Med Surg Exam 1-3 Practice Questions
What acid-base balance do the following arterial blood gas (ABG) results suggest?PaCO2=90, pH=7.50, CO2=28, HCO3=23 A. Metabolic alka B. Metabolic acid C. Respiratory acid D. Respiratory alka
D
What data should be monitored to assess chronic complications related to uncontrolled HTN? A. Diet high in unsaturated fats B. Serum glucose and C-reactive protein C. Otoscopic examination of the inner ear D. Serum BUN and creatinine
D
The patient is ordered enteral feedings via nasogastric (NG) tube to meet nutritional goals. Which intervention would the RN include in the plan of care to best promote fluid balance? A. Obtain orders for water boluses 6 times a day through the NG tube B. Weight the patient every other day C. Record strict I&O and flush the NG tube to keep it patent D. Assess the skin around the PEG tube site
A
A patient needs to learn how to administer a subcutaneous injection. Which of the following most reflects patient readiness to learn? A. Patient expresses the importance of learning the skill correctly B. Patient describing difficulties a family member has in taking insulin C. Patient has the dexterity needed to prepare and inject the mediation D. Patient can see and understand the markings on the syringe
A
An older adult is admitted to a long-term care facility. The nurse performs a baseline assessment that includes neurologic and sensory function. What is the purpose of this assessment? A. Determine a baseline level of function B. Show the family the reality of the patient's mental status C. Determine rehabilitation potential D. Gain information about their life history
A
Patients with Acromegaly have multiple problems that can affect multiple systems in the body and increase their risk for other disease processes and medical problems. Which of the following is not a problem/disease process related to Acromegaly? A. COPD B. Chewing difficulties C. Diabetes D. Hypertrophy of the heart
A
The 27 y/o patient has bilateral distended varicose veins and is traveling abroad in 2 days. What would the RN teach the patient to combat possible complications related to Virchow's triad for their upcoming 12-hr flight? A. Increase fluid intake before and during the flight B. Immediate heparin and warfarin therapy C. Unna boots on affected legs before the flight D. Increase their oral contraceptive therapy and wear compression stockings
A
The RN assessment findings include the patient sitting in the tripod position with bilateral clubbing, and a RR of 24bpm and pulse oximetry 92% on 4L NC O2. The patient states they are generally comfortable. What is the most appropriate action by the RN? A. Monitor the patient's respiratory status frequently B. Have the patient check their Peak Flow Meter reading C. Offer the patient protein drinks D. Increase nasal cannula oxygen
A
The RN is admitting a patient that has an ulcer on their left ankle. Which of the following data indicates a history of venous insufficiency? A. "My ankles have been discolored for years." B. "My feet are always really cold." C. +3 unilateral lower extremity edema and pain D. Pallor on elevation of the legs and rubor when the legs are dependent
A
The RN is assessing the patient in the emergency room after the patient caused an automobile accident while being under the influence of alcohol. Which statement, made by the RN, would be most therapeutic? A. "Tell me what happened before, during and after the car accident tonight." B. "We have multiple patients to see tonight as a result of this accident." C. "Why did you drive after you had been drinking?" D. "It will be okay. No one was seriously hurt in the accident."
A
The RN is caring for a patient who has a blood glucose of 38mg/dL. The patient is difficult to arouse, pale and tachycardic. Which of the following interventions should the RN perform first? A. Administer 1mg IM of glucagon B. Recheck the blood glucose in 15 minutes C. Offer a small meal including honey D. Provide 4 ounces of grape juice
A
The RN is evaluating teaching of a patient who has a new prescription for their Albuterol (Proventil, a Short Acting Beta 2 agonist/SABA) inhaler to treat asthma. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll take this medication when I get an asthma attack." B. "I'll take this medication once a day in the evening." C. "I'll rinse my mouth after taking this medication." D. "I will keep this inhaler in a locked in a drawer at home."
A
The RN is evaluating teaching on a client who has a new prescription for their salmeterol (Serevent, a Long Acting Beta 2 agonist/LABA) inhaler to manage their asthma. Which of the following statements by the client indicates an understanding of the teaching? A. "I'll take this medication everyday to prevent an asthma attack." B. "I'll rinse my mouth after taking this medication so I don't get thrush." C. "I'll take this medication when I get an asthma attack." D. "I'll need pursed lip breathing when I exhale this medication."
A
The RN is interviewing a patient with Type 2 diabetes mellitus. Which statement by the patient indicates an understanding of the treatment for this disorder? A. "The medications I'm taking help release the insulin I already make." B. "When I become ill, I need to decrease the number of pills I take." C. "By taking these medications, I am able to eat more." D. "I take oral insulin instead of shots.
