Exam 2 SG questions
A pulmonary embolus is suspected in a patient with a deep vein thrombosis who develops dyspnea, tachycardia, and chest pain. Diagnostic testing is scheduled. Which test should the nurse plan to teach the patient about? a. D-dimer b. CXR c. Spiral (helical) CT scan d. Ventilation-perfusion lung scan
C
What describes the primary difference in treatment for DKA and hyperosmolar hyperglycemic syndrome (HHS)? a. DKA requires administration of bicarbonate to correct acidosis b. Potassium replacement is not necessary in the management of HHS c. HHS requires greater fluid replacement to correct the dehydration d. Glucose is withheld in HHS until the blood glucose reaches a normal level
C
Why is the classification of pneumonia as community-acquired pneumonia or hospital acquired pneumonia clinically useful? a. Atypical pneumonia syndrome is more likely to occur in HAP b. Diagnostic testing does not have to be used to identify causative agents c. Causative agents can be predicted, and empiric treatment is often effective d. IV antibiotic therapy is necessary for HAP, but oral therapy is adequate for CAP
C
During an acute exacerbation of mild COPD, the patient is severely short of breath. The nurse identifies the nursing diagnosis of impaired breathing, etiology: alveolar hypoventilation and anxiety. What is the best nursing action? a. Prepare and administer routine bronchodilator medications b. Perform chest physiotherapy to promote removal of secretions c. Administer oxygen at 5 L/min until the shortness of breath is relieved d. Position the patient upright with the elbows resting on the over the bed table
D
In a patient with central diabetes insipidus, what is the expected outcome of administering ADH during a water deprivation test? a. decrease in body weight b. increase in urinary output c. decrease in blood pressure d. increase in urine osmolality
D
A patient with a pH of 7.29 has metabolic acidosis. Which value is useful in determining whether the cause of the acidosis is an acid gain or a bicarbonate loss? a. PaCO2 b. Anion gap c. Serum Na+ level d. Bicarbonate level
B
What is the priority nursing intervention during the management of the patient with pheochromocytoma? a. Administering IV fluids b. Monitoring BP c. Administering beta adrenergic blockers d. Monitoring intake and output daily weights
B
Tobacco smoke causes defects in multiple areas of the respiratory system. What is a long-term effect of smoking? a. bronchospasm and hoarseness b. Decrease mucus secretions and cough c. Increased function of alveolar macrophages d. Increased risk of infection and hyperplasia of mucous glands
D
What is the initial antibiotic treatment for pneumonia based on? a. The severity of symptoms b. The presence of characteristic leukocytes c. Gram stain and cultures of sputum specimens d. History and physical examination and characteristic chest x-ray findings
D
What is the primary principle involved in the various airway clearance devices used for mobilizing secretions? a. vibration b. inhalation therapy c. chest physiotherapy d. positive expiratory pressure
D
What are the characteristics of the carbonic acid bicarbonate buffer system (select all that apply)? a. The lungs eliminate CO2 b. Neutralizes HCl acid to yield carbonic acid and salt c. H2C03 formed by neutralization dissociates into H2O and CO2 d. Shift H+ in and out of cells in exchange for other cations, such as potassium and sodium e. Free basic radicals dissociate into ammonia and OH-, which combines with H+ to form water
A, B, C
During care of a patient with SIADH, what should the nurse do? a. Monitor neurologic status at least every two hours b. Teach the patient receiving diuretic therapy to restrict sodium intake c. Keep the head of the bed elevated to prevent antidiuretic hormone release d. Notify the HCP if the patient's blood pressure decreases more than 20 mmHg from baseline
a
The nurse is teaching the patient with prediabetes ways to prevent or delay the development of type 2 diabetes. What information should be included (select all that apply)? a. Exercise regularly b. Maintain a healthy weight c. Have BP checked regularly d. Assess for visual changes on a monthly basis e. Monitor for polyuria, polyphagia, and polydipsia
a, b, e
Nursing interventions for a patient with severe anemia related to peptic ulcer disease include (select all that apply) a. Instructions for high iron diet b. Taking vital signs every eight hours c. monitoring stools for occult blood d. teaching self injection of erythropoietin e. administration of cobalamin injections
a, c
What is the most important method to identify the presence of infection in a neutropenic patient? a. Frequent temperature monitoring b. Routine blood in sputum cultures c. Assessing for redness and swelling d. Monitoring WBC count
A
What preoperative instruction should the nurse give to the patient scheduled for a subtotal thyroidectomy? a. How to support the head with the hands when turning in bed b. Coughing should be avoided to prevent pressure on the incision c. Head and neck will have to remain immobile until the incision heals d. Any tingling around in the lips or in the fingers after surgery is expected and temporary
A
A patient with hypothyroidism is treated with levothyroxine (Synthroid). What should the nurse include when teaching a patient about this therapy? a. Explain that alternate day dosage maybe used a side effects occur b. Provide written instruction for all information related to the drug therapy c. Tell the patient that the drug must be taken until the hormone balance is reestablished d. Assure the patient that a return to normal function will occur with replacement therapy
B
A patient with type 1 diabetes is 20 U of Novolin 70/30 in the morning and at 6 PM. When teaching the patient about this regimen, what should the nurse emphasize? a. Hypoglycemia is most likely to occur before the noon meal b. A set meal pattern with a bedtime snack is necessary to prevent hypoglycemia c. Flexibility in food intake is possible because insulin is available 24 hours a day d. Premeal glucose checks are required to determine needed changes in daily dosing
B
Polydipsia and polyuria related to diabetes are primarily due to a. The release of key tones from cells during fat metabolism b. Fluid shifts resulting from the osmotic affect of hyperglycemia c. Damage to the kidneys from exposure to high levels of glucose d. Changes in RBCs resulting from attachment of excess glucose to hemoglobin
B
The nurse expects the long-term treatment of a patient with hyperphosphatemia from renal failure will include a. Fluid restriction b. Calcium supplement c. Magnesium supplements d. Increased intake of dairy products
B
The nurse has identified the nursing diagnosis of fatigue for a patient with hypothyroidism. What should the nurse do while caring for this patient? a. Assess for changes in orientation, cognition, and behavior b. Monitor vital signs in cardiac rhythm response to activity c. Monitor bowel movement frequency, consistency, shape, volume, and color d. Help in developing well-balanced meal plans consistent with energy expenditure level
B
The nurse is assessing a newly admitted patient with diabetes. Which observation should be addressed as a priority by the nurse? a. Bilateral numbness in both hands b. Rapid respirations with deep inspiration c. Stage 2 pressure injury on the right heel d. Areas of lumps and dents on the abdomen
B
The nurse recognizes that additional teaching is needed when the patient with asthma says: a. "I should exercise every day if my symptoms are controlled." b. "I may use over-the-counter bronchodilator drugs occasionally if I develop chest tightness." c. "I should inform my spouse about my medication's and how to get help if I have a severe asthma attack." d. "a diary to record my medication use, symptoms, PEF rates, and activity levels will help in adjusting my therapy."
