NURS 223: Exam 4 (New 2024/ 2025 Update) Questions and Verified Answers| 100% Correct| Gra, Exams of Advanced Education

Download NURS 223: Exam 4 (New 2024/ 2025 Update) Questions and Verified Answers| 100% Correct| Gra and more Exams Advanced Education in PDF only on Docsity! NURS 223: Exam 4 (New 2024/ 2025 Update) Questions and Verified Answers| 100% Correct| Graded A+ The nurse is caring for a client who is a strict vegetarian; the client is at greatest risk for the development of: a) Folic acid deficiency anemia b) Blood loss anemia c) Microcytic anemia d) Vitamin B12 deficiency anemia - Correct Answer-d) Vitamin B12 deficiency anemia Vitamin B12 is found in all foods of animal origin. Dietary deficiency is rare and usually found only in strict vegetarians who avoid all dairy products as well as meat and fish. The hallmark of vitamin B12 deficiency is megaloblastic anemia. The other options are not affected by the client being a vegetarian. The nurse is caring for a client diagnosed with sickle cell disease. Select the most important factor for the nurse to be aware of that may cause the cells to sickle. a) Rapid administration of intravenous fluids b) Reduced oxygen tension while the client sleeps c) Acute chest syndrome d) Presence of pain in the client's joints - Correct Answer-b) Reduced oxygen tension while the client sleeps Factors associated with sickling include cold, stress, physical exertion, infection, dehydration and illnesses that cause hypoxia, dehydration, or acidosis. Even such trivial incidents as reduced oxygen tension induced by sleep may contribute to the sickling process. Pain and acute chest syndrome are complications of sickle cell disease When an Rh-negative mother gives birth to an Rh-positive infant, the mother usually produces antibodies that will attack any subsequent pregnancies in which the fetus is Rh positive. When subsequent babies are Rh positive, erythroblastosis fetalis occurs. What is another name for erythroblastosis fetalis? a) Microcytic disease of the newborn b) Macrocytic disease of the newborn c) Hemolytic disease of the newborn d) Hemolytic iron deficiency anemia - Correct Answer-c) Hemolytic disease of the newborn A neonate has been diagnosed with hyperbilirubinemia and begun phototherapy. The infant's risk of encephalopathy will increase if: a) unconjugated bilirubin levels are not successfully reduced. b) conjugated bilirubin crosses the infant's blood-brain barrier. c) serum bilirubin cannot bind with RBC's for excretion. d) conjugated bilirubin reverts to unconjugated bilirubin. - Correct Answer-a) unconjugated bilirubin levels are not successfully reduced. Hyperbilirubinemia reflects an elevated level of unconjugated bilirubin. Conjugated bilirubin cannot change to an unconjugated state. Bilirubin does not bind with RBC's in order to be excreted. Unconjugated bilirubin poses no risk of crossing the blood-brain barrier because it is not lipid soluble The nurse is caring for a 2-day-old newborn infant who appears lethargic and has a yellowish tint to the skin. Select the most likely cause of this newborn's signs and symptoms. a) A decrease in the breakdown of red blood cells b) The inability of a newborn to produce bilirubin c) The inability of the immature liver to conjugate bilirubin d) Cirrhosis of the liver - Correct Answer-c) The inability of the immature liver to conjugate bilirubin Jaundice is a sign of increased bilirubin related to the increased red blood cell breakdown and the inability of the immature liver to conjugate bilirubin. Jaundice occurs from a large production of bilirubin, and a newborn would not have cirrhosis of the liver. Anemia refers to a deficiency of: a) Blood plasma b) Platelets c) Folic acid d) Hemoglobin - Correct Answer-d) Hemoglobin Anemia is a condition of an abnormally low number of circulating red blood cells or hemoglobin level, or both. It is not a disease but a manifestation of a disease process or alteration in body function. Which of the following is the most abundant type of plasma proteins? a) Globulins b) Albumin c) Fibrinogens d) Beta globulin - Correct Answer-b) Albumin Albumin makes up approximately 54% of the plasma proteins. Although the others are made up plasma proteins, they are in the plasma in smaller numbers than is albumin. A patient presents to the clinic with symptoms of elevated blood pressure, dizziness, red face, pain in fingers and toes, headache, and difficulty concentrating. A blood smear reveals an increased number of erythrocytes. Based on these findings, the nurse anticipates which of the following diagnoses? a) Hemolytic anemia b) Leukemia c) Polycythemia vera d) Hyperbilirubinemia - Correct Answer-c) Polycythemia vera Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell mass accompanied by elevated c) Lymphocytes and neutrophils d) Sodium and potassium - Correct Answer-a) Red blood cells and platelets A CBC is a commonly performed screening test that determines the number of red blood cells, white blood cells, and platelets per unit of blood. Lymphocytes and neutrophils may be included in the CBC if a differential of white blood cells was also ordered. Electrolytes and size/shape of blood cells are not part of a CBC. Normal red blood cells live an average of about how many days? a) 120 b) 3 c) 90 d) 12 - Correct Answer-a) 120 Normal red blood cells live 120 days. The client is an average-sized adult and has abnormal microcytic hypochromic red blood cells due to a long-term, chronic disease. Which of the following complete blood count (CBC) results is characteristic of her type of anemia? a) Reticulocytes 1.5% b) Hematocrit 44% c) Hemoglobin 8 g/dL d) Band cells 3000/mL - Correct Answer-c) Hemoglobin 8 g/dL Anemia of chronic disease is characterized by a low hemoglobin level, low hematocrit, and low reticulocyte count. The quantity of band cells, immature neutrophils released from the marrow, is unrelated to the anemia. A client tells the nurse that the doctor told her she has too many red blood cells accompanied by