Student Led Turning Point Fall Session 2 2008

NKU

The nurse knows that the client understands effective treatment of laryngitis when the client responds:

1. I will talk/sing frequently during this time to make sure I don’t lose my voice. 

2. I will avoid eating/drinking after taking the Vanceril inhaler to avoid rinsing away the medication. 

3. I will rest my voice to make sure I don’t aggravate the laryngitis.

4. To avoid aggravating the laryngitis, I will keep the air dry and warm. 

What is a primary nursing intervention for Laryngeal Paralysis?

1. monitor vital signs each shift

2. accurately monitor and record I & O ‘s

3. monitor and protect air way

4. assess for pain

Rationale Monitoring and protecting the patients air

way with Laryngeal Paralysis is most important because they are at risk for aspiration.

What are patients with Laryngeal Paralysis most at risk for?

1. ineffective breathing2. aspiration pneumonia3. sleep apnea4. slight hoarseness of

voice

Rationale Patients are most at risk for aspiration

pneumonia due to the aretyniod cartilage of the larynx not functioning and remaining loose in a neutral position. This leave the air way unprotected when swallowing.

If drug therapy is used for the treatment of laryngitis, the nurse would expect the physician to order what medication?

1. IV Epinephrine 2. Salagen3. Vanceril4. Medication is not used in

the treatment of laryngitis

A high priority nursing diagnosis for a person with chronic bronchitis would be

1. Nutrition imbalance2. Self-care deficit3. Ineffective airway

clearance4. Nausea

Rationale With chronic bronchitis the airway becomes

inflamed and thickened.  Increase in the number and size of mucus-producing cells results in excessive mucus production and a cough.  The cough makes it difficult to get air in and out of the lungs.

People with chronic bronchitis tend to be blue bloaters. All of the following are characteristics of blue bloaters except

CO2 rete

ntion

Compensate

d re...

ABGs show hypo...

pursed lip

bre...

25% 25%25%25%30

1. CO2 retention 2. Compensated respiratory

acidosis3. ABGs show hypoxemia4. pursed lip breathing

Rationale Pursed lip breathing is a characteristic of

pink puffers, a person with emphysema.

Which factor should be checked when evaluating the effectiveness of an alpha-adrenergic blocker given to a client with BPH?

Voiding pattern

Size

of the pro

state

Creatinine cl

earance

Seru

m testo

stero

ne leve

l

25% 25%25%25%30

1. Voiding pattern2. Size of the prostate3. Creatinine clearance4. Serum testosterone level

Rationale Voiding pattern; The prostate glad has alpha-

adrenergic receptors. Alpha-adrenergic blockers relax the smooth muscle of the bladder neck and prostate, so the urinary symptoms of BPH (frequency, urgency, hesitancy) are reduced in many clients. These drugs don't affect the size of the prostate, renal function, or production or metabolism of testosterone

Which one of the following drugs is used to treat BPH?

Danocri

ne

Prosc

ar

Halote

stin

Android

25% 25%25%25%30

1. Danocrine2. Proscar3. Halotestin4. Android

Rationale Proscar; Proscar is used to treat BPH.

Android and Halotestin are synthetic testosterone hormones. Danocrine is used to treat endometriosis

What does a radical hysterectomy consist of?

removal

of ute

...

removal

of ute

...

lymph nodes n

o...

Ovarie

s and fa

...

25% 25%25%25%30

1. removal of uterus2. removal of uterus, cervix,

supporting tissues, distal vagina, adnexa, pelvic lymph nodes

3. lymph nodes not removed4. Ovaries and fallopian

tubes

Rationale removal of uterus, cervix, supporting tissues,

distal vagina, adnexa, pelvic lymph nodes.rational: removal of uterus is known as a

simple hysterectomy. Lymph nodes not removed is known as a total abdominal hysterectomy (TAH).

According to The American Cancer Society, screening and diagnosing of breast ca are all done for early detection except for?

retra

ction of ..

.

yearly

mammogr..

.

yearly

clinica

...

month

ly breast.

..

ultraso

und dis...

biopsy

17% 17% 17%17%17%17%

301. retraction of nipple2. yearly mammogram @ 40

yrs. with doctor exam3. yearly clinical breast

exam4. monthly breast self exam5. ultrasound distinguishes

fluid filled cysts from solid mass

6. biopsy

Rationale retraction of nipple is a sign of breast cancer,

all others are preventative screenings that are recommended by ACS

Mary, a 45 yr female who has vaginal cancer is receiving external radiation treatment, There are 4 family members want to visit her. Which visitor should be able to visit Mary?

