NCLEX-RN Practice Quiz Test Bank #2 (75 Questions)

NCLEX-RN Practice Quiz Test Bank #2 (75 Questions) 1. 1. Question While assessing a one-month-old infant, which of the findings warrants further investigation by the nurse? Select all that apply. o A. Abdominal respirations o B. Irregular breathing rate o C. Inspiratory grunt o D. Increased heart rate with crying o E. Nasal flaring o F. Cyanosis o G. Asymmetric chest movement Incorrect Correct Answers: C, E, F, & G • Option C. Grunting occurs when an infant attempts to maintain an adequate functional residual capacity in the face of poorly compliant lungs by partial glottic closure. As the infant prolongs the expiratory phase against this partially closed glottis, there is a prolonged and increased residual volume that maintains the airway opening and also an audible expiratory sound. • Option E: Nasal flaring occurs when the nostrils widen while breathing and is a sign of troubled breathing or respiratory distress. • Option F: Cyanosis refers to the bluish discoloration of the skin and indicates a decrease in oxygen attached to the red blood cells in the bloodstream. • Option G: Asymmetric chest movement occurs when the abnormal side of the lungs expands less and lags behind the normal side. This indicates respiratory distress. • Option A: Abdominal respiration is normal among infants and young children. Since their intercostal muscles are not yet fully developed, they use their abdominal muscles much more to pull the diaphragm down for breathing. • Option B: Newborns can have irregular breathing patterns ranging from 30 to 60 breaths per minute with short periods of apnea (15 seconds). • Option D: An increase in heart rate is normal for an infant during activity (including crying). Fluctuations in heart rate follow the changes in the newborn’s behavioral state – crying, movement, or wakefulness corresponds to an increase in heart rate. 2. 2. Question A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a preoperative client. List the order in which the nurse must carry out the following actions prior to the administration of preoperative medications. View Answers: • Place the call bell within reach • Instruct the client to remain in bed • Have the client empty bladder • Raise the side rails on the bed Incorrect Correct order is shown above. 4. Have the client empty the bladder. The first step in the process is to have the client void prior to administering the pre-operative medication. If the client does not have a catheter, it is important to empty the bladder before receiving preoperative medications to prevent bladder injury (especially in pelvic surgeries). Else, a straight catheter or an indwelling catheter may be ordered to ensure the bladder is empty. 5. Instruct the client to remain in bed. Preoperative medications can cause drowsiness and lightheadedness which may put the client at risk for injury. 6. Raise the side rails on the bed. Raising the side rails on the bed helps prevent accidental falls and injury when the client decides to get out of the bed without assistance. 7. Place the call bell within reach. Call bells should always be within the reach of a client. 3. 3. Question A 32-year-old pregnant woman comes to the clinic for her prenatal visit. The nurse gathers data about her obstetric history, which includes 3-year-old twins at home and a miscarriage 10 years ago at 12 weeks gestation. How would the nurse accurately document this information? Fill in the blanks. o Answer: Gravida (3) para (1) Incorrect Correct Answer: Gravida 3 para 1 Gravida is the number of confirmed pregnancies and each pregnancy is only counted one time, even if the pregnancy was a multiple gestation (i.e., twins, triplets). Para (parity) indicates the total number of pregnancies that have reached viability (20 weeks) regardless of whether the infants were born alive. Thus, for this woman, she is now pregnant, had 2 prior pregnancies, and 1 viable birth (twins). 4. 4. Question Which individual is at the greatest risk for developing hypertension? o A. 45-year-old African-American attorney o B. 60-year-old Asian-American shop owner o C. 40-year-old Caucasian nurse o D. 55-year-old Hispanic teacher Incorrect Correct Answer: A: 45-year-old African American attorney • Option A: African-Americans develop high blood pressure at younger ages than other groups in the US. Researchers have uncovered that African-Americans respond differently to hypertensive drugs than other groups of people. They are also found out to be more sensitive to salt, which increases the risk of developing hypertension. • Option B: The incidence of hypertension in Asian-Americans does not appear to be significantly higher than the general population, according to limited US data. • Option C: The racial disparity in hypertension and hypertension-related outcomes has been recognized for decades with African-Americans with greater risks than Caucasians. • Option D: Hypertension prevalence rates in Hispanics may vary by gender and country of origin. Hispanic Americans overall have relatively low levels of hypertension, despite elevated levels of diabetes and obesity. 5. 5. Question A 15-year-old female who ingested 15 tablets of maximum strength acetaminophen 45 minutes ago is rushed to the emergency department. Which of these orders should the nurse do first? • A. Gastric lavage • B. Administer acetylcysteine (Mucomyst) orally • C. Start an IV Dextrose 5% with 0.33% normal saline to keep the vein open • D. Have the patient drink activated charcoal mixed with water Incorrect Correct Answer: A. Gastric lavage • Option A: Acetaminophen overdose is extremely toxic to the liver causing hepatotoxicity. Early symptoms of hepatic damage include nausea, vomiting, abdominal pain, and diarrhea. If not treated immediately, hepatic necrosis occurs and may lead to death. Removing as much of the drug as possible is the first step in treatment for acetaminophen overdose, this is best done through gastric lavage. Gastric lavage (irrigation) and aspiration consist of flushing the stomach with fluids and then aspirating the fluid back out. This procedure is done in life-threatening cases such as acetaminophen toxicity and only if less than one (1) hour has occurred after ingestion. • Option B: The oral formulation of acetylcysteine is the drug of choice for the treatment of acetaminophen overdose but should be done after GI decontamination with activated charcoal. Liver damage is minimized by giving acetylcysteine (Mucomyst), the antidote for acetaminophen. Acetylcysteine reduces injury by substituting for depleted glutathione in the reaction that converts the toxic metabolite of acetaminophen to its nontoxic form. When given within 8 hours of acetaminophen toxicity, acetylcysteine is effective in preventing severe liver injury. It is administered orally or intravenously. • Option C: Intermittent IV infusion with Dextrose 5% may be considered for late-presenting or chronic ingestion. • Option D: Oral activated charcoal (AC) avidly adsorbs acetaminophen and may be administered if the patient presents within 1 hour after ingesting a potentially toxic dose. Charcoal should not be administered immediately before or with antidotes since it can effectively adsorb it and neutralize the benefits. 6. 