PREBOARDS 1_NP4

Question 1

Immunity is the body’s specific protective response to a foreign agent or organism. Growing numbers of patients with primary immune deficiencies live to adulthood, and many others acquire immune disorders during their adult years. Thus, nurses in many practice settings need to understand how the immune system functions as well as immunopathologic processes.
1. It is the third protective response which involves the T lymphocytes, which can turn into special cytotoxic (or killer) T cells that can attack the pathogens.
*
1 point
A. Phagocytic immune response
B. Humoral immune response
C. Cellular immune response
D. Antibody immune response

Answer 1

C. Cellular Immune Response are Third Protecctive Response
A. 1st protective response
B. Also known as D this is 2nd protective response

Question 2

In this stage, either the antibody of the humoral response or the cytotoxic (killer) T cell of the cellular response reaches and connects with the antigen on the surface of the foreign invader.
*
1 point
A. Proliferation Stage
B. Response Stage
C. Effector Stage
D. Antigen Recognition

Answer 2

C. Effector Stage

Question 3

Enlargement of the lymph nodes in the neck in conjunction with a sore throat is one example of the immune response.
*
1 point
A. Proliferation Stage
B. Response Stage
C. Effector Stage
D. Antigen Recognition

Answer 3

A. Proliferation
Lymphocytes proliferate as response to the infection / antigen

Question 4

This stage begins with the production of antibodies by the B lymphocytes in response to a specific antigen. The cellular response stimulates the resident lymphocytes to become cells that attack microbes directly rather than through the action of antibodies.
*
1 point
A. Proliferation Stage
B. Response Stage
C. Effector Stage
D. Antigen Recognition

Answer 4

B. Response Stage

Question 5

This characteristics of immunoglobulin appears mostly in intravascular serum and activates the complement system
*
1 point
A. Immunoglobulin A
B. Immunoglobulin E
C. Immunoglobulin G
D. Immunoglobulin M

Answer 5

D. Immunoglobulin M

Question 6

SITUATION:
A discordant couple has come into the clinic to inquire about advice regarding sexual patterns and reduction of HIV transmission.
6. The nurse is correct if she tells the couple that:
*
1 point
A. The partner without HIV must take Pre Exposure Prophylaxis medications once a week in order to avoid contracting HIV
B. The partner with HIV must check their HIV status every 3 months to monitor
C. A properly maintained viral suppression with Antiretroviral therapy will completely remove the risk of transmitting HIV to your partner
D. If your partner is already taking Pre Exposure Prophylaxis judiciously, then they are not capable of contracting HIV and STDs, condoms are not needed anymore

Answer 6

C. A properly maintained viral suppression with Antiretroviral therapy will completely remove the risk of transmitting HIV to your partner = UNDETACTABLE VIRAL LOAD

Discordant couple: only one of the couple has HIV
Concordant couple: both partners has HiV

Question 7

The couple soon decides that they will be using PrEp, ART and Condom use, but have little to no knowledge regarding the relation of condoms with HIV transmission reduction. All but one of the following are correct health teachings.
*
1 point
A. As long as you use any type of condom, it will certainly reduce the risk for contracting HIV
B. The condoms must also be used for Oral Sex, if there is no available dental dam.
C. Other than abstinence, correct condom use is the only effective method of contraception that decreases risk for HIV
D. Voluntary male circumcision is 50% to 60% effective at preventing HIV infection especially when paired with correct condom use

Answer 7

A. As long as you use any type of condom, it will certainly reduce the risk for contracting HIV = LATEX CONDOMS ONLY

Question 8

The Correct Way to Use a Male Condom:
*
1 point
A. Put on a new condom before any kind of sex and do not pull out
B. Hold the condom by the tip
C. Unroll the condom all the way over the erect penis snugly and make sure no space is seen at the tip
D. Use KY Jelly and make sure condoms are cool and moist

Answer 8

B. Hold the condom by the tip

Question 9

Studies regarding reproductive education for HIV have been made by different researchers. Which among the following are true regarding reproduction:

i. HIV has been found in the spermatozoa of patients with HIV infection, and it is possible that HIV can replicate in the male germ cell

ii. An increased risk of HIV infection in women is associated with hormonal contraceptive use, and the cause and effect of it has been gradually established by the years
*
1 point
A. I only
B. II only
C. I and II
D. None of the above

Answer 9

A. I only

Question 10

Though the patient’s safety and well being is important in cases of HIV treatment and precaution, health care providers are equally given these treatments and precautions to make sure that their well-being is cared for so they could continue giving quality care. A post exposure prophylaxis (PEP) is given to the, select all that describes PEP:

i. includes taking antiretroviral medicines as soon as possible,

but no more than 48 hours (2 days) after possible HIV exposure

ii. two to three drugs are usually prescribed which must be taken for 20 days

iii. HIV status should be checked every 3 months to be sure that the person has not become infected.

iv. The ultimate goal of PEP is to reduce the acquisition of

HIV infection with its resulting morbidity, mortality, and cost to individuals and society

*
1 point
A. I and II
B. I, II and III
C. I, II, III and IV
D. None of the above

Answer 10

D. None of the above

Question 11

Situation:
Patients with HIV that do not consistently treat their conditions could suffer many complications which include opportunistic infections. As an immunology nurse, you must be familiar with these diseases
11. This disease is a common opportunistic infection that typically occurs in patients with CD4+ T- lymphocyte (CD4+) cell counts less than 50 cells/mm3.
*
1 point
A. Pneumocystis Pneumonia
B. HIV Wasting Syndrome
C. Kaposi Sarcoma
D. Mycobacterium avium Complex

Answer 11

A. Pneumocystis Pneumonia

Question 12

This opportunistic infection is caused by human herpesvirus-8 (HHV-8); it affects eight times more men than women, and it involves the epithelial layer of blood and lymphatic vessels.
*
1 point
A. Pneumocystis Pneumonia
B. AIDS-Related Lymphomas
C. Kaposi Sarcoma
D. Mycobacterium avium Complex

