TEST IV - Care of Clients with Physiologic and Psychosocial Alterations part 1

TEST IV - Care of Clients with Physiologic and

Psychosocial Alterations part 1

1. Randy has undergone kidney transplant, what

assessment would prompt Nurse Katrina to

suspect organ rejection?

a. Sudden weight loss

b. Polyuria

c. Hypertension

d. Shock

2. The immediate objective of nursing care for an

overweight, mildly hypertensive male client with

ureteral colic and hematuria is to decrease:

a. Pain

b. Weight

c. Hematuria

d. Hypertension

3. Matilda, with hyperthyroidism is to receive

Lugol’s iodine solution before a subtotal

thyroidectomy is performed. The nurse is aware

that this medication is given to:

a. Decrease the total basal metabolic rate.

b. Maintain the function of the parathyroid

glands.

c. Block the formation of thyroxine by the

thyroid gland.

d. Decrease the size and vascularity of the

thyroid gland.

4. Ricardo, was diagnosed with type I diabetes. The

nurse is aware that acute hypoglycemia also can

develop in the client who is diagnosed with:

a. Liver disease

b. Hypertension

c. Type 2 diabetes

d. Hyperthyroidism

5. Tracy is receiving combination chemotherapy for

treatment of metastatic carcinoma. Nurse Ruby

should monitor the client for the systemic side

effect of:

a. Ascites

b. Nystagmus

c. Leukopenia

d. Polycythemia

6. Norma, with recent colostomy expresses

concern about the inability to control the

passage of gas. Nurse Oliver should suggest that

the client plan to:

a. Eliminate foods high in cellulose.

b. Decrease fluid intake at meal times.

c. Avoid foods that in the past caused

flatus.

d. Adhere to a bland diet prior to social

events.

7. Nurse Ron begins to teach a male client how to

perform colostomy irrigations. The nurse would

evaluate that the instructions were understood

when the client states, “I should:

a. Lie on my left side while instilling the

irrigating solution.”

b. Keep the irrigating container less than

18 inches above the stoma.”

c. Instill a minimum of 1200 ml of irrigating

solution to stimulate evacuation of the

bowel.”

d. Insert the irrigating catheter deeper into

the stoma if cramping occurs during the

procedure.”

8. Patrick is in the oliguric phase of acute tubular

necrosis and is experiencing fluid and electrolyte

imbalances. The client is somewhat confused

and complains of nausea and muscle weakness.

As part of the prescribed therapy to correct this

electrolyte imbalance, the nurse would expect

to:

a. Administer Kayexalate

b. Restrict foods high in protein

c. Increase oral intake of cheese and milk.

d. Administer large amounts of normal

saline via I.V.

9. Mario has burn injury. After Forty48 hours, the

physician orders for Mario 2 liters of IV fluid to

be administered q12 h. The drop factor of the

tubing is 10 gtt/ml. The nurse should set the

flow to provide:

a. 18 gtt/min

b. 28 gtt/min

c. 32 gtt/min

d. 36 gtt/min

10. Terence suffered from burn injury. Using the rule

of nines, which has the largest percent of burns?

a. Face and neck

b. Right upper arm and penis

c. Right thigh and penis

d. Upper trunk

11. Herbert, a 45 year old construction engineer is

brought to the hospital unconscious after falling

from a 2-story building. When assessing the

client, the nurse would be most concerned if the

assessment revealed:

a. Reactive pupils

b. A depressed fontanel

c. Bleeding from ears

d. An elevated temperature

12. Nurse Sherry is teaching male client regarding

his permanent artificial pacemaker. Which

information given by the nurse shows her

knowledge deficit about the artificial cardiac

pacemaker?

a. take the pulse rate once a day, in the

morning upon awakening

b. May be allowed to use electrical

appliances

c. Have regular follow up care

d. May engage in contact sports

13. The nurse is ware that the most relevant

knowledge about oxygen administration to a

male client with COPD is

a. Oxygen at 1-2L/min is given to maintain

the hypoxic stimulus for breathing.

b. Hypoxia stimulates the central

chemoreceptors in the medulla that

makes the client breath.

c. Oxygen is administered best using a nonrebreathing

mask

d. Blood gases are monitored using a pulse

oximeter.

