NUR 332: Final Exam Practice Questions
Your patient is prescribed gentamicin to treat an infection. Which renal dysfunction are you monitoring for? A) Pre-renal B) Intra-renal C) Post-renal D) Not a renal problem
Answer = Rationale:
Major complications of cardiac catheterization include: A) Infection and respiratory distress. B) Pulmonary embolism and clotting. C) Hemorrhage and infection. D) Clotting and fatigue.
Answer = C
One of the most effective ways an RN can prevent falls is: A) Providing a pamphlet to the patient B) Instruct the day shift RN to teach the patient C) Clear instructions to patient and at handoff D) Keep patient in restraints
Answer = C
What is the priority EO for a patient with left sided heart failure? A) The patient will lose or maintain weight each week. B) The patient will have a decrease in BLE edema. C) The patient will have LSCTA, unlabored breathing, and o2 stats >93%. D) The patient will verbalize ways to assess if their pacemaker is functioning.
Answer = C
What type of kidney injury would an obstruction in from a catheter cause? A) Pre-renal B) Intra-renal C) Post-renal
Answer = C
When considering safety interventions for the patient who had a fall 30 minute ago and has been experiencing worsening confusion; which of the following safety interventions would not likely be implemented? A) bed alarm B) wristband, colored socks C) restraints D) frequent rounding
Answer = C
Which Karnofsky score represents the pt with the highest risk of complications from Ca treatment? A) 80 B) 95 C) 40 D) 22
Answer = C
Which is a risk factor for breast cancer? A) Low protein diet B) Breastfeeding C) Having first child after 30 D) Bearing 4 or more children
Answer = C
Which lung cancer typically has the worst prognosis? A) Non-small cell carcinoma B) Adenocarcinoma C) Small cell carcinoma D) Squamous cell carcinoma
Answer = C
Which patient is at highest risk for a functional bowel obstruction? A) A patient with a hernia. B) A patient with radiation to the prostate and local skin irritation. C) A patient recovering from surgery taking hydromorphone for pain. D) A patient with chronic renal insufficiency and high potassium.
Answer = C
Which reduces inflammation to minimize s/sx of increased ICP for pts with brain tumors? A) Lorazepam B) Anti-seizure medications C) Dexamethasone D) All of the above
Answer = C
Which results suggest an acute exacerbation of heart failure? A) BNP = 96, EF = 60% B) BNP = 80, EF = 80% C) BNP = 1,500, EF = 40% D) BNP = 42, EF = 55%
Answer = C
The client diagnosed with ARF is admitted to the intensive care department and placed on a therapeutic diet. Which diet is most appropriate for this client? A) A high-potassium and low-calcium diet. B) A low-fat and low-cholesterol diet. C) A high-carbohydrate and restricted-protein diet. D) A regular diet with 6 small feedings a day.
Answer = C Rationale: -Carbohydrates are increased in ARF in order to provide the high caloric needs. Protein is restricted to minimize protein breakdown in the kidneys which will cause the kidneys to work harder. -Potassium should be restricted/decreased for clients with ARF, and calcium is not restricted. -Low fat and low cholesterol is a diet recommended for cardiac disease/atherosclerosis; not relevant to ARF. -Small feedings are not required here.
Which is the breast cancer gene that is inherited? A) BRCA B) herceptin C) ER, Pr+ D) CA-125
Answer = A
True or False: The kidneys regulate BP and HR.
Answer = False
Which type of surgery is done when large portions of a malignant lesion are removed to decrease spread of the cancer? A) Diagnostic B) Prophylactic C) Control D) Reconstructive
Answer = C
Cholelithiasis is defined as: A) Inflammation of the gallbladder. B) Removal of gallstones. C) An exam to view the common bile duct. D) The presence of gallstones.
Answer = D
What is the purpose of giving an osmotic diuretic IV to a patient with increased ICP? A) Increase cell size in the brain. B) Expand extracellular fluid volume. C) Provide fluid hydration. D) Reduce edema of the brain.
Answer = D
A risk factor for bladder cancer includes: A) Female gender B) Age of 20-40 C) Smoking D) Undescended testes at birth
Answer = C
An RN is preparing to give PO meds to a patient with myasthenia gravis. Which should the RN do before giving meds? A) Have the client empty his bladder. B) Put up the side rails on the client's bed. C) Ask the client to take a few sips of water. D) Place the client in low Fowler's position.
Answer = C
Blast cells in the peripheral blood can indicate: A) Multiple Myeloma B) A blood infection C) Leukemia D) A healthy immune system
Answer = C
Which of the following is not a priority assessment related to AKI? A) Weight B) I&O C) Edema D) Lung assessment E) Abdomen auscultation
Answer = Rationale:
Chemotherapy targets: A) malignant cells specifically. B) all cells equally. C) rapidly dividing cells. D) none of the above - there is no way to determine.
