FINAL EXAM REVIEW

Question 47 See full question 5s A client's physician has ordered a "liver panel" in response to the client's development of jaundice. When reviewing the results of this laboratory testing, the nurse should expect to review what blood tests? Select all that apply.

Correct response: • Alanine aminotransferase (ALT) • Gamma-glutamyl transferase (GGT) • Aspartate aminotransferase (AST) Explanation: Liver function testing includes GGT, ALT, and AST. CRP addresses the presence of generalized inflammation and BNP is relevant to heart failure; neither is included in a liver panel.

Question 91 See full question 4s The nurse is caring for a client admitted with a diagnosis of acute kidney injury. When reviewing the client's most recent laboratory reports, the nurse notes that the client's magnesium levels are high. The nurse should prioritize assessment for what health problem?

Correct response: • Diminished deep tendon reflexes Explanation: To gauge a client's magnesium status, the nurse should check deep tendon reflexes. If the reflex is absent, this may indicate high serum magnesium. Tachycardia, flank pain, and cool, clammy skin are not typically associated with hypermagnesemia.

Question 7 See full question 6s Which of the following agents suppress release of thyroid hormones? Select all that apply.

Correct response: • Sodium iodide • Potassium iodide • Dexamethasone • Saturated solution of potassium iodide (SSKI) Explanation: Sodium iodide, potassium iodide, dexamethasone, and SSKI suppress the release of thyroid hormones. Methimazole blocks the synthesis of thyroid hormone.

Question 2 See full question 22s A nurse is caring for a client with COPD who needs teaching on pursed-lip breathing. Place the steps in order in which the nurse will instruct the client.

Correct response: • "Inhale through your nose." • "Slowly count to 3." • "Exhale slowly through pursed lips." • "Slowly count to 7." Explanation: Pursed-lip breathing is a technique used to prolong exhalation by propping the airways open and promoting the removal of trapped air and carbon dioxide. The nurse should instruct the client to first inhale through the nose to a slow count of 3. Next, the client should exhale slowly through pursed lips for a count of 7.

Question 81 See full question 8s A client with acute myeloid leukemia (AML) receiving chemotherapy is treated for an acute renal injury. What is the nurse's best understanding of the pathophysiological reason behind the client's injury?

Correct response: • Chemotherapy causes an increase in kidney stone formation. Explanation: Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation. This causes an increase in uric acid levels, potassium, and phosphate (also known as tumor lysis). The increase in uric acid predisposes the client to the development of kidney stones and increases the risk for renal injury.

Question 54 See full question 7s The nurse is planning the care of a client with Parkinson disease. The nurse should be aware that treatment will focus on what pathophysiologic phenomenon?

Correct response: • Decreased availability of dopamine Explanation: Parkinson disease develops from decreased availability of dopamine, not acetylcholine, epinephrine, or serotonin.

Question 36 See full question 26s A staff nurse teaches a client on the proper technique of self-injection for a client with multiple sclerosis. When does the nurse anticipate the end of the implementation phase of teaching-learning process?

Correct response: • When the client's responses to the actions have been recorded Explanation: The implementation phase ends when the teaching strategies have been completed and when the client's responses to the actions have been recorded. Finishing the plan of care marks the end of the planning phase, not the implementation phase. Determining the effectiveness of the teaching as well as evaluating the client's actual behavior related to teaching occurs in the evaluation phase of the teaching-learning process.

Question 18 See full question 16s A nurse cares for an adult client with chronic lymphocytic leukemia (CLL). Which statements regarding the disease will the nurse include in the teaching? Select all that apply.

Correct response: • "This type of leukemia primarily impacts older adults." • "This type of leukemia is rarely seen in certain ethnicities." Explanation: Chronic lymphocytic leukemia (CLL) is a common malignancy of older adults and primarily impacts older adults and has a strong familial predisposition. This type of leukemia rarely impacts Native Americans and infrequently individuals of Asian descent. While many clients will have a normal life expectancy, others will have a very short life expectancy due to the aggressive nature of the disease.

Question 82 See full question 16s An 84-year-old woman is to receive 2 units of packed red blood cells. During the transfusion of the first unit at 125 mL/hour, the client reports shortness of breath 30 minutes into the process. The client exhibits the vital signs shown in the accompanying table. The best nursing intervention is to:

Correct response: • slow the rate of the transfusion and obtain an order for furosemide (Lasix) Explanation: The description is consistent with a client who is experiencing circulatory overload. The nurse is to slow the rate of the transfusion and administer a diuretic. Oxygen is administered with a prescription and for severe dyspnea. This option does not allow for the nurse to slow the transfusion. The nurse would still be administering the blood at the current rate of 125 mL/hour. Diphenhydramine would be prescribed for an allergic reaction. Blood and urine specimens are obtained for acute hemolytic reactions.

Question 5 See full question 38s The nurse is caring for a client who had a brush biopsy 12 hours ago. The presence of what assessment finding should prompt the nurse to notify the physician? Correct response:

• Temperature 37.9°C (100.2°F) orally Explanation: Hematuria and renal colic are common and expected findings after the performance of a renal brush biopsy. The physician should be notified of the client's body temperature, which likely indicates the onset of an infectious process. IV infiltration does not warrant notification of the primary physician.

Question 76 See full question 3s A client's electronic health record states that the client receives regular transfusions of factor IX. The nurse would be justified in suspecting that this client has what diagnosis?

Correct response: • Hemophilia Explanation: Administration of clotting factors is used to treat diseases where these factors are absent or insufficient; hemophilia is among the most common of these diseases. Factor IX is not used in the treatment of leukemia, lymphoma, or anemia.

Question 49 See full question 7s A client with portal hypertension has been admitted to the medical floor. The nurse should prioritize what assessments?

Correct response: • Daily weights and abdominal girth measurement Explanation: Obstruction to blood flow through the damaged liver results in increased blood pressure (portal hypertension) throughout the portal venous system. This can result in varices and ascites in the abdominal cavity. Assessments related to ascites are daily weights and abdominal girths. Portal hypertension is not synonymous with cardiovascular hypertension and does not create a risk for unstable blood glucose or VTE.

Question 16 See full question 55s A nurse reviews the laboratory results of a client with polycythemia vera. Which findings will the nurse find? Select all that apply.

Correct response: • Decreased erythropoietin • Increased hemoglobin Explanation: Polycythemia vera causes increased hemoglobin and decreased erythropoietin. Additionally, polycythemia vera causes an increase in platelets and leukocytes as well.

Question 37 See full question 16s When the nurse is assessing the older adult patient, what gerontologic changes in the respiratory system should the nurse be aware of? (Select all that apply.)

Correct response: • Decreased gag reflex • Increased presence of collagen in alveolar walls • Decreased presence of mucus Explanation: Age-related changes in the respiratory system include a decrease in mucus, decrease in gag reflex, increase in collagen in the alveolar walls of the lungs, and increase in alveolar duct diameter.

Question 78 See full question 12s Place the pathophysiological processes in order for how sickle cell disease leads to fatigue.

Correct response: • Decreased hemoglobin in RBC • Inflamed vascular endothelium • Increased inflammatory cytokines • Decreased muscle strength Explanation: Fatigue is common and multifactorial in sickle cell disease. Decreased hemoglobin in the sickled red blood cell leads to inflammation of the vascular endothelium and increased inflammatory cytokines. These factors lead to decreased muscle strength--exacerbating fatigue.

