RESPIRATORY A critical-care nurse is caring for a postoperative patient following lung surgery. The patient has a shallow, monotonous respiratory pattern and is reluctant to cough. What may the patient may be at an increased risk for? Answer Selected Answer: Correct Answer: Response Feedback: B. Atelectasis B. Atelectasis

The reluctance to cough is likely due to poor pain control. A shallow, monotonous respiratory pattern places the patient at an increased risk of developing atelectasis. The patient would not be at increased risk for increased oxygen saturation, aspiration, or malnutrition.

Question 2
The nursing instructor is discussing the administration of nasal spray with the nursing students. What information is most important to include in this discussion? Answer Selected Answer: Correct Answer: Response Feedback: D. Overuse of nasal spray may cause rebound congestion. D. Overuse of nasal spray may cause rebound congestion.

The use of topical decongestants is controversial because of the potential for a rebound effect. The patient should hold his or her head back for maximum distribution of the spray. Only the patient should use the bottle.

Question 3
The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a firstline measure to minimize atelectasis? Answer Selected Answer: Correct Answer: Response Feedback: A. Incentive spirometry A. Incentive spirometry

Strategies to prevent atelectasis, which include frequent turning, early ambulation, lung-volume expansion maneuvers (deep breathing exercises,

incentive spirometry), and coughing serve as the first-line measures to minimize or treat atelectasis by improving ventilation. In patients who do not respond to first-line measures or who cannot perform deep-breathing exercises, other treatments such as positive end-expiratory pressure (PEEP), continuous or intermittent positive-pressure breathing (IPPB), or bronchoscopy may be used.

Question 4
You are doing an assessment on a patient who has been diagnosed with cancer of the larynx. Part of your assessment is the patient's general state of nutrition. Which lab value would be assessed in determining the nutritional status of the patient? (Mark all that apply.) Answer Selected Answers: B. Protein C. Albumin E. Glucose B. Protein C. Albumin E. Glucose

Correct Answers:

Response Feedback:

The nurse also assesses the patient's general state of nutrition, including height and weight and body mass index, and reviews laboratory values that assist in determining the patient's nutritional status (albumin, protein, glucose, and electrolyte levels). The white blood cell count and the platelet count would not assist in determining the patient's nutritional status.

Question 5
You are assessing an adult patient following a motor vehicle accident. You observe that the patient has an increased use of accessory muscles and is complaining of pain and shortness of breath. What condition is the patient exhibiting symptoms of? Answer Selected Answer: Correct Answer: Response A. Pneumothorax A. Pneumothorax

The signs and symptoms of a large pneumothorax include dyspnea, air

Feedback:

hunger, increased use of accessory muscles, and cyanosis. Therefore options B, C, and D are incorrect.

Question 6
A patient comes to the emergency department and is admitted with epistaxis. Pressure has been applied to the patient's midline septum for 10 minutes, but the bleeding continues. What treatments may be used to control the bleeding? Answer Selected Answer: Correct Answer: Response Feedback: A. Nasal plugs D. Silver nitrate applicators

If pressure to the midline septum does not stop the bleeding for epistaxis, additional treatment of silver nitrate application, Gelfoam, electrocautery, or vasoconstrictors may be used. This makes options A, B, and C incorrect.

Question 7
You are caring for a patient who has returned to the unit following a bronchoscopy. The patient is asking for something to drink. Which criterion will determine when you will allow the patient to drink fluids? Answer Selected Answer: Correct Answer: Response Feedback: A. Presence of a cough and gag reflex A. Presence of a cough and gag reflex

After the procedure, it is important that the patient takes nothing by mouth until the cough reflex returns because the preoperative sedation and local anesthesia impair the protective laryngeal reflex and swallowing for several hours.

Question 8
Your patient is scheduled for a tonsillectomy in the morning. Following the surgery, what will you assess the patient for? Answer

and restlessness may indicate a postoperative hemorrhage. What should the nurse tell the client? Answer Selected Answer: Correct Answer: Response Feedback: A. because the bioavailability may vary greatly among brands. fever. frequent swallowing does. B.  Question 9 You are doing discharge teaching with a patient who developed a pulmonary embolism after total knee surgery. Beconase Avoid in patients with recurrent epistaxis. Overanticoagulation predisposes the client to hemorrhage. During your intake assessment. it is important that he or she continue to take the same brand of warfarin. Afrin B. Increased pulse. and cataracts. glaucoma. Options A and C are pseudoephedrine and do not have a side effect of epistaxis.  Question 10 You are the clinic nurse doing triage when a patient complaining of frequent nose bleeds comes in. Once the patient starts an oral regimen. Restlessness Hemorrhage is a potential complication of a tonsillectomy. Infrequent swallowing does not indicate hemorrhage. The patient has been converted from heparin to sodium warfarin (Coumadin) anticoagulant therapy. Vitamin K reverses the effect of anticoagulant therapy and should not be taken in large amounts. Which medication would put the patient at a higher risk for recurrent epistaxis? Answer Selected Answer: Correct Answer: Response Feedback: A. Option D is a bronchodilator and does not have epistaxis as a .Selected Answer: Correct Answer: Response Feedback: C. you ask the patient what medications she is taking. Coumadin will continue to break up the clot over a period of weeks. It is important to take the same brand of medicine. Infrequent swallowing B. The therapy continues for approximately 6 months. Difficulty ambulating and bradycardia are not something you would assess a posttonsillectomy patient for. Anticoagulant therapy prevents further clot formation but cannot be used to dissolve a clot.

Toxic shock syndrome A compressed nasal sponge may be used. You visit the patient in the hospital and inform the patient that he will need to arrange for installation of which system in the home? . D. and elevating the head of the bed can also promote drainage. C.  Question 11 A patient visits the clinic and is diagnosed with acute sinusitis.  Question 12 You are caring for a patient with a severe nosebleed. it will expand and produce tamponade to halt the bleeding.  Question 13 You are the home care nurse who is assessing the home environment of a new patient with a laryngectomy. Antibiotics may be prescribed because of the risk of iatrogenic sinusitis and toxic shock syndrome. the nurse should instruct the patient that hot packs. Once the sponge becomes saturated with blood or is moistened with a small amount of saline.side effect. Viral sinusitis B. To promote sinus drainage. increase fluid intake. Applying a mustard poultice and postural drainage will not promote sinus drainage. increasing fluid intake. For a patient diagnosed with acute sinusitis. The physician inserts a nasal sponge and tells the patient it may have to remain in place up to 6 days before it is removed. and D incorrect. perform postural drainage. This makes options A. You would know that this patient is at increased risk for what? Answer Selected Answer: Correct Answer: Response Feedback: A. The packing may remain in place for 48 hours or up to 5 or 6 days if necessary to control bleeding. the nurse instructs the patient to Answer Selected Answer: Correct Answer: Response Feedback: C.

The patient has been diagnosed with pleurisy. Air-conditioning may be too cool and too drying for the patient. Preparing to assist with intubating the patient A patient who has ARDS usually requires mechanical ventilation with a higher-than-normal airway pressure. Setting up oxygen at 3 L/NP A. . What is the preferred treatment for pain caused by pleurisy? Answer Selected Answer: Correct Answer: Response Feedback: A. the priority is to secure the airway. Morphine sulfate D. A water purification system or a radiant heating system is not necessary.  Question 15 A patient has been brought to the emergency department by the paramedics. Indomethacin The drug that is commonly used to control pain for patients with pleurisy is indomethacin. and physiotherapy will be used to treat ARDS. The patient is suspected of having acute respiratory distress syndrome.  Question 14 The nurse is caring for a patient who has been in a motor vehicle accident. While oxygen. Acetaminophen may not provide enough relief for the pain. What should the nurse anticipate? Answer Selected Answer: Correct Answer: Response Feedback: B. A humidification system A. A humidification system The nurse stresses the importance of humidification at home and instructs the family to obtain and set up a humidification system before the patient returns home. nebulizer.Answer Selected Answer: Correct Answer: Response Feedback: A. Morphine sulfate and meperidine sulfate are generally not used.

” Elevated LDL levels and decreased HDL levels are associated with a greater incidence of coronary artery disease. “Increased LDL and decreased HDL increase my risk of coronary artery disease. what would the pulse pressure be? Answer Selected Answer: Correct Answer: Response Feedback: D. “Increased LDL and decreased HDL increase my risk of coronary artery disease. 47 A. 57 Pulse pressure is the difference between the systolic and diastolic pressure.  Question 3 You are conducting patient teaching about cholesterol levels in the body. When discussing the patient's elevated LDL and lowered HDL levels. The only correct option is A. The results show a decreased central venous pressure.” A. Right ventricular failure A.  Question 2 The instructor is teaching the beginning nursing class how to calculate pulse pressure.CARDIAC  The physician has placed a central venous pressure (CVP) monitoring line in your patient so assessments can be made on right ventricular function and venous blood return. Hypervolemia may cause an increased CVP. What does this indicate? Answer Selected Answer: Correct Answer: Response Feedback: C. If the patient's systolic pressure was 122 mm Hg and the diastolic pressure was 75 mm Hg. A CVP does not indicate ventricular failure in this scenario. Possible hypovolemia Hypovolemia may cause a decreased CVP. the patient shows an understanding of the significance of these levels by stating what? Answer Selected Answer: Correct Answer: Response Feedback: A. .

B. Even with a diagnosis of unstable angina. Troponin I is specific to cardiac muscle and is elevated within 3 to 4 hours after myocardial injury. If the patient and involved family members are able to recognize symptoms of an acute cardiac problem. The nurse recognizes what? Answer Selected Answer: Correct Answer: Response Feedback: B. This type of assessment is achieved by the use of direct pressure monitoring systems. Question 4 How is hemodynamic monitoring achieved? Answer Selected Answer: Correct Answer: Response Feedback: C. Direct pressure monitoring systems Critically ill patients require continuous assessment of their cardiovascular system to diagnose and manage their complex medical conditions. Options A. The laboratory result for the initial troponin I is elevated in this patient. This is an accurate indicator of myocardial injury. such as ACS or HF. this is a poor indicator of myocardial injury.  Question 6 The nursing instructor is talking to her clinical group about taking an intake assessment on a patient with coronary artery disease. and D do not describe hemodynamic monitoring systems. C. B. Direct pressure monitoring systems C.  Question 5 The nurse is caring for a patient admitted with unstable angina. and seek timely treatment for these symptoms . Because the entry diagnosis is unstable angina. and D are incorrect. Options A. referred to as hemodynamic monitoring. What would be an important determination to make during this intake assessment? Answer Selected Answer: C. this is an accurate indicator of myocardial injury.

nor can they understand teaching done on exercise and dietary modifications because the teaching has not yet been done.  Question 8 In preparation for a transesophageal echocardiography. Which sequence completes the conduction? Answer Selected Answer: Correct Answer: Response Feedback: D.Correct Answer: Response Feedback: C. Also. and seek timely treatment for these symptoms. such as ACS or HF.  Question 7 The student nurses are studying the conduction system of the heart. SA node to AV node to bundle of HIS to Purkinje fibers The normal conduction route is SA node to AV node to bundle of HIS to Purkinje fibers. such as ACS or HF. the nurse needs to determine if the patient and involved family members are able to recognize symptoms of an acute cardiac problem. the nurse must Answer Selected Answer: Correct Answer: Response Feedback: A. B. If the patient and involved family members are able to recognize symptoms of an acute cardiac problem. and seek timely treatment for these symptoms During the health history. the patient will have an intravenous line initiated pre-procedure. SA node to AV node to bundle of HIS to Purkinje fibers D. The patient will have BP and ECG monitored throughout the test and must be NPO 6 hours preprocedure. and C are incorrect. The instructor explains that the electrical conduction of the heart usually originates in the SA node. The patient is sedated to make him or her comfortable but will not be heavily sedated. The patient and involved family members cannot understand discharge medications if they are just being admitted. . instruct the patient to drink 1 liter of water before the test. Therefore options A. inform the patient that blood pressure (BP) and electrocardiogram (ECG) monitoring will occur throughout the test. C.

