VN224_FINAL_EXAM.doc.rtf

DRAFT Do Not Use Until Posted. ____________________________________________________________________________ VN224 FINAL EXAM - Confidential # of Questions: 56 ____________________________________________________________________________ Question #: 1 A nurse assesses a patient with Hodgkin's disease to determine staging. The client has cervical and inguinal lymph node involvement. What stage of Hodgkin's disease is the client in? A. Stage I B. Stage II C. Stage III D. Stage IV ____________________________________________________________________________ Question #: 2 A client is to have a hip replacement in 3 months and does not want a blood transfusion from random donors. What is the best option the nurse can discuss with the client? A. Sign a refusal of blood transfusion form so the client will not receive the transfusion. B. Bank autologous blood. C. Ask people to donate blood. D. Using volume expanders in case blood is needed. ____________________________________________________________________________ Question #: 3 The nurse is talking with a group of teens about transmission of human immunodeficiency virus (HIV). What body fluids does the nurse inform them will transmit the virus? Select all that apply. A. Semen B. Urine C. Breast Milk D. Blood E. Vaginal secretions ____________________________________________________________________________ Question #: 4 A client had a left radical mastectomy with an axillary node dissection 6 months ago and is having a large amount of edema in the left arm down to the fingers. What should the nurse inform the client is the reason for the edema? A. An accumulation of lymphatic fluid that results from impaired lymph circulation. B. It is congenitally acquired and is not related to the mastectomy. C. They are most likely ingesting too much sodium and should be advised to decrease the amount. D. There is inadequate blood flow from circulatory impairment. ____________________________________________________________________________ Question #: 5 A client is suspected of having leukemia and is having a series of laboratory and diagnostic studies performed. What does the nurse recognize as the hallmark signs of leukemia? Select all that apply. A. Diarrhea B. Nausea and vomiting C. Frequent infections D. Fatigue from anemia E. Easy bruising ____________________________________________________________________________ Question #: 6 The nurse is instructing a client about taking a liquid iron preparation for the treatment of iron-deficiency anemia. What should the nurse include in the instructions? A. Do not take medication with orange juice because it will delay absorption of the iron. B. Iron may cause indigestion and should be taken with an antacid such as Mylanta. C. Dilute the liquid preparation with another liquid such as juice and drink with a straw. D. Discontinue the use of iron if your stool turns black. ____________________________________________________________________________ Question #: 7 A client is found to have a low hemoglobin and hematocrit when laboratory work was performed. What does the nurse understand the anemia may have resulted from? Select all that apply. A. Infection B. Blood loss C. Abnormal erythrocyte production D. Destruction of normally formed red blood cells E. Inadequate formed white blood cells ____________________________________________________________________________ Question #: 8 A client is volunteering to donate blood for the second time and was mailed a letter telling him that he has type AB blood. If the client requires a blood transfusion in the future, what type of blood must he receive? A. They can receive blood from persons with any type of blood if the Rh factor is compatible. B. They can only receive blood from persons with type A blood. C. They can only receive blood from persons with type B blood. D. They can only receive blood from persons with type O blood if the Rh factor is positive. ____________________________________________________________________________ Question #: 9 The nurse is discussing vitamin replacement with a client in the clinic. Which vitamin should the nurse discuss with the client in order to increase the absorption of folic acid and iron? A. Vitamin B12 B. Vitamin C C. Vitamin B6 D. Vitamin E ____________________________________________________________________________ Question #: 10 The nurse is caring for three clients who have the following blood count values: Client A has 24,500/mm3 white blood cells (WBCs), client B has 13.4 g/dL hemoglobin, and client C has a 250,000/mm3 platelet count. Which statement correctly describes the condition of each client? A. Client A has a normal WBC count, client B has a higher hemoglobin count than normal, and client C has a normal platelet count. B. Client A has a higher WBC count than normal, client B has a normal hemoglobin count, and