Question 86 See full question 18s A patient with chronic renal failure is examined by the nurse practitioner for anemia. The nurse knows to review the laboratory data for a decreased hemoglobin level, red blood cell count, and which of the following?

Correct response: • Decreased level of erythropoietin Explanation: As renal function decreases, erythropoietin, which is produced by the kidney, also decreases. Because erythropoietin is produced outside the kidney, some erythropoiesis continues, even in patients whose kidneys have been removed. However, the number of red blood cells produced is small and the degree of erythropoiesis is inadequate.

Question 98 See full question 6s A client with suspected acute myocardial infarction is admitted to the coronary care unit. To help confirm the diagnosis, the physician orders serial enzyme tests. Increased serum levels of the isoenzyme creatinine kinase of myocardial muscle (CK-MB), found only in cardiac muscle, can be detected how soon after the onset of chest pain?

Correct response: • 4 to 6 hours Explanation: Serum CK-MB levels can be detected 4 to 6 hours after the onset of chest pain. These levels peak within 12 to 18 hours and return to normal within 3 to 4 days.

Question 27 See full question 7s A client, diagnosed with hypothyroidism began treatment with levothyroxine several weeks ago, telephones the clinic to report missing yesterday's dose. The nurse should base his/her response on what understanding concerning the length of the half-life of this medication.

Correct response: • 9 to 10 days Explanation: Levothyroxine has a long half-life, about 6 to 7 days in euthyroidism (normal thyroid function), but it is prolonged to 9 to 10 days in hypothyroidism and shortened to 3 to 4 days in hyperthyroidism.

Question 51 See full question 22s Allopurinol has been prescribed for a client receiving treatment for gout. The nurse caring for this client knows to assess the client for bone marrow suppression, which may be manifested by what diagnostic finding?

Correct response: • Decreased platelets Explanation: Thrombocytopenia occurs in bone marrow suppression. Hyperuricemia occurs in gout, but is not caused by bone marrow suppression. Increased erythrocyte sedimentation rate may occur from inflammation associated with gout, but is not related to bone marrow suppression. An elevated serum creatinine level may indicate renal damage, but this is not associated with the use of allopurinol.

Question 31 See full question 7s The root cause of cancer is damage to cellular deoxyribonucleic acid (DNA). Such damage results from multiple factors. Which of the following is a carcinogen?

Correct response: • Dietary substances • Environmental factors • Viruses • Chemical agents • Defective genes • Medically prescribed interventions Explanation: Carcinogens include chemical agents, environmental factors, dietary substances, viruses, defective genes, and medically prescribed interventions.

Question 11 See full question 4s A client has just been diagnosed with type 2 diabetes. The health care provider has prescribed an oral antidiabetic agent that will inhibit the production of glucose by the liver and thereby aid in the control of blood glucose. What type of oral antidiabetic agent did the health care provider prescribe for this client?

Correct response: • A biguanide Explanation: Sulfonylureas exert their primary action by directly stimulating the pancreas to secrete insulin and therefore require a functioning pancreas to be effective. Biguanides inhibit the production of glucose by the liver and are in used in type 2 diabetes to control blood glucose levels. Thiazolidinediones enhance insulin action at the receptor site without increasing insulin secretion from the beta cells of the pancreas. Alpha-glucosidase inhibitors work by delaying the absorption of glucose in the intestinal system, resulting in a lower postprandial blood glucose level.

Question 65 See full question 5s The nurse is assessing a client who is known to have right-sided heart failure. What assessment finding is most consistent with this client's diagnosis?

Correct response: • Distended neck veins Explanation: Right-sided heart failure may manifest by distended neck veins, dependent edema, hepatomegaly, weight gain, ascites, anorexia, nausea, nocturia, and weakness. The other answers are not characteristic signs of right-sided heart failure.

Question 40 See full question 7s The nurse is instructing a patient who is scheduled for a perfusion lung scan. What should be included in the information about the procedure? (Select all that apply.)

Correct response: • A mask will be placed over the nose and mouth during the test. • The patient will be expected to lie under the camera. • The imaging time will amount to 20 to 40 minutes. Explanation: A ventilation/perfusion lung scan is performed by injecting a radioactive agent into a peripheral vein and then obtaining a scan of the chest to detect radiation. The isotope particles pass through the right side of the heart and are distributed into the lungs in proportion to the regional blood flow, making it possible to trace and measure blood perfusion through the lung. This procedure is used clinically to measure the integrity of the pulmonary vessels relative to blood flow and to evaluate blood flow abnormalities, as seen in pulmonary emboli. The imaging time is 20 to 40 minutes, during which the patient lies under the camera with a mask fitted over the nose and mouth. This is followed by the ventilation component of the scan. The patient need not be NPO for 12 hours prior to the procedure.

Question 63 See full question 6s A nurse is providing an educational class to a group of older adults at a community senior center. In an effort to prevent osteoporosis, the nurse should encourage participants to ensure that they consume the recommended intake of what nutrients? Select all that apply.

Correct response: • Calcium • Vitamin D Explanation: A diet rich in calcium and vitamin D protects against skeletal demineralization. Intake of vitamin B12and potassium does not directly influence the risk for osteoporosis. Calcitonin is not considered to be a dietary nutrient.

Question 100 See full question 5s A client with chest pain arrives in the emergency department and receives nitroglycerin, morphine (Duramorph), oxygen, and aspirin. The physician diagnoses acute coronary syndrome. When the client arrives on the unit, his vital signs are stable and he has no complaints of pain. The nurse reviews the physician's orders. In addition to the medications already given, which medication does the nurse expect the physician to order?

Correct response: • Carvedilol (Coreg) Explanation: A client with suspected myocardial infarction should receive aspirin, nitroglycerin, morphine, and a beta-adrenergic blocker such as carvedilol. Digoxin treats arrhythmias; there is no indication that the client is having arrhythmias. Furosemide is used to treat signs of heart failure, which isn't indicated at this point. Nitroprusside increases blood pressure. This client has stable vital signs and isn't hypotensive.

Question 66 See full question 5s The nurse is caring for a client with systolic heart failure whose previous adverse reactions rule out the safe use of ACE inhibitors. The nurse should anticipate that the prescriber may choose what combination of drugs?

Correct response: • Combination of hydralazine and isosorbide dinitrate Explanation: A combination of hydralazine and isosorbide dinitrate may be an alternative for clients who cannot take ACE inhibitors. Antiplatelet aggregators, calcium channel blockers, and normal saline are not typically prescribed.

Question 45 See full question 7s A nurse is caring for a patient with cancer of the liver whose condition has required the insertion of a percutaneous biliary drainage system. The nurse's most recent assessment reveals the presence of dark green fluid in the collection container. What is the nurse's best response to this assessment finding?

Correct response: • Document the presence of normal bile output. Explanation: Bile is usually a dark green or brownish-yellow color, so this would constitute an expected assessment finding, with no other action necessary.

Question 35 See full question 20s Nursing students are reviewing statistics related to the older adult population and leading causes of death in this age group. The students demonstrate understanding of this information when they rank the following conditions in the order from highest to lowest.

