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1. Ms. Brown, 62, is receiving doxorubicin for treatment of Stage III adenocarcinoma of the lung. Her platelet count is 10,000/mm3. Based on this finding, the most appropriate nursing intervention is to
a. provide oral hygiene every 4 hours.
b. monitor her temperature every 4 hours.
c. check all stools for occult blood.
d. encourage her to wear loose-fitting clothing.
2. A pulse oximetry monitor indicates that the patient's Spo2 has dropped from 96% to 85% over 4 hours. Which of the following would you do first?
a. Request an order for stat arterial blood gases.
b. Start the patient on oxygen by nasal cannula at 2 liters/minute.
c. Notify the health care provider of the change.
d. Check the position of the probe on the patient's finger or earlobe.
3. If you're caring for a patient on mechanical ventilation, be concerned about the endotracheal (ET) tube position if
a. his respiratory rate increases above baseline.
b. his breaths aren't synchronous with the ventilator.
c. he needs more suctioning.
d. his chest movement is uneven.
4. The most common clinical finding of left-sided heart failure is
a. an S 3 gallop.
b. sinus bradycardia.
c. fever.
d. ascites.
5. Which pain medication is indicated for a patient with left-sided heart failure?
a. hydromorphone
b. meperidine
c. morphine
d. midazolam
6. Which medications can increase serum digoxin concentrations?
a. rifampicin and neomycin
b. cholestyramine and colestipol
c. sulfasalazine and metoclopramide
d. amiodarone and diltiazem
7. The first nursing intervention for a patient admitted to rule out myocardial infarction is
a. auscultating for adventitious breath sounds.
b. monitoring fluid and electrolyte status.
c. preventing thrombi and emboli.
d. providing appropriate analgesia.
8. The most effective treatment for ventricular fibrillation (VF) is
a. amiodarone.
b. atenolol.
c. defibrillation.
d. cardiac catheterization.
9. If your patient has a permanent pacemaker for sinus node dysfunction, teach him to
a. change the batteries.
b. monitor his pulse.
c. change the setting from demand to fixed.
d. strengthen his sinoatrial node.
10. Your patient had an ileostomy placed 5 days ago. Teach her to care for the ileostomy by
a. irrigating the stoma daily until continence is established.
b. changing the pouch daily.
c. using a skin barrier only when irritation develops.
d. changing the ostomy pouch when the stoma is inactive.
11. Your patient, who's had a gastric resection for gastric cancer, has a nasogastric (NG) tube in place with minimal output and is complaining of nausea. You administer an antiemetic as ordered, but the patient's nausea continues. You should
a. flush the tube with 30 ml of 0.9% sodium chloride solution.
b. reposition the tube 1 inch (2.5 cm) farther into the patient's stomach fundus.
c. flush the tube with 30 ml of dextrose solution.
d. reposition the tube 1 inch away from the patient's stomach wall.
12. To keep a patient safe during a seizure
a. put a bite block in his mouth.
b. restrain his flailing limbs.
c. suction to remove secretions.
d. ease him from a chair to the floor.
13. Vacuum-assisted wound closure has been ordered for your patient's Stage III pressure ulcer. This therapy's success depends on maintaining
a. removal of granulation tissue.
b. constant irrigation of the wound bed.
c. negative pressure in the wound bed.
d. an oxygen-rich wound bed.
14. A patient is receiving chemotherapy for treatment of breast cancer. Which is an early sign of thrombocytopenia related to chemotherapy?
a. pallor
b. petechiae
c. fever
d. hypoglycemia
15. Assessment findings that suggest hemolytic anemia include
a. bradycardia.
b. increased appetite.
c. decreased pulse pressure.
d. jaundice.
16. A patient with diabetes is unresponsive. His serum glucose is 816 mg/dl. You suspect diabetic ketoacidosis rather than hyperosmolar hyperglycemic nonketotic syndrome because of which assessment finding?
a. peripheral edema
b. polyuria
c. rapid, deep respirations
d. petechiae
17. A patient diagnosed with insulin resistance syndrome is also at greatest risk for
a. lung cancer.
b. cardiovascular disease.
c. liver failure.
d. pancreatic cancer.
18. Because the timing of insulin administration in relation to meals is important, administer a rapid-acting insulin
a. 60 to 90 minutes before a meal.
b. 30 minutes after the meal.
c. within 15 minutes before a meal or immediately after a meal.
d. a minimum of 30 minutes before the meal.
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Answers
1. c . When a patient has thrombocytopenia, test stool regularly for occult blood and observe for blood in emesis, sputum, feces, urine, nasogastric secretions, and wound drainage.
2. d . First, make sure the pulse oximetry reading is accurate. Pulse oximetry is inaccurate if the probe is loose or positioned in an area of poor circulation. Nail polish also may make readings inaccurate.
3. d . A correctly positioned ET tube is associated with symmetrical chest movement.
4. a . In severe forms of heart failure, an S 3 gallop is commonly present. In left-sided heart failure, low blood pressure results from low cardiac output; heart rate increases as a compensatory response. Ascites is a clinical finding of right-sided heart failure. Fever isn't associated with heart failure.
5. c . Morphine is the opioid of choice for patients with left-sided heart failure because it relieves pain and anxiety and promotes vasodilation.
6. d . Amiodarone and diltiazem may increase serum digoxin concentrations. Rifampicin, neomycin, cholestyramine, colestipol, sulfasalazine, and metoclopramide decrease digoxin concentration.
7. d . Treating pain with opioid analgesics is a priority of care for a patient with chest pain.
8. c . Defibrillation is the most effective treatment for VF.
9. b . Patients with permanent pacemakers—and their families—should be taught how to take a pulse.
10. d . By changing the pouch before meals or when the ostomy is inactive, the patient is less likely to experience elimination from the stoma during the change.
11. a . Flushing with 0.9% sodium chloride solution is the standard of care; repositioning the NG tube in a patient with a gastric resection is beyond the scope of practice for most nurses. Dextrose is unnecessary and may cause dumping syndrome.
12. d . If the patient is seated when a seizure begins, ease him to the floor. Don't restrain him or put anything in his mouth.
13. c . Vacuum-assisted wound closure uses suction to create a negative pressure in the wound bed, removing drainage and speeding wound healing.
14. c . Development of petechiae and prolonged epistaxis suggest that the patient may have developed bleeding tendencies.
15. d . Symptoms of severe hemolytic anemia (hemoglobin less than 6 grams/dl) include jaundice, tachycardia, anorexia, and increased pulse pressure.
16. c . Manifestations of diabetic ketoacidosis include Kussmaul's respirations (rapid, deep respirations associated with dyspnea), poor skin turgor, dry mucous membranes, tachycardia, and orthostatic hypotension.
17. b . Insulin resistance syndrome is also known as cardiovascular dysmetabolic syndrome because of the cluster of abnormalities that greatly increase the risk of cardiovascular disease: elevated insulin levels, high levels of triglycerides, decreased levels of high-density lipoproteins, increased levels of low-density lipoproteins, and hypertension.
18. c . Rapid-acting insulin is considered to be the type that best mimics natural insulin secretion in response to a meal. Inject it within 15 minutes before a meal or immediately after a meal.
Source
Medical-Surgical Nursing Review Questions , D Roberts (ed), Academy of Medical-Surgical Nurses (AMSN), 2004. Available for purchase online at http://www.medsurgnurse.org or by mail from the AMSN, E. Holly Ave., Box 56, Pitman, NJ 08071.
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