NCLEX RN EXAM PACK SET 11 75 QUESTIONS WITH RATIONALES & ANSWERS LATEST UPDATED 2023_2024, Exams of Nursing

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Correct Answer: A. Elevated serum calcium The parathyroid glands regulate the calcium level in the blood. In hyperparathyroidism, the serum calcium level will be elevated. A normal PTH in the presence of hypercalcemia is considered inappropriate and still consistent with PTH-dependent hypercalcemia. PTH levels should be very low in those patients with PTH-independent hypercalcemia. A comprehensive clinical evaluation complemented by routine laboratory and radiologic studies should be sufficient to establish a diagnosis of primary hyperparathyroidism in a patient with persistent hypercalcemia and an elevated serum level of parathyroid hormone. o Option B: Parathyroid hormone levels may be high or normal but not low. Patients with primary hyperparathyroidism and other causes of PTH- dependent hypercalcemia often have frankly elevated levels of PTH, while some will have values that fall within the reference range for the general population. It is uncommon for clinically occult malignancies to cause hypercalcemia. Most patients with malignancy-

1. 1. Question

A patient is admitted to the hospital with a diagnosis of primaryhyperparathyroidism. A nurse checking the patient‟s lab resultswould expect which of the following changes in laboratory findings?

o A. Elevated serum calcium o B. Low serum parathyroid hormone (PTH)

o C. Elevated serum vitamin D

o D. Low urine calcium

• 2. Question

A patient with Addison‟s disease asks a nurse for nutrition anddiet advice. Which of the following diet modifications is not recommended?

o A. A diet high in grains. o B. A diet with adequate caloric intake.

o C. A high protein diet.

o D. A restricted sodium diet.

o Option A: Addison‟ s disease is a rare condition. It develops when the adrenal glands, which are located above the kidneys, do not make enough of certain hormones. These hormones are important for normal body function. They help the body cope with stress, hold salt and water, and maintain blood pressure. The

Correct Answer: D. A restricted sodium diet. A patient with Addison‟ s disease requires normal dietary sodium to prevent excess fluid loss. Do not reduce salt in the diet. The client may need to add extra salt to his food during hot and humid weather or after exercise to replace salt lost through sweating. Do not use salt substitutes.

associated hypercalcemia are known to have cancer, or cancer is readily detectable on initial evaluation, and PTH levels will be suppressed. o Option C: Parathyroid hormone levels may be high or normal but not low. The body will lower the level of vitamin D in an attempt to lower calcium. o Option D: Urine calcium may be elevated, with calcium spilling over from elevated serum levels. This may cause renal stones. A review of previous medical records can often be of significant value in establishing the cause of hypercalcemia. Most patients with hyperparathyroidism have persistent or intermittent hypercalcemia for many years before a definitive diagnosis is established.

Correct Answer: C. Hypoglycemia A postoperative diabetic patient who is unable to eat is likely to be suffering from hypoglycemia. The actual treatment recommendations for a given patient should be individualized, based on diabetes classification, usual diabetes regimen, state of

• 3. Question

A patient with a history of diabetes mellitus is in the second postoperative day following cholecystectomy. She has complained of nausea and isn‟t able to eat solid foods. The nurseenters the room to find the patient confused and shaky. Which ofthe following is the most likely explanation for the patient‟s symptoms?

o A. Anesthesia reaction o B. Hyperglycemia

o C. Hypoglycemia o D. Diabetic ketoacidosis

client should include complex carbohydrates in his diet, including grains. o Option B: A high protein diet is recommended for the client with Addison‟ s disease. The adrenal fatigue diet aims to stabilize blood sugar and balance cortisol levels by limiting sugar while increasing the intake of protein, healthy fats, veggies, and whole grains. Healthy fats and high-quality proteins slow the blood sugar rollercoaster and promote stable blood sugar levels throughout the day. o Option C: Adequate caloric intake is recommended. Refined carbohydrates quickly break down into sugar after you ingest them, which causes a spike in blood sugar followed by a steep decline. The diet discourages foods that are inflammatory or hard to digest and may contribute to gut health issues. The adrenal fatigue diet is more about eating more foods that make the client feel good and nourish the body versus restricting.

