Medical Exam Questions And Answers

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Medical Exam Questions And Answers - Quiz

Do you know what are the symptoms of Anaemia? Do you know how to treat a person with Diarrhea? Check out our online quiz to test yourself and learn more information.


Questions and Answers
  • 1. 

    You admit a 23 yr old african american female patient w/ a diagnosis of rule-out anemia. She has a hx of gastric bypass surgery for obesity 4 yrs ago. Current assessment findings are P 110, R 27, BP 104/66, pale mucous membranes and dyspnea upon exertion. Which type of anemia would you expect the patient has developed?

    • A.

      Vit B12 deficiency

    • B.

      Folic acid deficiency

    • C.

      Iron deficiency

    • D.

      Sickle cell anemia

    Correct Answer
    A. Vit B12 deficiency
    Explanation
    The rugae in the stomach produces IF to allow the body to use B12. Gastric bypass reduces the amount of rugae drastically.

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  • 2. 

    The patient dx with menorrhagia complains to the nurse of feeling listless and tired all the time. Which scientific rationale would explain why these symptoms are happening?

    • A.

      Pain from menorrhea does not allow the patient to rest

    • B.

      The symptoms are unrelated to menorrhea

    • C.

      Pt has been exposed to a virus that causes fatigue

    • D.

      The menorrhea has caused the patient to have decreased hemoglobin

    Correct Answer
    D. The menorrhea has caused the patient to have decreased hemoglobin
    Explanation
    Menorrhagia is excessive blood loss during the menses. If blood loss is severe, then the patient will not have the blood's oxygen carrying capacity needed for daily activities. The most frequent symptom and complication of anemia is fatigue.

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  • 3. 

    SATA. You write a dx of altered tissue perfusion for your patient dx with anemia. Which interventions should you include

    • A.

      Monitor hb and hct

    • B.

      Move the patient closer to the nurse's station.

    • C.

      Limit intake of green veggies

    • D.

      Assess for numbness and tingling

    • E.

      Allow for periods of rest during the day

    Correct Answer(s)
    A. Monitor hb and hct
    B. Move the patient closer to the nurse's station.
    D. Assess for numbness and tingling
    E. Allow for periods of rest during the day
    Explanation
    Nurse should monitor hb and act in all patients dx with anemia. Decreased O2 levels can cause confusion and safety issues so the patient should be near the nurses station. Numbness and tingling is a near symptom of anemia. Fatigue is the most common symptom of anemia.

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  • 4. 

    A patient that has dx of iron deficiency anemia is prescribed ferrous gluconate orally. Which should the nurse educate on.

    • A.

      Take ammonium for diarrhea

    • B.

      Limit exercise until tolerance is achieved

    • C.

      Stool may be very dark and can mask appearance of blood

    • D.

      Eat only red meat.

    Correct Answer
    C. Stool may be very dark and can mask appearance of blood
    Explanation
    Stool will be a dark-green black, which can mask appearance of blood in stool

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  • 5. 

    The nurse and a UAP are taking care of patients. What task can the nurse delegate?

    • A.

      Check on the bowel movements of a patient with melena

    • B.

      Take vitals of a patient who received blood a day prior

    • C.

      Eval dietary intake of a patient who is noncompliant with eating.

    • D.

      Shave the patient with a dx of severe hemolytic anemia

    Correct Answer
    B. Take vitals of a patient who received blood a day prior
    Explanation
    The UAP can take vitals of a stable patient.

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  • 6. 

    A patient is being admitted with a dx of folic acid deficiency anemia. Which is the most appropriate referral?

    • A.

      Alcoholic anonymous

    • B.

      Leukemia Society of America

    • C.

      A hematologist

    • D.

      A social worker

    Correct Answer
    A. Alcoholic anonymous
    Explanation
    Most patients dx with folic acid deficiency anemia have developed anemia from chronic ETOH abuse.

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  • 7. 

    The charge nurse is making assignments on a medical floor. Which patient should be assigned to the most experienced nurse?

