduce catheter-associated urinary tract infections. A sitz bath may be given a few days after surgery for comfort. Maintaining strict bed rest is not indicated. A cleansing enema is provided before surgery, not after.

23. A patient with cirrhosis has increased abdominal girth from ascites. Which items identify the pathophysiology related to ascites (select all that apply.)? a. Hepatocytes are unable to convert ammonia to urea. b. Osmoreceptors in the hypothalamus stimulate thirst. c. An enlarged spleen removes blood cells from the circulation. d. Portal hypertension causes leaking of protein and water into the peritoneal cavity. e. Aldosterone is released to stabilize intravascular volume by saving salt and water. f. Inability of the liver to synthesize albumin reducing intravascular oncotic pressure.

ANS: B,D,E,F Rationale: Ascites related to cirrhosis is caused by decreased colloid oncotic pressure. The liver does not produce albumin that holds fluid in the vascular space, so fluid shifts into interstitial and third spaces. Portal hypertension causes back pressure in the vessels, shifting protein and fluids into the peritoneal cavity. Decreased intravascular volume stimulates the release of aldosterone, which increases sodium and fluid retention. Oral intake of fluids and removal of blood cells by the spleen do not directly contribute to ascites.

13. The nurse is providing preoperative teaching for the patient having a facelift (rhytidectomy) surgery. Which patient response indicates the patient understands the teaching? a. "I am afraid of the pain afterwards, while it is healing." Incorrect b. "I can't wait to have my forehead and lip wrinkles eliminated." c. "I have some time off work so I will not look so bad when I go back." d. "Now I can be excited to go to my 50th high school reunion this week."

ANS: C A rhytidectomy or face-lift surgery will not have immediate results and will take time to heal, so taking time off from work will allow more healing to be accomplished before returning to work. There is not much pain with most cosmetic surgeries. A rhytidectomy will not eliminate forehead lines and vertical lip wrinkles.

20. The nurse is caring for a patient with pneumonia unresponsive to two different antibiotics. Which action is most important for the nurse to complete before administering a newly prescribed antibiotic? a. Teach the patient to cough and deep breathe. b. Take the temperature, pulse, and respiratory rate. c. Obtain a sputum specimen for culture and Gram stain. d. Check the patient's oxygen saturation by pulse oximetry. e. n

ANS: C A sputum specimen for culture and Gram stain to identify the organism should be obtained before beginning antibiotic therapy. However, antibiotic administration should not be delayed if a specimen cannot be readily obtained because delays in antibiotic therapy can increase morbidity and mortality risks.

2. The nurse is performing a respiratory assessment for a patient admitted with pneumonia. Which clinical manifestation should the nurse expect to find? a. Hyperresonance on percussion b. Vesicular breath sounds in all lobes c. Increased vocal fremitus on palpation d. Fine crackles in all lobes on auscultation

ANS: C A typical physical examination finding for a patient with pneumonia is increased vocal fremitus on palpation. Other signs of pulmonary consolidation include bronchial breath sounds, egophony, and crackles in the affected area. With pleural effusion, there may be dullness to percussion over the affected area.

10. While ambulating a patient with metastatic lung cancer, the nurse observes a drop in oxygen saturation from 93% to 86%. Which nursing action is most appropriate? a. Continue with ambulation. b. Obtain a physician's order for arterial blood gas. c. Obtain a physician's order for supplemental oxygen. d. Move the oximetry probe from the finger to the earlobe. e. n

ANS: C An oxygen saturation level that drops below 90% with activity indicates that the patient is not tolerating the exercise and needs to use supplemental oxygen. The patient will need to rest to resaturate. ABGs or moving the probe will not be needed as the pulse oximeter was working at the beginning of the walk.

17. A patient with breast cancer is having teletherapy radiation treatments after her surgery. What should the nurse teach the patient about the care of her skin? a. Use Dial soap to feel clean and fresh. b. Scented lotion can be used on the area. c. Avoid heat and cold to the treatment area. d. Wear the new bra to comfort and support the area.

ANS: C Avoiding heat and cold in the treatment area will protect it. Only mild soap and unscented, nonmedicated lotions may be used to prevent skin damage. The patient will want to avoid wearing tight-fitting clothing such as a bra over the treatment field and will want to expose the area to air as often as possible.

10. The patient has been diagnosed with head and neck cancer. Along with the treatment for the cancer, what other treatment should the nurse expect to teach the patient about? a. Nasal packing b. Epistaxis balloon c. Gastrostomy tube d. Peripheral skin care

ANS: C Because 50% of patients with head and neck cancer are malnourished before treatment begins, many patients need enteral feeding via a gastrostomy tube because the effects of treatment make it difficult to take in enough nutrients orally, whether surgery, chemotherapy, or radiation is used. Nasal packing could be used with epistaxis or with nasal or sinus problems. Peripheral skin care would not be expected because it is not related to head and neck cancer.

15. The patient is told that her adenoma tumor is not encapsulated but has normally differentiated cells and surgery will be needed. The patient asks the nurse what this means. What should the nurse tell the patient? a. It will recur. b. It has metastasized. c. It is probably benign. d. It is probably malignant.

ANS: C Benign tumors are usually encapsulated, have normally differentiated cells, and do not metastasize. Malignant tumors are rarely encapsulated, have poorly differentiated cells, and are capable of metastasis.

19. The nurse is caring for a group of patients. Which patient is at risk of aspiration? a. A 58-yr-old patient with absent bowel sounds 12 hours after abdominal surgery b. A 67-yr-old patient who had a cerebrovascular accident with expressive dysphasia c. A 26-yr-old patient with continuous enteral tube feedings through a nasogastric tube d. A 92-yr-old patient with viral pneumonia and coarse crackles throughout the lung fields e. n

ANS: C Conditions that increase the risk of aspiration include decreased level of consciousness, difficulty swallowing (dysphagia), and nasogastric intubation with or without tube feeding. With loss of consciousness, the gag and cough reflexes are depressed, and aspiration is more likely to occur. Dysphasia is difficulty with speech. Absent bowel sounds and coarse crackles do not increase the risk for aspiration.

13. A patient has scleroderma and hypertension. The nurse knows this could be related to which renal diagnoses? a. Obstructive uropathy b. Goodpasture syndrome c. Chronic glomerulonephritis d. Calcium oxalate urinary calculi

ANS: C Hypertension occurs with chronic glomerulonephritis, which may be found in patients with scleroderma. Obstructive uropathy, Goodpasture syndrome, and calcium oxalate urinary calculi are not related to scleroderma and do not cause hypertension.

15. A patient is diagnosed with a lung abscess. What should the nurse include when teaching the patient about this diagnosis? a. Lobectomy surgery is usually needed to drain the abscess. b. IV antibiotic therapy will be used for a 6-month period of time. c. Oral antibiotics will be used until there is evidence of improvement. d. Culture and sensitivity tests are needed for 1 year after resolving the abscess e. n

ANS: C IV antibiotics are used until the patient and radiographs show evidence of improvement. Then oral antibiotics are used for a prolonged period of time. Culture and sensitivity testing is done during the course of antibiotic therapy to ensure that the infecting organism is not becoming resistant to the antibiotic as well as at the completion of the antibiotic therapy. Lobectomy surgery is only needed when reinfection of a large cavitary lesion occurs or to establish a diagnosis when there is evidence of a neoplasm or other underlying problem.

16. One week after a thoracotomy, a patient with chest tubes (CTs) to water-seal drainage has an air leak into the closed chest drainage system (CDS). Which patient assessment warrants follow-up nursing actions? a. Water-seal chamber has 5 cm of water. b. No new drainage in collection chamber c. Chest tube with a loose-fitting dressing d. Small pneumothorax at CT insertion site e. n

ANS: C If the dressing at the CT insertion site is loose, an air leak will occur and will need to be sealed. The water-seal chamber usually has 2 cm of water, but having more water will not contribute to an air leak, and it should not be drained from the CDS. No new drainage does not indicate an air leak but may indicate the CT is no longer needed. If there is a pneumothorax, the chest tube should remove the air.

21. The patient was told that he would have intraperitoneal chemotherapy. He asks the nurse when the IV will be started for the chemotherapy. What should the nurse teach the patient about this type of chemotherapy delivery? a. It is delivered via an Ommaya reservoir and extension catheter. b. It is instilled in the bladder via a urinary catheter and retained for 1 to 3 hours. c. A Silastic catheter will be percutaneously placed in the abdomen for chemotherapy administration. d. The arteries supplying the tumor are accessed with surgical placement of a catheter connected to an infusion pump.

ANS: C Intraperitoneal chemotherapy is delivered to the peritoneal cavity via a temporary percutaneously inserted Silastic catheter and drained from this catheter after the dwell time in the peritoneum. The Ommaya reservoir is used for intraventricular chemotherapy. Intravesical bladder chemotherapy is delivered via a urinary catheter. Intraarterial chemotherapy is delivered via a surgically placed catheter that delivers chemotherapy via an external or internal infusion pump.

14. When caring for a patient with nephrotic syndrome, which food selection indicates the patient understands dietary teaching? a. Peanut butter and crackers b. One small grilled pork chop c. Salad made of fresh vegetables d. Spaghetti with canned spaghetti sauce

ANS: C Of the options listed, only salad made with fresh vegetables would be acceptable for the diet that limits sodium and protein as well as saturated fat if hyperlipidemia is present. Peanut butter and crackers are processed, so they contain significant sodium, and peanut butter contains some protein. A pork chop is a high-protein food with saturated fat. Canned spaghetti sauce is also high in sodium.

2. The nurse provides discharge instructions for a 64-yr-old woman with ascites and peripheral edema related to cirrhosis. Which patient statement indicates teaching was effective? a. "Lactulose should be taken every day to prevent constipation." b. "It is safe to take acetaminophen up to four times a day for pain." c. "Herbs and other spices should be used to season my foods instead of salt." d. "I will eat foods high in potassium while taking spironolactone (Aldactone)."

ANS: C Rationale: A low-sodium diet is indicated for patients with ascites and edema related to cirrhosis. Table salt is a well-known source of sodium and should be avoided. Alternatives to salt to season foods include the use of seasonings such as garlic, parsley, onion, lemon juice, and spices. Pain medications such as acetaminophen, aspirin, and ibuprofen should be avoided because these medications may be toxic to the liver. The patient should avoid potentially hepatotoxic over-the-counter drugs (e.g., acetaminophen) because the diseased liver is unable to metabolize these drugs. Spironolactone is a potassium-sparing diuretic. Lactulose results in the acidification of feces in bowel and trapping of ammonia, causing its elimination in feces.

5. The nurse instructs a 50-yr-old woman about cholestyramine to reduce pruritus caused by gallbladder disease. Which patient statement indicates understanding of the instructions? a. "This medication will help me digest fats and fat-soluble vitamins." b. "I will apply the medicated lotion sparingly to the areas where I itch." c. "The medication is a powder and needs to be mixed with milk or juice." d. "I should take this medication on an empty stomach at the same time each day."

ANS: C Rationale: For treatment of pruritus, cholestyramine may provide relief. This is a resin that binds bile salts in the intestine, increasing their excretion in the feces. Cholestyramine is in powder form and should be mixed with milk or juice before oral administration.

12. The condition of a patient who has cirrhosis of the liver has deteriorated. Which diagnostic study would help determine if the patient has developed liver cancer? a. Serum α-fetoprotein level b. Ventilation/perfusion scan c. Hepatic structure ultrasound d. Abdominal girth measurement

ANS: C Rationale: Hepatic structure ultrasonography, CT scan, and MRI are used to screen for and diagnose liver cancer. Serum α-fetoprotein level may be elevated with liver cancer or other liver problems. Ventilation/perfusion scans are used to diagnose pulmonary emboli. Abdominal girth measurement would not differentiate between cirrhosis and liver cancer.

6. The nurse is caring for a patient receiving an initial dose of chemotherapy to treat a rapidly growing metastatic colon cancer. The nurse is aware that the patient is at risk for tumor lysis syndrome (TLS) and will monitor for which abnormality associated with this oncologic emergency? a. Hypokalemia b. Hypocalcemia c. Hypouricemia d. Hypophosphatemia

ANS: C TLS is a metabolic complication characterized by rapid release of intracellular components in response to chemotherapy. This can rapidly lead to acute renal injury. The hallmark signs of TLS are hyperuricemia, hyperphosphatemia, hyperkalemia, and hypocalcemia.

18. A female patient is having chemotherapy for brain metastasis. She is concerned about how she will look when she loses her hair. What is the best response by the nurse to this patient? a. "When your hair grows back, it will be patchy." b. "Don't use your curling iron, and that will slow down the loss." c. "You can get a wig now to match your hair so you will not look different." d. "You should contact "Look Good, Feel Better" to figure out what to do about this."

ANS: C The best response by the nurse is to suggest getting a wig before she loses her hair so she will not look or feel so different. Although hair loss with chemotherapy is usually reversible, hair loss with radiation is usually permanent in the areas radiation was administered. When hair grows back it could be a different color or texture. Avoiding use of electric hair dryers, curlers, and curling irons may slow the hair loss but will not answer the patient's concern. The American Cancer Society's "Look Good, Feel Better" program will be helpful, but this response is avoiding the patient's immediate concern.

11. A patient presents with a flat, dry, scaly area on the eyebrows that is treated with a chemical peel. What should the nurse include in the discharge teaching? a. Metastasis of this type of lesion is rare. b. The patient has an increased risk for melanoma. c. Recurrence of the premalignant lesion is possible. d. Untreated lesions may metastasize to regional lymph nodes.

ANS: C The flat or elevated dry scaly area is actinic keratosis from sun damage and is a premalignant skin lesion common in older whites with possible recurrence even with adequate treatment. Metastasis of basal cell carcinoma is rare; it is a small slowly enlarging papule. There is an increased risk for melanoma with atypical or dysplastic nevi. With squamous cell carcinoma, untreated lesions may metastasize to regional lymph nodes and distant organs, but it has a high cure rate with early detection and treatment.

13. The nurse is teaching the patient with human immunodeficiency virus (HIV) about the diagnosis of Candida albicans. What statement made by the patient indicates to the nurse that further teaching is required? a. "I will be given amphotericin B to treat the fungus." b. "I got this fungus because I am immunocompromised." c. "I need to be isolated from my family and friends so they won't get it." d. "The effectiveness of my therapy can be monitored with fungal serology titers." e. n

ANS: C The patient with an opportunistic fungal infection does not need to be isolated because it is not transmitted from person to person. This immunocompromised patient will be likely to have a serious infection so it will be treated with IV amphotericin B. The effectiveness of the therapy can be monitored with fungal serology titers.

5. The nurse is performing a skin assessment for an older adult patient. What finding should the nurse immediately report to the health care provider? a. The presence of wrinkles on the face and hands b. The patient's report of dry skin that is frequently itchy c. The presence of an irregularly shaped mole that the patient states is new d. The presence of veins on the back of the patient's leg that are blue and tortuous

ANS: C The presence of an irregular mole that is new is suggestive of a neoplasm and warrants immediate reporting and follow-up. Age-related changes may occur that involve the decrease in skin oils that may cause dry skin that itches. Blue and tortuous veins may be unsightly for the patient but are a normal age-related change. Wrinkles are a normal age-related change.

7. The nurse is caring for a patient with unilateral malignant lung disease. What is the priority nursing action to enhance oxygenation in this patient? a. Positioning patient on right side b. Maintaining adequate fluid intake c. Positioning patient with "good lung" down d. Performing postural drainage every 4 hours e. n

ANS: C Therapeutic positioning identifies the best position for the patient, thus assuring stable oxygenation status. Research indicates that positioning the patient with the unaffected lung (good lung) dependent best promotes oxygenation in patients with unilateral lung disease. For bilateral lung disease, the right lung down has best ventilation and perfusion. Increasing fluid intake and performing postural drainage will facilitate airway clearance, but positioning is most appropriate to enhance oxygenation.

15. Which instruction should the nurse provide when teaching a patient to exercise the pelvic floor? a. Tighten both buttocks together. b. Squeeze thighs together tightly. c. Contract muscles around rectum. d. Lie on back and lift the legs together.

ANS: C To teach pelvic floor exercises (Kegel exercise), instruct: (without contracting legs, butt, abdomen) to contract muscles around rectum (pelvic floor muscles) as if stopping stool, → pelvic lifting sensation.

