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1. A patient is admitted to the hospital with a diagnosis of primary hyperparathyroidism. A nurse checking the patient's lab results would expect which of the following changes in laboratory findings?
A. Elevated serum calcium.
B. Low serum parathyroid hormone (PTH).
C. Elevated serum vitamin D.
D. Low urine calcium.
2. A patient with Addison's disease asks a nurse for nutrition and diet advice. Which of the following diet modifications is NOT recommended?
A. A diet high in grains.
B. A diet with adequate caloric intake.
C. A high protein diet.
D. A restricted sodium diet.
3. A patient with a history of diabetes mellitus is in the second post-operative day following cholecystectomy. She has complained of nausea and isn't able to eat solid foods. The nurse enters the room to find the patient confused and shaky. Which of the following is the most likely explanation for the patient's symptoms?
A. Anesthesia reaction.
D. Diabetic ketoacidosis.
4. A nurse assigned to the emergency department evaluates a patient who underwent fiberoptic colonoscopy 18 hours previously. The patient reports increasing abdominal pain, fever, and chills. Which of the following conditions poses the most immediate concern?
A. Bowel perforation.
B. Viral gastroenteritis.
C. Colon cancer.
5. A patient is admitted to the same day surgery unit for liver biopsy. Which of the following laboratory tests assesses coagulation?
A. Partial thromboplastin time.
B. Prothrombin time.
C. Platelet count.
6. A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission?
A. Sexual contact with an infected partner.
B. Contaminated food.
C. Blood transfusion.
D. Illegal drug use.
7. A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this?
A. A history of hepatitis C five years previously.
B. Cholecystitis requiring cholecystectomy one year previously.
C. Asymptomatic diverticulosis.
D. Crohn's disease in remission.
8. A physician has diagnosed acute gastritis in a clinic patient. Which of the following medications would be contraindicated for this patient?
A. Naproxen sodium (Naprosyn).
B. Calcium carbonate.
C. Clarithromycin (Biaxin).
D. Furosemide (Lasix).
9. The nurse is conducting nutrition counseling for a patient with cholecystitis. Which of the following information is important to communicate?
A. The patient must maintain a low calorie diet.
B. The patient must maintain a high protein/low carbohydrate diet.
C. The patient should limit sweets and sugary drinks.
D. The patient should limit fatty foods.
10. A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?
A. Slow, deep respirations.
D. Air hunger.
11. A nurse caring for several patients on the cardiac unit is told that one is scheduled for implantation of an automatic internal cardioverter-defibrillator. Which of the following patients is most likely to have this procedure?
A. A patient admitted for myocardial infarction without cardiac muscle damage.
B. A post-operative coronary bypass patient, recovering on schedule.
C. A patient with a history of ventricular tachycardia and syncopal episodes.
D. A patient with a history of atrial tachycardia and fatigue.
12. A patient is scheduled for a magnetic resonance imaging (MRI) scan for suspected lung cancer. Which of the following is a contraindication to the study for this patient?
A. The patient is allergic to shellfish.
B. The patient has a pacemaker.
C. The patient suffers from claustrophobia.
D. The patient takes anti-psychotic medication.
13. A nurse calls a physician with the concern that a patient has developed a pulmonary embolism. Which of the following symptoms has the nurse most likely observed?
A. The patient is somnolent with decreased response to the family.
B. The patient suddenly complains of chest pain and shortness of breath.
C. The patient has developed a wet cough and the nurse hears crackles on auscultation of the lungs.
D. The patient has a fever, chills, and loss of appetite.
14. A patient comes to the emergency department with abdominal pain. Work-up reveals the presence of a rapidly enlarging abdominal aortic aneurysm. Which of the following actions should the nurse expect?
A. The patient will be admitted to the medicine unit for observation and medication.
B. The patient will be admitted to the day surgery unit for sclerotherapy.
C. The patient will be admitted to the surgical unit and resection will be scheduled.
D. The patient will be discharged home to follow-up with his cardiologist in 24 hours.
15. A patient with leukemia is receiving chemotherapy that is known to depress bone marrow. A CBC (complete blood count) reveals a platelet count of 25,000/microliter. Which of the following actions related specifically to the platelet count should be included on the nursing care plan?
A. Monitor for fever every 4 hours.
B. Require visitors to wear respiratory masks and protective clothing.
C. Consider transfusion of packed red blood cells.
D. Check for signs of bleeding, including examination of urine and stool for blood.
16. A nurse in the emergency department is observing a 4-year-old child for signs of increased intracranial pressure after a fall from a bicycle, resulting in head trauma. Which of the following signs or symptoms would be cause for concern?
A. Bulging anterior fontanel.
B. Repeated vomiting.
C. Signs of sleepiness at 10 PM.
D. Inability to read short words from a distance of 18 inches.
17. A nonimmunized child appears at the clinic with a visible rash. Which of the following observations indicates the child may have rubeola (measles)?
A. Small blue-white spots are visible on the oral mucosa.
B. The rash begins on the trunk and spreads outward.
C. There is low-grade fever.
D. The lesions have a "tear drop on a rose petal" appearance.
18. A child is seen in the emergency department for scarlet fever. Which of the following descriptions of scarlet fever is NOT correct?
A. Scarlet fever is caused by infection with group A Streptococcus bacteria.
B. "Strawberry tongue" is a characteristic sign.
C. Petechiae occur on the soft palate.
D. The pharynx is red and swollen.
19. A child weighing 30 kg arrives at the clinic with diffuse itching as the result of an allergic reaction to an insect bite. Diphenhydramine (Benadryl) 25 mg 3 times a day is prescribed. The correct pediatric dose is 5 mg/kg/day. Which of the following best describes the prescribed drug dose?