B
To reduce the risk for many occupational lung diseases, what is the most important measure the occupational nurse should promote? a. Maintaining smoke free work environments for all employees b. Using masks and effective ventilation systems to reduce exposure to irritants c. Inspection and monitoring of workplaces by national occupational safety agencies d. Requiring periodic chest x-rays and pulmonary function tests for exposed employees
B
When caring for a patient with primary hyperaldosteronism, the nurse would question an HCP's prescription for which drug? a. Ketoconazole b. Furosemide (Lasix) c. Eplerenone (Inspra) d. Spironolactone (Aldactone)
B
When caring for the patient with nephrogenic diabetes insipidus, what should the nurse expect the treatment to include? a. Fluid restriction b. Thiazide diuretics c. A high sodium diet d. Metformin (Glucophage)
B
When obtaining assessment data from a patient with a microcytic, hypochromic anemia, the nurse would ask the patient about a. Folic acid intake b. Dietary intake of iron c. History of gastric surgery d. History of sickle cell anemia
B
Which anemia is manifested with pancytopenia? a. Thalassemia b. Aplastic anemia c. Megaloblastic anemia d. Anemia of chronic disease
B
Which class of oral glucose lowering agents (OA) is most commonly used for people with type 2 diabetes because it reduces fasting glucose production and enhances tissue uptake of glucose? a. Insulin b. Biguanide c. Meglitinide d. Sulfonylurea
B
With which disorder is hyperkalemia often associated? a. Hypoglycemia b. Metabolic acidosis c. Respiratory alkalosis d. Decreased urine potassium levels
B
A 45-year-old patient has symptoms including arthralgia, impotence, weight loss, and liver enlargement. His laboratory results include an elevated serum iron, total iron binding capacity (TIBC), and serum ferritin levels. Which disorder does this describe and which treatment would be used? a. Thalassemia, combination chemotherapy b. Hemochromatosis, the deferoxamine (Desferal) c. Myelodysplastic syndrome, blood transfusion d. Delayed transfusion reaction, deferaisrox (exjade)
B
A patient is admitted to the hospital with a diagnosis of Cushing's syndrome. On physical assessment of the patient, what should the nurse expect to find? a. Hypertension, peripheral edema, and petechiae b. weight loss, buffalo hump, and moon face with acne c. Abdominal and buttock striae, truncal obesity, and hypotension d. Anorexia, signs of dehydration, and hyperpigmentation of the skin
A
A patient with acromegaly is treated with a transsphenoidal hypophysectomy. What should the nurse do postoperatively? a. Ensure that any clear nasal drainage is tested for glucose and protein b. Maintain the patient flat in bed to prevent cerebrospinal fluid leakage c. Aid the patient with toothbrushing every four hours to keep the surgical area clean d. Encourage deep breathing, coughing, and turning to prevent respiratory complications
A
A patient with active TB continues to have positive sputum cultures after 6 months of treatment. She says she cannot remember to take the medication all the time. What is the best action for the nurse to take? a. Arrange for directly observed therapy (DOT) by a public health nurse b. Schedule the patient to come to the clinic every day to take the medication c. Have a patient who has recovered from TB tell the patient about his successful treatment d. Schedule more teaching sessions so that the patient will understand the risks of noncompliance
A
A patient with diabetes is learning to mix regular insulin and NPH insulin in the same syringe. The nurse determines that additional teaching is needed when a patient does what? a. Withdraws the NPH dose into the syringe first b. Injects air equal to the NPH dose into the NPH vial first c. Removes any air bubbles after withdrawing the first insulin d. Adds air equal to the insulin dose into the regular vial and withdraws the dose
A
Analyze the following diagnostic findings for your patient with type 2 diabetes. Which result will need further assessment? a. A1C 9% b. BP 126/80 mm Hg c. FBG 130 mg/dL d. LDL 100 mg/dL
A
The lungs act as an acid-base buffer by a. increasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. b. increasing respiratory rate and depth when CO2 levels in the blood are low, reducing base load c. decreasing respiratory rate and depth when CO2 levels in the blood are high, reducing acid load. d. decreasing respiratory rate and depth when CO2 levels in the blood are low, increasing acid load.
A
The nurse determines that teaching about pernicious anemia has been effective when the patient says, a. "this condition can kill me unless I take injections of the vitamin for the rest of my life." b. "I know symptoms can be completely reversed after I take a cobalamin supplement." c. "if my anemia does not respond to cobalamin therapy, my only other alternative is a bone marrow transplant." d. "the least expensive and most convenient treatment of pernicious anemia is to use a diet with foods high in cobalamin."
A
The nursing care for a patient with hyponatremia and fluid volume excess includes a. Fluid restriction b. Administration of hypotonic IV fluids c. Administration of cation exchange resin d. Placement of an indwelling catheter
A
To control the side effects of corticosteroid therapy, the nurse teaches the patient who is taking corticosteroids to a. Increase calcium intake to 1500 mg/day b. Perform glucose monitoring for hypoglycemia c. Obtain immunizations due to high risk for infections d. Avoid abrupt position changes because of orthostatic hypotension
A
To prevent hypoglycemia or hyperglycemia related to exercise, what should the nurse teach the patient using glucose lowering agents about the best time for exercise? a. Plan activity and food intake related to blood glucose levels b. When blood glucose is greater than 250 mg/dL and ketones are present c. When glucose monitoring reveals that the blood glucose is in the normal range d. When blood glucose levels are high, because exercise always has a hypoglycemic affect
A
Two days after a self managed hypoglycemic episode at home, the patient tells the nurse that his blood glucose levels since the episode has been between 80 and 90 mg/dL. What is the best response by the nurse? a. "that is a good range for your glucose levels." b. "you should call your HCP because you need to have your insulin increased." c. "that level is too low in view of your recent hypoglycemia and he should increase your food intake." d. "you should only take half your insulin dosage for the next few days to get your glucose level back to normal."
A
When caring for a patient with metabolic syndrome, the nurse should give the highest priority to teaching the patient about which treatment plan? a. Achieving a normal weight b. Performing daily aerobic exercise c. Eliminating red meat from the diet d. Monitoring the blood glucose periodically
A
When obtaining a health history from a 76-year-old patient with a suspected CAP, what does the nurse expect the patient or caregiver to report? a. confusion b. A recent loss of consciousness c. An abrupt onset of fever and chills d. A gradual onset of headache and sore throat
A
When teaching the patient about a new prescription for oral iron supplements, what does the nurse teach the patient to do? a. increase fluid and dietary fiber intake b. take the iron preparations with meals c. use enteric-coated preparations take with orange juice d. report the presence of black stools to the HCP
A
When teaching the patient with type 1 diabetes, what should the nurse emphasize as the major advantage of using an insulin pump? a. Tight glycemic control can be maintained b. Errors and insulin dosing are less likely to occur c. Complications of insulin therapy are prevented d. Frequent blood glucose monitoring is unnecessary
A
Which condition contributes to secondary pulmonary arterial hypertension by causing pulmonary capillary and alveolar damage? a. COPD b. Sarcoidosis c. Pulmonary fibrosis d. Pulmonary embolism
A
Which method of low, constant oxygen administration is the safest system to use for a patient with COPD exacerbation? a. Venturi mask b. Nasal cannula c. Simple face mask d. Nonrebreather mask
A
Which statement accurately describes Graves' disease? a. Exophthalmus occurs in grave's disease b. It is an uncommon form of hyperthyroidism c. Manifestations of hyperthyroidism occur from tissue desensitization to the sympathetic nervous system d. Diagnostic testing in the patient with Graves' disease will not reveal and increased thyroid stimulating hormone (TSH) level
A
Which statement indicates the patient with asthma requires further teaching about self-care? a. "I use my corticosteroid inhaler when I feel short of breath." b. "I get a flu shot every year and see my HCP if I have an upper respiratory tract infection." c. "I use my inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies." d. "I walk 30 minutes every day but sometimes I have to use my bronchodilator inhaler before walking to prevent me from getting short of breath."
