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Adult Health II Final Exam
Adult Health II (NUR 345)
Indiana Wesleyan University
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Adult Health II Final Exam
Exam 1 Material
- When counseling a couple in which the man has an autosomal recessive disorder and the woman has no gene for the disorder, the nurse uses punnett squares to show the couple the probability of their child having the disorder. Which statement by the nurse is accurate? A: “Each child would be a carrier of the disorder”
The sister of a pt diagnosed with BRCA gene- related to breast cancer asks the nurse “do you think I should be tested for this gene?” Which response by the nurse is most appropriate? A: “There are many things to consider”
A male pt with hemophilia (X-linked recessive) asks the nurse if his children will be hemophiliacs. The mother of the children does not carry the hemophilia gene. Which response by the nurse is accurate? A: “Your female children will be carriers”
When caring for a young adult pt who has abnormalities in the cytochrome P450 (CYP 450) gene, which action will the nurse include in the pt’s plan of care? A: Teach that some medications may not work effectively
Constance, an 81 year old pt with dehydration, explains to the nurse she does not understand how she became dehydrated. The nurse explains the following (choose): A: The loss of subcutaneous tissue, a reduced thirst drive, hormonal changes
A pt with a family history of CF asks for information about genetic testing. Which response is most appropriate? A: Refer the pt to a qualified genetic counselor
Which action will the nurse include in the plan of care for a pt who has thalassemia major? A: administer iron chelation therapy as needed
IV KCl 60 mEq is prescribed for treatment of a pt with severe hypokalemia. Which action should the nurse take? A: Infuse the KCl at a rate of 10 mEq/hr
A pt who was involved in a motor vehicle crash has had a tracheostomy placed to allow continued mechanical ventilation. How should the nurse interpret the following ABG’s: pH: 7, PaO2: 85 mmHg, PaCO2: 32 mm Hg, and HCO3: 25 mEq/L? A: resp. Alkalosis
A post op. Pt who had surgery for a perforated gastric ulcer has been receiving NG suctioning for 3 days. The pt has a serum sodium level of 127 mEq/L. Which prescribed therapy should the nurse question? A: Infuse 5% dextrose in water a 125 mL/hr
A pt receives 3% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the pt is receiving this infusion? A: Lung sounds
A pt who is lethargic and exhibits deep, rapid respirations has the following ABG results: pH: 7, PaO2: 88 mm Hg, PaCO2: 37 mm Hg, HCO3: 16 mEq/L. How should the nurse interpret these results? A: metabolic acidosis
A pt who has been receiving diuretic therapy is admitted to the ER with a serum potassium level of 3 mEq/L. The nurse should alert the healthcare provider immediately that the pt is on what medication? A: Digoxin (Lanoxin) 0 mg/day
The nurse is caring for a patient who has a calcium level of 12 mg/dL. Which nursing action should the nurse include on the care plan? A: Encourage fluid intake up to 4000 mL every day.
The nurse is caring for a pt who has CVAD. Which action by the nurse is appropriate? A: Use push-pause method to flush CVAD
A patient with renal failure who arrives for outpatient hemodialysis is unresponsive to questions and has decreased deep tendon reflexes. Family members report that the patient has been taking aluminum hydroxide/magnesium hydroxide suspension (Maalox) at home for indigestion. Which action should the nurse take first? A: Notify the patient's health care provider.
A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. The patient complains of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first? A: Give the patient the PRN IV morphine sulfate 4 mg.
A patient has a serum calcium level of 7 mEq/L. Which assessment finding is most important for the nurse to report to the health care provider? A: The patient is experiencing laryngeal stridor.
Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete? A: Presence of the Chvostek's sign
A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse? A: Serum calcium is 18 mg/dL.
Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? A: Auscultate the patient's breath sounds.
A patient with chronic anemia comes in with increased fatigue, and occasional palpitations at rest-what are some labs you would expect? A: Hemoglobin 8.
