Prof. Exam in Medicine Part I

EXAM 1 1.) THE NURSE IS DEVELOPING A PLAN OF CARE FOR A CLIENT DIAGNOSED WITH ACUTE KIDNEY INJURY. WHICH STATEMENT IS AN APPROPRIATE OUTCOME FOR THE CLIENT? ● ELECTROLYTES ARE WNL 2.) WHICH TYPE OF PRECAUTION SHOULD THE NURSE IMPLEMENT TO PROTECT FROM BEING EXPOSED TO ANY OF THE HEPATITIS VIRUSES? ● STANDARD PRECAUTIONS 3.) A CLIENT DIAGNOSED WITH PROSTATE CANCER IS BEING TREATED WITH LUTEINIZING HORMONE RELEASING HORMONE AGONIST THERAPY. WHICH STATEMENT BY THE CLIENT INDICATES HE UNDERSTANDS THE TREATMENT? ● I MAY HAVE HOT FLASHES WHILE TAKING THIS DRUG 4.) A CLIENT WITH END-STAGE LIVER DISEASE IS BEING TREATED FOR ASCITES. WHICH MEDICATION WOULD BE CONSIDERED FIRST LINE IN THE CLIENT’S TREATMENT? ● SPIRONOLACTONE 5.) THE CLIENT DIAGNOSED WITH ACUTE KIDNEY INJURY IS ADMITTED TO THE INTENSIVE CARE DEPARTMENT AND PLACED ON A THERAPEUTIC DIET. WHICH DIET IS MOST APPROPRIATE FOR THE CLIENT? ● HIGH CARB AND RESTRICTED PROTEIN DIET 6.) THE CLIENT DIAGNOSED WITH LIVER FAILURE IS EXPERIENCING PRURITUS SECONDARY TO SEVERE JAUNDICE AND IS SCRATCHING THE UPPER EXTREMITIES. WHICH INTERVENTION SHOULD THE REGISTERED NURSE IMPLEMENT FIRST? ● APPLY MITTENS 7.) THE UAP TELLS THE REGISTERED NURSE A CLIENT WHO HAD A LAPAROSCOPIC CHOLECYSTECTOMY IS REPORTING ABDOMINAL PAIN. WHICH INTERVENTION SHOULD THE RN IMPLEMENT FIRST? ● ASSESS THE CLIENT TO RULE OUT ANY POST OP SURGICAL COMPLICATIONS 8.) A CLIENT DIAGNOSED WITH VIRAL HEPATITIS IS COMPLAINING OF “NO APPETITE” AND “LOSING MY TASTE FOR FOOD.” WHAT INSTRUCTION WOULD THE NURSE GIVE THE CLIENT TO PROVIDE ADEQUATE NUTRITION? ● INCREASE INTAKE OF FLUIDS, INCLUDING JUICES 9.) THE CLIENT IS ADMITTED WITH END STAGE LIVER FAILURE AND IS PRESCRIBED THE LAXATIVE LACTULOSE. DURING DISCHARGE INSTRUCTIONS, WHICH STATEMENT INDICATES THE CLIENT NEEDS MORE TEACHING CONCERNING THIS MEDICATION ● “I MUST CHECK MY AMMONIA LEVEL THREE TIMES A DAY” 10.) THE NURSE IS ASSESSING A CLIENT WHO IS EXPERIENCING AN ACUTE EPISODE OF CHOLECYSTITIS. WHICH OF THESE CLINICAL MANIFESTATIONS SUPPORT THIS DIAGNOSE? SELECT ALL THAT APPLY - FEVER, - COMPLAINT OF INDIGESTION, - PAIN IN THE RUQ AFTER A FATTY MEAL 11.) THE CLIENT WITH A TRANSURETHRAL RESECTION OF THE PROSTATE WHO HAS A CONTINUOUS IRRIGATION CATHETER COMPLAINS OF THE NEED TO URINATE. WHICH INTERVENTION SHOULD THE NURSE IMPLEMENT FIRST? ● Assess the continuous irrigation catheter for patency 12.) A CLIENT IS ADMITTED TO THE HOSPITAL WITH A