NP4

SITUATION I: Aretha is a nurse researcher in a tertiary hospital. She is tasked to conduct a research on the effects of structured discharge plan for post-open heart surgery patients.

1. She states the significance of the research problem. Which of the following statements is the MOST significant for this study?

A. Improvement in patient care

2. Regardless of the significance of the study, the feasibility of the study needs to be considered. Which of the following is considered a priority?

A. Availability of research subjects

3. Aretha knows that a good research problem exhibits the following characteristics; which one is NOT included?

D. Indicates the hypothesis to be tested.

4. She states the purposes of the study. Which of the following describe the purpose of a study?

1. Establishes the general direction of a study
2. Captures the essence of the study of the study
3. Formally articulates the goals
4. Sometimes worded as an intent

D. 1, 2, 3, 4

5. She opts to use interviews in data collection. In addition to validity, what is the other MOST serious weakness of this method?

C. Objectivity

SITUATION II: Child abuse

6. Mindy, 4 years old is brought to the clinic with a high fever. She has been irritable for several days and is clinging to two dolls, and her mother says she refuses to eat. While performing an initial assessment, the nurse makes several observations that may indicate that Mindy is a victim of child abuse. Children like Mindy is usually abused by?

B. Relative

7. The child least at risk for being abused is one whose family

B. Owns their own home

8. Which test is least likely to indicate that Mindy has been sexually abused

B. Urine culture

9 . When interviewing a child suspected of being sexually abused, the nurse should

D. Use the child's words to describe body parts

10. Children who survive physical abuse are least likely to become

D. Academic achievers

SITUATION III: Care for various clients

11. A hospitalized client exhibits all of the following symptoms: excessive yawning, drowsiness, impaired memory, crying, and depression. The nurse would suspect which of the following problems?

A. Sensory deprivation

12. In planning nursing care to prevent pressure ulcers in the bedridden client, the nurse should include which of the following interventions?

B. Turn and position the client b.id.

13. A nurse preceptor overhears a group of student nurses discussing techniques for dressing changes. The nurse concludes that the student who needs to review the skill is the one who makes which of the following statements?

B. "To remove the used dressing, I should wear sterile gloves."

14. A client with a hearing impairment is admitted to a busy hospital unit. Which intervention is most important for the nurse to employ to meet the client's needs while preventing sensory overload?

B. Address the client directly and face the client during the conversation.

15. 78-year-old visually impaired client is admitted to the nursing unit. Which of the following interventions selected by the nurse would be most appropriate in reducing sensory deprivation?

A. Partially close window shades to reduce glare.

SITUATION IV: Basic hospital policies

16. On the traffic light, yellow means "proceed with caution". In the field of healthcare, where do you discard your used tissue papers?

D. Black bin

17. Biodegradable materials like foods and foodstuff, soap, papers and special biodegradable food packaging are all disposed in what bin?

C. Green bin

18. Radioactive waste, such as feces and urine from a person undergoing brachytherapy as well as radioactive strontium rods are all disposed in what bin?

A. Yellow bin with radioactive waste signage

19. Oxygen tanks are also color coded to prevent errors of administering compressed air instead of oxygen. In the operating room as well as in any health care settings, the typical color of these oxygen tanks are:

D. Green

20. While Air is colored:

B. Yellow

SITUATION V: CLIENTS SUFFERING FROM VARIOUS ENDOCRINE DISORDERS:


21. Which of the following is the priority nursing implementation for a client with a tumor of the posterior lobe of the pituitary gland that has had a urine output of 3 liters in the last hour with a specific gravity of 1.002?

C. Administer Pitressin Tannate as ordered

22. A patient has a diagnosis of Syndrome of Inappropriate secretion of Antidiuretic hormone (SIADH). For which of the following manifestations would a nurse monitor this patient?

B. Hyponatremia

23. Which of the following actions should a nurse include in the care plan for a patient who has water intoxication?

A. Measure urine specific gravity

24. Which of the following measures would a nurse include in the care plan of a patient who has Syndrome of Inappropriate secretion of Antidiuretic hormone(SIADH)?