A patient that just had a blood transfusion is having back pain and difficult breathing 15 min after completion what is action? A: disconnect transfusion and administer normal saline
A nurse coming onto shift has several patient with neutropenia which should she assess first? A: Patient with a fever of 100.
A patient that had traumatic bleeding begin 90 min ago would have what expected lab? A: a normal hemoglobin
SAA symptoms of stage IV-B Hodgkins lymphoma (choose) A: fever, night sweats, weight loss; involvement of multiple lymph
Nursing action to prepare patient for administration of potassium SAA (choose) A: Ensure to dilute potassium appropriately, monitor IV for infiltration and phlebitis
Symptoms of fluid volume deficit A: weight loss and poor skin turgor
Sex linked disorders appear more often in -than in - A: males/females
A change on a gene or a chromosome is a A: mutation
What compensatory mechanism occurs in respiratory acidosis A: retention of HCO3 by kidneys
What would you administer to a patient with pernicious anemia? A: vitamin B12 injections
A patient with anemia has labs draw and she has an increased MCV-what type of anemia may the patient have? (choose) A: pernicious anemia and folic acid deficiency
A patient’s room has seizure pads placed in it. What type of electrolyte imbalance would you expect the patient to have? A: hyponatremia
A hypertonic solution will A: increase fluid transfer from cells to blood vessels
What will be included in a fluid balance assessment? (choose) A: skin turgor, IV intake, BP
A pt comes in with resp. Acidosis. The nurse knows the following ABG results likely belongs to the pt with:
A: pH: 7, PaCO2: 55 mm Hg, HCO3: 24 mEq/L
- Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? A: Auscultate the pt’s breath sounds
Exam 2 Material
61 year old w/ multiple risk factors CAD o Elevated low-density lipoprotein (LDL) level Pt info that confirms chronic stable angina o Px that goes away after a Nitroglycerin tablet Sublingual nitroglycerin (Nitrostat) which statement indicates effective teaching? o Call ambulance if I still have px after taking 3 nitro’s 5 mins apart side effect of Lisinopril (Zestril) o Chronic cough Appropriate nursing dx for a pt to nervous to get washed up alone 3 days after an MI o Anxiety related to change in health status Effectiveness of pre-op teaching w/ pt scheduled for CABG using internal mammary artery. Additional teaching when pt says? o I will have incisions in my legs where they will remove the skin Pravastatin (Pravachol) & Niacin what is most important to communicate to provider? o Generalized muscle aches & pains Assessment finishing most important w/ coronary artery bypass graft using the right radial artery graft? o Pallor & weakness of the right hand Most important ECG change when pt has chest px o ST segment elevation 52 year old male w/ chronic stable angina w/ an order for Metoprolol (Lopressor) questions the order if? o The pt has a history of asthma Atypical symptoms of unstable angina (select all that apply) o Fatigue, indigestion, & anxiety Difference between unstable angina, NSTEMI & STEMI.. characteristics (select all that apply) o ST elevation on the ECG & positive biomarkers such as troponin 68 year old w/ ascites w/ jugular venous distention (JVD) HOB elevated 45 degree. Finding indicates? o Increased right atrial pressure Pt w/ chronic HF went to bed fine but woke up in the middle of the night feeling like I they were suffocating. Nurse documents this as: o Paroxysmal nocturnal dyspnea Following an acute MI a 63 year old develops clinical manifestations of HF. Discharge teaching includes? o Angiotensin-converting enzyme (ACE) inhibitors DIagnostic test most useful in determining whether a pt w/ acute SOB has HF? o B type natriuretic peptide Captopril which statement by the pt indicates effective teaching? o I will call for help when I need to get up to use the bathroom
o Uncontrolled HTN Drugs used for peripheral artery disease o Statins Legs cramp & hurt after walking a few mins & goes away when I stop. The nurse should? o Palpate for the presence of dorsalis pedis & posterior tibial pulses Pt w/ chronic PAD needs further teaching when the pt says I will? o Use a heating pad on my feet @ night to increase the circulation Plan of care after endovascular repair of an abdominal aortic aneurysm? o Monitor fluid intake & urine output Hx of intermittent claudication. Pt statement that supports this? o My legs cramp when I walk more than a block Teaching plan for a pt w/ PAD? o It’s very important that you stop smoking cigarettes History of AAA has severe back px & absent pedal pulses. 1st action by nurse? o Check BP Pt w/ repair of AAA has absent popliteal, posterior tibial, & dorsalis pedis pulses. Legs cool & mottled. 1st action by nurse? o Notify surgeon & anesthesiologist Right calf venous thromboembolism (VTE) what requires immediate action by the nurse? o New onset of SOB AAA w/ suspected spontaneous rupture. findings on assessment? (select all that apply) o Diaphoresis, tachycardia & pallor Stable aortic dissection w/o complication. Notify provider after which assessment finding? o BP of 162/ Surgery for an aortic aneurysm when it reaches what size? o 5 cm Pt w/ PAD requires further teaching when they say? o I should rest my legs & avoid exercise as often as I can.
