Medical Knowledge Part 3

Medical Knowledge Part 3

36. The nurse is caring for a client hospitalized with a facial stroke. Which diet selection would be suited to the client?

A. Roast beef sandwich, potato chips, pickle spear, iced tea

B. Split pea soup, mashed potatoes, pudding, milk✔️

C. Tomato soup, cheese toast, Jello, coffee

D. Hamburger, baked beans, fruit cup, iced tea

Explanation: The client with a facial stroke will have difficulty swallowing and chewing, and the foods in answer B provide the least amount of chewing. The foods in answers A, C, and D would require more chewing and, thus, are incorrect.

37. The physician has prescribed Novalog insulin for a client with diabetes mellitus. Which statement indicates that the client knows when the peak action of the insulin occurs?

A. “I will make sure I eat breakfast within 10 minutes of taking my insulin.”✔️

B. “I will need to carry candy or some form of sugar with me all the time.”

C. “I will eat a snack around three o’clock each afternoon.”

D. “I can save my dessert from supper for a bedtime snack.”

Explanation: Novalog insulin onsets very quickly, so food should be available within 10–15 minutes of taking the insulin. Answer B does not address a particular type of insulin, so it is incorrect. NPH insulin peaks in 8–12 hours, so a snack should be eaten at the expected peak time. It may not be 3 p.m. as stated in answer C. Answer D is incorrect because there is no need to save the dessert until bedtime.

38. The nurse is teaching basic infant care to a group of first-time parents. The nurse should explain that a sponge bath is recommended for the first two weeks of life because:

A. New parents need time to learn how to hold the baby.

B. The umbilical cord needs time to separate.✔️

C. Newborn skin is easily traumatized by washing.

D. The chance of chilling the baby outweighs the benefits of bathing.

Explanation: The umbilical cord needs time to dry and fall off before putting the infant in the tub. Although answers A, C, and D might be important, they are not the primary answer to the question.

39. A client with leukemia is receiving Trimetrexate. After reviewing the client’s chart, the physician orders Wellcovorin (leucovorin calcium). The rationale for administering leucovorin calcium to a client receiving Trimetrexate is to:

A. Treat iron-deficiency anemia caused by chemotherapeutic agents

B. Create a synergistic effect that shortens treatment time

C. Increase the number of circulating neutrophils

D. Reverse drug toxicity and prevent tissue damage✔️

Explanation: antagonists. Leucovorin is a folic acid derivative. Answers A, B, and C are incorrect because Leucovorin does not treat iron deficiency, increase neutrophils, or have a synergistic effect.

40. A four-month-old is brought to the well-baby clinic for immunization. In addition to the DPT and polio vaccines, the baby should receive:

A. Hib titer✔️

B. Mumps vaccine

C. Hepatitis B vaccine

D. MMR

Explanation: The Hemophilus influenza vaccine is given at four months with the polio vaccine. Answers B, C, and D are incorrect because these vaccines are given later in life.

41. The physician has prescribed Nexium (esomeprazole) for a client with erosive gastritis. The nurse should administer the medication:

A. ✔️30 minutes before a meal

B. With each meal

C. In a single dose at bedtime

D. 30 minutes after meals

Explanation: Proton pump inhibitors should be taken prior to the meal. Answers B, C, and D are incorrect times for giving proton pump inhibitors like Nexium.

42. A client on the psychiatric unit is in an uncontrolled rage and is threatening other clients and staff. What is the most appropriate action for the nurse to take?

A. Call security for assistance and prepare to sedate the client.✔️

B. Tell the client to calm down and ask him if he would like to play cards.

C. Tell the client that if he continues his behavior he will be punished.

D. Leave the client alone until he calms down.

Explanation: If the client is a threat to the staff and to other clients the nurse should call for help and prepare to administer a medication such as Haldol to sedate him. Answer B is incorrect because simply telling the client to calm down will not work. Answer C is incorrect because telling the client that if he continues he will be punished is a threat and may further anger him. Answer D is incorrect because if the

client is left alone, he might harm himself.

43. When the nurse checks the fundus of a client on the first postpartum day, she notes that the fundus is firm, is at the level of the umbilicus, and is displaced to the right. The next action the nurse should take is to:

A. Check the client for bladder distention.✔️

B. Assess the blood pressure for hypotension.

C. Determine whether an oxytocic drug was given.

D. Check for the expulsion of small clots.

Explanation: If the fundus of the client is displaced to the side, this might indicate a full bladder. The next action by the nurse should be to check for bladder distention and catheterize, if necessary. The answers in B, C, and D are actions that relate to postpartal hemorrhage

44. A client is admitted to the hospital with a temperature of 99.8°F, complaints of blood-tinged hemoptysis, fatigue, and night sweats. The client’s symptoms are consistent with a diagnosis of:

A. Pneumonia

B. Reaction to antiviral medication

C. Tuberculosis✔️

D. Superinfection due to low CD4 count

Explanation: A low-grade temperature, blood-tinged sputum, fatigue, and night sweats are symptoms consistent with tuberculosis. If the answer in A had said pneumocystis pneumonia, answer A would have been consistent with the symptoms given in the stem, but just saying pneumonia isn’t specific enough to diagnose the problem. Answers B and D are not directly related to the stem.