Answer 12

C. Kaposis Sarcoma
Purplish Lesions

Question 13

In accordance with question no. 1, which among the following medications are the initial treatment for this disease?
*
1 point
A. Fluconazole and amphotericin B
B. Clarithromycin and Ethambutol
C. Trimethoprim–sulfamethoxazole and Penicillin G
D. Valganciclovir and Foscarnet

Answer 13

B. Clarithromycin and Ethambutol for PCP Pneumonia

A. For Fungal infections (Cryptococcal Meningitis)
C.X not related
D. Cytomegalovirus Virus Retinitis

Question 14

In accordance with question no. 2, which among the following medications are the initial treatment for this disease?
*
1 point
A. Chemotherapy
B. Biologic therapy
C. None of the Above
D. All of the above

Answer 14

D. All of the above
Kaposis Sarcoma is a Cancer

Question 15

This condition typically occurs during the initial months after beginning ART and is associated with a wide spectrum of organisms. It is characterized by fever, respiratory and/or abdominal symptoms, and worsening of the clinical manifestations of an opportunistic infection.
*
1 point
A. MAC
B. IRIS
C. PTB
D. KS

Answer 15

B. IRIS: Immune Reconstitution Inflammatory Syndrome

MAC: Mycobacterium Avian Complex

Question 16

Situation:
Jessica, a 54 years old woman has been experiencing pain in her right upper quadrant, bleeding in the gums and bone pain for a couple of weeks now. Her daughter, Demi, became concerned and decided to have her checked at the hospital. Through the assessment of the doctor she was diagnosed with Acute Myeloid Leukemia.
16. Which among the following is a description of AML?
*
1 point
​​A. An excess (more than 10%) of blast cells is the hallmark of the diagnosis.
​​B. An excess (more than 20%) of blast cells is the hallmark of the diagnosis.
​​C. An excess (more than 30%) of blast cells is the hallmark of the diagnosis.
​​D. An excess (more than 50%) of blast cells is the hallmark of the diagnosis.

Answer 16

​​B. An excess (more than 20%) of blast cells is the hallmark of the diagnosis.

Question 17

In the assessment of the complete blood count of Mrs. Jessica, it is found that she is susceptible to have more potentially fatal bleeding episodes, and a higher incidence of disseminated intravascular coagulation (DIC) due to specific AML subtype called:
*
1 point
A. AML-M1
B. AML-M2
C. AML-M3
D. AML-M4

Answer 17

C. AML-M3

Question 18

Following the above question, the cure for the said AML subtype is:
*
1 point
A. High
B. Low
C. Unknown
D. In progress

Answer 18

A. High

Question 19

In AML, the aim of induction therapy is to eradicate the leukemic cells; however, this is also accompanied by the eradication of normal types of myeloid cells. Thus, the patient becomes severely neutropenic:

i. An absolute neutrophil count of 0 is not uncommon

ii. Anemia and severe thrombocytopenia is common

*
1 point
A. I only
B. II only
C. I and II
D. None of the above

Answer 19

C. I and II

Key: neutropenic

Question 20

Massive leukemic cell destruction from chemotherapy results in the release of intracellular electrolytes and fluids into the systemic circulation, this process is referred to as tumor lysis, among which of the following is related to tumor lysis?
*
1 point
A. Hyperuricemia, Hyperkalemia, Hypercalcemia, and Hypophosphatemia
B. Hyperuricemia, Hyperkalemia, Hypocalcemia, and Hyperphosphatemia
C. Hyperuricemia, Hypokalemia, Hypercalcemia, and Hypophosphatemia
D. Hyperuricemia, Hypokalemia, Hypercalcemia, and Hypophosphatemia

Answer 20

B. Hyperuricemia, Hyperkalemia, Hypocalcemia, and Hyperphosphatemia

Question 20

Situation:
65 years old, Mike was diagnosed with Chronic Lymphocytic Leukemia. He feels anxious and decided to ask more information regarding the disease
21. CLL is the most prevalent leukemia in adults in which type of race?
*
1 point
A. Mediterranean World
B. Eastern World
C. Western World
D. European World

Answer 20

C. Western World

Question 21

The disease is historically classified into three or four stages, based on the two classification systems that are used. In the early stage, an elevated lymphocyte count is seen; it can exceed:
*
1 point
A. 100,000/mm3.
B. 200,000/mm3.
C. 300,000/mm3.
D. 400,000/mm3.

Answer 21

A. 100,000/mm3.

Question 22

Complications of leukocytosis are typically found in what organs of the body? Select all that applies

i. Lungs

ii. Brain

iii. Liver

iv. Spleen

v. Lymph nodes

vi. Pancreas

*
1 point
A. i and ii
B. Iii and iv
C. Iv and v
D. iii and vi

Answer 22

C. IV and V

Question 23

It is a protein found on the surface of lymphocytes, can be measured in the serum; an elevated level correlates with a more advanced clinical stage and poorer prognosis.
*
1 point
A. Beta-1 microglobulin
B. Beta-2 microglobulin
C. Alpha- 1 microglobulin
D. Alpha- 2 microglobulin

Answer 23

B. Beta-2 microglobulin

Question 24

Many patients are asymptomatic and are diagnosed incidentally during routine physical examinations or during treatment for another disease. The following blood work usually occurs to patients with CLL:
*
1 point
A. Lymphocytosis, increased erythrocytes, increased platelets
B. Lymphocytosis, decreased erythrocytes, decreased platelets
C. Lymphocytosis. Increased erythrocytes, decreased platelets
D. Lymphocytosis. Decreased erythrocytes, increased platelets

Answer 24

B. Lymphocytosis, decreased erythrocytes, decreased platelets

Question 25

Situation:
For cancers like leukemia, the goal of treatment is to obtain remission without excess toxicity and with a rapid hematologic recovery so that additional therapy can be given if needed. As an oncology nurse, you must be aware with the treatment and interventions needed to aide your patient
26. Lymphoid blast cells are typically very sensitive to corticosteroids and to vinca alkaloids; therefore, these medications are an integral part of the initial induction therapy. Among the following corticosteroids, which is more preferred because of its toxicity to lymphoid cells and has better CNS penetration
*
1 point
A. Prednisone
B. Betamethasone
C. Dexamethasone
D. Hydrocortisone

