PrepU: Critical Thinking

The nurse is taking health history from a client admitted to rule out Guillain-Barre syndrome. An important question to ask related to the diagnosis is which of the following?

"Have you experienced any viral infections in the last month?"

A nurse is reviewing treatment options with parents of an infant born with severe combined immunodeficiency disease (SCID). The nurse recognizes that the parents understand the teaching based on which statement?

"We could have our 10-year-old daughter tested, as the ideal stem cell donor is a human leukocyte antigen-identical sibling."

A female patient comes to the clinic for evaluation. As part of the assessment, the nurse determines the patient's ideal body weight. The patient is 5' 5" tall and has an average frame. What would be her ideal body weight in lbs? Enter the correct number only.

125

A client with sickle cell crisis is admitted to the hospital in severe pain. While caring for the client during the crisis, which is the priority nursing intervention?

Administering and evaluating the effectiveness of opioid analgesics

A young client is being treated for a femoral fracture suffered in a snowboarding accident. The nurse's most recent assessment reveals that the client is uncharacteristically confused. What diagnostic test should be performed on this client?

Arterial blood gases

A client has been diagnosed with cardiac dysfunction and admitted to a health care center. The nurse notices that the client's ankles and feet are swollen. Using critical thinking skills, which nursing intervention does the nurse know to perform next?

Assess client for dependent edema

The nurse is instructing a client on the benefits of a cochlear implant. The client asks, "How am I able to interpret sound?" The nurse credits which of the following as significant in the production of hearing?

Auditory nerve

A patient describes numbness in the arms and hands with a tingling sensation. The patient also frequently stumbles when walking. What vitamin deficiency does the nurse determine may cause some of these symptoms?

B12

A group of students is reviewing information about cast composition in preparation for a discussion on the advantages and disadvantages of each. The students demonstrate understanding of the topic when they cite which of the following as an advantage of a plaster cast?

Better molding to the client

The nurse is caring for a client with a biliary disorder who has an elevated amylase level. If this elevation correlates to dysfunction, which body process does the nurse recognize may be impaired?

Carbohydrate digestion

Pentoxifylline (Trental) is a medication used for which of the following conditions?

Claudication

A young client is diagnosed with glucose-6-phosphate dehydrogenase deficiency (G-6-PD). After reviewing the client's recent activities, what instruction should the nurse recommend to the client?

Consult a health care provider about ingesting trimethoprim/sulfamethoxazole for a urinary tract infection

Which is one of the primary symptoms of irritable bowel syndrome (IBS)?

Diarrhea

A client is exhibiting digitalis toxicity. Which of the following medications would the nurse expect to be ordered for this client?

Digoxin immune FAB

The nurse is assessing a client newly diagnosed with myasthenia gravis. Which of the following signs would the nurse most likely observe?

Diplopia and ptosis

A client who is being treated for AML has bruises on both legs. What is the nurse's most appropriate action?

Evaluate the client's platelet count

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing which effect?

Facial nerve paralysis

The client with a fractured left humerus reports dyspnea and chest pain. Pulse oximetry is 88%. Temperature is 100.2 degrees Fahrenheit (38.5 degrees Centigrade); heart rate is 110 beats per minute; respiratory rate is 32 breaths per minute. The nurse suspects the client is experiencing:

Fat embolism syndrome

Which is often the most disabling clinical manifestation of multiple sclerosis?

Fatigue

A 48-year-old man recently diagnosed with benign prostatic hyperplasia (BPH) reports consuming <i>Serenoa repens</i> (saw palmetto berry). The nurse needs to intervene if the physician orders which treatment?

Finasteride

A patient describes a burning sensation in the esophagus, pain when swallowing, and frequent indigestion. What does the nurse suspect that these clinical manifestations indicate?

Gastroesophageal reflux disease

Nursing students are reviewing the various types of brain tumors. The students demonstrate understanding of the material when they identify which of the following as the most common type?

Gliomas

A nurse educator is teaching students the types of shock and associated causes. Which combination of shock type and causative factors is correct? Select all that apply. Hypovolemic shock; blood loss Obstructive shock; kidney stone Cardiogenic shock; myocardial infarction Anaphylactic shock; nut allergy Septic shock; infection Neurogenic shock; diabetes

Hypovolemic shock; blood loss Cardiogenic shock; myocardial infarction Anaphylactic shock; nut allergy Septic shock; infection

What is a characteristic of the intrarenal category of acute kidney injury (AKI)?

Increased BUN

A client with a brain tumor experiences projectile vomiting. The nurse integrates understanding of this occurrence as resulting from which of the following?