6. Question Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure? • A. Angina at rest • B. Thrombus formation • C. Dizziness • D. Falling blood pressure Incorrect Correct Answer: B. Thrombus formation A thrombus formation may prevent blood from flowing normally through the circulatory system, which may become an embolism, and block the flow of blood towards major organs in the body. • Option A: The reported incidence of myocardial infarction with angina at rest is less than 0.1%, and is mostly influenced by patient-related factors like the extent and severity of underlying cardiovascular-related diseases and technique-related factors. • Options C & D: A falling BP and dizziness occur along with hemorrhage of the insertion site which is associated with the first 12 hours after the procedure. 7. 7. Question A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is: • A. Maintain fluid and electrolyte balance • B. Control nausea • C. Manage pain • D. Prevent urinary tract infection Incorrect Correct Answer: C. Manage pain Managing pain is always a priority because it ultimately improves the quality of life. The cornerstone of ureteral colic management is analgesia, which can be achieved most expediently with parenteral narcotics or nonsteroidal anti-inflammatory drugs (NSAIDs). • Option A: IV hydration in the setting of acute renal colic is controversial. Whereas some authorities believe that IV fluids hasten the passage of the stone through the urogenital system, others express concern that additional hydrostatic pressure exacerbates the pain of renal colic. • Option B: Because nausea and vomiting frequently accompany acute renal colic, antiemetics often play a role in renal colic therapy. Several antiemetics have a sedating effect that is often helpful. • Option D: Overuse of the more effective antibiotic agents leaves only highly resistant bacteria, but failure to adequately treat a UTI complicated by an obstructing calculus can result in potentially life-threatening urosepsis and pyonephrosis. 8. 8. Question What would the nurse expect to see while assessing the growth of children during their school-age years? • A. Decreasing amounts of body fat and muscle mass • B. Little change in body appearance from year to year • C. Progressive height increase of 4 inches each year • D. Yearly weight gain of about 5.5 pounds per year Incorrect Correct Answer: D. Yearly weight gain of about 5.5 pounds per year School-age children gain about 5.5 pounds each year and increase about 2 inches in height. Between ages 2 to 10 years, a child will grow at a steady pace. • Option A: Decreasing amounts of body fat and muscle mass are common in toddlers. • Option B: A decrease in the change in body appearance occurs among young adults. • Option C: Growth spurts are common in school-age children, as are periods of slow growth. 9. 9. Question At a community health fair, the blood pressure of a 62-year-old client is 160/96 mmHg. The client states “My blood pressure is usually much lower.” The nurse should tell the client to: • A. Go get a blood pressure check within the next 15 minutes • B. Check blood pressure again in two (2) months • C. See the healthcare provider immediately • D. Visit the health care provider within one (1) week for a BP check Incorrect Correct Answer: A. Go get a blood pressure check within the next 15 minutes The blood pressure reading is moderately high with the need to have it rechecked after a few minutes to verify. The client states it is ‘usually much lower.’ Thus a concern exists for complications such as stroke. • Options B & D: Waiting 2 months or a week for follow-up is too long. • Option C: Immediate check by the provider of care is not warranted. 10. 10. Question The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission? • A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago. • B. A young adult with diabetes mellitus Type 2 for over ten (10) years and admitted with antibiotic-induced diarrhea 24 hours ago. • C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted with Stevens-Johnson syndrome that morning. • D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago. Incorrect Correct Answer: A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago. The best candidate for discharge is one who has had a chronic condition and is most familiar with their care. This client in option A is most likely stable and could continue medication therapy at home. • Option B: The client with antibiotic-induced diarrhea still needs continuous strict monitoring as the blood sugar levels may become unstable and dehydration is still possible. • Option C: Stevens-Johnson syndrome (SJS) is a rare, serious disorder of the skin and mucous membranes. It’s usually a reaction to medication that starts with flu-like symptoms, followed by a painful rash that spreads and blisters. • Option D: Cellulitis is often an underestimated complication of HIV disease, but they are responsible for an appreciable morbidity. 11. 11. Question A 25-year-old male client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication: • A. Should be taken in the morning • B. May decrease the client’s energy level • C. Must be stored in a dark container • D. Will decrease the client’s heart rate Incorrect Correct Answer: A. Should be taken in the morning • Option A: Levothyroxine (Synthroid) has a side effect of insomnia. Taking it in the morning could prevent interfering with the client’s sleeping pattern. • Option B: Some of the side effects of Levothyroxine include hyperactivity and an increase in heart rate. • Option C: Keep this drug in a cool, dark, and dry place. • Option D: A decrease in the heart rate is the desired effect of Levothyroxine. 12. 12. Question A 3-year-old child was brought to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue protruding, drooling, and suprasternal retractions. What should the nurse do first? • A. Prepare the child for X-ray of upper airways • B. Examine the child’s throat • C. Collect a sputum specimen • D. Notify the healthcare provider of the child’s status Incorrect Correct Answer: D. Notify the healthcare provider of the child’s status These findings suggest a medical emergency and may be due to epiglottitis. Any child with an acute onset of an inflammatory response in the mouth and throat should receive immediate care. • Option A: If epiglottitis is seriously considered, no imaging studies are required. In less-clear cases, imaging studies are occasionally helpful in establishing the diagnosis or excluding epiglottitis. • Option B: Examining the child’s throat should not be attempted because it may compromise respiratory effort. • Option C: There are no indications for the collection of sputum specimens. 13. 13. Question In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation? • A. Polyphagia • B. Dehydration • C. Bedwetting • D. Weight loss Incorrect Correct Answer: C. Bedwetting One of the first symptoms of type 1 diabetes in children is bedwetting. Bedwetting in a school-age child is readily detected by the parents. • Option A: Polyphagia or extreme hunger is one of the most common symptoms of diabetes both among adults and children. • Option B: Dehydration is not a symptom of type 1 diabetes, but it can be one of the many complications. • Option D: Unintentional weight loss would develop gradually in a child with type 1 diabetes. 14. 