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Final Review Basic Questions and Answers

FINAL EXAM REVIEW BASIC QUESTIONS AND ANSWERS/FINAL EXAM REVIEW BASIC QUESTIONS AND ANSWERS 1. A nurse is assessing a patient who has peptic ulcer disease. The patient requests more information about the typical causes of Helicobacter pylori infection. What would it be appropriate for the nurse to instruct the patient? A) Most affected patients acquired the infection during international travel. B) Infection typically occurs due to ingestion of contaminated food and water. C) Many people possess genetic factors causing a predisposition to H. pylori infection. D) The H. pylori microorganism is endemic in warm, moist climates. 2. A patient with type 2 diabetes achieves adequate glycemic control through diet and exercise. Upon being admitted to the hospital for a cholecystectomy, however, the patient has required insulin injections on two occasions. The nurse would identify what likely cause for this short-term change in treatment? A) Alterations in bile metabolism and release have likely caused hyperglycemia. B) Stress has likely caused an increase in the patient's blood sugar levels. C) The patient has likely overestimated her ability to control her diabetes using nonpharmacologic measures. D) The patient's volatile fluid balance surrounding surgery has likely caused unstable blood sugars. 3. A client who has had a radical neck dissection is being prepared for discharge. The discharge plan includes referral to an outpatient rehabilitation center for physical therapy. What would the goals of physical therapy for this client include? A) Promoting circulation to the graft site on the affected side B) Relieving nerve paralysis in the cervical plexus C) Promoting maximum shoulder function D) Alleviating achalasia decreasing esophageal peristalsis 4. A middle-aged woman has sought care from her primary care provider and undergone diagnostic testing that has resulted in a diagnosis of MS. What sign or symptom is most likely to have prompted the woman to seek care? A) Cognitive declines B) Personality changes C) Contractures D) Difficulty in coordination 5. A nurse in a long-term care facility is caring for an 83-year-old woman who has a history of heart failure and peripheral arterial disease. At present the patient is unable to stand or ambulate. What does the nurse know the patient is at significant risk for? A) Deep vein thrombosis B) Raynaud's disease C) Thoracic aortic aneurysm D) Aoritis 6. A patient being admitted with an acute exacerbation of ulcerative colitis reports crampy abdominal pain and passing 15 or more bloody stools a day. The nurse will plan to A) Administer IV metoclopramide (Reglan). B) Discontinue the patient's oral food intake. C) Administer cobalamin (vitamin B12) injections. D) Teach the patient about total colectomy surgery. 7. Patient is hypertensive what is the blood pressure goal that we can live with. We are going to give him medicine, what can we get down to that is at least safe, that is a good start at least? 8. A 62-year-old woman diagnosed with breast cancer is scheduled for a partial mastectomy. The oncology nurse explained that the surgeon will want to take tissue samples to ensure the disease has not spread to adjacent axillary lymph nodes. The patient has asked if she will have her lymph nodes dissected, like her mother did several years ago. What alternative to lymph node dissection will this patient most likely undergo? A) Lymphadenectomy B) Needle biopsy C) Open biopsy D) Sentinel node biopsy 9. Patient on antibiotics for UTI, what kind of education do we provide to them people? 10. Your patient is receiving postoperative morphine through a patient-controlled analgesic (PCA) pump and the patient's orders specify an initial bolus dose. What is your priority assessment? A) Assessment for decreased level of consciousness (LOC) B) Assessment for respiratory depression C) Assessment for fluid overload D) Assessment for paradoxical increase in pain 11. You are creating a nursing care plan for a patient with a primary diagnosis of cellulitis and a secondary diagnosis of chronic pain. What common trait of patients who live with chronic pain should inform your care planning? A) They are typically more comfortable with underlying pain than patients without chronic pain. B) They often have a lower pain threshold than patients without chronic pain. C) They often have an increased tolerance of pain. D) They can experience acute pain in addition to chronic pain. 12. A postsurgical patient has illuminated her call light to inform the nurse of a sudden onset of lower leg pain. On inspection, the nurse observes that the patient's left leg is visibly swollen and reddened. What is the nurse's most appropriate action? A) Administer a PRN dose of subcutaneous heparin. B) Inform the physician that the patient has signs and symptoms of VTE. C) Mobilize the patient promptly to dislodge any thrombi in the patient's lower leg. D) Massage the patient's lower leg to temporarily restore venous return. 