glycemic control, nature and extent of surgical procedure, andavailable expertise. o Option A: An anesthesia reaction would not occur on the second postoperative day. Anesthesia and surgery cause a stereotypical metabolic stress response that could overwhelm homeostatic mechanisms in patients with pre- existing abnormalities of glucose metabolism.The invariant features of the metabolic stress response include release of the catabolic hormones epinephrine, norepinephrine, cortisol, glucagons, and growth hormone and inhibition of insulin secretion andaction. o Option B: Confusion is a late sign of hyperglycemia. Shakiness is not one of its symptoms. The management approach in these categories of patients always includes insulin therapy in combination with dextrose and potassium infusion. Major surgery is defined as one requiring general anesthesia of ?1 h. Ata minimum, blood glucose should be monitored beforeand immediately after surgery in all patients. Those undergoing extensive procedures should have hourly glucose monitoring during and immediately following surgery. o Option D: Symptoms of DKA include excessive thirst, frequent urination, abdominal pain, fruity-scented breath, confusion, and shortness of breath. However, shakiness is not a sign of DKA. The stress of surgery itself results in metabolic perturbations that alter glucose homeostasis, and persistent hyperglycemia isa risk factor for endothelial dysfunction, postoperativesepsis, impaired wound healing, and cerebral ischemia. The stress response itself may precipitate diabetic crises (diabetic ketoacidosis [DKA].

• 4. Question

A nurse assigned to the emergency department evaluates a patient who underwent fiberoptic colonoscopy 18 hours previously. The patient reports increasing abdominal pain, fever,and chills. Which of the following conditions poses the most immediate concern?

o A. Bowel perforation

o B. Viral gastroenteritis

o C. Colon cancer

o D. Diverticulitis

Correct Answer: A. Bowel perforation Bowel perforation is the most serious complication of fiberoptic colonoscopy. Important signs include progressive abdominal pain,fever, chills, and tachycardia, which indicate advancing peritonitis. Bowel perforation results from insult or injury to the mucosa of the bowel wall resulting from a violation of the closed system. This exposes the structures within the peritoneal cavity to gastrointestinal contents. Patients presenting with abdominal pain and distension, especially in the appropriate historical setting, must be evaluated for this entity as delayed diagnosis can be life-threatening due to the risk of developing infections such as peritonitis. o Option B: Several different viruses including rotavirus, norovirus, adenovirus, and astroviruses account for most cases of acute viral gastroenteritis. Most are transmitted via the fecal-oral route, includingcontaminated food and water. Transmission has also been shown to occur via fomites, vomitus, and possibly airborne methods. Norovirus is more resistant to chlorine and ethanol inactivation than other viruses.Acute gastroenteritis is defined by loose or watery diarrhea that consists of 3 or more bowel movements in a day. Other symptoms may include nausea, vomiting, fever, or abdominal pain o Option C: Colon cancer does not cause these symptoms. Tumor location on clinical presentation canbe separated on left-sided with more changes in bowelhabits and hematochezia, and right-sided with obscured anemia impacting on late stage at diagnosis.The provider should perform a thorough physical examination for signs of ascites, hepatomegaly, and lymphadenopathy.

o Option A: PTT tests the function of all clotting factors except factor VII (tissue factor) and factor XIII (fibrin stabilizing factor). PTT is commonly used in clinical practice to monitor patient response to unfractionated heparin infusion, to target therapeutic anticoagulation, and as part of a “coagulation panel” to help elucidate causes of bleeding or clotting disorders.

Correct Answer: A, B, & C Prothrombin time, partial thromboplastin time, and platelet count are all included in coagulation studies.

• 5. Question

A patient is admitted to the same day surgery unit for liverbiopsy. Which of the following laboratory tests assesses coagulation? Select all that apply.

o A. Partial thromboplastin time

o B. Prothrombin time

o C. Platelet count

o D. Hemoglobin

o E. Complete Blood Count

o F. White Blood Cell Count

o Option D: Diverticulitis may cause pain, fever, and chills, but is far less serious than perforation and peritonitis. Acute diverticulitis is inflammation due to micro-perforation of a diverticulum. The diverticulum is a sac-like protrusion of the colon wall. Diverticulitis can present in about 10% to 25% of patients with diverticulosis. Diet appears to play a significant role. Low fiber, high fat, and red meat diets may increase the risk for development of diverticulosis and possible diverticulitis. Obesity and smoking are known to increase the potential for both diverticulitis and diverticular bleeding.

