LMS Multi-Choice, "The Game" & SDLP Flashcards by Mr Dirks

The patient asks the nurse what function the tonsils serve. Which of the following would be the most accurate response?

a. The tonsils aid digestion
b. The tonsils help to guard the body from invasion of organisms
c. The tonsils contain nerves that provoke sneezing
d. The tonsils regulate the airflow to the bronchi
e. The tonsils serve no known physiological purpose

b. The tonsils help to guard the body from invasion of organisms

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The nurse is caring for a patient who has just returned to the unit after a colon resection. The patient is showing signs of hypoxia.
The nurse knows that this is probably caused by what?

a. Diffusion
b. Interbalance
c. Perfusion
d. Shunting
e. Incorrect application of the oxygen saturation probe

d. Shunting

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You are caring for a patient admitted with chronic obstructive pulmonary disease. During your shift assessment, you find that your patient is experiencing a change in his respiratory and mental status.
You are aware that the most accurate measurement of the concentration of oxygen in the patient’s blood is what?

a. A capillary blood sample
b. Pulse oximetry
c. An arterial blood gas study
d. Assessment of the patient’s nailbeds
e. Lung field auscultation

c. An arterial blood gas study

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You are the nurse working on the respiratory intensive care unit. You are aware that several respiratory conditions can affect the compliance of the lung tissue. Which condition leads to an increase in lung compliance?

a. Emphysema
b. Pulmonary fibrosis
c. Pleural effusion
d. ARDS
e. Bronchitis

a. Emphysema

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Your patient has multiple sclerosis. Neuromuscular disorders such as multiple sclerosis may lead to a decreased vital capacity. What does vital capacity measure?

a. The volume of air inhaled and exhaled with each breath
b. The volume of air in the lungs after a maximum inspiration
c. The maximum volume of air inhaled after normal expiration
d. The maximum volume of air exhaled from the point of maximum inspiration
e. The maximum volume of air exhaled after a maximum expiration

d. The maximum volume of air exhaled from the point of maximum inspiration

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The instructor of the physiology class for pre-nursing students is talking about the lower respiratory tract. The instructor talks about the visceral and parietal pleura and the small amount of fluid between the two membranes. What does the instructor tell her students the function of the pleura and the pleural fluid is?

a. Allows for full expansion of the lungs within
the thoracic cavity
b. Prevents the lungs from collapsing within the
thoracic cavity
c. Determines lung expansion within the thoracic
cavity
d. Permits smooth motion of the lungs within the thoracic
cavity
e. None of the above

d. Permits smooth motion of the lungs within the thoracic

cavity

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You are caring for a patient with a lower respiratory tract infection. You know that this type of infection causes what?

a. Impaired gas exchange
b. Collapsed bronchial structures
c. Ruptured blebs
d. Closed bronchial tree
e. Sputum production

a. Impaired gas exchange

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You are working on a gerontology unit. You admit a 77-year-old with respiratory problems. You know that the amount of respiratory dead space increases with age.
What do these changes result in?

a. Increased diffusion of gases
b. Decreased diffusion capacity for oxygen
c. Decreased shunting of blood
d. Increased ventilation
e. Increased perfusion

b. Decreased diffusion capacity for oxygen

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Your patient has just had an MRI ordered because a routine chest x-ray showed suspicious areas in the right lung. The physician suspects bronchogenic carcinoma.
You would know that an MRI would assess for what in this patient?

a. Patency of the bronchial tree
b. To evaluate inflammatory activity
c. Ability to expand the lung
d. Chest wall invasion
e. Shunting of the blood supply

d. Chest wall invasion

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You are caring for a patient with chronic obstructive pulmonary disease. When you auscultate this patient’s breath sounds, what do you expect to hear?

a. Continuous popping sounds early in inspiration
b. Harsh, dry sounds originating in the large bronchi
c. Discontinuous popping sounds heard in early inspiration
d. Soft, high-pitched, popping sounds that occur during inspiration
e. snap crackle and pop just like Rice Bubbles

a. Continuous popping sounds early in inspiration

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The nursing instructor is explaining cardiac function to the senior nursing class. The instructor explains that blood is ejected into circulation as the chambers of the heart become smaller. The instructor categorises this action of the heart as what?

a. hyptertension
b. ejection fraction
c. systole
d. terminal volume
e. diastole

c. systole

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The nurse is caring for a patient with unstable angina. The laboratory result for the initial troponin I is elevated in this patient. The nurse recognises what?

a. It is not an accurate indicator of anything
b. Because the entry diagnosis is unstable angina this is a poor indicator of myocardial injury
c. This is only an accurate indicator of myocardial damage when it reaches its peak in 24 hrs
d. This is an accurate indicator of myocardial injury
e. It is only an accurate indicator of skeletal muscle injury

d. This is an accurate indicator of myocardial injury

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The nurse is caring for a patient who is receiving an ECG. The nurse notes that leads I, II, and III differ from one another on the cardiac rhythm strip. Why is this?
Select one:
a. The view of the electrical current changes in relation to the lead placement.
b. Electrocardiogram (ECG) equipment has malfunctioned
c. The limb leads are in an incorrect manner
d. The circadian rhythm has changed.
e. Conduction of the heart differs with lead placement.

a. The view of the electrical current changes in relation to the lead placement.

