NCLEX-RN Exam Pack Set 12 (75 Questions and Answers detailed explanation Updated 2023), Exams of Nursing

Download NCLEX-RN Exam Pack Set 12 (75 Questions and Answers detailed explanation Updated 2023) and more Exams Nursing in PDF only on Docsity! Option A: An altered level of consciousness does not occur in clients with mitral regurgitation. Physical examination may reveal altered mental status, tachycardia (or bradycardia if there is ischemic involvement of the conduction system), hypotension, tachypnea, hypoxemia, and cyanosis. Option C: Creatine phosphokinase (CPK) is an enzyme in the body. It is found mainly in the heart, brain, and skeletal muscle. High levels of CPK may be seen in people who have brain injury, convulsions, heart attack, myocarditis, and myopathy. Option D: The client feels no chest pain, but may feel palpitations as a result of chronic atrial dilatation. They Correct Answer: B. Exertional Dyspnea Mitral regurgitation (MR) is defined as an abnormal reversal of blood flow from the left ventricle (LV) to the left atrium (LA). Weight gain due to retention of fluids and worsening heart failure causes exertional dyspnea in clients with mitral regurgitation. The patient will usually complain of significant dyspnea at rest, exacerbated in the supine position, as well as cough with clear or pink, frothy sputum. NCLEX-RN Exam Pack Set 12 (75 Questions and Answers detailed explanation Updated 2023) 1.1. Question Among the following signs and symptoms, which would most likely be present in a client with mitral regurgitation? o A. Altered level of consciousness o B. Exertional Dyspnea o C. Increase creatine phosphokinase concentration o D. Chest pain • 2. Question Kris with a history of chronic infection of the urinary system complains of urinary frequency and burning sensation. To figure out whether the current problem is of renal origin, the nurse should assess whether the client has discomfort or pain in the: o A. Urinary meatus o B. Pain in the labium o C. Suprapubic area o D. Right or left costovertebral angle Correct Answer: D. Right or left costovertebral angle Discomfort or pain is a problem that originates in the kidney. It is felt at the costovertebral angle on the affected side. Flank or costovertebral angle (CVA) tenderness is most commonly unilateral over the involved kidney, although bilateral discomfort may be present. Discomfort varies from absent to severe. This finding is usually not subtle and may be elicited with mild or moderately firm palpation. o Option A: Pain or discomfort in the urinary meatus can also be indicative of urethritis or acute urinary tract infection. In both men and women, common causes of urethral pain include sexually transmitted diseases (STDs) such as chlamydia, local irritation from soaps or spermicides, and urinary tract infections (UTIs). In men, prostatitis isn’t an uncommon cause, whereas in women, vaginal dryness due to menopause can be an issue. o Option B: Pain in the labium can be due to a swollen labia or vulva. Chronic yeast infections and bacterial infections can both cause pain that ranges from mild discomfort and itching to severe burning or throbbing. Viral and bacterial may also endorse symptoms associated with myocardial ischemia, such as chest pain radiating to the neck, jaw, shoulders, or upper extremities, nausea, and diaphoresis. Correct Answer: C. Myoclonic seizure Myoclonic seizure is characterized by sudden uncontrollable jerking movements of a single or multiple muscle group. Myoclonus is defined as rapid, brief, jerky, or shock-like movements involving muscle or group of muscles. Among all hyperkinetic movement disorders, Myoclonus is considered to be the most rapid and brief. When caused by sudden muscle contraction, it is known as “positive myoclonus,” while a brief loss of muscular tone results in “negative myoclonus” as in asterixis. o Option A: A tonic seizure causes a sudden • 4. Question John suddenly experiences a seizure, and Nurse Gina notices that John exhibits uncontrollable jerking movements. Nurse Gina documents that John experienced which type of seizure? o A. Tonic seizure o B. Absence seizure o C. Myoclonic seizure o D. Clonic seizure papaverine or acetylcholine did not increase UNaV or fractional Na excretion. o Option C: Checking the distention of the bladder is not an accurate indicator of renal function. It mostly indicates an obstruction or a loss of tone in the bladder muscles that fail to detect increased pressure exerted by urine. It is usually associated with pain and urge to urinate. Bladder catheterization should be performed. o Option D: Individuals with a high resting heart rate and a low beat-to-beat heart rate variability have an increased risk of developing kidney disease, according to a new study by the American Society of Nephrology. However, it is Correct Answer: D. Nicotine (Nicotrol) Nicotine (Nicotrol) is given in controlled and decreasing doses for the management of nicotine withdrawal syndrome. Nicotine replacement therapy (NRT) is for those who want to quit smoking, as abruptly quitting can cause withdrawals and cravings. Nicotine withdrawal occurs after smoking cigarettes discontinued suddenly. Using NRT helps one to reduce the motivation of smoking cigarettes because the body still gets nicotine from another safer method. o Option A: Paracetamol (acetaminophen) is a pain reliever and a fever reducer. Acetaminophen (APAP) is considered a non- opioid analgesic and antipyretic agent used to • 5. Question Smoking cessation is a critical strategy for the client with Buerger’s disease, Nurse Jasmin anticipates that the male client will go home with a prescription for which medication? o A. Paracetamol o B. Ibuprofen o C. Nitroglycerin o D. Nicotine (Nicotrol) happen during sleep. After the seizure, the client may feel tired or confused. o Option B: An absence seizure causes the client to blank out or stare into space for a few seconds. They are also called petit mal seizures. Absence seizures are most common in children and typically don’t cause any long-term problems. o Option D: Clonic seizures are characterized by repeated jerking movements of the arms and legs on one or both sides of the body, sometimes with numbness or tingling. If it is a focal (partial) seizure, the client may be aware Correct Answer: D. Episodic vasospastic disorder of the small arteries Raynaud’s disease is characterized by vasospasms of the small cutaneous arteries that involve fingers and toes. In Raynaud phenomenon, blood-flow restriction occurs during cold temperatures and emotional stress. Specifically, in Raynaud phenomenon, there is vasoconstriction of the digital arteries and cutaneous arterioles. o Option A: Only the arteries are affected in Raynaud’s disease. With cold temperatures, • 6. Question Nurse Lilly has been assigned to a client with Raynaud’s disease. Nurse Lilly realizes that the etiology of the disease is unknown but it is characterized by: o A. Episodic vasospastic disorder of capillaries o B. Episodic vasospastic disorder of small veins o C. Episodic vasospastic disorder of the aorta o D. Episodic vasospastic disorder of the small arteries moderate pain and in combination with an opioid analgesic for severe pain. o Option B: Ibuprofen is a nonsteroidal anti- inflammatory drug (NSAID). It works by reducing hormones that cause inflammation and pain in the body. Ibuprofen is used to reduce fever and treat pain or inflammation caused by many conditions such as headache, toothache, back pain, arthritis, menstrual cramps, or minor injury. o Option C: Nitroglycerin belongs to a class of drugs called vasodilators. It works by relaxing the smooth muscle and blood vessels in the body. This increases the amount of blood and oxygen that reaches the heart. In turn, the o D. 3.5 L Correct Answer: C. 2.0 L One liter of fluid approximately weighs 2.2 pounds. A 4.5- pound weight loss equals to approximately 2L. Diuresis is necessary for a variety of non-edematous and edematous conditions, which require clearing out excess water when the body abnormally sequesters fluid in third space in the form of edema. o Option A: Option A has a very low amount of fluid loss and is incompatible with the weight that the client has lost. Diuretics are drugs that pharmacologically tilt the renal fluid regulation in favor of excretion of water and electrolytes. Thus, diuretics are substances that increase the production and volume of urine. This class of drugs achieves this objective primarily by suppressing receptors that aid in reabsorption of Na+, the most abundant extracellular cation, from the renal tubules, thereby increasing the osmolality of the renal tubules and consequently suppressing water reabsorption. o Option B: 1.5 L is not an accurate amount of fluid loss based on the client’s weight loss. The most common adverse effect for any diuretic is mild hypovolemia, which can lead to transient dehydration and increased thirst. When there is an over-treatment with a diuretic, this could lead to severe hypovolemia, causing hypotension, dizziness, and syncope. o Option D: 3.5 L is more than the amount of fluid loss based on the client’s amount of weight loss. Diuretic treatment calls for careful assessment of extracellular fluid volume, urine output, electrolyte levels in plasma and urine, body weight, acid-base status, serum glucose, and BP regularly with particular emphasis on patients with cardiovascular, hepatic, renal, or metabolic disorders and in elderly individuals. • 9. Question Nurse Donna is aware that the shift of body fluids associated with Intravenous administration of albumin occurs in the process of: o A. Osmosis o B. Diffusion o C. Active transport o D. Filtration Correct Answer: A. Osmosis Osmosis is the movement of fluid from an area of lesser solute concentration to an area of greater solute