MCA II Exam 3 Questions With Complete Solutions
A 36-yr-old female patient is receiving treatment for chronic
hepatitis C with pegylatedinterferon (PEG-Intron, Pegasys),
ribavirin (Rebetol), and telaprevir (Incivek). Which findingis
important to communicate to the health care provider to suggest
a change in therapy?
a. Weight loss of 2 lb (1 kg)
b. Positive urine pregnancy test
c. Hemoglobin level of 10.4 g/dL
d. Complaints of nausea and anorexia Correct Answer b.
Positive urine pregnancy test
Because ribavirin is teratogenic, the medication will need to be
discontinued immediately. Anemia, weight loss, and nausea are
common adverse effects of the prescribed regimen and may
require actions such as patient teaching, but they would not
require immediate cessation of the therapy.
A 37-yr-old patient has just arrived in the postanesthesia
recovery unit (PACU) after a thyroidectomy. Which information
about the patient is most important to communicate to the
surgeon?
a. Difficult to awaken.
b. Increasing neck swelling.
c. Reports 7/10 incisional pain.
d. Cardiac rate 112 beats/minute. Correct Answer b.
Increasing neck swelling.
The neck swelling may lead to respiratory difficulty, and rapid
intervention is needed to prevent airway obstruction. The
,incisional pain should be treated but is not unusual after surgery.
A heart rate of 112 beats/min is not unusual in a patient who has
been hyperthyroid and has just arrived in the PACU from
surgery. Sleepiness in the immediate postoperative period is
expected.
A 62-yr-old patient with hyperthyroidism is to be treated with
radioactive iodine (RAI). The nurse instructs the patient
a. about radioactive precautions to take with all body secretions.
b. that symptoms of hyperthyroidism should be relieved in about
a week.
c. that symptoms of hypothyroidism may occur as the RAI
therapy takes effect.
d. to discontinue the antithyroid medications taken before the
radioactive therapy. Correct Answer c. that symptoms of
hypothyroidism may occur as the RAI therapy takes effect.
There is a high incidence of postradiation hypothyroidism after
RAI, and the patient should be monitored for symptoms of
hypothyroidism. RAI has a delayed response, with the maximum
effect not seen for 2 to 3 months, and the patient will continue to
take antithyroid medications during this time. The therapeutic
dose of radioactive iodine is low enough that no radiation safety
precautions are needed.
A client with a family history of goiter is experiencing changes
in voice and breathing. Which diagnostic study does the nurse
consider to be beneficial in confirming a diagnosis?
a. thyroglobulin
b. thyroid antibodies
c. thyroxine (free T4), total
,d. thyroid-stimulating hormone (TSH) Correct Answer b.
thyroid antibodies
Changes in voice and breathing can be seen in Hashimoto's
thyroiditis if the thyroid gland enlarges rapidly and constricts the
trachea and laryngeal nerves. Clients with a family history of
goiter may have this condition. A thyroid antibody test is used
diagnose Hashimoto's thyroiditis by differentiating thyroid
dysfunction from thyroiditis.
A client with a primary brain tumor has developed syndrome of
inappropriate secretion of antidiuretic hormone (SIADH). The
nurse will expect to see which clinical findings upon
assessment? Select all that apply.
a. Vomiting
b. Hyperthermia
c. Bradycardia
d. increased weight
e. Decreased serum sodium
f. Decreased level of consciousness Correct Answer A, D, E,
F
Water retention and decreased urinary output occur because of
excess secretion of antidiuretic hormone (ADH). Early
manifestations are related to water retention and may include
gastrointestinal (GI) disturbances, such as loss of appetite,
nausea, and vomiting. Weight gain occurs because of the water
retention. Serum sodium levels are decreased because of fluid
retention and sodium loss. Central nervous system changes
include headaches, lethargy, and decreased level of
consciousness, progressing to coma and seizures. Hypothermia
, also occurs because of central nervous system disturbance. The
pulse is full and bounding because of the increased fluid
volume.
A client with cirrhosis of the liver has a prolonged prothrombin
time and a low platelet count. A regular diet is prescribed. What
should the nurse instruct the client to do considering the client's
condition?
a. Avoid foods high in phytonadione
b. Check the pulse several times a day.
c. Drink a glass of milk when taking aspirin.
d. Report signs of bleeding no matter how slight. Correct
Answer d. Report signs of bleeding no matter how slight.
One of the many functions of the liver is the manufacture of
clotting factors; there is interference in this process with
cirrhosis of the liver, resulting in bleeding tendencies. The
storage of fat-soluble vitamins (A, D, E, and K), water-soluble
vitamins (B1, B2, folic acid, and cobalamin), and minerals
(including iron) is compromised in cirrhosis; therefore, these
nutrients, including phytonadione, should not be limited. Should
the client bleed, the pulse rate may be increased, but it is not
necessary for the client to check the pulse rate several times
daily. A client whose prothrombin time is prolonged and platelet
count is low should not be taking aspirin, even with milk.