Exam 3 Material:
Rhinoplasty teaching: indicate what teaching is considered successful o Elevate head for 48 hours to minimize swelling Management of upper respiratory infection with acute sinusitis. What indicates the need of additional teaching? o Use nasal decongestant spray until congestion is gone. When auscultating lungs you hear coarse crackles bilaterally, patient is unsuccessful coughing up secretions, what intervention should nurse do o Put on sterile gloves and use sterile catheter to suction What is the first action with epistaxis o Apply squeezing pressure to the bridge of nose for 5-15 minutes Patient has total laryngectomy and radial neck dissection in the first 24 hours what is the first priority nursing action o Keep patient in semi fowler’s position Patients that should receive in inactivated flu vaccine
o 76 year old in home residence o Pregnant 36 year old o 30 year old who takes corticosteroids for rheumatoid arthritis Nurse assess what in the chest of a patient with pneumococcal pneumonia o Increased tactile fremitus What indicates a good understanding of discharge instructions with a patient with pneumonia o Continue deep breathing and coughing exercise at home Patient taking Rifampin (Rifadin) for tuberculosis calls about orange urine and orange tears, nurses response would be o Orange urine and tears are normal Older patient receiving standard multidrug for tuberculosis should call health care professional if o Yellow tinged sclera Nurse and nursing student is taking care of a tuberculosis patient. The nurse corrects the student nurse if o The student nurse enters room with surgical face mask Most concern with 1 hour after chest tube placement o 400 mL of blood in collection chamber Patient comes in after automobile accident and has tracheal deviation to the LEFT and absent breath sounds on the RIGHT the nurses 1st intervention is o Right side chest tube insertion Patient with right side chest tube after thoracotomy continue bubbling in suction chamber o Nurse should continue to monitor collection device Patient is admitted with bacterial pneumonia and sepsis. What is the 1st order o Obtain blood cultures from 2 different sites
Patient comes into emergency department with open stab wound with sucking air to left chest, the first intervention of the nurse o Tape non porous dressing on 3 sides over wound Sprained ankle discharge instructions o Use pillow to elevate ankle above the heart Patient is wearing a body jacket brace for spinal fracture o Ask the patient about abdominal discomfort Long term arm plaster cast for fracture immobilization until cast is completely dry the nurse should o Handle the cast using fingertips ORIF of lower leg continues to have severe pain in 15 after IV morphine. Pulses are barely palpable, foot cool to touch o Notify health care professional (R/T being compartment syndrome) After 3 day hospitalization with right femur fracture patient suddenly feels short of breath and tachypnea and states, “I feel like I am going to die” first intervention o Apply O Most important communication to share with health care professional with casts o Capillary refill delayed What requires immediate report with lumbar compression fracture o Patient becomes incontinent of urine and stool (cauda equina) Patient discharge instruction after 1 week IV antibiotic therapy for acute osteomyelitis in right leg
o Bone resorption earlier and more rapid after menopause o Pregnancy o Breastfeeding o Longevity Bone degradation related to osteoporosis common in o Spine, hips, and wrists Patient came to the emergency room after automobile accident with left tension pneumothorax o Absent lung sounds on left with tracheal deviation to right Suction chamber o 20 cm water What is the nursing intervention when chest tube becomes disconnected o Place the distal end in tube of sterile water Primary risk factor for lung cancer o Smoking Hospital acquired pneumonia o More than 48 hours after admission Patient undergoing tuberculosis should o Avoid alcohol Patient has trach and on ventilator, for ventilation to be successful, the cuff of trach must be o Inflated
