RPN Integrated Test VIII A.docx

RPN Integrated Test VIII A.docx

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RPNIntegratedTestVIIIA

RPNIntegratedTestVIII（A）:

1.Peterisyoungathlete,preparingfortheOlympiccompetition,injureshiskneeonpractice.Thedoctorprescribes

Ibuprofen（Advil）forpainandtoreduceinflammation.Peterwentfora3-weektherapy.Onhis3rdweek,he

noticespetechiaealloverhisskin,andhisbloodtestshowedaplateletcountof9,000mm³.ThePNcanexpectthat

a.thepatientwillbeabletocontinuetherapywiththismedication–duetothesideeffect（bleeding–plateletdeceased）ofthedrug,itshouldbediscontinued

b.thedosagewillbereducedfrom3to2tabletsaday

c.themedicationwillbediscontinuedandanalternativeagentwillbeprescribed

d.thelabstudieswillberepeated,astheyarelikelyanerror

Answer:

C–petechiaearesignsofbleeding,acomplicationofMotrin（Ibuprofen）;themedicationmustbediscontinued

2.Inthe12thweekofgestation,thepatientcompletelyexpelstheproductsofconception.BecausethepatientisRh

（-）,thePNmust:

a.AdministerRhoGamwithin72hoursafterdelivery

b.MakecertainshereceivesRhoGamonherfirstclinicvisit–thisistoolate

c.NotgiveRhoGamsinceitisnotusedwiththebirthofastillborn

d.MakecertainthepatientdoesnotreceiveRhoGamsincethegestationwasonly12weeks

Answer:

A–thisistoprotectthesucceedingpregnancy;–RhoGammustbegivenwithin72hoursofabortionordeliverytokilltheRhpositiveRBCfromthefetusandthuspreventantibodyformation

3.ThePNwhoworksonthenightshiftentersthemedicationroomandfindsaco-workerwithtourniquetwrapped

aroundtheupperarm.Theco-workerwasabouttoinsertaneedle,attachedtoasyringecontainingaclearliquid,

intotheantecubitalarea.ThemostappropriateinitialactionbythePNiswhichofthefollowing?

a.calloneofthestafftowitness

b.confrontyourco-worker

c.obtainimmediatehelp

d.callthenursingsupervisor

Answer:

D-thenurseshouldreportthesituationtothenursingsupervisor.Properchannelofcommunicationshouldbeusedtodealwithlegalmatters.

4.ThreedaysafteradmissionforCVA,apatienthasanasogastrictubeinsertedandisreceivingintermittent

feedings.Tobestevaluateifapriorfeedinghasbeenabsorbed,thePNshould:

a.Evaluatetheintakeinrelationtotheoutput.

b.Aspirateforaresidualvolumeandreinstillit.

c.Instillairintothestomachwhileauscultating.

d.Comparethepatient’sbodyweighttothebaselinedata.

Answer:

B–thepresenceof50mlormoreofundigestedformulamayindicateimpairedabsorption;thevolumeofthenextfeedingmayneedtobereducedorthefeedingpostponedtoreducingtheriskofaspiration.

5.Themosttherapeuticdietforapatientwithhepaticcirrhosiswouldbe:

a.Highprotein,lowcarbohydrate,lowfat.

b.Lowprotein,lowcarbohydrate,highfat,soft.

c.Highcarbohydrate,lowsaturatedfat,1200calories.

d.Lowsodium,proteintotolerance,moderatefat,highcalorie,soft.

Answer:

D–lowsodiumcontrolsfluidretention,bloodpressure,andconsequentlyedema;lowproteincontrolsammoniaformationinproportiontotheliver’sabilitytodetoxifyammoniainformingurea;moderatefatandhighcaloriesandvitaminshelprepairalongstandingnutritionaldeficit.

6.Topreventtoxoplamosis,thePNshouldinstructtoavoid:

a.Contactwithcatfeces

b.Workingwithheavymetals

c.Ingestionoffreshwaterfish

d.Excessiveradiationexposure

Answer:

A-Toxoplasmagondii,aprotozoan,canbetransmittedbyexposuretoinfectedcatfecesoringestionofundercookedcontaminatedmeat.

7.JohnSherman’smedicalhistoryincludesRCVA.Hehasdifficultyswallowing.ThePNtakingcareofthepatient

willappropriatelydothefollowing:

a.Offerpureeddietandspoonfeedthepatient

b.Usestrawandinstructthepatienttodrinkoneglassofwater

c.EncourageMrs.Shermantobringhome-cookedfoodsothepatientcaneathisfavoritefoods

d.Encouragethepatienttofeedhimselfwithhisgoodhand

d.Important,pertinentandrelevantdatafromanotherhospiceinthecommunity.

8.InassessinganinfantforcongenitalhipdysplasiathePNwouldobservefor:

a.Unevenglutealfolds

b.PositiveBabinskireflex

c.Painwhenmovingthelowerextremities

d.Weaknessontheaffectedside

Answer:

A–Unevenglutealfoldsareanindicationthatonehipisdislocated

.