    • A.

      A patient dx with iron-deficiency anemia and is prescribed iron supplements.

    • B.

      A patient dx with pernicious anemia and is receiving B12 shots IM.

    • C.

      A patient dx with aplastic anemia who has developed pancytopenia.

    • D.

      A patient dx with renal disease who has an erythropoietin deficiency.

    Correct Answer
    C. A patient dx with aplastic anemia who has developed pancytopenia.
    Explanation
    Pancytopenia develops when the bone marrow is not able to produce cells of any kind. The patient has anemia, thrombocytopenia, and leukopenia. This pt could develop an infection or hemorrhage, have CHF, or other complications.

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  • 8. 

    A patient dx with anemia begins to c/o dyspnea when ambulating. Which intervention should you implement first?

    • A.

      Apply oxygen using a nasal cannula.

    • B.

      Get a wheelchair.

    • C.

      Assess the patient's lung fields.

    • D.

      Assist the patient when ambulating in the hall.

    Correct Answer
    B. Get a wheelchair.
    Explanation
    The patient has dyspnea upon exertion which is common for patients with anemia.

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  • 9. 

    You are discharging a patient dx with anemia. What should you educate on?

    • A.

      Take prescribed iron supplements until gone.

    • B.

      Monitor pulse and BP at a local pharmacy weekly.

    • C.

      Have a CBC checked at the HCP office.

    • D.

      Perform isometric exercise three times a week

    Correct Answer
    C. Have a CBC checked at the HCP office.
    Explanation
    The patient should have a CBC regularly to determine status of anemia.

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  • 10. 

    You write a client problem of activity intolerance for a patient dx with anemia. Which intervention should you implement?

    • A.

      Pace activities according to tolerance.

    • B.

      Provide supplements high in iron and vitamins

    • C.

      Administer packed RBCs

    • D.

      Monitor vitals q4hrs

    Correct Answer
    A. Pace activities according to tolerance.
    Explanation
    The patient's problem is activity intolerance and pacing of activities directly affects the diagnosis.

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  • 11. 

    Mild anemia has which as a symptom

    • A.

      Asymptomatic

    • B.

      Cardiopulmonary symptoms at rest

    • C.

      Multi-system problems

    • D.

      Extreme pallor

    Correct Answer
    A. Asymptomatic
    Explanation
    Mild anemia is characterized by a low red blood cell count or hemoglobin level, but it does not typically cause noticeable symptoms. Asymptomatic means that there are no apparent signs or symptoms of the condition. Therefore, it is the correct answer for mild anemia as it aligns with the fact that it does not cause any noticeable symptoms in most cases.

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  • 12. 

    Moderate anemia has which as a symptom

    • A.

      Asymptomatic

    • B.

      Cardiopulmonary symptoms at rest

    • C.

      Multi-system problems

    Correct Answer
    B. Cardiopulmonary symptoms at rest
    Explanation
    Moderate anemia is characterized by a decrease in the number of red blood cells or a decrease in hemoglobin levels. Cardiopulmonary symptoms at rest are commonly observed in individuals with moderate anemia. These symptoms may include shortness of breath, rapid heartbeat, chest pain, and fatigue. The reduced oxygen-carrying capacity of the blood in moderate anemia can lead to inadequate oxygen supply to the tissues, causing these cardiopulmonary symptoms to occur even during rest.

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  • 13. 

    Severe anemia has which symptoms

    • A.

      Asymptomatic

    • B.

      Cardiopulmonary symptoms at rest

    • C.

      Multi-organ problems

    Correct Answer
    C. Multi-organ problems
    Explanation
    Severe anemia can lead to multi-organ problems because it results in a decreased amount of oxygen being carried to various organs and tissues in the body. This lack of oxygen can cause dysfunction and damage in multiple organs, leading to symptoms such as fatigue, weakness, shortness of breath, dizziness, pale skin, and rapid heartbeat. The organs most commonly affected by severe anemia include the heart, lungs, brain, and kidneys. Additionally, severe anemia can also lead to complications such as heart failure, stroke, and kidney failure.

