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Oh yeah, we talked about that...
That's correct, but not the MOST correct...
You could do that...
Get your priorities straight
Hey Doc, are you sure you wanna do that?
100
A 65 year old man is prescribed Flomax (Tamsulosin) for Benign Prostatic Hyperplasia. The patient lives in an upstairs apartment. The nurse is most concerned about which side effect of Flomax? 1. Hypotension 2. Tachycardia 3. Back Pain 4. Difficulty Urinating
1. Hypotension Correct - Hypotension can lead to dizziness and a risk for injury to the patient. 2. Tachycardia Tachycardia can be a side effect of Flomax, but is not an immediate safety risk, nor is it a common side effect. 3. Back Pain Back Pain can be a side effect of Floma, but is not a safety risk 4. Difficulty Urinating Dysuria is a symptom of Benign Prostatic Hyperplasia, not a side effect of Flomax
100
A nurse knows that which of these patients are at greatest risk for a developing osteoporosis? 1. An 80-year old man who has a thin build 2. A 48-year old african american female who smokes cigarettes and drinks alcohol 3. A 55-year old female with an estrogen deficiency 4. A 70-year old caucasian female who takes oral corticosteroids
1. An 80-year old man who has a thin build Incorrect - Age and thin build are two primary risk factors, but another patient has more. 2. A 48-year old african american female who smokes cigarettes and drinks alcohol Smoking cigarettes and drinking alcohol are both primary risk factors, but being African American actually decreases the risk for osteoporosis 3. A 55-year old female with an estrogen deficiency Incorrect - Only two risk factors are present: being female, and having an estrogen deficiency. While her age is somewhat advanced, 65+ years of age is the 'cut-off' for having a risk factor in women. 4. A 70-year old caucasian female who takes oral corticosteroids Correct - This patient has by far the most risk factors, 3 of which are primary and one secondary. Age, gender, ethnicity are three primary risk factors, while her corticosteroid treatment is the secondary risk factor, bringing her total up to four.
100
Application - A nurse is caring for a patient admitted in the emergency room for an ischemic stroke with marked functional deficits. The physician is considering the use of fibrinolytic therapy with TPA (tissue plasminogen activator). Which history-gathering question would not be important for the nurse to ask? 1. "What time was the first time you noticed symptoms appearing consistently?" 2. "Have you been taking any blood thinners like heparin, lovenox, or warfarin?" 3. "Have you had another stroke or head trauma in the previous 3 months?" 4. "Have you had any blood transfusions within the previous year?"
1. "What time was the first time you noticed symptoms appearing consistently?" Incorrect - This is a relevant question because TPA is usually used no more than 5-6 hours after onset. This is the timeframe that damage to tissue is still reversible. 2. "Have you been taking any blood thinners like heparin, lovenox, or warfarin?" Incorrect - This is a relevant question because current anticoagulant use, or an INR of greater than 1.7, is a contraindication to TPA use. 3. "Have you had another stroke or head trauma in the previous 3 months?" Incorrect - This is a relevant question because having a stroke or head trauma in the last 3 months contraindicates TPA use 4. "Have you had any blood transfusions within the previous year?" Correct - This is not a relevant question and would not affect the decision to use TPA
100
Which of the following are s/s that a seizure may be coming on? Choose all that apply. A. Alteration in vision B. specific smell C. specific sound D. emotional feeling E. rhythmic jerking
A. Alteration in vision B. specific smell C. specific sound D. emotional feeling all of these are s/s of an "aura" which is a sign that a seizure is coming on (page 63 ATI Nursing resource) E. rhythmic jerking is a sign of the seizure itself.
