Question 1

A nurse is monitoring a patient who is recovering from moderate sedation with IV midazolam (Versed)and fentanyl administered during an outpatient diagnostic procedure.The nurse notes that the patient's pulse oximetry result has decreased from 94% to 90%.The patient is receiving oxygen by nasal cannula at 3 L/min.After confirming the result, which action should be taken by the nurse first?
A)Administer naloxone (Narcan)and/or flumazenil (Romazicon).
B)Call for help from the emergency response team.
C)Instruct the patient to take several deep breaths.
D)Reposition the patient to a side-lying position.

Accepted Answer

Instructing the patient to take several deep breaths is the first action the nurse should take when a patient's pulse oximetry decreases slightly, as it can help improve oxygenation and ventilation without immediately resorting to more invasive interventions.

Question 2

When preparing a child for a sweat test, the nurse should clean the skin on the:
A)Abdomen
B)Anterior chest
C)Forearm and/or thigh
D)Upper left back

Accepted Answer

The sweat test is typically performed on the forearm or thigh of the child to avoid discomfort or pain. These areas are less sensitive than the abdomen or chest. The skin should be cleaned thoroughly before beginning the test to ensure accurate results. It is important to follow the testing protocol and instructions provided by the healthcare provider.

Question 3

An alert and oriented patient, who is to provide a sputum specimen for cytology, has been unable to produce a specimen.A nurse has an order to obtain the specimen by tracheal suction with an in-line trap.Which precaution should the nurse observe when performing this procedure?
A)Apply suction for no longer than 10 to 15 seconds.
B)Maintain suction while withdrawing the suction catheter.
C)Place the patient in a supine position.
D)Turn off the oxygen for at least 5 minutes prior to suctioning.

Accepted Answer

Applying suction for no longer than 10 to 15 seconds helps prevent hypoxemia and tissue trauma. Maintaining suction while withdrawing the suction catheter is not recommended as it can cause tissue trauma and increase the risk of contamination. The patient should not be placed in a supine position as this increases the risk of aspiration. Turning off the oxygen for at least 5 minutes prior to suctioning is not necessary and can lead to hypoxemia.

Question 4

A neonate born to a family with a two children who have cystic fibrosis has a sweat test performed shortly after birth.The results are within normal limits.Which interpretation by the nurse is correct?
A)Genetic testing is the only reliable method to diagnose cystic fibrosis.
B)Results are inconclusive unless fecal analysis for trypsin also is negative.
C)The test should be repeated when the neonate is older.
D)This child does not have cystic fibrosis.

Accepted Answer

The sweat test, which measures the concentration of chloride in the sweat, is a key diagnostic test for cystic fibrosis. However, in neonates, the results can be unreliable because their sweat glands may not produce enough sweat for accurate analysis. Therefore, it is often recommended to repeat the test when the child is older, usually by 2 months of age, for more reliable results.

Question 5

A patient diagnosed with hypertension is maintained on losartan (Cozaar)-an angiotensin II receptor antagonist.Based on this information, which of the following lab results should a nurse monitor?
A)Hemoglobin and hematocrit
B)Serum glucose and sodium
C)Serum potassium and creatinine
D)Urinary sodium and calcium

Accepted Answer

Losartan can cause an increase in serum potassium levels and a decrease in creatinine clearance, so monitoring serum potassium and creatinine levels would be important. Hemoglobin and hematocrit are measures of blood cells and would not be directly affected by losartan use. Serum glucose and sodium levels are not typically affected by losartan use. Urinary sodium and calcium levels may be affected by losartan use, but monitoring serum potassium and creatinine levels is a higher priority.

Question 6

A patient who is in the second trimester of pregnancy reports urinary urgency and nocturia.The urine dipstick results are negative for nitrite and positive for leukocyte esterase.Which orders should the nurse anticipate when reporting this result to the requesting health-care provider?
A)Begin cephalexin (Keflex)intravenously.
B)Obtain a clean-catch, midstream urine specimen for culture.
C)Obtain a sterile specimen with a straight catheterization.
D)Repeat urine dipstick with first morning specimen.