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  • 14. 

    Which type of anemia is this? Inadequate dietary intake, malabsorption

    • A.

      Iron-deficiency anemia

    • B.

      Acute blood loss 

    • C.

      Chronic blood loss

    • D.

      Vit B12 deficiency

    Correct Answer
    A. Iron-deficiency anemia
    Explanation
    Iron-deficiency anemia is the correct answer because inadequate dietary intake and malabsorption are both common causes of iron deficiency. Iron is an essential component of hemoglobin, the protein in red blood cells that carries oxygen to the body's tissues. When there is insufficient iron in the body, it leads to a decrease in the production of healthy red blood cells, resulting in iron-deficiency anemia. Acute and chronic blood loss can also cause anemia, but the given information does not mention any bleeding. Vitamin B12 deficiency is not related to inadequate dietary intake or malabsorption, so it is not the correct answer.

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  • 15. 

    Which is a symptom of iron-deficiency anemia?

    • A.

      Pallor

    • B.

      Glossitis

    • C.

      Cheilitis

    • D.

      Pica

    • E.

      Internal pain

    • F.

      Impaired thought processes

    Correct Answer(s)
    A. Pallor
    B. Glossitis
    C. Cheilitis
    D. Pica
    Explanation
    Internal pain is a sx of acute blood loss and impaired though processes is a sx of folic acid deficiency anemia

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  • 16. 

    Which labs are most important in iron-deficiency anemia?

    • A.

      Hb

    • B.

      HCT

    • C.

      Platelets

    • D.

      Folate levels

    • E.

      Serum B12

    Correct Answer(s)
    A. Hb
    B. HCT
    C. Platelets
    Explanation
    The labs that are most important in iron-deficiency anemia are Hb (hemoglobin), HCT (hematocrit), and platelets. Hemoglobin and hematocrit levels are used to assess the severity of anemia and determine the need for treatment. Low platelet levels may indicate bleeding or other complications associated with iron-deficiency anemia. Folate levels and serum B12 are not specific to iron-deficiency anemia and may be useful in diagnosing other types of anemia.

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  • 17. 

    Can you use a stool guaiac test to diagnose iron-deficiency anemia?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    Yes, a stool guaiac test can be used to diagnose iron-deficiency anemia. This test detects the presence of blood in the stool, which can indicate bleeding in the gastrointestinal tract. Iron-deficiency anemia can be caused by chronic blood loss, and the stool guaiac test helps identify this underlying cause. Therefore, using a stool guaiac test is a valid method for diagnosing iron-deficiency anemia.

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  • 18. 

    Which -scopy can diagnose iron-deficiency anemia?

    • A.

      Endoscopy

    • B.

      Colonoscopy

    • C.

      Bronchoscopy

    • D.

      Cystoscopy

    Correct Answer(s)
    A. Endoscopy
    B. Colonoscopy
    Explanation
    Both endoscopy and colonoscopy can be used to diagnose iron-deficiency anemia. Endoscopy is a procedure that allows a doctor to examine the upper digestive system, including the esophagus, stomach, and small intestine. Colonoscopy, on the other hand, is a procedure that examines the large intestine and rectum. Iron-deficiency anemia can be caused by bleeding in the gastrointestinal tract, which can be detected and diagnosed through both endoscopy and colonoscopy.

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  • 19. 

    Which type of anemia is this? Result of sudden hemorrhage such as trauma or recent surgery

    • A.

      Iron-deficiency anemia

    • B.

      Acute blood loss

    • C.

      Chronic blood loss

    • D.

      Vitamin B12 deficiency

    • E.