DIAGNOSIS OF BENIGN PROSTATIC HYPERTROPHY, AND TRANSURETHRAL RESECTION OF THE PROSTATE IS PERFORMED. FOUR HOURS AFTER SURGERY, THE NURSE TAKES THE CLIENT’S VITAL SIGNS AND EMPTIES THE URINARY DRAINAGE BAG. WHICH ASSESSMENT FINDING INDICATES THE NEED TO NOTIFY THE PRIMARY HEALTH CARE PROVIDER? ● BP 100/50, PULSE 130 BPM 13.) THE NURSE IS CARING FOR THE CLIENT DIAGNOSED WITH HEPATIC ENCEPHALOPATHY. WHICH SIGN AND SYMPTOMS INDICATE THE DISEASE IS PROGRESSING? ● THE CLIENT IS UNABLE TO CIRCLE CHOICES ON THE MENU 14.) THE CLIENT NEWLY DIAGNOSED WITH CHRONIC KIDNEY DISEASE RECENTLY HAS BEGUN HEMODIALYSIS. KNOWING THAT THE CLIENT IS AT RISK FOR DISEQUILIBRIUM SYNDROME, THE NURSE WOULD ASSESS THE CLIENT DURING DIALYSIS FOR WHICH ASSOCIATED MANIFESTATIONS? ● H/A, DETERIORATING LOC, AND TWITCHING 15.) THE NURSE IS REVIEWING THE RECORD OF A CLIENT WITH A DIAGNOSIS OF CIRRHOSIS AND NOTES THAT THERE IS DOCUMENTATION OF THE PRESENCE OF ASTERIXIS. HOW WOULD THE NURSE ASSESS FOR ITS PRESENCE? ● ASK CLIENT TO EXTEND ARMS 16.) THE NURSE IS TEACHING MEN ABOUT EARLY DETECTION OF PROSTATE CANCER ACCORDING TO THE AMERICAN CANCER SOCIETY GUIDELINES. WHICH SHOULD THE NURSE TEACH THE CLIENTS? ● PSA 17.) A CLIENT HAS DEVELOPED HEPATITIS (A) AFTER EATING CONTAMINATED OYSTERS. THE NURSE ASSESSES THE CLIENT FOR WHICH EXPECTED ASSESSMENT? ● MALAISE 18.) THE NURSE IS CARING FOR THE IMMEDIATE POSTOPERATIVE CLIENT WHO HAD A LAPAROSCOPIC CHOLECYSTECTOMY. WHICH TASK COULD THE NURSE DELEGATE TO THE UNLICENSED ASSISTIVE PERSONNEL (UAP)? ● AMBULATE THE CLIENT TO THE BATHROOM 19.) THE NURSE HAS TAUGHT THE CLIENT WITH SUSPECTED GALL-BLADDER DISEASE ABOUT AN UPCOMING ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP) PROCEDURE. THE NURSE DETERMINES THAT THE CLIENT NEEDS FURTHER INFORMATION IF THE CLIENT MAKES WHICH STATEMENT? ● “ I’M GLAD I DON’T HAVE TO LIE STILL FOR THIS PROCEDURE.” 20.) THE NURSE EMPTIED 2000 ML FROM THE DRAINAGE BAG OF A CONTINUOUS IRRIGATION OF A CLIENT WHO HAD A TRANSURETHRAL RESECTION OF THE PROSTATE. AT THE BEGINNING OF THE SHIFT, THE AMOUNT OF IRRIGATION INFUSION HANGING WAS 3000 ML AND 1800 ML WAS LEFT IN THE BAG EIGHT HOURS LATER. WHAT IS THE URINE OUTPUT AT THE END OF THE EIGHT HOURS? - 3000-1800= 1200 mL - 2000- 1200= 800 mL 21.) THE CLIENT DIAGNOSED WITH HEPATITIS ASKS THE NURSE. “IS THERE ANY HERB I CAN TAKE TO HELP MY LIVER GET BETTER?” WHICH STATEMENT IS THE NURSE’S BEST RESPONSE? ● MILK THISTLE IS A POWERFUL OXIDANT AND PROMOTES