NCLEX-RN Exam Pack Set 12 (75 Questions with Answers, Exams of Nursing

Download NCLEX-RN Exam Pack Set 12 (75 Questions with Answers and more Exams Nursing in PDF only on Docsity! NCLEX-RN Exam Pack Set 12 (75 Questions with Answers 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 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. • 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. • 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 not the most accurate indicator of renal function. 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 stiffness or tension in the muscles of the arms, • 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 of what’s happening. During a generalized seizure, the 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 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, the sympathetic nervous system causes the release of vasoconstricting • 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. • 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 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. 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 afterward. • 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: 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 • 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 insight into the dialogue of Correct Answer: A. Pressure in the portal vein Enlarged cirrhotic liver impinges the portal system causing increased hydrostatic pressure resulting in ascites. Portal pressure increases above a critical threshold and 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 experienced • 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 arising from calcium deficiencies such as hypocalcemic tetany, 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, carrots, mangoes and tomatoes. 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: A. Rest in a sitting position It may take 4 to 6 months to eat anything, but most people can eat anything they want. Start with clear liquids after the surgery to prevent nausea, vomiting, and constipation, (soup, Jell-O, juices, popsicles, and carbonated beverages.) then advance to a regular low-fat diet. Eat smaller meals more often instead of fewer larger meals. o Option A: A high protein diet is unnecessary. A healthy meal should include small amounts of lean protein. If the patient has diarrhea, he should try avoiding spicy foods, dairy products, fatty foods, and alcohol. If diarrhea continues for more than 2 weeks, he should talk to his doctor. o Option B: High-fat foods should be avoided not only before the surgery, but it should be restricted a week after surgery as well. The patient can eat a normal diet, but avoid eating fatty foods for about one (1) month. Fatty foods include hamburgers, whole milk, cheese, and many snack foods. If the stomach is upset, try bland, low-fat foods like plain rice, broiled chicken, toast, and yogurt o Option C: Fatty foods, fried and greasy foods, and sauces should be avoided for at least a week after surgery. Eat lots of whole grains, fruits, and green leafy vegetables. Avoid foods that cause constipation such as dairy products, red meat, processed foods such as pizza, frozen dinners, pasta, and sugar products such as cakes, pies, pastries, doughnuts, and drinks containing caffeine. • 25. Question Nurse Rachel teaches a client who has been recently diagnosed with hepatitis A about untoward signs and symptoms related to Hepatitis that may develop. The one that should be reported immediately to the physician is: o A. Restlessness o B. Yellow urine o C. Nausea 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. certain pain • 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 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. 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 the gastric mucosa and induce acidity. • 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 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). 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 off- white mucus. • 32. Question Nurse Bea should instruct the male client with an ileostomy to report immediately which of the following symptoms? o A. Absence of drainage from the ileostomy for 6 or more hours o B. Passage of liquid stool in the stoma o C. Occasional presence of undigested food o D. A temperature of 37.6 °C Option A: For adults, pull the auricle backward and upward to prepare the ear for insertion of the drop and ensure the drop reaches the required area. If the bottle has a dropper, draw some liquid into the dropper. If the bottle has a dropper tip, you’ll just need to turn the bottle upside down. Option B: If indicated, the solution can be warmed by rolling the bottle in the hands for several minutes before the instillation. Warm the ear drops by holding the bottle in both hands for one to two minutes. This can help reduce any discomfort that could be caused by cold drops in the ear. Option D: Side-lying position is the best position