NP 3

1. The nurse knows that the laboratory results that supports the diagnosis of Systemic Lupus Erythematosus (SLE) is:

C. Pancytopenia, elevated Anti Nuclear Antibody

2. The nurse knows that the most common cardiac manifestation of SLE is:

A. Pericarditis

3. The nurse should instruct Dona Summer take her prednisone:

C. At the time scheduled

4. Dona Summer owns a pool in her backyard. Which instruction should the nurse give her?

D. "Wear a sunscreen and avoid exposure to sunlight."

5. Instructions for a client with systemic lupus erythematosus (SLE) would include information about which of the following blood dyscrasias?

C. Essential thrombocytopenia

SITUATION II: BASIC CARE FOR CLIENTS UNDERGOING CRISIS:

6. Crisis intervention therapy is considered to be which of the following?

A. Secondary prevention

7. Primary prevention for the community problem of rape would be achieved by which of the following?

B. A class by policewomen on how to avoid rape

SITUATION III: A client in the final stages of terminal cancer tells his nurse:" I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I only continue my chemotherapy and radiation treatment because my family wants me to."

8. A client is undergoing tests for multiple myeloma. Diagnostic stude findings in multiple myeloma include:

C. Bence Jones protein in the urine

9. A client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells?

A. Liver

10. An oncology nurse educator is speaking to a women's group about breast cancer. Different questions and comments from the audience reveal a misunderstanding of some aspects of the disease. Various members of the audience have made all of the following statements. Which one is accurate?

A. Men can develop breast cancer

11. During a breast examination, which finding most strongly suggests that the client has breast cancer?

B. A fixed nodular mass with dimpling of the overlying skin

12. The nurse is teaching a client who suspects that she has a lump in her breast. The nurse instructs the client that a diagnosis of breast cancer is confirmed by:

C. Fine needle aspiration

SITUATION III: HEALTH TEACHING AND SAFETY

13. The school nurse is asked to teach the school staff regarding the inspection of children regarding head lice. Head lice and dandruff look very similar. How can the school nurse best determine that a child has lice instead of dandruff?

D. Nits will not fall off the hair shafts when it is moved

14. In addition to explaining how to look for the ova(nits) on the hair shafts, the nurse would instruct the staff to assess for which of the following?

B. Enlarged cervical lymph nodes

D. Ring like lesions

15. Several cases of headlice are discovered in the school. The nurse telephones the children's parents to inform them. Each of the infested children is treated with Kwell shampoo. What is the most important information of this treatment to parents

A. Follow shampoo direction explicitly

SITUATION IV: The nurse is awaiting the arrival of a client from the emergency department. The client has a left ventricular myocardial infarction and is being admitted.

16. In caring for this client, the nurse should be alert for which signs and symptoms of left sided heart failure? Select all that applies:

1. Jugular vein distension
2. Hepatomegaly
3. Paroxysmal nocturnal dyspnea.
4. Crackles
5. Tachycardia
6. Right upper quadrant pain

B. 3, 4 and 5

17. A client is admitted to the emergency department after complaining of acute chest pain radiating down his left arm. Which of the following laboratory studies would be indicated? Select all that apply.

1. Hgt and Hct
2. Serum glucose
3. CK-MB
4. Trop T and Trop I
5. Myoglobin
6. BUN

A. Only 1, 2 and 6 are incorrect

18. To which of the following assessments of a patient who has had a recent myocardial infarction would the nurse give the highest priority?

D. Ventricular dysrhythmias

19. A patient has a nursing diagnosis of fluid volume excess following a myocardial infarction. Which of the following measures would be most effective in promoting the patients.comfort?

A. Elevating the head of the patient's bed

20. Immediately after femoral artery cardiac catheterization of a 25 year old client. All of the following orders are written. Which one should a nurse question?

B. Assess brachial pulses every 1 hr X 24 hrs

SITUATION V: RESEARCH PROCESS:

21. After the review session has been completed, Karen and the staff signed the document. Which of the following is the purpose of this?

C. Document that Karen and the staff reviewed the evaluation

22. Which of the following is NOT true about a hypothesis? Hypothesis is:

B. Proven

23. Which of the following measures will best prevent manipulation of vulnerable groups?

A. Secure informed consent

C. Protect privacy of patient

24. Which of the following procedures ensures that Ms. Montana has fully described to prospective subjects the nature of the study and the subject's rights?

