203 D final

Question 1

Your assessing your patient and you note he has clinical manifestations of acromegaly what are they?

Answer 1

Deep voice, big tongue, large forehead, and coarse facial hair.

Question 2

Patient is scheduled for transphenoidal pituitary adenoma pre op teaching will include?

Answer 2

No coughing or sneezing, no straws, report fluid drainage, do not brush teeth for a few days after surgery due to possibility of going through the nose.

Question 3

You have a patient with fluids volume excess related to SIADH.

Answer 3

Maintain fluids restriction as ordered.

Question 4

Following a pituitary tumor removal you suspect the patient could develop DI when you discover that they have?

Answer 4

Specific gravity of 1.003.

Question 5

Patient with a known DI and is on nasal desmopressin the nurse recognizes that the drug is not having an adequate therapeutic effect when the patient experiences?

Answer 5

Low Specific gravity of 1.002

Question 6

An adult has hypoparathyroidism for 20 years the patient has come to the center for a check- up the nurse should assess the patient for?

Answer 6

Tetany

Question 7

In teaching the patient with hypo parathyroid about the disorder the nurse explains the blood calcium levels are altered because the role of the parathyroid hormone is to?

Answer 7

Stimulate bone reabsorption of calcium and increase the calcium in the body when blood calcium levels fall.

Question 8

Muscular twitching and hyperirritability of the nerves indicates tetany the nurse can test for this complication by?

Answer 8

Tapping the facial nerve just proximal to the ear

Question 9

In the pathophysiology of antidiuretic hormone problems indicate what assessment findings are SIADH?

Answer 9

Serum osmolality will be low,
urine output will be low,
and urine specific gravity will be high.

Question 10

The nurse is assessing a 34 year old female who says she has a problem with constipation, cold all the time, always tired and can’t get anything done in addition she says her hair is falling out which of the following disorders does she have?

Answer 10

Hypothyroidism

Question 11

The nurse teaches the client to monitor signs and symptoms for which potential complication after they have their parathyroid removed?

Answer 11

Hypocalcemia.
Works for bone resorption and on the kidneys to stimulate the resorption of calcium in the presence of vitamin D and in GI tract to bring back calcium.

Question 12

Which medication would the nurse question in the patient diagnosis of untreated hypothyroidism?

Answer 12

Sedatives, already tired and slow may not wake up if you give them sedatives

Question 13

You patient has been experiencing symptoms suggestive of hyperthyroidism which might include?

Answer 13

Tachycardia, heat intolerance, nervousness

Question 14

Your patient has a hyper-functioning thyroid which results in exophthalmos (buggy eyes). Nursing interventions should include which of the following?

Answer 14

Lubricating eye drops and instructing patient to blink often.

Question 15

You have a patient who is 72 years old and diagnosed with hypothyroidism and they are on synthroid which assessment is most important to continue to make during the initiation of the thyroid replacement?

Answer 15

Pulse rate and blood pressure, because we are basically giving them a stimulant that they have not had. They get tachycardic and hypertensive.

Question 16

If I have a patient that has DI the secretion of ADH is?

Answer 16

Low ADH secretion,
urine output high, serum osmolality is high,
specific gravity is low.

Question 17

Which of the following early manifestations are associated with hypopituitarism?

Answer 17

Headache, visual changes, loss of smell, N/V, seizures.

Question 18

Your caring for a patient in the recovery room looking for complications after they had a parathyroidectomy?

Answer 18

Vocal cord paralysis (laryngeal nerve damage), SIADH and DI, increased urine output greater than 100 ml/hr, hypocalcemia, hematoma at surgical site.

Question 19

SATA: A patient with hyperthyroidism could having a life threatening complication known as a thyroid storm what signs and symptoms might be seen for this diagnosis?

Answer 19

Agitation,
delirium with psychosis,
severe tachycardia and a temperature.

Question 20

Patient that you are caring for has a Cushing’s syndrome and you are trying to explain to them about het dexamethasone suppression test that will be performed tomorrow what do you explain?

Answer 20

Administration of dexamethasone orally at 11pm and plasma cortisol level drawn at 8 am the next day.

Question 21

A patient who is suspected of having a phenochromocytoma complains of sweating, palpitations, and headache which assessment is essential for the nurse to take first?

Answer 21

Check the blood pressure.

Question 22

Which of the following applies to the patient with a phenochromocytoma?