for instillation of the drops and this also ensures comfort for the service user. Position the head so that the ear faces upward. If giving the drops to someone else, it may be easiest if the person tilts their head or lies down on their side. The dropper should not touch any object or any part of the client’s ear. Don’t allow the dropper tip to touch the ear, fingers, or any other surface. It could pick up bacteria or other germs that can lead to an ear infection. Correct Answer: A. Absence of drainage from the ileostomy for 6 or more hours Sudden decrease in drainage or onset of severe abdominal pain should be reported immediately to the physician because it could mean that obstruction has been developed. Sometimes the 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 Correct Answer: B. Peritonitis Complications of acute appendicitis are peritonitis, perforation and abscess development. Diffuse peritonitis and sepsis can also o D. Shortness of breath Correct Answer: B. Yellow sclera Liver inflammation and obstruction block the normal flow of bile. Excess bilirubin turns the skin and sclera yellow and the urine dark and frothy. After 3 to 10 days, the urine darkens, followed by jaundice. Systemic symptoms often regress, and patients feel better despite worsening jaundice. The liver is usually enlarged and tender, but the edge of the liver remains soft and smooth. Mild splenomegaly occurs in 15 to 20% of patients. Jaundice usually peaks within 1 to 2 weeks. o Option A: Watery stools or gastroenteritis occurs during the prodromal phase of the disease. Nonspecific symptoms occur; they include profound anorexia, malaise, nausea and vomiting, a newly developed distaste for cigarettes (in smokers), and often fever or right upper quadrant abdominal pain. Urticaria and arthralgias occasionally occur, especially in HBV infection. o Option C: Patients develop pale-colored stools during the icteric phase, not tarry stools. Manifestations of cholestasis may develop during the icteric phase (called cholestatic hepatitis) but usually resolve. When they persist, they cause prolonged jaundice, elevated alkaline phosphatase, and pruritus, despite general regression of inflammation. o Option D: Some may develop an aversion to cigarette smoke during the prodromal phase of the disease, but shortness of breath rarely occurs in this case. Patients experience anorexia, nausea, vomiting, alterations in taste, arthralgias, malaise, fatigue, urticaria, and pruritus, and some develop an aversion to cigarette smoke. • 36. Question Marco, who was diagnosed with a brain tumor, was scheduled for craniotomy. In preventing the development of cerebral edema after surgery, the nurse should expect the use of: o A. Diuretics o B. Antihypertensive • 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 hemolysis which is extremely rare, • 38. Question Nurse Maureen knows that the positive diagnosis of HIV infection is made based on which of the following: o A. A history of high-risk sexual behaviors. o B. Positive ELISA and western blot tests o C. Identification of an associated opportunistic infection o D. Evidence of extreme weight loss and high fever Option A: History of high-risk sexual behavior is one of the risk factors that predisposes a patient to HIV. In the United States, a critical risk factor for HIV propagation among young people is the use of drugs before having sex, including marijuana, alkyl nitrites (“poppers”), cocaine, and ecstasy. Other risk factors associated with acquiring HIV infection include men who have sex with men, unsafe sexual practices, the use of intravenous drugs, vertical transmission, and blood transfusions or blood products. Correct Answer: B. Positive ELISA and western blot tests These tests confirm the presence of HIV antibodies that occur in response to the presence of the human immunodeficiency virus (HIV). When there is a possibility of acute or early HIV infection, the most sensitive screening immunoassay available (ideally, a combination antigen/antibody immunoassay) in addition to an HIV virologic (viral load) test is performed. RT-PCR based viral load test is favored. A positive HIV virologic test generally indicates HIV infection. only occurring almost 1 in 2 million transfused units of RBC. o Option D: Vital signs could be obtained after stopping the infusion and infusing normal saline. There are multiple complications of blood transfusions, including infections, hemolytic reactions, allergic reactions, transfusion-related lung injury (TRALI), transfusion- associated circulatory overload, and electrolyte imbalance. 