D027 PRACTICE QUESTIONS AND
ANSWERS
A75patient75has75endured75several75dosage75adjustments75of75his75tricyclic75antidepress
ant,75so75the75provider75recommends75genetic75testing.75Which75statement75correctly75d
escribes75the75rationale75for75genetic75testing?
a.75The75CYP2D675gene75influences75metabolism75of75tricyclic75antidepressants75and75
certain75other75drugs
b.75The75HER275gene75is75a75tumor75marker75that75impacts75metabolism75of75tricyclic75a
ntidepressants
c.75The75BRCA275gene75influences75metabolism75of75certain75drugs75and75increases75th
e75risk75for75breast75cancer
d.75The75x-
linked75OPN1MW75gene75for75male75color75blindness75also75slows75metabolism75of75cer
tain75drugs75-75answer--
a.75The75CYP2D675gene75influences75metabolism75of75tricyclic75antidepressants75and75
certain75other75drugs
Answer/Rationale:75CYP2D675-
75page7515575Box754.375of75Chapter75475Genes75and75Genetic75Diseases,75McCance75&
75Huether,75Unit752,75Genes,75Environmental75Lifestyle,75and75Common75Diseases.75HE
R275is75a75gene75often75implicated75with75cancer,75as75is75BRCA2.75OPN1MW75is75the75
gene75that75codes75for75color75blindness75in75men.75Metabolism75of7525%75of75all75presc
ribed75drugs,75including75tricyclic75antidepressants,75beta75adrenergic75receptor75blocke
rs,75and75neuroleptics,75is75influenced75by75variants75in75a75certain75gene,75requiring75g
enetic75testing75to75reduce75trial-and-error75in75estimating75appropriate75drug-
dosage75levels.
As75an75advanced75practice75nurse,75you75want75to75learn75more75about75the75CDC's75i
nitiatives75relative75to75asthma75care75and75management75in75order75to75advocate75for75
asthma75sufferers75at75the75state75legislative75level.75Your75goal75is75to75reduce75medic
ations75costs75to75patients.75Which75CDC75recommendation75supports75your75goal?
,a.75The75CDC75recommends75that75payers75and75employers75promote75healthy75worksp
aces75to75decrease75environmental75trigger75exposures
b.75The75CDC75recommends75that75providers75prescribe75the75most75cost-
efficient75long-acting75inhalers75to75lower75patient75co-pays
c.75The75CDC75recommends75that75providers75deviate75from75the75stepwise75approach7
5to75lessen75the75financial75impact75to75the75patient
d.75The75CDC75recommends75that75co-
pays75be75removed75for75inhaled75corticosteroids75and75other75prescribed75medications7
5-75answer--d.75The75CDC75recommends75that75co-
pays75be75removed75for75inhaled75corticosteroids75and75other75prescribed75medications
Answer/Rationale:75D75-75The75CDC75recommends75that75co-
pays75be75removed75for75inhaled75corticosteroids75and75other75prescribed75medications7
5per75the75following75link,75https://healthpayerintelligence.com/news/top-10-most-
expensive-chronic-diseases-for-healthcare-
payers;75Genes,75Environmental75Lifestyle,75and75Common75Diseases;75Unit752
A75female75patient75has75been75recently75diagnosed75with75invasive75ductal75carcinoma
.75As75an75advanced75practice75nurse,75you75understand75that75she75will75be75undergoin
g75a75multi-
faceted75treatment75approach75that75will75include75one75or75more75medications.75Which7
5medication75is75considered75the75"gold75standard"75endocrine75treatment75for75breast75
cancer?
