PREDICTOR TEST 4

PREDICTOR TEST 4

ENDO

ADDISON’S / CORTICOSTEROID THERAPY

1. A 69 y.o. patient with Addison’s was placed under the care of the nurse. The patient asked what could have caused the development of this disease. In response to this, the nurse will tell the patient that the most common cause is:

1. Idiopathic
2. Sudden cessation of Steroids use
3. Autoimmune
4. Chronic Steroids use

Ø Autoimmunity is the most common cause of adrenal insufficiency. It accounts for 75% of primary adrenal insufficiency. Letters B and D may also cause Addison’s.

p. 1217-1218 Joyce Black 7^th edition, 2005

2. The nurse reviews the laboratories of the patient with Addison’s. Which of the following findings is the priority of the nurse?

1. Glucose 70 mg/dL
2. K 5.6 mEq/L
3. Sodium 148 mEq/L
4. Calcium 9 mg/dL

Ø Addisonian crisis can cause hypoglycemia, hyponatremia, hyperkalemia, and shock. A is within normal range. C and D are inappropriate.

p. 633 Saunders 3^rd edition, 2005

3. The nurse reviews the chart of the patient with Addison’s admitted for 4 days. Which of the following assessment would the nurse expect to find?

1. Hypocalcemia
2. Hypophosphatemia
3. Hyperkalemia
4. Hypertension

Ø A, B and D are manifestations for Cushing’s.

p. 633 Saunders 3^rd edition, 2005

4. Which among the statements made by the patient indicates the need for further teaching regarding corticosteroid therapy?
1. “I will eat foods high in calcium & vitamin D.”
2. “I will need to avoid crossing-legs.”
3. “I need to take low calories, low protein, low sodium foods.”
4. “I need to have regular eye-check ups.”

Ø When taking corticosteroids, encourage low-calorie and low-sodium diet to prevent moon face appearance and high protein to prevent muscle wasting.

Pg. 1245, Brunner 10^th edition, 2004

5. A nurse was given order to administer Solu-Cortef to a Mexican patient with Addison’s. The nurse knows that the best time to give the medicine is when?
1. Early morning, at about 7:00a.m.
2. After dinner, at 7:00p.m.
3. Before going to bed, at 10:00p.m.
4. After lunch, 12:30p.m.

Ø In keeping with the natural secretion of cortisol, the best time of the day for the total corticosteroid dose is in the early morning from 7 to 8am.

Pg. 1244, Brunner 10^th edition, 2004

PANCREATITIS

1. The nurse was assigned to Mr. Smith, a 56 y.o. Mexican with acute Pancreatitis. The nurse knows that the major cause of this disease is:

1. Alcohol abuse and Idiopathic
2. Cholelithiasis and Autoimmune
3. Alcohol abuse and cholelithiasis
4. Tumors of the pancreas and Idiopathic

Ø In the US, alcohol abuse is the major cause of acute pancreatitis, with common bile duct stone disease is the second most frequent occurrence.

Pg. 1289, Joyce Black 7^th edition, 2005

2. The nurse closely monitors Mr. Smith to avoid the development of complications. She would be alerted when the patient reported to experience which of the following complication for pancreatitis?

1. Nausea & Vomiting
2. Cullen’s sign
3. Abdominal distention
4. Severe abdominal pain

Ø Cullen’s sign is the bluish discoloration of the umbilical area. It indicates bleeding in the abdominal area and the patient may die of shock. Use Law of immediate Death!

Pg. 1136 Brunner 10^th edition, 2004

p. 1291 Joyce Black 7^th edition, 2005

3. Mr. Smith’s condition worsened and progressed to severe pancreatitis. Which among the following assessments for Mr. Smith the nurse should prioritize?

1. Cullen’s sign
2. Hypotension
3. Cyanosis
4. Renal failure

Ø Hypotension reflects hypovolemia and shock caused by the loss of large amounts of protein-rich fluid into the tissues and peritoneal cavity. Use Law of immediate death. A, C and D are late signs of worsening pancreatitis.

Pg. 1136, Brunner 10^th edition, 2004

4. The nurse was assigned to 4 patients for the day. Which of the following patients has a high risk for developing pancreatitis?

1. A 49 y.o. patient with a father who died from pancreatitis
2. A 40 y.o. man with a history of cholecystectomy
3. A 35 y.o. Class II obese woman
4. A 52 y.o. menopausal woman taking estrogen.

Ø Recent studies found out that obesity is a major risk factor for severe pancreatitis.

Pg. 1290 Joyce Black 7^th edition, 2005

5. Mr. Smith complains of severe abdominal pain in the morning during the nurse’s rounds. The nurse knows that the drug of choice for this is:

1. Morphine
2. Meperidine
3. Buprenorphine
4. Nalbuphine

Ø Pain is usually treated with opioid analgesics and meperidine has been the drug of choice because opioids were thought to stimulate spasm of the ducts and increase pain.

Pg. 1292, 1293 Joyce Black 7^th edition, 2005

HYPERTHYROIDISM

1. A 68-year-old with hyperthyroidism is admitted presenting thyroid storm with a pulse of 135/min. The nurse should prepare as ordered what drug to control the symptom?

1. PTU
2. Propranolol
3. Tapazole
4. Lugol’s solution

Ø Clients with thyroid storm (thyrotoxicosis) may receive Beta-adrenergic blockers to control HR and tremors.

Pg. 1196 Joyce Black 7^th edition, 2005

Ø Propranolol is useful in controlling Thyroid storm symptoms.

p. 1222 Brunner 10^th edition, 2004

2. Mrs. Montecarlo, 56 y.o. with hyperthyroidism received Radioactive Iodine Therapy. After 4 weeks, the patient went in for follow-up and complains that the symptoms are still present. What is the nurse best response?

1. “The first dose seems ineffective. You may need another dose of the therapy.”
2. “That is the normal and expected side effect of the radioactive therapy.”
3. “There’s nothing to be bothered about. Symptoms will subside in 3 to 4 weeks.”
4. “You did not respond to the therapy. I will refer you to your physician.”

Ø The manifestations of hyperthyroidism usually subsides within 6 to 12 weeks after Radioiodine administration.

Pg. 1201 Joyce Black 7^th edition, 2005

3. Mrs. Montecarlo was prescribed with Propranolol. Which of the following side effect of the drug would alert the nurse most?

1. Confusion
2. Wheezing
3. Weakness
4. Arrhythmias

Ø Propranolol causes bronchiolar constriction even in normal subjects. Wheezing indicates that the patient is having bronchospasm which may lead to respiratory distress.

Pg. 1331-1332 Nurses’ drug Handbook 2004 Prentice Hall

4. The nurse is giving a discharge teaching to a patient receiving Potassium Iodide to be cautious in drinking OTC medications. The nurse instructs that she must avoid the following drugs that may contain iodine except:

1. Bronchodilator
2. Expectorants
3. Anti-tussive
4. Steroids

Ø Patients receiving Iodide medications should be cautioned against the use of OTC medications that contain iodides and can increase response to iodide therapy. Cough medications, expectorants, bronchodilators and salt substitutes may contain iodide.

Pg. 1223 Brunner 10^th edition, 2004

5. A client with Hyperthyroidism. After receiving Tapazole for 3 days, she suddenly manifests fever, sore throat & URTI. The nurse would suspect that the patient is developing which side effect of the drug?

1. Leukopenia
2. Allergy to the drug
3. Thrombocytopenia
4. Aplastic anemia

Ø The client manifests signs of leucopenia or agranulocytosis.

Pg. 824 Lippincot’s Manual of Nursing Practice 7^th edition, 2001

6. The nurse closely monitors the patient with hyperthyroidism to prevent Thyroid Storm. She knows that which of the following is not a manifestation of a developing thyroid storm?

1. Delirium
2. Fever of 38 Celcius
3. Tachycardia; 135/min.
4. Chest pain

Ø Throid storm is characterized by: high fever (above 38.5^oC or 101.3^oF), extreme tachycardia (.130bpm), exaggerated symptoms of hyperthyroidism including dyspnea and chestpain, and altered neurological or mental state.

Pg. 1223, Brunner 10^th edition, 2004

7. SATA Clinical manifestations of Hyperthyroidism

___ Constipation

___ Personality changes

___ Forgetfulness

___ Menstrual disturbances

___ Smooth hair

___ Weight loss

___ Mood swings

___ Weakness

___ Cardiomegaly

___ Needs to be in cold climate

Ø Constipation, Forgetfulness, Menstrual disturbances, Weakness and Cardiomegaly are signs of hypothyroidism.

Pg. 636 Saunders 3^rd edition, 2005

8. The doctor orders medicines for the management of Thyroid Storm for a 45 y.o. Chinese patient with Hyperthyroidism who was just admitted at the Medical Unit. Which of the following should the nurse question?

1. Iodine compound
2. PTU
3. Aspirin for hyperthermia
4. Hydrocortisone for adrenal insufficiency

Ø A, B and D are management for Thyroid storm. Salicylates are not used because they displace thyroid hormone from binding proteins and worsen hypermetabolism.

Pg. 1223 Brunner 10^th edition, 2004

9. Mrs. Young went in to the Surgery unit 4 hours post-thyroidectomy from the recovery room. The nurse should prepare the following at bedside except:

1. Calcium Gluconate
2. Tracheostomy set
3. Lidocaine
4. Oxygen

Ø A, B and D should be at bed-side post-thyroidectomy. Lidocaine is not needed on the bedside.

Pg. 637, Saunders 3^rd edition, 2005

10. The nurse monitors Mrs. Young for tetany, which is a complication of thyroidectomy. The following are the signs of tetany except:

1. Hypercalcemia
2. Carpopedal spasm
3. Seizure
4. Photophobia

Ø The cause of tetany is hypocalcemia due to trauma of Parathyroid glands on patient post thyroidectomy.

