CPAN EXAM PRACTICE EXAM WITH 300
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The nurse is caring for a patient after a procedure to create an arteriovenous AV fistula for
dialysis. The patient is complaining of pain distal to the graft site along with pallor and
diminished pulses. The nurse suspects:
1. Infection
2. Aneurysm
3. Thrombosis
4. Steal syndrome
3
The skin of patients with arterial insufficiency is pale and cyanotic and is often cool, shiny, dry,
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, CPAN EXAM PRACTICE EXAM
and thin, whereas the skin of patients with venous insufficiency is warm; has a reddish-brown
pigmentation; and is scaly, scarred, and thick.
When performing an integumentary assessment of a patient with arterial insufficiency, the
nurse finds the skin:
1. Thick, scaly, and scarred
2. Brawny (reddish-brown color)
3. Thin, shiny, dry
4. Warm and mottled
2
The infant has produced approximately 5ml/kg/hr urine, which is above the minimal expected
2 to 3 ml/kg/hr. He is not demonstrating signs of dehydration, as his vital signs are in the
normal range for his age. He is eating well and not demonstrating signs and symptoms of pain
or a distended bladder.
A perianesthesia nurse is caring for a 6month old infant status postinguinal hernia repair who
weights 8.4 kg. He has been out of surgery for 3 hours. He has breastfed twice, with the
mother reporting that he appeared to feed normally and has an IV of lactated ringer's now at
TKO. He received a total of 320ml of IV fluid in the operating room and an additional 30 ml
since being on the unit. He is smiling and playful. During discharge teaching the nurse
assesses the infant's surgical site, which is still clean, dry, and intact, and notes that his
abdomen is soft. She shows the site to the baby's mother and changes the diaper. After
weighing the diaper the nurse notes that the infant has had 100ml urine output. His HR is 112
and RR is 32. The mother states that the diaper seems pretty dry. The correct response of the
nurse is:
1. I am going to call the surgeon because I, too, am concerned that his diaper is so dry
2. This is an acceptable amount of urine for the baby's body weight
3. It is normal for your baby not to urinate, he hasn't received much IV fluid
4. I am going to get an order to increase your baby's IV rate so he can produce more urine
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3
The nurse should assess for a functional graft or fistula. This would be demonstrated by a soft
pulse and a bruit audible on auscultation. This demonstrates that the access is patent with
good blood flow. If the site is visible due to a dressing, then a doppler ultrasound should be
used to document the presence of a pulse or bruit.
When assessing the function of a new graft or fistula for hemodialysis, the perianesthesia
nurse should monitor for the presence of:
1. Pink skin with a brisk capillary refill at the access site
2. A clean, dry, and intact pressure dressing
3. A pulse and audible bruit with a stethoscope
4. Ease when drawing blood from the site
2
Glycolic acid is used for chemical peels and would not be used immediately after laser
resurfacing.
A 63 year old female patient had a full face resurfacing as an outpatient. The phase II PACU
nurse gives discharge instructions that include all of the following EXCEPT:
1. Elevate head of bed to help minimize swelling
2. The patient may resume using glycolic acid products within 24 hours of the procedure
3. Avoid sun exposure while the skin is healing
4. Continue applying ointment to the keep the facial area moist and promote healing
1
autonomic hyperreflexia is an abnormal overreaction of the nervous system to stimulation
and is a common finding in patients with spinal cord injuries above the level of T6. The most
common symptoms of the reaction include high blood pressure, skin color changes (flushing),
profuse sweating, muscle spasms, and piloerection occurring above the level of the injury.
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Prompt treatment includes raising the head of the bed and relieving the cause of the
overstimulation.
The trauma team has just stabilized the spine, level T5, of a young victim of a diving accident.
The patient presents to the phase I PACU complaining of severe pain, with a BP 180/110,
profuse diaphoresis, and generalized vasodilation evidenced by ruddy, flushed skin. The nurse
recognizes that these are symptoms of:
1. autonomic hyperreflexia
2. horner's syndrome
3. sympathetic dysreflexia
4. anaphylactic reaction
2
the older patient loses renal mass and filtering surface with a decreased glomerular filtration
rate GFR, resulting in a decreased ability to concentrate urine.
Perioperative implications of renal changes in the older adult include all of the following
EXCEPT:
1. Altered thirst response
2. Increased ability to concentrate urine
3. Continued urine excretion in the face of hypovolemia
4. Decreased glomerular filtration rate
3
The process of aging predisposes the integumentary system to have fewer sweat glands,
decreased production of melanocytes (which decreased skin pigmentation), epidural atrophy,
and loss of collagen (which leads to increased risks of skin breakdown and decreased
elasticity and turgor), It is the loss of subcutaneous fat that compromises thermoregulation in
the older patient and exposes the patient to an increased risk of hypothermia.
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