A. It is the correct dose.
B. The dose is too low.
C. The dose is too high.
D. The dose should be increased or decreased, depending on the symptoms.
20. The mother of a 2-month-old infant brings the child to the clinic for a well baby check. She is concerned because she feels only one testis in the scrotal sac. Which of the following statements about the undescended testis is the most accurate?
A. Normally, the testes are descended by birth.
B. The infant will likely require surgical intervention.
C. The infant probably has with only one testis.
D. Normally, the testes descend by one year of age.
1. Answer: A
The parathyroid glands regulate the calcium level in the blood. In hyperparathyroidism, the serum calcium level will be elevated. Parathyroid hormone levels may be high or normal but not low. The body will lower the level of vitamin D in an attempt to lower calcium. Urine calcium may be elevated, with calcium spilling over from elevated serum levels. This may cause renal stones.
2. Answer: D
A patient with Addison's disease requires normal dietary sodium to prevent excess fluid loss. Adequate caloric intake is recommended with a diet high in protein and complex carbohydrates, including grains.
3. Answer: C
A post-operative diabetic patient who is unable to eat is likely to be suffering from hypoglycemia. Confusion and shakiness are common symptoms. An anesthesia reaction would not occur on the second post-operative day. Hyperglycemia and ketoacidosis do not cause confusion and shakiness.
4. Answer: A
Bowel perforation is the most serious complication of fiberoptic colonoscopy. Important signs include progressive abdominal pain, fever, chills, and tachycardia, which indicate advancing peritonitis. Viral gastroenteritis and colon cancer do not cause these symptoms. Diverticulitis may cause pain, fever, and chills, but is far less serious than perforation and peritonitis.
5. Answer: A, B, and C
Prothrombin time, partial thromboplastin time, and platelet count are all included in coagulation studies. The hemoglobin level, though important information prior to an invasive procedure like liver biopsy, does not assess coagulation.
6. Answer: B
Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.
7. Answer: A
Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis (gall bladder disease), diverticulosis, and history of Crohn's disease do not preclude blood donation.
8. Answer: A
Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason, it is contraindicated in a patient with gastritis. Calcium carbonate is used as an antacid for the relief of indigestion and is not contraindicated. Clarithromycin is an antibacterial often used for the treatment of Helicobacter pylori in gastritis. Furosemide is a loop diuretic and is contraindicated in a patient with gastritis.
9. Answer: D
Cholecystitis, inflammation of the gallbladder, is most commonly caused by the presence of gallstones, which may block bile (necessary for fat absorption) from entering the intestines. Patients should decrease dietary fat by limiting foods like fatty meats, fried foods, and creamy desserts to avoid irritation of the gallbladder.
10. Answer: D
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.
11. Answer: C
An automatic internal cardioverter-defibrillator delivers an electric shock to the heart to terminate episodes of ventricular tachycardia and ventricular fibrillation. This is necessary in a patient with significant ventricular symptoms, such as tachycardia resulting in syncope. A patient with myocardial infarction that resolved with no permanent cardiac damage would not be a candidate. A patient recovering well from coronary bypass would not need the device. Atrial tachycardia is less serious and is treated conservatively with medication and cardioversion as a last resort.
12. Answer: B
The implanted pacemaker will interfere with the magnetic fields of the MRI scanner and may be deactivated by them. Shellfish/iodine allergy is not a contraindication because the contrast used in MRI scanning is not iodine-based. Open MRI scanners and anti-anxiety medications are available for patients with claustrophobia. Psychiatric medication is not a contraindication to MRI scanning.
13. Answer: B
Typical symptoms of pulmonary embolism include chest pain, shortness of breath, and severe anxiety. The physician should be notified immediately. A patient with pulmonary embolism will not be sleepy or have a cough with crackles on exam. A patient with fever, chills and loss of appetite may be developing pneumonia.
14. Answer: C
A rapidly enlarging abdominal aortic aneurysm is at significant risk of rupture and should be resected as soon as possible. No other appropriate treatment options currently exist.
15. Answer: D
A platelet count of 25,000/microliter is severely thrombocytopenic and should prompt the initiation of bleeding precautions, including monitoring urine and stool for evidence of bleeding. Monitoring for fever and requiring protective clothing are indicated to prevent infection if white blood cells are decreased. Transfusion of red cells is indicated for severe anemia.
16. Answer: B
Increased pressure caused by bleeding or swelling within the skull can damage delicate brain tissue and may become life threatening. Repeated vomiting can be an early sign of pressure as the vomit center within the medulla is stimulated. The anterior fontanel is closed in a 4-year-old child. Evidence of sleepiness at 10 PM is normal for a four year old. The average 4-year-old child cannot read yet, so this too is normal.
17. Answer: A
Koplik's spots are small blue-white spots visible on the oral mucosa and are characteristic of measles infection. The body rash typically begins on the face and travels downward. High fever is often present. "Tear drop on a rose petal" refers to the lesions found in varicella (chicken pox).
18. Answer: C
Petechiae on the soft palate are characteristic of rubella infection. Choices A, B, and D are characteristic of scarlet fever, a result of group A Streptococcus infection.
19. Answer: B
This child weighs 30 kg, and the pediatric dose of diphenhydramine is 5 mg/kg/day (5 X 30 = 150/day). Therefore, the correct dose is 150 mg/day. Divided into 3 doses per day, the child should receive 50 mg 3 times a day rather than 25 mg 3 times a day. Dosage should not be titrated based on symptoms without consulting a physician.
20. Answer: D
Normally, the testes descend by one year of age. In young infants, it is common for the testes to retract into the inguinal canal when the environment is cold or the cremasteric reflex is stimulated. Exam should be done in a warm room with warm hands. It is most likely that both testes are present and will descend by a year. If not, a full assessment will determine the appropriate treatment.
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