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MED SURG QUESTIONS

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A nurse assesses a patient who has diabetes mellitus and notes that the patient is awake and alert, but shaky,
diaphoretic, and weak. Five minutes after administering a half-cup (120 mL) of orange juice, the patient’s
clinical manifestations have not changed. What action would the nurse take next?</span>
1. Administer another half-cup (120 mL) of orange juice.</span>
2. Administer 1 mg of glucagon intramuscularly.</span>
3. Administer 10 units of regular insulin subcutaneously.</span>
4. Administer a half-ampule of dextrose 50% intravenously.</span>
<span style="font-size:12pt">This patient is experiencing mild
hypoglycemia. For mild hypoglycemic manifestations, the nurse would
administer oral glucose in the form of orange juice. If the symptoms do not
resolve immediately, the treatment would be repeated. The patient does not
need intravenous dextrose, insulin, or glucagon.</span>
question_2. Which information will the nurse include when teaching an older patient about
skin care?</span>
<span style="font-size:12pt">Bathe and wash hair daily with
soap and shampoo.</span>
<span style="font-size:12pt">Use warm water and a
moisturizing soap when bathing.</span>
<span style="font-size:12pt">Dry the skin thoroughly before
applying lotions.</span>
<span style="font-size:12pt">Use antibacterial soaps when
bathing to avoid infection.
<span style="font-size:12pt">Warm water and moisturizing soap will avoid
overdrying the skin. Because older patients have dryer skin, daily bathing
and shampooing are not necessary and may dry the skin unnecessarily.
Antibacterial soaps are not necessary. Lotions should be applied while the
skin is still damp to seal moisture in.</span>
<span style="font-size:12pt">Warm water and moisturizing soap will avoid
overdrying the skin. Because older patients have dryer skin, daily bathing
and shampooing are not necessary and may dry the skin unnecessarily.
Antibacterial soaps are not necessary. Lotions should be applied while the
skin is still damp to seal moisture in.</span>
question_3_1
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Diabetes mellitus , hyperglycemia
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<span style="font-size:12pt">A nurse assesses a patient who
is being treated for hyperglycemic-hyperosmolar state (HHS).
Which clinical manifestation indicates to the nurse that the
therapy needs to be adjusted?</span>
<span style="font-size:12pt">Blood osmolarity has
decreased.</span>
<span style="font-size:12pt">Urine remains negative for
ketone bodies.</span>
<span style="font-size:12pt">Serum potassium level has
increased.</span>
<span style="font-size:12pt">Glasgow Coma Scale score is
unchanged.</span>
answer_4
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<span style="font-size:12pt">A slow but steady improvement in central
nervous system functioning is the best indicator of therapy effectiveness for
HHS. Lack of improvement in the level of consciousness may indicate
inadequate rates of fluid replacement. The Glasgow Coma Scale assesses
the patient&#8217;s state of consciousness against criteria of a scale
including best eye, verbal, and motor responses. An increase in serum
potassium, decreased blood osmolality, and urine negative for ketone bodies
do not indicate adequacy of treatment.</span>
<span style="font-size:12pt">A slow but steady improvement in central
nervous system functioning is the best indicator of therapy effectiveness for
HHS. Lack of improvement in the level of consciousness may indicate
inadequate rates of fluid replacement. The Glasgow Coma Scale assesses
the patient&#8217;s state of consciousness against criteria of a scale
including best eye, verbal, and motor responses. An increase in serum
potassium, decreased blood osmolality, and urine negative for ketone bodies
do not indicate adequacy of treatment.</span>
question_4_1
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Which of the following should be included in patient
education for the patient with Addison&#8217;s disease?
Lifelong condition, follow-up labs, hydrocortisine injection
Follow-up labs, Medic-Alert bracelet, no-added salt diet
Liberal sodium diet, self -limiting disease
Lifelong condition, no-added salt diet, push oral fluids
answer_1
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question_5_1
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<span style="font-size:12pt">An older patient has been
diagnosed with possible white coat hypertension. Which
planned action by the nurse <b>best</b> addresses the
suspected cause of the hypertension?</span>
<span style="font-size:12pt">Instruct the patient about the
need to decrease stress levels.</span>
<span style="font-size:12pt">Schedule the patient for regular
blood pressure (BP) checks in the clinic.</span>
<span style="font-size:12pt">Teach the patient how to selfmonitor and record BPs at home.</span>
<span style="font-size:12pt">Inform the patient and caregiver
that major dietary changes will be needed.</span>
answer_3
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<span style="font-size:12pt">In the phenomenon of &#8220;white
coat&#8221; hypertension, patients have elevated BP readings in a clinical
setting and normal readings when BP is measured elsewhere. Having the
patient self-monitor BPs at home will provide a reliable indication about
whether the patient has hypertension. Regular BP checks in the clinic are
likely to be high in a patient with white coat hypertension. There is no
evidence that this patient has elevated stress levels or a poor diet, and those
factors do not cause white coat hypertension.</span>
<span style="font-size:12pt">In the phenomenon of &#8220;white
coat&#8221; hypertension, patients have elevated BP readings in a clinical
setting and normal readings when BP is measured elsewhere. Having the
patient self-monitor BPs at home will provide a reliable indication about
whether the patient has hypertension. Regular BP checks in the clinic are
likely to be high in a patient with white coat hypertension. There is no
evidence that this patient has elevated stress levels or a poor diet, and those
factors do not cause white coat hypertension.</span>
question_6_1
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<span style="font-size:12pt">A patient who has been
receiving IV heparin infusion and oral warfarin (Coumadin)
for a deep vein thrombosis (DVT) is diagnosed with heparininduced thrombocytopenia (HIT) when the platelet level drops
to 110,000/&#181;L. Which action will the nurse include in
the plan of care?</span>
<span style="font-size:12pt">Prepare for platelet
transfusion.</span>
<span style="font-size:12pt">Use low-molecular-weight
heparin (LMWH).</span>
<span style="font-size:12pt">Discontinue the heparin
infusion.</span>
<span style="font-size:12pt">Administer prescribed warfarin
(Coumadin).</span>
answer_3
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<span style="font-size:12pt">All heparin is discontinued when HIT is
diagnosed. The patient should be instructed to never receive heparin or
LMWH. Warfarin is usually not given until the platelet count has returned
to 150,000/&#181;L. The platelet count does not drop low enough in HIT
for a platelet transfusion, and platelet transfusions increase the risk for
thrombosis.</span>
<span style="font-size:12pt">All heparin is discontinued when HIT is
diagnosed. The patient should be instructed to never receive heparin or
LMWH. Warfarin is usually not given until the platelet count has returned
to 150,000/&#181;L. The platelet count does not drop low enough in HIT
for a platelet transfusion, and platelet transfusions increase the risk for
thrombosis.</span>
question_7_1
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What are the five treatments S&#8217;s for the management
of a patient with Addison&#8217;s disease in an adrenal
crisis?
Steroids, salt, sugar, support, search for cause
Steroids, sugar, stress test, serologic tests, salt
Steroids, search for cause, stress test, serial labs, salt
Steroids, saline, sulfa antibiotics, supplemental oxygen,
struma (goiter)
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question_8_1
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<span style="font-size:12pt">A postoperative patient
receiving a transfusion of packed red blood cells develops
chills, fever, headache, and anxiety 35 minutes after the
transfusion is started. After stopping the transfusion, what
action should the nurse take?</span>
<span style="font-size:12pt">Give the PRN diphenhydramine
.</span>
<span style="font-size:12pt">Administer PRN acetaminophen
(Tylenol).</span>
<span style="font-size:12pt">Send a urine specimen to the
laboratory.</span>
<span style="font-size:12pt">Draw blood for a new type and
crossmatch.</span>
answer_2
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<span style="font-size:12pt">The patient&#8217;s clinical manifestations
are consistent with a febrile, nonhemolytic transfusion reaction. The
transfusion should be stopped and antipyretics administered for the fever as
ordered. A urine specimen is needed if an acute hemolytic reaction is
suspected. Diphenhydramine is used for allergic reactions. This type of
reaction does not indicate incorrect crossmatching.</span>
<span style="font-size:12pt">The patient&#8217;s clinical manifestations
are consistent with a febrile, nonhemolytic transfusion reaction. The
transfusion should be stopped and antipyretics administered for the fever as
ordered. A urine specimen is needed if an acute hemolytic reaction is
suspected. Diphenhydramine is used for allergic reactions. This type of
reaction does not indicate incorrect crossmatching.</span>
question_9_1
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What are physical symptoms do you expect a patient to exhibit
if diagnosed with Cushing&#8217;s syndrome?
Moon facies, purple striae on trunk, buffalo hump
Moon facies, edema, weight loss&#8195;
Moon facies, easy bruising,, weight loss
Moon facies, weight loss, ache&#8195;
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a
a
question_10_1
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<span style="font-size:12pt">A patient who is experiencing
an acute asthma attack is admitted to the emergency
department. Which assessment should the nurse complete
<b>first</b>?</span>
<span style="font-size:12pt">Obtain the forced expiratory
volume (FEV) flow rate.</span>
<span style="font-size:12pt">Listen to the patient&#8217;s
breath sounds.</span>
<span style="font-size:12pt">Ask about inhaled corticosteroid
use.</span>
<span style="font-size:12pt">Determine when the dyspnea
started.</span>
answer_2
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<span style="font-size:12pt">Assessment of the patient&#8217;s breath
sounds will help determine how effectively the patient is ventilating and
whether rapid intubation may be necessary. The length of time the attack
has persisted is not as important as determining the patient&#8217;s status
at present. Most patients having an acute attack will be unable to cooperate
with an FEV measurement. It is important to know about the medications
the patient is using but not as important as assessing the breath
sounds.</span>
<span style="font-size:12pt">Assessment of the patient&#8217;s breath
sounds will help determine how effectively the patient is ventilating and
whether rapid intubation may be necessary. The length of time the attack
has persisted is not as important as determining the patient&#8217;s status
at present. Most patients having an acute attack will be unable to cooperate
with an FEV measurement. It is important to know about the medications
the patient is using but not as important as assessing the breath
sounds.</span>
question_11_1
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<span style="font-size:12pt">A patient seen in the asthma
clinic has recorded daily peak flow rates that are 75% of the
baseline. Which action will the nurse plan to take
<b>next</b>?</span>
<span style="font-size:12pt">Increase the dose of the
leukotriene inhibitor.</span>
<span style="font-size:12pt">Administer a bronchodilator and
recheck the peak flow.</span>
<span style="font-size:12pt">Instruct the patient to keep the
scheduled follow-up appointment.</span>
<span style="font-size:12pt">Teach the patient about the use
of oral corticosteroids.</span>
answer_2
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<span style="font-size:12pt">The patient&#8217;s peak flow reading
indicates that the condition is worsening (yellow zone). The patient should
take the bronchodilator and recheck the peak flow. Depending on whether
the patient returns to the green zone, indicating well-controlled symptoms,
the patient may be prescribed oral corticosteroids or a change in dosing of
other medications. Keeping the next appointment is appropriate, but the
patient also needs to be taught how to control symptoms now and use the
bronchodilator.</span>
<span style="font-size:12pt">The patient&#8217;s peak flow reading
indicates that the condition is worsening (yellow zone). The patient should
take the bronchodilator and recheck the peak flow. Depending on whether
the patient returns to the green zone, indicating well-controlled symptoms,
the patient may be prescribed oral corticosteroids or a change in dosing of
other medications. Keeping the next appointment is appropriate, but the
patient also needs to be taught how to control symptoms now and use the
bronchodilator.</span>
question_12_1
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<span style="font-size:12pt">The nurse notes scleral jaundice
in a patient being admitted with hemolytic anemia. The nurse
will plan to check the laboratory results for the</span>
<span style="font-size:12pt">gastric analysis.</span>
<span style="font-size:12pt">stool occult blood.</span>
<span style="font-size:12pt">bilirubin level.</span>
<span style="font-size:12pt">Schilling test.</span>
answer_3
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<span style="font-size:12pt">Jaundice is caused by the elevation of
bilirubin level associated with red blood cell hemolysis. The other tests
would not be helpful in monitoring or treating a hemolytic anemia.</span>
<span style="font-size:12pt">Jaundice is caused by the elevation of
bilirubin level associated with red blood cell hemolysis. The other tests
would not be helpful in monitoring or treating a hemolytic anemia.</span>
question_13_1
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Your patient has been preliminarily diagnosed with
Cushing&#8217;s syndrome.&nbsp; What diagnostic test do
you anticipate the physician ordering for this patient?