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The staff educator is teaching a class on conduction problems in the heart. The educator explains that in an adult patient who has damage to the electrical conduction of the ventricles of the heart, the nurse would expect to see changes in what?

a. QRS complex
b. T wave
c. Y-Z wave
d. P wave
e. U Wave

a. QRS complex

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Your patient has returned from the operating room after having a permanent pacemaker implantation. Which potential complication should you assess for in a postoperative patient with permanent pacemaker implantation?

a. Decreased pulse rate
b. Decreased appetite
c. Bleeding at the generator-implantation site
d. Decreased respiratory rate
e. Decreased urine output

c. Bleeding at the generator-implantation site

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During a CPR, class a student in the class asks what the difference is between cardioversion and defibrillation. What would be the nurse’s best response?

a. “Defibrillation is synchronised with the electrical activity of the heart, cardioversion is not.”
b. “Cardioversion is done on a beating heart, defibrillation is not.”
c. “The difference is the timing of the delivery of the electric current.”
d. “Cardioversion is always attempted before defibrillation because it is not as dangerous.”
e. They are identical

b. “Cardioversion is done on a beating heart, defibrillation is not.”

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The triage nurse in the emergency department assesses a 66-year-old male patient who presents to the emergency department with complaints of midsternal chest pain that has lasted for the last 5 hours. The nurse is aware that because of the length of time the patient has been experiencing symptoms, if they are due to a MI, what has happened to the myocardium?

a. May have developed an increased area of infarction
b. That it couldn’t be an MI, it must be reflux
c. Will probably not have more damage than if he came in immediately
d. Has been damaged already, so immediate treatment is no longer necessary
e. Can have restoration of the area of dead cells with proper treatment

a. May have developed an increased area of infarction

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The nurse knows that the blood vessel most commonly used as source for a (coronary artery bypass graft) CABG is what?

a. Greater saphenous vein
b. Femoral artery
c. Femoral vein
d. Brachial vein
e. Brachial artery

a. Greater saphenous vein

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A patient with angina is beginning nitroglycerin. Before administering the drug the nurse informs the patient that immediately after administration, the patient may experience what?

a. Drowsiness
b. Throbbing headache or dizzyness
c. Nervousness
d. Paraesthesia
e. Tinnitus

b. Throbbing headache or dizzyness

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The nurse is caring for a patient who has experienced an MI. The nurse notes that there are changes in the ECG of the patient. What change on an ECG may indicate that ischaemia is occurring?

a. T-wave inversion
b. Q-wave changes with no change in ST or T wave
c. P-wave enlargement
d. T-wave elevation
e. P-wave inversion

a. T-wave inversion

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The nurse caring for a client with acute coronary syndrome knows that the top priority in the care of this patient is what?

a. Balancing intake and output
b. Decreasing energy expenditure of the myocardium
c. Balancing myocardial oxygen supply with demand
d. Decreasing nutritional need of myocardial muscle
e. Making sure they get a good cup of coffee

c. Balancing myocardial oxygen supply with demand

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You are caring for a patient who is scheduled to undergo a valvuloplasty to repair a defective heart valve. You would include in your patient education which priority area?

a. Long-term anticoagulant therapy
b. Exercise program
c. Patient controlled analgesia
d. Long-term steroid therapy
e. Long-term antibiotic therapy

a. Long-term anticoagulant therapy

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You are caring for an Ethiopian refugee who has been diagnosed with mitral valve regurgitation. You know that in developing countries the most common cause of mitral valve regurgitation is what?

a. Sepsis and its sequelae
b. A decrease in gamma globulins
c. An insect bite
d. Paracetamol overdose
e. Rheumatic heart disease and its sequelae

e. Rheumatic heart disease and its sequelae

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The nurse notes that a patient has developed a cough productive for mucoid sputum, is short of breath, has cyanotic hands and has noisy, moist-sounding, rapid breathing. These symptoms indicate:

a. Right ventricular hypertrophy
b. Pericarditis
c. Heart failure
d. Right atrial hypertrophy
e. Pulmonary oedema

e. Pulmonary oedema

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You are assessing a patient suspected of having right-sided heart failure. What assessment finding may indicate right-sided heart failure? a. Pulmonary oedema b. Distended neck veins c. Dry cough d. Hypotension e. Orthopnoea

b. Distended neck veins

You are caring for an 84-year-old male who has just returned from the operating room (OR) after inguinal hernia repair. You note the patient has fluid volume excess from the OR and is at risk for left-sided heart failure. What signs and symptoms indicate left-sided heart failure? a. Left upper quadrant pain b. Bibasilar fine crackles c. Dependent oedema d. Jugular vein distention e. Right upper quadrant pain

b. Bibasilar fine crackles Bibasilar crackles: are the clicking, rattling, or crackling noises heard on auscultation of the lung caused by the"popping open" of small airways and alveoli collapsed by fluid, exudate, or lack of aeration during expiration. (Which is a sign of left sided HF)

The cardiac monitor alarm alerts the critical care nurse that the patient is showing no cardiac rhythm on the monitor. When the nurse assesses the patient, she determines that the patient is experiencing cardiac arrest. In providing cardiac resuscitation documentation, how will the nurse describe this initial absence of cardiac rhythm? a. Pulseless electrical activity (PEA) b. asystole c. Atrial fibrillation d. Ventricular fibrillation e. Ventricular tachycardia

b. asystole

Intracardia thrombi are especially common in what kind of patients? a. Those with atrial fibrillation b. Those with ventricular tachycardia c. Those with pulmonary oedema d. Those with ventricular fibrillation e. Those with atrial tachycardia

a. Those with atrial fibrillation

The nurse is taking a health history on a new patient. The patient reports experiencing pain in the left lower leg and foot when walking. This pain is relieved with rest. The nurse notes that the left lower leg is slightly oedematous and is hairless. What does the nurse suspects that the patient may be experiencing? a. Coronary artery disease b. Raynaud's disease c. Intermittent claudication d. Diabetes e. Arterial embolus

c. Intermittent claudication Intermittent claudication is muscle pain (ache, cramp, numbness or sense of fatigue) which occurs during exercise, such as walking, and is relieved by a short period of rest.