a.75Fulvestrant75(Faslodex),75an75antiestrogen75indicated75for75metastatic75estrogen75re
ceptor-positive75breast75cancer75in75post-menopausal75women
b.75Tamoxifen75(Nolvadex),75a75prodrug75that75must75be75converted75to75active75metabo
lites75in75order75to75block75estrogen75receptors75in75breast75tissue
c.75Trastuzumab75(Herceptin),75a75monoclonal75antibody75approved75for75HER2-
positive75metastatic75breast75cancer
d.75Lapatinib75(Tykerb),75an75oral75inhibitor75of75HER275tyrosine75kinase75and75EGFR75t
yrosine75kinase,75resulting75in75apoptosis75and75suppression75of75tumor75cell75growth75-
75answer--
b.75Tamoxifen75(Nolvadex),75a75prodrug75that75must75be75converted75to75active75metabo
lites75in75order75to75block75estrogen75receptors75in75breast75tissue
Answer/
Rationale:75Tamoxifen,75page75929,75Chapter758275of75Lehne,75Unit752,75Human75Struct
ures75for75Self75Defense
A75patient75reports75a75maternal75family75history75of75Lynch75syndrome.75Which75laborat
ory75finding75might75indicate75a75need75for75further75testing75for75the75presence75of75Lyn
ch75syndrome75in75this75patient?
a.75Elevated75thyroid-stimulating75hormone
b.75Low75cortisol75level
,c.75Positive75heme-occult75test
d.75Sputum75positive75for75Pseudomonas75Aeruginosa75-75answer--c.75Positive75heme-
occult75test
Answer/Rationale:75Positive75heme-
occult75because75Lynch75syndrome75is75a75hereditary75form75of75colorectal75cancer75an
d75colorectal75bleeding75can75be75a75sign75of75cancer,75per75https://
www.healthypeople.gov/2020/topics-objectives/topic/
genomics,75Unit752,75Human75Structures75for75Self75Defense
Your75goal75as75the75intensive75care75unit75coordinator75is75to75reduce75falls.75Upon75re
view75of75hospital75data,75you75find75that75most75of75the75falls75are75occurring75in75the75p
atient75population,75ages756575and75older.75As75a75result,75you75coordinate75a75fall75red
uction75initiative75after75researching75the75etiology75of75falls75in75the75elderly.75Which75a
ction75should75be75included75in75the75protocol?
a.75Encourage75slow75position75changes75since75orthostatic75hypotension75is75a75signific
ant75risk75factor75for75falls.
b.75Allocate75budgetary75resources75for75assistive75devices75to75be75in75every75room75at
75all75times75since75falls75cannot75be75predicted.
c.75Initiate75depression75screening75on75all75new75admissions75since75depressed75affect
75has75been75indicated75in75fall75etiology.
d.75Decrease75the75number75of75situations75that75require75patient75standing75and75walki
ng,75as75upright75positions75result75in75higher75incidence75of75falls.75-75answer--
a.75Encourage75slow75position75changes75since75orthostatic75hypotension75is75a75signific
ant75risk75factor75for75falls.
Answer/
Rationale:75Encourage75slow75position75changes75since75orthostatic75hypotension75is75a
75significant75risk75factor75for75falls.75From75page751067,75chapter7533,75McCance75&75H
uether,75Causes75of75Pathology75in75the75Cardiovascular75System,75Unit753
A75patient75who75has75lung75cancer75reports75facial75and75neck75swelling75so75severe75t
hat75some75shirts75no75longer75fit.75What75question75by75the75healthcare75professional75
would75be75most75appropriate75to75screen75for75superior75vena75cava75syndrome,75a75p
ossible75complication75of75cancer75tumors?
a.75"Have75you75gained75weight75recently?"
b.75"Are75your75feet75and75ankles75swollen?"
c.75"Does75your75voice75sound75hoarse?"
d.75"When75was75your75last75chemotherapy?"75-75answer--
c.75"Does75your75voice75sound75hoarse?"
ANS:75C75Patients75with75certain75kinds75of75cancer75(small75cell75and75non-
small75cell75cancers75of75the75lung,75and75lymphoma)75can75develop75superior75vena75c
ava75syndrome75(SVCS)75which75is75a75progressive75occlusion75of75the75superior75vena
, 75cava.75This75leads75to75venous75distention75in75the75upper75extremities75and75head.75
Other75symptoms75include75hoarse75voice,75dyspnea,75dysphagia,75stridor,75cough,75an
d75chest75pain.75The75professional75should75ask75about75the75other75symptoms.75A75larg
e75weight75gain75would75occur75slowly.75Asking75about75edema75elsewhere75would75be7
5a75question75if75the75patient75denied75any75other75symptoms75of75SVCS.75The75date75o
f75the75last75chemotherapy75is75not75relevant.75Page751061,75ch7533,75McCance75&75Hu
ether,75Unit753
A75patient75is75diagnosed75with75chronic75obstructive75pulmonary75disease75(COPD)75a
nd75has75elevated75pulmonary75vascular75resistance.75Which75symptom75would75indicat
e75the75need75to75assess75for75the75complication75of75cor75pulmonale75(right-
sided75heart75failure)?