o Option B: Prothrombin time (PT) is one of several blood tests routinely used in clinical practice to evaluate the coagulation status of patients. More specifically, PT is used to evaluate the extrinsic and common pathways of coagulation, which would detectdeficiencies of factors II, V, VII, and X, and low fibrinogen concentrations. o Option C: Clinicians can monitor the function of platelets by evaluating the bleeding time, which evaluates the time between breaking the vasculatureand formation of an effective platelet plug. This timemay be elevated in conditions like uremia, in which platelet count is normal but demonstrates impaired function. o Option D: A hemoglobin test measures the levels of hemoglobin in the blood. Hemoglobin is a protein in the red blood cells that carries oxygen from the lungsto the rest of the body. Hemoglobin variant testing measures by percentage, the relative hemoglobin types present in erythrocytes. This testing allows for the detection of hemoglobin variants and thalassemicdisorders. o Option E: A complete blood count (CBC) is a blood test used to evaluate the overall health and detect a wide range of disorders, including anemia, infection and leukemia. A complete blood count test measuresseveral components and features of the blood, including red blood cells, white blood cells, hemoglobin, hematocrit, and platelets. o Option F: A white blood cell (WBC) count is a test thatmeasures the number of white blood cells in the body. Of note, if a subtype of white blood cells seems to be elevated based on the differential, the actual value of the type of white blood cells should be calculated by multiplying the percentage listed on the differential bythe total number of white blood cells. Question

• 6.

A patient on the cardiac telemetry unit unexpectedly goes into ventricular fibrillation. The advanced cardiac life support team prepares to defibrillate. Which of the following choices indicatesthe correct placement of the conductive gel pads?

o A. The left clavicle and right lower sternum.

o B. Right of midline below the bottom rib and the leftshoulder.

o C. The upper and lower halves of the sternum.

o D. The right side of the sternum just below theclavicle and left of the precordium.

Correct Answer: D. The right side of the sternum justbelow the clavicle and left of the precordium. One gel pad should be placed to the right of the sternum, just below the clavicle and the other just left of the precordium, as indicated by the anatomic location of the heart. To defibrillate, the paddles are placed over the pads. According to the ILCOR guidelines, the sternal paddle should be placed „just to the right of the upper sternal border below the clavicle‟ and the apical paddle „to the left of the nipple with the centre of the electrode inthe mid-axillary line‟. o Option A: During the gel pad placement study it was noticed that about 50% of doctors placed the rectangular apical paddle vertically upwards, pointing towards the left armpit. The other 50% placed it in a horizontal position across the chest. The present ILCOR guidelines do not specify which orientation should be used for defibrillation. It was hypothesized that, with the paddle method for defibrillation, it wouldbe more difficult to get good skin contact across the curved chest wall with the horizontal orientation, and in a small study this proved to be the case. o Option B: In theory, a paddle position that is too superomedial means that less current will traverse the myocardium. When 60 N (the median force used by defibrillator operators in clinical practice) is applied toboth paddles, the resulting TTI is 5% greater with the horizontal orientation. Thus, if paddles are used, it is recommended to use a vertical orientation. It is expected that their flexibility will allow better electrode/skin contact across the curved chest wall; however, in the absence of any evidence to the

Correct Answer: D. All of the above. All of the statements are true. Abdominal examination can give diagnostic clues regarding most gastrointestinal and genitourinary pathologies and may also give insight regarding abnormalities of other organ systems. A well-performed abdominal examination decreases the need for detailed radiological investigations also plays an important role in patient management.

o Option A: The gurgles and clicks described in the question represent normal bowel sounds, which vary with the phase of digestion. The diaphragm of the stethoscope should be placed on the right side of the umbilicus to listen to the bowel sounds, and their rate

• 7. Question

Thenurse performs an initial abdominal assessment on a patientnewly admitted for abdominal pain. The nurse hears what she describes as “clicks and gurgles in all four quadrants” as well as “swishing or buzzing sound heard in one or two quadrants.” Which of the following statements is correct?

o A. The frequency and intensity of bowel sounds variesdepending on the phase of digestion. o B. In the presence of intestinal obstruction, bowelsounds will be louder and higher pitched.

o C. A swishing or buzzing sound may represent theturbulent blood flow of a bruit and is not normal. o D. All of the above.

contrary, it is advised to use vertical orientation for this method as well. o Option C: Most healthcare workers are not achieving optimal TTI during defibrillation. There is now good evidence that the use of a coupling agent, chest hair removal, placement of the apical paddle in a vertical orientation lateral to the nipple in the mid-axillary line, and application of at least 80 N of force are all measures that help minimize the TTI.

