Final Exam NUR 306 Prep U
A client has had a right modified radical mastectomy and axillary lymph node dissection. The nurse is teaching the client about measures to reduce the risk of complications. The client demonstrates understanding of the instructions when she states which of the following? "Anytime I need blood drawn, they should get the sample from my right arm." "I need to use an electric shaver when shaving my right armpit." "I can lift with my right arm objects that weigh as much as 15 pounds." "I should tell my manicurist that it is okay to trim the cuticles on my right hand."
"I need to use an electric shaver when shaving my right armpit." To prevent complications after a right modified radical mastectomy and axillary lymph node dissection, the client should shave her right axillary area with an electric razor rather than a straight razor to reduce the risk of trauma to or breaks in the skin. Blood sampling should be done with the client's left arm, not the right one. The client should not lift objects more than 5 to 10 pounds with the right arm, and cuticles on the affected hand should be pushed back, not cut.
Which statement demonstrates that a client has understood instructions about breast self-examination? "I should perform the exam on the first day of my menstrual period." "I need to use the pads of three fingers to apply pressure when checking each breast." "I should move the palm of my hand around the breast in a diagonal fashion." "I don't need to check the nipple area of the breast or under my arm."
"I need to use the pads of three fingers to apply pressure when checking each breast." When performing breast self-examination, the client should examine the breasts 3 days after the end of her menstrual period, use light medium, and firm pressure applied with the pads of three fingers, move the fingers in circles, spokes of a wheel, or rows, and feel every part of the breast, including the nipple area and the armpit to the collar bone.
A client asks the nurse what the difference is between osteoarthritis (OA) and rheumatoid arthritis (RA). Which response is correct? "OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." "OA and RA are very similar. OA affects the smaller joints and RA affects the larger, weight-bearing joints." "OA affects joints on both sides of the body. RA is usually unilateral." "OA is more common in women. RA is more common in men."
"OA is a noninflammatory joint disease. RA is characterized by inflamed, swollen joints." OA is a degenerative arthritis, characterized by the loss of cartilage on the articular surfaces of weight-bearing joints with spur development. RA is characterized by inflammation of synovial membranes and surrounding structures. OA may occur in one hip or knee and not the other, whereas RA commonly affects the same joints bilaterally. RA is more common in women; OA affects both sexes equally.
When assessing the pressure of the anterior chamber of the eye, a nurse normally expects to find a pressure of: 5 to 10 mm Hg. 10 to 20 mm Hg. 20 to 30 mm Hg. over 30 mm Hg.
10 to 20 mm Hg.
A patient is suspected of having glaucoma. What reading of IOP would demonstrate an increase resulting from optic nerve damage? 0 to 5 mm Hg 6 to 10 mm Hg 11 to 20 mm Hg 21 mm Hg or higher
21 mm Hg or higher Intraocular pressure of greater than 21 mm Hg is a sign of primary open-angle glaucoma.
The nurse is educating a patient about the best time to perform breast self-examination (BSE). When does the nurse inform her is the best time after menses to perform BSE? 3 to 4 days 5 to 7 days 8 to 9 days After the 10th day
5 to 7 days Most women notice increased tenderness and lumpiness before their menstrual periods; therefore, BSE is best performed after menses (day 5 to day 7, counting the first day of menses as day 1).
The goal for oxygen therapy in COPD is to support tissue oxygenation, decrease the work of the cardiopulmonary system, and maintain the resting partial arterial pressure of oxygen (PaO2) of at least ______ mm Hg and an arterial oxygen saturation (SaO2) of at least ___%. 54 mm Hg; 84% 56 mm Hg; 86% 58 mm Hg; 88% 60 mm Hg; 90%
60 mm Hg; 90% The goal is a PaO2 of at least 60 mm Hg and an SaO2 of 90%.