Answer = C
What is the most common life-threatening infection in patients with HIV? A) Wasting syndrome B) Candidiasis C) Kaposi's sarcoma D) PCP pneumonia
Answer = D
Which medications are used to treat CKD? (select all that apply) A) Angiotensin-converting enzyme inhibitors B) Sevelamer (Renagel) C) Sodium polystyrene sulfonate (Kayexalate) D) Erythropoietin E) Acyclovir (Zovirax)
Answer = Rationale:
The patient suffers a fall, but explains that he feels fine. Thirty minutes later, the nurse assesses that his confusion has worsened since the fall. What action should the nurse take? A) Alert the physician, suggest a high level of concern. B) Attempt to orient the patient to surroundings and suggest rest. C) Ensure fall precautions are in place. D) Call the physician, suggest a low level of concern, and explain that the patient will continued to be monitored closely.
Answer = Rationale:
Following a fall, what is not a priority assessment? A) Signs of bleeding B) Pain C) Signs of fracture D) Respiratory rate E) Level of consciousness
Answer =
What is the priority intervention for a patient who might have a seizure? A) Assess airway B) Use restraints C) Educate on seizure recovery D) Assess blood pressure
Answer =
What might be found in someone with poor kidney function? A) BUN - 9 B) GFR - 125 C) Creatinine - 3 D) BP - 115/70
Answer =
Your patient, a 55 yo male has not produced any urine in the past 8 hours. He had been nauseous and vomiting and is not NPO. He has no fluids running. This patient is at risk for what type of AKI? A) Pre-renal B) Intra-renal C) Post-renal D) Patient is not at risk for AKI
Answer =
If your patient's spouse came in and told your patient is acting abnormally, angrier than usual, and suddenly dropped out of school, which location of her brain would you suspect has an abnormality? What are sx which you would expect if your pt had a tumor in the other locations? A) Parietal Lobe B) Temporal Lobe C) Frontal Lobe D) Occipital Lobe
Answer = Rationale:
What type of diet do you recommend for a hemodialysis patient who is presenting to the clinic for a follow-up 2 weeks after his renal treatment started? A) heavy protein B) low protein C) high fiber D) low carb
Answer = Rationale:
Your patient receiving peritoneal dialysis is complaining of pressure whenever they are completing their dialysis. What do you do? A) Reassure them that this is normal. B) Call a rapid response. C) Assess the site. D) Give them analgesics.
Answer = Rationale:
A RN accidentally experiences a needle stick injury from a needle contaminated with HIV+ blood. What test should be done? A) EIA now and in a couple months. B) CD4+ count now. C) Viral load in 6 months. D) Tests would not be recommended.
Answer = A
A common side effect of beta blockers is: A) Sexual dysfunction B) Joint pain C) Infertility D) Diarrhea
Answer = A
A major and common complication of hemodialysis is: A) Hypotension B) Hypoglycemia C) Hyperkalemia D) Hyperphosphatemia
Answer = A
A nurse is providing teaching to a patient with GERD. Which should the nurse tell the patient to avoid? A) Chocolate B) Apples C) Skim milk D) Oatmeal
Answer = A
A nursing priority for all patients with hematologic malignancies is: A) Using CBC results to guide care planning. B) Prevention of complications of hypercalcemia. C) Education about upcoming or recent surgery. D) Teaching about the importance of getting out & being active.
Answer = A
A patient comes to the floor and has an IV bag half infused. What should the nurse do? A) Update IV fluid orders and assess the patient. B) Stop the infusion. C) Continue the infusion as the only action. D) Ask the patient what the ER provider wanted ordered.
Answer = A
A patient grabs his chest and is SOB during his first walk post-surgery. What is the first action? A) Sit him down safely. B) Start cardiac monitoring. C) Start MONA. D) Call a code.
Answer = A
A patient with HIV develops encephalopathy. The nurse should prioritize: A) Establishing fall precautions and safety measures. B) Reinforcing the importance of using an incentive spirometer. C) Encourage frequent ambulation around the unit. D) Teaching the patient when she's alone to minimize distractions.
Answer = A
A patient with acute diverticulitis has an NGT draining green liquid bile. Which action should the nurse take? A) Document the findings as normal. B) Determine the patient's last BM. C) Assess the patient's bowel sounds. D) Insert the NGT at least 2 more inches.
Answer = A
A patient with diverticulitis should: A) Be NPO or on clears until the severe inflammation decreases. B) Always have surgery. C) Start TPN immediately. D) Eat a diet high in fiber as soon as the antibiotics are started.
Answer = A
A priority nursing diagnosis for a patient with heart failure is: A) activity intolerance B) impaired nutrition: more than body requirements C) fluid volume deficit D) risk for infection
Answer = A
An RN suspects a pt with myasthenia gravis is experimenting a myasthenic crisis. What should the nurse do? A) Prepare the patient for mechanical ventilation. B) Administer an anticholinesterase medication. C) Instruct the client to perform pursed lip breathing. D) Prepare to administer a vasoconstrictor.
Answer = A
An echocardiogram measures: A) Ejection fraction B) Cardiac biomarkers C) Cardiac electrical conduction D) Signs of angina
Answer = A
What PPE is appropriate for doing an assessment on a patient with HIV? A) Gloves for any potential contact with body fluids. B) Gown and N95 mask. C) Gown and gloves only if the patient is coughing. D) Goggles and face shield.
Answer = A
Which of the following is the most important teaching point for patients with chronic heart failure? A) Daily weights are important for tracking disease status. B) Chest pain is common and can be relieved by an NSAID. C) Weekly labs will help the provider manage your medications. D) Increasing oral intake will help maintain blood pressure.