Correct Answer: A. Irrigate the eye repeatedly with normal saline solution. Emergency treatment following a chemical splash to the eye includes immediate irrigation with normal saline. The irrigation should be continued for at least 10 minutes. Immediate irrigation with copious amounts of an isotonic solution is the mainstay of treatment for chemical burns. Never use any substance to

• 8. Question

A patient arrives in the emergency department and reports splashing concentrated household cleaner in his eye. Which ofthe following nursing actions is a priority?

o A. Irrigate the eye repeatedly with normal salinesolution. o B. Place fluorescein drops in the eye.

o C. Patch the eye.

o D. Test visual acuity.

should be calculated after listening for at least two minutes. Normal bowel sounds are low-pitched and gurgling, and the rate is normally 2 - 5/min. o Option B: Intestinal obstruction causes the sounds to intensify as the normal flow is blocked by the obstruction. Absent bowel sounds may indicate paralytic ileus and hyperactive rushes (borborygmi) are usually present in small bowel obstruction and sometimes may be auscultated in lactose intolerance o Option C: The swishing and buzzing sound of turbulent blood flow may be heard in the abdomen in the presence of abdominal aortic aneurysm, for example, and should always be considered abnormal. The diaphragm should be placed above the umbilicus to listen for an aortic bruit and then moved 2 cm above and lateral to the umbilicus to listen for a renal bruit. The presence of the former indicates an abdominal aortic aneurysm and the latter indicates renal artery atherosclerosis.

Correct Answer: D. Temperature of 101.8 F (38.7 C).

neutralize chemical exposure as the exothermic reaction can leadto secondary thermal injuries. Irrigation should continue until the pH of the eye is between 7.0 to 7.4 and remains within this rangefor at least 30 minutes after the irrigation has been discontinued. o Option B: Fluorescein drops are used to check for scratches on the cornea due to their fluorescent properties and are not part of the initial care of a chemical splash. A topical anesthetic such as tetracaine can be applied directly to the eye, or 10 mL of 1% lidocaine can be added to a liter of irrigating fluid, taking care not to reach a toxic dose if copious irrigation is required. o Option C: Patching the eye would not remove the chemical. Severe burns may require upwards of ten liters of irrigation. Irrigation should be gentle, and care should be taken to avoid direct irrigation to the cornea to prevent further injury. Use of a commercial irrigation lens such as a Morgan lens may be helpful. o Option D: Following irrigation, visual acuity will be assessed. Ocular burns, particularly any chemical burns with corneal clouding or abrasions, should have prompt ophthalmology evaluation. Topical antibiotic ointment and possibly topical steroids may be prescribed for both chemical and thermal burns, but topical steroids should only be prescribed in consultation with an ophthalmologist.

• 9. Question

A nurse is caring for a patient who has had hip replacement. Thenurse should be most concerned about which of the following findings?

o A. Complaints of pain during repositioning.

o B. Scant bloody discharge on the surgical dressing.

o C. Complaints of pain following physical therapy.

o D. Temperature of 101.8 F (38.7 C).

Post-surgical nursing assessment after hip replacement should beprincipally concerned with the risk of neurovascular complicationsand the development of infection. A temperature of 101.8 F (38.7 C) postoperatively is higher than the low grade that is to be expected and should raise concern. The THA postoperative wound complication spectrum ranges from superficial surgical infections (SSIs) such as cellulitis, superficial dehiscence, and/or delayed wound healing, to deep infections resulting in full- thickness necrosis. Deep infections result in returns to the operating room for irrigation, debridement (incision and drainage)and depending on the timing of the infection, may require explanation of THA components. o Option A: Joint replacement surgery relieves the painand stiffness of arthritis for most people. Some people may still have some symptoms of arthritis. For most people, surgery usually provides enough relief of symptoms for most people. Loosening of the new jointover time can cause pain, and sometimes another surgery is needed to fix the problem. o Option B: A small amount of bloody drainage on the surgical dressing is a result of normal healing. normal to lose blood during and after hip or knee replacementsurgery. Some people need a blood transfusion during surgery or during their recovery period in the hospital.Some surgeries require you to donate blood before surgery. Much of the bleeding during surgery comes from the bone that has been cut. A bruise may occur ifblood collects around the new joint or under the skin after surgery. o Option C: Some pain following physical therapy is to be expected and can be managed with analgesics. As in its counterpart TKA procedure, aseptic loosening is the result of a confluence of steps involving particulatedebris formation, prosthesis micromotion, and macrophage-activated osteolysis. Treatment requires serial imaging and radiographs and/or CT imaging for preoperative planning. Persistent pain requires revision THA surgery.

• 10. Question

A child is admitted to the hospital with an uncontrolled seizure disorder. The admitting physician writes orders for actions to be

taken in the event of a seizure. Which of the following actionswould not be included?

o A. Notify the physician. o B. Restrain the patient's limbs.

o C. Position the patient on his/her side with the headflexed forward.

o D. Administer rectal diazepam.

