NURSING NUR 3125 midterm exam questions & answers |Latest update

NURSING NUR 3125 midterm exam questions & answers |Latest update NURSING NUR 3125 midterm exam The nurse knows that which of the following treatment plans listed below is most likely to be prescribed after a computed tomography (CT) scan of the head reveals a new-onset aneurysmal subarachnoid hemorrhage? Answer s: A. Stat administration of tissue plasminogen activator (tPA) B. Administration of a diuretic such as mannitol to reduce cerebral edema and ICP C. Monitoring in the ICU for signs and symptoms of cerebral insult D. Craniotomy and clipping of the affected vessel • Question 2 1 out of 1 points The unique clinical presentation of a 3-month-old infant in the emergency department leads the care team to suspect botulism. Which of the following assessment questions posed to the parents is likely to be most useful in the differential diagnosis? Answer s: A. “Have you ever given your child any honey or honey-containing products?” B. “Has your baby ever been directly exposed to any chemical cleaning products?” C. “Is there any mold in your home that you know of?” D. “Is there any family history of neuromuscular diseases?” • Question 3 1 out of 1 points An IV drug abuser walks into the ED telling the nurse that, “he is sick.” He looks feverish with flushed, moist skin; dehydrated with dry lips/mucous membranes; and fatigued. The assessment reveals a loud murmur. An echocardiogram was ordered that shows a large vegetation growing on his mitral valve. The patient is admitted to the ICU. The nurse will be assessing this patient for which possible life-threatening complications? Answer s: A. GI upset from the massive amount of antibiotics required to kill the bacteria B. Petechial hemorrhages under the skin and nail beds C. Systemic emboli, especially to the brain D. Pancreas enlargement due to increased need for insulin secretion • Question 4 1 out of 1 points During a routine physical exam for a patient diagnosed with hypertension, the nurse practitioner will be most concerned if which of the following assessments are found? Answer s: A. Slight increase in the number of varicose veins noted bilaterally B. Inability to locate the kidneys with deep palpation to the abdomen C. Unable to feel vibrations when a tuning fork is placed on the skull D. Noted hemorrhages and microaneurysms during evaluation of the internal eye • Question 5 A 44-year-old Caucasian woman is being treated in an airport infirmary 1 out of 1 points after she developed a painful, swollen leg during a transatlantic flight in economy class. The woman is suspected of having deep vein thrombosis (DVT) and is questioning the paramedics about why this might be the case, given that she has twice previously had similar experiences. Which of the following teaching points by the airport medical staff would be most appropriate? Answer s: A. “There is a genetic disorder that causes many Caucasians to form more clots in their blood vessels.” B. “A lot of Caucasian people have a genetic mutation that causes platelets to stick to their blood vessel walls.” C. “Your doctor might be able to tell you if you've inherited a predisposition to bleeding in your veins.” D. “A lot of Caucasians have an inherited inability to dissolve clots that form in their bodies.” • Question 6 Two nursing students are attempting to differentiate between the 1 out of 1 points presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students' following statements best captures an aspect of the two health problems? Answer s: A. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.” B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis. C. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.” D. “ITP can be either inherited or acquired, and if it's acquired, it involves an enzyme deficiency.” • Question 7 1 out of 1 points A 70-year-old male has been diagnosed with a stroke that resulted in an infarct to his cerebellum. Which of the following clinical findings would be most closely associated with cerebellar insult? Answer s: A. Difficulty in starting movement, stopping movement, and maintaining rhythmic movements. B. Tremor, rigidity, and bradykinesia C. Flaccid loss of muscle tone D. Unsteady gait and difficulty in speaking and swallowing • Question 8 1 out of 1 points A 77-year-old patient with a history of coronary artery disease and heart failure has arrived in the emergency room with a rapid heart rate and feeling of “impending doom.” Based on pathophysiologic principles, the nurse knows the rapid heart rate could Answer A. s: desensitize the α-adrenergic receptors leading to increase in norepinephrine levels. B. be a result of catecholamines released from SNS that could increase the myocardial oxygen demand. C. prolong the electrical firing from the SA node resulting in the development of a heart block. D. decrease renal perfusion and result in the development of ascites. • Question 9 A nurse who provides care in a geriatric subacute medicine unit of a hospital has noted that a large number of patients receive β-adrenergic blocking medications such as metoprolol. Which of the following statements best conveys an aspect of the use of beta-blockers? 1 out of 1 points Answer s: A. They decrease myocardial oxygen demand by blocking the release of intracellular calcium ions. B. They counteract arrhythmias and tachycardias by increasing vagal stimulation. C. They inhibit the potassium current and repolarization, extending the action potential and refractoriness. D. They can be used to treat supraventricular arrhythmias and decrease automaticity by depressing phase 4 of the action potential. • Question 10 A geriatrician has ordered an echocardiogram and stress test for an 80- 1 out of 1 points year-old male client in an effort to gauge the client's cardiovascular health status. Which of the following changes would the physician most likely identify as an anomaly that is not an expected age-related change? Answer s: A. Increased left ventricular wall thickness B. Low maximal heart rate and cardiac output C. Increased resting, supine heart rate D. Delayed left ventricular filling • Question 11 1 out of 1 points A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem? Answer s: A. Cerebellar lesions; surgical and immunosuppressive treatment B. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids C. Excess acetylcholinesterase production; treatment with thymectomy D. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins • Question 12 1 out of 1 points A 72-year-old woman with a recent onset of syncopal episodes has been referred to a cardiologist by her family physician. As part of the client's diagnostic workup, the cardiologist has ordered her to wear a Holter monitor for 24 hours. Which of the following statements best captures an aspect of Holter monitoring? Answer s: A. Holter monitors are normally set to record electrical activity of the heart at least once per hour. B. Accurate interpretation of the results requires correlating the findings with activity that the woman was doing at the time of recording. C. A Holter monitor is preferable to standard ECG due to its increased sensitivity to cardiac electrical activity. D. The primary goal is to allow the cardiologist to accurately diagnose cardiomyopathies. • Question 13 1 out of 1 points A nurse is administering morning medications to a number of patients on a medical unit. Which of the following medication regimens is most suggestive that the patient has a diagnosis of heart failure? Answer s: A. Diuretic, ACE inhibitor, beta-blocker B. Antihypertensive, diuretic, antiplatelet aggregator C. Beta-blocker, potassium supplement, anticoagulant D. Anticoagulant, antihypertensive, calcium supplement • Question 14 A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup” injury. How will the nurse explain this to the family so they can understand? 1 out of 1 points Answer s: A. “It's like squeezing an orange so tight that the juice runs out of the top.” B. “Your son has a contusion of the brain at the site where the bat hit his head.” C. “When the bat hit his head, his neck jerked backward causing injury to the spine.” D. “Your son has a huge laceration inside his brain where the bat hit his skull.” • Question 15 A community health nurse is working with an 81-year-old female client who states that she has made a concerted effort throughout her life to protect her skin from the sun and regularly applies topical moisturizers. The client is lamenting the fact that her skin's appearance has nonetheless deteriorated in recent years. Which of the following statements best captures a fact that the nurse should take into 1 out of 1 points consideration when crafting a response to the client? Answer s: A. Output of sebaceous glands declines, with accompanying reductions in sweat production. B. Skin becomes more fragile and prone to hematomas because of impaired vascularity. C. Skin becomes weaker and less elastic in older adults because of the rearrangement of fibrin and keratin. D. The epidermal layer of the skin inevitably thins as part of the normal aging process, lending a transparent appearance to the skin. • Question 16 1 out of 1 points A 44-year-old male hospital client with a diagnosis of end-stage acquired immunodeficiency syndrome (AIDS) has been placed on neutropenic precautions that limit his interaction with visitors, staff, and other clients. What is the underlying rationale for these precautions? Answer s: A. Neutropenia limits the ability of his CD4 helper cells to present antigens. B. Cyclic neutropenia limits his body's ability to fight various infections. C. Insufficient levels of neutrophils make him particularly susceptible to infections. D. His antibody-mediated immunity is compromised by his low production of neutrophils. • Question 17 0 out of 1 points A 70-year-old woman with ongoing severe atrial fibrillation is scheduled for defibrillation. What is an aspect of the rationale and physiology of defibrillation treatment? Answer s: A. Defibrillation must be coincided with the R wave of the ECG in order to be successful. B. The goal is to depolarize the entire heart during the passage of current. C. Defibrillation can be achieved using either a transcutaneous or transvenous pacemaker. D. Interruption of disorganized impulses by the current allows the AV node to readopt its normal pacemaker role. • Question 18 1 out of 1 points A school-age child with a history of asthma has brought a note home from school stating that there has been one case of meningitis (Neisseria meningitides) in the school. Since the mother is a nurse, she is very concerned since she knows the portal of entry of this pathogen is Answer s: A. by direct contact with a contaminated object such as a pencil. B. by ingestion such as when children share their drink with their friends. C. by inhalation via the respiratory tract such as through breathing or yawning. D. through a cut or abrasion that may occur on the playground. • Question 19 An 81-year-old female is attending a scheduled visit to her family 1 out of 1 points physician. The client asks her doctor why it is that she and her peers seem to get sick frequently, in spite of their efforts to stay active and eat nutritiously. Which of the following responses best captures an aspect of the immune function of older adults? Answer s: A. “With a healthy lifestyle and proper medical treatment, you can generally maintain the same immune function as younger people.” B. “Normal, age-related changes combined with outside factors make older adults more susceptible to getting sick.” C. “Your body produces fewer antibodies as you age, making you more vulnerable to infections than younger people.” D. “It's normal that the function and resiliency of your immune system decrease with age.” • Question 20 1 out of 1 points A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC? Answer s: A. New platelets are released from the bone marrow into circulation. B. The half-life of a platelet is typically around 8 to 12 days. C. Platelets originate with granulocyte colony–forming units (CFU). D. The α-granules of platelets contribute primarily to vasoconstriction. • Question 21 A client has a suspected infection by a particular microorganism in 1 out of 1 points question that cannot be cultured. Which of the following processes listed below is most likely to result in an accurate diagnosis for the client? Answer s: A. Observe directly for the presence or absence of specific antigens in the client's blood serum sample. B. Introduce cultured, marked antibodies to the client, and observe for a reaction with antigens in the client. C. Release purified antigens into the client's circulation to observe whether the client has produced the relevant antibodies. D. Observe for a cytopathic effect on biopsy tissue samples from the client's mucosa. • Question 22 A physiotherapist is measuring the lying, sitting, and standing blood pressure of a patient who has been admitted to hospital following a 1 out of 1 points syncopal episode and recent falls. Which of the following facts about the patient best relates to these health problems? Answer s: A. The patient is male and has a history of hypertension. B. The patient's cardiac ejection fraction was 40% during his last echocardiogram. C. The patient has a history of acute and chronic renal failure. D. The client is 89 years old and takes a diuretic medication for his congestive heart failure. • Question 23 1 out of 1 points Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease? Answer s: A. “Make sure that you avoid taking aspirin.” B. “It's important that you avoid trauma.” C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.” D. “Your disease affects your platelet function rather than clot formation.” • Question 24 A 63-year-old woman has begun a diet that purports to minimize