Answer = A
Which of these might be used to treat transfusion associated circulatory overload? A) Administration of furosemide. B) Administration of antihistamine. C) Assessing if the patient got mismatched blood product. D) Prevention of cytokine release.
Answer = A
You are a nurse calling a provider in order to voice your concerns about his worsening confusion after a fall he had 30 minutes prior. The provider tells you not to worry about it, despite your concern. Which of the following is not an appropriate response? A) Accept the physician's order despite concern. B) Implement the CUS acronym (I am concerned, I am uncomfortable, this is a safety issue) with the physician. C) Speak to another individual who can mediate the problem. (e.g. charge nurse)
Answer = A
A nurse suspects a client who has myasthenia gravis is experiencing a myasthenic crisis. Which of the following interventions should the nurse take? A) Prepare the client for mechanical ventilation. B) Administer an anticholinesterase medication. C) Instruct the client to perform the pursed lip breathing. D) Prepare to administer a vasoconstrictor.
Answer = A Rationale: the client who is experiencing a myasthenic crisis is at risk for loss of adequate respiratory function. The nurse should closely monitor the client's respiratory status and prepare for possible mechanical ventilation. -the client should not receive anticholinesterase medication, because these meds are ineffective during a myasthenic crisis and they may increase respiratory secretions. -since myasthenia gravis is an autoimmune disease which results in progressive muscle weakness, the client who is having a myasthenic crisis will not benefit from pursed lip breathing. -the client will be hypertensive rather than hypotensive during myasthenic crisis.
A nurse is assessing a client who has an acoustic neuroma. Which of the following client manifestations should the nurse expect? A) Vertigo B) Dysphagia C) Diplopia D) Apraxia
Answer = A Rationale: -The RN should expect a client with an acoustic neuroma (a benign tumor of cranial nerve VIII) to manifest mild to moderate vertigo as time progresses. -The client with an acoustic neuroma would display manifestations controlled by cranial nerve VIII, including hearing and balance. Dysphagia, diplopia and apraxia are not associated with hearing and/or balance. (dysphagia = difficulty swallowing, diplopia = double vision, apraxia = inability to perform learned motor skills or commands.)
Patients with kidney disease demonstrate understanding of kidney disease when they: A) Avoid Campbell's tomato soup. B) Avoid wheat bread. C) Eat steak (10 oz) 5 times a week. D) Eat a baked potato daily.
Answer = A Rationale: -a proper renal diet incorporates low sodium intake, low protein intake, low potassium intake, and high carbohydrate (CHO) intake.
A nurse is preparing to administer an osmotic diuretic IV to a client with increased intracranial pressure. Which of the following should the nurse identify as the purpose of the medication? A) Reduce edema of the brain. B) Provide fluid hydration. C) Increase cell size in the brain. D) Expand extracellular fluid volume.
Answer = A Rationale: -an osmotic diuretic is used to decrease intracranial pressure by moving fluid out of the ventricles into the bloodstream. -an osmotic diuretic is used to rapidly reduce intracranial edema and is not used to provide fluid hydration. -an osmotic diuretic is used to rapidly reduce brain size, not increase the cell size of the brain. -an osmotic diuretic is used to rapidly reduce extracellular fluid volume to decrease brain edema.
The client is admitted to the telemetry unit diagnosed with acute exacerbation of congestive heart failure (CHF). Which signs/symptoms would the nurse expect to find when assessing this client? A) Apical pulse rate of 110 and 4+ pitting edema of the feet B) Thick white sputum and crackles that clear with cough C) The client is sleeping with no pillow and eupnea D) Radial pulse rate of 90 and CRT less than 3 seconds.
Answer = A Rationale: -the client with CHF would present with tachycardia (an apical rate of 110), dependent edema, fatigue, third heart sounds, lung congestion, and change in mental status. -In CHF, sputum is usually pink and frothy. Crackles do not clear after coughing. A CHF pt will have labored breathing - not normal breathing (eupnea means normal breathing). Lastly, apical pulse is preferred over radial in assessment of cardiac status in CHF.
A chest tube water seal stops fluctuating. What could be the cause? Select all that apply. A) An obstruction in the tubing. B) Resolution of the pneumo/hemothorax. C) forceful coughing. D) hypoxia.
Answer = A, B
Patients with an ileostomy are at risk for: A) disturbed body image. B) fluid volume deficit. C) fluid volume overload. D) impaired home maintenance.
Answer = A, B
Which actions will help prevent extravasation of chemotherapy? Select all that apply. A) Properly trained nurses B) Central venous access C) Properly trained support staff D) Prophylactic antibiotics
Answer = A, B
Chemotherapy commonly causes: (select all that apply) A) Alopecia B) Mouth sores C) Nausea D) Euphoria
Answer = A, B, C
Which specific agents or factors are associated with the etiology of cancer? Select all that apply. A) Dietary and genetic factors B) Viruses C) Hormonal and chemical agents
Answer = A, B, C
A pt has a h/o tonic-clonic seizure disorder. Which of the following nursing interventions are necessary? Select all that apply. A) Provide suction setup at the bedside. B) Elevate the side rails near head of the bed when the pt is in the bed. C) Place the bed in the lowest position. D) Keep oxygen setup at the bedside.
