2012 & 2013 Past Exam Flashcards
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) Spo2 of 85%
b) Respiratory rate of 28/min
c) Presence of greenish sputum
d) Crackles in the right and left lower lobes
d) Crackles in the right and left lower lobes
A patient with an acute exacerbation of COPD has the following ABG analysis: pH 7.32, PaO2 58mmHg and SaO2 86%. You recognise these values as evidence of:
a) Respiratory acidosis
b) Respiratory alkalosis
c) Normal acid-base balance with hypoxemia
d) Normal acid-base balance with hypercapnia
a) Respiratory acidosis Normal values: pH 7.35 -7.45 PaCO2 41 - 51 mmHg PaO2 80 - 100 mmHg HCO3 22-26 mmol/l Base excess +2.5 to -2.5 SaO2 98%
The most common cause of pulmonary oedema is abnormal______function?
a) Kidney
b) Lung
c) Cardiac
d) Alveolar
c) Cardiac
A patient has a chest tube following a thoracotomy. Regular intermittent bubbling in 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 functionioning normally
d) A tension pneumothorax is developing
c) The unit is functionioning normally
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
b) A pleural effusion is not a disease but rather a sign of some other disease
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 vasodilation
c) Decreased activity of the renin-angiotensin system
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 intravasucular coagulation and necrosis of tissue distal to occlusions
a) Promoting atherosclerosis and damage of the walls of the arteries.
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
a) P wave
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 adn the impulse rate
d) The afterload and the preload
b) The stroke volume and the pulse rate Stroke volume x Heart Rate= Cardiac Output
One unit of packed cells is prescribed to be infused over 2 hours. The volume of the packed cells is 250mL. 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
a) 42/drops/min 250x20 divide= 41.6 (42 rounded up)
A patient with acute coronary syndrome is admitted to the Emergency Department. Which of the following statements is not true of this 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
b) His chest pain lasts only 2-5 minutes Cardiac markers can be normal upto 12 hours after an MI ECG with ST segment elevation and T wave inversion is an clinical manifestion of ACS Chest pain can occur with rest in ACS Chest pain lasts longer!! Our rationale
CK(Creatine Kinase)-MB and troponin levels are evaluated for a patient who has experienced chest pain and aching for the last 4 days. You expect:
a) Myoglobin levels will be needed to confirm myocardial damage
b) CK-MB will be the most reliable indicator of any myocardial necrosis that is present
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
d) The presence of myocardial damage occurring several days earlier can be validated best by the troponin level
Cardiac Biomarkers are released when there is damage
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
d) Obesity/dyslipidaemia/hypertension
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
b) Cigarette smoking
Following rectal surgery, the patient tells you that he urinates about 10mL of urine every 30-60 minutes. From the list below the best 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 unrination
d) Monitor the patient’s fluid intake and output over an 8-hour period to dertermine whether urine output is adequate
a) Palpate for a distended bladder Unsure but it says what you would initially do otherwise it would be D
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.
a) Case studies
b) Systematic reviews
c) Randomized double blind controlled trials
d) Prospective cohort studies
b) Systematic reviews They are the gold standard!
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 dependant on an outside sources 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
b) There is decreased insulin secretion and/or increased cellular resistance to insulin that is produced
Type 2 the pancreas makes some insulin but it is not produced in the amount your body needs and it does not work effectively(insulin resistance)
Type 1 the pancreas does not make any insulin and the person needs daily insulin. This is because the body cannot turn glucose into energy and the body subsequently burns fat which causes KETOACIDOSIS.
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 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 daaminated by the liver, causing acidic by-products.
b) An insulin deficit promotes metabolism of fat stores, which produces large amounts acidic ketones. (The bodys response to starvation)
You are studying research that ivestigates the effectiveness of alginate dressings on the rate of wound healing. The rate of wound healing is known as the:
a) Control variables
b) Extranous variables
c) Independant variable
d) Dependant variable
d) Dependant variable (Dependent variable is the variable that is the effect or is the result or outcome of another variable (eg wound debridement).