the quantity and effects of free radicals in her body. What physiological 1 out of 1 points processes could best underlie her care provider's teaching about her new diet? Answer s: A. Free radicals contribute to atherosclerosis and decreased immune response. B. Free radicals increase cytokine expression and adhesion molecule levels, resulting in increased inflammation. C. Free radicals act as direct mediators in the inflammatory process. D. Free radicals inhibit the inflammatory response, limiting preadaptive response to infection. • Question 25 1 out of 1 points An elderly patient arrives to the health care provider's office complaining of a “sore” that would not heal on his lower leg. Upon assessment, the nurse finds thin, shiny, bluish brown pigmented desquamative skin. It is located medially over the lower leg. The nurse will educate the patient that the usual treatment is Answer s: A. initiation of Coumadin therapy to maintain an INR of 2 to 3 above norm. B. compression therapy to help facilitate blood flow back to the vena cava. C. long-term antibiotic therapy to facilitate healing of the wound. D. hydrotherapy to facilitate improvement in circulation. • Question 26 Members of an AIDS support group who have more advanced cases are 1 out of 1 points sharing some of their recent health problems with a member who has just been diagnosed. Which of the member's statements is most accurate? Answer s: A. “As people with HIV live longer, most of us are eventually succumbing to the cancers that are associated with HIV.” B. “Those of us with HIV are so much more prone to loss of vision and hearing.” C. “The eradication of Pneumocystis jiroveci pneumonia (PCP) has helped extend the life expectancy of a lot of persons living with AIDS.” D. “One of the scariest things out there now is the huge increase in drug-resistant tuberculosis.” • Question 27 1 out of 1 points A client has been diagnosed with herpes simplex virus. The client states that, “modern medicine produces more and more antivirals every year, and so the treatment should be simple.” Which of the following statements listed below is the best response? Answer s: A. “Treatment options for viruses are often limited because what destroys viruses often damages your own body cells.” B. “The recent rise of drug resistance has significantly hampered the elimination of viruses.” C. “The use of antivirals is severely limited by the unwanted adverse effects that they cause.” D. “The cell coat of viruses is particularly resilient to the available synthetic antivirals.” • Question 28 A 54-year-old man with a long-standing diagnosis of essential 1 out of 1 points hypertension is meeting with his physician. The patient's physician would anticipate that which of the following phenomena is most likely occurring? Answer s: A. Vasopressin is exerting an effect on his chemoreceptors and baroreceptors resulting in vasoconstriction. B. The patient's juxtaglomerular cells are releasing aldosterone as a result of sympathetic stimulation. C. Epinephrine from his adrenal gland is initiating the renin– angiotensin–aldosterone system. D. The conversion of angiotensin I to angiotensin II in his lungs causes increases in blood pressure and sodium reabsorption. • Question 29 1 out of 1 points A nurse has just learned that her child has a life-threatening complement disorder known as hereditary angioneurotic edema (HAE). Due to deficiency in C1-INH, the nurse needs to be prepared for which possible life-threatening clinical manifestation? Answer s: A. Bulging eyeballs B. Swelling of the airway C. Compressed carotid arteries D. Compression of brachial nerves • Question 30 A potential donor is angry at the personal nature of the questions about 1 out of 1 points HIV risk factors that he is required to answer at a blood collection center and states that simple blood testing should suffice. How can the nurse at the center best respond? Answer s: A. “There are some very uncommon subtypes of the HIV virus that are not detectable by current testing methods.” B. “There's a period shortly after someone is infected with HIV when blood tests might still be negative.” C. “There's a chance that persons who are asymptomatic, but HIV positive can have their antibodies missed by serum testing.” D. “Even though blood tests are completely accurate, the high stakes of blood donation and transfusion mean that double measures are appropriate.” • Question 31 Which of the following patients would be considered to be in the latent period of HIV infection? 1 out of 1 points Answer s: A. A 45-year-old alcohol abuser who is complaining of excessive vomiting of blood that started 2 weeks ago B. A 24-year-old college student who has developed a chronic cough that will not go away, even after taking two courses of antibiotics. C. A 16-year-old prostitute who has open sores on her labia that drain purulent secretions D. A 33-year-old heroin drug abuser who has numerous enlarged lymph nodes in his axilla and cervical neck region for the past 4 months • Question 32 1 out of 1 points As part of her prenatal education, a 29-year-old woman who is pregnant with her first child is receiving teaching from her primary care provider. Which of the following statements by the woman reflects an accurate understanding of HIV transmission? Answer s: A. “I know it's possible, but it's comforting that the chances of my child contracting my HIV are actually very low.” B. “It's discouraging to know that my breast milk can pass on HIV to my baby.” C. “I'm relieved to learn that a caesarean delivery will protect my baby from being born HIV positive.” D. “I know my baby is safe from HIV while in the womb, but the delivery will place him or her at real risk.” • Question 33 1 out of 1 points Mr. V. has been admitted for exacerbation of his chronic heart failure (HF). When the nurse walks into his room, he is sitting on the edge of the bed, gasping for air, and his lips are dusty blue. Vital signs reveal heart rate of 112, respiratory rate of 36, and pulse oximeter reading of 81%. He starts coughing up frothy pink sputum. The priority intervention is to Answer s: A. apply oxygen via nasal cannula at 3 lpm. B. call for emergency assistance utilizing hospital protocol. C. page the respiratory therapist to come give him a breathing treatment. D. have medical supply department bring up suction equipment. • Question 34 A new myocardial infarction patient requiring angioplasty and stent placement has arrived to his first cardiac rehabilitation appointment. In 1 out of 1 points this first session, a review of the pathogenesis of coronary artery disease is addressed. Which statement by the patient verifies to the nurse that he has understood the nurse's teachings about coronary artery disease? Answer A. s: “If I do not exercise regularly to get my heart rate up, blood pools in the veins causing a clot that stops blood flow to the muscle, and I will have a heart attack.” B. “Sounds like this began because of inflammation inside my artery that made it easy to form fatty streaks, which lead to my clogged artery.” C. “All I have to do is stop smoking, and then I won't have any more heart attacks.” D. “My artery was clogged by fat, so I will need to stop eating fatty foods like French fries every day.” • Question 35 Which of the following statements provides blood work results and rationale that would be most closely associated with acute coronary syndrome? 