A
What are characteristics of a phosphate buffer system (select all that apply)? a. Neutralizes a strong base to a weak base and water b. Resultant sodium bisphosphate is eliminated by kidneys c. Free acid radicals dissociate into H+ and CO2, buffering excess base d. Neutralizes a strong acid to yield sodium bisphosphate, weak acid, and salt e. Shifts chloride in and out of red blood cells in exchange for sodium bicarbonate, buffering both acids and bases
A, B, D
During routine health screening, a patient is found to have fasting plasma glucose of 132 mg/dL. At a follow up visit, a diagnosis of diabetes would be made based on which laboratory results (select all that apply)? a. A1C of 7.5% b. Glycosuria of 3+ c. FPG >= 127 mg/dL d. Random blood glucose of 126 mg/dL e. A two hour oral glucose tolerance test of 190 mg/dL
A, C
A patient with aplastic anemia has impaired oral mucous membranes. This problem can be related to the effects of what deficiencies (select all that apply)? a. RBCs b. Ferritin c. Platelets d. Coagulation factor VIII e. WBCs
A, C, E
How do microorganisms reach the lungs and cause pneumonia (select all that apply)? a. aspiration b. Lymphatic spread c. Inhalation of microbes in the air d. Touch contact with the infectious microbes e. Hematogenous spread from infections elsewhere in the body
A, C, E
Which microorganisms are associated with both CAP and HAP (select all that apply)? a. Klebsiella b. Acinetobacter c. Staphylococcus aureus d. Mycoplasma pneumoniae e. Pseudomonas aeruginosa f. Streptococcus pneumoniae
A, C, E, F
Which statements describe anemia related to blood loss (select all that apply)? a. A major concern is prevention of shock b. This anemia is most frequently treated with increased dietary iron intake c. In addition to the general symptoms of anemia, this patient also manifests jaundice d. A patient who has acute blood loss may have postural hypotension and increased heart rate e. Initial clinical symptoms are the most reliable way to evaluate the effect and degree of blood loss
A, D, E
The plan of care for a patient with COPD should include (select all that apply) a. Exercise such as walking b. High flow rate of oxygen administration c. Low dose chronic oral corticosteroids therapy d. Use of peak flow meter to monitor the progression of COPD e. Breathing exercises, such as pursed lip breathing that focuses on exhalation
A, E
The nurse recognizes that additional teaching is necessary about medications when the patient with moderate asthma makes which statements (select all that apply)? a. "If I can't afford all of my prescriptions, I will only use the salmeterol (Serevent)." b. "I will stay inside if there is a high pollen count to prevent having an asthma attack." c. "I will rinse my mouth after using fluticasone (Flovent HFA) to prevent oral candidiasis." d. "I must have omalizumab (Xolair) injected every 2 to 4 weeks because inhalers don't help my asthma." e. "I can use my inhaler 3 times, every 20 minutes, before going to the hospital if my peak flow has not improved." f. "My GERD medications will help my asthma, and my asthma medications will help my GERD."
A, F
A nurse working in an outpatient clinic plans a screening program for diabetes. What recommendations for screening should be included? a. OGTT for all minority populations every year b. FPG for all persons at age 45 years and then every three years c. Testing people under the age of 21 years for islet cell antibodies d. Testing for type two diabetes and all overweight or obese persons
B
A patient diagnosed with class 3 TB 1 week ago is admitted to the hospital with symptoms of chest pain and coughing. What nursing action has the highest priority? a. Administering the patients anti-tubercular drugs b. Admitting the patient to an airborne infection isolation room c. Preparing the patient's room with suction equipment and extra linens d. Placing the patient in an ICU, where he can be closely monitored
B
A patient is admitted to the emergency department with an acute asthma attack. Which patient assessment is of greatest concern to the nurse? a. the presence of a pulses paradoxus b. markedly decreased breath sounds with no wheezing c. a Respiratory rate of 34 breaths/min and increased pulse and BP d. use of accessory muscles of respiration and a feeling of suffocation
B
A patient with Addison's disease comes to the ED with reports of nausea, vomiting, diarrhea, and fever. What interprofessional care should the nurse expect? a. IV administration of vasopressors b. IV administration of Hydrocortisone c. IV administration of D5W with 20 mEq KCl d. Parenteral injections of adrenocorticotropic hormone (ACTH)
B
A patient with SIADH is treated with water restriction. Which findings would indicate that treatment has been effective? a. Increased urine output, decreased serum sodium, and increased urine specific gravity b. Increased urine output, increased serum sodium, and decreased urine specific gravity c. Decreased urine output, increased serum sodium, and decreased urine specific gravity d. Decreased urine output, decreased serum sodium, and increased urine specific gravity
B
A patient with a hemoglobin level of 7.8 g/dL has cardiac palpitations, a heart rate of 102 BPM, and an increased reticulocyte count. Considering the severity of anemia, what other manifestation with the nurse expect the patient to exhibit? a. pallor b. dyspnea c. a smooth tongue d. sensitivity to cold
B
A patient with pneumonia is having difficulty clearing the airway because of pain, fatigue, and thick secretions. What is an expected outcome for this patient? a. SpO2 is 90% b. Lungs clear to auscultation c. Patient tolerates walking in hallway d. Patient takes 3 to 4 shallow breaths before coughing to minimize pain
B
During discharge teaching for the patient with Addison's disease, which patient statement indicates a need for further teaching? a. "I should always call the doctor if I develop vomiting or diarrhea." b. "if my weight goes down, my dosage of steroid is probably too high." c. "I should double or triple my steroid dose if I undergo rigorous physical exercise." d. "I need to carry an emergency kit with injectable Hydrocortisone in case I can't take my medicine by mouth."
B
In teaching the patient with pernicious anemia about the disease, the nurse explains that results from a lack of a. Folic acid b. Intrinsic factor c. Extrinsic factor d. Cobalamin intake
B
In type 1 diabetes, glucose has an osmotic affect when insulin deficiency prevents the use of glucose for energy. Which classic symptom is caused by the osmotic effect of glucose? a. Fatigue b. Polydipsia c. Polyphagia d. Recurrent infections
B
Nursing interventions for the patient with aplastic anemia are directed toward the prevention of which complications? a. Fatigue and dyspnea b. Hemorrhage and infection c. Thromboemboli and gangrene d. Cardiac dysrhythmias and heart failure
B
The HCP prescribes levothyroxine for a patient with hypothyroidism. After teaching about this drug, the nurse determines that further instruction is needed when the patient says a. ""I can expect the medication dose may need to be adjusted." b. "I only need to take this drug until my symptoms are improved." c. "I can expect to return to normal function with the use of this drug." d. "I will report any chest pain or difficulty breathing to the doctor right away."