Mary's

broth

er...

Mary's

daughte...

Mary's

father ..

.

Mary's

husban

d...

25% 25%25%25%30

1. Mary's brother who had flu a week ago.

2. Mary's daughter who is 18.

3. Mary's father who is suffering fungus infection.

4. Mary's husband who has genital herpes.

Nursing intervention during internal radiation should NOT include:

Talk w

ith pati...

Enco

urage pati...

Restrict

visit..

.

Restrict

fluid...

25% 25%25%25%30

1. Talk with patient at least 6 feet from source and sand behind lead shield.

2. Encourage patient self care.

3. Restrict visitors under 18.4. Restrict fluid intake.

A client is diagnosed with multiple myeloma. The client asks a nurse about the diagnosis. The nurse bases the response on which of the following descriptions of this disorder?

malig

nant e

xac...

altere

d RBC pr...

altere

d produc..

.

malig

nant p

rol...

25% 25%25%25%30

1. malignant exacerbation in the number of leukocytes

2. altered RBC production3. altered production of

lymph nodes4. malignant proliferation of

plasma cells and tumors within the bone

Rationale multiple myeloma is a B cell neoplastic

condition characterized by abnormal malignant proliferation of plasma cells and the accumulation of abnormal plasma cells in the bone marrow. 

A nurse is reviewing the laboratory results of a client diagnosed with multiple myeloma. Which of the following would the nurse expect to specifically note in this disorder?

decrease

d numb...

incre

ased w

hit...

incre

ased ca

lc...

decrease

d bloo...

25% 25%25%25%30

1. decreased number of plasma cells in the bone marrow 

2. increased white blood cells

3. increased calcium level4. decreased blood urea

nitrogen (BUN) 

Rationale Findings indicative of multiple myeloma are

an increased number of plasma cells in the bone marrow, anemia, hypercalcemia resulting from the release of calcium from the deteriorating bone tissue, and an elevated BUN. An increased white blood cell count may or may not be present and is not specifically related to multiple myeloma. 

Which of the following is true regarding tracheostomy care?

A Passy-M

uir v...

The client w

il...

The cuff needs..

.

The client's

t...

25% 25%25%25%1. A Passy-Muir valve needs to be placed over the hub of the trach before the cuff is deflated.

2. The client will need to cover his/her trach while taking a shower.

3. The cuff needs to be inflated at less than 15 mm Hg to prevent aspiration.

4. The client's trach will only need suctioned once a week.

30

Rationale A shower cover is necessary to prevent water

from getting into the trach.

The nurse performs the following to prevent complications associated with tracheostomy tubes except:

Inse

rt th

e dec...

Maintai

n steri..

.

Change trac

h d...

Administer a

de...

25% 25%25%25%30

1. Insert the decannulation plug in the trach while the cuff is inflated.

2. Maintain sterile technique when suctioning and performing trach care.

3. Change trach dressing once every 8 hours and as needed.

4. Administer adequate warmed humidified air.

Rationale Insertion of the decannulation plug before

deflating the cuff will not allow the client to be able to breathe.   

People with empysema have which type of presentation:

Blue Bloaters

Purple Bloate

r...

Red Puffers

Pink Puffers

25% 25%25%25%30

1. Blue Bloaters2. Purple Bloaters3. Red Puffers4. Pink Puffers

Rationale People with emphysema have a reddish

complexion, tachypnea, pursed lip breathing, ABGs show no CO2 retention and less hypoxemia than blue bloaters

People with empysema have:

incre

ase th

e n...

inflammed airw

...

a few la

rge al...

producti

ve co

u...

25% 25%25%25%30

1. increase the number of mucus producing cells

2. inflammed airways3. a few large alveoli instead

of many tiny ones4. productive cough that

lasts 3 months or longer within a 2 year period

Rationale The walls between many of the alveoli are

detroyed. The large alveoli have less surface area for the exchange of oxygen and carbon dioxide than healthy alveoli.

Which is the American Cancer Society's recommendation for early detection of prostate cancer?

a yearly PSA l..

.

a Biannual re

c...

A semi-a

nnual ...

A yearly urin

a...