20. A patient admitted to the emergency department after a motor vehicle accident. Which urinalysis findings would the nurse expect if kidney trauma occurred (select all that apply.)? a. Casts b. Glucose c. Bilirubin d. Myoglobinuria e. Red blood cells f. White blood cells

ANS: D ,E After kidney trauma, the nurse will expect urinalysis results to be positive for myoglobin and red blood cells. Casts in urine indicate blood destruction intravascularly. Glucose in urine could indicate diabetes. Bilirubin in urine is suggestive liver dysfunction. White blood cells in urine indicate infection.

8. A patient had an open reduction repair of a bilateral nasal fracture. The nurse plans to implement an intervention that focuses on both nursing and medical goals for this patient. Which intervention should the nurse implement? a. Apply an external splint to the nose. b. Insert plastic nasal implant surgically. c. Humidify the air for mouth breathing. d. Maintain surgical packing in the nose.

ANS: D A goal that is common to nursing and medical management of a patient after rhinoplasty is to prevent the formation of a septal hematoma and potential infections resulting from a septal hematoma. Therefore, the nurse helps to keep the nasal packing in the nose. The packing applies direct pressure to oozing blood vessels to stop postoperative bleeding. A medical goal includes realigning the fracture with an external or internal splint. The nurse helps maintain the airway by humidifying inspired air because the nose is unable to do so following surgery because it is swollen and packed with gauze.

4. A 64-yr-old male patient who is receiving radiation to the head and neck as treatment for an invasive malignant tumor complains of mouth sores and pain. Which intervention should the nurse add to the plan of care? a. Provide ice chips to soothe the irritation. b. Weigh the patient every month to monitor for weight loss. c. Cleanse the mouth every 2 to 4 hours with hydrogen peroxide. d. Provide high-protein and high-calorie, soft foods every 2 hours.

ANS: D A patient with stomatitis should have soft, nonirritating foods offered frequently. The diet should be high in protein and high in calories to aid healing. Extremes of temperature are to be avoided. Saline or water should be used to cleanse the mouth (not hydrogen peroxide). Patients should be weighed at least twice each week to monitor for weight loss.

13. The nurse teaches a patient with hypertension and osteoarthritis about actions to prevent and control epistaxis. Which statement, if made by the patient, indicates further teaching is required? a. "I should avoid using ibuprofen for pain and discomfort." b. "It is important for me to take my blood pressure medication every day." c. "I will sit down and pinch the tip of my nose for at least 10 to 15 minutes." d. "If I get a nosebleed, I will lie down flat and raise my feet above my heart."

ANS: D A simple measure to control epistaxis (or a nosebleed) is for the patient to remain quiet in a sitting position. Another measure is to apply direct pressure by pinching the entire soft lower portion of the nose for 10 to 15 minutes. Aspirin and nonsteroidal antiinflammatory drugs such as ibuprofen increase the bleeding time and should be avoided. Elevated blood pressure makes epistaxis more difficult to control. The patient should continue with antihypertensive medications as prescribed.

19. The patient is receiving immunotherapy and targeted therapy for ovarian cancer. What medication should the nurse expect to administer before therapy to combat the most common side effects of these medications? a. Morphine sulfate b. Ibuprofen (Advil) c. Ondansetron (Zofran) d. Acetaminophen (Tylenol)

ANS: D Acetaminophen is administered before therapy and every 4 hours to prevent or decrease the intensity of the severe flu-like symptoms, especially with interferon which is frequently used for ovarian cancer. Morphine sulfate and ibuprofen will not decrease flu-like symptoms. Ondansetron is an antiemetic but is not used first to combat flu-like symptoms of headache, fever, chills, myalgias, and so on.

3. The nurse is caring for a patient with ineffective airway clearance. What is the priority nursing action to assist this patient expectorate thick lung secretions? a. Humidify the oxygen as able. b. Administer cough suppressant q4hr. c. Teach patient to splint the affected area. d. Increase fluid intake to 3 L/day if tolerated. e. n

ANS: D Although several interventions may help the patient expectorate mucus, the highest priority should be on increasing fluid intake, which will liquefy the secretions so that the patient can expectorate them more easily. Humidifying the oxygen is also helpful but is not the primary intervention. Teaching the patient to splint the affected area may also be helpful in decreasing discomfort but does not assist in expectoration of thick secretions.

10. The patient has bleeding gums and purpura. What vitamin in which foods should be encouraged as a nutritional aid to these problems? a. Vitamin B7 in liver, cauliflower, salmon, carrots b. Vitamin A in sweet potatoes, carrots, dark leafy greens c. Vitamin C in peppers, dark leafy greens, broccoli, and kiwi d. Vitamin D in canned salmon, sardines, fortified dairy, and eggs

ANS: D An absence of vitamin C causes symptoms of scurvy, including petechiae, bleeding gums, and purpura. A deficiency of vitamin B7 (biotin) may result in rashes and alopecia. Vitamins A is needed for wound healing. Vitamin D is needed for bone and body health.

17. A patient with idiopathic pulmonary fibrosis had bilateral lung transplantation and is now experiencing exertional dyspnea, nonproductive cough, and wheezing. What does the nurse determine is most likely occurring in this patient? a. Pulmonary infarction b. Pulmonary hypertension c. Cytomegalovirus (CMV) d. Bronchiolitis obliterans (BOS)

ANS: D BOS is a manifestation of chronic rejection and is characterized by airflow obstruction progressing over time with a gradual onset of exertional dyspnea, nonproductive cough, wheezing, and/or low-grade fever. Pulmonary infarction occurs with lack of blood flow to the bronchial tissue or preexisting lung disease. With pulmonary hypertension, the pulmonary pressures are elevated and can be idiopathic or secondarily due to parenchymal lung disease that causes anatomic or vascular changes leading to pulmonary hypertension. CMV pneumonia is the most common opportunistic infection 1 to 4 months after lung transplant.

8. An older adult patient is admitted with acute respiratory distress related to cor pulmonale. Which nursing action is most appropriate during admission of this patient? a. Perform a comprehensive health history with the patient to review prior respiratory problems. b. Complete a full physical examination to determine the effect of the respiratory distress on other body functions. c. Delay any physical assessment of the patient and review with the family the patient's history of respiratory problems. d. Perform a physical assessment of the respiratory system and ask specific questions related to this episode of respiratory distress.

ANS: D Because the patient is having respiratory difficulty, the nurse should ask specific questions about this episode and perform a physical assessment of this system. Further history taking and physical examination of other body systems can proceed when the patient's acute respiratory distress is being managed.

14. The nurse teaches a patient abou\t the use of budesonide intranasal spray for seasonal allergic rhinitis. The nurse determines that medication teaching is successful if the patient makes which statement? a. "My liver function will be checked with blood tests every 2 to 3 months." b. "The medication will decrease the congestion within 3 to 5 minutes after use." c. "I may develop a serious infection because the medication reduces my immunity." d. "I will use the medication every day of the season whether I have symptoms or not."

ANS: D Budesonide should be started 2 weeks before pollen season starts and used on a regular basis, not as needed. The spray acts to decrease inflammation and the effect is not immediate as with decongestant sprays. At recommended doses, budesonide has only local effects and will not result in immunosuppression or a systemic infection. Zafirlukast (Accolate) is a leukotriene receptor antagonist and may alter liver function tests (LFTs). LFTs must be monitored periodically in the patient taking zafirlukast.

12. A patient has been diagnosed with Burkitt's lymphoma. In the initiation stage of cancer, the cells genetic structure is mutated. Exposure to what may have functioned as a carcinogen for this patient? a. Bacteria b. Sun exposure c. Most chemicals d. Epstein-Barr virus

ANS: D Burkitt's lymphoma consistently shows evidence of the presence of Epstein-Barr virus in vitro. Bacteria do not initiate cancer. Sun exposure causes cell alterations leading to melanoma and squamous and basal cell skin carcinoma. Long-term exposure to certain chemicals (e.g., ethylene oxide, chloroform, benzene) is known to initiate cancer.

2. The nurse is caring for an 18-yr-old female patient with acute lymphocytic leukemia that is scheduled for hematopoietic stem cell transplantation (HSCT). Which patient statement indicates a correct understanding of the procedure? a. "I understand the transplant procedure has no dangerous side effects." b. "After the transplant, I will feel better and can go home in 5 to 7 days." c. "My brother will be a 100% match for the cells used during the transplant." d. "Before the transplant, I will have chemotherapy and possibly full-body radiation."

ANS: D Hematopoietic stem cell transplantation (HSCT) requires eradication of diseased or cancer cells. This is accomplished by administering higher-than-usual dosages of chemotherapy with or without radiation therapy. A relative such as a brother would not be a perfect match with human leukocyte antigens; only identical twins are an exact match. HSCT is an intensive procedure with adverse effects and possible death. HSCT recipients can expect a 2- to 4-week hospitalization after the transplant.

14. When caring for the patient with cancer, what does the nurse understand as the response of the immune system to antigens of the malignant cells? a. Metastasis b. Tumor angiogenesis c. Immunologic escape d. Immunologic surveillance

ANS: D Immunologic surveillance is the process in which lymphocytes check cell surface antigens and detect and destroy cells with abnormal or altered antigenic determinants to prevent these cells from developing into clinically detectable tumors. Metastasis is increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site in the progression stage of cancer development. Tumor angiogenesis is the process of blood vessels forming within the tumor itself. Immunologic escape is the cancer cells' evasion of immunologic surveillance that allows the cancer cells to reproduce.

5. A 70-yr-old man who has end-stage lung cancer is admitted to the hospital with confusion and oliguria for 2 days. Which finding would the nurse report immediately to the health care provider? a. Weight gain of 6 lb b. Nausea and vomiting c. Urine specific gravity of 1.004 d. Serum sodium level of 118 mEq/L

ANS: D Lung cancer cells are able to manufacture and release antidiuretic hormone (ADH) with resultant water retention and hyponatremia. Hyponatremia (serum sodium levels less than 135 mEq/L) may lead to central nervous system symptoms such as confusion, seizures, coma, and death. The other options listed are also symptoms of hyponatremia but are not as critical to report to the health care provider.

9. Which nursing diagnosis is most appropriate for a patient experiencing myelosuppression secondary to chemotherapy for cancer treatment? a. Acute pain b. Hypothermia c. Powerlessness d. Risk for infection

ANS: D Myelosuppression is accompanied by a high risk of infection and sepsis. Hypothermia, powerlessness, and acute pain are also possible nursing diagnoses for patients undergoing chemotherapy, but the threat of infection is paramount.

17. A patient is admitted for joint replacement surgery and has a permanent tracheostomy. Which task is appropriate for the nurse to delegate to unlicensed assistive personnel (UAP)? a. Suction the tracheostomy. b. Check stoma site for skin breakdown. c. Complete tracheostomy care using sterile technique. d. Provide oral care with a toothbrush and tonsil suction tube.

ANS: D Oral care (for a stable patient with a tracheostomy) can be delegated to UAP. A registered nurse would be responsible for assessments (e.g., checking the stoma for skin breakdown) and tracheostomy suctioning and care.

9. The nurse is providing care for a patient admitted to the hospital for treatment of nephrotic syndrome. What are the priority nursing assessments? a. Assessment of pain and level of consciousness b. Assessment of serum calcium and phosphorus levels c. Blood pressure and assessment for orthostatic hypotension d. Daily weights and measurement of the patient's abdominal girth

ANS: D Peripheral edema is characteristic of nephrotic syndrome, and a key nursing responsibility in the care of patients with the disease is close monitoring of abdominal girth, weights, and extremity size. Pain, level of consciousness, and orthostatic blood pressure are less important in the care of patients with nephrotic syndrome. Abnormal calcium and phosphorus levels are not commonly associated with the diagnosis of nephrotic syndrome.

12. The nurse is teaching the residents of an independent living facility about preventing skin infections and infestations. What should be included in the teaching? a. Use cool compresses if an infection occurs. b. Oral antibiotics will be needed for any skin changes. c. Antiviral agents will be needed to prevent outbreaks. d. Inspect skin for changes when bathing with mild soap.

ANS: D Persons living in independent living facilities are usually older, which means their skin does not need cleaning with hot water and vigorous scrubbing or as often as a younger person. Mild soap (e.g., Ivory) should be used to avoid loss of protection from neutralization of the skin's surface. The skin should be inspected for changes with bathing. Cool compresses are used with ringworm or stings for the antiinflammatory effect. Oral antibiotics are used for Lyme disease from ticks. Antiviral agents are used for viral infections but not to prevent outbreaks.

9. When planning care for a patient with cirrhosis, the nurse will give highest priority to which nursing diagnosis? a. Impaired skin integrity related to edema, ascites, and pruritus Incorrect b. Imbalanced nutrition: less than body requirements related to anorexia c. Excess fluid volume related to portal hypertension and hyperaldosteronism d. Ineffective breathing pattern related to pressure on diaphragm and reduced lung volume

ANS: D Rationale: Although all of these nursing diagnoses are appropriate and important in the care of a patient with cirrhosis, airway and breathing are always the highest priorities.

14. A patient with cholelithiasis is being prepared for surgery. Which patient assessment represents a contraindication for a cholecystectomy? a. Low-grade fever of 100°F and dehydration b. Abscess in the right upper quadrant of the abdomen c. Multiple obstructions in the cystic and common bile duct d. Activated partial thromboplastin time (aPTT) of 54 seconds

ANS: D Rationale: An aPTT of 54 seconds is above normal and indicates insufficient clotting ability. If the patient had surgery, significant bleeding complications postoperatively are very likely. Fluids can be given to eliminate the dehydration. The abscess can be assessed during surgery, and the obstructions in the cystic and common bile duct would be relieved with the cholecystectomy.

17. A patient with a history of lung cancer and hepatitis C has developed liver failure and is considering liver transplantation. After a comprehensive evaluation, which finding may be a contraindication for liver transplantation? a. History of hypothyroidism b. Stopped smoking cigarettes c. Well-controlled type 1 diabetes mellitus d. Chest x-ray showed another lung cancer lesion.

ANS: D Rationale: Contraindications for liver transplant include severe extrahepatic disease, advanced hepatocellular carcinoma or other cancer, ongoing drug or alcohol abuse, and the inability to comprehend or comply with the rigorous posttransplant course.

7. The health care provider orders lactulose for a patient with hepatic encephalopathy. Which finding indicates the medication has been effective? a. Relief of constipation b. Relief of abdominal pain c. Decreased liver enzymes d. Decreased ammonia levels

ANS: D Rationale: Hepatic encephalopathy is a complication of liver disease and is associated with elevated serum ammonia levels. Lactulose traps ammonia in the intestinal tract. Its laxative effect then expels the ammonia from the colon, resulting in decreased serum ammonia levels and correction of hepatic encephalopathy. An additional finding may be an improvement in level of consciousness.

8. The family of a patient newly diagnosed with hepatitis A asks the nurse what they can do to prevent becoming ill. Which response by the nurse is most appropriate? a. "You will need to be tested first; then treatment can be determined." b. "The hepatitis vaccine will provide immunity from this and future exposures." c. "There is nothing you can do since the patient was infectious before admission." d. "An immunoglobulin injection will be given to prevent infection or limit symptoms."

ANS: D Rationale: Immunoglobulin provides temporary (1-2 months) passive immunity and is effective for preventing hepatitis A if given within 2 weeks after exposure. It may not prevent infection in all persons, but it will at least modify the illness to a subclinical infection. The hepatitis vaccine is only used for preexposure prophylaxis.

11. A patient with hepatitis B surface antigen (HBsAg) present in the serum is being discharged with pain medication after knee surgery. Which medication order should the nurse question? a. Tramadol b. Hydromorphone (Dilaudid) c. Oxycodone with aspirin (Percodan) d. Hydrocodone with acetaminophen

ANS: D Rationale: The analgesic with acetaminophen should be questioned because this patient is a chronic carrier of hepatitis B and is likely to have impaired liver function. Acetaminophen is not suitable for this patient because it is converted to a toxic metabolite in the liver after absorption, increasing the risk of hepatocellular damage.

15. When teaching the patient with acute hepatitis C (HCV), which statement demonstrates understanding of the disease process? a. "I will use care when kissing my wife to prevent giving it to her." b. "I will need to take adefovir (Hepsera) to prevent chronic HCV." c. "Now that I have had HCV, I will have immunity and not get it again." d. "I will need to be monitored for chronic HCV and other liver problems."

ANS: D Rationale: The majority of patients who acquire HCV usually develop chronic infection, which may lead to cirrhosis or liver cancer. HCV is not transmitted via saliva but by blood exposures such as sharing needles and high-risk sexual activity. The treatment for acute viral hepatitis focuses on resting the body and adequate nutrition for liver regeneration. Adefovir (Hepsera) is taken for severe hepatitis B (HBV) with liver failure. Chronic HCV is treated with pegylated interferon with ribavirin. Immunity with HCV does not occur as it does with HAV and HBV, so the patient may be reinfected with another type of HCV.

