NUR205

Question 1

The student nurses are studying for a test on
diabetes mellitus. What should the students know is a complication of diabetes
termed “macrovascular”?

a. Nephropathy Incorrect
b. Renal failure
c. Stroke
d. Retinopathy
e. Liver failure

Answer 1

c. Stroke

Question 2

A patient is prescribed corticosteroid therapy.
What would be important information for the nurse to give the patient who is
prescribed corticosteroid therapy?
a. The patient’s diet should be low protein with
ample fat.
b. There will be no change in appearance.
c. The patient is at increased falls risk
d. The patient is at a decreased risk of developing
thrombophlebitis and thromboembolism.
e. The patient is at an increased risk of
developing infection. Correct

Answer 2

e. The patient is at an increased risk of

developing infection.

Question 3

The diabetic Nurse Educator is teaching a class
for newly diagnosed diabetics and their families. In this class the Nurse
Educator is teaching about “sick day rules.” What guideline applies to periods
of illness (“sick day rules”) in a diabetic patient?

Select one:
a. Report elevated glucose levels greater than 7 mmol/L
b. Do not eliminate insulin when nauseated and
vomiting.
c. If nauseated, do not eat solid foods.
d. Eat three meals a day.
e. Eat small regular meals

Answer 3

b. Do not eliminate insulin when nauseated and

vomiting.

Question 4

The PACU (theatre recovery) staff has brought a patient to the unit
following a thyroidectomy. To promote
comfort for this patient how would you position the patient?

Select one:
a. Side-lying (lateral) with one pillow under the
head
b. Side-lying (lateral) with no pillow under the head
c. Head of the bed elevated 30 degrees and no
pillows placed under the head Incorrect
d. Semi-Fowler’s with the head supported on one or two
pillows
e. Flat, with a small roll supporting the neck

Answer 4

d. Semi-Fowler’s with the head supported on one or two

pillows

Question 5

You are conducting a class on how to self-manage insulin
regimens. A patient asks you how long a vial of insulin can be stored at room
temperature before it “goes bad.” What would be your best answer?

Select one:
a. It can only be taken out of the fridge when you are drawing it up
b. If a vial of insulin will be used up within 21
days, it may be kept at room temperature.
c. If you are going to use up the vial within 1
month it can be kept at room temperature.
d. If a vial of insulin will be used up within 2
weeks, it may be kept at room temperature.
e. If a vial of insulin will be used up within 1
week, it may be kept at room temperature.

Answer 5

c. If you are going to use up the vial within 1

month it can be kept at room temperature.

Question 6

A patient has returned to the floor after having
a thyroidectomy for thyroid cancer. The nurse knows that sometimes during
thyroid surgery the parathyroid glands can be injured or removed. What
laboratory finding may be an early indication of parathyroid gland injury or
removal?

Select one:

a. Hyponatraemia
b. Hypocalcaemia
c. Hypophosphataemia
d. Hypokalaemia
e. Hyperkalaemia

Answer 6

b. Hypocalcaemia

Question 7

While assisting with the surgical removal of an
adrenal tumour the operating room nurse is aware that the patient’s vital signs
may change upon manipulation of the tumour. What vital sign changes would the
nurse expect to see?

Select one:

a. Hypotension and hypothermia
b. Hyperthermia and tachypnoea
c. Hyperthermia and bradycardia
d. Hypertension and heart rate changes
e. Hyperthermia and bradycardia

Answer 7

d. Hypertension and heart rate changes

Question 8

A patient has returned to the unit after having
a parathyroidectomy. What drug does the nurse ensure is immediately available?

Select one:

a. Calcium alginate
b. Digitalis
c. Ergocalciferol Incorrect
d. Amphojel
e. Calcium gluconate

Answer 8

e. Calcium gluconate

Question 9

You are caring for a patient with advanced
cirrhosis. You know that the most significant source of bleeding in a patient
with cirrhosis is what?

Select one:

a. Oesophageal varices
b. Portal hypertension
c. Common bile duct haemorrhage
d. Ascites
e. Haemolytic jaundice

Answer 9

a. Oesophageal varices

Question 10

A patient with a liver mass is undergoing a percutaneous
liver biopsy. After the procedure the nurse assists the physician in
positioning the patient. What position should they position the patient in?

Select one:
a. On the left side with a pillow under the knees
b. Supine position
c. Reverse Trendelenberg
d. Trendelenberg
e. On the right side with a pillow under the costal
margin

Answer 10

e. On the right side with a pillow under the costal

margin

Question 11

The critical care nurse is caring for a patient
with cirrhosis. What is an essential nursing function when caring for a patient
with cirrhosis?

Select one:

a. Monitoring the patient for signs of hypervolemia
b. Monitoring the patient’s oral intake
c. Monitoring the patient’s support network
d. Monitoring the patient’s mental status
e. Monitoring for constipation

Answer 11

d. Monitoring the patient’s mental status

Question 12

A nurse is assessing an elderly patient with
gallstones. The nurse is aware that the patient may not exhibit typical
symptoms and that symptoms that may be exhibited in the elderly patient may
include what?

Select one:

a. Chills and jaundice
b. Spontaneous haemorrhage
c. Nausea and vomiting
d. Septic shock and oliguria
e. Fever and pain

Answer 12

d. Septic shock and oliguria

Question 13

The nurse is caring for a patient with liver failure. The
nurse understands that patients in liver failure often require vitamin therapy.
Which vitamin does the liver require for the synthesis of prothrombin?

