NNN

12-01-2024 Q&A (Valdez)

Dec 01, 202416 min read3006 words

Same as before, this discussion is centered around a pre-test. Additionally, the post-test and its rationalization is also discussed by Prof. Ferdinand Valdez RN, MAN, MPH of the Royal Pentagon Review Specialists, Inc.

Pre-test Rationalization

A client with cancer is being evaluated for possible metastasis. Which of the following are the most common metastasis sites for cancer cells? Select all that apply. (4)

  1. Colon
  2. Reproductive Tract
  3. White Blood Cells
  4. Liver
  5. Lymph Nodes
  6. Lungs
  7. Bone
  8. Brain

The nurse understands that the following are general adverse effects of antineoplastic drugs. Select all that apply. (4)

  1. Urinary retention
  2. Infertility
  3. Stomatitis
  4. Bone marrow depression
  5. Extravasation
  6. Nausea

The nurse in a hypertensive clinic is caring for a woman who has just been diagnosed as having primary hypertension. She asks the nurse what causes primary hypertension. The nurse’s best response is:

  1. Unknown
  2. Atherosclerosis
  3. Renal Disease
  4. Diabetic Vascular Changes

The nurse is performing an admission assessment on a client who has been diagnosed with diabetes insipidus. Which of the following drugs should the nurse expect to administer as ordered? Select all that apply. (3)

  1. Ethacrynic Acid
  2. Diabenase
  3. Glipzide
  4. Declomycin
  5. Diabeta
  6. Mannitol

Which of the following actions should the nurse include in the care plan for a patient who has water intoxication from SIADH?

  1. Measure urine specific gravity
  2. Restrict salt in the diet
  3. Chew gum and hard candy
  4. Avoid ingestion of water

When helping a client with Parkinson’s disease to ambulate, what instruction should the nurse give the client?

  1. Avoid leaning forward
  2. Hesitate between steps
  3. Rest tremors when experienced
  4. Keep arms close to the center of gravity

A client with retroperitoneal abscess is receiving gentamycin (Garamycin). Which o the following should the nurse monitor? Select all that apply. (3)

  1. Hearing
  2. Urine output
  3. Hematocrit
  4. BUN and Creatinine
  5. Serum Calcium Levels

A client with Alzheimer’s will need assistance in maintaining contact with society for as long as possible. Which therapy may help him achieve this goal?

  1. Occupational Therapy
  2. Recreation Therapy
  3. Psychodrama
  4. Remotivation Therapy

A client with the following symptoms will receive what type of medications? (a) Demyelination of the spinal cord, (b) Nystagmus, (c) Bowel and bladder dysfunction, (d) Intentional tremors, and (e) Scanning speech

  1. Neostigmine, Tensilon, Steroids
  2. Steroids, Baclofen, Immunosuppresive
  3. Akineton, Benadryl, Cogentin
  4. Dilantin, Valium, Tegretol

The most common electrolyte intestinal lavage solutions used for effective cleansing of the bowel includes all of the following except:

  1. Glucolyte
  2. Nulytely
  3. Golytely
  4. Colyte

Disorders of the Antidiuretic Hormone

Diabetes Insipidus

Diabetes insipidus involves the hyposecretion of ADH, leading to excessive voiding.

  1. Predisposing factors: pituitary surgery (hypophysectomy), inflammation, trauma, or tumor involving the pituitary gland.
  2. Signs and symptoms: polydipsia, producing hypovolemia, hypotension (decreased cardiac output), tachycardia, palpitations, weight loss, weakness and fatigue
    • Signs of dehydration (early in adults, thirst; in children, tachycardia): dry mucous membranes, poor skin turgor
    • Hemoconcentration; increased viscosity, coagulability
  3. Complications: hypovolemic shock, renal failure (hypoperfusion)
  4. Diagnostic Evaluation:
    • (a) Urine specific gravity is decreased. This is normally 1.015 to 1.030.
    • (b) Serum sodium is high from hemoconcentrational hypernatremia. This is normally 135 to 145 mEq/L.
    • (c) Serum osmolality is increased. This is normally 270 to 290 mEq/L.

Management

  1. Force Fluids: 2,000-3,000 mL/day
  2. IV infusion of isotonic fluids (NSS, PLR)
  3. Strictly monitor I&O and Vital Signs
  4. Pharmacologic Therapy:
    • ADH Analogue: Vasopressin (Pitressin) is an oily solution best given deep IM; Desmopressin may be given orally or intranasally via drops.
    • Oral Hypoglycemic Agents (Sulfonylureas/Non-sulfonylureas) that increase ADH production: Chlorpropamide (Diabenase), Tolbutamide (Orinase), Olazamide (Tolinase), Glipzide (Glucotrol), Diabeta (Micronase)

Syndrome of Inappropriate Antidiuretic Hormone

  1. Predisposing Factors: head injury, bronchogenic cancer, hyperplasia of the pituitary gland.
  2. Signs and Symptoms: hypervolemia/fluid volume excess, urine retention (oliguria), hypertension, tachycardia, palpitations, jugular vein distention, weight gain, hemodilution, water intoxication— cerebral edema.
  3. Complications: seizures, increased intracranial pressure, which is normally 0 to 15 mm Hg.
  4. Diagnostic Evaluation:
    • (a) Urine specific gravity increased. This is normally 1.015 to 1.030.
    • (b) Serum sodium is low. This is normally 135 to 145 mEq/L.
    • (c) Serum osmolality is low. This is normally 270 to 290 mEq/L.

