NUR 128: Family Exam 2 practice questions.

Arachnophobia is the fear of ______. A: Spiders B: Water C: Flying D: Public places

A

When reviewing the medical record of a patient diagnosed with Alzheimer disease (AD), the healthcare provider notes the patient is aphasic. Which behavior supports this finding? A: Unable to speak B: Unable to recognize objects C: Difficultly with motor function D: Difficulty swallowing

A "-phasia" refers to speech. A patient who is aphasic is unable to speak.

You're caring for a patient who has experienced a Compound Fracture to the right arm. What nursing intervention will you take with this type of fracture?* A. Cover the fracture with a sterile dressing. B. Place the arm below the heart level. C. Attempt bone reduction by manually readjusting the bone. D. Place a tight compression bandage over the fracture.

A Due to the nature of this fracture, the patient is at major risk for infection because the skin is no longer intact. Therefore, the nurse should cover the fracture site with a sterile dressing.

During her first prenatal visit, a woman asks why she is being screened for syphilis. Which of the following is the best response by the healthcare provider? A: "Syphilis can be transferred from you to your baby through the placenta." B: "If you have the infection, the safest time to treat you is during the first trimester." C:"If you test positive you may need to be admitted to the hospital for care." D: "We must report all cases of syphilis to the health department."

A Syphilis is transmitted vertically from mother to baby during pregnancy and/or delivery, so routine prenatal care includes testing for syphilis.

Your patient is 2 hours post-op from a cast placement on the right leg. The patient has family in the room. Which action by the significant other requires you to re-educate the patient and family about cast care?* A. Gently moving the cast with the fingertips of the hands every 2 hours to help with drying. B. Elevating the cast above heart level with pillows. C. Checking the color and temperature of the right foot. D. Using a hair dryer on the cool setting to help with drying.

A The cast should always be moved with the palms of the hands (NOT finger tips) during the drying period to prevent dent formation because this can cause the development of ulcers under the skin where the dents develop.

The children of a patient diagnosed with Alzheimer disease (AD) tell the healthcare provider, "Our mother seems better during the day, but she gets very confused and agitated in the late afternoon and evenings." How should the healthcare provider document the patient's behavior? A: Sun-downing B: Psychosis C: Delirium D: Depression

A This patient is experiencing sundowning or sundowner syndrome, a phenomenon prevalent in patients diagnosed with dementia. Sundowning may be associated with impaired circadian rhythms, environmental or social factors, and impaired cognition.

Which assessment finding found while assessing a patient with a fracture who has traction requires immediate intervention?* A. The weights are freely hanging on the floor. B. Pin sites are free from drainage. C. Patient uses the overhead trapeze bar to move around in the bed. D. Patient's extremities have a capillary refill of less than 2 seconds.

A Weights used for traction should freely hang but NOT on the floor. All the other options are expected findings

A patient diagnosed with Alzheimer disease (AD) is admitted to a long-term care facility. Which of the following assessment findings will the healthcare provider anticipate? *Select all that apply* A: Amnesia B: Aphasia C: Agnosia D: Anhedonia E: Apathy

A, B, C Brain structure changes caused by neurofibrillary tangles or amyloid plaques in the temporoparietal areas of the brain can cause impaired speech (aphasia), deficiencies in purposeful movements (apraxia), and problems comprehending visual or auditory stimuli (agnosia). Alterations in the hippocampus can cause short-term memory loss (amnesia).

