Question 1

Following gastrectomy, the nurse must observe for signs of pernicious anemia because:

Accepted Answer

Pernicious anemia may occur following subtotal gastrectomy (when large portions of the stomach are removed) due to the loss of tissue that produces the intrinsic factor.

Question 2

Marcia, 68 years old, presents to the gynecology clinic with complaints of painless vaginal bleeding. The nurse should be certain the client is tested for which of the following health problems?

Accepted Answer

Because painless vaginal bleeding is often the only symptom of cervical or uterine cancer, this client should be tested for cancer. Choices A and D are not probable given the client's age. Hormonal imbalance (Choice C) may cause bleeding, but is less urgent than the threat of cancer.

Question 3

The non-insulin-dependent diabetic who is obese is best controlled by weight loss because obesity:

Accepted Answer

Obesity causes a reduce insulin binding at receptor sites and this leads to pancreatic hypersecretion of insulin and eventual pancreatic cell exhaustion.

Question 4

A client with multiple injuries following a vehicular accident is transferred to the critical care unit. He begins to complain of increased abdominal pain in the left upper quadrant. A ruptured spleen is diagnosed and he is scheduled for emergency splenectomy. In preparing the client for surgery, the nurse should emphasize in his teaching plan the:

Accepted Answer

Presence of abdominal drains for several days after surgery. Drains are usually inserted into the splenic bed to facilitate removal of fluid in the area that could lead to abscess formation.

Question 5

Mikaela, 25 years old, is scheduled for a skin biopsy and asks the nurse how painful the procedure is. The appropriate response by the nurse is:

Accepted Answer

Depending on the size and location of the lesion, a biopsy is usually a quick and also painless procedure. The most common source of pain is the initial local anesthetic, which can produce a burning or stinging sensation. Preoperative medication is not necessary with this procedure.

Question 6

Kevin, 23 years old, was admitted for closed head injury following a motor vehicle accident. Which of the following interventions should the nurse plan that would minimize increased intracranial pressure?

Accepted Answer

Positioning the client to maintain the head and neck alignment will facilitate cerebral spinal fluid drainage and prevent increased intracranial pressure due to impediment of spinal fluid drainage.
The head of bed should be elevated greater than or equal to 30 degrees (Choice A), unless specifically ordered otherwise by the physician. Grouping multiple nursing activities (Choice B) like turning, bathing, linen change, and suctioning will dramatically increase intracranial pressure for an extended amount of time. To minimize increase in intracranial pressure, nursing activities should be planned to give the client 30-60 minute breaks between activities. The intracranial pressure will increase with any activity, but the pressure will have an opportunity to decrease to safer levels if activities are not clustered. Positioning to prevent an increase in intracranial pressure is focused on alignment of the head and neck and elevation of the head of bed at 30 degrees, not the legs (Choice D).

Question 7

Ms. Margaret Shawn, a 45-year-old librarian, was ordered by her physician to undergo an oral cholecystography. Which nursing action is inappropriate in preparing Ms. Shawn for this procedure?

Accepted Answer

Drinking 6 oz with each pill is too much. Iopanoic acid (Telepaque) tablets are administered 1 hour after eating a fat-free meal (Choices A and B), one at a time, and in 5-minute intervals, with a minimal amount of water (usually 8 oz) to swallow all the tablets. Water is allowed until bedtime (Choice D), but food is withheld to allow as much dye as possible to concentrate in the gallbladder. The next morning an initial X-ray is taken, after which the client is given a fatty meal and several more pictures are taken to observe the functioning of the gallbladder.

Question 8

The physician has ordered a 24-hour urine specimen collection. After explaining the procedure to the client, the nurse collects the first specimen. She is doing the right thing if she ________.

Accepted Answer

The first specimen is discarded because it is considered "old urine"or urine that was in the bladder before the test began. After the first discarded specimen, urine is collected for 24 hours.

Question 9

Forty-eight hours after a nephrectomy, a client complains of increasing nausea and abdominal pressure. The nurse's first nursing action is to:

Accepted Answer

Auscultate bowel sounds. Though nausea may occur following the administration of narcotics, if it is accompanied by the absence of bowel sounds and upper abdominal distention, gastric or small-intestine dilation should be suspected and the nurse's findings reported to the physician.

Question 10

Mr. Gregory, a 55-year-old tailor, is admitted to the hospital complaining of difficulty holding objects. He states that his condition progressively worsened. Based on the initial examination, the physician suspects Amyotrophic Lateral Sclerosis (ALS). The nurse is aware that characteristics of ALS are the following except:

Accepted Answer

Bowel and bladder control of the client remains intact until the end, together with cognition and sensory functions. ALS is a progressive degenerative disease involving the motor neurons of the anterior horn cells, brain stem, and cerebral cortex. It is mainly characterized by weakness and wasting of involved muscles.