      Folic acid deficiency anemia

    Correct Answer
    B. Acute blood loss
    Explanation
    This type of anemia is known as acute blood loss. Acute blood loss anemia occurs as a result of sudden hemorrhage, such as from trauma or recent surgery. This type of anemia is characterized by a rapid decrease in the number of red blood cells, leading to a decrease in the oxygen-carrying capacity of the blood. Treatment for acute blood loss anemia typically involves addressing the underlying cause of the hemorrhage and providing blood transfusions if necessary.

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  • 20. 

    What are s/sx of acute blood loss?

    • A.

      Increased HR

    • B.

      Increased RR

    • C.

      Internal pain

    • D.

      Numbness

    • E.

      Glossitis

    • F.

      Cheilitis

    Correct Answer(s)
    A. Increased HR
    B. Increased RR
    C. Internal pain
    D. Numbness
    Explanation
    The symptoms and signs of acute blood loss include increased heart rate (HR) and increased respiratory rate (RR) as the body tries to compensate for the loss of blood volume. Internal pain may be experienced due to organ ischemia or damage caused by inadequate blood supply. Numbness may occur as a result of reduced blood flow to certain areas of the body. Glossitis, which is inflammation of the tongue, and cheilitis, which is inflammation of the lips, are not typically associated with acute blood loss.

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  • 21. 

    You would do a CBC for acute blood loss. True or false?

    • A.

      True

    • B.

      False

    Correct Answer
    A. True
    Explanation
    A CBC (Complete Blood Count) is a common blood test that provides information about the different components of blood, such as red blood cells, white blood cells, and platelets. Acute blood loss can lead to a decrease in red blood cells, causing anemia. By performing a CBC, healthcare professionals can assess the levels of red blood cells and other blood components to diagnose and monitor acute blood loss. Therefore, it is true that a CBC would be done for acute blood loss.

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  • 22. 

    Which is a treatment for acute blood loss?

    • A.

      Surgery

    • B.

      B12 replacement therapy

    • C.

      Insertion of NG tube

    Correct Answer
    A. Surgery
    Explanation
    Surgery is the correct answer because it is a common treatment for acute blood loss. When a person experiences significant blood loss, surgery may be necessary to stop the bleeding and repair any damaged blood vessels or organs. This can involve procedures such as blood vessel ligation, blood transfusions, or even organ removal if necessary. Surgery allows for direct intervention and control of the bleeding source, making it an effective treatment option for acute blood loss.

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  • 23. 

    Which type of anemia is this? Ulcer caused by bacteria or alcoholism. Slow bleed from injury. Menses

    • A.

      Iron-deficiency anemia

    • B.

      Acute blood loss

    • C.

      Chronic blood loss

    • D.

      Vit B12 deficiency

    • E.

      Folic acid deficiency anemia

    Correct Answer
    C. Chronic blood loss
    Explanation
    The given answer, chronic blood loss, is the most appropriate explanation for the symptoms described. Chronic blood loss can occur due to conditions such as ulcers caused by bacteria or alcoholism, slow bleed from injury, or heavy menstrual bleeding. This type of anemia is characterized by a gradual decrease in red blood cell count over time, leading to a deficiency in iron stores and subsequent iron-deficiency anemia. Therefore, chronic blood loss is the most likely cause of the anemia in this case.

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  • 24. 

    What type of anemia is missing intrinsic factor?

    Correct Answer
    Pernicious anemia, pernicious,
    Explanation
    Pernicious anemia is a type of anemia that is characterized by the lack of intrinsic factor, a protein produced by the stomach that is necessary for the absorption of vitamin B12. Without intrinsic factor, the body is unable to properly absorb vitamin B12 from the diet, leading to a deficiency of this essential vitamin. This deficiency can result in a decrease in the production of healthy red blood cells, causing symptoms such as fatigue, weakness, and shortness of breath. Therefore, pernicious anemia is the correct answer for the type of anemia that is missing intrinsic factor.

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  • 25. 

    If you do not treat a Vit B12 deficiency, does it cause irreversible neurological damage?

    • A.

      Yes

    • B.

