RPN Intergrated Test VII (A)

RPN – Integrated Practice Test VII (A):1.What assessment should the PN be alarmed for possibility of toxicity due to cardiac glycosides?a.K⁺ level of 3.1 mEq/L – hypokalemia is a predisposing factor to Digoxin toxicity and NOT a signs ofDigoxin toxicityb.Hearing lossc.Yellow vision, poor appetite – these are signs of Digoxin toxicityd.Dry mucous membranesAnswer: C – these are signs of Digoxin toxicity2.Twenty four hours post laparoscopy, the nurse noted bleeding in dressing. Important nursing action:a.assess for abdominal distentionb.check patient vital signsc.position the client to semi-fowler‘s positionrm the physicianAnswer: B – vital signs (hypotension and tachycardia) are additional assessment that will confirm bleeding3. A 9-month old baby had repair of the foot and medication for pain was given as ordered. The mother said,―Why is the drug not working on my baby?‖ What is the right response?a.call the doctor for analgesicb.explain the meds will have an effect this timec.re-assess the child for further complicationsd.give another dose of pain analgesicAnswer: C – following pain medication, some pain relief is expected, however, other factors (post op complications) may contribute to discomfort.4. A child who sustained burn was treated successfully. On discharge teaching, the P N will teach the child‘smother that infection can be prevented by:a.Holding the baby with sterile glovese bleach when doing the laundryc.Changing the diaper as necessaryd.F requent hand washingAnswer: D –hand washing is the single and most effective way of preventing infection5.Top priority to promote safe nursing action to newborn following delivery?a.perform APGAR scoring at 1-5 minute after birthb.warm the infantc.establish respiratory rate and heart rated.place in supine positionAnswer: C –keeping the newborn‘s airway is the top priority following birth. Suctioning, side lying, and trendelenburg positions are different ways of keeping the airway patent.6.Which diet is appropriate to a client with stage 4 ulcer in the posterior chest?a.ice cream; milk; fruitskshake using skim milk; green vegetables; fruitsc.diet high in roughage; milkshake; fruitsd.c itrus fruits; green vegetables; white chicken; milkAnswer: D – vitamins and minerals (from fruits and vegetables) along with protein (milk and chicken) promote tissue repair and healing7. A student nurse, supervised by the PN, has performed the wound dressing on a client with abdominal wound.When documenting the procedure in the progress note, thea.Student nurse should documentb.The RN should documentc.The teacher should documentd.The attending physician should documentAnswer: A – the student has performed the wound care and wound dressing and thus she/he is responsible for the documentation8.Which of the following foods will promote tissue repair?a.Vegetablesb.Roughagec.Carbohydratesd.N utsAnswer: D – nuts contain protein and this is good for tissue repair9.Thrombus formation is a danger for all post operative patients. The nurse should act independently toprevent this complication by:a.Applying elastic stockingsb.Massaging gently with lotionc.Encouraging in-bed exercisesd.Providing adequate fluids intakeAnswer: C –inactivity causes venous stasis, hypercoagulability, and external pressure against the veins, all of which lead to thrombus formation.10. The PN recognizes that a pacemaker is indicated when a patient is experiencing:a.Anginab.Chest painc.Heart blockd.TachycardiaAnswer: C – This is the primary indication for pacemaker because there is an interference with the electrical conduction system of the heart.11. An essential nursing function in the care of a patient with arterial insufficiency in the left foot caused by generalized arteriosclerosis should be to:a.Maintain elevation of the legs.b.Massage the legs when painful.c.Check arterial pulse frequently.d.Apply a hot water bag to the feet.Answer: C – an altered quality of a variety of pulses in the extremity is the earliest indication of limited circulation.A – would interfere with gravity.B- this can release an embolus into the circulation; it may also cause tissue trauma.D – altered sensation may limit sensitivity to heat, which could result in burns.12. A client can‘t take deep breath and refuses to get out of bed because his chest tube is causing himdiscomfort. To promote the cli ent‘s compliance with ambulation and deep breathing, the PN should:a.Administer pain medication before having the