Computerized tomography of the brain, chest, and abdomen;
24-hour urine cortisol levels; ACTH serum concentrations
Urine ACTH concentrations, thyroid panel, C-reactive protein
level
Serum and urine cortisol levels, thyroid panels, betanatriuretic peptide levels
Computerized tomography of the brain, chest, and abdomen;
thyroid levels; basic metabolic panel
answer_1
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question_14_1
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Diabetes mellitus , hypoglycemia
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<span style="font-size:12pt">At 4:45 PM, a nurse assesses a
patient with diabetes mellitus who is recovering from an
abdominal hysterectomy 2 days ago. The nurse notes that the
patient is confused and diaphoretic. The nurse reviews the
assessment data provided in the chart below:<br></span><div
style="font-size:2pt"></div><table cellpadding="0"
cellspacing="0" width="90%" border="0"><tr
valign="top"><td class="pad" style=" border-left:0.8pt solid
#000000; border-top:0.8pt solid #000000; border-right:0.8pt
solid #000000; border-bottom:0.8pt solid #000000;"><span
style="font-size:12pt">Capillary Blood Glucose Testing
(AC/HS)</span></td><td class="pad" style=" bordertop:0.8pt solid #000000; border-right:0.8pt solid #000000;
border-bottom:0.8pt solid #000000;"><span style="fontsize:12pt">Dietary Intake</span></td></tr><tr
valign="top"><td class="pad" style=" border-left:0.8pt solid
#000000; border-right:0.8pt solid #000000; borderbottom:0.8pt solid #000000;"><span style="fontsize:12pt">At 06:30&#8212;95<br>At
11:30&#8212;70<br>At 16:30&#8212;47</span></td><td
class="pad" style=" border-right:0.8pt solid #000000; borderbottom:0.8pt solid #000000;"><span style="fontsize:12pt">Breakfast: 10% eaten&#8212;patient states that
she is not hungry<br>Lunch: 5% eaten&#8212;patient is
nauseous; vomits once</span></td></tr><tr height="0"
style="border:none"><td width="53%"></td><td
width="47%"></td></tr></table><span style="fontsize:12pt">After reviewing the patient&#8217;s assessment
data, which action is appropriate at this time?</span>
<span style="font-size:12pt">Reorient the patient and apply a
cool washcloth to the patient&#8217;s forehead.</span>
<span style="font-size:12pt">Assess the patient&#8217;s
oxygen saturation level and administer oxygen.</span>
<span style="font-size:12pt">Provide a glass of orange juice
and encourage the patient to eat dinner.</span>
<span style="font-size:12pt">Administer dextrose 50%
intravenously and reassess the patient.</span>
answer_4
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<span style="font-size:12pt">The patient&#8217;s symptoms are related to
hypoglycemia. Since the patient has not been tolerating food, the nurse
would administer dextrose intravenously. The patient&#8217;s oxygen
level could be checked, but based on the information provided, this is not
the priority. The patient will not be reoriented until the glucose level
rises.</span>
<span style="font-size:12pt">The patient&#8217;s symptoms are related to
hypoglycemia. Since the patient has not been tolerating food, the nurse
would administer dextrose intravenously. The patient&#8217;s oxygen
level could be checked, but based on the information provided, this is not
the priority. The patient will not be reoriented until the glucose level
rises.</span>
question_15_1
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<span style="font-size:12pt">The nurse is taking a health
history from a 29-yr-old pregnant patient at the first prenatal
visit. The patient reports that she has no personal history of
diabetes, but her mother has diabetes. Which action will the
nurse plan to take?</span>
<span style="font-size:12pt">Teach the patient about
administering regular insulin.</span>
<span style="font-size:12pt">Teach about an increased risk
for fetal problems with gestational diabetes.</span>
<span style="font-size:12pt">Schedule the patient for a
fasting blood glucose level.</span>
<span style="font-size:12pt">Schedule an oral glucose
tolerance test for the twenty-fourth week of
pregnancy.</span>
answer_3
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<span style="font-size:12pt">Patients at high risk for gestational diabetes
should be screened for diabetes on the initial prenatal visit. An oral glucose
tolerance test may also be used to check for diabetes, but it would be done
before the twenty-fourth week. Teaching plans would depend on the
outcome of a fasting blood glucose test and other tests.</span>
<span style="font-size:12pt">Patients at high risk for gestational diabetes
should be screened for diabetes on the initial prenatal visit. An oral glucose
tolerance test may also be used to check for diabetes, but it would be done
before the twenty-fourth week. Teaching plans would depend on the
outcome of a fasting blood glucose test and other tests.</span>
question_16_1
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Acidbase imbalance
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<span style="font-size:12pt">A nurse is assessing a patient
who has acute pancreatitis and is at risk for an
acid&#8211;base imbalance. For which manifestation of this
acid&#8211;base imbalance would the nurse assess?</span>
<span style="font-size:12pt">Agitation</span>
<span style="font-size:12pt">Positive Chvostek&#8217;s
sign</span>
<span style="font-size:12pt">Seizures</span>
<span style="font-size:12pt">Kussmaul respirations</span>
answer_4
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<span style="font-size:12pt">The pancreas is a major site of bicarbonate
production. Pancreatitis can cause a relative metabolic acidosis through
underproduction of bicarbonate ions. Manifestations of acidosis include
lethargy and Kussmaul respirations. Agitation, seizures, and a positive
Chvostek&#8217;s sign are manifestations of the electrolyte imbalances
that accompany alkalosis.</span>
<span style="font-size:12pt">The pancreas is a major site of bicarbonate
production. Pancreatitis can cause a relative metabolic acidosis through
underproduction of bicarbonate ions. Manifestations of acidosis include
lethargy and Kussmaul respirations. Agitation, seizures, and a positive
Chvostek&#8217;s sign are manifestations of the electrolyte imbalances
that accompany alkalosis.</span>
question_17_1
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Endocrine system , assessment/diagnostic examination
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<span style="font-size:12pt">A nurse cares for a patient with
a deficiency of aldosterone. Which assessment finding would
the nurse correlate with this deficiency?</span>
<span style="font-size:12pt">Serum sodium of 144 mEq/L
(144 mmol/L)</span>
<span style="font-size:12pt">Increased urine output</span>
<span style="font-size:12pt">Blood glucose of 98 mg/dL (5.4
mmol/L)</span>
<span style="font-size:12pt">Vasoconstriction</span>
answer_2
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<span style="font-size:12pt">Aldosterone,<b> </b>the major
mineralocorticoid, maintains extracellular fluid volume. It promotes sodium
and water reabsorption and potassium excretion in the kidney tubules. A
patient with an aldosterone deficiency will have increased urine output.
Vasoconstriction is not related. These sodium and glucose levels are
normal; in aldosterone deficiency, the patient would have hyponatremia and
hyperkalemia.</span>
<span style="font-size:12pt">Aldosterone,<b> </b>the major
mineralocorticoid, maintains extracellular fluid volume. It promotes sodium
and water reabsorption and potassium excretion in the kidney tubules. A
patient with an aldosterone deficiency will have increased urine output.
Vasoconstriction is not related. These sodium and glucose levels are
normal; in aldosterone deficiency, the patient would have hyponatremia and
hyperkalemia.</span>
question_18_1
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How is insulin secretion regulated?
Chemical, hormonal, and neuronal controls
Chemical, glucagon, and insulin control.
Hormonal, exocrine gland secretion and glucose controls
Hormonal, insulin, and neuronal controls
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question_19_1
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Pneumonia , antibiotics , oxygen therapy
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<span style="font-size:12pt">A nurse admits a patient from
the emergency department. Patient data are listed
below:<br></span><div style="font-size:2pt"></div><table
cellpadding="0" cellspacing="0" width="93%"
border="0"><tr valign="top"><td class="pad" style=" borderleft:0.8pt solid #000000; border-top:0.8pt solid #000000;
border-right:0.8pt solid #000000; border-bottom:0.8pt solid
#000000;"><span style="fontsize:12pt">History</span></td><td class="pad" style="
border-top:0.8pt solid #000000; border-right:0.8pt solid
#000000; border-bottom:0.8pt solid #000000;"><span
style="font-size:12pt">Physical Assessment</span></td><td
class="pad" style=" border-top:0.8pt solid #000000; borderright:0.8pt solid #000000; border-bottom:0.8pt solid
#000000;"><span style="font-size:12pt">Laboratory
Values</span></td></tr><tr valign="top"><td class="pad"
style=" border-left:0.8pt solid #000000; border-right:0.8pt
solid #000000; border-bottom:0.8pt solid #000000;"><span
style="font-size:12pt">70 years of age<br>History of
diabetes<br>On insulin twice a day<br>Reports new-onset
dyspnea and productive cough</span></td><td class="pad"
style=" border-right:0.8pt solid #000000; border-bottom:0.8pt
solid #000000;"><span style="font-size:12pt">Crackles and
rhonchi heard throughout the lungs<br>Dullness to percussion
LLL<br>Afebrile<br>Oriented to person
only</span></td><td class="pad" style=" border-right:0.8pt
solid #000000; border-bottom:0.8pt solid #000000;"><span
style="font-size:12pt">WBC: 5,200/mm<sup>3</sup> (5.2
<span style="font-family:'Times New
Roman'">&#215;</span>
10<sup>9</sup>/L)<br>PaO<sub>2</sub> on room air 85
mm Hg</span></td></tr><tr height="0"
style="border:none"><td width="35%"></td><td
width="38%"></td><td
width="27%"></td></tr></table><span style="fontsize:12pt">What action by the nurse is the priority?</span>
<span style="font-size:12pt">Start an IV of normal saline at
50 mL/hr.</span>
<span style="font-size:12pt">Collect a sputum sample for
culture.</span>
<span style="font-size:12pt">Administer oxygen at 4 L per
nasal cannula.</span>
<span style="font-size:12pt">Begin broad-spectrum
antibiotics.</span>
answer_3
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<span style="font-size:12pt">All actions are appropriate for this patient
who has manifestations of pneumonia. However, airway and breathing
come first, so begin oxygen administration and titrate it to maintain
saturations greater than 95%. Start the IV and collect a sputum culture, and
then begin antibiotics.</span>
<span style="font-size:12pt">All actions are appropriate for this patient
who has manifestations of pneumonia. However, airway and breathing
come first, so begin oxygen administration and titrate it to maintain
saturations greater than 95%. Start the IV and collect a sputum culture, and
then begin antibiotics.</span>
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false
1.0
0.0
<span style="font-size:12pt">A 76-yr-old with benign
prostatic hyperplasia (BPH) is agitated and confused, with a
markedly distended bladder. Which intervention prescribed by
the health care provider should the nurse implement
<b>first</b>?</span>
<span style="font-size:12pt">Administer lorazepam (Ativan)
0.5 mg PO.</span>
<span style="font-size:12pt">Schedule an intravenous
pyelogram (IVP).</span>
<span style="font-size:12pt">Insert a urinary retention
catheter.</span>
<span style="font-size:12pt">Draw blood for a serum
creatinine level.</span>
answer_3
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<span style="font-size:12pt">The patient&#8217;s history and clinical
manifestations are consistent with acute urinary retention, and the priority
action is to relieve the retention by catheterization. The BUN and creatinine
measurements can be obtained after the catheter is inserted. The
patient&#8217;s agitation may resolve after the bladder distention is
corrected, and sedative drugs should be used cautiously in older patients.
The IVP may be used as a diagnostic test but does not need to be done
urgently.</span>
<span style="font-size:12pt">The patient&#8217;s history and clinical
manifestations are consistent with acute urinary retention, and the priority
action is to relieve the retention by catheterization. The BUN and creatinine
measurements can be obtained after the catheter is inserted. The
patient&#8217;s agitation may resolve after the bladder distention is
corrected, and sedative drugs should be used cautiously in older patients.
The IVP may be used as a diagnostic test but does not need to be done
urgently.</span>
question_21_1
Item
Dehydration , older adult , hydration
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse is working with an older
patient admitted with mild dehydration. What teaching does
the nurse provide to best address this issue?</span>
<span style="font-size:12pt">&#8220;Take your diuretic in
the morning.&#8221;</span>
<span style="font-size:12pt">&#8220;Dehydration can cause
incontinence.&#8221;</span>
<span style="font-size:12pt">&#8220;Have something to
drink every 1 to 2 hours.&#8221;</span>
<span style="font-size:12pt">&#8220;Cut some sodium out
of your diet.&#8221;</span>
answer_3
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<span style="font-size:12pt">Older adults often lose their sense of thirst.
Plus older adults have less body water than younger people. Since they
should drink 1 to 2 liters of water a day, the best remedy is to have the older
adult drink something each hour or two, whether or not he or she is thirsty.
Cutting &#8220;some&#8221; sodium from the diet will not address this
issue. Although dehydration can cause incontinence from the irritation of
concentrated urine, this information will not help prevent the problem of
dehydration. Instructing the patient to take a diuretic in the morning rather
than in the evening also will not directly address this issue.</span>
<span style="font-size:12pt">Older adults often lose their sense of thirst.
Plus older adults have less body water than younger people. Since they
should drink 1 to 2 liters of water a day, the best remedy is to have the older
adult drink something each hour or two, whether or not he or she is thirsty.