elevated white cells and platelet counts. The nurse recognizes this as: a) Aplastic anemia b) Hemolytic anemia c) Pernicious anemia d) Polycythemia vera - Correct Answer-d) Polycythemia vera Polycythemia vera is a neoplastic disease of the pluripotent cells of the bone marrow characterized by an absolute increase in total red blood cell (RBC) mass accompanied by elevated white cell and platelet counts. In pernicious anemia, the RBCs are not high in number but are larger in size. In aplastic and hemolytic anemia, there is a small number of RBCs A female patient comes to the clinic with symptoms of fatigue and heavy menses over the last 6 months. Laboratory tests reveal a microcytic hemochromic anemia. Based on these results, the nurse anticipates teaching the patient about which type of anemia? a) Aplastic anemia b) Iron deficiency anemia c) Anemia related to kidney disease d) Sickle cell anemia - Correct Answer-b) Iron deficiency anemia The red blood cell indices identified that it was a microcytic hemochromic anemia, specifically iron deficiency. A client was involved in an auto accident and suffered massive internal injuries that resulted in a large blood loss. Select the type of anemia the client is at greatest risk to develop. the body, but not for strength, only for its oxygen-binding capacity. The Rh-negative mother, who has become sensitized during a previous birth, gives birth to a Rh-positive infant. Which method will the practitioner chose to prevent kernicterus in the infant? a) Administration of erythropoietin b) Exchange transfusions c) Injection of Rh immune globulin d) Transfusion of fresh frozen plasma - Correct Answer-b) Exchange transfusions After an Rh-negative mother has been sensitized, the Rh antibodies from her blood are transferred to subsequent infants through placental circulation. These antibodies react with the red cell antigens of the Rh-positive infant causing agglutination and hemolysis. There is a danger of kernicterus developing in the infant, resulting in severe brain damange or death. Exchange transfusions are administered after birth by removing and replacing the infant's blood volume with type O Rh-negative blood. The injection of Rh immune globulin is given to the Rh-negative mother post delivery to prevent sensitization. Erythropoietin and plasma administration do not prevent kernicterus. An elderly patient is brought to the emergency department with garbled speech, unilateral facial drooping, and weakness. One hour after admission, the patient dies. An autopsy reveals the presence of polycythemia. Which of the following was the most likely cause of the patient's death? a) Cerebral thrombosis b) Infection and sepsis c) Acute leukemia d) Anaphylactic reaction - Correct Answer-a) Cerebral thrombosis Unregulated overproduction of the red cell mass is termed polycythemia, which causes a thickening of the blood and an increased risk of blood clots. An infant from parents of Mediterranean decent has been diagnosed with a severe form of β-thalassemia anemia. The nurse caring for this infant knows that the infant will likely receive which of the following medical treatments? a) Warfarin, a blood thinner to decrease clot formation b) Iron sulfate supplements c) Stem cell transplant d) Transfusion therapy - Correct Answer-d) Transfusion therapy Persons who are homozygous for the trait (thalassemia major) have severe, transfusion-dependent anemia that is evident at 6 to 9 months of age when the hemoglobin switches from HbF to HbA. If transfusion therapy is not started early in life, severe growth retardation occurs in children with the disorder. Iron and blood thinners will not be therapeutic for this client. Stem cell transplantation is a potential cure for low-risk clients, particularly in younger persons with no complications of the disease or its treatment, and has excellent results. After birth, red blood cells are normally made in which of the following locations? a) Kidneys b) Liver c) Bone marrow d) Spleen - Correct Answer-c) Bone marrow c) Packed red blood cell transfusion d) Phototherapy - Correct Answer-d) Phototherapy Phototherapy is the standard treatment for mild to moderate hyperbilirubinemia, with exchange transfusion an option for greater risks of kernicterus. Blood transfusions, phlebotomy, and antibiotics are not indicated in hyperbilirubinemia. Polycythemia develops in clients with lung disease as a result of: a) Decreased blood viscosity b) Excessive respiratory fluid loss c) Chronic hypoxia d) Hyperventilation - Correct Answer-c) Chronic hypoxia Secondary polycythemia results from a physiologic increase in the level of erythropoietin, commonly as a compensatory response to hypoxia. Conditions causing hypoxia include living at high altitudes, chronic heart and lung disease, and smoking. The practitioner carefully monitors his client who exhibits hemoglobin S (HbS) genes. The practitioner know that the client is predisposed to life-threatening infection due to damage by HbS to which of the following organs? a) Heart b) Lungs c) Pancreas d) Spleen - Correct Answer-d) Spleen Sickle cell disease is an inherited disorder in which the person has abnormal hemoglobin S (HbS). The spleen is especially susceptible to damage by HbS. The congestion of the spleen predisposes the person to life-threatening infections caused by encapsulated organisms The nurse is assessing a female patient with a hemoglobin of 6.8g/dL. Which of the following symptoms would the nurse expect to find? Select all that apply. a) Faintness b) Pink skin and mucous membranes c) Bradycardia d) Headache e) Dyspnea - Correct Answer-a) Faintness d) Headache e) Dyspnea In anemia, the oxygen-carrying capacity of hemoglobin is reduced, causing tissue hypoxia. Tissue hypoxia can give rise to fatigue, weakness, dyspnea and sometimes angina. Hypoxia of brain tissue results in headache, faintness and dim vision. Redistribution of blood from cutaneous tissues or a lack of hemoglobin causes pallor of the skin and mucous membranes. Tachycardia and palpitation may occur as the body tries to compensate with an increase in cardiac output. To be effective for treating chickenpox, acyclovir [Zovirax] should be initiated within how many hours of the appearance of the rash? 1) 24 2) 36 3) 48 4) 72 - Correct Answer-1) 24 The oral acyclovir [Zovirax] is used to treat varicella infections (chickenpox) in immunocompetent children if used within 24 hours of the appearance of the rash. Which drug is used to manage viral pneumonia in a patient with respiratory syncytial virus? 