Pg. 637, Saunders 3^rd edition, 2005

DI vs. SIADH

1. Write D for DI, S for SIADH and B for both.

B­­ ___ tachycardia

D ___ decrease urine specific gravity

S ___ weight gain

D ___ weight loss

S ___ hyponatremia

S ___ water retention

D ___ urinary frequency

D ___ Vasopressin for treatment

S ___ Democycline for treatment

S ___ Decrease mental status

S ___ Hypertension

D ___ Hypotension

D ___ Dehydration

P. 632 Saunders 3^rd edition, 2005

P. 1239-1240 Joyce Black 7^th edition, 2005

2. The nurse is caring for a 45y.o. patient with DI. Upon assessment, the nurse will expect to get what manifestation?

1. Tachycardia
2. Diarrhea
3. Decrease Urine output
4. Hypertension

Ø The answer is A. C and D are manifestations of SIADH. Diarrhea is not a manifestation of both.

p. 632 Saunders 3^rd edition, 2005

3. The patient with DI suddenly manifests signs of dehydration and with BP 90/60. The nurse will prepare which of the following to be given for this patient?

1. Demeclocycline
2. Vasopressin
3. ORS solution
4. Calcium channel blockers

Ø Administer vasopressin/desmospressin when the ADH deficiency is severe or chronic.

p. 632 Saunders 3^rd edition, 2005

4. The patient with SIADH manifests decrease deep tendon reflex, fatigue, headache, anorexia,, nausea and decreasing mental status. The nurse will suspect that this is due to?

a. Fluid overload

b. Hyponatremia

c. Hyperkalemia

d. Renal failure

Ø The presented manifestation indicate hyponatremia. Letters C and D are not complications of SIADH.

p. 89-90,633 Saunders 3^rd edition, 2005

5. A nurse is monitoring a client with DI who is receiving Desmospressin. Which of the following outcomes reflects a therapeutic effect of this medication?

a. Increased Serum osmolality > 320 mOsm/kg

b. Increase BP

c. Decrease Urinary Output

d. Decreased Urine Osmolality <100>

Ø Desmospressin is a synthetic ADH. The effect is Decrease in urinary output. It would demonstrate a decrease serum osmolality because more fluid is retained, and increase urine osmolality because less fluid is excreted. Increase BP is a side effect.

p. 652 Saunders 3^rd edition, 2005

NEURO

MULTIPLE SCLEROSIS

1. A 25-year-old with Multiple Sclerosis was assigned to the nurse. The nurse expects to see all of the following except one for her assessment of the primary symptoms of this disease.

1. Fatigue, weakness, numbness
2. Difficulty in coordination, loss of balance
3. Depression
4. Spasticity & drooping of the eyelids

Ø A, B and C are manifestations of MS including spasticity. Drooping of eyelids is a manifestation of Myasthenia Gravies.

Pg. 2177, Joyce Black 7^th edition, 2005

2. The nurse knows that the etiology of Multiple Sclerosis is:

1. Auto-immune
2. Genetic
3. Idiopathic
4. Triggered by infection

Ø The exact cause of MS is unknown.

Pg. 2177, Joyce Black 7^th edition, 2005

3. The nurse visited her patients after the endorsement. The patient with Multiple sclerosis developed spasms during the rounds. What is the medication of choice the nurse anticipates to be ordered for treating spasms for this disease?

1. Valium
2. Baclofen (Lioresal)
3. Tizanidine (Zanaflex)
4. Dantrolene (Dantrium)

Ø Baclofen, a GABA agonist, is the medication of choice in treating spasms in MS. Valium, Zanaflex, and Dantrolene may also be used.

Pg. 1952, Brunner 10^th edition, 2004

4. The nurse’s goal for the day is to promote motor function of a 25 y.o. male patient with Multiple sclerosis. She instructed the CNA what activities they will do. The nurse would question which of the following interventions she saw written by the CNA in a scratch?

1. Applying warm packs before stretching to reduce spasticity.
2. Providing ROM exercises.
3. Helping the client to walk with a wide-based gait.
4. Turning the patient from time to time.

Ø B, C, and D are correct interventions. To reduce spasticity, ice packs should be applied before stretching. Due to paresthesias, warming may only cause burning.

Pg. 475 Lippincot’s Manual of Nursing Practice 7^th edition, 2001

5. Beta-interferon (Betaseron) was prescribed for a patient with MS. The nurse knows that the primary purpose in giving this drug is to:

1. Decrease fatigue
2. Reduce exacerbations
3. Induce remission
4. Immunosuppression

Ø Betaseron is used for ambulatory clients with relapsing-remitting MS. Betaseron is a genetically engineered complex protein with both antiviral and immunoregulatory properties that can reduce the number of MS exacerbations. It has also provided a delay in disability in placebo-controlled studies.

p. 2178 Joyce Black 7^th edition, 2005

6. The patient with MS is receiving Beta-Interferon (Betaseron) SQ. He developed fever, chills, myalgia & sweating. What should the nurse do?

1. Refer to the doctor immediately.
2. Withhold the next medication.
3. Administer NSAID as ordered.
4. Prepare antihistamine immediately.

Ø The side effect of interferons is flu-like manifestations. 75% of patients taking Beta-interferons experience flu-like symptoms. These symptoms can be controlled with NSAIDs and usually resolve after a few months of therapy.

Pg. 1952, Brunner 10^th edition

p. 2178 Joyce Black 7^th edition, 2005

PARKINSON’S DISEASE

1. The nurse is caring for a client with Parkinson’s. She knows that the cardinal features of this disease are the following except:

1. Masklike facies
2. Loss of postural reflexes
3. Freezing movement
4. Flexed posture of neck, trunk and limbs

Ø The six cardinal features of PD are:

· Tremors at rest

· Rigidity

· Bradykinesia

• Flexed posture of neck, trunk and limbs
• Loss of postural reflexes

· Freezing movement

Ø Masklike face is a sign, but not a cardinal feature.

Pg. 2172, Joyce Black 7^th edition, 2005

2. The nurse is providing health teaching regarding diet to the client with Parkinson’s. Which of the ff. favorite foods of the client she must avoid?

1. vegetable salad
2. low-fat yogurt
3. corn soup
4. mashed potatoes

Ø Clients with PD should avoid foods high in Vitamin B6 because they block the effects of Antiparkinsonian medications. Yeast, corn, meat, poultry and fish are high in vitamin B6.

p. 129 and p. 958, Saunders 3^rd edition, 2005

3. The night duty nurse went in to client’s room who is just about to sleep. The nurse would recommend which position in sleeping for Parkinon’s?

1. Low-fowler’s
2. Prone Position
3. Side-lying position with pillows on the head
4. Any position preferred by the patient.

Ø The client should sleep on a form mattress. When resting, the client should avoid using pillow to prevent flexion of the spine. Periodically lying prone also helps.

P. 957, Saunders 3^rd edition, 2005

p. 2175 Joyce Black 7^th edition, 2005

4. The nurse is teaching a Parkinson’s patients some exercises to avoid rigidity and development of contractures. She instructs the patient that the best time to exercise is when?
a. Early in the morning

b. After taking breakfast

c. 2-hours after eating lunch

d. An hour before dinner

Ø To avoid rigidity and development of contractures, teach the patient to exercise first thing in the morning, when energy levels are highest.

p. 2174, Joyce Black 7^th edition, 2005

5. Mr. Clark, a 64 y.o patient with Parkinson’s manifests tremors during the morning rounds. The nurse advises to the patient to do the ff. to manage tremors except:

1. Hold a rubber ball
2. Use both hands to accomplish task
3. Lie face down on the floor and relax body
4. Sleep on the unaffected side

Ø To manage tremor, teach patient to:

· Hold change in the pocket or squeeze a rubber ball

· Use both hands to accomplish task

· Lie face down on the floor and relax body

· Sleep on the side that has the tremor

p. 2174, Joyce Black 7^th edition, 2005

CVA

1. A client with CVA was rushed in to the ER. Upon assessment, the nurse would expect what type of abnormal respiration?

1. Kussmaul
2. Cheyne-Stokes
3. Biot’s
4. Rhonchi

Ø Cheyne-Stoke’s respiration is observed on CVA. This is due to central cerebral or high brain-stem lesions that occur in brain injuries. Kussmaul’s is heard on diabetic and metabolic acidosis. Biot’s indicates damage to medulla. Rhinchi is heard on COPD patients and those with bronchospasm.

p. 953, Saunders 3^rd edition, 2005

p. 456 Nursing Assessment and Physical Examination by Estes, 3^rd edition 2006

2. Which among the causes of CVA the nurse should prioritize regarding the onset of the manifestations?

1. Thrombosis
2. Embolism
3. Hemorrhage
4. TIA

Ø Clinical manifestations in embolism occur rapidly. Within 10-30 seconds and often without warning. Thrombosis has a slow onset of manifestations. Hemorrhage may take up to 1 hour to manifest symptoms. TIA is not a cause of CVA.

p. 2111, Joyce Black 7^th edition, 2005

3. Which among the causes of CVA should be prioritized regarding the severity of its outcome?

1. Thrombosis
2. Embolism
3. Hemorrhage
4. TIA

Ø In hemorrhage, it results in extensive permanent loss of function with slower, less complete recovery. There is rapid progression to coma. In A and B, there is relative preservation of consciousness. TIA is not a cause of CVA.

p. 2111, Joyce Black 7^th edition, 2005

4. The patient is experiencing ischemic attack. The nurse knows that irreversible damages and cerebral infarction will occur when cerebral anoxia lasts for how many minutes?

1. 4 minutes
2. 6 minutes
3. 8 minutes
4. 10 minutes

Ø Cerebral Anoxia lasting longer than 10 minutes causes cerebral infarction with irreversible change.

p. 953, Saunders 3^rd edition, 2005

5. To prevent cerebral anoxia, the priority intervention for the client at this time is:

1. Clear respiratory tract
2. Thrombolytic therapy stat as ordered
3. Initiate a code
4. Provide Oxygen at 4L/min

Ø Airway patency is always a priority.

p. 953, Saunders 3^rd edition, 2005

6. The nurse knows that in ischemic stroke, the Thrombolytic therapy must be started:

1. Immediately.
2. Within an hour of the onset of manifestations.
3. Within 3 hours of the onset of manifestations.
4. Within 6 hours of the onset of manifestations.