Accepted Answer

A positive result for leukocyte esterase indicates the presence of white blood cells in the urine, which suggests a urinary tract infection (UTI). The negative nitrite result does not rule out a UTI, as some bacteria do not convert nitrates to nitrites. Therefore, a urine culture is necessary to confirm the diagnosis and determine the appropriate antibiotic therapy. Clean-catch, midstream urine collection is appropriate for obtaining a urine specimen for culture in a pregnant woman. Options A, C, and D are not necessary at this time.

Question 7

A patient's laboratory test results following analysis of a urine sample indicate a nuclear matrix protein (NMP)22 level of 12 units/mL.This finding indicates which of the following with regards to bladder cancer?
A)Indeterminate
B)Negative
C)Borderline
D)Positive

Accepted Answer

An NMP22 level greater than 10 units/mL is considered positive for bladder cancer. Therefore, a level of 12 units/mL indicates a positive result for bladder cancer.

Question 8

A patient who is undergoing a diagnostic work-up for possible lactose intolerance has an order for a lactose-tolerance test.To begin the test, the nurse should:
A)Administer 50 g of lactose dissolved in a small amount of water.
B)Collect a stool specimen after the patient eats a meal with dairy products.
C)Instruct the patient to drink an 8-ounce glass of whole milk.
D)Inject 10 mL of 10% lactose solution intravenously.

Accepted Answer

The lactose-tolerance test involves administering a measured amount of lactose (usually 50 g) in a small amount of water and then measuring the patient's blood glucose levels at certain intervals to see how well their body is able to digest and absorb the lactose. Collecting a stool specimen or having the patient drink a glass of whole milk are not appropriate methods for this test. Injecting lactose intravenously is not a recommended method for this test and could be dangerous.

Question 9

A patient's laboratory test results indicate a positive finding for hepatitis C virus (HCV).Because of this infection, the patient is at high risk for developing which of the following conditions?
A)Renal disease
B)Cirrhosis
C)Pancreatitis
D)Gastric cancer

Accepted Answer

Hepatitis C virus (HCV) infection is a major risk factor for the development of cirrhosis. Patients infected with HCV are at significant risk of developing cirrhosis, which can lead to liver failure, liver cancer, and potentially death. HCV infection does not directly increase the risk of renal disease, pancreatitis, or gastric cancer.

Question 10

A patient with an ileal conduit requires a urine specimen for culture.Which procedure should a nurse use to collect this specimen?
A)Cleanse the opening of the urinary pouch with alcohol and then transfer the urine from the pouch into a sterile specimen cup.
B)Collect urine by removing the pouch and performing a sterile catheterization through the stoma.
C)Place the patient in a side-lying position, remove the pouch, cleanse the area around the stoma with povidone-iodine, and collect the urine in a sterile specimen cup.
D)Remove the pouch and replace with a sterile device; once urine has accumulated, remove pouch with urine and send to the lab.

Accepted Answer

Collecting a urine specimen from an ileal conduit for culture requires a sterile technique to avoid contamination. The most accurate method to ensure a sterile sample is by performing a sterile catheterization through the stoma after removing the pouch. This method minimizes the risk of introducing external bacteria into the sample, which could affect the culture results.

Question 11

An infant with a history of vomiting has completed a gastroesophageal reflux scan.Which instruction should a nurse give to the infant's parents?
A)"It is important to minimize direct contact with the infant for at least 24 hours to avoid overexposure to radioactivity."
B)"This test does not require any special measures now that it is complete.Your health-care provider will follow up with the results."
C)"The infant should take only clear liquids for the first 24 hours.You can advance to formula if there is no vomiting."
D)"You must wear gloves when changing the infant's diapers and wash gloved hands after completing the diaper change and again after removing the gloves."

Accepted Answer

The scan involves the use of a radioactive tracer, so precautions like wearing gloves when handling the infant's diapers are necessary to avoid contamination from radioactive materials.

Question 12

A mother arrives at the emergency room with her 5-year-old son and explains that she is afraid that her son may have overdosed on acetaminophen.The boy undergoes blood testing and the nurse reviews the results.The nurse knows that any blood level of acetaminophen greater than which of the following constitutes a critical finding?
A)100 mcg/mL
B)200 mcg/mL
C)300 mcg/mL
D)400 mcg/mL

Accepted Answer

Blood levels of acetaminophen greater than 200 mcg/mL are considered critical and indicate a potential overdose, necessitating immediate medical intervention.

