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Tuesday, July 30, 2013

TEST III - Care of Clients with Physiologic and Psychosocial Alterations part 2

TEST III - Care of Clients with Physiologic and
Psychosocial Alterations part 2

51. A 37-year-old client with uterine cancer asks the
nurse, "Which is the most common type of
cancer in women?" The nurse replies that it's
breast cancer. Which type of cancer causes the
most deaths in women?
a. Breast cancer
b. Lung cancer
c. Brain cancer
d. Colon and rectal cancer

52. Antonio with lung cancer develops Horner's
syndrome when the tumor invades the ribs and
affects the sympathetic nerve ganglia. When
assessing for signs and symptoms of this
syndrome, the nurse should note:
a. miosis, partial eyelid ptosis, and
anhidrosis on the affected side of the
face.
b. chest pain, dyspnea, cough, weight loss,
and fever.
c. arm and shoulder pain and atrophy of
arm and hand muscles, both on the
affected side.
d. hoarseness and dysphagia.

53. Vic asks the nurse what PSA is. The nurse should
reply that it stands for:
a. prostate-specific antigen, which is used
to screen for prostate cancer.
b. protein serum antigen, which is used to
determine protein levels.
c. pneumococcal strep antigen, which is a
bacteria that causes pneumonia.
d. Papanicolaou-specific antigen, which is
used to screen for cervical cancer.

54. What is the most important postoperative
instruction that nurse Kate must give a client
who has just returned from the operating room
after receiving a subarachnoid block?
a. "Avoid drinking liquids until the gag
reflex returns."
b. "Avoid eating milk products for 24
hours."
c. "Notify a nurse if you experience blood
in your urine."
d. "Remain supine for the time specified by
the physician."

55. A male client suspected of having colorectal
cancer will require which diagnostic study to
confirm the diagnosis?
a. Stool Hematest
b. Carcinoembryonic antigen (CEA)
c. Sigmoidoscopy
d. Abdominal computed tomography (CT) scan

56. During a breast examination, which finding most
strongly suggests that the Luz has breast cancer?
a. Slight asymmetry of the breasts.
b. A fixed nodular mass with dimpling of
the overlying skin
c. Bloody discharge from the nipple
d. Multiple firm, round, freely movable
masses that change with the menstrual
cycle

57. A female client with cancer is being evaluated
for possible metastasis. Which of the following is
one of the most common metastasis sites for
cancer cells?
a. Liver
b. Colon
c. Reproductive tract
d. White blood cells (WBCs)

58. Nurse Mandy is preparing a client for magnetic
resonance imaging (MRI) to confirm or rule out a
spinal cord lesion. During the MRI scan, which of
the following would pose a threat to the client?
a. The client lies still.
b. The client asks questions.
c. The client hears thumping sounds.
d. The client wears a watch and wedding
band.

59. Nurse Cecile is teaching a female client about
preventing osteoporosis. Which of the following
teaching points is correct?
a. Obtaining an X-ray of the bones every 3
years is recommended to detect bone loss.
b. To avoid fractures, the client should
avoid strenuous exercise.
c. The recommended daily allowance of
calcium may be found in a wide variety of foods.
d. Obtaining the recommended daily
allowance of calcium requires taking a
calcium supplement.

60. Before Jacob undergoes arthroscopy, the nurse
reviews the assessment findings for
contraindications for this procedure. Which
finding is a contraindication?
a. Joint pain
b. Joint deformity
c. Joint flexion of less than 50%
d. Joint stiffness

61. Mr. Rodriguez is admitted with severe pain in
the knees. Which form of arthritis is
characterized by urate deposits and joint pain,
usually in the feet and legs, and occurs primarily
in men over age 30?
a. Septic arthritis
b. Traumatic arthritis
c. Intermittent arthritis
d. Gouty arthritis

62. A heparin infusion at 1,500 unit/hour is ordered
for a 64-year-old client with stroke in evolution.
The infusion contains 25,000 units of heparin in
500 ml of saline solution. How many milliliters
per hour should be given?
a. 15 ml/hour
b. 30 ml/hour
c. 45 ml/hour
d. 50 ml/hour

63. A 76-year-old male client had a thromboembolic
right stroke; his left arm is swollen. Which of the
following conditions may cause swelling after a
stroke?
a. Elbow contracture secondary to
spasticity
b. Loss of muscle contraction decreasing
venous return
c. Deep vein thrombosis (DVT) due to
immobility of the ipsilateral side
d. Hypoalbuminemia due to protein
escaping from an inflamed glomerulus

64. Heberden’s nodes are a common sign of
osteoarthritis. Which of the following statement
is correct about this deformity?
a. It appears only in men
b. It appears on the distal interphalangeal joint
c. It appears on the proximal
interphalangeal joint
d. It appears on the dorsolateral aspect of
the interphalangeal joint.