concentration. In physiology, osmosis (Greek for push) is the net movement of water across a semipermeable membrane. Across this membrane, water will tend to move from an area of high concentration to an area of low concentration. It is important to emphasize that ideal osmosis requires only the movement of pure water across the membrane without any movement of solute particles across the semipermeable membrane. o Option B: Diffusion is the movement of a substance from an area of high concentration to an area of low concentration. Passive transport, most commonly by diffusion, occurs along a concentration gradient from high to low concentration. No energy is necessary for this mode of transport. Examples will include diffusion of gases across alveolar membranes and diffusion of neurotransmitters such as acetylcholine across the synapse or neuromuscular junction. o Option C: Active transport is the process of transferring substances into, out of, and between cells, using energy. Active transport is an energy-driven process where membrane proteins transport molecules across cells, mainly classified as either primary or secondary, based on how energy is coupled to fuel these mechanisms. o Option D: Filtration is a process used to separate solids from liquids or gases using a filter medium that allows the fluid to pass through but not solid. The term “filtration” applies whether the filter is mechanical, biological, or physical. The fluid that passes through the filter is called the filtrate. The filter medium may be a surface filter, which is a solid that traps solid particles, or a depth filter, which • 11. Question Which of the following statements should the nurse teach the neutropenic client and his family to avoid? o A. Performing oral hygiene after every meal o B. Using suppositories or enemas o C. Performing perineal hygiene after each bowel movement o D. Using a filter mask Correct Answer: B. Using suppositories or enemas Neutropenic clients are at risk for infection especially bacterial infection of the gastrointestinal and respiratory tract. An ly administered enema can damage tissue in your rectum/colon, cause bowel perforation and, if the device is not sterile, infections. o Option A: Performing oral hygiene consistently after meals could help prevent infection of the oral mucous membranes. Recommend the use of soft-bristled toothbrushes and stool softeners to protect mucous membranes. Hard-bristled toothbrushes can compromise the integrity of the mucous membrane and provide a port of entry for pathogens. o Option C: Proper perineal hygiene helps prevent urinary tract infections. Wash hands or perform hand hygiene before having contact with the patient. Also impart these duties to the patient and their significant others. Friction and running water effectively remove microorganisms from hands. Washing between procedures reduces the risk of transmitting pathogens from one area of the body to another. o Option D: Wearing a mask, especially in a crowded place, would help prevent contagious respiratory infections. Provide surgical masks to visitors who are coughing and provide crutches can lead to injury. Most injuries are a direct result of falling. rationale to enforce usage. Option A: Placing the client in a Sims position could let the stomach contents spill out of the perforation. Tachycardia and abdominal tenderness with rigidity are common clinical signs. Severe pain, systemic inflammatory response from chemical peritonitis, and fluid deficit either due to poor intake or vomiting or pyrexia lead to compensatory tachycardia. Option B: The supine position could aggravate the pain of the ulcer. PPU is a surgical emergency associated with high mortality if left untreated. In general, all patients with PPU require prompt resuscitation, intravenous antibiotics, analgesia, proton pump inhibitor medications, nasogastric tube, urinary catheter, and surgical source control. Correct Answer: C. Semi-fowlers position Semi-fowlers position will localize the spilled stomach contents in the lower part of the abdominal cavity. Initiation of fluid resuscitation should start as soon as the diagnosis is made. Insertion of a nasogastric tube to decompress the stomach and a Foley catheter to monitor urine output are essential steps. • 12. Question A female client is experiencing a painful and rigid abdomen and is diagnosed with a perforated peptic ulcer. A surgery has been scheduled and a nasogastric tube is inserted. The nurse should place the client before surgery in o A. Sims position o B. Supine position o C. Semi-fowlers position o D. Dorsal recumbent position Instruct visitors to cover mouth and nose (by using the elbows to cover) during coughing or sneezing; use of tissues to contain respiratory secretions with immediate disposal to a no- touch receptacle; perform hand hygiene Correct Answer: C. I can eat shredded wheat cereal Wheat cereal has a low sodium content. Sodium controls fluid balance in the body and maintains blood volume and blood pressure. Eating too much sodium may raise blood pressure and cause fluid retention, which could lead to swelling of the • 15. Question A client who has been diagnosed with hypertension is being taught to restrict intake of sodium. The nurse would know that the teachings are effective if the client states that: o A. I can eat celery sticks and carrots o B. I can eat broiled scallops o C. I can eat shredded wheat cereal o D. I can eat spaghetti on rye bread pressure, which can be injurious (invagination of tissue into catheter eyelets, collapse of tissues around the catheter, and bleeding from rupture of small blood vessels). o Option C: The presence of excessive bubbling is not a normal finding. Observe for abnormal and continuous water-seal chamber bubbling. With suction applied, this indicates a persistent air leak that may be from a large pneumothorax at the chest insertion site (patient-centered) or chest drainage unit (system- centered). o Option D: Decreasing the amount of suction pressure without any appropriate orders may cause the system to be ineffective. Check suction control chamber for a correct amount of suction (determined by water level, wall or table regulator at correct setting. Water in a sealed chamber serves as a barrier that prevents atmospheric air from entering the pleural space should the suction source be disconnected and aids in evaluating whether the chest drainage Correct Answer: A. Pressure in the portal vein Enlarged cirrhotic liver impinges the portal system causing increased hydrostatic pressure resulting in ascites. Portal • 16. Question A male client with a history of cirrhosis and alcoholism is admitted with severe dyspnea resulting from ascites. The nurse should be aware that the ascites is most likely the result of increased: o A. Pressure in the portal vein o B. Production of serum albumin o C. Secretion of bile salts o D. Interstitial osmotic pressure o Option A: Celery and carrots are both high in sodium content. With 50 milligrams of sodium in both a large stock of celery and a large carrot, these vegetables provide that familiar savory flavor in soups and stews, without several pinches of salt. o Option B: Seafoods are rich in sodium. According to the American Heart Association, 1,500 mg of sodium per day is the recommended intake. Three ounces of scallops can give about 325 mg of sodium-20% of the recommendation. While most fish runs relatively low on the sodium scale, its ocean brethren can top the natural sodium charts. Shrimp, lobster, crab, and scallops (to name a few) can all contain hundreds of milligrams of sodium per 3-ounce serving o Option D: Rye bread has a high sodium content. Actions of industry in reducing the sodium in the processed food supply are important in the public health effort to lower the sodium of what we eat. Gorton7 gives oxide levels increase, leading to vasodilation. As the state of vasodilatation becomes worse, the plasma levels of vasoconstrictor sodium-retentive hormones elevate, renal function declines, and ascitic fluid forms, resulting in hepatic decompensation. o Option B: There is a decrease in the production of serum albumin in clients with ascites, leading the fluid to leak or escape from the interstitial spaces into the peritoneal cavity. Ascitic fluid protein and albumin are measured simultaneously with the serum albumin level to calculate the serum-ascites albumin gradient (SAAG). o Option C: The function of bile salts is to help process and digest the fats. Bile salts inhibit cholesterol 7alpha-hydroxylase, decreasing the synthesis of bile acids. Despite the increased water solubility of bile salts, they are amphipathic molecules overall. This critical property allows them to effectively emulsify lipids and form micelles with the products of lipid digestion. o Option D: Osmotic pressure is defined as a pressure that must be applied to the solution side to stop fluid movement when a semipermeable membrane separates a solution from pure water. Osmotic pressure is the pressure caused by water at different concentrations due to the dilution of water by dissolved molecules (solute), notably salts and nutrients. • 17. Question A newly admitted client diagnosed with Hodgkin’s disease undergoes an excisional cervical lymph node biopsy under local anesthesia. What does the nurse assess first after the procedure? o A. Vital signs o B. Incision site o C. Airway o C. Respiratory rate of 4 breath/min o D. Pulse rate less than 60 bpm Correct Answer: A. Systolic blood pressure less than 90mm Hg Typical signs and symptoms of hypovolemic shock includes systolic blood pressure of less than 90 mm Hg. The first changes in vital signs seen in hypovolemic shock include an increase in diastolic blood pressure with narrowed pulse pressure. As volume status continues to decrease, systolic blood pressure drops. As