13. A patient presents to a clinic complaining of a leg ulcer that isn't healing; subsequent diagnostic testing suggests osteomyelitis. The nurse is aware that the most common pathogen to cause osteomyelitis is what? A) Staphylococcus aureus B) Proteus C) Pseudomonas D) Escherichia coli 14. A nurse is assessing the neurovascular status of a patient who has had a leg cast recently applied. The nurse is unable to palpate the patient's dorsalis pedis or posterior tibial pulse and the patient's foot is pale. What is the nurse's most appropriate action? A) Warm the patient's foot and determine whether circulation improves. B) Reposition the patient with the affected foot dependent. C) Reassess the patient's neurovascular status in 15 minutes D) Promptly inform the primary care provider. 15. A patient states that her family has had several colds during this winter and spring despite their commitment to handwashing. The high communicability of the common cold is attributable to what factor? A) Cold viruses are increasingly resistant to common antibiotics. B) The virus is shed for 2 days prior to the emergence of symptoms. C) A genetic predisposition to viral rhinitis has recently been identified. D) Overuse of OTC cold remedies creates a "rebound" susceptibility to future cold 16. A nurse is caring for a patient with type 1 diabetes who is being discharged home tomorrow. What is the best way to assess the patient's ability to prepare and self-administer insulin? A) Ask the patient to describe the process in detail. B) Observe the patient drawing up and administering the insulin. C) Provide a health education session reviewing the main points of insulin delivery. D) Review the patient's first hemoglobin A1C result after discharge 17. A nurse is completing a focused respiratory assessment of a child with asthma. What assessment finding is most closely associated with the characteristic signs and symptoms of asthma? A) Shallow respirations B) Increased anterior-posterior (A-P) diameter C) Bilateral wheezes D) Bradypnea 18. You are the emergency department (ED) nurse caring for an adult patient who was in a motor vehicle accident. Radiography reveals an ulnar fracture. What type of pain are you addressing when you provide care for this patient? A) Chronic B) Acute C) Intermittent D) Osteopenic 19. The nurse has implemented a bladder retraining program for an older adult patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient typically has approximately 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding? A) Perform a straight catheterization on this patient. B) Avoid further interventions at this time, as this is an acceptable finding. C) Place an indwelling urinary catheter. D) Press on the patient's bladder in an attempt to encourage complete emptying. 20. A patient is admitted with cellulitis and experiences a consequent increase in white blood cell count. The nurse is aware that during the immune response, pathogens are engulfed by white blood cells that ingest foreign particles. What is this process known as? A) Apoptosis B) Phagocytosis C) Antibody response D) Cellular immune response 21. A 35-year-old male patient presents at the emergency department with symptoms of a small bowel obstruction. In collaboration with the primary care provider, what intervention should the nurse prioritize? A) Insertion of a nasogastric tube B) Insertion of a central venous catheter C) Administration of a mineral oil enema D) Administration of a glycerin suppository and an oral laxative 22. A nursing student is writing a teaching plan for a patient with venous insufficiency. The student covers measures to prevent complications from venous insufficiency. What is one measure the student should include in the plan? A) Avoiding tight-fitting socks B) Sleeping with legs dependent C) Reducing activity D) Avoiding pressure stockings 23. The nurse is assessing a patient whose respiratory disease in characterized by chronic hyperinflation of the lungs. What would the nurse most likely assess in this patient? A) Signs of oxygen toxicity B) Chronic chest pain C) A barrel chest D) Long, thin fingers 24. You are caring for a patient with sickle cell disease in her home. Over the years, there has been joint damage, and the patient is in chronic pain. The patient has developed a tolerance to her usual pain medication. When does the tolerance to pain medication become the most significant problem? A) When it results in inadequate relief from pain B) When dealing with withdrawal symptoms resulting from the tolerance C) When having to report the patient's addiction to her physician D) When the family becomes concerned about increasing dosage 25. The nurse is admitting a 32-year-old woman to the presurgical unit. The