Correct response: • Heart disease • Malignant neoplasms • Cerebrovascular disease • Chronic obstructive pulmonary disease • Alzheimer's disease • Diabetes Explanation: According to the National Center for Health Statistics, the leading causes of death in the older adult from highest to lowest are heart diseases, malignant neoplasms, cerebrovascular disease, chronic obstructive pulmonary disease, Alzheimer's disease, and diabetes.

Question 83 See full question 16s A male client has been receiving a continuous infusion of weight-based heparin for more than 4 days. The client's PTT is at a level that requires an increase of heparin by 100 units per hour. The client has the laboratory findings shown above. The most important action of the nurse is to

Correct response: • Consult with the physician about discontinuing heparin. Explanation: Platelet counts may decrease with heparin therapy, and this client's platelet count has decreased. The client may have heparin-induced thrombocytopenia (HIT). Treatment of HIT includes discontinuing the heparin. The question asks about the most important action of the nurse and that is to consult with the physician about discontinuing heparin therapy. The nurse may continue with the current rate and should not increase the heparin dose until consulting with the physician. Warfarin is not administered until the platelet count has returned to normal levels.

Question 38 See full question 17s The nurse assesses a patient with pneumonia and notes bronchial breath sounds over consolidated lung areas. Which of the following breath sounds are diagnostic for pneumonia? Select all that apply.

Correct response: • Crackles • Egophony • Whispered pectoriloquy • Percussion dullness Explanation: Physical examination findings may reveal bronchial breath sounds over consolidated lung areas: soft, high-pitched crackles, inspiratory vesicular sounds that are longer than expired normal breath sounds; increased tactile fremitus (vocal vibration detected on palpation), percussion dullness, egophony, and whispered pectoriloquy (whispered sounds are easily auscultated through the chest wall). Wheezes and friction rubs are not diagnostic for pneumonia.

Question 32 See full question 12s A 73-year-old female patient with cirrhosis of the liver is evaluated for clinical manifestations of FVE. Which of the following signs are consistent with that diagnosis? Select all that apply.

Correct response: • Crackles • Hematocrit level of 32% • Blood pressure of 140/110 • BUN of 8 mg/dL Explanation: The blood pressure is increased with FVE. Crackles are abnormal lung sounds found in fluid retention. Hematocrit and BUN may be decreased due to plasma dilution.

Question 41 See full question 3s A client admitted with pneumonia has a history of lung cancer and heart failure. A nurse caring for this client recognizes that he should maintain adequate fluid intake to keep secretions thin for ease in expectoration. The amount of fluid intake this client should maintain is:

Correct response: • 1.4 L. Explanation: Clients need to keep their secretions thin by drinking 2 to 3 L of clear liquids per day. In clients with heart failure, fluid intake shouldn't exceed 1.5 L daily.

Question 69 See full question 6s The nurse caring for a client with suspected renal dysfunction calculates that the client's weight has increased by 5 pounds (2.27 kg) in the past 24 hours. The nurse estimates that the client has retained approximately how much fluid?

Correct response: • 2,300 mL of fluid in 24 hours Explanation: An increase in body weight commonly accompanies edema. To calculate the approximate weight gain from fluid retention, the nurse should remember that 1 kg of weight gain equals approximately 1,000 mL of fluid. Five pounds = 2.27 kg = 2270 mL.

Question 72 See full question 7s The nurse is describing normal RBC physiology to a client who has a diagnosis of anemia. The nurse should explain that the RBCs consist primarily of which of the following?

Correct response: • Hemoglobin Explanation: Mature erythrocytes consist primarily of hemoglobin, which contains iron and makes up 95% of the cell mass. RBCs are not made of fibrin or plasminogen. Hematocrit is a measure of RBC volume in whole blood.

Question 8 See full question 16s A client admitted with severe epigastric abdominal pain radiating to the back is vomiting and reports difficulty breathing. Upon assessment, the nurse determines that the client is experiencing tachycardia and hypotension. Which actions are priority interventions for this client? Select all that apply.

Correct response: • Administer pain-relieving medication • Administer electrolytes • Administer plasma • Assist the client to a semi-Fowler position Explanation: The nurse promptly reports decreased blood pressure (BP) and reduced urine output, which indicate hypovolemia and shock or renal failure. The treatment goals for acute pancreatitis focus on relieving pain, maintaining circulatory and fluid volume, and decreasing the production of pancreatic enzymes. Intravenous replacement of fluid and electrolytes should begin immediately because of the loss of fluid in the body. If hypotension is evident, plasma should be administered to maintain BP within an acceptable range. Fluids are administered intravenously and may be accompanied by infusion of blood or blood products to maintain blood volume and to prevent or treat hypovolemic shock. Low serum calcium and magnesium concentrations may occur and require prompt treatment. The nurse maintains the client in a semi-Fowler position to decrease pressure on the diaphragm by a distended abdomen and to increase respiratory expansion. A low-fat diet, with small frequent meals, should be initiated after control of symptoms; it is not an immediate priority.

Question 10 See full question 10s A client has been admitted to the critical care unit with a diagnosis of thyroid storm. What interventions should the nurse include in this client's immediate care? Select all that apply.

Correct response: • Administering beta blockers to reduce heart rate • Applying interventions to reduce the client's temperature Explanation: Thyroid storm necessitates interventions to reduce heart rate and temperature. Diuretics, insulin, and steroids are not indicated to address the manifestations of this health problem.

Question 43 See full question 4s The nurse is caring for a client admitted with an acute exacerbation of chronic obstructive pulmonary disease. During assessment, the nurse finds that the client is experiencing increased dyspnea. What is the most accurate measurement of the concentration of oxygen in the client's blood?

Correct response: • An arterial blood gas (ABG) study Explanation: The arterial oxygen tension (partial pressure or PaO2) indicates the degree of oxygenation of the blood, and the arterial carbon dioxide tension (partial pressure or PaCO2) indicates the adequacy of alveolar ventilation. ABG studies aid in assessing the ability of the lungs to provide adequate oxygen and remove carbon dioxide and the ability of the kidneys to reabsorb or excrete bicarbonate ions to maintain normal body pH. Capillary blood samples are venous blood, not arterial blood, so they are not as accurate as an ABG. Pulse oximetry is a useful clinical tool but does not replace ABG measurement, because it is not as accurate. A CBC does not indicate the concentration of oxygen.

Question 64 See full question 6s A nurse is caring for a client with Paget disease and is reviewing the client's most recent laboratory values. Which of the following values is most characteristic of Paget disease?

Correct response: • An elevated serum alkaline phosphatase level and a normal serum calcium level Explanation: Clients with Paget disease have normal blood calcium levels. Elevated serum alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increased osteoblastic activity associated with this condition. Alterations in PTH and calcitonin levels are atypical.

Question 9 See full question 11s The nurse is caring for a client with acute glomerular inflammation. When assessing for the characteristic signs and symptoms of this health problem, the nurse should include which assessments? Select all that apply.

Correct response: • Assess for the presence of peripheral edema. • Assess the client's BP. Explanation: Most clients with acute glomerular inflammation have some degree of edema and hypertension. Dysrhythmias, RLQ pain, and changes in mental status are not among the most common manifestations of acute glomerular inflammation.