9.Beforeeatingameal,aclientwithobsessive-compulsivebehaviormustwashhishandsfor18times,combshishair444timesstrokes,andswitchthebathroomlightonandoff44times.Whatisthemostappropriatelongtermtreatmentgoalforthisclient?

a.omitoneunacceptablebehavioreachday

b.increaseclient’sacceptanceoftherapeuticdruguse

c.allowampletimefortheclienttocompleteallritualsbeforeeachmeal

d.systematicallydecreasetheamountoftimespentinandthenumberofrepetitionsofrituals--

10.A16-year-oldpatientwhosustainedpartialthicknessburnonbothhandsandleftlowerabdomenwithtotalof

36%burn.Thepatientunderwentskingrafting.VitalsignsareBP124/68;HR100bpm;RR24;T37.7ºC,

potentialcomplicationthatcanbepossiblydevelopwillbe:

a.Sepsis-skingraftingmaypredisposethepatienttosepticemia

b.Hypovolemic–thiswillnothappenfromskingrafting

c.Pain–thisisexpectedandnotacomplication

d.Electrolyteimbalance–thiswillnotoccurinskingrafting

11.Aclientadmittedcompletelyimmobilizedbyanacuteexacerbationofmultiplesclerosis.Twodaysafter

admission,theclientcriesfrequentlyandrefusestoseefamilymembers.Forthisclient,thePNidentifiesa

nursingdiagnosisofhopelessness.Toaddressthisdiagnosis,whichinterventionshouldthePNincludeinthe

client’scareplan?

a.Obtainanorderforatranquilizer–thisisnotanappropriatetreatmenttoadepressedpatient

b.Limitvisitorsto15minutesperday–socializationisencouragedindepression

c.Encouragetheclienttoverbalizehisfeelings–thisdecreasesanxietylevel

d.Reinforcetheclient’sresponsibilitytothefamily

12.A29-year-old-first-timemothercameforher6-weekpostpartumcheckup.Her,husband,whoaccompaniesher

tothevisit,reportsthathiswifeistearfulmuchofthetime.Shehasnotbeensleepingwell,haslittleenergy,and

areducedappetite.Shedeniesanysuicidalthought,hallucinationsorfeelingsthatshewantstoharmherbaby.

Whichofthefollowingisthemostlikelydiagnosis?

a.Maternalpostpartumblues

b.Postpartumpsychosis

c.Postpartumdepression

d.Normalresponsetotheoverwhelmingresponsibilitiesofmotherhood

Answer:

C–thisispostpartumdepression.Thesymptomsareidenticaltothoseofamajordepressiveepisode.Thematernalbluesisselflimitedthatstartsinthepostpartumweekandresolvedinthesecond.Thepatientdoesnothaveanysymptomsofpostpartumpsychosis–mania,hallucination,anddelusion.Managementincludemedication,counsellingandclosefollowup.

13.Whichnursinginterventionismostimportantwhencaringforaclientwithacutepyelonephritis?

a.Administersitzbathtwicedaily

b.Increasethefluidintaketo3Quartsperday

c.Useanindwellingcathetertomeasureoutputaccurately

d.Encouragetheclienttodrinkcranberryjuicetoacidifytheurine–thisacidifyurine;alkalineurineisonecauseofUTI（pyelonephritis）

14.Aclientadmittedwithincreasedascitesassociatedwithcirrhosis.Whichnursingdiagnosisshouldreceivetop

priority?

a.Fatigue-thismaynotbeduetoascites

b.Excessfluidvolume

c.Ineffectivebreathingpattern–thedistendedabdomen（ascites）pushesthediaphragmupcausing

SOB

d.Imbalancednutritionlessthanbodyrequirements

15.Oralhypoglycemicagentsmaybeusedforpatientswith:

a.Ketosis–thisisduetohyperglycemia

b.Obesity–notrelated

c.TypeIDM–usesinsulin

d.Someinsulinproduction

Answer:

D–oralhypoglycemicsmaybehelpfulwhensomefunctioningofthebetacellsexists,asintypeIIDM.

16.Adiabeticyoungdiabeticcametotheclinicfororalcontraceptive.Whichofthefollowingresponsesmadeby

thePNisappropriate?

a.“Let’sdiscussthevariousmethodsofcontraceptive”

b.“Oralcontraceptivesarenotappropriateforyourmedicalcondition”–oralcontraceptivesarefamilyofsteroidsandincreasesbloodsugar

c.“Youcanprobablyusecondom”

d.“Youneedtoconsultthephysician”

17.Dianabroughthermothertothelongtermfacility.ThePNwantedtointerviewthedaughterbutthepatient

startedcrying.WhatshouldthePNdo?

a.Leavethemaloneforsometimethencomebackwhenthepatientisfeelingbetter–thepatientmaynotfeelbetterrightaway

b.Leavethemaloneforsometimeandallowthepatienttoregainherself-esteemandcomebacklater–thismaytakesometimetohappen

c.Leavethemaloneforsometimeandletthepatientcomposeherselfandcomebacklatertodotheinterview-thisisanappropriate–oncecomposureisregain,thepatientmaybeabletocooperatewiththeinterview

d.ExplaintothedaughterthattheRNneedstodotheinterviewrightnow

18.Marionisa43-year-oldfemalepatientwhowasadmittedwithadiagnosisofdepression.Whenworking

withthepatientwhoisdepressed,thePNshouldinitially:

a.Acceptthepatientforwhatsheis.–unconditionalacceptanceofthepatientismostimportantinestablishingthenurse-clientrelationship

b.Attempttodivertthepatient’sattention.

c.Admitthepatientinaprivateroom.

d.Encouragethepatienttojoinotherpatientsinthepatients’lounge.

Answer:

A–acceptingthepatientforsheisanimportantelementinbuildingtrustingrelationship.

19.Edgarisa24-year-oldm