a result, oxygen delivery to vital organs is unable to meet oxygen demand. o Option B: Unequally dilated pupils refer to anisocoria. Acute onset should be considered an emergency because it may be due to brain mass lesions which cause oculomotor nerve palsy. Anisocoria is a condition characterized by unequal pupil size. The etiology of anisocoria is complex, ranging from benign to potentially life- threatening causes. There are many pathways involved in pupil size. Some potential etiologies of anisocoria include systemic drug use, topical ophthalmic drug use, headaches, and autonomic ganglion pathology. o Option C: This indicates a very low respiratory rate or bradypnea. Tachypnea is seen in clients with class II hemorrhage (loss of 15-30%). Similar to examining pulse pressure variation, measuring respiratory variation in inferior vena cava diameter as a measure of volume responsiveness has only been validated in patients without spontaneous breaths or arrhythmias. o Option D: The cardiovascular system initially responds to hypovolemic shock by increasing the heart rate, increasing myocardial contractility, and constricting peripheral blood vessels. Patients with volume depletion may complain of thirst, muscle cramps, and/or orthostatic hypotension. Severe hypovolemic shock can result in mesenteric and coronary ischemia that can cause abdominal or chest pain. Agitation, lethargy, or confusion may result from brain malperfusion. • 19. Question Nurse Lucy is planning to give preoperative teaching to a client who will be undergoing rhinoplasty. Which of the following should be included? o A. Results of the surgery will be immediately noticeable postoperatively o B. Normal saline nose drops will need to be administered preoperatively o C. After surgery, nasal packing will be in place 8 to 10 days o D. Aspirin-containing medications should not be taken 14 days before surgery Correct Answer: D. Aspirin-containing medications should not be taken 14 days before surgery Aspirin-containing medications should not be taken 14 days before surgery to decrease the risk of bleeding. Impaired coagulation may cause postoperative complications. Patients should be asked about a history of excessive bruising or bleeding, consumption of drugs, supplements, or vitamins that alter coagulation cascade or history of thrombotic events in the past. Any drug, vitamins, or supplement that impairs coagulation might have to be suspended preoperatively. o Option A: Results would not be seen immediately, as swelling on the postoperative part will be prominent after surgery. Preoperative photos have to be taken for previous analysis and planning and for medico-legal purposes. Frontal, both profiles, and a basal view are the minimum requirements. They should be taken using a dark background with good lighting settings. o Option B: There is no indication for normal saline nose drops after surgery. Closed rhinoplasty can be performed either with general anesthesia or local anesthesia and sedation, both with similar results in Correct Answer: D. Spinach and mangoes Beta-carotene and Vitamin E are antioxidants which help to inhibit oxidation. Vitamin E is found in the following foods: wheat germ, corn, nuts, seeds, olives, spinach, asparagus and other green leafy vegetables. Food sources of beta-carotene include dark green vegetables, • 21. Question Dr. Marquez tells a client that an increased intake of foods that are rich in Vitamin E and beta-carotene are important for healthier skin. The nurse teaches the client that excellent food sources of both of these substances are: o A. Fish and fruit jam o B. Oranges and grapefruit o C. Carrots and potatoes o D. Spinach and mangoes o Option C: Sodium bicarbonate is a medication used in the management and treatment of multiple disease pathologies. It is a general chemical compound by classification. Under arrhythmias and cardiovascular instability, sodium bicarbonate can be administered to adults at 4 to 8 hour IV infusions. Each dose should be monitored and planned in a standard protocol to help evaluate the degree of response expected and predicted to understand the necessity to advance further infusions or withhold administration, given its fluid overloading effects. o Option D: Calcium gluconate belongs to a class of drugs called Antidotes; Calcium Salts. It is an over-the- counter and a prescription medicine used to treat symptoms of hypocalcemia and as a calcium supplement. Calcium gluconate is used to treat conditions Correct Answer: A. Rest in a sitting position o Option A: Fish is rich in protein, while fruit jams are rich in fiber and carbohydrates. Fish is filled with omega-3 fatty acids and vitamins such as D and B2 (riboflavin). Fish is rich in calcium and phosphorus and a great source of minerals, such as iron, zinc, iodine, magnesium, and potassium. The American Heart Association recommends eating fish at least two times per week as part of a healthy diet. o Option B: Oranges and grapefruit are rich in Vitamin C. Lemons, limes, grapefruits, and oranges are high in phytonutrients, such as carotenoids, flavonoids, and polyphenols. These nutrients are types of antioxidants and give the fruits their bright colors and strong scents. They can also help protect the body and prevent many health issues. o Option C: Carrots are rich in beta-carotene, a compound the body changes into vitamin A, which helps keep the eyes healthy. And beta- carotene helps protect the eyes from the sun and lowers the chances of cataracts and other eye problems. Yellow carrots have lutein, which is also good for the eyes. Studies have linked potatoes and their nutrients to a variety of impressive health benefits, including improved blood sugar control, reduced heart disease risk, and higher immunity. They may also improve digestive health and combat signs of aging. • 22. Question A client has Gastroesophageal Reflux Disease (GERD). The nurse should teach the client that after every meal, the client should: o A. Rest in a sitting position o B. Take a short walk o C. Drink plenty of water o D. Lie down at least 30 minutes Correct Answer: B. Abdominal distention Abdominal distension may be associated with pain, may indicate perforation, a complication that could lead to peritonitis. Bowel perforation occurs in less than 0.3 % of cases, and infection is rarely reported. Complications typically are identified in the first 24 hours after the procedure. Perforation is identified due to fever, Option B: Walking after meals may cause regurgitation of stomach contents. Instruct the patient regarding eating small amounts of bland food followed by a small amount of water. Instruct to remain in an upright position at least 1–2 hours after meals, and to avoid eating within 2–4 hours of bedtime. Option C: The client should drink moderate amounts of water. Instruct the patient to avoid highly seasoned food, acidic juices, alcoholic drinks, bedtime snacks, and foods high in fat. These can reduce the lower esophageal sphincter pressure. Option D: Lying down would cause a reflux of the stomach contents. Avoid placing the patient in a supine position, have the patient sit upright after meals. Supine position after meals can increase regurgitation of acid. Gravity speeds up digestion and prevents reflux of stomach contents into the esophagus. Instruct to remain in an upright position at least 2 hours after meals; avoiding eating 3 hours before bedtime. Helps control reflux and causes less irritation from reflux action into the esophagus. • 23. Question After gastroscopy, an adaptation that indicates major complication would be: o A. Nausea and vomiting o B. Abdominal distention o C. Increased GI motility o D. Difficulty in swallowing o D. Clay-colored stools Correct Answer: D. Clay-colored stools Clay-colored stools are indicative of hepatic obstruction. Acute HAV infection is typically a self-limited illness characterized by nausea, vomiting, right upper quadrant abdominal discomfort, malaise, anorexia, myalgia, fatigue, and fever. Patients may develop dark urine and pale stools within a week, followed by jaundice, icteric (yellow-tinted) sclera, and pruritus. o Option A: Restlessness is not a symptom related to hepatitis A. The incubation period usually ranges from 14 to 28 days but can last up to 50 days. The severity of symptoms varies with age and comorbidities, particularly underlying chronic liver disease. Most children with acute HAV infection are asymptomatic. o Option B: One of the symptoms of hepatitis A is dark urine. Patients usually have elevated levels of serum alanine aminotransferase, aspartate aminotransferase, bilirubin, alkaline phosphatase, and lambda-glutamyl transpeptidase. These lab abnormalities typically resolve within 1 to 6 weeks following the onset of symptoms. o Option C: Sudden nausea and vomiting are some of the symptoms, but it is not of immediate concern. Extrahepatic manifestations rarely occur but may include pancreatitis, rash, acute kidney injury with interstitial nephritis or glomerulonephritis, pneumonitis, pericarditis, hemolysis, and acute cholecystitis. • 26. Question Which of the following antituberculosis drugs can damage the 8th cranial nerve? o A. Isoniazid (INH) o B. Para Aminosalicylic acid (PAS) o C. Ethambutol hydrochloride (Myambutol) o D. Streptomycin Correct Answer: D. Streptomycin Streptomycin is an aminoglycoside and damage to the 8th cranial nerve (ototoxicity) is a common side effect of aminoglycosides. Ototoxicity and vestibular impairment are often thought to be the hallmark of streptomycin toxicity. In extreme cases, deafness may occur due to ototoxicity, thus caution must be exercised when combining streptomycin with other potentially ototoxic drugs. Vestibular impairment usually manifests during the course of treatment and is typically permanent. o Option A: Isoniazid may