1 Ribavirin [Virazole] 2 Flucytosine [Ancobon] 3 Griseofulvin [Grifulvin V] 4 Amantadine [Symmetrel] - Correct Answer-1) Ribavirin [Virazole] Ribavirin [Virazole] is indicated for serious viral pneumonia caused by the respiratory syncytial virus. Amantadine [Symmetrel] is an antiinfluenza drug used in the management of Parkinson's disease). Flucytosine [Ancobon] and griseofulvin [Grifulvin V] are antifungal drugs. A patient is receiving weekly subcutaneous injections of peginterferon-alfa-2a [Pegasys] for chronic hepatitis C. A nurse teaches the patient that which adverse effect will diminish with continued therapy? 1 Flu-like symptoms 2 Dyspnea and wheezing 3 Black, sticky, tarry stools 4 Lower leg muscle weakness - Correct Answer-1) Flu-like symptoms The most common adverse side effect of peginterferon-alfa- 2a, a long-acting interferon used to treat chronic hepatitis C, is flu-like symptoms characterized by fever, fatigue, myalgia, headache, and chills. Symptoms are likely to diminish with continued therapy over time. Black, tarry stools; lower leg muscle weakness; dyspnea; and wheezing are not adverse effects of peg-interferon-alfa-2a. A patient asks the nurse for information about cytomegalovirus. Which is the most accurate response by the nurse? 1 "About 60% of people have the disease." 2 "Cytomegalovirus retinitis is the principal cause of loss of vision." 3 "After the initial infection, the virus stays dormant in the body for life." 4 "The mode of transmission for cytomegalovirus is airborne transmission." - Correct Answer-3) "After the initial infection, the virus stays dormant in the body for life." After the initial infection, which usually has mild symptoms in healthy people, the virus remains dormant in cells for life without causing any problems. Between 50% and 85% of adults in America 40 years and older harbor the virus. Cytomegalovirus (CMV) retinitis is a reason for loss of vision in persons with AIDS and CMV. The mode of transmission for CMV is contact with contaminated body fluids, including blood, urine, and breast milk. Which is the most appropriate antifungal agent for treating a patient with an aspergillosis lung infection? "Combining these two medications will greatly increase response rates." 2 "It is very important that you have blood counts checked every 2 weeks." 3 "An antidepressant can be prescribed to alleviate symptoms of depression." 4 "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." - Correct Answer-4) "If you are sexually active, use two reliable forms of birth control to prevent pregnancy." Cidofovir [Vistide] is an intravenous (IV) drug with just one indication: cytomegalovirus (CMV) retinitis in patients with AIDS who have failed on ganciclovir or foscarnet. Acyclovir [Zovirax] is effective against herpes simplex virus types 1 and 2, herpes zoster, and chickenpox. Ribavirin [Rebetol] is used to treat respiratory syncytial virus infection. Amantadine [Symmetrel] is an antiviral drug developed to treat influenza A but is no longer recommended for this purpose and is now used to treat Parkinson's disease. Which antifungal drug is contraindicated in a patient with porphyrias? 1 Fluconazole [Diflucan] 2 Ketoconazole [Nizoral, Extina] 3 Terbinafine [Lamisil, Lamisil AT] 4 Griseofulvin [Grifulvin V, Gris-PEG] - Correct Answer-4) Griseofulvin [Grifulvin V, Gris-PEG] Griseofulvin [Grifulvin V, Gris-PEG] is administered orally to treat superficial mycoses. The drug is inactive against organisms that cause systemic mycoses. The use of griseofulvin [Grifulvin V, Gris-PEG] is contraindicated in patients with porphyrias, which are disorders affecting the skin caused by a deficiency in a liver enzyme involved in the heme biosynthetic pathway. Griseofulvin [Grifulvin V, Gris- PEG] administration in patients with these disorders has been found to precipitate an acute worsening of the condition. Terbinafine [Lamisil, Lamisil AT], fluconazole [Diflucan], and ketoconazole [Nizoral, Extina] have not been known to worsen this condition; therefore, they are not contraindicated in porphyrias. A nurse is teaching a group of patients regarding flu season in the United States. Which statement should the nurse include in the teaching? 1 "To ensure full protection, the best time to vaccinate is September." 2 "In the United States, flu season usually peaks in October or November." 3 "For people who missed the best time, vaccinating as late as April may be of help." 4 "The influenza vaccine may not be administered at the same time as the pneumococcal vaccine." - Correct Answer-3) "For people who missed the best time, vaccinating as late as April may be of help." Peak flu season in the United States is usually January or February. To ensure full protection, the best time to vaccinate A client tells the nurse that he is concerned about developing hepatitis after being exposed to contaminated feces, saliva, and food. The nurse is aware that the client is at risk for: a) Hepatitis A b) Hepatitis D c) Hepatitis B d) Hepatitis C - Correct Answer-a) Hepatitis A Hepatitis A is normally transmitted through the fecal-oral route by drinking contaminated milk or water and eating shellfish from infected waters. Hepatitis B is transmitted through infected blood or serum, hepatitis C is transmitted by recreational injection drug use, and hepatitis D occurs largely to persons at high risk for HBV infection. A client with a history of cancer that metastasized to the liver has arrived at the outpatient clinic to have a