While assessing a patient the nurse notes that the patient's ankle-brachial index (ABI) of the right leg is 0.40. The nurse is aware that this may indicate what? a. Adequate peripheral circulation b. Dependent oedema c. Arterial narrowing d. Inadequate coronary output e. Venous narrowing

c. Arterial narrowing

You are admitting a 32-year-old woman to your unit. The woman is to undergo major surgery and will be on bed rest for at least 48 hours. While doing the admission assessment the patient tells you she takes oral contraceptives. You know that this puts the patient at an increased risk of developing what? a. Deep vein thrombosis b. Intermittent claudication c. Thoracic aneurysm d. Pressure areas e. Raynaud's disease

a. Deep vein thrombosis

The nurse is caring for a patient who is admitted to your unit with a diagnosis of venous ulceration unresponsive to treatment. What is the nurse most likely to find during an assessment of this patient? a. Pale wound bed b. No exudate c. Deep wound bed d. Heavy exudate e. Gangrene

d. Heavy exudate

Graduated compression stockings are used to treat and prevent venous insufficiency, leg ulcers, and varicose veins. What amount of compression would be prescribed for patients with venous stasis ulceration? a. Over 80 mm Hg b. 35–45 mm Hg c. 40–50 mm Hg d. 20–30 mm Hg e. 25–35 mm Hg

c. 40–50 mm Hg

A nurse is assessing a new patient who is diagnosed with peripheral arterial disease. The nurse cannot feel the pulse in the patient's left foot. What could the nurse use to assess the blood flow in the patient's left foot? a. Palpation b. Doppler c. An ultrasound machine d. A fetascope e. A stethoscope

b. Doppler

The steps to obtaining an ABI are: 1. Apply the appropriate size blood pressure cuff to the patient's ankle above the malleolus. 2. Measure brachial pressures in both arms. 3. Have the patient rest in a supine position for about 5 minutes. 4. Palpate the posterior tibial and dorsalis pedis arteries. Put the steps of measuring an ABI in the correct order. a. 3, 1, 4, 2 b. 2, 4, 3, 1 c. 4, 1, 3, 2 d. 1, 2, 3, 4 e. 4, 2, 1, 3

a. 3, 1, 4, 2

The nurse is caring for a client with a leg ulcer caused by arterial insufficiency. The nurse knows that a recommended treatment for arterial insufficiency of the leg is what? a. Anti thrombolytic medications b. TED stockings c. Compression stockings d. Vascular reconstruction e. Embolectomy