Select one:

a. Vitamin B12
b. Vitamin A
c. Vitamin K
d. Vitamin B6
e. Vitamin D

Answer 13

c. Vitamin K

Question 14

You are caring for a patient admitted with a diagnosis of renal failure. When you
review your patient’s laboratory reports, you note that the patient’s magnesium
levels are high. What would be important for you to assess?

Select one:

a. Cool, Clammy skin
b. Visual acuity
c. Diminished Deep tendon reflexes
d. Increased Serum magnesium
e. Tachycardia

Answer 14

c. Diminished Deep tendon reflexes

Question 15

You are working on a burn unit. One of your patients is exhibiting signs and
symptoms of third spacing, which occurs when fluid moves out of the intravascular
space but not into the intracellular space. Based upon this fluid shift, what
would you expect the patient to demonstrate?

Select one:

a. Hypervolaemia
b. Hypertension
c. Decreased oxygen saturations
d. Bradycardia
e. Hypovalaemia

Answer 15

e. Hypovalaemia

Question 16

A patient with anxiety presents to the emergency room. The triage nurse notes
upon assessment that the patient is hyperventilating. The triage nurse is aware
that hyperventilation is the most common cause of which acid-base imbalance?

Select one:
a. Respiratory
acidosis
b. Increased
PaCO2
c. None of the above
d. Respiratory alkalosis 
e. CNS
disturbances

Answer 16

d. Respiratory alkalosis

Question 17

<p>You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: PH 7.26, PaCO2 28, HCO3 11 mmol/L. How would you interpret these results? Select one: a. Respiratory acidosis with no compensation b. Respiratory alkalosis c. Metabolic acidosis with no compensation d. Metabolic acidosis with a compensatory respiratory alkalosis e. Metabolic alkalosis with a compensatory alkalosis</p>

Answer 17

<p>d. Metabolic acidosis with a compensatory respiratory alkalosis</p>

<p>metabolic alkalosis because pH is low so is HCO3 low</p>

<p>respitory compensation becauseCO2 is low</p>

Question 18

A nurse in the medical ICU has orders to infuse a hypertonic solution into her
patient with low blood pressure. This solution will increase the number of
dissolved particles in the patient’s blood, creating pressure for fluids in the
tissues to shift into the capillaries and increase the blood volume. Which term
or terms is/are associated with this process?

Select one:
a. Rhubarb
b. Hydrostatic
pressure
c. Active
transport
d. Diffusion
e. Osmosis
and osmolality Correct

Answer 18

e. Osmosis

and osmolality Correct

Question 19

The nursing instructor is discussing renal failure with her senior nursing class.
The instructor states, “A patient in renal failure partially loses the ability
to regulate changes in pH.” What is the cause of this partial inability?

Select one:
a. The
kidneys buffer acids through electrolyte changes.
b. The kidneys produce carbonic acid to act in the buffering process
c. The
kidneys regulate and reabsorb carbonic acid to change and maintain pH.
d. The
kidneys combine carbonic acid and bicarbonate to maintain a stable pH.
e. The
kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.

Answer 19

e. The

kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.

Question 20

While admitting a new patient to your medical-surgical unit, you note that the
patient is oliguric. You notify the medical officer who orders a
fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes.
What do you know this intervention will do?

Select one:

a. Help provide an effective treatment for hypertension induced oliguria
b. Help distinguish reduced renal blood flow from decreased renal function
c. Very little
d. Help evaluate pituitary gland function
e. Help distinguish hyponatraemia from hypernatraemia

Answer 20

b. Help distinguish reduced renal blood flow from decreased renal function

Question 21

A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for?

Select one:

a. Lack of blood pressure control Incorrect
b. Polyuria
c. Depletion of calcium
d. Retention of potassium
e. Accumulation of wastes

Answer 21

d. Retention of potassium

Question 22

What function does the kidney perform to assist
in maintaining acid–base balance within the necessary normal range?

Select one:

a. Return acid to the body’s circulation
b. Excrete acid in the lungs
c. Excrete bicarbonate in the urine
d. Excrete alkali from the body’s circulation
e. Return bicarbonate to the body’s circulation

Answer 22

e. Return bicarbonate to the body’s circulation

Question 23

The nurse is caring for a patient receiving haemodialysis treatments. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient?

Select one:
a. The patient shouldn’t feel pain during
initiation of dialysis
b. Using a stethoscope for auscultating the fistula is contraindicated.
c. The patient feels best immediately after the
dialysis treatment.
d. Taking a blood pressure reading on the affected
arm can cause clotting of the fistula.
e. All of the above

Answer 23

d. Taking a blood pressure reading on the affected

arm can cause clotting of the fistula.

Question 24

Renal failure can have prerenal, renal, or postrenal
causes. A patient presents with acute renal failure and is being assessed to
determine where, physiologically, the cause is. If the cause is found to be
prerenal, which condition most likely caused it?