A
The RN is monitoring the patient newly diagnosed with diabetes mellitus. Which sign, if exhibited in the patient, would indicate hyperglycemia? A. Polyuria B. Hypertension C. Tachycardia D. Diaphoresis
A
The RN is teaching grade school students the importance of healthy nutrition. The RN determines that after the teaching session the children will be able to name 3 examples of food that are fruit. This is an example of which of the following? A. A learning objective B. Motivation to learn C. A teaching plan D. Psychomotor learning
A
The RN observes a thick white coating on the patient's tongue and the patient complains of dysphagia. The nurse would anticipate: A. Administering an oral antifungal medication B. Contacting the speech therapist for complaints of dysphasia C. Administering oral bacterial antibiotics D. The need for frequent saltwater rinses
A
The male patient reports that they snore a lot and wake up throughout the night catching their breath. The RN assesses a BMI of 25 and notes a PMH of HTN. The patient also complains that they are frequently tired and irritable throughout the day. What interventions does the RN anticipate implementing? A. Teach the patient about risk factors for stroke and CAD and refer for sleep apnea intervention B. Teach the patient to use the Peak Flow Meter and adjust their COPD medications accordingly C. Encourage the patient to get a workup for suspected lung cancer D. Encourage pursed lip breathing to reduce bullae
A
The nurse is assessing the nutritional status of the patient who has been refusing to eat the hospital food. Which indicator is the best in identifying inadequate nutrition for this patient who is at risk for skin breakdown? A. Prealbumin level B. Weight loss C. Lymphocyte count D. Serum cholesterol level
A
The nurse notices that the 74-year-old patient, who has a peritoneal dialysis catheter, has increased confusion. What additional assessment findings would be of most concern to the nurse? A. Cloudy dialysate and tender abdomen B. Elevated hemoglobin and hematocrit C. Hypokalemia D. Hypoalbuminemia
A
The patient has a history of dementia and the nurse assesses that the patient gets confused very easily. What intervention is most appropriate for the nurse to use when communicating with the patient? A. Ask "yes/no" questions, one at time B. Offer the patient multiple options to ensure their patient rights C. Provide the patient with detailed descriptions of your plan of care for them for your shift D. Do not communicate with the patient as this will increase their confusion
A
The patient has been pleasant and cooperative. The nurse notices that after administering a new diuretic the patient's cognitive status has changed and now the patient is making inappropriate statements and is visibly irritated. Which of the following is the most appropriate action by the nurse? A. Consider causes related to this acute onset of delirium B. Understand this condition is most likely not reversible C. Let the family know the patient now has dementia D. Contact psychiatry for a depression consultation
A
The patient has chronic heart failure with a left ventricular EF of 15%. The client is taking an ACE inhibitor. What is the expected action of this medication? A. Decrease myocardial workload B. Increase BNP levels C. Decrease fluid overload D. Prevent thrombus formation
A
The patient has chronic heart failure with a left ventricular ejection fraction of 15%. Theclient is taking an ACE inhibitor (lisinopril/Zestril). What is the expected action of this medication? A. Decrease myocardial workload B. Decrease fluid overload C. Prevent thrombus formation D. Increase BNP levels
A
The patient has diabetes mellitus and is returning from an early morning x-ray procedure and states "I'm starving, give me my breakfast already." The nurse notes the patient is irritated and diaphoretic. What is the nurses priority action? A. Check the blood glucose level and be prepared to give 4 ounces of juice B. Reassure the patient that breakfast is on the way C. Monitor the patient for signs of diabetic gastroparesis D. Adminster oral insulin stimulating medication (glypizide/glucotrol) as ordered
A
The patient is admitted to the floor has peripheral arterial disease (PAD). During the RN's morning assessment, the patient complains of sudden leg pain with pallor, tingling, and loss of peripheral pulses. What is the priority action of the RNs? A. Notify the physician about the findings B. Perform passive ROM exercises to stimulate circulation C. Elevate the leg above the level of the heart D. Wrap the leg in a hot blanket
A
The patient presents on admission with sacral and bilateral hip pressure ulcers extending to the bone. How would the RN most accurately document this finding? A. Stage four sacral and bilateral hip ulcers B. Stage three pressure ulcers unilaterally C. Well-approximated and malodorous D. Granulating stage three pressure ulcers
A
The patient with end stage renal disease (ESRD) fell at home and arrived at the emergency room with complaints of left arm pain and swelling. The nurse suspects an arm fracture. What should the nurse include in the plan of care to promote bone strength in the patient with ESRD? A. Vitamin D supplements B. Oral phosphate supplements C. A diet high in bananas and sodium D. SQ Erythropoietin injections
A
The wound care nurse recommends treatment that will mechanically debride the wound. The RN knows wound care would include which of the following? A. A normal saline wet-to-dry dressing completed at the bedside B. An enzymatic crème that destroys necrotic tissues C. Preparing the patient for surgical debridement D. A surgical graft using the skin of a fish
A
What is the priority outcome in the patient with Guillain Barre Syndrome? A. Maintain airway patency and gas exchange B. Prevent complications of immobility C. Promote communication D. Manage pain
A
When admitting an elderly patient who has arrived to the unit from a nursing home, the nurse notes an intact, non-blanchable area on the patient's sacrum. What action should the nurse take? A. Measure the area and provide detailed documentation of its presence in the admission assessment B. No action is needed because the skin is intact C. Call the nursing home and asked what happened. D. Ask the doctor for an order for wet to dry dressing changes
A
When assessing the patient who has had diabetes for 15 years, the RN finds that they have decreased sensation in both feet. What is the RNs best first action? A. Examine the client's feet for signs of injury B. Recommend further dx to assess peripheral blood flow C. Administer the prescribed pregabalin (Lyrica) D. Administer their biguanide antidiabetic medication glipizide
A
When beginning to teach information about heart disease to a patient newly diagnosed with heart disease, what is most important for the RN to do first? A. Find out what the patient knows or has heard about the disease B. Consult with the physician to determine content based on severity of the disease C. Have family members present who can reinforce diet and exercise tips D. Proceed from simple to complex concepts when discussing pathophysiology
A
Which of the following puts the patients at greatest risk for developing endometrial (uterine) cancer? A. No pregnancies B. Genetic BRCA 1 mutation C. Multiple sex partners D. Frequent urinary tract infections
A
Which patient is most at risk for developing candida skin infections? A. Male with abdominal panniculus B. Female with a BMI of 18.5 C. Male with macular degeneration D. Female with has glaucoma
A
The patient is diagnosed with small cell lung cancer. Which statement by the patient displays understanding of this diagnosis? A. "I will be sure to report if I get blood in my sputum." B. "I will make an appointment right away to check if it spread." C. "I never smoked; it cannot be lung cancer." D. "I am relieved it is not an aggressive form of cancer."