d. Vascular reconstruction

``` The nurse is assessing a patient's bladder by percussion. The nurse elicits dullness after voiding. What does this finding indicate? Select one: a. The presence of an alien life-form b. Kidney enlargement c. Incomplete bladder emptying d. Ureteral obstruction e. Dehydration ```

c. Incomplete bladder emptying

You are a urology nurse caring for a male patient admitted to your unit with bladder distention from prostatichypertrophy. The physician orders placement of an indwelling urinary catheter. The nurse and urologist are both unsuccessful in catheterising this patient due to the prostatic obstruction. What approach does the nurse anticipate the physician using to drain the patient's bladder? a. Scheduling the patient immediately for surgery to relieve the bladder obstruction b. Restrict fluids and try again in 6 hours c. Application of warm compresses to the perineum to assist with relaxation, which will result in the patient voiding on his own d. Medication administration to relax the bladder muscles and attempting catheterisation in 6 hours e. Insertion of a suprapubic catheter

e. Insertion of a suprapubic catheter

The nurse has implemented a bladder retraining program in a 65-year-old woman after the removal of an indwelling urinary catheter from this patient. The nurse places the patient on a timed voiding schedule and performs an ultrasonic bladder scan after each void. The nurse notes that the patient has 50 mL of urine remaining in her bladder after voiding. What would be the nurse's best response to this finding? a. Place an indwelling urinary catheter b. Avoid further interventions at this time, as this is an acceptable finding c. Plan for insertion of a supra-pubic catheter d. Press on the patient's bladder in an attempt to encourage complete emptying e. Perform a straight catheterisation on this patient

b. Avoid further interventions at this time, as | this is an acceptable finding

The nurse is caring for a patient who is not allowed oral intake of fluid or food. When evaluating this patient's urinalysis, what would the nurse anticipate? a. A fixed urine specific gravity b. A fluctuating urine specific gravity c. None of the above d. An increased urine specific gravity e. A decreased urine specific gravity

d. An increased urine specific gravity

A diabetic patient with renal failure has been admitted to your unit. What is the most life-threatening effect of renal failure you will monitor for? a. Polyuria b. Accumulation of wastes c. Depletion of calcium d. Lack of blood pressure control e. Retention of potassium

e. Retention of potassium

The nurse is caring for a patient who describes his changes in voiding patterns. The patient states, "I feel the urge to empty my bladder several times an hour and when the urge hits me I have to get to the restroom quickly. But when I empty my bladder, there does not seem to be a great deal of urine flow." What would the nurse expect this patient's physical assessment will likely reveal? a. Renal failure b. Dehydration c. Urine retention d. Hypotension e. Haematuria

c. Urine retention

What function does the kidney perform to assist in maintaining acid–base balance within the necessary normal range? a. Excrete bicarbonate in the urine b. Excrete acid in the lungs c. Return bicarbonate to the body's circulation d. Return acid to the body's circulation e. Excrete alkali from the body's circulation

c. Return bicarbonate to the body's circulation

The nurse is caring for a patient receiving haemodialysis treatments. The patient has had surgery to form an arteriovenous fistula. What is most important for the nurse to be aware of when providing care for this patient? a. The patient shouldn't feel pain during initiation of dialysis b. All of the above c. Taking a blood pressure reading on the affected arm can cause clotting of the fistula. d. Using a stethoscope for auscultating the fistula is contraindicated. e. The patient feels best immediately after the dialysis treatment.

c. Taking a blood pressure reading on the affected arm can cause clotting of the fistula.

Renal failure can have prerenal, renal, or postrenal causes. A patient presents with acute renal failure and is being assessed to determine where, physiologically, the cause is. If the cause is found to be prerenal, which condition most likely caused it? a. Heart failure b. UTI c. Glomerulonephritis d. Aminoglycoside toxicity e. Ureterolithiasis

a. Heart failure Pre-renal- ECF volume depletion, Low cardiac output, Low systemic vascular resistance, Increased renal vascular resistance Renal- Infiltrative diseases, Infections & acute vascular nephropathy Post-renal- Tubular precipitation, Ureteral obstruction and Bladder obstruction

A patient is receiving patient education prior to beginning continuous ambulatory peritoneal dialysis. What would the nurse teach the patient that the most common complication associated with this procedure is? a. Constipation b. Dehydration c. Peritonitis d. Blood loss e. DVT

c. Peritonitis

The clinic nurse is teaching a young wife about preventing recurrent urinary tract infections. What information should the nurse include? a. Wipe back to front after going to the toilet b. Void every 6 to 8 hours. c. Drink liberal amounts of fluids. d. Avoid voiding immediately after sexual intercourse. e. Bathe daily.

c. Drink liberal amounts of fluids.

You are caring for a patient admitted with a diagnosis of renal failure. When youreview your patient's laboratory reports, you note that the patient's magnesium levels are high. What would be important for you to assess? a. Visual acuity b. Cool,Clammy skin c. Increased Serum magnesium d. Diminished Deep tendon reflexes e. Tachycardia

d. Diminished Deep tendon reflexes

You are working on a burn unit. One of your patients is exhibiting signs and symptoms of third spacing, which occurs when fluid moves out of the intravascular space but not into the intracellular space. Based upon this fluid shift, what would you expect the patient to demonstrate? a. Hypertension b. Hypervolaemia c. Decreased oxygen saturations d. Hypovalaemia e. Bradycardia

b. Hypervolaemia

A patient with anxiety presents to the emergency room. The triage nurse notes upon assessment that the patient is hyperventilating. The triage nurse is aware that hyperventilation is the most common cause of which acid-base imbalance? Select one: a. Respiratory acidosis b. None of the above c. CNS disturbances d. Respiratory alkalosis e. Increased PaCO2

d. Respiratory alkalosis

You are an emergency-room nurse caring for a trauma patient. Your patient has the following arterial blood gas results: PH 7.26, PaCO2 28, HCO3 11 mmol/L. How would you interpret these results? a. Metabolicalkalosis with a compensatory alkalosis b. Metabolic acidosis with a compensatory respiratory alkalosis c. Metabolic acidosis with no compensation d. Respiratory acidosis with no compensation e. Respiratory alkalosis

b. Metabolic acidosis with a compensatory respiratory alkalosis