Ø The time of onset of manifestations must be determined because thrombolytic therapy must be administered within 3 hours of the onset of manifestations.

p. 2116, Joyce Black 7^th edition, 2005

7. A client is disqualified from receiving Thrombolytic therapy when he has a history of: SELECT ALL THAT APPLIES

___ Recent MI

___ Baseline BP of 150/90

___ Blood glucose >400 mg/dl

___ Platelet count <>3

___ Use of Heparin a day ago

___ PT > 15sec

___ Seizure at onset of stroke

___ GI bleeding within preceeding 21 days

___ Blood glucose > 50mg/dL

Ø All situations disqualify a patient to receive thrombolytics.

p. 2120, Joyce Black 7^th edition, 2005

8. The nurse is preparing her care plan for a patient who had a stroke. What would be the best nursing Diagnosis for the client who had hemiplegia secondary to stroke and is unaware of his paralyzed side?

1. Risk for injury
2. Unilateral Neglect
3. Impaired Physical Mobility
4. Knowledge deficit

Ø Unilateral neglect is a pattern of lack of awareness of one side of the body. The client behaves as if that part is simply not there.

p. 2131, Joyce Black 7^th edition, 2005

9. The nurse is taking the ECG readings for a CVA patient. She knows that ECG changes in CVA includes the ff. except:

1. shortened PR interval
2. ST elevation
3. Prolonged QT interval
4. T wave changes

Ø Stroke ECG changes include T-wave changes, Shortened PR interval, prolonged QT interval, PVCs, Sinus bradycardia, and VTach and SVT.

p. 2111, Joyce Black 7^th edition, 2005

10. Heparin is ordered for a patient with Ischemic stroke. The following are true about heparin except:

1. Protamine at bedside
2. PT is monitored
3. Give thru IV
4. Non- teratogenic

Ø A, C, and D are correct. aPTT is monitored on Heparin and should be at least 1.5 to 2.5x control to be effective.

p. 2121, Joyce Black 7^th edition, 2005

GASTRO

GERD

1. A client was admitted complaining of heart burn. She was diagnosed with GERD. Which of the following drugs the nurse would anticipate the doctor will order first?

1. Ranitidine & Metoclopramide
2. Antacids & Ranitidine
3. Metoclopramide & Antacids
4. Omeprazole & Metoclopramide

Ø Management of GERD is divided into five phases:
Phase I – Lifestyle changes

Phase II – First Line Drug therapy (Antacids and Ranitidine)

Phase III – H2 Blockers+Prokinetic Agent+PPI

Phase IV – Drug Miantenance

Phase V – Surgery

Pg. 598, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

2. The nurse went in to client’s room during lunchtime. Which of the following meals on the table of the patient indicates the need for further teaching to the client?

1. Fresh Garden Salad
2. A slice of strawberry cake
3. Mashed potatoes
4. Spaghetti & garlic toast

Ø Fatty foods, garlic, onions, alcohol, coffee and chocolate should be avoided.

Pg. 598, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

3. The patient with GERD was prescribed with Reglan. The nurse knows that the primary purpose for this is?

1. Promote gastric emptying
2. Block gastric secretion
3. Reduce gastric acidity
4. Decrease gastric acid secretion

Ø Metoclopramide(Reglan) is a prokinetic agent that promotes gastric emptying.

Pg. 598, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

4. Which of the statements made by the patient indicates the need for further teaching?

1. “I should avoid eating and drinking 3 hours before sleeping.”
2. “I should decrease fluid intake at meals to prevent reflux.”
3. “I should elevate the head of the bed 6-8inches.”
4. “I should eat 6 small meals per day.”

Ø Drink adequate fluids at meals to assist food passage. A, C, and D are correct statements.

Pg. 732 Joyce Black 7^th edition, 2005

5. The nurse caring for a client with GERD must because cautious in giving medications because some drugs may decrease LES pressure. The following drugs should be avoided by the patient except:

1. Theophylline
2. Ca channel blockers
3. Bethanechol
4. Atropine SO4

Ø Anticholinergics, Ca channel blockers, biphosphonates and theophylline should be avoided because these drugs appear to decrease LES. Bethanechol (Urecholine) is given to clients with severe maifestations of GERD because it increases LES pressure and prevent reflux.

Pg. 732 Joyce Black 7^th edition, 2005

REGIONAL ENTERITIS VS. ULCERATIVE COLITIS

1. Write R – Regional ulceration, U – Ulcerative colitis, B – Both

U ___ Mucosal Ulceration

R ­­­___ Transmural Thickening

B ­­­___ Diarrhea

R ___ Right Colon

U ___Left Colon

B ___ Corticosteroids

B ___ Sulfonamides

R ___ Parenteral Nutrition

U ___ Abnormal Inflamed Mucosa

R ___ Thickened Bowel Wall

U ___ Perforation

Pg. 1041, Brunner 10^th edition

2. A patient with Chron’s was assigned to the nurse. Upon assessment, the nurse would note that the stool consistency from the patient is:

1. Liquid Stools
2. Bloody stools
3. Black Tarry stools
4. Semi-liquid stools

Ø Stool consistency in Chron’s is typically soft or semi-liquid. In ulcerative colitis, stools are liquid, bloody and with mucus or pus.

Pg. 818, Joyce Black 7^th edition, 2005

3. The nurse prepares the client with Regional Enteritis for Barium Swallow. The patient is complaining of crampy abdominal pain and is asking for his Demerol. What should the nurse do?

1. Give Demerol as ordered.
2. Report to the physician immediately.
3. Withhold the pain medication.
4. Postpone the procedure for the next day.

Ø Narcotics and Anticholinergics are withheld 24 hours before the test because they interfere with small intestine motility.

Pg. 573, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

4. The patient with Ulcerative Colitis suddenly develops fever, leukocytosis, tachycardia & abdominal distention. The nurse would suspect that the patient has developed?

1. Toxic Megacolon
2. Ruptured Colon
3. Perforation
4. Hemorrhage

Ø One of the complications of Ulcerative Colitis is Toxic Megacolon. The signs are fever, tachycardia, abdominal distention, peritonitis, leukocytosis, dilated colon on abdominal x-ray. This is life threatening.

Pg. 621, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

5. The characteristic pattern of progression of Ulcerative Colitis is:

1. Involves entire thickness of the bowel wall.
2. Starting from the distal colon, spreading upward.
3. Develops anywhere in the GI tract
4. Characterized by periods of remissions and exacerbations.

Ø A, B, and D are charcteristics of Chron’s. Ulcerative Colitis starts from the rectum spreading upward to the colon.

Pg. 621, Joyce Black 7^th edition, 2005

ILEO/COLOSTOMY CARE

1. What is the priority nursing diagnosis for a patient with an ileostomy exhibiting an irritated & reddened skin around the stoma?

1. Disturbed Body Image
2. Risk for Impaired Skin Integrity
3. Imbalanced Nutrition, Less Than Body Requirements
4. Fluid Volume Deficit

Ø Perisotmal Skin irritation is the most common complication of ileostomy. Letter A is about self-concept. C and D are irrelevant.

Pg. 1051, Brunner 10^th edition

2. During the morning care, the patient verbalized her concern regarding odor-formation of her ileostomy. The correct nursing response would be:

1. Frequent cleaning will remove all odors.
2. You can put some aspirin in the pouch.
3. Bismuth is helpful and effective in reducing odor.
4. You just need to avoid eating gas formers but fishes & meats are allowed.

Ø Bismuth subcarbonate tablets are effective in reducing odor. Cabbage, onions, and fishes are gas-formers and must be avoided. Letter A is very absolute, non-therapeutic. Letter B has no basis.

Pg. 1051, Brunner 10^th edition, 2004

3. A client with colostomy is concerned with the alterations in his ADL’s. He asks if he can still play basketball. What is the nurses’ best response?

1. ontact sports are not allowed for patients with colostomy.
2. I can see that you are bothered. Tell me more about this feeling.
3. You may play basketball but you must put a binder.
4. Yes, you can play basketball but you cannot run.

Ø Patient with ostomies can participate in sports as desired. Caution must be exercised with contact sports. During vigorous activities, a belt or binder may provide extra security.

Pg. 594, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

4. A patient with colostomy experienced depression 2 days post-op because of the disturbance in her body image. Which of the following indicates that the patient has accepted what happened?

1. The patient reads Ostomy literatures.
2. The patient looks at her abdomen in the mirror.
3. The patient asks question to the nurse regarding ostomy care.
4. The patient participates in Ostomy care.

Ø The patient should be able to verbalize acceptance of body image changes, incorporates ostomy management into ADLS and demonstrates skills for care of the ostomy.

Pg. 594, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

5. The nurse is providing a discharge teaching for a client with ileostomy. Which among the following is a common complication of ileostomy?

1. Peristomal skin irritation
2. Stomal Prolapse
3. Stomal Stenosis
4. Stomal Stricture

Ø All are complications. Perisotmal Skin irritation is the most common complication of ileostomy.
pg. 1051, Brunner 10^th edition, 2004

GI Tubes

1. The nurse is caring for a client with NGT. Frequent assessment of the tube placement is a priority. Which is the least advisable?

1. Auscultation
2. Measurement of tube length
3. Assessment of Aspirate
4. pH measurement of Aspirate

Ø Auscultation is the least reliable method and should not be used to evaluate the tube tip position.

p. 989 Brunner 10^th edition, 2004

p. 703 Joyce Black 7^th edition, 2005

2. The nurse was assigned to a pt. with Miller-Abott tube. Upon aspirating, the nurse found out that the pH of the secretion is 6.2. The nurse knows that this means?