A or B
The RN is caring for a patient who has chronic obstructive pulmonary disease (COPD). The patient tells the nurse, "I can feel the congestion in my lungs, and I cough a lot, but I can't seem to bring anything up." Which of the following actions should the nurse take to manage excessive bronchial secretions? A. Encouraging the patient to drink 2 liters of fluid daily B. Maintaining a semi-Fowler's position as often as possible C. Administering oxygen via nasal cannula at 2 L/min D. Administering Short Acting Beta 2 agonist (SABA) inhalers
A or D
The patient complains of dyspnea, cough, and chest pain. Which of the following diagnosis does the RN suspect? A. Chronic Obstructive Pulmonary Disease (COPD) B. Pneumonia C. Stable angina D. Stable angina, pneumonia and COPD, further studies need to be done
A, B, C, D
The RN is presenting information to a group of patients about nutritional habits that prevent complications related to diabetes mellitus Type 2. Which of the following should be included in the teaching? (Select all that apply) A. Increase daily fiber intake B. Limit saturated fat intake to 20-25% of daily intake C. Increase red meat and processed food intake D. Include Omega-3 fatty acids in diet E. Limit citrus fruits
A, B, D
The patient has an indwelling foley catheter. Which of the following would alert the nurse to the possibility of a urinary tract infection (UTI)? (Select all that apply) A. Suprapubic tenderness B. Confusion and new-onset incontinence C. Frequent urination with increased coffee intake D. Malodorous, cloudy urine E. Strict sterile technique when inserting the catheter
A, B, D
The RN performs an initial assessment for an older adult being admitted to an assisted-living facility. Which assessment finding indicates the patient is at risk for falls? (Select all that apply) A. Has a history of a previous fall B. Has bilateral cataracts C. Is oriented to person, place and time D. Has limited use of left upper and lower extremity E. Has a history of sodium electrolyte imbalances
A, B, D, E
The nurse is teaching the patient with chronic kidney disease (CKD) about limiting foods that are high in sodium. Which of the following foods should the patient be encouraged to eat? (Select all that apply) A. Green leafy vegetables B. Blueberries C. Pickles and pickles beets D. Canned green beans E. Beans and mushrooms
A, B, E
Which of the following interventions would be effective in managing excess fluid volume in the patient with heart failure? (Select all that apply) A. Fluid restriction B. Monitoring serum BNP C. 4-gram sodium restriction D. Weekly weights E. Administering diuretics (furosemide/Lasix)
A, B, E
The nurse is preparing patient education for the female patient who has frequent urinary tract infection (UTIs). Which of the following should the nurse include? (Select all that apply) A. Avoid sitting in a wet bathing suit B. Report unusual vaginal discharge C. Stop drinking cranberry juice D. Wipe the perineal area back to front following urination E. Empty the bladder when there is an urge to go F. Take a shower daily
A, B, E, F
What should be included in teaching to new graduate RNs to prevent complications of varicose veins? (Select all that apply) A. Wear supportive compression hose B. Importance of daily high impact exercise C. Elevate their legs after a 12-hour shift D. Sit less often during their work shift E. Reduce fluid intake at work
A, C
The patient with chronic obstructive pulmonary disease (COPD) has a BMI of 17, a large barrel chest and a low prealbumin. What priority teaching would the RN include in their plan of care? (Select all that apply) A. Eat small frequent meals including protein supplements B. Eat a lot of high fat, spicy foods C. Cough to clear mucous before eating D. Use your bronchodilator about 30 minutes before meals E. Drink 2 liters of fluid with each meal
A, C, D
The RN is teaching pneumonia prevention at a senior center. What information would the RN include? (Select all that apply) A. Annual influenza vaccinations B. Socialize frequently to avoid isolation C. Pneumococcal vaccinations D. Take anti-tubercullin medication as prescribed E. Rest, drink a lot of fluids and eat a well-balanced diet
A, C, E
The nurse is teaching the patient with chronic kidney disease (CKD) about limiting foods that are high in potassium. Which of the following foods should the patient be instructed to avoid? (Select all that apply) A. Tomatoes B. Cauliflower C. Potatoes D. Green Beans E. Cantaloupe
A, C, E
Which of the following put the hospitalized patient at risk for malnutrition? (Select all that apply) A. A stage IV sacral pressure ulcer B. Initiating tube feeding through a gastrostomy tube C. The patient NPO for greater than 3 days D. Patient serum prealbumin (PAB) level of 20 mg/dl E. The patient is admitted with an acute upper respiratory infection
A, C, E
A home health nurse is assessing an older adult client who has decreased vision due to a history of glaucoma. Which of the following findings should the nurse identify as a safety risk? A. Use of a microwave for cooking B. Loose rugs are present in the kitchen C. Handrails are present in the bathroom D. Electrical cords are placed along the walls
B
A patient asks about a new diagnostic test that the RN is not familiar with. What is the best response by the RN? A. "It is your doctor's responsibility to explain that procedure to you. Would you like me to call the doctor?" B. "I don't know a lot about that procedure, but I will find out and bring you information about it." C. "I can't explain that now, but I'll get back to you later after all the morning medications are administered." D. "The technicians in the radiology department will explain the procedure to you while you are down there getting the test."
B
A patient with multiple sclerosis tells the nurse "I am worried that this condition will make me too tired to do anything when I get home." Which response by the nurse most appropriately supports the goal of maintaining patient independence? A. "Maybe you can get a family member to help you out in the evening." B. "Let's look at the things you do every day and figure out how to space the activities throughout your day." C. "You are going to have to learn to be happy with doing less and taking more naps." D. "You should go to the drug store to get some assistive devices."