D. Increasing sodium intake

25. A patient who has a pituitary adenoma is scheduled for transphenoidal hypophysectomy. A nurse is teaching the patient about what to expect on the immediate post-operative period. Which of these statements by the nurse would be accurate?

D. "You will be unable to brush your teeth"

26. Which of these questions should a nurse ask a patient who is suspected of having acromegaly?

B. "Are you buying large size shoes"

27. The following are the most common feared complications of acromegaly. Select all that apply.

1. Diabetes insipidus
2. Diabetes Mellitus
3. Blindness
4. Hypocalcemia

C. 2 and 3 only

28. Which of the following findings in a paient taking Levothyroxine Sodium (Synthroid) for hypothyroidism would indicate that the medication is producing the desired effect?

C. Increased alertness

29. Methimazole(Tapazole) is ordered for a patient with hyperthyroidism. The nurse should instruct the patient to:

B. Contact the doctor if a sore throat develops

30. Mr. Ojeras who has undergone a thyroidectomy would be predisposed to the development of:

A. Hypocalcemia

31. Which of the following nursing diagnosis would be specific to planning care for a patient with hypothyroidism?

A. Altered thought process

32. Which of the following oral calcium supplement is readily absorbed by the bloodstream?

B. Calcium gluconate

33. The following are the signs and symptoms of acute tetany except:

C. Photophobia

34. A client is suffering from hypoparathyroidism. The following menu choices is recommended. Select all that apply.

1. Anchovies
2. Lean meat
3. Green turnips
4. Salmon

B. 2, 3 and 4

35. In an individual with the diagnosis of hypoparathyroidism. The nurse will assess for which primary symptoms?

C. Tetany

36. A patient with hyperparathyroidism has a tendency to develop?

C. Renal calculi

37. Which of the following parameters should be given priority when caring for a patient with hypoadrenalism (Addison's disease)?

C. Measuring blood pressure

38. A nurse would assess a patient who has adrenal insufficiency for signs of Addison's disease that includes:

C Melanosis

39. A patient who has Cushing's disease is to have an exploratory laparotomy. Post-operatively the patient is at risk for:

D. Poor wound healing.

SITUATION VI: CLIENT SUFFERING FROM BURNS:

40. Jeffrey suffered from burn injury. Using the rule of nines, which has the largest percent of burns?

D. Upper trunk

41. Nurse Ferdie is assessing a client admitted with second and third degree burns on the face, arms, and chest. Which finding indicates a potential problem?

B. Urine output of 20ml/hour

42. Which of the following can be fatal complication of upper airway burms?

D. Laryngeal spasm and swelling

43. During the first 24 hours after thermal injury, you should assess the client for:

C. Hyperkalemia and hyponatremia

44. A client who sustained deep partial thickness and full thickness burns of the face, whole anterior chest and both upper extremities two days ago begins to exhibit extreme restlessness. You recognize that this most likely indicates that the client is developing:

A. Cerebral hypoxia

SITUATION VII: Client suffering from Hodgkin's disease

45. A patient is admitted to the oncology unit for diagnosis is suspected Hodgkin's disease. Which of the following symptoms is typical of Hodgkin's disease?

B. Night sweats and fatigue.

46. The Hodgkin's disease patient described in the question above undergoes a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin's disease were correct, which of the following cell would the pathologist expect to find?

A. Reed-Sternberg cells.

47. The nurse understands that Hodgkin's disease is suspected when a client presents with a painless, swollen lymph node. Hodgkin's disease typically affects people in which age group?

A. Children (ages 6-12 years)

C. Young adults (ages 21-40)

48. A male client is admitted to the hospital with a suspected diagnosis of Hodgkin's disease. Which assessment findings would the nurse expect to note specifically in the client?

D. Enlarged lymph nodes

49. The nurse is aware that the following symptoms is most commonly an early indication of stage 1 Hodgkin's disease?

B. Night sweat

50. Upon Susan's admission to the CCU, oxygen was ordered. The primary purpose of oxygen administration in this case is to:

D. Increase oxygen concentration in the myocardium

51. What is the narcotic of choice in this situation?

A. Morphine sulfate

52. Susan was transferred to the CCU after an ECG indicated an inferior wall infarction. Upon arriving at the unit, she complained of chest pains. Which of the following is not a characteristics of pain of an acute MI?