a.75crackles75bilaterally
b.75generalized75arthralgia
c.75jugular75venous75distention
d.75occasional75constipation75-75answer--c.75jugular75venous75distention
ANS:75C75JVD75-75Symptoms75of75right-
sided75heart75failure75include75the75following:75hepatosplenomegaly,75extremity75edema,
75ascites,75jugular75venous75distention,75page751102,75chapter7533,75McCance75&75Huet
her,75Unit753
During75the75body's75inflammatory75process,75what75causes75edema?
a.75Vasodilation75of75blood75vessels
b.75Emigration75of75neutrophils
c.75Endothelial75cell75expansion
d.75Increased75capillary75permeability75-75answer--d.75Increased75capillary75permeability
The75increased75flow75and75capillary75permeability75result75in75a75leakage75of75plasma75
from75the75vessels75causing75swelling75(edema)75in75the75surrounding75tissue75and75is75
solely75responsible75for75inflammation75induced75edema
A7556-year-
old75diabetic75patient75has75not75taken75his75insulin75in75475days75due75to75him"75feeling7
5well75without75it".75He75is75admitted75to75the75ED75with75an75elevated75blood75sugar.75
What75electrolyte75should75be75assessed75FIRST?
a.75Calcium
b.75Sodium
c.75Potassium
d.75Chloride75-75answer--c.75Potassium
ANS:75C75-
75Insulin75facilitates75the75intracellular75transport75of75potassium,75phosphate,75and75ma
ANSWERS
A75patient75has75endured75several75dosage75adjustments75of75his75tricyclic75antidepress
ant,75so75the75provider75recommends75genetic75testing.75Which75statement75correctly75d
escribes75the75rationale75for75genetic75testing?
a.75The75CYP2D675gene75influences75metabolism75of75tricyclic75antidepressants75and75
certain75other75drugs
b.75The75HER275gene75is75a75tumor75marker75that75impacts75metabolism75of75tricyclic75a
ntidepressants
c.75The75BRCA275gene75influences75metabolism75of75certain75drugs75and75increases75th
e75risk75for75breast75cancer
d.75The75x-
linked75OPN1MW75gene75for75male75color75blindness75also75slows75metabolism75of75cer
tain75drugs75-75answer--
a.75The75CYP2D675gene75influences75metabolism75of75tricyclic75antidepressants75and75
certain75other75drugs
Answer/Rationale:75CYP2D675-
75page7515575Box754.375of75Chapter75475Genes75and75Genetic75Diseases,75McCance75&
75Huether,75Unit752,75Genes,75Environmental75Lifestyle,75and75Common75Diseases.75HE
R275is75a75gene75often75implicated75with75cancer,75as75is75BRCA2.75OPN1MW75is75the75
gene75that75codes75for75color75blindness75in75men.75Metabolism75of7525%75of75all75presc
ribed75drugs,75including75tricyclic75antidepressants,75beta75adrenergic75receptor75blocke
rs,75and75neuroleptics,75is75influenced75by75variants75in75a75certain75gene,75requiring75g
enetic75testing75to75reduce75trial-and-error75in75estimating75appropriate75drug-
dosage75levels.
As75an75advanced75practice75nurse,75you75want75to75learn75more75about75the75CDC's75i
nitiatives75relative75to75asthma75care75and75management75in75order75to75advocate75for75
asthma75sufferers75at75the75state75legislative75level.75Your75goal75is75to75reduce75medic
ations75costs75to75patients.75Which75CDC75recommendation75supports75your75goal?