100
Which of the following is not used to diagnose stroke? a. labs b. CT scan c. MRI d. PET scan
d. PET scan (positron emission tomography) which checks for: •Check brain function (checks function not whether you are bleeding or not or a block) •Diagnose cancer, heart problems, and brain disorders •See how far cancer has spread •Show areas in which there is poor blood flow to the heart
200
The client diagnosed with RA who has been prescribed Plaquenil, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach? a. Explain that the less medication loses its efficacy after a few months b. Continue to have regular eye exams while taking the medication c. Have yearly MRIs to follow the progress d. Discuss that the drug is taken for 3 weeks and then stopped for a week
b. Continue to have regular eye exams while taking the medication
200
While receiving normal saline infusions to treat a GI bleed, the nurse notes that the patient's lower legs have become edematous and auscultates crackles in the lungs. What should the nurse do first? 1. Stop the saline infusion immediately 2. Notify Physician 3. Elevate the patient's legs 4. Continue the infusion, since these are normal finding
1. Stop the saline infusion immediately CORRECT - the patient has a fluid volume overload as a result of overly rapid fluid replacement. The nurse should stop the infusion and notify the physician. 2. Notify Physician This is not the first action the nurse should take. 3. Elevate the patient's legs This would help with the edema, but is not a priority 4. Continue the infusion, since these are normal findings This is not a normal finding
200
A nurse is caring for a female patient 24 hours after a hip fracture. The patient is on bedrest. The nurse knows that which regular assessment or intervention is essential for detecting or preventing the complication of Fat Embolism Syndrome? 1. Performing passive, light, range of motion exercises on the hip as tolerated. 2. Assess the patient's mental status for drowsiness or sleepiness. 3. Assess the pedal pulse and capillary refill in the toes. 4. Administer a stool softener as ordered
1. Performing passive, light, range of motion exercises on the hip as tolerated. Incorrect - Immobilization and prevention of motion is the best way to reduce risk for fat embolism. 2. Assess the patient's mental status for drowsiness or sleepiness. Correct - A decreased Level of Consciousness is the earliest sign of FES, caused by decreased oxygen level. 3. Assess the pedal pulse and capillary refill in the toes. Incorrect - While assessing pedal pulse is important during a neurovascular assessment, it is not relevant to FES. Capillary refill is the least reliable indicator of poor perfusion 4. Administer a stool softener as ordered Incorrect - While this is an important intervention for patients on bedrest, it is not an intervention relevant to FES
200
What nursing action demonstrates the nurse understands the priority nursing diagnosis when caring for patients being treated with splints, casts, or traction? 1. The nurse assesses extremity pulse, temperature, color, pain, and feeling every hour. 2. The nurse orders meals with adequate protein and calcium for the patient. 3. The nurse teaches the patient never to insert objects under a cast to scratch an itch. 4. The nurse administers oral painkillers as ordered
1. The nurse assesses extremity pulse, temperature, color, pain, and feeling every hour. Correct - The priority nursing diagnosis would be Risk for Peripheral Neurovascular Dysfunction related to fractures, which is demonstrated by this action. 2. The nurse orders meals with adequate protein and calcium for the patient. Incorrect - This intervention relates to the diagnosis Imbalanced Nutrition: Less than Body Requirements. It is not the priority diagnosis. 3. The nurse teaches the patient never to insert objects under a cast to scratch an itch. Incorrect - This intervention relates to the diagnosis Insufficient Knowledge related to Traumatic Injury. It is not the priority diagnosis 4. The nurse administers oral painkillers as ordered Incorrect - This intervention relates to the diagnosis Acute Pain related to Traumatic Injury. It is not the priority diagnosis.
