Focus on Adult Health Medical-Surgical Nursing Psc Edition by Linda -Test Bank

 

 

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Sample Test

 

Chapter 3- Chronic Illness and End-of-Life Care

1.	A patient tells the nurse that her doctor just told her that she had a “chronic condition.” She asks the nurse what “chronic condition” means. What would be the nurse’s best response?
	A)	“Chronic conditions are defined as health problems that require management of 3 months or longer.”
	B)	“Chronic conditions are diseases that come and go.”
	C)	“Chronic conditions are medical conditions that have disabilities that require hospitalization.”
	D)	“Chronic conditions require short-term management in extended care facilities.”

 

 

2.	A patient scheduled for dialysis is on a fluid restriction of 1000 mL/day. The nurse sees the patient drinking a 355 mL soft drink after the patient has already reached the maximum intake of fluid for the day. The nurse has instructed the patient on the risks of fluid overload. What action should the nurse take?
	A)	Take the soft drink away from the patient and inform the dialysis nurse to remove extra fluid from the patient during his next dialysis treatment.
	B)	Document the patient’s behavior as noncompliant and notify the health care provider.
	C)	Restrict the patient’s fluid for the following day and communicate this information to the charge nurse.
	D)	Reinforce the importance of the fluid restriction, and document the teaching and the intake of extra fluid.

 

 

3.	A patient has recently been diagnosed with diabetes.  The patient is clinically obese and is sedentary.  How can the nurse best ensure potential success to increase activity in this patient?
	A)	Set up appointment times at a local fitness center for the patient to attend.
	B)	Have a family member ensure the patient follows a suggested exercise plan.
	C)	Construct an exercise program and have the patient follow it.
	D)	Identify barriers with the patient that will inhibit change.

 

 

4.	Research has shown that the incidence of chronic conditions is increasing. What lifestyle factor has been shown to contribute most significantly to this increase?
	A)	Exercise
	B)	Obesity
	C)	Eustress
	D)	Gastrointestinal disease

 

 

5.	You are the nurse giving palliative care to a patient with a diagnosis of chronic obstructive pulmonary disease (COPD). What is the primary goal of palliative care?
	A)	Improve the patient’s and family’s quality of life.
	B)	Support aggressive treatment for cure.
	C)	Provide physical support for the patient.
	D)	The patient may develop a separate plan with each discipline of the health care team.

 

 

6.	Your patient has a diagnosis of bladder cancer with metastasis. The patient asks you about hospice. Which principle underlies hospice care?
	A)	Death must be accepted.
	B)	Symptoms of terminal illness should not be treated.
	C)	Each member of the interdisciplinary team develops an individual plan of care for the patient.
	D)	Terminally ill patients should die in the hospital.

 

 

7.	You are the clinic nurse doing patient teaching for palliative radiotherapy to the spine.  After you complete the patient teaching, your patient continues to ask the same questions that you have already addressed. What can you conclude?
	A)	The patient is not listening.
	B)	The patient is not adhering to treatment.
	C)	The patient may have a learning disability.
	D)	Learning has not occurred.

 

 

8.	You are part of the health care team at an oncology center. Your patient has been diagnosed with leukemia and the prognosis is poor. The patient is unaware of the prognosis.  How can the bad news best be conveyed to the patient?
	A)	Family should be given the prognosis first.
	B)	The prognosis should be delivered with the patient at eye level.
	C)	The health care provider should deliver the news to the patient alone.
	D)	The appointment should be scheduled at the end of the day.

 

 

9.	Your patient has just been told that her illness is terminal. The patient states, “I can’t believe I am going to die. Why me?” What is your best response?
	A)	“I know how you are feeling.”
	B)	“You have lived a long life.”
	C)	“This must be very difficult for you.”
	D)	“Life can be so unfair.”