,a.75The75CDC75recommends75that75payers75and75employers75promote75healthy75worksp
aces75to75decrease75environmental75trigger75exposures
b.75The75CDC75recommends75that75providers75prescribe75the75most75cost-
efficient75long-acting75inhalers75to75lower75patient75co-pays
c.75The75CDC75recommends75that75providers75deviate75from75the75stepwise75approach7
5to75lessen75the75financial75impact75to75the75patient
d.75The75CDC75recommends75that75co-
pays75be75removed75for75inhaled75corticosteroids75and75other75prescribed75medications7
5-75answer--d.75The75CDC75recommends75that75co-
pays75be75removed75for75inhaled75corticosteroids75and75other75prescribed75medications
Answer/Rationale:75D75-75The75CDC75recommends75that75co-
pays75be75removed75for75inhaled75corticosteroids75and75other75prescribed75medications7
5per75the75following75link,75https://healthpayerintelligence.com/news/top-10-most-
expensive-chronic-diseases-for-healthcare-
payers;75Genes,75Environmental75Lifestyle,75and75Common75Diseases;75Unit752
A75female75patient75has75been75recently75diagnosed75with75invasive75ductal75carcinoma
.75As75an75advanced75practice75nurse,75you75understand75that75she75will75be75undergoin
g75a75multi-
faceted75treatment75approach75that75will75include75one75or75more75medications.75Which7
5medication75is75considered75the75"gold75standard"75endocrine75treatment75for75breast75
cancer?
a.75Fulvestrant75(Faslodex),75an75antiestrogen75indicated75for75metastatic75estrogen75re
ceptor-positive75breast75cancer75in75post-menopausal75women
b.75Tamoxifen75(Nolvadex),75a75prodrug75that75must75be75converted75to75active75metabo
lites75in75order75to75block75estrogen75receptors75in75breast75tissue
c.75Trastuzumab75(Herceptin),75a75monoclonal75antibody75approved75for75HER2-
positive75metastatic75breast75cancer
d.75Lapatinib75(Tykerb),75an75oral75inhibitor75of75HER275tyrosine75kinase75and75EGFR75t
yrosine75kinase,75resulting75in75apoptosis75and75suppression75of75tumor75cell75growth75-
75answer--
b.75Tamoxifen75(Nolvadex),75a75prodrug75that75must75be75converted75to75active75metabo
lites75in75order75to75block75estrogen75receptors75in75breast75tissue
Answer/
Rationale:75Tamoxifen,75page75929,75Chapter758275of75Lehne,75Unit752,75Human75Struct
ures75for75Self75Defense
A75patient75reports75a75maternal75family75history75of75Lynch75syndrome.75Which75laborat
ory75finding75might75indicate75a75need75for75further75testing75for75the75presence75of75Lyn
ch75syndrome75in75this75patient?
a.75Elevated75thyroid-stimulating75hormone
b.75Low75cortisol75level
,c.75Positive75heme-occult75test
d.75Sputum75positive75for75Pseudomonas75Aeruginosa75-75answer--c.75Positive75heme-
occult75test
Answer/Rationale:75Positive75heme-
occult75because75Lynch75syndrome75is75a75hereditary75form75of75colorectal75cancer75an
d75colorectal75bleeding75can75be75a75sign75of75cancer,75per75https://
www.healthypeople.gov/2020/topics-objectives/topic/
genomics,75Unit752,75Human75Structures75for75Self75Defense
Your75goal75as75the75intensive75care75unit75coordinator75is75to75reduce75falls.75Upon75re
view75of75hospital75data,75you75find75that75most75of75the75falls75are75occurring75in75the75p
atient75population,75ages756575and75older.75As75a75result,75you75coordinate75a75fall75red
uction75initiative75after75researching75the75etiology75of75falls75in75the75elderly.75Which75a
ction75should75be75included75in75the75protocol?
a.75Encourage75slow75position75changes75since75orthostatic75hypotension75is75a75signific
ant75risk75factor75for75falls.
b.75Allocate75budgetary75resources75for75assistive75devices75to75be75in75every75room75at
75all75times75since75falls75cannot75be75predicted.
c.75Initiate75depression75screening75on75all75new75admissions75since75depressed75affect
75has75been75indicated75in75fall75etiology.
d.75Decrease75the75number75of75situations75that75require75patient75standing75and75walki
ng,75as75upright75positions75result75in75higher75incidence75of75falls.75-75answer--
a.75Encourage75slow75position75changes75since75orthostatic75hypotension75is75a75signific
ant75risk75factor75for75falls.