paracentesis performed. The physician anticipates that the client will have more than 5 L of fluid removed. The physician has prescribed intravenous albumin following the procedure. The client asks why she needs, "more fluids in my vein?" The nurse responds: a) "Albumin will stay in your blood vessels a long time so that you will not seep out more fluid in your belly for at least a few weeks." b) "After the albumin, your potassium level will stay steady and you should keep excess water weight off for several weeks." c) "Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water." d) "Albumin works like your diuretics to help you get rid of excess fluid thru your kidneys, it's - Correct Answer-c) "Albumin is a volume expander. Since a lot of fluid was removed, you have a decrease in your vascular volume, so without this albumin, your kidneys will try to reabsorb and hold onto water." Large-volume paracentesis (removal of 5 L or more of ascitic fluid) may be done in persons with massive ascites and pulmonary compromise. Because the removal of fluid produces a decrease in vascular volume along with increased plasma renin activity and aldosterone-mediated sodium and water reabsorption by the kidneys, a volume expander such as albumin usually is administered to maintain the effective circulating volume. The other distractors are all incorrect. The community health nurse is teaching about prevention of hepatitis A. Which of these groups does the nurse suggest will benefit from this vaccine? a) Those traveling to third world countries b) Those who have been recently exposed to hepatitis A c) Those working for the Centers for Disease Control and Prevention d) Homosexual women - Correct Answer-a) Those traveling to third world countries International hepatitis A vaccine is suggested for travelers to regions where sanitation is poor and endemic HAV infections are high, children living in communities with high rates of HAV infection, homosexually active men, and users of illicit drugs. A major factor in the development of hepatic encephalopathy is: a) Neurotoxin accumulation b) Hypersplenism c) High sodium level d) Steroid hormone deficiency - Correct Answer-a) Neurotoxin accumulation secreted in the GI tract. The liver does not have a primary role in the maintenance of acid--base or electrolyte balance. What laboratory markers are most commonly used to diagnose acute pancreatitis? a) Cholesterol and triglycerides b) Lipase and amylase c) Amylase and cholesterol d) Lipase and triglycerides - Correct Answer-b) Lipase and amylase Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. Cholesterol and triglycerides are not used as laboratory markers for acute pancreatitis. Ascites is an accumulation of fluid in the peritoneal cavity and usually occurs in advanced cirrhosis. What is the treatment of choice for ascites? a) Thoracentesis b) Paracentesis c) DDAVP d) Diuretics - Correct Answer-d) Diuretics Because of the many limitations in sodium restriction, the use of diuretics has become the mainstay of treatment for ascites. A paracentesis may be done if the diuretics do not correct the problem. A thoracentesis would never be done for ascites. DDAVP is given to decrease urine output, not increase it. The liver has many jobs. One of the most important functions of the liver is to cleanse the portal blood of old and defective blood cells, bacteria in the bloodstream, and any foreign material. Which cells in the liver are capable of removing bacteria and foreign material from the portal blood? a) Epstein cells b) Langerhans cells c) Kupffer cells d) Davidoff cells - Correct Answer-c) Kupffer cells Kupffer cells are reticuloendothelial cells that are capable of removing and phagocytizing old and defective blood cells, bacteria, and other foreign material from the portal blood as it flows through the sinusoid. Langerhans cells are stellate dendritic cells found mostly in the stratum spinosum of the epidermis. Epstein cells do not exist. Davidoff cells are large granular epithelial cells found in intestinal glands. When assessing the client with acute pancreatitis, which of these diagnostic tests, consistent with the disease, does the nurse anticipate will be altered? a) Creatine kinase b) Amylase and lipase c) The transaminases d) Glucose values - Correct Answer-b) Amylase and lipase Serum amylase and lipase are the laboratory markers most commonly used to establish a diagnosis of acute pancreatitis. The nurse is caring for a female client with cholelithiasis. When teaching the client about the disease, the nurse includes which of these points? a) "You have an inflammation of your gallbladder caused by an autoimmune process." b) "Gallstones have developed, which are typically composed of cholesterol." if the common bile duct becomes obstructed, manifestations will also include which of these? a) Hyperbilirubinemia b) Vomiting c) Ascites d) Hemorrhage - Correct Answer-a) Hyperbilirubinemia Choledocholithiasis, stones in the common duct, usually originate in the gallbladder, but can form spontaneously in the common duct. Bilirubinuria and an elevated serum bilirubin (hyperbilirubinemia) are present if the common duct is obstructed. With acute cholecystitis, approximately 75% of patients have vomiting. Ascites is common with late-stage liver failure rather than duct obstructions. Bleeding is associated with liver failure due to deficiency of clotting factors and acute pancreatitis due to activated enzymes causing fat necrosis and hemorrhage from the necrotic vessels. The physician suspects a client may have developed pancreatitis, and the physician has ordered laboratory blood work. Diagnosis-confirming results would identify: a) Change in platelet count and prothrombin level b) High serum amylase and lipase c) Chymotrypsin level and fibrinogen level d) Altered alkaline phosphatase and red blood cell count - Correct Answer-b) High serum amylase and lipase Laboratory criteria for the diagnosis of pancreatitis are serum amylase or lipase greater than three times the