14. Tonny has undergoes a left thoracotomy and a

partial pneumonectomy. Chest tubes are

inserted, and one-bottle water-seal drainage is

instituted in the operating room. In the

postanesthesia care unit Tonny is placed in

Fowler's position on either his right side or on

his back. The nurse is aware that this position:

a. Reduce incisional pain.

b. Facilitate ventilation of the left lung.

c. Equalize pressure in the pleural space.

d. Increase venous return

15. Kristine is scheduled for a bronchoscopy. When

teaching Kristine what to expect afterward, the

nurse's highest priority of information would be:

a. Food and fluids will be withheld for at

least 2 hours.

b. Warm saline gargles will be done q 2h.

c. Coughing and deep-breathing exercises

will be done q2h.

d. Only ice chips and cold liquids will be

allowed initially.

16. Nurse Tristan is caring for a male client in acute

renal failure. The nurse should expect hypertonic

glucose, insulin infusions, and sodium

bicarbonate to be used to treat:

a. hypernatremia.

b. hypokalemia.

c. hyperkalemia.

d. hypercalcemia.

17. Ms. X has just been diagnosed with condylomata

acuminata (genital warts). What information is

appropriate to tell this client?

a. This condition puts her at a higher risk

for cervical cancer; therefore, she should

have a Papanicolaou (Pap) smear

annually.

b. The most common treatment is

metronidazole (Flagyl), which should

eradicate the problem within 7 to 10

days.

c. The potential for transmission to her

sexual partner will be eliminated if

condoms are used every time they have

sexual intercourse.

d. The human papillomavirus (HPV), which

causes condylomata acuminata, can't be

transmitted during oral sex.

18. Maritess was recently diagnosed with a

genitourinary problem and is being examined in

the emergency department. When palpating her

kidneys, the nurse should keep which anatomical

fact in mind?

a. The left kidney usually is slightly higher

than the right one.

b. The kidneys are situated just above the

adrenal glands.

c. The average kidney is approximately 5

cm (2") long and 2 to 3 cm (¾" to 1-1/8")

wide.

d. The kidneys lie between the 10th and

12th thoracic vertebrae.

19. Jestoni with chronic renal failure (CRF) is

admitted to the urology unit. The nurse is aware

that the diagnostic test are consistent with CRF if

the result is:

a. Increased pH with decreased hydrogen

ions.

b. Increased serum levels of potassium,

magnesium, and calcium.

c. Blood urea nitrogen (BUN) 100 mg/dl

and serum creatinine 6.5 mg/ dl.

d. Uric acid analysis 3.5 mg/dl and

phenolsulfonphthalein (PSP) excretion

75%.

20. Katrina has an abnormal result on a

Papanicolaou test. After admitting that she read

her chart while the nurse was out of the room,

Katrina asks what dysplasia means. Which

definition should the nurse provide?

a. Presence of completely undifferentiated

tumor cells that don't resemble cells of

the tissues of their origin.

b. Increase in the number of normal cells in

a normal arrangement in a tissue or an

organ.

c. Replacement of one type of fully

differentiated cell by another in tissues

where the second type normally isn't

found.

d. Alteration in the size, shape, and

organization of differentiated cells.

21. During a routine checkup, Nurse Mariane

assesses a male client with acquired

immunodeficiency syndrome (AIDS) for signs and

symptoms of cancer. What is the most common

AIDS-related cancer?

a. Squamous cell carcinoma

b. Multiple myeloma

c. Leukemia

d. Kaposi's sarcoma

22. Ricardo is scheduled for a prostatectomy, and

the anesthesiologist plans to use a spinal

(subarachnoid) block during surgery. In the

operating room, the nurse positions the client

according to the anesthesiologist's instructions.

Why does the client require special positioning

for this type of anesthesia?

a. To prevent confusion

b. To prevent seizures

c. To prevent cerebrospinal fluid (CSF)

leakage

d. To prevent cardiac arrhythmias

23. A male client had a nephrectomy 2 days ago and

is now complaining of abdominal pressure and

nausea. The first nursing action should be to:

a. Auscultate bowel sounds.

b. Palpate the abdomen.

c. Change the client's position.

d. Insert a rectal tube.