14. The patient had video-assisted thoracic surgery (VATS) to perform a lobectomy. What does the nurse know is the reason for using this type of surgery? a. The patient has lung cancer. Incorrect b. The incision will be medial sternal or lateral. c. Chest tubes will not be needed postoperatively. d. Less discomfort and faster return to normal activity

ANS: D The VATS procedure uses minimally invasive incisions that cause less discomfort and allow faster healing and return to normal activity as well as lower morbidity risk and fewer complications. Many surgeries can be done for lung cancer, but pneumonectomy via thoracotomy is the most common surgery for lung cancer. The incision for a thoracotomy is commonly a medial sternotomy or a lateral approach. A chest tube will be needed postoperatively for VATS.

13. A patient with a 25-year history of type 1 diabetes mellitus is reporting fatigue, edema, and an irregular heartbeat. On assessment, the nurse notes newly developed hypertension and uncontrolled blood sugars. Which diagnostic study is most indicative of chronic kidney disease (CKD)? a. Serum creatinine b. Serum potassium c. Microalbuminuria d. Calculated glomerular filtration rate (GFR)

ANS: D The best study to determine kidney function or CKD that would be expected in diabetic is calculated GFR obtained from patient's age, gender, race, & serum creatinine. It would need to be abnormal for 3 months to establish a diagnosis of CKD. A creatinine clearance test done with a blood sample and a 24-hour urine collection is also important. Serum creatinine is not the best test for CKD because the level varies with different patients. Serum potassium levels could explain why the patient has an irregular heartbeat. The finding of microalbuminuria can alert the patient with diabetes about potential renal involvement and potentially failing kidneys. However, urine albumin levels are not used for diagnosis of CKD.

5. The nurse evaluates that discharge teaching for a patient hospitalized with pneumonia has been effective when the patient makes which statement about measures to prevent a relapse? a. "I will seek immediate medical treatment for any upper respiratory infections." b. "I should continue to do deep breathing and coughing exercises for at least 12 weeks." c. "I will increase my food intake to 2400 calories a day to keep my immune system well." d. "I must have a follow-up chest x-ray in 6 to 8 weeks to evaluate the pneumonia's resolution."

ANS: D The follow-up chest x-ray examination will be done in 6 to 8 weeks to evaluate pneumonia resolution. A patient should seek medical treatment for upper respiratory infections that persist for more than 7 days. It may be important for the patient to continue with coughing and deep breathing exercises for 6 to 8 weeks, not 12 weeks, until all of the infection has cleared from the lungs. Increased fluid intake, not caloric intake, is required to liquefy secretions.

7. The nurse is caring for a patient suffering from anorexia secondary to chemotherapy. Which strategy would be most appropriate to increase the patient's nutritional intake? a. Increase intake of liquids at mealtime to stimulate the appetite. b. Serve three large meals per day plus snacks between each meal. c. Avoid the use of liquid protein supplements to encourage eating at mealtimes. d. Add items such as skim milk powder, cheese, honey, or peanut butter to selected foods.

ANS: D The nurse can increase the nutritional density of foods by adding items high in protein and/or calories (e.g., peanut butter, skim milk powder, cheese, honey, brown sugar) to foods the patient will eat. Increasing fluid intake at mealtime fills the stomach with fluid and decreases the desire to eat. Small frequent meals are best tolerated. Supplements can be helpful.

9. The patient seeks relief from the symptoms of an upper respiratory infection (URI) lasting for 5 days. Which patient assessment should the nurse use to help determine if the URI has developed into acute sinusitis? a. Coughing b. Fever, chills c. Dust allergy d. Maxillary pain

ANS: D The nurse should assess the patient for sinus pain or pressure as a clinical indicator of acute sinusitis. Coughing and fever are nonspecific clinical indicators of a URI. A history of an allergy that is likely to affect the upper respiratory tract is supportive of the sinusitis diagnosis but is not specific for sinusitis.

11. The nurse is caring for an older adult patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient reports shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4°F, blood pressure is 130/88 mm Hg, respirations are 36 breaths/min, and oxygen saturation is 91% on room air. What is the priority nursing action? a. Notify the health care provider. b. Administer a nitroglycerin tablet sublingually. c. Conduct a thorough assessment of the chest pain. d. Sit the patient up in bed as tolerated and apply oxygen.

ANS: D The patient's clinical picture is most likely pulmonary embolus, and the first action the nurse takes should be to assist with the patient's respirations. For this reason, the nurse should sit the patient up as tolerated and apply oxygen before notifying the physician. The nitroglycerin tablet would not be helpful, and the oxygenation status is a bigger problem than the slight chest pain at this time.

17. The nurse assesses small, firm, reddened raised lesions with flat, rough patches on a patient that are causing intense pruritus. What question should the nurse next ask the patient? a. "Have you started any new medications?" b. "Do you have a history of seasonal allergies?" c. "Have you had any lesions such as this before?" d. "Tell me about your activities the past 2 to 7 days."

ANS: D The patient's lesions are papules and plaques characteristic of contact dermatitis. The nurse should ask the patient about activities over the past 2 to 7 days to identify potential allergens because contact dermatitis has a delayed onset. Even if an offending agent is not identified, the nurse can provide patient teaching about managing the pruritus and preventing infection by decreasing scratching. Seasonal allergies and new medications are more likely to cause urticaria than papules and plaque. The nurse should also ask about pruritic rashes in the past to determine potential illnesses that can cause dermatologic manifestations.

22. The patient is being treated with brachytherapy for cervical cancer. What factors must the nurse be aware of to protect herself when caring for this patient? a. The medications the patient is taking b. The nutritional supplements that will help the patient c. How much time is needed to provide the patient's care d. The time the nurse spends at what distance from the patient

ANS: D The principles of ALARA (as low as reasonably achievable) and time, distance, and shielding are essential to maintain the nurse's safety when the patient is a source of internal radiation. The patient's medications, nutritional supplements, and time needed to complete care will not protect the nurse caring for a patient with brachytherapy for cervical cancer.

12. The patient has decided to use the voice rehabilitation that offers the best speech quality even though it must be cleaned regularly. The nurse knows that this is what kind of voice rehabilitation? a. Electromyography b. Intraoral electrolarynx c. Neck type electrolarynx d. Transesophageal puncture

ANS: D The transesophageal puncture provides a fistula between the esophagus and trachea with a one-way valved prosthesis to prevent aspiration from the esophagus to the trachea. Air moves from the lungs and vibrates against the esophagus, and words are formed with the tongue and lips as the air moves out the mouth. The electromyography and both electrolarynx methods produce low-pitched mechanical sounds.

15. A patient informs the nurse that they are afraid to use the treatment recommended for psoriasis. What is the best response by the nurse? a. "You will only know if you try it and see." b. "You may need to get counseling to help you cope." c. "No treatment is medically necessary, but it can be removed." d. "Topical, light therapy, and systemic medications are now available."

ANS: D Treatment of psoriasis usually involves a combination of strategies, including topical treatments; phototherapy; and/or systemic medications, including biologic drugs. Telling her that she will only know if she tries or that she may need counseling is denying the patient's concern. Psoriasis is treated to manage the disease as the patient may have a weakened immune system and be at risk for cardiovascular disease.

6. What should the nurse emphasize in the teaching for a woman diagnosed with pelvic inflammatory disease (PID)? a. The importance of contraception b. Manifestations of further infection c. The importance of maintaining hygiene d. Benefits of hormone replacement therapy (HRT)

ANS: PID frequently progresses to serious infection of the reproductive structures. The diagnosis does not present a particular need for contraception or specific hygiene measures. HRT is not used to treat PID.

4. The nurse counsels a 64-yr-old man on dietary restrictions to prevent recurrent uric acid renal calculi. Which foods should the patient avoid? a. Venison, crab, and liver b. Spinach, cabbage, and tea c. Milk, yogurt, and dried fruit d. Asparagus, lentils, and chocolate

ANS:A Foods high in purines (e.g., venison, crab, liver) should be avoided to prevent uric acid calculi formation. Foods high in calcium (e.g., milk, yogurt, dried fruit, lentils, chocolate) should be avoided to prevent calcium calculi formation. Foods high in oxalate (e.g., spinach, cabbage, tea, asparagus, chocolate) should be avoided to prevent oxalate calculi formation (see Table 45-12).

13. The nurse is caring for a 25-yr-old patient who has polycystic ovary syndrome (PCOS). When preparing the teaching plan, which classic manifestation should the nurse associate with severity of symptoms and infertility? a. Obesity b. Hirsutism c. Amenorrhea d. Irregular menstrual periods

ANS:A Obesity has been associated with the severity of symptoms such as excess androgens, oligorrhea, amenorrhea, and infertility. This knowledge will affect the teaching the nurse does for this patient to prevent cardiovascular disease and abnormal insulin resistance. Hirsutism, amenorrhea, and irregular menstrual periods are not associated with the severity of the symptoms. 14. A 60-yr-old woman comes to the clinic reporting unexpected bleeding. What statement should the nurse use regarding diagnosing the cause of bleeding? a. "It is probably the end of menopause." b. "A Pap smear is used to diagnose endometrial cancer." c. "A hysterectomy may be indicated to treat the bleeding." d. "An endometrial biopsy will help determine the cause of bleeding." @ANS:D With unexpected bleeding in a postmenopausal woman, an endometrial biopsy should be done to exclude or diagnose endometrial cancer. The abnormal bleeding should not be ignored just because she is postmenopausal. A hysterectomy with bilateral salpingo-oophorectomy with lymph node biopsies will be done to treat endometrial cancer if diagnosed. A Pap smear will not diagnose endometrial cancer unless it has spread to the cervix.

2. A 52-yr-old man with stage 2 chronic kidney disease is scheduled for an outpatient diagnostic procedure using contrast media. Which priority action should the nurse perform? a. Assess skin turgor to determine hydration status. b. Insert a urinary catheter for the expected diuresis. c. Evaluate the patient's lower extremities for edema. d. Check the patient's urine for the presence of ketones.

ANS:A Preexisting kidney disease is the most important risk factor for development of contrast-associated nephropathy & nephrotoxic injury. If contrast media must be administered to a high-risk patient, patient needs to have optimal hydration. Assess the hydration status of the patient before the procedure is performed. Indwelling catheter use should be avoided whenever possible to decrease risk of infection.

12. The patient has rapidly progressing glomerular inflammation. Weight has increased and urine output is steadily declining. What is the priority nursing intervention? a. Monitor the patient's cardiac status. b. Teach the patient about hand washing. c. Obtain a serum specimen for electrolytes. d. Increase direct observation of the patient.

ANS:A The nurse's priority is to monitor the patient's cardiac status. With the rapidly progressing glomerulonephritis, renal function begins to fail and fluid, potassium, and hydrogen retention lead to hypervolemia, hyperkalemia, and metabolic acidosis. Excess fluid increases the workload of the heart, and hyperkalemia can lead to life-threatening dysrhythmias. Teaching about hand washing and observation of the patient are important nursing interventions but are not the priority. Electrolyte measurement is a collaborative intervention that will be done as ordered by the health care provider.

2. A 21-yr-old female patient came to the clinic for instruction to prevent recurrence of urinary tract infections. Which patient statement indicates that teaching was effective? a. "I will urinate before and after having intercourse." b. "I will use vinegar as a vaginal douche every week." c. "I should drink three 8-oz glasses of water daily." d. "I can stop the antibiotics when symptoms disappear."

ANS:A The woman should empty her bladder before and after sexual intercourse. She should avoid vaginal douches and maintain adequate oral fluid intake (15 mL per pound of body weight). All of the antibiotics should be taken as prescribed even if symptoms are no longer present.

14. A 78-yr-old patient has stage 3 CKD and is being taught about a low-potassium diet. The nurse knows the patient understands the diet when the patient selects which foods to eat? a. Apple, green beans, and a roast beef sandwich b. Granola made with dried fruits, nuts, and seeds c. Watermelon and ice cream with chocolate sauce d. Bran cereal with ½ banana and milk and orange juice

ANS:A When patient selects apple, green beans, & roast beef sandwich, the patient demonstrates understanding of the low-potassium diet. Granola, dried fruits, nuts and seeds, milk products, chocolate sauce, bran cereal, banana, and orange juice all have elevated levels of potassium, at or above 200 mg per 1/2 cup.

20. Which findings will the nurse expect when caring for a patient with chronic kidney disease (CKD) (select all that apply.)? a. Anemia b. Dehydration c. Hypertension d. Hypercalcemia e. Increased risk for fractures Correct f. Elevated white blood cells

ANS:A, C When the kidney fails, erythropoietin in not excreted, so anemia is expected. Hypocalcemia from chronic renal disease stimulates the parathyroid to release parathyroid hormone, causing calcium liberation from bones increasing the risk of pathological fracture. Dehydration and hypercalcemia are not expected in chronic renal disease. Fluid volume overload and hypocalcemia are expected. Although impaired immune function should be expected, elevated white blood cells would indicate inflammation or infection not associated with chronic renal failure itself but a complication.

17. The nurse is providing teaching to a group of perimenopausal women. Which herbs and/or supplements would the nurse include in a discussion regarding effective alternative therapies for menopausal symptoms (select all that apply.)? a. Soy b. Garlic c. Gingko d. Vitamin A e. Cinnamon f. Black cohosh

ANS:A, F There is good scientific evidence that soy is useful in decreasing menopausal hot flashes and that black cohosh is safe to use for up to 6 months to decrease menopausal symptoms. Garlic, gingko, vitamin A, and cinnamon do not affect menopausal symptoms.

21. Which assessment findings would alert the nurse that the patient has entered the diuretic phase of acute kidney injury (AKI) (select all that apply.)? a. Dehydration b. Hypokalemia c. Hypernatremia d. BUN increases e. Urine output increases f. Serum creatinine increases

ANS:A,B,E The hallmark of entering the diuretic phase is the production of copious amounts of urine. Dehydration, hypokalemia, and hyponatremia occur in the diuretic phase of AKI because the nephrons can excrete wastes but not concentrate urine. Serum BUN and serum creatinine levels begin to decrease.

9. A patient with end-stage renal disease (ESRD) secondary to diabetes mellitus has arrived at the outpatient dialysis unit for hemodialysis. Which assessments should the nurse perform as a priority before, during, and after the treatment? a. Level of consciousness b. Blood pressure and fluid balance c. Temperature, heart rate, and blood pressure d. Assessment for signs and symptoms of infection

ANS:B Although all of the assessments are relevant to the care of a patient receiving hemodialysis, fluid removal during the procedure will require monitoring blood pressure and fluid balance prior, during, and after.

18. A 24-yr-old woman donated a kidney via a laparoscopic donor nephrectomy to a nonrelated recipient. The patient is experiencing significant pain and refuses to get up to walk. How should the nurse respond? a. Have the transplant psychologist convince her to walk. b. Encourage even a short walk to avoid complications of surgery. c. Tell the patient that no other patients have ever refused to walk. d. Tell the patient she is lucky she did not have an open nephrectomy.

ANS:B Because ambulating will improve bowel, lung, and kidney function with improved circulation, even a short walk with assistance should be encouraged after pain medication. The transplant psychologist or social worker's role is to determine if the patient is emotionally stable enough to handle donating a kidney; postoperative care is the nurse's role. Trying to shame the patient into walking by telling her that other patients have not refused and telling the patient she is lucky she did not have an open nephrectomy (implying how much more pain she would be having if it had been open) will not be beneficial to the patient or her postoperative recovery.

5. The nurse is caring for a 62-yr-old woman taking tolterodine (Detrol) to treat urinary urgency and incontinence. Which instruction should be included in the discharge plan? a. "Stop smoking for 2 to 3 weeks before starting to take this medication." b. "Suck on sugarless candy or chew sugarless gum if you develop a dry mouth." c. "Have your vision checked every 6 months because this drug can cause cataracts." d. "Ask your physician to prescribe an extended-release form if you have loose stools."

ANS:B Dry mouth is a common side effect of tolterodine. Patients can suck on hard candy or ice chips or chew gum if dry mouth occurs. Tobacco use does not affect the initiation of this medication. Visual changes (but not cataracts) can occur while taking this medication. Constipation may occur as a side effect of this medication.

1. The nurse is caring for a 68-yr-old man who had coronary artery bypass surgery 3 weeks ago. During the oliguric phase of acute kidney disease, which action would be appropriate to include in the plan of care? a. Provide foods high in potassium. b. Restrict fluids based on urine output. c. Monitor output from peritoneal dialysis. d. Offer high-protein snacks between meals.

