1. A nurse is
administering IV furosemide to a patient admitted with congestive heart
failure. After the infusion, which of the following symptoms is NOT expected?
A.
Increased urinary output.
B.
Decreased edema.
C.
Decreased pain.
D.
Decreased blood pressure.
2. There are a number
of risk factors associated with coronary artery disease. Which of the following
is a modifiable risk factor?
A.
Obesity.
B.
Heredity.
C.
Gender.
D.
Age.
3. Tissue plasminogen
activator (t-PA) is considered for treatment of a patient who arrives in the
emergency department following onset of symptoms of myocardial infarction.
Which of the following is a contraindication for treatment with t-PA?
A.
Worsening chest pain that began earlier in the evening.
B.
History of cerebral hemorrhage.
C.
History of prior myocardial infarction.
D.
Hypertension.
4. Following
myocardial infarction, a hospitalized patient is encouraged to practice
frequent leg exercises and ambulate in the hallway as directed by his
physician. Which of the following choices reflects the purpose of exercise for
this patient?
A.
Increases fitness and prevents future heart attacks.
B.
Prevents bedsores.
C.
Prevents DVT (deep vein thrombosis).
D.
Prevent constipations.
5. A patient arrives
in the emergency department with symptoms of myocardial infarction, progressing
to cardiogenic shock. Which of the following symptoms should the nurse expect
the patient to exhibit with cardiogenic shock?
A.
Hypertension.
B.
Bradycardia.
C.
Bounding pulse.
D.
Confusion.
6. A patient with a
history of congestive heart failure arrives at the clinic complaining of
dyspnea. Which of the following actions is the first the nurse should perform?
A.
Ask the patient to lie down on the exam table.
B.
Draw blood for chemistry panel and arterial blood gas (ABG).
C.
Send the patient for a chest x-ray.
D.
Check blood pressure.
7. A clinic patient
has recently been prescribed nitroglycerin for treatment of angina. He calls
the nurse complaining of frequent headaches. Which of the following responses
to the patient is correct?
A.
“Stop taking the nitroglycerin and see if the headaches
improve.”
B.
“Go to the emergency department to be checked because
nitroglycerin can cause bleeding in the brain.”
C.
“Headaches are a frequent side effect of nitroglycerine because
it causes vasodilation.”
D.
“The headaches are unlikely to be related to the nitroglycerin,
so you should see your doctor for further investigation.”
8. A patient received
surgery and chemotherapy for colon cancer, completing therapy 3 months
previously, and she is now in remission. At a follow-up appointment, she
complains of fatigue following activity and difficulty with concentration at
her weekly bridge games. Which of the following explanations could account for
her symptoms?
A.
The symptoms may be the result of anemia caused by chemotherapy.
B.
The patient may be immunosuppressed.
C.
The patient may be depressed.
D.
The patient may be dehydrated.
9. A clinic patient
has a hemoglobin concentration of 10.8 g/dL and reports sticking to a strict
vegetarian diet. Which of the follow nutritional advice is appropriate?
A.
The diet is providing adequate sources of iron and requires no
changes.
B.
The patient should add meat to her diet; a vegetarian diet is
not advised.
C.
The patient should use iron cookware to prepare foods, such as
dark green, leafy vegetables and legumes, which are high in iron.
D.
A cup of coffee or tea should be added to every meal.
10. A hospitalized
patient is receiving packed red blood cells (PRBCs) for treatment of severe
anemia. Which of the following is the most accurate statement?
A.
Transfusion reaction is most likely immediately after the
infusion is completed.
B.
PRBCs are best infused slowly through a 20g. IV catheter.
C.
PRBCs should be flushed with a 5% dextrose solution.
D.
A nurse should remain in the room during the first 15 minutes of
infusion.
11. A patient who has
received chemotherapy for cancer treatment is given an injection of Epoetin.
Which of the following should reflect the findings in a complete blood count
(CBC) drawn several days later?
A.
An increase in neutrophil count.
B.
An increase in hematocrit.
C.
An increase in platelet count.
D.
An increase in serum iron.
12. A patient is admitted
to the hospital with suspected polycythemia vera. Which of the following
symptoms is consistent with the diagnosis?
A.
Weight loss.
B.
Increased clotting time.
C.
Hypertension.
D.
Headaches.
13. A nurse is caring
for a patient with a platelet count of 20,000/microliter. Which of the
following is an important intervention?
A.
Observe for evidence of spontaneous bleeding.
B.
Limit visitors to family only.
C.
Give aspirin in case of headaches.
