Week 3 HESI

Question 1

A positive test for the ____ mutation identifies an increased risk for breast cancer.

Answer 1

BRCA1

Question 1

Placing the arm over the ______ when lying down helps spread the breast tissue over the chest wall, making palpation more effective.
[BSE]

Answer 1

head

Question 2

The single most important risk factor for breast cancer is being an ____________ . Teaching the client’s family about the need for routine BSE and mammograms is the nurse’s highest priority, so the client will be able to make an informed decision about screening.

Answer 2

older female

Question 3

Which side effect of tamoxifen should the nurse instruct the client to report immediately?

Irregular vaginal bleeding.

Decrease in visual acuity.

Leg cramping.

Hot flashes at night.

Answer 3

Decrease in visual acuity.
Decreased visual acuity can occur in women receiving high doses of tamoxifen and can be irreversible. The client should immediately report decreased visual acuity.

Question 4

Tamoxifen is an antiestrogen agent and may cause the same symptoms of decreased estrogen that occur during ____________ , such as hot flashes, dry skin, nausea, and menstrual irregularities.

Answer 4

menopause

Question 5

The nurse is aware that treatment with antineoplastic chemotherapeutic agents can cause immunosuppression, which predisposes the client to infection. Which assessment finding warrants intervention by the nurse?

Tingling in the fingers.

Sudden onset of nausea.

Temperature of 99.5° F (37.5° C).

Episodes of epistaxis.

Answer 5

Temperature of 99.5° F (37.5° C).

An immunosuppressed individual may only develop a low-grade fever in response to infection. The immunosuppressed client should report a low-grade fever, persistent cough, unusual drainage, or any other symptoms of infection to the HCP immediately.

Question 6

__________ superinfection is a common side effect of antibiotic therapy.

Answer 6

Candida

Question 7

Heavy ____________ is a risk factor for laryngeal cancer

Answer 7

drinking

Question 8

Which statement describes esophageal speech?

Vibration and sound are used to form words by occluding a valve over the stoma.

Swallowed air is used to create sound and words in a controlled belch.

A generator held to the neck creates vibrations that form words when the client speaks.

A handheld device delivers tone via a plastic tube that is inserted into the mouth.

Answer 8

Swallowed air is used to create sound and words in a controlled belch.
This describes esophageal speech where clients “burp” swallowed air to form sounds into words using the palate, tongue, lips, and teeth.

Question 9

A common site for blood to pool following any type of throat surgery is behind the client’s ______ .

Answer 9

neck

Question 10

Which laboratory result is consistent with blood loss through hemorrhaging?

Red blood cell count 5.2 x 106/μL (5.2 1012/L).

Hematocrit 40% (0.40).

Hemoglobin 11.3 g/dl (113 g/L).

Erythrocyte sedimentation rate 8 mm/h (mm/h).

Answer 10

Hemoglobin 11.3 g/dl (113 g/L).
Normal hemoglobin for a female is 12.0 g/dl-16.0 g/dl (120 - 160 g/L). Therefore, 11.3 g/dl (113 g/L) is consistent with blood loss through hemorrhaging.

Question 11

Take a deep breath, occlude the tracheostomy with your finger, cough, and remove your finger.
This technique is called “_________ stop,” which helps remove secretions.

Answer 11

glottal

Question 12

With a tracheostomy, humidification of inspired air in the upper airway is lost. _____________ the air helps maintain moist mucous membranes and secretions, which promotes secretion removal by coughing or suctioning.

Answer 12

Humidifying

Question 13

Which statement explains the mechanism of action of carbidopa-levodopa in the treatment of Parkinson’s disease?

Carbidopa-levodopa counteracts the neurotransmitter acetylcholine and restores the natural balance of neurotransmitters in the CNS.

Carbidopa-levodopa inhibits dopamine breakdown, leading to increased amounts of dopamine available in the CNS.

Carbidopa-levodopa causes a release of dopamine from neuronal storage sites and blocks re-uptake of dopamine.

Carbidopa-levodopa is converted to dopamine and provides an exogenous form of dopamine replacement.

Answer 13

Carbidopa-levodopa is converted to dopamine and provides an exogenous form of dopamine replacement.