 

 

10.	A patient is in a hospice receiving palliative care for lung cancer.  The cancer has metastasized to the liver and bones.  The patient is experiencing dyspnea.  What might the nurse do to help to relive the dyspnea the patient is experiencing?
	A)	A fluid bolus
	B)	High-flow oxygen to treat low oxygen saturation
	C)	High doses of opioids
	D)	Administer corticosteroids as ordered

 

 

11.	Although some people with chronic illness assume what might be called a “sick role” identity, most do not consider themselves to be sick or ill and try to live as normal a life as possible. What event is most likely to cause an individual who has a chronic illness to begin thinking of himself or herself as being disabled?
	A)	Referral to a medical specialist or a clinical nurse specialist
	B)	Involvement of family members or close friends in the planning of care
	C)	Decreased ability to perform activities of daily living
	D)	Qualifying for Medicare or Medicaid

 

 

12.	The incidence and prevalence of chronic illnesses have increased in recent decades, and this trend is expected to continue in the near future. What factor has contributed most significantly to this trend?
	A)	Decreasing availability of nutritious food
	B)	Misinformation about the relationship between health and wellness
	C)	Antibiotic resistance and increases in nosocomial (hospital-acquired) infections
	D)	Increases in lifespan and the accompanying changes in physiology

 

 

13.	A diabetes nurse is performing health education with a 44-year-old woman who has recently learned that she has type 2 diabetes. The nurse is teaching the patient the importance of adhering to her prescribed treatment regimen. When providing this health education, the nurse should emphasize:
	A)	The patient’s independent responsibility for making informed changes to her treatment regimen
	B)	The fact that adherence to a prescribed treatment regimen usually requires careful planning
	C)	The fact that well-intending friends and family members usually challenge the validity of the treatment regimen
	D)	The need to avoid online information sources because they tend to contradict evidence-based regimens

 

 

14.	A 71-year-old woman with a longstanding diagnosis of emphysema developed community-acquired pneumonia 3 weeks ago and was admitted to the hospital for treatment. A combination of respiratory therapy and IV antibiotics has resolved the woman’s infection and she is now preparing to return to the home she shares with her husband. What phase in the trajectory model of chronic illness is this patient currently experiencing?
	A)	Unstable
	B)	Crisis
	C)	Acute
	D)	Comeback

 

 

15.	Mr. Romanov is a 69-year-old man who was diagnosed with angina pectoris 2 years ago. With adherence to treatment, he has been largely able to maintain his chosen lifestyle. However, in recent weeks, he has been forced to limit his physical activity, take more rests, and refrain from going for walks. What phase in the trajectory model of chronic illness is Mr. Romanov currently experiencing?
	A)	Trajectory onset
	B)	Acute
	C)	Crisis
	D)	Unstable

 

 

16.	A patient with a recent history of joint stiffness and decreased mobility has received a diagnosis of osteoarthritis. When performing health education with this patient, what subject should the nurse prioritize?
	A)	The typical prognosis for patients who have osteoarthritis
	B)	Strategies that the patient can use to maintain her level of function
	C)	The role of lifestyle in the development of osteoarthritis
	D)	Strategies for researching her chronic illness and evaluating treatments

 

 

17.	A community health nurse has a large list of patients in the local community, many of whom are living with chronic illnesses. What principle should the nurse prioritize when planning and implementing the care of these patients?
	A)	The nurse should defer responsibility for decision-making to patients until an exacerbation of their illness.
	B)	The nurse should facilitate a gradual decrease in patients’ expectations for independence and level of function.
	C)	The nurse should recognize the cause-and-effect relationship that exists between the patients’ lifestyle choices and the etiology of their diseases.
	D)	The nurse should adopt a holistic approach that addresses each dimension of the patient’s being.

 

 

18.	A female patient with a diagnosis of breast cancer had a unilateral mastectomy with axillary node biopsy. The results of the biopsy have just come back positive, and the nurse and a coworker are discussing the patient’s possible response to this news. Which of the following statements by the coworker should the nurse correct or respond to with teaching?
	A)	“If she finds out about this too quickly, she might lose hope in her battle with cancer.”
	B)	“All considered, it’s best if she’s told this sooner rather than later.”
	C)	“Ideally, her family will be around when she learns about her biopsy results.”
	D)	“This will be hard to hear, but she deserves to know as much detail as she wants.”