Exam 4 Material
Instruction regarding prevention of future UTIs Empty bladder Finding by nurse to determine benign prostate hyperplasia/ pyelonephritis CVA tenderness Preventing recurrence of renal calculi Drink 2000 to 3000 ml Healthcare associated infection of urinary tract. Avoid unnecessary urinary catheterization Assessment data reported with lower urinary tract infection. Burning on urination Risk factors to screen for UTI. Diabetes, Kidney disease, frequent antibiotic use Which information is most important for nurse to report to HCP for bladder infection Intermittent hematuria Aside from giving opioid medication, the nurse anticipates to give what with a male with kidney stone? Flomax (Tamsulosin) Bacterial UTI, allergies to sulfa drugs and penicillins. Nitrofurantoin and Cipro Kayexalate Assess bowel sounds More teaching on progressive CKD Salt substitutes should be used instead of regular salt
Injury after an industrial accident and developed acute kidney injury. Serum potassium level of 6 Patient with BHP admitted with acute urinary retention and elevated BUN and creatinine levels Insert a catheter Patient with AKI has peaked T waves, first action. Check medical record for most recent potassium level During hemodialysis, patient complains of nausea and vomiting. Check blood pressure Postrenal causes of kidney injury. Prostate enlargement and ureteral calculi Patient with AKI. patient has begun to make about 2 liters of urine daily for the past 2 days. patient is at risk for? Hyponatremia and Dehydration Prominent cause of CKD is? Diabetes During treatment for CKD, patient develops a thromboembolism Erythropoietin Teachings with a newly diagnosed hyperthyroidism patient. Antithyroid medications may take several months for full effect. Plan of care for a patient with hyperthyroidism who has exophthalmos. Tape eyelids Most important to make during initiation of thyroid replacement with Synthroid (levothyroxine). Apical pulse rate Hyperthyroidism secondary to pituitary tumor, what lab values? Elevated TSH and elevated T3 and T Assessment finding for diagnosis of cushing's syndrome. Buffalo hump and moon face Therapies effective for a patient with acute adrenal insufficiency. Increasing serum sodium levels Addisonian crisis. I had a flu earlier this week, so I couldn't take hydrocortisone Adrenalectomy Monitor fluids and electrolytes Taking prednisone 40 mg daily most important to report? Patient stopped taking medication 2 days ago The table with Addison's disease Infuse 5% dextrose and 0% saline Teaching about migraine headache. I will lie down some place dark and quiet when headaches begin Assessment of a patient with cluster headache Unilateral eye pain Tonic clonic seizure Assist patient in a turning on their side without limiting movement Multiple sclerosis taking mitoxantrone (novantrone) risk. Cardiotoxicity and infertility Stooped posture, shuffling gait. EEG testing Patient complains of bilateral headache Acetaminophen
3. Statement by a patient with increased discomfort of GERD that needs additional
teaching
● I eat small frequent meals during the day and a bedtime snack
4. A nurse is explaining the medication Nexium to a patient with recurring heartburn.
● Nexium treats GERD by decreasing stomach acid production
5. The best snack for a GERD patient 3hrs before bedtime
● Cherry gelatin and fruit
6. Anticipate teaching of what medication for a patient with frequent heartburn
● PPI’s
7. Important information to teach a newly diagnosed GERD patient
● Raise head of bed with elevation blocks
8. A patient is vomiting blood streaked fluid. Which risk factor would the nurse ask
the patient about?