A client with esophageal varices has severe hematemesis, and a
Sengstaken-Blakemore tube is inserted. What design and
purpose does the tube have?
a. single-lumen; for gastric lavage
b. double-lumen; for intestinal decompression
A 36-yr-old female patient is receiving treatment for chronic
hepatitis C with pegylatedinterferon (PEG-Intron, Pegasys),
ribavirin (Rebetol), and telaprevir (Incivek). Which findingis
important to communicate to the health care provider to suggest
a change in therapy?
a. Weight loss of 2 lb (1 kg)
b. Positive urine pregnancy test
c. Hemoglobin level of 10.4 g/dL
d. Complaints of nausea and anorexia Correct Answer b.
Positive urine pregnancy test
Because ribavirin is teratogenic, the medication will need to be
discontinued immediately. Anemia, weight loss, and nausea are
common adverse effects of the prescribed regimen and may
require actions such as patient teaching, but they would not
require immediate cessation of the therapy.
A 37-yr-old patient has just arrived in the postanesthesia
recovery unit (PACU) after a thyroidectomy. Which information
about the patient is most important to communicate to the
surgeon?
a. Difficult to awaken.
b. Increasing neck swelling.
c. Reports 7/10 incisional pain.
d. Cardiac rate 112 beats/minute. Correct Answer b.
Increasing neck swelling.
The neck swelling may lead to respiratory difficulty, and rapid
intervention is needed to prevent airway obstruction. The
,incisional pain should be treated but is not unusual after surgery.
A heart rate of 112 beats/min is not unusual in a patient who has
been hyperthyroid and has just arrived in the PACU from
surgery. Sleepiness in the immediate postoperative period is
expected.
A 62-yr-old patient with hyperthyroidism is to be treated with
radioactive iodine (RAI). The nurse instructs the patient
a. about radioactive precautions to take with all body secretions.
b. that symptoms of hyperthyroidism should be relieved in about
a week.
c. that symptoms of hypothyroidism may occur as the RAI
therapy takes effect.
d. to discontinue the antithyroid medications taken before the
radioactive therapy. Correct Answer c. that symptoms of
hypothyroidism may occur as the RAI therapy takes effect.
There is a high incidence of postradiation hypothyroidism after
RAI, and the patient should be monitored for symptoms of
hypothyroidism. RAI has a delayed response, with the maximum
effect not seen for 2 to 3 months, and the patient will continue to
take antithyroid medications during this time. The therapeutic
dose of radioactive iodine is low enough that no radiation safety
precautions are needed.
A client with a family history of goiter is experiencing changes
in voice and breathing. Which diagnostic study does the nurse
consider to be beneficial in confirming a diagnosis?
a. thyroglobulin
b. thyroid antibodies
c. thyroxine (free T4), total
,d. thyroid-stimulating hormone (TSH) Correct Answer b.
thyroid antibodies
Changes in voice and breathing can be seen in Hashimoto's
thyroiditis if the thyroid gland enlarges rapidly and constricts the
trachea and laryngeal nerves. Clients with a family history of
goiter may have this condition. A thyroid antibody test is used
diagnose Hashimoto's thyroiditis by differentiating thyroid
dysfunction from thyroiditis.
A client with a primary brain tumor has developed syndrome of
inappropriate secretion of antidiuretic hormone (SIADH). The
nurse will expect to see which clinical findings upon
assessment? Select all that apply.
a. Vomiting
b. Hyperthermia
c. Bradycardia
d. increased weight
e. Decreased serum sodium
f. Decreased level of consciousness Correct Answer A, D, E,
F
Water retention and decreased urinary output occur because of
excess secretion of antidiuretic hormone (ADH). Early
manifestations are related to water retention and may include
gastrointestinal (GI) disturbances, such as loss of appetite,
nausea, and vomiting. Weight gain occurs because of the water
retention. Serum sodium levels are decreased because of fluid
retention and sodium loss. Central nervous system changes
include headaches, lethargy, and decreased level of
consciousness, progressing to coma and seizures. Hypothermia
, also occurs because of central nervous system disturbance. The
pulse is full and bounding because of the increased fluid
volume.
A client with cirrhosis of the liver has a prolonged prothrombin
time and a low platelet count. A regular diet is prescribed. What
should the nurse instruct the client to do considering the client's
condition?
a. Avoid foods high in phytonadione
b. Check the pulse several times a day.
c. Drink a glass of milk when taking aspirin.
d. Report signs of bleeding no matter how slight. Correct
Answer d. Report signs of bleeding no matter how slight.
One of the many functions of the liver is the manufacture of
clotting factors; there is interference in this process with
cirrhosis of the liver, resulting in bleeding tendencies. The
storage of fat-soluble vitamins (A, D, E, and K), water-soluble
vitamins (B1, B2, folic acid, and cobalamin), and minerals
(including iron) is compromised in cirrhosis; therefore, these
nutrients, including phytonadione, should not be limited. Should
the client bleed, the pulse rate may be increased, but it is not
necessary for the client to check the pulse rate several times
daily. A client whose prothrombin time is prolonged and platelet
count is low should not be taking aspirin, even with milk.
A client with esophageal varices has severe hematemesis, and a
Sengstaken-Blakemore tube is inserted. What design and
purpose does the tube have?
a. single-lumen; for gastric lavage
b. double-lumen; for intestinal decompression