client C has a normal platelet count. C. Client A has a higher WBC count than normal, client B has a normal hemoglobin count, and client C has a higher platelet count than normal. D. Client A has a normal WBC count than normal, client B has a normal hemoglobin count, and client C has a normal platelet count. ____________________________________________________________________________ Question #: 11 The patient's daughter asks the nurse "what could have contributed to my father getting laryngeal cancer?". The nurse states that the risk factors are ______________________________________________. Select all that apply. A. Alcohol B. Age C. Tobacco D. Industrial pollutants E. Alopecia ____________________________________________________________________________ Question #: 12 A client is brought to the emergency department following a motor vehicle accident. Which of the following nursing assessments is significant in diagnosing flail chest? A. Respiratory Acidosis B. Paradoxical chest movement C. Chest pain on inspiration D. Clubbing of fingers and toes ____________________________________________________________________________ Question #: 13 A nurse has been asked to ensure informed consent for a surgical procedure. What might be a role of the nurse? A. Securing informed consent from the client B. Signing the consent form as a witness C. Ensuring the client does not refuse treatment D. Refusing to participate based on legal guidelines ____________________________________________________________________________ Question #: 14 Match the patients with the appropriate vaccination. 1 Intramuscular Flu shot A. A 25 y/o healthy type I diabetic B. A 45 y/o man without any complications 2 FluMist C. A 25 y/o pregnant woman D. A child with allergies to eggs E. An adult with allergies to pineapple 1. A, C, D 2. B, E ____________________________________________________________________________ Question #: 15 A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assess the dressing and finds it saturated with blood. The client is restless and has a rapid weak pulse. What should the nurse do next? A. Document the data and apply a new dressing B. Apply a pressure dressing and report findings. C. Reassure the family that this is a common finding. D. Make assessments every 15 minutes for 4 hours ____________________________________________________________________________ Question #: 16 During a bed bath the client's chest tube has been disconnected from the drainage system. How should the nurse first respond to this event? A. Submerge the end of the tube in sterile water B. Clamp the tube near the end and also near the insertion point C. Place the end of the tube on a sterile surface and seek help promptly D. Clean thee end of the tube with an alcohol swab and reconnect it to the drainage unit. ____________________________________________________________________________ Question #: 17 Zyvox 600 mg IV once a day is ordered for a patient. The Zyvox is dissolved in 300 mL of NS and should infuse over 1 hour. Using tubing with a drop factor of 20 gtt/mL, the drip rate should be set to 1 drops per minute. Numbers only. 1. 100 ____________________________________________________________________________ Question #: 18 The nurse is invited to present a teaching program to parents of school-aged children. Which topic would be of greatest value for decreasing cancer risks? A. Pool and water safety B. Breast and testicular self-exams C. Handwashing and infection prevention D. Sun safety and use of sunscreen ____________________________________________________________________________ Question #: 19 A nurse is educating a preoperative client on how to cough effectively. What can the nurse tell thee client to do to facilitate coughing? A. Hold a pillow or folded bath blanket over the incision. B. Get up and walk before trying to cough. C. It would be best to not cough until you feel better. D. When you cough cover your nose and mouth with tissue ____________________________________________________________________________ Question #: 20 A client is admitted to the hospital and will be undergoing tests to determine if he has an abdominal mass. What should the nurse be sure to document when asking about allergies? A. If the client is allergic to beef B. If the client is allergic to pork C. If the client is allergic to seafood D. If the client is allergic to grapefruit ____________________________________________________________________________ Question #: 21 The nurse is providing information about foot care to a client with diabetes. Which of the following would the nurse include? A. Wash your feet in hot water everyday B. Use a razor to remove corns or calluses C. Be sure to apply a moisturizer to feet daily D. Wear well fitted comfortable rubber shoes. ____________________________________________________________________________ Question #: 