nu214- exam4
Which statement by a patient who has had an above-the-knee amputation indicates the nurses discharge teaching has been effective?
"I should lie flat on my abdomen for 30 minutes 3 or 4 times a day"
A patient reports to the nurse that he has been started on methotrexate, on of the disease-modifying antirehumatic drugs (DMARDS). Which presentation would be of most concern to the RN: a) Insomnia and decreased endurance b) Complaints that rings on fingers are too tight c) Temperature of 101 degree F with an area of cellulitis on the thigh d) Indigestion after meals
c
A patient that is HIV positive has been diagnosed with pneumocystis pneumonia caused by P. jeroveci. What medication does the nurse expect that the patient will be prescribed for the treatment of this infection? a) Amphotericin B (Fungizone) b) Nystatin (Mycostatin) c) Trimethoprim-sulfamethoxazole (Bactrim, Septra) d) Fluconazole (Diflucan)
c
A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect? a) Hematocrit of 46% b) Hemoglobin of 13.8 g/dL c) Elevated reticulocyte count d) Decreased white blood cell count
c
A patient with leukemia who is at risk for tumor lysis syndrome (TLS) receives rasburicase (Elitek) before administering chemotherapy. What is the nurse's priority assessment after administration of this medication? a) Serum calcium levels b) Serum potassium levels c) Serum uric acid levels d) Blood glucose levels
c
A patient with poorly controlled diabetes has developed end stage renal failure and consequent anemia. When reviewing this patient's treatment plan the nurse should anticipate the use of what drug? a) Magnesium sulfate b) Vitamin K c) Epoeitin alfa d) Heparin
c
Four hours after mechanical ventilation is initiated a patients ABG results include a pH 7.51 PaO2 of 82 mmHg, PaCO2 of 26 mmHg and HCO3- of 23 mEq/L. What change would the nurse anticipate to the ventilator settings? a) Increase the tidal volume b) Increase the respiratory rate c) Decrease the respiratory rate d) Increase FIO2
c
Which drug must be monitored for ototoxic effects? a) Azithromycin b) Foscarnet c) Vanomycin d) Ceftrazidime
c
Which patient who has arrived at the human immunodeficiency virus (HIV) clinic should the nurse assess first? a) Patient whose rapid HIV-antibody test is positive b) Patient whose latest CD4+ count has dropped to 250/uL c) Patient who has had 10 liquid stools in the last 24hrs d) Patient who has nausea from prescribed antiretroviral drugs
c - assess for dehydration
The nurse is preparing to care for a patient who has scleroderma. The nurse refers to resources that describe CREST syndrome. Which of the following is a component of CREST syndrome? a) Esophageal Varices b) Osteopenia c) Raynaud's phenomenon d) Thyroid dysfunction
c - raynaud's phenomenon
1) The nurse is caring for a patient suspected of having AIDS. What is the most likely diagnostic test ordered in the early stages of this disease to differentiate the patient's symptoms from those of a cardiac episode? a) C-Reactive protein (CRP) level b) Carboxyhemoglobin level c) Complete blood count (CBC) d) Brain natriuretic peptide (BNP) level
c) cbc
Burn compression how many hours per day should the patient keep the compression garment on?
23 hrs
An older patient with cardiogenic shock is cool and clammy. Hemodynamic monitoring indicates a high systemic vasculare resistance (SVR). Which intervention should the nurse anticipate?
Increase the rate for the nitroprusside infusion
P. jiroveci
Infections occur in 2-4 weeks Asymp. in healthy individuals - opportunistic in AIDs patients Symptoms: Fever, nonproductive cough, difficulty breakthing Chest radiographs may show interstitial infiltrates
A patient has informed the home health nurse that she has recently noticed distortions when she looks at the amsler grid that she mounted on the refrigerator. What is the nurses most appropriate action?