client deep breathe, cough or get out of bedb.Tell the client the importance of lung expansionc.Arrange a care schedule to provide rest periodd.Teach the client how to use an incentive spirometerAnswer: A – ambulation and deep breathing are causing discomfort to the patient. Pre-medication will help the patient to perform these activities more effectively13. A client is recovering from an ileostomy performed to treat inflammatory bowel disease. During dischargeteaching, the PN should stress:a.Increasing fluid intake to prevent dehydrationb.Wearing an appliance pouch only at bedtimec.Consuming a low protein, high fiber dietd.Taking only enteric-coated medicationsAnswer: A – ileostomy continuously drain liquid or very soft stools. Adequate and extra fluids must be taken by the patient14. A client with increasingly difficulty swallowing, weight loss and fatigue had just received a diagnosis ofesophageal cancer. Because this client has difficulty in swallowing, the PN should give the highest priority to which action?a.Helping the client to cope with body image changesb.Ensuring adequate nutritionc.Maintaining patent airway – this is not necessary for the affected part is the esophagusd.Preventing injuryAnswer: B – difficulty swallowing may prevent the patient to eat necessary amount of food needed by the body. Soft or pureed diet or foods via NGT ensure nutrition15. A client with heart failure develops pink frothy sputum, coarse crackles and restlessness. Which of thefollowing actions should the PN take first?a.C heck the client‘s BPb.Place the client in high fowler’s positionc.C alculate the client‘s fluid balanced.Notify the physicianAnswer: B – these manifestations are indication of congestion in the lungs. High fowl er‘s position will provide relief from breathing problem. The physician must be notified after.16.The PN is observing a one day-old neonate. Which assessment finding indicates that oxygen needs are notbeing met by current treatments?a.RR 54 bpm – the normal RR is 30 to 60 bpmb.Abdominal breathing – newborns are abdominal breathersc.Nasal flaringd.Acrocyanosis – this is normally observed in most newborns due to the developing peripheral vascularsystemAnswer: C – nasal flaring is a sign of breathing problem in newborn17. A 15-month-old toddler is admitted with a diagnosis of croup and was placed in a mist tent with oxygen.The PN checks the child when he‘s asleep and notes the heart rate has increased to 120 b pm and RR to 36.What should the nurse do?a.Notify the MD immediatelyb.Notify the ICU for possible admissionc.Check the child’s SaO2 level using pulse oxymetryd.Check the child‘s BPAnswer: C - the normal heart rate for 15 month old ranges from 90 to 110 bpm; normal RR should be less than 40 bpm; the child is in the croup tent and sound asleep with HR of 120 and RR of 36.18. A 3-week-old infant was admitted with possible diagnosis of pyloric stenosis. When caring for the baby,which nursing intervention would be most important?a.Place the infant on his back for sleepb.Weigh the infant Q 12 hoursc.Position the infant in an infant seatd.Take the infant‘s VS q 8 hoursAnswer: A – supine position is the safest to all newborn babies, however, following feeding, upright position is preferred to prevent aspiration specially if the newborn vomits. Side lying or prone positions are highly associated with SIDS.19. A 3-year-old is brought to the ER with fractured wrist and suspicious looking bruising on his arms. Thestep father claims that the boy fell out of bed. What is the most important criterion for the PN to considerwhen deciding to report suspected child abuse?a.Inappropriate parenteral concern for the degree of injuryb.Absence of parents for questioning about the injuryc.Inappropriate response of the child to the injuryd.Incompatibility between the history and injuryAnswer: D – in child abuse, the historical account is greater than the actual injury20. A 28-year-old was admitted in the ER with multiple laceration and bruises to her face. The PN is aware thatthe client has a history of being abuse. What is the role of the PN in domestic abuse?a.Document the findings and provide support to the victimb.Protect the client privacy by not documenting the abuse – documenting the finding is a legal responsibilityc.Provide counseling for the abuse –this is not the RN‘s roled.Provide counseling to the victim –this is not the RN‘s roleAnswer: A – reporting abuse, documenting the finding, and providing support to