1. the tube entered the respiratory tract
2. the tube is in the gastric area
3. the tube is in the intestinal area
4. needs further assessment

Ø The pH of gastric aspirate is acidic (1 to 5). The pH of intestinal aspirate is approximately 6 or greater and the pH of respiratory aspirate is more alkaline (7 or greater).

p. 989, Brunner 10^th edition, 2004

3. The nurse is about to feed a client with NGT. She aspirated gastric residual amounting to 130cc. What should the nurse do?

1. Continue feeding the client.
2. Withhold feeding for 30 minutes then check again.
3. Administer half of the feeding. After an hour, administer the other half.
4. Do not administer feeding.

Ø Do not administer feeding if residual is greater than 100ml.

p. 236, Saunders 3^rd edition, 2005

4. A client rushed-in to ER with hematemesis. The endoscopy revealed esophageal varices. The nurse will immediately prepare what tube?

1. Miller- Abott tube
2. Salem-Sump tube
3. Sengstaken-Blakemore tube
4. Levine tube

Ø The Sengstaken-Blakemore tube is a triple lumen gastric tube. The esophageal balloon directly compresses esophageal varices.

p. 237, Saunders 3^rd edition, 2005

5. The nurse is administering NGT feeding for a client. During NGT feeding, the client vomits. The nurse would do the ff. except:

1. Stop the feeding.
2. Measure abdominal girth.
3. Place in side-lying position.
4. Administer anti-emetics as ordered.

Ø B, C, and D are correct management. Feeding should still be administered slowly.

p. 236, Saunders 3^rd edition, 2005

CARDIO

HYPERTENSION

1. The nurse was assigned to the following clients on the Medical-Surgical floor. Who among the following is not at risk to develop secondary hypertension?

1. A 29 y.o. patient with Hyperthyroidism
2. A 36 y.o. patient with Pheochromocytoma
3. A 65 y.o. patient with Arteriosclerosis
4. A 49 y.o. patient with Addison’s disease

Ø A, B and D are prone to develop HPN. Addison’s disease is not a cause of secondary HPN. It should be Cushing’s.

Pg. 1495 Joyce Black 7^th edition, 2005

2. A patient with hypertension was assigned to the nurse. The nurse knows that the complications of HPN are the following except:

1. Angina/MI
2. RVH
3. Retinopathy
4. Accelerated HPN

Ø The complications of HPN are

-Angina/Mi due to decrease coronary perfusion

- LVH and CHF due to consistently elevated aortic pressure

- Retinopathy

- Renal Failure due to thickening of renal vessel and diminished perfusion of the glomerulus

-TIAs, Stroke and Cerebral Hemorrhage

Pg. 432, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

3. The nurse is teaching a client with Hypertension regarding the Dietary Approaches to Stop HPN (DASH). Which of the following statements made by the nurse is incorrect?

1. “You can eat 4-5 servings of vegetables/day.”
2. “You can eat 2-3 servings of fat free dairy foods/day.”
3. “You can eat 3-4 fish servings/day.”
4. “You can eat grain products of 7-8 servings/day.”

Ø The Dietary Approaches to Stop HPN (DASH) Diet

- Grains = 7-8 servings/day

- Vegetables = 4-5 servings/day

- Fruits = 4-5 servings/day

- Low Fat/Non Fat Dairy = 2-3 servings/day

- Meats, poultry, fish = 2 or less servings/day

- Nuts, seeds and legumes = 4-5 servings/week

- Fats and oils = 2-3 servings /day

- Sweets = 5 servings/week

p. 1500 Joyce Black 7^th edition, 2005

4. The relative of a patient asks the nurse about the importance of lifestyle modification to prevent HPN. Which among the following lifestyle modifications to manage HPN is the most important?

1. Maintaining normal body weight / BMI
2. DASH eating plan
3. Reducing sodium intake to 2.4g/day
4. Regular Aerobic physical activity

Ø Letter A decreases Systolic BP by 5-20 mmHg/10kg weight loss

Ø Letter B decreases SBP by 8-14 mmHg

Ø Letter C decreases SBP by 2-8mmHg

Ø Letter D decreases SBP by 4-9mmHg

Pg. 858Brunner 10^th edition, 2004

5. Order the above according to priority.

Answer: ABDC

6. The patient with Hypertension is to be given Lopressor. What should the nurse check before giving?

1. HR
2. RR
3. BP
4. Temparature

Ø Bradycardia is a common adverse effect of giving Lopressor. Check the HR before giving.

Pg. 862, Brunner 10^th edition

Pg. 1028 Nurses’ drug Handbook 2004 Prentice Hall

7. The nurse knows that Lopressor should not be given to a patient who has a history of?

1. HPN
2. Angina
3. MI
4. RVF

Ø Metoprolol (Lopressor) is contraindicated to RVF.

Pg. 431, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

8. A patient was determined to have a chronic kidney disease that led to the development of HPN. In the management of HPN, the goal blood pressure for this patient is?

1. 140/90
2. 130/80
3. 130/70
4. 120/80

Ø The goal of Management for HPN is to control Arterial BP below 140/90mmHg. For clients with diabetes or pregressive renal disease the goal is 130/80mmhhg.

Pg. 857, Brunner 10^th edition

9. The nurse reviews the laboratories of a patient with hypertension who was just admitted and was assigned to her today. The earliest sign that would indicate that the patient is progressing to kidney failure secondary to HPN is:

1. Increased Creatinine
2. Increased BUN
3. Microalbuminuria
4. Hematuria

Ø Proteinuria, increase BUN and Creatinine indicate kidney disease as a cause or effect of Hypertension. First voided urine microalbuminuria is the earliest sign.

Pg. 428, Lippincot’s Manual of Nursing Practice 7^th edition, 2001

10. The patient has an average BP of 150/90. The nurse would expect the doctor to formulate which management?

1. Life style modification
2. Life style modification + Thiazide
3. Life style modification + Thiazide + ACEI
4. Life style modification + Thiazide + Beta Blocker

Ø Management of BP for adults:

Prehypertension 120/80 – 139/89 Lifestyle Modification

Stage I HPN 140/90 – 159/99 Lifestyle modification + Thiazide

Stage II HPN > 160/100 Lifestyle Modification + Thiazide + another Anti HPN drug

Pg 1497 Joyce Black 7^th edition, 2005

Pg. 856 Brunner 10^th edition, 2004

ANGINA

1. A patient with angina was assigned to the nurse. Upon auscultation, the nurse noted a paradoxical split of S2 sound. This means that:

1. Pulmonic valve closes after Aortic valve.
2. There is a delayed closure of pulmonic valve.
3. Pulmonic valve closes before Aortic valve.
4. The Aortic valve and Pulmonic valve closes in unison.

Ø On auscultation, a paradoxical split of S2 may be noted in Angina. Normally, aortic valve closes slightly before pulmonic valve during inspiration. In paradoxical split of S2, the aortic valve closes after pulmonic valve.

p. 1705, Joyce Black 7^th edition, 2005

p. 514, Nursing Assessment and Physical Examination by Estes, 3^rd edition 2006

2. The patient had an anginal attack 8 hours ago. She asks the nurse if she can have sexual intercourse with her husband. What is the nurse’s best response?

1. You are limited to complete bed rest.
2. You need to take Nitroglycerin SL first.
3. Sexual activity can aggravate your condition.
4. You should ask your physician or sex counselor first.

Ø NTG increases tolerance for exercise and stress when taken prophylactically, before angina-producing activity, such as sexual intercourse.

p. 721, Brunner 10^th edition, 2004

3. The patient called for the nurse and complains of unrelieved chest pain. She verbalized, “I followed your instructions carefully. I already took 3 NTG SL tablets at 5-minute intervals from my pillbox. But the pain is still there.” The nurse’s best action would be:

1. Oxygenate the patient immediately.
2. Administer morphine stat as ordered.
3. Get NGT SL tab from the E-Cart and give to patient.
4. Call the doctor and report infarction.

Ø NTG is very unstable, it should be carried securely in its original container. Tablets should never be removed and stored in metal or plastic pillboxes.

p. 721, Brunner 10^th edition, 2004

4. During the morning nursing rounds, a client reported that he developed crushing chest pain at 1 a.m. while he was resting. The nurse knows that this is what type of angina?

1. Stable Angina
2. Unstable Angina
3. Prinzmetal’s
4. Intractable Angina

Ø Prinzmetal’s or Variant Angina is chest discomfort similar to classic angina but of longer duration. It may occur while the client is at rest. The attacks tend to happen between midnight and 8am.

p. 793 Saunders 3^rd edition, 2005

5. The patient with angina develops chest pain radiating to the shoulders and neck while he was ambulating at his room. The immediate nursing action would be:

1. Give morphine as ordered.
2. Start oxygen at 3L/min.
3. Administer NTG as ordered
4. Provide rest.

Ø Oxygenation is always the priority. Administer oxygen at 3L/min via Nasal Cannula.

p.794, Saunders 3^rd edition, 2005

6. A patient with suspected MI is to undergo Cardiac Catheterization. What is the nursing management after the procedure?

1. Position the client to Semi-fowler’s
2. Strict bed rest for 6-12 hours.
3. Keep extremities extended for 4-6 hours.
4. Turn client form side to side.