Select one:

a. Heart failure
b. Ureterolithiasis
c. Aminoglycoside toxicity
d. Glomerulonephritis
e. UTI

Answer 24

a. Heart failure

Question 25

A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is? Select one: a. Constipation b. Dehydration c. Peritonitis d. Blood loss e. DVT

Answer 25

c. Peritonitis

Question 26

1. Following assessment of a patient with pneumonia, the nurse identifies a nursing diagnosis of ineffective airway clearance. The nurse bases this nursing diagnosis on the finding of: a) SpO2 of 85% b) respiratory rate of 28 breaths/min c) presence of greenish sputum d) crackles in the right and left lower lobes

Answer 26

d) crackles in the right and left lower lobes

Question 27

2. A patient experiences a flail chest as a result of a motor vehicle accident. During the respiratory assessment the nurse would expect to find: a) bloody sputum b) laryngeal stridor c) deep, irregular respirations d) paradoxical chest movement

Answer 27

d) paradoxical chest movement

Question 28

3. A patient has a chest tube following a thoracotomy. Continuous bubbling in the -suction chamber of the collection device would alert the nurse that: a) an air leak may be present b) the lung has fully expanded c) the unit is functioning normally d) a tension pneumothorax is developing

Answer 28

a) an air leak may be present

Question 29

4. A patient is scheduled for a thoracentesis to obtain pleural fluid for diagnosis of a large pleural effusion. She asks the nurse to explain what causes the fluid in her lung. The nurse explains that: a) the pleural effusion could be caused by a tumour or other growth b) a pleural effusion is not a disease but rather a sign of some other disease c) pleural effusions occur when there is any inflammation or infection in the lung d) the cause of pleural effusions is not known but they can be treated by removing the fluid with a needle or tube

Answer 29

b) a pleural effusion is not a disease but rather a sign of some other disease (Smeltzer and Bares pg 542 “Pleural effusion is usually secondary to other disease processes).

Question 30

5. A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, PaO2 58 mmHg, PaCO2 55 mmHg and SaO2 86%. The nurse recognises these values as evidence of: a) respiratory acidosis b) respiratory alkalosis c) normal acid–base balance with hypoxaemia d) normal acid–base balance with hypercapnia

Answer 30

a) respiratory acidosis

Question 31

6. The nurse teaches a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by: a) promoting atherosclerosis and damage of the walls of the arteries b) thickening capillary membranes, leading to hypoxia of organ systems c) causing direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue d) increasing the viscosity of the blood, contributing to intravascular coagulation and necrosis of tissue distal to occlusions

Answer 31

a) promoting atherosclerosis and damage of the walls of the arteries

Question 32

7. During the assessment of a 50-year-old patient who has newly diagnosed stage 1 hypertension, the patient admits he uses a lot of salt on his food and has not been able to lose the 14 kg he has gained in the last 10 years. He does not understand why he has hypertension because he is not an anxious person. An appropriate nursing diagnosis for the nurse to identify for the patient is: a) non-compliance related to lack of motivation b) disturbed self-esteem related to diagnosis of hypertension c) altered health maintenance related to lack of knowledge of disease process and management d) anxiety related to complexity of management regimen and lifestyle changes associated with hypertension

Answer 32

c) altered health maintenance related to lack of knowledge of disease process and management

Question 33

8. A 45-year-old man is admitted to the emergency room after developing severe chest pain while raking leaves. On admission he has mid-chest dullness and a normal electrocardiogram (ECG). The doctor schedules the patient for cardiac catheterisation with coronary angiography and possible percutaneous coronary intervention (PCI). The nurse prepares the patient for the procedure by explaining that, in his case, it is used to: a) determine whether there are any structural defects in the walls or chambers of his heart b) determine whether any obstructions are present in his coronary arteries and to test for an allergy to thrombolytic agents c) measure the amount of blood being pumped from his heart with each contraction to determine whether there is heart damage d) visualise any blockages in the coronary arteries and, if necessary, to dilate an obstructed artery with the use of a small balloon

Answer 33

d) visualise any blockages in the coronary arteries and, if necessary, to dilate an obstructed artery with the use of a small balloon

Question 34

While observing the ECG monitor of a patient admitted to the emergency department with chest pain, the nurse suspects that the patient is having a myocardial infarction rather than angina upon finding: a) sinus tachycardia b) depressed R wave c) ST segment elevation d) occasional premature ventricular contractions

Answer 34

c) ST segment elevation

Question 35

10. CK-MB and troponin levels are evaluated for a patient who has experienced chest pain and aching for the last 4 days. The nurse expects: a) myoglobin levels will be needed to confirm myocardial damage b) CK-MB will be the most reliable indicator of any myocardial necrosis that has occurred c) any serum cardiac marker will be inconclusive in determining myocardial injury that is several days old d) the presence of myocardial damage occurring several days earlier can be validated best by the troponin level

Answer 35

d) the presence of myocardial damage occurring several days earlier can be validated best by the troponin level

Question 36

11. During assessment of a 72-year-old man with swelling in his ankles, the nurse finds jugular venous distension with the head of the bed elevated 45 degrees. The nurse knows this finding indicates: a) decreased fluid volume b) elevated right atrial pressure c) incompetent jugular vein valves d) atherosclerosis of the jugular veins

Answer 36

b) elevated right atrial pressure

Question 37

12. In analysing a patient’s electrocardiogram (ECG) rhythm strip, the nurse uses the knowledge that the time of the conduction of an impulse through the Purkinje fibres is represented by the: a) P wave b) PR interval c) QT interval d) QRS complex

Answer 37

b) PR interval – Rationale: The PR interval represents depolarization of the atria, AV node, bundle of His, bundle branches, and the Purkinje fibers, up to the point of depolarization of the ventricular cells.