14. Question A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection? • A. Trichomoniasis • B. Chlamydia • C. Staphylococcus • D. Streptococcus Incorrect Correct Answer: B. Chlamydia • Option B: Chlamydial infections are one of the most frequent causes of salpingitis or pelvic inflammatory disease. Chlamydial bacteria could travel up toward the vagina or cervix into the reproductive organs. • Option A: Trichomoniasis is a very common sexually transmitted disease, but it rarely predisposes to pelvic inflammatory disease. • Options C & D: Staphylococcus and streptococcus may cause PID but it rarely occurs. 15. 15. Question A registered nurse who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN? • A. A middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.” • B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two (2) days ago for my family. Why are my arms and legs jerking?” • C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 11, • D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the emergency room. Incorrect Correct Answer: C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 10. Nurses who are floated to other units should be assigned to a client who has minimal anticipated immediate complications of their problem. This client exhibits opioid toxicity with the pinpoint pupils and has the least risk of complications to occur in the near future. • Option A: The client in option A might be experiencing an overdose. • Option B: The client in option B is having withdrawal syndrome. • Option D: The client in option D may experience a decrease in sensorium later on due to head trauma. 16. 16. Question When teaching a client with coronary artery disease about nutrition, the nurse should emphasize: • A. Eating three (3) balanced meals a day • B. Adding complex carbohydrates • C. Avoiding very heavy meals • D. Limiting sodium to 7 gms per day Incorrect Correct Answer: C. Avoiding very heavy meals Eating large, heavy meals can pull blood away from the heart for digestion and is dangerous for the client with coronary artery disease. Too much plaque may accumulate in the arteries and block the delivery of blood and oxygen in major organs of the body. • Option A: Eating a balanced diet should be a part of the management of a client with coronary artery disease. • Option B: Complex carbohydrates decrease inflammation and help decrease the risk of plaque build-up in the arteries. • Option C: People with cardiovascular diseases should have a limit of less than 1.5 grams per day. 17. 17. Question Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain breakthrough for morphine drip is not working? • A. The client complains of discomfort at the IV insertion site • B. The client states “I just can’t get relief from my pain.” • C. The level of the drug is 100 ml at 8 AM and is 80 ml at noon • D. The level of the drug is 100 ml at 8 AM and is 50 ml at noon Incorrect Correct Answer: C. The level of the drug is 100 ml at 8 AM and is 80 ml at noon The minimal dose of 10 mL per hour which would be 40 mL given in a four (4) hour period. Only 60 mL should be left at noon. The pump is not functioning when more than expected medicine is left in the container. • Option A: Discomfort at the IV insertion site may indicate inflammation or infection of the site. • Option B: Morphine is a strong painkiller indicated for severe pain. • Option D: The pump is working correctly if there is only 50 ml left at noon. 18. 18. Question The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response? • A. Electrical energy fields • B. Spinal column manipulation • C. Mind-body balance • D. Exercise of joints Incorrect Correct Answer: B. Spinal column manipulation The theory underlying chiropractic is that interference with the transmission of mental impulses between the brain and body organs produces diseases. Such interference is caused by the misalignment of the vertebrae. Manipulation reduces subluxation. • Option A: Too much exposure to electrical energy can become a hazard to one’s health. • Option C: Mind-body balance refers to yoga. • Option D: Low-impact aerobic exercises are easier on the joints but are not part of chiropractic medicine. 19. 19. Question The nurse is performing a neurological assessment on a client post right cerebrovascular accident. Which finding, if observed by the nurse, would warrant immediate attention? • A. Decrease in the level of consciousness • B. Loss of bladder control • C. Altered sensation to stimuli • D. Emotional lability Incorrect Correct Answer: A. Decrease in the level of consciousness A further decrease in the level of consciousness may indicate an increase in intracranial pressure leading to inadequate oxygenation of the brain. A decrease in LOC may also reveal the presence of a transient ischemic attack which may warn of impending thrombotic CVA. • Option B: The patient post-stroke may have transient urinary incontinence due to inability to communicate needs, or impaired motor and postural control. Control of the urinary sphincter may also be lost or diminished. • Option C: Altered sensation to stimuli is expected for a patient post CVA. This may include sensory impairment to touch, loss of proprioception, difficulty interpreting visual, tactile, and auditory stimuli. • Option D: Depression and anxiety are common responses by a patient after a catastrophic event such as in stroke. Emotional lability (or pseudobulbar affect), refers to the involuntary and uncontrollable bursts of emotion without an emotional trigger. 20. 20. Question A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? • A. Positive sweat test • B. Bulky greasy stools • C. Moist, productive cough • D. Meconium ileus Incorrect Correct Answer: C. Moist, productive cough Noisy respirations and a dry non-productive cough are commonly the first of the respiratory signs to appear in a newly diagnosed client with cystic fibrosis (CF). The other options are the earliest findings. CF is an inherited (genetic) condition affecting the cells that produce mucus, sweat, saliva, and digestive juices. Normally, these secretions are thin and slippery, but in CF, a defective gene causes the secretions to become thick and sticky. Instead of acting as a lubricant, the secretions plug up tubes, ducts, and passageways, especially in the pancreas and lungs. Respiratory failure is the most dangerous consequence of CF. • Option A: A positive sweat test is one of the indications of cystic fibrosis. • Option B: A patient with CF experiences frequent greasy, bulky stools or difficulty with bowel movements as the thick mucus blocks the intestines. • Option D: Meconium ileus is one of the early signs of CF. 21. 21. Question The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs two (2) hours ago. The nurse should • A. Place a call to the client’s health care provider for instructions • B. Send him to the emergency room for evaluation • C. Reassure the client’s wife that the symptoms are transient • D. Instruct the client’s wife to call the doctor if his symptoms become worse Incorrect Correct Answer: B. Send him to the emergency room for evaluation This client requires immediate evaluation. A delay in treatment could result in further deterioration and harm. Home care nurses must prioritize interventions based on assessment findings that are in the client’s best interest. • Option A: Waiting to call for instructions may delay the diagnosis of the patient. • Option C: Reassuring the wife is incorrect since it is not a transient symptom. • Option D: The symptoms are indicative of an emergency situation so the patient must be brought to the emergency department immediately. 