D.
Impose immune precautions.
14. A nurse in the
emergency department assesses a patient who has been taking long-term
corticosteroids to treat renal disease. Which of the following is a typical
side effect of corticosteroid treatment? Note: More than one answer may be
correct.
A.
Hypertension.
B.
Cushingoid features.
C.
Hyponatremia.
D.
Low serum albumin.
15. A nurse is caring
for patients in the oncology unit. Which of the following is the most important
nursing action when caring for a neutropenic patient?
A.
Change the disposable mask immediately after use.
B.
Change gloves immediately after use.
C.
Minimize patient contact.
D.
Minimize conversation with the patient.
16. A patient is
undergoing the induction stage of treatment for leukemia. The nurse teaches
family members about infectious precautions. Which of the following statements
by family members indicates that the family needs more education?
A.
We will bring in books and magazines for entertainment.
B.
We will bring in personal care items for comfort.
C.
We will bring in fresh flowers to brighten the room.
D.
We will bring in family pictures and get well cards.
17. A nurse is caring
for a patient with acute lymphoblastic leukemia (ALL). Which of the following
is the most likely age range of the patient?
A.
3-10 years.
B.
25-35 years.
C.
45-55 years.
D.
over 60 years.
18. A patient is
admitted to the oncology unit for diagnosis of suspected Hodgkin’s disease.
Which of the following symptoms is typical of Hodgkin’s disease?
A.
Painful cervical lymph nodes.
B.
Night sweats and fatigue.
C.
Nausea and vomiting.
D.
Weight gain.
19. 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 cells would the pathologist expect to find?
A.
Reed-Sternberg cells.
B.
Lymphoblastic cells.
C.
Gaucher’s cells.
D.
Rieder’s cells
20. A patient is about
to undergo bone marrow aspiration and biopsy and expresses fear and anxiety
about the procedure. Which of the following is the most effective nursing
response?
A.
Warn the patient to stay very still because the smallest
movement will increase her pain.
B.
Encourage the family to stay in the room for the procedure.
C.
Stay with the patient and focus on slow, deep breathing for
relaxation.
D.
Delay the procedure to allow the patient to deal with her
feelings.
21. A 6-year-old child
with leukemia is hospitalized and is receiving combination chemotherapy.
Laboratory results indicate that the child is neutropenic, and the nurse
prepares to implement protective isolation procedures. Which interventions
would the nurse initiate? Select all that apply.
A.
Restrict all visitors.
B.
Place the child on a low-bacteria diet.
C.
Change dressings using sterile technique.
D.
Encourage the consumption of fresh fruits and vegetables.
E.
Perform meticulous hand washing before caring for the child.
F.
Allow fresh-cut flowers in the room as long as they are kept in
a vase with fresh water.
22. A 16-year-old
child is brought to the emergency department by his mother with a complaint
that the child just experienced a tonic-clonic seizure. On arrival in the
emergency department no apparent seizures were occurring. The mother states
that her son is taking medication for the seizure disorder. The nurse plans
care, knowing that which of the following medications are used for long-term control
of tonic-clonic seizures? Select all that apply.
A.
Diazepam (Valium)
B.
Alprazolam (Xanax)
C.
Gabapentin (Neurontin)
D.
Ethosuximide (Zarontin)
E.
Carbamazepine (Tegretol)
F.
Methylphenidate (Ritalin)
23. A child has been
diagnosed with meningococcal meningitis. Which of the following isolation
techniques is appropriate?
A.
Enteric precautions
B.
Neutropenic precautions
C.
No precautions are required as long as antibiotics have been
started.
D.
Isolation precautions for at least 24 hours after the initiation
of antibiotics
24. A client enters
the emergency department confused, twitching, and having seizures. His family
states he recently was placed on corticosteroids for arthritis and was feeling
better and exercising daily. On data collection, he has flushed skin, dry
mucous membranes, an elevated temperature, and poor skin turgor. His serum
sodium level is 172 mEq/L. Choose the interventions that the health care
provider would likely prescribe. Select all that apply.
A.
Monitor intake and output.
B.
Monitor vital signs.
C.
Maintain sodium-reduced diet.
D.
Monitor electrolyte levels.
E.
Increase water intake orally.
F.
Administer sodium replacements.
25. A client has died,
and a nurse asks a family member about the funeral arrangements. The family
member refuses to discuss the issue. The nurse’s appropriate action is to:
A.
Show acceptance of feelings.
B.
Provide information needed for decision making.
C.
Suggest a referral to a mental health professional.
