Exit 13 Flashcards
A child is admitted to the hospital with a diagnosis of Wilms tumor, stage II. Which of the following statements most accurately describes this stage?
A. The tumor is less than 3 cm. in size and requires no chemotherapy.
B. The tumor did not extend beyond the kidney and was completely resected.
C. The tumor extended beyond the kidney but was completely resected.
D. The tumor has spread into the abdominal cavity and cannot be resected.
C. The tumor extended beyond the kidney but was completely resected.
The staging of Wilms tumor is confirmed at surgery as follows: Stage I, the tumor is limited to the kidney and completely resected; stage II, the tumor extends beyond the kidney but is completely resected; stage III, residual non-hematogenous tumor is confined to the abdomen; stage IV, hematogenous metastasis has occurred with spread beyond the abdomen; and stage V, bilateral renal involvement is present at diagnosis.
A teen patient is admitted to the hospital by his physician who suspects a diagnosis of acute glomerulonephritis. Which of the following findings is consistent with this diagnosis? Note: More than one answer may be correct.
A. Urine specific gravity of 1.040.
B. Urine output of 350 ml in 24 hours.
C. Brown (“tea-colored”) urine.
D. Generalized edema.
A, B, and C.
Acute glomerulonephritis is characterized by high urine specific gravity related to oliguria as well as dark “tea colored” urine caused by large amounts of red blood cells. There is periorbital edema, but generalized edema is seen in nephrotic syndrome, not acute glomerulonephritis.
Which of the following conditions most commonly causes acute glomerulonephritis?
A. A congenital condition leading to renal dysfunction.
B. Prior infection with group A Streptococcus within the past 10-14 days.
C. Viral infection of the glomeruli.
D. Nephrotic syndrome.
B. Prior infection with group A Streptococcus within the past 10-14 days.
Acute glomerulonephritis is most commonly caused by the immune response to a prior upper respiratory infection with group A Streptococcus. Glomerular inflammation occurs about 10-14 days after the infection, resulting in scant, dark urine and retention of body fluid. Periorbital edema and hypertension are common signs at diagnosis.
An infant with hydrocele is seen in the clinic for a follow-up visit at 1 month of age. The scrotum is smaller than it was at birth, but fluid is still visible on illumination. Which of the following actions is the physician likely to recommend?
A. Massaging the groin area twice a day until the fluid is gone.
B. Referral to a surgeon for repair.
C. No treatment is necessary; the fluid is reabsorbing normally.
D. Keeping the infant in a flat, supine position until the fluid is gone.
C. No treatment is necessary; the fluid is reabsorbing normally.
A hydrocele is a collection of fluid in the scrotum that results from a patent tunica vaginalis. Illumination of the scrotum with a pocket light demonstrates the clear fluid. In most cases, the fluid reabsorbs within the first few months of life and no treatment is necessary. Massaging the area or placing the infant in a supine position would have no effect. Surgery is not indicated
A nurse is caring for a patient with peripheral vascular disease (PVD). The patient complains of burning and tingling of the hands and feet and cannot tolerate touch of any kind. Which of the following is the most likely explanation for these symptoms?
A. Inadequate tissue perfusion leading to nerve damage.
B. Fluid overload leading to compression of nerve tissue.
C. Sensation distortion due to psychiatric disturbance.
D. Inflammation of the skin on the hands and feet.
A. Inadequate tissue perfusion leading to nerve damage.
Patients with peripheral vascular disease often sustain nerve damage as a result of inadequate tissue perfusion. Fluid overload is not characteristic of PVD. There is nothing to indicate psychiatric disturbance in the patient. Skin changes in PVD are secondary to decreased tissue perfusion rather than primary inflammation.
A nurse is assessing a clinic patient with a diagnosis of hepatitis A. Which of the following is the most likely route of transmission?
A. Sexual contact with an infected partner.
B. Contaminated food.
C. Blood transfusion.
D. Illegal drug use.
B. Contaminated food.
Hepatitis A is the only type that is transmitted by the fecal-oral route through contaminated food. Hepatitis B, C, and D are transmitted through infected bodily fluids.
A leukemia patient has a relative who wants to donate blood for transfusion. Which of the following donor medical conditions would prevent this?
A. A history of hepatitis C five years previously.
B. Cholecystitis requiring cholecystectomy one year previously.
C. Asymptomatic diverticulosis.
D. Crohn’s disease in remission.
A. A history of hepatitis C five years previously.
Hepatitis C is a viral infection transmitted through bodily fluids, such as blood, causing inflammation of the liver. Patients with hepatitis C may not donate blood for transfusion due to the high risk of infection in the recipient. Cholecystitis (gallbladder disease), diverticulosis, and history of Crohn’s disease do not preclude blood donation.
A physician has diagnosed acute gastritis in a clinic patient. Which of the following medications would be contraindicated for this patient?
A. Naproxen sodium (Naprosyn).
B. Calcium carbonate.
C. Clarithromycin (Biaxin).
D. Furosemide (Lasix).
A. Naproxen sodium (Naprosyn).
Naproxen sodium is a nonsteroidal anti-inflammatory drug that can cause inflammation of the upper GI tract. For this reason, it is contraindicated in a patient with gastritis. Calcium carbonate is used as an antacid for the relief of indigestion and is not contraindicated. Clarithromycin is an antibacterial often used for the treatment of Helicobacter pylori in gastritis. Furosemide is a loop diuretic and is not contraindicated in a patient with gastritis.
