Download RNSG 2539 EXAM 2 2023-2024 | 200+ EXAM QUESTIONS AND ANSWERS | LATEST UPDATE and more Exams Nursing in PDF only on Docsity!
RNSG 2539 EXAM 2 2023 - 2024 |
200+ EXAM QUESTIONS AND
ANSWERS | LATEST UPDATE |
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A 37 - year-old man presents to the ED complaining of N/V and severe abdominal pain. The patient's abdomen is rigid and there is bruising to the patient's flank. The patient's wife states that he was on a drinking binge for the past 2 days. The ED nurse should assist in assessing the patient for what health problem? A) Severe pancreatitis with possible peritonitis B) Acute cholecystitis C) Chronic pancreatitis D) Acute appendicitis with possible perforation -----CORRECT ANSWER-----------A) Severe pancreatitis with possible peritonitis A patient with chronic pancreatitis had a pancreatojejunostomy created 3 months ago for relief of pain and to restore drainage of pancreatic secretions. The patient has come to the office for a routine appointment. The patient is frustrated that the pain has not decreased. What is the most appropriate initial response by the nurse? A)The majority of patients who have a pancreaticojejunostomy have their normal digestion restored but do not achieve pain relief." B) "Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain." C) "Your physician will likely want to discuss the removal of your gallbladder to achieve pain relief." D) "You are probably not appropriately taking the medications for your pancreatitis and pain, so we will need to discuss your medication regimen in detail." -----CORRECT ANSWER-----------B) "Pain relief occurs by 6 months in most patients who undergo this procedure, but some people experience a recurrence of their pain." A home health nurse is caring for a patient discharged home after pancreatic surgery. The nurse documents the nursing diagnosis Risk for Imbalanced Nutrition: Less than
Body Requirements on the care plan based on the potential complications that may occur after surgery. What are the most likely complications for the patient who has had pancreatic surgery? A) Proteinuria and hyperkalemia B) Hemorrhage and hypercalcemia C) Weight loss and hypoglycemia D) Malabsorption and hyperglycemia -----CORRECT ANSWER-----------D) Malabsorption and hyperglycemia A patient has been treated in the hospital for an episode of acute pancreatitis. The patient has acknowledged the role that his alcohol use played in the development of his health problem but has not expressed specific plans for lifestyle changes after discharge. What is the nurse's most appropriate response? A) Educate the patient about the link between alcohol use and pancreatitis. B) Ensure that the patient knows the importance of attending follow-up appointments. C) Refer the patient to social work or spiritual care. D) Encourage the patient to connect with a community-based support group ----- CORRECT ANSWER-----------D) Encourage the patient to connect with a community- based support group A patient is being treated on the acute medical unit for acute pancreatitis. The nurse has identified a diagnosis of Ineffective Breathing Pattern Related to Pain. What intervention should the nurse perform in order to best address this diagnosis? A) Position the patient supine to facilitate diaphragm movement. B) Administer corticosteroids by nebulizer as ordered. C) Perform oral suctioning as needed to remove secretions. D) Maintain the patient in a semi-Fowler's position whenever possible. -----CORRECT ANSWER-----------D) Maintain the patient in a semi-Fowler's position whenever possible. A nurse is creating a care plan for a patient with acute pancreatitis. The care plan includes reduced activity. What rationale for this intervention should be cited in the care plan? A) Bed rest reduces the patient's metabolism and reduces the risk of metabolic acidosis. B) Reduced activity protects the physical integrity of pancreatic cells. C) Bed rest lowers the metabolic rate and reduces enzyme production.