B
The following interventions are planned for a patient with diabetes. Which intervention can the nurse delegate to the UAP? a. Discuss complications of diabetes b. Check that the bathwater is not too hot c. Check the patient's technique for drawing up insulin d. Teach the patient to use a meter for self monitoring of blood glucose
B
The microorganisms Pneumocystis jiroveci (PJP) and cytomegalovirus (CMV) are associated with which type of pneumonia? a. Necrotizing pneumonia b. Opportunistic pneumonia c. HAP d. CAP
B
The nurse is reviewing a patient's morning laboratory results. Which result is of greatest concern? a. Serum Na+ of 150 mEq/L b. Serum Mg2+ of 1.1 mEq/L c. Serum PO3- of 4.5 mg/dL d. Serum Ca+ (total) of 8.6 mg/dL
B
The patient has had COPD for years, and his ABGs usually show hypoxia (PaO2 <60 mmHg or SaO2 <88%) and hypercapnia (PaCO2 >45 mmHg). Which ABG results show movement toward respiratory acidosis and further hypoxia indicating respiratory failure? a. pH 7.35, PaO2 62 mmHg, PaCO2 45 mmHg b. pH 7.34, PaO2 45 mmHg, PaCO2 65 mmHg c. pH 7.42, PaO2 90 mmHg, PaCO2 43 mmHg d. pH 7.46, PaO2 92 mmHg, PaCO2 32 mmHg
B
The patient is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). What manifestation should the nurse expect to find? a. Decreased body weight b. Decreased urinary output c. Increased plasma osmolality d. Increased serum sodium levels
B
To decrease the patient's sense of panic during an acute asthma attack, what is the best action for the nurse to do? a. leave the patient alone to rest in a quiet, calm environment b. stay with the patient and encourage slow, pursed-lip breathing c. reassure the patient that the attack can be controlled with treatment d. let the patient know that frequent monitoring is being done by measuring vital signs and SpO2
B
To what was the resurgence in tuberculosis resulting from the emergence of multi drug resistant (MDR) strains of mycobacterium tuberculosis related? a. A lack of effective means to diagnose TB b. Poor compliance with drug therapy in patients with TB c. Indiscriminate use of antitubercular drugs and treatment of other infections d. Increased population of immunosuppressed persons with acquired immunodeficiency syndrome (AIDS)
B
What causes the pulmonary vasoconstriction leading to the development of cor pulmonale in the patient with COPD? a. Increased viscosity of the blood b. Alveolar hypoxia and hypercapnia c. Long term low flow oxygen therapy d. Administration of high concentrations of oxygen
B
What finding is an indication of marked bronchoconstriction with air trapping and hyperinflation of the lungs in a patient with asthma? a. SaO2 of 85% b. PEFR of <200 L/min c. forced expiratory volume in 1 second (FEV1) of 85% of predicted d. CXR showing a flattened diaphragm
B
What is an appropriate nursing intervention for the patient with hyperparathyroidism? a. Pad side rails as a seizure precaution b. Increase fluid intake to 3000 to 4000 mL daily c. Maintain bedrest to prevent pathologic fracture's d. Monitor the patient for a Trousseau's and Chvostek's sign
B
What should the goals of nutrition therapy for the patient with type 2 diabetes include? a. Ideal body weight b. Normal serum glucose and lipid levels c. A special diabetic diet using dietetic foods d. Five small meals per day with a bedtime snack
B
When obtaining a health history from a patient suspected of having early TB, the nurse should ask the patient about what manifestations? a. Chest pain, hemoptysis, and weight loss b. Fatigue, low-grade fever, and night sweats c. Cough with purulent mucus and fever with chills d. Pleuritic pain, nonproductive cough, and temperature elevation at night
B
When planning care for a patient at risk for pulmonary embolism, the nurse prioritizes a. Maintaining the patient on bed rest b. Using intermittent pneumatic compression devices c. Encouraging the patient to cough and deep breathe d. Teaching the patient how to use the incentive spirometer
B
When teaching a patient with diabetes about insulin administration, the nurse should include which instruction? a. Pull back on the plunger after inserting the needle to check for blood b. Consistently use the same size of insulin syringe to avoid dosing errors c. Clean the skin at the injection site with an alcohol swab before each injection d. Rotate injection sites from arms to thighs to add them in with each injection to prevent lipodystrophies
B
When the patient with parathyroid disease has symptoms of hypocalcemia, what is a measure that can be used to temporarily raise serum calcium levels? a. Administer IV normal saline b. Have patient rebreathe in a paper bag c. administer oral phosphorus supplements d. Administer furosemide as ordered
B
Which dietary modifications help meet the nutritional needs of patients with COPD? a. Eating a high carbohydrate, low fat diet b. Avoiding foods that require a lot of chewing c. Preparing most foods of the diet to be eaten hot d. Drinking fluids with meals to promote digestion
B
Which statement best describes atherosclerotic disease affecting the cerebrovascular, and cardiovascular, and peripheral vascular systems in the patient with diabetes? a. It can be prevented by tight glucose control b. It occurs with a higher frequency and earlier on said than in the nondiabetic population c. It is caused by hyperinsulinemia related to insulin resistance common and type two diabetes d. It cannot be modified by reducing risk factors, such as smoking, obesity, and high fat intake
B
While caring for a patient with idiopathic pulmonary arterial hypertension (IPAH), the nurse observes that the patient has exertional dyspnea and chest pain in addition to fatigue. To what are the symptoms related? a. decreased left ventricular output b. Right ventricular hypertrophy and failure c. Increased systemic arterial blood pressure d. Development of alveolar interstitial edema
B
Pulmonary rehabilitation (PR) is designed to reduce symptoms and improve the patient's quality of life. Along with improving exercise capacity, what are the anticipated results of PR (select all apply)? a. Decreasing FEV1 b. Decreased depression c. Increased oxygen need d. Decreased fear of exercise e. Decreased hospitalizations
B, D, E
Which characteristics most accurately describes the use of RAI (select all that apply)? a. Decreases release of thyroid hormones b. Often causes hypothyroidism over time c. Blocks peripheral conversion of T4 to T3 d. Treatment of choice in non-pregnant adults e. Often used with iodine to reduce euthyroid before surgery f. Decreases thyroid hormone secretion by damaging thyroid gland
B, D, F
A 76-year-old woman has an Hgb of 7.3 g/dL and is experiencing ataxia, confusion, weakness, and fatigue on admission to the hospital. What is the priority nursing intervention for this patient? a. Provide a darkened, quiet room b. Have the family stay with the patient c. Keep top bedside rails up and call bell in close reach d. Question the patient about possible causes of anemia
C
A nurse assesses the technique of the patient with diabetes for self monitoring of blood glucose three months after initial instruction. Which error in the performance of SMBG noted by the nurse requires intervention? a. Doing the SMBG before and after exercising b. Puncturing the finger on the side of the finger pad c. Cleaning the puncture site with alcohol before the puncture d. Holding the hand down for a few minutes before the puncture
C
A patient is admitted to the hospital with acute thyrotoxicosis. On physical assessment of the patient, what should the nurse expect to find? a. Hoarseness and laryngeal stridor b. Bulging eyeballs in dysrhythmias c. Increased temperature and signs of heart failure d. Lethargic progressing suddenly to impaired consciousness
C
A patient is scheduled for a bilateral adrenalectomy. During the postoperative period, what should the nurse expect related to the administration of corticosteroids? a. Reduced to promote wound healing b. Withheld until symptoms of hypocortisolism appear c. Increased to promote an adequate response to the stress of surgery d. Reduced with excessive hormone release during surgical manipulation of adrenal glands
C
A patient taking insulin has recorded fasting glucose levels above 200 mg/dL on awakening for the last 5 mornings. What should the nurse have the patient do first? a. Increase the evening insulin dose to prevent the dawn phenomenon b. Use a single dose insulin regimen with an intermediate acting insulin c. Monitor the glucose level at bedtime, between 2 AM and 4 AM, and on arising d. Decrease the evening insulin dosage to prevent hypoglycemia and the Somogyi effect
C
A patient who has a large amount of carbon dioxide in the blood also has what in the blood? a. Large amount of carbonic acid and low hydrogen ion concentration b. Small amount of carbonic acid and low hydrogen ion concentration c. Large amount of carbonic acid and high hydrogen ion concentration d. Small amount of carbonic acid and high hydrogen ion concentration
C