B
The RN is assessing an elderly patient's ability to return home after discharge from the hospital following gallbladder surgery. Which of the following instrumental activity of daily living would the RN need to consider for discharge? A. Availability of family support system B. Patient ability to purchase and cook food C. Presence of dysphagia D. Patient ability to dress themselves
B
The RN is providing teaching for a patient who has asthma and a new prescription for an anti-inflammatory low dose inhaled corticosteroid. Which of the following instructions should the nurse provide? A. This medication decreases bronchoconstriction B. Rinse your mouth after inhalation of this medication C. Check the pulse after medication administration D. Use this as a reliever medication in asthma attack
B
The RN is providing teaching to a patient who has asthma and a new prescription for an anti-inflammatory low dose inhaled corticosteroid. Which of the following instructions should the nurse provide? A. Use this as a reliever medication in asthma attack B. Rinse your mouth after inhalation of this medication C. This medication decreases bronchoconstriction D. Check the pulse after medication administration
B
The RN observes a patient who is fidgeting, wringing their hands and has body tenseness and wrinkled eyebrows. What is the best response to the patient by the RN? A. "Why are you so jumpy and nervous?" B. "You look tense. Can you tell me if something is making you afraid or nervous?" C. "You are making me nervous. Please stop that." D. "You look upset. Would you like some medication to calm you down?"
B
The RN performs a physical assessment on a patient with Type 2 diabetes mellitus. Findings include a fasting glucose level of 98mg/dL, temperature of 38.3C (100.9F), pulse 88bpm, respirations 20 bpm, and BP 120/72mmg/Hg. Which finding would be of most concern to the RN? A. Blood pressure B. Temperature C. Respirations D. Fasting blood glucose
B
The RN would consider which of the following assessment findings to be indicative of severe malnutrition? A. Poverty B. Cachexia C. A serum albumin of 3.6g/dL D. Muscle weakness
B
The client with Cushing's syndrome verbalizes concern to the nurse regarding the appearance of the buffalo hump that has developed. Which statement by the nurse is appropriate? A. "This is permanent, but looks are deceiving and are not that important." B. "Usually these physical changes slowly improve following treatment." C. "Don't be concerned; this problem can be covered with clothing." D. "Try not to worry about it; there are other things to be concerned about."
B
The healthy 81-year-old patient is diagnosed with early stage prostate cancer and is currently asymptomatic. The nurse is aware that an appropriate treatment plan for this patient would include which of the following? A. A diet low in red meats and fruits and vegetables B. Active surveillance C. Monitoring for a normal Prostate Antigen Specific (PSA) level D. Radical surgery to remove the prostate and surrounding tissue
B
The nurse is caring for a patient who has an obstructed left ureter and a nephrostomy tube. Which of the following assessment findings is the priority for the nurse to act on? A. Decreasing serum Cr and BUN levels B. An elevated serum WBC count C. A consistent decreased urine output in the nephrostomy bag 2 days in a row D. Light blood tinged urine 3 hours after placement of nephrostomy
B
The nurse is planning care for the patient with trigeminal neuralgia. Which of the following would be a priority in the plan of care? A. Facial neuromuscular assessment B. Assess for facial pain C. Arrange for plasmapheresis sessions D. Assess for generalized weakness
B
The older adult is being admitted to the hospital and during the admission assessment, the RN notices multiple bruises in the patient's perineal area and upper thighs. What is the RNs most appropriate first action? A. Bath the patient and apply skin barrier cream B. Notify the unit social worker or case manager C. Turn the patient every two hours and add protein to their diet D. Tell the family member to be more careful providing care
B
The patient has angina and asks the nurse, "Why do I get chest pain?" Which statement would be the most appropriate response by the nurse? A. "There is ischemia to the myocardium as a result of hypoxemia." B. "Chest pain is caused by decreased oxygen to the heart muscle." C. "Claudication occurs when the lungs cannot adequately oxygenate the blood." D. "The heart muscle is unable to pump effectively to perfuse the body."
B
The patient has end-stage renal disease (ESRD) and is complaining of severe muscle weakness. What would the nurse anticipate is the next assessment priority? A. Assess labs for hypernatremia B. Assess for cardiac arrhythmias C. Assess labs for hypoalbuminemia D. Assess for increased fluid in the lungs
B
The patient has skin traction to treat a hip fracture. What intervention would the nurse include in the plan of care? A. Assess pin sites for signs of infection B. Frequent neurovascular assessments C. Contact physical therapy to assist the patient out of bed D. Encourage food intake high in protein and phosphorous
B
The patient is recovering from stroke and experiencing loss of upper extremity motor strength. The RN assesses that the patient cannot pick up a fork, a comb, or a toothbrush. Which interprofessional team member would the nurse most appropriately contact to aid this patient in recovery? A. Nutritional therapist B. Occupational therapist C. Respiratory therapist D. Speech therapist
B
The patient with Stage 3 chronic kidney disease (CKD) presents with edema and shortness of breath. The nurse would prioritize which of the following interventions? A. Monitoring for stable weight gain > 3 pounds between dialysis sessions B. Administering diuretics and teaching 1-3 G sodium diet C. A neurological assessment and administering PO sodium D. Encouraging 1 to 2 liters of fluid intake to flush the kidneys
B
The patient with end stage renal disease (ESRD) has the following arterial blood gas (ABGs) results: Ph = 7.52, CO2 = 45, HCO3= 44, PaO2 = 82. What do the findings suggest? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis
B
The patient with stable angina asks why they are prescribed daily aspirin (ASA). Which of the following is the most appropriate response by the RN? A. "Aspirin relieves the pain due to myocardial ischemia." B. "Aspirin reduces the formation of blood clots that could reduce blood flow to your heart." C. "Aspirin dissolves clots that are forming in your coronary arteries." D. "Aspirin relieves headaches from antihypertensive medications."
