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WorksheetsMidterm Examination in NCM 112
Total questions: 50
Worksheet time: 4hrs 49mins
COPD is a defined by all of the following except?
A. Characterized by reversible airway obstruction.
B. Which rarely occurs in patients under the age of 35.
C. In which symptoms rarely vary between days.
D. Which is linked to a chronic productive cough.
Other therapies which have shown usefulness in the management of COPD include all except:
A. Mucolytics.
B. Diuretics.
C. Theophylline.
D. Bronchodilators.
Which of the following statements best describes why the O2 therapy is maintained at a relatively low concentration?
A. The O2 will be lost at the client’s nostrils if given at a higher level with a nasal cannula.
B. The client’s long history of respiratory problems indicates that he would be unable to absorb O2 given at a higher rate.
C. The cells in the alveoli are so damaged by the client’s long history of respiratory problems that increased O2 levels and reduced CO2 levels likely will cause the cells to burst.
D. The client’s respiratory center is so accustomed to high CO2 and low blood O2 concentrations that changing these concentrations with O2 therapy may eliminate his stimulus for breathing.
A 77-year-old client is admitted as a case of chronic obstructive pulmonary disease. To help the diminished blood capacity to carry oxygen, ferrous sulfate is prescribed. The nurse knows that it will be best for the client to:
A. Take medication with a tall glass of orange juice.
B. Take medication with meals.
C. Take medication at night before going to bed.
D. Take medication upon arising in the morning.
The client is to be started on intravenous antibiotics immediately. Which of the following must be completed before antibiotic therapy begins?
A. Urinalysis.
B. Sputum examination.
C. Chest radiograph.
D. Red blood cell count.
Bed rest is prescribed for the client during the acute phase of her illness. The purpose of bed rest in this situation is to:
A. Reduce the cellular demand for oxygen.
B. Decrease the basal metabolic rate.
C. Promote safety.
D. Promote clearance of secretions.
A client with pneumonia is experiencing pleuritic chest pain. This type of chest pain is usually described as being:
A. A mild but constant aching in the chest.
B. Severe mid-sternal pain.
C. Moderate pain that worsens on inspiration.
D. Muscle spasm pain that accompanies coughing.
Which of the following measures would most likely be successful in reducing pleuritic chest pain due to pneumonia?
A. Encourage the client to breathe shallowly.
B. Have the client practice abdominal breathing.
C. Offer the client incentive spirometry.
D. Teach the client to splint the rib cage when coughing.
Aspirin is administered to clients with pneumonia because of its antipyretic and:
A. Analgesic effects.
B. Antiplatelet effects.
C. Antibacterial effects.
D. Antihistamine effects.
A client with bacterial pneumonia is coughing up tenacious, purulent sputum. Which of the following measures would most likely help liquefy these viscous secretions?
A. Performing postural drainage.
B. Breathing humidified air and increasing fluid intake
C. Clapping and percussing over the affected lung.
D. Performing coughing and deep-breathing exercises.
The single most effective way to decrease the spread of microorganisms is:
A. The single most effective way to decrease the spread of microorganisms is:
B. Having separate personal items for each person.
C. Using disposable equipment whenever possible.
D. Isolating people known to be harboring disease-causing microorganisms.
1. A 19 year old client comes to the emergency department with acute asthma. His respiratory rate is 44 breaths / min. and he appears in acute respiratory distress. Which of the following actions should be taken first?
A. Take a full nursing history.
B. Administer bronchodilator by nebulizer.
C. Provide emotional support to the client.
D. Administer oxygen by nasal cannula.
When performing an assessment on the client with emphysema, the nurse finds that the client has a barrel chest. The alteration in the client’s chest is due to:
A. Collapse of the distal alveoli.
B. Hyperinflation of the lungs.
C. Long term chronic hypoxia.
D. Use of accessory muscles.
The morning weight for a client indicates that the client has gained 5 lbs in less than a week, even though his oral intake has been modest. The client’s weight gain may reflect which associated complication of COPD?
A. Polycythemia.
B. Cor pulmonale.
C. LSCHF.
D. Compensated acidosis.
When caring for a male patient who has just had a total laryngectomy, the nurse should plan to:
A. Encourage oral feeding as soon as possible
B. Develop an alternative communication method
C. Keep the tracheostomy cuff fully inflated
D. Keep the patient flat in bed
A male patient has a sucking stab wound to the chest. Which action should the nurse take first?
A. Drawing blood for a hematocrit and hemoglobin level
B. Applying a dressing over the wound and taping it on three sides
C. Preparing a chest tube insertion tray
D. Preparing to start an I.V. line
A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?
A. Dyspnea
B. Bradypnea
C. Bradycardia
D. Decreased respirations
A male client with pneumococcal pneumonia is admitted to an acute care facility. The client in the next room is being treated for mycoplasmal pneumonia. Despite the different causes of the various types of pneumonia, all of them share which feature?