A patient with a head injury develops SIADH. Manifestations the nurse would expect to find include a. Hypernatremia and edema b. Muscle spasticity and hypertension c. Low urine output and hyponatremia d. Weight gain and decreased glomerular filtration rate
C
A patient with asthma has the following ABG results early in an acute asthma attack: pH 7.48, partial pressure of PaCO2 30 mmHg, PaO2 78 mmHg. What is the most appropriate action by the nurse? a. prepare the patient for mechanical ventilation b. have the patient breathe in a paper bag to raise the PaCO2 c. document the findings and monitor the ABGs for a trend toward acidosis d. reduce the patient's oxygen flow rate to keep the PaO2 at the current level
C
A patient with diabetes has a serum glucose level of 824 mg/dL and is unresponsive. After assessing the patient, the nurse suspects diabetes related ketoacidosis rather than hyperosmolar hyperglycemia syndrome based on a finding of a. Polyuria b. Severe dehydration c. Rapid, deep respirations d. Decreased serum potassium
C
A patient with diabetes insipidus is treated with nasal demopressin acetate (DDAVP). The nurse determines that the drug is not having an adequate therapeutic effect when the patient experiences a. Headache and weight gain b. Nasal irritation and nausea c. Urine specific gravity of 1.002 d. An oral intake greater than urinary output
C
A patient with hypoparathyroidism from surgical treatment of hyperparathyroidism is preparing for discharge. What should the nurse teach the patient? a. milk and milk products should be increased in the diet b. Parenteral replacement of parathyroid hormone will be needed for life c. Calcium supplements with vitamin D can effectively maintain calcium balance d. Bran and whole grain foods should be used to prevent gastrointestinal effects of replacement therapy
C
A patient with mild iatrogenic Cushing syndrome is on an alternative day regimen of corticosteroid therapy. What does a nurse explain to the patient about this regimen? a. It maintains normal adrenal hormone balance b. It prevents ACTH release from the pituitary gland c. It minimizes hypothalamic pituitary adrenal suppression d. It provides a more effective therapeutic effect of a drug
C
After a pneumonectomy, an appropriate nursing intervention is a. Monitoring chest tube drainage and functioning b. Positioning the patient on the unaffected side or back c. Doing range of motion exercises on the affected upper limb d. Auscultating frequently for lung sounds on the affected side
C
During assessment of the patient with acromegaly, what should the nurse expect the patient to report? a. Infertility b. Dry, irritated skin c. Undesirable changes in appearance d. An increase in height of 2 to 3 inches a year
C
During the assessment of a patient with cobalamin deficiency, which manifestation with the nurse expect to find in a patient? a. Icteric sclera b. Hepatomegaly c. Paresthesia of the hands and feet d. Intermittent heartburn with acid reflux
C
In a severely anemic patient, the nurse would expect to find a. Cyanosis and cardiomegaly b. Pulmonary edema and fibrosis c. Dyspnea at rest and tachycardia d. Ventricular dysrhythmias and wheezing
C
The nurse should observe the patient for symptoms of ketoacidosis when a. Illness causing nausea and vomiting leads to bicarbonate loss with body fluids b. Glucose levels become so hyper osmotic diuresis promotes fluid and electrolyte loss c. Insulin deficit causes the body to metabolize large amounts of fatty acids rather than glucose for energy d. The patient skips meals after taking insulin, leading to rapid metabolism of glucose in breakdown of fats for energy
C
What does the nurse include when planning for postural drainage for the patient with COPD? a. Schedule the procedure one hour before and after meals b. Has the patient cough before positioning to clear the lungs c. Assesses the patient's tolerance for dependent (head down) positions d. Ensures that percussion and vibration are done before positioning the patient
C
What should the nurse include when teaching the patient with COPD about the need for physical exercise? a. All patients with COPD should be able to increase walking gradually up to 20 minutes per day. b. A bronchodilator inhaler should be used to relieve exercise induced dyspnea immediately after exercise c. Shortness of breath is expected during exercise but should return to baseline within five minutes after the exercise d. Monitoring the heart rate before and after exercise is the best way to determine how much exercise can be tolerated
C
When teaching the patient with mild asthma about the use of the peak flow meter, what should the nurse teach the patient to do? a. Always carry the flow meter in case an asthma attack occurs b. Use the flow meter to check the status of the patient's asthma every time the patient takes quick relief medication c. Follow the written asthma action plan if the expiratory flow rate is in the yellow zone d. Use the flowmeter by emptying the lungs, closing the mouth around the mouthpiece, and inhaling through the meter as quickly as possible
C
Which breathing technique should the nurse teach the patient with moderate COPD to promote exhalation? a. Huff coughing b. Thoracic breathing c. Pursed lip breathing d. Diaphragmatic breathing
C
Which patient should the nurse plan to teach how to prevent or delay the development of diabetes? a. An obese 40-year-old Hispanic woman b. A 20-year-old man whose father has type one diabetes c. A 34-year-old woman whose parents both have type two diabetes d. A 12-year-old boy whose father has maturity onset diabetes of the young (MODY)
C
Which type of transfusion reaction occurs with leukocyte or plasma protein in compatibility and may be avoided with leukocyte reduction filters? a. Allergic reaction b. Acute hemolytic reaction c. Febrile, nonhemolytic reaction d. Massive blood transfusion reaction
C
Which descriptions are characteristic of iron deficiency anemia (select all that apply)? a. Lack of intrinsic factor b. Auto immune related disease c. Most common type of anemia d. Associated with chronic blood e. May occur with removal of the stomach f. May occur with removal of the duodenum
C, D, F
Which medications are the most effective in improving asthma control by reducing bronchial hyperresponsiveness, blocking the late-phase reaction, and inhibiting migration of inflammatory cells (select all that apply)? a. Zileuton (Zyflo CR) b. Omalizumab (Xolair) c. Fluticasone (Flovent HFA) d. Salmeterol (Serevent) e. Montelukast (Singulair) f. Budesonide g. Beclomethasone (Qvar) h. Theophylline I. Mometasone (Asmanex Twisthaler)
C, F, G, I
A 20-year-old female patient is in the emergency department for anorexia and fatigue. She takes phenytoin (Dilantin) for a seizure disorder and oral contraceptives. For which type of anemia is this patient most at risk? a. Aplastic anemia b. Hemolytic anemia c. Iron deficiency anemia d. Folic acid deficiency anemia
D
A patient has the following arterial blood gas results: pH 7.52, PaCO2 30, HCO3 24. The nurse determines that these results indicate a. Metabolic acidosis b. Metabolic alkalosis c. Respiratory acidosis d. Respiratory alkalosis
D
A patient who recently had a calcium oxalate renal stone had a bone density study, which showed a decrease in her bone density. What endocrine problem could this patient have? a. SIADH b. Hypothyroidism c. Cushing syndrome d. Hyperparathyroidism
D
After the healthcare provider sees a patient hospitalized with a stroke who developed a fever and adventitious lung sounds, the following orders are written. Which order should the nurse implement first? a. Anterior/posterior and lateral chest x-rays b. Start IV levofloxacin 500 mg every 24 hours now c. Complete blood count with differential d. Sputum specimen for Gram stain and culture and sensitivity
D
After thyroid surgery, the nurse suspects damage or removal of the parathyroid glands when the patient develops a. Muscle weakness and weight loss b. Hypothermia and severe tachycardia c. Hypertension and difficulty swallowing d. Laryngospasms and tingling in the hands and feet
D
During the postoperative care for a 76-year-old patient, the nurse monitors the patients intake and output carefully, knowing that the patient is at a risk for fluid and electrolyte imbalances primarily because a. Older adults have an impaired thirst mechanism and need reminding to drink fluids b. Water accounts for a greater percentage of body weight in the older adult than younger adults c. Older adults are more likely than younger adults to lose extracellular fluid during are surgical procedures d. Smaller losses of fluid are significant because body fluids account for 45% to 50% of body weight in order adults
D
Following the teaching of foot care to a patient with diabetes, the nurse determines that additional instruction is needed when the patient makes which statement? a. "I should wash my feet daily with soap and warm water." b. "I should always wear shoes to protect my feet from injury." c. "if my feet are cold, I should wear socks instead of using a heating pad." d. "i'll know if I have sores or lesions on my feet because they will be painful."