B
The patient's chart notes the presence of a Stage II pressure ulcer over the sacrum. What is the typical appearance of a Stage II pressure ulcer? A. Necrotic areas with tunneling B. Blistered areas with shallow crater C. Areas of eschar-covered crater D. Reddened areas with intact skin
B
What assessment finding would alert the RN to a sensorineural hearing loss in their patient? A. Patient complaints of vertigo and tinnitus B. The patient worked in a rock-and-roll band for decades C. The RN visualizes cerumen in the patients left ear D. The patient speaks softly and hears better in a noisy room
B
What data should be monitored to assess chronic complications related to uncontrolled hypertension (HTN)? A. Diet high in unsaturated fats B. Serum BUN and Creatinine C. Otoscopic examination of the inner ear D. Serum glucose and C-reactive protein levels
B
What interventions would the RN implement for the patient with Type 2 diabetes mellitus who is displaying signs of retinopathy? A. Assess mental status B. Teach importance of annual eye exams C. Teach to eat frequent small meals D. Assess urine protein levels
B
What is the priority nursing diagnosis in a 45-year-old man newly diagnosed with Cushing's syndrome? A. Risk for Infection related to immunosuppression B. Disturbed Body Image related to change in appearance C. Risk for Injury related to decreased bone density D. Risk for decreased cardiac Output related to electrolyte imbalance
B
Which action should the nurse include in the plan of care when teaching a patient about caring for their hearing aid? A. Leave the device turned on when they are not in the patient's ears B. Use toothpicks to clean in the small areas C. There is no need to use soap to clean the hearing aids. D. Immerse the hearing aid into a cup of water
B
Which assessment finding would the nurse anticipate in the patient with late-stage rheumatoid arthritis? A. Heberden's nodules B. Fibrotic lung disease C. Butterfly rash D. Sclerodactyly
B
Which of the following is a drug of choice for hyperthyroidism (Graves' Disease)? A. Prednisone B. Propylthiouracil (PTU) C. mesalamine (Pentasa) D. levothyroxine sodium (Synthroid)
B
Which of the following nursing diagnoses is not associated with hypothyroidism? A. Impaired comfort r/t cold intolerance B. Imbalanced nutrition: less than body requires C. Impaired skin integrity r/t dry skin D. Constipation r/t decreased gastric motility
B
Which of the following would alert the nurse to a potential myasthenic crisis? A. Increased muscle weakness that worsens with repetitive use B. Patient reports missing several doses of cholinesterase inhibitor medications C. A history of Parkinson's disease D. Patient complaints of diarrhea, nausea, vomiting and bradycardia
B
Which patient is least at risk for developing pressure ulcers? A. A thin patient who sits for long periods of time B. An ambulatory patient who has occasional urinary incontinence C. A morbidly obese patient who needs assistance getting back into bed D. An 84-year-old quadriplegic patient who is confused
B
Why is obesity considered as a major contributor to United States health care crisis? A. A 5% loss in body weight contributes to the development of more chronic disease B. Obesity contributes to the development of multiple chronic diseases C. Obesity can cause candida under pendulous breasts D. Genetics cause obesity
B
Which patient(s) are at increased risk for a stroke? (Select all that apply = 2) A. 25-year-old with Bell's palsy B. 65-year-old with diabetes mellitus and A1C 10.3% C. 35-year-old with multiple transient ischemic attacks D. 47-year -old who exercises regularly
B, C
Which of the following interventions would be effective in managing excess fluid volume in the patient with heart failure? Select all that apply A. 4g Na restriction B. Fluid restriction C. Administering diuretics (furosemide) D. Weekly weights E. Monitor serum BNP
B, C, E
Which techniques may improve communication when working with an older adult who is hearing-impaired? (Select all that apply). A. Speak loudly and use many hand gestures B. Keep statements short and to the point C. Restate terms in different ways if the patient does not understand D. Exaggerate lip movements to help the patient read your lips E. Give the patient time to respond to questions
B, C, E
Why must nurses communicate effectively with the health care team? (Select all that apply). A. Improve the nurses' friendships with other health care team members B. Reduce the risk of error to the patient C. Improve patient outcomes D. Prevent taking accountability for their actions E. Provide optimum level of patient care
B, C, E
The patient has functional urinary incontinence. Which of the following would be included in the patient's plan of care? (Select all that apply) A. Increased coffee intake daily B. Reminders to void every 4 hours C. Incontinence briefs D. Kegel exercises 4 times a day E. Anticholinergic medication F. An external catheter
B, C, F
Which medication (s) may delay the cognitive decline in patients with Alzheimer's Disease? (Select all that apply = 2) A. Dopamine agonists B. Cholinesterase inhibitors C. Plasmapharesis D. N-methyl-D-aspartate receptor antagonists E. Corticosteroids
B, D
After cataract surgery a client is taught to avoid strain on the operated eye. Which of the following statements if made by the client would alert the nurse that further teaching is needed? (Select all that apply) A. "I cannot lie on my operated side." B. "I will lay flat in bed with no pillows." C. "I cannot lift more than 10 pounds." D. "I need to take stool softeners." E. "I can rub my eye for pain relief."