22. 22. Question Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiography test? • A. Client must be NPO before the examination • B. Enema to be administered prior to the examination • C. Medicate client with furosemide 20 mg IV 30 minutes prior to the examination • D. No special orders are necessary for this examination Incorrect Correct Answer: D. No special orders are necessary for this examination There are no special orders for this procedure, however, the client must be instructed of the general rule during radiography tests: remove any clothing, jewelry, or objects that may interfere with the test. • Option A: There is no need to keep the client on NPO before the procedure. • Option B: Enemas are not recommended for any type of radiograph test. • Option C: Furosemide (Lasix) is unnecessary for this examination. 23. 23. Question The nurse is giving discharge teaching to a client seven (7) days post-myocardial infarction. He asks the nurse why he must wait six (6) weeks before having sexual intercourse. What is the best response by the nurse to this question? • A. “You need to regain your strength before attempting such exertion.” • B. “When you can climb 2 flights of stairs without problems, it is generally safe.” • C. “Have a glass of wine to relax you, then you can try to have sex.” Incorrect Correct Answer: B. “When you can climb 2 flights of stairs without problems, it is generally safe.” There is a risk of cardiac rupture at the point of the myocardial infarction for about six (6) weeks. Scar tissue should form about that time. Waiting until the client can tolerate climbing stairs is the usual advice given by healthcare providers. • Option A: The instruction in option A is vague and does not specifically tell the patient how to determine if the activity is already appropriate for him. • Option C: Having a glass of wine is not recommended for a client who just had a myocardial infarction. • Option D: Having an active walking program does not guarantee that the client has regained strength for strenuous activity. 24. 24. Question A triage nurse has these four (4) clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first? • A. A 2-month-old infant with a history of rolling off the bed and has bulging fontanelle with crying • B. A teenager who got a singed beard while camping • C. An elderly client with complaints of frequent liquid brown colored stools • D. A middle-aged client with intermittent pain behind the right scapula Incorrect Correct Answer: B. A teenager who got a singed beard while camping This client is in the greatest danger with a potential of respiratory distress. Any client with singed facial hair has been exposed to heat or fire in close range that could have caused serious damage to the interior of the lungs. Note that the interior lining of the lungs has no nerve fibers so the client will not be aware of swelling. • Option A: When an infant is crying, the fontanels may look like they are bulging. • Option C: The client in Option C can wait to be seen within the first hour. • Option D: The client in Option D does not have a life-threatening condition but will still require immediate pain relief. 25. 25. Question While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child’s developmental needs? • A. “I want to protect my child from any falls.” • B. “I will set limits on exploring the house.” • C. “I understand the need to use those new skills.” • D. “I intend to keep control over our child.” Incorrect Correct Answer: C. “I understand the need to use those new skills.” Erikson describes the stage of the toddler as being the time when there is normally an increase in autonomy. The child needs to use motor skills to explore the environment and develop autonomy. • Option A: The statement in Option A is correct but pertains to the risks associated with a toddler. • Option B: Setting limits on a toddler may cause frustration instead of independence. • Option D: Controlling the child may be harmful to her development as toddlers should be developing their autonomy at this stage. 26. 26. Question The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is: • A. Verify correct placement of the tube • B. Check that the feeding solution matches the dietary order • C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach • D. Ensure that feeding solution is at room temperature Incorrect Correct Answer: A. Verify correct placement of the tube Proper placement of the tube prevents aspiration and entrance of food content into the lungs. The definitive way to ascertain the position of the nasogastric tube is through visualization by an x-ray. Another method is to aspirate stomach contents and check its pH (usually pH 1 to 5). Aspirated stomach content can also be tested for bilirubin to confirm it is placed in the stomach. • Option B: It is also important to check that the feeding solution matches the dietary order to ensure that the client gets proper nutrition. • Option C: Aspirating the gastric contents is one of the methods used to determine the last feeding amount in the stomach, but is not the most important action the nurse should do. • Option D: Keep it at room temperature so it would not upset the stomach. 27. 27. Question The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq potassium chloride in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to the nurse that the infusions should be discontinued? • A. Narrowed QRS complex • B. Shortened “PR” interval • C. Tall peaked "T" waves • D. Prominent “U” waves Incorrect Correct Answer: C. Tall peaked “T” waves A tall peaked T wave is a sign of hyperkalemia. The healthcare provider should be notified regarding discontinuing the medication. • Option A: Narrow QRS complex indicates fast cardiac rhythms (generally more than 100 beats/min) with a QRS duration of 100 ms or less. • Option B: A short PR interval (<120 ms) is seen with preexcitation syndromes and AV nodal (junctional) rhythm. • Option D: Prominent U waves are characteristic of hypokalemia. 28. 28. Question A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body? • A. All striated muscles • B. The cerebellum • C. The kidneys • D. The leg bones Incorrect Correct Answer: A. All striated muscles Rhabdomyosarcoma is the most common children’s soft tissue sarcoma. It originates in striated (skeletal) muscles and can be found anywhere in the body. Symptoms of rhabdomyosarcoma include if the cancer is in the head or neck area: sudden bulging or swelling of the eyes, conjunctival chemosis, and headache. It can also affect the urinary or reproductive system. Its common site of metastasis is the lung. • Option B: The cerebellum is not affected in rhabdomyosarcoma. • Option C: The kidneys are not directly affected by the disease. • Option D: Bones are not directly affected by the disease. 29. 