Correct Answer: B. Restrain the patient’s limbs. During a witnessed seizure, nursing actions should focus on securing the patient‟s safety and curtailing the seizure. Restraining the limbs is not indicated because strong muscle contractions could cause injury. Use and pad side rails with the bed in lowest position, or place the bed up against the wall andpad floor if rails are not available or appropriate. o Option A: The nurse should notify the physician in theevent of a seizure so he could prescribe the correct medication. Ascertain knowledge of various stimuli that may precipitate seizure activity. Alcohol, various drugs, and other stimuli (loss of sleep, flashing lights, prolonged television viewing) may increase brain activity, thereby increasing the potential for seizure activity. o Option C: A side-lying position with head flexed forward allows for drainage of secretions and preventsthe tongue from falling back, blocking the airway. Turnhead to side and suction airway as indicated. Insert plastic bite blocks only if the jaw is relaxed. Helps maintain airway patency and reduces the risk of oral trauma but should not be “forced” or inserted when teeth are clenched because dental and soft-tissue damage may result. Note: Wooden tongue blades should not be used because they may splinter and break in the patient‟s mouth. o Option D: Rectal diazepam may be a treatment ordered by the physician, who should be notified ofthe seizure. Diazepam may be used alone (or in

• 11. Question

A patient who has received chemotherapy for cancer treatment isgiven an injection of Epoetin. Which of the following should reflectthe findings in a complete blood count (CBC) drawn several days later?

o A. An increase in neutrophil count. o B. An increase in hematocrit.

o C. An increase in platelet count.

o D. An increase in serum iron.

o Option A: Application of granulocyte-colony stimulating factor (G-CSF) can improve neutrophil functions and number. Prophylactic use of antibiotics and antifungals is reserved for some forms of alteration in neutrophil function such as chronic granulomatous disease CGD). The utilization of antimicrobials is compulsory if recurrent infections exist. Interferon-gamma has been successfully used to improve the quality of life of the patient suffering from neutropenia.

Correct Answer: B. An increase in hematocrit. Epoetin is a form of erythropoietin, which stimulates the production of red blood cells, causing an increase in hematocrit. Epoetin is given to patients who are anemic, often as a result of chemotherapy treatment. Epoetin alfa is 165 amino acid glycoprotein manufactured by recombinant DNA technology, which has similar biological effects as endogenous erythropoietin. Erythropoietin stimulates red blood cell production in-situ. It is a hormone produced in the kidney and augments the differentiation of erythroid progenitors in the bone marrow.

combination with phenobarbital) to suppress status seizure activity. Diastat, a gel, may be administered rectally, even in the home setting, to reduce the frequency of seizures and need for additional medical care.

Correct Answer: B, C, D & E Polycythemia vera is a condition in which the bone marrow produces too many red blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients can experience headaches, dizziness, tinnitus, and visual disturbances. Cardiovascular effects include increased blood pressure and delayed clotting time. o Option A: Weight loss is not a manifestation of polycythemia vera. Weight loss adversely impacts

• 12. Question

A patient is admitted to the hospital with suspected polycythemiavera. Which of the following symptoms is consistent with the diagnosis? Select all that apply.

o A. Weight loss

o B. Increased clotting time

o C. Hypertension

o D. Headaches

o E. Tinnitus

o Option C: First-line treatment includes glucocorticoids and intravenous immune globulins; these agents inhibit autoantibody production and platelet degradation. Second-line treatment includes rituximab, immunosuppressive drugs, and splenectomy. Third-line agents are thrombopoietin receptor agonists, which stimulate platelet production. o Option D: Iron supplementation should be taken without food to increase absorption. Low gastric pH facilitates iron absorption. Rapid response to treatment is often seen in 14 days. It is manifested by the rise in hemoglobin levels. Iron supplementation is needed for at least three months to replenish tissue iron stores and should proceed for at least a month even after hemoglobin has returned to normal levels.

survival in cancer patients. JAK2 myeloproliferative neoplasms (MPN) upregulate tumor necrosis factor alpha (TNF-?), interleukin-6 (IL-6), and IL-8 and inducedecreased leptin levels leading to weight loss. The impact of weight loss in PV patients receiving best supportive care (i.e. frontline hydroxyurea [HU] therapy, phlebotomy) on overall survival (OS) is largely unknown. o Option B: Bleeding and thrombotic complications areeach observed in 1% of patients. Bleeding events can include epistaxis, gum bleeding, and gastrointestinal (GI) bleeding. Thrombotic events can include deep venous thrombosis (DVT), pulmonary embolism (PE), Budd-Chiari syndrome, splanchnic vein thrombosis, stroke, and arterial thrombosis. o Option C: The overproduction of red blood cells and high hematocrit levels associated with polycythemia vera can contribute to systemic hypertension; high hematocrit levels have been found to interfere with the vasodilatory effects of nitric oxide. The treatment of polycythemia, which can involve phlebotomy, can alleviate the systemic hypertension, as well as the physiological consequences of having a high red bloodcell count. o Option D: As polycythemia vera is a myeloproliferative syndrome, it is based on an autonomic increase in the proliferation of all hematopoietic cells–mostly of erythropoiesis. An increase in blood viscosity induces disturbed microcirculation, resulting in headaches with clinicalsymptoms. o Option E: Symptoms are related to hyperviscosity and thrombosis, impairing oxygen delivery. Physical complaints can include fatigue, headache, dizziness,tinnitus, vision changes, insomnia, claudication, pruritus, gastritis, and early satiety.