 

 

19.	Mr. Hosa is a 68-year-old man who is in the end stages of pancreatic cancer. His care team has suggested the possibility of hospice care but Mr. Hosa is opposed, stating, “A hospice is just a place to wait to die.” Which of the following statements should underlie the nurse’s response to Mr. Hosa?
	A)	Spiritual and emotional needs are more important than physical needs.
	B)	A hospital setting is an inappropriate place to die.
	C)	Meaningful living can take place despite terminal illness.
	D)	Acceptance of mortality can delay physiologic death.

 

 

20.	A patient with amyotrophic lateral sclerosis (ALS) wishes to use his Medicare Hospice Benefit in an effort to maximize his quality of life prior to death. What criterion will determine whether the patient qualifies for this benefit?
	A)	A life expectancy of less than 6 months
	B)	Exhaustion of all reasonable treatment options
	C)	Copayment by a health insurance provider
	D)	A demonstrated lack of a support system

 

 

21.	A 70-year-old woman is in the end stages of colorectal cancer and has tended to defer decision making to her oldest son, in accordance with the norms of her culture. The woman’s health care provider has discussed the possibility of palliative radiotherapy with the patient and her family, and the patient has asked her son to make the decision whether to pursue or forego this treatment measure. How should the care team best respond?
	A)	Arrange a family meeting that includes social work and spiritual care.
	B)	Accommodate the patient’s wishes and elicit a decision from the son.
	C)	Discuss the matter with the patient at a later time when the son is absent from the bedside.
	D)	Encourage the patient and her son to make a decision collaboratively.

 

 

22.	A woman who is dying of heart failure has become listless, distracted, and difficult to engage in conversation in recent days despite no obvious changes in her physiologic state. She has admitted to feeling severely depressed and states that this sensation is something new to her. How should her care team best interpret this new onset of depression?
	A)	The patient should be encouraged to accept her depression and see it as a reasonable response to impending death.
	B)	The care team should acknowledge the patient’s depression but ensure that physical needs are prioritized over emotional symptoms.
	C)	The team should understand that depression is a normal stage of the grieving process that precedes death and should be accepted as such.
	D)	The patient’s depression should be actively treated and not seen as an inevitability.

 

 

23.	A patient with a primary diagnosis of lung cancer developed bone metastases in recent months and experienced excruciating pain. As a result, the patient was treated with a combination of continuous-release and immediate-release morphine delivered by the oral route. Since yesterday, the patient has experienced a decreased level of consciousness and has  become unable to swallow. How should the nurse best manage this patient’s analgesia?
	A)	Opioids should be discontinued because of the patient’s decreased level of consciousness.
	B)	The patient should receive similar doses of morphine by alternative routes.
	C)	The patient’s morphine should be reduced and a nonsteroidal anti-inflammatory (NSAID) introduced.
	D)	Analgesia should be discontinued because the patient’s decreased level of consciousness indicates that his pain has subsided.

 

 

24.	An elderly female patient who experienced a hemorrhagic stroke has a poor prognosis and multiple functional deficits, including dysphagia. A family meeting has been organized to discuss the possibility of tube feeding, and the patient’s daughter is incredulous that a tube feed has not yet been introduced, stating, “The only thing worse than dying of a stroke would be to starve to death.” What principle should underlie a response to the daughter?
	A)	There are potential benefits to withholding artificial hydration and nutrition.
	B)	The food energy derived from artificial hydration and nutrition can exacerbate disease processes.
	C)	It is unethical to withhold artificial hydration and nutrition unless it is physiologically impossible.
	D)	Unconscious patients are unable to metabolize nutrients that are derived from tube feeds or parenteral nutrition.

 

 

25.	A nurse who provides care on a palliative unit of a busy urban hospital performs numerous task and roles in the provision of holistic care to patients and their families. Which of the following tasks is essential for nurses to manage patients at the end of life? Select all that apply.
	A)	Obtain informed consent for palliative treatment measures.
	B)	Educate patients and families about end-of-life decision making.
	C)	Contribute to a coordinated, interdisciplinary plan of care.
	D)	Manage pain and symptoms.
	E)	Determine patients’ qualifications for hospice care.