ANS:B Fluid intake is monitored during oliguric phase. Fluid intake determined by adding all losses for previous 24 hours plus 600 mL. Potassium & protein intake may be limited in oliguric phase to avoid hyperkalemia & elevated urea nitrogen. Hemodialysis, not peritoneal dialysis, is indicated in AKI if dialysis is needed.

7. Which nursing intervention is most appropriate in providing care for an adult patient with newly diagnosed adult onset polycystic kidney disease (PKD)? a. Help the patient cope with the rapid progression of the disease. b. Suggest genetic counseling resources for the children of the patient. c. Expect the patient to have polyuria and poor concentration ability of the kidneys. d. Implement appropriate measures for the patient's deafness and blindness in addition to the renal problems.

ANS:B PKD is one of the most common genetic diseases. The adult form of PKD may range from a relatively mild disease to one that progresses to chronic kidney disease. Polyuria, deafness, and blindness are not associated with PKD.

3. The nurse provides nutritional counseling for a 45-yr-old man with nephrotic syndrome. The nurse determines teaching has been successful if the patient selects which breakfast menu? a. Scrambled eggs, milk, yogurt, and sliced ham b. Oatmeal, nondairy creamer, banana, and orange juice c. Cottage cheese, peanut butter, white bread, and coffee d. Waffle, bacon strips, tomato juice, and canned peaches

ANS:B Patients with nephrotic syndrome should follow a low-sodium (2-3 g/day), low- to moderate-protein (0.5-0.6 g/kg/day) diet. Ham, milk products, peanut butter, and bacon are high in sodium. Eggs, milk products, and peanut butter are high in protein.

8. Which statement regarding continuous ambulatory peritoneal dialysis (CAPD) would be most important when teaching a patient new to the treatment? a. "Maintain a daily written record of blood pressure and weight." b. "It is essential that you maintain aseptic technique to prevent peritonitis." c. "You will be allowed a more liberal protein diet once you complete CAPD." d. "Continue regular medical and nursing follow-up visits while performing CAPD."

ANS:B Peritonitis is a potentially fatal complication of peritoneal dialysis, and thus it is imperative to teach the patient methods of prevention. Although the other teaching statements are accurate, they do not have the potential for morbidity and mortality that peritonitis does.

15. Which patient has the most significant risk factors for CKD? a. A 50-yr-old white woman with hypertension b. A 61-yr-old Native American man with diabetes c. A 40-yr-old Hispanic woman with cardiovascular disease d. A 28-yr-old African American woman with a urinary tract infection

ANS:B The 61-yr-old Native American with diabetes is the most at risk. Diabetes causes about 50% of CKD. This patient is the oldest, and Native Americans with diabetes develop CKD six times more frequently than other ethnic groups. HTN causes about 25% of CKD. Hispanics have CKD about 1.5 times more than non-Hispanics. African Americans have the highest rate of CKD because HTN is significantly increased in African Americans. A UTI will not cause CKD unless it is not treated or UTIs occur recurrently.

5. The home care nurse visits a 34-yr-old woman receiving peritoneal dialysis. Which statement indicates a need for immediate follow-up by the nurse? a. "Drain time is faster if I rub my abdomen." b. "The fluid draining from the catheter is cloudy." c. "The drainage is bloody when I have my period." d. "I wash around the catheter with soap and water."

ANS:B The primary clinical manifestation of peritonitis is a cloudy peritoneal effluent. Blood may be present in the effluent of women who are menstruating, and no intervention is indicated. Daily catheter care may include washing around the catheter with soap and water. Drain time may be facilitated by gently massaging the abdomen.

6. A nurse is admitting a patient with advanced renal carcinoma. Which clinical manifestations represent the "classic triad" observed in patients with renal cancer? a. Fever, chills, and flank pain b. Hematuria, flank pain, and palpable mass c. Hematuria, proteinuria, and palpable mass d. Flank pain, palpable abdominal mass, and proteinuria

ANS:B There are no characteristic early symptoms of renal carcinoma. The classic manifestations of gross hematuria, flank pain, and a palpable mass are those of advanced disease.

16. Diffusion, osmosis, and ultrafiltration occur in both hemodialysis and peritoneal dialysis. Which strategy is used to achieve ultrafiltration in peritoneal dialysis? a. Increasing the pressure gradient b. Increasing osmolality of the dialysate c. Decreasing the glucose in the dialysate d. Decreasing the concentration of the dialysate

ANS:B Ultrafiltration in peritoneal dialysis is achieved by increasing the osmolality of the dialysate with additional glucose. In hemodialysis, the increased pressure gradient from increased pressure in the blood compartment or decreased pressure in the dialysate compartment causes ultrafiltration. Decreasing the concentration of the dialysate in either peritoneal or hemodialysis will decrease the amount of fluid removed from the blood stream.

15. What should the nurse include when teaching about early detection of ovarian cancer? a. Report any pelvic or vaginal bleeding soon. b. Use estrogen with progestin for menopause. c. Obtain annual bimanual pelvic examinations. d. Receive a preventive bilateral oophorectomy.

ANS:C Because it is difficult for a patient to detect early clinical indicators of ovarian cancer, the best method of early detection is to have a yearly bimanual pelvic examination to palpate for an ovarian mass. Although pelvic or vaginal bleeding should be reported soon after it occurs, this rarely occurs with ovarian cancer and is not an early symptom. Oral contraceptives may be used or a preventive bilateral oophorectomy may be done to reduce the risk, but they would not be done to detect early ovarian cancer.

19. The physician has decided to use renal replacement therapy to remove large volumes of fluid from a patient who is hemodynamically unstable in the intensive care unit. The nurse should expect which treatment to be used for this patient? a. Hemodialysis (HD) three times per week b. Automated peritoneal dialysis (APD) c. Continuous venovenous hemofiltration (CVVH) d. Continuous ambulatory peritoneal dialysis (CAPD)

ANS:C CVVH removes large volumes of water and solutes from the patient over a longer period of time by using ultrafiltration and convection. HD three times per week would not be used for this patient because fluid and solutes build up and then are rapidly removed. With APD (used at night instead of during the day) fluid and solutes build up during the day and would not benefit this patient as much. CAPD will not as rapidly remove large amounts of fluid as CVVH can do.

3. A 56-yr-old woman with type 2 diabetes mellitus and chronic kidney disease has a serum potassium level of 6.8 mEq/L. Which finding will the nurse monitor for? a. Fatigue b. Hypoglycemia c. Cardiac dysrhythmias d. Elevated triglycerides

ANS:C Hyperkalemia is the most serious electrolyte disorder associated with kidney disease. Fatal dysrhythmias can occur when serum potassium level reaches 7 to 8 mEq/L. Fatigue and hypertriglyceridemia may be present but do not require urgent intervention. Hypoglycemia is a complication related to diabetes control, not hyperkalemia. However, admin of insulin and dextrose is an emergency treatment for hyperkalemia.

10. A patient is recovering in the intensive care unit (ICU) 24 hours after receiving a kidney transplant. What is an expected assessment finding during the earliest stage of recovery? a. Hypokalemia b. Hyponatremia c. Large urine output d. Leukocytosis with cloudy urine output

ANS:C Patients frequently experience diuresis in the hours and days immediately following a kidney transplant. Electrolyte imbalances and signs of infection are unexpected findings that warrant prompt intervention.

17. During hemodialysis, the patient develops light-headedness and nausea. What should the nurse do first? a. Administer hypertonic saline. b. Administer a blood transfusion. c. Decrease the rate of fluid removal. d. Administer antiemetic medications.

ANS:C The patient is experiencing hypotension from a rapid removal of vascular volume. The rate and volume of fluid removal will be decreased, and 0.9% saline solution may be infused. Hypertonic saline is not used because of the high sodium load. A blood transfusion is not indicated. Antiemetic medications may help the nausea but would not help the hypovolemia.

8. A 58-yr-old woman is 1-day postoperative after an abdominal hysterectomy. Which intervention should the nurse perform to prevent deep vein thrombosis (DVT)? a. Place the patient in a high Fowler's position. b. Provide pillows to place under the patient's knees. c. Encourage the patient to change positions frequently. d. Teach the patient deep breathing and coughing exercises.

ANS:C The patient should be encouraged to change positions frequently and ambulate to prevent venous stasis. The high Fowler's position and pressure under the knees should be avoided in order to prevent DVT. Deep breathing and coughing are therapeutic exercises but do not directly address the risk of DVT.

9. What action should be recommended to a woman recovering from surgical repair of a fistula? a. Douche daily to prevent postoperative infection. b. Remove and cleanse her pessary on a daily basis. c. Resume normal activity to prevent adhesion formation. d. Ensure that she does not place stress on the repaired area.

ANS:D After surgical repair of a fistula, the patient should avoid placing stress on the repaired region. Normal activity is not commonly resumed until significant healing has occurred. Douching is contraindicated, and pessaries are used to treat prolapses, not fistulas. 10. A pregnant woman is experiencing amenorrhea, morning sickness, and breast tenderness. In the ninth week after her last menstrual period, she is rushed to the hospital with severe left shoulder pain, blood pressure of 90/60 mm Hg, and heart rate of 112 beats/min. What is the best diagnostic test is expected? a. Serum hemoglobin b. Transvaginal ultrasound c. 12-lead electrocardiogram (ECG) d. Serial β-human chorionic gonadotropin levels @ANS:B Because the patient is known to be pregnant, a transvaginal ultrasound will be used to assess for ectopic pregnancy and tubal rupture. Serum hemoglobin and 12-lead ECG would not define a diagnosis related to the manifestations that she has. Serial β-human chorionic gonadotropin levels could be used if the patient was stable to determine if a spontaneous abortion is occurring because the levels would decrease over time.

4. A frail 72-yr-old woman with stage 3 chronic kidney disease is cared for at home by her family. The patient has a history of taking many over-the-counter medications. Which over-the-counter medications should the nurse teach the patient to avoid? a. Aspirin b. Acetaminophen c. Diphenhydramine d. Aluminum hydroxide

ANS:D Antacids (that contain magnesium and aluminum) should be avoided because patients with kidney disease are unable to excrete these substances. Also, some antacids contain high levels of sodium that further increase blood pressure. Acetaminophen and aspirin (if taken for a short period of time) are usually safe for patients with kidney disease. Antihistamines may be used, but combination drugs that contain pseudoephedrine may increase blood pressure and should be avoided.

7. Which nursing action is indicated when providing immediate care for a female patient who has experienced a sexual assault? a. Administering a pregnancy test Incorrect b. Monitoring of the patient's vital signs c. Ensuring the patient is left alone when possible d. Informing the patient about possible financial support

ANS:D Many sexual assault survivors are unaware of the availability of financial compensation (a law in most states) and appreciate information about the application process. A pregnancy test is premature, and the patient should not be left alone. There is rarely a specific indication for close monitoring of vital signs unless the extent of physical injury indicates a need.

Question number corresponds to the same-numbered outcome at the beginning of the chapter. 1. When caring for a patient with acute bronchitis, the nurse will prioritize a. auscultating lung sounds. b. encouraging fluid restriction. c. administering antibiotic therapy. d. teaching the patient to avoid cough suppressants. 1.

Correct answer: a Rationale: Assessment of lung sounds is a priority nursing intervention for patients with bronchitis. Evidence of consolidation would indicate progression of bronchitis to pneumonia, which would necessitate a change in treatment. Fluid intake and use of cough suppressants should be encouraged. Antibiotic treatment is generally not indicated.

12. A priority nursing intervention for a patient who has just undergone a chemical pleurodesis for recurrent pleural effusion is a. administering ordered analgesia. b. monitoring chest tube drainage. c. sending pleural fluid for laboratory analysis. d. monitoring the patient's level of consciousness. 12.

Correct answer: a Rationale: Chemical pleurodesis involves the instillation of a chemical slurry after the pleural effusion is drained. The chest tubes are clamped while the patient is turned in different positions. Pain is common, and thus analgesic agents should be administered.

7. The emergency department nurse is caring for patients exposed to a chlorine leak from a local factory. The nurse would closely monitor these patients for a. pulmonary edema. b. anaphylactic shock. c. respiratory alkalosis. d. acute tubular necrosis. 7.

Correct answer: a Rationale: Chemical pneumonitis results from exposure to toxic chemical fumes. In the acute scenario, lung injury is diffuse and characterized as pulmonary edema.

13. A 70-year-old male patient has multiple myeloma. His wife calls to report that he sleeps most of the day, is confused when awake, and complains of nausea and constipation. Which complication of cancer is this most likely caused by? a. Hypercalcemia b. Tumor lysis syndrome c. Spinal cord compression d. Superior vena cava syndrome 13.

Correct answer: a Rationale: Hypercalcemia can occur with multiple myeloma. Immobility and dehydration can contribute to or exacerbate hypercalcemia. The primary manifestations of hypercalcemia include apathy, depression, fatigue, muscle weakness, electrocardiographic changes, polyuria and nocturia, anorexia, nausea, and vomiting.

9. An ESRD patient receiving hemodialysis is considering asking a relative to donate a kidney for transplantation. In assisting the patient to make a decision about treatment, the nurse informs the patient that a. successful transplantation usually provides better quality of life than that offered by dialysis. b. if rejection of the transplanted kidney occurs, no further treatment for the renal failure is available. c. hemodialysis replaces the normal functions of the kidneys, and patients do not have to live with the continual fear of rejection. d. the immunosuppressive therapy following transplantation makes the person ineligible to receive other forms of treatment if the kidney fails. 9.

Correct answer: a Rationale: Kidney transplantation is extremely successful, with 1-year graft survival rates about 90% for deceased donor organs & 95% for live donor organs. An advantage of kidney transplantation over dialysis is that it reverses many of the pathophysiologic changes associated with renal failure when normal kidney function is restored. It also eliminates the dependence on dialysis and the need for the accompanying dietary and lifestyle restrictions. Transplantation is less expensive than dialysis after the first year.

14. A patient has recently been diagnosed with early stages of breast cancer. What is most appropriate for the nurse to focus on? a. Maintaining the patient's hope b. Preparing a will and advance directives c. Discussing replacement child care for the patient's children d. Discussing the patient's past experiences with her grandmother's cancer 14.

Correct answer: a Rationale: Maintain hope, which is the key to effective cancer care. Hope depends on the status of the patient: hope that the symptoms are not serious, hope that the treatment is curative, hope for independence, hope for relief of pain, hope for a longer life, or hope for a peaceful death. Hope provides control over what is occurring and is the basis of a positive attitude toward cancer and cancer care.

5. In planning care for a patient with metastatic liver cancer, the nurse should include interventions that a. focus primarily on symptomatic and comfort measures. b. reassure the patient that chemotherapy offers a good prognosis. c. promote the patient's confidence that surgical excision of the tumor will be successful. d. provide information necessary for the patient to make decisions regarding liver transplantation. 5.

Correct answer: a Rationale: Nursing intervention for a patient with liver cancer focuses on keeping the patient as comfortable as possible. The prognosis for patients with liver cancer is poor. The cancer grows rapidly, and death may occur within 4 to 7 months as a result of hepatic encephalopathy or massive blood loss from gastrointestinal (GI) bleeding.

9. Important patient teaching after a chemical peel includes a. avoidance of sun exposure. b. application of firm bandages. c. limitation of vigorous exercise. d. use of moist heat to relieve discomfort. 9.

Correct answer: a Rationale: Patient teaching after a chemical peel should include instructions to use sunscreen and to avoid sun exposure for 6 months to prevent hyperpigmentation.

4. A mother and her two children have been diagnosed with pediculosis corporis at a health care center. An appropriate measure in treating this condition is a. applying pyrethrins to the body. b. topical application of griseofulvin. c. moist compresses applied frequently. d. administration of systemic antibiotics. 4.

Correct answer: a Rationale: Pediculosis corporis (i.e., body lice) is treated with γ-benzene hexachloride or pyrethrins.

5. A patient has been receiving high-dose corticosteroids and broad-spectrum antibiotics for treatment secondary to a traumatic injury and infection. The nurse plans care for the patient knowing that the patient is most susceptible to a. candidiasis. b. aspergillosis. c. histoplasmosis. d. coccidioidomycosis. 5.

Correct answer: a Rationale: Pulmonary fungal infections occur most commonly in seriously ill patients being treated with corticosteroids, antineoplastic, and immunosuppressive drugs or with multiple antibiotics and in patients with human immunodeficiency virus (HIV) infection and cystic fibrosis. Candida albicans is the leading cause of fungal infections.

4. The best method for determining the risk of 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. assess for change of sputum color 48 hours after patient drinks small amount of blue dye. d. suction above the cuff after the patient eats or drinks to determine presence of food in trachea. 4.