• 13. Question

A nurse is caring for a patient with a platelet count of 20,000/microliter. Which of the following is an importantintervention?

o A. Observe for evidence of spontaneous bleeding.

o B. Limit visitors to family only.

o C. Give aspirin in case of headaches.

o D. Impose immune precautions.

Correct Answer: A. Observe for evidence of spontaneousbleeding. Platelet counts under 30,000/microliter may cause spontaneous petechiae and bruising, particularly in the extremities. When thecount falls below 15,000, spontaneous bleeding into the brain and internal organs may occur. The blood clotting cascade is an integral system requiring intrinsic and extrinsic factors. Derangements in any factors can affect clotting ability. These laboratory tests provide important information about the patient‟scoagulation status and bleeding potential. The specific laboratory values to be monitored will depend on the patient‟s specific clinical condition. o Option B: There is no reason to limit visitors as long as any physical trauma is prevented. Educate the patient and family members about signs of bleeding that need to be reported to a health care provider. Early evaluation and treatment of bleeding by a healthcare provider reduce the risk for complications from blood loss. o Option C: Headaches may be a sign and should be watched for. Aspirin disables platelets and should never be used in the presence of thrombocytopenia. Educate the patient about over-the-counter drugs andavoid products that contain aspirin or NSAIDs such as ibuprofen and naproxen. These drugs not only decrease normal platelet aggregation but also decrease the integrity of gastric mucosa through inhibition of cyclooxygenase (COX)- inhibitor and therefore increase the risk for gastrointestinal bleeding. o Option D: Thrombocytopenia does not compromiseimmunity. Educate the at-risk patient about precautionary measures to prevent tissue trauma or

o Option A: Corticosteroid use is associated with hypertension, hyperglycemia, obesity, and conflicting evidence exists for hyperlipidemia. Mineralocorticoid activity, which varies by corticosteroid, leads to retention of free water and sodium with excretion of potassium. o Option B: Cushing syndrome can occur in patients taking corticosteroids through all routes of administration. Cushingoid features refer to the weight gain and the redistribution of adiposity (dorsocervical fat pad, aka “buffalo hump,” facial fat increase, aka “moon facies,” and truncal obesity) seen with excess

Correct Answer: A, B, & D Side effects of corticosteroids include weight gain, fluid retention with hypertension, Cushingoid features, a low serum albumin, and suppressed inflammatory response. Patients are encouraged to eat a diet high in protein, vitamins, and minerals and low in sodium.

• 14. Question

A nurse in the emergency department assesses a patient who hasbeen taking long-term corticosteroids to treat renal disease. Which of the following is a typical side effect of corticosteroidtreatment? Select all that apply.

o A. Hypertension

o B. Cushingoid features

o C. Hyponatremia

o D. Low serum albumin

o E. Hypernatremia

disruption of the normal clotting mechanisms. Information about precautionary measures lessens the risk for bleeding. Use a soft-bristled toothbrush and nonabrasive toothpaste. Avoid the use of toothpicks and dental floss.

cortisol. These features may develop within the firsttwo months of corticosteroid treatment. o Option C: Corticosteroids cause hypernatremia, not hyponatremia. Corticosteroids have varying degrees of mineralocorticoid activity. The corticosteroids with higher levels of mineralocorticoid activity may lead to free water and salt retention in addition to potassium excretion. Thus, fluid and electrolyte levels should be monitored in patients on corticosteroids with higher mineralocorticoid activity. o Option D: There was a significant correlation betweenthe extent of plasma protein binding of prednisolone and the serum albumin concentration. Azathioprine did not affect the plasma binding of prednisolone in vitro. The plasma half-life of prednisolone was prolonged in two of three patients with chronic liver disease studied. These, together with low serum albumin concentrations which are associated with higher levels of circulating unbound prednisolone, result in quite different levels of biologically active corticosteroids compared with equivalent doses of prednisone or prednisolone in subjects without liver disease. o Option E: Glucocorticoid can induce hypernatremia not only by enhancing sodium retention, but also by increasing electrolyte-free water loss. It has been shown that patients, as well as experimental animals,exhibit polyuria in the presence of excess glucocorticoid hormones.