D.
Remain with the family member without discussing funeral
arrangements.
Answers and Rationales
1.
Answer: C. Furosemide, a loop diuretic, does not alter pain. Furosemide
acts on the kidneys to increase urinary output. Fluid may move from the
periphery, decreasing edema. Fluid load is reduced, lowering blood pressure.
2.
Answer: A. Obesity is an important risk factor for coronary artery disease
that can be modified by improved diet and weight loss. Family history of
coronary artery disease, male gender, and advancing age increase risk but
cannot be modified.
3.
Answer: B. A history of cerebral hemorrhage is a contraindication to tPA
because it may increase the risk of bleeding. TPA acts by dissolving the clot
blocking the coronary artery and works best when administered within 6 hours of
onset of symptoms. Prior MI is not a contraindication to tPA. Patients
receiving tPA should be observed for changes in blood pressure, as tPA may
cause hypotension.
4.
Answer: C. Exercise is important for all hospitalized patients to prevent
deep vein thrombosis. Muscular contraction promotes venous return and prevents
hemostasis in the lower extremities. This exercise is not sufficiently vigorous
to increase physical fitness, nor is it intended to prevent bedsores or
constipation.
5.
Answer: D. Cardiogenic shock severely impairs the pumping function of the
heart muscle, causing diminished blood flow to the organs of the body. This
results in diminished brain function and confusion, as well as hypotension,
tachycardia, and weak pulse. Cardiogenic shock is a serious complication of
myocardial infarction with a high mortality rate.
6.
Answer: D. A patient with congestive heart failure and dyspnea may have
pulmonary edema, which can cause severe hypertension. Therefore, taking the
patient’s blood pressure should be the first action. Lying flat on the exam
table would likely worsen the dyspnea, and the patient may not tolerate it.
Blood draws for chemistry and ABG will be required, but not prior to the blood
pressure assessment.
7.
Answer: C. Nitroglycerin is a potent vasodilator and often produces
unwanted effects such as headache, dizziness, and hypotension. Patients should
be counseled, and the dose titrated, to minimize these effects. In spite of the
side effects, nitroglycerine is effective at reducing myocardial oxygen
consumption and increasing blood flow. The patient should not stop the
medication. Nitroglycerine does not cause bleeding in the brain.
8.
Answer: A. Three months after surgery and chemotherapy the patient is
likely to be feeling the after-effects, which often includes anemia because of
bone-marrow suppression. There is no evidence that the patient is
immunosuppressed, and fatigue is not a typical symptom of immunosuppression.
The information given does not indicate that depression or dehydration is a
cause of her symptoms.
9.
Answer: C. Normal hemoglobin values range from 11.5-15.0. This vegetarian
patient is mildly anemic. When food is prepared in iron cookware its iron
content is increased. In addition, dark green leafy vegetables, such as spinach
and kale, and legumes are high in iron. Mild anemia does not require that
animal sources of iron be added to the diet. Many non-animal sources are
available. Coffee and tea increase gastrointestinal activity and inhibit
absorption of iron.
10. Answer: D. Transfusion reaction
is most likely during the first 15 minutes of infusion, and a nurse should be
present during this period. PRBCs should be infused through a 19g or larger IV
catheter to avoid slow flow, which can cause clotting. PRBCs must be flushed
with 0.45% normal saline solution. Other intravenous solutions will hemolyze
the cells.
11. Answer: B. Epoetin is a form of
erythropoietin, which stimulates the production of red blood cells, causing an
increase in hematocrit. Epoetin is given to patients who are anemic, often as a
result of chemotherapy treatment. Epoetin has no effect on neutrophils,
platelets, or serum iron.
12. Answer: B, C, and D. Polycythemia vera is a
condition in which the bone marrow produces too many red blood cells. This
causes an increase in hematocrit and viscosity of the blood. Patients can
experience headaches, dizziness, and visual disturbances. Cardiovascular
effects include increased blood pressure and delayed clotting time. Weight loss
is not a manifestation of polycythemia vera.
13. Answer: A. Platelet counts under
30,000/microliter may cause spontaneous petechiae and bruising, particularly in
the extremities. When the count falls below 15,000, spontaneous bleeding into
the brain and internal organs may occur. Headaches may be a sign and should be
watched for. Aspirin disables platelets and should never be used in the
presence of thrombocytopenia. Thrombocytopenia does not compromise immunity,
and there is no reason to limit visitors as long as any physical trauma is
prevented.