During a breast examination, which finding most strongly suggests that a client has breast cancer? Slight asymmetry of the breasts A fixed nodular mass with dimpling of the overlying skin Bloody discharge from the nipple Multiple firm, round, freely movable masses that change with the menstrual cycle
A fixed nodular mass with dimpling of the overlying skin
Which symptoms may a client with Ménière disease report before an attack? Nystagmus Low blood pressure Photosensitivity A full feeling in the ear
A full feeling in the ear Clients with Ménière disease experience symptoms of headache and a full feeling in the ear before an attack. Nystagmus is an episodic symptom that occurs during an attack, and, at times, the client is symptom free. Ménière disease does not cause low blood pressure or photosensitivity.
Which type of glaucoma presents an ocular emergency? Acute angle-closure glaucoma Normal tension glaucoma Ocular hypertension Chronic open-angle glaucoma
Acute angle-closure glaucoma Acute angle-closure glaucoma results in rapid progressive visual impairment.
The nurse is reviewing the diagnostic test findings of a client with rheumatoid arthritis. What would the nurse expect to find? Increased red blood cell count Increased C4 complement Elevated erythrocyte sedimentation rate Increased albumin levels
Elevated erythrocyte sedimentation rate
Which is a risk factor for cervical cancer? Sex with circumcised males Underweight status Late childbearing Exposure to HPV
Exposure to HPV Risk factors for cervical cancer include exposure to HPV, sex with uncircumcised males, overweight, and early childbearing.
Which exposure acts as a risk factor for and accounts for the majority of cases of chronic obstructive pulmonary disease (COPD)? Exposure to tobacco smoke Occupational exposure Passive smoking Ambient air pollution
Exposure to tobacco smoke
When assessing an older adult's gastrointestinal system, the nurse would identify an increase in which of the following as normal? Feeling of fullness Gastric motility Stomach emptying Calcium absorption
Feeling of fullness In an older adult, gastric motility slows modestly, which results in delayed stomach emptying, which in turn leads to early satiety (feeling of fullness). Calcium absorption is also decreased.
Which of the following is the most common complication associated with peptic ulcer? Hemorrhage Vomiting Elevated temperature Abdominal pain
Hemorrhage Hemorrhage, the most common complication, occurs in 28% to 59% of patients with peptic ulcers. Vomiting, elevated temperature, and abdominal pain are not the most common complications of a peptic ulcer.
A nurse consulting with a nutrition specialist knows it's important to consider a special diet for a client with chronic obstructive pulmonary disease (COPD). Which diet is appropriate for this client? Full-liquid High-protein 1,800-calorie ADA Low-fat
High-protein Breathing is more difficult for clients with COPD, and increased metabolic demand puts them at risk for nutritional deficiencies. These clients must have a high intake of protein for increased calorie consumption
For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? Administering aspirin if the temperature exceeds 102° F (38.8° C) Inspecting the skin for petechiae once every shift Providing for frequent rest periods Placing the client in strict isolation
Inspecting the skin for petechiae once every shift
Which of the following is the most common HIV-related malignancy? Kaposi's sarcoma B-cell lymphoma Cervical carcinoma Pancreatic carcinoma
Kaposi's sarcoma
An elderly client reports that he feels like he voids frequently during the day and at night but cannot empty his bladder. The nurse instructs the client to Decrease fluid intake. Hold his urine as long as possible before voiding. Limit ingestion of caffeinated beverages. Drink no more than his current 2 to 3 ounces of alcohol each day.
Limit ingestion of caffeinated beverages.
A nurse is teaching a client about medications for glaucoma. What is the main marker of glaucoma control with medication? Changing the opacity of the lens Lowering intraocular pressure to target pressure Reducing the appearance of optic nerve head Increasing the visual field
Lowering intraocular pressure to target pressure
The nurse is providing instruction for testicular self-examination to a group of young adolescents. Which is the most correct examination technique? Palpate both testicles simultaneously for comparison. Palpate each testicle separately, following a warm shower. Palpate the front of the testicle first, where most tumors are found. Palpate for a soft, round shape with normal ridges on the testicles.
Palpate each testicle separately, following a warm shower. It is best to examine and palpate each testicle following a warm shower, when the testes are relaxed and not retracted. Because one testicle is normally larger and hangs lower, comparing the two sides is not indicated. Both testes should be oval in shape, smooth, and firm without masses or tenderness. Most tumors are located on the lateral aspect of the testicles.