Answer = A, B, C, D
Heart failure can happen after: A) An MI B) Cardiomyopathy C) Chronic HTN D) A compromised heart is overloaded with fluids
Answer = A, B, C, D
In a healthy adult on a post-op unit, pneumonia should be prevented with: A) Incentive spirometry B) Cough, turn, and deep breath C) Prophylactic antibiotics D) Ambulation
Answer = A, B, D
The nurse identifies the concepts of elimination and immunity for a female client diagnosed with a UTI. Which discharge instructions should the nurse provide the client? Select all that apply. A) Teach the client to wipe from front to back after voiding. B) Encourage the client to drink cranberry juice each morning. C) Inform the client that frequent episodes of incontinence are expected. D) Discuss the signs and symptoms of a recurrent infection. E) Have the client fill a container of water to sip until at least 2,000mL is consumed. F) Request that the client sit in a tub of warm water twice a day for 25 minutes.
Answer = A, B, D, E Rationale: -Cranberry juice is acidic and changes the pH of the urine, making the environment less conductive for bacterial growth. -Incontinence is not expected for a patient with a UTI. -The client should be taught the s/sx of UTIs so that they know when they should notify the HCP. -The client should increase intake of water to 200ml/24 hours in order to flush the bacteria from the urinary system. -Sitting in a tub of water will increase risk of bacteria entering the urethra.
The nurse writes a problem of "impaired gas exchange" for a client diagnosed with cancer of the lung. Which interventions should be included in the plan of care? Select all that apply. A) Apply O2 via nasal cannula. B) Have the dietitian plan for 6 small meals per day. C) Place the client in respiratory isolation. D) Assess vital signs for fever. E) Listen to lung sounds every shift.
Answer = A, B, D, E. Rationale: -O2 will help expand the lungs and get enough oxygenation to the tissues. -lung cancer pts commonly become fatigued trying to eat, so 6 small meals spaced out throughout the day can help. -Cancer is non communicable so no need for isolation. -Checking fevers are important. Clients with lung cancer are at increased risk for developing infection from lowered resistance as a result of treatments or from the tumor blocking secretions in the lung. -Assessment of lungs should be routine.
What is a risk factor for esophageal cancer? A) ETOH B) Being female C) Smoking D) HIV
Answer = A, C
A female client with amyotrophic lateral sclerosis (ALS) tells the nurse, "Sometimes I feel so frustrated. I can't do anything without help!" This comment best supports which nursing diagnosis? A) Anxiety B) Powerlessness C) Ineffective denial D) Risk for disuse syndrome
Answer = B
A major complication of peritoneal dialysis is: A) Fluid volume overload B) Peritonitis C) Tremors D) Weight Loss
Answer = B
A patient has a condition that is autosomal dominant. What is the likelihood his child will develop this condition? A) 25% B) 50% C) It is dependent upon the gender of the child. D) 100%
Answer = B
MONA stands for: A) Morphine On Narrow Airways B) Methylprednisone, Oral care, NSAIDs, ASA C) Morphine, Oxygen, Nitro, Aspirin D) Metoprolol, Oxygen, NSAIDs, Acetaminophen
Answer = C
A patient says they are getting "radiation inserted into their breast." The RN: A) Corrects the patient's misunderstanding of how XRT works. B) Teaches about minimizing radiation exposure to loved ones. C) Explains the process of teletherapy and skin care. D) Provides education on nausea and vomiting prevention.
Answer = B
A pt has a new diagnosis of MG. For which of the following manifestations should the nurse monitor? A) Confusion B) Weakness C) Increase ICP D) Increased urinary output
Answer = B
A sign of anemia is: A) Pulse ox of 84% B) HR of 119. C) Hyperstimulation D) Ruddy complexion
Answer = B
Acute coronary syndrome includes: A) Heart failure B) Unstable angina C) Cardiomyopathy D) Coronary artery disease
Answer = B
Clinical manifestations of myasthenia gravis (MG) get worse: A) in the morning. B) in the evening. C) during times of stress. D) when exposed to cold.
Answer = B
Digoxin has a small therapeutic window, toxicity is especially likely in conjunction with: A) hypocalcemia B) hypokalemia C) hypercalcemia D) hyperkalemia
Answer = B
In acute heart failure the primary priority is: A) promoting ambulation B) promoting oxygenation C) preventing blood clots D) preventing pneumonia
Answer = B
Lung cancer tends to metastasize to: A) The bowel B) The spine C) The breast D) The kidney
Answer = B
Nursing priorities for a patient with thrombocytopenia include: A) Hand hygiene and oral care. B) Prevention of constipation and hypertension. C) Prevention of sick people from visiting. D) Teaching about prioritizing ADLs and responsibilities.
Answer = B
Patients with acute myocardial infarctions will ALWAYS exhibit: A) Chest pain the majority of the time ischemia is occurring. B) Elevated cardiac enzymes 6 hrs after the onset of the infarction. C) Nausea immediately following the infarction. D) A hx of sedentary lifestyle and a high fat diet.
Answer = B
Patients with pleural effusions are treated with: A) Thoracotomy B) Thoracentesis C) Bronchoscopy D) Wedge resection
Answer = B
Side effects from chemotherapy depend most on: A) the half-life of the agent. B) the specific chemo agent. C) chance. D) the presence of a support system.