Answer 25

C. Dexamethasone

Question 26

Chemotherapeutic drugs such as fludarabine is a medication used to treat CLL. However, this medication comes with adverse effects. Fludarabine may cause a patient to have:
*
1 point
A. Bone marrow suppression
B. Hepatitis
C. Nephrotoxic
D. Neurotoxic

Answer 26

A. Bone marrow suppression

Question 27

Recurrent fevers are common in acute leukemia; at times, they are accompanied by shaking chills (rigors), which can be severe. Myalgias and arthralgias can result. Sponging may be useful, what temperature should be used for these fevers?
*
1 point
A. Cool water
B. Warm water
C. Lukewarm
D. Either cool or warm water

Answer 27

A. Cool water

Question 28

The patient has severe neutropenia and wants to ambulate in the corridor. As a dutiful nurse, you know that she may get easily infected if she went out of her room. What nursing intervention is needed to address the patient’s request?
*
1 point
A. Have a talk with her attending physician regarding the patient’s condition and get a doctor’s permission
B. Tell the patient that she could ambulate within her room until her blood tests improve
C. Have the patient wear a HEPA and permit her to ambulate outside
D. A and C

Answer 28

C. Have the patient wear a HEPA and permit her to ambulate outside

Question 29

Replacement of electrolytes, particularly ______ and _______, is commonly required. Patients receiving amphotericin or certain antibiotics are at increased risk for electrolyte depletion.
*
1 point
A. Sodium and Chloride
B. Potassium and Calcium
C. Phosphorus and Calcium
D. Potassium and Magnesium

Answer 29

D. Potassium and Magnesium

Question 30

Situation:
Irritable Bowel Syndrome is a functional disorder characterized by chronic or recurrent diarrhea, constipation, and/or abdominal pain and bloating. Nurse Melinda knows that IBS has two two types which are: Crohn’s Disease and Ulcerative Colitis. To be an effective healthcare provider, nurse Melinda should know the difference between these two diseases.
31. This type of ulcerative colitis results in vascular congestion, hemorrhage, edema, and ulceration of the bowel mucosa.
*
1 point
A. Acute Ulcerative Colitis
B. Chronic Ulcerative Colitis
C. Intermittent Ulcerative Colitis
D. Dysfunctional Ulcerative Colitis

Answer 30

Ulcerative Colitis -> affects color and Rectum (has not Cure)

Chrons Disease -> affects entire colon (scattered Fashion) has cobble stone appearance

A. Acute Ulcerative Colitis

Question 31

This type of ulcerative colitis causes muscular hypertrophy, fat deposits, and fibrous tissue, with bowel thickening, shortening, and narrowing.
*
1 point
A. Acute Ulcerative Colitis
B. Chronic Ulcerative Colitis
C. Intermittent Ulcerative Colitis
D. Dysfunctional Ulcerative Colitis

Answer 31

B. Chronic Ulcerative Colitis

Question 32

The following are signs and symptoms of ulcerative colitis, except:
*
1 point
A. Severe diarrhea that may contain blood, pus or blood
B. Intermittent fever
C. Malaise
D. Vitamin K deficiency

Answer 32

A. Severe diarrhea that may contain blood, pus or blood

Pus is seen in chron’s disease

Question 33

During the acute phase of ulcerative colitis, the following are interventions done for the client, except:
*
1 point
A. Maintain NPO
B. Provide ice chips as needed
C. Encourage the client to schedule activities around rest periods.
D. Restrict the client’s activity

Answer 33

(-)
C. Encourage the client to schedule activities around rest periods.
R: In Ulcerative colitis mama Yemeni we aim to reduce intestinal activities thus D is correct .
TSS: C & D are opposing choices

Question 34

Following the acute phase, the following is a diet provided to the client:
*
1 point
A. Low fiber, high protein, vitamins and iron
B. High fiber, high protein, vitamins and iron
C. Low fiber, low protein, vitamins and iron
D. High fiber, low protein, vitamins and iron

Answer 34

A. Low fiber, high protein, vitamins and iron
R: recommended to prevent exacerbation

Question 35

Crohn’s Disease is an inflammatory disease that can occur anywhere in the gastrointestinal tract but most often affects the:
*
1 point
A. Duodenum
B. Jejunum
C. Ileum
D. Cecum

Answer 35

C. Ileum (terminal)

There’s scattered injury

Question 36

The following are signs and symptoms of Crohn’s disease, except:
*
1 point
A. Cramplike and colicky pain after meals
B. Diarrhea which may contain blood, pus or blood
C. Fever
D. Vitamin K Deficiency

Answer 36

D. Vitamin K Deficiency - seen in ulcerative collitis

Question 37

Medications for Irritable Bowel Syndrome (IBS) are given to the patients, this/these may include: Select all that applies.

i. Salicylate compounds

ii. Corticosteroids

iii. Immunosuppressants

iv. Antidiarrheals

*
1 point
A. I and IV
B. II and IV
C. I, III and IV
D. I, II, III and IV

Answer 37

D. I, II, III and IV

IBS is GI expect a GI symptoms

Question 38

Surgical procedures such as Total Proctocolectomy is done in extreme cases if medical management is unsuccessful. Which one is included in the preoperative interventions?
*
1 point
A. Informed consent must be obtained a day before the surgery
B. The client may need to follow a low fiber diet 1 to 3 days before the surgery
C. Parenteral antibiotics are administered 1 hour before the surgical opening
D. Address body image concerns after the surgery is done

Answer 38

Highlight: PREOPINTERVENTIONS

C. Parenteral antibiotics are administered 1 hour before the surgical opening

A. X not before the surgery
B. X dat 2 days
D. X Dat BEFORE

Question 39

Surgical procedures such as Total Proctocolectomy is done in extreme cases if medical management is unsuccessful. Which one is included in the postoperative interventions?
*
1 point
A. Note that the normal stoma color is pale pink to bright red and shiny, indicating high vascularity.
B. If a pouch system is not covering the stoma, a petrolatum gauze dressing is placed over the stoma
C. Monitor the pouch system for proper fit and signs of leakage; the pouch is emptied when it is two-third full.
D. Instruct the client that normal activities may be resumed after two weeks