nurse learns during the admission assessment that the patient takes oral contraceptives. Consequently, the nurse's postoperative plan of care should include what intervention? A) Early ambulation and leg exercises B) Cessation of the oral contraceptives until 3 weeks postoperative C) Doppler ultrasound of peripheral circulation twice daily D) Dependent positioning of the patient's extremities when at rest 26. A patient with cancer of the tongue has had a radical neck dissection. What nursing assessment would be a priority for this client? A) Presence of acute pain and anxiety B) Tissue integrity and color of the operative site C) Respiratory status and airway clearance D) Self-esteem and body image 27. A nurse is planning care for a nephrology patient with a new nursing graduate. The nurse states, “the patient in renal failure partially loses the ability to regulate changes in pH.”. What is the cause of this partial inability? A) The kidneys regulate and reabsorb carbonic acid to change and maintain pH. B) The kidneys buffer acids through electrolyte changes. C) The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. D) The kidneys combine carbonic acid and bicarbonate to maintain a stable pH. 28. The nurse is providing discharge teaching for a patient who developed a pulmonary embolism after total knee surgery. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. What should the nurse teach the client? A) Anticoagulant therapy usually lasts between 3 and 6 months. B) Coumadin must be taken concurrent with ASA to achieve anticoagulation. C) Coumadin will continue to break up the clot over a period of weeks D) He should take a vitamin supplement containing vitamin K 29. The nurse educator on an orthopedic trauma unit is reviewing the safe and effective use of traction with some recent nursing graduates. What principle should the educator promote? A) Knots in the rope should not be resting against pulleys. B) Weights should rest against the bed rails. C) The end of the limb in traction should be braced by the footboard of the bed. D) Skeletal traction may be removed for brief periods to facilitate the patient's independence. 30. A school nurse is teaching a group of high school students about risk factors for diabetes. Which of the following actions has the greatest potential to reduce an individual's risk for developing diabetes? A) Have blood glucose levels checked annually. B) Stop using tobacco in any form. C) Undergo eye examinations regularly. D) Lose weight, if obese. 31. A nurse has obtained an order to remove a patient's NG tube and has prepared the patient accordingly. After flushing the tube and removing the nasal tape, the nurse attempts removal but is met with resistance. Because the nurse is unable to overcome this resistance, what is the most appropriate action? A) Gently twist the tube before pulling. B) Instill a digestive enzyme solution and reattempt removal in 10 to 15 minutes. C) Flush the tube with hot tap water and reattempt removal. D) Report this finding to the patient's primary care provider 32. The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis? A) Incentive spirometry B) Intermittent positive-pressure breathing (IPPB) C) Positive end-expiratory pressure (PEEP) D) Bronchoscopy 33. The public health nurse is presenting a health-promotion class to a group at a local community center. Which intervention most directly addresses the leading cause of cancer deaths in North America? A) Monthly self-breast exams B) Smoking cessation C) Annual colonoscopies D) Monthly testicular exams 34. A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP? A) Administration of prophylactic antibiotics B) Administration of antiretroviral medications to patients over age 65 C) Administration of pneumococcal vaccine to vulnerable individuals D) Obtaining culture and sensitivity swabs from all newly admitted patients 35. A nurse in the neurologic ICU has orders to infuse a hypertonic solution into a patient with increased intracranial pressure. This solution will increase the number of dissolved particles in the patient’s blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? A) Hydrostatic pressure B) Osmosis and osmolality C) Diffusion D) Active transport 36. A patient is complaining of pain in her casted leg. The nurse has administered analgesics and elevated the limb. Thirty minutes after administering the analgesics, the patient states the pain is unrelieved. The nurse should identify the warning signs of what complication? A) Edema B) Pressure ulcer C) Compartment syndrome D) Disuse syndrome 37. The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic? A) Assess the patient's level of consciousness (LOC). B) Assess the patient's extremities for signs of cyanosis. C) Assess the patient's oxygen saturation level. D) Review the patient's hemoglobin, hematocrit, and red blood cell levels. 