A nurse in the medical ICU has orders to infuse a hypertonic solution into her patient with low blood pressure. This solution will increase the number of dissolved particles in the patient's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. Which term or terms is/are associated with this process? a. Hydrostatic pressure b. Activetransport c. Osmosis and osmolality d. Diffusion e. Rhubarb

c. Osmosis and osmolality

The nursing instructor is discussing renal failure with her senior nursing class. The instructor states, “A patient in renal failure partially loses the ability to regulate changes in pH.” What is the cause of this partial inability? a. The kidneys regulate and reabsorb carbonic acid to change and maintain pH. b. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH. c. The kidneys buffer acids through electrolyte changes. d. The kidneys combine carbonic acid and bicarbonate to maintain a stable pH. e. The kidneys produce carbonic acid to act in the buffering process

b. The kidneys regenerate and reabsorb bicarbonate to maintain a stable pH.

While admitting a new patient to your medical-surgical unit, you note that the patient is oliguric. You notify the medical officer who orders a fluid challenge of 100 to 200 mL of normal saline solution over 15 minutes. What do you know this intervention will do? a. Help distinguish reduced renal blood flow from decreased renal function b. Very little c. Help evaluate pituitary gland function d. Help provide an effective treatment for hypertension induced oliguria e. Help distinguish hyponatraemia from hypernatraemia

a. Help distinguish reduced renal blood flow from decreased renal function (Oliguria or hypouresis is the low ouput of urine)

A patient's lab results show a slight decrease in potassium. The physician has declined to treat with drug therapy but has suggested increasing potassium through diet. Which of the following would be a good source of potassium? a. Apples b. Bananas c. Carrots d. Red wine e. Asparagus

b. Bananas

The nurse is caring for a patient with liver failure. The nurse understands that patients in liver failure often require vitamin therapy. Which vitamin does the liver require for the synthesis of prothrombin? Select one: a. Vitamin A b. Vitamin B6 c. Vitamin D d. Vitamin B12 e. Vitamin K

e. Vitamin K

You are caring for a patient with advanced cirrhosis. You know that the most significant source of bleeding in a patientwith cirrhosis is what? a. Common bile duct haemorrhage b. Ascites c. Portal hypertension d. Oesophageal varices e. Haemolytic jaundice

d. Oesophageal varices

The nurse is assessing a typical patient with cholecystitis. The patient complains of localised pain. Where would the nurse also ask the patient if the pain has radiated to? a. Neck b. Left upper arm c. Jaw d. Right shoulder e. Lower abdomen

d. Right shoulder

A patient returns to the floor after a laparoscopic cholecystectomy. The nurse caring for the patient is aware that the most serious potential complication is what? a. Bile duct injury b. Pulmonary atelectasis c. Decubitis ulcer d. Wound evisceration e. Constipation

a. Bile duct injury

A patient with a liver mass is undergoing a percutaneous liver biopsy. After the procedure the nurse assists the physician in positioning the patient. What position should they position the patient in? a. Reverse Trendelenberg b. On the right side with a pillow under the costalmargin c. Trendelenberg d. Supine position e. On the left side with a pillow under the knees

b. On the right side with a pillow under the costal margin

The critical care nurse is caring for a patient with cirrhosis. What is an essential nursing function when caring for a patient with cirrhosis? a. Monitoring the patient for signs of hypervolemia b. Monitoring the patient's oral intake c. Monitoring for constipation d. Monitoring the patient's support network e. Monitoring the patient's mental status

e. Monitoring the patient's mental status

A patient is admitted to the unit with acute cholecystitis. The physician has noted that surgery will be scheduled in 4 days. The patient asks why the surgery is being put off for a week when he has a “sick gallbladder.” What would be the nurse's best response? b. To determine whether a laparoscopic procedure can be used. c. Surgery is delayed until the acute symptoms subside. d. Surgery is delayed until the patient can eat a regular diet without vomiting. e. To get the patient stronger. f. The surgeon is on a golfing holiday

c. Surgery is delayed until the acute symptoms subside.

A nurse is assessing an elderly patient with gallstones. The nurse is aware that the patient may not exhibit typical symptoms and that symptoms that may be exhibited in the elderly patient may include what? a. Spontaneous haemorrhage b. Nausea and vomiting c. Fever and pain d. Chills and jaundice e. Septic shock and oliguria

e. Septic shock and oliguria

The triage nurse in the emergency department is assessing a patient who presented with complaints of not feeling well. The patient has ascites and an enlarged liver. The patient reports a history of drinking a 12 pack of beer every evening for the past 15 years. The nurse is aware that the patient is at risk for which disease? a. Coronary artery disease b. Cirrhosis c. Hepatitis d. Cardiovascular disease e. Renal failure

b. Cirrhosis

A patient with portal hypertension has been admitted to the floor you work on. What will you assess for related to portal hypertension? a. Ascites b. Bowel obstruction c. Vitamin A deficiency d. Hepatic encephalopathy e. Haemorrhoids

a. Ascites

Why does acute pancreatitis change the metabolic needs of the body? a. None of the above b. Acute illness and inability to eat increase metabolic needs. c. Acute illness, infection and fever increase metabolic needs. d. Acute illness and inability to eat decrease metabolic needs. e. Acute illness, infection and fever decrease metabolic needs.

c. Acute illness, infection and fever increase metabolic needs.

The nurse is caring for a patient with hepatic encephalopathy. While making the initial shift assessment the nurse notes that the patient has a flapping tremor of the hands. What will the nurse document this condition as in the patient's chart? a. Palmar erythema b. None of the above c. Fetor hepaticus d. Asterixis e. Constructional apraxia

d. Asterixis

Your patient has a gallstone blocking the bile duct. When you assess the patient's laboratory studies what would you expect to find? Select one: a. Decreased serum GGT level b. Decreased serum alkaline phosphatase level c. Increased BUN level d. Increased bilirubin level in the blood e. Decreased cholesterol level

d. Increased bilirubin level in the blood

How is hepatitis C transmitted? a. Unintentional needle sticks b. Contaminated food c. Pet hair d. Faecal–oral route e. Airborne route

a. Unintentional needle sticks

While assisting with the surgical removal of an adrenal tumour the operating room nurse is aware that the patient's vital signs may change upon manipulation of the tumour. What vital sign changes would the nurse expect to see? a. Hypertension and heart rate changes b. Hypotension and hypothermia c. Hyperthermia and tachypnoea d. Hyperthermia and bradycardia e. Hyperthermia and bradycardia

a. Hypertension and heart rate changes