LIVER CELL GROWTH 22.) A CLIENT WITH CHRONIC KIDNEY DISEASE RETURNS TO THE NURSING UNIT FOLLOWING A HEMODIALYSIS TREATMENT. ON ASSESSMENT, THE NURSE NOTES THAT THE CLIENT’S TEMPERATURE IS 101.2 F (38.5 C). WHICH NURSING ACTION IS MOST APPROPRIATE? ● NOTIFY THE HCP 23.) THE NURSE IS CARING FOR A CLIENT WITH CHRONIC KIDNEY DISEASE. THE CLIENT IS ON A FLUID RESTRICTION OF 1500 mL/day. ON THE 7AM-7PM SHIFT, THE CLIENT DRANK EIGHT OUNCES OF COFFEE, 4 OUNCES OF JUICE, 12 OUNCES OF TEA, AND 2 OUNCES OF WATER. WHAT AMOUNT OF FLUID CAN THE 7PM-7AM NURSE GIVE TO THE CLIENT? - 1 oz= 30 mL 8(30)= 240 4(30)= 120 12(30)= 360 2(30)= 60 240 + 120+360+60= 720mL 24.) A CLIENT WITH CHRONIC KIDNEY DISEASE IS RECEIVING EPOETIN ALPHA. WHICH LABORATORY RESULT WOULD INDICATE A THERAPEUTIC EFFECT OF THE MEDICATION? ● HEMATOCRIT OF 33% 25.) THE NURSE IS ADMITTED TO THE EMERGENCY DEPARTMENT AFTER A GUNSHOT WOUND TO THE ABDOMEN. WHICH NURSING INTERVENTION SHOULD THE NURSE IMPLEMENT FIRST TO PREVENT ACUTE KIDNEY INJURY (AKI)? ● ADMINISTER NORMAL SALINE IV OR IV FLUIDS 26.) THE CLIENT HAS END STAGE LIVER FAILURE SECONDARY TO ALCOHOLIC CIRRHOSIS. WHICH COMPLICATION INDICATES THE CLIENT IS AT RISK FOR DEVELOPING HEPATIC ENCEPHALOPATHY? ● GI BLEEDING 27.) A CLIENT WHO HAS A COLD IS SEEN IN THE EMERGENCY ROOM DEPARTMENT WITH AN INABILITY TO VOID. BECAUSE THE CLIENT HAS A HISTORY OF BENIGN PROSTATIC HYPERPLASIA, THE NURSE DETERMINES THAT THE CLIENT WOULD BE QUESTIONED ABOUT THE USE OF WHICH MEDICATION? ● DECONGESTANTS 28.) THE NURSE IS COLLECTING DATA FROM A CLIENT. WHICH SYMPTOM DESCRIBED BY THE CLIENT IS CHARACTERISTIC OF AN EARLY SYMPTOM OF BENIGN PROSTATIC HYPERPLASIA? ● DECREASED FORCE IN THE STREAM OF URINE 29.) A CLIENT ADMITTED TO THE HOSPITAL WITH A SUSPECTED DIAGNOSIS OF ACUTE PANCREATITIS IS BEING ASSESSED BY THE NURSE. WHICH ASSESSMENT FINDINGS WOULD BE CONSISTENT WITH ACUTE PANCREATITIS? SELECT ALL THAT APPLY - GRAY-BLUE COLOR AT THE FLANK ABDOMINAL GUARDING AND TENDERNESS LEFT UPPER QUADRANT PAIN WITH RADIATION TO THE BACK 30.) THE CLIENT IN END-STAGE LIVER FAILURE HAS VITAMIN K DEFICIENCY. WHICH INTERVENTIONS SHOULD THE NURSE IMPLEMENT? SELECT ALL THAT APPLY - AVOID RECTAL TEMPERATURES USE ONLY SOFT TOOTHBRUSH MONITOR PLATELET COUNT 31.) THE CLIENT DIAGNOSED WITH LIVER PROBLEMS ASKS THE NURSE, “WHY ARE MY STOOLS CLAY-COLORED?” ON WHICH SCIENTIFIC RATIONALE SHOULD THE NURSE BASE THE RESPONSE? ● THE LIVER IS UNABLE TO EXCRETE BILIRUBIN 32.) A