Cutting &#8220;some&#8221; sodium from the diet will not address this
issue. Although dehydration can cause incontinence from the irritation of
concentrated urine, this information will not help prevent the problem of
dehydration. Instructing the patient to take a diuretic in the morning rather
than in the evening also will not directly address this issue.</span>
question_22_1
Item
Rheumatoid arthritis , nursing assessment , autoimmune disorder
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse works in the
rheumatology clinic and sees patients with rheumatoid arthritis
(RA). Which patient would the nurse see first?</span>
<span style="font-size:12pt">Patient with a worse joint
deformity since the last visit</span>
<span style="font-size:12pt">Patient who has a puffy-looking
area behind the knee</span>
<span style="font-size:12pt">Patient with a red, hot, swollen
right wrist</span>
<span style="font-size:12pt">Patient who reports jaw pain
when eating</span>
answer_3
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<span style="font-size:12pt">All of the options are possible manifestations
of RA. However, the presence of one joint that is much redder, hotter, or
more swollen that the other joints may indicate infection. The nurse needs
to see this patient first.</span>
<span style="font-size:12pt">All of the options are possible manifestations
of RA. However, the presence of one joint that is much redder, hotter, or
more swollen that the other joints may indicate infection. The nurse needs
to see this patient first.</span>
question_23_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
Cortisol, glucagon, catecholamines, and growth hormone(
GH) as a group are classified as
Serotonin inhibitors
Insulin-antagonistic hormones
Neuroprotective hormones
Gluconeogenic hormones
answer_2
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question_24_1
Item
Diabetes mellitus , hypoglycemia
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse assesses a patient with
diabetes mellitus and notes that the patient only responds to a
sternal rub by moaning, has capillary blood glucose of 33 g/dL
(1.8 mmol/L), and has an intravenous line that is infiltrated
with 0.45% normal saline. What action would the nurse take
first?</span>
<span style="font-size:12pt">Encourage the patient to drink
orange juice.</span>
<span style="font-size:12pt">Insert a new intravenous access
line.</span>
<span style="font-size:12pt">Administer 1 mg of
intramuscular glucagon.</span>
<span style="font-size:12pt">Administer 25 mL dextrose 50%
(D50) IV push.</span>
answer_3
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<span style="font-size:12pt">The patient&#8217;s blood glucose level is
dangerously low. The nurse needs to administer glucagon IM immediately
to increase the patient&#8217;s blood glucose level. The nurse would insert
a new IV after administering the glucagon and can use the new IV site for
future doses of D50 if the patient&#8217;s blood glucose level does not
rise. Once the patient is awake, orange juice may be administered orally
along with a form of protein such as peanut butter.</span>
<span style="font-size:12pt">The patient&#8217;s blood glucose level is
dangerously low. The nurse needs to administer glucagon IM immediately
to increase the patient&#8217;s blood glucose level. The nurse would insert
a new IV after administering the glucagon and can use the new IV site for
future doses of D50 if the patient&#8217;s blood glucose level does not
rise. Once the patient is awake, orange juice may be administered orally
along with a form of protein such as peanut butter.</span>
question_25_1
Item
Cancer , patient safety , falls , patient education
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient has a platelet count of
9800/mm<sup>3</sup>. What action by the nurse is most
appropriate?</span>
<span style="font-size:12pt">Place the patient on protective
isolation precautions.</span>
<span style="font-size:12pt">Obtain cultures as per the
facility&#8217;s standing policy.</span>
<span style="font-size:12pt">Assess the patient for calf pain,
warmth, and redness.</span>
<span style="font-size:12pt">Instruct the patient to call for
help to get out of bed.</span>
answer_4
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<span style="font-size:12pt">A patient with a platelet count this low is at
high risk for serious bleeding episodes. To prevent injury, the patient would
be instructed to call for help prior to getting out of bed. Calf pain, warmth,
and redness might indicate a deep vein thrombosis, not associated with low
platelets. Cultures and isolation relate to low white cell counts.</span>
<span style="font-size:12pt">A patient with a platelet count this low is at
high risk for serious bleeding episodes. To prevent injury, the patient would
be instructed to call for help prior to getting out of bed. Calf pain, warmth,
and redness might indicate a deep vein thrombosis, not associated with low
platelets. Cultures and isolation relate to low white cell counts.</span>
question_26_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
What is the origin of microvascular disease associated with
diabetes mellitus?
Vasoconstriction from hyperglycemia
Repeated hypoglycemic events
Changes in the capillary basement membrane causing hypoxia
on a cellular level
Increased athersclerotic plaques on the intima
answer_3
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question_27_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which finding by the nurse for a
patient with a nursing diagnosis of impaired gas exchange will
be most useful in evaluating the effectiveness of
treatment?</span>
<span style="font-size:12pt">Absence of wheezes or
crackles</span>
<span style="font-size:12pt">Pulse oximetry reading of
92%</span>
<span style="font-size:12pt">Even, unlabored
respirations</span>
<span style="font-size:12pt">Respiratory rate of 18
breaths/min</span>
answer_2
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<span style="font-size:12pt">For the nursing diagnosis of impaired gas
exchange, the best data for evaluation are arterial blood gases (ABGs) or
pulse oximetry. The other data may indicate either improvement or
impending respiratory failure caused by fatigue.</span>
<span style="font-size:12pt">For the nursing diagnosis of impaired gas
exchange, the best data for evaluation are arterial blood gases (ABGs) or
pulse oximetry. The other data may indicate either improvement or
impending respiratory failure caused by fatigue.</span>
question_28_1
Item
Systemic lupus erythematosus , autoimmune disease , renal system
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The nurse on an inpatient
rheumatology unit receives a hand-off report on a patient with
an acute exacerbation of systemic lupus erythematosus (SLE).
Which reported laboratory value requires the nurse to assess
the patient further?</span>
<span style="font-size:12pt">Red blood cell count:
5.2/mm<sup>3</sup> (5.2 <span style="font-family:'Times
New Roman'">&#215;</span> 10<sup>12</sup>/L)</span>
<span style="font-size:12pt">White blood cell count:
4400/mm<sup>3</sup> (4.4 <span style="font-family:'Times
New Roman'">&#215;</span> 10<sup>9</sup>/L)</span>
<span style="font-size:12pt">Platelet count:
210,000/mm<sup>3</sup> (210 <span style="fontfamily:'Times New Roman'">&#215;</span>
10<sup>9</sup>/L)</span>
<span style="font-size:12pt">Creatinine: 3.9 mg/dL (345
mcmol/L)</span>
answer_4
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<span style="font-size:12pt">Lupus nephritis is the leading cause of death
in patients with SLE. The creatinine level is very high and the nurse needs
to perform further assessments related to this finding. The other laboratory
values are normal.</span>
<span style="font-size:12pt">Lupus nephritis is the leading cause of death
in patients with SLE. The creatinine level is very high and the nurse needs
to perform further assessments related to this finding. The other laboratory
values are normal.</span>
question_29_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which statement by a patient
indicates good understanding of the nurse&#8217;s teaching
about prevention of sickle cell crisis?</span>
<span style="font-size:12pt">&#8220;Routine continuous
dosage narcotics are prescribed to prevent a
crisis.&#8221;</span>
<span style="font-size:12pt">&#8220;There are no effective
medications that can help prevent sickling.&#8221;</span>
<span style="font-size:12pt">&#8220;Home oxygen therapy
is frequently used to decrease sickling.&#8221;</span>
<span style="font-size:12pt">&#8220;Risk for a crisis is
decreased by having an annual influenza
vaccination.&#8221;</span>
answer_4
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<span style="font-size:12pt">Because infection is the most common cause
of a sickle cell crisis, influenza, <i>Haemophilus influenzae,</i>
pneumococcal pneumonia, and hepatitis immunizations should be
administered. Although continuous dose opioids and oxygen may be
administered during a crisis, patients do not receive these therapies to
prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the
number of sickle cell crises.</span>
<span style="font-size:12pt">Because infection is the most common cause
of a sickle cell crisis, influenza, <i>Haemophilus influenzae,</i>
pneumococcal pneumonia, and hepatitis immunizations should be
administered. Although continuous dose opioids and oxygen may be
administered during a crisis, patients do not receive these therapies to
prevent crisis. Hydroxyurea (Hydrea) is a medication used to decrease the
number of sickle cell crises.</span>
question_30_1
Item
Cholecystitis , pain , postoperative care
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse cares for a patient who
is prescribed patient-controlled analgesia (PCA) after a
cholecystectomy. The patient states, &#8220;When I wake up
I am in pain.&#8221; What action would the nurse
take?</span>
<span style="font-size:12pt">Ask a family member to initiate
the PCA pump for the patient.</span>
<span style="font-size:12pt">Administer intravenous
morphine while the patient sleeps.</span>
<span style="font-size:12pt">Encourage the patient to use the
PCA pump upon awakening.</span>
<span style="font-size:12pt">Contact the provider and request
a different analgesic.</span>
answer_3
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<span style="font-size:12pt">The nurse would encourage the patient to use
the PCA pump prior to napping and upon awakening. Administering
additional intravenous morphine while the patient sleeps places the patient
at risk for respiratory depression. The nurse would also evaluate dosages
received compared with dosages requested and contact the provider if the
dose or frequency is not adequate. Only the patient should push the pain
button on a PCA pump.</span>
<span style="font-size:12pt">The nurse would encourage the patient to use
the PCA pump prior to napping and upon awakening. Administering
additional intravenous morphine while the patient sleeps places the patient
at risk for respiratory depression. The nurse would also evaluate dosages
received compared with dosages requested and contact the provider if the
dose or frequency is not adequate. Only the patient should push the pain
button on a PCA pump.</span>
question_31_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
What are the three major problems associated with
macrovascular disease in a patient with diabetes mellitus?
Diabetic peripheral neuropathy , peripheral vascular disease,
cerebral vascular disease
Peripheral neuropathy, coronary artery disease, cerebral
vascular disease
Retinopathy, coronary artery disease , cerebral vascular
disease
Coronary artery disease, cerebral vascular accident, peripheral
vascular disease
answer_4
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question_32_1
Item
Medications , medication safety , older adult
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">An older adult is brought to the
emergency department because of sudden onset of confusion.
After the patient is stabilized and comfortable, what
assessment by the nurse is most important?</span>
<span style="font-size:12pt">Determine if there are new
medications.</span>
<span style="font-size:12pt">Evaluate the patient for gait
abnormalities.</span>
<span style="font-size:12pt">Assess for orthostatic
hypotension.</span>
<span style="font-size:12pt">Perform a delirium screening
test.</span>
answer_1
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<span style="font-size:12pt">Medication side effects and adverse effects
are common in the older population. Something as simple as a new
antibiotic can cause confusion and memory loss. The nurse should
determine if the patient is taking any new medications. Assessments for
orthostatic hypotension, gait abnormalities, and delirium may be important
once more is known about the patient&#8217;s condition.</span>
<span style="font-size:12pt">Medication side effects and adverse effects
are common in the older population. Something as simple as a new
antibiotic can cause confusion and memory loss. The nurse should
determine if the patient is taking any new medications. Assessments for
orthostatic hypotension, gait abnormalities, and delirium may be important
once more is known about the patient&#8217;s condition.</span>
question_33_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The nurse is planning to
administer a transfusion of packed red blood cells (PRBCs) to
a patient with blood loss from gastrointestinal hemorrhage.
Which action can the nurse delegate to unlicensed assistive
personnel (UAP)?</span>
<span style="font-size:12pt">Verify the patient identification
(ID) according to hospital policy.</span>
<span style="font-size:12pt">Monitor the patient for shortness
of breath or chest pain during the transfusion.</span>
<span style="font-size:12pt">Obtain the temperature, blood
pressure, and pulse before the transfusion.</span>
<span style="font-size:12pt">Double-check the product
numbers on the PRBCs with the patient ID band.</span>
answer_3
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<span style="font-size:12pt">UAP education includes measurement of vital
signs. UAP would report the vital signs to the registered nurse (RN). The
other actions require more education and a larger scope of practice and
should be done by licensed nursing staff members.</span>
<span style="font-size:12pt">UAP education includes measurement of vital
signs. UAP would report the vital signs to the registered nurse (RN). The
other actions require more education and a larger scope of practice and
should be done by licensed nursing staff members.</span>
question_34_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
What is sre the major differneces between the Somoygi effect
and the Dawn Phenomenon.
The Somygi effect is nocturnal hypoglycemia with rebound
hyperglycemia and the Dawn Phenomenon is increased
morning glucose without nocturnal hypoglycemia.
They are the same process.
The Dawn Phenomenon is nocturnal hypoglycemia, and the
Somygi effect is greatly increased blood sugars in the
morning.
The Dawn Phenomenon is morning hypoglycemia, and the
Somygi effect is nocturnal hypoglycemia.
answer_1
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question_35_1
Item
Diabetes mellitus , insulin , medication safety
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse cares for a patient who
has diabetes mellitus. The nurse administers 6 units of regular
insulin and 10 units of NPH insulin at 07:00. At which time
would the nurse assess the patient for potential problems
related to the NPH insulin?</span>
<span style="font-size:12pt">23:00</span>
<span style="font-size:12pt">20:00</span>
<span style="font-size:12pt">16:00</span>
<span style="font-size:12pt">08:00</span>
answer_3
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<span style="font-size:12pt">Neutral protamine Hagedorn (NPH) is an
intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12
hours, and duration of action of 22 hours. Checking the patient at 08:00
would be too soon. Checking the patient at 20:00 and 23:00 would be too
late. The nurse would check the patient at 16:00.</span>
<span style="font-size:12pt">Neutral protamine Hagedorn (NPH) is an
intermediate-acting insulin with an onset of 1.5 hours, peak of 4 to 12
hours, and duration of action of 22 hours. Checking the patient at 08:00
would be too soon. Checking the patient at 20:00 and 23:00 would be too
late. The nurse would check the patient at 16:00.</span>
question_36_1
Item
Pneumonia , fluid and electrolyte imbalances , patient education
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient admitted for
pneumonia has been tachypneic for several days. When the
nurse starts an IV to give fluids, the patient questions this
action, saying &#8220;I have been drinking tons of water.