45. The client is seen in the clinic for treatment of migraine headaches. The drug Imitrex (sumatriptan succinate) is prescribed for the client. Which of the following in the client’s history should be reported to the doctor?

A. Diabetes

B. Prinzmetal’s angina✔️

C. Cancer

D. Cluster headaches

Explanation: If the client has a history of Prinzmetal’s angina, he should not be prescribed triptan preparations because they cause vasoconstriction and coronary spasms. There is no contraindication for taking triptan drugs in clients with diabetes, cancer, or cluster headaches, making answers A, C, and D incorrect.

46. The client with suspected meningitis is admitted to the unit. The doctor is performing an assessment to determine meningeal irritation and spinal nerve root inflammation. A positive Kernig’s sign is charted if the nurse notes:

A. Pain on flexion of the hip and knee✔️

B. Nuchal rigidity on flexion of the neck

C. Pain when the head is turned to the left side

D. Dizziness when changing positions

Explanation: Kernig’s sign is positive if pain occurs on flexion of the hip and knee. The Brudzinski reflex is positive if pain occurs on flexion of the head and neck onto the chest so answer B is incorrect. Answers C and D might be present but are not related to Kernig’s sign.

47. The client with Alzheimer’s disease is being assisted with activities of daily living when the nurse notes that the client uses her toothbrush to brush her hair. The nurse is aware that the client is exhibiting:

A. Agnosia

B. Apraxia✔️

C. Anomia

D. Aphasia

Explanation: Apraxia is the inability to use objects appropriately. Agnosia is loss of sensory comprehension, anomia is the inability to find words, and aphasia is the inability to speak or understand, so answers A, C, and D are incorrect.

48. The client with dementia is experiencing confusion late in the afternoon and before bedtime. The nurse is aware that the client is experiencing what is known as:

A. Chronic fatigue syndrome

B. Normal aging

C. Sundowning✔️

D. Delusions

Explanation: Increased confusion at night is known as “sundowning” syndrome. This increased confusion occurs when the sun begins to set and continues during the night. Answer A is incorrect because fatigue is not necessarily present. Increased confusion at night is not part of normal aging; therefore, answer B is incorrect. A delusion is a firm, fixed belief; therefore, answer D is incorrect.

49. The client with confusion says to the nurse, “I haven’t had anything to eat all day long. When are they going to bring breakfast?” The nurse saw the client in the day room eating breakfast with other clients 30 minutes before this conversation. Which response would be best for the nurse to make?

A. “You know you had breakfast 30 minutes ago.”

B. “I am so sorry that they didn’t get you breakfast. I’ll report it to the charge nurse.”

C. “I’ll get you some juice and toast. Would you like something else?”✔️

D. “You will have to wait a while; lunch will be here in a little while.”

Explanation: The client who is confused might forget that he ate earlier. Don’t argue with the client. Simply get him something to eat that will satisfy him until lunch. Answers A and D are incorrect because the nurse is dismissing the client. Answer B is validating the delusion.

50. The doctor has prescribed Exelon (rivastigmine) for the client with Alzheimer’s disease. Which side effect is most often associated with this drug?

A. Urinary incontinence

B. Headaches

C. Confusion

D. Nausea✔️

Explanation: Nausea and gastrointestinal upset are very common in clients taking acetylcholinesterase inhibitors such as Exelon. Other side effects include liver toxicity, dizziness, unsteadiness, and clumsiness. The client might already be experiencing urinary incontinence or headaches, but they are not necessarily associated; and the client with Alzheimer’s disease is already confused. Therefore, answers A, B, and C

are incorrect.

51. A client is admitted to the labor and delivery unit in active labor. During examination, the nurse notes a papular lesion on the perineum. Which initial action is most appropriate?

A. Document the finding.

B. Report the finding to the doctor.✔️

C. Prepare the client for a C-section.

D. Continue primary care as prescribed.

Explanation: Any lesion should be reported to the doctor. This can indicate a herpes lesion. Clients with open lesions related to herpes are delivered by Cesarean section because there is a possibility of transmission of the infection to the fetus with direct contact to lesions. It is not enough to document the finding, so answer A is incorrect. The physician must make the decision to perform a C-section, making answer C incorrect. It is not enough to continue primary care, so answer D is incorrect.

52. A client with a diagnosis of HPV is at risk for which of the following?

A. Hodgkin’s lymphoma

B. Cervical cancer ✔️

C. Multiple myeloma

D. Ovarian cancer

Explanation: The client with HPV is at higher risk for cervical and vaginal cancer related to this STI. She is not at higher risk for the other cancers mentioned in answers A, C, and D, so those are incorrect.