• 15. Question

A nurse is caring for patients in the oncology unit. Which of the following is the most important nursing action when caring for a neutropenic patient?

o A. Change the disposable mask immediately after use.

o B. Change gloves immediately after use.

o C. Minimize patient contact.

o D. Minimize conversation with the patient.

Correct Answer: B. Change gloves immediately after use. The neutropenic patient is at risk of infection. Changing gloves immediately after use protects patients from contamination with organisms picked up onhospital surfaces. This contamination canhave serious consequences for an immunocompromised patient.Wear gloves when providing direct care; perform hand hygiene after properly disposing gloves. o Option A: Changing the respiratory mask is desirable,but not nearly as urgent as changing gloves. Wear personal protective equipment (PPE) properly. Use masks, goggles, face shields to protect the mucous membranes of your eyes, mouth, and nose during procedures and in direct-care activities (e.g., suctioning secretions) that may generate splashes or sprays of blood, body fluids, secretions, and excretions. o Option C: Place the patient in protective isolation if the patient is at high risk of infection. Protective isolation is set when the WBC indicates neutropenia. Provide surgical masks to visitors who are coughing and provide rationale to enforce usage. Instruct visitors to cover mouth and nose (by using the elbowsto cover) during coughing or sneezing; use of tissues to contain respiratory secretions with immediate disposal to a no-touch receptacle; perform hand hygiene afterward. o Option D: Minimizing conversations are not necessaryand may cause nursing staff to miss changes in the patient‟s symptoms or condition. Educating visitors on the importance of preventing droplet transmission from themselves to others reduces the risk of infection.

• 16. Question

A nurse is counseling patients at a health clinic on the importanceof immunizations. Which of the following information is the most accurate regarding immunizations?

o A. All infectious diseases can be prevented with properimmunization.

o B. Immunizations provide natural immunity fromdisease.

o C. Immunizations are risk-free and should be universallyadministered.

o D. Immunization provides acquired immunity fromsome specific diseases.

Correct Answer: D. Immunization provides acquiredimmunity from some specific diseases. Immunization is available for the prevention of some, but not all, specific diseases. This type of immunity is “acquired” by causing antibodies to form in response to a specific pathogen. Live vaccines are more effective than killed vaccines because they retain more antigens of the microbes. However, toxoids, includingthose that cause tetanus and diphtheria, are the most effective bacterial vaccines of all because they are based on inactivated exotoxins that stimulate strong antibody production. Subunit vaccines, including hepatitis B, meningococcal, and Haemophilus influenzae B vaccines are effective when conjugated to carrier proteins such as tetanus toxoid. o Option A: Immunizations can prevent some, but not all, infectious diseases. The current immunizations protect against diphtheria, tetanus, pertussis, poliomyelitis, measles, mumps, rubella, pneumococcalpneumonia, smallpox, sepsis, meningitis, hepatitis B, varicella-zoster, tuberculosis, cholera, diarrhea causedby rotavirus, salmonellosis, and dengue. o Option B: Natural immunity is present at birth because the infant acquires maternal antibodies. Innate (natural) immunity is so named because it is present at birth and does not have to be learned through exposure to an invader. It thus provides an immediate response to foreign invaders. However, itscomponents treat all foreign invaders in much the same way.

o Option A: The physician will see the patient as soon as possible with the above actions underway. Often when anaphylaxis is diagnosed co-treatment is initiated with steroids, antihistamines, inhaled bronchodilators, and vasopressors. Glucagon can also be used if indicated. These agents can assist in

Correct Answer: B. Maintain a patent airway. The patient may be experiencing an anaphylactic reaction. Airway management is paramount. Thoroughly examine the patient for airway patency or any indications of an impending loss of airway. Perioral edema, stridor, and angioedema are very high risk, and obtaining a definitive airway is imperative. Delay may reduce the chances of successful intubation as continued swelling occurs, increasing the risk for a surgical airway.

• 17. Question

A patient is brought to the emergency department after a bee sting. The family reports a history of severe allergic reaction, andthe patient appears to have some oral swelling. Which of the following is the most urgent nursing action?

o A. Consult a physician. o B. Maintain a patent airway.

o C. Administer epinephrine subcutaneously.

o D. Administer diphenhydramine (Benadryl) orally.

o Option C: Immunization, like all medication, cannot be risk-free and should be considered based on the risk of the disease in question. Most vaccines have adverse reactions as any drug or medication. For example, BCG vaccination may provoke fever, vomiting, hematuria, lymphadenitis, and redness at the site of injection. HiB vaccine has few adverse reactions, and none of them are dangerous. These reactions include redness, warmth, swelling, and fever over 101 degrees F. A rare and lethal adverse reaction secondary to vaccination is the Guillain-Barre syndrome.