Correct answer: a Rationale: The ability to swallow secretions without aspiration has traditionally been evaluated with the use of blue dye. Recent studies, however, do not support this test, and it is no longer recommended. Instead, clinical assessment by a speech therapist, videofluoroscopy, or fiberoptic endoscopic evaluations of swallow are recommended. Patients should begin swallowing with thickened liquids, not plain water. Ability to swallow should be assessed with the cuff deflated, because cuff inflation may interfere with swallowing ability.

The number of the question corresponds to the same-numbered outcome at the beginning of the chapter. 1. A patient with hepatitis A is in the acute phase. The nurse plans care for the patient based on the knowledge that a. pruritus is a common problem with jaundice in this phase. b. the patient is most likely to transmit the disease during this phase. c. gastrointestinal symptoms are not as severe in hepatitis A as they are in hepatitis B. d. extrahepatic manifestations of glomerulonephritis and polyarteritis are common in this phase. 1.

Correct answer: a Rationale: The acute phase of jaundice may be icteric or anicteric. Jaundice results when bilirubin diffuses into the tissues. Pruritus sometimes accompanies jaundice. Pruritus is the result of an accumulation of bile salts beneath the skin.

2. When teaching a patient with malignant melanoma about this disorder, the nurse recognizes that the patient's prognosis is most dependent on a. the thickness of the lesion. b. the degree of asymmetry in the lesion. c. the amount of ulceration in the lesion. d. how much the lesion has spread superficially. 2.

Correct answer: a Rationale: The most important prognostic factor is tumor thickness at the time of diagnosis. Two methods are used to determine thickness. The Breslow measurement indicates the depth of the tumor in millimeters, and the Clark level indicates the depth of invasion of the tumor. The higher the number, the deeper the melanoma.

12. A kidney transplant recipient complains of having fever, chills, and dysuria over the past 2 days. What is the first action that the nurse should take? a. Assess temperature and initiate workup to rule out infection. b. Reassure the patient that this is common after transplantation. c. Provide warm cover for the patient and give 1 g acetaminophen orally. d. Notify the nephrologist that the patient has developed symptoms of acute rejection. 12.

Correct answer: a Rationale: The nurse must be astute in the observation and assessment of kidney transplant recipients because prompt diagnosis and treatment of infections can improve patient outcomes. Fever, chills, and dysuria indicate an infection. The temperature should be assessed, and the patient should undergo diagnostic testing to rule out an infection.

10. The nurse notes tidaling of the water level in the tube submerged in the waterseal chamber in a patient with closed chest tube drainage. The nurse should a. continue to monitor the patient. b. check all connections for a leak in the system. c. lower the drainage collector further from the chest. d. clamp the tubing at progressively distal points away from the patient until the tidaling stops. 10.

Correct answer: a Rationale: Tidaling is a normal fluctuation of the water in the water-seal chamber of a chest tube. Tidaling reflects the intrapleural pressure during inspiration and expiration.

4. The patient with advanced cirrhosis asks why his abdomen is so swollen. The nurse's response is based on the knowledge that a. a lack of clotting factors promotes the collection of blood in the abdominal cavity. b. portal hypertension and hypoalbuminemia cause a fluid shift into the peritoneal space. c. decreased peristalsis in the GI tract contributes to gas formation and distention of the bowel. d. bile salts in the blood irritate the peritoneal membranes, causing edema and pocketing of fluid. 4.

Correct answer: b Rationale: Ascites is the accumulation of serous fluid in the peritoneal or abdominal cavity and is a common manifestation of cirrhosis. With portal hypertension, proteins shift from the blood vessels through the larger pores of the sinusoids (capillaries) into the lymph space. When the lymphatic system is unable to carry off the excess proteins and water, those substances leak through the liver capsule into the peritoneal cavity. Osmotic pressure of the proteins pulls additional fluid into the peritoneal cavity. A second mechanism of ascites formation is hypoalbuminemia, which results from the inability of the liver to synthesize albumin. Hypoalbuminemia results in decreased colloidal oncotic pressure. A third mechanism is hyperaldosteronism, which occurs when aldosterone is not metabolized by damaged hepatocytes. The increased level of aldosterone causes increases in sodium reabsorption by the renal tubules. Sodium retention and an increase in antidiuretic hormone levels cause additional water retention.

8. The nurse explains to a patient undergoing brachytherapy of the cervix that she a. must undergo simulation to locate the treatment area. b. requires the use of radioactive precautions during nursing care. c. may experience desquamation of the skin on the abdomen and upper legs. d. requires shielding of the ovaries during treatment to prevent ovarian damage. 8.

Correct answer: b Rationale: Brachytherapy consists of the implantation or insertion of radioactive materials directly into the tumor or adjacent to the tumor. Caring for the person undergoing brachytherapy or receiving radiopharmaceuticals requires the nurse to take special precautions. The principles of ALARA (as low as reasonably achievable) and of time, distance, and shielding are vital to health care professional safety in caring for the person with an internal radiation source.

6. During the assessment of a patient, you note an area of red, sharply defined plaques covered with silvery scales that are mildly itchy on the patient's knees and elbows. You recognize this finding as a. lentigo. b. psoriasis. c. actinic keratosis. d. seborrheic keratosis. 6.

Correct answer: b Rationale: Clinical manifestations of psoriasis include sharply demarcated, silvery scaling plaques on reddish skin, commonly on the scalp, elbows, knees, palms, soles, and fingernails; itching, burning, and pain; localized or general, intermittent or continuous pattern; and symptoms that vary in intensity from mild to severe.

10. To prevent fever and shivering during an infusion of rituximab (Rituxan), the nurse should premedicate the patient with a. aspirin. b. acetaminophen. c. sodium bicarbonate. d. meperidine (Demerol). 10.

Correct answer: b Rationale: Common side effects of rituximab include constitutional flu-like symptoms, including headache, fever, chills, myalgias, fatigue, malaise, weakness, anorexia, and nausea. The patient is commonly premedicated with acetaminophen in an attempt to prevent or decrease the intensity of these symptoms, and large amounts of fluids help decrease symptoms.

When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes a. maintaining the patient on bed rest. b. using sequential compression devices. c. encouraging the patient to cough and deep breathe. d. teaching the patient how to use the incentive spirometer. 13.

Correct answer: b Rationale: Deep vein thrombosis (DVT) is the primary cause of pulmonary embolism. Preventing DVT with the use of sequential compression devices, early ambulation, and prophylactic use of anticoagulant medications would thus be a priority nursing intervention

2. A patient with acute hepatitis B is being discharged in 2 days. The discharge teaching plan should include instructions to a. avoid alcohol for the first 3 weeks. b. use a condom during sexual intercourse. c. have family members get an injection of immunoglobulin. d. follow a low-protein, moderate-carbohydrate, moderate-fat diet. 2.

Correct answer: b Rationale: Hepatitis B virus may be transmitted by mucosal exposure to infected blood, blood products, or other body fluids (e.g., semen, vaginal secretions, saliva). Hepatitis B is a sexually transmitted disease that is acquired through unprotected sex with an infected person. Condom use should be taught to patients to prevent transmission of hepatitis B.

6. When caring for a patient with a lung abscess, what is the nurse's priority intervention? a. Postural drainage b. Antibiotic administration c. Obtaining a sputum specimen d. Patient teaching regarding home care 6.

Correct answer: b Rationale: IV antibiotic therapy should be started as soon as possible. Postural drainage is not recommended because it may cause dissemination of infection into other bronchi. Findings in a sputum specimen are not diagnostic for a lung abscess. Patient teaching regarding home care is important but not the priority.

3. The nurse determines that a patient with a diagnosis of which disorder is most at risk for spreading the disease? a. Tinea pedis b. Impetigo on the face c. Candidiasis of the nails d. Psoriasis on the palms and soles 3.

Correct answer: b Rationale: Impetigo is caused by a bacterial infection (group A β-hemolytic streptococci or staphylococci) and is highly contagious. Good skin hygiene and infection control practices are necessary to prevent the spread of this infection. Tinea pedis and candidiasis are fungal infections. Psoriasis is an autoimmune chronic dermatitis and is not contagious.

3. A patient has been told that she has elevated liver enzymes caused by nonalcoholic fatty liver disease (NAFLD). The nursing teaching plan should include a. having genetic testing done. b. recommending a heart-healthy diet. c. the necessity to reduce weight rapidly. d. avoiding alcohol until liver enzymes return to normal. 3.

Correct answer: b Rationale: Nonalcoholic fatty liver disease (NAFLD) can progress to liver cirrhosis. There is no definitive treatment, and therapy is directed at reduction of risk factors, which include treatment of diabetes, reduction in body weight, and elimination of harmful medications. For patients who are overweight, weight reduction is important. Weight loss improves insulin sensitivity and reduces liver enzyme levels. No specific dietary therapy is recommended. However, a heart-healthy diet as recommended by the American Heart Association is appropriate.

The nurse receives an order for a patient with lung cancer to receive influenza vaccine and pneumococcal vaccines. The nurse will a. call the health care provider to question the order. b. administer both vaccines at the same time in different arms. c. administer the flu shot and tell the patient to come back 1 week later to receive the pneumococcal vaccine. d. administer the pneumococcal vaccine and suggest FluMist (nasal vaccine) instead of the influenza injection. 8.

Correct answer: b Rationale: Patients at risk for pneumonia (e.g., patients with lung cancer) should obtain influenza and pneumococcal vaccines. The vaccines may be administered at the same time in different arms.

9. Teaching in relation to home management after a laparoscopic cholecystectomy should include a. keeping the bandages on the puncture sites for 48 hours. b. reporting any bile-colored drainage or pus from any incision. c. using over-the-counter antiemetics if nausea and vomiting occur. d. emptying and measuring the contents of the bile bag from the T tube every day. 9.

Correct answer: b Rationale: The following discharge instructions are taught to the patient and caregiver after a laparoscopic cholecystectomy: First, remove the bandages on the puncture site the day after surgery and shower. Second, notify the surgeon if any of the following signs and symptoms occur: redness, swelling, bile-colored drainage or pus from any incision; and severe abdominal pain, nausea, vomiting, fever, or chills. Third, gradually resume normal activities. Fourth, return to work within 1 week of surgery. Fifth, resume a usual diet, but a low-fat diet is usually better tolerated for several weeks after surgery.

1. In telling a patient with infertility what she and her partner can expect, the nurse explains that a. ovulatory studies can help determine tube patency. b. a hysterosalpingogram is a common diagnostic study. c. the cause will remain unexplained for 40% of couples. d. if postcoital studies are normal, infection tests will be done. 1.

Correct answer: b Rationale: Tubal factors (i.e., occlusion or deformity) are assessed most commonly by means of hysterosalpingogram.

5. Which nursing action would be of highest priority when suctioning a patient with tracheostomy? a. Auscultating lung sounds after suctioning is complete b. Providing a means of communication for the patient during the procedure c. Assessing the patient's oxygenation saturation before, during, and after suctioning d. Administering pain and/or antianxiety medication 30 minutes before suctioning 5.

Correct answer: c Rationale: A patient with a tracheostomy is at risk for hypoxemia during and after suctioning. Patients should always be pre-oxygenated with 100% FIO2 prior to suctioning. In addition, it is imperative to monitor the patient's O2 status before, during, and after suctioning.

4. To prevent or decrease age-related changes that occur after menopause in a patient who chooses not to take hormone therapy, the most important self-care measure to teach is a. maintaining usual sexual activity. b. increasing the intake of dairy products. c. performing regular aerobic, weight-bearing exercise. d. taking vitamin E and B-complex vitamin supplements. 4.

Correct answer: c Rationale: A regular program (three to four times per week) of moderate aerobic and weight-bearing exercises can slow the process of bone loss and a tendency toward weight gain. Exercise is important for menopausal women in modifying risk factors for coronary artery disease, including stress, obesity, physical inactivity, and hypertension.

8. To decrease the patient's discomfort related to discussing his reproductive organs, the nurse should a. relate his sexual concerns to his sexual partner. b. arrange to have male nurses care for the patient. c. maintain a nonjudgmental attitude toward his sexual practices. d. use technical terminology when discussing reproductive function. 8.

Correct answer: c Rationale: Conducting routine health assessments on men places the nurse in a unique position. It provides an opportunity to ask the patient questions about general health and about sexual health and function. Given the opportunity, men are less hesitant to answer these questions when they know that someone cares and can provide them with answers. The nurse must remain nonjudgmental about sexual practices.

9. The nurse identifies a flail chest in a trauma patient when a. multiple rib fractures are determined by x-ray. b. a tracheal deviation to the unaffected side is present. c. paradoxical chest movement occurs during respiration. d. there is decreased movement of the involved chest wall. 9.

Correct answer: c Rationale: Flail chest produces paradoxical respiration. On inspiration, the flail section sinks in, with a mediastinal shift to the uninjured side. On expiration, the flail section bulges outward, with a mediastinal shift to the injured side.

4. If a patient is in diuretic phase of AKI, the nurse must monitor for which serum electrolyte imbalances? a. Hyperkalemia and hyponatremia b. Hyperkalemia and hypernatremia c. Hypokalemia and hyponatremia d. Hypokalemia and hypernatremia 4.

Correct answer: c Rationale: In the diuretic phase of AKI, the kidneys have recovered the ability to excrete wastes but not the ability to concentrate urine. Hypovolemia and hypotension can result from massive fluid losses. Because of the large losses of fluid and electrolytes, the patient must be monitored for hyponatremia, hypokalemia, and dehydration.

9. A patient on chemotherapy and radiation for head and neck cancer has a WBC count of 1.9 × 103/µL, hemoglobin of 10.8 g/dL, and a platelet count of 99 × 103/µL. Based on the CBC results, what is the most serious clinical finding? a. Cough, rhinitis, and sore throat b. Fatigue, nausea, and skin redness at site of radiation c. Temperature of 101.9° F, fatigue, and shortness of breath d. Skin redness at site of radiation, headache, and constipation 9.

Correct answer: c Rationale: Neutropenia is more common in patients receiving chemotherapy than in those receiving radiation, and it can seriously increase the risk for life-threatening infection and sepsis. Any sign of infection should be treated promptly because fever in the setting of neutropenia is a medical emergency.

3. The nurse should advise the woman recovering from surgical treatment of an ectopic pregnancy that a. she has an increased risk for salpingitis. b. bed rest must be maintained for 12 hours to assist in healing. c. having one ectopic pregnancy increases her risk for another one. d. intrauterine devices and infertility treatments should be avoided. 3.

Correct answer: c Rationale: Risk factors for ectopic pregnancy include a history of pelvic inflammatory disease, prior ectopic pregnancy, current use of a progestin-releasing intrauterine device (IUD), failure of progestin-only birth control, prior pelvic or tubal surgery, and procedures used in infertility treatment.

11. The nurse counsels the patient receiving radiation therapy or chemotherapy that a. effective birth control methods should be used for the rest of the patient's life. b. if nausea and vomiting occur during treatment, the treatment plan will be modified. c. after successful treatment, a return to the person's previous functional level can be expected. d. the cycle of fatigue-depression-fatigue that may occur during treatment may be reduced by restricting activity. 11.

Correct answer: c Rationale: Some cancer survivors may continue to experience symptoms or functional impairment related to treatment for years after treatment. Others who have successful treatment may not have any functional limitations. A cancer diagnosis can affect many aspects of a patients' life; cancer survivors commonly report financial, vocational, marital, and emotional concerns long after treatment is over. Resources for survivors are listed in Table 15-20.

11. Following a pneumonectomy, an appropriate nursing intervention is a. monitoring chest tube drainage and functioning. b. positioning the patient on the unaffected side or back. c. doing range-of-motion exercises on the affected upper limb. d. auscultating frequently for lung sounds on the affected side. 11.

Correct answer: c Rationale: Teach a patient who has had a pneumonectomy (i.e., removal of one whole lung) to perform range-of-motion exercises on the surgical side that are similar to those for patients who have undergone mastectomy. The patient will not always have chest tube drainage, should not be positioned on the unoperative tube, and will not have lung sounds on the operative side because the entire lung has been removed.

7. A patient with pancreatic cancer is admitted to the hospital for evaluation of possible treatment options. The patient asks the nurse to explain the Whipple procedure that the surgeon has described. The explanation includes the information that a Whipple procedure involves a. creating a bypass around the obstruction caused by the tumor by joining the gallbladder to the jejunum. b. resection of the entire pancreas and the distal portion of the stomach, with anastomosis of the common bile duct and the stomach into the duodenum. c. removal of part of the pancreas, part of the stomach, the duodenum, and the gallbladder, with joining of the pancreatic duct, the common bile duct, and the stomach into the jejunum. d. radical removal of the pancreas, the duodenum, and the spleen, and attachment of the stomach to the jejunum, which requires oral supplementation of pancreatic digestive enzymes and insulin replacement therapy. 7.