24. Wilfredo with a recent history of rectal bleeding

is being prepared for a colonoscopy. How should

the nurse Patricia position the client for this test

initially?

a. Lying on the right side with legs straight

b. Lying on the left side with knees bent

c. Prone with the torso elevated

d. Bent over with hands touching the floor

25. A male client with inflammatory bowel disease

undergoes an ileostomy. On the first day after

surgery, Nurse Oliver notes that the client's

stoma appears dusky. How should the nurse

interpret this finding?

a. Blood supply to the stoma has been

interrupted.

b. This is a normal finding 1 day after

surgery.

c. The ostomy bag should be adjusted.

d. An intestinal obstruction has occurred.

26. Anthony suffers burns on the legs, which nursing

intervention helps prevent contractures?

a. Applying knee splints

b. Elevating the foot of the bed

c. Hyperextending the client's palms

d. Performing shoulder range-of-motion

exercises

27. Nurse Ron is assessing a client admitted with

second- and third-degree burns on the face,

arms, and chest. Which finding indicates a

potential problem?

a. Partial pressure of arterial oxygen

(PaO2) value of 80 mm Hg.

b. Urine output of 20 ml/hour.

c. White pulmonary secretions.

d. Rectal temperature of 100.6° F (38° C).

28. Mr. Mendoza who has suffered a

cerebrovascular accident (CVA) is too weak to

move on his own. To help the client avoid

pressure ulcers, Nurse Celia should:

a. Turn him frequently.

b. Perform passive range-of-motion (ROM)

exercises.

c. Reduce the client's fluid intake.

d. Encourage the client to use a footboard.

29. Nurse Maria plans to administer dexamethasone

cream to a female client who has dermatitis over

the anterior chest. How should the nurse apply

this topical agent?

a. With a circular motion, to enhance

absorption.

b. With an upward motion, to increase

blood supply to the affected area

c. In long, even, outward, and downward

strokes in the direction of hair growth

d. In long, even, outward, and upward

strokes in the direction opposite hair

growth

30. Nurse Kate is aware that one of the following

classes of medication protects the ischemic

myocardium by blocking catecholamines and

sympathetic nerve stimulation is:

a. Beta -adrenergic blockers

b. Calcium channel blocker

c. Narcotics

d. Nitrates

31. A male client has jugular distention. On what

position should the nurse place the head of the

bed to obtain the most accurate reading of

jugular vein distention?

a. High Fowler’s

b. Raised 10 degrees

c. Raised 30 degrees

d. Supine position             

32. The nurse is aware that one of the following

classes of medications maximizes cardiac

performance in clients with heart failure by

increasing ventricular contractility?

a. Beta-adrenergic blockers

b. Calcium channel blocker

c. Diuretics

d. Inotropic agents

33. A male client has a reduced serum high-density

lipoprotein (HDL) level and an elevated lowdensity

lipoprotein (LDL) level. Which of the

following dietary modifications is not

appropriate for this client?

a. Fiber intake of 25 to 30 g daily

b. Less than 30% of calories from fat

c. Cholesterol intake of less than 300 mg

daily

d. Less than 10% of calories from saturated

fat

34. A 37-year-old male client was admitted to the

coronary care unit (CCU) 2 days ago with an

acute myocardial infarction. Which of the

following actions would breach the client

confidentiality?

a. The CCU nurse gives a verbal report to

the nurse on the telemetry unit before

transferring the client to that unit

b. The CCU nurse notifies the on-call

physician about a change in the client’s

condition

c. The emergency department nurse calls

up the latest electrocardiogram results

to check the client’s progress.

d. At the client’s request, the CCU nurse

updates the client’s wife on his condition

35. A male client arriving in the emergency

department is receiving cardiopulmonary

resuscitation from paramedics who are giving

ventilations through an endotracheal (ET) tube

that they placed in the client’s home. During a

pause in compressions, the cardiac monitor

shows narrow QRS complexes and a heart rate

of beats/minute with a palpable pulse. Which of

the following actions should the nurse take first?

a. Start an L.V. line and administer

amiodarone (Cardarone), 300 mg L.V.

over 10 minutes.

b. Check endotracheal tube placement.

c. Obtain an arterial blood gas (ABG)

sample.

d. Administer atropine, 1 mg L.V.

36. After cardiac surgery, a client’s blood pressure

measures 126/80 mm Hg. Nurse Katrina

determines that mean arterial pressure (MAP) is

which of the following?

a. 46 mm Hg

b. 80 mm Hg

c. 95 mm Hg

d. 90 mm Hg

37. A female client arrives at the emergency

department with chest and stomach pain and a

report of black tarry stool for several months.