Answer 39

B. If a pouch system is not covering the stoma, a petrolatum gauze dressing is placed over the stoma - too keep it moist then ff by dry sterile dressing

Pale pink stoma: low hgb, low hct levels
Purple black stoma: compromised circulation

Question 40

Situation:
Mikael, an 18 years old boy went to the Emergency Room complaining of severe pain in his right lower abdomen. Nurse Camille assessed Mikael and has found out that he is positive for rebound tenderness and with history of nausea and vomiting, she suspect that Mikael might be diagnosed with Appendicitis
41. Which is true regarding Appendicitis?
*
1 point
A. Pain starts from the umbilical area to the right lower quadrant
B. High grade fever
C. Abdominal pain that is most intense at the right lower quadrant when left lower quadrant is pressed
D. Diarrhea may be a sign of appendicitis

Answer 40

Highlight: Appendicitis

D. Diarrhea may be a sign of appendicitis

A. X dat PERIUMBILICAL area that descends to the right lower quadrant
B. X low grade fever
C. X McBurney’s point

Question 41

The Complete Blood Count of someone with an appendicitis demonstrates:
*
1 point
A. Elevated WBC, elevated neutrophils, elevated c-reactive protein
B. Elevated WBC, elevated neutrophils, decrease c-reactive protein
C. Elevated WBC, elevated neutrophils, elevated ESR
D. Elevated WBC, elevated neutrophils, decreased ESR

Answer 41

A. Elevated WBC, elevated neutrophils, elevated c-reactive protein

Question 42

The major complications of appendicitis are:

i. Hemorrhage

ii. Necrotitis

iii. Gangrene

iv. Perforation

*
1 point
A. I and IV
B. I and II
C. II and III
D. III and IV

Answer 42

iii. Gangrene
iv. Perforation
- may cause peritonitis

Question 43

Which is true among gerontologic considerations regarding appendicitis?
*
1 point
A. Acute appendicitis is common in older adults (Uncommon)
B. Pain may be present or minimal (Absent)
C. Fever and leukocytosis is present in most cases (Absent)
D. Incidence of complications is higher to younger adults (older adults)

Answer 43

Bonus

Question 44

After appendectomy, the nurse provides post-operative care. Which among the choices are included?
*
1 point
A. After the surgery the patient is placed in a semi fowler’s position
B. After the surgery the patient is placed in a high fowler’s position
C. After the surgery the patient is placed in a side lying position
D. After the surgery the patient is placed in a dorsal recumbent position

Answer 44

B. After the surgery the patient is placed in a high fowler’s position = reduces the tension; increased lung expansion

Question 45

Situation:
Nurse Annie is caring for a patient with diverticulosis.

46. Which is true regarding diverticulosis?
    *
    1 point
    A. Chronic constipation sometimes precedes the development of diverticulosis
    B. Acute constipation sometimes precedes the development of diverticulosis
    C. Chronic diarrhea sometimes precedes the development of diverticulosis
    D. Acute constipation sometimes precedes the development of diverticulosis

Answer 45

Diverticulosis
A. Chronic constipation sometimes precedes the development of diverticulosis

Question 46

Diverticulosis commonly occur at the left side of the colon, particularly the sigmoid colon, but due to the genetics of this race, diverticulosis may occur at the right side.
*
1 point
A. Black American
B. Asian Americans
C. European
D. Mediterranean

Answer 46

B. Asian American

Question 47

Which among the phrases are facts regarding diverticulosis

i. Diverticulosis is the most common pathologic incidental finding on colonoscopy

ii. Approximately 80% of patients with diverticulosis never develop any complications or symptoms of disease

*
1 point
A. I
B. II
C. I and II
D. Neither

Answer 47

C. I and II

Question 48

The following nursing management are intended for a patient with diverticulosis, except:
*
1 point
A. Fluid intake of 2-3L per day
B. Increased fiber in the patient’s diet
C. Encourages daily intake of bulk laxatives
D. Prepare cereals and soft-cooked vegetables as part of their diet

Answer 48

A. Fluid intake of 2-3L per day

Question 49

Although acute diverticulitis usually subsides with medical management, immediate surgical intervention is necessary if complications occur. Hartmann procedure is a primary resection for diverticulitis of the colon. The affected segment has been divided at its __________.
*
1 point
A. Proximal end
B. Distal end
C. Primary end
D. Secondary end

Answer 49

B. Distal end

Question 50

Situation:
Angelica Remi, 53 years old, complains of lower abdominal pain, burning on urination, and cloudy urine. Laboratory results reveal an elevated WBC count. She is diagnosed with acute cystitis.

51. Angelica is prescribed sulfadiazine. After reviewing her laboratory results and serum drug levels, which medical history should you be most concerned with?
    *
    1 point
    A. A history of diabetes
    B. A history of sexually transmitted disease
    C. A history of polycystic ovarian syndrome
    D. A history of osteoarthritis

Answer 50

A. A history of diabetes = risk for hypoglycemia

Question 51

. Inflammation of the urethra, also known as urethritis, can occur with cystitis and is commonly associated with sexually transmitted infections (STIs). All but one of the following statements made by the patient indicates adequate understanding of the proper interventions of STI-related urethritis:
*
1 point
A. Sterility is not a point of concern for urethritis caused by chlamydial infections.
B. Condom use can help prevent STIs.
C. Follow-up cultures can be requested in at least 4 days to evaluate the effectiveness of the medication regimen.
D. All sexual partners during the 30 days before diagnosis with chlamydial infection should be examined and treated as necessary.

