Test 1

Multiple Choice
Identify the choice that best completes the statement or answers the question.

____	1.	A patient with a diagnosis of chronic myelogenous leukemia (CML) is admitted to an acute care unit with a temperature of 100.4°F (38°C) and weight loss over the past 2 to 3 months. A nurse notes that the patient’s white blood cell (WBC) count is 230,000/mm3, and the physical examination shows splenomegaly. The priority nursing intervention should be:
1)	Avoiding falls	
2)	Managing pain	
3)	Preventing infection	
4)	Promoting adequate nutrition	

____	2.	A patient with diabetes requires assessment of long-term glucose control. Which test would be most appropriate for this patient?
1)	Glycated hemoglobin	
2)	Glucose	
3)	Glucose-6-phosphate dehydrogenase (G6PD)	
4)	Glucose tolerance test	

____	3.	A nurse notes that a patient has a urine pH of 7.2. Which information in the patient’s history may be related to this result?
1)	Maintaining a vegetarian diet	
2)	Training for a marathon	
3)	Recent febrile illness	
4)	Use of cranberry supplements daily	

____	4.	A patient with pernicious anemia has a laboratory order to test for intrinsic factor (IF) antibodies. A nurse scheduling this test should instruct the patient to:
1)	Begin a bowel prep 24 hours prior to the examination.	
2)	Eliminate red meat from the diet for 72 hours before the test.	
3)	Take nothing by mouth for 12 hours before the test is scheduled.	
4)	Withhold vitamin B12 for 48 hours before the test is scheduled.	

____	5.	A nurse observes that a patient admitted to the emergency department with decreased level of consciousness has urine with a very fruity odor. Based on this observation, the nurse should plan interventions to manage:
1)	Alcohol withdrawal	
2)	Diabetic ketoacidosis (DKA)	
3)	Fibromyalgia	
4)	Lyme disease	

____	6.	A patient must undergo pulmonary angiography but has a history of allergic reaction to some medications. Which of the following actions should be taken in response to this finding?
1)	Remove all metallic objects from the area to be examined.	
2)	Administer an antianxiety agent, as ordered.	
3)	Use a nonionic contrast medium.	
4)	Notify the health-care provider to cancel the procedure.	

____	7.	A patient’s laboratory test results following amniotic fluid analysis indicate elevated a1-fetoprotein (AFP) levels and presence of acetylcholinesterase (AChE). Which of the following diagnoses should the nurse most suspect given these findings?
1)	Respiratory distress syndrome	
2)	Fetal hemolytic disease	
3)	Neural tube defect	
4)	Fetal immaturity	

____	8.	A college student who is admitted to the hospital with newly diagnosed diabetes mellitus has a C-peptide level of 0.6 ng/mL and serum glucose of 256 mg/dL. Based on these results, which instruction should the nurse provide to this patient?
1)	“Based on these results, your diabetes will be controlled by oral medications and diet.”	
2)	“If you lose weight, you may be able to manage your diabetes with diet alone.”	
3)	“Since you are already an adult, this result confirms that you have type 2 diabetes.”	
4)	“You will need to take insulin for the rest of your life.”	

____	9.	Which laboratory test should a nurse monitor to determine if a patient is responding to the administration of iron for iron-deficiency anemia?
1)	Eosinophils	
2)	Lymphocytes	
3)	Monocytes	
4)	Reticulocytes	

____	10.	A patient with an indwelling urinary catheter has an order for a 24-hour urine creatinine clearance test. To begin the test, the nurse should:
1)	Collect all urine during any 24-hour period by labeling the drainage collection bag with the date and time most recently emptied.	
2)	Clamp the urinary catheter and then drain all urine into the container specified by the lab and repeat every 6 hours times 4.	
3)	Empty all urine in the urinary drainage bag at 0600 and then save all urine until the next day at 0600.	
4)	Increase meat portions in the diet for at least 48 hours prior to the planned start of the collection.	

____	11.	A nurse is preparing to perform a lumbar puncture to collect a specimen for diagnosis of Alzheimer’s disease. Which position should the nurse ask the patient to assume for this test?
1)	Knee-chest	
2)	Sidelying	
3)	Prone	
4)	Standing	

____	12.	Which blood tests should a nurse monitor to determine if a patient’s blood level of warfarin (Coumadin) is within the therapeutic range?
1)	Activated partial thromboplastin time (aPTT)	
2)	Bleeding time	
3)	Platelet count and aPTT	
4)	PT and international normalized ratio (INR)	

____	13.	A nurse has just conducted hearing loss audiometry testing on a 10-year-old patient. The patient’s pure tone average was 52 dB. Which category of hearing of the American Speech-Language-Hearing Association (ASHA) does this result represent?
1)	Normal	
2)	Slight loss	
3)	Moderate loss	
4)	Profound loss	

____	14.	A nurse has just administered an IV nucleotide to a patient before a gallium scan. The nurse should instruct the patient to return for the first scanning in how many hours, typically?
1)	6 hours	
2)	24 hours	
3)	48 hours	
4)	72 hours	

____	15.	A nurse notes that a patient’s laboratory results show an acetylcholine receptor antibody (AChR) of 2.46 nmol/L. Based on this information, the nurse should assess this patient for clinical manifestations of:
1)	Malignant hyperpraxia	
2)	Myasthenia gravis	
3)	Multiple myeloma	
4)	Muscular dystrophy	

____	16.	A patient is suspected of having increased risk for stroke. Which type of angiography should be performed to detect this condition?
1)	Abdominal	
2)	Adrenal	
3)	Carotid	
4)	Coronary	