CK-MB and its isoenzymes are the first levels to increase and will not be beneficial for a patient who has delayed seeking evaluation and treatment. HYPERTENSION/IMMUNE/HEMO 1  A patient with primary hypertension complains of dizziness with ambulation. These early and prolonged elevations make very early diagnosis of MI possible and allow for late diagnosis if the patient has delayed seeking treatment. This action of the heart is not diastole. they peak in 4 to 24 hours and remain elevated for 1 to 3 weeks. but these values peak in 2 to 3 days and. are not the best diagnostics for a patient who has been experiencing symptoms for 4 to 5 days. Troponin T and I After myocardial injury. again.  Question 10 The nursing instructor is explaining cardiac function to the senior nursing class. The instructor categorizes this action of the heart as what? Answer Selected Answer: Correct Answer: Response Feedback: A. Systole A. The instructor explains that blood is ejected into circulation as the chambers of the heart become smaller. what should the emphasis . elevated serum troponin T and I concentrations can be detected within 3 to 4 hours. The patient informs you that these symptoms have been occurring over the last 4 to 5 days. Creatine kinase (CK) and its isoenzyme CK-MB C. When teaching this patient about risks associated with postural hypotension. Which diagnostic study do you expect the physician to order to diagnosis an MI? Answer Selected Answer: Correct Answer: Response Feedback: B. Lactic dehydrogenase and its isoenzymes may also be analyzed. The patient is currently on an alpha-adrenergic blocker. The nurse assesses postural hypotension. hypertension. or ejection fraction. Systole Systole is the action of the chambers of the heart becoming smaller and ejecting blood. but negative results can be helpful in ruling out an early diagnosis of MI. Myoglobin alone is not used to diagnosis an MI. Question 9 You are on triage duty in the emergency department (ED) when a patient presents to the ED with symptoms indicative of a myocardial infarction (MI).

She has previously been immunized for mumps.  Question 2 A woman has been diagnosed with breast cancer and is being treated aggressively with a chemotherapeutic regimen. You should not teach the patient to stop the medication if dizziness persists. where they mature into several kinds of cells with different functions.  Question 3 During a mumps outbreak at a local school. Lymphocytes A. which are undifferentiated cells. a patient. T lymphocytes move from the bone marrow to the thymus. lymphocytes are generated from stem cells. Capillaries are small blood vessels. As a result of this regimen she has an inability to fight infection due to the fact her bone marrow is unable to produce a sufficient amount of what? Answer Selected Answer: Correct Answer: Response Feedback: A. Antibodies are found in normal circulation. is exposed.be placed on? Answer Selected Answer: Correct Answer: Response Feedback: A. Cytoblasts are the protoplasm of the cell outside the nucleus. Lymphocytes The white blood cells involved in immunity are produced in the bone marrow. who is a school teacher. Descendants of stem cells become lymphocytes. Rising slowly from a lying or sitting position Patients who experience postural hypotension should be taught to rise slowly from a lying or sitting position and use a cane or walker if necessary for safety. What type of immunity does she possess? Answer . Rising slowly from a lying or sitting position A. Like other blood cells. the B lymphocytes and the T lymphocytes. Antibodies are protein substances that response in the presence of an antigen. It is not necessary to teach these patients about increasing fluids or taking medication at night. B lymphocytes mature in the bone marrow and then enter the circulation.

In the bone marrow C. The window period is the time a person infected with HIV tests negative. The first line of defense. Acquired immunity Acquired immunity usually develops as a result of prior exposure to an antigen through immunization. A second protective response is the humoral immune response. The patient asks you where the body forms blood cells. which begeins when the B lymphocytes transform themselves into plasma cells that manufacture antibodies. Acquired immunity A.Selected Answer: Correct Answer: Response Feedback: A.  Question 5 You are caring for a patient with a hematologic disorder. When the body is attacked by bacteria. The nurse goes on to explain that after this first initial immune response the remaining amount of virus in the body is called what? Answer Selected Answer: Correct Answer: Response Feedback: C. or other pathogens it has three means of defense. viruses. Viral set point C. Where would you tell the patient that blood cells are formed? Answer Selected Answer: Correct Answer: C. In the bone marrow .  Question 4 The patient has been newly diagnosed with HIV. Viral set point The remaining amount of virus in the body after this initial immune response is referred to as the viral set point. The patient asks the nurse what is going on inside his body. The natural immune response system is rapid nonspecific immunity present at birth. Primary infection is the time from infection with HIV to the development of HIV-specific antibodies. The nurse explains that the body produces antibody molecules in an effort to contain the free HIV particles and assist in their removal. involves the WBCs that have the ability to ingest foreign particles. the phagocytic immune response. which results in a steady state of infection that lasts for years. Secondary stage is simply a distracter for this question.

kidneys. This makes options A. which stimulates the marrow to increase production of RBCs. and D incorrect. an allergy to fresh-water fish is not described in the scenario. or liver. Blood cells are not formed in the spleen. or delayed-type hypersensitivity.  Question 7 The nurse is caring for a teenage girl who has had an anaphylactic reaction after a bee sting. the nurse informs the patient that she should self-administer epinephrine in what site? Answer Selected Answer: Correct Answer: Response Feedback: B. Myasthenia gravis D. The nurse caring for this patient knows that an example of a hypersensitivity reaction characterized by a delayed reaction that occurs 24 to 72 hours after exposure to an antigen is what? Answer Selected Answer: Correct Answer: Response Feedback: A. She is diagnosed with a delayed hypersensitive reaction. The nurse is providing patient teaching prior to the patient's discharge. Thigh B. The device will auto inject a premeasured dose of epinephrine into the subcutaneous tissue. The kidneys release erythropoietin. The liver and spleen may be involved during embryonic development or when marrow is destroyed. Contact dermatitis from tape adhesive Type IV. Serum sickness would be a type II reaction. In the event of an anaphylactic reaction. C. .Response Feedback: Bone marrow is the primary site for hematopoiesis. occurs 24 to 72 hours after exposure to an allergen and is mediated by sensitized T-cells and macrophages. An example is contact dermatitis from an allergy to tape adhesive or cosmetics. Thigh The patient is taught to position the device at the middle portion of the thigh and push the device into the thigh as far as possible.  Question 6 A patient presents at the free clinic complaining of urticaria and a red rash. and myesthenia gravis is not a type IV reaction.

is strongly recommended. Gamma globulin Gamma globulin. side effects. and counsels elderly patients to use supportive devices as necessary to prevent falls that could result from dizziness. and low-fat dairy products. Measlesmumps-rubella vaccine would have no effect on this patient. has just been started on a beta-blocker. vegetables. Antibiotics would only help if what the patient was exposed to was a bacterial infection. Question 8 A staff nurse is exposed to hepatitis B. Albumin would not give the patient passive acquired immunity. newly diagnosed with primary hypertension.  Question 9 An 80-year-old male. Increasing fluids in elderly patients may be contraindicated due to cardiovascular disease. Hospital protocol is that the staff nurse report to the emergency department for the administration of what substance to provide passive acquired immunity? Answer Selected Answer: Correct Answer: Response Feedback: D. and schedule—she should also focus her teaching on what? Answer Selected Answer: Correct Answer: Response Feedback: C. obtained from the blood plasma of people with acquired immunity. . The nurse teaches patients to change positions slowly when moving from lying or sitting positions to a standing position. is used in emergencies to provide immunity to diseases when the risk for contacting a specific disease is great and there is not enough time for a person to develop adequate active immunity. The nurse knows that in addition to teaching the patient about his medication—ie. and a diet rich in fruits. purpose. Measles-mumps-rubella vaccine A. Lifestyle changes such as regular physical activity/exercise. Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension Elderly people have impaired cardiovascular reflexes and are more sensitive to postural hypotension. Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension C.

The young woman comes into the clinic to be tested. Window stage B. What disease is it? Answer Selected Answer: Correct Answer: Response Feedback: D. and D incorrect. 200 cells/mm3 of blood When CD4 T-cell levels drop below 200 cells/mm3 of blood. This makes options A. hyperimmunoglobulinemia E syndrome (formerly known as Job syndrome). Hyperimmunoglobulinemia E syndrome In one rare type of phagocytic disorder. white blood cells cannot initiate an inflammatory response to infectious organisms.  Question 12 A young woman is contacted by a public health nurse and informed that one of her sexual contacts has tested positive for HIV. B. Primary infection . She tells the nurse that she has heard that people who are infected with HIV have a period when they test negative even though they are very infectious. Patient's with CD4 T-cell levels greater than 200 cells/mm3 of blood is considered to have HIV. the person is said to have AIDS. Question 10 In one primary immunodeficiency disease white blood cells cannot initiate an inflammatory response to infectious organisms.  Question 11 The nursing instructor is going over laboratory results for HIV/AIDS patients. The instructor tells the students that upon interpretation of a patient's laboratory results. 200 cells/mm3 of blood A. What is this period called? Answer Selected Answer: Correct Answer: D. Common variable immunodeficiency C. the nurse should recognize that a patient with HIV is considered to have AIDS when the CD4+ T-lymphocyte cell count drops below what? Answer Selected Answer: Correct Answer: Response Feedback: A.

Zafirlukast (Accolate) Many manifestations of inflammation can be attributed in part to leukotrienes. Albuterol sulfate relaxes smooth muscle during an asthma attack. The patient should be encouraged to use a single primary health care provider to address health care concerns. Seek care from a single provider for pain relief.  Question 13 A nurse is caring for a 16-year-old who has sickle cell anemia. Epinephrine relaxes bronchial smooth muscle. Emergency department visits should be reported to the primary health care provider to achieve optimal management of the disease. Medications categorized as leukotriene antagonists or modifiers such as zafirlukast (Accolate) block the synthesis or action of leukotrienes and prevent signs and symptoms associated with asthma.Response Feedback: The period from infection with HIV to the development of HIVspecific antibodies is known as primary infection. Diphenhydramine prevents histamine's effect on smooth muscle.  Question 14 A 30-year-old male patient comes into the emergency department with severe asthmarelated signs and symptoms. Albuterol sulfate (Ventolin) B. What would the nurse encourage the patient to do to prevent substance abuse of analgesics in this patient? Answer Selected Answer: Correct Answer: Response Feedback: B.  Question 15 The pharmacology instructor is talking with the pre-nursing class about drugs used to . B. What medication is recommended to prevent the signs and symptoms of asthma? Answer Selected Answer: Correct Answer: Response Feedback: C. Seek care from a single provider for pain relief. The nurse is concerned about substance abuse in this patient.

like other anti-hypertensive drugs. A nursing diagnosis of Risk for noncompliance with therapeutic regimen related to side effects of prescribed therapy would be evaluated how? Answer Selected Answer: Correct Answer: Response Feedback: A.  Question 16 A patient with primary hypertension comes to the clinic complaining of a change in vision—ie. Retinal blood vessel damage Blurred vision. The most appropriate expected outcome for a patient who is given the nursing diagnosis of Noncompliance with therapeutic regimen would be “takes medication as prescribed and reports any side effects. C. Hypertensive emergency A. A. Therefore options B. or a hypertensive emergency. Blurred vision and a change in visual acuity are not usually indicative of chronic kidney disease. has side effects. Patient takes medication as prescribed and reports any side effects. and D are incorrect. Patient takes medication as prescribed and reports any side effects.  Question 17 A 47-year-old male patient calls the nurse and asks about the risk factors of hypertension. Patients are often anxious about the side effects of anti-hypertensives. spots in front of the eyes. What should the nurse list as risk factors for primary hypertension? Answer . An eye exam with an ophthalmoscope is particularly important and any significant findings are promptly reported to determine the need for additional diagnostic studies. The nurse is aware that these symptoms could be indicative of what? Answer Selected Answer: Correct Answer: Response Feedback: D. Propranolol hydrochloride. impending stroke. and diminished visual acuity can mean retinal blood vessel damage indicative of damage elsewhere in the vascular system.control hypertension.” as the patient has indicated that he or she is experiencing anxiety from the possible side effects. blurring and decreased visual acuity.