A. Inflamed lung tissue
B. Sudden onset
C. Responsiveness to penicillin.
D. Elevated white blood cell (WBC) count
A nurse is assessing the respiratory status of a male client who has suffered a fractured rib. The nurse would expect to note which of the following?
A. Slow deep respirations
B. Rapid deep respirations
C. Paradoxical respirations
D. Pain, especially with inspiration
A nurse performs an admission assessment on a female client with a diagnosis of tuberculosis. The nurse reviews the results of which diagnostic test that will confirm this diagnosis?
A. Bronchoscopy
B. Sputum culture
C. Chest x-ray
D. Tuberculin skin test
An adult male has had a hacking cough and shortness of breath for several months. He now has chest pain. His family has pressured him into seeking medical consultation. He continues to say, “It is just a smoker’s cough.” The physician examines the client and arranges for hospital admission for a diagnostic work-up. The nurse is explaining several types of tests that are ordered. Which of these tests is most definitive in the process of ruling out a malignancy?
A. Needle biopsy.
A. Thoracentesis.
A. Bronchogram.
A. Sputum analysis.
The nurse would instruct the client to eat which of the following foods to obtain the best supply of vitamin B12?
A. Whole grains
B. Green leafy vegetables
C. Meats and dairy products
D. Broccoli and Brussels sprouts
The nurse understands that the client with pernicious anemia will have which distinguishing laboratory findings?
A. Schilling’s test, elevated
B. Intrinsic factor, absent.
C. Sedimentation rate, 16 mm/hour
D. RBCs 5.0 million
The nurse devises a teaching plan for the patient with aplastic anemia. Which of the following is the most important concept to teach for health maintenance?
A. Eat animal protein and dark leafy vegetables each day
B. Avoid exposure to others with acute infection
C. Practice yoga and meditation to decrease stress and anxiety
D. Get 8 hours of sleep at night and take naps during the day
A client comes into the health clinic 3 years after undergoing a resection of the terminal ileum complaining of weakness, shortness of breath, and a sore tongue. Which client statement indicates a need for intervention and client teaching?
A. “I have been drinking plenty of fluids.”
B.“I have been gargling with warm salt water for my sore tongue.”
C. “I have 3 to 4 loose stools per day.”
D. “I take a vitamin B12 tablet every day.”
A vegetarian client was referred to a dietitian for nutritional counseling for anemia. Which client outcome indicates that the client does not understand nutritional counseling? The client:
A. Adds dried fruit to cereal and baked goods
B. Cooks tomato-based foods in iron pots
C. Drinks coffee or tea with meals
D. Adds vitamin C to all meals
A client was admitted with iron deficiency anemia and blood-streaked emesis. Which question is most appropriate for the nurse to ask in determining the extent of the client’s activity intolerance?
A. “What activities were you able to do 6 months ago compared with the present?”
B. “How long have you had this problem?”
C. “Have you been able to keep up with all your usual activities?”
D. “Are you more tired now than you used to be?”
The primary purpose of the Schilling test is to measure the client’s ability to:
A. Store vitamin B12
B. Digest vitamin B12
C. Absorb vitamin B12
D. Produce vitamin B12
A client with pernicious anemia asks why she must take vitamin B12 injections for the rest of her life. What is the nurse’s best response?
A. “The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient acid.”
B. “The reason for your vitamin deficiency is an inability to absorb the vitamin because the stomach is not producing sufficient intrinsic factor.”
C. “The reason for your vitamin deficiency is an excessive excretion of the vitamin because of kidney dysfunction.”
D. “The reason for your vitamin deficiency is an increased requirement for the vitamin because of rapid red blood cell production.”
The nurse is assessing a client’s activity intolerance by having the client walk on a treadmill for 5 minutes. Which of the following indicates an abnormal response?
A. Pulse rate increased by 20 bpm immediately after the activity
B. Respiratory rate decreased by 5 breaths/minute
C. Diastolic blood pressure increased by 7 mm Hg
D. Pulse rate within 6 bpm of resting phase after 3 minutes of rest.
When comparing the hematocrit levels of a post-op client, the nurse notes that the hematocrit decreased from 36% to 34% on the third day even though the RBC and hemoglobin values remained stable at 4.5 million and 11.9 g/dL, respectively. Which nursing intervention is most appropriate?
A. Check the dressing and drains for frank bleeding
B. Call the physician
C. Continue to monitor vital signs
D. Start oxygen at 2L/min per NC
A client is to receive epoetin (Epogen) injections. What laboratory value should the nurse assess before giving the injection?
A. Hematocrit
B. Partial thromboplastin time
C. Hemoglobin concentration
D. Prothrombin time
A client states that she is afraid of receiving vitamin B12 injections because of the potential toxic reactions. What is the nurse’s best response to relieve these fears?
A.“Vitamin B12 will cause ringing in the ear before a toxic level is reached.”