25% 25%25%25%30

1. a yearly PSA level and DRE beginning at age 50

2. a Biannual rectal exam beginning at age 40

3. A semi-annual alkaline phosphatase level beginning at age 45

4. A yearly urinalysis to determine the presence of prostatic fluid.

Rationale Answer: A- Men in high risk groups such as

African American men should begin at 45                   b- A biannual exam isn't recommended                   c.-Alkaline phosphatase levels are preformed on men with known prostate cancer to determine bone involvement.                   d.- This test is done if the client has signs and symptoms of prostatitis

The school nurse is preparing a class on testicular cancer for male high school seniors. Which information regarding testicular self-exam should the nurse include?

Perform

the ex..

.

Any lump sh

oul...

Disc

uss having...

The proce

dure ...

25% 25%25%25%30

1. Perform the exam in a cool room under a fan

2. Any lump should be examined by a HCP as soon as possible

3. Discuss having a second person to confirm a negative result

4. The procedure will cause a milk discomfort if done correctly

Rationale Answer: B- The pt should note a cordlike

structure; this is a normal finding. Any lump or mass is abnormal and should be checked by a HCP asap.                   a. the body temp should be warm for the scrotum to relax. The best place to perform an exam is a warm hot shower                   c.- The client can confirm his own negative results                   d.- The procedure is painless. If pain is elicited then an HCP should examine the pt.

A client labs showed that decreased blood flow and fibrin and leukocytes settled in the affected area, which stage of pneumonia is he/she in?

Resolution

Gray

hepatizat..

.

Congestion

Red hepatizati...

25% 25%25%25%30

1. Resolution2. Gray hepatization3. Congestion4. Red hepatization

Which is a priority nursing intervention to prevent pneumonia in the post-op client?

Coughing and d...

Ambulation aft...

Ince

ntive spir.

..

Proper o

ral h

y...

25% 25%25%25%30

1. Coughing and deep breathing

2. Ambulation after surgery3. Incentive spirometer4. Proper oral hygiene and

adequate pain control

Patients with ARDS are going to receive this type of care?

Exerci

se pro

gr...

Positive

End E...

Fluid Restr

ict...

Antihypertensi.

..

25% 25%25%25%30

1. Exercise program2. Positive End Expiratory

Pressure3. Fluid Restrictions4. Antihypertensives

Rationale PEEP is a special mode of ventilation that

keeps the alveoli partially inflated so they don't collapse and can participate in air exchange.

The first sign of ARDS is

Incre

ased Temp...

Incre

ased Puls.

..

Incre

ased Pain

Incre

ased re

sp...

25% 25%25%25%30

1. Increased Temperature2. Increased Pulse3. Increased Pain4. Increased respirations as

fluid fills their lungs.

An elderly client with pneumonia may appear with which of the following symptoms first?

Altere

d menta

l...

Fever a

nd chil..

.

Hemoptys

is and...

Pleuritic c

hes...

25% 25%25%25%30

1. Altered mental status and dehydration

2. Fever and chills3. Hemoptysis and dyspnea4. Pleuritic chest pain and

cough

Rationale A- fever, chills, hemoptysis, dyspnea, cough,

and pleuritic chest pain are the common symptoms of pneumonia, but elderly clients may first appear with only an altered mental status and dehydration due to a blunted immune response.

A client had been treated with antibiotics therapy for right lower-lobe pneumonia for 10 days and will be discharged today. Which off the following physical findings would lead the nurse to believe it is appropriate to discharge this client?

Continued dysp...

Fever o

f 102de...

Respira

tory

ra...

Vesicular b

rea...

25% 25%25%25%30

1. Continued dyspnea2. Fever of 102degrees F

(38.9 degrees Celsius)3. Respiratory rate of 32

breaths/minute4. Vesicular breath sounds

in right base

Rationale If the client still has pneumonia, the breath

sounds is in the right base will be bronchial, not the normal vesicular breath sounds. If the client still has dyspnea, fever, and increased respiratory rate, he should be examined by the physician before discharge because he may have another source of infection or still have pneumonia.

Of the following a symptom of a concussion, which is not something to report immediately to a physican?

Diffi

culty

spe...

Vomiting

Weakness

of on...

Depre

ssion

25% 25%25%25%30

1. Difficulty speaking2. Vomiting3. Weakness of one side of

the body4. Depression

Rationale Depression is not a symptom that is needed

report immediately to physician.(pg. 1913 in the med-surg volume 2 10 edition.)

Monitoring ICP is important part of the assessment for a patient with a brain injuries which of the following would help manage increase ICP?

Have

the patie...

Maintai

n adequ...

Have

the perso

...

IV of h

ypoto

ni...