B) ERCP
C) Pancreatic biopsy D) Abdominal ultrasonography -----CORRECT ANSWER-----------A) Glucose tolerance test A patient has been admitted to the hospital for the treatment of chronic pancreatitis. The patient has been stabilized and the nurse is now planning health promotion and educational interventions. Which of the following should the nurse prioritize? A) Educating the patient about expectations and care following surgery B) Educating the patient about the management of blood glucose after discharge C) Educating the patient about post-discharge lifestyle modifications D) Educating the patient about the potential benefits of pancreatic transplantation ----- CORRECT ANSWER-----------C) Educating the patient about post-discharge lifestyle modifications The family of a patient in the ICU diagnosed with acute pancreatitis asks the nurse why the patient has been moved to an air bed. What would be the nurse's best response? A) "Air beds allow the care team to reposition her more easily while she's on bed rest." B) "Air beds are far more comfortable than regular beds and she'll likely have to be on bed rest a long time." C) "The bed automatically moves, so she's less likely to develop pressure sores while she's in bed." D) "The bed automatically moves, so she is likely to have less pain." -----CORRECT ANSWER-----------C) "The bed automatically moves, so she's less likely to develop pressure sores while she's in bed." A patient is receiving care in the intensive care unit for acute pancreatitis. The nurse is aware that pancreatic necrosis is a major cause of morbidity and mortality in patients with acute pancreatitis. Consequently, the nurse should assess for what signs or symptoms of this complication? A) Sudden increase in random blood glucose readings B) Increased abdominal girth accompanied by decreased level of consciousness C) Fever, increased heart rate and decreased blood pressure D) Abdominal pain unresponsive to analgesics -----CORRECT ANSWER-----------C) Fever, increased heart rate and decreased blood pressure
A patient has been diagnosed with acute pancreatitis. The nurse is addressing the diagnosis of Acute Pain Related to Pancreatitis. What pharmacologic intervention is most likely to be ordered for this patient? A) Oral oxycodone B) IV hydromorphone (Dilaudid) C) IM meperidine (Demerol) D) Oral naproxen (Aleve) -----CORRECT ANSWER-----------B) IV hydromorphone (Dilaudid) A patient has just been diagnosed with chronic pancreatitis. The patient is underweight and in severe pain and diagnostic testing indicates that over 80% of the patient's pancreas has been destroyed. The patient asks the nurse why the diagnosis was not made earlier in the disease process. What would be the nurse's best response? A) "The symptoms of pancreatitis mimic those of much less serious illnesses." B) "Your body doesn't require pancreatic function until it is under great stress, so it is easy to go unnoticed." C) "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost." D) "It's likely that your other organs were compensating for your decreased pancreatic function." -----CORRECT ANSWER-----------C) "Chronic pancreatitis often goes undetected until a large majority of pancreatic function is lost." A patient is admitted to the ICU with acute pancreatitis. The patient's family asks what causes acute pancreatitis. The critical care nurse knows that a majority of patients with acute pancreatitis have what? A) Type 1 diabetes B) An impaired immune system C) Undiagnosed chronic pancreatitis D) An amylase deficiency -----CORRECT ANSWER-----------C) Undiagnosed chronic pancreatitis The nurse is providing care to a child with pancreatitis. When reviewing the child's laboratory test results, which of the following would the nurse expect to find? Select all answers that apply. A) Leukocytosis
The nurse is caring for a postpartum patient admitted to the intensive care unit with a diagnosis of disseminated intravascular coagulation (DIC). What is the drug of choice to treat this problem? A. Heparin B. Urokinase C. Aspirin D. Warfarin -----CORRECT ANSWER-----------A.) Heparin In the ICU, a postsurgical client has developed sepsis and is being treated with multiple medications. During the mid-morning assessment, which finding leads the nurse to suspect the client may be developing a complication called disseminated intravascular coagulation (DIC)? Select all that apply. A) Headaches associated with light sensitivity B) Oozing from all previous puncture and intravenous sites C) Decreased O2 saturation and diminished breath sounds in lower lobes D) Hemorrhage from the surgical site requiring deep pressure dressings E) Urine from the Foley catheter is bloody -----CORRECT ANSWER-----------D) Hemorrhage from the surgical site requiring deep pressure dressings A healthy, primiparous (first-time) mother delivered a healthy infant several hours ago, but the mother has experienced postpartum hemorrhage. Which of the following disorders is most likely to underlie the client's excessive bleeding after delivery? A) Disseminated intravascular coagulation B) Hemophilia A C) Von Willebrand disease D) Thrombotic thrombocytopenic purpura (TTP) -----CORRECT ANSWER-----------A) Disseminated intravascular coagulation What is the concept behind heparin for PT with DIC? -----CORRECT ANSWER------------ It prevents the clotting phase from being completed which inhibits the breakdown of fibrinogen.
