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NU 665 FINAL EXAM WEEK 11 QUESTIONS AND ANSWERS
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What is the normal number for the Glasgow Coma Scale? - ANSWER- 15 Which diagnostic test is the best to diagnose a subdural hematoma? - ANSWER- Magnetic resonance imaging (MRI) A 14-year-old female comes to the clinic with amenorrhea for 3 months. A pregnancy test is negative. The adolescent's body weight is at 82% of expected for height and age. The mother reports that her daughter often throws up and refuses to eat most foods. Which condition does the primary care pediatric nurse practitioner suspect? - ANSWER-Anorexia nervosa Which type of heat-related illness involves a core body temperature of at least 104.9°F, acute mental status changes, absent sweat, and tachypnea? - ANSWER- Heat stroke What percentage of burns is involved using the rule of nines if both front legs are burned? - ANSWER-18% Which drug commonly prescribed for burns is active against a wide spectrum of microbial pathogens and is the most frequently used agent for partial- and full- thickness thermal injuries? - ANSWER-Silver sulfadiazine (Silvadene) A sunscreen with a sun-protection factor of at least what number will block most harmful ultraviolet radiation? - ANSWER- 15 Which clinical feature is the first to be affected in increased intracranial pressure? - ANSWER-Decrease in level of consciousness The nurse is caring for a client who was just admitted with a diagnosis of schizoaffective disorder with depression. Which agent would the nurse anticipate as being prescribed for this client? - ANSWER-Clozapine
A school-age child has a fractured wrist with a Salter Harris Type II fracture, according to the radiologist. What is true about this type of fracture? - ANSWER- There is a metaphyseal fragment on the compression side of fracture. What will the primary care pediatric nurse practitioner elicit when obtaining a positive Barlow maneuver when screening for developmental dysplasia of the hip?
- ANSWER-Dislocation of an unstable hip A 3-year-old child is brought to the clinic by a parent who reports that the child refuses to use the right arm after being swung by both arms while playing. The child is sitting with the right arm held slightly flexed and close to the body. There is no swelling or ecchymosis present. What will the primary care pediatric nurse practitioner do? - ANSWER-Gently attempt a supination and flexion technique. A school-age child falls off a swing and suffers a closed fracture of the right clavicle. How will this be managed? - ANSWER-Immobilization with a sling to support the affected extremity A young adolescent reports chest pain associated with coughing and lifting. Physical examination reveals tenderness over several ribs, radiating to the back. Auscultation of the heart, lungs, and abdomen are normal. There is no history of injury. What will the primary care pediatric nurse practitioner do? - ANSWER- Recommend NSAIDs, stretching exercises, and ice packs to the area. A young adolescent female is observed to have mild unequal scapula prominences on gross examination while standing. In the Adams forward bending position, this inequality disappears. What will the primary care pediatric nurse practitioner do? - ANSWER-Discuss posture and exercise and ask about backpacks and books. The primary care pediatric nurse practitioner elicits positive Ortolani and Barlow signs in a 6-month-old infant not previously noted in the medical record. What is the correct treatment? - ANSWER-Surgical intervention A 14-year-old boy who is overweight develops a unilateral limp with pain in the hip and knee on the affected side. An exam reveals external rotation of the hip when flexed and pain associated with attempts to internally rotate the hip. What is most important initially when managing this child's condition? - ANSWER-Place the child on crutches or in a wheelchair to prevent weight-bearing.