25% 25%25%25%30

1. Have the patient in supine position.

2. Maintain adequate oxygenation.

3. Have the person cough and deep breathe.

4. IV of hypotonic solution.

Rationale The only answer that is correct is maintain

adequate oxygenation. for (a) you should elevate HOB. (c) coughing can increase icp. (d) only normal saline or ringers lactate should be used because hypotonic solution decreases plasma osmolality.

What instructions should the nurse not provide to someone newly diagnosed with epilepsy.

Keep a reco

rd ...

Take bath

s onl...

Avoid OTC m

eds...

When driv

ing h...

25% 25%25%25%30

1. Keep a record of seizure activity and report it to the neurologist.

2. Take baths only do not take showers.

3. Avoid OTC meds.4. When driving have

someone in the car with you.

Rationale New medications may cause drowsiness and

meds may not have reached therapeutic level and therefore patient may still be at risk for seizure. Driving laws dictate that a therapeutic level must be reached for the AED and that is determined by the physician. A newly diagnosed client may not be therapeutic and unless released by the physician- having a person with them is not enough to ensure safety.

The nurse enters a patients room and finds her sitting in the chair convulsing with rigid arms and legs and making sounds. The patient seems unaware. What should be the nurses first action?

Place th

e pati...

Assess

patient...

Gently

place p...

Move th

e furn

i...

25% 25%25%25%30

1. Place the patient on her side

2. Assess patients vitals3. Gently place patient on

floor4. Move the furniture away

from the patient

Rationale Place patient on floor for free movement, and

try to keep her safe.

Which of the following leukemias have low red blood cells, low H&H, low platelet count along with high myeloblast cells?

Chronic

myeloi...

Acute ly

mphocy...

Chronic

lympho...

Acute m

yeloid ...

25% 25%25%25%30

1. Chronic myeloid leukemia (CML)

2. Acute lymphocytic leukemia (ALL)

3. Chronic lymphocytic leukemia (CLL)

4. Acute myeloid leukemia (AML)

Rationale (Lab results will show low RBCs, low H&H,

low platelet count, low to high WBCs with high myeloblast cells.

The nurse is reviewing the lab report of a client who underwent a bone marrow biopsy. The findings that would most strongly support a diagnosis of acute leukemia is the existence of a large number of immature :

Thrombocy

tes

Leukocy

tes

Lymphocy

tes

reticu

locyte

s

25% 25%25%25%30

1. Thrombocytes2. Leukocytes3. Lymphocytes4. reticulocytes

Rationale (leukemia is manifested  by an abnormal

overproduction of immature leukocytes in the bone marrow)

The nurse is caring for a patient that is suffering from an acute onset of larnygeal edema as a result of chronic laryngitis. Which medication should the nurse expect to administer?

Cortico

stero

id...

IV epinephrin

e

Racemic

epinep...

Epi- P

EN

25% 25%25%25%30

1. Corticosteroids2. IV epinephrine3. Racemic epinephrine4. Epi- PEN

Rationale corticosteriods are treatment for slow

onset edema,  IV epinephrine and the Epi-PEN are treatment for fast onset related to allergic reaction

The nurse caring for a patient that is suffering from slow onset laryngeal edema can expect to administer which medication?

Cortico

sterio

d...

IV epinephrin

e

Epi-P

EN

Racemic

epinep...

25% 25%25%25%30

1. Corticosteriods2. IV epinephrine3. Epi-PEN4. Racemic epinephrine

Rationale b and c are treatment for acute onset, and

racemic epinephrine is for acute r/t chronic laryngitis 

Which diagnostic test for Chronic Glomerularonephritis (CGN) is difficult to do because of the signs and symptoms of CGN?

UA - fi

xed sp

e...

24 hour urin

e

renal b

iopsy

seru

m BUN/ cre

...

25% 25%25%25%30

1. UA - fixed specific gravity2. 24 hour urine3. renal biopsy4. serum BUN/ creatine

Rationale  answer: c renal biopsy; rationale: becuase of

atrophy of the kidneys (one of the S/S of CGN) its difficult to do renal biopsy

Which clinical manifestation of Nephrotic syndrome would the nurse question?

severe genera

l...

pronounce

d pro...

diarrhea an

d l...

hypolipidemia

25% 25%25%25%30

1. severe generalized edema2. pronounced proteinuria3. diarrhea and loss of

appetite4. hypolipidemia

Rationale A clinical manifestation of Nephrotic

syndrome is hyperlipidemia.