the victims are the primary responsibilities of the PN21.The PN is caring for a client with wound infection who’s on strict isolation. When leaving the room of theclient, which protective equipment should the PN remove first?a.capb.maskc.gownd.glovesAnswer: D – wound will prov ide the RN’s direct exposure to the patient’s wound. Clean gloves will afford protection to the PN22.One of the most important aspects of pre-operative care of a neonate born with myelomeningocele ispositioning. Which of the following position is most important?a.supine and flatb.side-lying and flatc.prone with hips elevatedd.prone with head elevatedAnswer: C – prone position prevent pressure on the sac in the spine23.After performing a physical examination and obtaining a health history on a newly admitted client, the PNshould document her finding. When documenting the information in a client medical record, the PN should do which of the following?a.Erase any errore # 2 lead pencilc.Leave one line blank before each new entryd.End each entry with the PN’s sign ature and titleAnswer: D –the legal aspect of nurse‘s documentation and each entry made by the RN include date, signature, and title of the nurse.24. A PN is preparing a client with AIDS for discharge to home. Which instruction should the PN be sure toinclude?a.apply disposable gloves before showeringb.sterilize all plates and utensils in boiling waterc.avoid sharing toothbrushes and razorsd.avoid eating foods from serving dishes shared by other family membersAnswer: C – insignificant bleeding from minor cuts may results with the use of toothbrush and razor blades. The cuts in the skin will serve as port of entry for HIV virus25.Mrs. H was admitted with severe dehydration. She was placed in an isolation room with a foley cath inplace. The RN noted no ―urine output‖ in the foley bag. What pertinent assessment performed by the PN is important?a.Check the tube placementb.Palpate the bladder–the patient was severely dehydrated and perhaps there was no urine form yetc.Remove the catheter and reinsertrm the physician26.The patient was admitted with dehydration. Which question asked by the PN can be used as basis inassessing the patient‘s hydration status?a.When was the last you peed?–this is an assessment of fluid in the bodyb.When was the last time you drink?c.When was the last you ate?d.When was the last time you moved your bowel?27.Seven days following a successful recovery from TURP, which of the following statement made by the PNfocuses on preventing possible post op complication?a.―You will expect your urine to have small amount of blood‖b.―You must continue doing kegal exercise‖c.―You may now resume sexual intercourse‖d.“You need to avoid strenuous exercise”–this may precipitate bleeding28.While you were doing your late afternoon rounds, you‘ve noticed fire coming from the nurse‘s lounge.What will be the most appropriate initial action?a.Pull the fire alarm–remember the acronym RACE when dealing with fireb.Close all doors in the unitc.Try to put out the fired.Start evacuating the patient to a safer place29. A nurse manager from the medical unit asks one of the staff to continue working after a 12 hour shiftbecause one of the staff was not able to come to work. What would be the staff appropriate response?a.Accept the offer if the hospital compensates fairlyb.Stay and ensure for an overtime payc.Ask the manager to call for a relief and continue working until the relief arrives–the welfare of thepatient should be the top priority when working extra shift; if the nurse is already tires, anarrangement like this should be doned.Stay and manage the complexity of the workload by distributing the load to the staff30.Your patient handed you an enveloped with large sum of money. What would you do?a.Take it as an appreciation to your excellent nursing careb.Take the money and inform your colleaguec.Instruct the patient to donate the funds to the hospital–this is appropriated.Take the money and keep it in the unitCase Study:Three days ago, Mr. Arnold is a 78-year-old ♂ patient, was admitted in the community hospital due to exacerbation of his emphysema and chronic bronchitis. In preparation for his discharge, he was referred to the respiratory therapist (RT) and was taught deep breathing and coughing exercises to improve his oxygenation.Questions 79 to 83 refer to this case31.Based on the progress‘ note entry made by the RT, Mr. Arnold was not performing deep breathing andcoughing exercises taught