upper limit of normal. Altered alkaline phosphatase and prothrombin level may indicate liver disease. Chymotrypsin digests proteins in the intestine. The nurse is caring for a client who is a carrier of hepatitis B. Which of these does the nurse teach the family? a) "Something in your home causes him to 'carry' the virus to his body." b) "The tests your loved one took show he has had hepatitis B in the past." c) "A carrier state means the individual is at risk for sudden death." d) "Your loved one may not look ill, but the virus is present in his blood." - Correct Answer-d) "Your loved one may not look ill, but the virus is present in his blood." Infection with HBV and HCV can produce a carrier state in which the person does not have symptoms but harbors the virus and can therefore transmit the disease. What is considered the normal amount of serum bilirubin found in the blood? a) >1.8mg/dL b) 2mg/dL c) 1.7mg/dL d) <1.5mg/dL - Correct Answer-d) <1.5mg/dL Usually, only a small amount of bilirubin is found in the blood; the normal level of total serum bilirubin is A 16-year-old girl has been admitted to the emergency department after ingesting 20 g of acetaminophen (Tylenol) in a suicide attempt. The care team would recognize that this patient faces risk for which of these complications? a) Portal hypertension b) Toxic hepatitis c) Hepatitis D virus infection a) Yellow-tinged blood b) Increased energy c) Blood in the stool d) Yellow-tinged sclera - Correct Answer-d) Yellow-tinged sclera The icterus phase is reflected by development of jaundice of skin and sclera, liver tenderness and worsened prodromal symptoms. A client presents with epigastric pain, a mild fever, nausea, and vomiting. His history shows a previous episode with similar symptoms that reverted in 24 hours. This time the pain is not subsiding. What diagnosis is the most likely? a) Calculous cholecystitis b) Hepatitis C virus (HCV) c) Pancreatic cancer d) Cirrhosis - Correct Answer-a) Calculous cholecystitis Persons with calculous cholecystitis usually, but not always, have experienced previous episodes of biliary pain. Hepatitis, pancreatic cancer, and cirrhosis have very different symptoms. Which of the following signs and symptoms is most suggestive of acute cholecystitis? a) Fever and sudden abdominal distention b) Appearance of undigested fat in feces c) Nausea resulting in greenish vomitus d) Upper right quadrant or epigastric pain - Correct Answer-d) Upper right quadrant or epigastric pain Persons with acute cholecystitis usually experience an acute onset of upper right quadrant or epigastric pain. Nausea and vomiting are also common, although these are not specific to cholecystitis. Abdominal distention and steatorrhea are not key signs of acute cholecystitis. The nurse teaches the client that which of these contributed to his developing acute cholelithiasis? a) Chronic pancreatitis b) Excessive alcohol intake c) Stasis of bile d) Rapid elimination of bile - Correct Answer-c) Stasis of bile Three factors contribute to the formation of gallstones: abnormalities in the composition of bile, stasis of bile (rather than rapid elimination), and inflammation of the gallbladder. Inflammation of the gallbladder alters the absorptive characteristics of the mucosal layer, allowing excessive absorption of water and bile salts. Although a number of factors are associated with the development of acute pancreatitis, most cases result from gallstones (rather than cause gallstone formation) or alcohol abuse. Alcohol is known to be a potent stimulator of pancreatic secretions, and it also is known to cause partial obstruction of the sphincter of the pancreatic duct; alcohol intake is not a factor in the development of cholesterol or bilirubin stones. A client who has been diagnosed with acute symptomatic viral hepatitis is now in the icteric period. The nurse would expect the client to manifest: a) Severe anorexia b) Severe pruritus and liver tenderness c) Disappearance of jaundice d) Chills and fever - Correct Answer-b) Severe pruritus and liver tenderness c) Tremors of the hands d) Long muscle group atrophy - Correct Answer-a) Rapid onset of jaundice Alcoholic hepatitis is the intermediate stage between fatty changes and cirrhosis and is characterized by inflammation and necrosis of liver cells. The condition is always serious and sometimes fatal. The cardinal sign of alcoholic hepatitis is rapid onset of jaundice. Hand tremors are not specific to alcoholic hepatitis. Long muscle group atrophy can occur but is not the primary sign. Development of nodules is not caused by alcoholic hepatitis. The nurse is assessing a client who has just been admitted to the unit with a diagnosis of cholelithiasis. The nurse is aware that the client may manifest: a) Right upper quadrant pain b) Left lower quadrant pain c) Left upper quadrant pain d) Right lower quadrant pain - Correct Answer-a) Right upper quadrant pain The pain is usually located in the upper right quadrant or epigastric area and may be referred to the upper back, right shoulder, or midscapular region. Typically, the pain is abrupt in onset, increases steadily in intensity, persists for 2 to 8 hours, and is followed by soreness in the upper right quadrant. A patient with hypercholesterolemia is prescribed lovastatin [Mevacor]. After reviewing the patient's medical history, the nurse discovers that the medication is not safe to prescribe for the patient and reports this finding to the healthcare provider. What did the nurse find in the patient's medical history? 1 The patient has leukemia. 2 The patient has renal disease. 3 The patient has hepatic disease. 