Answer/
Rationale:75Encourage75slow75position75changes75since75orthostatic75hypotension75is75a
75significant75risk75factor75for75falls.75From75page751067,75chapter7533,75McCance75&75H
uether,75Causes75of75Pathology75in75the75Cardiovascular75System,75Unit753
A75patient75who75has75lung75cancer75reports75facial75and75neck75swelling75so75severe75t
hat75some75shirts75no75longer75fit.75What75question75by75the75healthcare75professional75
would75be75most75appropriate75to75screen75for75superior75vena75cava75syndrome,75a75p
ossible75complication75of75cancer75tumors?
a.75"Have75you75gained75weight75recently?"
b.75"Are75your75feet75and75ankles75swollen?"
c.75"Does75your75voice75sound75hoarse?"
d.75"When75was75your75last75chemotherapy?"75-75answer--
c.75"Does75your75voice75sound75hoarse?"
ANS:75C75Patients75with75certain75kinds75of75cancer75(small75cell75and75non-
small75cell75cancers75of75the75lung,75and75lymphoma)75can75develop75superior75vena75c
ava75syndrome75(SVCS)75which75is75a75progressive75occlusion75of75the75superior75vena
, 75cava.75This75leads75to75venous75distention75in75the75upper75extremities75and75head.75
Other75symptoms75include75hoarse75voice,75dyspnea,75dysphagia,75stridor,75cough,75an
d75chest75pain.75The75professional75should75ask75about75the75other75symptoms.75A75larg
e75weight75gain75would75occur75slowly.75Asking75about75edema75elsewhere75would75be7
5a75question75if75the75patient75denied75any75other75symptoms75of75SVCS.75The75date75o
f75the75last75chemotherapy75is75not75relevant.75Page751061,75ch7533,75McCance75&75Hu
ether,75Unit753
A75patient75is75diagnosed75with75chronic75obstructive75pulmonary75disease75(COPD)75a
nd75has75elevated75pulmonary75vascular75resistance.75Which75symptom75would75indicat
e75the75need75to75assess75for75the75complication75of75cor75pulmonale75(right-
sided75heart75failure)?
a.75crackles75bilaterally
b.75generalized75arthralgia
c.75jugular75venous75distention
d.75occasional75constipation75-75answer--c.75jugular75venous75distention
ANS:75C75JVD75-75Symptoms75of75right-
sided75heart75failure75include75the75following:75hepatosplenomegaly,75extremity75edema,
75ascites,75jugular75venous75distention,75page751102,75chapter7533,75McCance75&75Huet
her,75Unit753
During75the75body's75inflammatory75process,75what75causes75edema?
a.75Vasodilation75of75blood75vessels
b.75Emigration75of75neutrophils
c.75Endothelial75cell75expansion
d.75Increased75capillary75permeability75-75answer--d.75Increased75capillary75permeability
The75increased75flow75and75capillary75permeability75result75in75a75leakage75of75plasma75
from75the75vessels75causing75swelling75(edema)75in75the75surrounding75tissue75and75is75
solely75responsible75for75inflammation75induced75edema
A7556-year-
old75diabetic75patient75has75not75taken75his75insulin75in75475days75due75to75him"75feeling7
5well75without75it".75He75is75admitted75to75the75ED75with75an75elevated75blood75sugar.75
What75electrolyte75should75be75assessed75FIRST?
a.75Calcium
b.75Sodium
c.75Potassium
d.75Chloride75-75answer--c.75Potassium
ANS:75C75-
75Insulin75facilitates75the75intracellular75transport75of75potassium,75phosphate,75and75ma