Ø Do not elevate the head of the bed more than 15 degrees. Maintain strict bed rest for 6-12 hours, however, the client may turn from side to side. Keep extremities extended for 4-6 hours to prevent arterial occlusion.

p. 783 Saunders 3^rd edition, 2005

HEART FAILURE

1. The nurse is assessing a 59 y.o. male patient with CHF who was just admitted on the Medical-Surgical Unit. Which of the following is not a manifestation of LVF:

1. Difficulty breathing
2. Sharp pain on the Upper Abdomen
3. Patient experiences sensation of suffocation
4. Patient assumes tripod position

Ø Dyspnea (Letter A), Orthopnea (Letter D), and Paroxysmal Nocturnal Dyspnea (Letter C) are signs of LVF. Abdominal pain on the RUQ occurs as the liver becomes congested with venous blood (hepatomegaly), indicating RVF.

p. 1655, Joyce Black 7^th edition, 2005

2. A 35 y.o. patient with RVF was assigned to the nurse. Which would be the priority assessment of the nurse?

1. Abdominal pain
2. Anorexia
3. Weight gain
4. Fatigue

Ø Signs of RVF are evident in the systemic circulation. All are signs of RVF. Weight gain is objective and most sensitive. A, B, and D are subjective.

p. 796, Saunders 3^rd edition, 2005

3. The nurse is caring for a 75 y.o. client with LVF. The nurse should be alerted when the patient experiences:

1. crackles
2. confusion
3. pallor
4. tachycardia

Ø Confusion indicates cerebral hypoxia and depressed cerebral function.

p. 797, Saunders 3^rd edition, 2005

p.1655 Joyce Black 7^th edition, 2005

4. The patient is receiving Digoxin to treat CHF. The nurse should monitor for the ff. laboratories. Which is a priority?

1. BUN levels
2. Magnesium levels
3. Creatinine levels
4. Potassium levels

Ø Potassium is the priority. An undetected, uncorrected potassium imbalance predisposes patient to digoxin toxicity and dysrhythmias.

p. 799, Brunner 10^th edition, 2004

5. The nurse monitors the patient closely to prevent Digoxin toxicity. Which of the ff. patients is at high risk of developing toxicity?

1. a patient with serum K=3.3 mEq/L and Digoxin level=1.8 ng/ml
2. a patient with serum K=3.8 mEq/L and Digoxin level=1.9 ng/ml
3. a patient with serum K=3.5 mEq/L and Digoxin level=1.9 ng/ml
4. a patient with serum K=3.4 mEq/L and Digoxin level=2.0 ng/ml

Ø Digoxin toxicity is more prevalent when serum concentration is equal to or greater than 2 ng/ml. Hypokalemia increase the risk of toxicity.

p. 1658, Joyce Black 7^th edition, 2005

RESPI

OXYGEN THERAPY

1. The nurse is caring for a client on oxygen therapy. Which among the Oxygen administration devices deliver the most highest Oxygen concentration?

1. Partial-Rebreather mask
2. Non-rebreather mask
3. Venturi mask
4. Face Mask

Ø Non- rebreather mask delivers 90-100% oxygen.

Ø Partial rebreather mask delivers 70-90% oxygen

Ø A venturi mask delivers 24-55% oxygen

Ø A simple face mask delivers 40-60% oxygen

p. 602 Brunner 10^th edition, 2004

p. 730 Saunders 3^rd edition, 2005

2. A patient with pneumonia has an oxygen saturation of 90%. He is having difficulty in breathing, shallow respirations of 30/min, crackles and productive coughing. The nurse’s primary concern is to improve respirations and decrease hypoxia. Which would deliver the most accurate oxygen concentration?

1. Partial Rebreather mask
2. Non-Rebreather mask
3. Venturi mask
4. T-piece

Ø Venturi mask delivers accurate oxygen. A precise volume of oxygen can be delivered by adjusting the flow of oxygen.

p. 602 Brunner 10^th edition, 2004

3. The nurse on the Respiratory unit received the following patients during the endorsement. She initially checked their oxygen therapy in the kardex and in the charts. Which of the following patients is at high risk for oxygen toxicity?

1. Patient on non-rebreather mask for 48 hours.
2. Patient on Venturi mask @5L/min for 36 hours
3. Patient on Nasal Cannula @6L/min for 7days
4. Patient on Venturi mask for 12 hours.

Ø Oxygen toxicity may occur when too high a concentration of oxygen (greater than 50%) is administered for an or an extended period (longer than 48 hours). Non-rebreather mask delivers a minimum of 90% oxygen. Venturi mask at 6L/min delivers 28-30% only. Nasal Cannula a2 6L/min delivers 42% only.

p. 601-602 Brunner 10^th edition, 2004

4. A patient with Emphysema rushed in to ER complaining of difficulty breathing and shortness of breath. The nurse will immediately give oxygen via?

1. Simple Mask at 6L/min
2. Nasal Cannula at 4L/min
3. Venturi mask at 4L/min
4. Nasal Cannula at 2L/min

Ø In patients with COPD, the stimulus for respiration is a decrease in blood oxygen rather than an increase in CO2 levels. Thus, administration of a high concentration of oxygen removes the respiratory drive. Oxygen-induced hypoventilation is prevented by administering oxygen at low flow rates (1 to 2L/min)

p. 602 Brunner 10^th edition, 2004

5. The nurse is caring for a client with simple face mask. The client’s O2 saturation is 93% and is not getting enough oxygen due to rebreathing of CO2. In order to flush the mask of CO2, the flow rate must be set at least?

1. 3L/min
2. 4L/min
3. 5L/min
4. 6L/min

Ø A minimal flow rate of 5L/min is needed to prevent rebreathing of exhaled air in simple face mask.

p. 730 Saunders 3^rd edition, 2005

RESPIRATORY PROBLEMS AND MANAGEMENT

1. A patient with Flail chest was assigned to the nurse. Upon assessment of the respiratory patterns of the client, the nurse would expect:

1. Mediastinal shift to the unaffected side during inspiration.
2. No mediastinal shift.
3. Mediastinal shift to unaffected side on both inspiration and expiration.
4. Mediastinal shift to affected side during inspiration.

Ø On inspiration, the flail segment of ribs is sucked inward. The affected lung and mediastinal structures shift to unaffected side. On expiration, the affected lung and mediastinal structures shift to the affected side.

P 1902 Joyce Black 7^th edition, 2005

2. The nurse is to provide a discharge health teaching to a 7 y.o. patient with Asthma regarding the use of a Metered dose Inhaler. Which of the following is not true?

1. Place the mouthpiece 1 to 2 inches away from mouth.
2. Puff during inspiration.
3. Hold breath for 5-10 seconds.
4. Wait for 30 seconds before administering the next dose.

Ø If the physician prescribed more than one puff, wait 1 minute between puffs to let the medication open up the upper airway. That way, the next puff can reach lower into the lungs.

p. 1816 Joyce Black 7^th edition, 2005

3. A client with COPD suddenly develops difficulty of breathing and wheezes. The nurse would prioritize which of the ff. drugs to be given?

1. Atrovent
2. Albuterol
3. Theophylline
4. Steroids

Ø Bronchodilators remain the mainstay in the treatment of COPD. Beta₂ Agonists (Albuterol) are the most frequently prescribed. They have minimal adverse effects, woth rapid onset of action, a peak effect of 60-90 mins, andduration of 3-4 hours.

p. 1821 Joyce Black 7^th edition, 2005

4. What is the priority nursing diagnosis for a 50 y.o. COPD client with dyspnea, wheezing, crackles, and a productive cough?

1. Ineffective Airway Clearance
2. Impaired Gas Exchange
3. Altered Tissue Perfusion
4. Ineffective Breathing Pattern

Ø The symptom presents an ineffective airway clearance. Impaired gas exchange can be measured through ABG and O2 sat. Altered Tissue perfusion is manifested by peripheral circulation (Cyanosis or pallor), and ineffective breathing pattern by respiratory rate, depth, and quality.

p. 1824 Joyce Black 7^th edition, 2005

5. The nurse is instructing the client regarding the use of Incentive Spirometry. Which is an incorrect statement made by the nurse?

1. Position the patient in an upright position.
2. Inhale and maintain flow rate at 600 marks.
3. Hold breath for 10 seconds.
4. Repeat process 10x every hour.

Ø A, B and are correct statements. Hold breath only for 5 seconds.

p. 729 Saunders 3^rd edition, 2005

RENAL FAILURE

1. Acute Renal Failure. Write O-oliguric phase, D-diuretic phase, B-both

O___ Decrease GFR

D___ Increase GFR

D___ Hypokalemia

O___ Hyperkalemia

B___ Hyponatremia

D___ Hypovolemia

O___ Fluid overload

O___ Increase BUN, creatinine

D___ Decrease BUN, creatinine

P. 855 Saunders 3^rd edition, 2005

2. The nurse is caring for a patient with ARF. In the diuretic phase of this disease, the nurse will expect the following changes except:

1. Hypokalemia
2. Hypovolemia
3. Hyponatremia
4. Decrease GFR

Ø A, B and C are expected in the diuretic phase of ARF. Decrease GFR is seen in oliguric phase of Acute renal failure.

p. 855 Saunders 3^rd edition, 2005

3. A 69 y.o. Japanese Client with ARF in the oliguric phase of the disease was brought to the hospital. The nurse knows that in order to be considered oliguric, the urine output of the patient should be?

1. <>
2. <>
3. <600>
4. <800>

Ø In oliguric phase of ARF, urine production is usually less than 400 ml/day. However, the aging kidney normally loses its concentrating ability and renal function becomes more susceptible to insult. Therefore an older client may have had oliguria even at urine volumes of 600-700 ml/day

p. 944 Joyce Black 7^th edition, 2005

4. The client’s laboratory result shows BUN 35mg/dL. What should the nurse do?

1. Administer Furosemide stat as ordered.
2. Initiate seizure precautions.
3. Watch out for Respiratory Depression.
4. Monitor LOC closely.