Question 4 See full question 54s A client has been hospitalized with heart failure multiple times. The home health nurse is visiting the client with the overall goal of decreasing the frequency of hospitalizations. Using the nursing process, outline the steps the nurse would do in the correct order from 1 to 5.

Correct response: • Assesses the client's weight as 88 kg, 117% of ideal body weight • Establishes the nursing diagnosis as Excess Fluid Volume • Identifies a goal for the client to weigh 86 kg within 1 week • Intervenes by teaching the client about weighing self every day • Evaluates the client's weight as 86 kg 1 week later Explanation: The nurse uses the nursing process when providing care for clients, including clients with chronic health problems such as heart failure. The order of the nursing process is assessment, diagnosis, planning, implementation, and evaluation.

Question 48 See full question 4s A nurse is caring for a client who has been admitted for the treatment of advanced cirrhosis. What assessment should the nurse prioritize in this client's plan of care?

Correct response: • Assessment for variceal bleeding Explanation: Esophageal varices are a major cause of mortality in clients with uncompensated cirrhosis. Consequently, this should be a focus of the nurse's assessments and should be prioritized over the other listed assessments, even though each should be performed.

Question 57 See full question 5s A client returns to the floor after a laparoscopic cholecystectomy. The nurse should assess the client for signs and symptoms of what serious potential complication of this surgery?

Correct response: • Bile duct injury Explanation: The most serious complication after laparoscopic cholecystectomy is a bile duct injury. Clients do not face a risk of diabetic coma. A decubitus ulcer is unlikely because immobility is not expected. Evisceration is highly unlikely, due to the laparoscopic approach.

Question 26 See full question 17s What is the difference between COX-1 and COX-2 enzymes?

Correct response: • COX-1 enzymes secrete cytoprotective mucus Explanation: They are converted from arachidonic acid to prostaglandins by the enzyme cyclooxygenase (COX). There are two forms of the COX enzyme: COX-1 and COX-2. COX-1 synthesizes prostaglandins that are involved in the regulation of normal cell activity, whereas COX-2 appears to produce prostaglandins mainly at sites of inflammation. For instance, in the gastrointestinal (GI) tract, COX-1 is responsible for secretion of cytoprotective mucus and bicarbonate, suppression of the output of gastric acid, and support for submucosal blood flow. In the renal system, COX-1 promotes vasodilation, resulting in increased blood flow to the kidneys. COX-2 is activated by arthritis and other stimuli and produces the prostaglandins that lead to inflammation, swelling, and joint pain.

Question 39 See full question 1m 10s The diagnosis of pulmonary hypertension associated with chronic obstructive pulmonary disease (COPD) is suspected when which of the following is noted? Select all that apply.

Correct response: • Dyspnea and fatigue disproportionate to pulmonary function abnormalities • Right ventricular enlargement • Elevated plasma brain natriuretic peptide (BNP) • Enlargement of central pulmonary arteries Explanation: The diagnosis of pulmonary hypertension associated with COPD is suspected in patients complaining of dyspnea and fatigue that appear to be disproportionate to pulmonary function abnormalities. Enlargement of the central pulmonary arteries on the chest X-ray, echocardiogram suggestive of right ventricular enlargement, and elevated plasma BNP may be present.

Question 14 See full question 20s Compliance to a renal diet is a difficult lifestyle change for a patient on hemodialysis. The nurse should reinforce nutritional information. Which of the following teaching points should be included? Select all that apply.

Correct response: • Eat foods such as milk, fish, and eggs. • Restrict sodium to 2,000 to 3,000 mg daily. • Restrict fluid to daily urinary output plus 500 to 800 mL. Explanation: With hemodialysis, protein should be limited to 1.2 to 1.3 g/kg/24 hr. Potassium, along with sodium and phosphorus should be restricted.

Question 28 See full question 4s The client with a brain tumor may be at increased risk for aspiration. What does the nurse determine is the most important nursing intervention?

Correct response: • Evaluation of gag reflex and ability to swallow Explanation: Evaluation of the gag reflex and ability to swallow to prevent the risk of aspiration is an important nursing intervention. Monitoring vital signs, assistance with self-care, and frequent reorientation are important but are not the most important intervention.

Question 60 See full question 9s An older adult client with type 2 diabetes is brought to the emergency department by his daughter. The client is found to have a blood glucose level of 600 mg/dL (33.3 mmol/L). The client's daughter reports that the client recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority?

Correct response: • Fluid and electrolyte replacement Explanation: The overall approach to HHS includes fluid replacement, correction of electrolyte imbalances, and insulin administration. Antihypertensive medications are not indicated, as hypotension generally accompanies HHS due to dehydration. Sodium bicarbonate is not given to clients with HHS, as their plasma bicarbonate level is usually normal. Insulin administration plays a less important role in the treatment of HHS because it is not needed for reversal of acidosis, as in diabetic ketoacidosis (DKA).

Question 77 See full question 6s A client was admitted to the hospital with the following laboratory values: hemoglobin 5 g/dL, leukocyte count 2000/mm3, and a platelet count of 48,000/mm3; abnormally shaped erythrocytes and hypersegmented neutrophils were seen. The platelets appear abnormally large. A bone marrow biopsy was competed and revealed hyperplasia. Based on this information, the nurse determines that client most likely has which diagnosis?

Correct response: • Folic acid deficiency Explanation: Anemia caused by a deficiency of folic acid cause bone marrow and peripheral blood changes. The erythrocytes that are produced are abnormally large and are called megaloblastic red cells. Other cells derived from the myeloid stem cell are also abnormal. A bone marrow analysis reveals hyperplasia (abnormal increase in the number of cells). Pancytopenia (a decrease in all myeloid stem cell-derived cells) can develop. In advanced stages of disease, the hemoglobin value may be as low as 4-5 g/dL, the leukocyte count 2,000-3,000/mm3, and the platelet count less than 50,000/mm3. Cells that are released into the circulation are often abnormally shaped. The neutrophils are hypersegmented. The platelets may be abnormally large. The erythrocytes are abnormally shaped.

Question 6 See full question 8s Enlargement of the prostate causes which of the following to occur? Select all that apply.

Correct response: • Frequency • Oliguria • Anuria • Obstruction of urine flow Explanation: Enlargement of the prostate gland causes obstruction of urine flow, resulting in frequency, oliguria, and anuria. Polyuria does not occur.

Question 59 See full question 7s A client with pancreatic cancer has been scheduled for a pancreaticoduodenectomy (Whipple procedure). During health education, the client should be informed that this procedure will involve the removal of which of the following? Select all that apply.

Correct response: • Gallbladder • Part of the stomach • Duodenum • Part of the common bile duct Explanation: A pancreaticoduodenectomy (Whipple procedure or resection) is used for potentially resectable cancer of the head of the pancreas. This procedure involves removal of the gallbladder, a portion of the stomach, duodenum, proximal jejunum, head of the pancreas, and distal common bile duct. The rectum is not affected.

Question 30 See full question 3s A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable method of confirming acromegaly?

Correct response: • Glucose tolerance test in combination with a GH measurement Explanation: A glucose tolerance test in combination with a GH measurement is the most reliable method of confirming acromegaly. Ingestion of a bolus of glucose should lower GH levels, but GH levels remain elevated in persons with acromegaly. Increased blood levels of IGF-1 can also indicate acromegaly in nonpregnant women; they typically have IGF-1 levels two to three times higher than normal in pregnant women. A serum glucose level is not an indicator of acromegaly. Growth hormone levels and bone radiographs may support the diagnosis but are not reliable indicators.