B. “Vitamin B12 may cause a very mild skin rash initially.”
C. “Vitamin B12 may cause mild nausea but nothing toxic.”
D. “Vitamin B12 is generally free of toxicity because it is water soluble.”
A client with pernicious anemia has a burn on her foot and states that she had been watching television while lying on a heating pad. What is the nurse’s first response?
A. Assess for potential abuse
B. Check for diminished sensations
C. Document the findings
D. Clean and dress the area
Which of the following nursing assessments is a late symptom of polycythemia vera?
A. Headache
B. Dizziness
C. Pruritus
D. Shortness of breath
When a client is diagnosed with aplastic anemia, the nurse monitors for changes in which of the following physiological functions?
A. Bleeding tendencies
B. Intake and output
C. Peripheral sensation
D. Bowel function
Which of the following blood components is decreased in anemia?
A. Erythrocytes
B. Granulocytes
C. Leukocytes
D. Platelets
A client with anemia may be tired due to a tissue deficiency of which of the following substances?
A. Carbon dioxide
B. Factor VIII
C. Oxygen
D. T-cell antibodies
Which of the following diagnostic findings are most likely for a client with aplastic anemia?
A. Decreased production of T-helper cells
B. Decreased levels of white blood cells, red blood cells, and platelets
C. Increased levels of WBCs, RBCs, and platelets
D. Reed-Sternberg cells and lymph node enlargement
The nurse explains to the parents of a 1-year-old child admitted to the hospital in a sickle cell crisis that the local tissue damage the child has on admission is caused by which of the following?
A. Autoimmune reaction complicated by hypoxia
B. Lack of oxygen in the red blood cells
C. Obstruction to circulation
D. Elevated serum bilirubin concentration.
You are reviewing the complete blood count (CBC) for a client who has been admitted for knee arthroscopy. Which value is most important to report to the physician prior to surgery?
White blood cell count 16,000/mm3
Hematocrit 33%
Platelet count 426,000/ mm3
Hemoglobin 10.9 g/dL
You are making a room assignment for a newly arrived client whose laboratory testing indicates pancytopenia. All of these clients are already on the nursing unit. Which one will be the best roommate for the new client?
The client with digoxin toxicity
The client with viral pneumonia
The client with shingles
The client with cellulitis
A 67-year-old client who is receiving chemotherapy for lung cancer is admitted to the hospital with thrombocytopenia. While you are taking the admission history, the client makes these statements. Which statement is of most concern?
“I’ve noticed that I bruise more easily since the chemotherapy started.”
“My bowel movements are soft and dark brown in color.”
“I take one aspirin every morning because of my history of angina.”
“My appetite has decreased since the chemotherapy started.”
As home health nurse, you are taking an admission history for a client who has a deep vein thrombosis and is taking warfarin (Coumadin) 2 mg daily. Which statement by the client is the best indicator that additional teaching about warfarin may be needed?
“I have started to eat more healthy foods like green salads and fruit.”
“The doctor said that it is important to avoid becoming constipated.”
“Coumadin makes me feel a little nauseated unless I take it with food.”
“I will need to have some blood testing done once or twice a week.”
A client is admitted to the intensive car unit (ICU) with disseminated intravascular coagulation (DIC) associated with a gram-negative infection. Which assessment information has the most immediate implications for the client’s care?
There is no palpable radial or pedal pulse.
The client complains of chest pain.
The client’s oxygen saturation is 87%
There is mottling of the hands and feet.
A client with acute myelogenous leukemia is receiving induction phase chemotherapy. Which assessment information is of most concern? A client with acute myelogenous leukemia is receiving induction phase chemotherapy. Which assessment information is of most concern?
Serum potassium level of 7.8 mEq/L
Urine output less than intake by 400 mL
Inflammation and redness of oral mucosa
Ecchymoses present on anterior trunk
Because of a common problem associated with the ingestion of an iron preparation, Nurse Chris teaches the client to perform which of the following?
Decrease fluid and fiber intake
Take iron preparations with food
Notify the physician if stools turn dark
Take ferrous sulfate with milk
Nurse Chris has provided nutritional teaching on foods high in folate to a client with folate deficiency related to malabsorption syndromes and poor nutrition. Which of the following foods, if chosen by the client, indicates that the client understands the teaching?
Liver and dark green leafy vegetables
Whole milk and eggs
Potatoes and carrots
Bread and fish
Which of the following foods would the nurse encourage the mother to offer to her child with iron deficiency anemia?
Rice cereal, whole milk, and yellow vegetables
Potato, peas, and chicken, horse radish
Macaroni, cheese, and ham
Pudding, green vegetables, and rice
A male adult client is suspected of having a pulmonary embolus. A nurse assesses the client, knowing that which of the following is a common clinical manifestation of pulmonary embolism?
Dyspnea
Bradypnea
Bradycardia
Decreased respirations