What dietary counseling will the nurse provide based upon the patient's medication regimen? Answer Selected Answer: Correct Answer: Response Feedback: A. and coarctation of the aorta are causes of secondary hypertension  Question 18 Prior to the administration of IV immunoglobulin what interventions should the nurse implement? Answer Selected Answer: Correct Answer: Response Feedback: A. Diabetes mellitus and oral contraceptives are risk factors for secondary hypertension. and family history are all risk factors for primary hypertension. Patients taking either of these . Obesity. Only administer immunoglobulin through a central line D. The nurse caring for the patient with AIDS knows the patient receives Agenerase. Metabolic syndrome. high intake of sodium or saturated fat. Avoid high-fat meals while taking this medication.  Question 19 A patient with AIDS is being prepared for discharge. It should be administered no faster than 3 mL/min.Selected Answer: Correct Answer: Response Feedback: A. renal disease. A. stress. Patients taking the protease inhibitor Amprenavir (APV) or Agenerase should be advised to avoid high-fat meals. High-fat meals decrease the blood concentration of this drug by 21%. Avoid high-fat meals while taking this medication. but should not be administered during the administration of the immunoglobulin. Weigh the patient before administration to determine onset of edema Immunoglobulin can be administered through a peripheral line. high intake of sodium and saturated fat Obesity. high intake of sodium and saturated fat A. Furosemide can be administered prior to the immunoglobulin to decrease edema. Obesity. The patient should be weighed prior to administration to determine if weight increases with administration. which may be indicative of the onset of anaphylaxis.

and protein restrictions play no role in relation to either of these drugs. What questions should the nurse ask during her assessment? (Mark all that apply. What would the nurse expect the diagnosis to be? Answer Selected Answer: Correct Answer: Response Feedback: C. Acute pariapical abscess Acute periapical abscess is usually secondary to a suppurative pulpitis (a pusproducing inflammation of the dental pulp) that arises from an infection extending from dental caries. tenesmus. sodium. Review of dietary habits D. GI  A patient comes to the walk-in clinic complaining of a lump in her gum and severe pain.”  Question 2 You are admitting a patient to your unit with diverticular disease. Fluid. Onset and duration of pain C. About history of normal stooling C. Onset and duration of pain Correct Answers: Response Feedback: When obtaining the health history. The nurse reviews dietary habits to determine fiber intake and asks the patient about straining at stool. history of constipation with periods of diarrhea. Periapical granuloma is actually a “blind dental abscess. the nurse asks the patient about the onset and duration of pain and about past and present elimination patterns. and distention.  Question 3 . The infection of the dental pulp extends through the apical foramen of the tooth to form an abscess around the apex. but the meals should not be high in fat. abdominal bloating. Review of dietary habits E. Blind dental abscess D.) Answer Selected Answers: B.drugs can take the drug with or without regard to meals. About tenesmus E. Pulpitis is an inflammation of the dental pulp.

A patient has undergone surgery for oral cancer and has just been extubated. Administering an antidiarrheal will not stop dumping symdrome. You would not place a patient who had just come out from under anesthesia in the lateral or the prone position. what nursing action would promote comfort and facilitate breathing for this patient? Answer Selected Answer: Correct Answer: Response Feedback: D. You do not stop the tube feeding or increase the hourly feed rate. the patient may be placed in Fowler's position to facilitate breathing and promote comfort. Placing the patient in Fowler's position After the endotracheal tube or airway has been removed and the effects of the anesthesia have worn off. What menu selection is the best choice for this patient? Answer Selected Answer: Correct Answer: Response Feedback: C. Administer an antidiarrheal. Placing the patient in semi-Fowler's position C. and high- .  Question 5 A patient admitted with inflammatory bowel disease asks the nurse for help with menu selections. Tofu Nutritional management of inflammatory bowel disease requires ingestion of a diet that is bland. Multigrain bagel B. How might the nurse help to alleviate this problem? Answer Selected Answer: Correct Answer: Response Feedback: D. When the anesthesia wears off. C. Dumping syndrome can generally be alleviated by starting with a dilute solution and then increasing the concentration of the solution over several days.  Question 4 Your patient is on tube feedings and is experiencing diarrhea. You suspect the patient is experiencing dumping syndrome. high-protein. Dilute the feeding solution. low-residue.

and may lead to scarring and stenosis often requiring dilation.vitamin. Stools may be bloody and contain mucus. and D are incorrect. What complication would the nurse be particularly likely to assess for? Answer Selected Answer: Correct Answer: Response Feedback: C. Chronic referred pain to the right shoulder is a symptom of peptic ulcer disease. Watery with blood and mucus A. C. the nurse notes the patient has a history of acute gastritis. What would she tell her students about the characteristics of the stools of these patients? Answer Selected Answer: Correct Answer: Response Feedback: A. It is not normally found in the esophagus. The patient states the symptoms have persisted for several days following a particularly spicy meal. Therefore options B.  Question 7 The nursing instructor is discussing ulcerative colitis with her clinical group. Watery with blood and mucus The predominant symptoms of ulcerative colitis are diarrhea and abdominal pain. C. Perforation is not a common occurrence following ingestion of a corrosive substance. but would not be an expected finding for a patient who has ingested a corrosive substance. Acute systemic infection occurs following perforation. Gastric hyperacidity related to excessive gastrin secretion A.  Question 8 A nursing student asks you when formula feeding can begin on a patient you are caring . When assessing the patient.  Question 6 The nurse is doing triage at the community clinic when a middle-aged patient presents with abdominal pains and heartburn. Esophageal or pyloric obstruction related to scarring Acute gastritis can result from dietary indiscretion. Gastrin is a hormone secreted in the stomach. Therefore options A. and D are incorrect.

The patient has just returned to your floor after having a PEG tube placed. Nonsteroidal anti-inflammatory drugs A. formula feeding may begin.  Question 9 A patient is scheduled to have a fecal occult blood test. . Second day after placement of tube By the second day. they aren't allowed the evening before the test. Encourage plenty of fluids. What would be your best response? Answer Selected Answer: Correct Answer: Response Feedback: A. Encourage plenty of fluids. Fiber intake is limited in a low-residue diet. provided it is tolerated and no fluid leaks from around the tube. What is an appropriate nursing intervention the day before the test? Answer Selected Answer: Correct Answer: Response Feedback: C. Adequate fluid intake is necessary to avoid dehydration that may be caused by the bowel preparation and to prevent fecal impaction after the procedure. the nurse should instruct the patient to avoid: Answer Selected Answer: Correct Answer: Response Feedback: A. and horseradish. Because dairy products leave a residue. turnips. nonsteroidal anti-inflammatory drugs.for.  Question 10 A nurse is caring for a patient with Crohn's disease. First day after placement of tube B. The patient may be placed on a low-residue diet 1 to 2 days before the procedure to reduce the contents in the GI tract. Before the test. Nonsteroidal anti-inflammatory drugs A false-positive occult blood can result from red meats. Only clear liquids are allowed the evening before the test. C. aspirin. The patient is scheduled for a barium enema.

Avoid applying suction on or near the graft site. Following a modified radical neck dissection with graft. Application of suction in these areas could damage the graft. tissue. The nurse is preparing to instruct the patient on a colon preparation procedure that will include . Evaluate the client's ability to swallow saliva and clear fluids. Protects the stomach's lining C. The patient has been newly prescribed misoprostol (Cytotec). like prostaglandin. What would the nurse be most accurate in informing the patient about the drug? Answer Selected Answer: Correct Answer: Response Feedback: C. and muscle grafting following a modified radical neck dissection requires suctioning. or increase lower esophageal sphincter pressure (option D). A. it is not directly linked to the client's need for suctioning. What is the most important consideration for the nurse when suctioning this client? Answer Selected Answer: Correct Answer: Response Feedback: D.  Question 13 The nurse is caring for a patient who is scheduled for a colonoscopy. improve emptying of the stomach (option B). NSAIDs decrease prostaglandin production and predispose the patient to peptic ulceration. the client is usually positioned with the head of the bed elevated to promote drainage and reduce edema. Maintenance of a patent airway is a nursing priority. Question 11 The nurse notes that a client who has undergone skin.  Question 12 The nurse is providing patient education for a patient with peptic ulcer disease secondary to chronic nonsteroidal anti-inflammatory drug (NSAID) use. The nurse should avoid positioning the suction catheter on or near the graft suture lines. however. Protects the stomach's lining Misoprostol is a synthetic prostaglandin that. Misoprostol doesn't reduce gastric acidity (option A). Similarly. protects the gastric mucosa. the client's ability to swallow is an important assessment for the nurse to make. Assessing viability of the graft is important but is not part of the suctioning procedure and may delay initiating suctioning.

polyethylene glycol electrolyte lavage prior to the procedure. Pain occurs about 2 hours after eating. Eating Taking antacids. In a patient with an inflammatory bowel disease A. Patients with a colostomy can receive a lavage solution. as a colonoscopy is the most frequently used diagnostic aid and screening device for patients with previous colon cancer or polyps. the nurse may brush them. Milk is contraindicated in relieving peptic ulcer pain. Cleansing of the colon using polyethylene glycol electrolyte lavage is a common procedure that precedes a colonoscopy. or as a substitute. or vomiting often relieves the pain.  Question 15 A comatose patient is receiving oral care. If the client is unable to brush his teeth. the nurse can achieve mechanical friction by wiping the teeth with a gauze . What is the nurse aware of about the use of lavage solutions and when they are contraindicated? Answer Selected Answer: Correct Answer: Response Feedback: A.  Question 14 A patient comes to the clinic complaining of pain in the epigastric region. Wiping the teeth and gums with a gauze pad C. The nurse suspects that the patient's pain is related to a peptic ulcer when the patient states the pain is relieved by what? Answer Selected Answer: Correct Answer: Response Feedback: B. taking precautions to prevent aspiration. eating. In a patient with an inflammatory bowel disease The use of a lavage solution is contraindicated in patients with intestinal obstruction or inflammatory bowel disease. Drinking milk A. Wiping the teeth and gums with a gauze pad Application of mechanical friction is the most effective way to cleanse the client's mouth. What oral care regimen would be most effective in decreasing the client's risk of tooth decay and plaque accumulation? Answer Selected Answer: Correct Answer: Response Feedback: C.

it is not as effective as application of mechanical friction. Water-soluble gel may be applied to lubricate dry lips. Lemon and glycerine swabs dry the oral mucosa and are ineffective in cleansing the client's mouth. also secreted by the gastric mucosa. What is this most likely a result of? . and C incorrect. Left groin area B. When you assess for referred pain on this patient. which combines with dietary B12. Gastric mucosa Intrinsic factor. Groin pain may be referred pain from ureteral colic. Referred pain above the left nipple may be associated with the heart. The nurse caring for this patient knows that intrinsic factor. but it is not part of oral care. what is the common location you would assess for referred pain related to biliary colic? Answer Selected Answer: Correct Answer: Response Feedback: C. This makes options A.  Question 18 The patient asks the nursing assistant for a bedpan. however. Bacteriocidal mouthwash does reduce plaque-causing bacteria. Small intestine D. combines with dietary vitamin B12 so that the vitamin can be absorbed in the ileum.pad. When the patient is finished.  Question 16 You are caring for a patient with biliary colic and are aware that the patient may experience referred abdominal pain. the nursing assistant notifies the nurse that the patient has bright red streaking of blood in the stool. B.  Question 17 An elderly lady is diagnosed with pernicious anemia. Below the right nipple Patients with referred abdominal pain associated with biliary colic complain of pain below the right nipple. is secreted by what? Answer Selected Answer: Correct Answer: Response Feedback: A.