Question 14

Uncontrolled movement of face, eyelids, mouth, tongue, arms, hands, or legs (tardive dyskinesia) mental changes, such as hallucinations or delusions are adverse effects of long-term _________ therapy. Therefore, the client needs to be assessed by the healthcare provider.

[Parkinson’s]

Answer 14

levodopa

Question 15

Which statement by the nurse leader best describes Parkinson’s disease?

There is premature death of cells in the part of the brain called the basal ganglia.

A chemical imbalance in the brain leads to movement and coordination problems.

There is increased dopamine in the substantia nigra due to hypertrophy of cells.

Parkinson’s is a chronic muscle disorder that causes wasting of skeletal muscles.

Answer 15

A chemical imbalance in the brain leads to movement and coordination problems.

Parkinson’s disease is a progressive neurodegenerative disease characterized by four cardinal symptoms: tremor, muscle rigidity, bradykinesia or akinesia (slow movement/no movement), and postural instability.

Question 16

What is the best response by the nurse leader?

It occurs mostly in men who have a history of seizure activity.

Smoking cigarettes over a long period of time may cause Parkinson’s.

There is really no known specific cause for Parkinson’s disease.

It is hereditary and usually passed to the male son by the mother.

Answer 16

There is really no known specific cause for Parkinson’s disease.

The cause of Parkinson’s is unknown, but research suggests several causative factors, including genetics, atherosclerosis, excessive accumulation of oxygen free radicals, viral infections, head trauma, chronic antipsychotic medication, and some environmental exposures.

Question 17

When an individual has less than $2,000.00 and/or all financial sources are exhausted as a result of prolonged nursing home care, the family, the institution, or both may apply for _________ reimbursement.

Answer 17

Medicaid

Question 18

Diarrhea, especially in an elderly client, can lead to ____________ . Since leg cramps are a symptom of low potassium, the nurse should assess Leo’s potassium level.

Answer 18

hypokalemia

Question 19

To be eligible for hospice care, the client must have fewer than __ months to live.

Answer 19

6

Question 20

The HCP administers a edrophonium chloride test to help confirm the diagnosis of myasthenia gravis (MG).

Which response to the test indicates that she has myasthenia gravis (MG)?

No significant change in the client’s neurovascular assessment.

Reduced amplitude of electrical stimulation in her muscle.

Antiacetylcholine receptor antibodies present in the blood.

A noticeably marked improvement in her muscle strength.

Answer 20

A noticeably marked improvement in her muscle strength.
Clients with MG show a significant improvement in muscle strength that lasts approximately 5 minutes when edrophonium chloride is injected. This test confirms the diagnosis

Question 21

She is diagnosed with myasthenia gravis. Her husband tells the nurse he does not understand how myasthenia will affect his wife. How should the nurse respond?

An increased number of acetylcholine receptor sites causes muscle weakness.

A virulent virus destroys the covering of junctions between nerves and muscles.

A chronic neuromuscular disorder that will eventually cause paralysis in the extremities.

The body is not able to transmit nerve impulses, which results in muscle weakness.

Answer 21

The body is not able to transmit nerve impulses, which results in muscle weakness.

In MG, antibodies destroy or block neuromuscular junction receptor sites, resulting in a decreased number of acetylcholine receptors. This results in a decrease in the muscle’s ability to transmit nerve impulses and contract.

Question 22

[MG] The HCP prescribes the anticholinesterase pyridostigmine for her. She asks the nurse how the medication therapy will help her.
How should the nurse respond about the expected outcome of pyridostigmine therapy? Select all that apply

Increases ability to independently perform activities of daily living (ADLs).

Increases tear production for adequate moisture in the eyes.

Reduces gastric acid production to aid digestion of food.

Eliminates muscle pain to enhance client’s ability to sleep.

Prevents the breakdown of acetylcholine, a natural substance, in the body.

Answer 22

Increases ability to independently perform activities of daily living (ADLs).

Prevents the breakdown of acetylcholine, a natural substance, in the body.