What intervention is a priority for a client diagnosed with osteoarthritis? Physical therapy and exercise Hydrotherapy Colchicine Allopurinol
Physical therapy and exercise Clients with osteoarthritis need to maintain joint mobility. To preserve joint function, individuals need to learn appropriate activities. Colchicine and allopurinol are used for gout, not osteoarthritis.
The nurse completes a history and physical assessment on a client with acquired immune deficiency syndrome (AIDS) who was admitted to the hospital with respiratory complications. The nurse knows to assess for what common infection (80% occurrence) in persons with AIDS? Cytomegalovirus Legionnaire's disease Mycobacterium tuberculosis Pneumocystis pneumonia
Pneumocystis pneumonia
A nurse administers albuterol (Proventil), as ordered, to a client with emphysema. Which finding indicates that the drug is producing a therapeutic effect? Respiratory rate of 22 breaths/minute Dilated and reactive pupils Urine output of 40 ml/hour Heart rate of 100 beats/minute
Respiratory rate of 22 breaths/minute
Pelvic infection is most commonly caused by which of the following? Sexual transmission Surgical abortion Hysteroscopy Insertion of intrauterine device
Sexual transmission Pelvic infection is most commonly caused by sexual transmission but can also occur with invasive procedures such as endometrial biopsy, surgical abortion, hysteroscopy, or insertion of an intrauterine device.
A pneumothorax is a possible complication of COPD. Symptoms will depend on the suddenness of the attack and the size of the air leak. The most common, immediate symptom that should be assessed is: Sharp, stabbing chest pain Dyspnea A dry, hacking cough Tachycardia
Sharp, stabbing chest pain he initial symptom is usually chest pain of sudden onset that leads to feelings of chest pressure, dyspnea, and tachycardia. A cough may be present.
A patient comes to the clinic for the third time in 2 months with chronic bronchitis. What clinical symptoms does the nurse anticipate assessing for this patient? Chest pain during respiration Sputum and a productive cough Fever, chills, and diaphoresis Tachypnea and tachycardia
Sputum and a productive cough Chronic bronchitis, a disease of the airways, is defined as the presence of cough and sputum production for at least 3 months in each of 2 consecutive years.
Which is a true statement regarding regional enteritis (Crohn's disease)? It has a progressive disease pattern. It is characterized by pain in the lower left abdominal quadrant. The clusters of ulcers take on a cobblestone appearance. The lesions are in continuous contact with one another.
The clusters of ulcers take on a cobblestone appearance.
When developing an educational program for a group of adolescents about sexually transmitted infections (STIs), what should the nurse inform the group about the single greatest risk factor for contracting an STI? The type of contraception used The number of times the person has contact with a partner The number of sexual partners Where the patient lives
The number of sexual partners
When conducting an eye exam, the nurse practitioner is aware that a diagnostic clinical manifestation of glaucoma is: A significant loss of central vision. Diminished acuity. Pain associated with a purulent discharge. The presence of halos around lights.
The presence of halos around lights. Most patients are unaware that they have glaucoma until they experience visual changes and vision loss. Usually the patient notices blurred vision and the presence of "halos" around lights.
A client that is HIV+ has been diagnosed with Pneumocystis pneumonia caused by P. jiroveci. What medication does the nurse expect that the client will take for the treatment of this infection? Trimethoprim-sulfamethoxazole Nystatin Amphotericin B Fluconazole
Trimethoprim-sulfamethoxazole To prevent and treat Pneumocystis pneumonia, trimethoprim-sulfamethoxazole (Bactrim, Septra) is prescribed. The other medications are antifungals and used to treat candidiasis.
A nurse is implementing appropriate infection control precautions for a client who is positive for human immunodeficiency virus (HIV). The nurse knows which body fluid is not a means of transmission? Urine Semen Blood Breast milk
Urine
Which manifestation is the most problematic for the client diagnosed with Ménière disease?
Vertigo Vertigo is usually the most troublesome complaint related to Ménière disease. Other clinical manifestations include tinnitus, diaphoresis, and hearing loss.