Notify the physician immediately for worsening macular degeneration
CD4+ normal range is
800 to 1200 cells/μL
A patient has Meniere's disease with frequent attacks, about what drug does the NP plan to teach the patient A) Meclizine 12.5 to 25 mg as needed 3-4 times a day B) Naproxen sodium 220 mg BID C) Ampicillin 250-500 every 6 hours D) Valium 5mg every 4 hours
A meclizine
A pateint with AIDS has been tested for cytomegalovirus (CMV) with positive titers. What severe complication should the nurse be alerted for with cytomegalovirus? a) Blindness b) Fatigue c) Hearing impairment d) Diarrhea
A- blindness
A client has the following results: HIV nucleic acid test (NAT) -> Positive, CD4+ count 200 cells/mm3, Dx: P. jiroveci. What stage of HIV is this patient in? a) Stage 2 - chronic b) Latent stage c) Stage 3 - AIDS d) Stage 1 - Acute
c
A hospitalized patient had CD4 count of 40 cells/mm3 due to AIDS. The physician orders a chest x-ray. What is the best way to implement the order?
Arrange for a portable x-ray machine to be used
The nurse is caring for a patient who is using Bucks traction after a hip fracture. Which action can the nurse delegate to experienced unlicensed assistive personnel (UAP) A) Remove and reapply traction periodocially B) Ensure the weight for the traction is hanging freely C) Monitor the skin under the traction boot for redness D) Check for intact sensation and movement in the affected leg
B
A client has discussed therapy for his HIV positive status. What does the nurse understand the goal of antiretroviral therapy is?
Bring the viral load to a virtually undetectable level
A patient who had a total hip replacement had an intraoperative hemorrhage 14 hours ago. Which laboratory test result would the nurse expect?
Elevated reticulocyte count
A nurse provides care for a client with deep partial-thickenss burns in the acute/intermediate phase. What could cause a reduced hematocrit (HCT) in this client?
Hemodilution resulting from interstitial-to plasma fluid shift
A 53-year old woman who was diagnosed with breast cancer following an abnormal mammogram. What action will best detect possible metastasis?
Sentinel node biopsy of the axillary lymph nodes
how to detect metastasis of breast cancer
Sentinel node biopsy of the axillary lymph nodes
a patient admitted to the emergency department with an open stab wound to the chest. What action should the nurse take?
Tape a nonporous dressing on three sides over the wound
A patient reports to the nurse that he has been started on methotrexate, one of the disease modifying antirheumatic drugs (DMARDS). Which presentation would be of most concern to the RN?
Temperature of 101 degree Fahrenheit with an area of cellulitus on thigh.
Which finding is the best indicator that the fluid resuscitation for a 90kg patient with hypovolemic shock has been effective?
Urine output is 65 ml over the past hour
antidote for warfarin
Vitamin K
A nurse provides care for a client with deep partial-thickness burns in the acute/intermediate phase. What could cause a reduced hematocrit (HCT) in this client? a) Hemodilution resulting from interstitial-to-plasma fluid shift b) Metabolic acidosis related to hypovolemic shock c) Hemoconcentration related to hypoalbuminemia, and systemic inflammatory response d) Lack of erythropoietin factor related to hypoperfused kidneys
a
A patient weighing 68 kg received full-thickness thermal burns to anterior and posterior surfaces of both legs and feet. According to the Parkland Formula, how much intravenous fluid should be administered to this patient in the first 8 hours after burn injury? a) 1224 mL b) 2448 mL c) 4896 mL d) 306 mL/hr
a
Interleukin-2 (IL-2) is used as adjuvant therapy for a patient with metastatic renal cell carcinoma. Which information should the nurse include when explaining the purpose of this therapy to the patient? a) IL-2 enhances the body's immunologic response to tumor cells b) IL-2 prevents bone marrow depression caused by chemotherapy c) IL-2 protects normal cells from harmful effects of chemotherapy d) IL-2 stimulates cancer cells in their resting phase to enter mitosis
a
The nurse administers an IV vesicant chemotherapeutic agent to a patient. Which action is most important for the nurse to take? a) Stop the infusion if swelling is observed at the site b) Hold the medication unless a central venous line is available c) Administer the chemotherapy through a small-bore catheter d) Infuse the medication over a short period of time
a
The nurse is teaching the patient newly diagnosed with systemic lupus about the condition. Which statement by the patient indicates teaching was effective? a) "I should avoid prolonged sun exposure." b) "I do not need to make any changes in my diet." c) "My energy level will gradually increase over time." d) "My medication will ultimately correct my problem."
