MULTISYSTEM STRESSORS

1. A 27 years old adult is admitted for treatment of Crohn’s disease. Which information is most significant when the nurse assesses nutritional health?
a. Anthropometric measurements
b. Bleeding gums
c. Dry skin
d. Facial rubor

2. Total parenteral nutrition (TPN) is ordered for an adult client. Which nutrient is not likely to be in the solution?
a. Dextrose 10%
b. Trace minerals
c. Electrolytes
d. Amino acids

3. The nurse caring for an adult client who is receiving TPN will need to monitor for which of the following metabolic complications?
a. Hypoglycemia and hypercalcemia
b. Hyperglycemia and hypokalemia
c. Hyperglycemia and hyperkalemia
d. Hyperkalemia and hypercalcemia

4. Acetylsalicylic acid is being administered to an adult client. The nurse understands that the most common mechanism of action for nornarcotic analgesics is their ability to
a. Inhibit prostaglandin synthesis
b. Alter pain perception in the cerebellum
c. Directly affect the central nervous system
d. Target the pain producing effect of kinins

5. An adult has been taking acetylsalicylic acid (ASA) 650 mg four times a day for chronic back pain. The nurse assessing this client knows that a common side effect of high dose of ASA is
a. Liver failure
b. Paralytic ileus
c. Gastrointestinal bleeding
d. Retinal detachment

6. Ibuprofen (Motrin) is prescribed for an adult with chronic pain. The nurse must teach the client to observe which dietary precaution while taking ibuprofen?
a. Eat high fiber diet
b. Drink citrus juices daily
c. Take the medication with milk
d. Omit spinach and other green leafy vegetables from the client’s diet

7. A 48 years old woman has just returned to her room after having a hysterectomy. She has patient controlled analgesia (PCA). To reduce anxiety regarding receiving adequate pain relief, the client was most likely told that
a. PCA is almost always effective
b. Comfort will be assessed frequently
c. Additional IM medication will be available
d. Most therapies are better than frequent IM injections

8. Preoperative teaching for an adult who is to have client controlled analgesia following surgery includes telling the client:
a. “You will not be drowsy”
b. “You will experience no pain”
c. “Pain control will be adequate”
d. “You will not have incisional pain but you may have muscle pain”

9. The client’s family expresses concern that the client could overdose with a PCA. What protective mechanism prevents drug overdose with a PCA?
a. The nurse controls the amount administered with each dose
b. Extensive client teaching precedes its use
c. The client can stop drug administration but not initiate it
d. After a bolus is administered, there is a mandatory waiting period before another dose is given

10. The nurse is the first professional to arrive at the scene of a multivehicle accident. An adult was riding a motorcycle. Upon impact, he fell off the bike and it fell back on his legs. Priority care for the client should be directed toward
a. Assessing blood loss
b. Monitoring respiratory status
c. Obtaining vital signs
d. Organizing lay people on the scene

11. The nurse is at the scene of a multivehicle accident. A young man was injured when his motorcycle was hit by a car. He fell off the bike and then it fell back on his legs. He is bleeding profusely from a 4 inch gash on his left leg. Which of the following is the best approach for the nurse to take to stop the bleeding?
a. Apply direct pressure to the wound
b. Move the motorcycle off his legs
c. Raise the extremity
d. Wrap a tourniquet above the wound

12. The nurse is caring for a client who is receiving IV fluids. Which observation the nurse makes best indicates the IV has infiltrated?
a. Pain at the site
b. A change in flow rate
c. Coldness around the insertion site
d. Redness around the insertion site
13. The nurse is caring for a client whose arterial blood gases indicate metabolic acidosis. The nurse knows that, of the following, the least likely to cause metabolic acidosis is
a. Cardiac arrest
b. Diabetic ketoacidosis
c. Hypokalemia
d. Renal failure

14. An adult client is admitted with metabolic acidosis. Which set of arterial blood gases should the nurse expect to find in a client with metabolic acidosis?
a. pH 7.28, PCO2 55, HCO 26
b. pH 7.50, PCO2 40, HCO3 31
c. pH 7.48, PCO2 30, HCO3 22
d. pH 7.30, PCO2 36, HCO3 18

15. A 93 years old adult is hospitalized for the treatment of gastroenteritis complicated by dehydration and hyponatremia. The nurseexpects that an early symptoms of hyponatremia exhibited by the client was
a. Ataxia
b. Hunger
c. Thirst
d. Weakness

16. An adult has just been brought in by an ambulance after a motor vehicle accident and has moderate anxiety. When assessing the client, the nurse would expect which of the following from sympathetic nervous system stimulation?
a. A rapid pulse and increased respiratory rate
b. Decreased physiologic functioning
c. Rigid posture and altered perceptual focus
d. Increased awareness and attending

17. An adult has received an injection of immunoglobulin. The nurse knows that the client will develop which of the following types of immunity?
a. Active natural immunity
b. Active artificial immunity
c. Passive natural immunity
d. Passive artificial immunity

18. The nurse knows which of the following is true about immunity?
a. Antibody medicated defense occurs through the T-cell system
b. Cellular immunity is mediated by antibodies produced by the B-cells
c. Antibodies are produced by the B-cells
d. Humoral or circulating immunity is lost with AIDS

19. An adult is on a clear liquid diet. The nurse can offer
a. Milk
b. Jello
c. Freshly squeezed orange juice
d. Ice cream

20. An adult is being taught about a healthy diet. The nurse explains that the food pyramid can guide the client
a. By indicating exactly how many servings of each group to eat
b. On how many calories the client should have
c. In making daily food choices
d. To divide food into four basic groups

21. Before administering a tube feeding the nurse knows to perform which of the following assessments?
a. The gastrointestinal (GI) tract, including bowel sounds, last bowel movement and distention
b. The client’s neurological status, especially gag reflex
c. The amount of air in the stomach
d. That the formula is used directly from the refrigerator

22. The nurse knows which of the following indicates protein deficiency?
a. Negative nitrogen balance
b. Koilonychias (spoon shape nails)
c. Magenta tongue
d. Bleeding gums

23. The nurse knows that a client understand a low residue diet when he selects which of the following from a menu?
a. Rice and lean chicken
b. Eggs and bacon
c. Pasta with vegetables
d. Tuna casserole

24. An adult is receiving total parenteral nutrition (TPN). The nurse knows which of the following assessments is essential?
a. Evaluation of the peripheral intravenous (IV) site
b. Confirmation of the tube is in the stomach
c. Assessment of the GI tract, including bowel sounds
d. Fluid and electrolyte monitoring

25. The nurse knows which of the following statements about TPN and peripheral parenteral nutrition (PPN) is true?
a. TPN is usually indicated for clients needing short-term (less than three weeks) nutritional support, while PPN is for long term maintenance
b. A client needing more than 3000 calories would receive PPN, whereas TPN is given to those requiring less than 3000 calories
c. TPN is often given to those with fluid restrictions, whereas PPN is used for those without constraints on their fluid intake
d. TPN is given to those who need to augment oral feeding, whereas PPN is used for those who are nothing by mouth (NPO)