29. Question The nurse anticipates that for a family who practices Chinese medicine the priority goal would be to: • A. Achieve harmony • B. Maintain a balance of energy • C. Respect life • D. Restore yin and yang Incorrect Correct Answer: D. Restore yin and yang For followers of Chinese medicine, health is maintained through the balance between the forces of yin and yang. Traditional Chinese medicine is a medical system that began being developed in China about 5000 years ago, which makes it the oldest continuous medical system on the planet. • Option A: Living in harmony with one’s natural environment with the aim of keeping all aspects of a person-mind, body, and spirit- in a state of harmony and balance so that disease never has a chance to develop. • Option B: This balance and a healthy lifestyle are the focus of Chinese medicine which empowers the individual to participate in his own health. • Option C: In Chinese medicine, the body, and indeed a human being, is not seen as a machine, living in isolation from the world around it. Human beings are seen as part of the whole of things, which includes our environments, nature, and the universe itself. 30. 30. Question During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of periodic dizzy spells. The nurse instructs the client to: • A. Increase fluids that are high in protein • B. Restrict fluids • C. Force fluids and reassess blood pressure • D. Limit fluids to non-caffeine beverages Incorrect Correct Answer: C. Force fluids and reassess blood pressure Orthostatic hypotension, a decrease in systolic blood pressure of more than 15 mmHg, and an increase in heart rate of more than 15 percent usually accompanied by dizziness indicate volume depletion, inadequate vasoconstrictor mechanisms, and autonomic insufficiency. • Option A: Fluids may not be necessarily protein-rich. • Option B: Restricting fluids could aggravate the client’s dizziness. • Option D: There is no need to restrict the fluid intake of the client. 31. 31. Question The nurse prepares the client for the insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: • A. Stroke volume • B. Cardiac output • C. Venous pressure • D. Left ventricular functioning Incorrect Correct Answer: D. Left ventricular functioning The catheter is placed in the pulmonary artery. Information regarding left ventricular function is obtained when the catheter balloon is inflated. • Option A: Stroke volume is calculated using measurements of ventricle volumes from an echocardiogram and subtracting the volume of the blood in the ventricle at the end of a beat (called end-systolic volume) from the volume of blood just prior to the beat (called end-diastolic volume). • Option B: Cardiac output is calculated by multiplying the stroke volume by the heart rate. • Option C: The CVP can be measured either manually using a manometer or electronically using a transducer. 32. 32. Question A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is: • A. Start a peripheral IV • B. Initiate high-quality chest compressions • C. Establish an airway • D. Obtain the crash cart Incorrect Correct Answer: B. Initiate high-quality chest compressions As per new guidelines, the American Heart Association recommends beginning CPR with chest compression (rather than checking for the airway first). Start CPR with 30 chest compressions before checking the airway and giving rescue breaths. Starting with chest compressions first applies to adults, children, and infants needing CPR, but not newborns. CPR can keep oxygenated blood flowing to the brain and other vital organs until more definitive medical treatment can restore a normal heart rhythm. • Option A: Starting a peripheral IV can come after the C-A-B sequence. • Option C: Establishing an airway comes after compressions. • Option D: After performing the guidelines by the AHA, the crash cart can be obtained by another nurse responding to the scene. 33. 33. Question A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the following should the nurse report immediately to the health care provider? • A. Blood pressure 94/60 mm Hg • B. Heart rate 76 bpm • C. Urine output 50 ml/hour • D. Respiratory rate 16 bpm Incorrect Correct Answer: A. Blood pressure 94/60 mm Hg Both medications decrease the heart rate. Metoprolol affects blood pressure. Therefore, the heart rate and blood pressure must be within the normal range (HR 60-100; systolic BP over 100) in order to safely administer both medications. • Option B: A heart rate of 76 is within the normal range. • Option C: Increase in urine output is the desired effect of diuretics, which is given with digoxin. • Option D: A respiratory rate of 16 is within the normal range. 34. 34. Question The nurse practicing in a maternity setting recognizes that the postmature fetus is at risk due to: • A. Excessive fetal weight • B. Low blood sugar levels • C. Depletion of subcutaneous fat • D. Progressive placental insufficiency Incorrect Correct Answer: D. Progressive placental insufficiency Postmature or post-term pregnancy is a prolonged pregnancy that exceeds the limits of 38 to 42 weeks (normal term pregnancy). Infants of such pregnancy are considered postmature or dysmature if there is evidence that placental insufficiency has occurred and interfered with fetal growth. It occurs in 12% of all pregnancies. The placenta loses its adequacy to function after 42 weeks, after which it acquires calcium deposits which decrease the blood perfusion, supply of oxygen and nutrients to the fetus. • Options A, B, & C: Excessive fetal weight, hypoglycemia, and depletion of subcutaneous fat are all observed in a postmature fetus. 35. 35. Question The nurse is caring for a client who had a total hip replacement seven (7) days ago. Which statement by the client requires the nurse’s immediate attention? • A. I have bad muscle spasms in my lower leg of the affected extremity. • B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” • C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.” • D. “It seems that the pain medication is not working as well today.” Incorrect Correct Answer: B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” The nurse would be concerned about all of these comments, however, the most life-threatening is option B. Clients who had hip or knee surgery are at higher risk for the development of postoperative pulmonary embolism. Sudden dyspnea and tachycardia are classic findings of pulmonary embolism. Without prophylaxis (e.g., anticoagulation medications), deep vein thrombosis can develop within 7 to 14 days following the surgery and can lead to pulmonary embolism. The nurse should be aware of the other signs of DVT which include: pain and tenderness at or below the area of the clot, skin discoloration, swelling, or tightness of the affected leg. Signs of pulmonary embolism include acute onset of dyspnea, tachycardia, confusion, and pleuritic chest pain. • Option A: Muscle spasms occur after total hip replacements and acute pain is expected after a surgical procedure. • Option C: May indicate urinary infection and needs further assessment by the nurse. • Option D: May require a reevaluation of pain and interventions to manage pain though does not need immediate action. 36. 