Which of the following, if assessed in a patient, will the healthcare provider identify as a risk factor for the development of delirium? *Select all that apply* A: Sleep deprivation B: Administration of opioids C: Infections D: Decreased physical activity E: Decreased social interactions F: Organ failure

A, B, C, F Sleep deprivation (common in hospitalized patients), organ failure, infections, and numerous drugs can put a patient at risk for delirium. Decreased social interaction can exacerbate delirium but will not cause delirium. Here's handy mnemonic to remember general risk factors for delirium: D = Dementia, E = Electrolyte disorders, L = Liver, lung, heart, kidney, brain, I = Infection, R = Rx (medications), I = Injury, pain, stress, U = Unfamiliar environment, M = Metabolic

The healthcare provider is assessing an elderly patient who is disoriented to time and place. Which additional finding would support a diagnosis of delirium? A: Often linked to an identifiable cause B: Attention is impaired C: Stable symptoms over time D: Rambling and incoherent speech E: Slow and progressive course F: Sudden onset of symptoms

A, B, D, F Sudden onset and fluctuation of symptoms are key findings in delirium. Delirium is usually reversible because unlike dementia, delirium is usually due to a problem that can be identified and treated. Speech in a patient diagnosed with delirium is often rambling or incoherent, whereas speech in a patient diagnosed with dementia may be limited or aphasic. Attention in delirium is impaired, whereas attention in dementia is not impaired until late stages of the disease.

Which of the following symptoms of Alzheimer disease correlate with the 5th stage? A: Disorientation to time and place B: Difficulty finding words C: Inability to identify family and caregivers D: Loss of ability to live independently E: Problems functioning in work or social settings

A, D B = stage 4 C = stage 7 E = stage 3

A patient is admitted with a diagnosis of tertiary syphilis. When planning care for this patient, which of the following should the healthcare provider keep in mind? *Select all that apply* A: The patient's heart should be auscultated for murmurs B: Contact precautions should be initiated immediately C: The patient is now in the latent stage of the disease D: The patient should be observed for changes in personality E: Nuchal rigidity is sometimes present in tertiary syphilis F: Hearing loss or tinnitus may be reported by the patient

A, D, E, F In the early stage of tertiary syphilis, general paresis is associated with symptoms of forgetfulness and personality change.

Which condition is classified as a progressive loss of cognitive function? A: Delirium B: Dementia

B

A 85 year old patient has an accidental fall while going to the bathroom without assistance. It appears the patient has sustained a bone fracture to the left leg. The leg's shape is deformed and the patient is unable to move it. The patient is alert and oriented but in pain. What will you do *FIRST* after confirming the patient is safe and stable?* A. Apply an ice pack covered with a towel to the site. B. Immobilize the fracture with a splint. C. Administer pain medication. D. Elevate the extremity above heart level.

B After confirming the patient is safe and stable, the nurse would immobilize the fracture with a splinting device. This will prevent the accidental movement of the extremity by the patient. Immobilization is important because it prevents further pain or bleeding along with more damage that can occur to the surrounding tissues. In addition, if a bone is not immobilized but moved after it has been fractured this can affect the healing process.

A patient diagnosed with dementia is prescribed a medication that inhibits acetylcholinesterase. Which of the following accurately explains how this medication benefits the patient? A: Acetylcholine increases norepinephrine activity and decreases depression B: Acetylcholine is needed for memory and problem solving C: Decreased levels of acetylcholine will help decrease the patient's anxiety D: Inhibition of acetylcholinesterase improves the patient's motor function

B Because acetylcholine is involved in cognitive functions like memory and problem solving, increased levels of acetylcholine will improve these functions.

During the administration of a Mini-Mental Status Exam (MMSE), the healthcare provider asks the patient to copy a simple geometric shape. This part of the exam tests which of the following mental functions? A: Attention and calculation abilities B: Visual comprehension and praxis C: Hearing and language skills D: Orientation and short-term memory

B Copying the shape successfully demonstrates visual comprehension and the ability to plan and execute coordinated movement (praxis).

A patient diagnosed with Alzheimer disease (AD) is demonstrating signs of impaired reasoning. The healthcare provider suspects an alteration in which area of the brain? A: Hippocampus B: Frontal lobe C: Occipital lobe D: Amygdala

B Frontal lobe function would be altered if the patient is demonstrating signs of impaired reasoning.