- It also helps avoid hemorrhage by preventing the body from depleting entire stage of coagulation factors.
What are some acute clinical manifestations of DIC? -----CORRECT ANSWER------------ Directly related to bleeding problems such as: Petechia, Purpura, oozing from puncture sites or severe hemorrhaging. How does DIC happen in postpartum hemorrhaging? -----CORRECT ANSWER------------ Tissue factors released from necrotic place/fetal tissue or amniotic fluid my enter the circulation, inciting DIC. What is a common cause of DIC? -----CORRECT ANSWER------------Sepsis A patient with DIC is at a higher risk for what? -----CORRECT ANSWER------------ Deficient fluid volume Increased levels of ____________, _______________, __________, and ________________ will be noted in DIC: -----CORRECT ANSWER------------Fibrinolycin, fibrinopeptide A, positive fibrin split products and D-dimers. DIC can occur secondary to what type of conditions? Select all that apply: ----- CORRECT ANSWER------------Abrupitoplacente
- Amniotic fluid embolism
- Endotoxin sepsis
- Retained dead fetus
- Post hemorrhage shock
- Hydatidformmole
- Gynecologic Malinganries DIC can be decreased as a loss of balance between what two activities? -----CORRECT ANSWER------------Clot forming activity of thrombin
- Clot lysin activity of plasmin What are some ways to combat DIC? Select all that apply: -----CORRECT ANSWER---- --------Anticoagulation therapy (low-molecular weight heparin)
How do you correct the clotting factor deficiency in DIC? -----CORRECT ANSWER------- -----Transition of FFP
- " " platelets
- " " fibrinogen containing cryoprecipitate How does DIC initiate activation of the extrinsic pathway? -----CORRECT ANSWER------ ------Occurs with liberation of tissue factor and associated with obstetric complications, trauma, bacterial sepsis & cancer How does DIC initiate activation of the intrinsic pathway? -----CORRECT ANSWER------ ------Activated through extensive endothelial damage with activation of factor XII. This results from viruses, infections, immune mechanisms, stasis of blood or temperature extremes. What are some potential therapies to DIC other than Heparin? -----CORRECT ANSWER------------Tissue factor pathway inhibitors, antithrombin, Protein C concentrates, & anti-inflammatory cytokines like INL-I What are some obstetric conditions that have been associated with DIC? ----- CORRECT ANSWER------------Abrupito placentratae
- Dead fetus syndrome
- Pre-eclampsia & eclampsia
- Amniotic fluid embolism What are some Cancers that have been associated with DIC? -----CORRECT ANSWER------------Metastatic cancer
- Acute leukemia What are some infections associations with DIC? -----CORRECT ANSWER------------ Acute bacterial infections (meningococal meningitis)
- Histoplasmosis, Aspergicrosis
- Ricketsial Infections (rocky mountain spotted fever)
- Parasitic infections (malaria)
- Sepsis/ Septic shock
What are some trauma signs that have been associated with DIC? -----CORRECT ANSWER------------Burns
- Heatstroke
- Massive traumas
- Snake bite
- Surgery including extracorpeal circulation? What are some hematologic conditions associated with DIC? -----CORRECT ANSWER- -----------Blood Transfusions Reactions What clinical manifestations of DIC are primarily involved? -----CORRECT ANSWER----- -------Compromise of organ function or failure
- PT typically develop mods How is bleeding characterized in DIC? -----CORRECT ANSWER------------Decreased Platelet count
- Decreased fibrinogen levels
- Prolonged PT, ApT (thrombiotic)
- Increased Fibrinogen Degradation
- Increased D-dimers PT with Frank DIC typically bleed from where? -----CORRECT ANSWER------------ Mucous Membranes
- Venipuncture Sites
- GI Urinary Tracts What is the only manifestation of DIC during its initial process? -----CORRECT ANSWER------------Decrease in platelet count What other test for DIC can be pre-determined at bedside, can better assess platelet function? -----CORRECT ANSWER------------Thrombelastography
What are 3 main causes of DIC? -----CORRECT ANSWER------------Burns
- Sepsis
- Abrupito placentae What is risk factor associated with DIC? -----CORRECT ANSWER------------Sepsis
- Cardiac Arrest
- ARDs
- DKA
- PE
- Sickle Cell Anemia
- Liver failure What are some complications associated with DIC? -----CORRECT ANSWER------------ Cardiac tamponade
- Hemothorax
- Stroke