Answer = B
Sinus bradycardia is characterized by: A) Absent P waves, rate of 50-80, regular rhythm. B) Normal P waves, rate <60, regular rhythm. C) Peaked P waves, rate <60, and irregular rhythm. D) Normal P waves, rate 50-80, irregular rhythm.
Answer = B
Which assessment finding for a patient with a hemothorax requires immediate action? A) Subcutaneous emphysema B) Tracheal deviation C) Dullness upon percussion D) Tidaling of water seal with each breath
Answer = B
Which is a common finding in a patient with pneumonia? A) Hyperresonance on percussion. B) Crackles in the affected area. C) Absent lung sounds. D) Low heart rate.
Answer = B
Which is a common side effect of chemotherapy? A) Leukocytosis B) Mucositis C) Vaginal stenosis D) Euphoria
Answer = B
Which is true about SL nitroglycerin for stable angina? A) It relieves HAs associated with an MI. B) It should be kept in a dark container. C) It should work about 10 min. after administration. D) It should be swallowed with a full glass of water.
Answer = B
Which of these has the strongest genetic link? A) Brain tumors B) Huntington's Disease C) ALS D) MG
Answer = B
Which of these is considered a chemotherapy spill? A) A drop of chemo landing on a disposable blue pad. B) A patient's urinal tipping over 2 hrs after receiving chemotherapy. C) Chemotherapy waste in a yellow chemo container. D) All are chemo spills.
Answer = B
Which tests are used to diagnose/confirm diagnosis of HIV? A) EIA and viral load B) EIA and western blot C) Viral load and CD4 D) CD4 and western blot
Answer = B
The client diagnosed with renal calculi is admitted to the medical unit. Which intervention should the nurse implement first? A) Monitor the client's urinary output. B) Assess the client's pain and r/o complications. C) Increase the client's oral fluid intake. D) Use a safety gait belt when ambulating the client.
Answer = B Rationale: -Monitoring urine output is a necessary intervention, however, assessment is the first part of the nursing process! It is important to assess the pain first. The renal colic pain can be so intense it can cause vasovagal response with a result in hypotension and syncope. -Increasing fluid intake will help facilitate the movement of the renal stone out through the ureter and therefore help decrease pain, however this is not the first intervention.
Which nursing assessment data support that the client has experienced a pulmonary embolism (PE)? A) Calf pain with dorsiflexion of the foot. B) Sudden onset of chest pain and dyspnea. C) Left-sided chest pain diaphoresis. D) Bilateral crackles and low-grade fever.
Answer = B Rationale: -The most common symptoms of a PE are sudden onset of chest pain when taking a deep breath and shortness of breath. -Calf pain is a sign of deep vein thrombosis (DVT) which is a precursor to pulmonary embolism (PE). -L-sided chest pain and diaphoresis are signs of a MI. -Bilateral crackles and low-grade fever are possible signs of pneumonia and other pulmonary complications, but not specifically a pulmonary embolism.
Lymphedema prevention includes: A) Avoiding harsh soaps on the affected side. B) Avoiding blood draws on the affected side. C) Elevation of the affected side at all times. D) Frequent soaks in a hot tub.
Answer = B *ask dr. boni about rationale*
A patient is very anxious about feeling pain during an upcoming colonoscopy. Which response by the nurse is appropriate? A) "Don't worry; most patients dislike the prep more than the actual procedure." B) "I know you're anxious, but this is recommended for people your age." C) "Before the exam your provider will give you a sedative to make you sleepy." D) "After you sign the consent form, we can talk more about this."
Answer = C
The client is receiving the angiotensin-converting enzyme inhibitor (ACE inhibitor) enalapril (Vasotec). When would the nurse question administering this medication? A) The client is not receiving potassium supplements. B) The client complains of a persistent irritating cough. C) The blood pressure for two consecutive readings is 110/70. D) The client's urinary output is 400mL for the last 8 hours.
Answer = B Rationale: -A persistent irritating cough is a possible adverse effect of ACE inhibitors, which may precipitate the HCP changing the client's medication if it is bothersome. -ACE inhibitors may increase potassium levels, so the client actually should avoid potassium supplements and potassium containing salt substitutes. -a BP of 110/70 would indicate the med is effective. Also, a u/o of 400mL over 8 hours (or 3ml/hr) indicates proper kidney functioning.
The client has recently had a myocardial infarction (MI). Which medication should the nurse anticipate the health care provider (HCP) recommending to prevent another heart attack. A) Vitamin K and a non-steroidal anti-inflammatory drug. B) Vitamin E and a daily low-dose aspirin (ASA). C) Vitamin A and an anticoagulant. D) Vitamin B complex and an iron supplement.
Answer = B Rationale: -Vitamin E is an antioxidant and is useful in the treatment and prevention of coronary heart disease; and aspirin is an antiplatelet which prevents platelet aggregation. -Vitamin K helps prevent clotting, and NSAIDs are recommended for inflammatory disorders and to relieve mild to moderate pain. -Vitamin A is required for healthy eyes, gums, and teeth and for fat metabolism. Anticoagulants are prescribed when there is a high risk for clot formation. (This doesn't directly pertain to the situation with the client as much as option B.) -Vitamin B complex is used for healthy functioning of the nervous system, cell repair, and for formation of RBCs. Also, there is no inclination of this client having iron deficiency anemia.