cause serious damage to the liver. Isoniazid is metabolized primarily by the liver, by acetylation of N-acetyltransferase 2 (NAT2). Three metabolites have implications that correlate with the liver injury associated with the drug: acetyl hydrazine (AcHz), hydrazine (Hz), and a metabolite from the bioactivation of isoniazid itself. There is considerable variation in acetylation rate and elimination half-life from individual to individual, which is not accounted for by dose and concentration, and this appears to contribute to risk for hepatotoxicity as well as the other adverse effects associated with isoniazid. o Option B: Despite having excellent efficacy against TB in both in vitro experiments and clinical trials, PAS was eventually replaced with better-tolerated ethambutol due to gastrointestinal disturbance associated with the usage of PAS. o Option C: One of the most well-known adverse effects is ototoxicity. The effect of ototoxicity is dose-related, with greater than 40% of adults developing toxicity at doses that were greater than 50 mg/kg and around 0 to 3% of adults developing toxicity at 15 mg/kg/daily. The manifestation of EMB-induced optic neuropathy appears to be from EMB’s chelation of copper. A study with 60 patients undergoing treatment with ethambutol monitored their serum copper levels. • 27. Question Option A: Bile green color of gastric drainage is due to the presence of bile and is not expected during the first 12 to 24 hours. Normal color of gastric drainage is light yellow to green in color due to the presence of bile. Option B: Bloody drainage may be expected in the first 6 to 12 hours after gastric surgery but must be monitored closely. Bright red blood may indicate bleeding from the esophagus, the stomach or swallowed from the lungs Correct Answer: D. Dark brown 12 to 24 hours after subtotal gastrectomy gastric drainage is normally brown, which indicates digested food. Assess color, amount, and odor of gastric drainage, noting any changes in these parameters or the presence of clots or bright bleeding. Initial drainage is bright red. It becomes dark, then clear or greenish-yellow over the first 2 to 3 days. A change in the color, amount, or odor may indicate a complication such as hemorrhage, intestinal obstruction, or infection. • 28. Question Ryan has undergone a subtotal gastrectomy. The nurse should expect that nasogastric tube drainage will be what color for about 12 to 24 hours after surgery? o A. Bile green o B. Bright red o C. Cloudy white o D. Dark brown relievers, and use of certain medications along with NSAIDs. Apart from NSAIDs, corticosteroids, bisphosphonates, potassium chloride, steroids, and fluorouracil have been implicated in the etiology of PUD. Smoking also appears to play a role in duodenal ulcers, but the correlation is not linear. Alcohol can irritate o Option A: Watching a circus would require a lot of eye movement and might strain the eyes. It is normal for vision to be blurry in the beginning – the eye needs to heal and adjust. Vision will normally begin to improve within a few days of the surgery. It’s also normal for the eye to feel itchy and to experience mild discomfort for a couple of days – the doctor will ask the client to wear an eye patch or protective shield at night to Correct Answer: C. Watching TV Watching TV is permissible because the eye does not need to move rapidly with this activity, and it does not increase intraocular pressure. Once the patient gets home, it is recommended that they rest their eyes and nap. Several hours post-surgery, most people are able to watch some television or look at a computer screen for a short period of time. Because cataract surgery is only performed on one eye at a time, the patient may notice an imbalance in the vision until the second eye is operated on (usually 1–4 weeks later). • 29. Question Nurse Joan is assigned to come for a client who has just undergone eye surgery. Nurse Joan plans to teach the client activities that are permitted during the postoperative period. Which of the following is best recommended for the client? o A. Watching circus o B. Bending over o C. Watching TV o D. Lifting objects o Option C: Cloudy white drainage is not expected during the first 12 to 24 hours. Gastric aspirates were most frequently cloudy and green, tan or off-white, or bloody or brown. Intestinal fluids were primarily clear and yellow to bile-colored. In the absence of blood, pleural fluid was usually pale yellow and serous, and tracheobronchial secretions were usually tan or Correct Answer: A. Fracture Common signs and symptoms of fracture include pain, deformity, shortening of the extremity, crepitus and swelling. These injuries are associated with symptoms of pain, deformity, swelling, and a wound that may be bleeding. It should be noted that the wound may not lie directly over the fracture site. The movement and neurovascular status of all involved limbs should be assessed to ascertain whether or not there is a possible • 30. Question A client suffered from a lower leg injury and seeks treatment in the emergency room. There is a prominent deformity to the lower aspect of the leg, and the injured leg appears shorter than the other leg. The affected leg is painful, swollen and beginning to become ecchymotic. The nurse interprets that the client is experiencing: o A. Fracture o B. Strain o C. Sprain o D. Contusion ensure they don’t rub their eye while they sleep. This discomfort should disappear after a few days. o Option B: Bending over increases intraocular pressure. Immediately after the procedure, avoid bending over to prevent putting extra pressure on the eye. If at all possible, don’t sneeze or vomit right after surgery. Don’t rub the eye after surgery. o Option D: Lifting objects could cause an increase in intraocular pressure. Don’t do any heavy lifting or strenuous activity for a few weeks. Be careful walking around after surgery, and don’t bump into doors or other objects. Correct Answer: B. Peritonitis Complications of acute appendicitis are peritonitis, perforation and abscess development. Diffuse peritonitis ileostomy does not function for short periods of time after surgery. This is not usually a problem, but if the stoma is not active for more than 6 hours and the patient experiences cramps or nausea, he may have an obstruction. o Option B: Passage of a moderate amount of stool in the stoma is expected during the first few days after surgery. With no large intestine to absorb as much water from it, stool becomes thinner. Stools may thicken up as the body adapts and the small intestine starts to absorb more water, but this is something that happens long-term. At first, the stool will be thin and output may be high. o Option C: As the body gets used to the stoma and ileostomy, the presence of undigested food every now and then can be normal. However, this piece of food might obstruct the stoma and cause abdominal pain and swelling. Avoid solid foods for the time being and drink plenty of water. o Option D: 37.6ºC is more than the normal range of temperature. Nursing interventions such as a tepid sponge bath may be done to decrease the temperature to the normal range. Pouchitis is when an internal pouch becomes inflamed. It’s a common complication in people with an ileo-anal pouch. • 33. Question Jerry has been diagnosed with appendicitis. He develops a fever, hypotension, and tachycardia. The nurse suspects which of the following complications? o A. Intestinal obstruction o B. Peritonitis o C. Bowel ischemia o D. Deficient fluid volume develop, which may progress to significant morbidity and possible death. Postoperative abscesses, hematomas, and wound complications are all complications that can be seen after appendectomies. If the wound does get infected, one may grow Bacteroides. “Recurrent” appendicitis can occur if too much of the appendiceal stump is left after an appendectomy. o Option A: Signs of intestinal obstruction include crampy abdominal pain, loss of appetite, constipation, vomiting, inability to have a bowel movement or pass gas, and swelling of the abdomen. Complications of appendicitis and appendectomy include surgical site infections, intra-abdominal abscess formation (3% to 4% in open appendectomy and 9% to 24% in laparoscopic appendectomy), prolonged ileus, enterocutaneous fistula, and small bowel obstruction. o Option C: Symptoms of bowel ischemia include sudden abdominal pain, an urgent need to have a bowel movement, frequent, forceful bowel movements, abdominal distention or swelling, bloody stool, and mental confusion in older adults. o Option D: Deficient fluid volume may be characterized by hypotension, concentrated urine, decreased skin turgor, decreased urine output, and dry mucous membranes. If diagnosed and treated early, within 24 to 48 hours, the recovery and prognosis should be very good. Cases that present with advanced abscesses, sepsis, and peritonitis may have a more prolonged and complicated course, possibly requiring additional surgery or other interventions. • 34. Question Which of the following complications should the nurse carefully monitor a client with acute pancreatitis? o A. Myocardial Infarction o B. Cirrhosis o C. Peptic ulcer o D. Pneumonia Correct Answer: D. Pneumonia A client with acute pancreatitis is prone to complications associated with the respiratory system. The relationship between Mycoplasma pneumoniae infection and acute pancreatitis has been debated in the literature. In 1973, Mardh et al. reported four adult cases of acute pancreatitis following pneumonia due to MP; in three of the patients, the pancreatitis occurred in the 3rd week after the onset of cough, by which time the respiratory tract symptoms had almost disappeared. o Option A: Myocardial infarction is not a complication of pancreatitis. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent. o Option B: Kidney failure, not liver failure, can be caused by acute pancreatitis. Acute pancreatitis may cause kidney failure, which can be treated with dialysis if the kidney failure is severe and persistent. o Option C: Pancreatitis cannot cause peptic ulcer. It is most commonly caused by a bacteria called H. pylori. H. pylorus is a gram-negative bacillus that is found within the gastric epithelial cells. This bacterium is responsible for 90% of duodenal ulcers and 70% to 90% of gastric ulcers. H. pylori infection is more prevalent among those with lower socioeconomic status and is commonly acquired during childhood. • 35. Question Which of the following symptoms during the icteric phase of viral hepatitis should the nurse expect the client to inhibit? o A. Watery stool o B. Yellow sclera o C. Tarry stool o D. Shortness of breath o C. Steroids o D. Anticonvulsants Correct Answer: C. Steroids Glucocorticoids (steroids) are used for their anti- inflammatory action, which decreases the development of edema. Corticosteroids produce their effect through multiple pathways. In general, they produce anti-inflammatory and immunosuppressive effects, protein and carbohydrate metabolic effects, water and electrolyte effects, central nervous system effects, and blood cell effects. o Option A: Diuretics help rid the body of salt (sodium) and water. Most of them help the kidneys release more sodium into the urine. The sodium takes with it water from the blood, decreasing the amount of fluid flowing in the veins and arteries, thereby reducing blood pressure. Diuretics are a medication used in the management and treatment of edematous and other non-edematous disease conditions. Diuretics are a class of drugs. o Option B: Antihypertensive drugs comprise several classes of compound with the therapeutic intention of preventing, controlling, or treating hypertension. The classes of antihypertensive drugs differ both structurally and functionally. They are important in anaesthetic practice because they are commonly prescribed to the general population, with the overall prevalence of hypertension being 31% in the UK [defined by the National Institute for Health and Care Excellence (NICE) as a measurement of 140/90 mm Hg or higher in clinic, with subsequent ambulatory or home measurement of 135/85 mm Hg or higher]. o Option D: Anticonvulsants suppress the excessive rapid firing of neurons during seizures. Anticonvulsants, or antiepileptics, are an ever- growing class of medications that act through multiple different mechanisms to control seizures — antiepileptic toxicity commonly presents with a triad of symptoms, which includes central nervous system (CNS) depression, ataxia, and nystagmus. • 37. Question Halfway through the administration of blood, the female client complains of lumbar pain. After stopping the infusion Nurse Hazel should: o A. Increase the flow of normal saline o B. Assess the pain further o C. Notify the blood bank o D. Obtain vital signs. Correct Answer: A. Increase the flow of normal saline The blood must be stopped at once, and then normal saline should be infused to keep the line patent and maintain blood volume. Treatment is to stop the transfusion, leave the IV in place, intravenous fluids with normal saline, keeping urine output greater than 100 mL/hour, diuretics may also be needed and cardiorespiratory support as appropriate. A hemolytic workup should also be performed which includes sending the donor blood and tubing as well as post-transfusion labs (see below for list) from the recipient to the blood bank. o Option B: Assessing the pain further could delay any interventions that are needed to be done. Fatal hemolysis is extremely rare, occurring only in 1 out of nearly 2 million transfusions. It is the result of ABO incompatibility, and the recipient’s antibodies recognize and induce hemolysis in donor’s transfused cells. Patients will develop an acute onset of fevers and chills, low back pain, flushing, dyspnea as well as becoming tachycardic and going into shock. o Option C: The blood bank can be notified after stopping the infusion first. According to the American Association of Blood Banks (AABB), febrile reactions are the most common, followed by transfusion- associated circulatory overload, allergic reaction, TRALI, hepatitis C viral infection, hepatitis B viral infection, human immunodeficiency virus (HIV) infection, and fatal Correct Answer: D. Cottage cheese One cup of cottage cheese contains approximately 225 calories, 27 g of protein, 9 g of fat, 30 mg cholesterol, and 6 g of carbohydrate. Proteins of high biological value (HBV) contain optimal levels of amino acids essential for life. In general, proteins from animal sources have a higher biological value than proteins from plant sources. • 39. Question Nurse Maureen is aware that a client who has been diagnosed with chronic renal failure recognizes an adequate amount of high- biological-value protein when the food the client selected from the menu was: o A. Raw carrots o B. Apple juice o C. Whole wheat bread o D. Cottage cheese o Option C: An associated opportunistic infection is one of the complications of HIV. In individuals with chronic HIV infection not on treatment with antiretroviral agents, as the CD4+ count drops they are vulnerable to a multitude of infections which rarely occur in an immunocompetent host, hence the term opportunistic infections (OIs). o Option D: These are symptoms of HIV, but these do not determine a positive diagnosis. A large number of patients may only have an asymptomatic infection after the exposure. The usual time from exposure to onset of symptoms is 2 to 4 weeks, although, in some cases, it can be as long as 10 months. A constellation of symptoms, known as an acute retroviral syndrome, may appear acutely. Although none of these symptoms are specific to HIV, Correct Answer: A. Flapping hand tremors Elevation of uremic waste products causes irritation of the nerves, resulting in flapping hand tremors. The classic description has been in hepatic diseases but other causes can commonly cause asterixis including azotemia and Option A: Raw carrots are rich in beta-carotene and sodium. Plants, legumes, grains, nuts, seeds and vegetables provide low biological value proteins. Option B: Apple juice is rich in carbohydrates and fiber. Omnivorous diets (containing foods derived from animals and plants) in the developed world provide adequate amounts of protein. However, subgroups of the population who avoid all foods of animal origin may have difficulties in meeting their protein requirements. Option C: Whole wheat bread contains high amounts of fiber and carbohydrates. However, as the limiting amino acid tends to be different in different vegetable proteins, combination of vegetable sources of proteins in the same meal (e.g. legumes or pulses with cereals), can result in a mix of higher biological value. These combinations are generally found in traditional culinary recipes from the different continents (e.g. beans with rice/pasta/manioc, chick-peas with bread, lentils with potatoes, etc). poultry, fish, eggs, milk, cheese and yogurt, and they provide high biological value proteins. • 40. Question Kenneth, who was diagnosed with uremic syndrome has the potential to develop complications. Which among the following complications should the nurse anticipates: o A. Flapping hand tremors o B. An elevated hematocrit level o C. Hypotension o D. Hypokalemia Asterixis is a disorder of motor control characterized by an inability to actively maintain a position and consequent irregular myoclonic lapses of posture affecting various parts of the body independently. o Option B: Hematocrit levels in uremic syndrome are usually very low, which leads to a higher risk of starting dialysis. Anemia-induced fatigue is thought to be one of the major contributors to the uremic syndrome. Erythropoietin (EPO), a hormone necessary for red blood cell production in bone marrow, is produced by peritubular cells in the kidney in response to hypoxia. o Option C: Life-threatening complications, such as hypertension, occur in clients with uremic syndrome. Cardiac arrest may occur from severe underlying electrolyte abnormalities, such as hyperkalemia, metabolic acidosis, or hypocalcemia. Renal dysfunction may contribute to associated fluid retention, which may lead to uncontrolled hypertension and congestive heart failure. o Option D: Several underlying electrolyte abnormalities such as hyperkalemia and hypocalcemia leads to cardiac arrest. Hyperkalemia (potassium >6.5 mEq/L) may be an acute or chronic manifestation of renal failure, but regardless of the etiology, a potassium level of greater than 6.5 mEq/L is a clinical emergency. As renal function declines, the nephron is unable to excrete a normal potassium load, which can lead to hyperkalemia if dietary intake remains constant. • 41. Question A client is admitted to the hospital with benign prostatic hyperplasia, the nurse most relevant assessment would be: o A. Flank pain radiating in the groin o B. Distention of the lower abdomen o C. Perineal edema o B. Apply warm soaks in the scrotum o C. Elevate the scrotum using a soft support o D. Prepare for a possible incision and drainage Correct Answer: C. Elevate the scrotum using a soft support Elevation increases lymphatic drainage, reducing edema and pain. The penis should then be placed upward on the lower abdomen, to limit any downward curvature of this penis postoperatively. Scrotal support or tight mesh underwear may be used after the sterile dressing is removed. o Option A: Several warm baths per day, beginning on the third day after the procedure, would reduce the swelling. Most patients will stay in the hospital overnight following prosthesis placement. This allows for proper guidance on post-operative