14. Answer: A, B, and D. Side effects of
corticosteroids include weight gain, fluid retention with hypertension, Cushingoid
features, a low serum albumin, and suppressed inflammatory response. Patients
are encouraged to eat a diet high in protein, vitamins, and minerals and low in
sodium. Corticosteroids cause hypernatremia, not hyponatremia.
15. Answer: B. The neutropenic patient
is at risk of infection. Changing gloves immediately after use protects
patients from contamination with organisms picked up on hospital surfaces. This
contamination can have serious consequences for an immunocompromised patient.
Changing the respiratory mask is desirable, but not nearly as urgent as
changing gloves. Minimizing contact and conversation are not necessary and may
cause nursing staff to miss changes in the patient’s symptoms or condition.
16. Answer: C. During induction
chemotherapy, the leukemia patient is severely immunocompromised and at risk of
serious infection. Fresh flowers, fruit, and plants can carry microbes and
should be avoided. Books, pictures, and other personal items can be cleaned
with antimicrobials before being brought into the room to minimize the risk of
contamination.
17. Answer: A. The peak incidence of
ALL is at 4 years (range 3-10). It is uncommon after the mid-teen years. The
peak incidence of chronic myelogenous leukemia (CML) is 45-55 years. The peak
incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-thirds of
cases of chronic lymphocytic leukemia (CLL) occur after 60 years.
18. Answer: B. Symptoms of Hodgkin’s
disease include night sweats, fatigue, weakness, and tachycardia. The disease
is characterized by painless, enlarged cervical lymph nodes. Weight loss occurs
early in the disease. Nausea and vomiting are not typically symptoms of
Hodgkin’s disease.
19. Answer: A. A definitive diagnosis
of Hodgkin’s disease is made if Reed-Sternberg cells are found on pathologic
examination of the excised lymph node. Lymphoblasts are immature cells found in
the bone marrow of patients with acute lymphoblastic leukemia. Gaucher’s cells
are large storage cells found in patients with Gaucher’s disease. Rieder’s
cells are myeloblasts found in patients with acute myelogenous leukemia.
20. Answer: C. Slow, deep breathing
is the most effective method of reducing anxiety and stress. It reduces the
level of carbon dioxide in the brain to increase calm and relaxation. Warning
the patient to remain still will likely increase her anxiety. Encouraging
family members to stay with the patient may make her worry about their anxiety
as well as her own. Delaying the procedure is unlikely to allay her fears.
21. Answer: B, C, and
E. For the hospitalized neutropenic child, flowers or plants should not be
kept in the room because standing water and damp soil harbor Aspergillus and
Pseudomonas, to which these children are very susceptible. Fruits and
vegetables not peeled before being eaten harbor molds and should be avoided
until the white blood cell count rises. The child is placed on a low-bacteria
diet. Dressings are always changed with sterile technique. Not all visitors
need to be restricted, but anyone who is ill should not be allowed in the child’s
room. Meticulous hand washing is required before caring for the child. In
addition, gloves, a mask, and a gown are worn (per agency policy).
22. Answers: C, D, and
E. Medications that are prescribed for long-term control of tonic-clonic
seizures are gabapentin, ethosuximide, and carbamazepine. Diazepam is a
medication that is prescribed to halt tonic-clonic episodes, and
methylphenidate is a medication used to treat attention deficit hyperactivity
disorder. Both of these medications are not suitable for long-term control of a
seizure condition. Alprazolam is a medication used to treat anxiety.
23. Answer: D. Meningococcal
meningitis is transmitted primarily by droplet infection. Isolation is begun
and maintained for at least 24 hours after antibiotics are given. Other
options are incorrect.
24. Answers: A, B, C, D,
and E. Hypernatremia is described as having a serum sodium level that
exceeds 145 mEq/L. Signs and symptoms would include dry mucous membranes, loss
of skin turgor, thirst, flushed skin, elevated temperature, oliguria, muscle
twitching, fatigue, confusion, and seizures. Interventions include monitoring
fluid balance, monitoring vital signs, reducing dietary intake of sodium,
monitoring electrolyte levels, and increasing oral intake of water. Sodium
replacement therapy would not be prescribed for a client with hypernatremia.
25. Answer: D. The
family member is exhibiting the first stage of grief (denial), and the nurse
should remain with the family member.Showing acceptance of feelings is an
appropriate intervention for the acceptance or reorganization and restitution
stage.Providing information needed for decision making may be an appropriate
intervention for the bargaining stage.Suggesting a referral to a mental health
professional may be an appropriate intervention for depression.
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