38. A nurse is addressing the prevention of esophageal cancer in response to a question posed by a participant in a health promotion workshop. What action has the greatest potential to prevent esophageal cancer? A) Promotion of a nutrient-dense, low-fat diet B) Annual screening endoscopy for patients over 50 with a family history of esophageal cancer C) Early diagnosis and treatment of gastroesophageal reflux disease D) Adequate fluid intake and avoidance of spicy foods 39. You are performing an admission assessment on an older adult patient newly admitted for end-stage liver disease. What principle should guide your assessment of the patient's skin turgor? A) Overhydration is common among healthy older adults. B) Dehydration causes the skin to appear spongy. C) Inelastic skin turgor is a normal part of aging. D) Skin turgor cannot be assessed in patients over 70 40. When caring for a patient with increased ICP the nurse knows the importance of monitoring for possible secondary complications, including syndrome of inappropriate antidiuretic hormone (SIADH). What nursing interventions would the nurse most likely initiate if the patient developed SIADH? A) Fluid restriction B) Transfusion of platelets C) Transfusion of fresh frozen plasma (FFP) D) Electrolyte restriction 41. A nurse who provides care in a long-term care facility is aware of the high incidence and prevalence of urinary tract infections among older adults. What action has the greatest potential to prevent UTIs in this population? A) Administer prophylactic antibiotics as ordered. B) Limit the use of indwelling urinary catheters. C) Encourage frequent mobility and repositioning. D) Toilet residents who are immobile on a scheduled basis 42. A patient's most recent diagnostic imaging has revealed that his lung cancer has metastasized to his bones and liver. What is the most likely mechanism by which the patient's cancer cells spread? A) Hematologic spread B) Lymphatic circulation C) Invasion D) Angiogenesis 43. As a clinic nurse, you are caring for a patient who has been prescribed an antibiotic for tonsillitis and has been instructed to take the antibiotic for 10 days. When you do a follow-up call with this patient, you are informed that the patient is feeling better and is stopping the medication after taking it for 4 days. What information should you provide to this patient? A) Keep the remaining tablets for an infection at a later time. B) Discontinue the medications if the fever is gone. C) Dispose of the remainder of the medication in a biohazard receptacle. D) Finish all the antibiotics to eliminate the organism completely. 44. A patient with herpes simplex virus encephalitis (HSV) has been admitted to the ICU. What medication would the nurse expect the physician to order for the treatment of this disease process? A) Cyclosporine (Neoral) B) Acyclovir (Zovirax) C) Cyclobenzaprine (Flexeril) D) Ampicillin (Prinicpen) 45. A patient with emphysema is experiencing shortness of breath. To relieve this patient's symptoms, the nurse should assist her into what position? A) Sitting upright, leaning forward slightly B) Low Fowler's, with the neck slightly hyperextended C) Prone D) Trendelenburg 46. Which of the following cells is first cell to arrive at the site where inflammation occurs? A) Eosinophils B) Red blood cell C) T-cells D) Neutrophils 47. Which of the following is a potential side effect of nitroglycerin? A) Decreased blood pressure B) Sudden increase in heart rate C) Difficulty breathing D) All of the above 48. You are the nurse caring for a patient with asthma hospitalized with an acute asthma exacerbation. What drugs would you expect to have ordered for this patient to gain underlying control of persistent asthma? A) Rescue inhalers B) Anti-inflammatory drugs C) Antibiotics D) Antitussives 49. A nurse is providing health education to an adolescent newly diagnosed with type 1diabetes mellitus and her family. The nurse teaches the patient and family that which of the following nonpharmacologic measures will decrease the body's need for insulin? A) Adequate sleep B) Low stimulation C) Exercise D) Low-fat diet 50. You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A) Palliative B) Reconstructive C) Salvage D) Prophylactic 51. The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroid medication? A) In the evening between 4 PM and 6 PM B) Prior to going to sleep at night C) At noon every day D) In the early morning between 7 AM and 8 AM 52. An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients? A) Encouraging patients to carry a corticosteroid rescue inhaler at all times B) Educating patients about recognizing and avoiding asthma triggers C) Teaching patients to utilize alternative therapies in asthma management D) Ensuring that patients keep their immunizations up to date 53. The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process? A) Diffusion B) Osmosis C) Active transport D) Filtration 54. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness. 55. You are caring for a patient who has just been told that her stage IV colon cancer has recurred and metastasized to the liver. The oncologist offers the patient the option of surgery to treat the progression of this disease. What type of surgery does the oncologist offer? A) Palliative B) Reconstructive C) Salvage D) Prophylactic 52. The home care nurse is conducting patient teaching with a patient on corticosteroid therapy. To achieve consistency with the body's natural secretion of cortisol, when would the home care nurse instruct the patient to take his or her corticosteroid medication? A) In the evening between 4 PM and 6 PM B) Prior to going to sleep at night C) At noon every day D) In the early morning between 7 AM and 8 AM 53. An asthma nurse educator is working with a group of adolescent asthma patients. What intervention is most likely to prevent asthma exacerbations among these patients? A) Encouraging patients to carry a corticosteroid rescue inhaler at all times B) Educating patients about recognizing and avoiding asthma triggers C) Teaching patients to utilize alternative therapies in asthma management D) Ensuring that patients keep their immunizations up to date 54. The nurse is providing care for a patient with chronic obstructive pulmonary disease. When describing the process of respiration the nurse explains how oxygen and carbon dioxide are exchanged between the pulmonary capillaries and the alveoli. The nurse is describing what process? A) Diffusion B) Osmosis C) Active transport D) Filtration 55. A diabetes nurse educator is teaching a group of patients with type 1 diabetes about "sick day rules." What guideline applies to periods of illness in a diabetic patient? A) Do not eliminate insulin when nauseated and vomiting. B) Report elevated glucose levels greater than 150 mg/dL. C) Eat three substantial meals a day, if possible. D) Reduce food intake and insulin doses in times of illness. 55. A perioperative nurse is caring for a postoperative patient. The patient has a shallow respiratory pattern and is reluctant to cough or to begin mobilizing. The nurse should address the patient's increased risk for what complication? A) Acute respiratory distress syndrome (ARDS) B) Atelectasis C) Aspiration D) Pulmonary embolism 56. A 28-year-old pregnant woman is spilling sugar in her urine. The physician orders a glucose tolerance test, which reveals gestational diabetes. The patient is shocked by the diagnosis, stating that she is conscientious about her health, and asks the nurse what causes gestational diabetes. The nurse should explain that gestational diabetes is a result of what etiologic factor? A) Increased caloric intake during the first trimester B) Changes in osmolality and fluid balance C) The effects of hormonal changes during pregnancy D) Overconsumption of carbohydrates during the first two trimesters 57. An 80-year-old man in a long-term care facility has a chronic leg ulcer. When the Nurse Practitioner makes his rounds, the man states that the area has become increasingly painful. The Nurse Practitioner assesses the area and notes that the wound bed of the ulcer is unchanged, but the site is now swollen and warm to the touch. The Nurse Practitioner notifies the physician of these symptoms as the patient may have developed what? A) Osteomyelitis B) Osteoporosis C) Osteomalacia D) Infectious arthritis 58. The nurse is caring for a patient who has been diagnosed with a peptic ulcer. The patient asks the nurse what a peptic ulcer is. Which of the following best describes a peptic ulcer? A) Inflammation of the lining of the stomach B) Erosion of the lining of the stomach or intestine C) Bleeding from the mucosa in the stomach D) Viral invasion of the stomach wall 59. A patient's screening colonoscopy revealed the presence of numerous polyps in the large bowel. What principle should guide the subsequent treatment of this patient's health problem? A) Adherence to a high-fiber diet will help the polyps resolve. B) The patient should be assured that these are a normal, age-related physiologic change. C) The patient's polyps constitute a risk factor for cancer. D) The presence of polyps is associated with an increased risk of bowel obstruction 60. The nurse is working with a patient who is newly diagnosed with MS. What basic information should the nurse provide to the patient? A) MS is a progressive demyelinating disease of the nervous system. B) MS usually occurs more frequently in men. C) MS typically has an acute onset. D) MS is sometimes caused by a bacterial infection. 