      No

    Correct Answer
    A. Yes
    Explanation
    If a Vitamin B12 deficiency is not treated, it can cause irreversible neurological damage. This is because Vitamin B12 is essential for the proper functioning of the nervous system. Without enough Vitamin B12, the nerves can become damaged, leading to symptoms such as tingling, numbness, and difficulty walking. If left untreated for a prolonged period, these neurological symptoms can become permanent. Therefore, it is important to address a Vitamin B12 deficiency to prevent irreversible damage to the nervous system.

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  • 26. 

    What is needed to absorb B12?

    Correct Answer
    Intrinsic factor, intrisic factor, IF, if
    Explanation
    In order to absorb B12, the body requires a substance called intrinsic factor. This factor is essential for the absorption of B12 in the small intestine. Without intrinsic factor, the body would not be able to effectively absorb B12 from the diet, leading to a deficiency in this important vitamin.

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  • 27. 

    Erythropoietin is a ________ produced by the kidneys

    Correct Answer
    Hormone, hormone
    Explanation
    Erythropoietin is a hormone produced by the kidneys.

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  • 28. 

    What plays a key role in the production of RBCs

    Correct Answer
    Erythropoietin, erythropoietin
    Explanation
    Erythropoietin is a hormone that plays a crucial role in the production of red blood cells (RBCs). It is produced primarily by the kidneys and stimulates the bone marrow to produce more RBCs. When the body detects low oxygen levels, such as during high altitude or in cases of anemia, it releases erythropoietin to increase RBC production. This hormone helps maintain the balance of oxygen-carrying RBCs in the bloodstream, ensuring adequate oxygen supply to tissues and organs.

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  • 29. 

    The client diagnosed with RA is being seen in the outpatient clinic. Which preventive care should the nurse include in the regularly scheduled clinic visits?

    • A.

      Perform joint x-rays to determine progression of the disease. 

    • B.

      Send blood to the laboratory for an erythrocyte sedimentation rate. 

    • C.

      Recommend the flu and pneumonia vaccines. 

    • D.

      Assess the client for increasing joint involvement. 

    Correct Answer
    C. Recommend the flu and pneumonia vaccines. 
    Explanation
    RA is a disease with many immunological abnormalities. The clients have increased susceptibility to infectious disease, such as the flu or pneumonia, and, therefore, vaccines, which are preventive, should be recommended.

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  • 30. 

    The client with RA has nontender, movable nodules in the subcutaneous tissue over the elbows and shoulders. Which statement is the scientific rationale for the nodules?

    • A.

      The nodules indicate a rapidly progressive destruction of the affected tissue. 

    • B.

      The nodules are small amounts of synovial fluid that have become crystallized. 

    • C.

      The nodules are lymph nodes which have proliferated to try to fight the disease. 

    • D.

      The nodules present a favorable prognosis and mean the client is better. 

    Correct Answer
    A. The nodules indicate a rapidly progressive destruction of the affected tissue. 
    Explanation
    The nodules may appear over bony prominences and resolve simultaneously. They appear in clients with the rheumatoid factor and are associated with rapidly ­ progressive and destructive disease.

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  • 31. 

    The nurse is assessing a client diagnosed with RA. Which assessment findings warrant immediate intervention?

    • A.

      The client complains of joint stiffness and the knees feel warm to the touch. 

    • B.

      The client has experienced one (1)-kg weight loss and is very tired. 

    • C.

      The client requires a heating pad applied to the hips and back to sleep. 

    • D.

      The client is crying, has a flat facial affect, and refuses to speak to the nurse.

    Correct Answer
    D. The client is crying, has a flat facial affect, and refuses to speak to the nurse.
    Explanation
    The client has the signs and symptoms of depression. The nurse should attempt to intervene with therapeutic conversation and discuss these findings with the HCP.

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  • 32. 

    The client diagnosed with RA who has been prescribed etanercept, a tumor necrosis factor alpha inhibitor, shows marked improvement. Which instruction regarding the use of this medication should the nurse teach?