Question 13

A nurse is preparing to obtain a blood specimen from a neonate, who is 3 days old and being treated with phototherapy for hyperbilirubinemia.Which action should be taken by the nurse to ensure that the specimen provides an accurate result?
A)Keep the neonate NPO for at least 8 hours.
B)Premedicate the neonate to minimize the stress response of the needlestick.
C)Stimulate the infant prior to obtaining the specimen.
D)Turn off the phototherapy light while drawing the specimen.

Accepted Answer

Phototherapy can affect the results of some lab tests, including bilirubin levels. Therefore, it is important to turn off the phototherapy light while drawing the specimen to ensure accurate results. NPO status, premedication, or stimulation are not necessary for obtaining an accurate blood specimen.

Question 14

A patient in a community clinic recently learned that a new sexual partner is a carrier for hepatitis B.The patient is concerned about being exposed and requests testing for hepatitis.In addressing this patient's concerns, which question by a nurse is most appropriate?
A)"Can you approximate how many times you have had sexual contact with this partner?"
B)"Did you use condoms or spermicidal gel during intercourse?"
C)"How long have you been involved in this relationship?"
D)"Is the relationship that you are in monogamous?

Accepted Answer

The answer of A patient in a community clinic recently...

Question 15

A postpartum patient who delivered a full-term, healthy neonate has blood drawn for a Kleihauer-Betke test.Based on this information, the nurse should plan care to manage:
A)A clotting disorder
B)An infection
C)Down syndrome
D)Rh incompatibility

Accepted Answer

The Kleihauer-Betke test is used to detect the presence of fetal red blood cells in the maternal circulation, which can occur due to fetal-maternal hemorrhage. If the mother is Rh negative, this can lead to Rh sensitization and possible complications in future pregnancies. Therefore, the nurse should plan care to manage Rh incompatibility.

Question 16

A nurse is preparing to obtain a capillary blood specimen from a 2-month-old.Which site should the nurse plan to use to draw the blood?
A)Dorsal surface of foot
B)Earlobe
C)Fingertip
D)Lateral heel

Accepted Answer

The lateral heel is the recommended site for capillary blood specimen collection in infants less than 1 year old. This is because there is less tissue, smaller nerves, and fewer bones in that area, making it less painful for the infant. The other options (dorsal surface of foot, earlobe, and fingertip) may be used in older children or adults but are not appropriate for infants.

Question 17

A middle-aged patient, with a strong family history of early death from occlusive coronary disease, has computed tomography (CT)for cardiac scoring with a score of 210 reported.Based on this score, which patient teaching should the nurse plan?
A)Lifestyle modifications to manage weight, promote activity, and control blood lipids
B)Preoperative instructions for cardiac bypass surgery
C)Preparation for cardiac catheterization and immediate stent placement
D)Reinforcement of current lifestyle patterns to maintain a healthy cardiac score

Accepted Answer

A cardiac CT score of 210 indicates a high risk for coronary artery disease, particularly with a strong family history. Therefore, the nurse should plan patient teaching on lifestyle modifications to manage weight, promote activity, and control blood lipids to reduce the risk of further cardiovascular events. Preoperative instructions for cardiac bypass surgery or preparation for cardiac catheterization and stent placement may be necessary in some cases, but this would depend on a comprehensive assessment of the patient's clinical status and should be determined by the healthcare provider. Reinforcement of current lifestyle patterns would not be appropriate given the high cardiac score and family history.

Question 18

A nurse is preparing to administer an intradermal tuberculin skin test to a patient.Which question should the nurse ask the patient to ensure that there are no interfering factors or contraindications for this test?
A)"Are you currently taking corticosteroids or immunosuppressive drugs?"
B)"Do you have symptoms such as cough, hemoptysis, or weight loss?"
C)"Do you have any history of AIDS?"
D)"Have you recently been exposed to someone with tuberculosis?"