36. Question A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication? • A. Weight gain of 5 pounds • B. Edema of the ankles • C. Gastric irritability • D. Decreased appetite Incorrect Correct Answer: D. Decreased appetite Furosemide is a loop diuretic that is used for pulmonary edema, edema in heart failure, nephrotic syndrome, and hypertension. Furosemide causes a loss of potassium unless a supplement or a potassium-rich diet is taken. A decrease in appetite is caused by hypokalemia. Signs and symptoms of hypokalemia include anorexia, fatigue, nausea, decreased GI motility, muscle weakness, dysrhythmias, reduced urine osmolality, altered level of consciousness. • Option A: Weight gain is not a negative side effect of furosemide. • Option B: Edema of the ankles are indications for the administration of furosemide. • Option C: Gastric irritability is not a side effect of furosemide. 37. 37. Question The nurse is caring for a 27-year-old female client with venous stasis ulcer. Which nursing intervention would be most effective in promoting healing? • A. Apply dressing using sterile technique • B. Improve the client’s nutrition status • C. Initiate limb compression therapy • D. Begin proteolytic debridement Incorrect Correct Answer: B. Improve the client’s nutrition status Venous stasis occurs when venous blood collects and stagnates in the lower leg due to incompetent venous valves. Eventually, little oxygen and nutrients are supplied to the cells of the lower extremities causing the cells to die or necrose. This ultimately leads to the formation of venous stasis ulcers characterized by shallow but large brown wounds with irregular margins that typically develop on the lower leg or ankle. The goal of clinical management in a client with venous stasis ulcers is to promote healing. This only can be accomplished with proper nutrition. Nutritional deficiencies are common causes of venous ulcers. Alterations in the diet to include foods high in protein, iron, zinc, and vitamins C and A are encouraged to promote wound healing. • Option A: Dressings are often used under compression bandages to promote faster healing and prevent adherence of the bandage to the ulcer. A wide range of dressings are available, including hydrocolloids (e.g., Duoderm), foams, hydrogels, pastes, and simple non-adherent dressings. • Option C: Compression therapy is the standard of care for venous ulcers and chronic venous insufficiency. A recent Cochrane review found that venous ulcers heal more quickly with compression therapy than without. Methods include inelastic, elastic, and intermittent pneumatic compression. Compression therapy reduces edema, improves venous reflux, enhances healing of ulcers, and reduces pain. • Option D: Removal of necrotic tissue and bacterial burden through debridement has long been used in wound care to enhance healing. Debridement may be sharp (e.g., using a curette or scissors), enzymatic, mechanical, biologic (i.e., using larvae), or autolytic. 38. 38. Question Which of these statements best describes the characteristics of an effective reward-feedback system? • A. Specific feedback is given as close to the event as possible • B. Staff is given feedback in equal amounts over time • C. Positive statements are to precede a negative statement • D. Performance goals should be higher than what is attainable Incorrect Correct Answer: A. Specific feedback is given as close to the event as possible Feedback is most useful when given immediately. Positive behavior is strengthened through immediate feedback, and it is easier to modify problem behaviors if the standards are clearly understood. • Option B: Positive feedback is most useful when given immediately. • Option C: Negative statements are never helpful in any given situation. • Option D: Every goal should always be attainable. 39. 39. Question The nurse is providing information to a client with multiple sclerosis on performing exercises and physical activities. The nurse determines the client needs additional teaching if the client makes which statements? Select all that apply. • A. “I can lift weights and do resistance training.” • B. “I should exercise to the point of exhaustion.” • C. “I can include aerobic exercises in my routine.” • D. “Proper stretching should be done before starting my routine.” • E. “I should exercise continuously without rest.” Incorrect Correct answers: B & E. • Option B: Patients with multiple sclerosis should not exercise to the point of fatigue as strenuous physical exercise raises body temperature and may aggravate symptoms. • Option E: Continuous exercise with no rest periods is contraindicated for patients with multiple sclerosis who wants to exercise. The patient should be advised to take short rest periods, preferably lying down. Again, extreme fatigue may contribute to the exacerbation of symptoms. • Option A: Exercises should include activities that would strengthen weak muscles because diminishing muscle strength is often a primary concern in multiple sclerosis. These activities include lifting weights and resistance exercises. • Option C: Aerobic exercises help promote muscle efficiency, increase flexibility, improves mood, and helps eliminate stress. • Option D: Muscle stretching should be included prior to exercise as this helps minimize muscle spasticity and contractures which is common in later stages of multiple sclerosis. 40. 40. Question During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member? • A. “At least two (2) full meals a day are eaten.” • B. “We go to a group discussion every week at our community center.” • C. “We have safety bars installed in the bathroom and have 24-hour alarms on the doors.” • D. “The medication is not a problem to have it taken three (3) times a day.” Incorrect Correct Answer: C. We have safety bars installed in the bathroom and have 24-hour alarms on the doors. Note all options are correct statements. However, safety is most important to reinforce. • Option C: Ensuring safety of the client with increasing memory loss is a priority of home care. In addition to installation of safety bars, all obvious hazards should be removed in order to prevent falls and other injuries. A hazard-free home environment allows the patient maximum independence and a sense of autonomy. • Option A: In addition to proper nutrition, mealtimes should be kept pleasant, simple, calm, and without confrontations. Patients with AD prefer foods that are familiar, appetizing, and tastes good. Food should be cut into smaller pieces when possible to prevent choking. Hot food and beverages should be served warm or have their temperature checked to prevent burns. • Option B: Socialization is encouraged for patients with dementia. Participation in simple activities, visits from friends, doing hobbies, or caring for pets helps improve the quality of life. • Option D: Medication for Alzheimer’s disease helps manage the cognitive and behavioral symptoms. 41. 41. Question A nurse is reviewing a patient’s medication during shift change. Which of the following medications would be contraindicated if the patient were pregnant? Select all that apply. • A. Warfarin (Coumadin) • B. Finasteride (Propecia, Proscar) • C. Celecoxib (Celebrex) • D. Clonidine (Catapres) • E. Transdermal nicotine (Habitrol) • F. Clofazimine(Lamprene) Incorrect Correct Answer: A. Warfarin (Coumadin); B. Finasteride (Propecia, Proscar) • Option A: Warfarin (Coumadin). Has a pregnancy category X and associated with central nervous system defects, spontaneous abortion, stillbirth, prematurity, hemorrhage, and ocular defects when given anytime during pregnancy and fetal warfarin syndrome when given during the first trimester. • Option B: Finasteride (Propecia, Proscar). Also has a pregnancy category X which has a high risk of causing permanent damage to the fetus. • Option C: Celecoxib (Celebrex). Large doses cause birth defects in rabbits; Pregnancy category C. • Option D: Clonidine (Catapres). Crosses the placenta but no adverse fetal effects have been observed. • Option E: Transdermal nicotine (Habitrol). Nicotine replacement products have been assigned to pregnancy category C (nicotine gum) and category D (transdermal patches, inhalers, and spray nicotine products). • Option F: Clofazimine (Lamprene). Clofazimine has been assigned to pregnancy category C. 42. 