Which diagnostic test is used to confirm the diagnosis of Amyotropic Lateral Sclerosis (ALS)? A) Electromyogram (EMG). B) Muscle biopsy. C) Serum creatine kinase (CK). D) Pulmonary function test.
Answer = B Rationale: -a biopsy can confirm presence of muscle atrophy and loss of muscle fiber. -an EMG does not confirm ALS; it is done to differentiate a neuropathy from a myopathy. -CK may or may not be elevated in ALS, however it does not diagnose ALS.
The lab results for a male client diagnosed with leukemia include RBC count 2.1 * 10^6/mm^3, WBC count 150 * 10^3 /mm^3 , platelets 22 * 10^3/mm^3, K+ 3.8 mEq/L, and Na+ 139 mEq/L. Based on these results, which intervention should the nurse teach the client? A) Encourage the client to eat foods high in iron. B) Instruct the client to use an electric razor while shaving. C) Discuss the importance of limiting sodium in the diet. D) Instruct the family to limit visits to once a week.
Answer = B Rationale: -anemia is a manifestation in leukemia, however it is not the type of anemia related to iron deficiency and eating foods higher in iron will not help. -His platelet count is 22,000 and thrombocytopenia is anything <100,000. This pt is at risk for bleeding, and should be placed on bleeding precautions. -This sodium level is WNL. Unless another disease which requires sodium restriction is present, there is no need to limit sodium in this pt's diet. -This pt is at risk for infection, however unless a family member is ill, they should be encouraged to visit whenever possible.
The client is being admitted to r/o a brain tumor. What classic triad of symptoms supports a diagnosis of a brain tumor? A) nervousness, metastasis to the lungs, seizures. B) headache, vomiting, and papilledema. C) hypotension, tachycardia, and tachypnea. D) abrupt loss of motor function, diarrhea, change in taste.
Answer = B Rationale: -the classic triad of symptoms suggesting a brain tumor includes a dull headache, vomiting (w/out nausea and unrelated to food) and papilledema, which is optic nerve edema. -Nervousness is not a symptom of a brain tumor, and brain tumors rarely metastasize outside the cranium. -HTN and bradycardia (not tachycardia) can occur in ICP, which may stump you to choose C -Abrupt loss of motor function is suggestive of a stroke.
The nurse is developing a discharge teaching plan for the client diagnosed with congestive heart failure. Which interventions should be included in plan? Select all that apply: A) Notify the provider if there is a weight gain of more than one pound in a week. B) Teach the client how to count the radial pulse when taking digoxin, a cardiac glycoside. C) Instruct the client to remove the saltshaker from the dinner table. D) Encourage the client to monitor urine output for change in color to become dark. E) Discuss the importance of taking the loop diuretic furosemide at bedtime.
Answer = B), C) Rationale: -the client needs to know that digoxin cannot be taken if radial pulse is less than 60. -Weight gain of 1 pound in 1 week is irrelevant. Client should call weight gain of more than 2 or 3 pounds in 1 day. -Urine should not be darker in this situation. If anything it may appear lighter and may increase due to diuretics. -The client should take diuretic in the morning - not at night! (to avoid nocturia)
The nurse is caring for a client with chronic renal failure (CRF). Which antecedents would the nurse assess? Select all the apply. A) Current diet B) Diabetes C) Hypertension D) Fluid restriction E) Race
Answer = B, C, E Rationale: *antecedent = cause* -The CURRENT diet should be one that limits the complications of CRF. It is current, not antecedent. -Diabetes is a leading cause of renal failure! (high blood glucose can cause macrovascular changes which can lead to renal dysfunction and eventually failure.) -HTN is also a leading cause of renal failure. The narrowing of the renal arteries d/t HTN decrease blood flow to the kidneys. -Fluid restriction is a recommended treatment for CRF and is not an antecedent. -Non-Caucasian clients are at higher risk for developing CRF, especially when the client has a comorbid condition such as diabetes or hypertension.
Which test is appropriate for a patient with gallbladder disorders? (select all that apply) A) TURP B) HIDA scan C) Western blot D) ERCP
Answer = B, D
A normal EF is between: A) 30 - 55% B) 40 - 60% C) 55 - 70% D) 65 - 90%
Answer = C
A normal absolute neutrophil count is: A) 3.0 - 5.8 B) 11.7 - 17.4 C) 3.0 - 7.0 (3,000 - 7,000) D) 150,000 - 400,000
Answer = C
A patient demonstrates understanding of lymphedema prevention when she states: A) "I will avoid compression garments." B) "I will carry my purse at the bend of my elbow." C) "I will wear loose clothes." D) "I can get lab draws on this side if a tourniquet isn't used."
Answer = C
A patient with an elevated troponin level and a normal EKG is experiencing: A) Stable angina B) Unstable angina C) An NSTEMI D) A STEMI
Answer = C
The client had a right-sided chest tube inserted 2 hours ago for a pneumothorax. Which action should the nurse implement if there is no fluctuation in the water-seal compartment? A) Obtain an order for a STAT chest x-ray. B) Increase the amount of wall suction. C) Check the tubing for kinks or clots. D) Monitor the client's pulse oximeter reading.
