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Silvestri401-500

Silvestri401-500

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Published by Linda Kuglarz

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Published by: Linda Kuglarz on Oct 14, 2008
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06/26/2014

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PN~Comp~Review~CD~401-500~
111 Mss Pages
PN Comprehensive Review CD Questions 401-500
401. A client with tuberculosis is being started on antituberculosis therapy with isoniazid(INH). The nurse reviews the client’s health care record to be sure that which of thefollowing baseline studies have been completed before giving the client the first dose?1. Coagulation times2. Electrolytes3. Serum creatinine4. Liver enzymesAnswer: 4Rationale: Isoniazid therapy can cause an elevation of hepatic enzymes and hepatitis.Therefore liver enzymes are monitored when therapy is initiated and during the first 3months of therapy. They may be monitored longer in the client who is over age 50 or abuses alcohol. Options 1, 2, and 3 are not specifically related to the administration of this medication.Test-Taking Strategy: Focus on the name of the medication. Recalling that thismedication can be toxic to the liver will direct you to the correct option. Review thismedication if you had difficulty with this question.Level of Cognitive Ability: AnalysisClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Adult Health/RespiratoryReference: Lehne, R. (2004).
 Pharmacology for nursing care
(5th ed.). Philadelphia:W.B. Saunders, p. 944.402. A nurse is monitoring the respiratory status of the client who has suffered afractured rib. The nurse monitors the client and understands that which manifestation isunrelated to the rib fracture?1. Pain, especially with inspiration2. Slow, deep respirations3. Splinting or guarding the chest4. Bruising over the fracture areaAnswer: 2Rationale: Rib fractures are a common injury, especially in the older client, and resultfrom a blunt injury or a fall. Typical signs and symptoms include pain and tendernessthat is localized at the fracture site and is exacerbated by inspiration and palpation,shallow respirations, splinting or guarding the chest protectively to minimize chestmovement, and possible bruising at the fracture site.Test-Taking Strategy: Use the process of elimination and note the key word
unrelated 
.This word indicates a false response question, and you need to select the incorrectmanifestation. Knowing that fractured ribs can cause pain and bruising helps you toeliminate options 1 and 4 first. To select between options 2 and 3, recalling that paincauses shallow, guarded respirations helps you to choose option 2 as the unrelatedfinding. Review the clinical manifestations in rib fractures if you had difficulty with this
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PN~Comp~Review~CD~401-500~
question.Level of Cognitive Ability: ComprehensionClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/Data CollectionContent Area: Adult Health/RespiratoryReference: Linton, A. & Maebius, N. (2003).
 Introduction to medical-surgical nursing 
(3rd ed.). Philadelphia: W.B. Saunders, p. 487.403. A nurse is admitting a client to the nursing unit who is suspected of havingtuberculosis. The nurse plans to admit the client to a room that has:1. Ultraviolet light and three air exchanges per hour 2. Ten air exchanges per hour and venting to the outside3. Venting to the outside and ultraviolet light4. Venting to the outside, six air exchanges per hour, and ultraviolet lightAnswer: 4Rationale: The client is admitted to a private room that has at least six air exchanges per hour, and which has negative pressure in relation to surrounding areas. The room should be vented to the outside and should have ultraviolet lights installed.Test-Taking Strategy: Begin to answer this question by recalling the specificrequirements of physical facilities that are used in the care of clients with TB. Knowingthat the air must vent to the outside helps to eliminate option 1. Knowing that ultravioletlight is useful in killing these organisms helps you to eliminate option 2. To select between the last two options, it is necessary to know that there must be an airflow systemthat allows for at least six air exchanges per hour. Review care to the client hospitalizedwith TB if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Safe, Effective Care EnvironmentIntegrated Process: Nursing Process/PlanningContent Area: Adult Health/RespiratoryReference: Christensen, B. & Kockrow, E. (2003).
 Adult health nursing 
(4th ed.). St.Louis: Mosby, p. 375.404. A client with human immunodeficiency virus (HIV) who has contractedtuberculosis (TB) asks the nurse how long the medication therapy lasts. The nurseresponds that the duration of therapy would most likely be for at least:1. Six total months and at least 1 month after cultures convert to negative2. Six total months and at least 3 months after cultures convert to negative3. Nine total months and at least 3 months after cultures convert to negative4. Nine total months and at least 6 months after cultures convert to negativeAnswer: 4Rationale: The client with tuberculosis who is coinfected with HIV requires thatantituberculosis therapy last longer than usual. The prescription is usually for a total of 9months and at least 6 months after sputum cultures convert to negative.Test-Taking Strategy: Use the process of elimination. Knowing that the client with HIVrequires longer therapy helps you to eliminate options 1 and 2 first. To select between thelast two options, it is necessary to recall that sputum culture must be negative for 6
2
 
PN~Comp~Review~CD~401-500~
months before terminating medication therapy because of the immunosuppressed statusof the client. Review the guidelines related to medication therapy in the client with TB if you had difficulty with this question.Level of Cognitive Ability: ApplicationClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/ImplementationContent Area: Adult Health/ImmuneReference: Christensen, B., & Kockrow, E. (2003).
 Adult health nursing 
(4th ed.). St.Louis: Mosby, p. 375.405. Morphine sulfate is being administered to a client with cancer. The nurse ismonitoring the client for signs of overdose related to this medication therapy. Which of the following findings if noted in the client would require notification of the registerednurse?1. Blood pressure 110/70 mm Hg2. Apical rate of 72 beats/min3. Temperature of 98.6° F4. Respirations of 10 breaths/minAnswer: 4Rationale: Before an opioid is administered, respiratory rate, blood pressure, and pulserate should be determined. The registered nurse is notified immediately if the respiratoryrate is at or below 12 breaths per minute, if the blood pressure is significantly below the pretreatment value, or if the pulse rate is significantly above or below the pretreatmentvalue. The registered nurse would then contact the physician.Test-Taking Strategy: Knowledge regarding normal vital sign measurements will assistin directing you to the correct option. Additionally, knowing that morphine sulfate primarily affects the respiratory rate will assist in directing you to option 4. Review theadverse effects of this medication if you had difficulty with this question.Level of Cognitive Ability: AnalysisClient Needs: Physiological IntegrityIntegrated Process: Nursing Process/EvaluationContent Area: PharmacologyReference: Lehne, R. (2004).
 Pharmacology for nursing care
(5th ed.). Philadelphia:W.B. Saunders, p. 250.406. A nurse is collecting data from a client who is experiencing the typical clinicalmanifestations of tuberculosis (TB). The nurse would expect the client to report havingsymptoms of fatigue and cough that have been present for:1. A day or two2. Almost a week 3. One to 2 weeks4. Several weeks to monthsAnswer: 4Rationale: The client with tuberculosis may report symptoms that have been present for weeks or even months. The symptoms may include fatigue, lethargy, chest pain, anorexia
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