to him. In this situation, the most appropriate action the PN takes would be:a.Assess and identify if the patient has some learning issues.b.Investigate if the patient‘s discharge can be delayed until he learns the procedure.c.Emphasize the importance of deep breathing and coughing exercises to the patient.d.Refer the patient to the respiratory therapist.Answer: A – the most common cause of the inability of the patient to perform the coughing and breathing exercises taught to him was lack of understanding of the importance of the teaching. The nurse needs to validate this aspect before taking further steps.32.How would the PN ensure that Mr. Arnold adheres to the coughing and breathing exercises post-discharge?a.Set up a follow-up appointment.b.Provide thorough health teachings before discharge.c.Refer the patient to the visiting nurse.d.Refer the patient to the home care management.Answer: A – setting up a follow up appointment enables the nurse to assess the patient and his compliance with the health teaching.33.While still in the hospital, Mr. Arnold fell on the floor from his chair. The PN rushed to rescue and foundthe patient very pale, cold, and clammy. Which actions made by the PN is most appropriate?a.Call the doctor; perform CPR.b.Loosen the patient‘s shirt‘s buttons and tie.c.Call for assistance.d.Ask the nursing aide to stay with the patient; while the nurse gets the code blue cart.Answer: C – if appropriate, the nurse may need an assistance to carry the patient back to the bed.Case StudyFatima is a 75-year-old-♀ patient, origina lly came from Iran, was admitted in the medical cardiac unit. Questions 84 to 85 refer to this case34.She complains of chest pain although it was described as mild, she was given NTG SL. After the 3rddose, she claims that she was still feeling the mild chest pain. Which of the following actions taken by the PN is appropriate?rm the RNb.Monitor VSc.Ensure strict bedrestd.Give another NTGAnswer: A – the physician must be informed since the patient has already received the maximum doses of NTG. Usually if chest pain persists after the 3rd dose of NGT, a more complicated and serious heart problem (like MI-myocardial infarction) has occurred.35.Fatima‘s serial cardiac enzymes tests confirmed an MI complicated by an acute heart failure or congestiveheart failure. Upon learning the outcome, Fatima became very depressed. The PN has taken the mostappropriate course of action by doing which of the following?a.Arrange that the patient be transferred to a private room.b.Arrange that the patient be transferred to th e room nearest to the nurse’s station.c.Place the patient in an orthopneic position.d.Ensure that the patient strictly follows her prescribed diet.Answer: B –the patient is depressed and very prone to suicide attempts. A room closer to the nurses‘ statio n will allow the nurses and other staff to constantly see and/or observe the patient.Case Studyboratory tests are performed on a patient with diabetic ketoacidosis. The PN should expect the tests toreveal:a.Low serum glucose, increased acidity, high carbon dioxide.b.Low serum glucose, decreased acidity, low carbon dioxide.c.Elevated serum glucose, normal acidity, high carbon dioxide.d.Elevated serum glucose, increased acidity, low carbon dioxide.Answer: D – diabetic ketoacidosis literally means high blood glucose; the pathophysiologic process includes the production of ketones (causing acidity) as the liver unconventionally uses ketones from fatty acids for energy; CO2 is low because this involves a metabolic process.37.The family of the elderly, aphasic patient, complains that the PN failed to obtain a signed consent beforeinserting an indwelling catheter to measure hourly output. This is an example of:a. A catheter inserted for the patient‘s benefit.b. A treatment that does not need a separate consent form.c.Treatment without consent of the patient, which is an invasion of rights.d.Inability to obtain consent for treatment because the patient was aphasic.Answer: B – on admission, patients or their proxy signs consent for general, non-invasive procedure that are commonly performed. These include starting peripheral IV; venipuncture; IM injection; inserting foley cath, ect.38.The patient has a bronchoscopy in ambulatory surgery. To prevent laryngeal edema, the PN should:a.Place ice chips in the patient‘s mouth.b.Offer the patient liberal amounts of fluid.c.Keep the patient in the semi-fowler’s position.d.Tell the patient to