NURS 441 Concepts: Exam 1 Questions With Complete
Solutions
ANS: A
There are many causes of cobalamin (B12) deficiency. The most
common cause is pernicious anemia, a disease in which the
gastric mucosa is not secreting intrinsic factor (IF) because of
antibodies being directed against the gastric parietal cells or IF
itself. Other causes of cobalamin deficiency include
gastrectomy, gastritis, nutritional deficiency, chronic
alcoholism, and hereditary enzymatic defects of cobalamin use.
Correct Answers Which individual is at high risk for a
cobalamin (vitamin B12) deficiency anemia?
a. A 47-year-old man who had a gastrectomy (removal of the
stomach)
b. A 54-year-old man with a history of irritable bowel disease
and ulcerative colitis
c. A 26-year-old woman who complains of heavy menstrual
periods
d. A 15-year-old girl who is a vegetarian
ANS: A
A decrease in urine output is a sensitive indicator of early shock.
In severe shock, urine output is decreased (compared with fluid
intake) or even absent. Alterations in temperature, irregular
rhythms, and changes in bowel movements are not early signs of
shock. Correct Answers The nurse is planning discharge
education for a client who had an exploratory laparotomy.
Which nursing statement is appropriate when teaching the client
to monitor for early signs of shock?
,a. "Monitor how much urine you void and report a decrease in
the amount."
b. "Take your temperature daily and report any below-normal
body temperatures."
c. "Assess your radial pulse every day and report an irregular
rhythm."
d. "Monitor your bowel movements and report ongoing
constipation or diarrhea."
ANS: A
A positive inotrope is a medication that increases the strength of
the heart's contractions. The other options are not correct.
Correct Answers The provider requests the nurse start an
infusion of an inotropic agent on a client. How does the nurse
explain the action of these drugs to the client and spouse?
a. "It increases the force of the heart's contractions."
b. "It dilates vessels, which lessens the work of the heart."
c. "It slows the heart rate down for better filling."
d. "It constricts vessels, improving blood flow."
ANS: A
A sign of early sepsis is low-grade fever. Both early sepsis and
thrombus may cause tachycardia, tachypnea, and hypotension.
Correct Answers A client recovering from an open reduction of
the femur suddenly feels light-headed, with increased anxiety
and agitation. Which key vital sign differentiates a pulmonary
embolism from early sepsis?
a. Temperature
b. Pulse
c. Respiration
d. Blood pressure
,ANS: A
Air trapping is not present in all cases of impaired gas exchange.
Delayed development does not occur unless the condition is
chronic or acutely damaging. The early phase of impaired gas
exchange does not cause injury or dehydration, although fatigue
can occur. Correct Answers A child in the early stages of
impaired gas exchange will often have which diagnosis as well?
a. Anxiety related to hypoxia
b. Fatigue related to air trapping
c. Injury related to fatigue and dehydration
d. Delayed Development related to hypoxia
ANS: A
All actions are appropriate, but remembering the ABCs, oxygen
would come first. The main problem in a sickle cell crisis is
tissue and organ hypoxia, so providing oxygen helps halt the
process. Correct Answers A client presents to the emergency
department in sickle cell crisis. What intervention by the nurse
takes priority?
a. Administer oxygen.
b. Apply an oximetry probe.
c. Give pain medication.
d. Start an IV line.
ANS: A
All responses indicate conditions that are beneficial to the child.
Respiratory distress and hypoxia cause anxiety as this vital life
function is threatened. When anxiety improves, the nurse knows
that the respiratory status must be improving as well even if
signs and symptoms continue. Correct Answers A 4-year-old
, child with croup is brought to the emergency department. The
child is anxious and crying and has a high-pitched stridor,
retractions, and a barky cough. After administration of cool mist
therapy, which assessment finding would indicate significant
improvement in the child's respiratory status?
a. The child is less anxious.
b. The respiratory rate is decreased.
c. Wheezing is less loud.
d. The child drinks 8 ounces of fluid.
ANS: A
Although most people with heart failure will have failure that
progresses from left to right, it is possible to have left-sided
failure alone for a short period. It is also possible to have heart
failure that progresses from right to left. Causes of left
ventricular failure include mitral or aortic valve disease,
coronary artery disease (CAD), and hypertension. Correct
Answers The nurse is assessing clients on a cardiac unit. Which
client does the nurse assess most carefully for developing left-
sided heart failure?
a. Middle-aged woman with aortic stenosis
b. Middle-aged man with pulmonary hypertension
c. Older woman who smokes cigarettes daily
d. Older man who has had a myocardial infarction
ANS: A
An elevated creatinine indicates kidney damage, which occurs in
SCD. A hematocrit level of 30% is an expected finding, as is a
slightly elevated white blood cell count. A sodium level of 147
mEq/L, although slightly high, is not concerning. Correct
Answers A nurse caring for a client with sickle cell disease
Solutions
ANS: A
There are many causes of cobalamin (B12) deficiency. The most
common cause is pernicious anemia, a disease in which the
gastric mucosa is not secreting intrinsic factor (IF) because of
antibodies being directed against the gastric parietal cells or IF
itself. Other causes of cobalamin deficiency include
gastrectomy, gastritis, nutritional deficiency, chronic
alcoholism, and hereditary enzymatic defects of cobalamin use.