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 D. Urethral discharge Correct Answer: B. Distention of the lower abdomen This indicates that the bladder is distended with urine, therefore palpable. In the elective setting, the examination should include abdominal examination (looking for a palpable bladder/loin pain) and examination of external genitalia (meatal stenosis or phimosis). Benign prostatic hyperplasia (BPH) refers to the nonmalignant growth or hyperplasia of prostate tissue and is a common cause of lower urinary tract symptoms in men. o Option A: Flank pain is a vague symptom associated with urinary system infections. Lower urinary tract symptoms can be divided into storage (frequency, nocturia, urgency) and voiding symptoms (stream, straining, hesitancy, prolonged micturition) and can help establish other causes of urinary symptoms such as urinary tract infections/overactive bladder, in addition to determining the site affected (bladder vs. prostate). o Option C: BPH only occurs in older men. Disease prevalence has been shown to increase with advancing age. Indeed the histological prevalence of BPH at autopsy is as high as 50% to 60% for males in their 60’s, increasing to 80% to 90% of those over 70 years of age. o Option D: Urethral discharge is not a manifestation of BPH. Men with BPH are likely to report predominant symptoms of nocturia, poor stream, hesitancy, or prolonged micturition. The examination should then conclude with a digital rectal examination making a note in particular of the size, shape (how many lobes), and consistency (smooth/hard/nodular) of the prostate (BPH is characterized by a smooth enlarged prostate). • 42. Question A client has undergone a penile implant. After 24 hrs of surgery, the client’s scrotum was edematous and painful. The nurse should: co o A. Assist the client with sitz bath 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 • 44. Question Nurse Maureen would expect a client with mitral stenosis would demonstrate symptoms associated with congestion in the: o A. Right atrium o B. Superior vena cava o C. Aorta o D. Pulmonary Option A: In mitral stenosis, the left atrium is the one which has difficulty in emptying its content, not the right atrium. Mitral valve area less than 1 square centimeter causes an increase in left atrial pressure. The normal left ventricular diastolic pressure is 5 mmHg. A pressure gradient across the mitral valve of 20 mmHg due to severe mitral stenosis will cause a left atrial pressure of about 25 mmHg. This left atrial pressure is transmitted to the pulmonary vasculature resulting in pulmonary hypertension. Correct Answer: D. Pulmonary When mitral stenosis is present, the left atrium has difficulty emptying its contents into the left ventricle because there is no valve to prevent backward flow into the pulmonary vein, the pulmonary circulation is under pressure. Mitral valve areas less than 2 square centimeters causes an impediment to the blood flow from the left atrium into the left ventricle. This creates a pressure gradient across the mitral valve. As the gradient across the mitral valve increases, the left ventricle requires the atrial kick to fill with blood. screening tests for cervical, colorectal, and breast cancer was below Healthy People 2020 target. In 2015, rates for Pap tests, mammography, colorectal cancer screening were 80%, 70%, and just above 60 %, respectively, whereas the HP 2020 targets are 93% for Pap tests, 81% for mammography, • 45. Question A client has been diagnosed with hypertension. The nurse priority nursing diagnosis would be: o A. Ineffective health maintenance o B. Impaired skin integrity o C. Deficient fluid volume o D. Pain o Option B: Superior vena cava (SVC) syndrome is a collection of clinical signs and symptoms resulting from either partial or complete obstruction of blood flow through the SVC. This obstruction is most commonly a result of thrombus formation or tumor infiltration of the vessel wall. The most common signs and symptoms include face or neck swelling, upper extremity swelling, dyspnea, cough, and dilated chest vein collaterals. o Option C: Aortic regurgitation is a condition in which the aortic valve does not close properly, allowing blood to leak from the aorta back into the heart’s left ventricle. This leakage increases the left ventricle’s volume load, causing it to Correct Answer: A. Ineffective health maintenance Managing hypertension is the priority for the client with hypertension. Clients with hypertension frequently do not experience pain, deficient volume, or impaired skin integrity. It is the asymptomatic nature of hypertension that makes it so difficult to treat. Monitor and record BP. Measure both arms and thighs three times, 3–5 min apart while the patient is at rest, then sitting, then standing for initial evaluation. Use correct cuff size and accurate technique. o Option B: Impaired skin integrity is an inappropriate nursing diagnosis because there is no alteration in the skin in hypertension. o A. High levels of low-density lipid (LDL) cholesterol o B. High levels of high-density lipid (HDL) cholesterol o C. Low concentration triglycerides o D. Low levels of LDL cholesterol. Correct Answer: A. High levels of low-density lipid (LDL) cholesterol An increase in LDL cholesterol concentration has been documented as a risk factor for the development