- MODs The increase with DiC is unknown but it occurs in 1%-2% of PT with 3. -----CORRECT ANSWER----------- 1 - 30%, 2-50%, 3-Sepsis What are some pysical finding for DIC? -----CORRECT ANSWER------------Hematoria
- Purpura, Jaundice
- Taghycardia
- Hemoptysic (coughing up blood)
- XXXXXX (low urine output)
- Dyspnea or tachypnea
- Pleural friction rub
- Confusion What results are indicative of DIC? -----CORRECT ANSWER------------Platelet count less than 150,000/mL
- Prothrombintine is more than 19 seconds
- partial thromboplastin time is greater than 40 sec
- D-dimer is positive at < 1:8 dilution
- BUN is elevated to more than 25 mg/dL What meds would be given for DIC? -----CORRECT ANSWER------------Anticoagulations such as unfractionated heparin or Lmw heparins sodium
- Broad spectrum antibiotics for Gram-neg sepsis
- O2 administration What is the PT teaching for DIC? -----CORRECT ANSWER------------Include their family Discharge planning for DIC? -----CORRECT ANSWER------------Multidisciplinary team
- Primary discharge nurse
- Care manager
- Hematologist
- PCP
- Assess PT level of independence before admission
- Document discharge planning evaluation in PT clinical record
- Include who was present and involved in discharge planning An intensive care nurse is aware of the need to identify patients who may be at risk of developing disseminated intravascular coagulation (DIC). Which of the following ICU patients most likely faces the highest risk of DIC? A) A patient with extensive burns B) A patient who has a diagnosis of acute respiratory distress syndrome C) A patient who suffered multiple trauma in a workplace accident D) A patient who is being treated for septic shock - ----CORRECT ANSWER-----------D) A patient who is being treated for septic shock A patient is being treated for DIC and the nurse has prioritized the nursing diagnosis of Risk for Deficient Fluid Volume Related to Bleeding. How can the nurse best determine if goals of care relating to this diagnosis are being met? A) Assess for edema. B) Assess skin integrity frequently. C) Assess the patient's level of consciousness frequently.
A) 'Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body.' B) 'A platelet transfusion often blunts your body's own production of platelets even further.' C) 'Finding a matching donor for a platelet transfusion is exceedingly difficult.' D) 'A very small percentage of the platelets in a transfusion are actually functional.' ----- CORRECT ANSWER-----------A) 'Transfused platelets usually aren't beneficial because they're rapidly destroyed in the body.' In immune thrombocytopenia purpura (ITP), the client has what type of disorder that primarily destroys which blood component? A) Allergic; fibrinogen B) Alloimmune; factor VIII C) Autoimmune; platelets D) Immunoglobulin; B cells -----CORRECT ANSWER-----------C) Autoimmune; platelets A client has been admitted for immune thrombocytopenic purpura. The client has not responded to corticosteroid treatment. The priority nursing intervention for this client would include which of the following treatment measures? A) Place the client in isolation, so the skin rashes will not spread to other clients. B) Insert an intravenous catheter, so immune globulin can be administered in a timely manner. C) Insert a Foley catheter to monitor hourly urine output. D) Prepare a surgical permit for an emergency splenectomy. -----CORRECT ANSWER-- ---------B) Insert an intravenous catheter, so immune globulin can be administered in a timely manner. A nurse is admitting a patient with immune thrombocytopenic purpura to the unit. In completing the admission assessment, the nurse must be alert for what medications that potentially alter platelet function? Select all that apply. A) Antihypertensives B) Penicillins C) Sulfa-containing medications D) Aspirin-based drugs E) NSAIDs -----CORRECT ANSWER-----------C) Sulfa-containing medications D) Aspirin-based drugs E) NSAIDs