Pneumonia D.  Question 20 You are caring for a patient who is scheduled for a gastroscopy. thromboembolism.  Question 19 What are the complications that can occur following gastric surgery? (Mark all that apply. . Spray or gargle the back of the throat with local anesthetic.Answer Selected Answer: Correct Answer: Response Feedback: C. Metabolic imbalances Correct Answers: Response Feedback: Complications that may occur in the immediate postoperative period include peritonitis.) Answer Selected Answers: A. Gastritis B. Metabolic imbalances E. stomal ulcers. Hemorrhoids C. Pneumonia D. and neither does gastritis. stomal obstruction. D. Hemorrhoids Lower rectal or anal bleeding is suspected if there is streaking of blood on the surface of the stool. Dumping syndrome does not generally occur in the immediate postoperative period. What preparation is needed for a gastroscopy? Answer Selected Answer: Correct Answer: D. Hemorrhoids are often a cause of anal bleeding. Stomal ulcers C. Spray or gargle the back of the throat with local anesthetic. and metabolic imbalances resulting from prolonged vomiting and diarrhea or altered gastrointestinal function. atelectasis and pneumonia. Dumping syndrome C.

shooting pains intermittently as the eustachian tube opens and allows air to enter the middle ear. there is risk of injuring this nerve during a mastoidectomy.  Question 2 The patient is 3 weeks postoperative and has come in for a routine postoperative checkup. Surgical removal of acoustic tumors is the treatment of choice because these tumors do not respond well to radiation or chemotherapy. and the semiimplantable hearing device. the client may display mouth droop and decreased lateral gaze on the operative side. Three types of implanted hearing devices are commercially available or in the investigational stage: the cochlear implant.Response Feedback: Preparation for a gastroscopy includes spraying or gargling with a local anesthetic. The patient should be positioned in a side-lying position in case of emesis. It is used to treat a perforated ear drum rather than cause it. the nurse knows that the patient had what surgery? Answer Selected Answer: Correct Answer: Response Feedback: D. When injury occurs. for the next 2 to 3 weeks after surgery. Ossiculoplasty B. Assessing for mouth droop and decreased lateral eye gaze The facial nerve runs through the middle ear and the mastoid. shooting pains on an intermittent basis in the operative area. the bone conduction device. Tympanoplasty is surgical reconstruction of the ear drum. Scar tissue is a long-term complication of tympanoplasty and therefore would not be evident during the immediate postoperative period. therefore. Mastoidectomy After a mastoidectomy. What do you know is a nursing priority postoperatively? Answer Selected Answer: Correct Answer: Response Feedback: C. From the patient's description of what has been happening. A nasogastric tube or a micro Fleet enema is not required for this procedure. Assessing for gradual onset of conductive hearing loss and nystagmus A. the patient may experience sharp. SENSORINEURAL  A client with mastoiditis is admitted to your unit prior to undergoing a radical mastoidectomy. . Hearing is restored by the tympanoplasty. The patient reports that for the past week he has been experiencing sharp. Ossiculoplasty is the surgical reconstruction of the middle ear bones to restore hearing.

abnormal spongy bone. Mobility B. and pregnancy may worsen it.  Question 4 A patient with visual acuity of 20/200 or more and a visual field restriction of 11 to 20 degrees is considered to have hand motion (HM) vision. Otosclerosis Otosclerosis involves the stapes and is thought to result from the formation of new. What would you suspect the patient has? Answer Selected Answer: Correct Answer: Response Feedback: B. Ossiculitis A. with resulting fixation of the stapes. Options A. C. Ossiculitis is a distracter for this question. especially around the oval window. The patient asks the nurse what these numbers mean. and D are incorrect. In the scenario described nothing is suggestive of chronic otitis media or mastoid disease. Otosclerosis is more common in women and frequently hereditary.  Question 5 A patient has come to the office for her first eye examination. These patients may require assistance with what? Answer Selected Answer: Correct Answer: Response Feedback: B. Question 3 A 25-year-old pregnant woman comes to the clinic complaining of unilateral hearing loss. The patient is diagnosed as having a visual acuity of 20/40. The efficient transmission of sound is prevented because the stapes cannot vibrate and carry the sound as conducted from the malleus and incus to the inner ear. Mobility People with low vision and peripheral field defects may have difficulty with mobility. What is a correct response by the nurse? Answer . The woman says her mother lost her hearing when she was pregnant.

but there are risks and complications associated with the inserts. “A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away. including endophthalmitis. surgically implanted. and D incorrect.Selected Answer: Correct Answer: Response Feedback: A.  Question 7 A patient has just returned to the floor after undergoing a retinal detachment repair. What drug. until first dressing change. Ganciclovir C. . This makes options A. Gentamicin and penicillin are antibiotics that are not used to treat CMV retinitis. It is composed of a series of progressively smaller rows of letters and is used to test distance vision. Call the physician and tell her the order is in error and must be reviewed.  Question 6 Cytomegalovirus (CMV) is the most common cause of retinal inflammation in patients with AIDS. The following order from the patient's physician is on the chart: Keep patient in upright sitting position. with head over the bed table. What should the nurse do? Answer Selected Answer: A. Most people can see the letters on the line designated as 20/20 from a distance of 20 feet. Ganciclovir The surgically implanted sustained-release insert of Ganciclovir enables higher concentrations of ganciclovir to reach the CMV retinitis.” The Snellen chart is a tool used to measure visual acuity.” B. “A person whose vision is 20/40 can see an object from 40 feet away that a person with 20/20 vision can see from 20 feet away. A person whose vision is 20/40 can see an object from 20 feet away that a person with 20/20 vision can see from 40 feet away. and hypotony. Pilocarpine is a muscarinic agent used in open-angle glaucoma. is used for the acute stage of CMV retinitis? Answer Selected Answer: Correct Answer: Response Feedback: C. The fraction 20/20 is considered the standard of normal vision. retinal detachment. C.

Both middle and inner ear age-related changes result in hearing . During retinal detachment repair. Identify yourself my stating your name and role. Sensorineural hearing loss Exostoses refer to small. The nurse recalls that the best way to approach a patient who is blind is to what? Answer Selected Answer: Correct Answer: Response Feedback: D. bony protrusions in the lower posterior bony portion of the ear canal. Follow the order because this position will help keep the retinal repair intact. Presbycusis is the term used to refer to the progressive hearing loss associated with aging. hard. This position should be maintained until the physician removes the dressing and assesses how well the retina is adhering to the choroid. There is no need to raise your voice unless the person asks you to do so. before touching or making physical contact with the patient. Sensorineural hearing loss C. Sensorineural hearing loss is loss of hearing related to damage of the end organ for hearing or cranial nerve VIII. What term is used to describe this condition? Answer Selected Answer: Correct Answer: Response Feedback: C. Otalgia refers to a sensation of fullness or pain in the ear. State your name and role after entering the patient's room. an air bubble is often injected into the eye to provide added pressure.  Question 9 Your patient has been diagnosed with a loss of hearing related to damage of the end organ for hearing or cranial nerve VIII. State your name and role after entering the patient's room.  Question 8 The registered nurse is taking shift report and finds that one of her assigned patients is blind. D. speak directly at him or her using a normal tone of voice.Correct Answer: Response Feedback: B. When talking to the person. Postoperative positioning is dependent on where the air bubble needs to apply pressure. There are several guidelines to consider when interacting with a person who is blind or has low vision. Do not approach or distract the guide dog unless the owner has given permission or instructed you to do so.

 Question 11 A 64-year-old patient with chronic open-angle glaucoma is being taught to selfadminister pilocarpine. The patient may also note difficulty adapting to the dark.loss. Likewise. Wearing glasses won't alter this temporary . a miotic drug used to treat glaucoma.) Answer Selected Answers: A. Which nursing action is most appropriate? Answer Selected Answer: Correct Answer: Response Feedback: D. and circulating nurse should each verify what? (Mark all that apply. Blurred vision lasting 1 to 2 hours after instilling the eyedrops is an expected adverse effect. the drug doesn't need to be withheld. and circulating nurse should each verify the correct IOL measurements. nor does the physician need to be notified. achieves its effect by constricting the pupil. The patient's age There is an informed consent The correct patient The correct chart Correct Answers: C. Explaining that this is an expected adverse effect D. E. D. After the patient administers the pilocarpine. Explaining that this is an expected adverse effect Pilocarpine. The correct chart Response Feedback: Each facility must have a policy for multiple checks and verification of the IOL type. The correct IOL measurements D. the correct patient. as well as the operative eye. The correct patient E. scrub nurse or technician. power. scrub nurse or technician. B. the patient doesn't need to be treated for an allergic reaction. and the patient's chart. the patient states that her vision is blurred. and diopter. The surgeon. Because blurred vision is an expected adverse effect.  Question 10 Before each surgery to remove a cataract and implant a lens the surgeon.

what middle ear mass is seen as a red blemish behind the tympanic membrane? Answer Selected Answer: Correct Answer: Response Feedback: B. vomiting. Nystagmus is an involuntary rhythmic movement of the eyes. Choesteatoma D. Motion sickness Motion sickness manifests itself in sweating. Ototoxicity D. and C are incorrect. the tympanic membrane cannot be visualized. and always about the same time of day. and very pale.  Question 14 The nurse is attempting to examine the client's ear with an otoscope.  Question 13 On otoscopy. a red blemish on or behind the tympanic membrane is seen on otoscopy. pallor. Therefore options A. and vomiting caused by vestibular overstimulation.  Question 12 A child is brought to the pediatric clinic by her mother. What would the clinic nurse suspect is bothering this child? Answer Selected Answer: Correct Answer: Response Feedback: A. These manifestations may persist for several hours after the stimulation stops.adverse effect. The scenario does not indicate that the child is taking any medications. nausea. Glomus tympanicum In the case of glomus tympanicum. B. The nurse irrigates the client's . The mother tells the clinic nurse that this has been happening several times a week over the last month. Ménière's disease is an abnormal inner ear fluid balance caused by a malabsorption in the endolymphatic sac or a blockage in the endolymphatic duct. Because of impacted cerumen. who tells the nurse that the school nurse called “again today” to ask her to pick the child up from school because the child was nauseated.