D
In a patient with a positive Chvostek's sign, the nurse would expect the IV administration of which medication? a. Calcitonin b. Vitamin D c. Loop diuretics d. Calcium gluconate
D
In a patient with sodium imbalances, the primary clinical manifestations are related to alterations in what body system? a. Kidneys b. Cardiovascular system c. Musculoskeletal system d. Central nervous system
D
In addition to smoking cessation, what treatment is included for COPD to slow the progression of the disease? A. Use of bronchodilator drugs B. Use of inhaled corticosteroids C. Lung volume reduction surgery D. Prevention of respiratory tract infections
D
The home care nurse should intervene to correct a patient whose insulin administration includes a. Warming a pre-filled refrigerated syringe in the hands before administration b. Storing syringes pre-filled with NPH and regular insulin needle up in the refrigerator c. Placing the insulin bottle currently in use in a small container on the bathroom countertop d. Mixing an evening dose of regular insulin with insulin glargine in one syringe for administration
D
The husband of a patient with severe COPD tells the nurse that he and his wife have not had any sexual activity since she was diagnosed with COPD because she becomes too short of breath. What is the nurses best response? a. "you need to discuss your feelings and needs with your wife so that she knows what you expect of her." b. "they are other ways to maintain intimacy besides sexual intercourse it will not make her short of breath." c. "you should explore other ways to meet your sexual needs since your wife is no longer capable of sexual activity." d. "would you like me to talk with you and your wife about some modifications that can be made to maintain sexual activity?"
D
The patient with diabetes insipidus is brought to the emergency department with confusion and dehydration after excretion of a large volume of urine today even though several liters of fluid were consumed. What is a diagnostic test that the nurse should expect to be done first to help make a diagnosis? a. Blood glucose b. Serum sodium level c. CT scan of the head d. Water deprivation test
D
What characteristic is related to Hashimoto's thyroiditis? a. Enlarged thyroid gland b. Viral induced hyperthyroidism c. Bacterial or fungal infection of thyroid gland d. Chronic autoimmune thyroiditis with antibody destruction of thyroid tissue
D
What is a cause of primary hypothyroidism in adults? a. Malignant or benign thyroid nodules b. Surgical removal or failure of the pituitary gland c. Surgical removal or radiation of the thyroid gland d. Autoimmune-induced atrophy of the thyroid gland
D
What is a compensatory mechanism for metabolic alkalosis? a. Shifting bicarbonate into cells in exchange for chloride b. Kidney conservation of bicarbonate and excretion of hydrogen ions c. Deep, rapid respirations (Kussmaul respirations) to increase CO2 excretion d. Decreased respiratory rate and depth to retain CO2 and kidney excretion of bicarbonate
D
What should the nurse teach patient with intermittent asthma about identifying specific triggers of asthma? a. food and drug allergies do not cause respiratory symptoms b. exercise-induced asthma is seen only in persons with sensitivity to cold air c. asthma attacks are psychogenic in origin and can be controlled with relaxation techniques d. viral upper respiratory infections are a common precipitating factor in acute asthma attacks
D
When providing discharge instructions to a patient who had a subtotal thyroidectomy for hyperthyroidism, what should the nurse teach the patient? a. Never miss a daily dose of thyroid replacement therapy b. Avoid regular exercise until thyroid function is normalized c. Use warm salt water gargles several times a day to relieve throat pain d. Substantially reduce caloric intake compared to what was eaten before surgery
D
When replacement therapy started for a patient with long-standing hypothyroidism, what is most important for the nurse to monitor for in this patient? a. Insomnia b. Weight loss c. Nervousness d. Dysrhythmias
D
When teaching the patient about going from a metered-dose inhaler (MDI) to a dry powder inhaler (DPI), which patient statement indicates to the nurse that the patient needs more teaching? a. "I do not need to use the spacer like I used to." b. "I will hold my breath fo 10 seconds or longer if I can." c. "I will not shake this inhaler like I did with my old inhaler." d. "I will store it in the bathroom, so I will be able to clean it when I need to."
D
Which medication should the nurse anticipate being used first in the ED for relief of severe respiratory distress r/t asthma? a. prednisone orally b. tiotropium inhaler c. fluticasone inhaler d. albuterol nebulizer
D
Which obstructive pulmonary disease would a 30-year-old white female patient with a parent with the disease be most likely to be diagnosed with? a. COPD b. asthma c. cystic fibrosis d. aplha1-antirypsin (AAT) deficiency
D
Which patient is at risk for hypernatremia? a. Has an aldosterone deficiency b. Has prolonged vomiting and diarrhea c. Receives excessive IV 5% dextrose solution d. Has impaired consciousness and decreased thirst sensitivity
D
Which statement would be correct for a patient with type 2 diabetes who is admitted to the hospital with pneumonia? a. The patient must receive insulin therapy to prevent ketoacidosis b. The patient has islet cell antibodies that have destroyed the pancreas's ability to make insulin c. The patient has minimal or absent endogenous insulin secretion and requires daily insulin injections d. The patient may have enough endogenous insulin to prevent ketosis but is at risk for hyperosmolar hyperglycemic syndrome
D
Which patients have the greatest risk for aspiration pneumonia (select all that apply)? a. patient with seizures b. patient with head injury c. patient who had a thoracic surgery d. patient who had a MI e. patient who is receiving nasogastric tube feeding
a, b, e
A patient is concerned that he may have asthma. Of the symptoms that he describes to the nurse, which one suggests asthma or risk factors for asthma? (Select all that apply) a. Allergic rhinitis b. Prolonged inhalation c. Cough, especially at night d. Gastric reflux or heartburn e. History of chronic sinusitis
a, c, d, e
The patient with diabetes has a blood glucose level 248 mg/dL. Which assessment findings would be related to this blood glucose level (select all that apply)? a. Headache b. Unsteady gait c. Abdominal cramps d. Emotional changes e. Increase in urination f. Weakness and fatigue
a, c, e, f
It is important for the nurse to assess for which manifestations in a patient who has just undergone a total thyroidectomy (select all apply)? a. confusion b. weight gain c. Depressed reflexes d. Circumoral numbness e. Positive Chvostek's sign
a, d, e
You are caring for a patient with newly diagnosed type 1 diabetes. What information is essential to include in your patient teaching before discharge from the hospital? (Select all that apply) a. Insulin administration b. Elimination of sugar from diet c. Need to reduce physical activity d. Use of a portable blood glucose monitor e. Hypoglycemia prevention, symptoms, and treatment
a, d, e
Which are appropriate therapies for patients with diabetes? (Select all apply) a. Use of statins to reduce CVD risk b. Use of diuretics to treat nephropathy c. Use of ACE inhibitors to treat nephropathy d. Use of serotonin agonists to decrease appetite e. Use of laser photocoagulation to treat retinopathy
a, e