``` The nursing tutor is discussing diabetes mellitus with the nursing students. What would the tutor tell the class may develop in the patient when ketone bodies accumulate in excessive amounts? ``` a. Oliguria b. Diabetic ketoacidosis c. Blurred vision d. Polyuria e. Hypovolaemia

b. Diabetic ketoacidosis

A newly admitted patient with type 1 diabetes asks the nurse what caused her diabetes. The nurse is explaining to the patient the aetiology of type 1 diabetes. Which of the following explanations is appropriate? a. “Destruction of special cells in the pancreas causes a decrease in insulin production and the level of glucose (sugar) in the bloodstream increases because the body lacks insulin to break down the glucose.” b. “The tissues in the body are resistant to the action of insulin, making insulin less effective in the body.” c. None of them are correct d. “The formation of an acidic substance when the liver breaks down fatty acids because of the lack of insulin in the body.” e. “The secretion of placental hormones causes the body to be resistant to insulin.”

a. “Destruction of special cells in the pancreas causes a decrease in insulin production and the level of glucose (sugar) in the bloodstream increases because the body lacks insulin to break down the glucose.”

A 35-year-old female patient with type 1 diabetes has come to the clinic because she just doesn't feel well. The patient confides in the nurse that she is going through a divorce and a custody battle for her children ages 2 and 4. She has started drinking and has lost her job. What would the nurse suspect is causing this patient to feel poorly? a. Hypoglycaemia b. Hypernatraemia c. Ketoacidosis d. Renal failure e. Fluid overload

c. Ketoacidosis

A patient with pheochromocytoma has been admitted for an adrenalectomy tomorrow. The patient is to start IV medication this evening to prevent adrenal insufficiency. What medication is the patient to start? a. Corticosteroids b. Dolbutamide infusion c. Antihypertensives d. Antibiotics e. Parenteral nutrition

a. Corticosteroids

A patient who has had a total parathyroidectomy has returned to the unit from the PACU (theatre recovery). The nurse caring for the patient knows he should assess for what complication following this surgery? a. Tetany b. Hypercalcaemia c. Confusion d. Brittle bones e. Fatigue

a. Tetany Is a medical sign consisting of the involuntary contraction of muscles, which may be caused by disease or other conditions that increase the action potential frequency of muscle cells or the nerves that innervate them.

The nursing instructor is teaching the nursing class Addison's disease. What symptom would the instructor teach the student's is characteristic of Addison's disease? a. Tetany b. Hypertension c. Truncal obesity d. “Moon” face e. Muscle weakness

e. Muscle weakness

A patient with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) is being cared for on your unit. You are writing a care plan for this patient. The priority nursing diagnosis for a patient with this condition is what? a. Excessive fluid volume b. Hyperthermia c. Deficient fluid volume d. Hypothermia e. Hypotension

a. Excessive fluid volume

``` A patient you are caring for is undergoing a renin–aldosterone stimulation test. What drugs may be discontinued for up to 2 weeks before the renin-aldosterone stimulation test? Select one: a. Beta-blockers b. Laxatives c. Calcium channel blockers d. Antihypertensives e. Antibiotics ```

d. Antihypertensives

``` You are conducting a class on how to self-manage insulin regimens. A patient asks you how long a vial of insulin can be stored at room temperature before it “goes bad.” What would be your best answer? ``` a. If you are going to use up the vial within 1 month it can be kept at room temperature. b. It can only be taken out of the fridge when you are drawing it up c. If a vial of insulin will be used up within 1 week, it may be kept at room temperature. d. If a vial of insulin will be used up within 21 days, it may be kept at room temperature. e. If a vial of insulin will be used up within 2 weeks, it may be kept at room temperature.

a. If you are going to use up the vial within 1 month it can be kept at room temperature.

A patient has returned to the floor after having a thyroidectomy for thyroid cancer. The nurse knows that sometimes during thyroid surgery the parathyroid glands can be injured or removed. What laboratory finding may be an early indication of parathyroid gland injury or removal? a. Hypophosphataemia b. Hypokalaemia c. Hyperkalaemia d. Hypocalcaemia e. Hyponatraemia

d. Hypocalcaemia

A patient has returned to the unit after having a parathyroidectomy. What drug does the nurse ensure is immediately available? a. Ergocalciferol b. Calcium alginate c. Amphojel d. Digitalis e. Calcium gluconate

e. Calcium gluconate

The nurse caring for a patient with Cushing's syndrome explains to her patient about the dexamethasone suppression test scheduled for tomorrow. What does the nurse explain that this test will involve? a. Administration of dexamethasone intravenously, followed by a plasma cortisol level 3 hours after the drug is administered b. None of them are correct c. Administration of dexamethasone intravenously, followed by an x-ray of the adrenal glands d. Administration of dexamethasone orally, followed by a plasma cortisol level every hour for 3 hours e. Administration of dexamethasone orally at 11 pm and a plasma cortisol level at 8 am the next morning

e. Administration of dexamethasone orally at 11 pm and a plasma cortisol level at 8 am the next morning Dexamethasone suppression test measures whether adrenocorticotrophic hormone (ACTH) secretion by the pituitary can be suppressed.