Which findings should a nurse expect to assess in client with Hashimoto's thyroiditis? Weight loss, increased appetite, and hyperdefecation Weight loss, increased urination, and increased thirst Weight gain, decreased appetite, and constipation Weight gain, increased urination, and purplish-red striae
Weight gain, decreased appetite, and constipation
Which allergic reaction is potentially life threatening? angioedema urticaria contact dermatitis None of the listed allergic reactions is potentially life threatening.
angioedema
A client with bronchiectasis is admitted to the nursing unit. The primary focus of nursing care for this client includes teaching the family how to perform postural drainage. instructing the client on the signs of respiratory infection. implementing measures to clear pulmonary secretions. providing the client a low-calorie, high-fiber diet.
implementing measures to clear pulmonary secretions.
The nurse is teaching a client with osteoarthritis about the disease. What is the most important client focus for disease management? detection of systemic complications strategies for remaining active disease-modifying antirheumatic drug therapy prevention of joint deformity
strategies for remaining active The goals of osteoarthritis disease management are to decrease pain and stiffness and improve joint mobility. Strategies for remaining active are the most important client focus. The detection of complications, disease-modifying antirheumatic drugs management, and prevention of joint deformity are considerations, but not the most important priorities for the client.
Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include: physician visits. testicular self-examination. risk factors. family history.
testicular self-examination.
A nurse is providing breast cancer education at a community facility. The American Cancer Society recommends that women of average risk for breast cancer get mammograms: yearly starting no later than age 45. after the birth of the first child and every 2 years thereafter. after the first menstrual period and annually thereafter. every 3 years between ages 20 and 44 and annually thereafter.
yearly starting no later than age 45. The American Cancer Society (ACS) recommends a mammogram yearly for women age 45 and older but states that women age 40-44 should have the choice to start screening with yearly mammograms. Women can change to having mammograms every 2 years starting at age 55 if they want. Some guidelines recommend that women between ages 20 and 44 have a professional breast examination (not a mammogram) every 3 years, but the ACS no longer recommends a clinical breast exam or breast self-exam as screening methods for women in the U.S.
A client with osteoarthritis expresses concerns that the disease will prevent the ability to complete daily chores. Which suggestion should the nurse offer? "Do all your chores in the morning, when pain and stiffness are least pronounced." "Do all your chores after performing morning exercises to loosen up." "Pace yourself and rest frequently, especially after activities." "Do all your chores in the evening, when pain and stiffness are least pronounced."
"Pace yourself and rest frequently, especially after activities." A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight-bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace oneself during daily activities. Telling the client to do chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace oneself and take frequent rests rather than doing all chores at once.
A client is experiencing an acute exacerbation of rheumatoid arthritis. What should the nursing priority be? Providing comprehensive client teaching; including symptoms of the disorder, treatment options, and expected outcomes Administering ordered analgesics and monitoring their effects Performing meticulous skin care Supplying adaptive devices, such as a zipper-pull, easy-to-open beverage cartons, lightweight cups, and unpackaged silverware
Administering ordered analgesics and monitoring their effects An acute exacerbation of rheumatoid arthritis can be very painful, and the nurse should make pain management her priority. Client teaching, skin care, and supplying adaptive devices are important, but these actions don't not take priority over pain management.
A client is being treated in the ED for respiratory distress coupled with bacterial pneumonia. The client has no medical history. However, the client works in a coal mine and smokes 10 cigarettes a day. The nurse anticipates which order based on the client's immediate needs? Administration of antibiotics Completion of a 12-lead ECG Administration of corticosteroids and bronchodilators Client education: avoidance of irritants like smoke and pollutants
Administration of antibiotics
A client with asthma is prescribed a short acting beta-adrenergic (SABA) for quick relief. Which of the following is the most likely drug to be prescribed? Ipratropium bromide Fluticasone propionate Ipratropium bromide and albuterol sulfate Albuterol
Albuterol
The client with prostatitis presents with low back pain, dysuria, and unusual sensation following ejaculation. Which treatment(s) does the nurse anticipate being prescribed? Select all that apply Analgesics Sitz baths Antibiotics Abstinence Treatment of sexual partner
Analgesics Sitz baths Antibiotics Treatment of sexual partner Prostatitis is an inflammation of the prostate gland that is most often caused by microorganisms. Treatment consists of up to 30 days of antibiotic therapy, mild analgesics, and sitz baths. Sexual partners also need to be treated. Regular drainage of the prostate gland through masturbation or intercourse can be helpful in decreasing the inflammation and discomfort.