instructions, as well as the ability to remove the foley catheter without an additional visit to the outpatient clinic. o Option B: Warm baths, instead of soaks, are recommended after three days post surgery. After the penile implant procedure, it is common for bruises and swelling of the scrotum to occur. With several warm baths per day, beginning on the third day after the penile procedure, swelling slowly disappears over a 7 to 14 day period. As healing occurs and swelling disappears, the pain will gradually subside. o Option D: Edema and pain are normal manifestations 24 hours after the surgery. A short course of narcotic pain medication may be warranted. The patient is instructed to avoid any heavy lifting until the follow-up visit in 7-14 days. A drain may be placed if the patient is scheduled to stay in the hospital overnight. The drain may be removed on postoperative day number one at the same time as foley catheter removal. • 43. Question Nurse Hazel receives emergency laboratory results for a client with chest pain and immediately informs the physician. An increased myoglobin level suggests which of the following? o A. Liver disease o B. Myocardial damage o C. Hypertension o D. Cancer Correct Answer: B. Myocardial damage Detection of myoglobin is a diagnostic tool to determine whether myocardial damage has occurred. Myoglobin, an oxygen-carrying protein found in cardiac muscle and striated skeletal muscle, presents an attractive alternative to CPK and LDH in the emergency department setting for identification of acute myocardial infarction. Myoglobin levels may be elevated in the serum within one hour after myocardial cell death with peak levels reached within four to six hours. o Option A: Liver disease usually has elevated hepatic enzymes, elevated serum bilirubin, elevated serum ammonia, low levels of glucose, and elevated creatinine, among others. In chronic liver disease, there is inflammation and destruction of hepatocytes that leads to the release of aspartate aminotransferase (AST) and alanine aminotransferase (ALT), hence the high levels of these markers in the blood. Other parameters (ALP and GGT) of LFTs also appear elevated in cholestatic conditions like PBC. o Option C: Initial laboratory tests for hypertension may include urinalysis; fasting blood glucose; hematocrit; serum sodium, potassium, creatinine, and calcium; and lipid profile. The evaluation consists of looking for signs of end-organ damage and consists of the following: blood workup including complete blood count, ESR, creatinine, eGFR, electrolytes, HbA1c, thyroid profile, blood cholesterol levels, and serum uric acid; 12 lead ECG (to document left ventricular hypertrophy, cardiac rate, and rhythm); and urine albumin to creatinine ratio. o Option D: Cancer is diagnosed based on a number of diagnostic tests and procedures and radiology. The 2015 NHIS findings show that the utilization of cancer Correct Answer: C. Headache Because of its widespread vasodilating effects, nitroglycerin often produces side effects such as • 46. Question Nurse Hazel teaches the client with angina about common expected side effects of nitroglycerin including: o A. High blood pressure o B. Stomach cramps o C. Headache o D. Shortness of breath involvement or scope of problem. Severe hypertension is classified in the adult as a diastolic pressure elevation to 110 mmHg; progressive diastolic readings above 120 mmHg are considered first accelerated, then malignant (very severe). Systolic hypertension also is an established risk factor for cerebrovascular disease and ischemic heart disease, when diastolic pressure is elevated. o Option C: The client with hypertension experiences no fluid deficit. Note presence, quality of central and peripheral pulses. Bounding carotid, jugular, radial, and femoral pulses may be observed and palpated. Pulses in the legs and feet may be diminished, reflecting effects of vasoconstriction (increased systemic vascular resistance [SVR]) and venous congestion. o Option D: There is no pain experienced in hypertension. Auscultate heart tones and breath sounds. S4 heart sound is common in severely hypertensive patients because of the presence of atrial hypertrophy (increased atrial volume and pressure). Development of S3 indicates ventricular hypertrophy and impaired dizziness. Headaches can be severe, throbbing, and persistent and may occur immediately after use. Vasodilation and venous pooling can increase the amount of blood in the cranial space, resulting in increased intracranial pressures; this can cause persistent, throbbing headaches, along with confusion, fever, vertigo, nausea, vomiting, and visual disturbances. o Option A: Nitroglycerin produces hypotension instead of hypertension due to its vasodilating effects. Many of these adverse effects are secondary to the hypotensive effects of nitroglycerin. Patients may report symptoms of orthostatic hypotension which manifest as dizziness, weakness, palpitations, and vertigo. Profound hypotension may occur in patients with preload-dependent conditions. o Option B: Stomach cramps are not a side effect of nitroglycerin. Some patients can be more sensitive to the hypotension caused by nitrates, which can result in nausea, vomiting, diaphoresis, pallor, and collapse even at therapeutic doses. Nitroglycerin is both a protein-bound drug, and it undergoes hepatic metabolism. Therefore it has numerous drug interactions. Before prescribing, providers should determine if the patient is taking any medications that may interact with nitroglycerin. o Option D: Difficulty of breathing is one of the side effects of nitroglycerin. In the event of overdose, monitoring of vital signs may be necessary to monitor the hemodynamic effects of nitroglycerin. Continuous monitoring of blood pressure, heart rate, respiratory rate, and oxygen saturation is recommended. As intracranial pressure increases, symptoms will progress to dyspnea secondary to a reduced respiratory effort, heart block, bradycardia, paralysis, seizures, coma, and, eventually, death. • 47. Question The following are lipid abnormalities. Which of the following is a risk factor for the development of atherosclerosis and PVD? o © A. High levels of low-density lipid (LDL) cholesterol aneurysm since there are Option B: Vegetables are good sources of potassium, dietary fiber, folate, vitamin A, and vitamin C. Adding vegetables can help increase intake of fiber and potassium, which are important nutrients that many Americans do not get enough of in their diet. Option C: Grains are important sources of complex carbohydrates, dietary fiber, thiamin, riboflavin, niacin, folate, iron, magnesium, and selenium. Consuming whole grains as part of a healthy diet may reduce the risk of heart disease. Consuming whole grain foods that contain fiber, as part of an overall healthy diet, can support healthy digestion. Correct Answer: A. Dairy products Good sources of vitamin B12 are dairy products and meats. Among animal products, those from ruminants are particularly rich in vitamin B12, which is naturally synthesized by the ruminal microflora and transferred to milk. Dairy products retain, in general, a major part of the vitamin B12 naturally present in milk, some processing conditions may even add to the basal level by production of vitamin B12 from propionic bacteria in Swiss-type cheeses. • 49. Question Nurse Josie should instruct the client to eat which of the following foods to obtain the best supply of Vitamin B12? o A. Dairy products o B. Vegetables o C. Grains o D. Broccoli no GI complications associated with this surgery. The nurse should also auscultate for bowel sounds and convey the results to the interprofessional team so that feeding can be initiated. Prior to discharge, the pharmacist and nurse should educate the patient on the importance of medication compliance, the need o Option A: GI abnormalities may occur with aplastic anemia but it is not an alarming anomaly. Aplastic anemia presents at any age with equal distribution among gender and race. Symptoms related to the absent cell lineage (anemia, progressive weakness, pallor, and dyspnea; neutropenia, frequent and persistent minor infections, or sudden onset febrile illness; thrombocytopenia, ecchymoses, mucosal bleeding, and petechiae). Correct Answer: C. Bleeding tendencies Aplastic anemia decreases the bone marrow production of RBCs, white blood cells, and platelets. The client is at risk for bruising and bleeding tendencies. Aplastic anemia refers to the syndrome of chronic primary hematopoietic failure from injury leading to diminished or absent hematopoietic precursors in the bone marrow and attendant pancytopenia. • 50. Question Karen has been diagnosed with aplastic anemia. The nurse monitors for changes in which of the following physiologic functions? o A. Bowel function o B. Peripheral sensation o C. Bleeding tendencies o D. Intake and output o Option D: Broccoli is rich in fiber, vitamin C, potassium, vitamin B6, and vitamin A. Broccoli is also packed with phytochemicals and antioxidants. Phytochemicals are chemicals in plants that are responsible for color, smell and flavor. Research shows that they have numerous healthful benefits, according to the American Institute for Cancer Research. Phytochemicals in broccoli are good for the immune system. They include glucobrassicin; carotenoids, such as zeaxanthin and beta- Correct Answer: D. Gastric distension Acute Lymphocytic Leukemia (ALL) does not cause gastric distention. It does invade the central nervous system, and clients experience headaches and vomiting from meningeal irritation. The primary care provider and nurse practitioner may be responsible for follow up after treatment and report back to the interprofessional team. These patients need close monitoring as they are prone to infections, coagulation