The PACU (theatre recovery) staff has brought a patient to the unitfollowing a thyroidectomy. To promote comfort for this patient how would you position the patient? a. Semi-Fowler's with the head supported on one or two pillows b. Side-lying (lateral) with no pillow under the head c. Flat, with a small roll supporting the neck d. Head of the bed elevated 30 degrees and no pillows placed under the head e. Side-lying (lateral) with one pillow under the head

a. Semi-Fowler's with the head supported on one or two | pillows

``` The diabetic Nurse Educator is teaching a class for newly diagnosed diabetics and their families. In this class the Nurse Educator is teaching about “sick day rules.” What guideline applies to periods of illness (“sick day rules”) in a diabetic patient? ``` a. If nauseated, do not eat solid foods. b. Do not eliminate insulin when nauseated and vomiting. c. Eat three meals a day. d. Eat small regular meals e. Report elevated glucose levels greater than 7 mmol/L

b. Do not eliminate insulin when nauseated and vomiting.

An adolescent, newly diagnosed with type 1 diabetes, asks the nurse what caused the diabetes. What would be the nurse's best response? a. “It is thought to be caused by environmental factors like a virus.” b. “Part of the cause of diabetes is immunologic. That means your body is destroying itself.” c. How would I know I'm only a nurse d. “The causes of type 1 diabetes are genetic, immunological and environmental.” e. “Type 1 diabetes has a variety of causes that work together to cause the disease.”

d. “The causes of type 1 diabetes are genetic, immunological and environmental.”

The nurse is caring for a patient with hyperthyroidism. What would the nurse closely monitor for? a. Thyroid storm b. Cardiac output c. Hypoxia d. tetany e. Hypoglycaemia

a. Thyroid storm

You are teaching a patient about nutrition. You know that the body needs iodine for the thyroid to function. What food would be the best source of iodine for the body? a. Red meat b. Strawberries c. Bananas d. Table salt e. Eggs

d. Table salt

A patient is prescribed corticosteroid therapy. What would be important information for the nurse to give the patient who is prescribed corticosteroid therapy? a. The patient's diet should be low protein with ample fat. b. The patient is at a decreased risk of developing thrombophlebitis and thromboembolism. c. The patient is at increased falls risk d. The patient is at an increased risk of developing infection. e. There will be no change in appearance.

d. The patient is at an increased risk of | developing infection.

The student nurses are studying for a test on diabetes mellitus. What should the students know is a complication of diabetes termed “macrovascular”? a. Renal failure b. Liver failure c. Nephropathy’s d. Stroke e. Retinopathy

d. Stroke

List the main clinical manifestations of a pulmonary embolus:

``` Dyspnea Sharp chest pain Tachypnea Anxiety Fever ```

What are the “Ps” Make up the main clinical manifestations of diabetes?

PolyUria Polydypsia Polyphagia

What is the difference between law and ethics?

Law is set, usually by the judiciary and the breaking of result in penalties. Ethics are principles and right behaviours that can be either personal or professional

What are the priority nursing actions in the event of pulmonary embolus?

``` High fowlers Oxygen MET call Vital signs Assessment Pharmacology ALS ```

What is the most life-threatening effect of renal failure that you know to monitor for?

Potassium retention(Hyperkalaemia)

What is an “ethical dilemma”?

When one must choose between two equally unfavourable choices, often involves two conflicting moral issues and has no perfect solution

Pulmonary oedema is primarily the abnormal function of which organ?

The heart

What are the two generally accepted methods to calculate heart rate from an ECG?

R to R interval and the start of the QRS complex to the next

Discharge advice being given to a patient with chronic renal failure should include the following general areas:

``` Fluid restriction Dietary management Drug management Monitor for infections ADLs/fatigue ```

The main pathophysiological difference between type 2 diabetes from type 1 is that in type 2?

There is decreased insulin secretion and/or cellular resistance to insulin that is produced

The 3 different type of renal replacement therapy are?

Haemodialysis Peritoneal dialysis Kidney transplant

What are the coroner’s main responsibilities?

Identify the deceased particulars needed to register the death Cause of death Circumstances surrounding the death Guidelines/procedures to put in place to prevent it occuring again(contexual)

Often the simplest method of establishing a patient’s airway is to?

Reposition the patient’s head to dislodge the tongue

The major contributing factor to the development of oesophageal ascites is?

Portal hypertension

How would you assess the Ankle Brachial index?

Take the brachial systolic pressure and ankle systolic pressure, and the divide ankle systolic pressure by brachial systolic pressure

Explain a “trial to void” procedure when planning to remove a super pelvic catheter. And what residual amount are you aiming for?

Clamp SPC for 4 hrs, patient attempts to void per urethra After the void, unclamped the SPC and measure the amount of urine left by bladder scan Usually aiming for less than 100 – 150 ml x 2 separate occasions

Define quantitative research

Formal, objective, systematic process in which variables are measurable and results in numerical data

What are the main risk factors to developing DVT?

``` Smoking On the pill Obese Over 35 Family history ```

The gall bladder normally produces how much bile per day?

(Trick question!) | Bile is produced by the liver, and stored in the gall bladder

List the 3 components of Virchow’s triad

Venous stasis Venous endothelial damage Hypercoagulability of the blood

Describe immediate management of hypoglycaemia?

``` Give 15 g of fast-acting, concentrated carbohydrate BGL Repeat two to three times Emergency medical treatment Vital signs Snack Light meal ```

Which type of the research has the highest strength of evidence? Expert opinion, Cohort studies, Randomised controlled trials?

Randomised controlled trials

Define azotaemia, and what is the cause of it?