42. Question A nurse is reviewing a patient’s past medical history (PMH). The history indicates the patient has photosensitive reactions to medications. Which of the following drugs is associated with photosensitive reactions? Select all that apply. • A. Ciprofloxacin (Cipro) • B. Sulfonamide • C. Norfloxacin (Noroxin) • D. Sulfamethoxazole and Trimethoprim (Bactrim) • E. Isotretinoin (Accutane) • F. Nitro-Dur patch Incorrect Correct Answer: A, B, C, D, and E. Photosensitivity is an extreme sensitivity to ultraviolet (UV) rays from the sun and other light sources. A type of photosensitivity called Phototoxic reactions are caused when medications in the body interact with UV rays from the sun. Anti-infectives are the most common cause of this type of reaction. • Option A: Ciprofloxacin is used to treat a variety of bacterial infections. Ciprofloxacin belongs to a class of drugs called quinolone antibiotics. It works by stopping the growth of bacteria. This antibiotic treats only bacterial infections. It will not work for virus infections (such as common cold, flu). Unnecessary use or overuse of any antibiotic can lead to its decreased effectiveness. • Option B: Sulfonamides are synthetic bacteriostatic antibiotics that competitively inhibit conversion of p-aminobenzoic acid to dihydropteroate, which bacteria need for folate synthesis and ultimately purine and DNA synthesis. Humans do not synthesize folate but acquire it in their diet, so their DNA synthesis is less affected. • Option C: Norfloxacin is an antibiotic in a group of drugs called fluoroquinolones. Norfloxacin fights bacteria in the body. Norfloxacin is used to treat different bacterial infections of the prostate or urinary tract (bladder and kidneys). Norfloxacin is also used to treat gonorrhea. • Option D: Sulfamethoxazole and trimethoprim combination is used to treat infections such as urinary tract infections, middle ear infections (otitis media), bronchitis, traveler’s diarrhea, and shigellosis (bacillary dysentery). This medicine is also used to prevent or treat Pneumocystis jiroveci pneumonia or Pneumocystis carinii pneumonia (PCP), a very serious kind of pneumonia. Sulfamethoxazole and trimethoprim combination is an antibiotic. It works by eliminating the bacteria that cause many kinds of infections. • Option E: Isotretinoin is a drug used to treat severe acne that hasn’t responded to other treatments. It may be prescribed for other uses, including other skin problems and certain kinds of cancer. This drug is a vitamin A derivative (retinoid), so your body reacts to it in a similar way that it does to vitamin A. • Option F: Nitro-Dur patch is used to prevent chest pain or angina. Its side effects are headache, lightheadedness, nausea, and flushing. 43. 43. Question A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration? • A. Sulfasalazine • B. Levodopa • C. Phenolphthalein • D. Aspirin Incorrect Correct Answer: D. Aspirin Aspirin is not known to cause discoloration of the urine. Side effects and complications of taking aspirin include stroke caused by a burst blood vessel. The Food and Drug Administration doesn’t recommend aspirin therapy for the prevention of heart attacks in people who haven’t already had a heart attack, stroke or another cardiovascular condition. • Option A: Sulfasalazine may discolor the urine or skin to orange-yellow color. Sulfasalazine is used to treat ulcerative colitis (UC), and to decrease the frequency of UC attacks. Sulfasalazine will not cure ulcerative colitis, but it can reduce the number of attacks you have. • Option B: Levodopa may discolor the urine, saliva, or sweat to a dark brown color. Levodopa is in a class of medications called central nervous system agents. It works by being converted to dopamine in the brain. Carbidopa is in a class of medications called decarboxylase inhibitors. It works by preventing levodopa from being broken down before it reaches the brain. • Option C: Phenolphthalein can discolor the urine to a red color. Phenolphthalein is often used as an indicator in acid-base titrations. For this application, it turns colorless in acidic solutions and pink in basic solutions. 44. 44. Question You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drugs, if found inside the fridge, should be removed? • A. Nadolol (Corgard) • B. Opened (in-use) Humulin N injection • C. Urokinase (Kinlytic) • D. Epoetin alfa IV (Epogen) Incorrect Correct Answer: A. Corgard Nadolol (Corgard) is stored at room temperature between 59 to 86 ºF (15 and 30 ºC) away from heat, moisture, and light. Do not store in the bathroom and keep the bottle tightly closed. • Option B: Humulin N injection if unopened (not in use) is stored in the fridge and can be used until the expiration date, or stored at room temperature and used within 31 days. If opened (in-use), store the vial in a refrigerator or at room temperature and use within 31 days. Store the injection pen at room temperature (do not refrigerate) and use within 14 days. Keep it in its original container protected from heat and light. Do not draw insulin from a vial into a syringe until you are ready to give an injection. Do not freeze insulin or store it near the cooling element in a refrigerator. Throw away any insulin that has been frozen. • Option C: Urokinase (Kinlytic) is refrigerated at 2–8°C. Lyophilized Urokinase although stable at room temperature for 3 weeks, should be stored desiccated below -18°C. Upon reconstitution Urokinase should be stored at 4°C between 2-7 days and for future use below -18°C. • Option D: Epoetin alfa IV (Epogen) vials should be stored at 2°C to 8°C (36°F to 46°F); Do not freeze. Do not shake. Protect from light. 45. 45. Question A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb? • A. IgA • B. IgD • C. IgE • D. IgG Incorrect Correct Answer: D. IgG IgG is the only immunoglobulin that can cross the placental barrier. About 70-80% of the immunoglobulins in the blood are IgG. Specific IgG antibodies are produced during an initial infection or other antigen exposure, rising a few weeks after it begins, then decreasing and stabilizing. The body retains a catalog of IgG antibodies that can be rapidly reproduced whenever exposed to the same antigen. IgG antibodies form the basis of long-term protection against microorganisms. • Option A: IgA antibodies protect body surfaces that are exposed to outside foreign substances. Immunoglobulin A (IgA) is the first line of defence in the resistance against infection, via inhibiting bacterial and viral adhesion to epithelial cells and by neutralisation of bacterial toxins and virus, both extra- and intracellularly. IgA also eliminates pathogens or antigens via an IgA-mediated excretory pathway where binding to IgA is followed by poly immunoglobulin receptor-mediated transport of immune complexes. • Option B: IgD antibodies are found in small amounts in the tissues that line the belly or chest. Secreted IgD appears to enhance mucosal homeostasis and immune surveillance by “arming” myeloid effector cells such as basophils and mast cells with IgD antibodies reactive against mucosal antigens, including commensal and pathogenic microbes. • Option C: IgE antibodies cause the body to react against foreign substances such as pollen, spores, animal dander. IgE antibodies are found in the lungs, skin, and mucous membranes. They are involved in allergic reactions to milk, some medicines, and some poisons. 