 

 

 

Answer Key

 

1.	A
2.	D
3.	D
4.	B
5.	A
6.	A
7.	D
8.	B
9.	C
10.	D
11.	C
12.	D
13.	B
14.	D
15.	D
16.	B
17.	D
18.	A
19.	C
20.	A
21.	B
22.	D
23.	B
24.	A
25.	B, C, D

Chapter 4- Fluid and Electrolyte and Acid-Base Imbalances

1.	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 the nurse expect the patient to demonstrate?
	A)	Hypertension
	B)	Bradycardia
	C)	Hypervolemia
	D)	Hypovolemia

 

 

2.	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 mEq/L.  How would you interpret these results?
	A)	Respiratory acidosis with no compensation
	B)	Metabolic alkalosis with a compensatory alkalosis
	C)	Metabolic acidosis with no compensation
	D)	Metabolic acidosis with a compensatory respiratory alkalosis

 

 

3.	You are doing an admission assessment on an elderly patient newly admitted for end-stage liver disease. You must assess the patient’s skin turgor. What should you remember when evaluating skin turgor?
	A)	Overhydration causes the skin to tent.
	B)	Dehydration causes the skin to appear edematous and spongy.
	C)	Inelastic skin turgor is a normal part of aging.
	D)	Normal skin turgor is moist and boggy.

 

 

4.	A nurse in the Medical ICU has orders to infuse a hypertonic solution into a 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. What term or terms are associated with this process?
	A)	Hydrostatic pressure
	B)	Osmosis and osmolality
	C)	Diffusion
	D)	Active transport

 

 

5.	You are caring for a 65-year-old male patient admitted to your unit 72 hours ago with pyloric stenosis.  A nasogastric tube was placed upon admission and has been on low intermittent suction ever since.  You notice that the patient’s potassium is very low. What would you be concerned that the patient may be at risk for?
	A)	Hypercalcemia
	B)	Metabolic acidosis
	C)	Metabolic alkalosis
	D)	Respiratory acidosis

 

 

6.	A patient in the ICU starts complaining of being “short of breath.” An arterial blood gas (ABG) is drawn. The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?
	A)	Respiratory acidosis
	B)	Metabolic alkalosis
	C)	Respiratory alkalosis
	D)	Metabolic acidosis

 

 

7.	A 73-year-old man comes into the emergency department (ED) by ambulance after slipping on a small carpet in his home. The patient fell on his hip with a resultant fracture. He is alert and oriented; PERRLA is intact. His heart rate is elevated, he is anxious and thirsty, a Foley catheter is placed and 40 ml of urine is present. What is the nurse’s most likely explanation for the urine output?
	A)	The man urinated prior to his arrival to the ED and will probably not need to have the Foley catheter kept in place.
	B)	The man has a brain injury, lacks antidiuretic hormone (ADH), and needs vasopressin.
	C)	The man is in heart failure and is releasing atrial natriuretic peptide that results in decreased urine output.
	D)	He is having a sympathetic reaction, which has stimulated the renin-angiotensin-aldosterone system that results in diminished urine output.

 

 

8.	A nurse assesses a patient’s IV lines on an hourly basis. When checking the IVs this hour, the nurse finds localized pain, redness, warmth, and swelling around the insertion site of a 25-year-old female patient.  What is the nurse’s first priority?
	A)	Elevate the extremity
	B)	Apply a warm compress
	C)	Restart the line in the opposite extremity
	D)	Apply a cold compress
	E)	Discontinue the IV infusion

 

 

9.	As the ICU nurse caring for a patient with multiple trauma from an ATV accident you draw arterial blood gases (ABGs) every 4 hours. What are you primarily assessing in this patient with the ABGs?
	A)	The bicarbonate–carbonic acid buffer system
	B)	The patient’s electrolyte balance
	C)	The patient’s intracellular buffer systems
	D)	The patient’s fluid balance

 

 

10.	You are called to your patient’s room by a family member who voices concern about the patient’s status. On assessment, you find the patient tachypneic, lethargic, weak, and exhibiting a diminished cognitive ability. You also find 3+ pitting edema. What electrolyte imbalance would you suspect?
	A)	Hypercalcemia
	B)	Hyponatremia
	C)	Hyperchloremia
	D)	Hypophosphatemia