200
Application - The nurse is caring for a patient who has the following labs: Creatinine 2.5mg/dL, WBC 11,000 cells/mL, and Hemoglobin of 12 g/dL. Based on this information, which of these orders would the nurse question? 1. Administer 30 Units of Lantus Daily 2. CT of the spine with contrast 3. X-ray of the abdomen and chest 4. Administer heparin subcutaneous 5,000 Units every 12 hours
What is 1. Administer 30 Units of Lantus Daily Incorrect - None of the above labs contraindicate this order 2. CT of the spine with contrast Correct - The creatinine level of this patient indicates impaired kidney function. Contrast is nephrotoxic and is contraindicated for patients with nephropathy. 3. X-ray of the abdomen and chest Incorrect - None of the above labs contraindicate this order 4. Administer heparin subcutaneous 5,000 Units every 12 hours Incorrect - None of the above labs contraindicate this order
300
A nurse is caring for a client who has a nasogastric tube attached to low intermittent suctioning. The nurse should monitor for which of the following electrolyte imbalances? A. Hypercalcemia B. Hyponatremia C. Hyperphosphatemia D. Hypomagnesemia
A. INCORRECT: An increase in calcium is not indicated with nasogastric losses due to suctioning. B. CORRECT: The nurse should monitor the client for hyponatremia. Nasogastric losses are isotonic and contain sodium. C. INCORRECT: An increase in phosphatemia is not indicated with nasogastric losses due to suctioning. D. INCORRECT: A decrease in magnesium is not indicated with nasogastric losses due to suctioning.
300
A nurse is caring for a patient undergoing a stress test on a treadmill. The patient turns to talk to the nurse. Which of these statements would require the most immediate intervention? 1. "I'm feeling extremely thirsty. I'm going to get some water after this." 2. "I can feel my heart racing." 3. "My shoulder and arm is hurting." 4. "My blood pressure reading is 158/80"
1. "I'm feeling extremely thirsty. I'm going to get some water after this." Incorrect - This does not require immediate intervention. This is a common response to exercise and activity. 2. "I can feel my heart racing." Incorrect - This does not require immediate intervention. This is a common response to exercise and activity. 3. "My shoulder and arm is hurting." Correct - Unilateral arm and shoulder pain is one of the classic symptoms of myocardial ischemia. The stress test should be halted. 4. "My blood pressure reading is 158/80" Incorrect - This does not require immediate intervention. Moderate elevation in blood pressure is a common response to exercise and activity.
300
A nurse is assessing a client for Chovstek's sign. Which of the following techniques should the nurse use to perform this test? A. Apply a blood pressure cuff to the client's arm. B. Place the stethoscope bell over the client's carotid artery. C. Tap lightly on the client's cheek. D. Ask the client to lower his chin to his chest.
A. INCORRECT: This is performed to assess for Trousseau's sign. B. INCORRECT: This is performed to auscultate a carotid bruit. C. CORRECT: The nurse taps the client's cheek over the facial nerve just below and anterior to the ear to elicit Chvostek's sign. A positive response is indicated when the client exhibits facial twitching on this side of his face. D. INCORRECT: This is performed to assess for range of motion of the neck.
300
A 58-year-old male presents to the ER with crushing chest pain and a sense of impending doom after playing tennis 30 minutes ago. EKG has normal sinus rhythm, CK-MB 32, Troponin I-0.2, and Troponin T-0.1. Symptoms resolve 35 minutes after MONA protocol initiated. Patient most likely has what? A. stable angina B. unstable angina C. Myocardial infarction D. STEMI
B. unstable angina
300
Which of the following is contraindicated in a post kidney transplantation? choose all that apply. A. Plavix B. ASA 81mg C. Motrin D. Protonix
B. ASA C. Motrin You will give Plavix for clotting control and protonix because the corticosteroids can mess with the GI flora.
400
A nurse is caring for a client who has experienced a right-hemispheric stroke. Which of the following are expected findings? (Select all that apply.) A. Impulse control difficulty B. Left hemiplegia C. Loss of depth perception D. Aphasia E. Lack of awareness
A. Correct: A client who has experienced a right-hemispheric stroke will exhibit impulse control difficulty, such as the urgency to use the restroom. B. Correct: A client who has experienced a right-hemispheric stroke will exhibit left-sided hemiplegia. C. Correct: A client who has experienced a right-hemispheric stroke will experience a loss in depth perception. D. Incorrect: A client who has experienced a left-hemispheric stroke will experience aphasia. E. Correct: A client who has experienced a right-hemispheric stroke will demonstrate a lack of awareness of surroundings.