    • A.

      Explain the medication loses its efficacy after a few months.

    • B.

       Continue to have checkups and laboratory work while taking the medication.

    • C.

      Have yearly magnetic resonance imaging to follow the progress. 

    • D.

      Discuss the drug is taken for three (3) weeks and then stopped for a week. 

    Correct Answer
    B.  Continue to have checkups and laboratory work while taking the medication.
    Explanation
    The drug requires close monitoring to prevent organ damage.

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  • 33. 

    The client diagnosed with RA has developed swan-neck fingers. Which referral is most appropriate for the client?

    • A.

      Physical therapy

    • B.

      Occupational therapy

    • C.

      Psychiatric counselor

    • D.

      Home health nurse

    Correct Answer
    B. Occupational therapy
    Explanation
    The occupational therapist assists the client in the use of the upper half of the body, fine motor skills, and activities of daily living. This is needed for the client with abnormal fingers.

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  • 34. 

    The nurse is planning the care for a client diagnosed with RA. Which intervention should be implemented?

    • A.

      Plan a strenuous exercise program.

    • B.

      Order a mechanical soft diet.

    • C.

      Maintain a keep-open IV.

    • D.

      Obtain an order for a sedative. 

    Correct Answer
    D. Obtain an order for a sedative. 
    Explanation
    Sleep deprivation resulting from pain is common in clients diagnosed with RA. A mild sedative can increase the client’s ability to sleep, promote rest, and increase the client’s tolerance of pain.

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  • 35. 

    The 20-year-old female client diagnosed with advanced unremitting RA is being admitted to receive a regimen of immunosuppressive medications. Which question should the nurse ask during the admission process regarding the medications?

    • A.

      “Are you sexually active, and, if so, are you using birth control?”

    • B.

      “Have you discussed taking these drugs with your parents?”

    • C.

      “Which arm do you prefer to have an IV in for four (4) days?” 

    • D.

      “Have you signed an informed consent for investigational drugs?”

    Correct Answer
    A. “Are you sexually active, and, if so, are you using birth control?”
    Explanation
    Immunosuppressive medications are considered ­ class C drugs and should not be taken while pregnant. These drugs are teratogenic and carcinogenic, and the ­ client is only 20 years old.

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  • 36. 

    Which client problem is priority for a client diagnosed with RA?

    • A.

      Activity intolerance

    • B.

      Fluid and electrolyte imbalance

    • C.

      Alteration in comfort

    • D.

      Excessive nutritional intake

    Correct Answer
    C. Alteration in comfort
    Explanation
    The client diagnosed with RA has chronic pain; therefore, alteration in comfort is a priority problem.

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  • 37. 

    The nurse is caring for clients on a medical floor. Which client should the nurse assess first?

    • A.

      The client diagnosed with RA complaining of pain at a “3” on a 1-to-10 scale. 

    • B.

      The client diagnosed with SLE who has a rash across the bridge of the nose. 

    • C.

      The client diagnosed with advanced RA who is receiving antineoplastic drugs IV. 

    • D.

      The client diagnosed with scleroderma who has hard, waxlike skin near the eyes. 

    Correct Answer
    C. The client diagnosed with advanced RA who is receiving antineoplastic drugs IV. 
    Explanation
    Antineoplastic drugs can be caustic to tissues; therefore, the client’s IV site should be assessed. The client should be assessed for any untoward reactions to the medications first.

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  • 38. 

    The nurse and a licensed practical nurse are caring for clients in a rheumatologist’s office. Which task can the nurse assign to the licensed practical nurse?

    • A.

      Administer methotrexate, an antineoplastic medication, IV. 

    • B.

      Assess the lung sounds of a client with RA who is coughing.

    • C.

      Demonstrate how to use clothing equipped with Velcro fasteners. 

    • D.

      Discuss methods of birth control compatible with treatment medications. 

