Focus on Adult Health Medical-Surgical Nursing Psc Edition by Linda -Test Bank A+

Focus on Adult Health  Medical-Surgical Nursing Psc Edition by Linda -Test Bank   A+

Focus on Adult Health Medical-Surgical Nursing Psc Edition by Linda -Test Bank A+

Focus on Adult Health Medical-Surgical Nursing Psc Edition by Linda -Test Bank A+

A patient tells the nurse that her doctor just told her that she had a “chronic condition.” She asks the nurse what “chronic condition” means. What would be the nurse’s best response?
A)“Chronic conditions are defined as health problems that require management of 3 months or longer.”
B)“Chronic conditions are diseases that come and go.”
C)“Chronic conditions are medical conditions that have disabilities that require hospitalization.”
D)“Chronic conditions require short-term management in extended care facilities.”

2.A patient scheduled for dialysis is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355 mL soft drink after the patient has already reached the maximum intake of fluid for the day. The nurse has instructed the patient on the risks of fluid overload. What action should the nurse take?
A)Take the soft drink away from the patient and inform the dialysis nurse to remove extra fluid from the patient during his next dialysis treatment.
B)Document the patient’s behavior as noncompliant and notify the health care provider.
C)Restrict the patient’s fluid for the following day and communicate this information to the charge nurse.
D)Reinforce the importance of the fluid restriction, and document the teaching and the intake of extra fluid.

3.A patient has recently been diagnosed with diabetes. The patient is clinically obese and is sedentary. How can the nurse best ensure potential success to increase activity in this patient?
A)Set up appointment times at a local fitness center for the patient to attend.
B)Have a family member ensure the patient follows a suggested exercise plan.
C)Construct an exercise program and have the patient follow it.
D)Identify barriers with the patient that will inhibit change.

4.Research has shown that the incidence of chronic conditions is increasing. What lifestyle factor has been shown to contribute most significantly to this increase?
D)Gastrointestinal disease

5.You are the nurse giving palliative care to a patient with a diagnosis of chronic obstructive pulmonary disease (COPD). What is the primary goal of palliative care?
A)Improve the patient’s and family’s quality of life.
B)Support aggressive treatment for cure.
C)Provide physical support for the patient.
D)The patient may develop a separate plan with each discipline of the health care team.

6.Your patient has a diagnosis of bladder cancer with metastasis. The patient asks you about hospice. Which principle underlies hospice care?
A)Death must be accepted.
B)Symptoms of terminal illness should not be treated.
C)Each member of the interdisciplinary team develops an individual plan of care for the patient.
D)Terminally ill patients should die in the hospital.

7.You are the clinic nurse doing patient teaching for palliative radiotherapy to the spine. After you complete the patient teaching, your patient continues to ask the same questions that you have already addressed. What can you conclude?
A)The patient is not listening.
B)The patient is not adhering to treatment.
C)The patient may have a learning disability.
D)Learning has not occurred.

8.You are part of the health care team at an oncology center. Your patient has been diagnosed with leukemia and the prognosis is poor. The patient is unaware of the prognosis. How can the bad news best be conveyed to the patient?
A)Family should be given the prognosis first.
B)The prognosis should be delivered with the patient at eye level.
C)The health care provider should deliver the news to the patient alone.
D)The appointment should be scheduled at the end of the day.

9.Your patient has just been told that her illness is terminal. The patient states, “I can’t believe I am going to die. Why me?” What is your best response?
A)“I know how you are feeling.”
B)“You have lived a long life.”
C)“This must be very difficult for you.”
D)“Life can be so unfair.”

10.A patient is in a hospice receiving palliative care for lung cancer. The cancer has metastasized to the liver and bones. The patient is experiencing dyspnea. What might the nurse do to help to relive the dyspnea the patient is experiencing?
A)A fluid bolus
B)High-flow oxygen to treat low oxygen saturation
C)High doses of opioids
D)Administer corticosteroids as ordered

11.Although some people with chronic illness assume what might be called a “sick role” identity, most do not consider themselves to be sick or ill and try to live as normal a life as possible. What event is most likely to cause an individual who has a chronic illness to begin thinking of himself or herself as being disabled?
A)Referral to a medical specialist or a clinical nurse specialist
B)Involvement of family members or close friends in the planning of care
C)Decreased ability to perform activities of daily living
D)Qualifying for Medicare or Medicaid

12.The incidence and prevalence of chronic illnesses have increased in recent decades, and this trend is expected to continue in the near future. What factor has contributed most significantly to this trend?
A)Decreasing availability of nutritious food
B)Misinformation about the relationship between health and wellness
C)Antibiotic resistance and increases in nosocomial (hospital-acquired) infections
D)Increases in lifespan and the accompanying changes in physiology

13.A diabetes nurse is performing health education with a 44-year-old woman who has recently learned that she has type 2 diabetes. The nurse is teaching the patient the importance of adhering to her prescribed treatment regimen. When providing this health education, the nurse should emphasize:
A)The patient’s independent responsibility for making informed changes to her treatment regimen
B)The fact that adherence to a prescribed treatment regimen usually requires careful planning
C)The fact that well-intending friends and family members usually challenge the validity of the treatment regimen
D)The need to avoid online information sources because they tend to contradict evidence-based regimens

14.A 71-year-old woman with a longstanding diagnosis of emphysema developed community-acquired pneumonia 3 weeks ago and was admitted to the hospital for treatment. A combination of respiratory therapy and IV antibiotics has resolved the woman’s infection and she is now preparing to return to the home she shares with her husband. What phase in the trajectory model of chronic illness is this patient currently experiencing?

15.Mr. Romanov is a 69-year-old man who was diagnosed with angina pectoris 2 years ago. With adherence to treatment, he has been largely able to maintain his chosen lifestyle. However, in recent weeks, he has been forced to limit his physical activity, take more rests, and refrain from going for walks. What phase in the trajectory model of chronic illness is Mr. Romanov currently experiencing?
A)Trajectory onset

16.A patient with a recent history of joint stiffness and decreased mobility has received a diagnosis of osteoarthritis. When performing health education with this patient, what subject should the nurse prioritize?
A)The typical prognosis for patients who have osteoarthritis
B)Strategies that the patient can use to maintain her level of function
C)The role of lifestyle in the development of osteoarthritis
D)Strategies for researching her chronic illness and evaluating treatments

17.A community health nurse has a large list of patients in the local community, many of whom are living with chronic illnesses. What principle should the nurse prioritize when planning and implementing the care of these patients?
A)The nurse should defer responsibility for decision-making to patients until an exacerbation of their illness.
B)The nurse should facilitate a gradual decrease in patients’ expectations for independence and level of function.
C)The nurse should recognize the cause-and-effect relationship that exists between the patients’ lifestyle choices and the etiology of their diseases.
D)The nurse should adopt a holistic approach that addresses each dimension of the patient’s being.

18.A female patient with a diagnosis of breast cancer had a unilateral mastectomy with axillary node biopsy. The results of the biopsy have just come back positive, and the nurse and a coworker are discussing the patient’s possible response to this news. Which of the following statements by the coworker should the nurse correct or respond to with teaching?
A)“If she finds out about this too quickly, she might lose hope in her battle with cancer.”
B)“All considered, it’s best if she’s told this sooner rather than later.”
C)“Ideally, her family will be around when she learns about her biopsy results.”
D)“This will be hard to hear, but she deserves to know as much detail as she wants.”

19.Mr. Hosa is a 68-year-old man who is in the end stages of pancreatic cancer. His care team has suggested the possibility of hospice care but Mr. Hosa is opposed, stating, “A hospice is just a place to wait to die.” Which of the following statements should underlie the nurse’s response to Mr. Hosa?
A)Spiritual and emotional needs are more important than physical needs.
B)A hospital setting is an inappropriate place to die.
C)Meaningful living can take place despite terminal illness.
D)Acceptance of mortality can delay physiologic death.

20.A patient with amyotrophic lateral sclerosis (ALS) wishes to use his Medicare Hospice Benefit in an effort to maximize his quality of life prior to death. What criterion will determine whether the patient qualifies for this benefit?
A)A life expectancy of less than 6 months
B)Exhaustion of all reasonable treatment options
C)Copayment by a health insurance provider
D)A demonstrated lack of a support system

21.A 70-year-old woman is in the end stages of colorectal cancer and has tended to defer decision making to her oldest son, in accordance with the norms of her culture. The woman’s health care provider has discussed the possibility of palliative radiotherapy with the patient and her family, and the patient has asked her son to make the decision whether to pursue or forego this treatment measure. How should the care team best respond?
A)Arrange a family meeting that includes social work and spiritual care.
B)Accommodate the patient’s wishes and elicit a decision from the son.
C)Discuss the matter with the patient at a later time when the son is absent from the bedside.
D)Encourage the patient and her son to make a decision collaboratively.

22.A woman who is dying of heart failure has become listless, distracted, and difficult to engage in conversation in recent days despite no obvious changes in her physiologic state. She has admitted to feeling severely depressed and states that this sensation is something new to her. How should her care team best interpret this new onset of depression?
A)The patient should be encouraged to accept her depression and see it as a reasonable response to impending death.
B)The care team should acknowledge the patient’s depression but ensure that physical needs are prioritized over emotional symptoms.
C)The team should understand that depression is a normal stage of the grieving process that precedes death and should be accepted as such.
D)The patient’s depression should be actively treated and not seen as an inevitability.

23.A patient with a primary diagnosis of lung cancer developed bone metastases in recent months and experienced excruciating pain. As a result, the patient was treated with a combination of continuous-release and immediate-release morphine delivered by the oral route. Since yesterday, the patient has experienced a decreased level of consciousness and has become unable to swallow. How should the nurse best manage this patient’s analgesia?
A)Opioids should be discontinued because of the patient’s decreased level of consciousness.
B)The patient should receive similar doses of morphine by alternative routes.
C)The patient’s morphine should be reduced and a nonsteroidal anti-inflammatory (NSAID) introduced.
D)Analgesia should be discontinued because the patient’s decreased level of consciousness indicates that his pain has subsided.

24.An elderly female patient who experienced a hemorrhagic stroke has a poor prognosis and multiple functional deficits, including dysphagia. A family meeting has been organized to discuss the possibility of tube feeding, and the patient’s daughter is incredulous that a tube feed has not yet been introduced, stating, “The only thing worse than dying of a stroke would be to starve to death.” What principle should underlie a response to the daughter?
A)There are potential benefits to withholding artificial hydration and nutrition.
B)The food energy derived from artificial hydration and nutrition can exacerbate disease processes.
C)It is unethical to withhold artificial hydration and nutrition unless it is physiologically impossible.
D)Unconscious patients are unable to metabolize nutrients that are derived from tube feeds or parenteral nutrition.

25.A nurse who provides care on a palliative unit of a busy urban hospital performs numerous task and roles in the provision of holistic care to patients and their families. Which of the following tasks is essential for nurses to manage patients at the end of life? Select all that apply.
A)Obtain informed consent for palliative treatment measures.
B)Educate patients and families about end-of-life decision making.
C)Contribute to a coordinated, interdisciplinary plan of care.
D)Manage pain and symptoms.
E)Determine patients’ qualifications for hospice care.

1.The nurse in a pain clinic is assessing a palliative patient. The patient indicates that he has been saving his analgesics until the pain is intense because the pain control has been poor. What teaching should the nurse perform with this patient?
A)Medication should be taken when pain levels are low so the pain is easier to reduce.
B)Pain medication can be increased when the pain is intense.
C)It is difficult to control chronic pain, so little can be done.
D)Instruct the patient to lie still and think of something else during intense pain.

2.Two patients on your unit have returned from right knee arthroscopies. Patient A is reporting pain of an 8 to 9 on a 0-to-10 pain scale. Patient B is reporting a pain level of 3 to 4 on the same pain scale. What may provide a rationale for the different perceptions of pain?
A)Endorphin levels may vary between patients, affecting the perception of pain.
B)One of the patients is exaggerating his sense of pain.
C)The patients are likely experiencing a variance in vasoconstriction.
D)One of the patients may be experiencing opiate tolerance.

3.Your patient has just returned from the PACU following orthopedic surgery. The patient is complaining of pain, and you are preparing to administer the patient’s first dose of meperidine. Prior to administering the drug, what assessment would you prioritize?
A)The patient’s electrolyte values
B)The patient’s blood pressure
C)The patient’s allergies to any medications
D)The patient’s hydration status

4.Your patient is receiving postoperative analgesic through a patient-controlled analgesia (PCA) pump. You have given the patient a bolus of an opioid medication. You should prioritize the assessment of what potential problem?
B)Respiratory depression
C)Fluid overload
D)Changes in their skin integrity

5.Your patient is 12 hours post-ORIF right ankle. The patient is asking for pain medication. The pain medication orders are written as a combination of an opioid analgesic and a nonsteroidal anti-inflammatory (NSAID) given together. What is the rationale for administering pain medication in this manner?
A)To prevent respiratory depression from the opioid
B)To eliminate the need for additional medication during the night
C)To combine the medications more effectively and relieve the patient’s pain with fewer opioids
D)To eliminate toxic effects of the opioid

6.The nurse is caring for a patient with metastatic bone cancer. The patient asks the nurse why he has had to keep getting larger doses of his pain medication and it doesn’t seem to affect him. What is the nurse’s best response?
A)“Over time, you become more tolerant of the drug.”
B)“You are immune to the effects of the drug.”
C)“You may have formed an addiction to the drug.”
D)“Your body absorbs less of the drug due to the cancer.”

7.A 52-year-old female patient is seeing the nurse on the oncology unit for pain control related to breast cancer that has metastasized to her lungs and liver. The nurse wants to prevent further pain and is aware that:
A)Cancer pain is often related to the stress of the patient knowing he or she has cancer and requires a very low dose of pain medications along with a high dose of anti-anxiety medications.
B)Cancer pain is always chronic and difficult to treat so distraction is often the best intervention.
C)Cancer pain can be acute or chronic; it may even be the result of the cancer treatment and usually requires high doses of pain medications.
D)Cancer patients often misreport pain because of confusion related to their disease process.

8.The nurse caring for a 74-year-old man who has just returned to the surgical unit following surgery for a total knee replacement received report from the PACU. Part of the report had been passed on from the preoperative assessment, in which the patient stated that he has “gotten confused” in the past when he takes pain medications. The nurse should recognize which of the following principles of pain management among older adults?
A)The elderly may require lower doses of medication and are easily confused with new medications.
B)The elderly may have altered absorption and metabolism, which prohibits the use of opioids.
C)The elderly may be confused following surgery, a fact that is related to normal aging and unrelated to the medication.
D)The elderly may require a higher initial dose of pain medication followed by a tapered dose.

9.You are the emergency department (ED) nurse caring for a 9-year-old who was in a motor vehicle accident. The mother arrives at the ED, and you explain that the child is in pain from a broken arm, which will need surgical intervention to set the bones. You ask the mother to comfort the child. What type of pain are you dealing with in this patient?

10.You are the nurse caring for an elderly Asian-American patient who speaks little English. How would you assess this patient’s pain?
A)Make a chart with English on one side and the patient’s native language on the other.
B)Use the regular 0-to-10 pain scale.
C)Base your assessment on objective, physiological data.
D)Have a translator come in every time you assess the patient, so you can document what the patient said.

11.A 36-year-old woman has been experiencing chronic pain for several months, a problem that has recently been found to be attributable to fibromyalgia. When assessing this patient, the nurse should prioritize assessments related to:

12.Mrs. Ota is a 72-year-old woman whose recent fall resulted in a femoral head fracture. In the days since her subsequent hip surgery, she has been experiencing intermittent pain and requested breakthrough analgesia several times over the past 24 hours. However, her son and daughter-in-law came to visit for the first time 2 hours ago, and Mrs. Ota has denied pain during this time period. The nurse recognizes that Mrs. Ota may be experiencing less pain at this time because:
A)Being distracted has activated her descending control system.
B)Serotonin is inhibiting signals from her nociceptors.
C)C fibers are overriding signals from her A delta fibers.
D)Distraction has heightened the response of her spinal cord neurons.

13.A patient who is postoperative day 1 following a discectomy has lit his call light and requested a dose of hydromorphone, which he receives on a p.r.n. basis for breakthrough pain. What should the nurse first do in response to the patient’s request?
A)Assess the characteristics of the patient’s pain.
B)Draw up the prescribed dose of hydromorphone.
C)Propose the use of nonpharmacologic interventions.
D)Discuss the use of NSAIDs as an alternative to opioids.

14.A 20-year-old man has presented to the emergency department with a 24-hour history of abdominal pain. The nurse who is admitting the patient notes that he is diaphoretic, wincing, and guarding the lower right quadrant of his abdomen. The nurse asks the patient to rate his pain on a scale of 1 to 10, to which the patient responds, “One or two.” How should the nurse best respond to this patient’s statement?
A)Administer ibuprofen or acetaminophen rather than an opioid.
B)Reassess the patient’s pain in 30 to 45 minutes.
C)Explain the 0-to-10 pain scale in greater detail.
D)Document the fact that the patient has slight pain.

15.You are an obstetrical nurse who is providing care for a woman who gave birth by cesarean section a few hours ago. Knowing that the woman is likely to experience pain, you are providing patient education about pain. Which of the following statements should you include when teaching this patient about pain and about pain management?
A)“When your pain crosses the line between being bearable and unbearable, I’ll be able to give you some medication for it.”
B)“I’ll teach you some techniques that you can use so that you’ll be able to avoid using drugs to manage your pain.”
C)“When you feel like you’re not able to manage your pain on your own, ring your call bell, and I can get you something for pain.”
D)“I’ll be checking with you often, but please let me know as soon as you’re starting to feel pain.”

16.A 19-year-old woman had a mandibular osteotomy (jaw surgery) performed early this morning and is being assessed by the nurse after being transferred from the PACU. The nurse has asked the patient about her pain, to which the patient has responded, “I’m not really having any pain, but I’ve got a dull ache all around my jaw that’s really bad.” How should the nurse best interpret this patient’s statement?
A)The patient is not experiencing pain but likely requires interventions for her discomfort.
B)The patient is misinterpreting her body’s pain response.
C)The patient is currently free of pain but is likely to experience pain in the near future.
D)The patient is experiencing pain but is describing it in different terms.

17.A woman has received a discharge order the day after the spontaneous vaginal delivery of a healthy infant. Her health care provider has provided her with a prescription for codeine-acetaminophen tablets as well as diclofenac suppositories. What strategy should the nurse teach the patient about the potential side effects of her codeine-acetaminophen pills?
A)“It’s important that you minimize your salt intake when you’re taking these to avoid cramping.”
B)“These might cause you to lose your appetite but please try to maintain good nutrition nonetheless.”
C)“Try to drink plenty of fluids to make sure you don’t get constipated while you’re taking these pills.”
D)“Try to avoid taking these on an empty stomach to minimize the chance of irritating your stomach lining.”

18.A patient with a diagnosis of cellulitis was experiencing pain at her infection site and requested a breakthrough dose of morphine. The nurse administered the patient’s ordered dose of 5 mg PO 15 minutes ago, and the patient is now asking to speak to his health care provider because he has not experienced relief from his pain. How should the nurse best understand this patient’s complaint?
A)The patient’s pain is being exacerbated by anxiety.
B)There has been insufficient time for the onset of the drug’s therapeutic effect.
C)The patient likely requires subcutaneous or IV administration of morphine.
D)An NSAID should be administered to potentiate the effect of the opioid.

19.Mrs. Laird is a 56-year-old postsurgical patient who has an unremarkable social and medical history. Her surgeon has ordered fentanyl patient-controlled analgesia (PCA) but Mrs. Laird admits to you that she is very reluctant to use it for fear of becoming addicted. How should you best respond to Mrs. Laird’s concerns?
A)“Your risks of becoming addicted to this drug are very, very low.”
B)“These days, there are very effective measures that we can use to address addiction.”
C)“People who do not have a history of drug abuse almost never develop a tolerance or addiction to narcotics in the hospital.”
D)“I will make a note for your health care provider to see if you can receive non-narcotic medications for your pain.”

20.A 68-year-old woman developed rheumatoid arthritis 18 months ago and states that she is able to control her symptoms and maintain her level of function by taking doses of ibuprofen three times daily. This patient achieves pain relief through which of the following physiological processes?
A)The release of endorphins
B)The inhibition of cyclo-oxygenase (COX)
C)Blocking of pain pathways to the thalamus
D)Blocking of opioid receptors

21.A patient with a history of chronic pain has responded favorably to a new pain control regimen that exemplifies the principles of balanced analgesia. If the nurse were administering the patient’s scheduled 08:00 medications, which of the following best demonstrates balanced analgesia?
A)650 mg acetaminophen PO and 1 mg lorazepam SL
B)4 mg morphine PO and 1 mg morphine IV
C)2 mg hydromorphone PO and 600 mg ibuprofen PO
D)10 mg morphine extended-release PO and 2 mg morphine immediate-release PO

22.A patient has been admitted to the surgical unit from postanesthetic recovery and begun on a morphine patient-controlled analgesic (PCA) pump. What teaching point should the nurse who is performing this action provide to the patient?
A)“It’s important that you not push the button twice in rapid succession, so that you avoid giving yourself a double dose.”
B)“Try to use the deep-breathing techniques that you were taught before you resort to using your PCA.”
C)“Don’t hesitate to use you PCA when you first feel mild pain or when you anticipate you’re going to have pain.”
D)“Please ring your call bell to check with your nurse before you push your PCA button so you can be assessed first.”

23.A nurse who provides care for a diverse patient population on a busy medical unit has had significant success with the use of ice and heat in the management of patients’ pain. The nurse should exercise particular caution when applying cold therapy or heat therapy to a patient who:
A)Is unable to communicate or has a cognitive or sensory deficit
B)Is simultaneously using a patient-controlled analgesic (PCA) pump
C)Consistently rates his or her pain at 8 out of 10 or higher
D)Has pain unrelated to observable tissue damage

24.In response to a patient’s complaint of pain, the nurse administered 2 mg oxycodone PO to a patient 40 minutes ago. The physical therapist on the unit has liaised with the nurse and plans to ambulate the patient. How should the nurse follow-up the physical therapist’s statement?
A)Ask the physical therapist to wait for 1 hour before ambulating the patient
B)Reevaluate the patient’s pain
C)Supervise while the therapist works with the patient
D)Inform the physical therapist that the patient will be unlikely to ambulate

25.A patient has a long history of severe and persistent pain and has trialed a number of different analgesia regimens, all with limited success. The patient is increasingly distraught and depressed as a result of continued pain. Which of the following interventions would be most likely to benefit this patient?
A)Guided imagery and relaxation techniques
B)Transcutaneous electrical nerve stimulation (TENS)
C)Use of a patient-controlled analgesia (PCA) pump
D)Neurosurgery to interrupt the patient’s pain pathways

1.The nurse is performing patient teaching with a young mother who has brought her 3-month-old to the clinic for a well-baby check. Knowing that it is cold season, what information should the nurse provide to the mother to best prevent transmission of organisms?
A)Take prescribed antibiotics
B)Use warm salt-water gargles
C)Dress warmly
D)Wash hands frequently

2.A patient comes to the emergency department (ED) and is admitted with epistaxis. Pressure has been applied to the patient’s midline septum for 10 minutes but the bleeding continues. What treatment will best control the bleeding?
A)Nasal plugs
C)Nasal spray
D)Silver nitrate applicators

3.The nurse is preparing the care plan for a patient who is scheduled for a laryngectomy. Which nursing diagnosis should receive the highest priority?
A)Anxiety related to diagnosis of cancer
B)Altered nutrition related to swallowing difficulties
C)Ineffective airway clearance related to surgical alterations in the airway
D)Impaired verbal communication related to removal of the larynx

4.An emergency department (ED) nurse is assessing a 20-year-old gymnast who fell from a balance beam. The gymnast presents with a clear fluid leaking from the nose. What should the ED nurse suspect?
A)Fracture of the cribriform plate
B)Potential loss of consciousness
C)Abrasion of the soft tissue
D)Fracture of the nasal septum

5.The nurse is discussing the administration of nasal spray with participants of a health fair. What information is most important to include in this discussion?
A)Finish the bottle of nasal spray to clear the infection effectively.
B)Nasal spray can be shared between family members only.
C)Administer the nasal spray in a prone position.
D)Overuse of nasal spray may cause rebound congestion.

6.The nurse is caring for a patient in the outpatient clinic with suspicion of cancer due to recent weight loss for unidentifiable reasons. The patient has a 25-year history of smoking. The nurse performs an assessment and asks the patient about symptoms related to laryngeal cancer. What is an early symptom associated with laryngeal cancer?

7.The health care provider has ordered continuous positive airway pressure (CPAP) with the delivery of oxygenation. The patient asks the nurse what the benefit of CPAP is. What would be the nurse’s best response?
A)CPAP allows a higher percentage of oxygen to be used
B)CPAP prevents the collapse of the patient’s airway
C)CPAP eliminates the need for oxygen supplementation during the day
D)CPAP alters alveolar perfusion

8.While caring for a patient with an endotracheal tube the nurse recognizes that suctioning is required:
A)Every 2 hours
B)When adventitious breath sounds are auscultated
C)To prevent the patient from coughing
D)To stimulate the cough reflex

9.The nurse is preparing to suction a patient with an endotracheal tube. What would be the nurse’s first step in the suctioning process?
A)Explain the procedure to the patient before beginning and offer reassurance during suctioning.
B)Turn on suction source at or below 120 mm Hg.
C)Assess the patient’s lung sounds and SaO2 via pulse oximeter.
D)Perform hand hygiene, then put on nonsterile gloves, goggles, gown, and mask.

10.A critical care nurse is caring for a patient with an endotracheal tube who is on a ventilator. The nurse knows that meticulous management of this patient’s needs is necessary. What is the rationale for this?
A)Maintaining a patent airway
B)Preventing the need for suctioning
C)Decreasing the patient’s time on the ventilator
D)Increasing the patient’s lung compliance

11.A college student has sought care at the campus medical clinical after a 5-day history of malaise that he believes is due to a bad cold. Which of the student’s following statements should cause the nurse to suspect an alternative diagnosis?
A)“I never normally get headaches, but I’ve had a splitting headache for days.”
B)“My eyes and ears are so itchy that it’s driving me crazy.”
C)“I’ve been burning up with a fever at night and then getting terrible chills too.”
D)“My nose is raw because of my runny nose and sneezing.”

12.During a period of significant workplace stress, a patient has been experiencing the recurrence of viral rhinitis for the past several weeks and claims that he has been unable to fully recover from this cold. The nurse should recognize that this patient is at risk of developing:
D)Allergic rhinitis

13.A patient with a diagnosis of acute rhinosinusitis has approached the nurse and asked for advice about “rinsing out my sinuses with saltwater,” a treatment that was suggested by a friend. The nurse’s response should be premised on which of the following statements?
A)Saline rinses have the potential to damage the mucosa of the sinuses.
B)Nasal saline lavage can help to improve the patency of the sinuses.
C)Nasal saline lavage can result in rebound congestion.
D)Rinsing with saline has been shown to be ineffective in clearing the sinuses of mucus.

14.A 23-year-old man has missed numerous work days over the past 2 years as a result of chronic viral pharyngitis. The nurse who is providing care for this patient should recognize that this patient may benefit from:
A)Intravenous antibiotics
B)Nebulized bronchodilators

15.The nurse in a long-term-care facility is aware of the importance of preventing upper respiratory infections (URIs) among the residents of the facility. How is this best accomplished?
A)Vigilant handwashing by staff and residents
B)Providing a high-calorie diet for residents
C)Encouraging residents’ fluid intake
D)Providing topical decongestants to residents

16.A 64-year-old patient and his wife have presented to their primary care provider. The patient’s wife has prompted her husband to seek care because she is worried about his apneic episodes and loud snoring. The husband had earlier undergone a diagnostic workup for obstructive sleep apnea (OSA) and been diagnosed with the disease but is not motivated to treat his health problem. How can the nurse at the clinic best characterize the risks of OSA?
A)“Sleep apnea actually increases your risk of having a stroke or heart attack.”
B)“People with sleep apnea are much more susceptible to infections in their sinuses and throat.”
C)“Sleep apnea has actually been identified as a risk factor for throat cancer.”
D)“Without treatment, your sleep apnea could progress to chronic obstructive lung disease.”

17.A 60-year-old man has been diagnosed with obstructive sleep apnea (OSA) based on his clinical symptoms and polysomnographic findings. What intervention should the nurse perform to assist this patient in the management of his health problem?
A)Encouraging the patient to adopt a later bedtime and earlier rising hour
B)Encouraging the patient to avoid alcohol and hypnotic medications
C)Teaching the patient deep breathing and coughing exercises to perform before going to bed
D)Teaching the patient strategies for waking himself up when he experiences an apneic spell

18.A female patient with obstructive sleep apnea (OSA) has been recommended a continuous positive airway pressure (CPAP) machine for the treatment of her health problem. The nurse’s priority for patient education should be:
A)The need to use inhaled corticosteroids and bronchodilators each night prior to applying CPAP
B)The importance of participating in daily physical exercise when using CPAP on a regular basis
C)The need to have continuous pulse oximetry in place while the CPAP machine is in use
D)The importance of complying with CPAP despite the inconvenience associated with its use

19.A nurse has responded to a patient’s call light and found her to being experiencing a nosebleed. What is the first action that the nurse should perform in the treatment of epistaxis?
A)Position the patient supine and apply an ice pack to the bridge of her nose.
B)Insert rolled 2×2 gauzes coated with water-soluble lubricant into each nostril.
C)Have the patient sit in a high Fowler’s position and apply direct pressure to her nose.
D)Instruct the patient to look up at the ceiling and to exhale through her mouth.

20.A 13-year-old boy has been brought to the emergency department by his mother after he took a powerful blow to his nose during a volleyball game. Preliminary examination suggests a nasal fracture, which should prompt the nurse to:
A)Apply ice and tell the patient to keep his head elevated
B)Administer saline lavage and tell the patient not to swallow the solution
C)Apply warm compresses to the bridge of the patient’s nose
D)Administer analgesia and a nebulized bronchodilator

21.A 58-year-old male patient with a 60 pack-year history of cigarette smoking and a history of heavy alcohol use has been diagnosed with laryngeal cancer following a physical examination and endoscopy. The patient has been scheduled for a partial laryngectomy and is highly anxious about the consequences of this surgery. What patient education should the nurse provide for this man?
A)“Most people who have a partial laryngectomy find that their breathing, swallowing, and speech are unchanged.”
B)“After a partial laryngectomy, most patients work with a speech therapist and regain some of their ability to speak.”
C)“A partial laryngectomy has the advantage of having only a minimal effect on your speech.”
D)“Unfortunately, the nature of a partial laryngectomy means that you can no longer use your vocal cords.”

22.A patient is postoperative day 2 following a total laryngectomy, and the nurse is aware of the importance of assessing for tracheostomal stenosis. The nurse can best prevent this complication by:
A)Ensuring that cuff pressures are appropriate
B)Performing deep suctioning q2h
C)Administering bronchodilators p.r.n.
D)Providing humidified air for the patient

23.The nurse is receiving shift report about a patient who has a tracheostomy. The nurse learns that the patient was suctioned seven times during the past shift and has questioned the necessity of such frequent suctioning. Why is it important not to perform unnecessary tracheal suctioning?
A)Excessive suctioning can result in bronchospasm.
B)Frequent suctioning inhibits the patient’s existing cough reflex.
C)Excessive suctioning produces “rebound” production of secretions.
D)Frequent suctioning is a risk factor for respiratory alkalosis.

24.The nurse is preparing to perform the care of a patient’s tracheostomy tube. Which of the following actions should the nurse perform during this procedure?
A)Clean the stoma and the skin surrounding the stoma with chlorhexidine.
B)Perform deep suctioning before and after the trach care.
C)Remove the soiled twill tape after new tape has been put in place.
D)Wash the inner cannula with soap and warm tap water if it is not disposable.

25.The nurse is preparing to perform tracheal suction for a patient who has had a tracheostomy for several months following a traumatic brain injury. After securing the end of the suction tubing to the suction device, the nurse should turn on suction source at a pressure that should not exceed:
A)100 mm Hg
B)125 mm Hg
C)150 mm Hg
D)175 mm Hg

1.The nurse is caring for a 24-year-old patient with an antitrypsin deficiency who states that she has never smoked in her life. An antitrypsin deficiency predisposes the patient to what?
A)Pulmonary edema
C)Community-acquired pneumonia

2.The school nurse is caring for a 10-year-old girl who is having an asthma attack on the school ground at recess. What is the preferred treatment to alleviate this patient’s current airflow obstruction?
D)Peak flow monitoring device

3.The nurse is performing an admission assessment of a patient who has a history of asthma. The nurse should be aware that the most common signs of asthma are what?
A)Shallow respirations
B)Increased A-P diameter
C)Bilateral wheezes
D)Rhonchi in the lower bases

4.The patient is having pulmonary function studies performed. The patient has a spirometry test and has a FEV1/FVC ratio of 60%. This finding suggests:
A)Strong exercise tolerance.
B)Exhalation volume is normal.
C)Healthy lung volumes.
D)Obstructive lung disease.

5.The nurse has been asked to give a workshop on chronic obstructive pulmonary disease (COPD) for a local community group. When talking about what can be done for patients with COPD, the nurse encourages a COPD patient not to smoke because smoking has what effect?
A)Increases the amount of mucus production
B)Deoxygenates the hemoglobin
C)Shrinks the alveoli in the lungs
D)Collapses the alveoli in the lungs

6.The nurse is caring for a patient with chronic obstructive pulmonary disease (COPD) and is now performing discharge teaching with this patient. What should the nurse include in the teaching about breathing techniques?
A)Make inhalation longer than exhalation.
B)Exhale through a wide open mouth.
C)Use diaphragmatic breathing.
D)Use chest breathing.

7.The admitting nurse is assessing a patient with chronic obstructive pulmonary disease (COPD). The nurse auscultates diminished breath sounds, which signify changes in the airway. These changes indicate to the nurse the need to monitor the patient for what related signs and symptoms?
A)Hypoxemia and clubbing of the fingers
B)Dyspnea and hypoxemia
C)Clubbing of the fingers and cyanosis
D)Bronchospasm and clubbing of the fingers

8.A student nurse is developing a teaching plan for a patient with chronic obstructive pulmonary disease (COPD). What should the student include as a priority area of teaching?
A)Avoiding extremes of heat and cold
B)Setting and accepting realistic short-term and long-range goals
C)Adopting a lifestyle of moderate activity, ideally in a climate with minimal shifts in temperature and humidity
D)Avoiding emotional disturbances and stressful situations that might trigger a coughing episode

9.The nurse is caring for an asthmatic patient hospitalized with an acute asthma exacerbation. What drugs would the nurse anticipate being ordered for this patient to gain underlying control of persistent asthma?
A)Rescue inhalers
B)Anti-inflammatory drugs

10.An asthma educator is teaching a new patient with asthma and his family about the use of a peak flow meter. What does a peak flow meter measure?
A)Highest airflow during a forced inspiration
B)Highest airflow during a forced expiration
C)Highest airflow during a normal inspiration
D)Highest airflow during a normal expiration

11.After an extensive diagnostic workup, a 64-year-old man has received a diagnosis of chronic obstructive pulmonary disease (COPD). He is eager to learn as much as possible about his new diagnosis and has asked the nurse numerous questions about his course of treatment and his prognosis. Which of the nurse’s following statements is most accurate?
A)“With careful management and lifestyle changes, many people are able to recover from COPD.”
B)“The priority during your treatment will likely be to prevent your COPD from progressing to lung cancer.”
C)“There is no cure for COPD but there are several measures that can help you maintain your quality of life.”
D)“Despite advances in the early diagnosis of COPD, there are still very few medications that appreciably affect the symptoms of the disease.”

12.A patient’s history, physical exam, and pulmonary function testing have culminated in a diagnosis of chronic obstructive bronchitis. The nurse who is providing care for this patient will understand that the effects of the disease are primarily attributable to:
A)Autoimmune of alveoli
B)Chronic mucus hypersecretion
C)A reduction in oxygen binding sites on erythrocytes
D)Decreased respiratory drive

13.A public health nurse works with numerous patients who live with chronic obstructive pulmonary disease (COPD) in the community and has seen firsthand the effects of many of the risk factors underlying the disease. Which of the following public health initiatives addresses the most salient risk factor for COPD?
A)Close follow-up of older adults who have a history of pneumonia
B)Allergy screening for elementary school students
C)A lung health awareness program at a large industrial complex
D)An anti-smoking campaign in a junior high school

14.A 58-year-old smoker is undergoing lung function testing because of his recent history of progressive dyspnea and a productive cough. Which of the following assessment findings during spirometry would be consistent with a diagnosis of chronic obstructive pulmonary disease (COPD)?
A)The patient’s vital capacity is £75% of expected norms for his age and gender.
B)The patient’s SaO2 does not increase with the application of supplementary oxygen.
C)The patient’s ability to forcibly exhale is significantly diminished.
D)The patient exhibits adventitious lung sounds during inhalation.

15.In light of her recent diagnosis of chronic obstructive pulmonary disease (COPD), a 66-year-old woman has been prescribed bronchodilators and corticosteroids, both of which will be administered by metered dose inhaler. How should the nurse instruct the patient on the correct administration of her medications?
A)“Gauge the dose of your medications based on the severity of your symptoms on that particular day.”
B)“When you’re taking your inhalers, breathe in as deeply as you can and hold each breath for several seconds.”
C)“Inhale for several short, forceful breaths after depressing your inhaler in order to get the medication well-distributed in your lungs.”
D)“Exhale through your inhaler prior to and after using it so that you purge the old medication from the device.”

16.The nurse is providing care for an adult patient who has a diagnosis of chronic obstructive pulmonary disease (COPD). Which of the following principles should the nurse apply when managing this patient’s supplementary oxygen?
A)Supplementary oxygen should be used with caution with COPD patients in order to avoid depressing the respiratory drive.
B)Room air is preferable to supplementary oxygen for COPD patients because this stimulates respiratory function.
C)Supplementary oxygen should be provided to COPD patients at the highest concentration that they can comfortably tolerate.
D)Supplementary oxygen is vital in the management of COPD and should never be withheld from patients who may benefit from it.

17.The nurse is planning the care of a complex elderly patient who has been admitted to the medical ward for the treatment of cellulitis. The nurse notes that the patient has a longstanding history of chronic obstructive pulmonary disease (COPD). What assessment finding would most clearly indicate the need for oxygen therapy?
A)SaO2 of 86% on room air
B)Respiratory rate (RR) of 25 breaths per minute at rest
C)Presence of bilateral fine crackles to lower lung fields on auscultation
D)Presence of an occasional productive cough

18.Mrs. Fawcett is a 70-year-old woman who has a diagnosis of emphysema and who receives long-term oxygen therapy. She has presented to the emergency department because she states that she is experiencing an exacerbation of her chronic obstructive pulmonary disease (COPD), and she is in visible respiratory distress. How can the nurse best assess Mrs. Fawcett’s dyspnea?
A)Observe her activity tolerance and assess her skin tone.
B)Measure her SpO2 by pulse oximetry and assess her respiratory rate.
C)Auscultate her anterior and posterior lung fields.
D)Ask her to rate her shortness of breath on a scale of 0 to 10.

19.Long-term oxygen therapy has been prescribed for a patient whose chronic obstructive pulmonary disease (COPD) has recently increased in severity. When teaching this patient about this treatment modality, what information should the nurse provide?
A)“In time, you will learn to effectively adjust your flow rates depending on the dyspnea you are experiencing or that you anticipate.”
B)“It’s important to use your oxygen as ordered and not to base it solely on your shortness of breath at the time.”
C)“A good rule of thumb is to temporarily stop your oxygen whenever you feel like you could comfortably go without it.”
D)“Try to predict those situations where you’ll need oxygen and apply your nasal prongs 30 minutes ahead of time.”

20.A resident of a long-term care facility has lived with chronic obstructive pulmonary disease (COPD) for many years but has experienced a gradual increase in dyspnea despite the use of long-term oxygen therapy. In recent weeks, dyspnea has interfered with the resident’s ability to eat, and the nurse recognizes the potential nursing diagnosis of altered nutrition: less than body requirements. How can the nurse best foster this resident’s nutritional status?
A)Arrange for a high-protein diet to promote gas exchange.
B)Provide meals early in the morning and late at night.
C)Liaise with the resident’s health care provider to organize total parenteral nutrition (TPN).
D)Order small, frequent meals and nutritional supplements for the resident.

21.The nurse recognizing a female patient’s susceptibility to infection due to her history of chronic obstructive pulmonary disease (COPD). When teaching this patient to reduce her risk of infection in the community, what measure should the nurse emphasize to the patient?
A)Avoiding abrupt transitions from cold air to hot air
B)Washing her hands frequently and thoroughly
C)Remaining indoors when possible during allergy season
D)Avoiding contact with individuals who have not received an influenza vaccination

22.A hospital patient with a complex medical history that includes asthma has rung his call bell and states that he is having an asthma attack. The nurse has completed a rapid assessment of the patient and has identified the need for pharmacologic interventions. After consulting the patient’s medication administration record, the nurse should administer a p.r.n. dose of:
A)Hydromorphone (Dilaudid)
B)Albuterol (Ventolin)
C)Ipratropium (Atrovent)
D)Fluticasone (Flovent)

23.A patient in an acute-care setting is being monitored closely after recently experiencing status asthmaticus. The nurse who is providing care for the patient has been assessing the patient’s respiratory status frequently and has just completed auscultation of the patient’s breath sounds. The nurse notes that the patient’s breath sounds are significantly quieter than during the previous assessment. How should the nurse best interpret this assessment finding?
A)The patient’s upper airways are responding to bronchodilators.
B)The patient’s respiratory wheeze is resolving.
C)The patient’s airflow may be severely limited.
D)The patient is in the early stages of a pulmonary infection.

24.Asthma is a chronic illness and requires life-long management by patients and clinicians to achieve the goals of therapy. The signs and symptoms of this disease are primarily attributable to what pathophysiological process?
A)Acute inflammation of the patient’s hyperresponsive airway
B)Hypersecretion of mucus by goblet cells in the upper airway
C)Misinterpretation of chemoreceptor signals by the pons and medulla
D)Autoimmune destruction of the mucosa in the patient’s upper airway

25.A pediatric nurse is conducting patient education with a 13-year-old girl who has just been diagnosed with asthma. What subject should the nurse prioritize when teaching this patient and her parents about the management of asthma?
A)Identification of the triggers that exacerbate her asthma
B)The appropriate use of antibiotics in the treatment of asthma
C)Techniques for managing long-term oxygen therapy
D)Demonstrating the use of continuous positive airway pressure (CPAP)

1.An 80-year-old man, newly diagnosed with primary hypertension, has just been started on a beta-blocker. The nurse knows that in addition to teaching the patient about his medication (ie, side effects, purpose, and schedule), she should also focus her teaching on what?
A)Limiting fluids in order to decrease vascular volume
B)Maintaining a diet high in dairy to increase protein necessary to prevent organ damage
C)Use of supportive devices such as hand rails and walkers to prevent falls stemming from postural hypotension
D)Limiting exercise to avoid injury that can be caused by postural hypotension

2.The staff educator is talking to a group of new emergency department nurses about hypertensive crises. The nurse educator is aware that hypertensive urgency differs from hypertensive emergency in what way?
A)The patient’s blood pressure (BP) is always higher in a hypertensive emergency.
B)Close hemodynamic monitoring is required during treatment of hypertensive emergencies.
C)Hypertensive urgency is treated with rest and tranquilizers to lower BP.
D)Hypertensive emergencies are associated with evidence of target organ damage.

3.A 56-year-old man has sought care because the automated blood pressure machine in his pharmacy indicated a blood pressure reading of 146/96 mm Hg. He has said to the nurse, “My pressure has never been this high. Will I need to take medication to reduce it?” Which of the following responses by the nurse would be best?
A)“Yes. Hypertension is prevalent among males; it’s fortunate we caught this during your routine examination.”
B)“Quite likely, because your age places you at high risk for hypertension.”
C)“A single elevated blood pressure doesn’t confirm hypertension. You’ll need to have your blood pressure reassessed several times before a diagnosis can be made.”
D)“You have no need to worry. Your pressure was probably elevated because of your anxiety.”

4.A 40-year-old man newly diagnosed with hypertension is discussing risk factors with the nurse. The nurse talks about lifestyle changes with the patient and advises that the patient should avoid tobacco use. What is the rationale behind that advice to the patient?
A)Smoking directly causes high blood pressure.
B)Smoking increases the risk of heart disease.
C)Smoking causes obesity, which exacerbates hypertension.
D)Smoking increases cardiac output.

5.A patient newly diagnosed with hypertension asks the nurse what happens when uncontrolled hypertension is prolonged. The nurse explains that a patient with prolonged uncontrolled hypertension is at risk for developing what health problem?
A)Renal failure
B)Right ventricular hypertrophy

6.The nurse is talking with a patient about her hypertension and her antihypertensive drug therapy. The patient enjoys generally good health apart from her high blood pressure. When assessing the response to an antihypertensive drug regimen what blood pressure would be the goal of treatment?
A)156/96 mm Hg or lower
B)140/90 mm Hg or lower
C)Average of 2 BP readings of £150/80 mm Hg
D)120/80 mm Hg or lower

7.A patient with secondary hypertension has come into the clinic for a routine check-up. The nurse is aware that the difference between primary and secondary hypertension is what?
A)Secondary hypertension has a specific cause.
B)Secondary hypertension has a more gradual onset than primary hypertension.
C)Secondary hypertension does not cause target organ damage.
D)Secondary hypertension does not respond to antihypertensive drug therapy.

8.A patient has come to the clinic for a follow-up assessment. Before taking the blood pressure, the nurse should determine if the patient has:
A)Tried to rest quietly for 5 minutes before the reading is taken
B)Refrained from smoking for at least 8 hours
C)Been NPO for at least 2 hours
D)Avoided drinking coffee for 12 hours before the visit

9.The nurse is working with a patient who has uncontrolled hypertension. The patient asks the nurse what can happen if his blood pressure is not brought under control. What are potential consequences of uncontrolled hypertension? Select all that apply.
A)Transient ischemic attacks
B)Cerebrovascular accident
C)Retinal hemorrhage
D)Venous insufficiency
E)Right ventricular hypertrophy

10.A patient comes to the walk-in clinic. While assessing the patient’s vital signs, the nurse assesses the patient’s blood pressure at 128/89 mm Hg. According to JNC7, how would this patient’s blood pressure be classified?
C)Slightly hypertensive

11.A team of public health nurses are strategizing around a new initiative that will address screening, education, and management of hypertension in residents of the community. Which of the following facts surrounding hypertension should underlie the nurses’ design of this health initiative?
A)Many of the pathophysiological effects of hypertension are poorly understood in the health literature.
B)Hypertension is difficult to identify in many of the individuals who are at highest risk of the problem.
C)Hypertension tends to be inadequately managed in many of the people who have been diagnosed with the problem.
D)Hypertension is among the health problems that are most difficult to treat successfully.

12.As part of a patient’s admission assessment, the nurse has assessed the patient’s blood pressure (BP) and achieved a reading of 133/78. What physiological factors contribute to the patient’s blood pressure reading?
A)Cardiac output multiplied by peripheral vascular resistance
B)The differences between preload and afterload during systole and diastole
C)Stroke volume multiplied by total vascular space
D)Heart rate multiplied by mean heart contractility

13.A detailed history and assessment of a 59-year-old male patient lead the nurse to suspect that the patient may have masked hypertension. A patient who has masked hypertension:
A)Lacks the characteristic risk factors associated with hypertension
B)Has occasional “spikes” in blood pressure (BP) but lacks the high serial BP readings necessary for a diagnosis
C)Tends to have normotensive BP during health assessments and high BP at other times
D)Has signs and symptoms of hypertension but is unwilling to engage in the treatment process

14.After a series of visits to her care provider, a 40-year-old woman has been diagnosed with primary hypertension and metabolic syndrome. In addition to her persistently high blood pressure (BP) readings, what criterion would contribute to the woman’s diagnosis of metabolic syndrome?
A)Serum sodium levels of ³135 mmol/L
B)Abnormal lipid levels
C)Increased serum creatinine and/or blood urea nitrogen (BUN) levels
D)Presence of proteinuria

15.Mr. Faulkner is a 69-year-old man who has enjoyed generally good health for his entire adult life. As a result, he has been surprised to receive a new diagnosis of hypertension after a series of visits to his primary care provider. The nurse who is working with Mr. Faulkner should recognize which of the following aspects of aging and hypertension?
A)The diagnostic criteria for hypertension in adults over 65 differ from those for younger adults.
B)The incidence and prevalence of hypertension increase with age.
C)Blood pressure remains stable throughout adulthood but tends to be assessed more often by health care providers of older adults.
D)Older adults are less vulnerable to the pathophysiological effects of hypertension than are younger adults.

16.A 56-year-old man visits his primary care provider infrequently but has now presented with complaints of transient visual disturbances. Assessment of the patient has yielded few remarkable findings with the exception of blood pressure (BP) of 169/106 mm Hg. When do signs and symptoms of hypertension typically appear?
A)Once the patient’s average BP crosses the threshold of 140/90 mm Hg
B)During the prehypertension stage of the disease
C)After target organ damage has occurred
D)After hypertension becomes an irreversible condition

17.An adult patient’s blood pressure readings have ranged from 138/92 to 154/100 during the past several weeks. As a result, the patient’s nurse practitioner has ordered diagnostic follow-up. Which of the following diagnostic tests should the nurse prioritize when assessing the patient for target organ damage?
A)C-reactive protein (CRP) levels
B)Sodium, chloride, and potassium levels
C)Arterial blood gas (ABG) results
D)Blood urea nitrogen (BUN) and creatinine levels

18.A nurse on a busy medical unit is aware of the importance of accurate blood pressure (BP) measurement. To ensure accuracy when assessing patients’ blood pressures, the nurse should always:
A)Use a manual, rather than automated, sphygmomanometer
B)Alternate blood pressure readings between patients’ right and left arms
C)Take serial blood pressure readings on each patient
D)Ensure that the correct cuff size is used for each patient

19.The nurse is performing health education–related lifestyle modifications for a patient who has been newly diagnosed with hypertension. As a component of these modifications, the DASH (Dietary Approaches to Stop Hypertension) eating plan has been recommended to the patient. Which of the nurse’s recommendations is most congruent with this eating plan?
A)“Try to buy and consume as many organic and natural foods as you can.”
B)“Try to replace the complex carbohydrates in your diet with protein-rich foods.”
C)“Try to reduce the overall amount of fat that is in your diet.”
D)“If you eat four of five small meals each day, you’ll find that you’re able to reduce your calorie intake.”

20.A community health nurse is conducting a workshop for adults who have hypertension and is now teaching participants about reading food labels when they are shopping at the supermarket. What teaching point should this nurse prioritize?
A)“Take particular note of the amount of sodium that a serving contains.”
B)“Try to buy foods that have a high ratio of fiber to carbohydrates.”
C)“If a food has ingredients that you can’t pronounce, it’s best to avoid it.”
D)“Look at the percentage of the daily recommended intake of vitamins that is in a serving.”

21.The nurse is discussing the role of lifestyle modifications with a patient who has a diagnosis of primary hypertension. Which of the following lifestyle modifications typically results in the greatest reduction in blood pressure (BP)?
A)Reduction in salt intake
B)Weight loss
C)Vigilant blood pressure monitoring
D)Reduction in alcohol intake

22.A 40-year-old man with overall good health has implemented many of the lifestyle modifications that his care provider recommended when he was diagnosed with hypertension. While these have resulted in reductions in his blood pressure readings over the past several months, the man remains borderline hypertensive. As a result, his care provider has proposed pharmacologic therapy. What medication should the nurse anticipate being prescribed for this patient?
A)An angiotensin-converting enzyme (ACE) inhibitor
B)A thiazide diuretic
C)A beta blocker
D)An angiotensin receptor blocker (ARB)

23.The nurse is performing patient education for a patient who has been prescribed hydrochlorothiazide and metoprolol (Lopressor) for the treatment of hypertension. What teaching point should the nurse emphasize when teaching the patient about this medication regimen?
A)“It’s best not to take aspirin for pain while you’re taking your antihypertensives.”
B)“Avoid taking over-the-counter decongestants because they can increase your blood pressure (BP).”
C)“Most allergy medications can’t be taken with BP meds, so make sure to check with your doctor or pharmacist.”
D)“If you get an infection, make sure that your care provider knows you have hypertension before he or she prescribes an antibiotic.”

24.A medical patient has rung her call bell complaining of a severe headache, and the nurse has conducted a rapid assessment of the patient. The assessment reveals tachycardia and a blood pressure (BP) reading of 198/144. The nurse would recognize the need to treat this patient for:
A)Primary hypertension
B)Hypertensive emergency
C)Hypertensive urgency
D)Secondary hypertension

25.The DASH (Dietary Approaches to Stop Hypertension) diet has been recommended to a 58-year-old woman with a recent diagnosis of primary hypertension. What dietary component will the woman consume most if she adheres to this diet?
A)Grains and grain products
D)Low-fat dairy products

1.The nurse is planning and providing the care of a patient with heart failure (HF). What will be the overall goals of management for this patient? Select all that apply.
A)Improve functional status
B)Increase cardiac contractility
C)Extend survival
D)Decrease pulmonary venous pressure
E)Relieve patient symptoms

2.The nurse is providing care for a patient newly diagnosed with systolic heart failure (HF). What medications should the nurse anticipate administering?
B)Calcium channel blockers
C)Alpha agonists
D)Angiotensin prohibiters

3.The nurse has conducted a comprehensive assessment of a new resident of a long-term care facility. Which assessment data, collected by the nurse, indicate the most significant increase in a patient’s risk for heart failure (HF)?
A)Lasix 20 mg/day PO
B)Potassium level of 5.7 mEq/L
C)African American race
D)Age of 65 years or older

4.The nurse is providing discharge teaching to a patient diagnosed with heart failure. What should the nurse teach this patient to do to monitor fluid balance?
A)Monitor blood pressure.
B)Assess radial pulses.
C)Monitor weight daily.
D)Monitor bowel movements

5.The nurse is assessing for hepatojugular reflux in a patient with a history of heart failure. When performing this assessment, the nurse will:
A)Elevate the patient’s head to 90 degrees
B)Press the patient’s right upper abdomen
C)Palpate the patient’s jugular veins simultaneously
D)Lay the patient flat in bed

6.The nurse has attended morning report on a busy medical unit. The nurse recognizes which patient to be at greatest risk for the development of cardiogenic shock?
A)The patient admitted with acute renal failure.
B)The patient admitted following a myocardial infarction (MI).
C)The patient admitted following hypertensive urgency.
D)The patient admitted following a stroke.

7.When assessing the patient with pericardial effusion, the nurse will assess for pulsus paradoxus. Pulsus paradoxus is characterized by:
A)A diastolic blood pressure that is lower during exhalation.
B)A diastolic blood pressure that is higher during inhalation.
C)A systolic blood pressure that is higher during exhalation.
D)A systolic blood pressure that is lower during inhalation.

8.The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. When the nurse assesses the patient, the patient is found to be experiencing cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm?
A)Pulseless electrical activity (PEA)
B)Ventricular fibrillation
C)Ventricular tachycardia

9.The nurse is performing a physical assessment on a patient suspected of being in heart failure. During auscultation, heart failure would be suggested by:
A)An S3 heart sound
D)An S4 heart sound

10.A nurse has asked the unit educator what happens when the amount of fluid in the pericardial sac increases. What should the educator tell the nurse?
A)It raises the pressure inside the pericardial sac, causing fluid to leak through.
B)It raises the pressure inside the pericardial sac, compressing the lungs.
C)It raises the pressure inside the pericardial sac, compressing the heart.
D)It raises the pressure inside the pericardial sac, causing it to rupture.

11.A 69-year-old man has been experiencing progressive dyspnea and activity intolerance in recent months and is currently undergoing a diagnostic workup for heart failure (HF). During echocardiography, systolic HF could be differentiated from diastolic HF by appraising the patient’s:
A)Sinus rhythm
B)Ejection fraction (EF)
C)Stroke volume
D)Left ventricular wall thickness

12.The nurse recognizes that an older adult patient with heart failure is experiencing the effects of inadequate cardiac output, a problem that affects many of the body’s systems. Inadequate perfusion of the patient’s kidneys leads to which of the following pathophysiological effects?
A)Decreased erythropoiesis
B)Acid–base imbalances
D)Increased renin release

13.A patient has been admitted to the hospital with exacerbation of heart failure (HF) that has resulted in pulmonary and peripheral edema. The nurse has been carefully monitoring the trajectory of the patient’s signs and symptoms of HF. How can the nurse best monitor the patient’s fluid balance?
A)By monitoring the patient’s blood urea nitrogen (BUN) and creatinine levels
B)By measuring and recording the patient’s oral fluid intake
C)By performing daily weights at the same time each day
D)By assessing the patient’s skin turgor at several different sites

14.The nurse has completed a head-to-toe assessment of a patient who was admitted for the treatment of heart failure (HF). Which of the following assessment findings should signal to the nurse a possible exacerbation of the patient’s condition?
A)Crackles are audible on chest auscultation.
B)The patient’s blood pressure (BP) is 144/99.
C)The patient has put out 600 mL of dilute urine over the past 8 hours.
D)Blood glucose testing reveals a glucose level of 158 mg/dL.

15.A patient has been newly diagnosed with heart failure (HF) and has come to the meet with the nurse at the clinic for health education. What lifestyle recommendation should the nurse provide to this patient when discussing dietary modifications?
A)“It’s in your best interests to avoid excessive fluids and sodium in your diet.”
B)“Try to replace as many of the complex carbohydrates in your diet with simple sugars.”
C)“I’ll teach you some good sources of potassium, which you should try to eat regularly.”
D)“Many people with HF find that small, frequent meals allow them to manage their diet effectively.”

16.The nurse is conducting a morning assessment of an 80-year-old female patient who has a longstanding diagnosis of heart failure (HF). The nurse notes an elevation in jugular venous pressure (JVP) greater than 4 cm above the woman’s sternal angle, a finding that did not exist the day before. What conclusion should the nurse draw from this assessment finding?
A)The woman is demonstrating the early signs of cardiogenic shock.
B)The woman has left-sided heart failure.
C)The woman is also likely to experience shortness of breath.
D)The woman may be experiencing an exacerbation of right-sided HF.

17.A community health nurse is participating in a healthy-living workshop that has been sponsored by a local seniors’ center. The discussion has turned to the problem of heart failure, and the nurse is emphasizing preventative measures. When teaching older adults to decrease their future risks of developing heart failure, the nurse should emphasize what action?
A)Effective stress management
B)A low-fat, high-protein diet
C)Physical exercise and the importance of getting 30 to 60 minutes of activity each day
D)Close blood pressure monitoring and vigilant adherence to hypertension therapy

18.A nurse has performed an assessment of a patient and subsequently administered the patient’s scheduled dose of ramipril, an angiotensin-converting enzyme (ACE) inhibitor prescribed for the treatment of the patient’s longstanding heart failure (HF). The nurse understands that this drug will aid in the treatment of the patient’s disease by:
A)Reducing the patient’s overall oxygen demand
B)Reducing preload through the excretion of fluid and sodium
C)Increasing the contractility of the heart and increasing ejection fraction
D)Causing vasodilation and decreasing the heart’s workload

19.A patient has developed pulmonary edema during an exacerbation of heart failure. The patient is experiencing dyspnea primarily because of the accumulation of pressure in the patient’s:
A)Right atrium
B)Right ventricle
C)Left atrium
D)Left ventricle

20.An elderly patient is experiencing an acute onset of pulmonary edema with a cardiac etiology. When assessing the patient, what findings should the nurse identify as being consistent with this diagnosis? Select all that apply.
D)Cold, moist skin
E)Weak, rapid pulse

21.A 70-year-old man has been living with a diagnosis of heart failure (HF) for several years and has been vigilant about monitoring the trajectory of disease and adhering to his prescribed treatment regimen. The man has scheduled an appointment with his primary care provider because he has noted a weight gain of 6 pounds over the past week. The nurse should anticipate that this patient may benefit from which of the following treatment measures?
A)A further reduction in his dietary sodium intake
B)An increase in the dose of his prescribed diuretic
C)A decrease in his daily activity level

22.A patient has been admitted to the medical unit because of an exacerbation of heart failure. Over the past hour, the patient has become increasingly restless, tachypneic, and short of breath, and pulse oximetry reveals SaO2 of 78%. Which of the following actions should the nurse prioritize?
A)Providing reassurance to calm the patient and slow the patient’s respiratory rate
B)Protecting the patient’s airway and taking measures to promote gas exchange
C)Monitoring the patient’s cardiac function
D)Obtaining a complete set of vital signs

23.A critical care nurse is providing care for a patient who was admitted to the intensive care unit after going into cardiogenic shock while on one of the hospital’s medical units. This nurse should plan assessments and interventions in the knowledge that the effects of cardiogenic shock primarily result from:
A)Tissue hypoperfusion
B)Toxic effects of cardiac biomarkers
C)Overcompensation by the autonomic nervous system (ANS)
D)Osmotic changes

24.A nurse in the cardiac critical care unit is assisting with pericardiocentesis for a patient who developed a pericardial effusion. Which of the following outcomes would suggest that the procedure has achieved the desired effect?
A)The patient’s arterial blood gases normalize
B)The patient’s pulse pressure narrows
C)The patient’s heart rate increases
D)The patient’s blood pressure increases

25.A nurse has been providing care for an older adult patient who has a number of comorbid medical conditions. The nurse has been performing frequent assessment throughout the morning due to the patient’s pallor, decreased level of consciousness, and unstable vital signs. During the nurse’s most recent assessment, the patient has lost consciousness and the carotid pulse is not palpable. What is the nurse’s priority action?
A)Applying oxygen by face mask
B)Performing a rapid head-to-toe assessment
C)Initiating cardiopulmonary resuscitation
D)Activating the hospital’s code system

1.The nurse is caring for a patient with a hematologic disorder. The patient asks the nurse where the body forms blood cells. Where should the nurse tell the patient that blood cells are formed?
A)In the spleen
B)In the kidneys
C)In the bone marrow
D)In the liver

2.An elderly adult trips over her dog and receives an injury to her skin that causes minor blood loss. Primary hemostasis is activated in this patient. What occurs during primary hemostasis?
A)Severed blood vessels constrict.
B)Thromboplastin is released.
C)Prothrombin is converted to thrombin.
D)Fibrin is lysed.

3.A patient has come to the Ob-Gyn clinic with complaints of a heavy menstrual flow. The nurse knows that red blood cell production will be increased in the patient’s body. Because of this, the nurse is aware that the patient may need to increase her daily intake of what?
A)Vitamin C
B)Vitamin D

4.A patient with renal failure has decreased erythropoietin production. Upon analysis of the patient’s complete blood count (CBC), the nurse will expect which of the following CBC results?
A)An increased hemoglobin and hematocrit
B)A decreased hemoglobin and hematocrit
C)A decreased mean corpuscular volume (MCV) and mean corpuscular hemoglobin (MCH)
D)An increased MCV and MCH

5.A patient has asked the nurse about the clotting cascade, and the nurse explains that plasminogen is a component necessary in the clotting cascade. Where in the body is plasminogen present?
A)Myocardial muscle tissue
B)All body fluids
C)Cerebral tissue
D)Renal cells

6.The nurse is caring for a patient whose bone marrow has been replaced by scar tissue in much of the areas that produce blood cells for the body. What organs can become active in blood cell production by the process of extramedullary hematopoiesis?
A)Spleen and kidneys
B)Kidneys and pancreas
C)Pancreas and liver
D)Liver and spleen

7.The nurse is working with a patient who has a hematological disorder. The nurse is aware that, in the process of hematopoiesis, stem cells differentiate into either myeloid or lymphoid stem cells. Into what broad cell types do myeloid stem cells differentiate? Select all that apply.
B)Mast cells

8.A child has suffered a laceration in a playground accident. When a human body receives an injury that causes blood loss, several processes are involved in maintaining hemostasis. When a blood clot is no longer needed, what digests the fibrinogen and fibrin?

9.The nurse is providing care for a patient with a diagnosis of cellulitis. What laboratory value would the nurse assess most closely to gauge the patient’s infection?
A)Creatinine levels
B)Hepatic function tests
C)Electrolyte levels
D)White blood cell (WBC) count

10.A patient with esophageal varices secondary to liver cirrhosis has received a transfusion of frozen plasma. The nurse is aware of the fact that plasma:
A)Acts solely as a solvent for the cellular components of the blood
B)Accounts for the majority of the blood’s volume in the body
C)Plays a regulatory role in the process of erythropoiesis
D)Primarily regulates the pH of blood and other body fluids

11.A patient’s most recent blood work reveals an elevated level of reticulocytes. The nurse recognizes that this assessment finding may be suggestive of:
A)An infectious process
B)A lack of oxygen-carrying capacity
C)Fluid volume deficit
D)Oxygen toxicity

12.A nurse is aware of the central role that erythropoietin plays in the initiation of erythropoiesis. Which of the following individuals would be likely to require administration of exogenous erythropoietin?
A)A woman who experienced a postpartum hemorrhage after spontaneous vaginal delivery
B)A child who experienced severe blood loss during a motor vehicle accident
C)A woman who has been diagnosed with hepatic encephalopathy after a long history of alcohol abuse
D)A man with a diagnosis of acute renal failure secondary to type 1 diabetes

13.A patient’s most recent complete blood count (CBC) reveals that her mean corpuscular volume (MCV) is well below reference ranges. The nurse should identify what potential contributing factor for this phenomenon?
A)The woman has an iron deficiency.
B)The woman has been exposed to carbon monoxide at some point in the past.
C)The woman is experiencing nephrotoxicity.
D)The woman’s oxygen demands are currently lower than normal.

14.A nurse is reviewing the admission blood work of an adult woman who presented with complaints of progressive fatigue over the past several weeks. The woman’s subsequent blood work is indicative of iron-deficiency anemia. What assessment question by the nurse most directly addresses the potential cause of the woman’s iron deficiency?
A)“Would you say that you tend to eat a well-balanced diet?”
B)“Have you noticed lately that you are passing less urine or that your urine is quite dilute?”
C)“Have you seen any blood when you have had a bowel movement in recent weeks?”
D)“Have you had a bad cold or a case of the flu in the past few weeks?”

15.A 66-year-old man underwent a successful partial gastrectomy for the treatment of stomach cancer 3 years ago. The man had a scheduled follow-up appointment with his primary caregiver and had blood work completed. The results of the man’s blood work indicated anemia. The nurse who is contributing to the patient’s care should recognize that this patient’s anemia may be attributable to what factor?
A)A recurrence of the man’s cancer
B)Paralytic ileus
D)Decreased vitamin B12 absorption

16.A patient’s health care provider has ordered blood work that included a white blood cell (WBC) differential. The results of this blood test reveal a bandemia, in which the patient’s WBC count indicates a higher-than-normal proportion of band cells. What should the nurse infer from this assessment finding?
A)The patient is currently fighting an infection.
B)The patient is deficient in folic acid and/or iron intake.
C)The patient’s kidneys are under physiological duress.
D)The patient should be assessed for leukemia and Hodgkin’s disease.

17.A patient with a diagnosis of HIV exhibits a decreased level of T lymphocytes. What consequence does this state present for this patient?
A)The patient will be incapable of mounting a response to allergens.
B)The patient is particularly susceptible to infection.
C)The patient has diminished oxygen-carrying capacity.
D)The patient will be unable to maintain hemostasis.

18.A patient with a diagnosis of hepatitis C is being treated in the medical unit of the hospital and has experienced a downward trend in albumin levels. In light of this diagnostic finding, what assessments should the nurse prioritize?
A)Assessment of the patient’s integumentary system and assessment for skin breakdown on dependent surfaces
B)Assessment of the patient’s fluid balance and assessment for third-spacing and edema
C)Assessment of the patient’s urine output, creatinine levels, and blood urea nitrogen (BUN) levels
D)Assessment for signs and symptoms of metabolic acidosis and metabolic alkalosis

19.A nurse administered a subcutaneous injection to a patient and noted a small amount of bleeding from the administration site. After a minute, the bleeding ceased, a process that the nurse attributed to hemostasis. Which of the following physiological phenomena occurred during secondary hemostasis?
A)The patient’s blood vessels surrounding the injection site constricted.
B)Platelets aggregated at the site where the bleeding occurred.
C)The patient’s plasma fibrinolytic system was activated.
D)The patient’s clotting cascade resulted in the formation of fibrin.

20.An 82-year-old resident of a long-term care facility has had a scheduled appointment with his primary care provider and had blood work drawn thereafter. The results of the resident’s blood work are suggestive of anemia. How should the nurse best interpret this laboratory finding?
A)Mild to moderate anemia is considered a normal, age-related change.
B)The resident’s anemia is likely the result of psychological stressors.
C)The specific etiology of the resident’s anemia should be investigated.
D)The resident would benefit from a high-iron diet and folic acid supplements.

21.An older adult with a history of decreased self-care has been admitted to the geriatric medical unit after being found in state of dehydration and malnutrition by paramedics. The admission assessment of the patient included a complete blood count, which revealed several hematological abnormalities, including a hematocrit of 61%. The nurse should consequently assess the patient for signs and symptoms of:
A)Gastrointestinal bleeding or other internal hemorrhage
B)Spontaneous clotting and thromboembolism
C)Confusion and decreased level of consciousness
D)Activity intolerance

22.A 44-year-old man with a longstanding diagnosis of AIDS has been admitted to the hospital with an absolute neutrophil count (ANC) of 385/mm3. When planning the patient’s care, what action should the nurse prioritize?
A)Placing the patient on protective isolation precautions
B)Obtaining the patient’s blood type and cross-match in anticipation of transfusion
C)Providing the patient with supplementary oxygen by simple face mask
D)Padding hard surfaces on the patient’s bed to reduce the risk of injury

23.While performing a morning assessment of an elderly patient on a subacute medical unit, the nurse notes petechiae on a patient’s lower extremities. When checking this patient’s most recent blood work, the nurse should pay particular attention to the patient’s level of:

24.A patient with a recent history of hematologic abnormalities has been scheduled for a bone marrow biopsy. The patient has expressed to the nurse, “That sounds like an incredibly painful experience.” How should the nurse best respond to this patient’s concern?
A)“Actually, you won’t feel anything other than the initial shot where the doctor injects anesthetic.”
B)“A bone marrow biopsy can be a painful experience, but know that it is only ordered when absolutely necessary.”
C)“There is some pressure and pain when the doctor removes the marrow, but this should only be short-lasting.”
D)“The doctor will inject some anesthetic into your bone a few hours ahead of time reduce the pain associated with the procedure.”

25.The nurse is providing patient education in anticipation of the patient’s scheduled boned marrow aspiration and biopsy. When teaching the patient about care after the procedure, the nurse should encourage the patient to do which of the following?
A)Take aspirin to alleviate pain.
B)Remain on bed rest for 24 to 36 hours after the procedure.
C)Avoid bathing until the site heals.
D)Avoid the use of oral analgesics.

1.An adult patient is scheduled for an upper GI series that will use a barium swallow. What teaching should the nurse include when the patient has completed the test?
A)Stool will be yellow for the first 24 hours postprocedure.
B)The barium may cause diarrhea.
C)Fluids must be increased to facilitate the evacuation of the stool.
D)This series includes analysis of gastric secretions.

2.A patient has come into the radiology department to undergo testing for possible polyps. What diagnostic test may be done to diagnose this type of lesion?
A)Gastric analysis
B)Barium enema
C)Barium swallow

3.The nurse is caring for a patient who is scheduled for a gastroscopy. What preparation is needed for a gastroscopy?
A)Insert a nasogastric tube.
B)Administer a micro Fleet enema.
C)Have the patient lie in a dorsal position.
D)Spray or gargle the back of the throat with local anesthetic.

4.A patient is scheduled to have a fecal occult blood test. Before the test, the nurse should instruct the patient to avoid:
A)Inspection, auscultation, percussion, and palpation
B)Inspection, auscultation, palpation, and percussion
C)Inspection, percussion, palpation, and auscultation
D)Inspection, palpation, percussion, and auscultation

5.The nurse is preparing to perform an abdominal assessment of a newly admitted patient. When performing an abdominal assessment, what examination sequence should the nurse follow?
A)Inspection, auscultation, percussion, and palpation
B)Inspection, auscultation, palpation, and percussion
C)Inspection, percussion, palpation, and auscultation
D)Inspection, palpation, percussion, and auscultation

6.A nurse is caring for a newly admitted patient with a suspected gastrointestinal (GI) bleed. The nurse assesses the patient’s stool after a bowel movement and notes it to be a tarry-black color. The nurse recognizes that the bleeding is likely occurring where?
A)The lower GI tract
B)The upper GI tract
C)The esophagus
D)The anal area

7.The nurse is providing care for a patient whose cancer has metastasized to her small intestine. What does the small intestine do? Select all that apply.
A)Creation of human waste products
B)Reabsorption of water to maintain blood pressure
E)Movement of nutrients into the blood stream.

8.A nurse is reviewing the liver function panel of a patient’s most recent blood work. What liver function test is a sensitive indicator of injury to liver cells and useful in detecting acute liver disease such as hepatitis?
A)Clotting factors
B)Serum aminotransferases
D)Alkaline phosphatase

9.The nurse is caring for a patient who has a gallstone blocking his bile duct. When the nurse assesses the patient’s laboratory studies, what would be an expected finding?
A)Increased bilirubin level in the blood
B)Decreased cholesterol level
C)Increased blood urea nitrogen (BUN) level
D)Decreased serum alkaline phosphatase level

10.A nurse is explaining to a patient about an ultrasound of the gallbladder the patient is going to have the following morning. What will the nurse do in preparation for this diagnostic study?
A)Initiate NPO status after midnight.
B)Administer the contrast agent orally 10 to 12 hours before the study.
C)Administer the radioactive agent intravenously the evening before the study.
D)Encourage the intake of 64 ounces of water 8 hours before the study.

11.Following a CT and biopsy, a female patient has received a diagnosis of mesenteric cancer. What is the physiologic function of a mesentery?
A)Surrounding and protecting many of the organs in the gastrointestinal tract
B)Secreting exocrine digestive enzymes into the peritoneal space
C)Producing the rhythmic muscular contractions of peristalsis
D)Resorbing excess bile between meals and while an individual is fasting

12.The complex and diverse functions of the gastrointestinal (GI) tract require precise innervation. Which of the following statements most accurately conveys an aspect of the neurology of the GI tract?
A)Digestion and secretion are primarily results of the sympathetic nervous system (SNS), which is activated by food intake.
B)The majority of the lower GI tract is directly innervated by the central nervous system (CNS).
C)Sympathetic stimulation exerts an inhibitory effect, decreasing gastric secretion and motility.
D)Parasympathetic activity slows most of the secretory functions within the GI tract.

13.An individual has had a snack consisting of half a bagel with cream cheese, lox (smoked salmon), red onions, and capers. Stimulation of the person’s gastrointestinal tract has resulted in the secretion of numerous digestive enzymes into the small intestine, including trypsin. What component of this person’s snack will be primarily digested by the action of trypsin?
A)The bagel
B)The lox
C)The cream cheese
D)The red onions and capers

14.An elderly patient has developed Clostridium difficile-related diarrhea, a problem that has led to dehydration and hypokalemia. The increased peristalsis that characterizes diarrhea has the potential to cause fluid volume deficit and electrolyte deficits because:
A)Increased peristalsis diverts energy away from the absorptive activities of the small intestine.
B)Increased peristalsis creates increased metabolic demand, which in turn depletes fluid and electrolyte reserves.
C)An increase in peristalsis means that the colon cannot absorb the substances that it normally absorbs.
D)An increase in peristalsis reduces the normal surface area of the villi and microvilli in the colon.

15.The liver performs numerous functions that contribute to homeostasis, including the synthesis of bile. How is bile utilized in the processes of digestion and absorption?
A)Bile is produced in the liver in response to meals that are high in protein.
B)Bile is stored in the gallbladder until it is needed for carbohydrate metabolism.
C)Bile is produced in the liver but released by the gallbladder when needed for digesting fats.
D)Bile production increases when an individual’s fat intake is reduced over several days.

16.As part of a newly admitted patient’s admission assessment, the nurse is questioning the patient about risk factors for liver disease. Which of the following questions most directly addresses these risk factors?
A)“How much alcohol do you typically drink?”
B)“Do you know if your immunizations are up to date?”
C)“What do you do for a living?”
D)“Do you have any chronic illnesses that your care team is not aware of?”

17.A patient with a history of liver cirrhosis has experienced a recent exacerbation in the signs and symptoms of his disease and has consequently been admitted to the hospital. The patient exhibits a firm, distended abdomen, and an abdominal ultrasound confirms a diagnosis of ascites. When reviewing this patient’s blood work, what value is most congruent with the presence of ascites?
A)Increased D-dimer levels
B)Decreased levels of amylase
C)Increased levels of B-type natriuretic peptide (BNP)
D)Decreased levels of albumin

18.The nurse is receiving the morning report about a patient who is being treated on the hospital’s medical unit. The nurse is informed that the patient’s serum bilirubin level has been trending upward over the past 2 days and is now well above the normal reference range. The nurse should anticipate which of the following assessment findings?
A)Dependent edema
B)Cold intolerance

19.The nurse is conducting an abdominal assessment of a patient who is postoperative day 1 following an open cholecystectomy. During auscultation of the patient’s abdomen, the nurse has noted that clicks and gurgles are audible approximately every 10 seconds. How should the nurse follow up this assessment finding?
A)The nurse should administer a p.r.n. stool softener.
B)The nurse should contact the patient’s care provider.
C)The nurse should assess the patient for paralytic ileus.
D)The nurse should document normoactive bowel sounds.

20.The nurse is providing care for a patient with a diagnosis of cirrhosis. Daily assessment of the patient’s abdominal girth has revealed a gradual increase, and the nurse now wishes to assess for the presence of ascites using a fluid wave test. When conducting this assessment, the nurse should:
A)Ask the patient to slowly move from one side-lying position to the other.
B)Determine if motion is transmitted from one of the patient’s flanks to the other.
C)See if rebound tenderness is symmetrical between the patient’s flanks.
D)Determine if the patient’s abdomen maintains its shape during deep palpation.

21.A 56-year-old presented to her nurse practitioner because she had been experiencing unprecedented constipation and the passage of pencil-like stools despite her high fluid and fiber intake. The nurse recognized the need to assess the patient for colorectal cancer and ordered diagnostic evaluations. What component of the patient’s blood work would be most indicative of the presence of cancer?
A)C-reactive protein (CRP)
B)Carcinoembryonic antigen (CEA)

22.A 50-year-old male patient with a history of cholelithiasis (gallstones) has presented to the emergency department (ED) with severe upper right quadrant pain. The ED nurse should anticipate the need to facilitate which of the following diagnostic tests?
A)Computed tomography (CT) of the abdomen
B)Barium swallow
C)Abdominal ultrasonography
D)Endoscopic retrograde cholangiopancreatography (ERCP)

23.A patient with a history of chronic constipation has been scheduled for a lower gastrointestinal tract study (barium enema). The patient has presented to the outpatient clinic at the scheduled time and has expressed anxiety about the potential pain and unpleasantness of the barium enema to the nurse. How should the nurse who will assist with the procedure respond to this patient’s concerns?
A)“A barium enema can be uncomfortable but we’ll do it very carefully to minimize this.”
B)“A barium enema can be painful, but it does not last long, and we’ll give you painkillers ahead of time.”
C)“Actually, most patients report that they hardly even feel the procedure.”
D)“The sedatives that we’ll give you will make sure that you don’t remember the procedure.”

24.A male patient’s present signs and symptoms are suggestive of an incompetent cardiac sphincter, and he has been scheduled for an upper GI series (barium swallow). What preprocedure teaching should the nurse provide to this patient?
A)“Make sure to tell your doctor about any allergies to shellfish.”
B)“It’s important that you take your laxatives as ordered on the day prior to your barium swallow.”
C)“Make sure that you don’t eat anything after midnight the day before your test.”
D)“You’ll need to restrict your fluid intake for 24 hours after the test.”

25.The nurse has noted that a patient’s plasma ammonia levels are trending upward and are currently high-normal (45 mg/dL; 32 mmol/L). The nurse should most likely associate this laboratory finding with:
A)Liver disease
C)Cancer of the gastrointestinal tract
D)Esophageal or gastric ulcers

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