65. Which of the following statements explains the
main difference between rheumatoid arthritis
and osteoarthritis?
a. Osteoarthritis is gender-specific,
rheumatoid arthritis isn’t
b. Osteoarthritis is a localized disease
rheumatoid arthritis is systemic
c. Osteoarthritis is a systemic disease,
rheumatoid arthritis is localized
d. Osteoarthritis has dislocations and
subluxations, rheumatoid arthritis
doesn’t

66. Mrs. Cruz uses a cane for assistance in walking.
Which of the following statements is true about
a cane or other assistive devices?
a. A walker is a better choice than a cane.
b. The cane should be used on the affected
side
c. The cane should be used on the
unaffected side
d. A client with osteoarthritis should be
encouraged to ambulate without the
cane

67. A male client with type 1 diabetes is scheduled
to receive 30 U of 70/30 insulin. There is no
70/30 insulin available. As a substitution, the
nurse may give the client:
a. 9 U regular insulin and 21 U neutral
protamine Hagedorn (NPH).
b. 21 U regular insulin and 9 U NPH.
c. 10 U regular insulin and 20 U NPH.
d. 20 U regular insulin and 10 U NPH.
68. Nurse Len should expect to administer which
medication to a client with gout?
a. aspirin
b. furosemide (Lasix)
c. colchicines
d. calcium gluconate (Kalcinate)

69. Mr. Domingo with a history of hypertension is
diagnosed with primary hyperaldosteronism.
This diagnosis indicates that the client's
hypertension is caused by excessive hormone
secretion from which of the following glands?
a. Adrenal cortex
b. Pancreas
c. Adrenal medulla
d. Parathyroid

70. For a diabetic male client with a foot ulcer, the
doctor orders bed rest, a wet-to-dry dressing
change every shift, and blood glucose
monitoring before meals and bedtime. Why are
wet-to-dry dressings used for this client?
a. They contain exudate and provide a
moist wound environment.
b. They protect the wound from
mechanical trauma and promote
healing.
c. They debride the wound and promote
healing by secondary intention.
d. They prevent the entrance of
microorganisms and minimize wound
discomfort.         

71. Nurse Zeny is caring for a client in acute
addisonian crisis. Which laboratory data would
the nurse expect to find?
a. Hyperkalemia
b. Reduced blood urea nitrogen (BUN)
c. Hypernatremia
d. Hyperglycemia

72. A client is admitted for treatment of the
syndrome of inappropriate antidiuretic hormone
(SIADH). Which nursing intervention is
appropriate?
a. Infusing I.V. fluids rapidly as ordered
b. Encouraging increased oral intake
c. Restricting fluids
d. Administering glucose-containing I.V.
fluids as ordered

73. A female client tells nurse Nikki that she has
been working hard for the last 3 months to
control her type 2 diabetes mellitus with diet
and exercise. To determine the effectiveness of
the client's efforts, the nurse should check:
a. urine glucose level.
b. fasting blood glucose level.
c. serum fructosamine level.
d. glycosylated hemoglobin level.

74. Nurse Trinity administered neutral protamine
Hagedorn (NPH) insulin to a diabetic client at 7
a.m. At what time would the nurse expect the
client to be most at risk for a hypoglycemic
reaction?
a. 10:00 am
b. Noon
c. 4:00 pm
d. 10:00 pm

75. The adrenal cortex is responsible for producing
which substances?
a. Glucocorticoids and androgens
b. Catecholamines and epinephrine
c. Mineralocorticoids and catecholamines
d. Norepinephrine and epinephrine

76. On the third day after a partial thyroidectomy,
Proserfina exhibits muscle twitching and
hyperirritability of the nervous system. When
questioned, the client reports numbness and
tingling of the mouth and fingertips. Suspecting
a life-threatening electrolyte disturbance, the
nurse notifies the surgeon immediately. Which
electrolyte disturbance most commonly follows
thyroid surgery?
a. Hypocalcemia
b. Hyponatremia
c. Hyperkalemia
d. Hypermagnesemia

77. Which laboratory test value is elevated in clients
who smoke and can't be used as a general
indicator of cancer?
a. Acid phosphatase level
b. Serum calcitonin level
c. Alkaline phosphatase level
d. Carcinoembryonic antigen level

78. Francis with anemia has been admitted to the
medical-surgical unit. Which assessment findings
are characteristic of iron-deficiency anemia?
a. Nights sweats, weight loss, and diarrhea
b. Dyspnea, tachycardia, and pallor
c. Nausea, vomiting, and anorexia
d. Itching, rash, and jaundice                

79. In teaching a female client who is HIV-positive
about pregnancy, the nurse would know more
teaching is necessary when the client says:
a. The baby can get the virus from my
placenta."
b. "I'm planning on starting on birth control
pills."
c. "Not everyone who has the virus gives
birth to a baby who has the virus."
d. "I'll need to have a C-section if I become
pregnant and have a baby."