Ø The increasing BUN decreases seizure threshold, resulting in an increase in the number of seizures.

p. 946 Joyce Black 7^th edition, 2005

5. Lasix 20 mg IV stat was ordered. The nurse should be cautious in administering this drug in ARF patients because of its many adverse effects. The primary concern of the nurse is that this drug causes:

1. Nephrotoxicity
2. Hypokalemia
3. Hypocalcemia
4. Circulatory collapse

Ø Furosemide can be nephrotoxic, increasing the risk of further renal damage. Diuretics are typically not effective in people with ARF.

p. 946 Joyce Black 7^th edition, 2005

6. The client’s ABG is: pH 7.32, PCO2 42, HCO3 20. The nurse would immediately prepare what solution?

1. KCl
2. MgSO4
3. NaHCO3
4. Acetazolamide

Ø Metabolic Acidosis usually results from the accumulation of acid waste products. Sodium Bicarbonate, Sodium Lactate, or Sodium Acetate may be used in the short term to correct this condition.

p. 945 Joyce Black 7^th edition, 2005

7. The nurse is closely monitoring her patients’ laboratories in the Renal Department. The client with ARF will most probably reveal what Fluid and Electrolyte changes?

1. Hyperkalemia, hyponatremia, hypermagnesemia
2. Hyperkalemia, hyponatremia, hypomagnesemia
3. Hypokalemia, hypernatremia, hypermagnesemia
4. Hypokalemia, hyponatremia, hypomagnesemia

Ø Fluid and electrolyte changes in ARF in includes hyperkalemia, hyponatremia, hypocalcemia, and hypermagnesemia.

p. 944 Joyce Black 7^th edition, 2005

8. The nurse needs to closely monitor a patient with ARF for edema. Which of the ff. assessments the nurse will prioritize?

1. I&O hourly
2. Weight
3. Abdominal Girth Measurement
4. VS

Ø Weight measurement is the most accessible. An increase of ½ to 1 lb. daily indicates fluid retention.

p. 856 Saunders 3^rd edition, 2005

9. Mr. Wayne, a 59 y.o. patient rushed in to ER and was diagnosed with ARF. He registered tall peaked T-wave in the ECG. The nurse immediately considered hyperkalemia and would prepare what drug?
   Bumetanide

1. Aldactone
2. Kayexalate
3. Lasix

Ø Kayexelate promotes GI sodium absorption and potassium excretion and is given to patients with Hyperkalemia who have renal impairment.

p. 92, p.856 Saunders 3^rd edition, 2005

10. Mr. Wayne developed hyperkalemia. The nurse should anticipate preparing what type of solution to be hooked to the patient?

1. D50-50
2. D5 LR
3. PNSS
4. D5 NS

Ø IV administration of glucose move excess potassium into the cells.

p. 92 Saunders 3^rd edition, 2005

Ø Administration of 50% glucose and regular insulin with sodium bicarbonate if necessary can temporarily prevent cardiac arrest by moving potassium into the cells and reducing serum potassium levels.

p. 946 Joyce Black 7^th edition, 2005

11. Mr. Wayne’s condition worsened and developed to Chronic Renal Failure. The nurse knows that the leading cause of CRF is:

1. SLE
2. ARF
3. HPN
4. DM

Ø Diabetes is the leading cause and accounts for more than 30% of clients who receive dialysis. HPN is the second. SLE and ARF can also cause of CRF

p. 949 Joyce Black 7^th edition, 2005

12. Upon assessment, the patient exhibited mild azotemia, impaired urine concentration, nocturia, and mild anemia. The nurse suspects that the patient is at which stage of CRF?

1. Reduced Renal Reserve
2. Renal Insufficiency
3. Renal Failure
4. ESRD

Ø The manifestations of the patient are signs of renal insufficiency, the second stage of CRF. In reduced renal reserve, the first stage of CRF, BUN is normal to high, but the client has no clinical manifestations. In the 3^rd stage, Renal Failure, manifestations are severe azotemia, acidosis, impaired urine dilution, severe anemia and electrolyte imbalances such as hyperkalemia, hypernatremia and hyperphosphatemia.

p. 949 Joyce Black 7^th edition, 2005

13. The nurse would expect what abnormal respiration pattern for a client with Renal Failure?

1. Cheyne – Stoke
2. Kussmaul’s
3. Biot’s
4. Agonal

Ø Kussmaul’s respiration is seen on clients with metabolic acidosis, which is a manifestation of renal failure.

p. 856 Saunders 3^rd edition, 2005

p. 456 Nursing Assessment and Physical Examination by Estes, 3^rd edition 2006

14. The patient with renal insufficiency was admitted to the renal unit 6 hours ago. The nurse reviews the chart and questions what drug?

1. Aminoglycosides
2. Kayexelate
3. Propranolol
4. Aluminum OH

Ø Aminoglycosides causes nephrotoxicity. Kayexelate can be used to patients with RF to decrease potassium levels. Propranolol helps in maintaining BP. And Aluminum OH allows axcess Phosphates to be eliminated in patient with RF.

p. 856-857 Saunders 3^rd edition, 2005

15. The goals of medical management for CRF are as follows. Order the following.

1. Improve body chemistry values
2. Alleviate extrarenal manifestations
3. Preserve Renal Function
4. Provide an optimal quality of life for client

C – B – A – D

Ø The five goals of Medical management in patients with CRF are:

· Preserve Renal Function

· Delay the need for dialysis or transplantation as long as feasible

· Alleviate extrarenal manifestations as much as possible

· Improve body chemistry values

· Provide an optimal quality of life for the client and significant others

p. 955 Joyce Black 7^th edition, 2005

16. The patient was brought to the Hemodialysis unit. The nurse knows that the purposes of hemodialysis are the ff. except?

1. Remove excess Bicarbonates from blood
2. Remove end products of CHON metabolism
3. Maintain a safe concentration of serum electrolytes
4. Remove excess fluid form blood

Ø The four basic goals of dialysis therapy are:

· Remove end products of CHON metabolism (BUN and Creatinine)

· Maintain a safe concentration of serum electrolytes

· Correct acidosis and replenish the bicarbonate levels of the blood

· Remove excess fluid form blood

p. 956 Joyce Black 7^th edition, 2005

17. The hemodialysis nurse has an important role in monitoring the patient during the entire procedure. The nurse should assess the patient regularly to prevent Disequilibrium syndrome. Which of the ff. is not indicative of this complication?

1. Nausea and vomiting
2. Hypotension
3. Confusion
4. Restlessness

Ø The signs of disequilibrium syndrome are: nausea, vomiting, headache, confusion and agitation, restlessness, seizures and hypertension.

p. 859 Saunders 3^rd edition, 2005

18. The internal AV fistula is the access of choice for Chronic dialysis. The nurse knows however that AV fistula could lead to the development of:

1. Pulmonary Edema
2. Myocardial Infarction
3. CHF
4. Hypoxemia

Ø CHF can occur from the increase blood flow in the venous system.

P.861 Saunders 3^rd edition, 2005

19. The nurse is caring for an out-patient on Peritoneal Dialysis. She is reported to have exceeded the dwell time prescribed by the physician. The nurse knows that the patient is at risk for developing:

1. Hyperglycemia
2. Hypernatremia
3. Hypokalemia
4. Hypotension

Ø Do not allow dwell time to extend beyond the physician’s order because this increases risk for hyperglycemia.

p. 863 Saunders 3^rd edition, 2005

20. 5 days post-insertion of Tenckhoff catheter for Peritoneal Dialysis, the patient came in to hospital complaining of leaks around the catheter site. The correct nursing response is:

1. “I will report this immediately to your physician.”
2. “You will need to take Antibiotics as ordered.”
3. “It will take up to 2 weeks for the incision to completely heal.”
4. “I will need to monitor your laboratories for the next 24 hours.”

Ø Over a period of 1-2 weeks post-insertion of the catheter, an ingrowth of fibroblasts and blood vessels into the cuffs of the catheter occurs that fixes the catheter in place and provides a barrier against dialysate leakage and infection.

p. 864 Saunders 3^rd edition, 2005

21. A 47 y.o patient on peritoneal dialysis went in for follow-up after 2 weeks. She reported to have an amber-colored outflow this morning. The nurse would suspect:

1. Bladder perforation
2. Bowel perforation
3. Peritonitis
4. This is a normal outflow characteristic.

Ø During the first exchanges, the outflow may be bloody. A brown outflow indicates bowel perforation. A cloudy outflow indicates peritonitis. If the outflow is same color as urine, it indicates bladder perforation.

p. 864 Saunders 3^rd edition, 2005

22. The patient on Peritoneal Dialysis went-in for follow-up after 4 weeks. She said she did not have bowel movement for 3 days. She is having an insufficient outflow of dialysate. The nurse should prioritize which of the ff.?

1. Check for kinks in the tubing.
2. Administer stool softeners as prescribed.
3. Assess the color of outflow.
4. Refer to the physician for further assessment.

Ø Insufficient outflow can be caused by a full colon. Stool softeners are given as prescribed. Patient is also encouraged a high fiber diet.

p. 864 Saunders 3^rd edition, 2005

HEMATOLOGY

1. A patient with Sickle cell disease is assigned to the nurse. The nurse is to give analgesic to the patient and she knows that she must avoid giving Demerol because this may induce:

1. Respiratory depression
2. Seizures
3. Sickle cell crisis
4. Hypotension

Ø Administration of Meperidine in Sickle cell disease is avoided because of the risk of normeperidine-induced seizures.

p. 494 Saunders 3^rd edition, 2005

2. The patient is closely monitored for acute exacerbations of the Sickle cell disease. Which of the ff. phases of this disease poses a life-threatening crisis which may lead to hypovolemia and shock?

1. Vasoocclusive crisis
2. Splenic sequestration
3. Aplastic Crisis
4. Hematologic crisis

Ø In splenic sequestration, blood pools in the spleen. The signs include profound anemia, hypovolemia and shock. In vasooclusive crisis, there is stasis and clumping of blood and the manifestations include fever, pain, and tissue engorgement. In aplastic crisis, there is a decrease production and increase destruction of RBs and patient experiences profound anemia and pallor.

p. 494 Saunders 3^rd edition, 2005

3. Which is the most common type of crisis in Sickle cell disease?

a. Vasoocclusive crisis

b. Splenic sequestration

c. Aplastic Crisis

d. Hematologic crisis

Ø Vasoocclusive crisis is the most common type of crisis. This is the most common reason for seeking medical care.

p. 494 Saunders 3^rd edition, 2005

4. The nurse is to perform a Trendelenburg’s test to a patient with Varicose veins. A positive result is:

a. Veins fill from distal end when the client sits.

b. Veins fill from proximal end when the client sits.

c. Veins engorge when the client sits.

d. No veins are seen when the client sits.

