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(GASTROINTESTINAL SYSTEM) CBQ n0. 1 List 4 nursing interventions for the client with a hiatal hernia.

Answer: Sit up while eating and one hour after eating. Eat small, frequent meals. Eliminate foods that are problematic. CBQ n0. 2 List 3 categories of medications used in the treatment of peptic ulcer disease. Answer: Antacids, H2 receptor-blockers, mucosal healing agents, proton pump inhibitors. CBQ no. 3 List the symptoms of upper and lower gastrointestinal bleeding. Answer: Upper GI: melena, hematemesis, tarry stools. Lower GI: bloddy stools, tarry stools. Similar: tarry stools. CBQ n0. 4 What bowel sound disruptions occur with an intestinal obstruction? Answer: Early mechanical obstruction: high-pitched sounds; late mechanical obstruction: diminished or absent bowel sounds. CBQ n0. 5 List 4 nursing interventions for post-op care of the client with a colostomy. Answer: Irrigate daily at same time; use warm water for irrigations; wash around stoma with mild soap/water after each colostomy bag change; pouch opening should extend at least 1/8 inch around the stoma. CBQ n0. 6 List the common clinical manifestations of jaundice. Answer: Sclera-icteric (yellow sclera), dark urine, chalky or clay-colored stools CBQ n0. 7 What are the common food intolerances for clients with cholelithiasis? Answer: Fried/spicy or fatty foods. CBQ n0. 8 List 5 symptoms indicative of colon cancer. Answer: Rectal bleeding, change in bowel habits, sense of incomplete evacuation, abdominal pain with nausea, weight loss. CBQ n0. 9 In a client with cirrhosis, it is imperative to prevent further bleeding and observe for bleeding tendencies. List 6 relevant nursing interventions. Answer: Avoid injectons, use small bore needles for IV insertion, maintain pressure for 5 minutes on all venipuncture sites, use electric razor, use soft-bristle toothbrush for mouth care, check stools and emesis for occult blood. CBQ n0. 10 What is the main side effect of lactulose, which is used to reduce ammonia levels in clients with cirrhosis? Answer: Diarrhea. CBQ n0. 11 List 4 groups who have a high risk of contracting hepatitis. Answer: Homosexual males, IV drug users, recent ear piercing or tattooing, and health care worker

CBQ n0. 12 How should the nurse administer pancreatic enzymes? Answer: Give with meals or snacks. Powder forms should be mixed with fruit juices.

Common Board Questions (CBQ) in Nurse Licensure Examination (CARDIOVASCULAR SYSTEM)

CBQ no. 1 How do clients experiencing angina? Describe that pain. Answers: Described as squeezing, heavy, burning, radiates to left arm or shoulder, transient or prolonged. CBQ no. 2 Develop a teaching plan for the client taking nitroglycerin. Answers: Take at first sign of anginal pain. Take no more than 3, five minutes apart. Call for emergency attention if no relief in 10 minutes. CBQ no. 3 List the parameters of blood pressure for diagnosing hypertension. Answers: >140/90 CBQ no. 4 Differentiate between essential and secondary hypertension. Answers: Essential has no known cause while secondary hypertension develops in response to an identifiable mechanism. CBQ no. 5 Develop a teaching plan for the client taking antihypertensive medications. Answers: Explain how and when to take med, reason for med, necessary of compliance, need for follow-up visits while on med, need for certain lab tests, vital sign parameters while initiating therapy. CBQ no. 6 Describe intermittent claudication. Answers: Pain related to peripheral vascular disease occurring with exercise and disappearing with rest. CBQ no. 7 Describe the nurse¶s discharge instructions to a client with venous peripheral vascular disease. Answers: Keep extremities elevated when sitting, rest at first sign of pain, keep extremities warm (but do NOT use heating pad), change position often, avoid crossing legs, wear unrestrictive clothing. CBQ no. 8 What is often the underlying cause of abdominal aortic aneurysm? Answers: Atherosclerosis.