How am I dehydrated?&#8221; What response by the nurse is
best?</span>
<span style="font-size:12pt">&#8220;This is really just to
administer your antibiotics.&#8221;</span>
<span style="font-size:12pt">&#8220;Everyone with
pneumonia is dehydrated.&#8221;</span>
<span style="font-size:12pt">&#8220;Breathing so quickly
can be dehydrating.&#8221;</span>
<span style="font-size:12pt">&#8220;Why do you think you
are so dehydrated?&#8221;</span>
answer_3
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<span style="font-size:12pt">Tachypnea and mouth breathing, both seen in
pneumonia, increase insensible water loss and can lead to a degree of
dehydration. The other options do not give the patient useful information
that addresses this specific concern.</span>
<span style="font-size:12pt">Tachypnea and mouth breathing, both seen in
pneumonia, increase insensible water loss and can lead to a degree of
dehydration. The other options do not give the patient useful information
that addresses this specific concern.</span>
question_37_1
Item
Infection , anti-tuberculosis agents , laboratory values , communication
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient has been taking
isoniazid (INH) for tuberculosis for 3 weeks. What laboratory
results need to be reported to the healthcare provider
immediately?</span>
<span style="font-size:12pt">Red blood cell (RBC) count:
5.2/million/&#181;L (5.2 <span style="font-family:'Times
New Roman'">&#215;</span> 10<sup>12</sup>/L)</span>
<span style="font-size:12pt">White blood cell (WBC) count:
12,500/mm<sup>3</sup> (12.5 <span style="fontfamily:'Times New Roman'">&#215;</span>
10<sup>9</sup>/L)</span>
<span style="font-size:12pt">Albumin: 5.1 g/dL (7.4
mcmol/L)</span>
<span style="font-size:12pt">Alanine aminotransferase
(ALT): 180 U/L</span>
answer_4
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<span style="font-size:12pt">INH can cause liver damage, especially if the
patient drinks alcohol. The ALT (one of the liver enzymes) is extremely
high and needs to be reported immediately. The albumin and RBCs are
normal. The WBCs are slightly high, but that would be an expected finding
in a patient with an infection.</span>
<span style="font-size:12pt">INH can cause liver damage, especially if the
patient drinks alcohol. The ALT (one of the liver enzymes) is extremely
high and needs to be reported immediately. The albumin and RBCs are
normal. The WBCs are slightly high, but that would be an expected finding
in a patient with an infection.</span>
question_38_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient who has acute
myelogenous leukemia develops an absolute neutrophil count
of 850/&#181;L while receiving outpatient chemotherapy.
Which action by the outpatient clinic nurse is most
appropriate?</span>
<span style="font-size:12pt">Discuss the need for hospital
admission to treat the neutropenia.</span>
<span style="font-size:12pt">Teach the patient to administer
filgrastim (Neupogen) injections.</span>
<span style="font-size:12pt">Plan to discontinue the
chemotherapy until the neutropenia resolves.</span>
<span style="font-size:12pt">Order a high-efficiency
particulate air (HEPA) filter for the patient&#8217;s
home.</span>
answer_2
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<span style="font-size:12pt">The patient may be taught to self-administer
filgrastim injections. Although chemotherapy may be stopped with severe
neutropenia (neutrophil count &lt;500/&#181;L), administration of
filgrastim usually allows the chemotherapy to continue. Patients with
neutropenia are at higher risk for infection when exposed to other patients
in the hospital. HEPA filters are expensive and are used in the hospital,
where the number of pathogens is much higher than in the patient&#8217;s
home environment.</span>
<span style="font-size:12pt">The patient may be taught to self-administer
filgrastim injections. Although chemotherapy may be stopped with severe
neutropenia (neutrophil count &lt;500/&#181;L), administration of
filgrastim usually allows the chemotherapy to continue. Patients with
neutropenia are at higher risk for infection when exposed to other patients
in the hospital. HEPA filters are expensive and are used in the hospital,
where the number of pathogens is much higher than in the patient&#8217;s
home environment.</span>
question_39_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse develops a teaching
plan for a patient diagnosed with basal cell carcinoma (BCC).
Which information should the nurse include in the teaching
plan?</span>
<span style="font-size:12pt">Screening for metastasis will be
important.</span>
<span style="font-size:12pt">Low dose systemic
chemotherapy is used to treat BCC.</span>
<span style="font-size:12pt">Treatment plans include
watchful waiting.</span>
<span style="font-size:12pt">Minimizing sun exposure will
reduce risk for future BCC.</span>
answer_4
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<span style="font-size:12pt">BCC is frequently associated with sun
exposure and preventive measures should be taken for future sun exposure.
BCC spreads locally, and does not metastasize to distant tissues. Since BCC
can cause local tissue destruction, treatment is indicated. Local (not
systemic) chemotherapy may be used to treat BCC.</span>
<span style="font-size:12pt">BCC is frequently associated with sun
exposure and preventive measures should be taken for future sun exposure.
BCC spreads locally, and does not metastasize to distant tissues. Since BCC
can cause local tissue destruction, treatment is indicated. Local (not
systemic) chemotherapy may be used to treat BCC.</span>
question_40_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The nurse has obtained the
health history, physical assessment data, and laboratory results
shown in the accompanying figure for a patient admitted with
aplastic anemia. Which information is <b>most</b> important
to communicate to the health care
provider?<br></span><span style="fontsize:12pt"><br></span><div style="fontsize:2pt"></div><table cellpadding="0" cellspacing="0"
width="100%" border="0"><tr valign="top"><td class="pad"
style=" border-left:0.8pt solid #000000; border-top:0.8pt solid
#000000; border-right:0.8pt solid #000000; borderbottom:0.8pt solid #000000;"><span style="fontsize:12pt">History</span></td><td class="pad" style="
border-top:0.8pt solid #000000; border-right:0.8pt solid
#000000; border-bottom:0.8pt solid #000000;"><span
style="font-size:12pt">Physical Assessment</span></td><td
class="pad" style=" border-top:0.8pt solid #000000; borderright:0.8pt solid #000000; border-bottom:0.8pt solid
#000000;"><span style="font-size:12pt">Laboratory
Results</span></td></tr><tr valign="top"><td class="pad"
style=" border-left:0.8pt solid #000000; border-right:0.8pt
solid #000000; border-bottom:0.8pt solid #000000;"><span
style="font-size:12pt"><span style="font-family:'Times New
Roman'">&#8226; </span>Fatigue, which has increased over
last month<br><span style="font-family:'Times New
Roman'">&#8226; </span>Frequent
constipation</span></td><td class="pad" style=" borderright:0.8pt solid #000000; border-bottom:0.8pt solid
#000000;"><span style="font-size:12pt"><span style="fontfamily:'Times New Roman'">&#8226; </span>Conjunctiva
pale pink, moist<br><span style="font-family:'Times New
Roman'">&#8226; </span>Multiple bruises<br><span
style="font-family:'Times New Roman'">&#8226;
</span>Clear lung sounds</span></td><td class="pad"
style=" border-right:0.8pt solid #000000; border-bottom:0.8pt
solid #000000;"><span style="font-size:12pt"><span
style="font-family:'Times New Roman'">&#8226;
</span>Hct 33%<br><span style="font-family:'Times New
Roman'">&#8226; </span>WBC 1500/&#181;L<br><span
style="font-family:'Times New Roman'">&#8226;
</span>Platelets 70,000/&#181;L</span></td></tr><tr
height="0" style="border:none"><td width="34%"></td><td
width="33%"></td><td width="33%"></td></tr></table>
<span style="font-size:12pt">Increasing fatigue</span>
<span style="font-size:12pt">Thrombocytopenia</span>
<span style="font-size:12pt">Constipation</span>
<span style="font-size:12pt">Neutropenia</span>
answer_4
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<span style="font-size:12pt">The low white blood cell count indicates that
the patient is at high risk for infection and needs immediate actions to
diagnose and treat the cause of the leukopenia. The other information may
require further assessment or treatment but does not place the patient at
immediate risk for complications.</span>
<span style="font-size:12pt">The low white blood cell count indicates that
the patient is at high risk for infection and needs immediate actions to
diagnose and treat the cause of the leukopenia. The other information may
require further assessment or treatment but does not place the patient at
immediate risk for complications.</span>
question_41_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
Whichof the following conditions can cause a thyroid storm in
a patient with hyperthyroidism?
Increased iodine intake
An overdose of PTU (propylyhyrouricil)
Decreased iodine intake
Trauma or infection
answer_4
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question_42_1
Item
Pituitary disorder , electrolyte imbalance
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse cares for a patient who
possibly has syndrome of inappropriate antidiuretic hormone
(SIADH). The patient&#8217;s serum sodium level is 114
mEq/L (114 mmol/L). What action would the nurse take
first?</span>
<span style="font-size:12pt">Consult with the dietitian about
increased dietary sodium.</span>
<span style="font-size:12pt">Handle the patient gently by
using turn sheets for repositioning.</span>
<span style="font-size:12pt">Instruct unlicensed assistive
personnel to measure intake and output.</span>
<span style="font-size:12pt">Restrict the patient&#8217;s
fluid intake to 600 mL/day.</span>
answer_4
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<span style="font-size:12pt">With SIADH, patients often have dilutional
hyponatremia. The patient needs a fluid restriction, sometimes to as little as
500 to 600 mL/24 hr. Adding sodium to the patient&#8217;s diet will not
help if he or she is retaining fluid and diluting the sodium. The patient is not
at increased risk for fracture, so gentle handling is not an issue. The patient
would be on intake and output; however, this will monitor only the
patient&#8217;s intake, so it is not the best answer. Reducing intake will
help increase the patient&#8217;s sodium.</span>
<span style="font-size:12pt">With SIADH, patients often have dilutional
hyponatremia. The patient needs a fluid restriction, sometimes to as little as
500 to 600 mL/24 hr. Adding sodium to the patient&#8217;s diet will not
help if he or she is retaining fluid and diluting the sodium. The patient is not
at increased risk for fracture, so gentle handling is not an issue. The patient
would be on intake and output; however, this will monitor only the
patient&#8217;s intake, so it is not the best answer. Reducing intake will
help increase the patient&#8217;s sodium.</span>
question_43_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which patient should the nurse
assign as the roommate for a patient who has aplastic
anemia?</span>
<span style="font-size:12pt">A patient with chronic heart
failure</span>
<span style="font-size:12pt">A patient who has viral
pneumonia</span>
<span style="font-size:12pt">A patient who has right leg
cellulitis</span>
<span style="font-size:12pt">A patient with multiple
abdominal drains</span>
answer_1
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<span style="font-size:12pt">Patients with aplastic anemia are at risk for
infection because of the low white blood cell production associated with
this type of anemia, so the nurse should avoid assigning a roommate with
any possible infectious process.</span>
<span style="font-size:12pt">Patients with aplastic anemia are at risk for
infection because of the low white blood cell production associated with
this type of anemia, so the nurse should avoid assigning a roommate with
any possible infectious process.</span>
question_44_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">After receiving change-of-shift
report for several patients with neutropenia, which patient
should the nurse assess <b>first</b>?</span>
<span style="font-size:12pt">A 23-yr-old who is complaining
of severe fatigue</span>
<span style="font-size:12pt">A 33-yr-old with a fever of
100.8&#176; F (38.2&#176; C)</span>
<span style="font-size:12pt">A 56-yr-old with frequent
explosive diarrhea</span>
<span style="font-size:12pt">A 66-yr-old who has white
pharyngeal lesions</span>
answer_2
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<span style="font-size:12pt">Any fever in a neutropenic patient indicates
infection and can quickly lead to sepsis and septic shock. Rapid assessment
and (if prescribed) initiation of antibiotic therapy within 1 hour are needed.
The other patients also need to be assessed but do not exhibit symptoms of
potentially life-threatening problems.</span>
<span style="font-size:12pt">Any fever in a neutropenic patient indicates
infection and can quickly lead to sepsis and septic shock. Rapid assessment
and (if prescribed) initiation of antibiotic therapy within 1 hour are needed.
The other patients also need to be assessed but do not exhibit symptoms of
potentially life-threatening problems.</span>
question_45_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A 37-yr-old female patient is
hospitalized with acute kidney injury (AKI). Which
information will be <b>most</b> useful to the nurse in
evaluating improvement in kidney function?</span>
<span style="font-size:12pt">Urine volume</span>
<span style="font-size:12pt">Glomerular filtration rate
(GFR)</span>
<span style="font-size:12pt">Blood urea nitrogen (BUN)
level</span>
<span style="font-size:12pt">Creatinine level</span>
answer_2
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<span style="font-size:12pt">GFR is the preferred method for evaluating
kidney function. BUN levels can fluctuate based on factors such as fluid
volume status and protein intake. Urine output can be normal or high in
patients with AKI and does not accurately reflect kidney function.