Question 38

13. A patient has been receiving intravenous heparin therapy for 6 days for treatment of deep vein thrombosis. The doctor now orders warfarin without discontinuing the heparin. The patient questions the nurse about the use of both drugs. The nurse’s best response to the patient is: a) ‘I will check with the doctor about this. You could be at risk of bleeding with both drugs.’ b) ‘Because of the potential for a pulmonary embolism, it is important for you to have additional anticoagulants.’ c) ‘It takes several days for the warfarin to have an effect, so we need to keep you on the heparin for a few more days.’ d) ‘Because you are allowed more activity now, the heparin is metabolised faster and needs to be supplemented with the warfarin.’

Answer 38

c) ‘It takes several days for the warfarin to have an effect, so we need to keep you on the heparin for a few more days.’

Question 39

14. In planning care for a patient with a venous stasis ulcer on the right lower leg, the nurse understands that the most important intervention in promoting healing of the ulcer is: a) adequate dietary intake of proteins and vitamins b) prevention of infection with prophylactic antibiotics c) application of external compression to decrease venous stasis and oedema d) keeping the ulcer moist with hydrocolloid or damp gauze dressings to promote epithelialisation

Answer 39

a) adequate dietary intake of proteins and vitamins

Question 40

List the 4 components of a physical examination of the respiratory system and list 2 abnormalities that may affect the results from each component:

Answer 40

I – Inspection Abnormalities: Skeletal deformities may limit thoracic cage excursion: scoliosis, kyphosis , broken ribs, thoracic cage abnormalities. P – Palpation Abnormalities: Thickness of the chest wall and relative location of bronchi to the chest wall will affect the normal intensity of tactile fremitus. P – Percussion Abnormalities: The resonant note may be modified somewhat in the athlete with a heavily muscular chest wall and in the heavily obese adult in whom subcutaneous fat produces scattered dullness. A – Auscultation Abnormalities: Noises may be modified by obstruction within respiratory passageways or by changes in the lung parenchyma, the pleura or the chest wall. (Note: it is Respiratory Assessment pneumonic - HIPPA from 105 minus the H for History – Remember HIPPA minus the H so just IPPA) Spinal and Rib abnormalities - Abnormalities in the skeletal system or chest wall itself can result in a restrictive ventilatory defect.

Question 41

4. Give the normal adult male values of the following: Tidal volume – Vital Capacity – Anatomical Dead Space Volume -

Answer 41

Tidal volume – 500ml or 5-10mL/kg Vital Capacity – 4,600 mL Anatomical Dead Space Volume - The anatomic dead space is equal to the volume exhaled during the first phase plus half that exhaled during the second phase and is about 150 ml on the average in humans which is a third of the Tidal volume

Question 42

1. Name three types of validity:

Answer 42

1. Content validity 2. Criterion related validity 3. Construct validity

Question 43

List the five first line response drugs used in the event of a cardiac arrest. Give a brief description of each drug’s specific mechanism of action:

Answer 43

Oxygen – improves tissue oxygenation and corrects hypoxaemia Adrenaline – increases systemic vascular resistance and BP, improves coronary and cerebral perfusion and myocardial contractility Vasopressin – increases systemic vascular resistance Atropine – blocks parasympathetic action, increases SA node automaticity and AV conduction Sodium bicarbonate – corrects metabolic acidosis Magnesium – promotes adequate functioning of cellular sodium-potassium pump

Question 44

The coronary artery blood flow is mainly regulated by pressure within the:

Answer 44

Aorta

Question 45

The hydrogen ion concentration of a solution is measured as it’s:

Answer 45

pH

Question 46

Define and explain the pathophysiology of intermittent claudication:

Answer 46

A muscular cramp-like pain in the extremities consistently reproduced with the same degree of exercise or activity and relieved by rest. This pain is caused by the inability of the arterial system to provide adequate blood flow to the tissues in the face of increased demands for nutrients during exercise. As the tissues are forced to compete the energy cycle without nutrients, muscle metabolites aggravate the nerve endings of the surrounding tissue. Usually about 50% of the arterial lumen or 75% of the cross-sectional area must be obstructed before intermittent claudication is experienced. This subsides by rest because it deceases the metabolic needs of the muscles and the pain subsides.

Question 47

8. List the 3 components of Virchow’s triad

Answer 47

* Venous stasis (Slow/Stagnant blood flow) * Hypercoagulability * Endothelial injury/damage (e.g. hypertension)

Question 48

Following assessment of a patient with pneumonia, you identify a nursing diagnosis of ineffective airway clearance. You base this nursing diagnosis on the finding of: a) 5po2 of 85% b) respiratory rate of 28 breaths/min c) presence of greenish sputum d) crackles in the right and left lower lobes

Answer 48

d) crackles in the right and left lower lobes

Question 49

A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, Pao2 58 mmHg, Paco2 55 mmHg and Sao2 86%. You recognise these values as evidence of: a) respiratory acidosis b) respiratory alkalosis c) normal acid-base balance with hypoxaemia d) normal acid-base balance with hypercapnia

Answer 49

a) respiratory acidosis

Question 50

Define and explain the pathophysiology of “insulin resistance:”

Answer 50

Beta cells in the pancreas produce insulin in response to food ingestion. The insulin receptor cells force glucose into the cells for normal cell function, removing glucose from the blood. Insulin resistance in type 2 diabetics is formed when the cell has too much glucose already causing the receptor cells to become insensitive to glucose. This forces the beta cells to create more insulin, resulting in too much glucose and insulin in the blood. In type 1 diabetics insulin resistance can be a result of antibodies binding to the injected insulin.