Nursing Management

  1. Restrict fluids at less than 500 mL per day. Educate the client about the hidden sources of fluids.
  2. Strictly monitor I&O and vital signs
  3. Administer Medications:
    • Diuretics
    • Antimicrobial Agents, such as Declomycin to decrease the levels of ADH.

Diuretics

  1. Potassium-Wasting Diuretics (BFHM):
  • Bumex
  • Furosemide (Lasix): oral or IV push. In IV administration, this takes 5 to 10 minutes to take effect, and can last for up to 6 hours (LaSIX)
  • Hydrochlorothiazide
  • Mannitol: IV bottle given fast-drip to prevent crystallization of precipitate.
  1. Potassium-Sparing Diuretics (SAT):
  • Spironolactone
  • Amiloride
  • Triamterene

Post-test Rationalization

Which of the following patients are at risk for developing heart failure? Select all that apply. (3)

  1. A 69-year-old make with history of alcohol abuse and is recovering from myocardial infarction
  2. A 55-year-old female with a health history of asthma and hypoparathyroidism
  3. A 30-year-old male with a history of endocarditis and has severe mitral stenosis
  4. A 45-year-old female with lung cancer stage 2
  5. A 58-year-old female with uncontrolled hypertension and is being tested for influenza

Which of the following are not typical signs and symptoms of right-sided heart failure? Select all that apply. (3)

  1. Jugular venous distention
  2. Persistent cough
  3. Weight gain
  4. Crackles
  5. Nocturia
  6. Orthopnea

Select all the correct statements about educating the patient with heart failure: (3)

  1. It is important patients with heart failure notify their physician if they gain more than 6 pounds in a day or 10 pounds in a week.
  2. Patients with heart failure should receive an annual influenza vaccine and be up-to-date with the pneumonia vaccine.
  3. Heart failure patients should limit sodium intake to 2-3 grams per day.
  4. Heart failure is exacerbated by illness, too much fluid or sodium intake, and arrhythmias.
  5. Patient with heart failure should limit exercise because of the risks.

Which of the following is a late sign of heart failure?

  1. Shortness of breath
  2. Orthopnea
  3. Edema
  4. Frothy blood-tinged sputum

A patient is taking Digoxin. Prior to administration, you check the patient’s apical pulse and find it to be 61 BPM. Morning lab values showed potassium was at 3.3 mEq/L and serum digoxin levels was at 5 ng/mL. Which of the following is the correct nursing action?

  1. Hold this dose and administer the second dose at 1800
  2. Administer the dose as ordered
  3. Hold the dose and notify the physician of the digoxin level
  4. Hold this dose until the patient’s potassium level is normal.

In which of the following positions should the nurse place a client with suspected heart failure?

  1. Semi-Fowler’s
  2. Right Side Lying
  3. High-Fowler’s
  4. Lying on the back with the head lowered

A client with congestive heart failure has Lanoxin ordered every day. Prior to giving the medication, the nurse assesses that the digoxin level is 1.2 ng/mL and auscultates a one-minute pulse rate of 62. The nurse should:

  1. Withhold the digoxin
  2. Withhold the dose and request an order for a potassium level
  3. Give the digoxin as ordered
  4. Notify the physician

The nurse is assessing a 59-year-old male patient with congestive heart failure who was just admitted to the medical-surgical unit. Which of the following is not a manifestation of left ventricular failure?

  1. Difficulty breathing
  2. Patient experiences sensation of suffication
  3. Sharp pain on the upper abdomen
  4. Patient assumes a tripod position

Furosemide is administered intravenously to a client with heart failure. How soon after the administration should the nurse begin to see evidence of the drug’s desired effect?

  1. 30-60 minutes
  2. 2-4 hours
  3. 5-10 minutes
  4. 6-8 hours

A 35-year-old patient with right ventricular failure was assigned to the nurse. Which would be the priority assessment of the nurse?

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

The nurse is caring for a 75-year-old client with left ventricular failure. The nurse should be alerted when the patient experiences:

  1. Confusion
  2. Crackles
  3. Pallor
  4. Tachycardia

The patient is receiving Digoxin to treat congestive heart failure. The nurse should monitor the following laboratory values. Which is the priority?

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

The physician’s order says to administer Lasix 40 mg IV twice a day. The patient has the following laboratory values in the morning: sodium of 148 mEq/L, BNP of 900, potassium of 2.0, and BUN of 10. Which of the following is a nursing priority?

  1. Administer the Lasix as ordered
  2. Notify the physician of the BNP level
  3. Assess the patient for edema
  4. Hold the dose and notify the physician

A patient taking Digoxin is experiencing severe bradycardia, nausea and vomiting. A laboratory diagnosis shows that their digoxin level is 4 ng/mL. What medication do you anticipate the physician to order for this patient?