53. During the initial interview, the client reports that she has a lesion on the perineum. Further investigation reveals a small blister on the vulva that is painful to touch. The nurse is aware that the most likely source of the lesion is:

A. Syphilis

B. Herpes✔️

C. Gonorrhea

D. Condylomata

Explanation: A lesion that is painful is most likely a herpetic lesion. A chancre lesion associated with syphilis is not painful, so answer A is incorrect. Condylomata lesions are painless warts, so answer D is incorrect. In answer C, gonorrhea does not present as a lesion, but is exhibited by a yellow discharge.

54. A client visiting a family planning clinic is suspected of having an STI. The best diagnostic test for treponema pallidum is:

A. Venereal Disease Research Lab (VDRL)

B. Rapid plasma reagin (RPR)

C. Fluorescent treponemal antibody (FTA)✔️

D. Thayer-Martin culture (TMC)

Explanation: Fluorescent treponemal antibody (FTA) is the test for treponema pallidum. VDRL and RPR are screening tests done for syphilis, so answers A and B are incorrect. The Thayer-Martin culture is done for gonorrhea, so answer D is incorrect.

55. A 15-year-old primigravida is admitted with a tentative diagnosis of HELLP syndrome. Which laboratory finding is associated with HELLP syndrome?

A. Elevated blood glucose

B. Elevated platelet count

C. Elevated creatinine clearance

D. Elevated hepatic enzymes✔️

Explanation: The criteria for HELLP is hemolysis, elevated liver enzymes, and low platelet count. In answer A, an elevated blood glucose level is not associated with HELLP. Platelets are decreased, not elevated, in HELLP syndrome, as stated in answer B. The creatinine levels are elevated in renal disease and are not associated with HELLP syndrome, so answer C is incorrect.

56. The nurse is assessing the deep tendon reflexes of a client with preeclampsia. Which method is used to elicit the biceps reflex?

A. The nurse places her thumb on the muscle inset in the antecubital space and taps the thumb briskly with the reflex hammer.✔️

B. The nurse loosely suspends the client’s arm in an open hand while tapping the back of the client’s elbow.

C. The nurse instructs the client to dangle her legs as the nurse strikes the area below the patella with the blunt side of the reflex hammer.

D. The nurse instructs the client to place her arms loosely at her side as the nurse strikes the muscle insert just above the wrist.

Explanation: Answer B elicits the triceps reflex, so it is incorrect. Answer C elicits the patella reflex, making it incorrect. Answer D elicits the radial nerve, so it is incorrect.

57. A primigravida with diabetes is admitted to the labor and delivery unit at 34 weeks gestation. Which doctor’s order should the nurse question?

A. Magnesium sulfate 4gm (25%) IV

B. Brethine 10mcg IV✔️

C. Stadol 1mg IV push every 4 hours as needed prn for pain

D. Ancef 2gm IVPB every 6 hours

Explanation: Brethine is used cautiously because it raises the blood glucose levels. Answers A, C, and D are all medications that are commonly used in the diabetic client, so they are incorrect.

58. A diabetic multigravida is scheduled for an amniocentesis at 32 weeks gestation to determine the L/S ratio and phosphatidyl glycerol level. The L/S ratio is 1:1 and the presence of phosphatidylglycerol is noted. The nurse’s assessment of this data is:

A. The infant is at low risk for congenital anomalies.

B. The infant is at high risk for intrauterine growth retardation.

C. The infant is at high risk for respiratory distress syndrome.✔️

D. The infant is at high risk for birth trauma.

Explanation: When the L/S ratio reaches 2:1, the lungs are considered to be mature. The infant will most likely be small for gestational age and will not be at risk for birth trauma, so answer D is incorrect. The L/S ratio does not indicate congenital anomalies, as stated in answer A, and the infant is not at risk for intrauterine growth retardation, making answer B incorrect.

59. Which observation in the newborn of a diabetic mother would require immediate nursing intervention?

A. Crying

B. Wakefulness

C. Jitteriness✔️

D. Yawning

Explanation: Jitteriness is a sign of seizure in the neonate. Crying, wakefulness, and yawning are expected in the newborn, so answers A, B, and D are incorrect.

60. The nurse caring for a client receiving intravenous magnesium sulfate must closely observe for side effects associated with drug therapy. An expected side effect of magnesium sulfate is:

A. Decreased urinary output

B. Hypersomnolence✔️

C. Absence of knee jerk reflex

D. Decreased respiratory rate

Explanation: The client is expected to become sleepy, have hot flashes, and be lethargic. A decreasing urinary output, absence of the knee-jerk reflex, and decreased respirations indicate toxicity, so answers A, C, and D are incorrect.