Question 23

___________ can result in an exacerbation of MG and can cause extreme weakness. In addition, the client with MG should increase fluid intake to help mobilize and expectorate sputum to aid in the prevention of respiratory complications.

Answer 23

Infections

Question 24

A speech therapist addresses ____________ problems. Clients with MG are dysphagic and are at risk for aspiration. The speech therapist can help match food consistency to the client’s ability to swallow, which helps enhance client safety.

Answer 24

swallowing

Question 25

Which further data indicates to the nurse the client is experiencing a cholinergic crisis?

The circulating acetylcholine receptor antibodies test is positive.

The symptoms improve when a cholinesterase inhibitor is administered.

The blood pressure and pulse increase after a blood transfusion.

The Tensilon test does not show improvement in muscle strength.

Answer 25

The Tensilon test does not show improvement in muscle strength.

The edrophonium chloride test not only diagnoses MG, but it also helps determine which type of crisis the client is experiencing. In a myasthenia crisis, the test is positive (the client’s muscle strength improves), and in a cholinergic crisis, the test is negative (there is no improvement in muscle strength).

Question 26

___________ is the antidote for a cholinergic crisis and should be administered as soon as it is determined that the client is in a cholinergic crisis rather than a myasthenia crisis.

Answer 26

Atropine

Question 27

There is a ________ that is usually inactive after puberty that sometimes continues to produce antibodies. Removing it sometimes cures myasthenia gravis

[thymectomy]

Answer 27

gland

Question 28

The thoracotomy and chest incision will cause pain when the client is coughing. The nurse should demonstrate how to ________ the incision to help the pain. Pulmonary hygiene must be a priority to prevent pulmonary complications of atelectasis and pneumonia.

Answer 28

splint

Question 29

After initial interventions are implemented, the client continues to have a tonic-clonic seizure.

What action should the nurse implement next?

Insert an oral airway into the client’s mouth.

Determine if the client is incontinent of urine.

Note the time, duration, and type of seizure.

Notify the neurologist of the client’s seizure.

Answer 29

Note the time, duration, and type of seizure.

Accurate assessment by the nurse during the seizure provides important data used in determining the area in which focal activity originates, the area of the brain involved, and the type of seizure. It is important to document whether the beginning of the seizure was observed.

Question 30

An _______ is a visual, auditory, or olfactory occurrence that occurs prior to a seizure and warns the client that the seizure is about to occur. The aura often allows time for the client to fall to the floor or find a safe place to have the seizure.

Answer 30

aura

Question 31

The neurologist schedules an electroencephalogram (EEG) and a magnetic resonance image (MRI) to help evaluate the client’s seizure disorder. The nurse discusses the tests with the client.

Which action should the nurse include in preparing the client for the EEG?

Advise the client not to eat anything for 12 hours prior to the procedure.

Instruct the client to refrain from consuming caffeine prior to the EEG.

Explain that there will be some discomfort during the procedure.

Determine if the client has any allergies to iodine or shellfish.

Answer 31

Instruct the client to refrain from consuming caffeine prior to the EEG.

Ingestion of caffeine will cause a stimulating effect to the brain.

Question 32

An MRI can determine the presence of any of the following potential __________ of the seizures: a tumor, congenital lesions, an edema, an infarct, a hemorrhage, an arteriovenous malformation, or a structural deviation.

Answer 32

causes

Question 33

Factors that may _________ seizures are abrupt withdrawal from medication, constipation, fatigue, fever, and sounds and sights such as television, flashing videos, and computer screens.

Answer 33

trigger

Question 34

Your menstrual cycle can cause seizure activity due to ___________ levels.

The onset of menstruation can cause seizure activity due to increased hormone levels that alter the excitability of neurons in the cerebral cortex. The client should be instructed to keep a record to determine if this pattern continues.

Answer 34

hormone

Question 35

The Epilepsy Foundation states there is no reason why people with epilepsy should not participate in ______________ as a leisure activity; however, it is recommended that a swimming partner be present who is knowledgeable about what to do during a seizure.

Answer 35

swimming

Question 36

If seizures are well-controlled, there are no specific contraindications to any activity. However, if seizures are still occurring it is probably advisable to _______ some sports and activities.

Answer 36

avoid