Question 29 See full question 9s A client is brought to the emergency department by the paramedics. The client is a type 2 diabetic and is experiencing hyperglycemic hyperosmolar syndrome (HHS). The nurse should identify what components of HHS? Select all that apply.

Correct response: • Glycosuria • Dehydration • Hypernatremia • Hyperglycemia Explanation: In HHS, persistent hyperglycemia causes osmotic diuresis, which results in losses of water and electrolytes. To maintain osmotic equilibrium, water shifts from the intracellular fluid space to the extracellular fluid space. With glycosuria and dehydration, hypernatremia and increased osmolarity occur. Leukocytosis does not take place.

Question 70 See full question 15s A client diagnosed with chronic renal failure is receives continuous peritoneal dialysis (PD). The nurse instructs the client about which diet plan?

Correct response: • High-protein diet Explanation: Because of protein loss with continuous PD, the client is instructed to eat a high-protein, nutritious diet. The client is also encouraged to increase daily fiber intake to help prevent constipation, which can impede the flow of dialysate into or out of the peritoneal cavity. A low-protein diet is required to reduce the production of end products of protein metabolism that the kidneys are unable to excrete. Establishing a diet high in calories and low in protein, sodium, and potassium is essential for clients with acute renal failure.

Question 34 See full question 10s When malignant cells are killed (tumor lysis syndrome), intracellular contents are released into the bloodstream. This leads to which of the following? Select all that apply.

Correct response: • Hyperkalemia • Hyperuricemia • Hyperphosphatemia Explanation: When intracellular contents are released into the bloodstream, phosphorous is elevated. This results in an inverse decline in the levels of calcium, so hypercalcemia would not occur.

Question 19 See full question 34s An ED nurse is assessing a 71-year-old female client for a suspected MI. When planning the assessment, the nurse should be cognizant of what signs and symptoms of MI that are particularly common in female clients? Select all that apply.

Correct response: • Indigestion • Nausea Explanation: Many women experiencing coronary events including--unstable angina, MIs, or sudden cardiac death events--are asymptomatic or present with atypical symptoms including indigestion, nausea, palpitations, and numbness. Shortness of breath, chest pain, and anxiety are common symptoms of MI among clients of all ages and genders.

Question 95 See full question 7s The triage nurse in the ED assesses an adult client who presents with reports of midsternal chest pain that has lasted for the last 5 hours. If the client's symptoms are due to an MI, what will have happened to the myocardium?

Correct response: • It may have developed an increased area of infarction during the time without treatment. Explanation: When the client experiences lack of oxygen to myocardium cells during an MI, the sooner treatment is initiated, the more likely the treatment will prevent or minimize myocardial tissue necrosis. Delays in treatment equate with increased myocardial damage. Despite the length of time the symptoms have been present, treatment needs to be initiated immediately to minimize further damage. Dead cells cannot be restored by any means.

Question 88 See full question 5s In a client with chronic bronchitis, which sign would lead the nurse to suspect right-sided heart failure?

Correct response: • Leg edema Explanation: Right-sided heart failure is characterized by signs of circulatory congestion, such as leg edema, jugular vein distention, and hepatomegaly. Left-sided heart failure is characterized by circumoral cyanosis, crackles, and a productive cough.

Question 96 See full question 9s The nurse is providing care for a client with high cholesterol and triglyceride values. In teaching the client about therapeutic lifestyle changes such as diet and exercise, the nurse realizes that the desired goal for cholesterol levels is which of the following?

Correct response: • Low LDL values and high HDL values Explanation: The desired goal for cholesterol readings is for a client to have low LDL and high HDL values. LDL exerts a harmful effect on the coronary vasculature because the small LDL particles can be easily transported into the vessel lining. In contrast, HDL promotes the use of total cholesterol by transporting LDL to the liver, where it is excreted. Elevated triglycerides are also a major risk factor for cardiovascular disease. A goal is also to keep triglyceride levels less than 150 mg/dL. All individuals possess detectable levels of total cholesterol.

Question 89 See full question 9s A client is in the early stage of heart failure. During this time, which compensatory mechanism occurs?

Correct response: • Low blood pressure triggers the baroreceptors to increase sympathetic nervous system stimulation. Explanation: In the early stage of heart failure, low blood pressure triggers baroreceptors in the carotid sinus and aortic arch to increase sympathetic nervous system stimulation, causing an increased heart rate, vasoconstriction, and increased myocardial oxygen consumption. Decreased renal blood flow causes the renin-angiotensin-aldosterone system to increase, not reduce, secretion of aldosterone and antidiuretic hormone, causing sodium and water retention and arterial vasoconstriction.

Question 44 See full question 6s A client is undergoing testing to see if he has a pleural effusion. Which of the nurse's respiratory assessment findings would be most consistent with this diagnosis?

Correct response: • Lung fields dull to percussion, absent breath sounds, and a pleural friction rub Explanation: Assessment findings consistent with a pleural effusion include affected lung fields being dull to percussion and absence of breath sounds. A pleural friction rub may also be present. The other listed signs are not typically associated with a pleural effusion.

Question 25 See full question 20s A client diagnosed with diabetes is demonstrating slow, deep respirations and is difficult to arouse. Which nursing intervention is directed specifically at treating this serious complication of diabetes?

Correct response: • Maintaining adequate intravenous fluid delivery Explanation: Hyperglycemia, or high blood sugar, results when there is an increase in glucose in the blood. Clinical signs include Kussmaul respirations, impaired orientation and alertness, and the presence of a fruit breath resulting for a build up ketones being excreted via the lungs. Fluid and electrolytes are lost through the kidneys causing dehydration that must be addressed through the introduction of adequate IV fluids. The remaining options are appropriate assessment activities but do not address the focus of the question; a specific intervention.

Question 61 See full question 6s A medical nurse is aware of the need to screen specific clients for their risk of hyperglycemic hyperosmolar syndrome (HHS). In what client population does hyperosmolar nonketotic syndrome most often occur?

Correct response: • Middle-aged or older people with either type 2 diabetes or no known history of diabetes Explanation: HHS occurs most often in older people (50 to 70 years of age) who have no known history of diabetes or who have type 2 diabetes. The incidence is lower among the other listed groups.

Question 85 See full question 9s Which nursing intervention should be incorporated into the plan of care for a client with impaired liver function and a low albumin concentration?

Correct response: • Monitor for edema at least once per shift Explanation: Albumin is particularly important for the maintenance of fluid balance within the vascular system. Capillary walls are impermeable to albumin, so its presence in the plasma creates an osmotic force that keeps fluid within the vascular space. Clients with impaired hepatic function may have low concentrations of albumin, with a resultant decrease in osmotic pressure and the development of edema.

Question 84 See full question 3s Which cell of hematopoiesis is responsible for the production of red blood cells (RBCs) and platelets?

Correct response: • Myeloid stem cell Explanation: Myeloid stem cells are responsible not only for all nonlymphoid white blood cells (WBC) but also for the production of red blood cells and platelets. Lymphoid cells produce either T or B lymphocytes. A monocyte is large WBC that becomes a macrophage when is leaves the circulation and moves into body tissues, and not responsible for RBC production.. A neutrophil is a fully mature WBC capable of phagocytosis and not responsible for RBC production.