of atherosclerosis. LDL cholesterol is not broken down into the liver but is deposited into the wall of the blood vessels. As the LDL particles leave the blood and enter the arterial intima, they accumulate by being trapped by proteoglycans and are modified. While the modifications of LDL are not elucidated, oxidative modification generating oxidized LDL appears to be an attractive candidate. o Option B: High-density lipids are called the “good” cholesterol. They absorb cholesterol and carry it back to the liver. The liver then flushes it from the body. HDL is known for its anti- atherogenic and anti- inflammatory properties, thanks to its uptake and return of the cholesterol stored in the foam cells of atherosclerotic plaques to the liver. Thus, reducing the size of the plaque and its associated inflammation. o Option C: Triglycerides are the type of fat found in the blood. When we eat, the body converts any calories it doesn’t need to use right away into triglycerides. These are stored into fat cells. Later, hormones release triglycerides for energy between meals. o Option D: Low levels of LDL or the “bad” cholesterol reduces the risk for atherosclerosis and PVD. Modified LDL is taken up by scavenger receptors (SR) such as SRA and CD36 resulting in foam cell formation since cellular cholesterol content does not regulate these SRs. Following endothelial dysfunction induced by LDL, smoking, diabetes, hypertension, among others, there is a deficiency of NO and prostacyclin and/or an increase in plasminogen activator inhibitor type 1 (PAI- 1) and cell adhesion molecules (CAMs). • 48. Question Which of the following represents a significant risk immediately after surgery for repair of aortic aneurysm? o A. Potential wound infection o B. Potential ineffective coping o C. Potential electrolyte imbalance o D. Potential alteration in renal perfusion Correct Answer: D. Potential alteration in renal perfusion There is a potential alteration in renal perfusion manifested by decreased urine output. The altered renal perfusion may be related to renal artery embolism, prolonged hypotension, or prolonged aortic cross-clamping during the surgery. Intervention or surgical treatment risks versus benefits of repair in patients at increased risk for open surgery should be considered, and no intervention may be appropriate in some cases. Patients should be well informed regarding their options, risks of repair, and potential postoperative complications. o Option A: Wound infection may occur with a poorly dressed postoperative site, but it is not a priority after surgery. During postoperative care, the nurse has to be familiar with potential complications of the surgery and notify the interprofessional team if the patient has abdominal or back pain, wound discharge, fever, oliguria, or hypotension. o Option B: Ineffective coping can be a possible diagnosis after a surgery, however, it is not considered as an immediate risk. The nurse should also ensure that the appropriate consulting physician/dietitian/social workers have seen the patient and the surgeon notified prior to discharge. Open communication between the interprofessional team is vital to ensure good outcomes. o Option C: Electrolyte imbalance cannot be considered a potential diagnosis for a client who just had a surgery for repair of aortic aneurysm since there are • 51. Question Lydia is scheduled for elective splenectomy. Before the client goes to surgery, the nurse in charge final assessment would be: o A. Signed consent o B. Vital signs o C. Name band o D. Empty bladder Option A: A signed consent is needed as soon as the client has consented to the procedure. General anesthesia is required. The patient is placed in the supine position, with the arms extended. The surgeon stands on the patient’s right side with the assistant opposite. Correct Answer: B. Vital signs An elective procedure is scheduled in advance so that all preparations can be completed ahead of time. The vital signs are the final check that must be completed before the client leaves the room so that continuity of care and assessment is provided for. o Option B: Peripheral sensation among clients with aplastic anemia are unaffected. Splenomegaly is not seen, and its presence suggests an alternative diagnosis. Labs will demonstrate macrocytic normochromic anemia with reticulopodia, neutropenia, and thrombocytopenia. There must be no cytologic abnormalities as this would suggest an underlying hematologic process. o Option D: Intake and output may be disturbed, especially if the client is undergoing chemotherapy, but it can be managed. The most common complications of aplastic anemia include bleeding, infections, or transformation to lymphoproliferative disorders. These are managed by surveillance • 52. Question What is the peak age range for acquiring acute lymphocytic leukemia (ALL)? o A. 4 to 12 years. o B. 20 to 30 years o C. 40 to 50 years o D. 60 to 70 years Option B: There are rare incidences of ALL