Correct answer: c Rationale: The classic operation for pancreatic cancer is a radical pancreaticoduodenectomy, or Whipple procedure. This entails resection of the proximal pancreas (i.e., proximal pancreatectomy), the adjoining duodenum (i.e., duodenectomy), the distal portion of the stomach (i.e., partial gastrectomy), and the distal segment of the common bile duct. The pancreatic duct, common bile duct, and stomach are anastomosed to the jejunum.

6. The goals of cancer treatment are based on the principle that a. surgery is the single most effective treatment for cancer. b. initial treatment is always directed toward cure of the cancer. c. a combination of treatment modalities is effective for controlling many cancers. d. although cancer cure is rare, quality of life can be increased with treatment modalities. 6.

Correct answer: c Rationale: The goals of cancer treatment are cure, control, and palliation. When cure is the goal, treatment is offered that is expected to have the greatest chance of disease eradication. Curative cancer therapy depends on the particular cancer being treated and may involve local therapies (i.e., surgery or radiation) alone or in combination, with or without adjunctive systemic therapy (i.e., chemotherapy).

5. A common site for the lesions associated with atopic dermatitis is the a. buttocks. b. temporal area. c. antecubital space. d. plantar surface of the feet. 5.

Correct answer: c Rationale: The most common location for atopic dermatitis in adults is the antecubital or popliteal space.

5. In caring for a patient with endometriosis, the nurse teaches the patient that interventions used to treat or cure this condition may include (select all that apply) a. radiation. b. antibiotic therapy. c. oral contraceptives. d. surgical removal of tissue. e. total abdominal hysterectomy and salpingo-oophorectomy. 5.

Correct answer: c, d, e Rationale: Interventions to treat or manage endometriosis include oral contraceptives, laparotomy to remove implanted tissue and adhesions, and/or total abdominal hysterectomy and bilateral salpingo-oopherectomy.

3. An appropriate nursing intervention for a patient with pneumonia with the nursing diagnosis of ineffective airway clearance related to thick secretions and fatigue would be to a. perform postural drainage every hour. b. provide analgesics as ordered to promote patient comfort. c. administer O2 as prescribed to maintain optimal O2 levels. d. teach the patient how to cough effectively to bring secretions to the mouth. 3.

Correct answer: d Rationale: A forced expiratory technique (i.e., huff coughing) clears secretions with less change in pleural pressure and less likelihood of bronchial collapse. Before the patient attempts coughing, the nurse should ensure the patient is breathing deeply from the diaphragm. The nurse should place hands on the patient's lower lateral chest wall and then ask the patient to breathe deeply through the nose. The nurse's hands should move outward, which represents a breath from the diaphragm.

8. A patient with acne vulgaris tells the nurse that she has quit her job as a receptionist because she believes her facial appearance is unattractive to customers. The nursing diagnosis that best describes this patient response is a. ineffective coping related to lack of social support. b. impaired skin integrity related to presence of lesions. c. anxiety related to lack of knowledge of the disease process. d. social isolation related to decreased activities secondary to fear of rejection. 8.

Correct answer: d Rationale: Acne can develop and persist into adulthood, with flares occurring during menses and with the use of androgen-dominant birth control pills. Affected patients may withdraw from social contacts because of visible lesions.

6. Nursing responsibilities related to the patient with endometrial cancer who has a total abdominal hysterectomy and salpingectomy and oophorectomy include a. maintaining absolute bed rest. b. keeping the patient in high Fowler's position. c. need for supplemental estrogen after removal of ovaries. d. encouraging movement and walking as much as tolerated. 6.

Correct answer: d Rationale: After an abdominal hysterectomy and salpingectomy and oophorectomy the nurse should encourage the patient to be mobile. Bed rest is not indicated and may increase complications. Estrogen is not used following surgery.

2. A patient with allergic rhinitis reports severe nasal congestion; sneezing; and watery, itchy eyes and nose at various times of the year. To teach the patient to control these symptoms, the nurse advises 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. 2.

Correct answer: d Rationale: An important intervention involves identifying and avoiding triggers of allergic reactions. The nurse should instruct the patient to keep a diary of times when the allergic reaction occurs and of the activities that precipitate the reaction.

6. In assessing a patient for testicular cancer, the nurse understands that the manifestations of this disease often include a. acute back spasms and testicular pain. b. rapid onset of scrotal swelling and fever. c. fertility problems and bilateral scrotal tenderness. d. painless mass and heaviness sensation in the scrotal area. 6.

Correct answer: d Rationale: Clinical manifestations of testicular cancer include a painless lump in the scrotum, scrotal swelling, and a feeling of heaviness. The scrotal mass usually is not tender and is very firm. Some patients complain of a dull ache or heavy sensation in the lower abdomen, perianal area, or scrotum.

7. The most effective method of administering a chemotherapy agent that is a vesicant is to a. give it orally. b. give it intraarterially. c. use an Ommaya reservoir. d. use a central venous access device. 7.

Correct answer: d Rationale: If vesicants are inadvertently infiltrated into the skin, severe local tissue breakdown and necrosis may result. It is extremely important to monitor for and promptly recognize symptoms associated with extravasation of a vesicant and to take immediate action if it occurs. The infusion should be immediately turned off, and protocols for drug-specific extravasation procedures should be followed to minimize further tissue damage. Infusion with central venous access devices can reduce the risk of infiltration of chemotherapy agents that are vesicants.

7. 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? a. Notify the physician immediately. b. Place the patient in the prone position to facilitate drainage. c. Instill 3 mL of normal saline into the tracheostomy tube to loosen secretions. d. Continue your assessment of the patient, including O2 saturation, respiratory rate, and breath sounds. 7.

Correct answer: d Rationale: Immediately after surgery, the patient with a laryngectomy requires frequent suctioning by means of the laryngectomy tube. Secretions typically change in amount and consistency over time. Secretions may initially be blood-tinged and then diminish in amount and become less bloody over time. Normal saline through the tracheostomy tube is not recommended to assist with removal of thickened secretions because it causes hypoxia and may contribute to the development of ventilator-associated pneumonia (VAP).

12. A patient on chemotherapy for 10 weeks started at a weight of 121 lb. She now weighs 118 lb and has no sense of taste. Which nursing intervention would be a priority? a. Advise the patient to eat foods that are fatty, fried, or high in calories. b. Discuss with the physician the need for parenteral or enteral feedings. c. Advise the patient to drink a nutritional supplement beverage at least three times a day. d. Advise the patient to experiment with spices and seasonings to enhance the flavor of food. 12.

Correct answer: d Rationale: Instruct the patient to experiment with spices and other seasoning agents in an attempt to mask taste alterations. Lemon juice, onion, mint, basil, and fruit juice marinades may improve the taste of certain meats and fish. Onion and pieces of ham may enhance the taste of vegetables.

8. The nursing management of the patient with cholecystitis associated with cholelithiasis is based on the knowledge that a. shock-wave therapy should be tried initially. b. once gallstones are removed, they tend not to recur. c. the disorder can be successfully treated with oral bile salts that dissolve gallstones. d. laparoscopic cholecystectomy is the treatment of choice in most patients who are symptomatic. 8.

Correct answer: d Rationale: Laparoscopic cholecystectomy is the treatment of choice for symptomatic cholelithiasis.

2. An appropriate question to ask the patient with painful menstruation to differentiate primary from secondary dysmenorrhea is a. "Does your pain become worse with activity or overexertion?" b. "Have you had a recent personal crisis or change in your lifestyle?" c. "Is your pain relieved by nonsteroidal antiinflammatory medications?" d. "When in your menstrual history did the pain with your period begin?" 2.

Correct answer: d Rationale: Primary dysmenorrhea starts 12 to 24 hours before the onset of menses. The pain is most severe on the first day of menses and rarely lasts more than 2 days. Secondary dysmenorrhea usually occurs after the woman has experienced problem-free periods for some time. The pain may be unilateral, and it is usually more constant and continues longer than in primary dysmenorrhea. Depending on the cause, symptoms such as dyspareunia (pain during intercourse), pain during defecation, or irregular bleeding may occur at times other than menstruation.

3. A characteristic of the stage of progression in the development of cancer is a. oncogenic viral transformation of target cells. b. a reversible steady growth facilitated by carcinogens. c. a period of latency before clinical detection of cancer. d. proliferation of cancer cells despite host control mechanisms. 3.

Correct answer: d Rationale: Progression is the final stage of cancer. This stage is characterized by increased growth rate of the tumor, increased invasiveness, and spread of the cancer to a distant site (i.e., metastasis). Progression occurs as a result of the following characteristics of cancer cells: rapid proliferation and decreased cell adhesion.

2. RIFLE defines three stages of AKI based on changes in a. blood pressure and urine osmolality. b. fractional excretion of urinary sodium. c. estimation of GFR with the MDRD equation. d. serum creatinine or urine output from baseline. 2.

Correct answer: d Rationale: The RIFLE classification is used to describe the stages of AKI. RIFLE standardizes the diagnosis of AKI. Risk (R) is the first stage of AKI, followed by injury (I), which is the second stage, and then increasing in severity to the final or third stage of failure (F). The two outcome variables are loss (L) and end-stage renal disease (E). The first three stages are characterized by the serum creatinine level and urine output.

Question number corresponds to the same-numbered outcome at the beginning of the chapter. 1. A patient was seen in the clinic for an episode of epistaxis, which was controlled by placement of anterior nasal packing. During discharge teaching, the nurse instructs the patient to a. use aspirin for pain relief. b. remove the packing later that day. c. skip the next dose of antihypertensive medication. d. avoid vigorous nose blowing and strenuous activity. 1.

Correct answer: d Rationale: The nurse should teach the patient about home care before discharge: to avoid vigorous nose blowing, strenuous activity, lifting, and straining for 4 to 6 weeks; to sneeze with the mouth open; and to avoid the use of aspirin-containing products or nonsteroidal antiinflammatory drugs (NSAIDs).

8. Nutritional support and management are essential across the entire continuum of chronic kidney disease. Which statements would be considered true related to nutritional therapy (SATA)? a. Fluid is not usually restricted for patients receiving peritoneal dialysis. b. Sodium and potassium may be restricted in someone with advanced CKD. c. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving hemodialysis. d. Decreased fluid intake and a low-potassium diet are hallmarks of the diet for a patient receiving peritoneal dialysis. e. Decreased fluid intake and a diet with phosphate-rich foods are hallmarks of a diet for a patient receiving hemodialysis. 8.

Correct answers: a, b, c Rationale: Water and any other fluids are not routinely restricted before Stage 5 end-stage renal disease (ESRD). Patients receiving hemodialysis have a more restricted diet than do patients receiving peritoneal dialysis. Patients receiving hemodialysis are frequently educated about the need for a dietary restriction of potassium- and phosphate-rich foods. However, patients receiving peritoneal dialysis may actually require replacement of potassium because of the higher losses of potassium with peritoneal dialysis. Sodium and salt restriction is common for all patients with CKD. For those receiving hemodialysis, as their urinary output diminishes, fluid restrictions are enhanced. Intake depends on the daily urine output. In general, 600 mL (from insensible loss) plus an amount equal to the previous day's urine output is allowed for a patient receiving hemodialysis. Patients are advised to limit fluid intake so that weight gains between dialysis sessions (i.e., interdialytic weight gain) are no more than 1 to 2 kg. For the patient who is undergoing dialysis, protein is not routinely restricted. The beneficial role of protein restriction in CKD stages 1 through 4 as a means to reduce the decline in kidney function is controversial. Historically, dietary counseling often encouraged restriction of protein for individuals with CKD. Although there is some evidence that protein restriction has benefits, many patients find these diets difficult to adhere to. For CKD stages 1 through 4, many clinicians encourage a diet with normal protein intake. However, patients must be taught to avoid high-protein diets and supplements because they may overstress the diseased kidneys.

7. Patients with chronic kidney disease experience an increased incidence of cardiovascular disease related to (SATA) a. hypertension. b. vascular calcifications. c. a genetic predisposition. d. hyperinsulinemia causing dyslipidemia. e. increased high-density lipoprotein levels. 7.

Correct answers: a, b, d Rationale: CKD patients have traditional cardiovascular (CV) risk factors, such as hypertension and elevated lipids. Hyperinsulinemia stimulates hepatic production of triglycerides. Most patients with uremia develop dyslipidemia. CV disease may be related to nontraditional CV risk factors, such as vascular calcification and arterial stiffness, which are major contributors to CV disease in CKD. Calcium deposits in the vascular medial layer are associated with stiffening of the blood vessels. The mechanisms involved are multifactorial and incompletely understood, but they include (1) change of vascular smooth muscle cells into chondrocytes or osteoblast-like cells, (2) high total-body amounts of calcium and phosphate as a result of abnormal bone metabolism, (3) impaired renal excretion, and (4) drug therapies to treat the bone disease (e.g., calcium phosphate binders).

Question number corresponds to the same-numbered outcome at the beginning of the chapter. 1. Which safe sun practices would the nurse include in the teaching plan for a patient who has photosensitivity SATA)? a. Wear protective clothing. b. Apply sunscreen liberally and often. c. Emphasize the short-term use of a tanning booth. d. Avoid exposure to the sun, especially during midday. e. Wear any sunscreen as long as it is purchased at a drugstore. 1.

Correct answers: a, b, d Rationale: Patients should recognize that sun safety guidelines include sun avoidance, especially during the midday hours; protective clothing; and broad-spectrum sunscreen (e.g., sun protective factor [SPF] 15; SPF 30 if a patient has a history of skin cancer or sun sensitivity). Sunscreens should be applied 20 to 30 minutes before the patient goes outdoors and should be reapplied every 2 hours and after swimming. Patients should avoid tanning booths and sun lamps.

6. 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 hard liquor since her husband died 15 years ago e. 22-year-old woman who has been diagnosed with human papilloma virus (HPV) of the cervix 6.

Correct answers: a, b, d, e Rationale: Eighty five percent of head and neck cancers are caused by tobacco use. Excessive alcohol consumption is also a major risk factor. Head and neck cancers in people younger than 50 years of age have been associated with human papillomavirus (HPV) infection. Sun exposure is also a risk factor.

6. Nurses must teach patients at risk for developing chronic kidney disease. Individuals considered to be at increased risk include (select all that apply) a. older African Americans. b. patients more than 60 years old. c. those with a history of pancreatitis. d. those with a history of hypertension. e. those with a history of type 2 diabetes. 6.

Correct answers: a, b, d, e Rationale: Risk factors for CKD include diabetes mellitus, hypertension, age older than 60 years, cardiovascular disease, family history of CKD, exposure to nephrotoxic drugs, and ethnic minority (e.g., African American, Native American).

7. Postoperative goals in caring for the patient who has undergone an abdominal hysterectomy include (SATA) a. monitoring urine output. b. changing position frequently. c. restricting all food for 24 hours. d. observing perineal pad for bleeding. e. encouraging leg exercises to promote circulation. 7.

Correct answers: a, b, e Rationale: After an abdominal hysterectomy, postoperative care includes monitoring urinary output because urinary retention may occur from temporary bladder atony related to edema or nerve trauma. Frequent changes of position, avoidance of the high Fowler's position, and avoidance of pressure under the knees minimize the risk of deep vein thrombosis (DVT). Food and fluids may be restricted if the patient is nauseated. Leg exercises promote circulation. After an abdominal hysterectomy, the nurse observes the abdominal dressing for bleeding.

2. For which patients with pneumonia would the nurse suspect aspiration as the likely cause of pneumonia (select all that apply)? a. Patient with seizures b. Patient with head injury c. Patient who had thoracic surgery d. Patient who had a myocardial infarction e. Patient who is receiving nasogastric tube feeding

Correct answers: a, b, e Rationale: Conditions that increase the risk of aspiration include decreased level of consciousness (e.g., as a result of seizure, anesthesia, head injury, stroke, or alcohol intake), difficulty swallowing, and nasogastric tubes with or without tube feeding.

1. Which descriptions characterize acute kidney injury (select all that apply)? a. Primary cause of death is infection. b. It almost always affects older people. c. Disease course is potentially reversible. d. Most common cause is diabetic nephropathy. e. Cardiovascular disease is most common cause of death. 1.