61. An older adult patient with type 2 diabetes is brought to the emergency department by his daughter. The patient is found to have a blood glucose level of 623 mg/dL. The patient's daughter reports that the patient recently had a gastrointestinal virus and has been confused for the last 3 hours. The diagnosis of hyperglycemic hyperosmolar syndrome (HHS) is made. What nursing action would be a priority? A) Administration of antihypertensive medications B) Administering sodium bicarbonate intravenously C) Reversing acidosis by administering insulin D) Fluid and electrolyte replacement 62. A patient who had a radical neck dissection has a Jackson-Pratt drain in place. The nurse observes the output from the drain over a 24-hour period. Which of the following findings should be reported to the physician immediately? A) 80 cc of serosanguinous drainage B) 400 cc of milky or cloudy drainage C) Spots of drainage on the dressings surrounding the drain D) Several small clots noted in the drainage 63. The nurse caring for a 79-year-old man who has just returned to the medical-surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment where it was noted that he has been agitated in the past following opioid administration. What principle should guide the nurse's management of the patient's pain? A) The elderly may require lower doses of medication and are easily confused with new medications. B) The elderly may have altered absorption and metabolism, which prohibits the use of opioids. C) The elderly may be confused following surgery, which is an age-related phenomenon unrelated to the medication. D) The elderly may require a higher initial dose of pain medication followed by a tapered dose. 64. A patient has been taking prednisone for several weeks after experiencing a hypersensitivity reaction. To prevent adrenal insufficiency, the nurse should ensure that the patient knows to do which of the following? A) Take the drug concurrent with levothyroxine (Synthroid). B) Take each dose of prednisone with a dose of calciumchloride. C) Gradually replace the prednisone with an OTC alternative. D) Slowly taper down the dose of prednisone, as ordered. 65. A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? A) Hyponatremia B) Hypophosphatemia C) Hypocalcemia D) Hypokalemia 66. The nurse is caring for a 39-year-old woman with a family history of breast cancer. She requested a breast tumor marking test and the results have come back positive. As a result, the patient is requesting a bilateral mastectomy. This surgery is an example of what type of oncologic surgery? A) Salvage surgery B) Palliative surgery C) Prophylactic surgery D) Reconstructive surgery 67. A mother calls the clinic asking for a prescription for Amoxicillin for her 2-year-old son who has what you suspect is viral rhinitis. What should you tell this mother? A) You will relay her request to the physician B) Antibiotics should not be used because they do not affect the virus or reduce the incidence of bacterial complications C) You will call in the prescription for her D) Amoxicillin is not the correct antibiotic for this type of rhinitis but you will call in the right prescription for her 68. A patient who experienced an upper GI bleed due to gastritis has had the bleeding controlled and the patient's condition is now stable. For the next several hours, the nurse caring for this patient should assess for what signs and symptoms of recurrence? A) Tachycardia, hypotension, and tachypnea B) Tarry, foul-smelling stools C) Diaphoresis and sudden onset of abdominal pain D) Sudden thirst, unrelieved by oral fluid administration 69. An unlicensed nursing assistant (NA) reports to the nurse that a postsurgical patient is complaining of pain that she rates as 8 on a 0-to-10 point scale. The NA tells the nurse that he thinks the patient is exaggerating and does not need pain medication. What is the nurse's best response? A) “Pain often comes and goes with postsurgical patients. Please ask her about pain again in about 30 minutes.” B) “We need to provide pain medications because it is the law, and we must always follow the law.” C) “Unless there is strong evidence to the contrary, we should take the patient's report at face value.'” D) “It's not unusual for patients to misreport pain to get our attention when we are busy.” 70. A nurse has cited a research study that highlights the clinical effectiveness of using placebos in the management of postsurgical patients' pain. What principle should guide the nurse's use of placebos in pain management? A) Placebos require a higher level of informed consent than conventional care. B) Placebos are an acceptable, but unconventional, form of nonpharmacological pain management. C) Placebos are never recommended in the treatment of pain. D) Placebos require the active participation of the patient's family. 