Irritation of the medullary vagal centers

Based on the nurse's knowledge of the increased risk for bleeding in a client undergoing chemotherapy or radiation, which of the following interventions does the nurse need to include in the client's plan of care? Select all that apply. Monitoring the platelet count Monitoring for signs of abnormal bleeding Instructing the client to use a soft toothbrush Instructing the client to use an electric razor Instructing the client to add low-dose aspirin to daily medication regimen Increasing the patient's injections for pain control

Monitoring the platelet count Monitoring for signs of abnormal bleeding Instructing the client to use a soft toothbrush Instructing the client to use an electric razor

The nurse is performing an initial nursing assessment on a client with possible Guillain-Barre syndrome. Which of the following findings would be most consistent with this diagnosis?

Muscle weakness and hyporeflexia of the lower extremities

A client is being seen in the emergency department for exacerbation of chronic obstructive pulmonary disease (COPD). The first action of the nurse is to administer which of the following prescribed treatments?

Oxygen through nasal cannula at 2 L/minute

Which term describes the passage of a hollow instrument into a cavity to withdraw fluid?

Paracentesis

A nurse who is a member of an emergency response team anticipates that several patients with airway obstruction may need a cricothyroidotomy. For which of the following patients would this procedure be appropriate? Select all that apply. Patient with extensive facial trauma Patient with a lumbar spine injury Patient with laryngeal edema secondary to anaphylaxis Patient who is bleeding from the chest Patient with an obstructed larynx

Patient with extensive facial trauma Patient with laryngeal edema secondary to anaphylaxis Patient with an obstructed larynx

The nurse knows that inflammatory response following a burn is proportional to the extent of injury. Which factor presents the greatest impact on the ability to modify the magnitude and duration of the inflammatory response in a client with a burn?

Preexisting conditions

The nurse analyzes the electrocardiogram (ECG) tracing of a client newly admitted to the cardiac step-down unit with a diagnosis of chest pain. Which finding indicates the need for follow-up?

QT interval that is 0. 46 seconds long

When a client is in the compensatory stage of shock, which symptom occurs?

Tachycardia

A nurse is assessing the postoperative client on the second postoperative day. What assessment finding requires the nurse to immediately notify the health care provider?

The client has an absence of bowel sounds

Students are reviewing the structure of DNA in preparation for a class test tomorrow. They demonstrate understanding of this information when they identify which of the following as a nitrogenous base found in DNA? Select all that apply. Thiamine Adenine Guanine Leucine Valine Cytosine

Thiamine Adenine Guanine Cytosine

The nurse is assessing a client for constipation. Which factor should the nurse review first to identify the cause of constipation?

Usual pattern of elimination

Which assessment finding would the nurse expect to document for a client with ataxia-telangiectasis?

Vascular lesions

Which condition indicates an overdose of lactulose?

Watery diarrhea

Following a splenectomy, a client has a hemoglobin (Hb) level of 7.5 g/dL, and a blood pressure lying in bed of 110/70 mm Hg. The nurse suspects abnormal orthostatic changes when the client gets out of bed and reports vertigo. What vital sign value most supports the client's orthostatic changes?

Blood pressure of 90/50 mm Hg

What is a characteristic of the intrarenal category of acute renal failure?

Increased BUN

A client has been diagnosed with a frontal lobe brain abscess. Which nursing intervention is appropriate?

Initiate seizure precautions

A nurse explains to a client that she will administer his first insulin dose in his abdomen. How does absorption at the abdominal site compare with absorption at other sites?

Insulin is absorbed more rapidly at abdominal injection sites than at other sites

An emergency department nurse is interviewing a client who is presenting with signs of an ischemic stroke that began 2 hours ago. The client reports a history of a cholecystectomy 6 weeks ago and is taking digoxin, warfarin, and labetalol. What factor poses a threat to the client for thrombolytic therapy?

International normalized ratio greater than 2

A secondary immunodeficiency is characterized by the following. Choose all that apply. It usually occurs as a result of underlying disease processes. It frequently is caused by certain autoimmune disorders. It may be caused by certain viruses. IgA deficiency is present in 40% of individuals. It is less common than primary immunodeficiency.

It usually occurs as a result of underlying disease processes. It frequently is caused by certain autoimmune disorders. It may be caused by certain viruses.

When assessing the impact of medications on the etiology of acute renal failure, the nurse recognizes which of the following as the drug that is not nephrotoxic?

Penicillin

A client is admitted with nausea, vomiting, and diarrhea. His blood pressure on admission is 74/30 mm Hg. The client is oliguric and his blood urea nitrogen (BUN) and creatinine levels are elevated. The physician will most likely write an order for which treatment?