Match the acid base imbalances with their mechanisms. a. Increased carbonic acid b. Decrease carbonic acid c. Increased base bicarbonate d. Decreased base bicarbonate 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
a. 3 b. 4 c. 2 d. 1
A common collaborative problem related to both hyperkalemia and hypokalemia is which potential complication? a. Seizures b. Paralysis c. Dysrhythmias d. Acute kidney injury
C
A patient who is on corticosteroid therapy for treatment of an autoimmune disorder has the following drugs ordered. Which one is used to prevent corticosteroid-induced osteoporosis? a. potassium b. Furosemide (Lasix) c. Alendronate (Fosamax) d. Pantoprazole (Protonix)
C
An important preoperative nursing intervention before an adrenalectomy for hyperaldosteronism is to a. Monitor blood glucose levels b. Restrict fluid and sodium intake c. Administer potassium sparing diuretics d. Advise the patient to make postural changes slowly
C
The typical fluid replacement for the patient with a fluid volume deficit is a. Dextran b. 0.45% saline c. Lactated ringer's solution d. 5% dextrose in 0.45% saline
C
What is the normal pH range of the blood, and what ratio of base to acid does this reflect? a. 7.32 to 7.42, 25 to 2 b. 7.32 to 7.42, 28 to 2 c. 7.35 to 7.45, 20 to 1 d. 7.35 to 7.45, 30 to 1
C
What is the priority action for the nurse to take if the patient with type 2 diabetes complains of blurred vision and irritability? a. call the physician b. administer insulin as ordered c. check the patient's blood glucose level d. assess for other neurologic symptoms
C
What medication is given in thyrotoxicosis to block the effects of the sympathetic nervous stimulation of the thyroid hormones? a. Potassium iodine b. Propylthiouracil c. Propanolol (Inderal) d. Radioactive iodine (RAI)
C
An appropriate nursing intervention to assist a patient with pneumonia manage the secretions and fatigue would be to a. perform postural drainage every hour b. Provide analgesics as ordered to promote patient comfort c. Administer oxygen as prescribed to maintain optimal oxygen levels d. Teach the patient how to cough effectively and expectorate secretions
D
Which guideline should the nurse include when teaching a patient how to use a metered dose inhaler (MDI)? a. After activating the MDI, breathe in as quickly as you can b. Estimate the amount of remaining medicine in the MDI by floating the canister and water c. Disassemble the plastic canister from the inhaler and rinse both pieces under running water every week d. To determine how long the canister will last, divide the total number of puffs in the canister by the puffs needed per day
D
What assessment findings occur with diabetic ketoacidosis (DKA) (select all that apply)? a. Thirst b. Ketonuria c. Dehydration d. Metabolic acidosis e. Kussmaul respirations f. Sweet, fruity breath odor
all answers are correct
What is a major method of preventing infection in the patient with neutropenia? a. Prophylactic antibiotics b. A diet that eliminates fresh fruits and vegetables c. High efficiency particulate air (HEPA) filtration d. Strict handwashing by all persons in contact with the patient
d
Which lab results indicate the patient has pre-diabetes? a. Glucose tolerance result of 132 mg/dL b. Glucose tolerance result of 240 mg/dL c. Fasting blood glucose result of 80 mg/dL d. Fasting blood glucose result of 120 mg/dL
d
While receiving a unit of packed RBCs, the patient develops chills and a temperature of 102.2°F. What is the priority action for the nurse to take? a. Stop the transfusion and instill normal saline b. Notify the healthcare provider and the blood bank c. Add a leukocyte reduction filter to the blood administration set d. Recognize this as a mild allergic transfusion reaction and slow the transfusion
a
What characterizes type 2 diabetes (select all that apply)? a. Beta cell exhaustion b. Insulin resistance c. Genetic predisposition d. Altered production of adipokines e. Inherited defect in insulin receptors f. Inappropriate glucose production by the liver
all answers are correct
Cortisol, glucagon, epinephrine, and growth hormone are referred to as counterregulatory hormones because they a. Decrease glucose production b. Stimulate glucose output by the liver c. Increase glucose transport into the cells d. Independently regulate glucose level in the blood
b
Which medications would be most appropriate to administer to a patient experiencing an acute asthma attack? (Select all that apply) a. montelukast (Singulair) b. inhaled hypertonic saline c. albuterol (Proventil HFA) d. ipratropium (Atrovent HFA) e. salmeterol (serevent diskus)
c, d
A 72-year-old woman is diagnosed with diabetes. What does the nurse recognize about managing diabetes in the older adult? a. It is harder to achieve strict glucose control than younger patients b. Treatment is not warranted unless the patient develops severe hyperglycemia c. It does not include a treatment with insulin because of limited dexterity and vision d. It usually requires that a younger family member be responsible for care of the patient
A
A patient with diabetes calls the clinic because she has nausea and flu like symptoms. Which advice from the nurse will be the best for this patient? a. Administer the usual insulin dosage b. Hold fluid intake until the nausea subsides c. Come to the clinic immediately for evaluation and treatment d. Monitor the blood glucose every 1 to 2 hours and call if it rises over 150 mg/dL
A
After a hypophysectomy for acromegaly, immediate postoperative nursing care should focus on a. frequent monitoring of serum and urine osmolarity. b. parenteral administration of a GH-receptor antagonist. c. keeping the patient in a recumbent position at all times. d. patient teaching regarding the need for lifelong hormone therapy.
A
During an annual health assessment of a 66-year-old patient at the clinic, the patient tells the nurse he has not had the pneumonia vaccine. What should the nurse advise him about the best way for him to prevent pneumonia? a. Obtain a pneumococcal vaccine now and get a booster 12 months later b. Seek medical care in antibiotic therapy for all upper respiratory infections c. Obtain the pneumococcal vaccine if he is exposed to individuals with pneumonia d. Obtain only the influenza vaccine every year because he should have immunity to the pneumococcus because of his age
A
Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of impaired gas exchange based on which finding? a. Arterial oxygen saturation by pulse oximetry of 86% b. Crackles in both lower lobes c. Temperature of 101.4°F d. Production of greenish purulent sputum
A
Individualized nutrition therapy for patients using conventional, fixed insulin regimen should include teaching the patient to a. Eat regular meals at regular times b. Restrict calories to promote moderate weight loss c. Eliminate sucrose and other simple sugars from the diet d. Limit saturated fat intake to 30% of dietary calorie intake
A
The nurse is caring for a patient with COPD. Which intervention could be delegated to the UAP? a. Assist the patient to get out of bed b. Auscultate breath sounds every four hours c. Plan patient activities to minimize exertion d. Teach the patient pursed lip breathing technique
A
Which statement by the patient with type 2 diabetes is accurate? a. "I will limit my alcohol intake to one drink each day." b. "I am not allowed to eat any sweets because of my diabetes." c. "I cannot exercise because I take a blood glucose lowering medication." d. "the amount of fat in my diet is not important. Only carbohydrates raise my blood sugar."