CLIENT IS ADMITTED TO THE MEDICAL UNIT WITH DIAGNOSE OF CHRONIC KIDNEY DISEASE STAGE 4 FOR MONITORING. BASIC METABOLIC PANEL RESULTS ARE AVAILABLE. WHICH OF THE FOLLOWING LAB VALUES SHOULD BE REPORTED TO THE CLIENT’S PROVIDER URGENTLY? ● POTASSIUM LEVEL OF 5.9 33.) A CLIENT WITH CHRONIC KIDNEY DISEASE BEING HEMODIALYZED SUDDENLY BECOMES SHORT OF BREATH AND COMPLAINS OF CHEST PAIN. THE CLIENT IS TACHYCARDIC, PALE, AND ANXIOUS, AND THE NURSE SUSPECTS AIR EMBOLISM. WHAT IS THE PRIORITY NURSING ACTIONS? SELECT ALL THAT APPLY - ADMINISTER OXYGEN TO THE CLIENT NOTIFY THE PHCP AND RAPID RESPONSE TEAM STOP DIALYSIS, AND TURN THE CLIENT ON THE LEFT SIDE WITH HEAD LOWER THAN FEET 34.) THE NURSE IS ASSESSING THE PATENCY OF A CLIENT’S LEFT ARM ARTERIOVENOUS FISTULA PRIOR TO INITIATING HEMODIALYSIS. WHICH FINDING INDICATES THAT THE FISTULA IS PATENT? ● PALPATION OF A THRILL OVER THE FISTULA 35.) THE NURSE IS REVIEWING THE LABORATORY RESULTS FOR A CLIENT WITH CIRRHOSIS AND NOTES THAT THE AMMONIA LEVEL IS 85mcg/dL (51 mcmol/L). WHICH DIETARY SELECTION DOES THE NURSE SUGGEST TO THE CLIENT? ● PASTA WITH SAUCE 36.) THE CHARGE NURSE IS MONITORING CLIENT LABORATORY VALUES. WHICH VALUE IS EXPECTED IN THE CLIENT WITH CHOLECYSTITIS WHO HAS CHRONIC INFLAMMATION? ● AN ELEVATED WBC 37.) THE NURSE IS PERFORMING AN ASSESSMENT ON A CLIENT WHO HAS RETURNED FROM THE DIALYSIS UNIT FOLLOWING HEMODIALYSIS. THE CLIENT IS COMPLAINING OF A HEADACHE AND NAUSEA AND IS EXTREMELY RESTLESS. WHICH IS THE PRIORITY NURSING ACTION? ● NOTIFY PHCP 38.) THE NURSE IS MONITORING A CLIENT RECEIVING PERITONEAL DIALYSIS NOTES THAT THE CLIENT’S OUTFLOW IS LESS THAN THE INFLOW. WHICH ACTIONS WOULD THE NURSE TAKE? SELECT ALL THAT APPLY - CHECK LEVEL OF DRAINAGE BAG REPOSITION THE CLIENT TO HER/HIS SIDE PLACE CLIENT IN GOOD BODY ALIGNMENT CHECK THE PERITONEAL DIALYSIS SYSTEM FOR KINKS 39.) THE NURSE OBSERVES RED URINE AND SEVERAL LARGE CLOTS IN THE TUBING OF THE NORMAL SALINE CONTINUOUS IRRIGATION CATHETER FOR THE CLIENT WHO IS ONE DAY POSTOPERATIVE TRANSURETHRAL RESECTION OF THE PROSTATE. WHICH INTERVENTION SHOULD THE NURSE IMPLEMENT? ● TITRATE THE NS IRRIGATION TO RUN FASTER 40.) A CLIENT WITH ACUTE KIDNEY INJURY HAS A SERUM POTASSIUM LEVEL OF 7.0 mEq/L (7.0 mmol/L). THE NURSE WOULD PLAN WHICH ACTIONS AS A PRIORITY? SELECT ALL THAT APPLY - PLACE THE CLIENT ON A CARDIAC MONITOR - NOTIFY THE PHCP REVIEW THE CLIENT’S MEDICATIONS TO DETERMINE WHETHER ANY CONTAIN OR RETAIN POTASSIUM 