Question 51

Describe the nursing care and clinical management of a patient who has been diagnosed with an acute myocardial infarction. Assuming the patient undergoes immediate thrombolysis treatment describe the nursing care and potential complications:

Answer 51

Administer oxygen and position in semi-fowler’s position Promote rest and reduce anxiety (reassurance, clear explanations) Regular and careful monitoring of ECG, vital signs, respiratory status, LOC Administer analgesia (morphine) for pain - follow up with pain assessment Administer Ace Inhibitors, beta-blockers and GTN Administer Thrombolytics – increased risk of bleeding, therefore: monitor for bleeding, minimise skin punctures, avoid IM injections, start IV lines before initiating thrombolytic therapy, cease if bleeding occurs. Prepare for percutaneous coronary intervention

Question 52

11. The greater the validity of an instrument, the more confidence you can have that the instrument will obtain data that will answer the research questions? True / False

Answer 52

True

Question 53

12. Patients with diastolic type heart failure have a normal ejection fraction? True / False

Answer 53

True

Question 54

13. Up to 70% FiO2 may be used safely for 48 hours for oxygen supplementation True / False

Answer 54

True

Question 55

14. The ankle-brachial index is calculated by dividing the ankle systolic pressure by the brachial arm systolic pressure True / False

Answer 55

True

Question 56

15. In an ECG the QRS complex represents ventricular depolarisation and contraction? True / False

Answer 56

True

Question 57

Instructions:- please consider the case study below. Formulate three nursing diagnoses with expected outcome, with two interventions and rationale each. Complete these in order of priority in the care plan template below. Patient profile • Mrs Simmons, a 30-year-old Indigenous Australian mother of two preschool children, comes to the emergency department (ED) with severe wheezing, dyspnoea and anxiety. She was in the ED only 6 hours ago with an acute asthma attack. Subjective data • Treated in the ED previously with nebulised salbutamol and started to respond to the treatment. She left against medical advice earlier, stating that she needed to care for her 2 young children, stating that her husband was unreliable. • Can speak only one- to three-word sentences • Is allergic to cigarette smoke • Began to experience increased shortness of breath and tightness in her chest when she returned home • Used salbutamol MDI (without a spacer) repeatedly at home with no relief • Coughing at night wakes her up 3–4 times a week • Has no healthcare provider she sees regularly. On no prescribed medications ``` Objective data Physical examination • Uses accessory muscles to breathe with some nasal flaring • Has audible wheezing • Respiratory rate: 34 breaths/min • SaO2 is 85% • Auscultation reveals no air movement in lower lobes • Heart rate: 126 beats/min ``` Diagnostic studies ABGs: PaO2 10.5 kPa (80 mmHg); PaCO2 4.5 kPa (35 mmHg); pH 7.46 PEFR: 150 L/min (personal best: 400 L/min)

Answer 57

Ineffective airway clearance: assessment, administer medication (bronchodilator therapy, corticosteriods, mucolytics, expectorants), encourage deep breathing and cough, promote hydration to thin secretions etc. Impaired gas exchange: assessment, O2 therapy with humidification, position for maximum lung expansion etc. Fatigue: promote rest, reduce anxiety (kids), assistance with ADL’s etc

Question 58

The most common cause of pulmonary oedema is abnormal ___ function? (Fill in the blank from the choice below) a) kidney b) lung c) cardiac d) alveolar

Answer 58

c) cardiac

Question 59

A patient has a chest tube following a thoracotomy. Regular intermittent bubbling in the suction chamber of the collection device would alert you that: a) an air leak may be present b) the lung has fully expanded c) the unit is functioning normally d) a tension pneumothorax is developing

Answer 59

c) the unit is functioning normally

Question 60

A female patient is scheduled for a thoracentesis to obtain pleural fluid. She asks you to explain what causes the fluid in her lung; you explain that: a) the pleural effusion could be caused by a tumour or other growth b) a pleural effusion is not a disease but rather a sign of some other disease c) pleural effusions occur when there is any inflammation or infection in the lung d) the cause of pleural effusions is not known but they can be treated by removing the fluid with a needle or tube

Answer 60

b) a pleural effusion is not a disease but rather a sign of some other disease

Question 61

6. Factors that influence the development of hypertension include all of the following except: a) Increased sympathetic nervous system activity b) Increased renal absorption of sodium chloride and water c) Decreased activity of the renin-angiotensin system d) Decreased vasodilatation

Answer 61

c) Decreased activity of the renin-angiotensin system

Question 62

You teach a patient with hypertension that uncontrolled hypertension may damage organs in the body primarily by: a) promoting atherosclerosis and damage of the walls of the arteries b) thickening capillary membranes, leading to hypoxia of organ systems c) causing direct pressure on organs, resulting in necrosis and replacement of cells with scar tissue d) increasing the viscosity of the blood, contributing to intravascular coagulation and necrosis of tissue distal to occlusions

Answer 62

a) promoting atherosclerosis and damage of the walls of the arteries

Question 63

In analysing a patient's electrocardiogram (ECG) rhythm strip, You use the knowledge that the time of the conduction of an impulse from the SA node to the AV node is represented by the: a) P wave b) PR interval c) QT interval d) QRS complex

Answer 63

b) PR interval

Question 64

Cardiac output is calculated by multiplying: a) the stroke volume and the afterload b) the stroke volume and the pulse rate c) the stroke volume and the impulse rate d) the afterload and the preload

Answer 64

b) the stroke volume and the pulse rate

Question 65

One unit of packed cells is prescribed to be infused over 2 hrs. The volume of the packed cells is 250 ml. The infusion set drop factor is 20 drops/ml. Which answer below is correct (to the nearest whole number)? a) 42 drops/min. b) 84 drops/min. c) 21 drops/min. d) 125 drops/min.

