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General Exams (Nursing Physiologya) – Page 3

#41. After several days of admission, Francis becomes disoriented and complains of frequent headaches. The nurse in-charge first action would be_______________.
A Document the patient’s status in his charts.
B Call the physician
C Raise the side rails
D Prepare oxygen treatment
Answer: Raise the side rails
#42. During routine care, Francis asks the nurse, “How can I be anemic if this disease causes increased my white blood cell production?” The nurse in-charge best response would be that the increased number of white blood cells (WBC) is________________.
A Have an abnormally short life span of cells
B Uses nutrients from other cells
C Crowd red blood cells
D Are not responsible for the anemia
Answer: Crowd red blood cells
#43. Diagnostic assessment of Francis would probably not reveal______________.
A Elevated thrombocyte counts
B Leukocytosis
C Predominance of lymhoblasts
D Abnormal blast cells in the bone marrow
Answer: Leukocytosis
#44. Robert, a 57-year-old client with acute arterial occlusion of the left leg undergoes an emergency embolectomy. Six hours later, the nurse isn’t able to obtain pulses in his left foot using Doppler ultrasound. The nurse immediately notifies the physician, and asks her to prepare the client for surgery. As the nurse enters the client’s room to prepare him, he states that he won’t have any more surgery. Which of the following is the best initial response by the nurse?
A Recording the client’s refusal in the nurses’ notes
B Notifying the nursing supervisor
C Notifying the physician immediately
D Explain the risks of not having the surgery
Answer: Explain the risks of not having the surgery
#45. During the endorsement, which of the following clients should the on-duty nurse assess first?
A The 58-year-old client who was admitted 2 days ago with heart failure, blood pressure of 126/76 mm Hg, and a respiratory rate of 22 breaths/minute.
B The 62-year-old client who was admitted 1 day ago with thrombophlebitis and is receiving L.V. heparin
C The 75-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving L.V. dilitiazem (Cardizem)
D The 89-year-old client with end-stage right-sided heart failure, blood pressure of 78/50 mm Hg, and a “do not resuscitate” order
Answer: The 75-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving L.V. dilitiazem (Cardizem)
#46. Honey, a 23-year old client complains of substernal chest pain and states that her heart feels like “it’s racing out of the chest”. She reports no history of cardiac disorders. The nurse attaches her to a cardiac monitor and notes sinus tachycardia with a rate of 136beats/minutes. Breath sounds are clear and the respiratory rate is 26 breaths/minutes. Which of the following drugs should the nurse question the client about using?
A Opioids
B Cocaine
C Benzodiazepines
D Barbiturates
Answer: Cocaine
#47. A 51-year-old female client tells the nurse in-charge that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client’s lump is cancerous?
A Nonmobile mass with irregular edges
B Eversion of the right nipple and mobile mass
C Nonpalpable right axillary lymph nodes
D Mobile mass that is soft and easily delineated
Answer: Nonmobile mass with irregular edges
#48. A 35-year-old client with vaginal cancer asks the nurse, “What is the usual treatment for this type of cancer?” Which treatment should the nurse name?
A Immunotherapy
B Surgery
C Chemotherapy
D Radiation
Answer: Radiation
#49. Cristina undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, N0, M0. What does this classification mean?
A Carcinoma in situ, no demonstrable metastasis of the regional lymph nodes, and ascending degrees of distant metastasis
B No evidence of primary tumor, no abnormal regional lymph nodes, and no evidence of distant metastasis
C Can’t assess tumor or regional lymph nodes and no evidence of metastasis
D Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
Answer: Carcinoma in situ, no abnormal regional lymph nodes, and no evidence of distant metastasis
#50. Lydia undergoes a laryngectomy to treat laryngeal cancer. When teaching the client how to care for the neck stoma, the nurse should include which instruction?
A “Keep the stoma uncovered
B Keep the stoma moist.
C Have a family member perform stoma care initially until you get used to the procedure
D Keep the stoma dry
Answer: Keep the stoma moist.
#51. A 37-year-old client with uterine cancer asks the nurse, “Which is the most common type of cancer in women?” The nurse replies that it’s breast cancer. Which type of cancer causes the most deaths in women?
A Brain cancer
B Colon and rectal cancer
C Breast cancer
D Lung cancer
Answer: Lung cancer
#52. Antonio with lung cancer develops Horner’s syndrome when the tumor invades the ribs and affects the sympathetic nerve ganglia. When assessing for signs and symptoms of this syndrome, the nurse should note ____________.
A arm and shoulder pain and atrophy of arm and hand muscles, both on the affected side.
B hoarseness and dysphagia.
C miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face.
D chest pain, dyspnea, cough, weight loss, and fever.
Answer: miosis, partial eyelid ptosis, and anhidrosis on the affected side of the face.
#53. Vic asks the nurse what PSA is. The nurse should reply that it stands for _________________.
A protein serum antigen, which is used to determine protein levels.
B prostate-specific antigen, which is used to screen for prostate cancer
C pneumococcal strep antigen, which is a bacteria that causes pneumonia
D Papanicolaou-specific antigen, which is used to screen for cervical cancer
Answer: prostate-specific antigen, which is used to screen for prostate cancer
#54. What is the most important postoperative instruction that nurse Kate must give a client who has just returned from the operating room after receiving a subarachnoid block?
A Notify a nurse if you experience blood in your urine
B Avoid drinking liquids until the gag reflex returns
C Remain supine for the time specified by the physician
D Avoid eating milk products for 24 hours
Answer: Remain supine for the time specified by the physician
#55. A male client suspected of having colorectal cancer will require which diagnostic study to confirm the diagnosis?
A Abdominal computed tomography (CT) scan
B Carcinoembryonic antigen (CEA)
C Stool Hematest
D Sigmoidoscopy
Answer: Sigmoidoscopy
#56. During a breast examination, which finding most strongly suggests that the Luz has breast cancer?
A Slight asymmetry of the breasts.
B Multiple firm, round, freely movable masses that change with the menstrual cycle
C A fixed nodular mass with dimpling of the overlying skin
D Bloody discharge from the nipple
Answer: A fixed nodular mass with dimpling of the overlying skin
#57. A female client with cancer is being evaluated for possible metastasis. Which of the following is one of the most common metastasis sites for cancer cells?
A White blood cells (WBCs)
B Liver
C Colon
D Reproductive tract
Answer: Liver
#58. Nurse Mandy is preparing a client for magnetic resonance imaging (MRI) to confirm or rule out a spinal cord lesion. During the MRI scan, which of the following would pose a threat to the client?
A The client asks questions.
B The client hears thumping sounds.
C The client wears a watch and wedding band.
D The client lies still.
Answer: The client wears a watch and wedding band.
#59. Nurse Cecile is teaching a female client about preventing osteoporosis. Which of the following teaching points is correct?
A Obtaining an X-ray of the bones every 3 years is recommended to detect bone loss.
B The recommended daily allowance of calcium may be found in a wide variety of foods.
C Obtaining the recommended daily allowance of calcium requires taking a calcium supplement.
D To avoid fractures, the client should avoid strenuous exercise.
Answer: The recommended daily allowance of calcium may be found in a wide variety of foods.
#60. Before Jacob undergoes arthroscopy, the nurse reviews the assessment findings for contraindications for this procedure. Which finding is a contraindication?
A Joint stiffness
B Joint flexion of less than 50%
C Joint pain
D Joint deformity
Answer: Joint flexion of less than 50%
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