B. Relieved by nitroglycerin

SITUATION IX: Another patient named Selina, 40 years old, is being monitored in the CCU for possible complications of heart attack.

53. The nurse knows that the most dangerous time for the client following an MI is:

A. The first 24 to 48 hours

54. Selina experiences a cardiac arrest. What should be the first nursing in this situation?

C. Start chest compression

SITUATION X: Mang Julio, 50 years old, is experiencing severe dyspnea which often awakens him at night. It is associated with crackles and expectoration of frothy sputum. He is admitted in the hospital and was diagnosed with congestive heart failure complicated by pulmonary edema.

55. One of the characteristic signs of congestive heart failure is dyspnea. This is due to:

C. Accumulation of serous fluid in alveolar space

56. Left sided CHF is most often associated with which of the following sign or symptom?

A. Dyspnea

57. The nurse administers oxygen inhalation as ordered. The patient would be most comfortable with oxygen set at:

A. 2 to 4 liters

SITUATION XI: James, age 46, os the president fa major corporation. He comes to the hospital complaining of
abdominal pain. He is admitted with a suspected peptic ulcer.

58. The nurse is completing James' initial assessment. Which physical examination technique is used when assessing the abdomen?

B. Auscultation

59. If James is diagnosed with a gastric ulcer, the nurse would expect the pain to occur:

C. In the epigastric area

60. James' doctor prescribes sucralfate (Carafate). The nurse knows that the sucralfate is given to:

A. Prevent additional bleeding

D. Protect the ulcer's surface by forming a barrier

61. A nurse is preparing to teach James about the diet that should be followed after discharge. The nurse should explain that the diet will most likely consist of the following:

A. Bland foods

62. James is prescribed with Ranitidine (Zantac) as his home medication. The nurse should instruct James to take this medication:

A. At bedtime

SITUATION XII: Nurse MIke attends a Health Education Class on Colostomy Care. The following are taken up: Types of ostomies, indication, and care.

63. During the initial postoperative period, which of the following observations in the client's stoma should be reported immediately to the physician?

B. The stoma is dark red to purple

64. A colostomy patient who wishes to avoid gas should be instructed about foods that help to reduce gas which include:

A. Yoghurt and crackers

65. The following are appropriate nursing interventions during colostomy irrigation except

C. Increase the irrigation solution flow rate when abdominal cramps are left

66. What sensation is used as a gauge so that patients with ileostomy can determine how often their pouch should be drained?

D. Sensation of pressure

SITUATION XIII: Mang Jose has a history of long standing COPD, but present with edema of the kegs and feet, distended neck veins and large palpable liver.

67. Mang Jose is most likely suffering from:

C. Cor pulmonale

68. Which finding would the nurse expect to find in Mang Jose?

C. Increased chest diameter

69. Mang Jose's arterial blood gases in admission were: pH - 7.4, p02-60, PCO2: 70, bicarbonate is 30. These values are indicative of which of the following conditions:

B. Compensated Respiratory acidosis

70. As the nurse enters Mang Jose's room, his oxygen is running at 6 Imp, his color is pink, and his RR is 8, what is the best initial action?

C. Lower the oxygen rate

71. Mang Jose asks the nurse why he needs to use pursed-lip breathing. The nurse knows that the primary purpose of pursed-lip breathing is:

A. Prolonged exhalation helps prevent air trapping

SITUATION XIV: Organ donation is a new form of treatment that multiple complication such as rejection.

72. Organ donation to save life was initially with the first transplant done by:

A. Dr. Christian Barnard of the Union of South Africa

73. In 1983, the FDA approved the first anti-rejection drug by the name of:

A. Cyclosporine

74. You would expect that in cases of organ donation, you would expect that the immunosuppressant medications such as Cyclosporine, Prednisone and Imuran are taken:

D. For the rest of the client's life

75. Which of the following is a sign that the transplanted kidney is being rejected?

D. Anuria, Fever, Weight gain and Hematuria

76. Among children candidates for organ transplant, when all selected children have appropriate tissue matches for the same donated organ, the basis for the decision as to which child gets the organ is given to the child who:

A. Will receive the most benefit from the new organ

SITUATION XV: Mr. Roberto was long diagnosed with chronic renal failure. You are his nurse and the following question assesses your knowledge in the different fluid and electrolyte imbalances that are associated with chronic renal failure.