Accumulation of nitrogenous wastes from the diseased kidneys being unable to remove waste (especially urea)

Often the simplest method of establishing an airway is …?

Hyperextension of the neck (head tilt) used in CPR and jaw thrust without head tilt.

How is an oropharyngeal (Guedel) airway measured prior to insertion? And what is its purpose?

A Guedel is measured from the corner of mouth to the ear. (Think of holding a phone to your ear to remember) The purpose of a Guedel is to establish an airway and assist with helping the patient breath either by balloon pump or machine.

What are the indications for suctioning an airway?

Removing phlegm/secretions/vomit that the patient is too weak to expectorate themselves or if the patient is unconscious/ill and can’t protect their airway through limited or no muscle function and also to collect specimens for diagnosis/microbiology.

Compare and contrast wet dressings, moisture-retentive dressings and occlusive dressings.

Occlusive dressings, keep the wound air tight using plastic film and can also cover topical medication to the wound if needed. Moisture-retentive dressings allow the wound to remain moist to promote healing, these dressings can also have antimicrobial agents, zinc or saline as an addition to eliminate the need for topical application of gels. Wet dressings used commonly in skin conditions such as eczema, as when the moisture evaporates it cools and dries the skin and stimulates drainage.

Consider the components of an Electrocardiogram (ECG) and describe what they reflect is physiologically occurring within the heart.

P wave: Represents the electrical impulse starting in the Sinus node and spreading through the atria also represents atrial muscle depolarisation. PR interval: Measure from the beginning of the P wave to the beginning of the QRS complex and represents the time needed for sinus node stimulation, atrial depolarisation and conduction through the AV node before ventricular depolarisation.

Consider the components of an Electrocardiogram (ECG) and describe what they reflect is physiologically occurring within the heart.

QRS complex: Represents ventricular depolarisation QT interval: represents the total time for ventricular depolarisation and repolarisation. Measured from the beginning of the QRS complex to the end of the P wave. (If QT interval is prolonged the patient is at risk for Ventricular arrhythmia called Torsades de points).

Consider the components of an Electrocardiogram (ECG) and describe what they reflect is physiologically occurring within the heart.

ST segment: Represents early ventricular repolarisation lasts from the end of the QRS complex to the beginning of the T wave. ST segment can be difficult to identify because it merges into the T wave. T wave: Represents ventricular muscle repolarisation following the QRS complex usually in the same direction as the QRS complex.

Describe (anatomically) the positions of the electrodes:

V1 Fourth intercostal space at the right border of the sternum V2 Fourth intercostal space at the left border of the sternum V3 Midway between locations V2 and V4 V4 At the midclavicular line in the fifth intercostal space V5 At the anterior axillary line on the same horizontal level as V4 V6 At the midaxillary line on the same horizontal level as V4 and V5

What are the precautions you need to make in attaching them to ensure results are accurate?

1. Ensure that the patient is warm and relaxed 2. Shave electrode area before placement and cleaning 3. Clean the area with alcohol 4. Let dry prior to applying electrode 5. Make sure the leads are on the arteries and connected properly 6. Positioning of the patient and making sure the leads aren’t tangled

Explain why these dysrhythmias are associated with a cardiac arrest while other dysrhythmias do not cause a cardiac arrest.

Asystole is no cardiac activity so the heart isn’t pumping blood/oxygen around the body Ventricular Tachycardia is where the heart beats so fast due to improper electrical activity of the heart(ventricles) the patient can become unconscious/pulseless and this then can lead the person into Ventricular Fibrillation or Asystole/death Ventricular Fibrillation is rapid disorganised ventricular rhythm (uncoordinated contraction of the cardiac muscle of the ventricles in the heart, making them quiver rather than contract properly) with no atrial activity so there is ineffective pumping of blood around the body which then can also lead into asystole/death.

List and discuss the 5 main reasons why catheterisation is performed

Relieve urinary tract obstruction. Assist with post-operative drainage in urological and other surgeries. Provide a means to monitor accurate urine output in critically ill patients. Promote urinary drainage in patients with neurogenic bladder dysfunction or urinary retention. Prevent urinary leakage in patients with stage 3/4 pressure injuries.

Explain “trial to void” procedure in a patient who is required to have their suprapubic catheter (SPC) removed

After the patient has voided, the catheter is unclamped and the residual urine is measured. If the urine inside the bladder is less than 100mls on two separate occasions eg morning and evening the catheter is usually removed. If a patient complains of pain/discomfort it is normally left in place until the patient can void successfully.

List and briefly discuss the advantages of a SPC over a urethral catheter.

Patients can usually void sooner after surgery when compared to urethral catheters. More comfortable (Patient dependant though) Greater mobility Permits measurement of residual urine without urethral instrumentation Lesser risk of bladder infection

List and briefly discuss the main principals of preventing a UTI in a patient with a catheter

As the catheter is a foreign body inside the urethra there may be some discharge. Vigorous cleaning of the meatus is discouraged as not only is this uncomfortable for the patient there is an increased risk of infection from this action because you’re moving the catheter. Choice of catheter tubing and making sure the patient has adequate fluid intake to keep the catheter patent and free of obstructions. Continual monitoring of the patients urine and vital signs can help prevent UTI’s How the catheter is positioned as if flow back is allowed infection can occur Maintenance and regular care of the catheter and the surrounding area