1 out of 1 points Answer s: A. Elevated creatine kinase and troponin, both of which normally exist intracellularly rather than in circulation B. Increased serum creatinine and troponin I as a result of enzyme release from damaged cells C. Increased serum potassium and decreased sodium as a result of myocardial cell lysis, release of normally intracellular potassium, and disruption of the sodium–potassium pump D. Low circulatory levels of myoglobin and creatine kinase as a result of the inflammatory response • Question 36 The geriatrician providing care for a 74-year-old man with diagnosis of 1 out of 1 points Parkinson disease has recently changed the client's medication regimen. What is the most likely focus of the pharmacologic treatment of the man's health problem? Answer s: A. Increasing the functional ability of the underactive dopaminergic system B. Preventing axonal degradation of motor neurons C. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions D. Preventing demyelination of the efferent cerebellar pathways • Question 37 1 out of 1 points Which of the following statements is an accurate descriptor of the role of viruses in human infections? Answer s: A. Viruses require stimulation after a latent period before they are able to produce symptoms. B. Viruses are often implicated in cases of transmissible neurodegenerative diseases. C. Some viruses are capable of transforming normal host cells into malignant cells. D. Viruses have no genetic material of their own. • Question 38 In which of the following individuals would a clinician most suspect multiple myeloma as a diagnosis? 1 out of 1 points Answer s: A. A 40-year-old man who has had three broken bones over the past 6 months and whose serum calcium and creatinine levels are elevated B. A 70-year-old woman whose blood work reveals large numbers of immature granulocytes C. A 68-year-old former coal miner who has white cell levels exponentially higher than normal ranges D. An 81-year-old male resident of a long-term care home who has an uncommon bacterial pneumonia and who is unable to produce a fever • Question 39 1 out of 1 points When talking about the lifespan of various blood components, the students should know that once a neutrophil moves into tissue, it lives approximately for how long? Answer s: A. 12 hours B. 24 hours C. 4 days D. 2 days • Question 40 1 out of 1 points A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient's bleeding? Answer s: A. Idiopathic immune thrombocytopenic purpura (ITP) B. Hemophilia B C. Excess calcium D. Vitamin K deficiency • Question 41 1 out of 1 points A 16-year-old female has been brought to her primary care physician by her mother due to the girl's persistent sore throat and malaise. Which of the following facts revealed in the girl's history and examination would lead the physician to rule out infectious mononucleosis? Answer s: A. Blood work reveals an increased white blood cell count. B. Chest auscultation reveals crackles in her lower lung fields bilaterally. C. Her liver and spleen are both enlarged. D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes. • Question 42 Which of the following scenarios best describes an example of infection originating with a fomite? 1 out of 1 points Answer s: A. A nurse with a positive tuberculin screening test (PPD) after admitting a patient diagnosed with tuberculosis (TB) B. A woman who contracted Lyme disease after a tick bite C. A client who contracted hepatitis C through sharing a contaminated syringe with an infected person D. A man who has been diagnosed with trichinosis after eating undercooked pork • Question 43 A 79-year-old female resident of an assisted living facility receives care from a community nurse on a regular basis for treatment of a chronic 1 out of 1 points venous leg ulcer. Which of the following factors would the nurse be most justified in ruling out as a contributing factor to the client's impaired wound healing? Answer s: A. A lower skin collagen content than in younger adults B. Decreased antibody levels C. Decreased fibroblast synthesis D. Slow reepithelialization • Question 44 A child has been diagnosed with thalassemia. Which of the following comorbidities may occur as a result of having thalassemia? 1 out of 1 points Answer s: A. Iron deficiency B. Neutropeniab b C. Hypocoagulati on D. Splenomegaly • Question 45 1 out of 1 points Which of the following patients is most likely to have impairments to the wound-healing process? A patient with Answer s: A. chronic obstructive pulmonary disease. B. poorly controlled blood sugars with small blood vessel disease. C. a diagnosis of multiple sclerosis and consequent impaired mobility. D. congenital heart defects and anemia. • Question 46 A nurse practitioner is providing care for a client with low levels of the 1 out of 1 points plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems? Answer s: A. Infection s B. Blood clots C. Anemia D. Jaundice • Question 47 1 out of 1 points Which of the following patients should the nurse be assessing for long QT syndrome? Answer s: A. A 56-year-old female admitted for total hysterectomy due to excessive bleeding and clotting B. A 32-year-old male admitted for cocaine overdose with long history of illicit drug abuse C. A 95-year-old patient with Alzheimer's who is having periods of apnea D. A 68-year-old male who was in a car accident with sternal bruising and fractured femur • Question 48 A 14-year-old boy has been diagnosed with infectious mononucleosis. 1 out of 1 points Which of the following pathophysiological phenomena is most responsible for his symptoms? Answer s: A. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes. B. The Epstein-Barr virus (EBV) is lysing many of the boy's neutrophils. C. Viruses are killing some of his B cells and becoming incorporated into the genome of others. D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes. • Question 49 A patient is reading a brochure on atherosclerosis while in the waiting room of medical clinic. Which of the following excerpts from the educational brochure warrants correction? 