Question 1

Mrs) Oates is scheduled for a bowel diversion surgery next week. She is diagnosed with bowel obstruction due to malignancy of the rectum. The physician informed her that they will create a permanent descending colostomy. When the nurse starts preparing the client for tests prior to the procedure, she asks the client if she has any questions about the procedure. Which of the following statements indicates a good understanding of the procedure?

Accepted Answer

When a client says that she can eat all the foods that she wants just like before, this indicates a good understanding of the procedure. There are relatively few food restrictions when the client goes home; however, she should avoid foods that can cause diarrhea. Option A is incorrect; the anatomical location of the colostomy depends on the individual case. Option C is also incorrect; the descending colostomy will produce a semi-formed or almost normal stool consistency. Liquid fecal drainage is expected in ileostomy and ascending colostomy. Option D is incorrect; this particular colostomy is permanent.

Question 2

A woman prescribed digoxin is complaining of weakness, nausea, and anorexia. A serum potassium test revealed a level of 3.2 mEq/L. The physician orders a digoxin level for to rule out digoxin toxicity. The nurse checking the results knows that the therapeutic levels for digoxin range from:

Accepted Answer

The therapeutic levels for digoxin range from 0.5 to 2.0 ng/mL. Digoxin toxicity is manifested by anorexia, nausea, vomiting, and visual disturbances.

Question 3

A client with hypertension is prescribed furosemide (Lasix). When the client asks why this medication is given for hypertension, the nurse tells the client that furosemide:

Accepted Answer

Furosemide is a loop diuretic that inhibits the reabsorption of sodium and water, causing a decrease in blood pressure. Osmotic diuretics like mannitol inhibit the reabsorption of sodium and water in the renal proximal tubule.

Question 4

A nurse prepares to administer potassium chloride to a client with hypokalemia. Which of the following actions is included in the nurse's plan of care?

Accepted Answer

The nurse monitors for the signs and symptoms of phlebitis, such as redness, warmth, and pain after the administration of potassium chloride. Potassium chloride is administered intravenously, diluted in normal saline, and infused by a controlled-infusion pump. It may also be administered orally.

Question 5

A physician orders 1000 ml of normal saline solution to be infused over 12 hours. The drop factor is 15 drops per 1 ml. A nurse sets the flow rate at how many drops per minute?

Accepted Answer

To obtain the number of drops per minute, use the IV flow rate formula:
Total volume x drop factor = drops per minute
Time in minutes
1000 ml x 15 gtts/ml = 15000 gtts = 20.8 = 21 drops per minute
12 hrs x 60 min/hr 720 min

Question 6

A nurse finds that the site of a client's intravenous catheter is reddened, warm, and slightly edematous. The client complains of pain. The immediate action of the nurse is to:

Accepted Answer

The client is experiencing phlebitis. Removing the IV and restarting in the opposite extremity is the nurse's immediate action. Options A and B are appropriate, but they are not the nurse's immediate actions. The catheter must not be irrigated.

Question 7

What class of drugs is recommended as the first line therapy for hypercholesterolemia, after lifestyle modifications?

Accepted Answer

The statins work by blocking an enzyme, HMG-CoA reductase that is the rate-limiting step in the manufacture of cholesterol. Statins reduce LDL-cholesterol, total cholesterol, and triglycerides and slightly increase high-density lipoprotein (HDL-c).

Question 8

What medication has long been the drug of choice for strep pharyngitis?

Accepted Answer

Penicillin is often considered the drug of choice for cases of strep pharyngitis. Tetracycline is not as commonly used against strep infections and acyclovir is an antiviral drug while metronidazole is an antifungal. Recent research is indicating that other antibiotics may be more effective than penicillin for the condition.

Question 9

Which of the following drugs is NOT a calcium channel blocker?

Accepted Answer

Metoprolol is not a calcium channel blocker. It is a beta blocker.

Question 10

The nurse is assessing a 27-year-old patient who came in to the clinic for severe dysmenorrhea. After being assessed by the physician, the patient was started on hormonal therapy. The most suitable type of HT for this patient is:

Accepted Answer

The most suitable type of hormonal therapy for relief of dysmenorrhea is a progestin-containing drug like Depo-Provera (medroxyprogesterone acetate). Estrogen-only drugs are avoided in this patient's case because they could alter her hormonal levels, resulting in breakthrough bleeding, amenorrhea, and worsening dysmenorrhea. The nurse should inform the patient about adverse effects of this drug such as irregular vaginal bleeding during the first year of use, gastrointestinal symptoms (e.g., nausea and weight gain) that can be relieved by taking the drug with food, and CNS changes (e.g., drowsiness, mental depression, and insomnia).