a
The nurse is caring for a client with Hodgkin's disease. What factor is the most significant risk factor for cardiac tamponade in this client? a) Radiation to the mediastinum b) Pulse pressure of 60mm Hg c) Potassium level of 5.2 mEq/L d) Pulmonary embolus
a radiation is a risk factor for cardiac tamponade
A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include? a) Vitamin K administration b) Platelet transfusion c) Splenectomy d) Prednisone
c
The nurse palpates enlarged cervical lymph nodes on a patient diagnosed with acute human immunodeficiency virus (HIV). Which action would be appropriate for the nurse to take? a) Instruct the patient to apply ice to the neck b) Tell the patient a secondary infection is present c) Explain to the patient that this is an expected finding d) Request that an antibiotic be prescribed for the patient
ans: C Persistent generalized lymphadenopathy is common in the early stages of HIV infection. No antibiotic is needed because the enlarged nodes are probably not caused by bacteria. Applying ice to the neck may provide comfort, but the initial action is to reassure the patient this is an expected finding. Lymphadenopathy is common with acute HIV infection and is therefore not likely the flu.
A nurse is caring for a client who is preparing for discharge following a stable vertebral fracture of L5. Which of the following outcomes must be met prior to discharge? a) The client is able to demonstrate full range of motion of the spine b) The client is able to perform transfers safely c) The client can climb stairs without a handrail d) The client is able to perform ADL's independently
b
Meclizine (Antivert) is first line treatment for: a) Acoutsic neuroma b) Meniere's disease c) Otosclerosis d) Cholesteatoma
b
The nurse is caring for a patient who is using Buck's traction after a hip fracture. Which action can the nurse delegate to experienced assistive personnel (UAP)? a) Remove and reapply traction periodically b) Ensure the weight for the tractions is hanging freely c) Monitor the skin under the traction boot for redness d) Check for intact sensation and movement in the affected leg
b
The nurse is creating a care plan for a patient who is status post-total laryngectomy. Much of the plan consists of a long-term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen? a) Esophageal speech b) Tracheoesophageal puncture c) Electic larynx d) American sign language (ASL)
b
The nurse obtains information about a hospitalized patient who is receiving chemotherapy for colorectal cancer. Which information about the patients alerts the nurse to discuss a possible change in cancer therapy with the health care provider? a) Elevated WBC b) Increased carcinoembryonic antigen (CEA) c) Nausea and Vomiting d) Frequent loose stools
b
The tuberculin skin test (PPD) results are negative for a patient who has been diagnosed with HIV and who has a CD4+ count of 75 cells/mm3. How should the healthcare provider interpret this test result? a) The examiner failed to palpate the patient's arm thoroughly b) The patient has not been exposed to the tuberculosis bacteria c) The patient is unable to mount an immune response to the test d) Poor technique was used when administering the PPD
b
When a client's wife is visiting, she observes the client's chest drainage system and begins to nervously question the nurse regarding the amount of bloody drainage in the system. Which is the BEST response from the nurse? a) "I have checked all of the equipment and it is working fine. You have nothing to be worried about." b) "The system is draining collected fluid from around the lung. The drainage is expected and does not mean that he is bleeding." c) "The chest tube is draining the secretions from his chest. It is important for him to deep breath frequently." d) "Your husband has been really sick. This must be a very difficult time. Let's sit down and talk about it."