Question 46 See full question 4s A nurse is caring for a client with a blocked bile duct from a tumor. What manifestation of obstructive jaundice should the nurse anticipate?

Correct response: • Orange and foamy urine Explanation: If the bile duct is obstructed, the bile will be reabsorbed into the blood and carried throughout the entire body. It is excreted in the urine, which becomes deep orange and foamy. Bloody diarrhea, ascites, and cognitive changes are not associated with obstructive jaundice.

Question 97 See full question 4s The hospital nurse is caring for a client who tells the nurse that he has an angina attack beginning. What is the nurse's most appropriate initial action?

Correct response: • Place the client on bed rest in a semi-Fowler position. Explanation: When a client experiences angina, the client is directed to stop all activities and sit or rest in bed in a semi-Fowler position to reduce the oxygen requirements of the ischemic myocardium. Pursed-lip breathing and standing will not reduce workload to the same extent. There is no need to have the client put his head between his legs because cerebral perfusion is not lacking

Question 71 See full question 10s A client is diagnosed with a right-sided stroke. The client is now experiencing hemianopsia. How might the nurse help the client manage her potential sensory and perceptional difficulties?

Correct response: • Place the client's extremities where she can see them. Explanation: The client with homonymous hemianopsia (loss of half of the visual field) turns away from the affected side of the body and tends to neglect that side and the space on that side; this is called amorphosynthesis. In such instances, the client cannot see food on half of the tray, and only half of the room is visible. It is important for the nurse to remind the client constantly of the other side of the body, to maintain alignment of the extremities, and if possible, to place the extremities where the client can see them. Clients with a decreased field of vision should be approached on the side where visual perception is intact. All visual stimuli (clock, calendar, and television) should be placed on this side. The client can be taught to turn the head in the direction of the defective visual field to compensate for this loss. Increasing the natural or artificial lighting in the room and providing eyeglasses are important in increasing vision. There is no reason to keep the lights dim.

Question 3 See full question 24s A nurse prepares to suction a client's tracheostomy tube. Place the procedure steps in correct order.

Correct response: • Position the client in Fowlers position. • Don sterile gloves. • Lubricate the sterile suction catheter. • Insert suction catheter into the lumen of the tube. • Apply intermittent suction while withdrawing the catheter. Explanation: Suctioning a tracheostomy is a sterile procedure. The nurse should first position the client in Fowler's position then don sterile gloves. Next, the nurse will lubricate the sterile suction catheter and insert the catheter into the lumen of the tube. Finally, the nurse will apply intermittent suction while withdrawing the catheter.

Question 87 See full question 11s A physician orders digoxin (Lanoxin) for a client with heart failure. During digoxin therapy, which laboratory value may predispose the client to digoxin toxicity?

Correct response: • Potassium level of 2.8 mEq/L Explanation: Conditions that may predispose a client to digoxin toxicity include hypokalemia (evidenced by a potassium level less than 3.5 mEq/L), hypomagnesemia (evidenced by a magnesium level less than 1.5 mEq/L), hypothyroidism, hypoxemia, advanced myocardial disease, active myocardial ischemia, and altered autonomic tone. Hypermagnesemia (evidenced by a magnesium level greater than 2.5 mEq/L), hypercalcemia (evidenced by an ionized calcium level greater than 5.3 mg/dl), and hypernatremia (evidenced by a sodium level greater than 145 mEq/L) aren't associated with a risk of digoxin toxicity.

Question 33 See full question 7s An older adult has been medicated with an oral opioid for postoperative pain. To make the pain medication more effective, the nurse first

Correct response: • Provides the client with a fresh gown and changes the bed linens Explanation: Clients are usually more comfortable and pain relief measures are increased when physical needs are met. Nursing interventions would include providing a fresh gown, changing bed linens, placing the client in a more comfortable position, brushing teeth, and combing hair. Hydroxyzine may be given with opioid analgesics. However, elderly clients are more susceptible to adverse reactions of this medication, and other alternative measures should be tried first. A high Fowler's position in a chair may not be more comfortable. Ingesting food with an opioid medication does not make the medication more effective.

Question 90 See full question 7s The nurse notes that a client has developed a cough productive for mucoid sputum, is short of breath, has cyanotic hands, and has noisy, moist-sounding, rapid breathing. These symptoms and signs are suggestive of what health problem?

Correct response: • Pulmonary edema Explanation: As a result of decreased cerebral oxygenation, the client with pulmonary edema becomes increasingly restless and anxious. Along with a sudden onset of breathlessness and a sense of suffocation, the client's hands become cold and moist, the nail beds become cyanotic (bluish), and the skin turns ashen (gray). The pulse is weak and rapid, and the neck veins are distended. Incessant coughing may occur, producing increasing quantities of foamy sputum. Pericarditis, ventricular hypertrophy, and cardiomyopathy do not involve wet breath sounds or mucus production.

Question 53 See full question 5s A gerontologic nurse planning the neurologic assessment of an older adult is considering normal, age-related changes that may influence the assessment results. Of what phenomenon should the nurse be aware?

Correct response: • Reduction in cerebral blood flow Explanation: Reduction in cerebral blood flow (CBF) is a change that occurs in the normal aging process. Deep tendon reflexes can be decreased or, in some cases, absent. Cerebral metabolism decreases as the client advances in age. Reaction to painful stimuli may be decreased with age. Because pain is an important warning signal, caution must be used when hot or cold packs are used.

Question 79 See full question 8s A client has hereditary hemochromatosis. Laboratory test results indicate an elevated serum iron level, high transferrin saturation, and normal complete blood count (CBC). It is most important for the nurse to

Correct response: • Remove the prescribed one unit of blood. Explanation: Treatment for hemochromatosis is phlebotomy or removal of whole blood from a vein to reduce iron. Limiting dietary intake of iron is not an effective treatment. The client needs to perform activities to protect the liver, such as limiting alcohol ingestion. The definitive test for hemochromatosis had been a liver biopsy, but now genetic testing is performed. A liver biopsy could be performed to determine liver damage. However, this does not address the most immediate problem of too high iron.

Question 17 See full question 30s A 24 year old with infective endocarditis is admitted to the hospital. While obtaining a history, the nurse should ask the patient about which of the following? Choose all that apply.

Correct response: • Renal dialysis • Intravenous (IV) drug use • Nasal piercing • Prosthetic cardiac valves • Recent urinary tract infection Explanation: Endocarditis infections are common among IV injection drug users; patients with debilitating disease or indwelling catheters; patients receiving hemodialysis or prolonged IV fluid or antibiotic therapy; those with body piercing, especially oral, nasal, and nipple piercings; and patients with prosthetic cardiac valves.

Question 20 See full question 10s A terminally ill client the nurse is caring for is reporting pain. The physician has prescribed a large dose of intravenous opioids by continuous infusion. When the nurse assesses the client's respiratory status, the rate has decreased from 16 to 10 breaths per minute. What action should the nurse take?