Answer 51

A. Sterility is not a point of concern for urethritis caused by chlamydial infections. = serious infection > sterility

Question 52

A few weeks after initial treatment, Patient Angelica develops flank pain, costovertebral angle tenderness, with bloody, cloudy urine. Her vital signs are: temp: 38C; BP: 140/115 mmHg; HR: 110 bpm; RR: 23 breaths/min. Diagnostic results reveal pyelonephritis. You know that the most common causative bacterial organism for pyelonephritis is?
*
1 point
A. S. aureus
B. E. coli
C. P. aeruginosa
D. None of the above

Answer 52

B. E. Coli
Most common bacterial organism

Question 53

. Lily comes into the ER complaining of sharp, severe pain in the lumbar region. CT scans reveal renal nephrolithiasis. After further analysis, it is known that the renal calculi are high in oxalate content. Which of the following foods should you instruct the patient to avoid?
*
1 point
A. Milk and dairy products
B. Sardines and liver
C. Chicken and bacon
D. Cabbage and tomatoes

Answer 53

D. Cabbage and Tomatoes
Rich in OXalate

Question 54

Which of the following assessment findings indicate that the disease has progressed significantly?
*
1 point
A. Post-void dribbling
B. Nocturia
C. Diminished size and force of urinary stream
D. Hesitancy

Answer 54

A. Post-void dribbling

Question 55

Renal calculi can lead to hydronephrosis, which is the distention of the renal pelvis and calyces caused by obstruction of normal urine flow. Which of the following assessment parameters should you suspect in a patient with hydronephrosis?
*
1 point
A. Renal colic which originates in the lumbar region and radiates to the bladder.
B. Pain below the level of the umbilicus that radiates to the shoulders.
C. Flank pain that worsens with activity and is relieved when lying down.
D. Colicky or dull flank pain that radiates to the groin.

Answer 55

D. Colicky or dull flank pain that radiates to the groin.

Question 56

A patient complains of severe back pain and hematuria. He is found to have hydronephrosis secondary to renal stone formation. As his nurse, which of the following treatment modalities will you expect?
*
1 point
A. Intermittent peritoneal dialysis
B. Nephrostomy tube insertion
C. Urinary stone analysis
D. Extracorporeal shockwave therapy

Answer 56

B.
B. Nephrostomy tube insertion
Allow to the urine to drain and relive the obstruction in the ureters (main concern is Hydronephrosis)

Question 57

A patient complains of fever, chills, and hematuria. To check whether the client’s problem is related to polycystic kidney disease, the nurse reviews the results of the physical examination for which characteristic of this disorder?
*
1 point
A. Colicky or dull flank pain that radiates to the groin.
B. Renal colic which originates in the lumbar region and radiates to the bladder.
C. Flank pain that worsens with activity and is relieved when lying down.
D. Pain below the level of the umbilicus that radiates to the shoulders.

Answer 57

C. Flank pain that worsens with activity and is relieved when lying down.

A. For Hydronephrosis
B. Rena Stone calcium
D. Badder Trauma

Question 58

Which of the following assessment findings renders prompt attention by the nurse for a patient with polycystic kidney disease?
*
1 point
A. Fever and chills
B. Hypertension
C. Recurrent UTIs
D. Hematuria

Answer 58

D. Hematuria
R: Close monitoring in case of Cysts Rupture

Question 59

For a patient with polycystic kidney disease, which of the following medications should you stay alert for?
*
1 point
A. Oral hypoglycemics
B. NSAIDs
C. Diazepam
D. Clonidine

Answer 59

B. NSAIDs and Aspirin > risk for bleeding

Question 60

Situation:
Situation: Jean Tatlock, 66 years old, female, is admitted in the Medical Ward of AEC Hospital. Because of an upper motor neuron lesion, she has lost conscious sensation and control of her voiding patterns.
61. For Patient Tatlock’s case, the bladder empties on reflex, with minimal or no controlling influence to regulate its activity. This type of neurogenic bladder dysfunction is called?
*
1 point
A. Spastic
B. Flaccid
C. Paradoxic
D. Atypical

Answer 60

A. Spastic or Reflex bladder

Two types of neurogenic bladder
1. Spastic Bladder: More common; spinal cord lesion (Upper motor neuron lesion)
2. Flaccid Bladder:

Question 61

Patient Tatlock is scheduled for catheterization. Which of the following step(s) below is/are correctly implemented?
*
1 point
A. Position the patient supine, with thighs slightly abducted or apart.
B. Lubricate the catheter at 15 cm and place it with the drainage end inside the collection container.
C. Advance the catheter 5 cm farther after the urine begins to flow through it.
D. All steps are correct.

Answer 61

C. Advance the catheter 5 cm farther after the urine begins to flow through it.

Position should be supine with knees flexed, feet 2ft apart, hips slightly externally rotated

Lubricate for 2.5 cm - 5 cm

Question 62

While caring for Patient Tatlock, you understand that infection prevention for a catheterized patient is one of your priorities. Which of the intervention(s) below should you avoid?
*
1 point
A. Irrigate the catheter routinely.
B. Wash the perineal area with soap and water at least twice a day.
C. Ensure free-flowing urine.
D. Empty the collection bag at least every 8 hours through the drainage spot.

Answer 62

A. Irrigate the catheter routinely.

Question 63

As part of your teaching plan, you instruct Patient Tatlock about bladder retraining after indwelling catheterization. All but one of the following choices are correct points to include in your plan:
*
1 point
A. At specified times, ask the patient to void by applying pressure on the abdomen.
B. Instruct the patient to drink a measured amount of fluid from 8 AM to 10 PM to avoid bladder overdistention. Offer no fluids (except sips) after 10 PM.
C. Instruct the patient without usual sensation to be alert for any signs that indicate a full bladder, such as perspiration, cold hands or feet, and feelings of anxiety.
D. Lengthen the intervals between catheterizations as the volume of residual urine decreases.