Question 11

A nurse is caring for a female client who was admitted less than a week ago, due to moderate depression. The client tells the nurse that she feels much better now and is more than excited to interact with other clients. The nurse's immediate action is to:

Accepted Answer

A client who was admitted due to moderate depression cannot achieve such significant improvement in less than a week. Once depression lifts, it is more likely that the client has decided to harm herself; therefore, the nurse must increase suicide precautions. Allowing in-room activities and recommending discharge are inappropriate.

Question 12

A client was ordered to have urinalysis. The laboratory report reveals that the specific gravity of the client's urine is 1.50. What is the most probable cause of the client's urine specific gravity result?

Accepted Answer

The most probable cause of low specific gravity of urine is dehydration. The specific gravity of urine decreases if the urine is highly concentrated. Dehydration stimulates the cells to retain salts, which results in the excretion of highly concentrated urine. The urine is poorly concentrated in cases of diabetes insipidus, diuresis due to the use of diuretics, and renal failure. In these cases, the urine's specific gravity is greater than normal.

Question 13

An older client with Alzheimer's disease is agitated and angry. The most appropriate nursing action to calm the client is to:

Accepted Answer

To calm down an agitated client with Alzheimer's disease, it is most appropriate to decrease environmental stimuli and to approach the client calmly. An agitated client should not be included in a group activity. Using restraints and isolating the client are not considered.

Question 14

A client with obsessive-compulsive disorder is admitted for treatment of skin breakdown. The nurse asked the client to refrain from washing his hands too much. Upon hearing this, the client became agitated. The client's nursing care should be based upon the understanding that:

Accepted Answer

Obsessive thought and compulsive behavior occur together. They increase during stressful times. The nurse should avoid interrupting the compulsive behavior because this worsens the anxiety. OCD behavior arises from repression of anxiety, displacement of obsessive thoughts, and undoing of intrusive thoughts.

Question 15

Which of the following shows therapeutic use of a defense mechanism?

Accepted Answer

Depending on the use, a defense mechanism may be therapeutic or pathologic. One therapeutic defense mechanism is identification, the attempt to identify with another person's traits to reach a certain goal or serve self-esteem. Pathologic defense mechanisms, including projection (option A), dissociation (option B), and conversion (option D), distort reality.

Question 16

A nurse is conducting preoperative teaching for a client scheduled for coronary artery bypass graft surgery in 1 week. The client has been taking aspirin. Which of the following statements, if made by the client, suggests that the client understands the teachings?

Accepted Answer

Aspirin is discontinued at least 48 hours before surgery, as it can prevent the formation of blood clots, resulting in bleeding. Aspirin does not cause blood clots, rather, it prevents their formation. The other options are not correct.

Question 17

A client was diagnosed with panic disorder a few months ago after going through a traumatic accident. The client has been taking medications and attending therapy for two months now. What is a desirable outcome observed by the nurse?

Accepted Answer

A desirable outcome of treatment is resumption of work at the office. This indicates that the client is able to focus and concentrate on his or her work. Panic attacks usually last for 5-30 minutes. Appetite is usually not affected by panic attacks; fatigue and sleep disturbances are more common. Titrating medications is not acceptable; the client should be weaned off the drug to avoid adverse effects.

Question 18

A client is admitted, presenting with hypertension, tachycardia, and hyperthermia. The client is combative and paranoid. The client's bowel sounds are diminished and the urine output is lower than normal. These are the characteristic symptoms of:

Accepted Answer

Cocaine toxicity is characterized by tachycardia, diminished bowel sounds, hypertension, decreased urine output, and hyperthermia. Cocaine, a stimulant, will present with symptoms similar to sympathetic nervous system stimulation. In contrast, alcohol and heroin toxicity would exhibit symptoms of sedation, such as decreased respirations and depressed CNS. Marijuana induces euphoria and could result in hallucinations in high doses.

Question 19

A nurse finds a client lying unconscious on the floor. An empty bottle of tricyclic antidepressant pills is found near the client. The immediate nursing action is to:

Accepted Answer

Regardless of the number of pills taken and the last dose of TCA, a TCA overdose is a medical emergency and may result in life-threatening symptoms; therefore, alerting the medical resuscitation team is the best immediate action. Vomiting is not induced in an unconscious client.

Question 20

A nurse is assigned to a 25-year-old woman scheduled for therapeutic termination of pregnancy due to a recently discovered heart condition of the mother. The nurse refuses to care for this client because of a conflict in religious beliefs. How should the charge nurse handle this situation?

Accepted Answer

The charge nurse or the employer should guarantee free exercise of beliefs without discrimination. Some nurses have religious beliefs that may prohibit them from participating in certain procedures. Employers should accommodate the nurse's request not to participate in any care or procedure that is in conflict with their religious beliefs. A written statement should be provided by the nurse indicating the moral or religious basis for refusing the client assignment.

Quiz 1: American Association of Colleges of Nursing (AACN) Clinical Nurse Specialist