Correct Answer: A, B, D & E ADHD in children is frequently treated with CNS stimulant medications, which increase focus and improve concentration.

• 18. Question

A mother calls the clinic to report that her son has recently started medication to treat attention-deficit/hyperactivity disorder(ADHD). The mother fears her son is experiencing side effects of the medicine. Which of the following side effects are typically related to medications used for ADHD? Select all that apply.

o A. Poor appetite

o B. Insomnia

o C. Sleepiness

o D. Agitation

o E. Decreased attention span

refractory initial anaphylaxis or aid in the prevention of recurrence and biphasic reactions. o Option C: The most urgent action is to maintain an airway, particularly with visible oral swelling, followed by the administration of epinephrine by subcutaneous injection. Epinephrine is given through intramuscular injection and at a dose of 0.3 to 0.5 mL of 1:1,000 concentration of epinephrine. Pediatric dosing is 0.01 mg/kg or 0.15 mg intramuscularly (IM) (epinephrine injection for pediatric dosage). Intramuscular delivery has proven to provide more rapid delivery and produce better outcomes than subcutaneous or intravascular. o Option D: Oral diphenhydramine is indicated for mild allergic reactions and is not appropriate for anaphylaxis. Antihistamines are often routinely used; most commonly is Hblocker administration of diphenhydramine 25 to 50 mg IV/IM. While the clinical benefit is unproven in anaphylaxis, its utility is evident in more minor allergic processes.

Children often experience insomnia, agitation, and decreasedappetite. ADHD treatment commonly uses a combination of dextroamphetamine and levoamphetamine, as well as pure dextroamphetamine and lisdexamfetamine. o Option A: Loss of appetite is among the most common side effects of stimulants for ADHD. Acrossstudies, approximately 20% of patients with ADHD who were treated with stimulants reported a loss of appetite. Weight loss is also quite common, as are digestive problems. o Option B: Insomnia or delayed SOL greater than 30 minutes is one of the most common adverse events associated with stimulant medications. This should bedistinguished from bedtime resistance, which is when the child refuses to go to bed. Insomnia is a frequent side effect of all stimulant medications, based on parent report or side effects scales completed side effects scales by parents. o Option C: Sleepiness is not a side effect of stimulants.Efron et al. compared twice-daily, immediate-release MPH and dextroamphetamine in 125 ADHD youth in a crossover study. Using the parent-completed, Barkley Side Effect Scale, dextroamphetamine, but not MPH, was associated with higher ratings of severe insomnia relative to baseline. o Option D: The immediate psychological effects of stimulant administration include a heightened sense ofwell- being, euphoria, excitement, heightened alertness, and increases in motor activity. Stimulants also reduce food intake, reduce sleep time, and may increase socialization activities. Stimulants may also enhance performance of certain types of psychomotor tasks. High doses may result in restlessness and agitation, and excessive doses may produce stereotypic behaviors (repetitive and automatic acts). o Option E: In people with ADHD, stimulants produce a paradoxical calming effect. This results in a reduction in hyperactivity and an improvement in attention spanin many patients.

• 19. Question

A patient at a mental health clinic is taking Haldol (haloperidol) for treatment of schizophrenia. She calls the clinic to report abnormal movements of her face and tongue. The nurse concludes that the patient is experiencing which of the followingsymptoms:

o A. Comorbid depression

o B. Psychotic hallucinations

o C. Negative symptoms of schizophrenia

o D. Tardive dyskinesia

Correct Answer: D. Tardive dyskinesia Abnormal facial movements and tongue protrusion in a patient taking haloperidol is most likely due to tardive dyskinesia, an adverse reaction to the antipsychotic. Tardive dyskinesia is a syndrome that includes a group of iatrogenic movement disorderscaused by the blockade of dopamine receptors. The movement disorders include akathisia, dystonia, buccolingual stereotypy, myoclonus, chorea, tics and other abnormal involuntary movements which are commonly caused by the long-term use of typical antipsychotics. o Option A: Depression and anxiety is frequently seen in many schizophrenic patients and may be further aggravated or diminished by antipsychotic treatments.Haloperidol is a conventional antipsychotic used in schizophrenia and psychosis. o Option B: Psychotic hallucinations may be visual orauditory but do not include abnormal movements. Hallucinations are most often associated with schizophrenia, a mental illness characterized by disordered thoughts and behaviors. o Option C: Depression may occur along with schizophrenia and would be characterized by such symptoms as loss of affect, appetite and/or sleep changes, and anhedonia. These depressive changes and lack of volition are part of the negative symptomsof schizophrenia.