A client with rheumatoid arthritis (RA) is having a routine examination. Which findings indicate to the nurse that this client has systemic involvement from the condition? Select all that apply Fever Fatigue Weight loss Enlarged lymph nodes Hypoactive bowel sound
Fever Fatigue Weight loss Enlarged lymph nodes The most common findings of systemic involvement include a fever, fatigue, weight loss, and enlarged lymph nodes. RA does not affect gastrointestinal motility.
Which is a characteristic of a breast cancer mass? Occurs as disseminated masses Symmetrical mass Tender upon palpation Firm, hard, embedded in surrounding tissue
Firm, hard, embedded in surrounding tissue A characteristic of a breast cancer mass is a firm, hard, embedded lesion in surrounding tissue. It has an irregular shape, usually is not tender, and occurs as a single mass in one breast.
During the first 24 hours after a client is diagnosed with addisonian crisis, which intervention should the nurse perform frequently? Weigh the client. Test urine for ketones. Assess vital signs. Administer oral hydrocortisone.
Assess vital signs. Because the client in addisonian crisis is unstable, vital signs and fluid and electrolyte balance should be assessed every 30 minutes until he's stable.
A client returns to the recovery room following a mastectomy. An initial postoperative assessment is performed by the nurse. What is the nurse's priority assessment? Checking for urinary retention and the need to void. Checking the dressing, drain, and amount of drainage. Checking level of pain first upon the clients return from the operating room. Assessing the vital signs and oxygen saturation levels.
Assessing the vital signs and oxygen saturation levels.
The nurse identifies a nursing diagnosis of ineffective airway clearance related to pneumocystis pneumonia and increased bronchial secretions for a client with AIDS. Which of the following would be appropriate for the nurse to include in the client's plan of care? Maintain the client in a supine or side-lying position. Encourage client to ambulate frequently in the halls. Assist with chest physiotherapy every 2 to 4 hours. Limit fluid intake to 1 1/2 to 2 liters per day.
Assist with chest physiotherapy every 2 to 4 hours. The nurse should include interventions such as assisting with and/or performing chest physiotherapy every 2 to 4 hours to prevent stasis of secretions, assist the client to attain the semi- or high Fowler's position to facilitate breathing and airway clearance, allow for frequent rest periods to prevent excessive fatigue, and maintain a fluid intake of at least 3 liters per day unless contraindicated.
The nurse should be alert for a complication of bronchiectasis that results from a combination of retained secretions and obstruction that leads to the collapse of alveoli. This complication is known as Atelectasis Emphysema Pleurisy Pneumonia
Atelectasis
A client with acquired immune deficiency syndrome (AIDS) reports diarrhea after every meal. What is the nurse's best response? Avoid residue, lactose, fat, and caffeine. Encourage large, high-fat meals. Reduce food intake. Increase the intake of iron and zinc.
Avoid residue, lactose, fat, and caffeine.
A client is receiving external radiation to the left thorax to treat lung cancer. Which intervention should be part of this client's care plan? Avoiding using soap on the irradiated areas
Avoiding using soap on the irradiated areas Because external radiation commonly causes skin irritation, the nurse should wash the irradiated area with water only and leave the area open to air. No soaps, deodorants, lotions, or powders should be applied. A lead apron is unnecessary because no radiation source is present in the client's body or room. Skin in the area to be irradiated is marked to position the radiation beam as precisely as possible; skin markings must not be removed.