    Correct Answer
    C. Demonstrate how to use clothing equipped with Velcro fasteners. 
    Explanation
    The nurse cannot assign assessment, evaluation, or teaching or any medication requiring specialized knowledge or skills to administer safely.

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  • 39. 

    The client with early-stage RA is being discharged from the outpatient clinic. Which discharge instruction should the nurse teach regarding the use of nonsteroidal anti-inflammatory drugs (NSAIDs)?

    • A.

      Take with an over-the-counter medication for the stomach. 

    • B.

      Drink a full glass of water with each pill. 

    • C.

      If a dose is missed, double the medication at the next dosing time. 

    • D.

      Avoid taking the NSAID on an empty stomach. 

    Correct Answer
    D. Avoid taking the NSAID on an empty stomach. 
    Explanation
    NSAID medications decrease prostaglandin production in the stomach, resulting in less mucus production, which creates a risk for the development of ulcers. The client should take the NSAID with food.

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  • 40. 

    The nurse is preparing to administer morning medications. Which medication should the nurse administer first?

    • A.

      The pain medication to a client diagnosed with RA.

    • B.

      The diuretic medication to a client diagnosed with SLE. 

    • C.

      The steroid to a client diagnosed with polymyositis.

    • D.

      The appetite stimulant to a client diagnosed with OA.

    Correct Answer
    A. The pain medication to a client diagnosed with RA.
    Explanation
    Pain medication is important and should be given before the client’s pain becomes worse.

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  • 41. 

    The school nurse is preparing to teach a health class to ninth graders regarding sexually transmitted diseases. Which information regarding acquired immunodeficiency syndrome (AIDS) should be included?

    • A.

      Females taking birth control pills are protected from becoming infected with HIV. 

    • B.

      Protected sex is no longer an issue because there is a vaccine for the HIV virus. 

    • C.

      Adolescents with a normal immune system are not at risk for developing AIDS.

    • D.

      Abstinence is the only guarantee of not becoming infected with sexually transmitted HIV.

    Correct Answer
    D. Abstinence is the only guarantee of not becoming infected with sexually transmitted HIV.
    Explanation
    Abstinence is the only guarantee the ­ client will not contract a sexually transmitted disease, including AIDS. An individual who is HIV negative in a monogamous relationship with another individual who is HIV negative and committed to a monogamous relationship is the safest sexual relationship.

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  • 42. 

    The nurse is admitting a client diagnosed with protein-calorie malnutrition secondary to AIDS. Which intervention should be the nurse’s first intervention?

    • A.

      Assess the client’s body weight and ask what the client has been able to eat.

    • B.

      Place in contact isolation and don a mask and gown before entering the room.

    • C.

      Check the HCP’s orders and determine what laboratory tests will be done. 

    • D.

      Teach the client about total parenteral nutrition and monitor the subclavian IV site.

    Correct Answer
    A. Assess the client’s body weight and ask what the client has been able to eat.
    Explanation
    Assessment is the first step in the nursing process. The nursing process is a good place to start when setting priorities for the nurse’s actions.

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  • 43. 

    The client diagnosed with AIDS is complaining of a sore mouth and tongue. When the nurse assesses the buccal mucosa, the nurse notes white, patchy lesions covering the hard and soft palates and the right inner cheek. Which interventions should the nurse implement?

    • A.

      Teach the client to brush the teeth and patchy area with a soft-bristle toothbrush.

    • B.

      Notify the HCP for an order for an antifungal swish-and-swallow medication. 

    • C.

      Have the client gargle with an antiseptic based mouthwash several times a day. 

    • D.

      Determine what types of food the client has been eating for the last 24 hours.

    Correct Answer
    B. Notify the HCP for an order for an antifungal swish-and-swallow medication. 
    Explanation
    This most likely is a fungal infection known as oral candidiasis, commonly called thrush. An antifungal medication is needed to treat this condition.

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  • 44. 

    Which type of isolation technique is designed to decrease the risk of transmission of recognized and unrecognized sources of infections?

    • A.