Answer = C Rationale: -The air from the pleural space is not getting to the water seal compartment. Checking the tubing is appropriate in finding out why this is, and usually it's because the client is lying on the tubing, it is kinked, or there is a dependent loop. (Note: the key here is '2 hours ago') -increasing the amount of wall suction will not address WHY there is no fluctuation in the water-seal compartment. Need to find out what is causing this before taking action.
The acronym to help you remember the progression of kidney injury is: A) SNOW B) RUSHING C) RIFLE D) STAPLE
Answer = C Risk Injury Failure Loss of kidney function End-stage kidney disease
Which cardiac enzyme would the nurse expect to elevate first in a client diagnosed with a myocardial infarction (MI)? A) Creatine Kinase (CK-MB) B) Lactate Dehydrogenase (LDH) C) Troponin D) WBCs
Answer = C Rationale: -Troponin is the enzyme that elevates quickly- within 1 to 2 hours. -CK-MB elevates in 12 to 24 hours. -LDH elevates in 24-36 hours -WBCs are not a cardiac enzyme! They elevate as a result of necrotic tissue.
The male client diagnosed with CKD has received the initial dose of erythropoietin, a biologic response modifier, 1 week ago. Which complain by the client indicates the need to notify the health care provider? A) The client complains of flu-like symptoms. B) The client complains of being tired all the time. C) The client reports an elevation in his blood pressure. D) The client reports discomfort in his legs and back.
Answer = C Rationale: -Erythropoietin therapy is contraindicated in patients with uncontrolled HTN. After erythropoietin is initially given, a client's antihypertensive meds may need to be adjusted. So this complaint would require calling the HCP. -Flu-like symptoms are expected initially with erythropoietin, and usually subside with repeated doses. -Erythropoietin takes 2-6 weeks to become effective when it's used for improving anemia (a reason why a client with fatigue would be getting this medication).
The nurse is caring for the client diagnosed with chronic kidney disease (CKD) who is experiencing metabolic acidosis. Which statement best describes the scientific rationale for metabolic acidosis in this client? A) There is an increased excretion of phosphates and organic acids, which leads to an increase in arterial blood pH. B) A shortened life span of red blood cells because of damage secondary to dialysis treatments in turn leads to metabolic acidosis. C) The kidney cannot excrete increased levels of acid because they cannot excrete ammonia or cannot reabsorb sodium bicarbonate. D) An increase in nausea and vomiting causes a loss of hydrochloric acid and the respiratory system cannot compensate adequately.
Answer = C Rationale: -There is a decrease in the excretion of phosphates and organic acids; not an increase. -RBC destruction doesn't affect the arterial blood pH. -Compensatory mechanisms occur in order to maintain the blood pH between 7.35 and 7.45. However it does not occur as a direct result of CKD.
Which dietary selection is most appropriate for a patient with diverticulitis? A) Turkey sandwich with celery sticks B) Pork tenderloin and green peas C) Grilled chicken breast and white rice D) Sliced ham with a spinach salad
Answer = C Rationale: -in diverticulitis there is acute inflammation occurring in the intestines, and dietary fiber should be avoided. Answer C is the only option low in fiber (without vegetables) -A high fiber diet is optimal in diverticulosis, which is a chronic GI disorder. The names of these two disorders are very similar, which makes it easy to mistake one's diet for the other!
The client diagnosed with rule-out myocardial infarction is experiencing chest pain while walking to the bathroom. Which action should the nurse implement first? A) Administer sublingual nitroglycerin. B) Obtain a STAT electrocardiogram (ECG). C) Have the client sit down immediately. D) Assess the client's vital signs.
Answer = C Rationale: -stopping all activity will decrease the need of the myocardium for oxygen (may decrease chest pain) -An ECG should be ordered, but not before having the client sit down. -taking vital signs will not help the client relieve chest pain.
A patient has just had a CT & has been on gentamycin. His Cr = 1.9., and yesterday is Cr was 1.2. You suspect: A) CKD stage 3 B) Diabetic neuropathy C) Intra-renal AKI D) Ineffective peritoneal dialysis
Answer = C Rationale: a change in creatinine from 1.2 to 1.9 indicates there is an abrupt decline in the kidney's ability to excrete wastes. CKD is more slowly progressive.
A leader can use _ to hold "touch base" meetings to discuss critical issues & emerging events. A) Debrief B) Handoff C) Brief D) Huddle
Answer = D
A patient resides in a group home and has HIV Stage 3. The nurse should prioritize assessing for: A) Nutritional intake B) Central line IV access C) Petechiae and purpura D) PCP pneumonia and TB
Answer = D
A patient with a GFR of 5 must have: A) Kayaxelate B) Fluid restriction C) Renagel with each meal D) A renal replacement therapy
Answer = D
A patient with diverticulitis might require: A) IV fluids B) Oral antibiotics C) Surgery D) All of the above
Answer = D
An RN is talking with a patient with cholelithiasis & will have an oral cholangiogram. Which statement indicates patient understanding? A) "Soon those shock waves will get rid of my gallstones." B) "I'll have a camera put down my throat so they can see my gallbladder." C) "They'll put medication into my gallbladder to dissolve the stones." D) "They are going to examine my gallbladder and ducts."