Answer 63

A. At specified times, ask the patient to void by applying pressure on the abdomen.

Question 64

You assess Patient Tatlock and find that she has an indwelling catheter still in place. Which of the following early signs prompt you to suspect that the patient is having an infection?
*
1 point
A. Fever
B. Elevated WBC count
C. Dysrhythmia
D. Confusion

Answer 64

D. Confusion

Question 65

Situation:
The nurse is caring for patients admitted in the orthopedic ward.
66. Kate, 16, female, is rushed to the ER after sustaining a right arm fracture from a bicycle fall A fracture in which a fragment of the bone has been pulled away by a tendon and its attachment is called?
*
1 point
A. Expulsion fracture
B. Compression fracture
C. Involution fracture
D. Avulsion fracture

Answer 65

D. Avulsion fracture

B.Vertebral or backbone fracture - Compressed Bone

Question 66

Patient Kai sustained a fracture on his wrist after a poor landing during his gymnastic competition. The patient complains of deep, throbbing, unrelenting pain which continues to increase despite pain medications. The pain intensifies with passive ROM. You suspect compartment syndrome. As his nurse, you understand that the pathophysiology of the pain is caused by:
*
1 point
A. An increase in the size of the muscle compartment due to compression and crowding of muscles, nerves, and blood vessels sustained from the injury.
B. A decrease in the size of the muscle compartment along with an increase in compartment contents because of hemorrhage from the fracture site.
C. An increase in the size of the muscle compartment along with a decrease in compartment contents because of displacement of muscles, nerves, and blood vessels to surrounding tissues.
D. A decrease in the size of the muscle compartment because the enclosing fascia contracts to counter the compression of muscles, nerves, and blood vessels sustained from the injury.

Answer 66

B. A decrease in the size of the muscle compartment along with an increase in compartment contents because of hemorrhage from the fracture site.

Question 67

68. Patient Peter sustained a fracture of the femur from a vehicular accident. The patient is placed on a suspension traction for fracture approximation. Suddenly, he becomes restless and complains of sudden chest pain. What key assessment findings should the nurse watch out for if the patient is suspected to have developed a fat embolism?
    *
    1 point
    A. Hemoptysis and crackles.
    B. Decreased sensation in the fracture site.
    C. Pain with passive movement.
    D. Elevated ESR with erythema and pain in the affected site.

Answer 67

A. Hemoptysis and crackles.

Question 68

Hannibal Lecter is using crutches for the first time after sustaining an injury from running after his victims. Nurse Koi observes Hannibal as he advances both crutches together. Both legs are lifted through and beyond the crutches and placed down again at a point in front of the crutches. Nurse Koi knows that this crutch gait is best used when ______.
*
1 point
A. Doing a two-point gait for partially weight bearing legs.
B. Doing a swing-to gait when there is adequate muscle power and balance in the arms and legs.
C. Doing a four-point gait if the weight-bearing leg is allowed and there is adequate muscle power in the arms.
D. Doing a swing-through gait and there is adequate muscle power and balance in the arms and legs.

Answer 68

D. Doing a swing-through gait and there is adequate muscle power and balance in the arms and legs.

Question 69

. Accurate crutch measurement for the patient is important in order to avoid damage to the brachial plexus. The following guidelines should be observed during crutch walking. Select all that apply.

I. Inform the patient that tingling in the arms is normal and will subside while ambulating.

II. The distance between the axillae and the arm pieces on the crutches should be at least 2 finger widths in the axilla space.

III. When ambulating with the client, stand on the affected side.

IV. When tired, the client can rest the axillae momentarily on the axillary bars.

V. Instruct the client to look down and inward when ambulating and to place the crutches 6 to 10 inches parallel in front of the foot.

VI. The elbows should be slightly flexed at most 30 degrees while walking. .

*
1 point
A. I, III, VI
B. II, III, VI
C. III, IV, VI
D. IV, III, II

Answer 69

B. II, III, VI

Question 70

Which of the following statements are true regarding tractions?

I. Tractions are used for long-term interventions along with external or internal fixations which reduce the risk of disuse syndrome.

II. Weights can be removed if intermittent traction is prescribed.

III. A skeletal traction can be momentarily interrupted if intermittent traction is prescribed.

IV. Knots in the rope of the footplate must not touch the pulley or the foot of the bed.

V. Care must be taken to avoid pressure on the peroneal nerve at the point at which it passes around the neck of the fibula just below the knee, because skin traction can place pressure on peripheral nerves.

*
1 point
A. I, II, IV
B. I, III, IV
C. II, IV, V
D. III, IV, V

Answer 70

Bonus
IV, V

Question 71

The following are pin site care interventions to avoid osteomyelitis for patients in skeletal tractions with pin insertion sites, except:
*
1 point
A. During the first 72 hours after insertion, the site is covered with a sterile absorbent non-stick dressing.
B. The frequency of pin care is initially done once or twice a day, and is increased as needed.
C. Water and saline can be used to clean pin sites.
D. Pins can be removed if systemic infection occurs.

Answer 71

A. During the first 72 hours after insertion, the site is covered with a sterile absorbent non-stick dressing.

Question 72

The following choices correctly define common orthopedic surgical procedures. Which is the exception?
*
1 point
A. In bone grafts, bone tissues which are either autologous or homologous are used in the placement of bone tissue.
B. Open reduction is the stabilization of the reduced fracture by the use of metal plates.
C. Meniscectomy is the excision of damaged joint fibrocartilage.
D. Arthroplasty is the repair of joint problems through the operating arthroscope.

Answer 72

B. Open reduction is the stabilization of the reduced fracture by the use of metal plates. (Internal Fixation)

Open reduction: correction and alignment of fracture after surgical exposure

Question 73

You are caring for Patient Petal who underwent hip replacement surgery. You understand that until the hip prosthesis stabilizes after surgery, it is necessary to follow instructions for proper positioning so that the prosthesis remains in place. Which of these instructions will you include in your health teaching?

I. Neutral rotation and flexion of less than 90 degrees are allowable.

II. When sitting, the hips should be higher than the knees.

III. The knees should be together at all times to avoid displacement of the hip joints farther away from each other.

IV. When picking up objects from the floor, bend forward to allow ease of movement.

V. Pillows should be put in-between the legs when in a supine or side-lying position or when turning.

VI. When going out of bed, the patient should pivot on the unaffected leg with assistance from the nurse to prevent abduction and excessive weight bearing.

*
1 point
A. I, II, V
B. II, III, V
C. III, V, VI
D. IV, V, VI

Answer 73

A. I, II, V

Question 74

A fractured hip can be intracapsular or extracapsular in nature. Which of the following choices correctly differentiates the two?
*
1 point
A. In an intracapsular fracture, the fracture occurs at the greater trochanter. (Extracapsular)
B. In an extracapsular fracture, the femoral head and neck receive decreased blood supply leading to slow healing. (Intracapsular)
C. In an extracapsular fracture, treatment includes hip replacement or open reduction internal fixation (ORIF). (Intracapsular)
D. In an intracapsular fracture, skin traction is applied preoperatively to reduce the fracture and decrease muscle spasms.