C. Informed consent

25. This technique refers to the use of multiple research designs to draw conclusions about what constitutes the truth

A. Triangulation

SITUATION VI: EMERGENCY AND DISASTER NURSING:

26. Michael works as a triage nurse, and four clients arrive at the Emergency Department at the same time. List the order in which he will assess these clients from first to last.

1. A 50-year-old female with moderate abdominal pain and occasional vomiting.
2. A 35-year-old jogger with a twisted ankle, having a pedal pulse and no deformity.
3. Ana ambulatory dazed 25-year-old male with a bandaged head wound.
4. An irritable infant with a fever, petechiae, and nuchal rigidity.

C. 4, 3, 2, 1

27. A 65-year-old patient arrived at the triage area with complaints of diaphoresis, dizziness, and left-sided chest pain. This patient should be prioritized into which category?

C. Emergent

28. You respond to a call for a help from the ED waiting room. There is an elderly patient lying on the floor. List the order for the actions that you must perform.

1. Call for help and activate the code team.
2. Instruct a nursing assistant to get the emergency cart.
3. Initiate cardiopulmonary resuscitation (CPR)
4. Perform the chin lift of jaw thrust maneuver. .
5. Establish unresponsiveness

D. 5, 1, 4, 3, 2

29. A client in a one-car rollover presents with multiple injuries the interventions that must be initiated for this patient

1. Assess for spontaneous respirations.
2. Give supplemental oxygen per mask.
3. Insert a Foley catheter if not contraindicated.
4. Obtain a full set of vital signs.
5. Remove patient's clothing.
6. Secure/start two large-bore IVs with normal saline.
7. Use the chin lift or jaw thrust method to open the airway.

A. 1, 7, 2, 6, 4, 5, 3

30. A client arrived at the Emergency Department after suffering multiple physical injuries including a fractured pelvis 60/40 mm Hg, heart rate of 143 beats/minute, and a respiratory rate from a vehicular accident. Upon assessment, the client is incoherent, pale and diaphoretic. With vital signs as follows: temperature of blood pressure of 97°F (36.11°c), of 30 breaths/minute. The client is mostly suffering from which of the following?

C. Hypovolemic

31. A 15-year-old male client was sent to the emergency unit following a small laceration on the forehead. The client says that he can't move his legs. Upon assessment, respiratory rate of 20, strong pulses, and less than 2 seconds. Which triage catégory would this client be assigned to? capillary refill time of

D. Yellow

32. A client arrives in the emergency unit and reports that a concentrated household cleaner was splashed in both eye. Which of the following nursing actions is a priority?

B. Flush the eye repeatedly using sterile normal saline

33. A client was brought to the emergency department after suffering a closed head injury and lacerations arouch the face due to a hit and run accident. The client the following assessment findings if observed after al t is unconscious and has minimal response few hours, should be to noxious stimuli. Which of reported to the physician immediately?

D. Drainage of a clear fluid from the client's nose

34. The following clients come at care in order of the severity of the conditions. the, Emergency Department complaining of acute abdominal pain. Prioritize them for

1. A 27-year-old woman complaining of lightheadedness and severe sharp left lower quadrant pain who reports she is possibly pregnant. of yellow right upper quadrant pain who has vomited small amounts
2. A 43-year-old woman with moderate bile and whose symptoms have worsened over the week.
3. A 15-year-old boy with a low grade fever, right lower quadrant pain, vomiting nausea and loss of appetite for the past few days.
4. A 57 year-old woman who complains of a sore throat and gnawing midepigastric pain that is worse between meals and during night.
5. A 59-year-old man with a pulsating abdominal mass and sudden onset of persistent abdominal or back pain, which can be described as a tearing sensation within the past hour

C. 5, 1, 3, 2, 4

35. Nurse Kobie is talking to a male client, the client begins choking on his lunch. He's coughing forcefully. The nurse should:

A. Stand him up and perform the abdominal thrust maneuver from behind

D. Stay with him but not intervene at this time

SITUATION VII: NURSING RESEARCH IN CLINICAL AREAS:

36. Mrs. Montana committed on a research process. The statement, "Ninety percent (90%) of the respondents are female staff nurses validates previous research findings (Santos, 2001; Reyes, 2005) that the nursing profession is largely a female dominated profession is an example of

B. Interpretation

D. Conclusion

37. The study is said to be completed when Ms. Montana achieved which of the following activities?

C. The results of the study is used by the nurses in the hospital

SITUATION VIII: DIET AND NUTRITION THERAPY:
38. A nurse instructs a client at risk for hypokalemia about the foods high in potassium that should be included in the daily diet. The nurse determines that the client understand of the food sources of potassium if the client states that the food item lowest in potassium is:

D. Apples

39. A nurse is reviewing laboratory results and notes that a client's sodium level is 150mEq/L. The nurse reports the serum sodium level to the physician and the doctor prescribes dietary instructions based on the sodium level. Which food item does the nurse instruct the client to avoid?