A middle school age child is skipping school frequently and getting poor grades since the child's father was killed while deployed in the military. How will the primary care pediatric nurse practitioner manage this situation? - ANSWER-Refer the child to a mental health specialist for evaluation and treatment. The parent of a 4-year-old child reports that the child seems to be having trouble adjusting to a new daycare and reportedly is always engaging in solitary play when the parent arrives to pick up the child. What will the primary care pediatric nurse practitioner do? - ANSWER-Ask the parent if the child is slow to warm up to other new situations. The parent of a school-age child is concerned because the child has started to express anger about a grandparent's death even though this occurred when the child was a toddler. What will the primary care pediatric nurse practitioner tell the parent? - ANSWER-The significance of this loss must be reworked at each developmental level. The parent of a school-age child reports that the child doesn't like being alone in rooms because of a fear of aliens hiding in closets. What will the primary care pediatric nurse practitioner tell the parent? - ANSWER-"Fear of imaginary creatures does not usually occur at this age." The parent of a preschool age child reports that the child often appears anxious and nervous and that this is associated occasionally with a rapid heart rate and tremors. What is the best type of referral that the primary care pediatric nurse practitioner could recommend? - ANSWER-Play therapy A 9-year-old child exhibits school refusal and a reluctance to attend sleepovers with classmates. The parent is concerned because the child has recently begun sleeping in the parents' bed. Which initial action by the primary care pediatric nurse practitioner is appropriate? - ANSWER-Assess for environmental stress, parental dysfunction, and maternal depression. The parent of a school-age child reports that the child becomes frustrated when unable to perform tasks well and often has temper tantrums and difficulty sleeping. Which disorder may be considered in this child? - ANSWER-Generalized anxiety disorder (GAD) The parent of a school-age girl reports that the child has difficulty getting ready for school and is often late because of a need to check and recheck whether her teeth
are clean and her room light has been turned off. What will the primary care pediatric nurse practitioner recommend to this parent? - ANSWER-Cognitive behavioral therapy The parents of a 4-year-old boy are concerned because he has begun twisting and pulling out his hair, especially when he is tired or stressed. What will the primary care pediatric nurse practitioner recommend as part of an initial approach to treat this behavior? - ANSWER-Cutting his hair so that it is too short to pull A newly divorced mother of a toddler reports that the child began having difficulty sleeping and nightmares along with exhibiting angry outbursts and tantrums 2 months prior. The primary care pediatric nurse practitioner learns that the child refuses to play with usual playmates and often spends time sitting quietly. What will the nurse practitioner do initially? - ANSWER-Ask the mother about the child's relationship with the father. An adolescent has recently begun doing poorly in school and has stopped participating in sports and other extracurricular activities. During the history interview, the adolescent reports feeling tired, having difficulty concentrating, and experiencing a loss of appetite for the past few weeks but cannot attribute these changes to any major life event. Which is an important next step in managing this patient? - ANSWER-Determining suicidal ideation and risk of suicide An adolescent is diagnosed with major depression, and the mental health specialist has prescribed fluoxetine. What other treatment is important to protect against suicide risk? - ANSWER-Cognitive behavioral therapy A 13-year-old child has exhibited symptoms of mild depression for several weeks. The parent reports feeling relieved that the symptoms have passed but concerned that the child now seems to have boundless energy and an inability to sit still. What will the primary care pediatric nurse practitioner do? - ANSWER-Refer the child to a child psychiatrist for evaluation of bipolar disorder. A toddler has begun hitting and biting other children at a day care center and is exhibiting temper tantrums and bad language at home. The parent reports that these behaviors began shortly after a sibling was born. What will the primary care pediatric nurse practitioner do? - ANSWER-Engage the parent in positive parenting strategies to facilitate appropriate child coping.
Cerebrospinal fluid (CSF) may leak through the cribriform plate region of the skull following a head injury and cause which of the following? - ANSWER-Nasal CSF rhinorrhea Which classic feature of an epidural hematoma may distinguish it from other skull hematomas? - ANSWER-A brief loss of consciousness, then a brief "lucid" moment, followed by momentary unconsciousness minutes after the injury A patient with a basilar skull fracture may experience an impaired downward gaze or diplopia from which affected cranial nerve? - ANSWER-CN IV A history of overuse or excessive force, as opposed to a fall, hyperextension, or the twisting of a joint, is more likely related to which musculoskeletal injury? - ANSWER-A strain In a healthy adult, the process of remodeling after a fracture of the humerus takes how long? - ANSWER-2 months A patient who sustains blunt chest trauma and/or penetrating chest trauma must have which of the following imaging examinations? - ANSWER-Upright chest x- ray film Josie, age 30, has a pneumothorax. It may be treated conservatively without a chest tube if it is deflated by what percentage? - ANSWER-30% Hepatic necrosis with jaundice may occur after ingesting massive doses of which medication? - ANSWER-Acetaminophen Pink, cherry red tissues and skin may result from which type of poisoning? - ANSWER-Carbon monoxide In which type of burn is the injury more extensive than it appears, and the cardiac conduction system may be affected, leading to sudden death or arrhythmias? - ANSWER-Electrical burns Eddie, age 4, presents to the ED with a live insect trapped in his ear canal causing a lot of distress. What should be your first step? - ANSWER-Immobilize the insect with 2% lidocaine.