Answer 22

Related to catecholamine

Question 23

Prior to discharge the physician prescribes hydrocortisone 10mg TID and Florinef 0.1 QD nursing education should focus on to consult the physician if they experience this side effect of glucocorticoid and florinef?

Answer 23

Rapid Weight gain and dependent edema

Question 24

Clinical manifestations of Addison’s disease include?

Answer 24

Anorexia, weight loss, hyperkalemia, hyperpigmentation, decreased resistance to stress.

Question 25

While caring for patient during an Addison’s crisis a priority goal of treatment would be?

Answer 25

Prevent shock

Question 26

Which of the following signs and symptoms would indicate that a patient with Addison’s disease is receiving too much corticoid replacement?

Answer 26

moon face

Question 27

The nurse is admitting a patient with SIADH which clinical manifestation would be reported to the MD?

Answer 27

A serum sodium of 112 and a headache

Question 28

The patient admitted with a history of vomiting for the past two days and unable to take their glucocorticoids the nurse should anticipate that?

Answer 28

The patient may develop adrenal insufficiency

Question 29

Teaching about corticosteroid therapy would include which of the following?

Answer 29

Don’t stop the medication, but taper off the medication as prescribed.

Question 30

To measure the effectiveness of steroid therapy the serum cortisol level should be measured at?

Answer 30

8 am and 4pm

Question 31

A nursing assessment of a patient with Cushing’s syndrome reveals that the patient has trunk obesity then arms and legs an additional finding the nurse should expect would be?

Answer 31

Purplish red striae of the abdomen.

Question 32

A patient has developed Iatrogenic Cushing’s disease that what is the rationale for this problem?

Answer 32

Secondary to steroid, too much cortisol.

Question 33

Which type of food should the nurse advise the patient with hyper cortisol levels to avoid?

Answer 33

Caffeine

Question 34

The patient ordered an IV hydrocortisone infusion to be started prior to the patient that is ending up with a bilateral adrenalectomy the nurse understands that the rational for this is?

Answer 34

Compensate for the sudden lack of hormones following surgery

Question 35

Following bilateral adrenalectomy the highest priority assessment is?

Answer 35

Vital signs

Question 36

You patient return from surgery after a bilateral adrenalectomy you notice the patient is sleepy, but easy to arouse. You notice an IV with hydrocortisone is still running at this time the nurse planning care for this patient knows it is essential to include which of the following nursing interventions?

Answer 36

monitor blood glucose levels to watch for the development for hyper and hypo glycemia.

Question 37

Your patient is ready to discharge following a bilateral adrenalectomy the nurse determines that the patient understand the discharge instructions when they state?

Answer 37

I should wear a medical alert bracelet or necklace at all times.

Question 38

After receiving a change of shift report on the following patients which patient should the RN see first?

Answer 38

70 year old who recently started taking synthroid who has an irregular pulse of 130.

Question 39

Comatose patient is experiencing flexion of that arms wrist and fingers with abduction of the upper extremities this condition is assessed as?

Answer 39

Decorticate

Question 40

When the nurse is able to observe that patients tongue is midline this could be interpreted as?

Answer 40

Cranial nerve 12 –hypoglossal

Question 41

A patient who has a moderate contusion in a motor vehicle accident a day ago based on current Glasgow coma scale a score of 7 the nurse would include which of the following interventions in the care plan?

Answer 41

Decrease noxious stimuli, monitoring the vital signs, neurological status carefully, elevate HOB to 45 and position patient with good head and body alignment.

Question 42

When the physician obtains a specimen of spinal fluid via lumbar puncture it is important for the nurse to?

Answer 42

Number all the specimens drawn.

Question 43

When assessing a patient with a head injury the nurse notes that an early/ first signs of increase ICP is?

Answer 43

Change of LOC a little agitated or confused.

Question 44

A nurse identifies a nursing diagnosis for ineffective breathing airway related to loss of cranial nervous system function for a patient who has post traumatic brain swelling based on what finding?

Answer 44

Loss of cough and gag reflex

Question 45

The most significant observation to report when monitoring a patient with increased ICP is?

Answer 45

Decreased pulse, widening pulse pressure, and Cheyne stokes respirations ( Cushing’s triad)

Question 46

The nursing care plan includes elevating the head of the bed, positioning the patients head in straight alignment in order to reduce increased ICP the nurse recognizes that these actions are effective because they act by?