If cold irrigation fluid is used. Availabilty of close-captioned TV programs is very advantageous. While it is important that a member of the nursing staff assist all postoperative clients who are getting out of bed for the first time after surgery.  Question 15 A nurse is planning preoperative teaching for a client with conductive hearing loss due to otosclerosis. A. approximately 95% of clients experience restoration of hearing. Maintain the irrigation fluid at 98 degrees Fahrenheit. however. or depression after surgery. No more than 15 mL of irrigation fluid should be instilled at a time. Cerumen curettes should not be routinely used by the nurse. Special training is required to use a curette safely. this information is routinely provided and is not specific to the client undergoing stapedectomy. The irrigating solution should be warm. anxiety. the client is at risk for experiencing nausea and vertigo. What nursing intervention is most important in order to minimize nausea and vertigo during the procedure? Answer Selected Answer: Correct Answer: Response Feedback: B. thereby making removal more difficult. it is not crucial information related to surgical . Aiming the stream of irrigation fluid directly at the impacted cerumen is likely to drive it more deeply into the ear canal. notify the physician. The client is scheduled for a stapedectomy with insertion of a prosthesis. Instill no more than 30 mL of fluid each time the syringe is inserted into the ear canal. hearing returns gradually and can continue to improve for several weeks after surgery. Noticeable improvement in hearing may not be experienced for up to 6 weeks after surgery. If ear wax is unable to be adequately removed by irrigation or instillation of ceruminolytic agents.ear with a solution of hydrogen peroxide and water to remove the impacted cerumen. Stapedectomy is a very successful procedure. Noticeable improvement in hearing may not be experienced for up to 6 weeks after surgery. B. What information is most crucial to include in the client's preoperative teaching? Answer Selected Answer: Correct Answer: Response Feedback: B. It is important that the client understand this in order to prevent disappointment. However.

The nurse recognizes that the characteristic of this drainage may indicate what? Answer Selected Answer: B. The patient has just been told that the tumor is growing very fast. The nurse notes the drainage is serosanguineous. Postnasal drainage . and D are incorrect. “Astrocytomas infiltrate the surrounding neural connective tissue. Astrocytomas invade both the gray and white matter indiscriminately.” A. Therefore options A.” Usually. Dopamine Parkinson's disease develops from decreased availability of dopamine. These answers are not the most correct.  Question 2 A patient with Parkinson's disease is being cared for on your unit.outcomes. while acetylcholine binding to muscle cells is impaired in myasthenia gravis. and will grow down the spinal cord if they spread far enough. NEUROLOGIC  A nurse on the oncology unit is caring for a patient with an astrocytoma. astrocytomas spread by infiltrating into the surrounding neural connective tissue. What would be the nurse's best response? Answer Selected Answer: Correct Answer: Response Feedback: B. The patient asks the nurse how these tumors grow. and therefore cannot be totally removed without causing considerable damage to vital structures.  Question 3 While assessing the patient at the beginning of the shift the nurse inspects a surgical dressing covering the operative site after the patients' cervical discectomy. Dopamine B. “Astrocytomas grow by invading the surrounding gray matter. C. The nurse would be correct in identifying what neurotransmitter as being decreased in this disease? Answer Selected Answer: Correct Answer: Response Feedback: B.

 Question 6 . The nurse explains to the patient that this is an invasive procedure. the nurse will monitor the operative site and dressing covering this site. A dural leak After a cervical discectomy. or an indication of hemorrhage.  Question 5 A patient is scheuled for a myelogram. Exposing the skin to sunlight would not be harmful to this patient.  Question 4 The nurse is planning discharge teaching for a patient with trigeminal neuralgia. The nurse knows to include information about factors that precipitate an attack. Electroencephalography (EEG) A. This is not an abnormal finding.Correct Answer: Response Feedback: D. postnasal drip. Lumbar puncture A myelogram is an x-ray of the spinal subarachnoid space taken after the injection of a contrast agent into the spinal subarachnoid space through a lumbar puncture. Exposing his skin to sunlight A. Using artificial tears and drinking liquids at room temperature would be appropriate behaviors. due to the fact that this activity can trigger an attack of pain in a patient with trigeminal neuralgia. The nurse knows that the preparation is similar to which of the following neurological tests? Answer Selected Answer: Correct Answer: Response Feedback: D. Serosanguineous drainage may indicate a dural leak. What would the nurse be correct in teaching the patient to avoid? Answer Selected Answer: Correct Answer: Response Feedback: B. Washing his face Washing the face should be avoided if possible. which assesses for any lesions in the spinal cord. Patient preparation for a myelogram would be similar to that for lumbar puncture (Refer to Chart 60-03).

Assess gag reflex. but not because of the decreased sense of heat or cold. Cerebral angiography is not diagnostic of CJD. The nurse would include in her presentation information on sensory losses due to aging. The instructor would teach the students to do what? Answer Selected Answer: Correct Answer: Response B. The older patient may be burned or suffer frostbite before being aware of any discomfort.A public health nurse has been asked to give an educational presentation on aging to the senior citizens at the senior citizens center. Arterial blood gas analysis D.  Question 8 The nursing instructor is teaching the beginning nursing students how to assess a patient's cranial nerve function. Assess orientation to person. time. what must be used with caution when treating the elderly? Answer Selected Answer: Correct Answer: Response Feedback: A. D. The gag reflex is governed by the glossopharyngeal nerve. Lumbar puncture Recent detection of a polyclonal antibody (protein 14-3-3) in CSF has enabled the diagnosis of CJD. one of the . Hot or cold packs A. Whirlpool baths are generally not a routine treatment ordered for the elderly. caution must be used when hot or cold packs are used. Because pain is an important warning signal. The nurse would expect what diagnostic test to be ordered for this patient? Answer Selected Answer: Correct Answer: Response Feedback: B.  Question 7 A patient with suspected Creutzfeldt-Jakob disease is being admitted to the unit. they would not be utilized as a diagnostic test. Any medication is used with caution in the elderly. Since reaction to painful stimuli is an important warning signal. and place. A CT scan is used to rule out disorders that may mimic the symptoms of CJD. Hot or cold packs Reaction to painful stimuli may be decreased with age. Arterial blood gases would not be necessary until the later stages of CJD.

a GABA agonist. The test is also useful in the diagnosis of demyelinating diseases. Orientation is an assessment parameter related to a mental status examination. Included in the admission orders is baclofen (Lioresal). The test is not done to diagnose peripheral sensory deficits.  Question 9 A patient diagnosed with multiple sclerosis has been admitted to your unit for treatment of an MS exacerbation. Corticosteroids limit the severity and duration of exacerbations. You know that this test is used to diagnose what? Answer Selected Answer: Correct Answer: Response Feedback: D.Feedback: cranial nerves. Hand grip and arm drifting are part of motor function assessment. or diabetic neuropathies. Anticholinesterase agents increase muscle strength in the upper extremities. Decreased muscle spasms in the lower extremities B. Demyelinating diseases SERs are used to detect deficits in spinal cord or peripheral nerve conduction and to monitor spinal cord function during surgical procedures.  Question 11 . Decreased muscle spasms in the lower extremities Baclofen. where nerve conduction is slowed.  Question 10 The physician has ordered a somatosensory evoked responses (SERs) test for a patient you are caring for. It can be administered orally or by intrathecal injection. such as multiple sclerosis and polyneuropathies. Diabetic neuropathies B. is the medication of choice in treating spasms. Avonex and Betaseron reduce the appearance of new lesions on the MRI. brainstem deficits. What would you include as an expected outcome of this medication? Answer Selected Answer: Correct Answer: Response Feedback: B.

Taking the bandage off is only done at the surgeon's order.” The basic pathology involves premature death of cells in the striatum (caudate and putamen) of the basal ganglia. as is increasing the pain medicine. is diagnosed with Huntington's disease. Fatigue B. the region deep within the brain that is involved in the control of movement. The son asks what causes his father to do the things he does. What would you do? Answer Selected Answer: Correct Answer: Response Feedback: C. “Your father's brain is trying to rebuild the area of the brain that controls movement. The physiologic changes that result cause what pathophysiologic events? (Mark all that apply. What would be the nurse's best response? Answer Selected Answer: Correct Answer: Response Feedback: B. Call the surgeon If the patient experiences a sudden increase in pain. The instructor explains that the effects of neoplasms are caused by the compression and infiltration of normal tissue.  Question 12 A patient. One of those patients had a cervical diskectomy earlier today. “Your father's brain is dying in the area of the brain that controls movement.) Answer Selected Answers: A. Slurred speech . A sudden increase in pain should be promptly reported to the surgeon. brought to the clinic by his son.You are covering patients for a nurse who is at dinner. if the procedure was an anterior cervical diskectomy the entubation tray should already be in the room. The patient calls you to her room and tells you she is having severe pain and that it came on suddenly. requiring reoperation.  Question 13 The pathophysiology instructor is discussing neoplasms with the pre-nursing students. Call the surgeon C. You would not call for an entubation tray. extrusion of the graft may have occurred.” C.

and altered pituitary function. The patient should be encouraged to eat on the unaffected side.Correct Answers: C. the involved eye must be protected. Increased ICP D. head injury. renal failure. central nervous system infections.) Answer Selected Answer: Correct Answer: Response Feedback: A. While paralysis lasts. Focal neurologic signs E. Cerebrovascular disease D. Applying a protective eye shield A. Causes of acquired seizures include cerebrovascular disease. hydrocephalus. due to swallowing .  Question 15 A patient diagnosed with Bell's palsy is being cared for on an outpatient basis. Altered pituitary function Response Feedback: The effects of neoplasms are caused by the compression and infiltration of tissue. metabolic and toxic conditions (eg. A variety of physiologic changes result. hypoglycemia. pesticide exposure). seizure activity and focal neurologic signs. developmental defects) and acquired. Applying a protective eye shield Corneal irritation and ulceration may occur if the eye is unprotected. including vascular insufficiency. drug and alcohol withdrawal. hypoxemia of any cause. hypertension. causing any or all of the following pathophysiologic events: increased intracranial pressure (ICP) and cerebral edema. and allergies. hyponatremia. hypocalcemia. An expected nursing intervention for this patient would be what? Answer Selected Answer: Correct Answer: Response Feedback: A. fever (childhood). Brain tumor The specific causes of seizures are varied and can be categorized as idiopathic (genetic. brain tumor.  Question 14 The causes of acquired seizures include what? (Mark all that apply.

Pressure ulcer D. pneumonia. C. E. Contractures Pressure ulcer DVT Pneumonia Correct Answers: Response Feedback: Based on the assessment data. The parasympathetic nervous system makes the bladder contract. pressure ulcer. DVT A.difficulties. aspiration. When talking about the parasympathetic nervous system what would the instructor tell the students about the bladder? Answer Selected Answer: Correct Answer: Response Feedback: C. Contractures C. not a possible complication.) Answer Selected Answers: A. . The parasympathetic nervous system causes urge incontinence. deep vein thrombosis (DVT). potential complications may include respiratory distress or failure. The patient should continue to provide self-care including oral hygiene. Analgesics are used to control the facial pain.  Question 16 When caring for a patient with a neurologic dysfunction.  Question 17 The nursing instructor is discussing the nervous system with his nursing students. whereas the sympathetic division produces relaxation (inhibition) of the urinary bladder and an increase (stimulation) in the rate and force of the heartbeat. and contractures. D. Interrupted family processes is a nursing diagnosis. The parasympathetic division of the nervous system causes contraction (stimulation) of the urinary bladder muscles and a decrease (inhibition) in heart rate. D. what complications must the nurse monitor for? (Mark all that apply.

Drowsiness Side effects of Tegretol include nausea. The girl is unconscious. dizziness. What side effects would it be important for the nurse to inform the patient may occur from taking Tegretol? Answer Selected Answer: Correct Answer: Response Feedback: B. and aplastic anemia. Trigeminal neuralgia D. How would the nurse document the girl's activity in her chart at school? Answer Selected Answer: Correct Answer: Response Feedback: B. Complex partial seizure In a simple partial seizure. Complex partial seizure B. On assessment the nurse notes diminished reflexes in the upper extremities bilaterally and bilateral loss of sensation. . Skin discoloration.  Question 19 A school nurse is called to the playground where a 6-year-old girl has fallen off the slide. The patient must also be monitored for bone marrow depression during long-term therapy. The nurse knows that these findings are indicative of what? Answer Selected Answer: Correct Answer: Response C. whereas in a complex partial seizure. Peripheral nerve disorder The major symptoms of peripheral nerve disorders are loss of sensation. consciousness is impaired. and tinnitus are not side effects of Tegretol. drowsiness. consciousness remains intact. Question 18 To alleviate pain associated with trigeminal neuralgia a patient is taking Tegretol (carbamazepine). Drowsiness B.  Question 20 A patient presents at the clinic complaining of pain and weakness in her hands. insomnia. When the nurse gets to the playground the girl is exhibiting jerking motions in her left arm and leg.