1 out of 1 points Answer s: A. “All things being equal, men have a higher risk of coronary heart disease than perimenopausal women.” B. “Because smoking causes a permanent increase in your risk of heart disease, it's best not to start.” C. “Every bit that you can lower your cholesterol means that you'll have a lower risk of developing heart disease.” D. “High blood pressure often accompanies, or even causes, clogging of the arteries.” • Question 50 A physician is teaching a group of medical students about the 1 out of 1 points physiological basis for damage to the circulatory and neurological systems that can accompany hypotension. Which of the following responses by a student would warrant correction by the physician? Answer s: A. “Tension and vessel thickness increase proportionately.” B. “As vessel wall thickness increases, tension decreases.” C. “The smaller the vessel radius, the greater the pressure needed to keep it open.” D. “Smaller blood vessels require more pressure to overcome wall tension.” • Question 51 The nurse knows which of the following statements best describes the 1 out of 1 points characteristic trait of risckettsiae related to Rocky Mountain spotted fever? Rickettsiae Answer s: A. are neither gram negative nor gram positive. B. have both RNA and DNA. C. are eukaryotic. D. have a distinct spiral-shaped morphology. • Question 52 When counseling a male patient with suspected HIV, the nurse informs 1 out of 1 points him that if the enzyme-linked immunosorbent assay (ELISA) comes back positive, then Answer s: A. if the second test, the Western blot, returns negative, he has not developed a case of full-blown AIDS. B. he will be sent to an infectious disease physician for a tissue biopsy to confirm infection. C. no further testing is required since this confirms HIV infection. D. a second test known as the Western blot assay will be ordered to confirm positive HIV status. • Question 53 1 out of 1 points After several months on a waiting list, a 44-year-old male received a liver transplant 5 days ago. In the last 36 hours, he has developed a rash beginning on his palms and soles, along with abdominal pain and nausea. It has been determined by his care team that the immune response that is causing his symptoms originates not with his own compromised immune components but with those introduced with his new organ. This man's most likely medical diagnosis is Answer s: A. acute transplant rejection. B. graft versus host disease (GVHD). C. hyperacute organ rejection. D. T-cell–mediated graft rejection. • Question 54 1 out of 1 points A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor? Answer s: A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA) B. Hypoxia C. The fact that the infant is being breast-fed D. Hepatic immaturity of the infant • Question 55 Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition 1 out of 1 points declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents? Answer s: A. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.” B. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.” C. “Your daughter's condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.” D. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.” • Question 56 A nurse educator in a geriatric medicine unit of a hospital is teaching a group of new graduates specific assessment criteria related to heart failure. Which of the following assessment criteria should the nurses prioritize in their practice? 1 out of 1 points Answer s: A. Pupil response and counting the patient's apical heart rate B. Palpation of pedal (foot) pulses and pain assessment C. Measurement of urine output and mental status assessment D. Activity tolerance and integumentary inspection • Question 57 A toddler is displaying signs and symptoms of weakness and muscle atrophy. The pediatric neurologist suspects it may be a lower motor 1 out of 1 points neuron disease called spinal muscular atrophy (SMA). The patient's family asks how he got this. The nurse will respond Answer s: A. “This is a degenerative disorder that tends to be inherited as an autosomal recessive trait.” B. “This could result from playing in soil and then ingesting bacteria that are now attacking his motor neurons.” C. “No one really knows how this disease is formed. We just know that in time, he may grow out of it.” D. “This is a segmental demyelination disorder that affects all nerve roots and eventually all muscle groups as well.” • Question 58 During a prenatal education class, an expectant mother tells the group about a friend whose blood pressure became so high during pregnancy 1 out of 1 points that she had to be admitted to hospital. Which of the following statements should the nurse include in response to this? Answer s: A. “I'm sure this was hard for your friend, but rest assured that it won't affect your baby even if it affects you.” B. “A large increase in blood pressure is a normal part of the changes in blood circulation that accompany pregnancy.” C. “By avoiding salt, staying active, and minimizing weight gain, you can prevent this during your pregnancy.” D. “Essentially, experts don't really know why so many pregnant women develop high blood pressure.” • Question 59 1 out of 1 points An 8-week-old boy has been recently diagnosed with a severe combined immunodeficiency (SCID). His parents have performed a significant amount of research on the Internet and have brought a large amount of material to discuss with their care provider. Which of the following statements best reflects an accurate understanding of their son's health situation? Answer s: A. “Our son likely has a deficiency of B lymphocytes and can't produce antibodies.” B. “We feel guilty, because dietary and environmental factors have been shown to contribute to SCID” C. “We read that gene therapy could cure our son; we'd like you to look into that option.” D. “The antibodies that our son produces are mismatched to the infections that he was born with and encounters.” • Question 60 A couple who are pregnant with their first child have made an 1 out of 1 points appointment with a clinical geneticist to discuss prenatal screening. The man states that they, “just want to make sure that there is nothing wrong with our baby.” How could the clinician best respond to this statement? Answer s: A. “You need to be aware that if abnormalities are detected, termination is normally required.” B. “Prenatal screening is not usually necessary unless you are among a high-risk group.” C. “Testing the umbilical blood and performing amniocentesis can give us some information, but not a guarantee.” D. “We can't rule out all abnormalities, but a routine fetal tissue biopsy can yield useful information.” • Question 61 Which of the following patients will likely experience difficulty in maintaining lipoprotein synthesis resulting in elevated LDL levels? 