Answer 46

Promoting venous drainage/ return

Question 47

Your patient requires the insertion of an ICP monitor nursing responsibilities include?

Answer 47

Intervening when ICP pressure in greater than 18.

Question 48

After your patients craniotomy you patients family asks why a bone flap is necessary?

Answer 48

Accommodate post-operative brain swelling.

Question 49

The charge nurse observes an in-experienced staff nurse caring for a patient following a craniotomy for brain tumor which action by the in-experienced nurse requires the charge nurse to intervene?

Answer 49

Staff nurse suctions the patient every hour

Question 50

The patient suffered a sub arachnoid hemorrhage and complains of pain when moving his head the nursing diagnosis of pain would be related to?

Answer 50

Blood causing irritation to the meninges.

Question 51

A patient with a head injury opens his eyes to verbal stimuli, curses when stimulated, and does not respond to verbal command to move, but attempts to remove to painful stimuli the Glasgow coma scale is?

Answer 51

11

Question 52

During the assessment of a patient with a tumor of the left frontal lobe the nurse would expect to find?

Answer 52

Personality changes and judgement

Question 53

Which of the following types of brain tumors is most malignant?

Answer 53

Gliomultiforme

Question 54

Anti-convulsants medications must be taken in adequate amounts and on a regular schedule the method most commonly used to measure compliance and toxicity is?

Answer 54

Blood test for levels

Question 55

Flashing lights, spots in front of your eyes, numbness and tingling of the arms are all examples of?

Answer 55

Aura experience

Question 56

While discussing plans for the child’s discharge the nurse teaches the parents to take what actions when the child has a seizure, the nurse determines the teaching as effective when the father states?

Answer 56

Stay with her during the seizure and after it is over

Question 57

The nurse aide is attempting to put an oral airway into the mouth of a patient who is having a tonic-clonic seizure the nurse should take what action?

Answer 57

Tell the aide to stop trying to insert anything into the mouth

Question 58

In caring for a patient with epilepsy who is hospitalized and successfully treated for status epilepsy a precaution the nurse should include is?

Answer 58

Placing oxygen suction equipment at the beside

Question 59

A patient admitted after MVA with an open fracture of the femur in the OR she has a 60 minute period of hypotension. Post op labs BUN: 25 and creatinine of 1.2 additionally she was placed on a high dose of vancomycin in the recovery room. Today’s labs show a creatinine of 5.2 and a BUN 55 and no urine output what type of renal failure is this?

Answer 59

Intra-renal

Question 60

The patient scheduled for MRI because of a back injury which questions is essential for the nurse to ask?

Answer 60

Do you have metal in your body

Question 61

When developing a teaching plan for a patient scheduled for a spinal fusion which of the following should the nurse discuss with the patient?

Answer 61

The patient typically experiences more pain at the donor site then the fusion site.

Question 62

When the patient neck is flexed, flexion of the knees and hips is elicited. This is known as a?

Answer 62

Positive Brudzinski’s sign

Question 63

When assessing a patient with bacterial meningitis, which of the following should be immediately reported to the healthcare provider?

Answer 63

Blood pressure is 80/42

Question 64

Your patient is 24 presents to the emergency room with what is described as an exploding headache, photophobia and nausea these are classic signs and symptoms of?

Answer 64

Subarachnoid hemorrhage

Question 65

When placing a meal tray in front a patient who has sensory and perceptual problems of the right visual field during the rehabilitation phase the nurse should?

Answer 65

Stay with the patient and periodically draw her attention to the food on the right side of the tray.

Question 66

Stroke patient has received heparin intravenously for the past two days upon chart review the therapeutic level for heparin is 2 x the baseline PTT, today the PTT is less than 1.5 times his baseline PTT what is the appropriate action of the nurse?

Answer 66

Continue the heparin and notify the physician

Question 67

During your initial assessment you document a negative trousseau’s sign choose an answer that would indicate a negative signs?

Answer 67

When you inflate the BP cuff and occlude arterial, no carpel tunnel spasms

Question 68

A patient with a history of polycystic kidney disease has been admitted to the medical surgical unit following a post op knee surgery, which of the routine post-op orders is most important for the nurse to discuss with the physician?

Answer 68

Give Lovenox 60 mg Q 6 hours daily

Question 69

Which of the following is most important consideration when provided nursing care to a possible cervical spine injury?