Cellular density. family and public education. tingling) of the extremities. Cellular density. Information B.) Answer Selected Answers: A. It does not provide individual assessments or exclusion from research studies. What would the instructor tell the students the grade is based on? Answer Selected Answer: Correct Answer: C. What kind of help can this patient and family receive from this organization? (Mark all that apply. Public education Correct Answers: Response Feedback: The Huntington's Disease Foundation of America helps patients and families by providing information. an autoimmune disorder affecting the myoneural junction. She is requesting help from the Huntington's Disease Foundation of America. is characterized by varying degrees of weakness of the voluntary muscles. indicating the degree of malignancy. and support for research.  Question 22 The nursing instructor is talking with the junior nursing class about glial cell tumors. Guillain-Barré syndrome is an autoimmune attack on the peripheral nerve myelin. but most commonly the second and third branches of the trigeminal nerve. cell mitosis. The instructor tells the students that the most common type of glioma is an astrocytoma and that astrocytomas are graded from I to IV. and paresthesia (numbness.Feedback: muscle atrophy. Myasthenia gravis. referrals. Public education A. Referrals C. pain. and appearance C. diminished reflexes. weakness.  Question 21 A family member of a patient diagnosed with Huntington's disease calls you at the clinic. and appearance . Trigeminal neuralgia is a condition of the fifth cranial nerve that is characterized by paroxysms of pain in the area innervated by any of the three branches. cell mitosis. Information C.

Sit quietly on the toilet every 2 hours B. What are you assessing? Answer Selected Answer: Correct Answer: Response Feedback: C. This makes options B. Damage to the hypoglossal nerve The hypoglossal nerve is the 12th cranial nerve. Usually. The grading of the tumor is not based on the size of the cells or the number of cells. A raised toilet seat A raised toilet seat is useful. C. these tumors spread by infiltrating into the surrounding neural connective tissue and therefore cannot be totally removed without causing considerable damage to vital structures. When assessing this patient you have the patient stick out the tongue and move it back and forth. It is responsible for movement of the tongue.  Question 23 You are caring for a patient diagnosed with Parkinson's disease. Damage to the spinal nerve A. and D incorrect. Your patient is having increasing problems with rising from the sitting to the standing position. indicating the degree of malignancy.  Question 24 A patient is admitted to your unit with an exacerbation of multiple sclerosis. What would you suggest to the patient to use that will aid in getting from the sitting to the standing position as well as aid in improving bowel elimination? Answer Selected Answer: Correct Answer: Response Feedback: C.Response Feedback: Astrocytomas are the most common type of glioma and are graded from I to IV. The grade is based on cellular density. neither will following the outlined bowel program. Sitting quietly on the toilet every 2 hours will not aid in getting from the sitting to standing position. because the patient has difficulty in moving from a standing to a sitting position. and appearance. cell mitosis.  Question 25 . A handicapped toilet is not high enough and will not aid in improving bowel elimination.

and ADH is antidiuretic hormone. REPRODUCTIVE A woman comes to the clinic complaining of PMS that is disrupting her quality of life. Sarafem]). the nurse would be correct in documenting this form of dizziness as a dysfunction of which of the following cranial nerves? Answer Selected Answer: Correct Answer: Response Feedback: A. The acoustic nerve functions in hearing and equilibrium. The hypoglossal nerve moves the tongue. Clomid is an infertility drug. Acoustic Vertigo. Serafem Pharmacologic remedies include selective serotonin reuptake inhibitors (eg. which correlates with cranial nerve VIII (acoustic). fluoxetine [Prozac. is defined as a sensation that is usually a manifestation of vestibular dysfunction. Stop taking vitamin E one week before . The trigeminal nerve functions in facial sensation. is having her preoperative teaching done by the clinic nurse. Motrin] and naproxen [Anaprox]). a specific form of dizziness. antianxiety agents. corneal reflex. Trigeminal B. diuretics. What pharmacologic remedy may be tried to relieve the symptoms of PMS? Answer Selected Answer: Correct Answer:  Response Feedback: A. Oral contraceptives containing drospirenone (a synthetic progestin) and extended regimens also may be effective. and chewing. Clomid D. Refer to Table 60-2. klonopin is an antiseizure medication.  Question 2 A woman. The patient is complaining of vertigo. gonadotropin-releasing hormone (GnRH) agonists. Increase her water intake to 8 glasses per day C. scheduled for a simple mastectomy in one week. The trochlear nerve controls muscles that move the eye. and calcium supplements. What educational intervention will be of primary importance to prevent hemorrhage in the postoperative period? Answer Selected Answer: Correct Answer: B. Based on the knowledge of the cranial nerves. ibuprofen [Advil. prostaglandin inhibitors (eg.The nurse is caring for a patient diagnosed with Ménière's disease.

ultraviolet light treatment of psoriasis on the penis. Vulvodynia Vulvodynia is a chronic vulvar pain syndrome. Priapism A. Bartholin's cyst results from the obstruction of a duct in one of the paired vestibular glands located in the posterior third of the vulva. What risk factors would the staff educator list in her presentation? (Mark all that apply. lichen sclerosus. phimosis. including lack of circumcision. Vulvitis B. The mother explains to the nurse that her daughter has just started using tampons but is not yet sexually active.  Question 4 A 76-year-old with a diagnosis of penile cancer has been admitted to your floor.) Answer Selected Answers: Correct Answers: B. smoking. Vitamin E has an anticoagulant effect.” What might the nurse suspect is the problem with the 14-year-old? Answer Selected Answer: Correct Answer: Response Feedback: A. Phimosis D. irritation. HPV. Vulvitis is an inflammation of the vulva. Limiting green leafy vegetables will decrease vitamin K and increase bleeding. Increasing fluid intake or being without fluid 24 hours before surgery will have no effect on bleeding. . Increasing age E. The mother states “I am very concerned because my daughter is having a lot of stabbing pain and burning. stinging.Response Feedback: The nurse should instruct the patient to stop taking vitamin E.  Question 3 A 14-year-old is brought to the clinic by her mother. Because the incidence of penile cancer is so rare the staff educator has been asked to a staff meeting to talk about penile cancer. Lack of circumcision Response Feedback: Several risk factors for penile cancer have been identified. Symptoms may include burning. poor genital hygiene. or stabbing pain. near the vestibule. increasing age (twothirds of cases occur in men older than 65 years of age).

The patient asks the nurse about her treatment options. Retinopathy Patients with cataracts. Retinopathy B. the patient's age and menopausal status. The nurse reviews the patient's history prior to instructing the patient on the use of this medication.and balanitis xerotica obliterans. the nearby lymph nodes. In a total (simple) mastectomy. Lichen scleroticus is a distracter for this question. Priapism. The lump is found to be a small. Lumpectomy involves a small incision with removal of the surrounding tissue and. The patient usually undergoes radiation therapy afterward. tadalafil (Cialis) and sildenafil (Viagra) are contraindicated with diabetic . well-defined nodule in the right breast. hypotension. In a partial mastectomy. a relatively uncommon disorder. is defined as a persistent penile erection that may or may not be related to sexual stimulation. the tumor is removed along with a wedge of normal tissue. Partial mastectomy and chemotherapy A. Which treatment would be considered best for this patient? Answer Selected Answer: Correct Answer: Response Feedback: C. skin. the entire breast is removed. However. What disorder will contraindicate the use of tadalafil (Cialis) and sildenafil (Viagra)? Answer Selected Answer: Correct Answer: Response Feedback: B. possibly. The physician orders tadalafil (Cialis) to be taken 1 hour before sexual intercourse. lumpectomy is the most likely option.  Question 6 A 55-year-old man presents at the clinic complaining of erectile dysfunction. or lung cancer will be allowed to take tadalafil (Cialis) and sildenafil (Viagra) if needed. For this patient. and possibly axillary lymph nodes. The patient has a history of diabetes mellitus.  Question 5 A patient comes to the clinic after finding a lump in her breast. Lumpectomy and radiation Treatment for breast cancer depends on the disease stage and type. and the disfiguring effects of the surgery.

 Question 7 A 65-year-old patient is diagnosed with lichen sclerosus. babies delivered vaginally may become infected with the virus. In pregnant women with active herpes. squamous cell hyperplasia. Itching and pain accompany the process as the infected area becomes red and swollen. Flu-like symptoms may occur 3 to 4 days after the lesions appear. and other dermatoses. The teaching plan for this patient should include which of the following? Answer Selected Answer: Correct Answer: Response Feedback: C.” C. “Lichen sclerosus is a benign condition that is easily treated. Lesions are not controlled with excision. Pain generally does not occur with a herpes outbreak. A. vulvar vestibulitis. The woman asks the nurse what this really means. What should the nurse teach the patient about this medication? Answer . There is a risk for fetal morbidity and mortality if this occurs.  Question 9 A patient has been prescribed sildenafil citrate. Aspirin and other analgesics are usually effective in controlling the pain.retinopathy. What is the nurse's best response? Answer Selected Answer: Correct Answer: Response Feedback: C. simplex chronicus. lichen sclerosus.  Question 8 A nurse is caring for a pregnant patient with active herpes.” Benign dystrophies include lichen planus. Babies delivered vaginally may become infected with the virus. “Lichen sclerosus is a benign condition that is easily treated.

Dorsal with both legs bent at a 90-degree angle D.Selected Answer: Correct Answer: Response Feedback: B. The drug should be taken 1 hour prior to intercourse. and running nose are common side effects of Viagra. B. The “blue haze” that occurs with the 100-mg dosage is transient and will last for about 1 hour. The drug should be taken 1 hour prior to intercourse. Options A. indigestion. and frequency with urination. Sims' position on her left side with the right leg bent at a 90degree angle If the patient is too ill. or neurologically impaired to lie on a table with stirrups. burning. Sims' position may be used. frequency with urination. and the drug should be taken 1 hour before intercourse. Facial flushing. Prostatitis Perineal discomfort. In Sims' position. The patient states he has pain with ejaculation. Prostatitis C. the patient lies on her left side with her right leg bent at a 90-degree angle. urgency. The nurse knows that the patient is exhibiting symptoms of what? Answer Selected Answer: Correct Answer: Response C. and C would be inappropriate positions to place this patient in. disabled. and pain . urgency.  Question 10 A female patient has come into the OB/GYN clinic for a routine check-up. The patient must have sexual stimulation to create the erection. mild headache. B.  Question 11 The family practice physician is seeing a 55-year-old male patient who is complaining of perineal discomfort. What is an alternative position that the patient may be placed in to obtain the smear effectively? Answer Selected Answer: Correct Answer: Response Feedback: C. burning. The patient is disabled and is unable to be positioned in the supine lithotomy position for her Pap smear.