Answer 74

D. In an intracapsular fracture, skin traction is applied preoperatively to reduce the fracture and decrease muscle spasms.

Intracapsular: femoral head is broken within joint capsule
Extracapsular: fracture is outside joint capsule

Question 75

Assessing peripheral nerve function allows the nurse to test sensation and motion. To assess the sensation involving the peroneal nerve, what maneuver should the nurse do?
*
1 point
A. Prick the skin midway between the thumb and second finger.
B. Prick the medial and lateral surface of the toe.
C. Prick the distal fat pad of the small finger.
D. Prick the skin midway between the great and second toe.

Answer 75

D. Prick the skin midway between the great and second toe.

A. Radial Nerve
B. Tibial nerve
C. Ulnar Nerve

Question 76

Patient Levi is for discharge following cervical disc surgery after a severe spinal cord compression from a vehicular accident. The following statements show that the patient does not understand the discharge instructions, except?
*
1 point
A. “I may suspect cervical spine instability if I experience pain that radiates from the back of the leg to the foot.”
B. “Hoarseness is expected after surgery and will go away after a few hours.”
C. “I will use anesthetic lozenges for my sore throat to help decrease post-op pain.”
D. “If I have difficulty swallowing, a clear liquid diet can help.”

Answer 76

A. “I may suspect cervical spine instability if I experience pain that radiates from the back of the leg to the foot.”

Question 77

. Patient Lia is diagnosed with gouty arthritis. Allopurinol is part of her daily medication regimen. Which of the following nursing considerations should you consider when administering allopurinol to the client?
*
1 point
A. Advise the patient to take Vitamin C in order to increase its effect.

A. “I may suspect cervical spine instability if I experience pain that radiates from the back of the leg to the foot.”
B. Advise patient to minimize exposure to sunlight
C. Both A and B.
D. None of the above.

Answer 77

B. Advise the patient to minimize exposure to sunlight. = for possible visual changes for prolonged use of allopurinol

Question 78

DMARDs are effective antirheumatic medications that are used to slow the degenerative effects of rheumatoid arthritis. Which of the following nursing considerations correctly matches the prescribed drug and its adverse effect?
*
1 point
A. A patient taking etanercept must have a routine cardiovascular assessment.
B. A patient taking hydroxychloroquine should have complete blood count assessments.
C. A patient taking rituximab must immediately report itching and chest pain.
D. A patient taking infliximab should report increased thirst.

Answer 78

A. A patient taking etanercept must have a routine cardiovascular assessment.
R: Due to Risk of Heart Failure

B. Irreversible Retinopathy
C. X AE is Increase thirst and urination
D. Possible infusion Reaction : Fever, Chills, Pruritus

Question 79

You are conducting a health teaching regarding the signs and symptoms of compartment syndrome. You know that the client understands your health teaching when he correctly identifies which early symptom of compartment syndrome?
*
1 point
A. Pain that increases when the arm is moved or is on a dependent position.
B. A feeling of prickly sensations in the fingers.
C. Cold, bluish fingers.
D. Pain that is very intense, such that it is out of proportion from the severity of the fracture.

Answer 79

B. A feeling of prickly sensations in the fingers. (Paresthesia)

Question 80

Patient Adolf, 73 years old, male, is prescribed cyclobenzaprine, a skeletal muscle relaxant. Which significant medical history should you carefully consider when administering this medication to the patient?
*
1 point
A. A history of community-acquired pneumonia
B. A history of schizophrenia
C. A history of angle-closure glaucoma
D. A history of atopic dermatitisC

Answer 80

C. A history of angle-closure glaucoma
Clycobenzaprine has anticholinerg effect is CI to pt with Glaucoma

Question 81

Spondyloarthropathies are systemic inflammatory disorders of the skeleton. Which of the following statements is/are true regarding spondyloarthropathies?
*
1 point
A. Reiter’s syndrome is characterized by synovitis, polyarthritis, and spondylitis. = psoriatic aethritis
B. Psoriatic arthritis occurs after an infection and is characterized by urethritis, arthritis, and conjunctivitis. = reiiter’s
C. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues.
D. All statements are true.

Answer 81

(+)

C. Ankylosing spondylitis affects the cartilaginous joints of the spine and surrounding tissues.

A. Psoriatic Arthritis
B. Reiter syndrome

Question 82

Zea, 67 years old, female, is diagnosed with gouty arthritis. She is prescribed febuxostat (Uloric) to decrease her uric acid levels. Which of the following nursing considerations should you keep in mind?
*
1 point
A. Monitor for side effects including bone marrow depression, vomiting, and abdominal pain.
B. Monitor serum electrolytes, ECG tracings, and pulmonary function tests.
C. Monitor liver function tests.
D. Watch out for nausea, rash, and GI upset.

Answer 82

A. Monitor for side effects including bone marrow depression, vomiting, and abdominal pain.

Question 83

Patient Lulu, 78 years old, is diagnosed with gouty arthritis. She is taking probenecid as part of her antigout medication regimen. Which of the following medication orders will you question from her therapeutic sheet?
*
1 point
A. Acetaminophen
B. Amlodipine
C. Aspirin
D. Atorvastatin

Answer 83

C. Aspirin

Question 84

Pia, 62 years old, female, is on a medication regimen to manage her osteoporosis. Aside from her calcium and vitamin D supplementation, she is also prescribed alendronate. Which of the following statements made by Patient Pia exhibits understanding of the proper intake of alendronate?
*
1 point
A. “I must remain sitting or standing and avoid eating anything for at least 30 minutes after taking the medication.”
B. “I should consult my doctor if I notice unusual bruising on my arms and legs.”
C. “I should drink the medication with meals.”
D. “I should consult my doctor if I suddenly develop a fever after a week of taking the medication.”