Answer 65

a) 42 drops/min. | 250/2 = 125 x20 / 60= 41.666666

Question 66

A patient with acute coronary syndrome is admitted to Emergency Department. Which of the following statements is not true ofthis diagnosis: a) His ECG demonstrates ST segment elevation with T Wave inversion b) His chest pain lasts only 2-5 minutes c) His chest pain occurs at rest d) His cardiac markers are normal

Answer 66

b) His chest pain lasts only 2-5 minutes

Question 67

CI

Answer 67

b) CI

Question 68

``` Metabolic syndrome increases the risk of coronary artery disease and consists of insulin resistance and : a) smoking/hypertension/obesity b) smoking/dyslipidaemia/genetics c) obesity/smoking/genetics d) obesity/dyslipidaemia/hypertension ```

Answer 68

d) obesity/dyslipidaemia/hypertension

Question 69

``` On admitting a patient with bladder cancer you identify a significant risk factor for this diagnosis is: a) chronic cystitis b) cigarette smoking c) high caffeine intake d) use of artificial sweeteners ```

Answer 69

b) cigarette smoking

Question 70

Following rectal surgery, the patient tells you that he urinates about 10 ml of urine every 30-60 minutes. From the list below the best action for you to take initially is to: a) palpate for a distended bladder b) have the patient drink only small amounts of fluid throughout the day c) show the patient how to apply pressure on his bladder during urination d) monitor the patient's fluid intake and output over an 8-hour period to determine whether urine output is adequate

Answer 70

a) palpate for a distended bladder

Question 71

You are searching the literature for the highest level of evidence for the effectiveness of low glycaemic index (GI) diets on the reduction of blood sugar levels. You would therefore look for: a) Case studies b) Systematic reviews c) Randomized double blind controlled trials d) Prospective cohort studies

Answer 71

b) Systematic reviews

Question 72

You explain to the patient that type 2 diabetes differs from type 1 diabetes primarily in that with type 2 diabetes: a) the patient is totally dependent on an outside source of insulin b) there is decreased insulin secretion and/or increased cellular resistance to insulin that is produced c) there are islet cell antibodies and insulin autoantibodies that destroy beta cells in the pancreas d) the C-peptide chain of proinsulin secreted by the pancreas cannot be removed by the liver, resulting in a lack of active insulin

Answer 72

b) there is decreased insulin secretion and/or increased cellular resistance to insulin

Question 73

A patient recovering from diabetic ketoacidosis asks you how acidosis occurs. The best response you can give is that: a) excess glucose in the blood is metabolised by the liver into acetone, which is acidic in nature b) an insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones c) insufficient insulin leads to cellular starvation and, as cells rupture, they release organic acids into the blood d) when an insulin deficit causes hyperglycaemia, then proteins are deaminated by the liver, causing acidic by-products

Answer 73

b) an insulin deficit promotes metabolism of fat stores, which produces large amounts of acidic ketones

Question 74

You are studying research that investigates the effectiveness of alginate dressings on the rate of wound healing. The rate of wound healing is known as the: a) control variables b) extraneous variable c) independent variable d) dependent variable

Answer 74

d) dependent variable

Question 75

In a study where antiembolic (TED) stockings and a calf stimulator were found to be significantly more effective in preventing postoperative deep vein thrombosis than TED stockings alone, the significance level (p) would be: a) less than .05 b) less than .5 c) greater than .5 d) greater than 1

Answer 75

a) less than .05

Question 76

A patient with hypovolaemic shock has a urinary output of 30 mL/hour. You understand that the compensatory physiological mechanism that leads to altered urinary output is: a) release of aldosterone, which increases serum osmolarity, causing release of antidiuretic hormone (ADH) b) movement of interstitial fluid to the intravascular space, increasing renal blood flow c) activation of the sympathetic nervous system, causing vasodilation of the renal arteries d) beta-adrenergic receptor stimulation that causes increased cardiac output as a result of increased heart rate and myocardial contractility

Answer 76

``` a) release of aldosterone, which increases serum osmolarity, causing release of antidiuretic hormone (ADH) ```

Question 77

22. The major contributing factor to the development of oesophageal ascites is: a) portal hypertension b) water retention c) lymphoedema d) increased serum bilirubin levels

Answer 77

a) portal hypertension

Question 78

Hepatitis A is transmitted primarily through the: a) sharing of needles b) faecal-oral route c) unsafe sexual practices d) abuse of alcohol

Answer 78

b) faecal-oral route

Question 79

You are caring for a patent with hepatic encephalopathy due to severe liver disease. What clinical manifestations specific to this disease should you be alert to when caring for this patient? a) Intermittent severe right upper quadrant pain b) Impaired peripheral circulation c) Asterixis d) Urinary retention

Answer 79

c) Asterixis

Question 80

A reliable means of determining a patient's total fluid status is to conduct: a) 4 hourly blood pressures b) Daily weights c) Strict fluid balance charts d) Diuretic challenges

Answer 80

b) Daily weights

Question 81

The primary functions of the thyroid gland are to: a) Control cellular metabolic activity b) Maintain body metabolism c) Control normal growth d) All of the above

Answer 81

d) All of the above

Question 82

Corticosteroid dosages must be gradually tapered off to avoid a) Thyroid storm b) Addisonian crisis c) Urinary retention d) Adrenal insufficiency

Answer 82

d) Adrenal insufficiency

Question 83

Cushing's syndrome has several classic signs, including facial hair, buffalo hump and: a) Moon face b) Pendulous breasts c) Greatly enlarged ear lobes d) Urinary retention

Answer 83

a) Moon face

Question 84