B. Processed oat cereals

40. A nurse has provided dietary instruction to a client with renal calculi who must learn to eat an alkaline ash diet. The nurse determines that the client has properly understood the information presented if the client chooses which of the following selections from a diet menu?

C. Spinach salad, milk and banana

41. A clear diet has been prescribed for a client who is recovering from gastric surgery. A nurse would check with the dietary department to ensure that the nursing unit kitchen is stocked with which food item that is allowed in this diet?

A. Chicken broth

42. When taking a dietary history from a newly admitted female client, Nurse Rocky should remember that which of the following foods is a common allergen?

C. Oranges

D. Strawberries

SITUATION IX: INFLAMMATORY CONDITIONS OF THE JOINTS:

43. Heberden's nodes are common sign of osteoarthritis. Which of the following statement is correct about this deformity;

B. It appears on the distal interphalyngeal joints

44. Which of the following statements explains the main difference between rheumatoid arthritis and osteoarthritis?

B. Osteoarthritis is localized disease, rheumatoid arthritis is systemic

45. A 78 year old client has a history of osteoarthritis. Which signs and symptoms would the nurse expect to find on physical assessment?

A. Joint pain, crepitus, bouchard nodes

46. During a routine check-up, the nurse evaluates a client with rheumatoid arthritis. To assess for the most obvious disease manifestations first, the nurse checks for:

B. Joint abnormalities

47. Mr. Santos with rheumatoid arthritis is about to begin aspirin therapy to reduce inflammation. When teaching the client about aspirin, the nurse discusses adverse reactions to prolonged aspirin therapy. These include:

D. Bilateral hearing loss

SITUATION X: Stephanie is a nurse researcher of the Patient Care Services Division. She plans to conduct a literature search for her study.

48. Which of the following is the first step in selecting appropriate materials for her review?

A. Track down relevant resources

49. She knows that the most important categories of information in literature review is the:

A. research findings

50. While reviewing journal articles, Stephanie got interested in reading the brief summary of the article placed at the beginning of the journal report. Which of the following refers to this?

C. Abstract

SITUATION XI: Stephanie belongs to the research department of the hospital

51. She notes down ideas that were derived from the description of an investigation written by the person who conducted it. Which type of reference source refers to this?

C. Primary source

52. She came across a study which is referred to as meta-analysis. Which of the following statements best defines this type of study?

B. Findings from multiple studies are combined to yield a data set which is analyzed as individual data

D . Combining and thus integrating the results of multiple studies on a given topic.

53. This kind of research gathers data in detail about a individual or groups and presented in narrative form, which is

A. Case study

54. Stephanie is finished with the steps in the conceptual phase when she has conducted the LAST step, which is

D. formulate a hypothesis

55. She states the hypothesis of the study. Which of the following is a null hypothesis?

A. Infants who are breastfed have the same weight as those who are bottle fed.

SITUATION XII: PHARMACOLOGICAL AND DRUG THERAPY:

56. A client who takes theophylline (Theo-dur) for chronic obstructive pulmonary disease (COPD) is seen in the urgent care center for respiratory distress. Just before therapy is initiated, a baseline theophylline is drawn. Once the client is stabilized, a nurse begins discharge teaching. The nurse would be especially vigilant to include information about complying with medication therapy if the client's baseline result was:

A. 10ug/ml

57. A client with a history of a seizure disorder who has been compliant with medication therapy is admitted to the hospital with seizure activity. Phenytoin (Dilantin) is administered to the client by the IV push route and subsequently a serum phenytoin level is drawn. A nurse evaluates that the medication therapy has been most effective if the laboratory result is:

C. 16ug/ml

58. A client who is receiving cyclosporine (Sandimmune) must practice good oral hygiene, including regular brushing and flossing of the teeth to minimize gingival hyperplasia. Good oral hygiene also is essential to minimize gingival hyperplasia during long-term therapy with certain drugs. Which of the following drugs falls into this category?