The nurse is conducting nutrition counseling for a patient with cholecystitis. Which of the following information is important to communicate?
A. The patient must maintain a low calorie diet.
B. The patient must maintain a high protein/low carbohydrate diet.
C. The patient should limit sweets and sugary drinks.
D. The patient should limit fatty foods.
D. The patient should limit fatty foods.
Cholecystitis, inflammation of the gallbladder, is most commonly caused by the presence of gallstones, which may block bile (necessary for fat absorption) from entering the intestines. Patients should decrease dietary fat by limiting foods like fatty meats, fried foods, and creamy desserts to avoid irritation of the gallbladder.
A patient admitted to the hospital with myocardial infarction develops severe pulmonary edema. Which of the following symptoms should the nurse expect the patient to exhibit?
A. Slow, deep respirations.
B. Stridor.
C. Bradycardia.
D. Air hunger.
D. Air hunger.
Patients with pulmonary edema experience air hunger, anxiety, and agitation. Respiration is fast and shallow and heart rate increases. Stridor is noisy breathing caused by laryngeal swelling or spasm and is not associated with pulmonary edema.
A nurse is evaluating a postoperative patient and notes a moderate amount of serous drainage on the dressing 24 hours after surgery. Which of the following is the appropriate nursing action?
A. Notify the surgeon about evidence of infection immediately.
B. Leave the dressing intact to avoid disturbing the wound site.
C. Remove the dressing and leave the wound site open to air.
D. Change the dressing and document the clean appearance of the wound site.
D. Change the dressing and document the clean appearance of the wound site.
A moderate amount of serous drainage from a recent surgical site is a sign of normal healing. Purulent drainage would indicate the presence of infection. A soiled dressing should be changed to avoid bacterial growth and to examine the appearance of the wound. The surgical site is typically covered by gauze dressings for a minimum of 48-72 hours to ensure that initial healing has begun.
A patient returns to the emergency department less than 24 hours after having a fiberglass cast applied for a fractured right radius. Which of the following patient complaints would cause the nurse to be concerned about impaired perfusion to the limb?
A. Severe itching under the cast.
B. Severe pain in the right shoulder.
C. Severe pain in the right lower arm.
D. Increased warmth in the fingers.
C. Severe pain in the right lower arm.
Impaired perfusion to the right lower arm as a result of a closed cast may cause neurovascular compromise and severe pain, requiring immediate cast removal. Itching under the cast is common and fairly benign. Neurovascular compromise in the arm would not cause pain in the shoulder, as perfusion there would not be affected. Impaired perfusion would cause the fingers to be cool and pale. Increased warmth would indicate increased blood flow or infection.
An older patient with osteoarthritis is preparing for discharge. Which of the following information is correct?
A. Increased physical activity and daily exercise will help decrease discomfort associated with the condition.
B. Joint pain will diminish after a full night of rest.
C. Nonsteroidal anti-inflammatory medications should be taken on an empty stomach.
D. Acetaminophen (Tylenol) is a more effective anti-inflammatory than ibuprofen (Motrin).
A. Increased physical activity and daily exercise will help decrease discomfort associated with the condition.
Physical activity and daily exercise can help to improve movement and decrease pain in osteoarthritis. Joint pain and stiffness are often at their worst during the early morning after several hours of decreased movement. Acetaminophen is a pain reliever, but does not have anti-inflammatory activity. Ibuprofen is a strong anti-inflammatory, but should always be taken with food to avoid GI distress.
Which patient should NOT be prescribed alendronate (Fosamax) for osteoporosis?
A. A female patient being treated for high blood pressure with an ACE inhibitor.
B. A patient who is allergic to iodine/shellfish.
C. A patient on a calorie restricted diet.
D. A patient on bed rest who must maintain a supine position.
D. A patient on bed rest who must maintain a supine position.
Alendronate can cause significant gastrointestinal side effects, such as esophageal irritation, so it should not be taken if a patient must stay in a supine position. It should be taken upon rising in the morning with 8 ounces of water on an empty stomach to increase absorption. The patient should not eat or drink for 30 minutes after administration and should not lie down. ACE inhibitors are not contraindicated with alendronate and there is no iodine allergy relationship.
Which of the following strategies is NOT effective for prevention of Lyme disease?
A. Insect repellant on the skin and clothes when in a Lyme endemic area.
B. Long sleeved shirts and long pants.
C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks.
D. Careful examination of skin and hair for ticks following anticipated exposure.
C. Prophylactic antibiotic therapy prior to anticipated exposure to ticks.
Prophylactic use of antibiotics is not indicated to prevent Lyme disease. Antibiotics are used only when symptoms develop following a tick bite. Insect repellant should be used on skin and clothing when exposure is anticipated. Clothing should be designed to cover as much exposed area as possible to provide an effective barrier. Close examination of skin and hair can reveal the presence of a tick before a bite occurs.