Correct answers: a, c Rationale: Acute kidney injury (AKI) is potentially reversible. AKI has a high mortality rate, and the primary cause of death in patients with AKI is infection. The primary cause of death in patients with chronic kidney failure is cardiovascular disease. Most commonly, AKI follows severe, prolonged hypotension or hypovolemia or exposure to a nephrotoxic agent. Older adults are more susceptible to AKI because the number of functioning nephrons decrease with age, but AKI can occur at any age.

2. What features of cancer cells distinguish them from normal cells (select all that apply)? a. Cells lack contact inhibition. b. Oncogenes maintain normal cell expression. c. Cells return to a previous undifferentiated state. d. Proliferation occurs when there is a need for more cells. e. New proteins characteristic of embryonic stage emerge on cell membrane. 2.

Correct answers: a, c, e Rationale: Two major dysfunctions in the process of cancer are defective cell proliferation (i.e., growth) and defective cell differentiation. Cancer cells lack contact inhibition and are poorly differentiated. Cancer cell growth is infiltrative and expansive, and cancer cells are abnormal and become more unlike parent cells.

3. Which factors would place a patient at a higher risk for prostate cancer (select all that apply)? a. Older than 65 years b. Asian or Native American c. Long-term use of an indwelling urethral catheter d. Father diagnosed and treated for early stage prostate cancer e. Previous history of undescended testicle and testicular cancer 3.

Correct answers: a, d Rationale: Age, ethnicity, and family history are risk factors for prostate cancer. The incidence of prostate cancer rises markedly after age 50, and more than 66% of men with this diagnosis are older than 65 years. The incidence of prostate cancer worldwide is higher in African Americans than in any other ethnic group (except Jamaican men of African descent). A family history of prostate cancer, especially cancer in first-degree relatives (e.g., fathers, brothers), is associated with an increased risk.

6. Nursing management of the patient with acute pancreatitis includes (select all that apply) a. checking for signs of hypocalcemia. b. providing a diet low in carbohydrates. c. giving insulin based on a sliding scale. d. observing stools for signs of steatorrhea. e. monitoring for infection, particularly respiratory tract infection. 6.

Correct answers: a, e Rationale: During the acute phase, it is important to monitor vital signs. Hemodynamic stability may be compromised by hypotension, fever, and tachypnea. Injection fluids are ordered, and the response to therapy is monitored. Fluid and electrolyte balances are closely monitored. Frequent vomiting, along with gastric suction, may result in decreased levels of chloride, sodium, and potassium. Because hypocalcemia can occur in acute pancreatitis, the nurse should observe for symptoms of tetany, such as jerking, irritability, and muscular twitching. Numbness or tingling around the lips and in the fingers is an early indicator of hypocalcemia. The patient should be assessed for Chvostek's sign or Trousseau's sign. A patient with acute pancreatitis should be observed for fever and other manifestations of infection. Respiratory infections are common because the retroperitoneal fluid raises the diaphragm, which causes the patient to take shallow, guarded abdominal breaths.

8. 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. 8.

Correct answers: b, c, d Rationale: Although regular exercise is important, such as walking and shoulder and arm exercises, swimming is contraindicated. The nurse would instruct the patient NOT to swim, as water entering the laryngeal stoma would risk choking and aspiration. All of the other activities identified (including cleaning around the stoma daily with a damp, moist washcloth, providing pictures and "hands-on" time to practice for tracheostomy care, and encouraging the patient to join a support group with other laryngectomees) are appropriate.

14. Which statement(s) describe(s) the management of a patient following lung transplantation (SATA)? a. High doses of O2 are administered around the clock. b. The use of a home spirometer will help to monitor lung function. c. Immunosuppressant therapy usually involves a three-drug regimen. d. Most patients experience an acute rejection episode in the first 2 days. e. The lung is biopsied using a transtracheal method if rejection is suspected. 14.

Correct answers: b, c, e Rationale: Acute rejection after lung transplantation is common and can happen as soon as 5 to 7 days after surgery. Accurate diagnosis is achieved by transtracheal biopsy. Home spirometry has been useful in monitoring trends in lung function. Teach patients to keep medication logs, documentation of laboratory results, and spirometry records. Immunosuppressive therapy usually includes a three-drug regimen of cyclosporine or tacrolimus, mycophenolate mofetil (CellCept), and prednisone. 1. The nurse is performing a respiratory assessment. Which finding best supports the nursing diagnosis of ineffective airway clearance? a. Basilar crackles b. Oxygen saturation of 85% c. Presence of greenish sputum d. Respiratory rate of 28 breaths/min @ANS: A The presence of adventitious breath sounds indicates that there is accumulation of secretions in the lower airways. This would be consistent with a nursing diagnosis of ineffective airway clearance because the patient is retaining secretions. The rapid respiratory rate, low oxygen saturation, and presence of greenish sputum may occur with a lower respiratory problem but do not definitely support the nursing diagnosis of ineffective airway clearance.

7. The nurse should explain to the patient who has erectile dysfunction (ED) that (select all that apply). a. the most common cause is benign prostatic hypertrophy. b. ED may be due to medications or conditions such as diabetes. c. only men who are over 65 years or older benefit from PDE5 inhibitors. d. there are medications and devices that can be used to help with erections. e. this condition is primarily due to anxiety and best treated with psychotherapy. 7.

Correct answers: b, d Rationale: Erectile dysfunction may be due to a variety of causes, including medications, other chronic diseases, or may be due to psychologic issues. Treatment options include medications (such as PDE5 inhibitors, vacuum erection devices, or penile implants). PD5E inhibitors are not restricted to any specific age category.

5. The nurse explains to the patient with chronic bacterial prostatitis who is undergoing antibiotic therapy that (SATA) a. all patients require hospitalization. b. pain will lessen once treatment has ended. c. course of treatment is generally 2 to 4 weeks. d. long-term therapy may be indicated in immunocompromised patient. e. if the condition is unresolved and untreated, he is at risk for prostate cancer. 5.

Correct answers: b, d Rationale: Patients with chronic bacterial prostatitis are usually given antibiotics for 4 to 12 weeks. Antibiotics may be given for a lifetime if the patient is immunocompromised. Although patients with chronic bacterial prostatitis tend to experience much discomfort, the pain resolves as the infection is treated. If the patient with acute bacterial prostatitis has high fever or other signs of impending sepsis, hospitalization and IV antibiotics are prescribed.

7. In teaching a patient who is using topical corticosteroids to treat acute dermatitis, the nurse should tell the patient that (select all that apply) a. the cream form is the most efficient system of delivery. b. short-term use of topical corticosteroids usually does not cause systemic side effects. c. apply creams and ointments with a glove in small amounts to prevent further infection. d. abruptly discontinuing the use of topical corticosteroids may cause a reappearance of the dermatitis. e. systemic side effects may be experienced from topical corticosteroids if the person is malnourished. 7.

Correct answers: b, d Rationale: Systemic corticosteroids often have undesirable systemic effects. Topical corticosteroids for short-term therapy have fewer systemic effects. Rebound dermatitis is common when therapy is stopped abruptly; this effect can be reduced by tapering the use of topical corticosteroids.

3. During the oliguric phase of AKI, the nurse monitors the patient for (select all that apply) a. hypotension. b. ECG changes. c. hypernatremia. d. pulmonary edema. e. urine with high specific gravity. 3.

Correct answers: b, d Rationale: The nurse monitors the patient in oliguric phase of acute renal injury for the following: • Hypertension and pulmonary edema: When urinary output decreases, fluid retention occurs. The severity of the symptoms depends on the extent of the fluid overload. In the case of reduced urine output (i.e., anuria, oliguria), the neck veins may become distended with a bounding pulse. Edema and hypertension may develop. Fluid overload can eventually lead to heart failure (HF), pulmonary edema, and pericardial and pleural effusions. • Hyponatremia: Damaged tubules cannot conserve sodium. Consequently, the urinary excretion of sodium may increase, which results in normal or below-normal serum levels of sodium. • Electrocardiographic changes and hyperkalemia: Initially, clinical signs of hyperkalemia are apparent on electrocardiogram (ECG) demonstrating peaked T waves, widening of the QRS complex, and ST-segment depression. • Urinary specific gravity: Urinary specific gravity is fixed at about 1.010.

10. To assess the patency of a newly placed arteriovenous graft for dialysis, the nurse should SATA) a. monitor the BP in the affected arm. b. irrigate the graft daily with low-dose heparin. c. palpate the area of the graft to feel a normal thrill. d. listen with a stethoscope over the graft to detect a bruit. e. frequently monitor the pulses and neurovascular status distal to the graft. 10.

Correct answers: c, d, e Rationale: A thrill can be felt on palpation of the area of anastomosis of the arteriovenous graft, and a bruit can be heard with a stethoscope. The bruit and thrill are created by arterial blood rushing into the vein. The BP should not be taken in the arm with the AV graft.

3. 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 etiology. 3.

Correct answers: c, d, e Rationale: The goals of nursing management are infection control, symptom relief, and prevention of secondary complications. Drugs are not prescribed until the etiology is known. Unnecessary use of antibiotics leads to the development of antibiotic-resistant organisms. A thorough history and a throat culture help identify the cause. The nurse should encourage the patient with pharyngitis to increase fluid intake. Cool, bland liquids and gelatin do not irritate the pharynx; citrus juices are often irritating.

4. A patient with TB has been admitted to the hospital and is placed in an airborne infection isolation room. What should the patient be taught (select all that apply)? a. Expect routine TST to evaluate infection. b. Visitors will not be allowed while in airborne isolation. c. Take all medications for full length of time to prevent multidrug-resistant TB. d. Wear a standard isolation mask if leaving the airborne infection isolation room. e. Maintain precautions in airborne infection isolation room by coughing into a paper tissue. 4.

Correct answers: c, d, e Rationale: To reduce antibiotic-resistant tuberculosis, patients must take multiple drugs for a minimum of 3 moths (or possibly longer). If patients need to be out of the negative-pressure room, they must wear a standard isolation mask to prevent exposure to others. Teach patients to cover the nose and mouth with paper tissue every time they cough, sneeze, or produce sputum. If a person has a positive reaction to the tuberculin skin test, he or she need not be tested again because the sensitivity to tuberculin persists throughout life. Nurses and visitors must wear high-efficiency particulate air (HEPA) masks when entering the patient's room.

4. One of the nurse's most important roles in relation to acute poststreptococcal glomerulonephritis is to a. promote early diagnosis and treatment of sore throats and skin lesions. b. encourage patients to obtain antibiotic therapy for upper respiratory tract infections. c. teach patients with APSGN that long-term prophylactic antibiotic therapy is necessary to prevent recurrence. d. monitor patients for respiratory symptoms that indicate the disease is affecting the alveolar basement membrane. 4.

correct answer: a Rationale: Acute poststreptococcal glomerulonephritis (APSGN) develops 5 to 21 days after an infection of the tonsils, pharynx, or skin (e.g., streptococcal sore throat, impetigo) by nephrotoxic strains of group A β-hemolytic streptococci. The most important ways to prevent the development of APSGN are early diagnosis and treatment of sore throats and skin lesions.

6. A patient is admitted to the hospital with severe renal colic. The nurse's first priority in management of the patient is to a. administer opioids as prescribed. b. obtain supplies for straining all urine. c. encourage fluid intake of 3 to 4 L/day. d. keep the patient NPO in preparation for surgery 6.

correct answer: a Rationale: Pain management and patient comfort are primary nursing responsibilities in managing an obstructing stone and renal colic.

3. The immunologic mechanisms involved in acute poststreptococcal glomerulonephritis include a. tubular blocking by precipitates of bacteria and antibody reactions. b. deposition of immune complexes and complement along the GBM. c. thickening of the GBM from autoimmune microangiopathic changes. d. destruction of glomeruli by proteolytic enzymes contained in the GBM. 3.

correct answer: b Rationale: All forms of immune complex disease are characterized by an accumulation of antigen, antibody, and complement in the glomeruli, which can result in tissue injury. The immune complexes activate complement. Complement activation results in the release of chemotactic factors that attract polymorphonuclear leukocytes, histamine, and other inflammatory mediators. The result of these processes is glomerular injury.

8. The nurse identifies a risk factor for kidney and bladder cancer in a patient who relates a history of a. aspirin use. b. tobacco use. c. chronic alcohol abuse. d. use of artificial sweeteners. 8.

correct answer: b Rationale: Cigarette smoking is the most significant risk factor for renal cell carcinoma. An increased incidence has also been identified in first-degree relatives of patients with this condition. Other risk factors include obesity, hypertension, and exposure to asbestos, cadmium, and gasoline. Risk for renal cancer is also increased in individuals who have acquired cystic disease of the kidney in association with end-stage renal disease. Risk factors for bladder cancer include smoking, exposure to dyes used in the rubber and cable industries, and chronic abuse of phenacetin-containing analgesics.

10. A patient with a ureterolithotomy returns from surgery with a nephrostomy tube in place. Postoperative nursing care of the patient includes a. encouraging the patient to drink fruit juices and milk. b. encouraging fluids of at least 2 to 3 L/day after nausea has subsided. c. irrigating the nephrostomy tube with 10 mL of normal saline solution as needed. d. notifying the physician if nephrostomy tube drainage is more than 30 mL/hr. 10.

correct answer: b Rationale: The nephrostomy tube is inserted directly into the renal pelvis and attached to connecting tubing for closed drainage. The catheter should never be kinked, compressed, or clamped. If the patient complains of excessive pain in the area, or if drainage around the tube is excessive, check the catheter for patency. If irrigation is ordered, strict aseptic technique is required. To prevent overdistention of the renal pelvis and renal damage, no more than 5 mL of sterile saline solution is gently instilled at one time. Infection and secondary stone formation are complications associated with the insertion of a nephrostomy tube. Patients should drink 2 to 3 L of fluid per day to reduce risk of infection and stone formation.

2. The nurse teaches the female patient who has frequent UTIs that she should a. take tub baths with bubble bath. b. urinate before and after sexual intercourse. c. take prophylactic sulfonamides for the rest of her life. d. restrict fluid intake to prevent the need for frequent voiding. 2.

correct answer: b Rationale: When teaching a patient to prevent a recurrence of a urinary tract infection, the nurse should explain the importance of emptying the bladder before and after sexual intercourse.

7. The nurse recommends genetic counseling for the children of a patient with a. nephrotic syndrome. b. chronic pyelonephritis. c. malignant nephrosclerosis. d. adult-onset polycystic kidney disease. 7.

correct answer: d Rationale: The adult form of polycystic kidney disease (PKD) is an autosomal dominant disorder. If one parent has the disease, the child has a 50% chance of developing PKD. Many patients who have adult PKD have had children by the time the disease is diagnosed. Patients need appropriate counseling regarding plans for having more children, and genetic counseling resources should be provided for the children.

5. The edema that occurs in nephrotic syndrome is due to a. increased hydrostatic pressure caused by sodium retention. b. decreased aldosterone secretion from adrenal insufficiency. c. increased fluid retention caused by decreased glomerular filtration. d. decreased colloidal osmotic pressure caused by loss of serum albumin. 5.

correct answer: d Rationale: The increased permeability of the glomerular membrane found in nephrotic syndrome is responsible for the massive excretion of protein in the urine. This results in decreased serum protein levels and subsequent edema formation. Ascites and anasarca (i.e., massive generalized edema) develop if hypoalbuminemia is severe.

1. In teaching a patient with pyelonephritis about the disorder, the nurse informs the patient that the organisms that cause pyelonephritis most commonly reach the kidneys through a. the bloodstream. b. the lymphatic system. c. a descending infection. d. an ascending infection. 1.

correct answer: d Rationale: The organisms that usually cause urinary tract infections (UTIs) are introduced via the ascending route from the urethra, and the infections originate in the perineum.

Evolve Online Questions 1. The nurse provides medication instruction for a 30-yr-old woman who is prescribed clomiphene (Clomid). Which patient statement is most important for the nurse to clarify? a. "Hormone production and release will be increased." b. "This drug is like estrogen and is used to treat infertility." c. "I should avoid intercourse while taking this medication." d. "This medication will stimulate my ovaries to produce eggs."

ANS C Clomiphene is an oral medication administered for infertility. The medication is a selective estrogen-stimulation modulator that stimulates ovulation, making pregnancy after intercourse or artificial insemination more likely. The drug increases gonadotropin-releasing hormone production. In addition, the release of the follicle-stimulating hormone and luteinizing hormone is increased.

Evolve Online Questions 1. The nurse is caring for a 62-yr-old man after a transurethral resection of the prostate (TURP). Which instructions should the nurse include in the teaching plan? a. Avoid straining during defecation. b. Restrict fluids to prevent incontinence. c. Sexual functioning will not be affected. d. Prostate examinations are not needed after surgery.