 Question 13 The physician explains to the patient that he has an inflammation of the Cowper glands. generally in the tunica vaginalis of the testis. . they do not lie above the prostate or along the vas deferens. Epididymitis is an infection of the epididymis that usually descends from an infected prostate or urinary tract. although it also may collect within the spermatic cord. providing lubrication. Every 3 years B. This gland empties its secretions into the urethra during ejaculation.Feedback: with ejaculation is indicative of prostatitis. Every 3 years The American Cancer Society (ACS) recommends that women at average risk for breast cancer undergo a clinical breast examination at least every 3 years while in their 20s and 30s.  Question 12 A 21-year-old patient presents to the clinic for a physical before her wedding. C. Below the prostate within the posterior aspect of the urethra Cowper glands lie below the prostate. Therefore options A. Within the anterior aspect of the urethra just above the prostate B. A hydrocele is a collection of fluid. and D are incorrect. Where are the Cowper glands located? Answer Selected Answer: Correct Answer: Response Feedback: C. within the posterior aspect of the urethra. The Family Nurse Practitioner does a breast examination and explains that the patient should do self-examination of her breasts monthly and she should get a breast exam from her primary care provider on a regular schedule. and then annually thereafter. What are the guidelines for a woman at average risk for breast cancer to get a clinical breast exam while in her 20s and 30s? Answer Selected Answer: Correct Answer: Response Feedback: B. The Cowper glands do not lie within the epididymis. also may develop as a complication of gonorrhea. A varicocele is an abnormal dilation of the pampiniform venous plexus and the internal spermatic vein in the scrotum (the network of veins from the testis and the epididymis that constitute part of the spermatic cord).

 Question 14
A 60-year-old male presents at the clinic complaining that his breasts are enlarging and they hurt. Upon examination the Family Nurse Practitioner finds an enlargement of firm glandular tissue underneath the areola and immediately surrounding it. She diagnoses gynecomastia. What would be an appropriate drug to assess if the patient is taking? Answer Selected Answer: Correct Answer: Response Feedback: B. Ranitidine B. Ranitidine

Gynecomastia can also occur in older men and usually presents as a firm, tender mass underneath the areola. In these patients, gynecomastia may be diffuse and related to use of certain medications (eg, digitalis, ranitidine). There is no indication that gynecomastia is related to the use of Gas-X, Tums, or Nexium.

 Question 15
A woman has been treated for a tumor of the left breast that has not responded to chemotherapy. The woman has just found out that she has the BRCA mutations and discusses her options with her physician. What treatment would be most difficult for this woman? Answer Selected Answer: Correct Answer: Response Feedback: C. Radiation therapy D. Bilateral mastectomy

Chemotherapy, left mastectomy, and radiation therapy may be difficult for the woman, but the most difficult and controversial treatment is bilateral mastectomy. Right mastectomy is considered a prophylactic mastectomy which is a primary prevention modality. Patients who are considering prophylactic mastectomy are often faced with a very controversial and emotion decision.

 Question 16
The PLISSIT (Permission, Limited Information, Specific Suggestions, Intensive Therapy) model of sexual assessment and intervention may be used to provide a framework for nursing interventions. By initiating an assessment about sexual concerns what does the nurse convey to the patient? (Mark all that apply.)

Answer Selected Answers: Correct Answers: A. That sexual issues are valid health issues C. That sexual issues are only a small part or you as a person A. That sexual issues are valid health issues B. That it is safe to talk about sexual issues D. Changes or problems in sexual functioning should be discussed with your health care provider By initiating an assessment about sexual concerns, the nurse communicates to the patient that issues about changes or problems in sexual functioning are valid health issues and provides a safe environment for discussing these sensitive topics.

Response Feedback:

 Question 17
A nurse is caring for a patient whose Pap smear results are low-grade squamous intraepithelial lesion (LSIL), which is equivalent to cervical intraepithelial neoplasia and to mild changes related to exposure to HPV. The nurse knows that this is considered what grade of Pap smear? Answer Selected Answer: Correct Answer: Response Feedback: A. Normal C. CIN grade 1

A Class 1 result is negative (normal); Class 2 is probably negative; Class 3 is suspicious or mild dysplasia; Class 4 is more suspicious moderate or severe dysplasia; and Class 5 is malignant.

 Question 18
A nursing student is doing clinical hours in the emergency department (ED) and is assisting in the care of a patient who presented to the ED with priapism of the penis. The student nurse is aware that this condition is classified as a urologic emergency because of the potential for what? Answer Selected Answer: Correct Answer: D. Hypovolemia C. Permanent damage

Response Feedback:

The ischemic form, which is described as nonsexual, persistent erection with little or no cavernous blood flow, must be treated promptly to prevent permanent damage to the penis. Priapism has not been indicated in the development of cancer of the penis or hypovolemia.

 Question 19
To decrease glandular cellular activity and prostate size, an 83-year-old patient has been prescribed finasteride (Proscar). When performing patient education with this patient, the nurse should be sure to tell the patient what? Answer Selected Answer: Correct Answer: Response Feedback: B. Decrease the intake of fluids to prevent retention. A. Avoid the use of saw palmetto.

Saw palmetto is an herbal product used in treating the symptoms associated with BPH. The active element comes from the fruit of the American dwarf tree. Research has shown that the efficacy of saw palmetto is similar to that of medications such as finasteride, and the herbal product may be better tolerated and less expensive. In theory, it functions by interfering with the conversion to DHT. In addition, saw palmetto may directly block the ability of DHT to stimulate prostate cell growth. It should not be used with finasteride, dutasteride, or medications containing estrogen. Transurethral needle ablation is another treatment modality for benign prostatic hyperplasia. A penile implant is utilized for erectile dysfunction. The patient should maintain normal fluid intake.

MUSCULOSKELETAL

 A patient presents at the dermatology clinic with suspected pemphigus. The nurse knows to prepare what diagnostic test for this condition? Answer Selected Answer: Correct Answer: Response Feedback: B. Patch test C. Tzanck smear

The Tzanck smear is a test used to examine cells from blistering skin conditions, such as herpes zoster, varicella, herpes simplex, and all forms of pemphigus. The secretions from a suspected lesion are applied to a glass slide, stained, and examined. Options A, B, and D are incorrect.

Pulse-dye laser The tunable pulse-dye laser is especially useful in treating cutaneous vascular lesions such as port-wine stains and telangiectasia. A skin biopsy is completed to rule out malignancy and to establish an exact diagnosis of skin lesions. tattoos. Surgical excision C. certain warts. What diagnostics would be completed to identify the causative allergen? Answer Selected Answer: Correct Answer: Response Feedback: B. and keloids. Skin scrapings are done for suspected fungal lesions. Question 2 A new patient has come to the dermatology clinic to be assessed for a reddened rash on his abdomen. The nurse knows that the primary method of treatment in this type of cancer is what? Answer Selected Answer: Correct Answer: C. such as herpes zoster. The nurse knows that the procedure that is especially useful in treating cutaneous vascular lesions like port-wine stains is what? Answer Selected Answer: Correct Answer: Response Feedback: C. Carbon dioxide laser B.  Question 3 A patient comes to the dermatology clinic requesting the removal of a port-wine stain on his right cheek.  Question 4 A patient with squamous cell carcinoma has been scheduled for treatment of this malignancy. Skin grafts and free flaps would not be used to remove a port-wine stain. The carbon dioxide laser is useful for removing epidermal nevi. A Tzanck smear is used to examine cells from blistering skin conditions. Surgical excision . Patch testing Patch testing is performed to identify substances to which the patient has developed an allergy. skin cancer. ingrown toenails. Skin biopsy C.

because x-ray changes may be seen after 5 to 10 years. and feet. perineum. Options D and E are not factors that bear on the severity of the injury. How to cope with patient's pain . These factors include age of the patient. and malignant changes in scars may be induced by irradiation 15 to 30 years later. Radiation therapy is reserved for older patients.  Question 5 A 45-year-old man is brought in by Life-Flight after a motor vehicle accident is which he was trapped in a burning vehicle. it may be an intervention. Depth of the burn A. Obtaining a biopsy would not be a goal of treatment. Presence of inhalation injury Response Feedback: The severity of each burn injury is determined by multiple factors that when assessed help the burn team estimate the likelihood that a patient will survive and plan the care for each patient.) Answer Selected Answers: Correct Answers: B. The emergency department nurse knows that the severity of the injury is based on what factors? (Mark all that apply. and presence of a past medical history. metastasizing by the blood or lymphatic system. depth of the burn. presence of other injuries. The burn team is estimating the patient's likelihood of survival based on the severity of the burn injury. Squamous cell carcinoma is an invasive carcinoma.  Question 6 The nurse in an outpatient plastic surgery facility is educating the family of a patient having a “tummy tuck” about home care for this patient. What does the nurse know to include in this education? (Mark all that apply.Response Feedback: The primary goal of surgical management of squamous cell carcinoma is to remove the tumor entirely. location of the injury in special care areas such as the face. Age B.) Answer Selected Answers: C. presence of inhalation injury. Depth of the burn C. hands. Chemotherapy would not be the treatment goal. amount of surface area of the body that is burned.

Isotretinoin (Accutane) Accutane is an oral retinoid that has shown dramatic results in patients with nodular cystic acne unresponsive to conventional therapy. What interventions can you institute to help this patient cope more effectively? (Mark all that apply. Assist the patient in practicing appropriate strategies .) Answer Selected Answers: Correct Answers: C. How to cope with patient's pain Response Feedback: Most cosmetic procedures are performed in an outpatient facility.  Question 8 Your patient is in the acute phase of a burn injury. Assist the patient in practicing appropriate strategies A. Triamcinolone (Kenalog) B. therefore. Skin care plan that is prescribed C. The family does not need to worry about maintaining nutrition for a patient who has had a “tummy tuck” and they do not need to know how to improve the patient's self-image. family members are integral to postoperative care. and how to cope with the patient's pain. One of the nursing diagnoses on the plan of care is ineffective coping due to burn injury and altered body image. Intralesional injections of Kenalog have been utilized in the treatment of psoriasis. the skin care plan that is prescribed. Benadryl is an oral antihistamine used in the treatment of pruritus. They should understand what to expect as the patient emerges from the procedure room: the type of dressings that will be in place. Promote truthful communication C. The Nurse Practitioner would know that the treatment would consist of which of the following medications? Answer Selected Answer: Correct Answer: Response Feedback: D. Zovirax is used in the treatment of herpes zoster as an oral antiviral agent.  Question 7 The Nurse Practitioner is seeing a 16-year-old male who has come to the dermatology clinic for treatment of nodular cystic acne. Type of dressings patient will have B.Correct Answers: A.

nail beds are dusky.E. The nurse should set specific expectations.  Question 9 A nurse on the burn unit is caring for a patient who has gone into the acute phase of her burn.  Question 10 While assessing a patient at the clinic the nurse notes patchy. not the patient. In a burn patient there is a hyperglycemic response. Hyperkalemia B. The nurse knows that this finding is a symptom of what? Answer Selected Answer: Correct Answer: Response Feedback: C. Hyperkalemia occurs in the emergent phase of the burn. What would be important for the nurse to monitor the patient for? Answer Selected Answer: Correct Answer: Response Feedback: C. and conjunctiva. Polycythemia D. Give positive reinforcement when appropriate Response Feedback: The nurse can assist the patient to develop effective coping strategies by setting specific expectations for behavior. milky white spots. Each staff member needs to stop the manipulation of the patient with the involved staff member. and giving positive reinforcement when appropriate. the nurse notes ruddy blue face. not a hypoglycemic response. Hypermetabolism can occur up to 1 year after the burn. Vitiligo is a condition characterized by destruction of the melanocytes in circumscribed areas of skin and appears in light or dark as patchy.” is associated with Addison's disease. With polycythemia. . promoting truthful communication to build trust. or “external tan. Vitiligo With cyanosis. helping the patient practice appropriate strategies. oral mucosa. often symmetric bilaterally. Hyponatremia Hyponatremia is common during the first week of the acute phase. A bronzed appearance. as water shifts from the interstitial space to the vascular space. milky white spots.