22 The nurse is describing the action of insulin in the body to a client newly diagnosed with type I diabetes. Which of the following would the nurse explain as being the primary action? A. It carries glucose into the body cells B. It aids in the process of gluconucleogenesis C. It stimulates the pancreatic beta cells D. It decreases the intestinal absorption of glucose ____________________________________________________________________________ Question #: 23 The client who is managing diabetes through diet and insulin control asks the nurse why is exercise important. Which is the best response by the nurse to support adding exercise to the daily routine? A. Increases ability for glucose to get into the cell and lowers blood sugar B. Creates and overall feeling of well-being and lowers risk of depression C. Decreases need for pancreas to produce more cells D. Decreases risk of developing insulin resistance and hyperglycermia ____________________________________________________________________________ Question #: 24 On initial nursing rounds, the diabetic client reports "not feeling well." Later, the nurse finds the client to be diaphoretic and in a stuporous state. What is the immediate action taken by the nurse? A. Call the pysician B. Obtain a glucometer reading C. Administer fruit juice D. Start an IV of dextrose ____________________________________________________________________________ Question #: 25 The nurse is caring for a client with a cardiovascular disorder. What intervention should the nurse perform before administering the prescribed beta-blockers to clients with disorders of the heart? A. Monitor the prothrombin time. B. Monitor for episodes of bleeding. C. Take the client's apical pulse. D. Monitor for bluish discoloration of the palms. ____________________________________________________________________________ Question #: 26 A client with diagnosed aortic stenosis is exhibiting fatigue, shortness of breath on exertion, and systolic murmur. Which of the following would the nurse list as the most concerning problem? A. Decreased Cardiac Output B. Activity Intolerance C. Fatigue D. Edema ____________________________________________________________________________ Question #: 27 A 68-year-old is scheduled to undergo mitral valve replacement for severe mitral stenosis and mitral regurgitation secondary to pericarditis. Although the diagnosis was made during childhood, she did not have any symptoms until 4 years ago. Recently, she noticed increased symptoms, despite daily doses of digoxin and furosemide. During the initial interview with the client, the nurse would most likely learn that the client’s childhood health history included: A. mumps B. chicken pox C. meningitis D. rheumatic fever ____________________________________________________________________________ Question #: 28 Your client has just been diagnosed with a dysrhythmia. The client asks you to explain normal sinus rhythm. What would you explain is the main characteristic of a normal sinus rhythm? A. Heart rate between 60 and 100 beats/minute produces a normal sinus rhythm. B. Impulse travels to the atrioventricular (AV) node in 0.15 to 0.5 second. C. The ventricles depolarize in 0.5 second or less, producing a normal sinus rhythm. D. The sinoatrial (SA) node (the pacemaker) initiates the impulse and communicates with the atrioventricular (AV) node to produce a normal sinus rhythm. ____________________________________________________________________________ Question #: 29 A nurse collaborates with an unlicensed assistive personnel (UAP) to provide care for a client with congestive heart failure. Which instructions should the nurse provide to the UAP when delegating care for this client? (Select all that apply.) A. “Reposition the client every 2 hours.” B. “Teach the client to perform deep-breathing exercises.” C. “Accurately record intake and output.” D. “Use the same scale to weigh the client each morning.” E. “Place the client on oxygen if the client becomes short of breath.” ____________________________________________________________________________ Question #: 30 A nurse cares for a client with right-sided heart failure. The client asks, “Why do I need to weigh myself every day?” How should the nurse respond? A. “Weight is the best indication that you are gaining or losing fluid.” B. “Daily weights will help us make sure that you’re eating properly.” C. “The hospital requires that all inpatients be weighed daily.” D. “You need to lose weight to decrease the incidence of heart failure.” ____________________________________________________________________________ Question #: 31 The P wave represents 1 ____________________ and the T wave represents 2 _____________________. 1. Atrial depolarization 2. Ventricular repolarization ____________________________________________________________________________ Question #: 32 1. Name this rhythm. 