1.

A student nurse is assigned to a client who has a diagnosis of thrombophlebitis. Which action by this team member is most appropriate? A. B. C. D. Apply a heating pad to the involved site. Elevate the clients legs 90 degrees. Instruct the client about the need for bed rest. Provide active range-of-motion exercises to both legs at least twice every shift. 5.

D.

Blood gases are monitored using a pulse oximeter.

When suctioning mucus from a clients lungs, which nursing action would be least appropriate? A. Lubricate the catheter tip with sterile saline before insertion. B. Use sterile technique with a two-gloved approach

2.

A client receiving heparin sodium asks the nurse how the drug works. Which of the following points would the nurse include in the explanation to the client? A. B. It dissolves existing thrombi. It prevents conversion of factors that are needed in the formation of clots. C. It inactivates thrombin that forms and dissolves existing thrombi. D. It interferes with vitamin K absorption. 6.

C.

Suction until the client indicates to stop or no longer than 20 second

D.

Hyperoxygenate the client before and after suctioning

Dr. Santos prescribes oral rifampin (Rimactane) and isoniazid (INH) for a client with a positive Tuberculin skin test. When informing the client of this decision, the nurse knows that the purpose of this choice of treatment is to A. B. Cause less irritation to the gastrointestinal tract Destroy resistant organisms and promote proper blood levels of the drugs C. D. Gain a more rapid systemic effect Delay resistance and increase the tuberculostatic effect

3.

The nurse is conducting an education session for a group of smokers in a stop smoking class. Which finding would the nurse state as a common symptom of lung cancer? : A. B. C. D. Dyspnea on exertion Foamy, blood-tinged sputum Wheezing sound on inspiration Cough or change in a chronic cough 7.

Mario undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and onebottle water-seal drainage is instituted in the operating room. In the postanesthesia care unit Mario is placed in

4.

Which is the most relevant knowledge about oxygen administration to a client with COPD? A. Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing. B. Hypoxia stimulates the central chemoreceptors in the medulla that makes the client breath. C. Oxygen is administered best using a nonrebreathing mask

Fowlers position on either his right side or on his back to A. B. C. D. Reduce incisional pain. Facilitate ventilation of the left lung. Equalize pressure in the pleural space. Increase venous return

8.

A client with COPD is being prepared for discharge. The following are relevant instructions to the client regarding the use of an oral inhaler EXCEPT A. Breath in and out as fully as possible before placing the mouthpiece inside the mouth. B. Inhale slowly through the mouth as the canister is pressed down C. Hold his breath for about 10 seconds before exhaling D. Slowly breath out through the mouth with pursed lips after inhaling the drug.

B. C. D.

Decreased tissue perfusion. Impaired gas exchange. Risk for infection

12. A nurse at the weight loss clinic assesses a client who has a large abdomen and a rounded face. Which additional assessment finding would lead the nurse to suspect that the client has Cushings syndrome rather than obesity? A. B. C. large thighs and upper arms pendulous abdomen and large hips abdominal striae and ankle enlargement posterior neck fat pad and thin extremities

9.

A client is scheduled for a bronchoscopy. When teaching the client what to expect afterward, the nurses highest priority of information would be A. Food and fluids will be withheld for at least 2 hours. B. C. Warm saline gargles will be done q 2h. Coughing and deep-breathing exercises will be done q2h. D. Only ice chips and cold liquids will be allowed initially.

D.

13. Which statement by the client indicates understanding of the possible side effects of Prednisone therapy? A. I should limit my potassium intake because hyperkalemia is a side-effect of this drug. B. I must take this medicine exactly as my doctor ordered it. I shouldnt skip doses. C. This medicine will protect me from getting any colds or infection. D. My incision will heal much faster because of this drug.

10. The nurse enters the room of a client with chronic obstructive pulmonary disease. The clients nasal cannula oxygen is running at a rate of 6 L per minute, the skin color is pink, and the respirations are 9 per minute and shallow. What is the nurses best initial action? A. B. C. D. Take heart rate and blood pressure. Call the physician. Lower the oxygen rate. Position the client in a Fowlers position.

14. A client, who is suspected of having Pheochromocytoma, complains of sweating, palpitation and headache. Which assessment is essential for the nurse to make first? A. B. C. D. Pupil reaction Hand grips Blood pressure Blood glucose

11. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient? A. Fluid volume deficit 15. The nurse is attending a bridal shower for a friend when another guest, who happens to be a diabetic, starts to

tremble and complains of dizziness. The next best action for the nurse to take is to: A. Encourage the guest to eat some baked macaroni

B. C. D.

Call the guests personal physician Offer the guest a cup of coffee Give the guest a glass of orange juice

1.