B, E
The nurse is talking to a 68-year-old obese African American male patient who smokes 2 packs per day. Recognizing all the patient's risk factors for kidney cancer, which assessment findings is the nurse most concerned about? A. Urinary frequency B. Overflow incontinence C. Frank hematuria D. Nocturia
C
A patient has a history of Addison's disease and is admitted to the unit with Addison's crisis with symptoms of severe hypotension and unresponsiveness. Which statement by the client's family would provide information to the nurse as to the possible precipitating factors to the crisis? A. The client increased his prescribed hydrocortisone medication several days ago B. The client increased the sodium intake in his diet C. The client has recently experienced several major stressors including an infection and an accident D. All of the above could have been precipitating factors to the client going into a crisis
C
The 18-year-old patient has a new colostomy bag and is going home. They are avoiding discussion of their diagnosis and colostomy care. What is the nurses' best plan in teaching this patient? A. Convince the patient that learning about their health is necessary B. Focus on knowledge the patient will need in a few weeks C. Provide the most important information the patient needs to go home D. Teach the patient's mother
C
The 27-year old patient has bilateral distended varicose veins and is traveling abroad in 2 days. What would the RN teach the patient to combat possible complications related to Virchow's triad for their upcoming 12-hour airplane flight? A. Immediate heparin and warfarin (Coumadin) therapy B. Increase their oral contraceptive therapy and wear compression stockings C. Increase fluid intake before and during the flight D. Unna boots on affected legs before the flight
C
The 30-year-old patient had a bone mineral density (BMD) T score of zero. The nurse would teach the patient which of the following? A. Continue to drink caffeine and carbonated beverages to sustain bone density B. Increase dietary calcium as bone density is poor C. They have the sound bone density for their age D. They are at increased risk for bone fractures
C
The RN is planning to teach the patient about the importance of getting out of bed. Which is the best time for teaching to occur? A. While the patient is talking about current stressors in their life B. When there are visitors in the room C. When that patient states they are pain free D. Just before lunch, when the patient is most awake
C
The RN is reviewing the laboratory results for a patient diagnosed with hypertension (HTN) and hyperlipidemia (HLD). Which of the following lab levels indicates to the nurse that the client has been most compliant with diet and anti-cholesterol (simvastatin/Zocor) medication therapy? A. Total cholesterol 295 mg/dL, HDL 40 mg/dL and LDL 150 mg/dL B. Elevated BNP, total cholesterol 250mg/dL and low C-reactive protein C. HDL 60mg/dL, Total cholesterol 174 mg/dL, and LDL 98 mg/dL D. Elevated C-reactive protein and Hgb A1C 11%
C
The RN received shift report. Which patient would be a priority to assess first? A. The patient with coronary artery disease (CAD) with a BP of 156/87 B. The patient with peripheral artery disease (PAD) with bilateral +1 pedal pulses C. The patient with deep vein thrombosis (DVT) who is complaining of shortness of breath D. The patient with heart failure with a 92% pulse oximeter reading
C
The nurse is obtaining a history from the patient who is being evaluated for benign prostatic hyperplasia (BPH). Which of the following findings indicate BPH? A. A positive prostate tissue biopsy report B. Urinary frequency with large output C. Difficulty urinating and constant dribbling D. Complaints of severe lower back pain
C
The nurse is reviewing the ABGs of a patient who has Chronic Kidney Disease (CKD). What acid-base balance to the following ABGs suggest?Ph = 7.25, HCO3 = 19, CO2 = 30, PaO2 = 95. A. Metabolic alkalosis B. Respiratory acidosis C. Metabolic acidosis D. Respiratory alkalosis
C
The nurse is teaching interventions to decrease the patient's stress incontinence. Which of the following would be included in the teaching? A.Preparation for brachytherapy B. Bladder behavioral training strengthens pelvic muscles C. Begin pelvic muscle strengthening with 3 sets of 15 exercises a day D. Anticholinergic medication like oxybutynin (Ditropan) will help
C
The nurse knows that surgical debridement occurs by which method? A. The process of Autolysis B. Enzymatic agent C. Incision and drainage D. Wet to dry dressing
C
The patient has a history of dementia and is admitted to the hospital. What is the most appropriate RN intervention to promote patient safety? A. Apply restraints on the patient and give oral sedatives B. Tell family members they must stay with the patient C. Move the patient to a room where they can be monitored frequently D. Keep the patient isolated in a dark and quiet room
C
The patient has end-stage renal disease (ESRD) and the nurse is teaching them about hemodialysis. What information should the nurse include in the teaching? A."Hemodialysis restores kidney function since yours are not working." B. "Hemodialysis allows for an unrestricted diet." C. "Hemodialysis temporarily balances your body's electrolytes." D. "Since you have the beginning of kidney disease, you won't need this if you take care of your kidneys."