Answer 69

Immobilize the head and spine keeping them in alignment

Question 70

You patient experiences a stab wound to S2-S4 region, this resulted in a lower motor neuron lesion he probably will experience?

Answer 70

Flaccid bladder

Question 71

1. Your patient is 22 and re-admitted to the rehabilitation unit after a T4-incomplete spinal cord injury that occurred 6 months ago which technique displayed by your patient displays good technique regarding urinary care?

Answer 71

Checking for bladder distention frequently

Question 72

During the routine assessment the nurse auscultates the adolescent’s abdomen the nurse explains to the parents that this is necessary because patients with spinal cord injuries often develop?

Answer 72

Paralytic ileus.

Question 73

A patient with a T 2 spinal cord fracture beginning intensive rehabilitation one morning as the nurse prepares to assist her patient from bed to the wheelchair the patient tells the nurse that she does not feel like getting up and that she had a throbbing headache and she is slightly nauseated it is more important that the nurse?

Answer 73

Check the BP

Question 74

The nurse notes that the patients urinary appliance has pale yellow urine with large amounts of mucous how would the nurse best interpret this data?

Answer 74

The findings are normal for a patient with an ileal conduit.

Question 75

A positive Chovstek’s and trousseau’s sign is indication of?

Answer 75

Hypocalcemia

Question 76

Major complication for a patient with neurogenic bladder is?

Answer 76

Infection

Question 77

1. In a home setting how can a patient who has a neurogenic bladder evaluate the effectiveness of the Valsalva maneuver for emptying the balder?

Answer 77

Catheter for post-void residual

Question 78

SATA: When you are assessing your patient’s hemodialysis access site during your morning assessment, which findings would be complications of your graft site?

Answer 78

Local bleeding at the site, thrombus yellow-greenish fluid at the site.

Question 79

A patient with impaired renal function has secondary hypertension the nurse understands that one of the causes of hypertension results from?

Answer 79

Increased RAAS production

Question 80

During assessment of the patient with a disorder of urinary system the nurse identifies a potential nephrotoxic agent when the patient reports the frequent use of?

Answer 80

NSAIDS

Question 81

Patient with a history of renal calculi and hospitalized with gross hematuria and severe colicky flank pain which radiates to his testicles the physician scheduled IV push dilaudid, straining all urine, encourage fluids too 500cc a day, the nurse gives the highest priority to the nursing diagnosis of?

Answer 81

Pain

Question 82

A patient urinalysis indicates a large amounts of protein in the urine the nurse recognizes that this finding most likely indicates damage to the?

Answer 82

Glomerulus

Question 83

A patient with renal disease is schedule for a creatinine clearance test the in preparing for the test the nurse?

Answer 83

Obtains samples and instructs patient on a 24 hour urine collection

Question 84

During a 24 hour urine collection one voided specimen is inadvertently discarded the nurse should?

Answer 84

Start over

Question 85

Pre- renal causes of acute renal failure include?

Answer 85

Hypotension, hypovolemia, cardiac pump failure

Question 86

When taking a history of a patient diagnosed with acute glomerulonephritis the nurse notes the potential cause is when the patient states?

Answer 86

I had a throat infection with a group A streptococcal

Question 87

Which of the following is an oliguric phase of acute renal failure and the nurse care plan should include?

Answer 87

Control of fluids

Question 88

A patient who lives alone with nausea and vomiting for 5 days today the neighbor finds him weak and feverish. Presents to the ER with BP 78/50, urine output 50 ml after straight cath, BUN 72, and creatinine 1.6. This is considered acute renal failure based on what you know the cause of the renal failure is dehydration so it is?

Answer 88

pre-renal

Question 89

In preparation for hemodialysis a patient with an AV fistula in the left arm you are going to post operatively assess for?

Answer 89

Auscultate the fistula for the bruit

Question 90

When teaching a patient about home peritoneal dialysis the nurse should explain that the primary concept of the prevention of peritonitis is to?

Answer 90

Maintain aseptic techniques

Question 91

A spouse of the patient with chronic renal failure confides to the nurse that the patient has been confused, irritable, paranoid, and that as a results the spouse is thinking about divorce based on this information the nurse would most like make which of the following nursing diagnosis?

Answer 91

Altered family process related to effect of chronic renal failure

Question 92

Post- operative management of renal transplant patients includes?

Answer 92

Aspetic technique to avoid infection, isolation room when immunosuppression (highest), hourly output of urine to monitor kidney function. *All the above is the answer*