dyscrasias, and relapse. o Option A: Some effects of radiation are nauseas, vomiting, and headaches. The pharmacist should educate the patient on chemotherapy medications, their adverse • 53. Question Marie with acute lymphocytic leukemia suffers from nausea and headache. These clinical manifestations may indicate all of the following except: o A. Effects of radiation o B. Chemotherapy side effects o C. Meningeal irritation o D. Gastric distension is a disease with low incidence overall in population studies. The incidence of Acute Lymphocytic Leukemia is about 3.3 cases per 100,000 children. Survival rates for ALL have improved dramatically since the 1980s, with a current five-year overall survival rate estimated at greater than 85 percent. o Option D: Prognosis among older adults above 60 years old is poor. Prognosis is diminished in children when diagnosed in infants less than one year of age and in adults. It is more favorable for children. Correct Answer: B. Administering Coumadin Disseminated Intravascular Coagulation (DIC) has not been found to respond to oral anticoagulants such as Coumadin. Warfarin is contraindicated in patients with hemorrhagic tendencies (e.g., active GI ulceration, patients bleeding from the GI, respiratory, or GU tract; a cerebral aneurysm; central nervous system (CNS) hemorrhage; dissecting aortic aneurysm; spinal puncture and other diagnostic or therapeutic procedures with the • 54. Question A client has been diagnosed with Disseminated Intravascular Coagulation (DIC). Which of the following is contraindicated with the client? o A. Administering Heparin o B. Administering Coumadin o C. Treating the underlying cause o D. Replacing depleted blood products washing, washing of fruits and vegetables and maintaining good personal hygiene. o Option B: Chemotherapy side effects include nausea, vomiting, and hair loss. Treatment options include prochlorperazine, haloperidol, metoclopramide, lorazepam, dexamethasone, ondansetron, granisetron, dolasetron, palonosetron, dronabinol, aprepitant, fosaprepitant, netupitant. palonosetron has a longer half-life, better efficacy, and higher binding affinity than granisetron. o Option C: Clients may experience headaches and vomiting due to meningeal irritation. Meningitis can have a varied clinical presentation depending on age and immune status of the host. Symptoms typically include fever, neck pain/stiffness, and photophobia. More non-specific symptoms include o Option A: Heparin, an anticoagulant, is widely used during DIC treatment and in the prevention of thrombotic diseases. Heparin may also become necessary if a patient has extensive clotting as this medication may prevent further activation of the clotting cascade. Patients with DIC who are not actively bleeding should receive prophylactic anticoagulation with heparin or low molecular weight heparin (LMWH). o Option C: The DIC component will resolve on its own once the underlying disorder is addressed. The treatment for DIC centers on addressing the underlying disorder, which ultimately led to this condition. Consequently, therapies such as antibiotics for severe sepsis, possible delivery for placental abruption, and possible exploratory surgical intervention for trauma represent the mainstays of treatment for DIC. o Option D: Platelet and factor replacement should be directed not at simply correcting laboratory abnormalities but at addressing clinically relevant bleeding or meeting procedural needs. Platelet and plasma transfusions should only be considered in patients with active bleeding or a high risk of bleeding or those patients requiring an invasive procedure. A common threshold utilized for platelet transfusions in this patient population is less than 50 x 10^9 platelets per liter for actively hemorrhaging patients and 10-20 x 10^9 platelets per liter for those not actively bleeding but at high risk of future bleeding. • 55. Question Which of the following findings is the best indication that fluid replacement for the client with hypovolemic shock is adequate? o A. Urine output greater than 30ml/hr o B. Respiratory rate of 21 breaths/minute o C. Diastolic blood pressure greater than 90 mmHg Which of the following signs and symptoms would Nurse Maureen include in her teaching plan as an early manifestation of laryngeal cancer? o A. Stomatitis o B. Airway obstruction o C. Hoarseness o D. Dysphagia Correct Answer: C. Hoarseness Early warning signs of laryngeal cancer can vary depending on tumor location. Hoarseness lasting 2 weeks should be evaluated because it is one of the most common warning signs. Patients are typically male with a history of current or past tobacco smoking. Hoarseness is often an early presenting symptom of glottic cancers due to vocal cord immobility or fixation, with pain with swallowing and referred ear pain indicating advanced disease. o Option A: Stomatitis is one of the early signs of oral cancer. Oral mucosal cancer presents clinically in various ways depending on its location. Early disease may manifest as irregular white, red, or mixed patches on the mucosa. More established cancers appear as an indurated raised nodule, often with an ulcerated surface that may cause little pain. o Option B: Airway obstruction occurs in the late stage, when the swelling or lump in the neck increases in size, enough to obstruct the larynx. Nodal metastases present as fixed, firm, painless masses in the neck. Late symptoms across all subsites include weight loss, dysphagia, aspiration, and its sequelae, and airway compromise. The most crucial component of a physical examination is an invasive assessment of the primary lesion, including indirect laryngoscopy, mirror exam, and often fiberoptic endoscopy. o Option D: Dysphagia is one of the symptoms of laryngeal cancer, but it does not occur in the early stages. The majority of patients first present with hoarseness, otalgia, dysphagia and weight loss to the Correct Answer: C. Decreases the production of autoantibodies that attack the acetylcholine receptors. Steroids decrease the body’s immune response thus decreasing the production of antibodies that attack the acetylcholine receptors at the neuromuscular junction. Immunotherapy is used to upregulate or downregulate the immune system to achieve a therapeutic effect in immunological mediated disorders including immunodeficiencies, hypersensitivity reactions, autoimmune diseases, tissue and organ transplantations, malignancies, inflammatory disorders, infectious diseases, and any other disease, where immunotherapy can improve the quality and life expectancy. o Option A: Immunosuppressive therapies do not remove the antibodies, they reduce the production of these antibodies that attack the acetylcholine receptors at the neuromuscular • 57. Question Karina, a client with myasthenia gravis, is to receive immunosuppressive therapy. The nurse understands that this therapy is effective because it: o A. Promotes the removal of antibodies that impair the transmission of impulses o B. Stimulates the production of acetylcholine at the neuromuscular junction. o C. Decreases the production of autoantibodies that attack the acetylcholine receptors. o D. Inhibits the breakdown of acetylcholine at the neuromuscular junction. nurse practitioner or primary care provider. Patients are typically male with a history of current or past tobacco smoking. A referral to an ENT surgeon should be made if the hoarseness is prolonged and associated with Correct Answer: A. Accurate dose delivery These devices are more accurate because they are easy to use and have improved adherence to insulin regimens by young people because the medication can be administered discreetly. Once in use, most insulin analog vials, cartridges, and prefilled pens must be discarded after 28 days. This means that many patients who use a 10-ml vial end up either wasting insulin or using insulin beyond its recommended discard date. This is rarely a problem for patients using either a 3-ml prefilled pen or a reusable pen containing a 3-ml insulin cartridge. o Option B: Injection time of insulin pens and the traditional insulin syringes have no significant difference. Patients must therefore keep the device in place with the button pressed in for 5– 10 seconds. If the patient is using more than 50 units of insulin per dose, a good rule of thumb might be to instruct them to count to 10 regardless of the pen they are using to ensure complete absorption of the insulin. o Option C: An additional issue is the greater prescription cost of insulin cartridges and prefilled insulin pens compared with insulin vials, although the cost to the patient may be the same depending on their coverage; in fact, if they have one copay per box of pens, the cost to the patient may actually be less per unit of insulin. It should be noted, however, that despite the higher unit cost of insulin in pen devices versus vials, several studies have found that overall diabetes-related treatment costs are lower with pen devices than with vial and syringe. o Option D: For all insulin pen devices, a separate prescription for pen needles is required, with gauges ranging from 29 to 32 and in lengths from 5 to 12.7 mm, much like the traditional insulin syringes used. More recent developments have resulted in the introduction of safety needles with protective shields that not only reduce needle-stick injuries but may also allay patient anxieties about needle use. • 60. Question A male client’s left tibia was fractured in an automobile accident, and a cast is applied. To assess for damage to major blood vessels from the fracture tibia, the nurse in charge should monitor the client for: o A. Swelling of the left thigh o B. Increased skin temperature of the foot o C. Prolonged reperfusion of the toes after blanching o D. Increased blood pressure Correct Answer: C. Prolonged