C. Phenytoin (Dilantin)

59. Warlacious, a 23 year old client complains of substernal chest pain and states that her heart feels like"its racing out of the chest". She reports no history of cardiac disorders. The nurse attaches her to a cardiac monitor and notes sinus tachycardia with a rate of 136 beats/min. Breath sounds are clear and the respiratory rate is 26 breaths/min. Which of the following drugs should the nurse question the client about using?

C Cocaine

60. A female client requires hemodialysis. Which of the following drugs should be withheld before this procedure?

B. Insulin

SITUATION XIII: CLIENTS SUFFERING FROM FLUID AND
ELECTROLYTE IMBALANCES:

61. Which of the following clients is at highest risk for developing fluid volume deficit?

A. A 76-year-old client who has an NG tube to low suction following colon cancer surgery

62. Which of the following statements should not be included in an education program for the elderly about prevention of dehydration during hot weather?

D. "Use your thirst as a guide to the amount of fluid you should be drinking."

63. An adult client in the clinic complains of a cough, fever, nausea, and vomiting for three days. Examinationer sigals dry tongue and oral mucosa and concentrated urine. The client also reports feeling weak and dizzy. Which vital sign measurement would provide the best indicator of current fluid status?

C. BP and pulse in lying and standing positions

64. A 70-year-old client with a past medical history of hypertension and myocardial infraction is in the hospital following stomach surgery. Vital signs have been stable and an IV of Ds NS is infusing at 100 mL/hour. The client now complains of trouble breathing, has a moist cough; and pulse oximetry reading has fallen to 92%. What action should the nurse take first?

D. Slow the intravenous rate to 10 to 20 mL/hour

65. Which of the following is the best indicator of an excessive response to diuretic therapy?

A. Elevated blood urea nitrogen (BUN) and hematocrit (HCT) and an 8-pound weight loss in 24 hours

66. The nurse is helping a client who was recently placed on a low-sodium diet to choose foods for lunch. Wh ich lunch menu would be best for this client?

A. Grilled chicken sandwich on white bread, apple, salad and iced tea

67. A 17-year-old client who sustained a head injury in a motorcycle collision two days ago is responsive only to pain. Which intravenous fluid order would the nurse question because it could increase the risk of complications?

B. 5% dextrose in water

68. A father telephones the clinic nurse asking what he should do for his 3-year-old son who developed fever, vomiting, and diarrhea today. What dietary advice would be best?

B. "Give him small sips of commercial oral rehydration fluids frequently."

69. A client just finished an hour of strenuous exercise. Which of the following laboratory results would the nurse expect?

C. Increased osmolality

70. Which of the following serum electrolyte imbalances would the nurse assess for in a client admitted with a high fever and severe dehydration?

C. Hypernatremia and hyperchloremia

71. Which of the following clients would be most at risk to develop a sodium imbalance?

A. An adult client taking corticosteroid therapy

72. A 58-year-old client was brought to the hospital following a near-drowning experience in the Atlantic Ocean. In providing care to this client, the nurse knows that it is important to monitor for:

B. Hypornatremia

73. When providing care to clients with syndrome of inappropriate antidiuretic hormone (SIADH), water intake should be:

B. Restricted

74. Which of the following clients would be most likely to develop hyperkalemia?:

A. A client which chronic renal failure

75. A client with hypokalemia must be assessed carefully for which of the following that can occur because of this electrolyte imbalance?

B. Paralytic ileus

76. Which of the following foods should the client who is ould taking spironolactone (Aldactone) be advised to avoid?

B. Cantaloupe

77. A new RN orientee asks the nurse preceptor about acid-base imbalances. Which of the following responses by the preceptor best describes respiratory acidosis?

C. "This condition occurs when a client has inadequate ventilation, retains CO₂, and the pH drops

78. A nurse is teaching a group of clients with chronic obstructive pulmonary disease (COPD) about the importance of the acid-base balance in relation to respiratory disease. Which of the following explanations reflects the nurse's understanding of of acid-base balance and respiratory disease? A. "The pH is an indication of how well your body is adjusting to the acidosis that sometimes occurs with COPD."

A. "The pH is an indication of how well your body is adjusting to the acidosis that sometimes occurs with COPD."

79. Which of the following arterial blood gases (ABGs) would the nurse expect to see when a client has apnea and develops acidosis?