``` The most immediately life threatening of the fluid and electrolyte changes that occur in patients with acute renal failure is: a) Hyponatremia b) Hyperkalemia c) Hypocalcemia d) Hyperphosphatemia ```

Answer 84

b) Hyperkalemia

Question 85

The preferred method of permanent access for haemodialysis is: a) Arteriovenous graft b) PIC line c) Peritoneal access device d) Arteriovenous fistula

Answer 85

d) Arteriovenous fistula

Question 86

List and briefly discuss the importance of three priority nursing care responsibilities as you care for a patient post percutaneous liver biopsy.

Answer 86

Assess vital signs - Complications usually occur within the first three hours of liver biopsy as the blood pressure returns to normal parameters. Those who bleed post-liver biopsy do so into the peritoneal cavity and therefore there is often no external sign of bleeding. assist pt to lie on right side w pillow under coastal margin instruct pt to avoid coughing/ straining Assess pain - To ensure the patient comfort and minimise the risk of complications.

Question 87

Give the normal adult male values of the following: Tidal volume ----------------------------- Vita I capacity __________________ _ TotaI Iung capacity ___________________ _

Answer 87

Tidal volume – 0.5 itres Vital Capacity – 4.6 litres Total lung capacity 5.8 litres

Question 88

The coronary artery blood flow is mainly regulated by pressure within the:

Answer 88

aorta

Question 89

The hydrogen ion concentration of a solution is measured as it's:

Answer 89

pH

Question 90

Briefly explain how the following are affected in a patient with heart failure: Stroke volume, ejection fraction, preload, afterload

Answer 90

stroke volume decreased (less volume of blood pumped out) Ejection fraction decreased - (lower percentage of blood pumped with every contraction usually less then 40%) Preload increased due to stretch in the ventricle wall Afterload increased due to the amount of blood left in the ventricle after systole and also the resistance in the aorta.

Question 91

List the three components of Virchow's triad and give one nursing intervention for each component aimed at decreasing the risk of your patient forming a DVT:

Answer 91

venous stasis - get patient to elevate legs, to help venous return. Venous endothelial damage - educate patient to avoid damage to vessels. - move any potential objects that could cause damage to the legs. Hypercoaguability - take anticoagulant meds as prescribed

Question 92

List and explain the 3 processes of respiration, and describe a medical condition that can affect the function of each process:

Answer 92

ventilation - the movement of air in and out of the alveoli a common medical condition related to this movement is asthma as inflammation and mucous prevent air moving in and out. Diffusion - the exchange of oxygen and carbon dioxide across the capillary membrane Pulmonary oedema prevents the alveoli from making this exchange due to fluid overload. Perfusion-The movement of blood through though the pulmonary capillaries shunting is a medical condition which prevents the blood passing through the pulmonary capillaries.

Question 93

Describe the Coroner's main responsibilities?

Answer 93

* the identity of the deceased person; * the cause of death; and * in certain cases, the circumstances in which the death occurred.

Question 94

You follow good nursing practice and have two non-toothed clamps and 1000ml of sterile water at the bedside of your patient who has an ICC insitu. According to the relevant Nursing Practice Standard of Royal Perth Hospital explain: a) when and how you would use the sterile water (2 marks) b) when and how you would use the two clamps (2 marks

Answer 94

a. you would use sterile water to perform a chamber bottle change place the tube into the sterile water to act as a sterile seal while the chamber bottle is changed. b. the two clamps would be to close off the tube while removing it from the bottle to change the sealed container, if this is not done you could cause a tension pnemothorax.

Question 95

Acute upper airway obstruction is a life-threatening emergency. Describe and discuss three methods that you can use to establish a patent airway.

Answer 95

Head-tilt chin-lift — The head-tilt chin-lift is the primary maneuver used in any patient in whom cervical spine injury is not a concern. Jaw-thrust maneuver — The jaw-thrust maneuver is an effective airway technique, particularly in the patient in whom cervical spine injury is a concern. Guedel airways- rigid plastic curved devices used to maintain an open airway. It does this by preventing the tongue from covering the epiglottis, which could prevent the person from breathing. Suction - this can be used to remove any foreign object or saliva from blocking the airway

Question 96

Discuss three strategies that you may use to assist your patient to arrive at a solution when they are faced by an ethical dilemma.

Answer 96

1. educate patient 2. get patient to assess pros and cons 3. refer patient to community resources

Question 97

Prioritise and discuss five nursing interventions in the care of your patient who is experiencing shock.

Answer 97

1. assess and document peripheral perfusion status - early sign of decreased cardiac output 2. assess vital signs - indicate a worsening state, BP may indicate perfusion status. Resp - possible respiratory failure 3. if hypotensive place in supine position to promote venous return 4. monitor ABG results for the presence of acidosis/alkalosis 5. Assess for mental state changes and reasure patient.