CBQ no. 9 What lab values should be monitored daily for the client with thrombophlebitis who is undergoing anticoagulant therapy? Answers: PTT, PT, Hgb, and Hct, platelets. CBQ no. 10 When do PVCs (premature ventricular contractions) present a grave danger? Answers: When they begin to occur more often than once in 10 beats, occur in 2s or 3s, land near the T wave, or take on multiple configurations. CBQ no. 11 Differentiate between the symptoms of left-sided cardiac failure and rightsided cardiac failure. Answers: Left-sided failure results in pulmonary congestion due to back-up of circulation in the left ventricle. Right-sided failure results in peripheral congestion due to back-up of circulation in the right ventricle. CBQ no. 12 List 3 symptoms of digitalis toxicity. Answers: Dysrhythmias, headache, nausea and vomiting CBQ no. 13 What condition increases the likelihood of digitalis toxicity occurring? Answers: When the client is hypokalemic (which is more common when diuretics and digitalis preparations are given together). CBQ no. 14 What life style changes can the client who is at risk for hypertension initiate to reduce the likelihood of becoming hypertensive? Answers: Cease cigarette smoking if applicable, control weight, exercise regularly, and maintain a low-fat/low-cholesterol diet. CBQ no. 15 What immediate actions should the nurse implement when a client is having a myocardial infarction? Answers: Place the client on immediate strict bedrest to lower oxygen demands of heart, administer oxygen by nasal cannula at 2-5 L/min., take measures to alleviate pain and anxiety (administer prn pain medications and anti-anxiety medications). CBQ no. 16 What symptoms should the nurse expect to find in the client with hypokalemia? Answers: Dry mouth and thirst, drowsiness and lethargy, muscle weakness and aches, and tachycardia. CBQ no. 17 Bradycardia is defined as a heart rate below ___ BPM. Tachycardia is defined as a heart rate above ___ BPM. Answers: bradycardia 60 bpm; tachycardia 100 bpm CBQ no. 18 What precautions should clients with valve disease take prior to invasive procedures or dental work? Answers: Take prophylactic antibiotics.

(RENAL SYSTEM) CBQ no. 1 Differentiate between acute renal failure and chronic renal failure. Answers: Acute renal failure: often reversible, abrupt deterioration of kidney function. ± Chronic renal failure: irreversible, slow deterioration of kidney function characterized by increasing BUN and creatinine. Eventually dialysis is required. CBQ no. 2 During the oliguric phase of renal failure, protein should be severely restricted. What is the rationale for this restriction? Answer: Toxic metabolites that accumulate in the blood (urea, creatinine) are derived mainly from protein catabolism. CBQ no. 3 Identify 2 nursing interventions for the client on hemodialysis. Answer: Do NOT take BP or perform venipunctures on the arm with the A-V shunt, fistula, or graft. Assess access site for thrill or bruit. CBQ no. 4 What is the highest priority nursing diagnosis for clients in any type of renal failure? Answer: Alteration in fluid and electrolyte balance. CBQ no. 5 A client in renal failure asks why he is being given antacids. How should the nurse reply? Answer: Calcium and aluminum antacids bind phosphates and help to keep phosphates from being absorbed into blood stream thereby preventing rising phosphate levels, and must be taken with meals. CBQ no. 6 List 4 essential elements of a teaching plan for clients with frequent urinary tract infections. Answer: Fluid intake 3 liters/day; good handwashing; void every 2-3 hours during waking hours; take all prescribed medications; wear cotton undergarments. CBQ no. 7 What are the most important nursing interventions for clients with possible renal calculi? Answer: Strain all urine is the MOST IMPORTANT intervention. Other interventions include accurate intake and output documentation and administer analgesics as needed. CBQ no. 8 What discharge instructions should be given to a client who has had urinary calculi? Answer: Maintain high fluid intake 3-4 liters per day. Follow-up care (stones tend to recur). Follow prescribed diet based in calculi content. Avoid supine position. CBQ no. 9 Following transurethral resection of the prostate gland (TURP), hematuria should subside by what post-op day? Answer: Fourth day

CBQ no. 10 After the urinary catheter is removed in the TURP client, what are 3 priority nursing actions? Answer: Continued strict I&O; continued observations for hematuria; inform client burning and frequency may last for a week. CBQ no. 11 After kidney surgery, what are the primary assessments the nurse should make? Answer: Respiratory status (breathing is guarded because of pain); circulatory status (the kidney is very vascular and excess bleeding can occur); pain assessment; urinary assessment most importantly, assessment of urinary output.

(RESPIRATORY SYSTEM) CBQ n0. 1 List 4 common symptoms of pneumonia the nurse might note on a physical exam. Answer: Tachypnea, fever with chills, productive cough,bronchial breath sounds. CBQ no. 2 State 4 nursing interventions for assisting the client to cough productively. Answer: Deep breathing, fluid intake increased to 3 liters/day, use humidity to loosen secretions, suction airway to stimulate coughing. CBQ no. 3 What symptoms of pneumonia might the nurse expect to see in an older client? Answer: Confusion, lethargy, anorexia, rapid respiratory rate. CBQ no. 4 What should the O2 flow rate be for the client with COPD? Answer: 1-2 liters per nasal cannula, too much O2 may eliminate the COPD client¶s stimulus to breathe, a COPD client has hypoxic drive to breathe. CBQ no. 4 How does the nurse prevent hypoxia during suctioning? Answer: Deliver 100% oxygen (hyperinflating) before and after each endotracheal suctioning. CBQ no. 5 During mechanical ventilation, what are three major nursing intervention? Answer: Monitor client¶s respiratory status and secure connections, establish a communication mechanism with the client, keep airway clear by coughing/suctioning. CBQ no. 6 When examining a client with emphysema, what physical findings is the nurse likely to see? Answer: Barrel chest, dry or productive cough, decreased breath sounds, dyspnea, crackles in lung fields. CBQ no. 7 What is the most common risk factor associated with lung cancer? Answeer: Smoking