4 The patient has chronic pulmonary disease. - Correct Answer- 3) The patient has hepatic disease Lovastatin [Mevacor] can cause an increase in liver enzymes and should not be prescribed to patients with preexisting liver disease. Statins induce cell death in malignant cells. Cell death occurs via apoptosis and lovastatin [Mevacor] concentrations are used in the treatment of leukemia. Statins slow down the progress of chronic kidney disease by reducing kidney inflammation or improving the function of kidney tissues. Statins reduce chronic obstructive pulmonary disease (COPD).Lovastatin [Mevacor] can be prescribed to the patient with leukemia, renal disease and COPD. A patient receiving atorvastatin [Lipitor] therapy to reduce high cholesterol levels calls the clinic and reports, "I am experiencing severe pain in both my legs." What is the nurse's best response? 1 "Stop taking the drug and visit the clinic immediately." 2 "Continue taking the drug; leg pain is a common side effect." 3 "Stop taking the drug if the symptoms persist for another week." 4 A patient with cardiovascular disease is taking rosuvastatin [Crestor]. Which finding would indicate a potential adverse effect of this drug? 1 Muscle pain and tenderness 2 Platelet count of 100 × 103/mm3 3 Blood pressure of 140/90 mm Hg 4 Wheezing and shortness of breath - Correct Answer-1) Muscle pain and tenderness The statins, such as rosuvastatin [Crestor], typically are well tolerated; however, in rare cases they can cause the serious adverse effect of myopathy and rhabdomyolysis. If unexplained muscle pain and tenderness develop, the prescriber should be notified. The other effects would not likely be caused by rosuvastatin [Crestor]. A patient is taking pravastatin sodium [Pravachol]. Which assessment finding requires immediate action by the nurse? 1 Fatigue 2 Headache 3 Muscle pain 4 Slight nausea - Correct Answer-3) Muscle pain Patients who experience severe muscle pain while taking pravastatin sodium [Pravachol] need to report the findings right away as this may be indicative of rhabdomyolysis, a muscle disintegration that can become fatal. Headaches, slight nausea, and fatigue are not high priority symptoms and may not be caused by the medication. Muscle pain is the only one that is most likely caused by the medication. When teaching the nursing student about coronary heart disease, which statement will the nurse include in the session? 1 "Coronary heart disease occurs due to the formation of atherosclerotic plaques." 2 "Coronary heart disease cannot be prevented by changing lifestyle modifications." 3 "Coronary heart disease is due to decreases in the cholesterol levels to below 200 mg/dL." 4 "Coronary heart disease is nonlethal and cannot be prevented by antilipemic medications." - Correct Answer-1) "Coronary heart disease occurs due to the formation of atherosclerotic plaques." Coronary heart disease (CHD) occurs due to the formation of atherosclerotic plaques inside the walls of the coronary arteries. CHD is lethal and can be prevented by antilipemic medications that lower the serum cholesterol levels, if diagnosed early. Antilipemic therapy is used as primary prevention in patients with known risk factors for CHD. Cholesterol levels above 200 mg/dL increase the risk for developing coronary artery disease. The risk of CHD also increases with an unhealthy lifestyle, which should be modified. The serum cholesterol level of 250 mg/dL and the triglyceride levels of 450 mg/dL indicate that the patient has type IV hyperlipidemia. These patients have elevated VLDL levels. Gemfibrozil [Lopid] activates the enzyme lipoprotein lipase, an enzyme responsible for the breakdown of cholesterol. This drug decreases the very-low-density lipoproteins and increases the levels of LDL. A decrease in LDL levels occurs upon further continuation of the drug. Gemfibrozil [Lopid] increases HDL levels by converting LDL to HDL. However, in this case HDL remains unchanged at the time of the serum test. The serum levels of VLDL are decreased by gemfibrozil [Lopid] due to the activation of the enzyme lipoprotein lipase that converts VLDL to LDL. What is the mechanism of action of ezetimibe [Zetia]? 1 It inhibits the biosynthesis of cholesterol in the liver. 2 It decreases the adhesion of cholesterol on the arterial walls. 3 It inhibits absorption of dietary and biliary cholesterol in the small intestine. 4 It inhibits the absorption of bile thus causing the liver to produce bile from cholesterol. - Correct Answer-3) It inhibits absorption of dietary and biliary cholesterol in the small intestine. Ezetimibe [Zetia] works by selectively inhibiting the absorption of cholesterol and related sterols in the small intestine. The mechanism of action of ezetimibe [Zetia] does not involve the liver or arterial walls. Which statement made by the patient indicates to the nurse that understanding of the discharge instructions on antihyperlipidemic medications has occurred? 1 "I will stop taking the medication if it causes nausea and vomiting." 2 "It is important to double my dose if I miss one in order to maintain therapeutic blood levels." 3 "I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels." 4 "Antihyperlipidemic medications will replace the other interventions I have been doing to try to decrease my cholesterol." - Correct Answer-3) "I will continue to modify my diet and keep exercising to help increase my high-density lipoprotein serum levels." Antihyperlipidemic medications are an addition to, not a replacement for, the therapeutic regimen of diet modification combined with exercise that is used to decrease serum cholesterol levels. The dose should never be doubled if one is missed nor stopped due to side effects. If the medication causes nausea or vomiting, the healthcare provider should be notified. When will the nurse administer hydroxymethylglutaryl- coenzyme A (HMG-CoA) reductase inhibitors (statins)? 1 In the evening 2 With breakfast 3 With an antacid 4 The patient should realize that loss of folic acid can cause spina bifida in the developing fetus as well as other neural tube defects. The patient should continue dosing as scheduled and should not double the dose if a dose is missed. Anemia is not the only risk, as there are various risks to the fetus. A patient who has received iron dextran is complaining of chest pain. What is the nurse's best action? 1 Call a code. 2 Administer an antacid. 