When giving discharge instructions to a patient with a laceration injury to his lower leg, which is the most important one? - ANSWER-Recommend cleansing the wound every 4 hours to prevent an infection. Cerebellar function may be assessed by performing which examination/test? - ANSWER-Romberg's test In the epithelialization phase of wound healing, the wound will have only what percent of its normal tensile strength at 3 weeks? - ANSWER-15% to 20% Which of the following statements is true about antibiotic prophylaxis for most wounds? - ANSWER-It is not indicated for most wounds and does not affect the infection rate. A patient sustained injuries in a motor vehicle accident and is in the Emergency Department. A CT scan of the head and neck have been ordered. What part of the survey is this? - ANSWER-Secondary A patient who is in the Emergency Department was attacked in a parking lot and suffered several stab wounds to various areas on the chest and abdomen; BP 100/60, heart rate 108, respiratory rate 20, pulse oximetry 98%. In order to counteract the blood loss and restore circulating volume for this patient, what priority intervention will the nurse perform? - ANSWER-Start lactated ringers at 150 mL/hr The nurse is assigned to a patient in the Emergency Department who exhibits paradoxical chest movement. What intervention by the nurse can help improve oxygenation in this patient? - ANSWER-Turn the patient with the injured side down A patient has been involved in a motor vehicle accident. The patient, who was driving, was unrestrained by a seat belt when hitting the car in front of him. The patient is complaining of midsternal pain, restlessness, and difficulty breathing. What is the priority nursing diagnosis for this patient? - ANSWER-Impaired gas exchange A patient has suffered a mild pulmonary contusion from a jet ski accident. What nursing interventions are appropriate for this patient? - ANSWER-Frequent pulse oximetry monitoring, assessment of lung sounds every 2 hours, continuous epidural analgesia
A patient was in a serious motor vehicle crash. At the scene, what is the highest priority of care? - ANSWER-Cervical spine protection On initial admission of a trauma victim to the emergency department, the nurse completes a primary survey. The patient is awake and tachypneic, is using accessory muscles of respiration, has unequal chest expansion, and is very anxious. There are absent breath sounds on the right and cyanosis on 100% oxygen, and the trachea is deviated to the left. What action takes the highest priority during the primary survey? - ANSWER-Chest tube insertion A patient has been admitted to the emergency department after being in a severe motor vehicle crash. The patient was a passenger and had a lap and seat belt in place. The patient is lethargic and moaning. Initial exposure and head-to-toe examination reveals scattered minor abrasions and contusions and bruising over the upper abdomen. The patient moans more when the abdomen is palpated, and the abdomen is rigid. Heart rate is 110, capillary refill is greater than 4 seconds, and blood pressure is 140/88 mm Hg. What is the nursing priority of care? - ANSWER-Increase rate of IV crystalloid As part of a major trauma, a patient has suffered a flail chest injury. What hallmark sign of flail chest does the nurse expect to find? - ANSWER-Flail segment depression during inhalation A patient is admitted to the CCU after experiencing blunt trauma to the chest. Among other injuries, the patient has a flail chest on the left and several extremity fractures. About 12 hours after admission, the patient is tachypneic and complaining of shortness of breath. Breath sounds are present bilaterally with scattered fine crackles. Chest radiograph shows an ill-defined, patchy, ground- glass area of density on the left. If the patient has a pulmonary contusion, what is the nursing priority? - ANSWER-Monitor pulse oximetry and arterial blood gases closely A patient has suffered severe blunt trauma to the abdomen with bruising, diffuse pain, guarding, and rigidity evident. Damage to which structure is most likely? - ANSWER-Liver As part of a multiple trauma injury, the patient has suffered a closed fracture of the radius. What nursing assessment finding indicates a significant complication warranting immediate treatment? - ANSWER-Loss of pulses distal to the fracture