 

 

11.	A 43-year-old patient with a history of alcohol abuse has been admitted to an acute medical unit with complications resulting from liver failure. Upon assessment, the patient’s abdomen is distended, firm to touch, and nontender. The nurse recognizes that the patient has excess fluid in his peritoneal space (ascites), a problem that results from the disruption of normal movement of water and electrolytes. What process is primarily responsible for maintaining fluid balance along a concentration gradient?
	A)	Hydrostatic pressure
	B)	Active transport
	C)	Osmosis
	D)	Filtration

 

 

12.	A patient with a history of poorly controlled type 1 diabetes has begun displaying the characteristic signs and symptoms of diabetic nephropathy. The patient’s nurse recognizes that the patient is at risk of disruptions to fluid balance. What role do the kidneys play in the maintenance of normal fluid balance?
	A)	Secreting or withholding antidiuretic hormone in response to extracellular fluid volume
	B)	Selectively retaining needed substances and excreting waste products
	C)	Synthesizing and releasing angiotensin in cases of fluid volume deficit
	D)	Maintaining the correct concentration of H+ ions in the blood

 

 

13.	An elderly patient has developed Clostridium difficile-related diarrhea and been subsequently diagnosed with fluid volume deficit (FVD). The nurse providing care for this patient should anticipate:
	A)	A decreased level of blood urea nitrogen (BUN)
	B)	An increased level of serum potassium
	C)	The administration of a hypertonic IV solution
	D)	The administration of hypotonic or isotonic IV solution

 

 

14.	A 77-year-old woman with a diagnosis of congestive heart failure has experienced a downward trend in her hemoglobin levels in recent days, and her care team ordered the administration of two units of packed red blood cells. In the hours following her blood transfusion, the patient complained of increasing shortness of breath, and chest auscultation revealed diffuse crackles. The nurse also noted an increase in the patient’s peripheral edema, and fluid volume excess (FVE) is suspected. What assessment should the nurse prioritize in the care of this patient?
	A)	Close monitoring of the patient’s intake and output
	B)	Assessment of the patient’s hemoglobin, hematocrit, and red blood cell levels
	C)	Neurovital signs q1h
	D)	Assessment of the patient’s electrolyte levels

 

 

15.	A 22-year-old man with a diagnosis of schizophrenia has been transferred from the psychiatric unit to the medical unit after drinking 5 liters of water over the past hour. Assessment reveals that the patient is oriented to person but not to time or place and that he is drowsy but rousable by touch. When reviewing this patient’s most recent blood work, the nurse should pay particular attention to the patient’s levels of:
	A)	Phosphate
	B)	Calcium
	C)	Blood urea nitrogen (BUN)
	D)	Sodium

 

 

16.	A patient with a diagnosis of colon cancer has undergone a bowel resection with the creation of an ileostomy. The patient’s ileostomy output has been unexpectedly high in the 2 days since surgery, and the patient’s most recent blood work indicates a K+ level of 2.7 mEq/L. This potassium level should prompt the nurse to assess for which of the following physical manifestations?
	A)	Confusion and decreased level of consciousness
	B)	Shortness of breath, rales, and peripheral edema
	C)	Dysphagia, tetany, and emotional lability
	D)	Fatigue, cramps, and weakness

 

 

17.	A patient with a diagnosis of thyroid cancer is postoperative day 1 following a total thyroidectomy in which her parathyroid gland was also removed. When assessing for related electrolyte imbalances, what question should the nurse ask the patient?
	A)	“Do you feel like you’re having heart palpitations where your heart feels like it skips a beat?”
	B)	“How thirsty are you feeling right now?”
	C)	“Are you feeling any tingling in your hands or around your mouth?”
	D)	“How would you rate your energy level right now?”