Creatinine alone is not an accurate reflection of renal function.</span>
<span style="font-size:12pt">GFR is the preferred method for evaluating
kidney function. BUN levels can fluctuate based on factors such as fluid
volume status and protein intake. Urine output can be normal or high in
patients with AKI and does not accurately reflect kidney function.
Creatinine alone is not an accurate reflection of renal function.</span>
question_46_1
Item
Cancer , chemotherapy , nursing assessment , IV therapy
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient is receiving
chemotherapy through a peripheral IV line. What action by the
nurse is most important?</span>
<span style="font-size:12pt">Monitoring the patient for
nausea</span>
<span style="font-size:12pt">Providing warm packs for
comfort</span>
<span style="font-size:12pt">Assessing the IV site every
hour</span>
<span style="font-size:12pt">Educating the patient on side
effects</span>
answer_3
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<span style="font-size:12pt">Intravenous chemotherapy can cause local
tissue destruction if it extravasates into the surrounding tissues. Peripheral
IV lines are more prone to this than centrally placed lines. The most
important intervention is prevention, so the nurse should check hourly to
ensure the IV site is patent, or frequently depending on facility policy.
Education and monitoring for side effects such as nausea are important for
all patients receiving chemotherapy. Warm packs may be helpful for
comfort, but if the patient reports that an IV site is painful, the nurse needs
to assess further.</span>
<span style="font-size:12pt">Intravenous chemotherapy can cause local
tissue destruction if it extravasates into the surrounding tissues. Peripheral
IV lines are more prone to this than centrally placed lines. The most
important intervention is prevention, so the nurse should check hourly to
ensure the IV site is patent, or frequently depending on facility policy.
Education and monitoring for side effects such as nausea are important for
all patients receiving chemotherapy. Warm packs may be helpful for
comfort, but if the patient reports that an IV site is painful, the nurse needs
to assess further.</span>
question_47_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which menu choice indicates
that the patient understands the nurse&#8217;s teaching about
recommended dietary choices for iron-deficiency
anemia?</span>
<span style="font-size:12pt">Omelet and whole wheat
toast</span>
<span style="font-size:12pt">Cantaloupe and cottage
cheese</span>
<span style="font-size:12pt">Strawberry and banana fruit
plate</span>
<span style="font-size:12pt">Cornmeal muffin and orange
juice</span>
answer_1
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<span style="font-size:12pt">Eggs and whole grain breads are high in iron.
The other choices are appropriate for other nutritional deficiencies but are
not the best choice for a patient with iron-deficiency anemia.</span>
<span style="font-size:12pt">Eggs and whole grain breads are high in iron.
The other choices are appropriate for other nutritional deficiencies but are
not the best choice for a patient with iron-deficiency anemia.</span>
question_48_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient in the emergency
department complains of back pain and difficulty breathing 15
minutes after a transfusion of packed red blood cells is started.
The nurse&#8217;s <b>first</b> action should be to</span>
<span style="font-size:12pt">obtain a urine specimen to send
to the laboratory.</span>
<span style="font-size:12pt">administer oxygen therapy at a
high flow rate.</span>
<span style="font-size:12pt">disconnect the transfusion and
infuse normal saline.</span>
<span style="font-size:12pt">notify the health care provider
about the symptoms.</span>
answer_3
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<span style="font-size:12pt">The patient&#8217;s symptoms indicate a
possible acute hemolytic reaction caused by the transfusion. The first action
should be to disconnect the transfusion and infuse normal saline. The other
actions also are needed but are not the highest priority.</span>
<span style="font-size:12pt">The patient&#8217;s symptoms indicate a
possible acute hemolytic reaction caused by the transfusion. The first action
should be to disconnect the transfusion and infuse normal saline. The other
actions also are needed but are not the highest priority.</span>
question_49_1
Item
Diabetes mellitus , medication safety , electrolyte imbalance
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse reviews the chart and
new prescriptions for a patient with diabetic
ketoacidosis:<br></span><div style="fontsize:2pt"></div><table cellpadding="0" cellspacing="0"
align="right" width="99%" border="0"><tr valign="top"><td
class="pad" style=" border-left:0.8pt solid #000000; bordertop:0.8pt solid #000000; border-right:0.8pt solid #000000;
border-bottom:0.8pt solid #000000;"><span style="fontsize:12pt">Vital Signs and Assessment</span></td><td
class="pad" style=" border-top:0.8pt solid #000000; borderright:0.8pt solid #000000; border-bottom:0.8pt solid
#000000;"><span style="font-size:12pt">Laboratory
Results</span></td><td class="pad" style=" border-top:0.8pt
solid #000000; border-right:0.8pt solid #000000; borderbottom:0.8pt solid #000000;"><span style="fontsize:12pt">Medications</span></td></tr><tr
valign="top"><td class="pad" style=" border-left:0.8pt solid
#000000; border-right:0.8pt solid #000000; borderbottom:0.8pt solid #000000;"><span style="fontsize:12pt">Blood pressure: 90/62 mm Hg<br>Pulse: 120
beats/min<br>Respiratory rate: 28 breaths/min<br>Urine
output: 20 mL/hr via catheter</span></td><td class="pad"
style=" border-right:0.8pt solid #000000; border-bottom:0.8pt
solid #000000;"><span style="font-size:12pt">Serum
potassium: 2.6 mEq/L (2.6 mmol/L)</span></td><td
class="pad" style=" border-right:0.8pt solid #000000; borderbottom:0.8pt solid #000000;"><span style="fontsize:12pt">Potassium chloride 40 mEq/L (40 mmol/L) IV
bolus STAT<br>Increase IV fluid to 100
mL/hr</span></td></tr><tr height="0"
style="border:none"><td width="39%"></td><td
width="31%"></td><td width="30%"></td></tr></table><br
clear="all"><span style="font-size:12pt">What action would
the nurse take?</span>
<span style="font-size:12pt">Increase the intravenous flow
rate before administering the potassium.</span>
<span style="font-size:12pt">Increase the intravenous rate and
then consult with the provider about the potassium
prescription.</span>
<span style="font-size:12pt">Administer the potassium and
then consult with the provider about the fluid
prescription.</span>
<span style="font-size:12pt">Administer the potassium first
before increasing the infusion flow rate.</span>
answer_2
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<span style="font-size:12pt">The patient is acutely ill and is severely
dehydrated and hypokalemic. The patient requires more IV fluids and
potassium. However, potassium would not be infused unless the urine
output is at least 30 mL/hr. The nurse would first increase the IV rate and
then consult with the provider about the potassium.</span>
<span style="font-size:12pt">The patient is acutely ill and is severely
dehydrated and hypokalemic. The patient requires more IV fluids and
potassium. However, potassium would not be infused unless the urine
output is at least 30 mL/hr. The nurse would first increase the IV rate and
then consult with the provider about the potassium.</span>
question_50_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
What the common complaints with&nbsp; Addison&#8217;s
disease?
Weght gain, anorexia, constipation
Weight loss, weakness, fatigue
Constipation, weight loss,&nbsp; salt craving
Increased appetite, weight loss, insomnia
answer_2
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question_51_1
Item
Cirrhosis , nutritional requirements , support
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse cares for a patient with
hepatic portal-systemic encephalopathy (PSE). The patient is
thin and cachectic in appearance, and the family expresses
distress that the patient is receiving little dietary protein. How
would the nurse respond?</span>
<span style="font-size:12pt">&#8220;Low dietary protein is
needed to prevent fluid from leaking into the
abdomen.&#8221;</span>
<span style="font-size:12pt">&#8220;Increasing dietary
protein will help the patient gain weight and muscle
mass.&#8221;</span>
<span style="font-size:12pt">&#8220;A low-protein diet will
help the liver rest and will restore liver
function.&#8221;</span>
<span style="font-size:12pt">&#8220;Less protein in the diet
will help prevent confusion associated with liver
failure.&#8221;</span>
answer_4
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<span style="font-size:12pt">A low-protein diet is prescribed when serum
ammonia levels increase and/or the patient shows signs of PSE. A lowprotein diet helps reduce excessive breakdown of protein into ammonia by
intestinal bacteria. Encephalopathy is caused by excess ammonia. A lowprotein diet has no impact on restoring liver function. Increasing the
patient&#8217;s dietary protein will cause complications of liver failure
and would not be suggested. Increased intravascular protein will help
prevent ascites, but patients with liver failure are not able to effectively
synthesize dietary protein.</span>
<span style="font-size:12pt">A low-protein diet is prescribed when serum
ammonia levels increase and/or the patient shows signs of PSE. A lowprotein diet helps reduce excessive breakdown of protein into ammonia by
intestinal bacteria. Encephalopathy is caused by excess ammonia. A lowprotein diet has no impact on restoring liver function. Increasing the
patient&#8217;s dietary protein will cause complications of liver failure
and would not be suggested. Increased intravascular protein will help
prevent ascites, but patients with liver failure are not able to effectively
synthesize dietary protein.</span>
question_52_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The home health nurse is
visiting a patient with chronic obstructive pulmonary disease
(COPD). Which nursing action is appropriate to implement for
a nursing diagnosis of impaired breathing pattern related to
anxiety?</span>
<span style="font-size:12pt">Suggest the use of over-thecounter sedative medications.</span>
<span style="font-size:12pt">Discuss a high-protein, highcalorie diet with the patient.</span>
<span style="font-size:12pt">Titrate O<sub>2</sub> to keep
saturation at least 90%.</span>
<span style="font-size:12pt">Teach the patient how to use
pursed-lip breathing.</span>
answer_4
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<span style="font-size:12pt">Pursed-lip breathing techniques assist in
prolonging the expiratory phase of respiration and decrease air trapping.
There is no indication that the patient requires O<sub>2</sub> therapy or
an improved diet. Sedative medications should be avoided because they
decrease respiratory drive.</span>
<span style="font-size:12pt">Pursed-lip breathing techniques assist in
prolonging the expiratory phase of respiration and decrease air trapping.
There is no indication that the patient requires O<sub>2</sub> therapy or
an improved diet. Sedative medications should be avoided because they
decrease respiratory drive.</span>
question_53_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which information will the
nurse include when teaching a patient who has type 2 diabetes
about glyburide ?</span>
<span style="font-size:12pt">Glyburide stimulates insulin
production and release from the pancreas.</span>
<span style="font-size:12pt">Glyburide decreases glucagon
secretion from the pancreas.</span>
<span style="font-size:12pt">Glyburide should be taken even
if the morning blood glucose level is low.</span>
<span style="font-size:12pt">Glyburide should not be used
for 48 hours after receiving IV contrast media.</span>
answer_1
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<span style="font-size:12pt">The sulfonylureas stimulate the production
and release of insulin from the pancreas. If the glucose level is low, the
patient should contact the health care provider before taking glyburide
because hypoglycemia can occur with this class of medication. Metformin
should be held for 48 hours after administration of IV contrast media, but
this is not necessary for glyburide. Glucagon secretion is not affected by
glyburide.</span>
<span style="font-size:12pt">The sulfonylureas stimulate the production
and release of insulin from the pancreas. If the glucose level is low, the
patient should contact the health care provider before taking glyburide
because hypoglycemia can occur with this class of medication. Metformin
should be held for 48 hours after administration of IV contrast media, but
this is not necessary for glyburide. Glucagon secretion is not affected by
glyburide.</span>
question_54_1
Item
Anti-tuberculosis agents , referrals , infection , interdisciplinary team
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient is being discharged on
long-term therapy for tuberculosis (TB). What referral by the
nurse is most appropriate?</span>
<span style="font-size:12pt">Community social worker for
Meals on Wheels</span>
<span style="font-size:12pt">Visiting nurses for directly
observed therapy</span>
<span style="font-size:12pt">Physical therapy for homebound
therapy services</span>
<span style="font-size:12pt">Occupational therapy for job
retraining</span>
answer_2
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<span style="font-size:12pt">Directly observed therapy is often utilized for
managing patients with TB in the community. Meals on Wheels, job
retraining, and home therapy may or may not be appropriate.</span>
<span style="font-size:12pt">Directly observed therapy is often utilized for
managing patients with TB in the community. Meals on Wheels, job
retraining, and home therapy may or may not be appropriate.</span>
question_55_1
Item
Crohn's disease , bowel care
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse plans care for a patient
with Crohn&#8217;s disease who has a heavily draining
fistula. Which intervention would the nurse indicate as the
priority action in this patient&#8217;s plan of care?</span>
<span style="font-size:12pt">Antibiotic
administration</span>
<span style="font-size:12pt">Intravenous
glucocorticoids</span>
<span style="font-size:12pt">Low-fiber diet</span>
<span style="font-size:12pt">Skin protection</span>
answer_4
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0.0
0.0
0.0
0.0
<span style="font-size:12pt">Protecting the patient&#8217;s skin is the
priority action for a patient who has a heavily draining fistula. Intestinal
fluid enzymes are caustic and can cause skin breakdown or fungal
infections if the skin is not protected. The plan of care for a patient who has
Crohn&#8217;s disease includes adequate nutrition focused on highcalorie, high-protein, high-vitamin, and low-fiber meals, antibiotic
administration, and glucocorticoids.</span>
<span style="font-size:12pt">Protecting the patient&#8217;s skin is the
priority action for a patient who has a heavily draining fistula. Intestinal
fluid enzymes are caustic and can cause skin breakdown or fungal
infections if the skin is not protected. The plan of care for a patient who has
Crohn&#8217;s disease includes adequate nutrition focused on highcalorie, high-protein, high-vitamin, and low-fiber meals, antibiotic
administration, and glucocorticoids.</span>
question_56_1
Item
Acidbase imbalance , laboratory values , elimination
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse is caring for a patient
who is experiencing excessive diarrhea. The patient&#8217;s
arterial blood gas values are pH 7.18, PaO<sub>2</sub> 98
mm Hg, PaCO<sub>2</sub> 45 mm Hg, and
HCO<sub>3</sub><sup>-</sup> 16 mEq/L (16 mmol/L).