  1. Nalmefene
  2. Aminophylline
  3. No medication because this is a normal digoxin level
  4. Immune Fab

The nurse should teach the client that signs of digitalis toxicity include which of the following?

  1. Skin rash over the chest and back
  2. Increased appetite
  3. Visual disturbances such as seeing yellow spots
  4. Elevated blood pressure

In case of hospital evacuation, the nurse will evacuate the patients in which order?

  1. Bedridden, Ambulatory, Wheelchair Bound
  2. Ambulatory, Bedbound, Wheelchair Bound
  3. Wheelchair Bound, Bedridden, Ambulatory
  4. Ambulatory, Wheelchair Bound, Bedbound

The most common cause of aspiration of food in adults is:

  1. Vegetable
  2. Bolus of meat
  3. Softdrinks
  4. Bread

How will you distribute 2 total care patients and 9 ambulatory care patients for three registered nurses and two nursing assistants?

  1. 2 RNs for Total Care, 1 RN and 1 NA for Primary Care, and 1 NA for Ambulatory Care
  2. 1 RN and 1 NA for Total Care, 1 RN and 1 NA for Primary Care, and 1 RN for Ambulatory Care
  3. 2 RNs for Total Care, 2 NAs for Primary Care, and 1 RN for Ambulatory Care
  4. 2 RNs for Total Care, 1 RN and 1 NA for Primary Care, and 1 RN and 1 NA for Ambulatory Care

The cooked food most likely to remain contaminated by the virus that causes Hepatitis A is:

  1. Canned Tuna
  2. Broiled Shrimp
  3. Baked Haddock
  4. Steamed Lobster

A patient with Parkinson’s disease is experiencing weight loss due to difficulty chewing and swallowing. Which meal option is the best for this patient?

  1. Scrambed eggs with a side of cottage cheese
  2. Grilled cheese with apple slices
  3. Baked chicken with bacon slices
  4. Tacos with refried beans

The nurse observes the nurse’s aid assisting the patient with Parkinson’s disease during mealtime. Which of the following actions by the aid should the nurse recognize as inappropraite?

  1. Setting limits on the length of mealtimes
  2. Placing the patient in an upright position
  3. Allowing the patient to cut the food
  4. Filling the coffee cup half full

When interviewing a client with a tentative diagnosis of Parkinson’s disease, the nurse expects the client to report the onset of symptoms occured:

  1. Gradually
  2. Overnight
  3. Suddenly
  4. Irregularly

A client with the diagnosis of Parkinson’s disease asks the nurse, “why do I drool so much?” Which is the nurse’s best response?

  1. We do not know why this happens.
  2. There is a paralysis of the throat muscles
  3. You have a loss involuntary movements
  4. Muscle rigidity prevents normal swallowing

A nurse is reviewing laboratory results and notes that the client’s sodium level is 150 mEq/L. Which food item does the nurse instruct the client to avoid?

  1. Processed oat cereals
  2. Low-fat yogurt
  3. Cauliflower
  4. Peas

A patient arrives at the ER and is unable to give you a healthy history due to altered mental status. The family reports the patient has gained over 10 lbs. in one week and that it is mainly “water weight”. In addition, they report the patient hasn’t been able to urinate or eat within the past week as well and was recently diagnosed with small cell lung cancer. On assessment, the patient’s HR is 115 and BP is 180/92. Patient sodium is 90 mEq/L. Which of the following conditions do you suspect the patient is most likely presenting with?

  1. Syndrome of Inappropriate Antidiuretic Hormone
  2. Diabetes Insipidus
  3. Addison’s Disease
  4. Fluid Volume Deficit

In the scenario above, what drug do you anticipate the patient will be started on per doctor’s order?

  1. Desmopressin (DDAVP) IV
  2. Declomycin
  3. Diabinese
  4. Stimate

Which of the following is the priority nursing implementation for a client with a tumor of the posterior lobe of the pituitary gland that has had a urine output of 3 liters in the last hour with a specific gravity of 1.002?

  1. Measure and record vital signs each shift
  2. Turn the client every two horus to prevent skin breakdown
  3. Administer Pitressin Tannate as ordered
  4. Maintain a dark and quiet room

Which of the following measures would a nurse include in the care plan of a patient who has SIADH?

  1. Straining all voided urine
  2. Encouraging blood glucose
  3. Monitoring blood glucose
  4. Increasing sodium intake

The nurse determines that demeclocycline (Declomycin) is effective for a patient with a syndrome of inappropraite antidiuretic hormone based on finding that the patient’s:

  1. Weight has increased
  2. Urinary output is increased
  3. Peripheral edema is decreased
  4. Urine specific gravity is increased

The nurse determines that additional instruction is needed for a 60-year-old patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH) when the patient says which of the following?

  1. I need to shop for foods low in sodium and avoid adding salt to food
  2. I should weigh myself daily and report any sudden weight loss or gain
  3. I need to limit my fluid intake to no more than 1 quart of liquids a day.
  4. I will eat foods high in potassium because diuretics cause potassium loss.

Backlinks

  • No backlinks found

Graph View