● NSAID use
9. Teaching for Cobalamin B12 injections
● Used in prevention of becoming anemic
10. Patient with Peptic Ulcer Disease related to H. Pylori needs what medication
teaching
● Amoxicillin, Clarithromycin, Omeprazole
11. Patient with NG tube is experiencing severe upper abdominal pain, diaphoresis,
and a ridgid abdomen. What is the priority nursing action?
● Check vitals
12. Dietary teaching for management of Peptic Ulcer Disease
● Avoid foods that cause pain
13. Info about a patient that should be reported to HCP following a gastrectomy 8hr
ago
● Elevated Temperature (possible infection)
14. Acute gastritis patient needs a lavage. What are possible causes that indicate
lavage
● NSAID overdose, Alcoholic binge, Aspirin use
15. Patient is vomiting bright red blood. What is the priority nursing action
● Take BP and Pulse
16. Patient has achalasia. What are possible medications the nurse would want to
teach the client about?
● Nitrates, Calcium channel blockers, and Botulinum Injections
17. Non-pharmacological teaching for achalasia
● Eat slowly, Sleep with head of bed elevated, Semi-soft diet, high calorie foods
18. 32 Year old patient with Barrett’s esophagus needs what teaching?
● Should have an endoscopy every 2-3 years
19. Newly diagnosed patient with IBS teaching
● Avoid/Eliminate gas producing foods from diet
20. Exacerbation of ulcerative colitis (pt experiencing crampy abdominal pain, 15
bloody stools). Nurse should perform what action?
● Discontinue patient’s oral intake of food
21. Patient admitted with exacerbation of IBD. What is a priority nursing action?
● Monitor pt. Stools for blood
22. Teaching about sulfasalazine
● Skin and urine may turn orange
32. Symptoms not associated with IBS that should be examined
● Fever
33. Patient ate Hepatitis infected food. Which antigen would be expected in serologic
testing results
● Anti-hepatitis A IgM
34. Information stated by patient during a health screening that would result in the
patient needing a Hepatitis C screening
● Used IV drugs 20yrs ago
35. Patient is experiencing abrupt onset of jaundice/ nausea with abnormal liver
function but serologic testing is negative for hepatitis. Which question should the
nurse ask about use of?
● Use of any OTC drugs? (OTC drugs can cause liver toxicity aka. Acetaminophen)
36. Nurse should monitor what level in patient with 4+ edema?
● Albumin Levels
37. Most important information to tell a patient with alcoholic cirrhosis
● Avoid alcohol consumption
38. Potassium level of 3 mEq/L in a patient with cirrhosis. Spironolactone and
Furosemide are due. Which drugs or drug should be administered at this time.
● Only administer spironolactone (potassium level low and is a potassium sparing
diuretic)
39. Indication that lactulose medication has been effective in an advanced cirrhosis
patient
● Patient is alert and oriented
40. Monitor what level in a patient with severe cirrhosis?
● Ammonia levels (hepatic encephalopathy)
41. Paracentesis teaching for ascites patient
● Empty bladder before procedure
42. Nurse monitors which lab for effectiveness of therapy in acute pancreatitis patient
● Amylase levels
43. Acute pancreatitis admission needs to be asked about history of?
● Alcohol consumption
44. Big red flag when assessing a patient when assessing a patient with cirrhosis
● Patients hands flap when arms are extended
45. Specific purpose of Zantac in a patient with bleeding esophageal varices
● Prevents irritation of enlarged veins
46. Primary nursing action for a patient that is vomiting blood
● Check BP and HR
47. Patient had a Hep A infection one year ago. Ask patient about additional screening
of what?
● Hepatitis C (Chad likes A##, Brennan likes D###)
48. Tell HCP about this information when assessing a patient with acute liver failure
● Asterixis and Lethargy
49. Cullen’s sign is around which area of the body
● Belly button area
50. Complaint of Abdominal pain radiating to right scapula (Referred pain) would aid
in diagnosis of what?
● Cholithiasis
Adult Health II Final Exam
Course: Adult Health II (NUR 345)
University: Indiana Wesleyan University
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