1 out of 1 points Answer s: A. A 55-year-old male admitted for exacerbation of chronic obstructive pulmonary disease (COPD) B. A 44-year-old female admitted for hysterectomy due to cervical cancer with metastasis C. A 35-year-old patient with a history of hepatitis C and B with end- stage liver disease D. A 27-year-old patient with pancreatitis related to alcohol abuse • Question 62 A college student has been experiencing frequent headaches that he 1 out of 1 points describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms? Answer s: A. Increased tissue perfusion at the site of the malformation B. High pressure and local hemorrhage of the venous system C. Hydrocephalus and protein in the cerebral spinal fluid D. Localized ischemia with areas of necrosis noted on CT angiography • Question 63 1 out of 1 points While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders? Answer s: A. Infuse FFP stat B. Switch to Coumadin 2.5 mg once/day C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d D. Immediately discontinue the heparin therapy • Question 64 1 out of 1 points A hospital client is receiving intravenous infusion of heparin for treatment of a pulmonary embolus. Which of the following phenomena is most likely to occur, resulting in the drug's therapeutic effect? Answer s: A. Inhibition of vitamin K synthesis in the liver B. Suppression of fibrin formation C. Deactivation of the intrinsic clotting pathway D. Inhibition of ADP-induced platelet aggregation • Question 65 The medical team is assessing a newly admitted patient who is hypothermic following a night spent lost on a ski slope. The health care professionals would recognize that which of the following phenomena most likely contributed to minimizing the client's heat loss in a cold environment? 1 out of 1 points Answer s: A. Increased blood flow to the outer shell prevented superficial freezing and loss of heat. B. The tissue thickness of the outer shell increased and preserved heat. C. The high heat conductivity of subcutaneous tissue protected against core heat loss. D. Shell temperature dropped, minimizing the temperature variance between the core temperature and environmental temperature. • Question 66 While undergoing a kidney transplant from a nonfamily member, the patient's transplanted kidney has just had the arterial clamps removed. 1 out of 1 points The OR staff notice that the organ is turning purple with no urine output. When explaining to the family why they had to remove the donor kidney, the nurse will anticipate that the surgeon would likely include which statement? Answer s: A. The circulating B and T lymphocytes are just doing their job. B. Hyperacute rejection occurs because antibodies against HLA antigens are deposited in vessels causing necrosis. C. Obviously, there has been a mismatch during the human leukocyte antigen (HLA) testing. D. Previous exposure to the HLA antigens is responsible for the high titers of complement fixing antibodies that cause the rejection. • Question 67 Which of the following infectious agents listed below would be a site- 1 out of 1 points specific pathogen and not spread throughout the body via the circulatory system? A patient diagnosed with Answer s: A. Helicobacter pylori diagnosed after an endoscopic procedure. B. Salmonella typhi related to ingestion of contaminated food or water. C. B. burgdorferi caused by a tick bite. D. N. meningitidis infection in a child in a daycare setting. • Question 68 A patient is experiencing impaired circulation secondary to increased 1 out of 1 points systemic arterial pressure. Which of the following statements is the most relevant phenomenon? Answer s: A. Impaired contractility due to aortic resistance B. High afterload because of backpressure against the left ventricle C. Systolic impairment because of arterial stenosis D. Increased preload due to vascular resistance • Question 69 A nurse is providing care for a number of older clients on a restorative 0 out of 1 points care unit of a hospital. Many of the clients have diagnoses or histories of hypertension, and the nurse is responsible for administering a number of medications relevant to blood pressure control. Which of the following assessments would the nurse be most justified in eliminating during a busy morning on the unit? Answer s: A. Measuring the pulse of a client taking an ACE inhibitor B. Checking the recent potassium levels of a client receiving an ACE inhibitor C. Measuring the heart rate of a client who takes a β-adrenergic blocker D. Noting the sodium and potassium levels of a client who is receiving a diuretic • Question 70 A 30-year-old woman presents at a hospital after fainting at a memorial 1 out of 1 points service, and she is diagnosed as being in neurogenic shock. Which of the following signs and symptoms is she most likely to display? Answer s: A. Dry and warm skin B. Faster than normal heart rate C. Pain D. Increased thirst • Question 71 A number of older adults have come to attend a wellness clinic that 1 out of 1 points includes both blood pressure monitoring and education about how to best control blood pressure. Which of the leader's following teaching points is most accurate? Answer s: A. “High blood pressure is largely controllable, except for those with a significant family history or African Americans.” B. “Too much alcohol, too little exercise, and too much body fat all contribute to high blood pressure.” C. “It's important to minimize the amount of potassium and, especially, sodium in your diet.” D. “Hypertension puts you at a significant risk of developing type 2 diabetes later in life.” • Question 72 1 out of 1 points Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the Answer s: A. basophils. B. albumin. C. neutrophils . D. erythrocyt es. • Question 73 1 out of 1 points A 60-year-old male office worker presents to a clinic complaining of new onset of lower back pain that has been worsening over the last 6 weeks. The nurse knows which of the following components of his physical assessment and history is most indicative of a serious pathological process (like aortic aneurysm or cancer)? Answer s: A. When supine, passive rising of his leg to 90 degrees results in hamstring pain. B. He has needed regular nonsteroidal anti-inflammatory drugs to control the pain in recent weeks. C. His pain is relieved by extended bed rest. D. His onset of pain has been gradual, and he has no prior history of lower back problems. • Question 74 A nurse is changing the wound dressing on the coccyx-region pressure ulcer of an immobilized patient. The existing dressing is saturated with both watery, clear discharge and foul, gray-colored liquid. Which of the following entries in the patient's chart best captures this? 1 out of 1 points Answer s: A. “Abscess activity noted to coccyx wound” B. “Purulent discharge and fibrinous exudates noted on existing dressing” C. “Plasma proteins and membranous exudates present on existing dressing” D. “Large amounts of suppurative and serous exudates noted” • Question 75 1 out of 1 points Which of the following assessment findings of a newly admitted 30-year- old male client would be most likely to cause his physician to suspect polyarteritis nodosa? Answer s: A. The man is acutely short of breath, and his oxygen saturation is 87%. B. The man's temperature is 101.9°F, and he is diaphoretic (heavily sweating). C. The man's blood pressure is 178/102, and he has abnormal liver function tests. D. The man's blood work indicates polycythemia (elevated red cell levels) and leukocytosis (elevated white cells). • Question 76 The nurse in the emergency department knows that clients exposed to Clostridium botulinum, an agent of bioterrorism, would likely be exhibiting which of the following clinical manifestations listed below? 