Answer = D
An ideal donor for a kidney transplant is: A) Anyone living B) NHBD C) Under 20 years old D) A family member
Answer = D
How is leukemia diagnosed? A) Preventive screening measures. B) Biopsy following surgical resection of the tumor. C) Cat scan (CT scan) D) Bone marrow aspiration and biopsy
Answer = D
The nurse is admitting a patient with adenocarcinoma of the rectosigmoid colon. Which assessment data supports this diagnosis? A) The client reports up to 20 bloody stools per day. B) The client has a feeling of fullness after a heavy meal. C) The client complains of RLQ pain. D) The client has diarrhea alternating with constipation.
Answer = D
What is the most common way to assess if a patient systemically tolerates a procedure? A) Weight monitoring B) Chest x-ray (CXR) evaluation C) Assessing the procedure site/dressing D) Vital sign (VS) monitoring
Answer = D
Which of these types of breast cancer is the least aggressive/has the best prognosis? A) Inflammatory breast cancer B) Metastatic breast cancer C) Infiltrating lobular carcinoma D) Ductal carcinoma in situ
Answer = D
A nurse is receiving a transfer report for a client who has a head injury. The client has a Glasgow Coma Scale (GCS) score of 3 for eye opening, 5 for best verbal response, and 5 for best motor response. Which of the following is an appropriate conclusion based on this data? A) The client can follow simple motor commands. B) The client is unable to make vocal sound. C) The client is unconscious. D) The client opens his eyes when spoken to.
Answer = D Rationale: -A GCS of 3-5-5 indicates that the client opens his eyes in response to speech, is oriented, and is able to localize pain. -The client's ability to follow commands would require a score of 6 for best motor response. -The inability of the client to make vocal sounds would result in a score of 1 for best verbal response. -The unconscious client would have a score of 1 for eye opening and a 1 for best verbal response.
Which test is considered diagnostic for Hodgkin's lymphoma? A) A magnetic resonance image (MRI) of the chest. B) A computed tomography (CT) scan of the cervical area. C) An erythrocyte sedimentation rate (ESR). D) A biopsy of the cervical lymph nodes.
Answer = D Rationale: -Cancers of all types are definitively diagnosed from biopsies. The pathologist must identify Reed-Sternberg cells for a diagnosis of Hodgkin's disease - which requires a biopsy. -MRI and CT are not able to pathologically diagnose Hodgkin's disease and are used to view presence of tumors and/or disease entities of the area. -An ESR can be used to monitor the progress of treatment of Hodgkin's lymphoma, however they are not used in diagnostics. ESR levels can be increased in numerous disease processes and are not able to specifically indicate presence of Hodgkin's disease.
A nurse is caring for a client who is schedule to have a magnetic resonance imaging (MRI) scan. The client asks the nurse what to expect during the procedure. Which of the following statements should the nurse make? A) "An MRI scan is not distorted by movement, so you do not have to lie still." B) "An MRI scan is a short procedure and should take no longer than 30 minutes." C) "The MRI contrast dye contains iodine and can cause your skin to itch." D) "An MRI scan is very noisy, and you will be allowed to wear earplugs while in the scanner."
Answer = D Rationale: -The nurse should instruct the client that many clients report being disconcerted by the loud thumping and humming noises produced by the scanner, and for that reason, earplugs are offered to reduce the discomfort. -An MRI scan IS distorted by movement, and it is important for the client to be informed to lie still during the procedure. -An MRI scan is a lengthy procedure and can last between 60 and 90 minutes. -MRI contrast does not contain iodine and therefore is not subject to hypersensitivity reactions like contrast dye used in a traditional CT scan.
The nurse is preparing to administer the morning dose of digoxin, a cardiac glycoside, to a client diagnosed with CHF. Which data would indicate the medication is effective? A) The apical heart rate is 72 bpm. B) The client denies having any anorexia or nausea. C) The client's BP is 120/80 mmHg. D) The client's lung sounds are clear bilaterally.
Answer = D Rationale: -apical rate is assessed PRIOR to administering the dose and does not indicate if the medication is effective. -Anorexia and nausea are sx of digoxin toxicity. -Digoxin does not have an effect on the BP. -The purpose of administering digoxin is to treat heart failure and dysrhythmias, so clear lung sounds would indicate that the heart failure is being controlled by the medication.
True or False: AKI is usually irreversible and progresses to CKD.
Answer = False
True or False: Pharmacologic interventions are the priority for patients with heart failure
Answer = False
True or False: Patients with an EKG which shows sinus bradycardia should always be treated with atropine.
Answer = False Rationale: -Atropine is the treatment of choice for symptomatic patients with sinus bradycardia (report weakness, dizziness, lightheadedness). -Sinus bradycardia should not be treated if the pt is asymptomatic. In this case, as the nurse, you'd want to look for underlying causes and treat or remove those. (Pt may have taken too many beta blockers, or the pt may be having an MI)
True or False: Brain tumor classification is based on location and histologic characteristics.
Answer = True
True or False: The flu shot can prevent the flu & prevent the severity/risk of death if a patient develops the flu.
Answer = True
True or False: The kidneys remove excess fluids and waste.
Answer = True