C
The patient has stage 4 chronic kidney disease (CKD) and has increased lethargy, pruritis from their uremic frost, ataxia and halitosis. The nurse suspects which of the following? A. Hypokalemia B. Hypernatremia C. Azotemia D. Hypophosphatemia
C
The patient lives in a nursing home and is being admitted to the hospital with elevated temperature, chest pain with coughing, pulse oximeter 89% on room air and left lower lobe crackles. The RN anticipates implementing interventions related to which diagnosis? A. Ventilator assisted pneumonia B. Community acquired tuberculosis C. Health care acquired pneumonia D. Hospital acquired pneumonia
C
The patient with diabetes mellitus has a Hgb A1C 9%, BP of 150/96, and an elevated C-reactive protein. Based on this data, which complication(s) of diabetes mellitus is this patient most at risk for? A. Hypoglycemia B. Polyuria, polydipsia and polyphagia C. Cardiovascular disease and death D. Depression
C
The sedentary patient wants to lose weight and asks the RN what the most appropriate form of exercise is to help them reach their goals. What response is most appropriate from the RN? A. Swimming twice a week and biking other days B. Rigorous weight lifting twice a day C. Find and activity they enjoy doing and do it consistently D. Find someone who lost weight and do what they did
C
What is a priority nursing diagnosis for the patient with bilateral hand osteoarthritis? A. Impaired tissue perfusion B. Risk for infection C. Impaired mobility D. Risk for osteoporosis
C
Which assessment finding would indicate to the nurse that patient has potentially aspirated their gastric tube feedings? A. Frequent liquid bowel movements B. A low serum albumin level C. Cough and diminished breath sounds D. Elevated blood sugars
C
Which data would alert the nurse to a diagnosis of osteomyelitis? A. Elevated T3 and T4 B. Hemoglobin AIC 7% and fasting blood glucose of 82 C. Elevated erythrocyte sedimentation rate (ESR) and temperature D. Elevated C-reactive protein (CRP) and antinuclear antibodies (ANA)
C
Which of the following is considered an appropriate intervention when implementing aspiration precautions? A. Elevate head of bed (HOB) at least 20 degrees B. Have a speech evaluation done to rule out dysphagia C. Check feeding tube placement prior to administering medications D. Patient coughs with oral intake
C
Which of the following patients is most at risk for urinary incontinence? A. The patient that had a foley catheter placed while hospitalized B. The 92-year-old that is independent and lives alone C. The 67-year-old with multiple sclerosis and a recent stroke D. The patient living in a long-term care facility
C
Which precaution is most important for the RN to teach a patient who has cardiovascular autonomic neuropathy from diabetes mellitus? A. Check blood pressure twice daily B. Eat small frequent meals instead of 3 large meals C. Change positions slowly when moving from sitting to standing D. Check hands and feet twice daily for numbness
C
The RN is teaching the patient who has emphysema about self-management strategies. Which of the following statements by the client indicates an understanding of the teaching? A. "I will lie on my stomach to practice abdominal breathing every day." B. "I will inhale slowly through pursed lips to help me breathe better." C. "I will follow a daily diet high in calories and protein." D. "I will avoid getting a flu shot."
C or B
The nurse is assessing the patient with myasthenia gravis. Which manifestation(s) would the nurse anticipate observing? (Select all that apply = 3) A. Increased muscle strength with repetitive use B. Peripheral vision loss C. Fatigue after feeding self D. Droopy eyelids E. Diplopia
C, D, E
A new graduate RN is experiencing passive - aggressive behavior from a seasoned registered nurse (RN) at work. The RN is telling untrue stories about the new graduate that make them appear unable to perform their work. Which step would the new nurse take first to address this problem? A. Challenge the RN in a public forum to embarrass them and change their behavior B. Talk with the unit secretary to find out if this has been a problem with other nurses C. Say nothing and hope things get better D. Talk with their preceptor or unit manager and ask for assistance in handling the issue
D
A patient had I131 treatment for hyperthyroidism. All of the following would be important to include in the plan of care except? A. Keep the patient in a private room with a lead shield. B. Double flush all body fluids C. Provide meals on disposable plates with plastic silverware D. Encourage his family to visit
D
A stage three pressure ulcer measures 4 inches wide and 2 inches deep. It has 35 % granulation tissue, 45% slough with eschar and circumferential undermining and the edges are not well approximated. The nurse identifies that they doctor's note says that the wound must heal from the inside, out. Wound care orders include wet to dry dressing changes twice daily. Which of the following best describes this wound? A. An unstageable wound B. Wound base filled with beefy red granulation tissue C. In the inflammatory (first) phase of healing D. Healing by secondary intention
D
Post operative care for the patient who has had a transsphenoidal hypophysectomy includes which intervention? A. Encouraging coughing and deep breathing to decrease pulmonary complications B. Assisting the patient with brushing the teeth to reduce the risk of infection C. Keeping the bed flat to decrease CSF leakage D. Testing nasal drainage for glucose to determine whether it contains CSF
D
The 25-year-old patient with Type 1 diabetes mellitus has postive albuminuria and tells the RN, "I have two kidneys and I'm still young. I expect to be around for a long time, so why should I worry about my blood sugar?" What is the nurse's best response? A. "You should discuss this with your doctor because you are being unrealistic." B. "You're right, you have nothing to be concerned about, you can live with one kidney." C. "You have little to worry about as long as your kidneys keep making urine." D. "Keeping your blood sugar under control now can help to prevent damage to both kidneys."