1 out of 1 points Answer s: A. Frothy, odiferous diarrhea and dehydration B. Muscle weakness in extremities eventually leading to paralysis of respiratory muscles C. Hemorrhage from all orifices resulting in signs of shock and coma D. Blindness and respiratory distress • Question 77 When advising a morbidly obese patient about the benefits of weight reduction, which of the following statements would be most accurate to share? 1 out of 1 points Answer s: A. “All you need to do is stop drinking sodas and sugary drinks.” B. “If your leptin (hormone) level is too low, you are at increased risk for developing high BP.” C. “An increased 'waist-to-hip' ratio can lead to too much pressure on the liver and intestines.” D. “A 10 lb loss of weight can produce a decrease in blood pressure.” • Question 78 A clinician is conducting an assessment of a male client suspected of having a disorder of motor function. Which of the following assessment findings would suggest a possible upper motor neuron (UMN) lesion? 1 out of 1 points Answer s: A. The client has decreased deep tendon reflexes. B. The client displays weakness in the distal portions of his limbs. C. The client displays increased muscle tone. D. The client's muscles appear atrophied. • Question 79 1 out of 1 points Amniocentesis has suggested that a couple's first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification? Answer s: A. “Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones.” B. “Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so.” C. “Our son or daughter likely won't show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.” D. “Our baby's red cells are prone to early destruction because of his or her weak membranes.” • Question 80 1 out of 1 points A patient in the intensive care unit has a blood pressure of 87/39 and has warm, flushed skin accompanying his sudden decline in level of consciousness. The patient also has arterial and venous dilatation and a decrease in systemic vascular resistance. What is this client's most likely diagnosis? Answer s: A. Septic shock B. Hypovolemic shock C. Neurogenic shock D. Obstructive shock • Question 81 A 36-year-old woman with a diagnosis of antiphospholipid syndrome is 1 out of 1 points receiving a scheduled checkup from her nurse practitioner. Which of the following teaching points would the nurse most likely prioritize? Answer s: A. “You'll need to avoid taking nonsteroidal anti-inflammatory drugs when you have menstrual cramps.” B. “You need to ensure your birth control pills don't contain estrogen.” C. “It's important for you to do regular physical activity and maintain a healthy body weight.” D. “Good nutrition and blood sugar control are important in your case.” • Question 82 1 out of 1 points A nurse who works on a pediatric cardiology unit of a hospital is providing care for an infant with a diagnosis of tetralogy of Fallot. Which of the following pathophysiologic results should the nurse anticipate? Answer s: A. The aortic valve is stenotic, resulting in increased afterload. B. The right ventricle is atrophic as a consequence of impaired myocardial blood supply. C. There is a break in the normal wall between the right and left atria that results in compromised oxygenation. D. Blood outflow into the pulmonary circulation is restricted by pulmonic valve stenosis. • Question 83 A nurse is providing care for a 17-year-old boy who has experienced 1 out of 1 points recurrent sinus and chest infections throughout his life and presently has enlarged tonsils and lymph nodes. Blood work indicated normal levels of B cells and free immunoglobulins but a lack of differentiation into normal plasma cells. The boy is currently receiving intravenous immunoglobulin (IVIG) therapy. What is the boy's most likely diagnosis? Answer s: A. X-linked hypogammaglobulinemia B. IgG subclass deficiency C. Transient hypoglobulinemia D. Common variable immunodeficiency • Question 84 1 out of 1 points An agricultural worker is picking fruit on a day when the air temperature is 106°F. Which of the following processes will most likely be occurring while he works? Answer s: A. Conduction of heat from the air will be heating his skin surface and raising his core temperature. B. His autonomic nervous system will be stimulating him to sweat. C. Blood volume at his skin surface will be increasing to dissipate heat. D. Radiation from his skin surfaces will be dissipating heat into the environment. • Question 85 1 out of 1 points A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care? Answer s: A. Regular pain assessment and administration of opioid analgesics as needed B. Assessment of swallowing ability and respiratory status C. Cardiac monitoring and administration of inotropic medications D. Assessment and documentation of cognitive changes, including confusion and restlessness • Question 86 A 6-year-old boy who has mental retardation secondary to fragile X 1 out of 1 points syndrome has been admitted to hospital with a mitral valve prolapse. A health care worker who is providing care for the family should have which of the following statements as part of her knowledge base around the disease? Answer s: A. The boy will pass the gene to all his future daughters who will become carriers. B. Genes of the boy's Y chromosome can be affected in addition to the X chromosome. C. The common pattern of inheritance is an affected mother who carries one normal and one mutant allele. D. The boy's mother had a 100% chance of transmitting the defective gene to her son. • Question 87 A 78-year-old man has been experiencing nocturnal chest pain over the last several months, and his family physician has diagnosed him with variant angina. Which of the following teaching points should the physician include in his explanation of the man's new diagnosis? 