 

 

18.	A nurse who provides care on the oncology unit of the hospital is aware of the high incidence of hypercalcemia among patient with cancer. What factors contribute to this fact? Select all that apply.
	A)	Bone demineralization
	B)	Secretion of parathyroid hormone (PTH)-related protein by tumors
	C)	Consequences of immobility
	D)	Use of artificial nutrition and hydration
	E)	Use of chemotherapeutic agents

 

 

19.	A patient’s most recent arterial blood gases reveal pH = 7.5; HCO3– = 29 mEq/L, and PaCO2 = 51 mm Hg. What health problem could account for these findings?
	A)	Volume depletion from vomiting
	B)	Diabetic ketoacidosis (DKA)
	C)	Atelectasis
	D)	Hyperventilation

 

 

20.	The actions of buffer systems allow the body to rapidly and effectively respond to alterations in the H+ concentration of body fluids. How do the kidneys primarily contribute to a stable balance between acids and bases?
	A)	By regulating the combination of water and carbon dioxide, thus controlling levels of carbonic acid
	B)	By selectively reabsorbing HCO3–  ions, which in turn act as H+ ion receptors
	C)	By regulating the ventilation rate and consequent blood levels of CO2
	D)	By controlling the process of erythropoiesis and consequent hemoglobin levels

 

 

21.	Hypomagnesemia is a common yet often overlooked imbalance in acutely and critically ill patients. Which of the following patients is most likely at the highest risk of experiencing low serum magnesium levels?
	A)	An obese male patient who has a history of atherosclerosis and a previous non-ST wave elevation myocardial infarction
	B)	A patient who is temporarily receiving total parenteral nutrition (TPN) as a result of complications from gastric bypass surgery
	C)	A female patient who has liver cirrhosis and who is experiencing withdrawal from heavy alcohol use
	D)	A teenage patient who is currently being treated for non-Hodgkin’s lymphoma (NHL)

 

 

22.	Mrs. Kruger is a 53-year-old woman who has been admitted to the surgical unit following urethral sling surgery that was performed to treat her recurrent stress incontinence. The nurse notes that Mrs. Kruger was treated for breast cancer 3 years earlier and had a left unilateral mastectomy and axillary node biopsy performed. How will Mrs. Kruger’s medical history affect the nurse’s care during this admission?
	A)	The nurse should monitor Mrs. Kruger closely for signs and symptoms of hypercalcemia due to her history of cancer.
	B)	The nurse should use Mrs. Kruger’s right arm for IV access and blood pressure assessment.
	C)	Venous access should be established using a central vein rather than a peripheral vein.
	D)	Mrs. Kruger should be placed on strict intake and output monitoring.

 

 

23.	As part of a large hospital’s IV team, two nurses are responsible for inserting peripherally inserted central catheters (PICCs) at the bedside for patients who require this form of venous access. Which of the following patients would most likely require a PICC?
	A)	A woman who recently suffered a pelvic fracture in a motor vehicle accident
	B)	An elderly man who has been admitted from the community with a fluid volume deficit
	C)	A man whose hypocalcemia requires a stat infusion of calcium gluconate
	D)	A woman who has just been ordered total parenteral nutrition (TPN)

 

 

24.	A patient has been admitted to the medical unit from the emergency department with a peripheral IV in situ and normal saline infusing by gravity. How should the nurse best ensure that the patient’s ordered solution infuses at the correct rate?
	A)	Change from gravity infusion to an electronic IV pump.
	B)	Monitor the patient’s IV infusion hourly.
	C)	Label the patient’s bag of IV solution with a time-calibrated strip of tape.
	D)	Assess the patient often for signs and symptoms of fluid overload.

 

 

25.	A patient’s scheduled dose of furosemide (Lasix) 20 mg IV has recently finished infusing, and the nurse is preparing to administer metoclopramide (Reglan) 10 mg IV, which has just been ordered. Before administering this drug, the nurse should:
	A)	Reassess the patient’s allergy status.
	B)	Flush the patient’s IV tubing.
	C)	Aspirate 1 to 2 mL of blood.
	D)	Clean the area around the patient’s IV cannula with normal saline.

 

 

 

Answer Key

 

1.	D
2.	D
3.	C
4.	B
5.	C
6.	A
7.	D
8.	E
9.	A
10.	C
11.	C
12.	B
13.	D
14.	A
15.	D
16.	D
17.	C
18.	A, B, C
19.	A
20.	B
21.	C
22.	B
23.	D
24.	A
25.	B