A client asks the nurse how their rheumatoid arthritis is diagnosed. The nurse knows that which finding from diagnostic tests can be used to diagnose rheumatoid arthritis? Boney erosions on x-ray Reduced muscle mass on CT scan Evidence of healed fractures on MRI Atherosclerotic plaques on an arteriogram
Boney erosions on x-ray
A nurse is monitoring the client's progression of human immunodeficiency virus (HIV). What debilitating gastrointestinal condition found in up to 90% of all AIDS clients should the nurse be aware of? Anorexia Chronic diarrhea Nausea and vomiting Oral candida
Chronic diarrhea It can cause profound weight loss and severe fluid and electrolyte imbalances.
Upon assessment, the nurse suspects that a client with COPD may have bronchospasm. What manifestations validate the nurse's concern? Select all that apply. Compromised gas exchange Decreased airflow Wheezes Jugular vein distention Ascites
Compromised gas exchange Decreased airflow Wheezes
Which disorder is characterized by a group of symptoms produced by an excess of free circulating cortisol from the adrenal cortex? Cushing syndrome Addison disease Graves disease Hashimoto disease
Cushing syndrome
Which of the following should nurses teach all men, especially those who have had cryptorchidism? Need for blood tests to measure serum acid phosphatase levels. Importance of regular monitoring of prostate-specific antigen (PSA) levels. Need to undergo a baseline and follow up lymph node biopsies. How to perform a testicular self-examination.
How to perform a testicular self-examination. The nurses should teach all men, especially those who have had cryptorchidism, to perform testicular self-examination to detect any abnormal mass in the scrotum. The nurse instructs the clients to examine the testicles monthly, preferably when warm, such as in the shower. Having regular PSA levels, lymph node biopsies, and blood tests for measuring serum acid phosphatase are for the clients who are treated for prostrate cancer.
A nurse is teaching personal hygiene care techniques to a client with genital herpes. Which statement by the client indicates the teaching has been effective? I will wear loose cotton underwear." "I will apply a water-based lubricant to my lesions." "I should rub rather than scratch in response to itching." "I can pour moisturizer over my lesions."
I will wear loose cotton underwear." Wearing loose cotton underwear promotes drying and helps avoid irritation of the lesions. The use of lubricants is contraindicated because they can prolong healing time and increase the risk of secondary infection. Lesions shouldn't be rubbed or scratched because of the risk of tissue damage and additional infection. Cool, wet compresses can be used to soothe the itch. The use of moisturizer on lesions isn't recommended.
The nurse identifies which of the following as an age-related change in the respiratory system? Increased residual lung volume Increased vital capacity Increased diffusion capacity Increased cough efficiency
Increased residual lung volume The older adult experiences an increase in residual lung volume, decreased vital capacity, decreased diffusing capacity, and decreased cough efficiency.
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 Intravenous methylprednisolone (Solu-Medrol) 120 mg Ipratropium bromide (Alupent) by metered-dose inhaler Vancomycin 1 gram intravenously over 1 hour
Oxygen through nasal cannula at 2 L/minute
The nurse is assigned to care for a patient with COPD with hypoxemia and hypercapnia. When planning care for this patient, what does the nurse understand is the main goal of treatment? Providing sufficient oxygen to improve oxygenation Avoiding the use of oxygen to decrease the hypoxic drive Monitoring the pulse oximetry to assess need for early intervention when PCO2 levels rise Increasing pH
Providing sufficient oxygen to improve oxygenation The main objective in treating patients with hypoxemia and hypercapnia is to give sufficient oxygen to improve oxygenation.
A nurse is developing a teaching plan for a client with asthma. Which teaching point has the highest priority? Avoid contact with fur-bearing animals. Change filters on heating and air conditioning units frequently. Take ordered medications as scheduled. Avoid goose down pillows.
Take ordered medications as scheduled.
A client comes to the clinic for a routine evaluation. During the physical examination, the nurse palpates the client's breast and finds a small lump. Which of the following would lead the nurse to suspect possible breast cancer? The client reports tenderness during the palpation. The lump is mobile. The lump is soft. The lump is irregularly shaped.
The lump is irregularly shaped. Generally, breast cancer lesions are nontender, fixed rather than mobile, and hard with irregular borders. Diffuse breast pain and tenderness with menstruation are usually associated with benign breast disease.