3 Administer a respiratory treatment. 4 Consult with the healthcare provider to assess the ECG. - Correct Answer-4) Consult with the healthcare provider to assess the ECG. Circulatory failure and cardiac arrest can occur in the administrationration of iron dextran. The nurse should consult with the healthcare provider to assess the electrocardiogram (ECG) to look for a myocardial infarction. The nurse should also assess the patient's pain intensity. A patient being treated for pernicious anemia with cyanocobalamin, the patient reports new onset of muscle weakness and states, "My heart is skipping beats." Which laboratory value most likely is contributing to these new symptoms? 1 Serum chloride level of 98 mEq/L 2 Serum sodium level of 133 mEq/L 3 Serum glucose level of 185 mg/dL 4 Serum potassium level of 2.3 mEq/L - Correct Answer-4) Serum potassium level of 2.3 mEq/L Potassium depletion (hypokalemia) may occur as a natural consequence of erythrocyte production. Because erythrocytes incorporate significant amounts of potassium and a large number of erythrocytes are being produced, potassium levels may fall. A serum potassium level of 2.3 mEq/L indicates hypokalemia. The sodium, chloride, and blood glucose levels are not affected. A patient cannot take oral cyanocobalamin. Which is an appropriate intervention? 1 Administer an antidote. 2 Administer an antihistimine. 3 Prepare the patient for surgery. 4 Administer intranasal cyanocobalamin. - Correct Answer-4) Administer intranasal cyanocobalamin. Intranasal administration is an alternative to to oral, intramuscular, or even subcutaneous injection for people who cannot take cyanocobalamin by mouth. There is no need for surgery, an antihistamine, or antidote. Chloride 4 Potassium - Correct Answer-4) Potassium Potassium depletion (hypokalemia) may occur as a natural consequence of erythrocyte production. Because erythrocytes incorporate significant amounts of potassium and a large number of erythrocytes are being produced, potassium levels may fall. The other electrolytes are not affected. Which instructions should the nurse include in the plan of care for a patient receiving ferrous sulfate therapy? 1 "Iron does not absorb." 2 "Iron should only be taken at night." 3 "Iron compounds are not taken orally." 4 "Antacids should not be taken with iron." - Correct Answer-4) "Antacids should not be taken with iron." Antacids can decrease the absorption of iron. Iron is typically taken in the morning. It is absorbed readily and is taken orally. Which patient will benefit most from prophylactic iron therapy? 1 A teenage girl 2 An elderly patient 3 A pregnant woman 4 An adolescent boy - Correct Answer-3) A pregnant woman Pregnant women are the principal candidates for prophylactic iron therapy as iron is needed for fetal growth. Other candidates are infants, children, and women experiencing menorrhagia. A large number of megaloblasts are seen in the patient's lab results. What should the nurse teach the patient? 1 This is a normal finding. 2 This is a result of B12 deficiency. 3 Megaloblasts are oversized white cells. 4 This could be caused by chronic kidney disease. - Correct Answer-2) This is a result of B12 deficiency. The most conspicuous consequence of B12 deficiency is anemia, in which large numbers of megaloblasts (oversized erythroblasts) appear in the bone marrow and macrocytes (oversized erythrocytes) appear in the blood. A patient with hemophilia is frightened about contracting human immunodeficiency virus (HIV) from therapy. How should the nurse respond to the patient? 1 "This is a risk." 2 "All blood is screened for viruses." 3 causes irreversible inhibition of platelet aggregation and can thus increase bleeding risk. Aspirin can also induce gastrointestinal ulceration and bleeding, an obvious problem. The nurse is assessing a patient with hemophilia for complications of clotting factor administration. Which assessment findings would indicate an adverse effect of this treatment? Select all that apply. A Hives and urticaria B Bethesda titer of 40 units C Creatinine level of 2.5 mg/dL D Potassium level of 3.2 mEq/L E Alkaline phosphatase of 303 units/L - Correct Answer-A) Hives and urticaria B) Bethesda titer of 40 units Complications of clotting factor administration include allergic reactions, which can range from mild to anaphylactic, and the development of antibodies against the factor (known as inhibitors). Hives and urticaria indicate an allergic reaction. The Bethesda assay titers are used to detect the presence of inhibitors. Clotting factor administration is not associated with hypokalemia, renal dysfunction (elevated creatinine), or liver dysfunction (elevated alkaline phosphatase). The nurse teaches a patient about therapy for hemophilia. What should be included in the plan? 1 Treatment can cure the disease. 2 Treatment with factor VIII or IX is preferred. 3 Antifibrinolytic drugs are the mainstay of therapy. 4 Replacement therapy should only occur during acute episodes. - Correct Answer-2) Treatment with factor VIII or IX is preferred. Treatment with factor replacement is the preferred treatment for patients with hemophilia. Replacement therapy is prescribed prophylactically. Antifibrinolytic drugs are used as adjunct treatment. Medication therapy does not cure the patient. Hemophilia is a genetically based bleeding disorder seen almost exclusively in which patients? 1 Males 2 Females 3 Hispanics 4 Caucasians - Correct Answer-1) Males Hemophilia is a genetically based bleeding disorder seen almost exclusively in males. Because males have only one X chromosome, a male with a defective gene has hemophilia. In contrast, a female with a defective gene on just one X chromosome is an asymptomatic carrier. opioids such as codeine and MS Contin. Mild pain can be treated with Tylenol. What should the nurse recommend in relation to immunizations for a child with hemophilia? 1 Start immunizations as an adult. 2 Administer only inhaled immunizations. 3 Avoid immunization due to the risk of bleeding. 