between the ages of 20 to 30 years. Acute Lymphocytic Leukemia is more common in children with Trisomy 21 (Down syndrome), neurofibromatosis type 1, Bloom syndrome, and ataxia telangiectasia. All are common in children between two and three years of age. Option C: Adults between 40 to 50 years old very rarely have cases of ALL. Acute Lymphocytic Leukemia Correct Answer: A. 4 to 12 years. The peak incidence of Acute Lymphocytic Leukemia (ALL) is 4 years of age. It is uncommon after 15 years of age. It is diagnosed in about 4000 people in the United States each year with the majority being under the age of 18. It is the most common malignancy of childhood. The peak age of diagnosis is between two and ten years of age. o Option C: Name bands are given to the client upon admission. Sequential compression devices are used before the operation begins. Preoperative antibiotics are given within 60 minutes of the skin incision. The skin is prepared and draped with aseptic technique in the standard surgical fashion. o Option D: The client may empty the bladder prior to surgery, but it is not of the utmost importance. Before open splenectomy, a Foley catheter should be placed. An orogastric or nasogastric tube should be inserted during intubation and removed postoperatively as • 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: 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 effects, and benefits. o D. Systolic blood pressure greater than 110 mmHg Correct Answer: A. Urine output greater than 30ml/hr Urine output provides the most sensitive indication of the client’s response to therapy for hypovolemic shock. Urine output should be consistently greater than 30 to 35 mL/hr. Renal losses of salt and fluid can lead to hypovolemic shock. The kidneys usually excrete sodium and water in a manner that matches intake. Diuretic therapy and osmotic diuresis from hyperglycemia can lead to excessive renal sodium and volume loss. In addition, there are several tubular and interstitial diseases beyond the scope of this article that cause severe salt- wasting nephropathy. o Option B: Respiratory rate is not an indicator of adequate fluid replacement. 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. o Option C: Diastolic blood pressure is a less reliable indicator of adequate fluid replacement. Although relatively nonsensitive and nonspecific, physical exams can be helpful in determining the presence of hypovolemic shock. Physical findings suggestive of volume depletion include dry mucous membranes, decreased skin turgor, and low jugular venous distention. Tachycardia and hypotension can be seen along with decreased urinary output. o Option D: Systolic blood pressure is not a reliable indicator of fluid volume replacement. For hypovolemic shock due to fluid losses, history and physical should attempt to identify possible GI, renal, skin, or third-spacing as a cause of extracellular fluid loss. Symptoms of hypovolemic shock can be related to volume depletion, electrolyte imbalances, or acid- base disorders that accompany hypovolemic shock. • 56. Question 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 cessation of mannitol and evaluation for possible renal or genitourinary issues. o Option A: Vital signs monitoring is a must for every shift, not just for mannitol administration. It is essential to monitor cardiac function as the fluid shifts can precipitate heart failure. Additional electrolytes, including sodium, potassium, and osmolality, require monitoring by the nurses and physicians. Abnormalities in these laboratory values necessitate prompt communication to all members of the team. o Option B: The patient’s weight is a less reliable indicator especially for safe administration of mannitol. The nursing staff should pay particular attention to urine output and monitor it carefully, reporting any concerns to the treating clinician. The pharmacist can verify dosing and perform medication reconciliation and alert the team if any interactions are present. o Option D: It would be more appropriate to monitor the patient’s neurological status if she has an increase in intracranial pressure. When giving mannitol, it is essential to monitor cardiac function as the fluid shifts can precipitate heart failure. Additional electrolytes, including sodium, potassium, and osmolality, all require monitoring. The clinician should stop mannitol if significant electrolyte abnormalities develop or the osmolality reaches 320 mOsm or higher. • 59. Question Patricia, a 20-year-old college student with diabetes mellitus, requests additional information about the advantages of using a pen-like insulin delivery device. The nurse explains that the advantages of these devices over syringes include: o A. Accurate dose delivery o B. Shorter injection time o C. Lower cost with reusable insulin cartridges o D. Use of a smaller gauge needle. 