A patient asks the healthcare provider about the benefits of receiving the human papillomavirus (HPV) vaccine. Which statement is the most appropriate response by the healthcare provider? A: "You will no longer need to get a routine cervical exam." B: "The HPV vaccine can help prevent cervical cancer." C: "You will need to have a booster vaccination each year." D: "The HPV vaccine will protect you from all types of the virus."

B The vaccine is effective in preventing cervical cancer associated with certain types of HPV, but because it does not protect against all HPV types, regular cervical screenings are recommended.

A 5 year old has a fracture of the right upper arm. The x-ray showed that one side of the bone is bent while the other is broken. This known as a __________ fracture?* A. Spiral B. Greenstick C. Oblique D. Transverse

B This is a greenstick fracture. These types of fractures are more common in the pediatric population because their bones tend to be more flexible and the periosteum is stronger than an adult.

Which statement by a patient, who just received a cast on the right arm for a fracture, requires you to notify the physician immediately?* A. "It is really itchy inside my cast!" B. "My pain is so severe that it hurts to stretch or elevate my arm." C. "I can feel my fingers and move them." D. "I've been using ice packs to reduce swelling."

B This statement is very concerning and may represent a condition called compartment syndrome. Compartment syndrome is where the nerves and blood vessels are becoming compromised due to increasing pressure in the compartments within the fascia (remember fascia doesn't expand, so if there is building pressure within the compartments of muscle from bleeding etc. it will compromise circulation and nerve function). Remember to monitor the 6 P's. (pain, pallor, paralysis, paresthesia, pulselessness (late sign), poikilothermia)

Which of the following symptoms of Alzheimer disease correlate with the 7th stage? A: Loss of ability to live independently B: Sun-downing C: Gradual loss of ability to walk D: Withdrawal from social situations E: Increased tendency to become lost

B, C A, E = stage 5 D = stage 4

The healthcare provider is teaching a patient who is diagnosed with genital herpes about the disease. Which of the following will be included in the teaching plan for this patient? *Select all that apply* A: "You will not be contagious when you are taking your antiviral medications." B: "This infection also increases your risk of human immunodeficiency (HIV) virus infection." C: "There is no cure for genital herpes but outbreaks can be shortened with medication." D: "Your infection is caused by a corkscrew bacteria called a spirochete." E: "Transmission of the virus can occur even if there are no visible herpes sores." F: "Use condoms between outbreaks to reduce the risk of transmission."

B, C, E, F There is no cure for herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. And daily use of antiviral medications can reduce the likelihood of transmission to partners.

A patient diagnosed with dementia often becomes agitated and has angry outbursts. Which of the following interventions will the healthcare provider implement when caring for this patient? *Select all that apply* A: Ignore the patient when agitation occurs B: Move the patient to a quiet environment C: Utilize distraction when agitation occurs D: Discuss the patient's behaviors in a rational manner E: Assist the patient to get involved in unit activities F: Ensure the safety of the patient and staff

B, C, F Safety for all of the patients on the unit and for the staff is always the priority. Moving the patient to a quiet environment is aimed at decreasing stimulation. Distracting the patient at the first sign of agitation may also be helpful. Ignoring the patient can allow the agitation to escalate.

Which of the following symptoms of Alzheimer disease correlate with the 3rd stage? *Select all that apply* A: Difficulty recalling recent events B: Difficulty learning and remembering new things C: Difficulty recalling one's address or phone number D: Difficulties with planning and organization E: Sun-downing

B, D A = stage 4 C = stage 5 E = stage 7

What are the signs and symptoms that will present in compartment syndrome? *select all that apply* A. Capillary refill less than 2 seconds B. Pallor C. Pain relief with medication D. Feeling of tingling in the extremity E. Affected extremity feels cooler to the touch than the unaffected extremity

B, D, E These symptoms may present with compartment syndrome. Option A and C are normal findings. Remember in compartment syndrome nerve and blood vessel function is being compromised, so expect signs and symptoms that occur when these structures are affected.