Start IV fluids with a normal saline solution bolus followed by a maintenance dose

Which of the following is the treatment of choice for acoustic neuromas?

Surgery

The nurse is reviewing the medical record of a client who is positive for human immunodeficiency virus (HIV). The nurse notes that the client is classified as HIV asymptomatic based on which CD4+ T lymphocyte count?

Greater than 500/mm3

When learning about HIV/AIDS, the student should be able to differentiate the two subtypes of virus by which characteristic?

HIV-1 is more prevalent than HIV-2 subtypes

The nurse is administering medications to a client that has elevated ammonia due to cirrhosis of the liver. What medication will the nurse give to detoxify ammonium and to act as an osmotic agent?

Lactulose

A client is prescribed montelukast as part of a treatment plan for an allergic disorder. The nurse understands that this drug belongs to which class?

Leukotriene-receptor antagonist

Which factor causes wrinkles among older adults?

Loss of subcutaneous tissue

Which feature is the hallmark of systolic heart failure?

Low ejection fraction (EF)

Which is the hallmark of heart failure?

Low ejection fraction (EF)

A client with obesity is interested in trying orlistat for weight loss. Which disease or condition in the client's medical history alert the nurse of potential complications if the client uses this medication?

Renal insufficiency

The nurse observes a client with an onset of heart failure having rapid, shallow breathing at a rate of 32 breaths/minute. What blood gas analysis does the nurse anticipate finding initially?

Respiratory alkalosis

When the patient tells the nurse that his vision is 20/200, and asks what that means, the nurse informs the patient that a person with 20/200 vision:

Sees an object from 20 feet away that a person with normal vision sees from 200 feet away

The client exhibits a blood pressure of 110/68 mm Hg, pulse rate of 112 beats/min, temperature of 102°F with skin warm and flushed. Respirations are 30 breaths/min. The nurse assesses the client may be exhibiting the early stage of which shock?

Septic

Cerebral edema peaks at which time point after intracranial surgery?

24 hours

What is the body mass index (BMI) of a client who weighs 195 lbs and is 6 feet tall? Round to the nearest whole number, and enter the correct number ONLY.

26

A client has been prescribed a protein intake of 0.6 g/kg of body weight. The client weighs 154 pounds. The nurse calculates the daily protein intake to be how many grams? Enter the correct number ONLY.

42

The nurse caring for a 2-year-old near-drowning victim monitors for what possible complication?

Acute respiratory distress syndrome

Which drug is considered a stimulant laxative?

Bisacodyl

Which is a characteristic of right-sided heart failure?

Jugular vein distention

What is located in the cochlea of the inner ear?

Organ of Corti

The nurse is prioritizing a client's care plan based on Maslow's hierarchy of needs. What is an example of the nurse's first priority action?

administering pain medication to a client in acute pain

A nurse is assessing a client who has been in a motor vehicle collision. The client directly and accurately answers questions. The nurse notes a contusion to the client's forehead; the client reports a headache. Assessing the client's pupils, what reaction would confirm increasing intracranial pressure?

unequal response

A neurologic deficit is best defined as a deficit of the:

central and peripheral nervous systems with decreased, impaired, or absent functioning

The nurse is caring for a client with a blood pressure of 210/100 mm Hg in the emergency room. What is the most appropriate route of administration for antihypertensive agents?

continuous IV infusion

A triple-lumen indwelling urinary catheter is inserted for continuous bladder irrigation following a transurethral resection of the prostate. In addition to balloon inflation, the functions of the three lumens include:

continuous inflow and outflow of irrigation solution

The nurse is providing care to a client with cardiogenic shock requiring a intra-aortic balloon pump (IABP). What is the therapeutic effect of the IABP therapy?

decreased left ventricular workload

A client with unresolved hemothorax is febrile, with chills and sweating. He has a nonproductive cough and chest pain. His chest tube drainage is turbid. A possible explanation for these findings is:

empyema

If untreated, squamous cell carcinoma of the external ear can spread through the temporal bone, causing

facial nerve paralysis

The six elements necessary for infection include a causative organism, a reservoir of available organisms, a portal or mode of exit from the reservoir, a mode of transmission from reservoir to host, a susceptible host, and

mode of entry into the host

The nurse assesses a client to determine if there is increased risk for complications intraoperatively or postoperatively. Which are general risk factors? Select all that apply. nutritional status age physical condition gender health status ethnicity

nutritional status age physical condition health status

An oncologist advises a client with an extensive family history of breast cancer to consider a mastectomy. What type of surgery would the nurse include in teaching?

prophylactic

A nurse using critical thinking interprets data and determines appropriate interventions. What factor will affect the nurse's ability to employ critical thinking with data interpretation?

the nurse's personal biases