71. The registered nurse is preparing to insert a nasogastric tube in an adult client. To determine the accurate measurement of the length of the tube to be inserted, the nurse should take which action? A) Mark the tube at 10 inches. B) Mark the tube at 32 inches. C) Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the xiphoid process. D) Place the tube at the tip of the nose and measure by extending the tube to the earlobe and then down to the top of the sternum 72. A patient has been diagnosed with a small bowel obstruction and has been admitted to the medical unit. The nurse's care should prioritize which of the following outcomes? A) Preventing infection B) Maintaining skin and tissue integrity C) Preventing nausea and vomiting D) Maintaining fluid and electrolyte balance 73. A nurse is creating a health promotion intervention focused on chronic obstructive pulmonary disease (COPD). What should the nurse identify as a complication of COPD? A) Lung cancer B) Cystic fibrosis C) Respiratory failure D) Hemothorax 74. A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. When the nurse is explaining to the patient the etiology of type 1 diabetes, what process should the nurse describe? A) “The tissues in your body are resistant to the action of insulin, making the glucose levels in your blood increase.” B) “Damage to your pancreas causes an increase in the amount of glucose that it releases, and there is not enough insulin to control it.” C) “The amount of glucose that your body makes overwhelms your pancreas and decreases your production of insulin. D) “Destruction of special cells in the pancreas causes a decrease in insulin production. Glucose levels rise because insulin normally breaks it down.” 75. A patient comes to the clinic complaining of pain in the epigastric region. What assessment question during the health interview would most help the nurse determine if he patient has a peptic ulcer? A) “Does your pain resolve when you have something to eat?” B) “Do over-the-counter pain medications help your pain?” C) “Does your pain get worse if you get up and do some exercise?” D) “Do you find that your pain is worse when you need to have a bowel movement?” 76. An orthopedic nurse is caring for a patient who is postoperative day one following foot surgery. What nursing intervention should be included in the patient's subsequent care? A) Dressing changes should not be performed unless there are clear signs of infection. B) The surgical site can be soaked in warm bath water for up to 5 minutes. C) The surgical site should be cleansed with hydrogen peroxide once daily. D) The foot should be elevated in order to prevent edema 77. A 16-year-old presents at the emergency department complaining of right lower quadrant pain and is subsequently diagnosed with appendicitis. When planning this patient's nursing care, the nurse should prioritize what nursing diagnosis? A) Imbalanced Nutrition: Less Than Body Requirements Related to Decreased OralIntake B) Risk for Infection Related to Possible Rupture of Appendix C) Constipation Related to Decreased Bowel Motility and Decreased Fluid Intake D) Chronic Pain Related to Appendicitis 78. The nurse is caring for patients in a primary care clinic. Which individual is most at risk to develop osteomyelitis caused by Staphylococcus aureus? A) 22-year-old female with gonorrhea who is an IV drug user B) 48-year-old male with muscular dystrophy and acute bronchitis C) 32-year-old male with type 1 diabetes mellitus and a stage IV pressure ulcer D) 68-year-old female with hypertension who had a knee arthroplasty 3 years ago 79. A nurse is caring for a patient who has a newly inserted nasogastric tube. Which of the following methods is appropriate for verifying the initial placement? A) X ray examination of the chest and abdomen B) Auscultation of injected air C) pH measurement of gastric aspirate D) Color of gastric contents 80. When checking for nasogastric tube placement, the nurse should conduct which of the following procedures? A) Instill 20 ml of air into the tube and listen for a whooshing sound B) Aspirate stomach contents and check the pH C) Aspirate stomach contents and check their color D) Auscultate lung sounds 81. A nursing student is writing a teaching plan for a patient with venous insufficiency. The student covers measures to prevent complications from venous insufficiency. What is one measure the student should include in the plan? A) Avoiding tight-fitting socks B) Sleeping with legs dependent C) Reducing activity D) Avoiding pressure stockings 82. A patient has been treated with Norvasc, the therapeutic effects of calcium channel blockers include what? Angina and hypertension. 83. A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe? A) Older adults have less compliant lung tissue than younger adults. B) Older adults are not normally candidates for pneumococcal vaccination. C) Older adults often lack the classic signs and symptoms of pneumonia. D) Older adults often cannot tolerate the most common antibiotics used to treat pneumonia. 