Steven, an athletic 20-year-old college student, suffered a fractured shoulder and sprained wrist in a fall at a ski resort.
1. In developing Steven's care plan following surgery, which of the following typical problems would you anticipate?
A. He will undergo an alteration in self-concept.
B. He will experience anxiety as a result of flashbacks about the skiing accident.
C. He will have impaired mobility caused by immobilization of upper extremity.
D. There will be abnormal tissue perfusion caused by swelling.
Jean Thomas is a 25-year-old secretary admitted to the emergency room with diaphoresis, hyperventilation, palpitations, and trembling. Jean tells the nurse that she has been "very upset and nervous" over a poor employment evaluation. A tentative diagnosis of acute anxiety episode is made.
2. Which of the following acid-base imbalances would likely occur as a result of Jean's hyperventilation?
A. Respiratory acidosis
B. Respiratory alkalosis
C. Metabolic acidosis
D. Metabolic alkalosis
Mrs. Durham is recovering from a colon resection for removal of a malignant mass in the large bowel. Following breakfast one morning, she told the nurse, "I'm tired of waiting, I want my bath now. You're never here when I need you."
3. Which of the following responses by the nurse is most appropriate?
A. What do you mean, I'm never here? I spent all three hours with you yesterday, Mrs. Durham.
B. I'm sorry you've been waiting Mrs. Durham. Let's get you comfortable now and I'll be back in twenty minutes to give you a bath.
C. I'm doing my best, Mrs. Durham. You know I have three other patients to take care of today, besides you.
D. I must see Mrs. Jones right now, Mrs. Durham. She's really sick today. I'll be back as soon as I can.
Brian, aged 4 years, is sitting in the pediatric day room with Michael, another patient. He suddenly realizes that he has wet his pants and runs to the nurse, crying.
4.The most appropriate initial response by the nurse is:
A. Why, Brian, what happened? Why did you wet your pants?
B. You know better than this, Brian; next time you'll get a good spanking.
C. Let's take off those wet pants, Brian, and put on something dry so you'll be more comfortable.
D. Wait until I tell Michael what you did. Aren't you ashamed of yourself?
Margaret O'Hara, a 30-year-old known diabetic, is brought to the emergency department by ambulance. The paramedic team reports symptoms of apparent hyperglycemia. Stat blood glucose is 640.
5. The nurse is aware that excess serum glucose acts to draw fluids osmotically with resultant polyuria. In addition to increased urinary output, the nurse should expect to observe which of the following sets of symptoms in Margaret?
A. Polydipsia, diaphoresis, bradycardia
B. Thirst, dry mucous membranes, hot dry skin
C. Hypotension, bounding pulse, headache
D. Nervousness, rapid respirations, diarrhea
Molly Flannery is a 67-year-old female with chronic congestive heart failure and hypertension. She is being evaluated for complaints of muscular weakness and general fatigue.
6. Molly's serum electrolyte studies reveal a K+ level of 2.9. Which of the following medications taken by the patient at home contributed most to her hypokalemic state?
A. Digoxin, .125 mg, PO, daily
B. Lasix, 80 mg, PO, daily
C. Aldomet, 250 mg, PO, tid
D. Aspirin, 10 grains, bid
Mr. Robert Bacchus is a 63-year-old retired business executive who comes to the emergency room with complaints of dyspnea, shortness of breath, and chest pain radiating to the left arm.
7. The nurse caring for Mr. Bacchus should implement which of the following actions FIRST?
A. Administer prescribed pain medication
B.. Apply oxygen per nasal cannula as ordered
C. Assess vital signs
D. Apply electrocardiogram electrodes to the patient's chest
Loberta Jackson, a 21-year-old college student, is admitted to a medical unit with diagnosis of uncontrolled diabetes, acute hypoglycemic reaction.
8. Loberta explains to the admitting nurse that she had been feeling "sick to my stomach, like I was coming down with the flu" for the past 48 hours. She has continued to take her usual daily dosage of insulin. Noting that Loberta has been admitted with a blood-glucose value of 46, which of the following assessment questions would provide the most valuable information about Loberta's status?
A.. "Have you been under a great deal of stress lately, Loberta?"
B. "Were you having difficulty sleeping after this illness started?"
C. "Have you eaten anything in the past 48 hours?"
D. "Did you take any medications for this illness other than your insulin?"
Jerry is a 32-year-old white male. He has been married for 10 months, and he and his wife, Sue, are expecting their first child in 6 months. Prior to marrying Sue, Jerry was sexually active and nonmonogamous. He has been sexually active since the age of 18. Recently Jerry has complained of persistent dry cough, night sweats, and a temperature over 100?F. Although
Jerry is concerned about his weight and watches his diet, he has lost 15 pounds without even trying. Upon assessing Jerry, he admits to having had sexual intercourse with prostitutes, both male and female, during the last 10 years.
9. Jerry's symptoms of elevated temperature, chills, and dry cough are probably related to which undiagnosed condition?
A. Alteration in tissue perfusion
B. An infection, etiology unknown
C. Indigestion from too frequent traveling
D. Lack of knowledge related to frequent travel
Mrs. Brown's husband was admitted to the emergency room in delirium tremens (DTs). This admission is his third visit in 2 weeks. While waiting to see her husband, Mrs. Brown said to the nurse, "What in the world can I do to help Joe get over this drinking problem?"
10. The best initial response for the nurse is:
A. Don't feel guilty, Mrs. Brown; I know this must be difficult for you.
B. Let's go into the lounge so we can talk more about your concern, Mrs. Brown.
C. You need to convince Joe to seek professional help, Mrs. Brown.
D. How long has your husband been drinking, Mrs. Brown?
Amy Stevens is a 17-year-old student admitted for evaluation of lower abdominal pain. She tells the nurse, "I wish my friends would come to visit me. I don't like being here alone."
11. Which of the following would be the most appropriate response of the nurse?
A. "You sound very lonely. Shall I stay with your for awhile?"
B. "I'm sure your friends will come to see you soon."
C. "It's a little too early for visiting hours. You'll have to wait until this afternoon."
D. "It's hard to be alone. Would you like me to stay with you?"
Patty Daniels is a 25-year-old white female, pregnant with her first child. She is being seen in the obstetrical clinic for her first prenatal visit.
12. Patty tells the nurse, "I drank a glass of wine at a party before I found out that I was pregnant. I'm worried that I might have hurt the baby." Based on an understanding of alcohol use in pregnancy, which of the following responses is the most appropriate?
A. "We don't really know how much alcohol is too much during pregnancy. Don't drink anymore and try not to worry about it."
B. "As long as your drinking is moderate, I wouldn't worry about it. There were plenty of healthy babies born to drinking mothers before they ever discovered fetal alcohol syndrome."
C. "An occasional drink shouldn't hurt the baby. Research has shown that the risk to the fetus increases as the amount and frequency of alcohol consumption increases."
D. "I can understand why you're so upset, but an occasional drink shouldn't hurt the baby."
Kelly Jones, aged 3 years, is brought to the emergency room by her mother following an accidental ingestion of acetaminophen. When questioned, Mrs. Jones states that she believes that Kelly ingested approximately 20 tablets. She further states that she believes that the ingestion occurred within the last hour.
13. Immediately upon arrival in the emergency room the nurse should:
A. Assess vital signs
B. Administer O2
C. Start IV fluids
D. Perform an arterial puncture for blood gases
CLICK HERE For the correct answers and rationales