A patient has experienced multiple fractures, including pelvic and long bone fractures. After 72 hours, the patient complains of tachypnea and dyspnea and is found to have cyanosis, tachycardia, confusion, and fever. Laboratory analysis reveals a normal complete blood count except for thrombocytopenia and progressive respiratory insufficiency. What is the nursing care priority? - ANSWER-Administer oxygen and monitor pulse oximetry During a motor vehicle accident, a patient sustained blunt trauma to the head and face, resulting in hairline skull fracture and a LeFort III maxillofacial fracture. The patient also has bruising across the chest and upper abdomen and multiple small superficial bleeding abrasions and lacerations. On admission to the emergency department, what is the nursing care priority? - ANSWER-Perform endotracheal intubation As part of a multiple trauma injury, a patient developed hemorrhagic hypovolemic shock, necessitating fluid resuscitation with massive amounts of intravenous crystalloid fluids and blood products as well as extensive surgical repair under general anesthesia. Twenty- four hours later, the patient develops hypoxia unresponsive to oxygen therapy and diffuse white, ground-glass infiltrates of the lung fields on a chest radiograph. Development of this complication has what effect on the patients recovery? - ANSWER-Significantly greater chance of death Which of the following is likely to result from lead poisoning? - ANSWER- Damage to the brain and peripheral nerves During the development of hyperthermia, the state of heat exhaustion is indicated when: - ANSWER-hypovolemia and fainting occur What is/are signs of hypothermia? - ANSWER-Lethargy and confusion Which of the following types of cells are most likely to be damaged by exposure to radiation? - ANSWER-Epithelial tissue and bone marrow Which of the following events would most likely cause a person to faint and experience difficulty breathing? - ANSWER-An insect sting Bites and stings cause disease in which three ways? - ANSWER-Injection of toxins, transmission of infectious agents, or allergic reactions
Two types of eye damage that can be caused by a laser beam are: - ANSWER- thermal burn and photochemical damage. A nurse from the ICU is participating in the hospitals disaster response preparedness team. One issue that proves difficult for the team to agree on is a statement regarding the standard of medical care observed during a disaster. Which of the following do you think the nurse should recommend to the team? - ANSWER-The goal should be to provide the highest care possible, with limited resources and equipment. A nurse learns that local law enforcement officials have informed the hospital that an imminent terrorist attack has been threatened in a building just down the street from the hospital. Which of the following are appropriate responses? Select all that apply. - ANSWER-Review the hospitals disaster plan and make sure that it is distributed to the rest of the medical staff. Determine what her specific role in the disaster plan is. Check the number of ventilators available in the ICU to determine whether more would be needed in the event of an attack. The nurse is at the bedside of her 90-year-old patient, Ruth, who is comatose and on life support in the ICU, when she begins to feel the room shaking violently. The power suddenly fails and emergency generators have not started yet. The nurse provides bag-mask resuscitation for Ruth while she waits for the power to be restored. Moments later, the ICU is inundated with patients injured by the collapse of a nearby apartment building as a result of the earthquake. The nurse is called to help. Kevin has been impaled by a metal rod through the chest, is in a state of shock, and will die without immediate intervention. Gwyneth has compound fractures of the femur and a dislocated shoulder, is in pain, but is responsive. Mason is unconscious and unresponsive. Based on the START triage categories, whom should the nurse assist first in this situation? - ANSWER-Kevin A patient arrives at the ICU after being injured by car bomb that exploded 20 feet away. The patient sustained only primary blast injuries. Which of the following are injuries he might have sustained? - ANSWER-Perforated eardrum caused by a sudden change in atmospheric pressure. Hemorrhagic contusion of the lungs. Gastrointestinal hemorrhage A group of patients, colleagues from the same office, arrive at the ICU with symptoms of nausea, vomiting, and diarrhea. It is determined that they are suffering from radiation exposure as a result of an inconspicuous device placed in the office that leaked radiation over a period of days. The nurse suspects that which