Which provider order does the nurse expect to
receive?</span>
<span style="font-size:12pt">Indwelling urinary
catheter</span>
<span style="font-size:12pt">Furosemide (Lasix) 40 mg
intravenous push</span>
<span style="font-size:12pt">Sodium bicarbonate 100 mEq
diluted in 1 L of D<sub>5</sub>W</span>
<span style="font-size:12pt">Mechanical ventilation</span>
answer_3
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<span style="font-size:12pt">This patient&#8217;s arterial blood gas
values represent metabolic acidosis related to a loss of bicarbonate ions
from diarrhea. The bicarbonate would be replaced to help restore this
patient&#8217;s acid&#8211;base balance as the pH is below 7.2 and the
bicarbonate level is abnormal. Furosemide would cause an increase in acid
fluid and acid elimination via the urinary tract; although this may improve
the patient&#8217;s pH, the patient has excessive diarrhea and cannot
afford to lose more fluid. Mechanical ventilation is used to treat respiratory
acidosis for patients who cannot keep their oxygen saturation at 90%, or
who have respirator muscle fatigue. Mechanical ventilation and an
indwelling urinary catheter would not be prescribed for this patient.</span>
<span style="font-size:12pt">This patient&#8217;s arterial blood gas
values represent metabolic acidosis related to a loss of bicarbonate ions
from diarrhea. The bicarbonate would be replaced to help restore this
patient&#8217;s acid&#8211;base balance as the pH is below 7.2 and the
bicarbonate level is abnormal. Furosemide would cause an increase in acid
fluid and acid elimination via the urinary tract; although this may improve
the patient&#8217;s pH, the patient has excessive diarrhea and cannot
afford to lose more fluid. Mechanical ventilation is used to treat respiratory
acidosis for patients who cannot keep their oxygen saturation at 90%, or
who have respirator muscle fatigue. Mechanical ventilation and an
indwelling urinary catheter would not be prescribed for this patient.</span>
question_57_1
Item
Thyroid gland disorder , medications
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse cares for a patient who
has hypothyroidism as a result of Hashimoto&#8217;s
thyroiditis. The patient asks, &#8220;How long will I need to
take this thyroid medication?&#8221; How does the nurse
respond?</span>
<span style="font-size:12pt">&#8220;When blood tests
indicate normal thyroid function, you can stop the
medication.&#8221;</span>
<span style="font-size:12pt">&#8220;You will need to take
the thyroid medication until the goiter is completely
gone.&#8221;</span>
<span style="font-size:12pt">&#8220;You&#8217;ll need
thyroid pills for life because your thyroid won&#8217;t start
working again.&#8221;</span>
<span style="font-size:12pt">&#8220;Thyroiditis is cured
with antibiotics. Then you won&#8217;t need thyroid
medication.&#8221;</span>
answer_3
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<span style="font-size:12pt">Hashimoto&#8217;s thyroiditis results in a
permanent loss of thyroid function. The patient will need lifelong thyroid
replacement therapy. The patient will not be able to stop taking the
medication.</span>
<span style="font-size:12pt">Hashimoto&#8217;s thyroiditis results in a
permanent loss of thyroid function. The patient will need lifelong thyroid
replacement therapy. The patient will not be able to stop taking the
medication.</span>
question_58_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient who has had
progressive chronic kidney disease (CKD) for several years
has just begun regular hemodialysis. Which information about
diet will the nurse include in patient teaching?</span>
<span style="font-size:12pt">More protein is allowed because
urea and creatinine are removed by dialysis.</span>
<span style="font-size:12pt">Increased calories are needed
because glucose is lost during hemodialysis.</span>
<span style="font-size:12pt">Unlimited fluids are allowed
because retained fluid is removed during dialysis.</span>
<span style="font-size:12pt">Dietary potassium is not
restricted because the level is normalized by dialysis.</span>
answer_1
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<span style="font-size:12pt">When the patient is started on dialysis and
nitrogenous wastes are removed, more protein in the diet is encouraged.
Fluids are still restricted to avoid excessive weight gain and complications
such as shortness of breath. Glucose is not lost during hemodialysis.
Sodium and potassium intake continues to be restricted to avoid the
complications associated with high levels of these electrolytes.</span>
<span style="font-size:12pt">When the patient is started on dialysis and
nitrogenous wastes are removed, more protein in the diet is encouraged.
Fluids are still restricted to avoid excessive weight gain and complications
such as shortness of breath. Glucose is not lost during hemodialysis.
Sodium and potassium intake continues to be restricted to avoid the
complications associated with high levels of these electrolytes.</span>
question_59_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which action will the nurse
include in the plan of care for a patient who has thalassemia
major?</span>
<span style="font-size:12pt">Teach the patient to use iron
supplements.</span>
<span style="font-size:12pt">Administer iron chelation
therapy as needed.</span>
<span style="font-size:12pt">Notify health care provider of
hemoglobin 11 g/dL.</span>
<span style="font-size:12pt">Avoid the use of intramuscular
injections.</span>
answer_2
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<span style="font-size:12pt">The frequent transfusions used to treat
thalassemia major lead to iron toxicity in patients unless iron chelation
therapy is consistently used. Iron supplementation is avoided in patients
with thalassemia. There is no need to avoid intramuscular injections. The
goal for patients with thalassemia major is to maintain a hemoglobin of 10
g/dL or greater.</span>
<span style="font-size:12pt">The frequent transfusions used to treat
thalassemia major lead to iron toxicity in patients unless iron chelation
therapy is consistently used. Iron supplementation is avoided in patients
with thalassemia. There is no need to avoid intramuscular injections. The
goal for patients with thalassemia major is to maintain a hemoglobin of 10
g/dL or greater.</span>
question_60_1
Item
Gout , musculoskeletal system , patient education , nutrition
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The nurse is teaching a patient
with gout dietary strategies to prevent exacerbations of other
problems. Which statement by the nurse is most
appropriate?</span>
<span style="font-size:12pt">&#8220;Liver is a good source
of iron.&#8221;</span>
<span style="font-size:12pt">&#8220;Never eat hard cheeses
or sardines.&#8221;</span>
<span style="font-size:12pt">&#8220;Have 10 to 12 ounces
(300 to 360 mL) of juice a day.&#8221;</span>
<span style="font-size:12pt">&#8220;Drink 1 to 2 L of water
each day.&#8221;</span>
answer_4
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<span style="font-size:12pt">Kidney stones are common in patients with
gout, so drinking plenty of water will help prevent this from occurring.
Citrus juice is high in ash, which can help prevent the formation of stones,
but the value of this recommendation is not clear. Patients with gout should
not eat organ meats or fish with bones, such as sardines.</span>
<span style="font-size:12pt">Kidney stones are common in patients with
gout, so drinking plenty of water will help prevent this from occurring.
Citrus juice is high in ash, which can help prevent the formation of stones,
but the value of this recommendation is not clear. Patients with gout should
not eat organ meats or fish with bones, such as sardines.</span>
question_61_1
Item
Diabetes mellitus , preoperative nursing
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A preoperative nurse assesses a
patient who has type 1 diabetes mellitus prior to a surgical
procedure and is NPO. The patient&#8217;s blood glucose
level is 160 mg/dL (8.9 mmol/L). What action would the nurse
take?</span>
<span style="font-size:12pt">Document the finding in the
patient&#8217;s chart.</span>
<span style="font-size:12pt">Call the surgeon to cancel the
procedure.</span>
<span style="font-size:12pt">Administer a 2 units of regular
insulin subQ.</span>
<span style="font-size:12pt">Draw blood gases to assess the
metabolic state.</span>
answer_1
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<span style="font-size:12pt">Patients who have type 1 diabetes and are
having surgery have been found to have fewer complications, lower rates of
infection, and better wound healing if blood glucose levels are maintained
at between 140 and 180 mg/dL (7.8 and 10 mmol/L) throughout the
perioperative period. The nurse would document the finding and proceed
with other operative care. The need for a bolus of insulin, canceling the
procedure, or drawing arterial blood gases is not required.</span>
<span style="font-size:12pt">Patients who have type 1 diabetes and are
having surgery have been found to have fewer complications, lower rates of
infection, and better wound healing if blood glucose levels are maintained
at between 140 and 180 mg/dL (7.8 and 10 mmol/L) throughout the
perioperative period. The nurse would document the finding and proceed
with other operative care. The need for a bolus of insulin, canceling the
procedure, or drawing arterial blood gases is not required.</span>
question_62_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient has the following risk
factors for melanoma. Which risk factor should the nurse
assign as the <b>priority </b>focus<b> </b>of patient
teaching?</span>
<span style="font-size:12pt">The patient has multiple
dysplastic nevi.</span>
<span style="font-size:12pt">The patient uses a tanning booth
throughout the winter.</span>
<span style="font-size:12pt">The patient is fair-skinned and
has blue eyes.</span>
<span style="font-size:12pt">The patient&#8217;s mother
died of a malignant melanoma.</span>
answer_2
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<span style="font-size:12pt">Because the only risk factor that the patient
can change is the use of a tanning booth, the nurse should focus teaching
about melanoma prevention on this factor. The other factors also will
contribute to increased risk for melanoma.</span>
<span style="font-size:12pt">Because the only risk factor that the patient
can change is the use of a tanning booth, the nurse should focus teaching
about melanoma prevention on this factor. The other factors also will
contribute to increased risk for melanoma.</span>
question_63_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which instruction will the nurse
plan to include in discharge teaching for a patient admitted
with a sickle cell crisis?</span>
<span style="font-size:12pt">Take a daily multivitamin with
iron.</span>
<span style="font-size:12pt">Limit fluids to 2 to 3 quarts per
day.</span>
<span style="font-size:12pt">Avoid exposure to crowds when
possible.</span>
<span style="font-size:12pt">Drink only two caffeinated
beverages daily.</span>
answer_3
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<span style="font-size:12pt">Exposure to crowds increases the
patient&#8217;s risk for infection, the most common cause of sickle cell
crisis. There is no restriction on caffeine use. Iron supplementation is
generally not recommended. A high-fluid intake is recommended.</span>
<span style="font-size:12pt">Exposure to crowds increases the
patient&#8217;s risk for infection, the most common cause of sickle cell
crisis. There is no restriction on caffeine use. Iron supplementation is
generally not recommended. A high-fluid intake is recommended.</span>
question_64_1
Item
Electrolyte imbalance
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse is caring for a patient
who has the following laboratory results: potassium 3.4
mEq/L (3.4 mmol/L), magnesium 1.8 mEq/L (0.74 mmol/L),
calcium 8.5 mEq/L (2.13 mmol/L), and sodium 144 mEq/L
(144 mmol/L). Which assessment does the nurse complete
first?</span>
<span style="font-size:12pt">Grip strength</span>
<span style="font-size:12pt">Depth of respirations</span>
<span style="font-size:12pt">Bowel sounds</span>
<span style="font-size:12pt">Electrocardiography</span>
answer_2
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<span style="font-size:12pt">A patient with a low serum potassium level
may exhibit hypoactive bowel sounds, cardiac dysrhythmias, and muscle
weakness resulting in shallow respirations and decreased handgrips. The
nurse should assess the patient&#8217;s respiratory status first to ensure
that respirations are sufficient. The respiratory assessment should include
rate and depth of respirations, respiratory effort, and oxygen saturation. The
other assessments are important but are secondary to the patient&#8217;s
respiratory status.</span>
<span style="font-size:12pt">A patient with a low serum potassium level
may exhibit hypoactive bowel sounds, cardiac dysrhythmias, and muscle
weakness resulting in shallow respirations and decreased handgrips. The
nurse should assess the patient&#8217;s respiratory status first to ensure
that respirations are sufficient. The respiratory assessment should include
rate and depth of respirations, respiratory effort, and oxygen saturation. The
other assessments are important but are secondary to the patient&#8217;s
respiratory status.</span>
question_65_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient with possible
disseminated intravascular coagulation arrives in the
emergency department with a blood pressure of 82/40,
temperature of 102&#176; F (38.9&#176; C), and severe back
pain. Which prescribed action will the nurse implement
<b>first</b>?</span>
<span style="font-size:12pt">Administer morphine sulfate 4
mg IV.</span>
<span style="font-size:12pt">Infuse normal saline 500 mL
over 30 minutes.</span>
<span style="font-size:12pt">Give acetaminophen (Tylenol)
650 mg.</span>
<span style="font-size:12pt">Schedule complete blood count
and coagulation studies.</span>
answer_2
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<span style="font-size:12pt">The patient&#8217;s blood pressure indicates
hypovolemia caused by blood loss and should be addressed immediately to
improve perfusion to vital organs. The other actions are also appropriate
and should be rapidly implemented, but improving perfusion is the priority
for this patient.</span>
<span style="font-size:12pt">The patient&#8217;s blood pressure indicates
hypovolemia caused by blood loss and should be addressed immediately to
improve perfusion to vital organs. The other actions are also appropriate
and should be rapidly implemented, but improving perfusion is the priority
for this patient.</span>
question_66_1
Item
Acidbase imbalance , laboratory values
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse evaluates the following
arterial blood gas values in a patient: pH 7.48,
PaO<sub>2</sub> 98 mm Hg, PaCO<sub>2</sub> 28 mm
Hg, and HCO<sub>3</sub><sup>-</sup> 22 mEq/L (22
mmol/L). Which patient condition does the nurse correlate
with these results?</span>
<span style="font-size:12pt">Diabetic ketoacidosis and
emphysema</span>
<span style="font-size:12pt">Diarrhea and vomiting for 36
hours</span>
<span style="font-size:12pt">Anxiety-induced
hyperventilation</span>
<span style="font-size:12pt">Chronic obstructive pulmonary
disease (COPD)</span>
answer_3