80. When preparing Judy with acquired
immunodeficiency syndrome (AIDS) for
discharge to the home, the nurse should be sure
to include which instruction?
a. "Put on disposable gloves before
bathing."
b. "Sterilize all plates and utensils in boiling
water."
c. "Avoid sharing such articles as
toothbrushes and razors."
d. "Avoid eating foods from serving dishes
shared by other family members."

81. Nurse Marie is caring for a 32-year-old client
admitted with pernicious anemia. Which set of
findings should the nurse expect when assessing
the client?
a. Pallor, bradycardia, and reduced pulse
pressure
b. Pallor, tachycardia, and a sore tongue
c. Sore tongue, dyspnea, and weight gain
d. Angina, double vision, and anorexia

82. After receiving a dose of penicillin, a client
develops dyspnea and hypotension. Nurse
Celestina suspects the client is experiencing
anaphylactic shock. What should the nurse do
first?
a. Page an anesthesiologist immediately
and prepare to intubate the client.
b. Administer epinephrine, as prescribed,
and prepare to intubate the client if
necessary.
c. Administer the antidote for penicillin, as
prescribed, and continue to monitor the
client's vital signs.
d. Insert an indwelling urinary catheter and
begin to infuse I.V. fluids as ordered.

83. Mr. Marquez with rheumatoid arthritis is about
to begin aspirin therapy to reduce inflammation.
When teaching the client about aspirin, the
nurse discusses adverse reactions to prolonged
aspirin therapy. These include:
a. weight gain.
b. fine motor tremors.
c. respiratory acidosis.
d. bilateral hearing loss.

84. A 23-year-old client is diagnosed with human
immunodeficiency virus (HIV). After recovering
from the initial shock of the diagnosis, the client
expresses a desire to learn as much as possible
about HIV and acquired immunodeficiency
syndrome (AIDS). When teaching the client
about the immune system, the nurse states that
adaptive immunity is provided by which type of
white blood cell?
a. Neutrophil
b. Basophil
c. Monocyte
d. Lymphocyte

85. In an individual with Sjögren's syndrome, nursing
care should focus on:
a. moisture replacement.
b. electrolyte balance.
c. nutritional supplementation.
d. arrhythmia management.

86. During chemotherapy for lymphocytic leukemia,
Mathew develops abdominal pain, fever, and
"horse barn" smelling diarrhea. It would be most
important for the nurse to advise the physician
to order:
a. enzyme-linked immunosuppressant
assay (ELISA) test.
b. electrolyte panel and hemogram.
c. stool for Clostridium difficile test.
d. flat plate X-ray of the abdomen.

87. A male client seeks medical evaluation for
fatigue, night sweats, and a 20-lb weight loss in 6
weeks. To confirm that the client has been
infected with the human immunodeficiency virus
(HIV), the nurse expects the physician to order:
a. E-rosette immunofluorescence.
b. quantification of T-lymphocytes.
c. enzyme-linked immunosorbent assay
(ELISA).
d. Western blot test with ELISA.

88. A complete blood count is commonly performed
before a Joe goes into surgery. What does this
test seek to identify?
a. Potential hepatic dysfunction indicated
by decreased blood urea nitrogen (BUN)
and creatinine levels
b. Low levels of urine constituents normally
excreted in the urine
c. Abnormally low hematocrit (HCT) and
hemoglobin (Hb) levels
d. Electrolyte imbalance that could affect
the blood's ability to coagulate properly

89. While monitoring a client for the development
of disseminated intravascular coagulation (DIC),
the nurse should take note of what assessment
parameters?
a. Platelet count, prothrombin time, and
partial thromboplastin time
b. Platelet count, blood glucose levels, and
white blood cell (WBC) count
c. Thrombin time, calcium levels, and
potassium levels
d. Fibrinogen level, WBC, and platelet
count

90. When taking a dietary history from a newly
admitted female client, Nurse Len should
remember that which of the following foods is a
common allergen?
a. Bread
b. Carrots
c. Orange
d. Strawberries

91. Nurse John is caring for clients in the outpatient
clinic. Which of the following phone calls should
the nurse return first?
a. A client with hepatitis A who states, “My
arms and legs are itching.”
b. A client with cast on the right leg who
states, “I have a funny feeling in my right
leg.”
c. A client with osteomyelitis of the spine
who states, “I am so nauseous that I
can’t eat.”
d. A client with rheumatoid arthritis who
states, “I am having trouble sleeping.”