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 • 61. Question After a long leg cast is removed, the male client should: o A. Cleanse the leg by scrubbing with a brisk motion o B. Put leg through full range of motion twice daily o C. Report any discomfort or stiffness to the physician o D. Elevate the leg when sitting for long periods of time. Correct Answer: D. Elevate the leg when sitting for long periods of time. Elevation will help control the edema that usually occurs. o Option A: Cleansing the leg should be done by patting a wet cloth to avoid injuring the dry skin. It is not unusual for the skin to have some changes (dry skin and more hair). A few baths in warm water will soak off the dry, flaky skin. This may take a few days, but be patient and avoid scrubbing the skin. Scrubbing may damage the new skin. o Option B: The leg should be exercised daily but not put through a full range of motion because the bones are still on the mend and the muscles are weak. It is normal for there to be some discomfort in the muscles and joints that were immobilized. It is not unusual for an arm or leg to be smaller than the other side. Begin gentle range of motion and strengthening of your injured area after the cast is removed. You may be placed into a removable splint after the cast is removed. o Option C: Discomfort and stiffness are normal after a cast is removed. Regular exercises recommended by the physician would help the pulselessness, paresthesia, paralysis, and pallor. However, aside from paresthesia, which may occur earlier in the course of the condition, these are typically late findings. extremity return to its normal function. As the client progresses out of the • 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. • 64. Question Mang Jose with rheumatoid arthritis states, “The only time I am without pain is when I lie in bed perfectly still”. During the convalescent stage, the nurse in charge with Mang Jose should encourage: o A. Active joint flexion and extension o B. Continued immobility until pain subsides o C. Range of motion exercises twice daily o D. Flexion exercises three times daily Option B: Immobility would only allow the exudates to settle between the joints, aggravating the pain during future movement. Local effects of the joint effusion are likely to be responsible for the acute decrease in tendon stiffness whilst the systemic inflammatory processes of RA could be responsible for Correct Answer: A. Active joint flexion and extension Active exercises, alternating extension, flexion, abduction, and adduction, mobilize exudates in the joints relieves stiffness and pain. The role of exercise in promoting the joint health of a person with RA is of great importance, especially as this is the most pronounced and invariant element of the RA disease pathology. o Option C: The axillary area should never bear the client’s weight because the nerves might be damaged. The user’s strength and coordination should undergo evaluation before issuing them a set of crutches. The use of the wrong crutches can lead to injury. Most injuries are a direct result of falling. o Option D: Placing the weight on both feet would not allow the client to lift the crutches properly. Through offloading body weight to the injured extremity optimal conditions are provided to allow healing of acute injuries. Crutches provide ambulatory support and mobility options to those with neurologic injuries or chronic orthopedic injuries enabling • 65. Question A male client has undergone spinal surgery, the nurse should: o A. Observe the client’s bowel movement and voiding patterns o B. Log-roll the client to prone position o C. Assess the client’s feet for sensation and circulation o D. Encourage client to drink plenty of fluids the long-term effects. Tendon stiffness can be increased, however, following strength training in older people and with endurance training. o Option C: Range of motion exercises are great for the joints but it should be done more frequently than twice daily. Exercise can reduce pain, morning stiffness, and even reduce fatigue in RA; exercise can improve functional ability and psychological well-being; exercise has not been shown to exacerbate disease activity. o Option D: Flexion exercises would be most effective if done together with other active exercises, such as extension, abduction, and adduction. The importance for the inclusion of exercise training in the treatment of RA is now clear and proven. Exercise in general seems to improve overall function in RA without any proven detrimental effects to disease activity. Thus all RA patients should be encouraged to include some form of aerobic and resistance Correct Answer: C. Assess the client’s feet for sensation and circulation Alteration in sensation and circulation indicates damage to the spinal cord, if these occur, notify the physician immediately. Assess movement and sensation of lower extremities and feet (lumbar) and hands or arms (cervical). Although some degree of sensory impairment is usually present, 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