400
A patient with Meningitis is being treated with Vancomycin intravenously 3 times per day. The nurse notes that the urine output during the last 8 hours was 200mL. What is the nurse's priority action? 1. Check the patient's last BUN 2. Ask the patient to increase their fluid intake 3. Ask the physician to order a diuretic 4. Notify the physician of this finding
1. Check the patient's last BUN Incorrect - This may be relevant to nephrotoxicity and poor urine output, but is not the priority action. An assessment finding has already been done and indicates an immediate intervention. 2. Ask the patient to increase their fluid intake Incorrect - Increasing oral intake without other interventions will increase risk of increased ICP and fluid overload. 3. Ask the physician to order a diuretic Incorrect - This is premature and would not be the correct intervention. 4. Notify the physician of this finding Correct - Vancomycin is a nephrotoxic drug and can cause impaired renal perfusion, which would cause a decreased urine output. This is a serious adverse effect and should be reported to the physician.
400
Chlamydia trachomatis and Neisseria gonorrhea often present with sx in men of?
serous, milky or purulent penile discharge, burning on urination
400
What is the biggest complication of hyponatremia?
increased ICP causing neurological changes and brain damage.
400
What two types of Ischemic stroke are there? what is an Ischemic stroke defined by?
Thrombolytic and embolic. It is blood flow being blocked by either narrowing of the vessel (thrombolytic) or something floating in the vessel (embolism)
500
A nurse on a cardiac unit is reviewing the laboratory findings of a client who has a diagnosis of myocardial infarction (MI) and reports that his dyspnea began 2 weeks ago. Which of the following cardiac enzymes would confirm the infarction occurred 14 days ago? A. CK-MB B. Troponin I C. Troponin T D. Myoglobin
A. INCORRECT: The creatinine kinase MB levels are no longer evident after 3 days. B. INCORRECT: Troponin I levels are no longer evident after 7 days. C. CORRECT: The Troponin T level will still be evident 14 to 21 days following an MI. D. INCORRECT: Myoglobin levels are no longer evident after 24 hr.
500
A nurse enters a patient's room and finds them unconscious with a rhythmic jerking of all four extremities. The patient is foaming heavily at the mouth. The patient was on seizure precautions and the bedrails are up and padded. What is the nurse's priority action? 1. Administer Lorazepam (Ativan) 2. Turn the patient to his/her side 3. Call the physician 4. Suction the patient
1. Administer Lorazepam (Ativan) Incorrect - If a seizure lasts more than 5 minutes, it is called Status epilepticus and can be life-threatening. Physicians will often order anxiolytics or sedatives to treat this condition. However, at this point it would not be appropriate for the nurse to administer this drug. 2. Turn the patient to his/her side Correct - Turning the patient to the side will keep the airway open, which is the first priority 3. Call the physician Incorrect - This would be a priority action after ensuring the patient's safety, or in the case of Status epilepticus 4. Suction the patient Incorrect - This intervention is warranted, but after an assessment of the patient's airway, since forcing a suction catheter into a patient's mouth is a last resort.
500
Chlamydia trachomatis and Neisseria gonorrhoeae often present with sx in women of: a. Frequently do not cause symptoms in women b: UTI c. vaginitis d. mucopurulent cervicitis
a. Frequently do not cause symptoms in women But when they do, they will have sx of UTI, vaginitis, and mucopurulent cervicitis. (no sx is the most right answer since it is an option)
500
A nurse is caring for a client who just experienced a generalized seizure. Which of the following actions should the nurse perform first? A. Keep the client in a side-lying position. B. Monitor the client's vital signs. C. Reorient the client to the environment. D. Check the client for injuries.
A. Correct: The greatest risk to the client is aspiration during the postictal phase. Therefore, the priority intervention is to keep the client in a side-lying position so secretions can drain from the mouth. B. Incorrect: Monitoring vital signs to determine the stability of the client is important, but it is not the priority nursing action. C. Incorrect: Reorienting the client to the environment because the client may feel confused after a seizure is important, but it is not the priority nursing action. D. Incorrect: Checking the client for injuries that may of occurred from involuntary movement during the seizure is important, but it is not the priority nursing action.
500
what is the defining characteristic of a fat embolism?
petechiae