Ø If varicosities are present, a positive trendelenburg means veins fill from the proximal end when the client sits up. Veins normally fill from the distal end.

p. 805 Saunders 3^rd edition, 2005

5. The nurse and CNA plans their interventions for the day for the client with Peripheral Arterial disease. Which of the ff. should not be done to the client?

1. Elevate feet at rest to decrease swelling.
2. Provide ROM.
3. Apply warm packs to dilate vessels.
4. Encourage walking

Ø Direct heat such as with heating pad should never be applied to the limb because the decrease sensitivity in the limb will cause burning. Elevating feet at rest to decrease swelling is advised because swelling prevents arterial blood flow. However, feet should not be elevated above the level of the heart. ROM and walking will improve arterial flow through collateral circulation.

p. 806 Saunders 3^rd edition, 2005

SHOCK

3. A 65 y.o. patient was rushed in to ER and diagnosed with Toxic Shock Syndrome. The nurse assesses the patient and looks for the classic sign of TSS which is:

1. maculopapular rash
2. papulovesicular rash
3. pustular rash
4. macular erythroderma

Ø A red, macular rash similar to sunburn (diffuse, macular erythroderma) is a classic sign of TSS.

p. 1418 Brunner 10^th edition, 2004

4. Which of the following statements made by by the patient who was rushed in to ER alerts the nurse that the patient has TSS?

1. A sunburn-like rash appeared in my hands yesterday
2. I have a fever of 38^oC for 3 days
3. My tongue are very reddish
4. Small tiny dark spots appeared on my chest this morning

Ø Macular erythroderma is a sunburn-like rash. In TSS, fever is always at least 38.9^oC. Strawberry tongue appears in Scarlet fever. Pettechiae is not a sign for TSS.

p. 1418 Brunner 10^th edition, 2004

5. The nurse caring for a 75. y.o. patient with TSS will be alerted that the client is progressing to septic shock when the patient is experiencing:

1. Hypotension
2. Tachypnea
3. Tachycardia
4. Confusion

Ø Confusion may be the first sign of infection and sepsis in elderly patients. High risk patients (elderly and immunosuppressed) may not develop typical or classic signs of infection and sepsis.

p. 310 Brunner 10^th edition, 2004

6. The patient is in septic shock revealed the following ABG result: pH 7.31, pCO2 46, HCO3 19. The nurse would immediately anticipate preparing what solution for fluid replacement?

1. D5 NSS
2. PNSS
3. D5 LR
4. PLR

Ø Ringer’s Lactate Solution contains Lactic ions and is converted to bicarbonate, which helps to buffer the overall acidosis that occurs in shock.

p. 302 Brunner 10^th edition, 2004

7. Epinephrine 1mg is ordered stat. The nurse knows watches out for the adverse effect of this drug which is:

1. Increase oxygen demand
2. Hypotension
3. Increase afterload
4. Increase cardiac workload

Ø B, C, and D are desired action of Epinephrine in shock. Increase Oxygen demand is a side effect of this drug.

p. 303 Brunner 10^th edition, 2004

8. Dobutamine was subsequently ordered. All of the following are the actions of this drug except:

1. Increase BP by vasoconstriction
2. Increase cardiac output
3. Enhances Renal Perfusion
4. Increases Renal Output

Ø B, C, and D are actions of Dobutamine for CHF and Cardiogenic Shock. Dobutamine has no effect on blood vessels. It increase Cardiac output and decrease pulmonary wedge pressure and total sysytemic vascular resistance with little or no effect to BP.

p. 517 Nurses’ drug Handbook 2004 Prentice Hall

MUSCULOSKELETAL

1. The nurse is giving a discharge instruction to a client with crutches. Which is an incorrect statement made by the nurse?

1. Your elbows should be slightly flexed when walking.
2. Never rest the axilla in the axilla bars.
3. Watch your crutches carefully when walking.
4. Place the crutches 6-10 inches diagonally infront of the foot.

Ø The client is instructed to look up and outward when ambulating. A, B and D are correct teachings for the client with crutches.

p. 1005 Saunders 3^rd edition, 2005

2. The nurse plans to ambulate with the client during her morning care. When walking with the client on crutches, the nurse should be on:

1. behind the patient
2. affected side of the patient
3. unaffected side of the patient
4. either side

Ø When ambulating with the client, the nurse should stand on the affected side.

p. 1005 Saunders 3^rd edition, 2005

3. The nurse is assisting a 45 y.o. client with Left short leg cast on crutches who wants to go down to the cafeteria. The correct method to go down with crutches is:

1. The affected leg first.
2. The unaffected leg first.
3. The affected leg and crutches first.
4. The unaffected leg and crutches first.

Ø In assisting the client with crutches to go down stairs, the nurse instructs the client to move the crutches and the affected leg down first. Followed by the unaffected leg down. To go up the stairs, client moves the unaffected leg first, follwed by the affected leg and crutches up.

p. 1006 Saunders 3^rd edition, 2005

4. The nurse is to provide a discharge teaching to a 23 y.o. male with a right tibial fracture on short leg cast. The correct statement made by the nurse regarding 3-point crutch gait is:

1. Advance both crutches forward first with the affected leg.
2. Advance one crutch with the affected leg first.
3. Advance the unaffected leg first.
4. Advance one crutch opposite the unaffected leg first.

Ø In a 3-point crutch gait, the client advances both crutches forward with the affected leg and shifts weight to the crutches. Then, advances unaffected leg and shift weight onto it.

p. 1005 Saunders 3^rd edition, 2005

5. A 6-day old neonate is diagnosed with Hip dysplasia. To correct this, the nurse will anticipate to use:

1. BST
2. Hip spica cast
3. Buck’s traction
4. Pavlik’s harness

Ø Pavlik’s harness is applied to neonates with hip dysplasia to splint the hips and maintain flexion and abduction and external rotation.

p. 487 Saunders 3^rd edition, 2005

6. After endorsement, the nurse visited her patients. Which of the following patients is not at risk to develop Osteoporosis?

1. a 40 y.o. Obese female Chinese
2. a 48 y.o. European on early menopausal period
3. a 56 y.o. Filipino who is a Chronic smoker
4. A 65 y.o. Spanish Librarian

Ø The risk factors for osteoporosis are:

· Cigarette smoking

· Early menopause

· Excessive use of alcohol

· Family history

· Female gender

· Increasing age

· Insufficient calcium intake

· Sedentary lifestyle

· Thin, small frame (<128lbs)

· White (European) or Asian race

p. 1011 Saunders 3^rd edition, 2005

p. 598 Joyce Black 7^th edition, 2005

7. A 50 y.o. female Japanese on menopausal period was admitted 3 days ago with Osteoporosis. The nurse expects the patient to receive the following drugs except:

1. PTH
2. Alendronate
3. Raloxifene
4. Calcium gluconate

Ø Medications approved by FDA to prevent and treat osteoporosis include Hormone replacement therapy, Alendronate, Raloxifene, Risendronate, Calcitonin, and teriparatide. Parathyroid Hormone has recently been approved for treatment of Osteoporsis for post menopausal women.

p. 603 Joyce Black 7^th edition, 2005

8. Upon endorsement, the nurse received a patient with Paget’s disease. The nurse went to the patient’s room to assess him. What would the nurse find out?

1. barrel chest, muscular dystrophy
2. Waddling gait, scoliosis, myalgia
3. Barrel chest, waddling gait, kyphosis
4. Waddling gait, kyphosis, myalgia

Ø Signs of Paget’s are: deepa, aching bone pain, skeletal deformity such as barrel-shaped chest, bowing of tibia or femur, kyphosis, changes in skin temp, pathologic fractures and nerve compression.

p. 606 Joyce Black 7^th edition, 2005

9. The patient is to receive Alendronate to treat Paget’s. The nurse knows that the client understands the use of this drug when the client states:

1. I will read my newspaper 30 minutes after taking the drug.
2. I should drink it before sleeping with full glass of water.
3. I should crush the drug first.
4. I should take the drug before rising in the morning.

Ø Clients should not eat/drink anything for 30minutes following administration and should not lie down after taking the med. It should be taken after rising in the morning and not before bed time or before arising. It should never be crushed and should be takien with full glass water to avoid esophageal irritation.

p.1030 Saunders 3^rd edition, 2005

MIMS 2007

10. The nurse is caring for a patient with rheumatoid arthritis. Which of the following management is incorrect?

1. Administer ASA as ordered.
2. Instruct client to sit in a chair with high, straight back.
3. Encourage weight-bearing exercises.
4. Apply paraffin baths and massage as prescribed.

Ø A, B, and D are correct management for Rheumatoid Arthritis. Weight bearing should be avoided especially in inflamed joints.

p. 1016

PEDIA

1. A couple brought their 5 month old baby to the ER, pulseless, no respirations, and cyanotic. Which statement made by the mother tells the nurse that the infant may have died of SIDS?

a. My baby sleeps in the crib.

b. I am breast feeding my baby.

c. We use room heater in our baby’s room.

d. I placed him facing towards the ceiling.

Ø The baby may have died due to thermal stress. Avoid overheating during sleep. Bed- sharing is avoided so the child may sleep in the crib. Pillow, quilts and soft bedding should not be used for bedding. Breastfeeding, is encouraged. Supine position is also encouraged.

p. 405 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

2. A 7 y.o. have a younger sister who was admitted to the hospital. During the nursing rounds, the boy offered to help the nurse in assisting her sister to ambulate. What should the nurse do?

a. Ask the boy that her sister needs to ambulate by herself.

b. Allow the boy to participate in the procedure.

c. Tell the boy that his sister will not recover well if he will help.

d. Let the boy observe what you will do.