Which of the following order should the nurse

Oliver anticipate?

a. Cardiac monitor, oxygen, creatine kinase

and lactate dehydrogenase levels

b. Prothrombin time, partial

thromboplastin time, fibrinogen and

fibrin split product values.

c. Electrocardiogram, complete blood

count, testing for occult blood,

comprehensive serum metabolic panel.

d. Electroencephalogram, alkaline

phosphatase and aspartate

aminotransferase levels, basic serum

metabolic panel

38. Macario had coronary artery bypass graft (CABG)

surgery 3 days ago. Which of the following

conditions is suspected by the nurse when a

decrease in platelet count from 230,000 ul to

5,000 ul is noted?

a. Pancytopenia

b. Idiopathic thrombocytopemic purpura

(ITP)

c. Disseminated intravascular coagulation

(DIC)

d. Heparin-associated thrombosis and

thrombocytopenia (HATT)

39. Which of the following drugs would be ordered

by the physician to improve the platelet count in

a male client with idiopathic thrombocytopenic

purpura (ITP)?

a. Acetylsalicylic acid (ASA)

b. Corticosteroids

c. Methotrezate

d. Vitamin K

40. A female client is scheduled to receive a heart

valve replacement with a porcine valve. Which

of the following types of transplant is this?

a. Allogeneic

b. Autologous

c. Syngeneic

d. Xenogeneic

41. Marco falls off his bicycle and injuries his ankle.

Which of the following actions shows the initial

response to the injury in the extrinsic pathway?

a. Release of Calcium

b. Release of tissue thromboplastin

c. Conversion of factors XII to factor XIIa

d. Conversion of factor VIII to factor VIIIa

42. Instructions for a client with systemic lupus

erythematosus (SLE) would include information

about which of the following blood dyscrasias?

a. Dressler’s syndrome

b. Polycythemia

c. Essential thrombocytopenia

d. Von Willebrand’s disease

43. The nurse is aware that the following symptom

is most commonly an early indication of stage 1

Hodgkin’s disease?

a. Pericarditis

b. Night sweat

c. Splenomegaly

d. Persistent hypothermia

44. Francis with leukemia has neutropenia. Which of

the following functions must frequently

assessed?

a. Blood pressure

b. Bowel sounds

c. Heart sounds

d. Breath sounds

45. The nurse knows that neurologic complications

of multiple myeloma (MM) usually involve which

of the following body system?

a. Brain

b. Muscle spasm

c. Renal dysfunction

d. Myocardial irritability

46. Nurse Patricia is aware that the average length

of time from human immunodeficiency virus

(HIV) infection to the development of acquired

immunodeficiency syndrome (AIDS)?

a. Less than 5 years

b. 5 to 7 years

c. 10 years

d. More than 10 years

47. An 18-year-old male client admitted with heat

stroke begins to show signs of disseminated

intravascular coagulation (DIC). Which of the

following laboratory findings is most consistent

with DIC?

a. Low platelet count

b. Elevated fibrinogen levels

c. Low levels of fibrin degradation products

d. Reduced prothrombin time

48. Mario comes to the clinic complaining of fever,

drenching night sweats, and unexplained weight

loss over the past 3 months. Physical

examination reveals a single enlarged

supraclavicular lymph node. Which of the

following is the most probable diagnosis?

a. Influenza

b. Sickle cell anemia

c. Leukemia

d. Hodgkin’s disease

49. A male client with a gunshot wound requires an

emergency blood transfusion. His blood type is

AB negative. Which blood type would be the

safest for him to receive?

a. AB Rh-positive

b. A Rh-positive

c. A Rh-negative

d. O Rh-positive

Situation: Stacy is diagnosed with acute lymphoid

leukemia (ALL) and beginning chemotherapy.

50. Stacy is discharged from the hospital following

her chemotherapy treatments. Which statement

of Stacy’s mother indicated that she understands

when she will contact the physician?

a. “I should contact the physician if Stacy

has difficulty in sleeping”.

b. “I will call my doctor if Stacy has

persistent vomiting and diarrhea”.

c. “My physician should be called if Stacy is

irritable and unhappy”.

d. “Should Stacy have continued hair loss, I

need to call the doctor”.