Correct response: • Report the decreased respiratory rate to the physician. Explanation: End-of life issues that often involve ethical dilemmas include pain control, "do not resuscitate" orders, life support measures, and administration of food and fluids. The risk of respiratory depression is not the intent of the action of pain control. Respiratory depression should not be used as an excuse to withhold pain medication for a terminally ill client. The client's respiratory status should be carefully monitored and any changes should be reported to the physician.

Question 15 See full question 10s An older adult patient who is postmenopausal informs the nurse that she believes she has developed another urinary tract infection (UTI). The nurse understands that postmenopausal females are at greater risk for UTIs. What risk factors do female patients in this age group have? (Select all that apply.)

Correct response: • Residual urine • Urinary incontinence • Estrogen deficiency Explanation: For example, postmenopausal females are at a greater risk for urinary tract infections due to residual urine, urinary incontinence, and estrogen deficiency (Torine, 2011).

Question 93 See full question 1m 10s A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn. The ABG has the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?

Correct response: • Respiratory acidosis Explanation: The pH is below 7.40, PaCO2 is greater than 40, and the HCO3 is normal; therefore, it is a respiratory acidosis, and compensation by the kidneys has not begun, which indicates this was probably an acute event. The HCO3 of 24 is within the normal range so it is not metabolic alkalosis. The pH of 7.21 indicates an acidosis, not alkalosis. The pH of 7.21 indicates it is an acidosis but the HCO3 of 24 is within the normal range, ruling out metabolic acidosis.

Question 68 See full question 3s A client with kidney injury secondary to diabetic nephropathy has been admitted to the medical unit. What is the most life-threatening effect of kidney injury for which the nurse should monitor the client?

Correct response: • Retention of potassium Explanation: Retention of potassium is the most life-threatening effect of kidney injury. Aldosterone causes the kidney to excrete potassium, in contrast to aldosterone's effects on sodium described previously. Acid-base balance, the amount of dietary potassium intake, and the flow rate of the filtrate in the distal tubule also influence the amount of potassium secreted into the urine. Hypocalcemia, the accumulation of wastes, and lack of BP control are complications associated with kidney injury, but do not have same level of threat to the client's well-being as hyperkalemia.

Question 62 See full question 7s A client with type 2 diabetes has been managing his blood glucose levels using diet and metformin. Following an ordered increase in the client's daily dose of metformin, the nurse should prioritize which of the following assessments?

Correct response: • Reviewing the client's creatinine and BUN levels Explanation: Metformin has the potential to be nephrotoxic; consequently, the nurse should monitor the client's kidney function. This drug does not typically affect clients' neutrophils, liver function, or cognition.

Question 75 See full question 11s A client's most recent blood work reveals low levels of albumin. This assessment finding should suggest the possibility of what nursing diagnosis?

Correct response: • Risk for imbalanced fluid volume related to low albumin Explanation: Albumin is particularly important for the maintenance of fluid balance within the vascular system. Deficiencies nearly always manifest as fluid imbalances. Tissue oxygenation and skin integrity are not normally affected. Low albumin does not constitute a risk for infection.

Question 52 See full question 10s A client with rheumatic disease has developed a gastrointestinal bleed. The nurse caring for the client should further assess the client for the adverse effects of what medications?

Correct response: • Salicylate therapy Explanation: GI bleeding is an adverse effect that is associated with salicylates. Steroids, antimalarials, and immunomodulators do not normally have this adverse effect.

Question 22 See full question 4s An older adult client has a diagnosis of rheumatoid arthritis (RA) and has been achieving only modest relief with the use of nonsteroidal anti-inflammatory drugs (NSAIDs). When creating this client's plan of care, which nursing diagnosis would most likely be appropriate?

Correct response: • Self-care deficit related to fatigue and joint stiffness Explanation: Nursing diagnoses are actual or potential problems that can be managed by independent nursing actions. Self-care deficit would be the most likely consequence of rheumatoid arthritis. Anxiety and hopelessness are plausible consequences of a chronic illness such as RA, but challenges with self-care are more likely. Ineffective airway clearance is unlikely.

Question 12 See full question 4s A client is diagnosed with gallstones in the bile ducts. The nurse knows to review the results of blood work for a

Correct response: • Serum bilirubin level greater than 1.0 mg/dL Explanation: Jaundice occurs in a few clients with gallbladder disease, usually with obstruction of the common bile duct. If the flow of bile is impeded (eg, by gallstones in the bile ducts), bilirubin does not enter the intestine. As a result, blood levels of bilirubin increase.

Question 13 See full question 16s The nurse should assess for an important early indicator of acute pancreatitis, which is a prolonged and elevated level of:

Correct response: • Serum lipase Explanation: In most cases, serum amylase and lipase levels are elevated within 24 hours of the onset of the symptoms. Serum amylase usually returns to normal within 48 to 72 hours, but serum lipase levels may remain elevated for a longer period, often days longer than amylase.

Question 55 See full question 7s A 37-year-old male client presents at the emergency department (ED) reporting nausea and vomiting and severe abdominal pain. The client's abdomen is rigid, and there is bruising to the client's flank. The client's wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the client for what health problem?

Correct response: • Severe pancreatitis with possible peritonitis Explanation: Severe abdominal pain is the major symptom of pancreatitis that causes the client to seek medical care. Pain in pancreatitis is accompanied by nausea and vomiting that does not relieve the pain or nausea. Abdominal guarding is present and a rigid or board-like abdomen may be a sign of peritonitis. Ecchymosis (bruising) to the flank or around the umbilicus may indicate severe peritonitis. Pain generally occurs 24 to 48 hours after a heavy meal or alcohol ingestion. The link with alcohol intake makes pancreatitis a more likely possibility than appendicitis or cholecystitis.

Question 42 See full question 3s The nurse is caring for a client who has just returned to the unit after a colon resection. The client is showing signs of hypoxia. The nurse knows that this is probably caused by what?

Correct response: • Shunting Explanation: Shunting appears to be the main cause of hypoxia after thoracic or abdominal surgery and most types of respiratory failure. Impairment of normal diffusion is a less common cause. Infection would not likely be present at this early stage of recovery and nitrogen narcosis only occurs from breathing compressed air.

Question 74 See full question 4s The nurse's review of a client's most recent blood work reveals a significant increase in the number of band cells. The nurse's subsequent assessment should focus on which of the following?

Correct response: • Signs and symptoms of infection Explanation: Ordinarily, band cells account for only a small percentage of circulating granulocytes, although their percentage can increase greatly under conditions in which neutrophil production increases, such as infection. This finding is not suggestive of problems with oxygenation and subsequent activity intolerance.

Question 56 See full question 6s A client has undergone a laparoscopic cholecystectomy and is being prepared for discharge home. When providing health education, the nurse should prioritize what topic?

Correct response: • Signs and symptoms of intra-abdominal complications Explanation: Because of the early discharge following laparoscopic cholecystectomy, the client needs thorough education in the signs and symptoms of complications. Fluid balance is not typically a problem in the recovery period after laparoscopic cholecystectomy. There is no need for blood glucose monitoring or pancreatic enzymes.

Question 58 See full question 5s A nurse is assessing an elderly client with gallstones. The nurse is aware that the client may not exhibit typical symptoms, and that particular symptoms that may be exhibited in the elderly client may include what?