of the following was used in this terrorist attack? - ANSWER-Simple radiological device A patient arrives at the ICU with symptoms of radiation exposure. While in the ICU, he begins gasping for air and clutching his throat with his hand. What intervention should take priority at this point? - ANSWER-Perform CPR on the patient to restore normal respiratory function. A woman arrives at the ICU after being the victim of a terrorist attack in a nearby shopping center involving a gas that spewed from a metal canister. The woman complains of a burning sensation in her eyes, mouth, and throat, and the nurse observes blistering on her face and arms. What chemical agent should the nurse suspect, and what intervention should she implement? - ANSWER-Vesicant agent; soap and water blot A worker at a local chemical plant arrives at the ICU following an industrial accident involving a gas leak. The patient shows signs of pulmonary edema and bronchospasm. What chemical should the nurse suspect is involved, and what intervention would be most appropriate? - ANSWER-Chlorine; airway management and ventilatory support A man presents to the ICU with a severe case of H1N1 viral infection. What would be the most appropriate intervention for this patient? - ANSWER-Administer an antiviral agent. A young man arrives at the ICU after being held hostage while a passenger on a commercial airplane. He sustained a bullet wound in his chest and has undergone surgery to repair his lung. He is now receiving an analgesic for his pain. The nurse observes that the patient frequently complains that he is sick to his stomach and has no appetite. His sleep is regularly interrupted by nightmares, and he is prone to outbursts of anger and grief. What is the most likely cause of these symptoms? - ANSWER-Post-traumatic stress disorder The nurse is caring for a group of patients from the same workplace who have similar symptoms of cough, respiratory distress, and nausea and vomiting. What should the nurse suspect? - ANSWER-Mass exposure to an inhaled agent The nurse is part of a planning committee developing a disaster response plan for a hospital that serves as the major trauma center for the local area. The committee has identified that the most likely cause of a disaster in the community is a
center and some are vesicular. What biological exposure is most likely? - ANSWER-Cutaneous anthrax A patient and his family have been exposed to probable anthrax spores through contaminated postal contents within the past 8 hours. Upon arrival at the emergency department, all members of the family are anxious and say they are afraid of dying. The best nursing response is based on what rationale? - ANSWER- Antibiotic therapy is very effective for cutaneous anthrax. A male client asks the nurse about the purpose of the prostate gland. The nurse should respond that it is a structure that: - ANSWER-provides a milky alkaline substance that neutralizes the acidity of the male urethra and the female vagina. A 50-year-old male client has had a prostate-specific antigen test. The nurse realizes that the normal range for this test would be: - ANSWER-3.0 to 4 ng/mL. A male client, having difficulty voiding, tells the nurse that he thinks something is wrong with his penis. The nurse reviews the structures of the penis with the client and explains that the structure that surrounds the urethra is the: - ANSWER-corpus spongiosum. The nurse is preparing to discuss the male reproductive system with a group of adolescent school students. Which of the following would the nurse not include as a primary function of the male reproductive system? - ANSWER-Frequent erectile functioning and increased libido A male client is diagnosed as being infertile. The nurse realizes which of the following structures of the clients reproductive system is affected? - ANSWER- Seminiferous tubules The nurse, preparing to discuss the female reproductive system with a group of adolescent females, would include that which of the following is not a primary function of the female reproductive system? - ANSWER-Sensory innervation A young adult female client is concerned that she does not have enough eggs since she has not yet become pregnant. The nurse should assure her that the number of ova available to produce a pregnancy would be around: - ANSWER-300,000.