4 Have immunizations administered intramuscularly. - Correct Answer-4) Have immunizations administered intramuscularly. Children with hemophilia should undergo the normal immunization schedule. Some clinicians inject vaccines subQ, rather than IM, to avoid muscle hemorrhage. However, since the efficacy of subQ vaccination is not certain, and since most patients tolerate IM injections without bleeding, IM vaccination is generally preferred. The risk of bleeding after IM injection can be reduced by prolonged application of pressure. The patient has been placed on aspirin as an antiplatelet drug. Which side effect is the patient most likely to experience? 1) Itching 2) Edema 3) Nausea 4) Chest pain - Correct Answer-3) Nausea Nausea accompanied by vomiting is an expected side effect of treatment with aspirin. Chest pain, edema, and itching are side effects that are more likely to be seen with the use of clopidogrel. In which patient would a low-dose aspirin be contraindicated? 1 A patient with thrombosis 2 A patient with a heart problem 3 A patient with a hemorrhagic stroke 4 A patient with a deep vein thrombosis - Correct Answer-3) A patient with a hemorrhagic stroke The patient contraindicated to take a low-dose aspirin is the patient with a hemorrhagic stroke. The patient with a thrombosis, deep vein thrombosis, and a heart problem would benefit from a low-dose aspirin. A patient is receiving warfarin [Coumadin] for a chronic condition. Which patient statement requires immediate action by the nurse? 1 "I will avoid contact sports." 2 "I will take my medication at the same time each day." 3 "I will increase dark green, leafy vegetables in my diet." 4 "I will contact my healthcare provider if I develop excessive bruising." - Correct Answer-3) "I will increase dark green, leafy vegetables in my diet." A patient who is receiving heparin therapy has bruises covering the abdomen as well as red-colored urine. What does the nurse need to assess? 1 Urine culture 2 Platelet level 3 Over-the-counter medications 4 Ingestion of acetaminophen [Tylenol] - Correct Answer-2) Platelet level The patient's platelet level should be assessed when he or she receives heparin and then develops bruises and blood in the urine. The patient may have type II heparin-induced thrombocytopenia (HIT). The patient's medication would need to be changed. Although over-the-counter medications may potentiate bleeding, they are not likely to cause these symptoms. Acetaminophen and urinary tract infections should not cause these symptoms. The laboratory calls to report a drop in the platelet count to 90,000/mm3 for a patient receiving heparin for the treatment of postoperative deep vein thrombosis (DVT). Which action by the nurse is the most appropriate? 1 Obtain vitamin K and prepare to administer it by intramuscular (IM) injection. 2 Notify the healthcare provider to discuss the reduction or withdrawal of heparin. 3 Observe the patient and monitor the activated partial thromboplastin time (aPTT) as indicated. 4 Call the healthcare provider to discuss increasing the heparin dose to achieve a therapeutic level. - Correct Answer-2) Notify the healthcare provider to discuss the reduction or withdrawal of heparin. The nurse should notify the healthcare provider to discuss the reduction or withdrawal of heparin. Heparin-induced thrombocytopenia (HIT) is a potential immune-mediated adverse effect of heparin infusions that can prove fatal. HIT is suspected when the platelet counts fall significantly. A platelet count below 100,000/mm3 would warrant discontinuation of the heparin. A patient who was admitted with deep vein thrombophlebitis is complaining of difficulty breathing and chest pain. What is the most likely cause of these symptoms? 1 Anxiety 2 Medication reaction 3 Embolus to the lungs 4 Fatigue from the extra work of walking with pain - Correct Answer-3) Embolus to the lungs A thrombus can become an embolus and travel to the lungs. This pulmonary embolus can cause chest pain and difficulty breathing. It is not likely that fatigue, anxiety, or a medication reaction would cause chest pain and dyspnea in this case. with no instruction other than to simply refer the patient to the healthcare provider. A patient who has been taking warfarin [Coumadin] is admitted with coffee-ground emesis. What can the nurse anticipate being prescribed for this patient? 1 Vitamin E 2 Vitamin K 3 Protamine sulfate 4 Calcium gluconate - Correct Answer-2) Vitamin K Vitamin K is the antagonist for warfarin. If a heparin overdose occurs, the antidote is protamine sulfate. Vitamin E and calcium gluconate are not used to counteract the effects of warfarin. The patient is scheduled to receive argatroban. Which is the correct route by which to administer the drug? 1 Intradermal 2 Intravenous 3 Intramuscular 4 Subcutaneous - Correct Answer-2) Intravenous Argatroban is given only by the intravenous route. A nurse sends a blood sample to the lab for analysis. Assuming the sample is normal, the nurse anticipates which of the following white blood cells (WBCs) will account for the highest percentage? a) Monocytes b) Eosinophils c) Lymphocytes d) Neutrophils - Correct Answer-d) Neutrophils Neutrophils constitute 55-65% of the total WBCs. A 16-year-old male client who has been diagnosed with infectious mononucleosis asks the health care provider what caused the condition. The best response would be: a) Abnormal cell nucleus development b) Epstein-Barr virus (EBV) c) Human immunodeficiency virus (HIV) d) Non-Hodgkin lymphoma - Correct Answer-b) Epstein-Barr virus (EBV) EBV is the usual causative factor that results in the development of infectious mononucleosis. People with HIV may be at more risk for contacting mononucleosis. EBV may contribute to lymphoproliferative disorders, such as non- Hodgkin lymphoma. Select the option that best describes the production of T lymphocytes. a) Bone marrow - thymus - lymph nodes b) Bone marrow - plasma cells - lymph nodes c) Plasma cells - lymph nodes - arteries