D
The RN is admitting a patient who has active tuberculosis to a medical-surgical unit. Which of the following precautions should the nurse include? A. Isolation with contact precautions B. A room that is within view of the nurses' station C. Patient does not wear mask for transport to XRAY D. Assign the patient a room with negative airflow
D
The RN is assessing a patient who a history of stable angina and now has a suspected MI (myocardial infarction). Which of the following findings distinguish stable angina from infarction? A. Unstable angina is predictable with patient activity B. Stable anginal pain radiates to the arm and jaw and lasts longer than 30 minutes C. Substernal infarction pain resolves in less than 15 minutes D. Angina is relieved with rest and nitroglycerin
D
The RN is assessing the patient that is complaining of visual changes. The patient complaint of loss of central vision would alert the RN to which of the following disease processes? A. Glaucoma B. Presbycusis C. Cataracts D. Macular degeneration
D
The RN is assessing the patients' functional status in consideration of discharge needs. What factor would take priority when considering the patients' discharge needs? A. The patient's ability to walk upstairs B. The patient's ability to drive C. The patient's ability to grocery shop D. The patient's history of dysphagia
D
The RN is caring for a patient who has a blood glucose of 38 mg/dL. The patient is difficult to arouse, pale, and tachycardic. Which of the following interventions should the RN perform first? A. Recheck the BG in 15 minutes B. Offer a small meal including honey C. Provide 4oz of grape juice D. Administer 1mg IM of glucagon
D
The RN is teaching a group of college students the importance of using sunscreen with prolonged exposure to the sun. How would the RN best ensure learning has occurred? A. Ask another RN to verify that the teaching was organized and clear B. Repeat the material several times C. Refer the group of students to a dermatologist D. Listen to comments from the students
D
The RN is teaching the patient dietary habits to decrease the further progression of their atherosclerosis. What dietary recommendations are most appropriate? A. McDonald's quarter pounder with cheese and large French fries. B. Canned creamy broccoli soup with salty butter crackers C. Fried vegetables with carrot cake and low-fat ice cream D. Baked chicken, walnuts and kale salad
D
The lab values of a patient who has diabetes mellitus include a fasting glucose of 82 and a Hbg A1C of 5.9 %. How does the RN most appropriately interpret these findings? A. The patient is at increased risk for developing hypoglycemia B. The patient has poorly managed their blood sugars C. The patient's glucose control over the last 24 hours has been good, but overall control has been poor D. The patient is demonstrating good control of their blood glucose
D
The nurse is caring for the patient with Stage 2 Alzheimer's Disease (AD). Which intervention is appropriate for the patient in this stage of AD? A. Place the patient in a bright, stimulating environment B. Instruct ancillary caregivers to assess the patient's level of consciousness hourly C. Write a note in their chart requesting a prn order for restraints D. Ensure the patient is wearing an ID badge or bracelet
D
The nurse is conducting a screening for osteoporosis. Which of the following is at greatest risk for developing the disorder? A. A 25-year-old female that jogs B. A 36-year-old male who has asthma C. A 70-year-old male that consumes excess alcohol D. A sedentary 65-year-old female that smokes cigarettes
D
The nurse is planning care for a patient who has Parkinson's disease and dysphagia. Which of the following actions should the nurse avoid including in the plan of care? A. Place food on the unaffected side of the mouth B. Provide foods with the consistency of oatmeal C. Feed the patient slowly D. Give the client thin liquids
D
The nurse is teaching a group of college students about methods to decrease their risk of skin cancer. Which intervention should the nurse include in the teaching plan? A. Inform the students that only elderly people get skin cancer B. Teach the students ways to avoid using sunscreen C. Telling students that it is normal for moles to change shape D. Teach the students how to conduct monthly, self, skin assessments
D
The nurse would expect to find which set of lab values on a patient suspected of having hyperthyroidism: A. T4 low and TSH low B. T4 high and TSH high C. T4 low and TSH high D. T4 high and TSH low
D
The patient is admitted with community acquired pneumonia and presents with crackles in the right lower lobe, shortness of breath and pain with coughing. Vital signs are: T 39.5C, pulse 96bpm, RR 28bpm, BP 102/89, PO 89% on 2L nasal cannula; WBC = 12. The nurse would best prioritize care in which of the following orders? A. Infection, fluid volume overload, impaired gas exchange B. Fluid volume overload, pain, infection C. Pain, activity intolerance, skin integrity impairment D. Impaired gas exchange, infection, pain
D
The patient is newly diagnosed with diabetes and tells the nurse "I'm so worried about my diabetes. I have young kids and I want to see them grow up. Every diabetic I have known has died." The nurse replies "When you say you are worried, what do you mean?" Which of the following therapeutic communication techniques is the nurse displaying? A. Confrontation B. Silence C. Validation D. Clarifying
D
The patient is recovering from an exacerbation of left-sided heart failure and has a nursing diagnosis of activity intolerance. Which of the following changes in vital signs during activity would be the best indicator that the client is tolerating ambulation? A. Blood pressure decrease from 140/86 mm Hg to 100/50 Hg B. Pulse rate increase from 80 beats/min to 128 beats/min C. Oxygen saturation decrease from 98% to 91% D. Respiratory rate increase from 16 breaths/min to 20 breaths/min
D
The patient presents with claudication relieved with rest. What assessment findings will the RN anticipate? A. Gangrenous foot ulcers B. Necrotic black toes C. Retinopathy and nephropathy D. Decreased but palpable peripheral pulses
D
The patient with DM has a Hgb A1C of 9%, BP of 150/96, and an elevated C-reactive protein. Based on the data, which complication(s) of diabetes is the patient most at risk for? A. Hypoglycemia B. Depression C. Polyuria, polydipsia, polyphagia D. Cardiovascular disease and death
D
The patient's urinalysis is positive for nitrates and leukocytes. Which of the following actions should the nurse anticipate taking next? A. Insert an indwelling Foley catheter to ensure CAUTI B. Limit the patient's fluid intake C. Obtain blood cultures D. Administer the broad-spectrum antibiotic
D
What dietary modification should you suggest for the client with hyperthyroidism? A. Eliminate carbohydrates, increase proteins and fats B. Decrease calories and proteins and increase in carbohydrates C. No dietary modification is needed D. Increase calories, proteins and carbohydrates
D
What interventions would the RN implement for the patient with Type 2 DM who is displaying signs of retinopathy? A. Assess urine protein levels B. Assess mental status C. Teach to eat frequent small meals D. Teach importance of annual eye exams
D
Which patient is at greatest risk for developing coronary artery disease related to obesity? A. Male with sleep apnea and chronic back pain B. Female who is pear shaped C. Female with BMI 31 D. Male patient who is apple shaped
D
Which statement made by the client after a bilateral adrenalectomy for treatment of Cushing's disease indicates a need for further clarification regarding medications? A. "I will avoid aspirin or aspirin-containing products." B. "I will take my cortisol replacement with food." C. "If I have any kind of stress, I will discuss with my doctor the need to increase my doses of cortisol." D. "If I have nausea or vomiting, I will skip the medication until I am better."
D