During a gynecological exam, it is noted that a clients os is in the shape of a slit. The nurse realizes that this shape means that the client has: - ANSWER-borne children. The nurse, reviewing the reproductive hormones needed to produce sperm and ova, realizes that which of the following hormones is not involved in the formation of sperm and ova? - ANSWER-Prolactin During the examination of the male testes, the nurse should instruct the client on: - ANSWER-monthly testicular self-examinations. A male client has a prostate specific antigen level of 22 nanograms. The nurse realizes that this client will most likely be scheduled for a(n): - ANSWER-bone scan A female clients Pap test revealed atypical results. The nurse realizes that this client will most likely be scheduled for a(n): - ANSWER-colposcopy. A female client has an infection of the paraurethral glands. When asked by the client what these glands do, the nurse should respond: - ANSWER-These glands function like the prostate gland in the male. These glands secrete mucus. These glands are located inside the urethra. The nurse is instructing a postmenopausal client in the importance of having serum lipid levels analyzed because after menopause, which of the following changes can occur? - ANSWER-Total cholesterol increases, low-density lipoprotein increases, triglycerides increase, high-density lipoprotein decreases The nurse is reviewing the physiological sexual response pattern within males and females and realizes that which of the following occur in both genders? - ANSWER-Resolution, orgasm, plateau, excitement A female client is concerned that she has not had sexual intercourse with her husband for over 2 months. Which of the following can the nurse respond as causes for an alteration in sexual functioning? - ANSWER-Chronic illnesses, physical disabilities, negative body image, medications, surgical procedures The nurse is concerned that a female client might be experiencing intimate partner violence. Which of the following assessment questions can be used to gain more information from the client? - ANSWER-In the last year have you been hit,
A female client tells the nurse that she is planning on having plastic surgery to correct a minor facial defect and then have her breasts done. The nurse would identify which of the following nursing diagnoses as being appropriate for this client? - ANSWER-Body dysmorphic disorder The nurse is determining if a female client is at risk for benign breast disease. Which of the following is a risk factor for this disorder? - ANSWER-Caffeine use A client is scheduled for a prophylactic mastectomy. The nurse should remind the client that skin flaps will be left after the surgery for: - ANSWER-reconstruction. When instructing a client on breast self-examination, the nurse reviews the importance of visual inspection of the breasts. Which of the following should the nurse instruct the client to focus on when doing this part of the examination? - ANSWER-Contour and symmetry of the breasts, Skin changes, Position of the nipples, Presence or absence of masses The nurse is preparing to assess a clients nipples during a breast examination. Which of the following are considered pathological conditions that affect the nipple? - ANSWER-Bleeding, discharge, fissures Which of the following should the nurse do if a female client is experiencing nipple discharge? - ANSWER-Note the color of the discharge. Determine if the discharge is from one or both breasts. Obtain a sample of the discharge with a sterile cotton-tipped swab. Assess the nipple drainage for occult blood. A client is experiencing galactorrhea. Which of the following should the nurse assess in this client? - ANSWER-Recent vigorous nipple stimulation. Prescribed hormones, blood pressure medications, or antidepressants. Intake of herbal remedies such as fennel or anise. Use of street drugs such as opiates and marijuana. Recent chest trauma. A client is considering breast augmentation surgery. Which of the following postoperative complications should the nurse discuss with the client regarding this surgery? - ANSWER-Change in sensation. Development of a hematoma. Fibrous tissue around the implant. A 23-year-old sexually active woman presents for her first Pap smear. Her history includes nulligravida, age at first intercourse 14, and more than 10 sexual partners.
Which of the following conditions should the clinician be particularly alert for during her examination? - ANSWER-Human papillomavirus A 20-year-old woman is seen in the clinic because her boyfriend was found to have gonorrhea. Which of the following is the treatment of choice for gonorrhea? - ANSWER-Ceftriaxone A 24-year-old woman presents to the clinic with dysuria, dyspareunia, and a mucopurulent vaginal discharge. Her boyfriend was recently treated for nongonococcal urethritis. What sexually transmitted disease has she most probably been exposed to? - ANSWER-Chlamydia A 45-year-old woman is seen in the clinic with complaints of a vaginal discharge. The clinician identifies clue cells on the vaginal smear. Which of the following diagnoses is associated with this finding? - ANSWER-Bacterial Vaginosis Which of the following medications is the treatment of choice for trichomonas? - ANSWER-Metronidazole A 58-year-old woman presents with a breast mass. Which of the following responses by the clinician would be most appropriate? - ANSWER-"We will order a mammogram and ultrasound to help establish a diagnosis." A 26-year-old woman is seen with complaints of irregular vaginal bleeding. Which of the following tests should be the first priority? - ANSWER-Pregnancy test A 42-year-old woman presents to the clinic with complaints of painful intercourse for the last month. Which of the following should be explored as the likely cause of her dyspareunia? - ANSWER-Menopause A 36-year-old woman is seen with complaints of vaginal itching, burning, and discharge. On potassium hydroxide (KOH) wet mount of vaginal discharge, the clinician notices hyphae. Which of the following treatments would be appropriate?
- ANSWER-Fluconazole A 21-year-old woman is seen in the clinic requesting birth control pills. Which of the following tests is essential before prescribing any oral contraceptive? - ANSWER-Pregnancy test