77. Disequilibrium syndrome is always a risk in all clients undergoing hemodialysis for chronic renal failure. The nurse should assess Mr. Roberto for which of the following sign and symptom associated with Disequilibrium syndrome?

D. Headache, deteriorating level of consciousness and twitching

78. After Mr. Roberto completed his hemodialysis, the nurse should use which indicators to evaluate the client's status after dialysis?

D. Vital signs and weight

79. Mr. Roberto's chronic renal failure was caused by a crush injury to the lower leg right after the accident. The acute renal failure until now, his case is irreversible. The nurse is correct in determining that the cause of Mr. Roberto's
Acute renal failure before was:

A. Prerenal

80. Mr. Roberto misses 2 sessions of hemodialysis. Blood was drawn and is sent for analysis. Which electrolyte disturbances is expected in a client with chronic renal failure?

B. Hyperkalemia

81. In Mr. Roberto's ECG tracing, you would expect to find:

C. A peaked T wave

SITUATION XVI: Client in Various Clinical Settings

82. A client is admitted to the health care facility with a diagnosis of a bleeding gastric ulcer. The nurse expects this client's stools to be:

A. Coffee-ground-like

83. A client is admitted with increased ascites related to cirrhosis. Which nursing diagnosis should receive top priority?

B. Excessive fluid volume

84. A client comes to the emergency department complaining of acute GI distress. When obtaining the client's history, the nurse inquires about the family history. Which disorder has a familial basis?

C. Ulcerative colitis

85. A client with severe abdominal pain is being evaluated for appendicitis. What is the most common cause of appendicitis?

B. Obstruction of the appendix

86. The nurse is performing would care. Which of the following practices violates surgical asepsis?

C. Pouring solution onto a sterile field cloth

87. The nurse is teaching a client with pernicious anemia who requires vitamin B12 replacement therapy. Which statement indicates that the client understands the treatment program?

C. "I'll need an injection of vitamin B12 every month for life."

88. A nurse who is caring for a 32-year old client admitted with pernicious anemia. Which set of findings should the nurse expect when assessing the client?

B. Pallor, tachycardia, and a sore tongue

89. The nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice?

C. Clay-colored stools

90. The physician prescribes pentoxifylline (Trental), 400 me three time daily with meals, for a client with intermittent claudication and a history of adult-onset diabetes mellitus. The nurse knows that pentoxifylline is a:

D. Blood viscosity-reducing agent

91. The most important reason for the nurse to encourage a client with peripheral vascular disease to initiate a walking program is because this form of exercise:

D. Promotes collateral circulation

92. The nurse is developing a teaching plan for a client with diabetes mellitus. A client with diabetes mellitus should:

C. Wash and inspect the feet daily

93. The nurse is assessing a client who is receiving total parenteral nutrition (TPN). Which finding suggests that the client has developed hyperglycemia?

B. Increased urine output

94. A client with mild diarrhea, fever, and abdominal discomfort is being evaluated for inflammatory bowel disease (IBD). Which statement about IBD is true?

A. Diarrhea is the most common sign of IBD

95. When caring for a client with hepatitis B, the nurse should monitor closely for the development of which finding associated with a decrease in hepatic function?

A. Jaundice

96. When planning care for a client with a small-bowel obstruction the nurse should consider the primary goal to be:

B. Maintaining fluid balance

97. Who holds the packet flaps of sutures to open it and place it in the sterile table for use?

A. Scrub nurse

98. The operating room is divided into three areas, the unrestricted, the semi restricted and the restricted areas. Where is the operating room?

A. Restricted

99. One of the hidden dangers in the OR is missing instruments. What is the appropriate approach to his happening?

B. "a place for everything and everything in its place"

100. In patients with acute pancreatitis, the administration of the analgesic morphine may cause:

D. Spasms of the sphincter of Oddi