b
Which statement by a patient who has had an above the knee amputation indicates the nurse's discharge teaching has been effective? a) "I should elevate my residual limb on a pillow 2 or 3 times a day" b) "I should lie flat on my abdomen for 30 mins 3-4 times a day." c) "I should change the limb sock when it becomes soiled or each week." d) "I should use lotion on the stump to prevent skin drying and cracking."
b
The nurse recognizes that the goal of treatment for metastatic bone cancer is to: a) Diagnose the extent of bone damage b) Promote pain relief and quality of life c) Cure the diseased bone and cartilage d) Reconstruct the bone with a prosthesis
b - pain relief & quality of life
Norepinephrine has been prescribes for a patient who was admitted with dehydration and hypotension. Which data indicate that the nurse should consult with the health care provider before starting the norepinephrine? a) The patient is receiving low dose dopamine b) The patient's central venous pressure is 2 mm Hg c) The patien is in sinus tachycardia at 120 BPM d) The patient has had no urine output since admission
b -low cvp Adequate fluid administration is essential before administration of vasopressors to patients with hypovolemic shock. The patient's low central venous pressure indicates a need for more volume replacement. The other patient data are not contraindications to norepinephrine administration.
The RN is caring for a patient on IV heparin infusion and oral coumadins. Current laboratory values indicate that the patient's aPPT is 5 times the control value and the PT/INR is 2 times the control value. What action does the nurse anticipate? a) Obtain an order for Vit K injection b) Decrease the heparin rate c) Decrease the coumadin dose d) Clarify vegetable consumption with the patient
b) decrease heparin
What should the nurse assess when conducting a focused assessment of gastrointestinal system of client with a burn injury?
curlings ulcer
A hospitalized patient has a CD4+ count of 40 cells/mm3 due to AIDS. The physician orders a chest x-ray. What is the best way to safely implement the order? a) Ensure that the radiology department has been disinfected prior to the test b) Have the patient wear a mask to the x-ray department c) Send the patient to the x-ray department and have the staff in the department wear masks d) Arrange for a portable x-ray machine to be used
d
A patient with a possible pulmonary embolism reports chest pain and difficulty breathing. The nurse finds a heart rate of 142 BPM, BP 100/60, and respirations of 42 breaths/min. Which actions should the nurse take FIRST? a) Administer anticoagulant drug therapy b) Notify the patients health care provider c) Prepare the patient for a spiral computed tomography (CT) d) Elevate the head of the bed to a semi-fowlers position
d
The nurse is caring for the client involved in an MVA who sustained an unstable pelvic fracture. Which physician order should the nurse prioritize and do first? a) Computed tomography (CT) scan of the pelvis b) Insert Foley catheter to prevent periotonitis c) Blood alcohol level and toxicology screen d) Type and cross-match for four units of PRB
d
The nurse reviews the laboratory test results of a patient admitted with abdominal pain. Which information will be most important for the nurse to communicate to the health care provider? a) Monocytes 4% b) Hemoglobin 13.6 g/d: c) Platelet count 168,000/uL d) White blood cell count 15,500/Ul
d
Which finding is the best indicator that the fluid resuscitation for a 90-kg patient with hypovolemic shock has been effective? a) There are no signs of hemorrhage b) Mean arterial pressure (MAP) is 72mmg Hg c) Hemoglobin is within normal limits d) Urine output is 65ml over the past hour
d
Which of the following medications is the antidote to heparin? a) Aspirin b) Vitamin k c) Clopidogrel (plevix) d) Protamine sulfate
d
You are assessing the diagnostic testing results for a patient that has rheumatoid arthritis. What result is NOT an indicator of this disease? a) Positive rheumatoid factor b) Elevated erythrocyte sedimentation rate c) Positive c-reactive protein d) X-ray imaging showing osteophyte formation.