Question 98

Explain how you would manage a typical "trial to void" procedure in your patient who is required to have their suprapubic catheter removed. (3 marks) Generally what amount of urine remaining in your patient's bladder would you accept. (1 mark)

Answer 98

explain procedure to patient clamp the suprapubic catheter for up to 4 hours, unclamp and measure the residual post void and if it measures less than 100 mls on 2 seperate occassions the trial of void has been successful.

Question 99

Prioritise and discuss five nursing interventions in the care of your patient you suspect of suffering a haemolytic reaction as they commence a blood transfusion. (5 marks)

Answer 99

1. stop the transfusion 2. assessVital signs (temp, BP, pulse, respiratory rate, O2 saturation levels or blood gases) and respiratory status (dyspnoea, tachypnoea, wheeze and cyanosis) should be checked and recorded. 3. return blood with a sample of patients blood for crossmatching 4. treat symptoms of shock ie administer oxygen and possibly anticoagulants 5. monitor abgs

Question 100

a) Describe the nursing care and clinical management of a patient who has been diagnosed with an acute myocardial infarction. (4 marks) b) Assuming the patient undergoes immediate thrombolysis treatment describe the nursing care and potential complications.

Answer 100

1. assess vital signs and document for baseline readings 2. assess pain and administer analgesics as prescribed 3. ecg to evaluate heart conductivity. 4. monitor electrolytes to check for imbalances 5. reasure patient to reduce anxiety b. educate patient on the risks bleeding , stroke, assess for bleeding. assess mental state and for bleeding.

Question 101

The classic clinical manifestations of all types of diabetes include the '3 Ps'. List and define them:

Answer 101

Polyuria - the need to urinate frequently Polydipsia - increased thirst & fluid intake Polyphagia - increased appetite

Question 102

Discuss the main nursing management strategies in caring for your patient who is at risk of developing tetany following a thyroidectomy

Answer 102

Assess verbal/nonverbal reports of pain, noting location, intensity (0–10 scale), and duration. Place in semi-Fowler’s position and support head/neck with sandbags or small pillows. Maintain head/neck in neutral position and support during position changes. Instruct patient to use hands to support neck during movement and to avoid hyperextension of neck. Give cool liquids or soft foods, such as ice cream or popsicles. patient comfort

Question 103

Of which gland is pheochromocytoma a tumour and what are the five "H's" used to diagnose it?

Answer 103

``` Catecholamine secreting tumor of the Adrenal Gland Hypertension Headache - Hyperhidrosis or excessive sweating Heart consciousness or Palpitations Hypermetabolism Hyperglycemia ```

Question 104

Describe your immediate nursing interventions that you would make when your patient who is 48 hrs post major surgery starts demonstrating symptoms typical of a pulmonary embolus. {5 marks) 13

Answer 104

1. met call 2. oxygen therapy 10 litres 3. raise bed into high fowlers 4. take all vital signs and document

Question 105

20. The strongest predisposing factor for asthma is allergy? | True I False

Answer 105

True

Question 106

21. Patients with diastolic type heart failure have a normal ejection fraction? True I False

Answer 106

true but not always

Question 107

Patients in atrial fibrillation are at greater risk of stroke (CVAs)?

Answer 107

true

Question 108

People who consume 4 or 5 standard drinks per day are at high risk of developing cirrhosis of the liver?

Answer 108

true

Question 109

In an ECG the QRS complex represents ventricular depolarisation and contraction? True I False

Answer 109

true

Question 110

The top margin of ECG paper is marked at 4 second intervals to aid the calculation of a patient's pulse rate? True I False

Answer 110

false

Question 111

Hypotension, a result of over secretion of renin, is common in renal failure? True I False

Answer 111

false

Question 112

The ankle-brachial index is calculated by dividing the ankle systolic pressure by the brachial arm systolic pressure True I False

Answer 112

true

Question 113

In acid base balance, a buffer is a substance that can release or combine with an acid but not a base True I False

Answer 113

false

Question 114

Vomiting and diarrhoea are common manifestations of a lower urinary tract infection? True I False

Answer 114

false

Question 115

Define the following terms (1 mark each) | a. Glycosuria

Answer 115

is the excretion of glucose into the urine

Question 116

Define the following terms (1 mark each) | b. Steatorrhoea

Answer 116

is the presence of excess fat in feces.

Question 117

Define the following terms (1 mark each) | c. Aldosterone

Answer 117

is a steroid hormone produced by the outer section of the adrenal cortex in the adrenal gland

Question 118

Define the following terms (1 mark each) | d. Pruritis

Answer 118

itchy skin

Question 119

Define the following terms (1 mark each) | e. Exopthalmus

Answer 119

is a bulging of the eye anteriorly out of the orbit.

Question 120

Define the following terms (1 mark each) | f. Hyperhidrosis

Answer 120

is the condition characterised by abnormally increased sweating/perspiration,

Question 121

Define the following terms (1 mark each) | g. Ecchymosis

Answer 121

subcutaneous purpura larger than 1 centimeter

Question 122

Define the following terms (1 mark each) | h. Nocturia

Answer 122

the complaint that the individual has to wake at night one or more times for voiding.

Question 123

Define the following terms (1 mark each) | i. Empyema

Answer 123

is a collection of pus within a naturally existing anatomical cavity.

Question 124

Define the following terms (1 mark each) | j. Azotaemia

Answer 124

is a medical condition characterized by abnormally high levels of nitrogen-containing compounds (such as urea, creatinine, various body waste compounds, and other nitrogen-rich compounds) in the blood. It is largely related to insufficient filtering of blood by the kidneys