suck on medicated lozenges.Answer: C- with the head elevated, rather than horizontal or dependent, fluid will not collect in the interstitial spaces around the trachea.39.Christy is a 75-year-old elderly female patient who has a history of controlled diabetes mellitus andosteoarthritis of her right arm. She lives alone in her apartment and able to manage her activities of dailyliving without assistance. Three days ago she was admitted in the hospital for a total hip replacement of the L hip. She is now on her 2nd day post op. Nursing care plan promoting circulation for Christy would include:a.Isometric quadriceps exercise.b.Range of motion exercise.c.Active and passive range of motion exercise.d.Place abduction pillows in between the legs.Answer: A – this is the best and safest exercise that promotes circulation and prevents hip dislocation post hip replacement post hip replacement. Post hip replacement, the affected hip should remain extended and abducted. Isometric Exercise, no joint movement but has muscle contraction.40.The incidence of anemia among young adults is progressively increasing. Which of the followingpredisposing factors may cause anemia among young adults?a.sleeping patternb.not eating meat & vegetablesc.WBC 9000d.drinking too much alcoholic beveragesAnswer: B – meat and vegetables are rich in iron. Iron is essential in RBC production.41.James is a young-13-year-old teen-ager who presented himself to the school nurse due to his acne andlesions noticeable in his forehead and chin. The boy claims that he is seriously bothered by his physicalappearance and that he needs help to clear up the lesions. Based on this assertion, the nurse will suggestthat the young boya.avoids exposing himself, especially his face, to the sunb.dries his face with 100% cotton towel following a warm shower.es mild soap for his face and face wash that contains the lowest concentration of alcohol andhydrogen peroxide.d.limits or avoids sweets, chocolate, and fried foods.Answer: D – foods traditionally blamed for acne breakouts include nuts, chocolate, sweets, fried foods and milk. Thus, the best way to teat acne is by changing the diet.42.Mr. Chu was admitted in the hospital with a diagnosis of kidney infection. On physical assessment, hecomplains of tenderness in his flank area. He said that he has been eating poorly for about 3 days nowand he is also nauseated. In v iew of the nurses‘ findings, an appropriate intervention for the patientwould be:a. To d rink at least 3 to 4 L of fluid per day.b. To take sitz baths 3 to 4 times per day for urethral burning.c. To void immediately after sexual intercourse.d. To avoid exposure to persons with upper respiratory infections.Answer: A - kidney infection occurs when bacteria gets access to the bladder. Large amount of fluids promote urination, empty and wash out bacteria in the bladder.43.Michael is a 33-year-old openly self- pronounced homosexual, was admitted for a pulmonary infection. Heis positive for HIV and an active user of illicit drug. He was treated with combinations of antibiotics. His recovery was uneventful and today he is being discharged to home. Which of the following patient‘sstatements indicate a thorough understanding of the discharge instructions?a.―Condom will not be required for u s during sex as my partner and myself are both HIV⁺.‖b.―I will start donating blood again as soon I‘m fully recovered.‖c.―I will keep a box of condom in my glove compartment and make them readily available.‖d.“I’ll see to it that a sharp container for my used needles is placed in a secured place at home.”Answer: D – sharp container for used needles promote safety not only for the patient but also for other people living with the patient.44.In evaluating the client‘s fluid balance, which of the following findings would most likely require anintervention:a.Intake is greater than outputb.Output is greater than intakec.Weight lossd.Weight gainAnswer: A – output is essentially desired to be greater than intake. Intake more than output can stress the heart especially in elderly patients and/or patients with heart and kidney problems45.Pritzy, a 21-year-old young lady, was raped by her boyfriend. Following an extensive investigation in theemergency department, Pritzy decided to withdraw charges against her boyfriend. The PN who is involved in the care of the patient will appropriately do which of the following?a.The PN states, ―It‘s really upsetting when people have different opinions.