Correct Answers Which individual is at high risk for a
cobalamin (vitamin B12) deficiency anemia?
a. A 47-year-old man who had a gastrectomy (removal of the
stomach)
b. A 54-year-old man with a history of irritable bowel disease
and ulcerative colitis
c. A 26-year-old woman who complains of heavy menstrual
periods
d. A 15-year-old girl who is a vegetarian
ANS: A
A decrease in urine output is a sensitive indicator of early shock.
In severe shock, urine output is decreased (compared with fluid
intake) or even absent. Alterations in temperature, irregular
rhythms, and changes in bowel movements are not early signs of
shock. Correct Answers The nurse is planning discharge
education for a client who had an exploratory laparotomy.
Which nursing statement is appropriate when teaching the client
to monitor for early signs of shock?
,a. "Monitor how much urine you void and report a decrease in
the amount."
b. "Take your temperature daily and report any below-normal
body temperatures."
c. "Assess your radial pulse every day and report an irregular
rhythm."
d. "Monitor your bowel movements and report ongoing
constipation or diarrhea."
ANS: A
A positive inotrope is a medication that increases the strength of
the heart's contractions. The other options are not correct.
Correct Answers The provider requests the nurse start an
infusion of an inotropic agent on a client. How does the nurse
explain the action of these drugs to the client and spouse?
a. "It increases the force of the heart's contractions."
b. "It dilates vessels, which lessens the work of the heart."
c. "It slows the heart rate down for better filling."
d. "It constricts vessels, improving blood flow."
ANS: A
A sign of early sepsis is low-grade fever. Both early sepsis and
thrombus may cause tachycardia, tachypnea, and hypotension.
Correct Answers A client recovering from an open reduction of
the femur suddenly feels light-headed, with increased anxiety
and agitation. Which key vital sign differentiates a pulmonary
embolism from early sepsis?
a. Temperature
b. Pulse
c. Respiration
d. Blood pressure
,ANS: A
Air trapping is not present in all cases of impaired gas exchange.
Delayed development does not occur unless the condition is
chronic or acutely damaging. The early phase of impaired gas
exchange does not cause injury or dehydration, although fatigue
can occur. Correct Answers A child in the early stages of
impaired gas exchange will often have which diagnosis as well?
a. Anxiety related to hypoxia
b. Fatigue related to air trapping
c. Injury related to fatigue and dehydration
d. Delayed Development related to hypoxia
ANS: A
All actions are appropriate, but remembering the ABCs, oxygen
would come first. The main problem in a sickle cell crisis is
tissue and organ hypoxia, so providing oxygen helps halt the
process. Correct Answers A client presents to the emergency
department in sickle cell crisis. What intervention by the nurse
takes priority?
a. Administer oxygen.
b. Apply an oximetry probe.
c. Give pain medication.
d. Start an IV line.
ANS: A
All responses indicate conditions that are beneficial to the child.
Respiratory distress and hypoxia cause anxiety as this vital life
function is threatened. When anxiety improves, the nurse knows
that the respiratory status must be improving as well even if
signs and symptoms continue. Correct Answers A 4-year-old
, child with croup is brought to the emergency department. The
child is anxious and crying and has a high-pitched stridor,
retractions, and a barky cough. After administration of cool mist
therapy, which assessment finding would indicate significant
improvement in the child's respiratory status?
a. The child is less anxious.
b. The respiratory rate is decreased.
c. Wheezing is less loud.
d. The child drinks 8 ounces of fluid.
ANS: A
Although most people with heart failure will have failure that
progresses from left to right, it is possible to have left-sided
failure alone for a short period. It is also possible to have heart
failure that progresses from right to left. Causes of left
ventricular failure include mitral or aortic valve disease,
coronary artery disease (CAD), and hypertension. Correct
Answers The nurse is assessing clients on a cardiac unit. Which
client does the nurse assess most carefully for developing left-
sided heart failure?
a. Middle-aged woman with aortic stenosis
b. Middle-aged man with pulmonary hypertension
c. Older woman who smokes cigarettes daily
d. Older man who has had a myocardial infarction
ANS: A
An elevated creatinine indicates kidney damage, which occurs in
SCD. A hematocrit level of 30% is an expected finding, as is a
slightly elevated white blood cell count. A sodium level of 147
mEq/L, although slightly high, is not concerning. Correct
Answers A nurse caring for a client with sickle cell disease