92. Nurse Sarah is caring for clients on the surgical
floor and has just received report from the
previous shift. Which of the following clients
should the nurse see first?
a. A 35-year-old admitted three hours ago
with a gunshot wound; 1.5 cm area of
dark drainage noted on the dressing.
b. A 43-year-old who had a mastectomy
two days ago; 23 ml of serosanguinous
fluid noted in the Jackson-Pratt drain.
c. A 59-year-old with a collapsed lung due
to an accident; no drainage noted in the
previous eight hours.
d. A 62-year-old who had an abdominalperineal
resection three days ago; client
complaints of chills.

93. Nurse Eve is caring for a client who had a
thyroidectomy 12 hours ago for treatment of
Grave’s disease. The nurse would be most
concerned if which of the following was
observed?
a. Blood pressure 138/82, respirations 16,
oral temperature 99 degrees Fahrenheit.
b. The client supports his head and neck
when turning his head to the right.
c. The client spontaneously flexes his wrist
when the blood pressure is obtained.
d. The client is drowsy and complains of
sore throat.

94. Julius is admitted with complaints of severe pain
in the lower right quadrant of the abdomen. To
assist with pain relief, the nurse should take
which of the following actions?
a. Encourage the client to change positions
frequently in bed.
b. Administer Demerol 50 mg IM q 4 hours
and PRN.
c. Apply warmth to the abdomen with a
heating pad.
d. Use comfort measures and pillows to
position the client.

95. Nurse Tina prepares a client for peritoneal
dialysis. Which of the following actions should
the nurse take first?
a. Assess for a bruit and a thrill.
b. Warm the dialysate solution.
c. Position the client on the left side.
101
d. Insert a Foley catheter

96. Nurse Jannah teaches an elderly client with
right-sided weakness how to use cane. Which of
the following behaviors, if demonstrated by the
client to the nurse, indicates that the teaching
was effective?
a. The client holds the cane with his right
hand, moves the can forward followed
by the right leg, and then moves the left
leg.
b. The client holds the cane with his right
hand, moves the cane forward followed
by his left leg, and then moves the right
leg.
c. The client holds the cane with his left
hand, moves the cane forward followed
by the right leg, and then moves the left
leg.
d. The client holds the cane with his left
hand, moves the cane forward followed
by his left leg, and then moves the right
leg.

97. An elderly client is admitted to the nursing home
setting. The client is occasionally confused and
her gait is often unsteady. Which of the
following actions, if taken by the nurse, is most
appropriate?
a. Ask the woman’s family to provide
personal items such as photos or
mementos.
b. Select a room with a bed by the door so
the woman can look down the hall.
c. Suggest the woman eat her meals in the
room with her roommate.
d. Encourage the woman to ambulate in
the halls twice a day.

98. Nurse Evangeline teaches an elderly client how
to use a standard aluminum walker. Which of
the following behaviors, if demonstrated by the
client, indicates that the nurse’s teaching was
effective?
a. The client slowly pushes the walker
forward 12 inches, then takes small
steps forward while leaning on the
walker.
b. The client lifts the walker, moves it
forward 10 inches, and then takes
several small steps forward.
c. The client supports his weight on the
walker while advancing it forward, then
takes small steps while balancing on the
walker.
d. The client slides the walker 18 inches
forward, then takes small steps while
holding onto the walker for balance.

99. Nurse Deric is supervising a group of elderly
clients in a residential home setting. The nurse
knows that the elderly are at greater risk of
developing sensory deprivation for what reason?
a. Increased sensitivity to the side effects
of medications.
b. Decreased visual, auditory, and
gustatory abilities.
c. Isolation from their families and familiar
surroundings.
d. Decrease musculoskeletal function and
mobility.

100. A male client with emphysema becomes
restless and confused. What step should
nurse Jasmine take next?
a. Encourage the client to perform pursed
lip breathing.
b. Check the client’s temperature.
c. Assess the client’s potassium level.

d. Increase the client’s oxygen flow rate.

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