.” Based on the assessment data. dressing changes. fluid and electrolyte balance. Question 11 The nursing instructor is going over burn injuries. Based upon these care priorities. conjunctival retraction. and initial wound assessment and care. “He could get lesions on his cornea. The patient's wife asks you what complications her husband might have. The instructor tells the students that the nursing care priorities for a patient with a burn injury include wound care.  Question 12 You are an ICU nurse caring for a patient with Stevens-Johnson syndrome. and nutritional support are priorities at this stage and are discussed in detail in the following sections. Priorities during the emergent or immediate resuscitative phase include first aid.” A. pain management. Acute The acute or intermediate phase of burn care follows the emergent/resuscitative phase and begins 48 to 72 hours after the burn injury. attention is directed toward continued assessment and maintenance of respiratory and circulatory status. functional and cosmetic reconstruction. topical antibacterial therapy. and psychosocial counseling. wound debridement. rehabilitation. wound cleaning. During this phase. potential complications include sepsis. and prevention of complications such as infection. The priorities during the rehabilitation phase include prevention of scars and contractures. nutritional support. and gastrointestinal function. detection and treatment of concomitant injuries. and wound grafting). Infection prevention. wound dressing. prevention of shock and respiratory distress. and corneal lesions. Emergent C. scars. “He can become disfigured and have to have reconstructive surgery. burn wound care (ie. the instructor is most likely discussing a patient in what phase of burn care? Answer Selected Answer: Correct Answer: Response Feedback: A. What would be your best response? Answer Selected Answer: Correct Answer: Response Feedback: C.

SLE. adaptation and adjustment to alterations in body image. Psoriasis C. increased understanding of the injury.) Answer Selected Answers: Correct Answers: D. Increased participation in activities of daily living B. C. The nurse notes that this is a definite indication of what? Answer Selected Answer: Correct Answer: Response Feedback: C. and absence of complications. During the assessment the nurse notes that the fingernails of the patient are pitted. Question 13 A patient presents at the clinic complaining of hay fever. The nurse changes dressings as quickly as possible. Pitting of the nails does not indicate eczema. and lifestyle. What does the nurse do to reduce pain and discomfort at this time? Answer Selected Answer: Correct Answer: A. What goals would be appropriate at this time? (Mark all that apply. or COPD. self-concept. treatment. .  Question 15 It is time to change the dressings on a burn patient. Increased understanding of the planned follow-up care D.  Question 14 A patient in the rehabilitation phase of the burn injury is setting goals with the nurse. The nurse lets the patient decide on when to change the dressing. Psoriasis Pitted surface of the nails is a definite indication of psoriasis. and planned follow-up care. Adjustment to alterations in lifestyle Response Feedback: The major goals for the patient include increased participation in activities of daily living. Adjustment to alterations in lifestyle A.

You never delegate a dressing change on a burn patient. When writing the care plan for this patient what major goal would you include for this patient? Answer Selected Answer: Correct Answer: Response Feedback: A. Wide excision Wide excision is the primary treatment for malignant melanoma and removes the entire lesion and determines the level and staging. Nothing in the scenario tells us that this patient needs to increase her support network. Letting the patient decide the time of the dressing change lets the patient feel more in control. but they are not considered major goals.Response Feedback: The nurse works quickly to complete treatments and dressing changes to reduce pain and discomfort. Chemotherapy (option A) may be used after the melanoma is excised. Relief of discomfort from lesions The major goals for the patient may include relief of discomfort from lesions.  Question 1 . and absence of complications. Immunotherapy (option B) is experimental. Radiation therapy (option D) is palliative. It doesn't reduce pain and discomfort.  Question 16 You are caring for a 69-year-old female admitted to your unit with bullous pemphigoid. skin healing. reduced anxiety and improved coping capacity. Immunotherapy C. The nurse caring for this patient explains that the first and most important treatment for malignant melanoma is what? Answer Selected Answer: Correct Answer: Response Feedback: B. Improved nutritional status D. The nurse should never skip an ordered dressing change.  Question 17 A patient has just been told he has malignant melanoma. Options A and B may be goals for this patient.

 Question 2 A nurse. caring for a patient with Paget's disease. Risk for imbalanced nutrition: less than body requirements A. is analyzing her patient's laboratory values. Patient teaching provided by the nurse would include what instructions to decrease the pain associated with this condition? Answer Selected Answer: Correct Answer: Response Feedback: D. An elevated serum alkaline phosphatase level and a normal serum calcium level Patients with Paget's disease have normal blood calcium levels. Which of the following values is most often seen in a patient with Paget's disease? Answer Selected Answer: Correct Answer: Response Feedback: B.A 42-year-old man presents at the clinic complaining of pain in his heel so bad it inhibits his ability to walk.  Question 3 The nurse is writing a care plan for a patient admitted to the Emergency Department (ED) with an open fracture. Risk for infection While all nursing diagnoses may be pertinent to the care of a patient with . Application of keratolytic ointment B. The patient is diagnosed with plantar fasciitis. The nurse will assign priority to what nursing diagnosis for a patient with an open fracture of the radius? Answer Selected Answer: Correct Answer: Response C. A low serum alkaline phosphatate level and a low serum calcium level C. Elevated serum alkaline phosphatase concentration and urinary hydroxyproline excretion reflect the increase osteoblastic activity associated with this condition. Gently stretching the foot and the Achilles tendon Plantar fasciitis leads to pain that is localized to the anterior medial aspect of the heel and diminishes with gentle stretching of the foot and Achilles tendon.

and bone and to promote healing. B. The objectives of management are to prevent infection of the wound. The nurse notes that the patient is experiencing Volkmann's contracture. the muscles of the patient are at risk of developing what? Answer . Obstructed arterial blood flow to the forearm and hand A. and D are incorrect. Therefore options A. The arm was put in an arm cast. soft tissue. the nursing diagnosis that will receive the highest priority is “Risk for infection” related to the risks of osteomyelitis and tetanus. which is referred to as the diaphysis.Feedback: an open fracture of the radius. C.  Question 6 The nurse considers when developing the patient's care plan that without proper intervention. The patient states that he is unable to straighten his fingers.  Question 4 An 18-year-old male patient broke his arm in a skateboarding accident. What is the diaphysis of the femur mainly constructed of? Answer Selected Answer: Correct Answer: Response Feedback: C.  Question 5 A patient injured in a motor vehicle accident has sustained damage to the diaphysis of the right femur. Cortical bone The long bone shaft. Another priority diagnosis for a patient with an open fracture would be “Risk for peripheral neurovascular dysfunction”. which is due to what? Answer Selected Answer: Correct Answer: Response Feedback: A. Obstructed arterial blood flow to the forearm and hand Volkmann's contracture occurs when arterial blood flow is restricted to the forearm and hand and results in contractures of the fingers and wrist. Therefore options B. and D are incorrect. Cortical bone C. is constructed primarily of cortical bone.

Atrophy B. what preventive measures would the nurse implement? Answer Selected Answer: Correct Answer: Response Feedback: C. Comfort measures may include analgesics and elevation of the affected extremity to the heart level. as this classification of drug will inhibit the healing of the fracture.  Question 8 The nurse is caring for a patient who is in skeletal traction.Selected Answer: Correct Answer: Response Feedback: B. it is at risk of developing atrophy. Osteoporosis is the loss of bone. Encourage the patient to perform ankle and calf muscle exercises once a shift.  Question 7 A patient with a simple fracture is involved in discharge teaching with their nurse. The nurse will encourage the patient to engage in exercises that strengthen the unaffected muscles. What would the nurse instruct the patient to do? Answer Selected Answer: Correct Answer: Response Feedback: B. The patient should be encouraged to use the overhead trapeze to shift weight for repositioning. The nurse should inform the patient that fracture healing and restoration of full strength may take months. D. and fasciculation is the involuntary twitch of muscle fibers. B. Engage in exercises that strengthen the unaffected muscles. Hypertrophy is the increase in size of muscle. which is the decrease in size. Assess the pin insertion site every 8 hours. The pin insertion site should be assessed every 8 hours for inflammation and infection. Engage in exercises that strengthen the unaffected muscles. Atrophy If a muscle is in disuse for an extended period of time. Ankle and calf exercises should . To prevent the complication of skin breakdown in a patient with skeletal traction. Corticosteroids should be avoided.

During repositioning. Inability to tolerate required positions .  Question 11 The nurse is caring for a patient who has an MRI scheduled. Instruct the patient to walk away from the nurse for a short distance. Gait is assessed by having the patient walk away from the examiner for a short distance. D. what should the nurse do? Answer Selected Answer: Correct Answer: Response Feedback: A. Traction is used to reduce the fracture and must be maintained at all times. Options A. Place slight additional tension on the traction cords. Instruct the patient to balance on one foot for as long as possible. What does the nurse assess the patient for prior to the study? Answer Selected Answer: D. The examiner observes the patient's gait for smoothness and rhythm.be done 10 times an hour while awake. C. Maintain the same degree of traction tension. The patient needs to be repositioned toward the head of the bed. and C are incorrect because it isn't appropriate to increase traction tension or release or lift the traction during repositioning. B.  Question 10 A patient with a fractured femur is in balanced suspension traction. including during repositioning.  Question 9 Which of the following techniques will the nurse implement to assess a patient's gait? Answer Selected Answer: Correct Answer: Response Feedback: D.

A compression fracture involves compression of bone and is seen in vertebral fractures. or an egg allergy. pregnancy. the patient is assessed for possible allergies. metal implants).  Question 13 A patient has been admitted to the orthopedic unit with a suspected diagnosis of osteomalacia. or arthrography. a Hibiclens bath. The nurse expects to find which of the following laboratory study results to be present? Answer Selected Answer: Correct Answer: Response Feedback: D. claustrophobia. Compression B. inability to tolerate required positioning due to age. Inability to tolerate required positions Before the patient undergoes an imaging study. debility. or disability. Low serum calcium and low phosphorus level D.Correct Answer: Response Feedback: D. While giving report to the floor nurse. MRI. If contrast agents will be used for CT scan. A transverse fracture occurs straight across the bone shaft. An impacted fracture occurs when a bone fragment is driven into another bone fragment. Low serum calcium and low phosphorus level Laboratory studies will reveal a low serum calcium and low . Prior to an MRI the patient is not assessed for an empty bladder. the emergency room nurse states that the patient has a fracture of the nose that has resulted in a skin tear and involvement of the mucous membranes of the nasal passages. the nurse assesses for conditions that may require special consideration during the study or that may be contraindications to the study (eg. The orthopedic nurse is aware that this description likely indicates which type of fracture? Answer Selected Answer: Correct Answer: Response Feedback: A.  Question 12 A patient is arriving to the orthopedic floor from the emergency room. Compound A compound fracture involves damage to the skin or mucous membranes and is also called an open fracture.

phosphorus level. and fingers. wrist. Elevate the arm above the shoulder 3 or 4 times daily. but the nurse should encourage the patient to exercise the elbow. What would the nurse instructs the patient to do? Answer Selected Answer: Correct Answer: Response Feedback: B. A. The patient may be permitted to use the arm for light activities within the range of comfort. and C are incorrect. . wrist. Therefore options A. Avoid moving the elbow. Vigorous activity is limited for 3 months.  Question 14 You are caring for a patient wearing a sling to support her arm after a clavicle fracture. and fingers for about 2 months. B. The patient should not elevate the arm above the shoulder level until the ends of the bones have united at about 6 weeks. A patient with a clavicle fracture may use a sling to support the arm and relieve the pain.

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