A client was started on a protocol for the prevention of deep vein thrombosis shortly after admission and has been receiving 5000 units of heparin twice daily for the last week. An immune response to this treatment may increase the client's chance of developing which health problem? A) Antiphospholipid syndrome B) Disseminated intravascular coagulation (DIC) C) Von Willebrand disease D) Thrombocytopenia -----CORRECT ANSWER-----------D) Thrombocytopenia When the nurse administers heparin it is anticipated the drug will have what action on the patient's body? A) Binds to factor X B) Blocks the formation of thrombin C) Binds to factor Xa D) Promotes the inactivation of factor VIII -----CORRECT ANSWER-----------B) Blocks the formation of thrombin The nurse is reviewing the laboratory test results of a pregnant client. Which one of the following findings would alert the nurse to the development of HELLP syndrome? A) Hyperglycemia B) Elevated platelet count C) Leukocytosis D) Elevated liver enzymes -----CORRECT ANSWER-----------D) Elevated liver enzymes A woman is receiving magnesium sulfate as part of her treatment for severe preeclampsia. The nurse is monitoring the woman's serum magnesium levels. Which level would the nurse identify as therapeutic? A) 3.3 mEq/L B) 6.1 mEq/L C) 8.4 mEq/L D) 10.8 mEq/L -----CORRECT ANSWER-----------B) 6.1 mEq/L
D) "I drink a glass of wine about once a week." -----CORRECT ANSWER-----------B) "I take aspirin for my arthritis." A young man has been diagnosed with hemophilia and the nurse is planning his discharge teaching and includes what teaching point? A) Using nonsteroidal anti-inflammatory drugs (NSAIDs) for mild pain B) Preventing trauma to the body C) Receiving IV factor VIII therapy at home D) Understanding the condition is an X-linked recessive disorder -----CORRECT ANSWER-----------B) Preventing trauma to the body A 55-year-old man has been newly diagnosed with acute pancreatitis and admitted to the acute medical unit. How should the nurse most likely explain the pathophysiology of this patient's health problem? A) Toxins have accumulated and inflamed your pancreas B) Bacteria likely migrated from your intestines and became lodged in your pancreas C) A virus that was likely already present in your body has begun to attack your pancreatic cells D) The enzymes that your pancreas produces have damaged the pancreas itself ----- CORRECT ANSWER-----------D) The enzymes that your pancreas produces have damaged the pancreas itself A patient's assessment and diagnostic testing are suggestive of acute pancreatitis. When the nurse is performing the health interview, what assessment questions address likely etiologic factors? Select all that apply. A) How many alcoholic drinks do you typically consume in a week? B) Have you ever been tested for diabetes? C) Have you ever been diagnosed with gall stones? D) Would you say you eat a particularly high fat diet? E) Does anyone in your family have cystic fibrosis? -----CORRECT ANSWER-----------A) How many alcoholic drinks do you typically consume in a week? C) Have you ever been diagnosed with gall stones?
A nurse who provides care at a walk-in clinic assesses a wide range of individuals. The nurse should identify which of the following patients as having the highest risk for chronic pancreatitis? A) A 45-year-old obese woman with a high fat diet B) An 18-year-old man who is a weekend binge drinker C) A 39-year old man with chronic alcoholism D) A 51-year old-woman who smokes one- and one-half packs of cigarettes per day ----- CORRECT ANSWER-----------C) A 39-year old man with chronic alcoholism A nurse educator is teaching a group of recent nursing graduates about their occupational risks for contracting hepatitis B. What preventative measures should the educator promote? Select all that apply. A) Immunization B) Use of standard precautions C) Consumption of a vitamin-rich diet D) Annual vitamin K injections E) Annual vitamin B12 injections -----CORRECT ANSWER-----------A) Immunization B) Use of standard precautions A patient with a history of injection drug use has been diagnosed with hepatitis C. When collaborating with the care team to plan this patient's treatment, the nurse should anticipate what intervention? A) Administration of immune globulins B) A regimen of antiviral medications C) Rest and watchful waiting D) Administration of fresh-frozen plasma (FFP) -----CORRECT ANSWER-----------B) A regimen of antiviral medications When explaining acute pancreatitis to a newly diagnosed client, the nurse will emphasize the pathogenesis begins with an inflammatory process whereby: A) Activated pancreatic enzymes escape into surrounding tissues, causing autodigestion of pancreatic tissue. B) The pancreas is irreversibly damaged and will not recover to normal functioning (chronic). C) The pancreas will hypertrophy (enlarge) to the point of causing bowel obstruction.