46. 46. Question A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that the nursing student should take? • A. Immediately see a social worker • B. Start prophylactic AZT treatment • C. Start prophylactic Pentamidine treatment • D. Seek counseling Incorrect Correct Answer: B. Start prophylactic AZT treatment Azidothymidine (AZT) treatment is the most critical intervention. It is an antiretroviral medication used to prevent and treat HIV/AIDS by reducing the replication of the virus. Post-exposure prophylaxis (PEP) for HIV is a treatment to suppress the virus and prevent infection after exposure. PEP should be taken within 72 hours of possible exposure to HIV, so it is important to seek treatment quickly. • Option A: Before reporting to a social worker, it is imperative to start a prophylaxis to reduce viral replication. • Option C: Pentamidine is an antimicrobial medication given to prevent and treat pneumocystis pneumonia. • Option D: It is natural to have strong emotions after an exposure to HIV in the workplace. The healthcare worker might feel anger, fear, blame, or depression. During the difficult time of prevention treatment and waiting, they may want to seek support. Try an employee-assistance program or local mental health expert. 47. 47. Question A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? • A. Atherosclerosis • B. Diabetic nephropathy • C. Autonomic neuropathy • D. Somatic neuropathy Incorrect Correct Answer: C. Autonomic neuropathy Autonomic neuropathy (also known as Diabetic Autonomic Neuropathy) affects the autonomic nerves, which control the bladder, intestinal tract, and genitals, among other organs. Paralysis of the bladder is a common symptom of this type of neuropathy, as manifested by bladder urgency and inability to start urination. • Option A: Atherosclerosis, or hardening of the arteries, is a condition in which plaque builds up inside the arteries. Plaque is made of cholesterol, fatty substances, cellular waste products, calcium, and fibrin (a clotting material in the blood). • Option B: Diabetic nephropathy (DN) is typically defined by macro albuminuria—that is, a urinary albumin excretion of more than 300 mg in a 24-hour collection—or macroalbuminuria and abnormal renal function as represented by an abnormality in serum creatinine, calculated creatinine clearance, or glomerular filtration rate (GFR). Clinically, diabetic nephropathy is characterized by a progressive increase in proteinuria and an increased need to urinate. • Option D: Somatic neuropathy affects the whole body and presents with diverse clinical pictures, most common is the development of diabetic foot followed by diabetic ulceration and possible amputation. 48. 48. Question You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect? • A. Multiple sclerosis • B. Anorexia nervosa • C. Bulimia nervosa • D. Systemic sclerosis Incorrect Correct Answer: B. Anorexia nervosa All of the clinical signs and symptoms point to a condition of anorexia nervosa. The key feature of anorexia nervosa is self-imposed starvation, resulting from a distorted body image and an intense, irrational fear of gaining weight, even when the patient is emaciated. Anorexia nervosa may include refusal to eat accompanied by compulsive exercising, self-induced vomiting, or laxative or diuretic abuse. • Option A: Multiple sclerosis (MS) is a demyelinating disease in which the insulating covers of the nerve cells in the brain and spinal cord are damaged. • Option C: On the other hand, bulimia nervosa features binge eating followed by a feeling of guilt, humiliation, and self-deprecation. These feelings cause the patient to engage in self-induced vomiting, use of laxatives, or diuretics. • Option D: Systemic sclerosis or systemic scleroderma is an autoimmune disease of the connective tissue. 49. 49. Question A 24-year-old female is admitted to the ER due to confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely suspect? • A. Diverticulosis • B. Hypercalcemia • C. Hypocalcemia • D. Irritable bowel syndrome Incorrect Correct Answer: B. Hypercalcemia Hypercalcemia can cause polyuria, severe abdominal pain, and confusion. • Option A: Diverticulosis is a condition that develops when pouches (diverticula) form in the wall of the large intestine; most people don’t have symptoms. • Option C: Hypocalcemia is low calcium levels in the blood; it is asymptomatic in mild forms but can cause paresthesia, tetany, muscle cramps, and carpopedal spasms in severe hypocalcemia. • Option D: Irritable bowel syndrome is a widespread condition involving recurrent abdominal pain and diarrhea or constipation, often associated with stress, depression, anxiety, or previous intestinal infection. 50. 50. Question Rhogam is most often used to treat____ mothers that have a ____ infant. • A. RH positive, RH positive • B. RH positive, RH negative • C. RH negative, RH positive • D. RH negative, RH negative Incorrect Correct Answer: C. RH negative, RH positive Rhogam prevents the production of anti-RH antibodies in the mother that has an Rh-positive fetus. • Option A: RhoGAM is a prescription medicine that is used to prevent Rh immunization, a condition in which an individual with Rh-negative blood develops antibodies after exposure to Rh-positive blood. • Option B: If the father or baby is not conclusively shown to be Rh-negative, RhoGAM should be given to an Rh-negative mother in the following clinical situations to prevent Rh immunization: after delivery of an Rh-positive baby; routine prevention of Rh immunization at 26 to 28 weeks of pregnancy; maternal or fetal bleeding during pregnancy from certain conditions; or an actual or threatened pregnancy loss at any stage. • Option D: It isn’t until second and subsequent pregnancies when antibodies are already built up, that Rh incompatibility can cause problems. Indeed, these antibodies can cross the placenta and attack the baby’s red blood cells. This can cause the baby to develop anemia, and in severe cases, result in miscarriage. 51. 51. Question A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU? • A. A Guthrie test can check the necessary lab values • B. The urine has a high concentration of phenyl pyruvic acid • C. Mental deficits are often present with PKU • D. The effects of PKU are reversible Incorrect Correct Answer: D. The effects of PKU are reversible. Phenylketonuria (PKU) is an inherited disorder that increases the levels of phenylalanine (a building block of proteins) in the blood. If PKU is not treated, phenylalanine can build up to harmful levels in the body, causing intellectual disability and other serious health problems. The signs and symptoms of PKU vary from mild to severe. The most severe form o