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

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

50. Lydia undergoes a laryngectomy to treat

laryngeal cancer. When teaching the client how

to care for the neck stoma, the nurse should

include which instruction?

a. "Keep the stoma uncovered."

b. "Keep the stoma dry."

c. "Have a family member perform stoma

care initially until you get used to the

procedure."

d. "Keep the stoma moist."

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.

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.