Question 11

Romeo Diaz, age 78, is admitted to the hospital with the diagnosis of benign prostatic hyperplasia (BPH). He is scheduled for a transurethral resection of the prostate (TURP). It would be inappropriate to include which of the following points in the preoperative teaching?

Accepted Answer

He will be pain free. Surgical interventions involve an experience of pain for the client, which can come in varying degrees. Telling the client that he will be pain free is giving him false reassurance.

Question 12

Mr. Rodriguez is to undergo a vasectomy the next day. The nurse discussed with him important points after the operation is done. Which of the following instructions should the nurse include in her health teaching?

Accepted Answer

If the client has pain or swelling, application of ice will help reduce symptoms. Sexual activity can be resumed, but the client will not be clear of sperm from the ductus for 4 to 6 weeks. Bed rest is not indicated and sutures are absorbable.

Question 13

Luis, 32 years old, obtained a third-degree circumferential arm burn after a pot of boiling oil was accidentally turned over. Escharotomy procedure was ordered for Luis. The nurse understands that the anticipated therapeutic outcome of the escharotomy is:

Accepted Answer

Escharotomies are performed to relieve the compartment syndrome that can occur when edema forms under nondistensible eschar in a circumferential third-degree burn. Escharotomies are performed through avascular eschar to subcutaneous fat. Although bleeding may occur from the site, it is considered a complication rather than an anticipated therapeutic outcome. Usually, direct pressure with a bulky dressing and elevation will control the bleeding, but occasionally an artery is damaged and may require ligation. Formation of granulation tissue is not the intent of an escharotomy. Escharotomy will not affect the formation of edema.

Question 14

While installing Christmas lights on his rooftop, Matt fell from the staircase and sustained a fractured femur. He was placed in a balance skeletal traction with a Thomas splint. To prevent pressure points from occurring around the top of the splint, the most important intervention is to:

Accepted Answer

The most important intervention for preventing pressure points is to keep the client pulled up in bed. The nurse may also pad the top of the splint with soft material, such as cotton wadding, to prevent excoriation. The footplate would prevent foot drop.

Question 15

Which of the following individuals is least likely to be at risk of developing psoriasis?

Accepted Answer

Psoriasis occurs equally among women and men, although the incidence is lower in darker skinned races and ethnic groups. A genetic predisposition has been recognized in some cases. Emotional distress, trauma, systemic illness, seasonal changes, and hormonal changes are linked to exacerbations.

Question 16

Which of the following clients would indicate that he/she is manifesting chronic renal failure?

Accepted Answer

Chronic renal failure presents with decreased urinary output and increased serum BUN, creatinine, and potassium levels. In this case, the serum BUN level is elevated (normal range: 10-20 mg/dL) and everything else is within normal limits.

Question 17

A client newly diagnosed with trigeminal neuralgia asks the nurse to explain why it hurts so much when an episode occurs. The nurse would explain that the pain of trigeminal neuralgia is the result of which of the following?

Accepted Answer

The pain of trigeminal neuralgia is triggered by stimulation of the sensory fibers of the trigeminal nerve. Examples of pressure-related triggering events include shaving, brushing the teeth, washing the face, and eating or drinking. Examples of temperature-related triggers include environmental changes and hot or cold food and drink. The other options listed do not initiate pain of this disorder.

Question 18

Kaitlyn, who was diagnosed with juvenile rheumatoid arthritis, must take long-term steroids. Through health teaching on the nurse's part, which adverse effect of the medications can be prevented?

Accepted Answer

Infection, a common manifestation of clients taking long-term steroids due to immunosuppression, can be prevented through hand washing and staying away from others who are ill. The other choices are also adverse effects of the drug regimen; however, they are unpreventable.

Question 19

Faye, a nurse in a urology clinic, conducts a community education program about benign prostatic hypertrophy. When asked to explain the condition, Faye should respond that BPH is:

Accepted Answer

The only known risk factor for BPH is aging. It is estimated that over 50% of men over the age of 50 will develop BPH, with the incidence increasing in age. Prostate size correlates poorly with symptoms.

Question 20

Kyle, a 28-year-old teacher, is admitted to the hospital with a diagnosis of renal calculi. The result of Kyle's blood studies shows a BUN of 20 mg/dL, serum calcium level of 4.5 mEq/L, serum phosphorus of 1.8 mEq/L, serum sodium of 138 mEq/L, and urine pH of 5.1. Calcium phosphate stone is suspected. What nursing intervention would be most effective in altering Kyle's urine pH?

Accepted Answer

Foods high in calcium, such as milk products, tend to alkalinize urine. Avoiding high calcium foods will help to decrease urine pH.

Quiz 1: Medical Surgical