      Contact Precautions. 

    • B.

      Airborne Precautions 

    • C.

      Droplet Precautions. 

    • D.

      Standard Precautions.

    Correct Answer
    D. Standard Precautions.
    Explanation
    Standard Precautions are used for all contact ­ with blood and body secretions.

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  • 45. 

    The nurse is describing the HIV virus infection to a client who has been told he is HIV positive. Which information regarding the virus is important to teach?

    • A.

      The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in. 

    • B.

      The HIV virus can be eradicated from the host body with the correct medical regimen.

    • C.

      It is difficult for the HIV virus to replicate in humans because it is a monkey virus.

    • D.

      The HIV virus uses the client’s own red blood cells to reproduce the virus in the body. 

    Correct Answer
    A. The HIV virus is a retrovirus, which means it never dies as long as it has a host to live in. 
    Explanation
    Standard Precautions are used for all contact ­ with blood and body secretions.

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  • 46. 

    The client who has engaged in needle-sharing activities has developed a flu-like infection. An HIV antibody test is negative. Which statement best describes the scientific rationale for this finding?

    • A.

      The client is fortunate not to have contracted HIV from an infected needle.

    • B.

      The client must be repeatedly exposed to HIV before becoming infected. 

    • C.

      The client may be in the primary infection phase of an HIV infection. 

    • D.

      The antibody test is negative because the client has a different flu virus.

    Correct Answer
    C. The client may be in the primary infection phase of an HIV infection. 
    Explanation
    The primary phase of infection ranges from being asymptomatic to severe flu-like symptoms, but during this time, the test may be negative although the ­ individual is infected with HIV.

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  • 47. 

    The nurse caring for a client who is HIV positive is stuck with the stylet used to start an IV. Which intervention should the nurse implement first?

    • A.

      Flush the skin with water and try to get the area to bleed. 

    • B.

      Notify the charge nurse and complete an incident report.

    • C.

      Report to the employee health nurse for prophylactic medication.

    • D.

      Follow up with the infection control nurse to have laboratory work done. 

    Correct Answer
    A. Flush the skin with water and try to get the area to bleed. 
    Explanation
    The nurse should attempt to flush the skin and get the area to bleed. It is hoped this will remove contaminated blood from the body prior to infecting the nurse.

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  • 48. 

    The client on a medical floor is diagnosed with HIV encephalopathy. Which client problem is priority?

    • A.

      Altered nutrition, less than body requirements. 

    • B.

      Anticipatory grieving. 

    • C.

      Knowledge deficit, procedures and prognosis. 

    • D.

      Risk for injury. 

    Correct Answer
    D. Risk for injury. 
    Explanation
    Safety is always an issue with a client with diminished mental capacity.

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  • 49. 

    The client diagnosed with Pneumocystis pneumonia (PCP) is being admitted to the intensive care unit. Which HCP’s order should the nurse implement first?

    • A.

      Draw a serum for CD4 and complete blood count STAT. 

    • B.

      Administer oxygen to the client via nasal cannula.

    • C.

      Administer trimethoprim-sulfamethoxazole, a sulfa antibiotic, IVPB. 

    • D.

      Obtain a sputum specimen for culture and sensitivity. 

    Correct Answer
    B. Administer oxygen to the client via nasal cannula.
    Explanation
    Oxygen is a priority, especially with a client ­ diagnosed with a respiratory illness.

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  • 50. 

    Which intervention is an important psychosocial consideration for the client diagnosed with AIDS?

    • A.

      Perform a thorough head-to-toe assessment. 

    • B.

      Maintain the client’s ideal body weight.

    • C.

      Complete an advance directive. 

    • D.

      Increase the client’s activity tolerance.

    Correct Answer
    C. Complete an advance directive. 
    Explanation
    Clients diagnosed with AIDS should be encouraged to discuss their end-of-life issue with the significant others and to put those wishes in writing. This is important for all clients, not just those diagnosed with AIDS.

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