CBQ no. 8 Describe the pre-op nursing care for a client undergoing a laryngectomy. Answer: Involve family/client in manipulation of tracheostomy equipment before surgery, plan acceptable communication method, refer to speech pathologist, discuss rehabilitation program. CBQ no. 9 List 5 nursing interventions after chest tube insertion. Answer: Maintain a dry occlusive dressing to chest tube site at all times. Check all connections every 4 hours. Make sure bottle III or end of chamber is bubbling. Measure chest tube drainage by marking level on outside of drainage unit. Encourage use of incentive spirometry every 2 hours. CBQ no. 10 What immediate action should the nurse take when a chest tube becomes disconnected from a bottle or a suction apparatus? What should the nurse do if a chest tube is accidentally removed from the client? Answer: Place end in container of sterile water. Apply an occlusive dressing and notify physician STAT. CBQ no. 11 What instructions should be given to a client following radiation therapy? Answer: Do NOT wash off lines; wear soft cotton garments, avoid use of powders/creams on radiation site. CBQ no. 12 What precautions are required for clients with TB when placed on respiratory isolation? Answer: Mask for anyone entering room; private room; client must wear mask if leaving room. CBQ no. 13 List 4 components of teaching for the client with tuberculosis. Answer: Cough into tissues and dispose immediately into special bags. Long-term need for daily medication. Good handwashing technique. Report symptoms of deterioration, i.e., blood in secretions. (ENDOCRINE SYSTEM) CBQ. no 1. What diagnostic test is used to determine thyroid activity? Answers: T3 and T4 CBQ. no 2. What condition results from all treatments for hyperthyroidism? Answers: Hypothyroidism, requiring thyroid replacement CBQ. no 3. State 3 symptoms of hyperthyroidism and 3 symptoms of hypothyroidism. Answers: Hyperthyroidism: weight loss, heat intolerance, diarrhea. Hypothyroidism: fatigue, cold intolerance, weight gain. CBQ. no 4. List 5 important teaching aspects for clients who are beginning corticosteroid therapy. Answers: Continue medication until weaning plan is begun by physician, monitor serum potassium, glucose, and sodium frequently; weigh daily, and report gain of >5lbs./wk; monitor BP and pulse closely; teach symptoms of Cushing¶s syndrome

CBQ. no 5. Describe the physical appearance of clients who are Cushinoid. Answers: Moon face, obesity in trunk, buffalo hump in back, muscle atrophy, and thin skin. CBQ. no 6. Which type of diabetic always requires insulin replacement? Answers: Type I, Insulin-dependent diabetes mellitus (IDDM) CBQ. no 7. What type of diabetic sometimes requires no medication? Answers: Type II, Non-insulin dependent diabetes mellitus (NIDDM) CBQ. no 8. List 5 symptoms of hyperglycemia. Answers:Polydipsia, polyuria, polyphagia, weakness, weight loss CBQ. no 9. List 5 symptoms of hypoglycemia. Answers: Hunger, lethargy, confusion, tremors or shakes, sweating CBQ. no 10. Name the necessary elements to include in teaching the new diabetic. Answers: Teach the underlying pathophysiology of the disease, its management/ treatment regime, meal planning, exercise program, insulin administration, sick-day management, symptoms of hyperglycemia (not enough insulin) CBQ. no 11. In less than ten steps, describe the method for drawing up a mixed dose of insulin (regular with NPH). Answers: Identify the prescribed dose/type of insulin per physician order; store unopened insulin in refrigerator. If opened, may be kept at room temperature for up to 3 months. Draw up regular insulin FIRST. Rotate injection sites. May reuse syringe by recapping and storing in refrigerator. CBQ. no 12. Identify the peak action time of the following types of insulin: rapid-acting regular insulin, intermediate-acting, long-acting. Answers: Rapid-acting regular insulin: 2-4 hrs. Immediate-acting: 6-12 hrs. Long-acting: 14-20 hrs. CBQ. no 13. When preparing the diabetic for discharge, the nurse teaches the client the relationship between stress, exercise, bedtime snacking, and glucose balance. State the relationship between each of these. Answers: Stress and stress hormones usually increase glucose production and increase insulin need; exercise can increase the chance for an insulin reaction, therefore, the client should always have a sugar snack available when exercising (to treat hypoglycemia); bedtime snacking can prevent insulin reactions while waiting for long-acting insulin to peak. CBQ. no 14. When making rounds at night, the nurse notes that an insulin-dependent client is complaining of a headache, slight nausea, and minimal trembling. The client¶s hand is cool and moist. What is the client most likely experiencing? Answers: Hypoglycemia/insulin reaction. CBQ. no 1. Identify 5 foot-care interventions that should be taught to the diabetic client. Answers: Check feet daily & report any breaks, sores, or blisters to health care provider, wear

well-fitting shoes; never go barefoot or wear sandals, never personally remove corns or calluses, cut or file nails straight across; wash daily with mild soap & warm water.