Answer: (C) Instruct the client about the need for bed rest.

In a client with thrombophlebitis, bedrest will prevent the dislodgment of the clot in the extremity which can lead to pulmonary embolism.

2.

Answer: (B) It prevents conversion of factors that are needed in the formation of clots.

Heparin is an anticoagulant. It prevents the conversion of prothrombin to thrombin. It does not dissolve a clot. 3. Answer: (D) Cough or change in a chronic cough

Cigarette smoke is a carcinogen that irritates and damages the respiratory epithelium. The irritation causes the cough which initially maybe dry, persistent and unproductive. As the tumor enlarges, obstruction of the airways occurs and the cough may become productive due to infection. 4. Answer: (A) Oxygen at 1-2L/min is given to maintain the hypoxic stimulus for breathing.

COPD causes a chronic CO2 retention that renders the medulla insensitive to the CO2 stimulation for breathing. The hypoxic state of the client then becomes the stimulus for breathing. Giving the clientoxygen in low concentrations will maintain the clients hypoxic drive. 5. Answer: (C) Suction until the client indicates to stop or no longer than 20 second

One hazard encountered when suctioning a client is the development of hypoxia. Suctioning sucks not only the secretions but also the gases found in the airways. This can be prevented by suctioning the client for an average time of 5-10 seconds and not more than 15 seconds and hyperoxygenating the client before and after suctioning.

6.

Answer: (D) Delay resistance and increase the tuberculostatic effect

Pulmonary TB is treated primarily with chemotherapeutic agents for 6-12 mons. A prolonged treatment duration is necessary to ensure eradication of the organisms and to prevent relapse. The increasing prevalence of drug resistance points to the need to begin the treatment with drugs in combination. Using drugs in combination can delay the drug resistance. 7. Answer: (B) Facilitate ventilation of the left lung.

Since only a partial pneumonectomy is done, there is a need to promote expansion of this remaining Left lung by positioning the client on the opposite unoperated side. 8. Answer: (D) Slowly breath out through the mouth with pursed lips after inhaling the drug.

If the client breathes out through the mouth with pursed lips, this can easily force the just inhaled drug out of the respiratory tract that will lessen its effectiveness. 9. Answer: (A) Food and fluids will be withheld for at least 2 hours.

Prior to bronchoscopy, the doctors sprays the back of the throat with anesthetic to minimize the gag reflex and thus facilitate the insertion of the bronchoscope. Giving the client food and drink after the procedure without checking on the return of the gag reflex can cause the client to aspirate. The gag reflex usually returns after two hours. 10. Answer: (C) Lower the oxygen rate. The client with COPD is suffering from chronic CO2 retention. The hypoxic drive is his chief stimulus for breathing. Giving O2 inhalation at a rate that is more than 2-3L/min can make the client lose his hypoxic drive which can be assessed as decreasing RR. 11. Answer: (C) Impaired gas exchange. Pneumonia, which is an infection, causes lobar consolidation thus impairing gas exchange between the alveoli and the blood. Because the patient would require adequate hydration, this makes him prone to fluid volume excess. 12. Answer: (D) posterior neck fat pad and thin extremities Buffalo hump is the accumulation of fat pads over the upper back and neck. Fat may also accumulate on the face. There is truncal obesity but the extremities are thin. All these are noted in a client with Cushings syndrome. 13. Answer: (B) I must take this medicine exactly as my doctor ordered it. I shouldnt skip doses.

The possible side effects of steroid administration are hypokalemia, increase tendency to infection and poor wound healing. Clients on the drug must follow strictly the doctors order since skipping the drug can lower the drug level in the blood that can trigger acute adrenal insufficiency or Addisonian Crisis 14. Answer: (C) Blood pressure Pheochromocytoma is a tumor of the adrenal medulla that causes an increase secretion of catecholamines that can elevate the blood pressure.

15. Answer: (D) Give the guest a glass of orange juice In diabetic patients, the nurse should watch out for signs of hypoglycemia manifested by dizziness, tremors, weakness, pallor diaphoresis and tachycardia. When this occurs in a conscious client, he should be given immediately carbohydrates in the form of fruit juice, hard candy, honey or, if unconscious, glucagons or dextrose per IV.