41.) THE CLIENT DIAGNOSED WITH END-STAGE LIVER FAILURE IS ADMITTED WITH HEPATIC ENCEPHALOPATHY. WHICH DIETARY RESTRICTION SHOULD BE IMPLEMENTED BY THE NURSE TO ADDRESS THIS COMPLICATION? ● REDUCE PROTEIN INTAKE TO 60-80 g/day 42.) THE NURSE IDENTIFIES THE CLIENT PROBLEM “EXCESS FLUID VOLUME” FOR THE CLIENT IN LIVER FAILURE. WHICH SHORT-TERM GOAL WOULD BE MOST APPROPRIATE FOR THIS PROBLEM? ● THE CLIENT WILL HAVE NO INCREASE IN ABDOMINAL GIRTH 43.) THE NURSE IS REVIEWING THE PRESCRIPTION FOR A CLIENT ADMITTED TO THE HOSPITAL WITH A DIAGNOSIS OF ACUTE PANCREATITIS. WHICH INTERVENTIONS WOULD THE NURSE EXPECT TO BE PRESCRIBED FOR THE CLIENT? SELECT ALL THAT APPLY - MAINTAIN NPO STATUS ENCOURAGE COUGHING AND DEEP BREATHING GIVE HYDROMORPHONE IV AS PRESCRIBED FOR PAIN 44.) THE CLIENT IS DIAGNOSED WITH END STAGE LIVER FAILURE. THE CLIENT ASKS THE NURSE , “WHY IS MY DOCTOR DECREASING THE DOSES OF MY MEDICATIONS?” WHICH STATEMENT IS THE NURSE’S BEST RESPONSE? ● “YOU MAY HAVE AN OVERDOSE OF THE MEDICATIONS BECAUSE YOUR LIVER IS DAMAGE” 45.) THE NURSE IS CARING FOR A CLIENT SCHEDULED FOR A RADICAL PROSTATECTOMY. THE CLIENT HAS A PRESCRIPTION FOR INTRAVENOUS ANTIBIOTIC MEDICATION ON CALL TO SURGERY. THE ANTIBIOTIC IS PREPARED IN 100mL STERILE NORMAL SALINE. AT WHAT RATE SHOULD THE NURSE INFUSE THE MEDICATION VIA THE IV PUMP TO INFUSE IT IN 30 MINUTES? ● 100/0.5 = 200mL 46.) THE NURSE IS REVIEWING A CLIENT’S RECORD AND NOTES THAT THE PRIMARY HEALTH CARE PROVIDER HAS DOCUMENTED THAT THE CLIENT HAS CHRONIC KIDNEY DISEASE. ON REVIEW OF THE LABORATORY RESULTS, THE NURSE MOST LIKELY WOULD EXPECT TO NOTE WHICH FINDING? ● ELEVATED CREATININE LEVEL 47.) A 56 YEAR OLD MALE IS DIAGNOSED WITH EARLY CANCER OF THE PROSTATE. WHICH ASSESSMENT DATA WOULD THE CLIENT REPORT? ● NO PROBLEMS HAVE BEEN NOTICED 48.) THE NURSE IS CARING FOR A FOUR-PATIENT ASSIGNMENT. WHICH PATIENT SHOULD THE NURSE SEE FIRST? ● TALL TENTED OR PEAKED T WAVES 49.) THE NURSE IS INSTRUCTING A CLIENT WITH DIABETES MELLITUS ABOUT PERITONEAL DIALYSIS. THE NURSE TELLS THE CLIENT THAT IT IS IMPORTANT TO MAINTAIN THE PRESCRIBED DWELL TIME FOR THE DIALYSIS BECAUSE OF THE RISK OF WHICH COMPLICATION? ● HYPERGLYCEMIA 50.) THE PUBLIC HEALTH NURSE IS DISCUSSING HEPATITIS B WITH A GROUP IN THE COMMUNITY. WHICH HEALTH PROMOTION ACTIVITIES SHOULD THE NURSE DISCUSS WITH THE GROUP? SELECT ALL THAT APPLY. ● DO NOT SHARE NEEDLES OR EQUIPMENT ● USE BARRIER PROTECTION DURING SEX ● GET THE HEPATITIS B VACCINES