2. What is the heart rate (bpm)? 3. Is this a 6 second strip? ____________________________________________________________________________ Question #: 33 The nurse is working on a telemetry unit at a local hospital. The nurse obtains report on a client with symptoms of sharp chest pain and tachycardia. The nurse begins to collect and critical think through assessment data. Which client symptom distinguishes between a myocardial infarction and myocarditis? A. Pulse deficit B. White frothy sputum C. +3 peripheral edema D. Relief of pain when sitting up ____________________________________________________________________________ Question #: 34 A client is being treated in the hospital for hypovolemia related to a bleeding peptic ulcer. The nurse obtains a blood pressure reading of 88/62 mm Hg, heart rate of 112 beats/minute, and a respiratory rate of 24 breaths/minute. What is the first action by the nurse? A. Administer blood. B. Notify the physician. C. Insert two large-bore intravenous catheters. D. Administer a colloid solution. ____________________________________________________________________________ Question #: 35 A postoperative patient is moving from the bed to a chair when blood drips from the abdominal dressing. The nurse assesses the incision and notes evisceration. What does the nurse do first? A. Place a dry, sterile dressing over the protruding organs. B. Place a pressure dressing over the opening and secure. C. Have the patient lay quietly on back and call the physician. D. Moisten sterile guaze with normal saline and place on any exposed organ(s). ____________________________________________________________________________ Question #: 36 The nurse assesses the lab results of a preoperative patient and notice a potassium level of 6.5mEq/L. The nurse knows this could increase the patients operative risk of _________________________. A. Infection B. Cardiac Dysrhythmias C. Bleeding and anemia D. Fluid imbalances ____________________________________________________________________________ Question #: 37 What are pulmonary toiletries? ____________________________________________________________________________ Question #: 38 The nurse is explaining gylcosylated hemoglobin testing to a diabetic client. Which of following provides the best reason for this order? A. Provide best information on the body's abilty to maintain normal blood functioning B. Best indicator for thr nutritional state of the client C. is less costly than performing daily blood sugar test D. Reflects the amount of glucose stored in hemoglobin over the past several months ____________________________________________________________________________ Question #: 39 A nurse assesses a client’s electrocardiogram (ECG) and observes the reading shown below: How should the nurse document this client’s ECG strip? A. Ventricular tachycardia B. Ventricular fibrillation C. Sinus rhythm with premature atrial contractions (PACs) D. Sinus rhythm with premature ventricular contractions (PVCs) ____________________________________________________________________________ Question #: 40 A nurse assesses clients on a medical-surgical unit. Which client should the nurse identify as having the greatest risk for cardiovascular disease? A. An 86-year-old man with a history of asthma B. A 32-year-old Asian-American man with colorectal cancer C. A 45-year-old American Indian woman with diabetes mellitus D. A 53-year-old postmenopausal woman who is on hormone therapy ____________________________________________________________________________ Question #: 41 The medication Riluzole used for treatment of amyotrophic lateral sclerosis works to block glutamate. True or False. A. True B. False ____________________________________________________________________________ Question #: 42 A 60 year old man reports to the medical surgical unit with mask like expressions, stooped posture, tremors, and short shuffled steps. While performing a medication reconciliation the nurse expects to see what at home medications? Select all that apply. A. Levodopa B. Aspirin C. Amatadine D. Entacapone E. Metformin ____________________________________________________________________________ Question #: 43 The patient with myasthenia gravis complains that he "feels like he has everything wrong with him". The nurse attempts to comfort him by telling him which signs and symptoms are not associated with myasthenia gravis. These signs and symptoms are _________________________. Select all that apply. A. ptosis B. muscle twitching C. diplopia D. total paralysis E. difficulty chewing and swallowing ____________________________________________________________________________ Question #: 44 A patient with multiple sclerosis (MS) is in remission. The patient wants to know what can she avoid to decrease risk of reappearance of symptoms. The nurse explains the factors that may