84. Your patient is 12-hours post ORIF right ankle. The patient is asking for a break through dose of analgesia. The pain-medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory drug (NSAID) given together. What is the primary rationale for administering pain medication in this manner? A) To prevent respiratory depression from the opioid B) To eliminate the need for additional medication during the night C) To achieve better pain control than with one medication alone D) To eliminate the potentially adverse effects of the opioid 85. A patient with thyroid cancer has undergone surgery and a significant amount of parathyroid tissue has been removed. The nurse caring for the patient should prioritize what question when addressing potential complications? A) “Do you feel any muscle twitches or spasms?” B) “Do you feel flushed or sweaty?” C) “Are you experiencing any dizziness or light headedness?” D) “Are you having any pain that seems to be radiating from your bones?” 86. A patient is being admitted to the neurologic ICU with suspected herpes simplex virus encephalitis. What nursing action best addresses the patient's complaints of headache? A) Initiating a patient-controlled analgesia (PCA) of morphine sulfate B) Administering hydromorphone (Dilaudid) IV as needed C) Dimming the lights and reducing stimulation D) Distracting the patient with activity 87. A 16-year-old has been brought to the emergency department by his parents after falling through the glass of a patio door, suffering a laceration. The nurse caring for this patient knows that the site of the injury will have an invasion of what? A) Interferons B) Phagocytic cells C) Apoptosis D) Cytokines 88. A clinic nurse is caring for a patient who has just been diagnosed with chronic obstructive pulmonary disease (COPD). The patient asks the nurse what he could have done to minimize the risk of contracting this disease. What would be the nurse's best answer? A) “The most important risk factor for COPD is exposure to occupational toxins.” B) “The most important risk factor for COPD is inadequate exercise.” C) “The most important risk factor for COPD is exposure to dust and pollen.” D) “The most important risk factor for COPD is cigarette smoking.” 89. A nurse is reviewing a patient's activities of daily living prior to discharge from total hip replacement. The nurse should identify what activity as posing a potential risk for hip dislocation? A) Straining during a bowel movement B) Bending down to put on socks C) Lifting items above shoulder level D) Transferring from a sitting to standing position 90. An adult patient has been hospitalized with pyelonephritis. The nurse's review of the patient's intake and output records reveals that the patient has been consuming between 3 L and 3.5 L of oral fluid each day since admission. How should the nurse best respond to this finding? A) Supplement the patient's fluid intake with a high-calorie diet B) Encourage the patient to continue this pattern of fluid intake 91. The prevention of VTE is an important part of the nursing care of high-risk patients. When providing patient teaching for these high-risk patients, the nurse should advise lifestyle changes, including which of the following? Select all that apply. A) High-protein diet B) Weight loss C) Regular exercise D) Smoking cessation E) Calcium and vitamin D supplementation 92. The nurse is caring for a 77-year-old woman with MS. She states that she is very concerned about the progress of her disease and what the future holds. The nurse should know that elderly patients with MS are known to be particularly concerned about what variables. Select all that apply. A) Possible nursing home placement B) Pain associated with physical therapy C) Increasing disability D) Becoming a burden on the family E) Loss of appetite 93. A nurse is working with a child who is undergoing a diagnostic workup for suspected asthma. What are the signs and symptoms that are consistent with a diagnosis of asthma? Select all that apply. A) Chest tightness B) Crackles C) Bradypnea D) Wheezing E) Cough 94. A nurse is caring for a patient who has a gastrointestinal tube in place. Which of the following are indications for gastrointestinal intubation? Select all that apply. A) To remove gas from the stomach B) To administer clotting factors to treat a GI bleed C) To remove toxins from the stomach D) To open sphincters that are closed E) To diagnose GI motility disorders 95. A gerontologic nurse is teaching students about the high incidence and prevalence of dehydration in older adults. What factors contribute to this phenomenon? Select all that apply. A) Decreased kidney mass B) Increased conservation of sodium C) Increased total body water D) Decreased renal blood flow E) Decreased excretion of potassium 96. A patient is brought to the emergency department by the paramedics. The patient is a type 2 diabetic and is experiencing HHS. The nurse should identify what components of HHS? Select all that apply. A) Leukocytosis B) Glycosuria C) Dehydration D) Hypernatremia E) Hyperglycemia

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