d
The nurse is caring for a patient with advanced stage metastasized breast cancer. The nurse enters the room and finds the patient struggling to breath and rapid assessment reveals that the patient's jugular veins are distended. The nurse should suspect the development of what oncologic emergency? a) Metastatic tumor of the neck b) Spinal cord compression c) Increased intracranial pressure d) Superior vena cava syndrome
d - svcs Feedback: SVCS occurs when there is gradual or sudden impaired venous drainage giving rise to progressive shortness of breath (dyspnea), cough, hoarseness, chest pain, and facial swelling; edema of the neck, arms, hands, and thorax and reported sensation of skin tightness and difficulty swallowing; as well as possibly engorged and distended jugular, temporal, and arm veins. Increased intracranial pressure may be a part of SVCS, but it is not what is causing the patients symptoms. The scenario does not mention a problem with the patients spinal cord. The scenario says that the cancer has metastasized, but not that it has metastasized to the neck.
The is providing care for a patient who has been living with human immunodeficiency virus (HIV) for several years. Which assessment finding most clearly indicates an acute exacerbation of the disease? a) Presence of mononucleosis-like symptoms b) A sharp decrease in the patients CD4+ count c) A sudden increase in the patients WBC count d) A new onset of polcythemia
d -polycythemia
A patient with colon cancer has received induction chemotherapy resulting in myelosuppression. The physician has been ordering both granulocyte colony-stimulating factor and erythropoietin. Which morning laboratory results would warrant a call to the provider prior to administering these growth factors? a) Platelets 120,000/uL b) Absolute Neutrophil Count (ANC) 200 cells/uL c) Hemoglobin 12.9 g/dL d) Potassium 5.0 mEq/L
d -potassium --only one that is high
A group of students are reviewing information about CYPP 450 metabolic activity levels based on a persons CYP genotype and drug response. The students demonstrate understanding of this information when they identify which of the following as being associated with poor metabolizers?
greater risk of toxicity
CD4+ cell count
measures the number of CD4+ T cells (helper T cells) in the bloodstream of patients with AIDS
After a patient who has septic shock receives 2L of normal saline intravenously, the central venous pressure is 10 mm hg and the blood pressure is 82/40 mm hg. What should the nurse anticipate?
norepiphrine
The term that describes the percentage of individuals known to carry the gene for a trait and who actually manifest the condition is
penetrance
Which information shown in the table below about a patient who has just arrived in the emergency department is MOST urgent for the nurse to communicate to the health care provider? Assessment: BP 110/68 Pulse 98 bpm Brisk capillary refill Multiple ecchymoses on arms CBC: Hgb: 10.6 g/dL, Hct: 30% WBC: 5100/uL Platelets 19,500/uL Patient history: Occasional ASA use, Adbominal pain x 1 wk, Lg dark stool this AM. Heart Rate Platelet coung Abdominal pain White blood cell count
platelet count
A patient with leukemia who is at risk for tumor lysis syndrome (TLS) receives rasburicase (Elitek) before administering chemotherapy. What is the nurses priority assessment after administration of this medication?
serum uric acid levels
A critical care nurse is caring for a patient with autoimmune hemolytic anemia. The patient is not responding to conservative treatments, and his condition is now becoming life threatening. The nurse is aware that a treatment option in this case may include what?
splenectomy -hemolytic anemia causes splenomegaly
A patient has the following results: HIV nucleic acid test (NAT) is positive CD4+T count 300 cells/mm3 DX: P. jirovect What stage of HIV is the patient in?
stage 3
Norepinephrine has been prescribed for a patient who was admitted with dehydration and hypotension. Which data indicate that the nurse consult with the health care provider before starting the norepinephrine?
the patient central venous pressure is 2 mm hg -norepi is a vasodilator, we dont want to dilate if cvp is low!
The nurse is creating a care plan for a patient who is status post total laryngectomy. Much of the plan consists of a long term postoperative communication plan for alaryngeal communication. What form of alaryngeal communication will likely be chosen?
transesophageal puncture
Which lab test would be ordered to evaluate the effectiveness of ART?
viral load
To evaluate the effectiveness of antiretroviral therapy (ART), which laboratory test result will the nurse review?
viral load testing -NAAT