A
Which characteristics are related to an acute hemolytic transfusion reaction (select all that apply)? a. ABO incompatibility b. Hypothermia common c. Destruction of donor RBCs d. Acute kidney injury occurs e. Hypocalcemia and hyperkalemia f. Epinephrine used for severe reaction
A, C, D
Which findings indicate that a patient is developing status asthmaticus? (select all that apply) a. PEFR <300L/min b. Positive sputum culture c. Unable to speak in complete sentences d. Lack of response to conventional treatment e. Chest x-ray shows hyperinflated lungs and a flattened diaphragm
A, C, D
A patient has been diagnosed with hypoparathyroidism. What manifestations should the nurse expect to observe (select all that apply)? a. Skeletal pain b. Dysrhythmias c. Dry, scaly skin d. Personality changes e. Abdominal cramping f. Muscle spasms and stiffness
A, C, D, E, F
Which medications would be used in 4-drug treatment for the initial phase of TB (select all that apply)? a. isoniazid b. levofloxacin c. pyrazinamide d. rifampin (rifadin) e. rifabutin (mycobutin) f. ethambutol (myambutol)
A, C, D, F
While caring for an 84-year-old patient, the nurse monitors the patient's fluid and electrolyte balance, recognizing what is a normal change of aging? a. Hyperkalemia b. Hyponatremia c. Decreased insensible fluid loss d. Increased plasma oncotic pressures
B
A patient with chronic kidney disease has hyperphosphatemia. What is a common associated electrolyte imbalance? a. Hypokalemia b. Hyponatremia c. Hypocalcemia d. Hypomagnesemia
C
The major advantage of a Venturi mask is that it can a. Deliver up to 80% oxygen b. Provide continuous 100% humidity c. Deliver a precise concentration of oxygen d. Be used while the patient sleeps and eats
C
A patient with Graves' disease asks the nurse what caused the disorder. What is the best response by the nurse? a. "The cause of Graves' disease is not known, although it is thought to be genetic." b. "It is usually associated with goiter formation from an iodine deficiency over a long period of time." c. "Antibodies develop against thyroid tissue and destroy it, causing a deficiency of thyroid hormones." d. "In genetically susceptible persons, antibodies are formed that cause excessive thyroid hormone secretion."
D
A patient with diabetes is found unconscious at home, and a family member calls the clinic. After determining that a glucometer is not available, what should the nurse advise the family member to do? a. Have the patient drink some orange juice b. Administer 10 units of regular insulin subcutaneously c. Call for an ambulance to transport the patient to a medical facility d. Administer glucagon 1 mg intramuscularly or subcutaneously
D
During the physical assessment of a patient with severe anemia, which finding is of most concern to the nurse? a. anorexia b. bone pain c. hepatomegaly d. dyspnea at rest
D
Lispro insulin (Humalog) with NPH (Humulin N) insulin is ordered for a patient with newly diagnosed type 1 diabetes. When should the nurse administer lispro insulin? a. Only once a day b. One hour before meals c. 30 to 45 minutes before meals d. At meal time or within 15 minutes of meals
D
The strict vegetarian is at highest risk for the development of which anemia? a. Thalassemia b. Iron deficiency anemia c. Folic acid deficiency anemia d. Cobalamin deficiency anemia
D
Which medication is a long-acting beta2-adrenergic agonist and DPI that is used only for COPD? a. Roflumilast (Daliresp) b. Salmeterol (Serevent) c. Ipratropium (Atrovent HFA) d. Indacaterol (Arcapta Neohaler)
D
The patient with type 2 diabetes is being put on acarbose (Prcose) and wants to know about taking it. What should the nurse include in this patient teaching (select all that apply)? a. Take it with the first bite of each meal b. It is not used in patients with heart failure c. Endogenous glucose production is decreased d. Effectiveness is measured by two hour postprandial glucose e. Delays glucose absorption from the gastrointestinal tract
a, d, e
Match the acid base imbalances with their common causes (answers may be used more than once). a. Renal failure b. Severe shock c. Diabetic ketosis d. Respiratory failure e. Prolonged vomiting f. Baking soda used as antacid g. Mechanical over ventilation h. Sedative or opioid overdose i. Response to anxiety, fear, and pain 1. Metabolic acidosis 2. Metabolic alkalosis 3. Respiratory acidosis 4. Respiratory alkalosis
a. 1 b. 1 c. 1 d. 3 e. 2 f. 2 g. 4 h. 3 i. 4
In addition to promoting the transport of glucose from the blood into the cell, what does insulin do? a. Enhances the breakdown of adipose tissue for energy b. Stimulates hepatic glycogenolysis and glucosegenisis c. Prevents the transport of triglycerides into adipose issue d. Increases amino acid transport into cells and proteins synthesis
d
A patient suspected of having acromegaly has an increased plasma growth hormone (GH) level. In acromegaly, what would the nurse expect the patient's diagnostic results to show? a. Hyperinsulinemia b. Plasma glucose of less than 70 mg/dL c. Decreased GH levels with an oral glucose challenge test d. Increased levels of plasma insulin like growth factor 1 (IGF-1)
d
A nurse determines that a patient with a two hour OGTT of 152 mg/dL has a. Diabetes b. Elevated A1C c. Impaired fasting glucose d. impaired glucose tolerance
D
A patient is taking diuretic drugs. Which fluid or electrolyte imbalance can occur in this patient (select all that apply)? a. Hyperkalemia b. Hyponatremia c. Hypocalcemia d. Hypotonic fluid loss e. Hypertonic fluid loss
B, C
Place the most common pathophysiologic stages of pneumonia in order. Number the first stage with 1 in the last stage with 4. a. Macrophages lyse the debris and normal lung tissue and function is restored. b. Mucus production increases and can obstruct airflow and further decrease gas exchange. c. Inflammatory response in the lungs with neutrophils is activated to engulf and kill the offending organism. d. Increased capillary permeability contributes to alveolar filling with organisms and neutrophils leading to hypoxia.
a. 4 b. 3 c. 1 d. 2
Indicate whether the following manifestations are most characteristic of asthma (A), chronic obstructive pulmonary disease (C), or both (B). a. wheezing b. weight loss c. barrel chest d. polycythemia e. cor pulmonale f. flattened diaphragm g. decreased breath sounds h. Increased total lung capacity i. Frequent sputum production j. Increased fractional exhaled nitric oxide (FENO)
a. A b. C c. C d. C e. C f. C g. B h. B i. C j. A
Which statements describe the management of a patient following lung transplantation (select all that apply)? a. High doses of oxygen are administered around the clock b. Using a home spirometer will help to monitor lung function c. Immunosuppressant therapy usually involves a three drug regimen d. Most patients have an acute rejection episode within the first two days e. A lung biopsy is done using a transtracheal method of rejection is suspected
b, c, e
What disorders and diseases are related to macrovascular complications of diabetes (select all that apply)? a. Chronic kidney disease b. Chronic artery disease c. Microaneurysms and destruction of retinal vessels d. Ulceration and amputation of the lower extremities e. Capillary and arterial membrane thickening specific to diabetes
b, d
Important nursing interventions when caring for a patient with Cushing's syndrome include (select all that apply) a. Restricting protein intake b. Monitoring blood glucose levels c. Observing for signs of hypotension d. Are administering medication in equal doses e. Protecting patient from exposure to infection
b, e
A patient with TB has been admitted to the hospital and is placed on airborne precautions and in an isolation room. What should the nurse teach the patient? (Select all that apply) a. Expect routine TB testing to evaluate the infection b. No visitors will be allowed while in airborne isolation c. Adherence to precautions includes coughing into a paper tissue d. Take all medications for full length of time to prevent multi drug resistant TB e. Wear a standard isolation mask if leaving the airborne infection isolation room
c, d, e
Which tissues require insulin to enable movement of glucose into the tissue cells (select all that apply)? a. Liver b. Brain c. Adipose d. Blood cells e. Skeletal muscle
c, e