reperfusion of the toes after blanching Damage to blood vessels may decrease the circulatory perfusion of the toes, this would indicate the lack of blood supply to the extremity. If the intracompartmental pressure becomes higher than arterial pressure, a decrease in arterial inflow will also occur. The reduction of venous outflow and arterial inflow result in decreased oxygenation of tissues causing ischemia. If the deficit of oxygenation becomes high enough, irreversible necrosis may occur. o Option A: Compartment syndrome is one of the most serious complications of casting. Symptoms may include swelling, delayed capillary refill, or dusky appearance of exposed extremities. Beware that the presence or absence of a palpable arterial pulse may not accurately indicate relative tissue pressure or predict the risk for compartment syndrome. In some patients, a pulse is still present, even in a severely compromised extremity. o Option B: Thermal injuries to the skin can occur as a result of casting. In the initial stages, pain may be characterized as a burning sensation or as a deep ache of the involved compartment. Paresthesia, hypoesthesia, or poorly localized deep muscular pain may also be present. o Option D: Increased blood pressure is not a symptom of damage to the major blood vessels. Classically, the presentation of acute compartment syndrome has been remembered by “The Five P’s”: pain, • 62. Question While performing a physical assessment of a male client with gout of the great toe, Nurse Vivian should assess for additional tophi (urate deposits) on the: o A. Buttocks o B. Ears o C. Face o D. Abdomen Correct Answer: B. Ears Uric acid has a low solubility, it tends to precipitate and form deposits at various sites where blood flow is least active, including cartilaginous tissue such as the ears. Tophi, which are subcutaneous depositions of urate that form nodules, can also be found in patients with persistent hyperuricemia. Tophi typically occur in the joints, ears, finger pads, tendons, and bursae. o Option A: The buttocks are incredibly vascular areas making it a rare location for the growth of tophi. In a patient who is having a gout flare-up, the symptoms are often apparent. The most commonly involved joint is the first metatarsophalangeal joint. The talar, subtalar, ankle, and knee can also be involved in some cases. o Option C: Tophi rarely grow on the face; they are found most commonly on the fingers, toes, wrists, and ears. Although affliction of the joints mentioned above is common in gout, the physician should pay attention to other joints, specifically those joints with underlying osteoarthritis. Besides joints, other periarticular structures such as tendons and bursa may also be affected. o Option D: The abdomen is not a location for tophi growth because it occurs most cast, physical therapy may be beneficial to help the client to return to normal everyday activities, work, or even sports activities. commonly in least o Option A: Placing the weight on the palms of the hands are correct, but the nerves of the axillary area could be damaged if it bears the client’s weight. Crutch palsy is observable in axilla crutch users who rest their weight on the shoulder rest. The pressure on the brachial plexus can result in palsy to the radial and ulnar nerves. Extra padding on the shoulder rest can aid in preventing crutch palsy. Education should be provided to patients to discourage supporting body weight on the shoulder rest. With treatment, this can be a repairable injury. Correct Answer: B. Palms of the hand The palms should bear the client’s weight to avoid damage to the nerves in the axilla. This is the most used technique. The left and right crutch along with the injured leg are both advanced while the uninjured leg supports the body weight. Next, the uninjured leg is advanced. Hand grips are part of each class of crutches. They serve as a significant connection between the crutch and the user. Hand grips have always been adjustable in the up, down, forward and back positioning depending on the crutch. • 63. Question Nurse Katrina would recognize that the demonstration of crutch walking with tripod gait was understood when the client places weight on the: o A. Palms of the hands and axillary regions o B. Palms of the hand o C. Axillary regions o D. Feet, which are set apart vascular areas or in joints. The physical exam findings align with the patient history. The affected joint is typically red, swollen, warm, and tender. In patients with chronic gout, the flare-up may involve multiple joints. With the involvement of many joints, it can cause a systemic inflammatory response syndrome may reflect development or resolution of spinal cord edema and inflammation of the tissues secondary to damage to motor nerve roots from surgical manipulation. o Option A: After surgery, the bowel and bladder patterns of the client would not immediately return to normal. The anesthesia would take time to wear off. Catheterize for bladder residual after voiding, when indicated. Insert and maintain indwelling catheter as needed. Intermittent or continuous catheterization may be necessary for several days postoperatively until the swelling is decreased. o Option B: Keeping the spine aligned correctly is important after surgery in order to minimize its workload and reduce the risk of disrupting the healing process. Only physical and occupational therapists would be allowed to work with the patient regarding his activity. Logroll patient from side to side. Have the patient fold arms across the chest, tighten long back muscles, keeping shoulders and pelvis straight. Use pillows between knees during position change and when on the side. Use a turning sheet and sufficient personnel when turning, especially on the first postoperative day. o Option D: Drinking immediately after surgery would not be allowed since the gag reflex has not yet returned to normal. Choking would be a great risk. After the test, urge the patient to remain in bed with his head elevated, especially if metrizamide was used. To relieve the patient from discomfort and frustration of low back pain. • 66. Question Marina with acute renal failure moves into the diuretic phase after one week of therapy. During this phase the client must be assessed for signs of developing: o A. Hypovolemia o B. Renal failure o C. Metabolic acidosis o D. Hyperkalemia Correct Answer: A. Hypovolemia In the diuretic phase fluid retained during the oliguric phase is excreted and may reach 3 to 5 liters daily, hypovolemia may occur and fluids should be replaced. The diuretic stage usually lasts for 1-2 weeks but can persist longer. In this stage, an increase in urine output is noted and uremia begins to resolve as the kidney continues to heal. o Option B: The client is already experiencing renal failure. In the initiating stage, which begins when the kidney is injured and lasts from hours to days, signs of renal impairment are present such as altered BUN and creatinine levels and decreased urine output. During this phase, the cause of acute renal failure is sought and treatment is initiated. o Option C: Metabolic acidosis is caused by a build-up of too many acids in the blood. Differentiating between pre-renal azotemia and ATN can be difficult. In prerenal azotemia, urine output is diminished. In ATN, urine output may or may not be diminished. In pre-renal assaults, the urinalysis will show normal urinary sediment with hyaline or granular casts, high specific gravity, high osmolality, low urinary sodium and urea, and normal urine creatinine. o Option D: People with chronic kidney disease have a high risk for hyperkalemia, due in part to the effects of kidney dysfunction on potassium homeostasis. Other complications can include cardiac arrest from hyperkalemia due to the decrease in urine output, elevated phosphorus levels due to impaired renal regulation of calcium and phosphates, metabolic acidosis due to decreases in excretion hydrogen ions, GI bleeding, and decreased nutritional status. In treating hyperkalemia, all sources of dietary potassium should be stopped and a low potassium diet prescribed. • 67. Question Nurse Judith obtains a specimen of clear nasal drainage from a client with a head injury. Which of the following tests differentiates mucus from cerebrospinal fluid (CSF)? o A. Protein o B. Specific gravity o C. Glucose o D. Microorganism Correct Answer: C. Glucose The constituents of CSF are similar to those of blood plasma. An examination for glucose content is done to determine whether a body fluid is a mucus or a CSF. A CSF normally contains glucose. A true normal range cannot be given for CSF glucose. As a general rule, CSF glucose is about two thirds of the serum glucose measured during the preceding two to four hours in a normal adult. This ratio decreases with increasing serum glucose levels. CSF glucose levels generally do not go above 300 mg per dL (16.7 mmol per L) regardless of serum levels. o Option A: Testing for protein would not differentiate mucus from CSF because CSF does not contain protein. CSF protein concentration is one of the most sensitive indicators of pathology within the CNS. Newborn patients have up to 150 mg per dL (1.5 g per L) of protein. The adult range of 18 to 58 mg per dL (0.18 to 0.58 g per L) is reached between six and 12 months of age. o Option B: The specific gravity of CSF at normal body temperature remains between 1.004 and 1.003. Cerebrospinal fluid is alleged to have markedly varied readings: extravagant differences are quoted-1.004 to 1.012, and even greater diversities. If such estimates were arrived at by some form of small hydrometer, or there was delay in testing, or no account was taken of the temperature of the fluid at the moment, then such computed answers were inevitable. o Option D: If microorganisms are found in