ANS: A Activities that increase abdominal pressure, such as sitting or walking for prolonged periods and straining to have a bowel movement (Valsalva maneuver), should be avoided in the postoperative recovery period to prevent a postoperative hemorrhage. Instruct the patient to drink at least 2 L of fluid every day. Digital rectal examinations should be performed yearly. The prostate gland is not totally removed and may enlarge after a TURP. Sexual functioning may change after prostate surgery. Changes may include retrograde ejaculation, erectile dysfunction, and decreased orgasmic sensation.

2. The nurse is caring for a 26-yr-old patient who is being discharged after an induced abortion. Which statement should the nurse include in discharge teaching? a. "Avoid sexual intercourse for 2 weeks." b. "Heavy bleeding is expected for 24 hours." c. "A temperature of 101oF (38.9oC) is normal" d. "Birth control pills should not be taken for 30 days."

ANS: A After an abortion, teach the patient to avoid intercourse for 2 weeks. Contraception can be started the day of the procedure. Symptoms of possible complications include a fever and abnormal vaginal bleeding. These symptoms should be reported immediately.

3. The nurse is teaching clinic patients about risk factors for testicular cancer. Which individual is at highest risk for developing testicular cancer? a. A 30-yr-old white man with a history of cryptorchidism b. A 48-yr-old African American man with erectile dysfunction c. A 19-yr-old Asian man who had surgery for testicular torsion d. A 28-yr-old Hispanic man with infertility caused by a varicocele

ANS: A The incidence of testicular cancer is four times higher in white men than in African American men. Testicular tumors are also more common in men who have had undescended testes (cryptorchidism) or a family history of testicular cancer or anomalies. Other predisposing factors include orchitis, human immunodeficiency virus infection, maternal exposure to exogenous estrogen, and testicular cancer in the contralateral testis.

5. The nurse is teaching health promotion to a variety of women in a community center. When asked when a female should begin having a Pap smear, how should the nurse respond? a. Every year beginning at age 30 years b. Every 3 years beginning at age 21 years c. Every 3 years beginning at age 18 years if sexually active d. Every year beginning at the onset of menarche and continuing until menopause

ANS: B A Pap test (Pap smear) should be done at least once every 3 years at the age of 21 years regardless of when a woman becomes sexually active. Women 65 years or older may stop having Pap tests after having no abnormal Pap test results for the previous 2 years.

3. A 23-yr-old woman admitted with a possible ectopic tubal pregnancy reports sudden intense pelvic pain radiating to the left shoulder. Which action by the nurse should receive the highest priority? a. Observe the amount of vaginal bleeding every 15 minutes for 1 hour. b. Check the vital signs and immediately notify the health care provider. c. Administer the prescribed pain medication and reassess in 30 minutes. d. Assess the fetal heart tones and determine the presence of fetal movement.

ANS: B A ruptured ectopic pregnancy may produce pelvic or abdominal pain and vaginal bleeding. If the tube ruptures, the pain is intense and may be referred to the shoulder. External vaginal bleeding may not be an accurate indicator of actual blood loss. Vital signs should be monitored closely along with observation for signs of shock. A ruptured ectopic pregnancy is an emergency because of the risk of hemorrhage and hypovolemic shock. The patient may need a blood transfusion and IV fluid therapy. In addition, the patient will need emergency surgery. Fetal assessment is not indicated for an ectopic pregnancy.

14. The nurse coordinates postoperative care for a 70-yr-old man with osteoarthritis after prostate surgery. Which task is appropriate for the nurse to delegate to a licensed practical/vocational nurse (LPN/LVN) (select all that apply.)? a. Clean around the catheter daily. b. Increase flow of irrigation solution. c. Teach the patient how to perform Kegel exercises. d. Provide instructions to the patient on catheter care. e. Administer oxybutynin (Ditropan) for bladder spasms. f. Manually irrigate the urinary catheter to restore catheter flow.

ANS: B,E The nurse may delegate the following to an LPN/LVN: monitor catheter drainage for increased blood or clots, increase flow of irrigating solution to maintain light pink color in outflow, and administer antispasmodics and analgesics as needed. The UAP will clean around the catheter daily. A registered nurse may not delegate teaching, assessments, or clinical judgments to a LPN/LVN.

7. A patient is one day postoperative after a transurethral resection of the prostate (TURP). Which event is an unexpected finding? a. Requires two tablets of Tylenol 3 during the night b. Complains of fatigue and claims to have minimal appetite c. Continuous bladder irrigation (CBI) infusing, but output has decreased d. Expressed anxiety about his planned discharge home the following day

ANS: C A decrease or cessation of output in a patient with CBI requires immediate intervention. The nurse should temporarily stop the CBI and attempt to resume output by repositioning the patient or irrigating the catheter. Complaints of pain, fatigue, and low appetite at this early postoperative stage are not unexpected. Discharge planning should be addressed, but this should not precede management of the patient's CBI.

2. The nurse teaches a 30-yr-old man with a family history of prostate cancer about dietary factors associated with prostate cancer. The nurse determines that teaching is successful if the patient selects which menu? a. Grilled steak, French fries, and vanilla shake b. Hamburger with cheese, pudding, and coffee c. Baked chicken, peas, apple slices, and skim milk d. Grilled cheese sandwich, onion rings, and hot tea

ANS: C A diet high in red meat and high-fat dairy products along with a low intake of vegetables and fruits may increase the risk of prostate cancer.

8. An older male patient visits his primary care provider because of burning on urination and production of foul-smelling urine. What contributing factor should the health care provider consider? a. High-purine diet Incorrect b. Sedentary lifestyle c. Benign prostatic hyperplasia (BPH) d. Recent use of broad-spectrum antibiotics

ANS: C BPH causes urinary stasis, which is a predisposing factor for UTIs. A sedentary lifestyle and recent antibiotic use are unlikely to contribute to UTIs, but a diet high in purines is associated with renal calculi.

9. Which task can the nurse delegate to an unlicensed assistive personnel (UAP) in the care of a patient who has recently undergone prostatectomy? a. Assessing the patient's incision b. Irrigating the patient's urinary catheter c. Reporting complaints of pain or bladder spasms d. Evaluating the patient's pain and selecting analgesia

ANS: C Cleaning around the catheter, recording intake and output, and reporting complaint of pain or bladder spasms to the registered nurse are appropriate tasks for delegation to the UAP. Selecting analgesia, irrigating the patient's catheter, and assessing the incision are not appropriate skills or tasks for unlicensed personnel.

6. To monitor the progression of decreased urinary stream, the nurse should encourage which type of regular screening? a. Uroflowmetry b. Transrectal ultrasound c. Digital rectal examination (DRE) d. Prostate-specific antigen (PSA) monitoring

ANS: C DRE is part of a regular physical examination and is a primary means of assessing symptoms of decreased urinary stream, which is often caused by benign prostatic hyperplasia (BPH) in men older than 50 years of age. The uroflowmetry helps determine the extent of urethral blockage and the type of treatment needed but is not done on a regular basis. Transrectal ultrasound is indicated with an abnormal DRE and elevated PSA to differentiate between BPH and prostate cancer. The PSA monitoring is done to rule out prostate cancer, although levels may be slightly elevated in patients with BPH.

4. A hospitalized older patient reports his foreskin is retracted and will not return to normal. Which action is the priority? a. Start antibiotics. b. Apply ice to reduce swelling. c. Attempt to move the foreskin over the glans. d. Call the physician to prepare for circumcision.

ANS: C Paraphimosis can occur when the foreskin is pulled back during bathing, during catheter insertion, or after intercourse and not returned to the normal position. Attempting to return the foreskin over glans is the priority action. If the nurse is unsuccessful, then ice would be applied to decrease swelling. If the foreskin is not returned to the normal position manually by the health care provider, then circumcision would be indicated. Paraphimosis is considered a urologic emergency because arterial blood flow to the glans penis is impaired.

13. The patient has a history of cardiovascular disease and has developed erectile dysfunction. He is frustrated because he is taking nitrates and cannot take erectogenic medications. What should the nurse do first? a. Give the patient choices for penile implant surgery. b. Recommend counseling for the patient and his partner. c. Obtain a thorough sexual, health, and psychosocial history. d. Assess levels of testosterone, prolactin, luteinizing hormone, and thyroid hormones.

ANS: C The nurse's first action to help this patient is to obtain a thorough sexual, health, and psychosocial history. Alternative treatments for the cardiac disease would then be explored if that had not already been done. Further examination or diagnostic testing would be based on the history and physical assessment, including hormone levels, counseling, or penile implant options.

15. The patient has a low-grade carcinoma on the left lateral aspect of the prostate gland and has been on "watchful waiting" status for 5 years. Six months ago, his last prostate-specific antigen (PSA) level was 5 ng/mL. Which manifestations indicate prostate cancer may be extending and require a change in the plan of care (select all that apply.)? a. Casts in his urine b. Presence of α-fetoprotein c. Serum PSA level 10 ng/mL d. Onset of erectile dysfunction e. Nodularity of the prostate gland f. Development of a urinary tract infection

ANS: C, E The manifestations of increased PSA level along with the new nodularity of the prostate gland potentially indicate that the tumor may be growing. Casts in the urine, presence of α-fetoprotein, and new onset of erectile dysfunction do not indicate prostate cancer growth. Development of a urinary tract infection may indicate urinary retention or could be related to other issues.

1. The nurse is caring for a 73-yr-old male patient with a history of benign prostatic hyperplasia and symptoms of a urinary tract infection. Which diagnostic finding would support this diagnosis? a. White blood cell count is 7500 cells/µL. Incorrect b. Antistreptolysin-O (ASO) titer is 106 Todd units/mL. c. Glucose, protein, and ketones are present in the urine. d. Nitrites and leukocyte esterase are present in the urine.

ANS: D A diagnosis of urinary tract infection is suspected if there are nitrites (indicating bacteriuria), white blood cells (WBCs), and leukocyte esterase (an enzyme present in WBCs indicating pyuria). The presence of glucose and ketones indicate uncontrolled diabetes mellitus. An elevated WBC count (>11,000 cells/µL) indicates a bacterial infection. AASO titer is a blood test to measure antibodies against streptolysin O, a substance produced by group A Streptococcus bacteria.

4. A 55-yr-old woman diagnosed with endometrial cancer is receiving brachytherapy. The nurse is most concerned if what is observed? a. Foul-smelling vaginal discharge Incorrect b. 5 to 8 liquid stools over a period of 24 hours c. Use of a bedpan instead of a bedside commode or toilet. d. Request for a nursing assistant to stay in the room for company.

ANS: D Brachytherapy is internal radiation applied directly to the tumor. Health care providers should limit close contact with the patient to less than 30 minutes per day. Internal radiation causes the destruction of cells and results in a foul-smelling vaginal discharge. Internal radiation may cause systemic reactions such as nausea, vomiting, diarrhea, and malaise. The patient receiving brachytherapy is placed in a lead-lined private room and on absolute bed rest.

7. When caring for a patient during the oliguric phase of acute kidney injury (AKI), which nursing action is appropriate? a. Weigh patient three times weekly. b. Increase dietary sodium and potassium. c. Provide a low-protein, high-carbohydrate diet. d. Restrict fluids according to previous daily loss.

ANS:D Patients in the oliguric phase of AKI will have fluid volume excess with potassium and sodium retention. Therefore, they will need to have dietary sodium, potassium, and fluids restricted. Daily fluid intake is based on the previous 24-hour fluid loss (measured output plus 600 mL for insensible loss). The diet also needs to provide adequate, not low, protein intake to prevent catabolism. The patient should also be weighed daily, not just three times each week.

6. The nurse preparing to administer a dose of calcium acetate to a patient with chronic kidney disease (CKD). Which laboratory result will the nurse monitor to determine if the desired effect was achieved? a. Sodium b. Potassium c. Magnesium d. Phosphorus

ANS:D Phosphorus and calcium have inverse or reciprocal relationships, meaning that when phosphorus levels are high, calcium levels tend to be low. Therefore, administration of calcium should help to reduce a patient's abnormally high phosphorus level, as seen with CKD. Calcium acetate will not have an effect on sodium, potassium, or magnesium levels.

12. A woman with endometriosis is seeking a cure. After identifying childbearing is no longer desired, the nurse should introduce which potential treatment? a. Danazol b. Leuprolide (Lupron) c. Nonsteroidal antiinflammatory drugs d. Surgical removal of endometrial implants

ANS:D The only cure for endometriosis is the surgical removal of all endometrial implants, which may include the uterus, fallopian tubes, and ovaries. Leuprolide is a gonadotropin-releasing hormone agonist that causes amenorrhea with menopausal side effects. Danazol is a synthetic androgen that inhibits the anterior pituitary. Nonsteroidal antiinflammatory drugs relieve pain but do not affect the problem of endometriosis.

11. Because of the risks, a 50-yr-old patient does not want hormone replacement therapy for perimenopausal symptoms. She asks the nurse how to minimize hot flashes and night sweats. What should the nurse recommend first? a. Increase warmth to avoid chills. b. Good nutrition to avoid osteoporosis c. Vitamin B complex and vaginal lubrication d. Decrease heat production and increase heat loss.

ANS:D To avoid hot flashes and sweating at night, decrease heat production with a cool environment, limit caffeine and alcohol, and practice relaxation techniques. Heat loss may be facilitated with increased circulation in the room, avoidance of heavy bedding, and wearing loose-fitting clothes. Warmth will facilitate hot flashes. Nutrition, vitamin B complex, and vaginal lubrication will help with other complications of perimenopause but not hot flashes and sweating at night.

4. A patient scheduled for a prostatectomy for prostate cancer expresses the fear that he will have erectile dysfunction. In responding to this patient, the nurse should keep in mind that a. erectile dysfunction can occur even with a nerve-sparing procedure. b. the most common complication of this surgery is postoperative bowel incontinence. c. retrograde ejaculation affects sexual function more frequently than erectile dysfunction. d. preoperative sexual function is the most important factor in determining postoperative erectile dysfunction. 4.

Correct answer: a Rationale: A major complication after prostatectomy (even with nerve-sparing procedures) is erectile dysfunction.

11. A major advantage of peritoneal dialysis is a. the diet is less restricted and dialysis can be performed at home. b. the dialysate is biocompatible and causes no long-term consequences. c. high glucose concentrations of dialysate cause a reduction in appetite, promoting weight loss. d. no medications are required because of the enhanced efficiency of the peritoneal membrane in removing toxins. 11.

Correct answer: a Rationale: Advantages of peritoneal dialysis = fewer dietary restrictions and possibility of home dialysis.

1. Symptoms of BPH are primarily caused by a. obstruction of the urethra. b. untreated chronic prostatitis. c. decreased bladder compliance. d. excessive secretion of testosterone. 1.

Correct answer: a Rationale: Benign prostatic hyperplasia (BPH) is a benign enlargement of the prostate gland. Enlargement of the prostate gradually compresses the urethra, eventually leading to partial or complete urethral obstruction. Compression of the urethra ultimately leads to development of clinical symptoms.

5. A patient is admitted to the hospital with chronic kidney disease. The nurse understands that this condition is characterized by a. progressive irreversible destruction of the kidneys. b. a rapid decrease in urine output with an elevated BUN. c. an increasing creatinine clearance with a decrease in urine output. d. prostration, somnolence, and confusion with coma and imminent death. 5.

Correct answer: a Rationale: Chronic kidney disease (CKD) involves progressive, irreversible loss of kidney function.

2. Postoperatively, a patient who has had a laser prostatectomy has continuous bladder irrigation with a three-way urinary catheter with a 30-mL balloon. When he complains of bladder spasms with the catheter in place, the nurse should a. deflate the balloon to 10 mL to decrease bulk in the bladder. b. deflate the balloon and then reinflate to ensure that it is patent. c. encourage the patient to try to have a bowel movement to relieve colon pressure. d. explain that this feeling is normal and that he should not try to urinate around the catheter. 2.

Correct answer: d Rationale: Bladder spasms occur as a result of irritation of the bladder mucosa from the insertion of the resectoscope, presence of a catheter, or clots that cause obstruction of the catheter. The nurse should instruct the patient not to urinate around the catheter because this increases the likelihood of spasm.

9. In planning nursing interventions to increase bladder control in the patient with urinary incontinence, the nurse includes a. teaching the patient to use Kegel exercises. b. clamping and releasing a catheter to increase bladder tone. c. teaching the patient biofeedback mechanisms to suppress the urge to void. d. counseling the patient concerning choice of incontinence containment device. 9.

correct answer: a Rationale: Pelvic floor muscle training (i.e., Kegel exercises) is used to manage stress, urge, or mixed urinary incontinence.