Correct response: • Signs and symptoms of septic shock Explanation: The elderly client may not exhibit the typical symptoms of fever, pain, chills jaundice, and nausea and vomiting. Symptoms of biliary tract disease in the elderly may be accompanied or preceded by those of septic shock, which include oliguria, hypotension, change in mental status, tachycardia, and tachypnea.

Question 73 See full question 3s An older adult client is exhibiting many of the characteristic signs and symptoms of iron deficiency. In addition to a complete blood count, what diagnostic assessment should the nurse anticipate?

Correct response: • Stool for occult blood Explanation: Iron deficiency in the adult generally indicates blood loss (e.g., from bleeding in the GI tract or heavy menstrual flow). Bleeding in the GI tract can be preliminarily identified by testing stool for the presence of blood. A bone marrow biopsy would not be undertaken for the sole purpose of investigating an iron deficiency. Lumbar puncture and urinalysis would not be clinically relevant.

Question 1 See full question 6m 35s Place the following steps in order when determining the type and severity of a transfusion reaction. Use all options.

Correct response: • Stop the transfusion. • Assess the client. • Notify the health care provider. • Notify the blood bank. • Send the tubing and container to the blood bank. Explanation: It is important for the nurse to take the proper steps when determining the type and severity of a transfusion reaction. The priority action is to stop the infusion and then assess the client. Next, the health care provider will be notified, followed by the blood bank. Finally, the nurse should send the tubing and container to the blood bank for analysis.

Question 23 See full question 13s The nurse is teaching the client about use of the pictured item with a metered-dose inhaler (MDI). The nurse instructs the client as follows: (Select all that apply.)

Correct response: • Take a slow, deep inhalation from the device. • Activate the MDI once. • The device may increase delivery of the MDI medication. Explanation: The pictured device is a spacer, which is attached to an MDI for client use. The client activates the MDI once and takes a slow, deep inhalation, not normal inhalations. The client then holds the breath for 10 seconds. The spacer may increase delivery of the MDI medication.

Question 50 See full question 5s A nurse is caring for a 78-year-old client with a history of osteoarthritis (OA). When planning the client's care, what goal should the nurse prioritize?

Correct response: • The client will express satisfaction with her ability to perform ADLs. Explanation: Pain management and optimal functional ability are major goals of nursing interventions for OA. Cure is not a possibility and it is unrealistic to expect a complete absence of signs and symptoms. Adherence to the plan of care is highly beneficial, but this is not the priority goal of care; adherence is of little benefit if the regimen has no effect on the client's functional status.

Question 92 See full question 9s A nurse is planning care for a nephrology client with a new nursing graduate. The nurse states, "A client with kidney disease partially loses the ability to regulate changes in pH." What is the cause of this partial inability?

Correct response: • The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. Explanation: The kidneys regulate the bicarbonate level in the ECF; they can regenerate bicarbonate ions as well as reabsorb them from the renal tubular cells. In respiratory acidosis and most cases of metabolic acidosis, the kidneys excrete hydrogen ions and conserve bicarbonate ions to help restore balance. The lungs regulate and reabsorb carbonic acid to change and maintain pH. The kidneys do not buffer acids through electrolyte changes; buffering occurs in reaction to changes in pH. Carbonic acid works as the chemical medium to exchange O2 and CO2 in the lungs to maintain a stable pH whereas the kidneys use bicarbonate as the chemical medium to maintain a stable pH by moving and eliminating H+.

Question 21 See full question 5s An elderly client is admitted with a diagnosis of community-acquired pneumonia. During admission the client states, "I have a living will." What implication of this should the nurse recognize?

Correct response: • This document specifies the client's wishes before hospitalization. Explanation: A living will is one type of advance directive. In most situations, living wills are limited to situations in which the client's medical condition is deemed terminal. The other answers are incorrect because living wills are not always honored in every circumstance, they are not binding for the duration of the client's life, and they are not drawn up by the client's family.

Question 67 See full question 7s A nurse is preparing a client diagnosed with benign prostatic hyperplasia (BPH) for a lower urinary tract cystoscopic examination. The nurse should caution the client about what common temporary complication of this procedure?

Correct response: • Urinary retention Explanation: After a cystoscopic examination, the client with obstructive pathology may experience urine retention if the instruments used during the examination caused edema. The nurse will carefully monitor the client with prostatic hyperplasia for urine retention. Postprocedure, the client will experience some hematuria, but is not at great risk for hemorrhage. Unless the condition is associated with another disorder, nausea is not commonly associated with this diagnostic study. Bladder perforation is rare.

Question 80 See full question 7s A client with sepsis is experiencing disseminated intravascular coagulation (DIC). The client is bleeding from mucous membranes, venipuncture sites, and the rectum. Blood is present in the urine. The nurse establishes the nursing diagnosis of Risk for deficient fluid volume related to bleeding. The most appropriate and measurable outcome for this client is that the client exhibits

Correct response: • Urine output greater than or equal to 30 mL/hour Explanation: All options could be expected outcomes for a nursing diagnosis of risk for deficient fluid volume. However, the key words are most appropriate and measurable. That would be the option relating to urine output, which is the most direct measurement listed of fluid volume.

Question 94 See full question 14s A newly graduated nurse is admitting a client with a long history of emphysema. The nurse learns that the client's PaCO2 has been between 56 and 64 mm Hg for several months. Why should the nurse be cautious administering oxygen?

Correct response: • Using oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. Explanation: When PaCO2 chronically exceeds 50 mm Hg, it creates insensitivity to CO2 in the respiratory medulla, and the use of oxygen may result in the client developing carbon dioxide narcosis and hypoxemia. No information indicates the client's calcium will rise dramatically due to pituitary stimulation. No feedback system that oxygen stimulates would create an increase in the client's intracranial pressure and create confusion. Increasing the oxygen would not stimulate the client to hyperventilate and become acidotic; rather, it would cause hypoventilation and acidosis.

Question 99 See full question 5s A client with chronic arterial occlusive disease undergoes percutaneous transluminal coronary angioplasty (PTCA) for mechanical dilation of the right femoral artery. After the procedure, the client will require long-term administration of:

Correct response: • aspirin or clopidogrel (Plavix). Explanation: After PTCA, the client begins long-term aspirin or clopidogrel therapy to prevent thromboembolism. Physicians order heparin for anticoagulation during this procedure; some physicians discharge clients with a prescription for long-term warfarin (Coumadin) or low-molecular-weight heparin therapy. Pentoxifylline, a vasodilator used to treat chronic arterial occlusion, isn't required after PTCA because the procedure itself opens the vessel. The physician may order short-term acetaminophen therapy to manage fever or discomfort, but prolonged therapy isn't warranted. The client may need an antibiotic, such as penicillin or erythromycin, for a brief period to prevent infection associated with an invasive procedure; long-term therapy isn't necessary.

Question 24 See full question 31s The basic difference between nursing diagnoses and collaborative problems is that

Correct response: • nurses manage collaborative problems using physician-prescribed interventions. Explanation: Collaborative problems are physiologic complications that nurses monitor to detect onset of changes in patient status and manage through the use of physician-prescribed and nursing-prescribed interventions to minimize the complications of events. Collaborative problems require both nursing and physician-prescribed interventions. Nursing diagnoses can be managed by independent nursing interventions. Nursing diagnoses refer to actual or potential health problems that can be managed by independent nursing interventions.