B. pH 7.29, PaCO2 62 mmHg, HCO3 23 mEq/L

80. Which of the following ABG results would the nurse expect to see when a client is admitted with diarrhea that has lasted for four days?

B. pH 7.30, PaCO2 40 mmHg, HCO3 18 mEq/L

81. Which of the following laboratory values would the nurse expect to see in an anxious client?

C. pH 7.50

82. The nurse anticipates which of the following responses in a client who develops metabolic acidosis?

C. Respiratory rate will increase

83. The nurse assesses a client with uncontrolled Type 1 diabetes mellitus for which of the following acid-base imbalances?

C. Metabolic acidosis

84. The client with COPD asks the nurse why a continuous pulse oximeter is ordered. Which of the following responses by the nurse is correct?

B. "The pulse oximeter measures the oxygen saturation in your blood at any given time."

85. A client with COPD is admitted to the hospital with an exacerbation of the disease. ABG results are pH 7.30, PaCO2 51, and HCO3 25. How would the nurse interpret these?

A. Respiratory acidosis, uncompensated

86. A client admitted to the Emergency Department following a motor vehicle accident with chest injuries complains that it hurts to breathe. The client's respiratory rate is 12 and very shallow. The nurse would anticipate which of the following results on ABGs?

B. pH 7.31, PaCO2 49 mmHg, HCO, 24 mEq/L, SaO2 87%

87. What action can the nurse take initially when a client becomes anxious and starts to hyperventilate?

C. Give the client a paper bag to breathe into

88. The nurse would closely monitor a client with diabetic ketoacidosis (DKA) for which of following acid-base imbalances?

A. Metabolic acidosis

89. A 36-year-old female is admitted with vomiting and dehydration due to the flu for three days. ABGs are pH 7.46, PaCO2 50, HCO 33, SaO2 95%. What do these value indicate to the nurse?

C. Metabolic alkalosis partially compensated

90. A client is admitted to the Emergency Department in a full cardiac arrest. ABGs indicate a respiratory acidosis. How does the nurse respond to correct this condition?

C. Ventilate client to "blow off" excess CO₂

91. Which of the following responses by the nurse is correct when trying to explain to a client why vomiting caused the development of metabolic alkalosis?

D. "Vomiting can cause a loss of gastric acids from the stomach and metabolic alkalosis develops from this loss."

92 . A 68-year-old client is admitted with pneumonia. ABG results are pH 7.46, PaCO2 30, HCO, 19, and SaO, 72. These nurse interprets this as:

A. Respiratory acidosis, uncompensated

93. A 71-year-old client develops hypertension, tachycardia, and increased respirations two days after surgery. ABG results are pH 7.29, PaCO2 52, HCO3 24, and SaO2 95%. These indicate:

A. Respiratory acidosis, uncompensated

94. A 57-year-old client is admitted with a diagnosis of an acute myocardial infraction. ABG results are are pH 7.36, PaCO2 29, HCO3 20, and SaO2 100%. The nurse interprets that this clients is:

C. Well oxygenated with compensated metabolic acidosis.

SITUATION XIV: ENDOCRINE DISORDERS:

95. A client is diagnosed with syndrome of inappropriate antidiuretic hormone (SIADH). The nurse informs the client that the physician will prescribe diuretic therapy and restrict fluid and sodium intake to treat the disorder. If the client does not comply with the recommended treatment, which complication may arise?

A. Seizure

96. The nurse is planning care for a 52 year old male client in acute addisonian crisis. Which nursing diagnosis should receive the highest priority?

B. Decreased cardiac output

97. Which nursing diagnosis takes highest priority for a client with hyperthyroidism?

D. Imbalanced nutrition: Less than body requirements related to thyroid hormone excess

98. When instructing the client diagnosed with hyperparathyroidism about diet, the nurse should stress the importance of which of the following?

C. Forcing fluids

99. Before undergoing a subtotal thyroidectomy, a client recieves potassium iodide (Lugol's solution) and prophylthiuracil (PTU). The nurse would expect the client's symptoms to subside:

D. In 1 to 2 weeks

100. On the third day after a partial thyroidectomy, a client exhibits muscle twitching and hyperirritability of the nervous system. When questioned, the client reports numbness and tingling of the mouth and fingertips. Suspecting a life threatening electrolyte disturbance, the nurse notifies the surgeon immediately. Which electrolyte disturbance most commonly follows thyroid surgery?

B. Hypocalcemia