‖b.The PN states, “The client’s decision must be respected”.c.The PN agrees with the medical team that the patient should press charges against her boyfriend.d.The medical team should perform a more extensive investigation.Answer: B –the patient‘s decision must be respected even if it is against the health team‘s view.46.Candice is a young girl who was admitted in the ER due to an acute asthma attack. She was placed inthe ER holding area and waiting for a bed in the medical unit. She receives bronchodilating agents(Albuterol) via hand held nebulizer and was started on IV Solucortef. Which of the following changes in the patient‘s condition best indicates th at Candice is responding favorably to the medications?a.RR 22; wheezing decreased.b.HR 90; BP 100/64.c.Urine output 40 ml last 2 hours; BP 100/64.d.RR 18; HR 54.Answer: A – normal respiratory rate and decreased wheezing are signs of bronchodilation, a desired effect of the albuterol.47.Nursing assessment indicating effective fluid resuscitation on a patient who sustained 2nd and 3rd degreeburnsinclude:a.Urine output of 100 ml for the last 2 hours.b.Skin recoils when pinch.c.Hematocrit level higher than the previous reading.d.Increasing heart rate.Answer: A – increased urine output is a good indication that the fluids replaced in a burn patient was successful. This means that the kidneys are adequately perfused.rry is a 38 year-old male patient, HIV+ and has history of Hepatitis C, presents with 4-day history of earproblem. He also complains of dizziness, headache, and loss of balance when ambulating. He states, ‗I feel bugs crawling to my left ear, I need a flush‘. He has seen 4 different doctors about his ear problem but‗nothing was ever done‘ he claimed. Following otoscopic examination, the physician ordered earirrigation. The PN who performs the procedure can prevent transmission of HIV infection by which of thefollowing precautionary measures?a.Wear gloves when irrigating the patient’s ear.b.Wear mask and gown when irrigating the patient‘s ear.c.Isolate the patient during the ear irrigation procedure.d.Wash hands before and after the procedure.Answer: A – HIV virus can be transmitted through body fluids. Used of clean gloves when irrigating the ear of the patient who is HIV⁺ prevents the nurse from being directly exposed to the body fluids of the patient. This is usually sufficient protection.49.Viktoriya, a 74-year-old Russian immigrant, was being discharge to home following blood sugar controlfor her diabetes. She was diagnosed with type 1 DM when she was 8 years old. She sustainedpoor/impaired vision from her DM; had a mild stroke 5 years ago; heart failure; and well-controlledhypertension. She was prescribed different medications for maintenance of her blood pressure, heartproblem and other medical condition. An important discharge teaching for this patient who will be takingdifferent medications that come in tablets forms and different colors would be:a.Encourage the technique of color flagging.b.Encourage the patient to use magnifying glass.c.Instruct the patient to store the pills in different places in the house.cate the patient on the sizes and shapes of the pills.Answer: D – a patient who is visually impaired usually has a well-developed sense of touch (as well as other senses) to compensate for loss of good vision.50.Understanding that there is a need to protect susceptible persons from exposure to chickenpox during theacute phase, the PN should question the mother of a child with chickenpox about relatives or friends whoare receiving:a.Long-term anticonvulsant therapy.b.Prolonged topical antibiotic therapy.c.High doses of systemic steroid therapy.d.Therapeutic doses of vitamins and minerals.Answer: C – individuals taking steroids have lowered resistance and may become fatally ill if exposed to varicella virus.51.The patient weighed 210 pounds on admission to the hospital. After 2 days of diuretic therapy the patientweighs 205.5 pounds. The PN could estimate that the amount of fluid the patients has lost is:a.0.5 Lb. 1.0 Lc. 2.0 Ld. 3.5 LAnswer: C – one liter weighs approximately 2.2 pounds; therefore, a 4.5 pound weight loss equal approx 2 liters.52.When taking the BP of a patient who has AIDS the PN must:a.Wear clean gloves.e barrier techniques.c.Wear a mask and gown.d.Wash the hands thoroughly.Answer: D – blood and body fluid precautions require that hands be washed before and after patient care to minimize the risk of transmission.Case Study。