Ø School age children are eager to develop skills and participate in meaningful and socially useful work. Letter B improves the boy’s Industry stage.

p. 499 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

3. The nurse was assigned to a 10 y.o. pt who is 2 days post-appendectomy. What is the best diversional activity for this patient?

a. let her play chess

b. let her play video games

c. call her friends to visit

d. let her organize her stamp collection

Ø Although the play of school age children is highly active, they also enjoy many quiet and solitary activities. The middle years are the time for collections, which constitutes another ritual.

p. 504 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

4. The nurse is preparing to admit a 6 month old infant with myelomeningocele. What would be the nursing consideration prior to admission?

a. Reserve a negative-pressure room in the pediatric unit.

b. Remove all latex objects in the room.

c. Provide a dimly lit and quiet room.

d. Get a room near the nurse station.

Ø Children who have SB are prone to develop allergy to latex. Avoiding latex products is the most important intervention.

p. 1258 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

5. A nurse is caring for a mother who had just given birth to a LGA baby boy. She is giving instructions on cord care for the neonate. Which of the following would alert the nurse the most?

a. A large umbilical base at 2 days

b. A gangrenous cord at 7 days

c. A dull, yellowish brown cord at 3 days.

d. A greenish black cord still attached at 7 days.

Ø At birth, cord appears bluish white and moist. After clamping, it begns to dry and appears dull, yellowish brown. It progressively shrivels in size and turns greenish black. The stump deteriorates through the process of dry gangrene. An enlarged umbilical base may indicate hematoma, omphalocele, or gastroschisis.

p. 211, 225 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

6. A newborn with Gastroschisis was brought in to NICU. The nurse prepares the neonate for the operation. She should the do the following except:

a. Set up an overhead warming unit.

b. Prepare NGT insertion.

c. Put the neonate on NPO.

d. Wrap a moist, saline-soaked pads at the exposed bowel.

Ø The exposed bowel is covered loosely in saline-soaked pads. Wrapping around the exposed bowel is contraindicated because if the exposed bowel expands, wrapping could cause pressure and necrosis.

p. 454 Saunders 3^rd edition, 2005

p. 920 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

7. A 2y.o. child with Cystic fibrosis was admitted to the pediatric floor 2 days ago. The child frequently cries and the parents cannot stop her. For this day, the goal of the nurse is to promote the psychosocial development of the child. What should the nurse do?

a. Allow the child to explore the surroundings.

b. Have the child join other children in the playpen.

c. Place the child in the playpen with favorite toys.

d. Bring the child to another room to play with another child.

Ø Pulmonary complications are present in almost all children with CF and constitute the most serious threat to life. A and D is avoided to prevent acquiring nosocomial infection. The play therapy for toddlers is parallel-play, the toddler plays alongside; not with other children. Letter C is the correct answer. Transitional objects, such as favorite toys, provide security for children especially when they are separated from parents, dealing with new stress or just fatigued. It should be provide to avoid feelings of fears and loneliness.

p. 418, 863 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

8. The nurse is preparing her care plan for a child with cystic fibrosis. Which of the following interventions is correct?

a. Give antitussives as ordered for cough.

b. Maintain negative pressure in the room.

c. Encourage a high calorie, high protein diet.

d. Discourage breast feeding.

Ø Children with CF require a well-balanced, high calorie, high protein diet. In fact, they often require up to 150% of the recommended daily allowances to meet their needs for growth. Negative pressure rooms are only for communicable diseases to those who communicable diseases that requires isolation. Breastfeeding is encouraged to those who prefer it. Cough suppressants are discouraged for they will inhibit expectoration of secretions and promote infection.

p. 866 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

p. 428 Saunders 3^rd edition, 2005

9. A 7 month old child with bronchiolitis is on an oxygen tent when the nurse did her rounds. Which among the following observations made by the nurse indicates the need for further teaching?

a. A superman action figure inside the tent.

b. A cotton blanket covers the mattress.

c. The tent wrapped around the bed edges securely.

d. The child sucks a pacifier.

Ø Keep the child warm and dry by checking the temperature inside the tent and the child’s bedding and clothing frequently. Vinyl or plastic toys are allowed. Items that absorb moisture and are difficult to dry should not be placed inside the tent. The tent should be tucked in snugly around the bed.

p. 802 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

10. The nurse was assigned to a 5 month old infant with bronchiolitis. Before visiting the patient, what should the nurse put-on?

a. Gloves

b. Gown and mask

c. Gown, gloves and mask

d. Mask

Ø The routine use of gown and masks has not been shown of additional benefit to control infection for RSV patients. The most important is handwashing and not touching the nasal mucosa or conjunctivae. Contact precautions.

p. 843 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

11. A nurse is caring for a newly diagnosed infant with RSV. Her initial goal is to prevent infection from spreading in her unit and observe the activity of other people handling the patient. When will the nurse intervene?

a. The laboratory technician wears N95 mask.

b. The CAN uses gloves when taking VS.

c. The UAP wears gown when cleaning the secretions.

d. The parents alcoholizes every now and then.

Ø Prevention of RSV/Bronchiolitis is by Contact precautions. Handwashing and gloving is enough for infection control. Gowns can be worn during close contact when secretions can contaminate clothing.

p.843 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

12. The nurse did her morning rounds. Upon entering the room, the mother of a 5 month child with RSV called for the nurse to assess her baby who seems to be in distress. Which of the following assessments indicates that the disease is severe?

a. Wheezing

b. Respiration of 40/min

c. Fever

d. Diminished breath sound

Ø Wheezing and fever are initial signs of RSV. Tachypnea occurs as the disease progresses. Diminished breath sounds indicate poor air exchange and is indicative of severe complication of this disease.

13. A 6 month old child came to OPD for the third dose of Hepa B Vaccine. Considering the developmental milestone of the child, the nurse encourages that the following be done after injection. Which is the best?

a. The nurse massages the IM site.

b. The mother gives the child her favorite toy.

c. The nurse brings the child in the play pen alone.

d. The mother cuddles the child after injection.

Ø Although massaging may help, this stage (6-8 mos.) is the height of separation anxiety and fear of strangers. Transitional objects, such as favorite toys can decrease anxiety for toddlers and not effective for infants. Play therapy for infants is solitary play, but this doesn’t mean they should play alone, they need to be with. Cuddling provides cutaneous stimulation and relaxation, both of which are effective non-pharmacologic interventions.

p. 340-341, 698 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

p. 1293 Saunders 3^rd edition, 2005

14. The nurse is planning her discharge teaching for a teenage mom who has a baby rushed-in to ER 3 days ago due to fall. The correct teaching about child safety is:

a. Placing the child on the front seat rear-facing beside the mother

b. Placing the crib in the lowest position.

c. Adjust water heater to 130^oF

d. Place the child securely on walker

Ø Infants should be placed on rear seats of cars rear-facing. Front seats may be equipped with an airbag and the child could be seriously injured. The safe temperature to set water heater is up to 49^oF(120^oC). Wlakers are responsible for a number of different types of injuries including tripping and falling from the stairs.

p. 374-376 Wong’s Essentials of Pediatric Nursing, 6^th edition 2001

15. A 3 month old pediatric patient with Percutaneous endoscopic gastrosomy was placed under the care of the nurse in the Digestive Care Unit. The nurse is about to administer feeding through the tube. What is the nursing consideration before doing this?

1. Measure the tube to be inserted while feeding
2. Apply consistent pressure in the syringe while feeding
3. Maintain the syringe at the level of the patient’s abdomen
4. Check that formula is at room temperature.

Ø Infusate/formula should be at room temperature for neonates and infants unless otherwise ordered. Chilled fluids may reduce core body temperatures. The tube can be inserted into the ostomy 10 to 15cm. It is measured before feeding and not during feeding. The method of feeding for PEG is by gravity, applying pressure to the syringe should not be done. The syringe should be maintained 10-12 cm above the abdominal wall and not at the level of the abdomen of the patient.

UTMB NURSING PRACTICE STANDARDS,2001

p. 1055 Fundamentals of Nsg, kozier, 5^th edition 2002

HERBAL MEDS

1. A 49y.o. woman is taking supplemental Black Cohosh. The nurse knows that this herbal drug is indicated for the following except:

a. Menopausal symptoms

b. Premenstrual Syndrome

c. Painful Menstruation

d. Irregular Menstruation

p. 1685 Lippincot’s Manual of Nursing Practice 7^th edition, 2001

2. A patient on Sudafed was assigned to the nurse. When will the nurse intervene?

a. Patient taking Valerian

b. Patient taking Kava-kava

c. Patient taking Ma huang

d. Patient taking Saw Palmetto

Ø Law of incest. Upper + upper = Cardiac dysrhythmias.

p.1685 Lippincot’s Manual of Nursing Practice 7^th edition, 2001

3. A patient with insomnia is taking Valerian. The nurse will watch out for the possible side-effect of this drug which is?

a. Hepatotoxic

b. Nephrotoxic

c. Ototoxic

d. Cardiotoxic

p.1685 Lippincot’s Manual of Nursing Practice 7^th edition, 2001

4. A patient with Moderate anxiety is taking Kava-Kava. The nurse takes the client history of medications. When will the nurse intervene?

a. Patient is taking valium

b. Patient is taking MAOI

c. Patient is taking Prozac

d. Patient is taking Ma Huang

Ø Law of Incest. Downer + Downer = Respiratory Depression

p. 1658 Lippincot’s Manual of Nursing Practice 7^th edition, 2001

5. The nurse is preparing a discharge plan for a patient taking Echinacea. Which of the following is incorrect?

a. It is immune- stimulant

b. It may cause allergic reactions

c. Take it for 12 weeks

d. Use it for colds and URTI

Ø Maximum of 6-8 weeks

p. 1658 Lippincot’s Manual of Nursing Practice 7^th edition, 2001