contribute to the reappearance of symptoms of MS. Select all that apply? A. hyperglycemia B. poor dietary habits C. volume overload D. infection E. emotional upsets ____________________________________________________________________________ Question #: 45 Match the signs of meningeal irritation with the correct name. 1 Kernig Sign 2 Brudzinski Sign 3 Opisthotonos 4 Nuchal Rigidity A. B. C. D. 1. C 2. D 3. B 4. A ____________________________________________________________________________ Question #: 46 The nursing student walks in on the nurse educating a patient on an eye disorder that is an opacity in the lens causing the lens to lose transparency or scatter light. The nursing student knows this condition is called _________________. A. Glaucoma B. Detached Retina C. Cataracts D. Entropion ____________________________________________________________________________ Question #: 47 A client you are caring for experiences a seizure. What would be a priority nursing action? A. Restrain the client during the seizure. B. Insert a tongue blade between the teeth. C. Protect the client from injury. D. Suction the mouth during the convulsion. ____________________________________________________________________________ Question #: 48 A client falls to the floor in a generalized seizure with tonic-clonic movements. Which is the first action taken by the nurse? A. Insert an airway or bite block. B. Manually restrain the extremities. C. Turn client to side-lying position. D. Monitor vital signs. ____________________________________________________________________________ Question #: 49 A client who has experienced an initial transient ischemic attack (TIA) states: “I'm glad it wasn't anything serious.” Which is the best nursing response to this statement? A. “I sense that you are happy it was not a stroke.” B. “People who experience a TIA will develop a stroke.” C. “TIA symptoms are short lived and resolve within 24 hours.” D. “TIA is a warning sign. Let's talk about lowering your risks.” ____________________________________________________________________________ Question #: 50 When evaluating a client’s risk for cerebrovascular accident, which client should the nurse identify as being at highest risk? A. A 42-year-old Caucasian female who smokes B. A 68-year-old African-American male with hypertension C. A 70-year-old Caucasian male who has one to two beers a day D. A 35-year-old African-American male who has sleep apnea ____________________________________________________________________________ Question #: 51 The nurse is performing a functional assessment on an 82-year-old patient who recently had a stroke. Which of these questions would be most important to ask? A. “Do you wear glasses?” B. “Are you able to get dressed by yourself?” C. “Do you have any thyroid problems?” D. “How many times a day do you have a bowel movement?” ____________________________________________________________________________ Question #: 52 The nurse is planning health teaching for a 65-year-old woman who has had a cerebrovascular accident (stroke) and has aphasia. Which of these questions is most important to use when assessing mental status in this patient? A. “Please count backward from 100 by seven.” B. “I will name three items and ask you to repeat them in a few minutes.” C. “Please point to articles in the room and parts of the body as I name them.” D. “What would you do if you found a stamped, addressed envelope on the sidewalk?” ____________________________________________________________________________ Question #: 53 A client experiences impaired swallowing after a stroke and has worked with speech-language pathology on eating. What nursing assessment best indicates that a priority goal for this problem has been met? A. Chooses preferred items from the menu B. Eats 75% to 100% of all meals and snacks C. Has clear lung sounds on auscultation D. Gains 2 pounds after 1 week ____________________________________________________________________________ Question #: 54 A client has sought care because she states that she has begun to see halos around headlights and streetlights when she is out at night. The nurse should recognize the need to refer the client for further assessment related to what health problem? A. Episcleritis B. Strabismus C. Macular degeneration D. Glaucoma ____________________________________________________________________________ Question #: 55 Which of the following disorders of the eye is an emergency? A. Cataracts B. Primary open-angle glaucoma C. Angle-closure glaucoma D. Dry eye ____________________________________________________________________________ Question #: 56 The nurse inspects a client's mouth and notes the presence of a bifid uvula. The nurse understands that this finding is most common in which ethnic group? A. Italian Americans B. Native Americans C. African Americans D. Non-Hispanic American