Accepted Answer

The question about corticosteroids or immunosuppressive drugs is important because these medications can affect the immune system's ability to respond to the tuberculin test, potentially leading to a false negative result. Questions B, C, and D are also important in assessing a patient's risk for tuberculosis, but they do not specifically address factors that could interfere with the accuracy of the tuberculin skin test.

Question 19

Following an outpatient endoscopic retrograde cholangiopancreatography (ERCP), a nurse's first priority should be to monitor the patient for:
A)Fever
B)Nausea
C)Respiratory depression
D)Pain

Accepted Answer

Respiratory depression is a critical concern following ERCP due to the sedation used during the procedure. Monitoring for respiratory issues is a priority to ensure patient safety.

Question 20

A nurse is preparing to obtain a blood specimen from a geriatric patient in an acute care setting.The patient is confused about time and place but responds to name.The patient has been hospitalized for over 1 week, and this nurse has provided care to this patient several times.The patient's armband is taped to the foot of the bed, and the patient is sitting in the chair next to the bed with a family member visiting.Which method should be used by the nurse to confirm this is the correct patient?
A)Ask the family member to confirm the patient's identification and compare to the armband on the bed.
B)Compare the requisition form to the armband to confirm the patient's identification using name and room number.
C)Request that another nurse, who knows the patient, replace the armband before the specimen is obtained.
D)State the patient's name and use the armband for additional confirmation using two numeric identifiers.

Accepted Answer

The nurse should ensure the armband is properly placed on the patient for accurate identification, as it is a critical safety measure.

Quiz 2: Preface

When preparing a child for a sweat test, the nurse should clean the skin on the:

An alert and oriented patient, who is to provide a sputum specimen for cytology, has been unable to produce a specimen.A nurse has an order to obtain the specimen by tracheal suction with an in-line trap.Which precaution should the nurse observe when performing this procedure?

A neonate born to a family with a two children who have cystic fibrosis has a sweat test performed shortly after birth.The results are within normal limits.Which interpretation by the nurse is correct?

A patient diagnosed with hypertension is maintained on losartan (Cozaar) -an angiotensin II receptor antagonist.Based on this information, which of the following lab results should a nurse monitor?

A patient who is in the second trimester of pregnancy reports urinary urgency and nocturia.The urine dipstick results are negative for nitrite and positive for leukocyte esterase.Which orders should the nurse anticipate when reporting this result to the requesting health-care provider?

A patient's laboratory test results following analysis of a urine sample indicate a nuclear matrix protein (NMP) 22 level of 12 units/mL.This finding indicates which of the following with regards to bladder cancer?

A patient who is undergoing a diagnostic work-up for possible lactose intolerance has an order for a lactose-tolerance test.To begin the test, the nurse should:

A patient's laboratory test results indicate a positive finding for hepatitis C virus (HCV) .Because of this infection, the patient is at high risk for developing which of the following conditions?

A patient with an ileal conduit requires a urine specimen for culture.Which procedure should a nurse use to collect this specimen?

An infant with a history of vomiting has completed a gastroesophageal reflux scan.Which instruction should a nurse give to the infant's parents?

A nurse is preparing to obtain a blood specimen from a neonate, who is 3 days old and being treated with phototherapy for hyperbilirubinemia.Which action should be taken by the nurse to ensure that the specimen provides an accurate result?

A patient in a community clinic recently learned that a new sexual partner is a carrier for hepatitis B.The patient is concerned about being exposed and requests testing for hepatitis.In addressing this patient's concerns, which question by a nurse is most appropriate?

A postpartum patient who delivered a full-term, healthy neonate has blood drawn for a Kleihauer-Betke test.Based on this information, the nurse should plan care to manage:

A nurse is preparing to obtain a capillary blood specimen from a 2-month-old.Which site should the nurse plan to use to draw the blood?

A middle-aged patient, with a strong family history of early death from occlusive coronary disease, has computed tomography (CT) for cardiac scoring with a score of 210 reported.Based on this score, which patient teaching should the nurse plan?

A nurse is preparing to administer an intradermal tuberculin skin test to a patient.Which question should the nurse ask the patient to ensure that there are no interfering factors or contraindications for this test?

Following an outpatient endoscopic retrograde cholangiopancreatography (ERCP) , a nurse's first priority should be to monitor the patient for: