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Nursing 211: Exam 2 Practice

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Practice Exam
taxenos
Quiz by taxenos, updated more than 1 year ago
taxenos
Created by taxenos about 9 years ago
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Question 1

Question
You are the nurse preparing discharge instructions for a 9 y.o. ♀ newly prescribed methylphenidate (Daytrana) for the treatment of ADHD. The pt's mother appears a bit overwhelmed but reluctant to express any concerns, you take note of this and make sure to emphasize which of the following in her discharge:
Answer
  • methylphenidate (Daytrana) is a transdermal patch, placed on the hip each morning. This eliminates the need for swallowing pills and re-medicating at school.
  • If the patch is still on at 4:45 then you might as well keep it on throughout the night.
  • Most patients I've seen have had great success with methylphenidate (Daytrana). The pitfall is the plummet in appetite but she looks nutritionally sound to me.
  • methylphenidate (Daytrana) is a highly addictive CNS stimulant that may cause hypersensitvity reactions at patch site & severe cardiovascular side effects. Most patients on this therapy end up with long-term polysubstance issues.

Question 2

Question
A 17 y.o. ♂ patient was admitted yesterday evening for a Crohn's exacerbation. An NG-tube was placed to enforce bowel-rest. She made several comments to the nurse during the 9 AM med pass, one of which potentiated the need for some education. Which of the following statements made by the patient perpetuates the need for further teaching?
Answer
  • "Nobody has been in to check my suction canister since 6 AM, does it look okay to you?"
  • "I don't understand why I didn't get my Adderall-XR this morning? The hospitalist didn't tell me he was discontinuing any of my meds"
  • "Could you please disconnect my suction so that I can get up and go to the bathroom?"
  • "I know this thing in my nose is helping but goodness I'll be happy when it comes out"

Question 3

Question
A nurse is caring for a febrile 11 y.o. ♂ who is awaiting transport to the OR for an emergency appendectomy—as she disconnects the monitor from the wall unit the patient vomits and begins to cry. He proceeds to tell her that he actually feels a little bit better and that the “pain isn’t as bad”. She immediately suspects rupture, and anticipates which of the following:
Answer
  • Severe internal bleeding evidenced by bradycardia + pallor
  • Hypovolemic shock d/t aneurysm caused by rupture
  • Resolution of fever
  • Rebound pain that is diffuse accompanied by tachycardia + irritability

Question 4

Question
You are the charge RN on WMCH, a unit inundated with 3 sick babies all of whom need transport to higher-acuity facilities. You receive word that DHART is now available for heli-transport. Prior to consulting with the physicians, your nursing judgment clues you into advocate for which of the following patients:
Answer
  • Infant W—6 hrs. old with severe cleft lip/palate, undetermined chromosomal abnormalities with difficulty breathing
  • Infant X—9 hrs. old who is irritable and has yet to eliminate with suspected meconium plug obstruction
  • Infant Y—2 hrs. old with cephalohematoma after traumatic exit
  • Infant Z—3 hrs. old who has needed constant bulb suction of frothy saliva since delivery

Question 5

Question
Which of the following diagnostic studies confirms the diagnosis of Hirschsprung’s Disease?
Answer
  • Stool culture
  • Full thickness rectal biopsy
  • Blood tests to revealing absence of ganglion cells
  • Abdominal x-ray indicative of bound-up stool

Question 6

Question
A nurse is caring for a newborn with Omphalocele, a defect of the umbilical ring into which varying amounts of abdominal organs may herniate. She recognizes the priority nursing intervention is:
Answer
  • Keep umbilical herniation from drying out with sterile H2O
  • Assess for other serious GI syndromes + defects
  • Keep moist with NS and cover with bag to prevent rupture
  • Administer STAT IV antibiotics to prevent infection caused by exposure of viscera

Question 7

Question
Correct placement of Fat emulsion (lipid infusion) is:
Answer
  • Below the TPN filter
  • Level with TPN filter
  • Above the TPN filter
  • Behind the TPN filter

Question 8

Question
Which of the following sets of symptoms are consistent with re-feeding syndrome?
Answer
  • fluid retention, hypoglycemia + hypernatremia
  • N/V, hypokalemia, hypomagnesmia + hypophostphatemia
  • N/V, hypoglycemia +hypernatremia
  • fluid retention, hypokalemia, hypomagnesmia + hypophostphatemia

Question 9

Question
A nurse is assuming the care of a 56 y.o. ♂ who has throat CA with severe esophageal metastasis. He underwent esophageal re-section last evening. The patient is unable to communicate with the nurse but has obvious chills + dyspnea. The nurse obtains a full-set of VS, notes a 101.4 temperature and suspects which of the following:
Answer
  • Aspirate syndrome
  • Pneumothorax
  • Chyle fistula
  • Mediastinal leak

Question 10

Question
The nurse knows that all of the following may confirm correct placement of the nasogastric tube but is the golden standard:
Answer
  • Radiographic confirmation (eg. KUB)
  • Aspiration of gastric fluid + testing of pH
  • Auscultation of over stomach as air irrigates the NG
  • Lack of respiratory distress + resistance

Question 11

Question
Dumping Syndrome & Postprandial Hypoglycemia are both complications of?
Answer
  • Billroth I
  • Billroth II
  • Vagotomy
  • Pyloroplasty

Question 12

Question
A nurse is preparing a bolus feeding for a patient. She aspirates for gastric residual with a return of 520 mL’s. Which of the following are appropriate interventions going forward?
Answer
  • Hold the feeding
  • Reassess in 4 hrs.
  • Administer 5 mg of metoclopramide (Reglan)
  • Proceed with the feeding as the patient is significantly malnourished

Question 13

Question
A nurse is documenting her assessment findings on a 2 wk. old infant with pyloric stenosis. Which of the following statements made by the nurse might you expect to find in the chart: (Hint=3)
Answer
  • VS WNL.
  • Hyperactive bowel sounds noted in all 4 quadrants
  • Pyloric spasms noted superficially
  • Labs consistent with metabolic alkalosis

Question 14

Question
XX is a clinical nurse specialist formulating the care-plan for a 6-day-old baby girl who has a cleft lip + palate she recognizes the 2 most important nursing diagnoses are:
Answer
  • Failure to cope—as parents were not prepared for this type of impairment
  • Increased risk for infection—as void lip exposes oral cavity to all kinds of bacteria
  • Failure to thrive—as nutritional needs are impaired by ability feed
  • Increased risk for aspiration—as palate deformity make swallowing difficult

Question 15

Question
A long-time L&D nurse who conducts home-visits for parents + babies with extra needs. She reviews the chart of a 22 y.o. first-time mom who is 37 wks. pregnant with a baby boy who has an ultrasound-establish cleft-lip & palate. She knows which of the following will be needs of mom + baby within the first several weeks:
Answer
  • Emotional support
  • Audiology consult
  • Haberman feeder
  • Speech pathology

Question 16

Question
You are doing a medication teaching with a patient newly prescribed cholestyramine (Questran) which of the following might you include in the teaching:
Answer
  • You may take up to 9 grams of Questran daily
  • Administer other medications 1 hour before or 4 hrs. after Questran
  • Questran may cause constipation + bloating
  • Questran may increase LDL cholesterol
  • Questran may eliminate the need for cholesysectomy

Question 17

Question
XX is the CRNA scrubbing in on 1-day old meconium-ileus obstruction with a student nurse. After sedating and intubating the neonate she begins to describe the disorder to the SN, including which of the following:
Answer
  • Meconium ileus is caused by inhalation of meconium into the GI tract
  • Meconium ileus is the precursor to Cystic Fibrosis
  • Meconium ileus typically manifests 48 hrs. after delivery
  • The tube coming from the infants nose was placed to decompress the stomach

Question 18

Question
A mother frantically carries her 4 yr. old ♂ in the ED yelling “it all started with a sore throat!” You note the boy’s color is good but he’s clammy, his tongue is out and he’s drooling. Your next step:
Answer
  • Have the patient lay down, administer 2L of oxygen and call the charge RN
  • Reassure her in saying “he isn’t blue so he is moving oxygen around just fine”
  • Encourage the mother to sit down and take a few deep breaths while you assess her son’s airway
  • Recognize this is likely epiglottitis—bypass triage and find him a blue room with a available intubation supplies

Question 19

Question
Which of the following assessment finding(s) are consistent with Acute Epiglottitis?
Answer
  • Bradycardia
  • Full-body tremors
  • Inspiratory stridor
  • Visible retractions

Question 20

Question
You are the nurse caring for a 6 yr. old ♀ with Acute Laryngotracheobronchitis (LTB). She is stridorous, with an occasional bark, has a temp of 99.6° F and is saturating at 93% on RA. Using your nursing judgment you plan to implement which of the following intervention(s):
Answer
  • Administer 2L of oxygen
  • Stop IV fluids
  • Administer IV corticosteroids
  • Offer a cool pop to dilate the blood vessels in the back of the patient's throat

Question 21

Question
The nurse recognizes ___________________ is the most specific marker of myocardial infarction (MI)
Answer
  • CK-MB
  • B-type Natriuretic Peptide (BNP)
  • Troponin
  • Total CK

Question 22

Question
A nurse is preparing to administer Nitro-BID (paste) to a patient with CP. Which of the following are important action(s) preformed by the nurse prior to medicating:
Answer
  • Confirm Name & D.O.B.
  • Don gloves
  • Place patient on 2L of oxygen prophylactically
  • Ensure skin is clean, dry and free of rash

Question 23

Question
Which of the following sets of EKG findings are consistent with Chronic Stable Angina?
Answer
  • Q-waves + tall T-wave
  • ST-segment depression + T-wave inversion
  • ST-segment elevation
  • Prolonged QT-interval
  • Asystole

Question 24

Question
Which of the following patient(s) are NOT candidates for Fibrinolytic Therapy?
Answer
  • A 48 y.o. ♂ with controlled HTN & DM who lives 2 hrs. away from a tertiary facility with PCI
  • A 60 y.o. ♀ on warfarin therapy for A-FIB
  • A 32 y.o. ♀ with congenital heart history, who is 22 wks. pregnant
  • A 56 y.o. ♂ MV vs. tree, after arresting behind the wheel. Actively bleeding.

Question 25

Question
The first line of treatment for patient's with confirmed STEMI:
Answer
  • Percutaneous Cardiac Intervention (PCI)
  • Therapeutic Hypothermia
  • Coronary Revascularization
  • Fibrinolytic Therapy

Question 26

Question
Morphine Sulfate is utilized in the collaborative treatment of ACS by working in which of the following way(s):
Answer
  • Relaxing bronchioles to improve oxygenation
  • Revascularizing ischemic myocardial tissue
  • Reducing preload thus, reducing pain
  • Increasing respiratory rate to facilitate oxygen support to area of ischemia

Question 27

Question
Baby X was rushed to the ED following her mother's complaint that the infant has been irritable, difficult to breastfeed and has had diarrhea for the past 3 days. The infant's respiratory rate is elevated and the fontanels are sunken. The ED physician orders ABGs after assessing ABCs, with results as follows: pH 7.39, PaCO2 27 mmHg and HCO3 19 mEq/L. What does this mean?
Answer
  • Respiratory Alkalosis, Fully Compensated
  • Metabolic Acidosis, Uncompensated
  • Metabolic Acidosis, Fully Compensated
  • Respiratory Acidosis, Uncompensated

Question 28

Question
A 3 y.o. ♂ is admitted to the hospital with a diagnosis of asthma and respiratory distress syndrome. The mother of the child tells you that she has witnessed slight tremors and behavioral changes in her child over the past 4 days. The attending physician orders routine ABGs following an assessment of the ABCs. The ABG results are pH 7.35, PaCO2 72 mmHg and HCO3 38 mEq/L. What acid-base disorder is shown?
Answer
  • Metabolic Alkalosis, Partially Compensated
  • Respiratory Alkalosis, Fully Compensated
  • Respiratory Acidosis, Fully Compensated
  • Respiratory Acidosis, Uncompensated

Question 29

Question
X, was drinking a glass of wine when she syncopized and hit her head. Her friend dials "911" because AP is unconscious, with depressed ventilation (shallow and slow respirations), rapid heart rate, and is profusely bleeding from both ears. Which primary acid-base imbalance is AP at risk for if medical attention is not provided?
Answer
  • Respiratory Acidosis
  • Metabolic Alkalosis
  • Metabolic Acidosis
  • Respiratory Alkalosis

Question 30

Question
X is admitted to the hospital and is to undergo brain surgery. You note the patient is reluctant to ask any questions or express concerns but has become increasingly anxious. He begins to hyperventilate, hands contract tries to articulate that he "feels dizzy" before he loses consciousness. STAT ABGs reveal pH 7.61, PaCO2 22 mmHg and HCO3 25 mEq/L. What is the ABG interpretation based on the findings?
Answer
  • Respiratory Alkalosis, Partially Compensated
  • Metabolic Alkalosis, Partially Compensated
  • Respiratory Alkalosis, Uncompensated
  • Metabolic Acidosis, Uncompensated

Question 31

Question
Why is it important to encourage oral rinse mouth after using inhaled corticosteroids?
Answer
  • Corticosteroids are corrosive and may cause ulcerations in the oral mucosa
  • Corticosteroids may break down tooth enamel
  • Corticosteroids may cause thrush, a candidal infection
  • Corticosteroids will be reabsorbed by the oral mucosa and exert it's action twice

Question 32

Question
___________________ = the most important indicator of Asthma in an asymptomatic patient
Answer
  • ABGs
  • CXR
  • ⇡ eosinophils
  • Detailed history of symptoms + episodes

Question 33

Question
A nurse on a pulmonary-rehab floor is reconciling med's with a patient and his wife. The nurse notes the patient, despite being on safer and equally effective therapies, is still prescribed theophylline (Theo-Dur). She stars the medication so that she can SBAR with the pulmonologist. Fondly recalling nursing school the nurse knows the following are true of Methylxanthines:
Answer
  • Have a narrow margin of safety
  • Cause CNS stimulation + dysrhythmias at high doses
  • Are the primary treatment option for persistent asthma
  • Require strict monitoring of drug levels
  • Are the mainstay for acute asthma attacks

Question 34

Question
A nurse is evaluating suitable treatment options for a 61 yr. old ♀ who has a history of Asthma & Parkinson's Disease. Which of the following would be most-appropriate for this patient and increase her compliance?
Answer
  • DPI (dry powder inhaler)
  • MDI with Spacer

Question 35

Question
Earl is a 56 y.o. ♂ cruising the tropics with his wife. On the 2nd day of his trip, he develops a a gnarley sinus infection and present's to the ship infirmary. The practitioner asks Earl about PMH, but after a couple of morning libations he forgets to disclose the fact he takes daily carvediolol (Coreg) + rosuvastatin (Crestor). He is prescribed pseudoephedrine (Sudafed) and sent back up to the deck for a limbo contest. Where in lays the problem?
Image:
678646f2-8434-4c7f-a39e-0b93fdb2f056 (image/png)
Answer
  • The pseudoephedrine (Sudafed) is contraindicated in patient's with HTN as it too causes hypertension
  • The pseudoephedrine (Sudafed) is likely to cause rebound congestion, which will interfere with his aerial lesson he has scheduled for the evening
  • Earl should know better than to be drinking Bloody Mary's with his high cholesterol
  • He will be getting cozy in his cabin for the rest of the trip as pseudoephedrine (Sudafed) causes significant photosensitivity
  • The prescription of pseudoephedrine (Sudafed) was probably not necessary, as the Mai Tai's are likely the culprit of Earl's congestion

Question 36

Question
Clinical Manifestations of Myocardial Infarction (MI) include which of the following:
Answer
  • S3 + S4 heart sounds
  • Jugular venous distention (JVD)
  • Crushing chest pain unrelieved by rest, position change + nitrates
  • Stridor
  • Fever
  • Severe cramping of the lower extremities
  • Nausea + vomiting
  • Diaphoresis
  • Crackles
  • Strabismus

Question 37

Question
Prinzmetal's Angina can be best described as:
Answer
  • Angina r/t to the lack of collateral circulation
  • Angina r/t to coronary artery spasm
  • Angina that produces QT-interval prolongation
  • Angina that produces symptoms similar to GERD

Question 38

Question
A child diagnosed with ADHD is reprimanded for taking the nurse's pen without asking first. He reponds by shouting, "You don't like me! You won't let me have anything, even a pen!" The nurse is most therapeutic when responding:
Answer
  • "I do like you, but I don't like it when you grab my pen."
  • "Liking you has nothing to do with whether I will loan you my pen."

  • "It sounds as though you are feeling helpless and insecure."

  • "You need ask for permission before taking someone else's things."

Question 39

Question
Freddy is a 7 y.o. ♂ who was recently diagnosed with ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. Which of the following statements by Freddy's mother best indicates an accurate understanding of the treatment that has been planned for him?
Answer
  • "Freddy's medication will make him behave appropriately and like other kids his age."

  • "I am already looking forward to the teenage years, when his bothersome symptoms will disappear."
  • "If I can keep Kevin on a special restricted diet, he will outgrow his ADHD in 5 to 8 years."

  • "Freddy's medication, plus decreasing his environmental stimuli, will help him control his behavior."


Question 40

Question
The priority nursing diagnosis for a child diagnosed with ADHD is:
Answer
  • Risk for anxiety
  • Risk for injury
  • Defensive coping
  • Impaired verbal communication

Question 41

Question
While talking with you (the school nurse), Freddy's mother states "I feel like I caused all of his problems." Which response would be most appropriate?


Answer
  • "You shouldn't feel that way. No one really knows what causes ADHD."

  • "There's no reason to feel that way. Most experts feel there is no connection between heredity or parenting skills and ADHD."

  • "Sometimes parents feel that way, when they shouldn't. I can give you information about a support group for parents of children with ADHD."

  • "It may be true that ADHD is inherited, but there is nothing you can do about that now."

Question 42

Question
Freddy is a 7 y.o. ♂ who was recently diagnosed with ADHD. He is taking methylphenidate (Ritalin) to help him cope with the symptoms of the disorder. As the school nurse, you are assisting in planning his care. Which of the following best indicates to you that the time of Kevin's methylphenidate administration may need to be adjusted?
Answer
  • Freddy has not eaten his lunch in several days, stating, "I'm just not hungry."

  • Freddy's math grade has risen from 62% to 82% since the beginning of the school year.

  • According to Freddy's mother, he has been sleeping well every night.

  • At noon recess, Freddy has been socializing effectively with his peers

Question 43

Question
An 8 y.o. ♀ just moved in a couple of houses down. You miss out on much of the neighborhood action because your a night-shift nurse. Your neighbors however have described her as "extremely obstinate" for an 8 yr. old as well "aggressive" and "deceitful." One neighbor witnessed her kicking a dog at the bus stop, and another destroying a garden. You recognize her behaviors are consistent with:
Image:
82984fbd-835e-4559-85b0-62bf9c3354fd (image/png)
Answer
  • Oppositional Defiant Disorder (ODD)
  • Inhibited Reactive Attachment Disorder
  • Conduct Disorder
  • Psychosis NOS

Question 44

Question
A nurse is caring for a 27 y.o. ♂ with a Paralytic Ileus. Which of the following medication orders would prompt immediate intervention by the nurse:
Answer
  • bismuth subsalicylate (Kaopectate)
  • naproxen sodium (Aleve)
  • ondansetron (Zofran)
  • promethazine (Phenergan)
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