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<span style="font-size:12pt">The elevated pH level indicates alkalosis. The
bicarbonate level is normal, and so is the oxygen partial pressure. Loss of
carbon dioxide is the cause of the alkalosis, which would occur in response
to hyperventilation. Diarrhea and vomiting would cause metabolic
alterations, COPD would lead to respiratory acidosis, and the patient with
emphysema most likely would have combined metabolic acidosis on top of
a mild, chronic respiratory acidosis.</span>
<span style="font-size:12pt">The elevated pH level indicates alkalosis. The
bicarbonate level is normal, and so is the oxygen partial pressure. Loss of
carbon dioxide is the cause of the alkalosis, which would occur in response
to hyperventilation. Diarrhea and vomiting would cause metabolic
alterations, COPD would lead to respiratory acidosis, and the patient with
emphysema most likely would have combined metabolic acidosis on top of
a mild, chronic respiratory acidosis.</span>
question_67_1
Item
Falls , safety , older adult
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">An older adult patient is in the
hospital. The patient is ambulatory and independent. What
intervention by the nurse would be most helpful in preventing
falls in this patient?</span>
<span style="font-size:12pt">Order a bedside commode for
the patient.</span>
<span style="font-size:12pt">Keep the light on in the
bathroom at night.</span>
<span style="font-size:12pt">Use side rails to keep the patient
in bed.</span>
<span style="font-size:12pt">Put the patient on a toileting
schedule.</span>
answer_2
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<span style="font-size:12pt">Although this older adult is independent and
ambulatory, being hospitalized can create confusion. Getting up in a dark,
unfamiliar environment can contribute to falls. Keeping the light on in the
bathroom will help reduce the likelihood of falling. The patient does not
need a commode or a toileting schedule. Side rails used to keep the patient
in bed are considered restraints and should not be used in that
fashion.</span>
<span style="font-size:12pt">Although this older adult is independent and
ambulatory, being hospitalized can create confusion. Getting up in a dark,
unfamiliar environment can contribute to falls. Keeping the light on in the
bathroom will help reduce the likelihood of falling. The patient does not
need a commode or a toileting schedule. Side rails used to keep the patient
in bed are considered restraints and should not be used in that
fashion.</span>
question_68_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which information obtained by
the nurse assessing a patient admitted with multiple myeloma
is <b>most</b> important to report to the health care
provider?</span>
<span style="font-size:12pt">Patient reports no stool for 5
days.</span>
<span style="font-size:12pt">Serum calcium level is 15
mg/dL.</span>
<span style="font-size:12pt">Urine sample has Bence-Jones
protein.</span>
<span style="font-size:12pt">Patient is complaining of severe
back pain.</span>
answer_2
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0.0
0.0
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<span style="font-size:12pt">Hypercalcemia may lead to complications
such as dysrhythmias or seizures, and should be addressed quickly. The
other patient findings will also be discussed with the health care provider
but are not life threatening.</span>
<span style="font-size:12pt">Hypercalcemia may lead to complications
such as dysrhythmias or seizures, and should be addressed quickly. The
other patient findings will also be discussed with the health care provider
but are not life threatening.</span>
question_69_1
Item
Gastrointestinal disorders , cancer , laboratory values , communication
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient is scheduled for a total
gastrectomy for gastric cancer. What preoperative laboratory
result would the nurse report to the surgeon
immediately?</span>
<span style="font-size:12pt">Hemoglobin: 8.1 g/dL (81
mmol/L)</span>
<span style="font-size:12pt">International normalized ratio
(INR): 4.2</span>
<span style="font-size:12pt">Albumin: 2.1 g/dL (21
g/L)</span>
<span style="font-size:12pt">Hematocrit: 28% (0.28)</span>
answer_2
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<span style="font-size:12pt">An INR as high as 4.2 poses a serious risk of
bleeding during the operation and would be reported. The albumin is low
and is an expected finding. The hematocrit and hemoglobin are also low,
but this is expected in gastric cancer.</span>
<span style="font-size:12pt">An INR as high as 4.2 poses a serious risk of
bleeding during the operation and would be reported. The albumin is low
and is an expected finding. The hematocrit and hemoglobin are also low,
but this is expected in gastric cancer.</span>
question_70_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">Which finding about a patient
with polycythemia vera is <b>most</b> important for the
nurse to report to the health care provider?</span>
<span style="font-size:12pt">Hematocrit 55%</span>
<span style="font-size:12pt">Platelet count 450,000/<span
style="font-family:'Times New
Roman'">&#0956;</span>L</span>
<span style="font-size:12pt">K= 3.8</span>
<span style="font-size:12pt">Calf swelling and pain</span>
answer_4
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<span style="font-size:12pt">The calf swelling and pain suggest that the
patient may have developed a deep vein thrombosis, which will require
diagnosis and treatment to avoid complications such as pulmonary embolus.
The other findings will also be reported to the health care provider but are
expected in a patient with this diagnosis.</span>
<span style="font-size:12pt">The calf swelling and pain suggest that the
patient may have developed a deep vein thrombosis, which will require
diagnosis and treatment to avoid complications such as pulmonary embolus.
The other findings will also be reported to the health care provider but are
expected in a patient with this diagnosis.</span>
question_71_1
Item
Rheumatoid arthritis , autoimmune disorder , coping , psychosocial response
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The nurse is working with a
patient who has rheumatoid arthritis (RA). The nurse has
identified the priority problem of poor body image for the
patient. What finding by the nurse indicates goals for this
patient problem are being met?</span>
<span style="font-size:12pt">Has a positive outlook on
life</span>
<span style="font-size:12pt">Attends meetings of a book
club</span>
<span style="font-size:12pt">Uses assistive devices to protect
joints</span>
<span style="font-size:12pt">Takes medication as
directed</span>
answer_2
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<span style="font-size:12pt">All of the activities are appropriate for a
patient with RA. Patients who have a poor body image are often reluctant to
appear in public, so attending public book club meetings indicates that goals
for this patient problem are being met.</span>
<span style="font-size:12pt">All of the activities are appropriate for a
patient with RA. Patients who have a poor body image are often reluctant to
appear in public, so attending public book club meetings indicates that goals
for this patient problem are being met.</span>
question_72_1
Item
Systemic lupus erythematosus , autoimmune disorders , patient education , self-care , fever
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A patient has newly diagnosed
systemic lupus erythematosus (SLE). What instruction by the
nurse is most important?</span>
<span style="font-size:12pt">&#8220;Weigh yourself every
day on the same scale.&#8221;</span>
<span style="font-size:12pt">&#8220;Eat plenty of highprotein, high-iron foods.&#8221;</span>
<span style="font-size:12pt">&#8220;Notify your provider at
once if you get a fever.&#8221;</span>
<span style="font-size:12pt">&#8220;Be sure you get enough
sleep at night.&#8221;</span>
answer_3
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<span style="font-size:12pt">Fever is the classic sign of a lupus flare and
would be reported immediately. Rest and nutrition are important but do not
take priority over teaching the patient what to do if he or she develops an
elevated temperature. Daily weights may or may not be important
depending on renal involvement.</span>
<span style="font-size:12pt">Fever is the classic sign of a lupus flare and
would be reported immediately. Rest and nutrition are important but do not
take priority over teaching the patient what to do if he or she develops an
elevated temperature. Daily weights may or may not be important
depending on renal involvement.</span>
question_73_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
Your patient&#8217;s TSH (thyroid-stimulating hormone)
level is 0.001.&nbsp; What condition&nbsp; does this value
indicate?
Hyperactive anterior pituitary function
Hyperthyroidism
Hypoactive anterior pituitary function
Hypothyroidism
answer_4
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0.0
0.0
0.0
0.0
0.0
question_74_1
Item
Inflammatory bowel disorder , nutritional requirements
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse teaches a patient who
has viral gastroenteritis. Which dietary instruction would the
nurse include in this patient&#8217;s teaching?</span>
<span style="font-size:12pt">&#8220;You should only drink
1 L of fluids daily.&#8221;</span>
<span style="font-size:12pt">&#8220;Increase your protein
intake by drinking more milk.&#8221;</span>
<span style="font-size:12pt">&#8220;Drink plenty of fluids
to prevent dehydration.&#8221;</span>
<span style="font-size:12pt">&#8220;Sips of cola or tea may
help to relieve your nausea.&#8221;</span>
answer_3
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<span style="font-size:12pt">The patient should drink plenty of fluids to
prevent dehydration. Milk products may not be tolerated. Caffeinated
beverages increase intestinal motility and should be avoided.</span>
<span style="font-size:12pt">The patient should drink plenty of fluids to
prevent dehydration. Milk products may not be tolerated. Caffeinated
beverages increase intestinal motility and should be avoided.</span>
question_75_1
Item
Delegation , oral care , pneumonia , older adult , unlicensed assistive personnel (UAP)
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse is caring for several
older patients in the hospital that the nurse identifies as being
at high risk for healthcare-associated pneumonia. To reduce
this risk, what activity should the nurse delegate to the
unlicensed assistive personnel (UAP)?</span>
<span style="font-size:12pt">Report any new onset of
cough.</span>
<span style="font-size:12pt">Monitor temperature every 4
hours.</span>
<span style="font-size:12pt">Provide oral care every 4
hours.</span>
<span style="font-size:12pt">Encourage between-meal
snacks.</span>
answer_3
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0.0
0.0
0.0
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<span style="font-size:12pt">Oral colonization by gram-negative bacteria
is a risk factor for healthcare-associated pneumonia. Good, frequent oral
care can help prevent this from developing and is a task that can be
delegated to the UAP. Encouraging good nutrition is important, but this will
not prevent pneumonia. Monitoring temperature and reporting new cough in
patients are important to detect the onset of possible pneumonia but do not
prevent it.</span>
<span style="font-size:12pt">Oral colonization by gram-negative bacteria
is a risk factor for healthcare-associated pneumonia. Good, frequent oral
care can help prevent this from developing and is a task that can be
delegated to the UAP. Encouraging good nutrition is important, but this will
not prevent pneumonia. Monitoring temperature and reporting new cough in
patients are important to detect the onset of possible pneumonia but do not
prevent it.</span>
question_76_1
Item
Test
Subsection
Multiple Choice
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">An appropriate nursing
intervention for a patient with non-Hodgkin&#8217;s
lymphoma whose platelet count drops to 18,000/&#181;L
during chemotherapy is to</span>
<span style="font-size:12pt">check all stools for occult
blood.</span>
<span style="font-size:12pt">check the temperature every 4
hours.</span>
<span style="font-size:12pt">encourage fluids to 3000
mL/day.</span>
<span style="font-size:12pt">provide oral hygiene every 2
hours.</span>
answer_1
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<span style="font-size:12pt">Because the patient is at risk for spontaneous
bleeding, the nurse should check stools for occult blood. A low platelet
count does not require an increased fluid intake. Oral hygiene is important,
but it is not necessary to provide oral care every 2 hours. The low platelet
count does not increase risk for infection, so frequent temperature
monitoring is not indicated.</span>
<span style="font-size:12pt">Because the patient is at risk for spontaneous
bleeding, the nurse should check stools for occult blood. A low platelet
count does not require an increased fluid intake. Oral hygiene is important,
but it is not necessary to provide oral care every 2 hours. The low platelet
count does not increase risk for infection, so frequent temperature
monitoring is not indicated.</span>
question_77_1
Item
Skin lesions/wounds , infection , transmission precautions
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse prepares to admit a
patient who has herpes zoster. Which actions would the nurse
take? (<i>Select all that apply.</i>)</span>
<span style="font-size:12pt">Check the admission
prescriptions for analgesia.</span>
<span style="font-size:12pt">Choose a roommate who also is
immune suppressed.</span>
<span style="font-size:12pt">Ensure that gloves are available
in the room.</span>
<span style="font-size:12pt">Prepare a room for reverse
isolation.</span>
<span style="font-size:12pt">Assess staff for a history of or
vaccination for chickenpox.</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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<span style="font-size:12pt">Herpes zoster (shingles) is caused by
reactivation of the same virus, varicella zoster, in patients who have
previously had chickenpox. Anyone who has not had the disease or has not
been vaccinated for it is at high risk for getting chickenpox. Herpes zoster is
very painful and requires analgesia. Use of gloves and good handwashing
are sufficient to prevent spread. It is best to put this patient in a private
room. Herpes zoster is a disease of immune suppression, so no one who is
immune-suppressed would be in the same room.</span>
<span style="font-size:12pt">Herpes zoster (shingles) is caused by
reactivation of the same virus, varicella zoster, in patients who have
previously had chickenpox. Anyone who has not had the disease or has not
been vaccinated for it is at high risk for getting chickenpox. Herpes zoster is
very painful and requires analgesia. Use of gloves and good handwashing
are sufficient to prevent spread. It is best to put this patient in a private
room. Herpes zoster is a disease of immune suppression, so no one who is
immune-suppressed would be in the same room.</span>
question_78_1
Item
Immunity , decreased immunity , Older adult risk factors
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">The nurse is teaching an elderly
patient on the risks of infection for older adults. Which of the
following factors would the nurse include in the education?
(<i>Select all that apply.</i>)</span>
<span style="font-size:12pt">Older adults may not have a
fever with severe infection.</span>
<span style="font-size:12pt">Skin tests for tuberculosis may
be falsely negative.</span>
<span style="font-size:12pt">Older adults show expected
changes in white blood cell counts.</span>
<span style="font-size:12pt">Older patients are at more risk
for respiratory tract and genitourinary infections.</span>
<span style="font-size:12pt">Older adults should receive
influenza, pneumococcal, and shingles vaccinations.</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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0.0
<span style="font-size:12pt">Immunity changes during an adult&#8217;s
life and older adults have decreased immune function. The number and
function of neutrophils and macrophages are reduced leading to reduced
response to infection and injury, such as temperature elevation. The usual
response of an increased white blood cell count is delayed or absent. Older
adults are less able to make new antibodies in response to the presence of
new antigens requiring repeat vaccinations and immunizations. Skin tests
for tuberculosis may be falsely negative and there is an increased risk for
bacterial and fungal infections due to the decreased number of circulating
T-lymphocytes.</span>
<span style="font-size:12pt">Immunity changes during an adult&#8217;s
life and older adults have decreased immune function. The number and
function of neutrophils and macrophages are reduced leading to reduced
response to infection and injury, such as temperature elevation. The usual
response of an increased white blood cell count is delayed or absent. Older
adults are less able to make new antibodies in response to the presence of
new antigens requiring repeat vaccinations and immunizations. Skin tests
for tuberculosis may be falsely negative and there is an increased risk for
bacterial and fungal infections due to the decreased number of circulating
T-lymphocytes.</span>
question_79_1
Item
Diabetes mellitus , foot care
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse teaches a patient with
diabetes mellitus about foot care. Which statements would the
nurse include in this patient&#8217;s teaching? (<i>Select all
that apply.</i>)</span>
<span style="font-size:12pt">&#8220;Treat any blisters or
sores with Epsom salts.&#8221;</span>
<span style="font-size:12pt">&#8220;Wash your feet every
other day.&#8221;</span>
<span style="font-size:12pt">&#8220;Do not walk around
barefoot.&#8221;</span>
<span style="font-size:12pt">&#8220;Soak your feet in a tub
each evening.&#8221;</span>
<span style="font-size:12pt">&#8220;Trim toenails straight
across with a nail clipper.&#8221;</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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0.0
<span style="font-size:12pt">Patients who have diabetes mellitus are at
high risk for wounds on the feet secondary to peripheral neuropathy and
poor arterial circulation. The patient would be instructed to not walk around
barefoot or wear sandals with open toes. These actions place the patient at
higher risk for skin breakdown of the feet. The patient would be instructed
to trim toenails straight across with a nail clipper. Feet should be washed
daily with lukewarm water and soap, but feet should not be soaked in the
tub. The patient should contact the provider immediately if blisters or sores
appear and should not use home remedies to treat these wounds.</span>
<span style="font-size:12pt">Patients who have diabetes mellitus are at
high risk for wounds on the feet secondary to peripheral neuropathy and
poor arterial circulation. The patient would be instructed to not walk around
barefoot or wear sandals with open toes. These actions place the patient at
higher risk for skin breakdown of the feet. The patient would be instructed
to trim toenails straight across with a nail clipper. Feet should be washed
daily with lukewarm water and soap, but feet should not be soaked in the
tub. The patient should contact the provider immediately if blisters or sores
appear and should not use home remedies to treat these wounds.</span>
question_80_1
Item
Electrolyte imbalance
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse is assessing a patient
who has an electrolyte imbalance related to renal failure. For
which potential complications of this electrolyte imbalance
does the nurse assess? (<i>Select all that apply.</i>)</span>
<span style="font-size:12pt">Skeletal muscle
weakness</span>
<span style="font-size:12pt">Paralytic ileus</span>
<span style="font-size:12pt">Electrocardiogram
changes</span>
<span style="font-size:12pt">Slow, shallow
respirations</span>
<span style="font-size:12pt">Orthostatic hypotension</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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<span style="font-size:12pt">Electrolyte imbalances associated with acute
renal failure include hyperkalemia. The nurse should assess for
electrocardiogram changes, paralytic ileus caused by decrease bowel
mobility, and skeletal muscle weakness in patients with hyperkalemia. The
other choices are potential complications of hypokalemia.</span>
<span style="font-size:12pt">Electrolyte imbalances associated with acute
renal failure include hyperkalemia. The nurse should assess for
electrocardiogram changes, paralytic ileus caused by decrease bowel
mobility, and skeletal muscle weakness in patients with hyperkalemia. The
other choices are potential complications of hypokalemia.</span>
question_81_1
Item
Adrenal gland disorder , laboratory values
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse assesses a patient who
potentially has hyperaldosteronism. Which serum laboratory
values would the nurse associate with this disorder? (<i>Select
all that apply.</i>)</span>
<span style="font-size:12pt">Potassium: 5.0 mEq/L (5.0
mmol/L)</span>
<span style="font-size:12pt">Sodium: 150 mEq/L (150
mmol/L)</span>
<span style="font-size:12pt">pH 7.50</span>
<span style="font-size:12pt">Potassium: 2.5 mEq/L (2.5
mmol/L)</span>
<span style="font-size:12pt">Sodium: 130 mEq/L (130
mmol/L)</span>
<span style="font-size:12pt">pH 7.28</span>
answer_0
answer_1
answer_2
answer_3
answer_4
answer_5
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0.0
<span style="font-size:12pt">Aldosterone increases reabsorption of sodium
and excretion of potassium. Hyperaldosteronism causes hypernatremia,
hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and
acidosis are manifestations of adrenal insufficiency.</span>
<span style="font-size:12pt">Aldosterone increases reabsorption of sodium
and excretion of potassium. Hyperaldosteronism causes hypernatremia,
hypokalemia, and metabolic alkalosis. Hyponatremia, hyperkalemia, and
acidosis are manifestations of adrenal insufficiency.</span>
question_82_1
Item
Ulcerative colitis
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse assesses a patient with
ulcerative colitis. Which complications are paired correctly
with their physiologic processes? (<i>Select all that
apply.</i>)</span>
<span style="font-size:12pt">Toxic
megacolon&#8212;transmural inflammation resulting in
pyuria and fecaluria</span>
<span style="font-size:12pt">Lower gastrointestinal
bleeding&#8212;erosion of the bowel wall</span>
<span style="font-size:12pt">Abscess
formation&#8212;localized pockets of infection develop in
the ulcerated bowel lining</span>
<span style="font-size:12pt">Fistula&#8212;dilation and
colonic ileus caused by paralysis of the colon</span>
<span style="font-size:12pt">Nonmechanical bowel
obstruction&#8212;paralysis of colon resulting from
colorectal cancer</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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0.0
<span style="font-size:12pt">Lower GI bleeding can lead to erosion of the
bowel wall. Abscesses are localized pockets of infection that develop in the
ulcerated bowel lining. Nonmechanical bowel obstruction is paralysis of the
colon that results from colorectal cancer. When the inflammation is
transmural, fistulas can occur between the bowel and bladder resulting in
pyuria and fecaluria. Paralysis of the colon causing dilation and subsequent
colonic ileus is known as a toxic megacolon.</span>
<span style="font-size:12pt">Lower GI bleeding can lead to erosion of the
bowel wall. Abscesses are localized pockets of infection that develop in the
ulcerated bowel lining. Nonmechanical bowel obstruction is paralysis of the
colon that results from colorectal cancer. When the inflammation is
transmural, fistulas can occur between the bowel and bladder resulting in
pyuria and fecaluria. Paralysis of the colon causing dilation and subsequent
colonic ileus is known as a toxic megacolon.</span>
question_83_1
Item
Endocrine system , pathophysiology
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse cares for patients with
hormone disorders. Which are common key features of
hormones? (<i>Select all that apply.</i>)</span>
<span style="font-size:12pt">Most hormones cause target
tissues to change activities by changing gene activity.</span>
<span style="font-size:12pt">Continued hormone activity
requires continued production and secretion.</span>
<span style="font-size:12pt">Control of hormone activity is
caused by negative feedback mechanisms.</span>
<span style="font-size:12pt">Most hormones are stored in the
target tissues for use later.</span>
<span style="font-size:12pt">Hormones may travel long
distances to get to their target tissues.</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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<span style="font-size:12pt">Hormones are secreted by endocrine glands
and travel through the body to reach their target tissues. Hormone activity
can increase or decrease according to the body&#8217;s needs, and
continued hormone activity requires continued production and secretion.
Control is maintained via negative feedback. Hormones are not stored for
later use, and they do not alter genetic activity.</span>
<span style="font-size:12pt">Hormones are secreted by endocrine glands
and travel through the body to reach their target tissues. Hormone activity
can increase or decrease according to the body&#8217;s needs, and
continued hormone activity requires continued production and secretion.
Control is maintained via negative feedback. Hormones are not stored for
later use, and they do not alter genetic activity.</span>
question_84_1
Item
Electrolyte imbalance
Test
Subsection
Multiple Answer
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse is caring for patients
with electrolyte imbalances on a medical-surgical unit. Which
common causes are correctly paired with the corresponding
electrolyte imbalance? (<i>Select all that apply.</i>)</span>
<span style="font-size:12pt">Hyperkalemia&#8212;Salt
substitutes</span>
<span style="fontsize:12pt">Hypophosphatemia&#8212;Calcium
deficit</span>
<span style="fontsize:12pt">Hypomagnesemia&#8212;Kidney failure</span>
<span style="fontsize:12pt">Hypernatremia&#8212;Hyperaldosteronism</span
>
<span style="fontsize:12pt">Hypocalcemia&#8212;Diarrhea</span>
answer_0
answer_1
answer_2
answer_3
answer_4
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<span style="font-size:12pt">Salt substitutes contain potassium and are a
cause of hyperkalemia. Hyperaldosterone is a cause of hypernatremia and
diarrhea causes actual calcium deficits. Decreased kidney function is a
cause of magnesium excess, not deficit. Hyperphosphatemia creates a
relative calcium deficit.</span>
<span style="font-size:12pt">Salt substitutes contain potassium and are a
cause of hyperkalemia. Hyperaldosterone is a cause of hypernatremia and
diarrhea causes actual calcium deficits. Decreased kidney function is a
cause of magnesium excess, not deficit. Hyperphosphatemia creates a
relative calcium deficit.</span>
question_85_1
Item
Test
Subsection
Essay
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A procainamide drip is ordered (
2 gms in 250 ml D5W) to infuse 4 mg/min. The patient&nbsp;
weighs 165 pounds. Calculate the drip rate in ml/hr for which
the infusion pump will be set at. Round to the whole
number.<br></span><br><br><br>_____________________
_______________
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30 ml/hr
question_86_1
Item
Test
Subsection
Essay
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A lidocaine drip is infusing on
your 90 kg patient at 22 ml/hr.&nbsp; The lidocaine
concentration is 2 grams in 250 mlof D5W.&nbsp; How many
mg/min is your patient receiving? Round to the whole
number.<br><br><br><br>____________________________
________</span>
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3 mg/hr
question_87_1
Item
Test
Subsection
Essay
false
letter_lower
false
vertical
false
1.0
0.0
<span style="font-size:12pt">A nurse prepares to administer
prescribed regular and NPH insulin. Place the nurse&#8217;s
actions in the correct order to administer these
medications.<br><br>1. Inspect bottles for expiration
dates.<br>2. Gently roll the bottle of NPH between the
hands.<br>3. Wash your hands.<br>4. Inject air into the
regular insulin.<br>5. Withdraw the NPH insulin.<br>6.
Withdraw the regular insulin.<br>7. Inject air into the NPH
bottle.<br>8. Clean rubber stoppers with an alcohol
swab.<br><br><br>__________________________________
__</span>
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<span style="font-size:12pt">3, 1, 2, 8, 7, 4, 6, 5</span>
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