Answer 84

A. “I must remain sitting or standing and avoid eating anything for at least 30 minutes after taking the medication.”

Question 85

Situation:
As nurses, we are also expected to be knowledgeable in emergency response and disaster nursing as the country is prone to natural and manmade disasters. You are a beginner nurse learning the basic concepts about ERDN.
86. There are four disaster management phases: mitigation, preparedness, response, and recovery. You are part of the team that orients the LGU about the available community resources and community health personnel to facilitate mobilization of activities and minimize chaos and confusion if a disaster occurs. Which phase does this refer?
*
1 point
A. Mitigation
B. Preparedness
C. Response
D. Recovery

Answer 85

A. Mitigation

Question 86

87. How often do you need to replace the stored water and food supply for the emergency supplies?
    *
    1 point
    A. Every 13 months for the water and food supply.
    B. Every 3 months for the water supply and every 4 months for the food supply
    C. Every 4 months for the water supply and every 8 months for the food supply
    D. Every 3 months for the water supply and every 6 months for the food supply

Answer 86

D. Every 3 months for the water supply and every 6 months for the food supply

Question 87

In the event that no other reliable clean source of drinking water is available, treating uncertain quality water can be done. There are no perfect ways to decontaminate water, but a combination of methods is the best. Which of the following are correct methods to treat water? Select all that apply.

I. Boil water to a rolling boil for 30 seconds

II. Using regular household bleach that contains 5.25 to 6.0 percent sodium chlorite

III. Boil the water for 20 minutes and then collect the vapor that condenses back to water
*
1 point
A. I, II
B. III only
C. II, III
D. I, II, III

Answer 87

C. II, III
Chlorination and Distilation

Question 88

Over the past few days, there has been several warnings about a strong typhoon coming to your hometown which is near a undermaintained water dam. It started heavily raining and you noticed that the undermaintained started overflowing and cracks show up the dam. What is your priority action as part of emergency response and disaster team?
*
1 point
A. Contact the LGU immediately and tell them about the water dam
B. Activate the emergency response plan
C. Inform the house owners near the water dam, to save as many people as you can
D. Gather the necessary disaster kit for evacuation

Answer 88

B. Activate the emergency response plan
TSS: Umbrella Answer

Question 89

. In which phase is practicing of community emergency response plans belong to?

*
1 point
A. Mitigation
B. Preparedness
C. Response
D. Recovery

Answer 89

B. Preparedness

Question 90

Situation:
You and your team arrive at the collapsed building due to an earthquake. You survey the scene and saw a lot of patients lying on the floor, some are walking away from the building with varying degree of injuries, and few are crouching on the lying bodies. The team leader oriented the team to use the NATO triage system.
91. Which of the following patients require the most immediate attention?
*
1 point
A. Patient with abdominal wound but stable for now
B. Patient with femur fracture
C. Patient with 2nd degree burns more than half of the body
C. Patient with sunken skull and appears unresponsive

Answer 90

B. Patient with femur fracture = risk for fat embolism

Question 91

Which of the following patients can be given delayed attention?
*
1 point
A. Patient with jaw injury
B. Patient with 2nd degree burns (15% BSA)
C. Patient with arm fracture
D. Patient with minor burns

Answer 91

A. Patient with jaw injury

Question 92

. Which of the following can be already removed from the main triage area
*
1 point
A. Patient with eye injury
B. Patient with unstable chest wound
C. Patient with stable abdominal wound
D. Patient with arm fracture

Answer 92

D. Patient with arm fracture

Question 93

. In another type of triage, who are the priority patients if the resources are very limited, there are few healthcare workers present, and it is necessary to return the people to the state of being capable in helping others as much as possible?
*
1 point
A. Patient with agonal respirations
B. Patient with sucking chest wound
C. Patient with lacerations on the face and arms
D. Patient with vascular injuries

Answer 93

C. Patient with lacerations on the face and arms

Question 94

In another type of triage, which level of ESI (Emergency Severity Index) would you categorize a patient with only one resource needed to be stabilized?
*
1 point
A. ESI level 2
B. ESI level 3
C. ESI level 4
D. ESI level 5

Answer 94

C. ESI level 4 C. ESI level 4

Question 95

Situation:
You are a nurse assigned to different emergency cases.
96. One patient was admitted to the ER from a recent fist fight in prison. You received the patient, who is a person deprived of liberty, aggressive and violent as he still feels mad about not finishing the fight. Which is the correct nursing action?
*
1 point
A. Treat the patient as how you treat normal adult patients as this is only fair.
B. Withdraw basic nursing care, only give life-saving interventions.
C. Do not release handcuffs.
D. Refrain from putting any masks on the patient to avoid further aggression.

Answer 95

C. Do not release handcuffs.

Question 96

You are assessing a patient for a quick neurologic assessment. The patient only responds to your voice when you enter the room, she says non-related responses to your questions, and withdraws from pain. What is the patient’s GCS score?
*
1 point
A. E2V4M5
B. E3V3M4
C. E2V2M3
D. E3V3M3

Answer 96

B. E3V3M4

Question 97

During the secondary survey done after a triage, which of the following are not included under this phase?
*
1 point
A. Gordon’s Functional Patterns, and complete history taking
B. Diagnostic and radiologic tests
C. Physical assessment from head to toe
D. Neurological assessment (GCS)

Answer 97

D. Neurological Assessment (GCS)
This is primary surgery

Question 98

. One of the patients was found to be a victim of hazing. He was brought to the hospital with symptoms of dark tea-colored urine, weakness, and myalgia. What specific parameter would reflect that the resuscitative management is effective?
*
1 point
A. Decrease in serum lactic acid
B. Increase in serum lactic acid
C. Decrease in serum creatinine-kinase
D. Increase in serum creatinine-kinase

Answer 98

A. Decrease in serum lactic acid

Possible rhabdomyolysis

Question 99

Based on the patient in the previous item, which of the following is true about his condition?
*
1 point
A. Myopathy refers to the muscle symptoms with creatinine kinase elevation
B. Myalgia refers to muscle ache or weakness with marked creatinine kinase elevation
C. Rhabdomyolysis involves muscle symptoms with marked creatinine kinase levels, typically >11 times in elevation
D. Treatment for the condition is initially curative, preventing limb loss or damage.

Answer 99

C. Rhabdomyolysis involves muscle symptoms with marked creatinine kinase levels, typically >11 times in elevation