1 out of 1 points Answer s: A. “With some simple lifestyle modifications and taking your heparin regularly, we can realistically cure you of this.” B. “I'll be able to help track the course of your angina through regular blood work that we will schedule at a lab in the community.” C. “There are things you can do to reduce the chance that you will need a heart bypass, including limiting physical activity as much as possible.” D. “I'm going to start you on low-dose aspirin, and it will help greatly if you can lose weight and keep exercising.” • Question 88 1 out of 1 points Which of the following statements most accurately captures a principle of blood flow? Answer A. s: Smaller cross-sectional vessel area is associated with lower flow velocity. B. With constant pressure, a small increase in vessel radius results in an exponential increase in blood flow. C. Blood flows most quickly in the small diameter peripheral capillaries. D. Blood flow is primarily determined by blood viscosity and temperature. • Question 89 Utilizing the World Health Organization (WHO) framework of clinical 1 out of 1 points categories for persons with acquired immunodeficiency syndrome (AIDS) over 15 years of age, a visitor to the United States goes to a city clinic complaining of diarrhea, weight loss of 20 lb, and feeling like he is running a temperature. These manifestations have been occurring for the past 5 weeks. The nurse would identify this patient to be in which clinical stage? Answer s: A. Stage 2 B. Stage 4 C. Stage 1 D. Stage 3 • Question 90 The nurse working in the ICU knows that chronic elevation of left 1 out of 1 points ventricular end-diastolic pressure will result in the patient displaying which of the following clinical manifestations? Answer s: A. Muscle cramping and cyanosis in the feet B. Petechia and spontaneous bleeding C. Chest pain and intermittent ventricular tachycardia D. Dyspnea and crackles in bilateral lung bases • Question 91 1 out of 1 points A pediatrician is teaching a group of medical students about some of the particularities of heart failure in children as compared with older adults. Which of the physician's following statements best captures an aspect of these differences? Answer s: A. “You'll find that in pediatric patients, pulmonary edema is more often interstitial rather than alveolar, so you often won't hear crackles.” B. “Fever is a sign of heart failure in children that you are unlikely to see in older adults.” C. “Because of their higher relative blood volume, jugular venous distention is a better assessment technique for suspected heart failure in young patients.” D. “Signs and symptoms in children may sometimes mimic those of shock, with a low blood pressure and high heart rate.” • Question 92 During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his 1 out of 1 points medical history. The patient asks, “What is that?” How should the nursing student reply? Answer s: A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles” B. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well” C. “A degenerative disease where you have trouble walking without the help of a cane or walker” D. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot” • Question 93 A physiotherapist (PT) at an assisted living facility for older adults is leading an exercise class for the residents. Part of the PT's introductory class is an explanation of the health problems that can be mitigated by 1 out of 1 points physical activity and those that are considered inevitabilities of the aging process. Which of the following phenomena would the PT most justifiably characterize as modifiable? Answer s: A. Overall reduction in muscle strength B. Decline in height C. Reduction in density of the trabecular bone D. Gradual decline in physical reaction time • Question 94 A formerly normotensive woman, pregnant for the first time, develops 1 out of 1 points hypertension and headaches at 26 weeks' gestation. Her blood pressure is 154/110 mm Hg, and she has proteinuria. What other lab tests should be ordered for her? Answer s: A. Urinary catecholamines and metabolites B. Urinary sodium and potassium C. Platelet count, serum creatinine, and liver enzymes D. Plasma angiotensin I and II and renin • Question 95 Which of the following patients is most likely to benefit from transplantation of thymic tissue or major histocompatibility complex (MHC)-compatible bone marrow? Answer A. 1 out of 1 points s: A 6-year-old boy whose pre-B cells are incapable of translation to normal B cells B. A 12-year-old girl with a history of epilepsy and low IgG levels secondary to phenytoin use C. A 9-year-old girl who has a diagnosis of IgA deficiency D. A 7-year-old boy whose blood work indicates decreased IgA and IgG with increased IgM • Question 96 1 out of 1 points A 19-year-old intravenous drug user was exposed to the HIV 3 weeks ago and is experiencing a rapid proliferation in viral load. Which of the following statements best captures an aspect of the process of HIV replication that underlies this proliferation? Answer s: A. Free HIV RNA is able to attach to the cell coat of CD4+ cells. B. Expression of reverse transcriptase by CD4+ cells allows replication of HIV cells rather than new lymphocytes. C. The cytoplasm of CD4+ cells provides a protected environment for the replication of RNA by HIV. D. HIV is able to change its RNA into DNA to allow for replication by CD4+ cells. • Question 97 An 81-year-old female client of a long-term care facility has a history of congestive heart failure. The nurse practitioner caring for the client has positioned her sitting up at an angle in bed and is observing her jugular 1 out of 1 points venous distention. Why is jugular venous distention a useful indicator for the assessment of the client's condition? Answer s: A. Heart valves are not capable of preventing backflow in cases of atrial congestion. B. Peripheral dilation is associated with decreased stroke volume and ejection fraction. C. Blood backs up into the jugular vein because there are no valves at the point of entry into the heart. D. Increased cardiac demand causes engorgement of systemic blood vessels, of which the jugular vein is one of the largest. • Question 98 1 out of 1 points The educator of a geriatric, subacute medical unit in a hospital is oriented new staff and teaching orientees' strategies for communicating with older adults with impaired hearing. Which of the following teaching points is most justifiable? Answer s: A. “Avoid complex or abstract ideas when you're talking.” B. “Speak slowly and directly to these clients.” C. “Increase the volume of your speech as much as possible.” D. “Choose simple, short words to minimize confusion.” • Question 99 1 out of 1 points A 22-year-old male is experiencing hypovolemic shock following a fight in which his carotid artery was cut with a broken bottle. What immediate treatments are likely to most benefit the man? Answer s: A. Administration of oxygen and epinephrine to promote perfusion B. Resolution of compensatory pulmonary edema and heart arrhythmias C. Infusion of vasodilators to foster perfusion and inotropes to improve heart contractility D. Infusion of normal saline or Ringer lactate to maintain the vascular space • Question 100 A nurse is providing care for a client with a diagnosis of Crohn disease. 1 out of 1 points The nurse recognizes the fact that the disease involves the inflammation and irritation of the intestinal lining. Which of the following types of tissue is most likely involved in the client's pathology? Answer s: A. Stratified epithelium B. Glandular epithelium C. Simple columnar epithelium D. Simple cuboidal epithelium