As per Lecture slide (Week 13)
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 (p) would be:
a) Less than .05
b) Less than .5
c) Greater than .5
d) Greater than 1
a) Less than .05 Expressed as a proportion between 0 and 1, where 0 = the event will not occur, 1 = the event will occur Level of significance is set before a study is commenced and is usually set at: p
A patient with hypovalemic shock has a urinary output of 30mL/hour. You understand that the compensatory physiological mechanism that leads to altered urinary output is:
a) Release of aldosterone, which increases serum osmolarity, causing releaseof antidiuretic hormone (ADH)
b) Movement of interstitual fluid to the intravascular space, increasing renal blood flow
c) Activation of the sympathetic nervous system, causing vasodilationn of the renal arteries
d) Beta-adrenergic receptor stimulation that causes increased cardiac output as a result of increased heart rate and myocardial contractility
a) Release of aldosterone, which increases serum osmolarity, causing releaseof antidiuretic hormone (ADH) ADH has an antidiuretic action that prevents the production of dilute urine to save fluid in the body
The major contributing factor to the development of oesophageal varices is:
a) Portal hypertension
b) Water retention
c) Lymphoedema
d) Increased serum
a) Portal hypertension Portal hypertension is defined as elevation of hepatic venous pressure.
Varices is an abnormally dilated vessel usually in the venous system, but may also occur in arterial or lymphatic vessels.
Ascites: Accumulation of fluid in the peritoneal cavity.
Hepatitis A is transmitted primarily through the:
a) Sharing of needles
b) Faecal-oral route
c) Unsafe sexual practices
d) Abuse of alcohol
b) Faecal-oral route
You are caring for a patient 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 quandrant pain
b) Impaired peripheral circulation
c) Asterixis
d) Urinary retention
c) Asterixis This is a tremor of the hand when the wrist is extended.(extension-hand facing up)
Asterixis is a clinical manifestation specific to hepatic encephalopathy
A reliable means of determining a patients total fluid status is to conduct:
a) 4 hourly blood pressures
b) Daily weights
c) Strict fluid balance charts
d) Diuretic challenges
c) Strict fluid balance charts Daily weights dont give an accurate account of urinary function but can give a clue to fluid shift within the body and the build up of oedoma.
The primary functions of the thyroid gland are to:
a) Control cellular metabolic actvitity
b) Maintain body metabolism
c) Control normal growth
d) All of the above
d) All of the above
Corticosteriod dosages must be gradually tapered off to avoid:
a) Thyroid storm
b) Addisonian crisis
c) Urinary retention
d) Adrenal insufficiency
d) Adrenal insufficiency This is because long term corticosteriod usage takes the place over from the body and if stopped suddenly can result in this.
Addison’s disease, the common term for primary adrenal insufficiency, occurs when the adrenal glands are damaged and cannot produce enough of the adrenal hormone cortisol.
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
a) Moon face Cushing’s syndrome, or hypercortisolism, is a collection of hormonal disorders characterised by high levels of the hormone cortisol.
A buffalo hump, which is extra fat around the neck and upper part of the back.
The most immediately life threatening of the fluid and electrolyte changes that occur in patients with acute renal failure is:
a) Hyponatramia
b) Hyperkalemia
c) Hypocalcemia
d) Hyperophosphatemia
b) Hyperkalemia In patients with acute renal failure they cannot remove excess potassium and this can cause deadly dysrythmias and alter muscle function.
Addison’s disease can lead to hyperkalemia. Hyponatramia– Low sodium (NA is sodium)
Hyperkalemia– High potassium (K is potassium) Hypocalcemia– Low calcium (CA is calcium) Hyperophosphatemia– High serum phosphate levels
The preferred method of permanent access for haemodialysis is:
a) Arteriovenous graft
b) PICC line(peripherally inserted central cathetor)
c) Peritoneal access device d)
Arteriovenous fistula
e)Venous cathetor (Emergency or short term access)
a) Arteriovenous graft= Long term access Arteriovenous fistula is a connection between an artery (which carries blood away from the heart) and a vein (which carries blood back to the heart). This allows the vein to become larger and for the walls of the vein to thicken, a process termed maturation. Arteriovenous graft Similiar to the fistula but is used for people with small veins/other contraindications while it lasts longer than the fistula it comes with an increased risk of clotting.
Define the following terms: Glycosuria
Is the excretion of glucose into the urine Two basic causes of glycosuria. One is that the level of blood glucose is so high that the renal tubules are unable to reabsorb all that is presented. The other is a failure of the tubules to reabsorb all glucose at a level where this should be possible called renal glycosuria.
Define the following terms: Steatorrhoea
Presence if excess fat in the faeces Diagnosis confirmed by stool testing for fat, patients with steatorrhoea typically report fatty, bulky stools that are difficult to flush away.
Define the following terms: Aldosterone
Steriod hormone(mineralcorticoid) Aldosterone is a hormone produced in the outer section (cortex) of the adrenal glands which sit above the kidneys. Aldosterone acts on organs such as the kidney and the colon to increase the amount of salt (sodium) reabsorbed into the bloodstream and the amount of potassium removed in the urine.