On the second day postpartum after a vaginal delivery, a woman develops a number of lesions on her labia that are vesicular and painful. The woman is diagnosed with genital herpes. Which of the following will the healthcare provider include when caring for the newborn? *Select all that apply* A: Assist with serial chest radiographs B: Administer intravenous antiviral medications C: Apply antibiotic ointment to both eyes D: Culture the conjunctivae, nasopharynx, and rectum E: Institute contact precautions F: Isolate the baby from other infants

B, D, E, F Contact precautions also should be used for infants who are hospitalized with HSV infection, and the baby should be isolated from other infants on the unit.

Acrophobia is the fear of _____. A: Water B: Clowns C: Height D: Spiders

C

The healthcare provider is teaching a youth group about how to avoid acquiring a sexually transmitted disease (STD) if they are sexually active. Which of the following is the best method of prevention? A: Use of spermicidal creams B: Douching after intercourse C: Consistent condom use D: Human papillomavirus (HPV) vaccination

C Although not 100% effective, routine condom use is the best way to prevent acquiring a sexually transmitted disease (STD).

When teaching a group of students about chlamydia, which of the following points is most important for the healthcare provider to emphasize? A: Good hand washing technique is the best way to prevent chlamydial infections B: Chlamydia is the least common of all the major sexually transmitted diseases C: Most people infected with chlamydia are unaware that they are infected D: Burning and pain with urination is a frequent symptom of chlamydial infections

C Chlamydia is known as a 'silent' infection because most infected people are asymptomatic and lack abnormal physical examination findings.

A patient sustained a fracture to the femur. The patient has suddenly become confused, restless, and has a respiratory rate of 30 breaths per minute. Based on the location of fracture and the presenting symptoms, this patient may be experiencing what type of complication?* A. Compartment Syndrome B. Osteomyelitis C. Fat embolism D. Hypovolemia

C Patients who experience a fracture of the long bones (such as the femur) are at risk for a fat embolism. The patient will become confused and restless along with an abnormal respiratory status.

A patient presents to the clinic with a report of joint pain, malaise, fever, and a rash on the palms of the hands. Based on these findings, which action should the healthcare provider implement next? Choose 1 answer: Choose 1 answer: A: Inquire about the patient's recent sexual activity B: Draw blood for laboratory analysis C: Inquire about the development of genital lesions D: Administer a fever-reducing medication

C The patient presentation is consistent with secondary syphilis, so a report of genital lesions would be an indication the patient has had primary syphilis.

A patient has been diagnosed with primary syphilis (Stage I). When assessing the patient, which of these findings will the healthcare provider anticipate? A: Reddish rash on the palms of the hands B: Muscle weakness and visual changes C: Sore throat and swollen lymph glands D: Firm and painless genital ulcers

D Although there may be multiple sores, the first indication someone is in the primary stage of syphilis is the appearance of a single chancre, which is a round, firm, and painless sore found at the location where syphilis entered the body.

When planning care for a patient diagnosed with Alzheimer disease (AD), which of these interventions is most therapeutic? Choose 1 answer: Choose 1 answer: (Choice A) A: Giving the patient several directions at a time to improve memory B: Providing immediate feedback by correcting errors in the patient's speech C: Speaking in a loud, clear voice when talking to the patient D: Encouraging both verbal and nonverbal communication

D As the ability to communicate verbally declines, nonverbal communication may become more prominent. Encouraging both can facilitate communication and decrease frustration.

What is a late sign of compartment syndrome?* A. Paralysis B. Pain C. Parethesia D. Pulselessness

D Pulselessness is a late sign of compartment syndrome.

A patient diagnosed with delirium sees the intravenous (IV) tubing and believes it to be a snake. How should the healthcare provider document this behavior? A: Delusion B: Hallucination C: Confusion D: Illusion

D The patient is experiencing an illusion, which is the misinterpretation of a real stimulus. A hallucination is a false sensory perception not associated with a real stimulus. A delusion is a false personal belief that is maintained in spite of evidence to the contrary. A patient who is confused would not believe the IV tubing is a snake.