____	17.	Which factor in a patient’s history may be associated with an elevated creatine phosphokinase (CK) level?
1)	Sedentary lifestyle	
2)	Early muscular dystrophy	
3)	Bedrest for 48 hours	
4)	History of chronic renal failure	

____	18.	A nurse is preparing to administer a radionuclide to an adult patient for a gastroesophageal reflux (GER) scan. What should the nurse mix the radionuclide with?
1)	Orange juice	
2)	Milk	
3)	Water	
4)	Soda	

____	19.	A patient is suspected of having multiple myeloma and needs to undergo testing to identify the individual types of immunoglobulins present to confirm a diagnosis. Which test would be most appropriate for this purpose?
1)	Immunofixation electrophoresis (IFE)	
2)	Immunoglobulin E (IgE)	
3)	Immunoglobulin A (IgA)	
4)	Immunosuppressant cyclosporine	

____	20.	A patient with a history of hypertension has a serum creatinine of 1.9 mg/dL and 1+ proteinuria. When assessing this patient, a nurse should interpret these results as an indication this patient may have:
1)	Early signs of renal insufficiency	
2)	Evidence of severe renal dysfunction	
3)	Hypertension secondary to renal disease	
4)	Normal renal function	

MULTIPLE RESPONSE

	1.	ANS:	1, 3, 4
Feedback: Abdominal angiography is contraindicated for patients who are pregnant or suspected of being pregnant, unless the potential benefits of a procedure using radiation far outweigh the risk of radiation exposure to the fetus and mother. It is contraindicated for conditions associated with adverse reactions to the contrast medium, but not due to latex allergy (which can be avoided by using non-latex materials). It is contraindicated in patients with preexisting renal insufficiency, including recipients of single kidney transplants, because iodinated contrast is nephrotoxic. It is contraindicated in elderly and compromised patients who are chronically dehydrated before the test because of their risk of contrast-induced renal failure. Abdominal angiography is indicated for detection of arterial occlusion, which may be evidenced by a transection of the artery caused by trauma or penetrating injury.

Heading: Angiography, Abdomen
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Urinary Elimination
Page: 75
Difficulty: Moderate

PTS:	1	CON:	Urinary Elimination	

	2.	ANS:	1, 3, 5
Feedback: Decreased levels of antithrombin III are associated with cirrhosis (related to decreased synthesis), pulmonary embolism (related to increased consumption), and septic shock (related to increase consumption and decreased synthesis due to hepatic impairment. Increased levels of antithrombin III are associated with acute hepatitis and vitamin K deficiency (decreased consumption related to impaired coagulation factor function).

Heading: Antithrombin III
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Clotting
Page: 167
Difficulty: Moderate

PTS:	1	CON:	Clotting

	3.	ANS:	2, 4, 5
Feedback: The D-xylose tolerance test is used to assist in the differential diagnosis of small intestine malabsorption syndromes, such as celiac, tropical sprue, and Crohn’s diseases. A peanut allergy is related to an allergic response by the body’s immune system, not to malabsorption in the small intestine. A gastric, or stomach, ulcer is likewise not associated with malabsorption in the small intestine.

Heading: D-Xylose Tolerance Test
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Digestion
Page: 718
Difficulty: Moderate

PTS:	1	CON:	Digestion

	4.	ANS:	2, 3, 5
Feedback: Possible interventions for treating cyclic antidepressant toxicity include administration of activated charcoal; emesis; gastric lavage with saline; administration of physostigmine to counteract seizures (not needed in this case), hypertension, or respiratory depression; administration of bicarbonate (not needed in this case), propranolol, lidocaine, or phenytoin to counteract arrhythmias; and electrocardiographic monitoring.

Heading: Antidepressant Drugs (Cyclic): Amitriptyline, Nortriptyline, Protriptyline, Doxepin, Imipramine
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Cognition
Page: 158
Difficulty: Difficult

PTS:	1	CON:	Cognition

	5.	ANS:	2, 3, 4
Feedback: The nurse should instruct the patient to do the following: rest (not exercise daily); drink plenty of fluids (water and fruit juice); take prescribed antibiotics to treat strep throat; take prescribed steroids to treat swollen throat or tonsils; gargle with warm saltwater (not cold water) to decrease pain of sore throat; use over-the-counter ibuprofen or acetaminophen; and avoid at-risk activities that may cause trauma and spleen rupture.

Heading: Infectious Mononucleosis Screen
Integrated Processes: Teaching and Learning
Client Need: Physiological Integrity: Basic Care and Comfort
Cognitive Level: Application [Applying]
Concept: Infection
Page: 975
Difficulty: Moderate

PTS:	1	CON:	Infection

	6.	ANS:	1, 4, 5
Feedback: DHEAS is produced by the adrenal cortex and testis; therefore, any condition suppressing these organs or associated feedback mechanisms—such as Addison’s disease, aging adults (related to natural decline in production with age), and hyperlipidemia—will result in decreased levels, and any condition stimulating them—such as ectopic ACTH-producing tumors and polycystic ovary—will result in increased levels.

Heading: Dehydroepiandrosterone Sulfate
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Female Reproduction
Page: 712
Difficulty: Moderate

PTS:	1	CON:	Female Reproduction	

	7.	ANS:	2, 3, 5
Feedback: Signs and symptoms of carbamazepine toxicity include respiratory depression, seizures, leukopenia, hyponatremia, hypotension, stupor, and possible coma. Possible interventions include gastric lavage (contraindicated if ileus is present); airway protection; administration of fluids and vasopressors for hypotension; treatment of seizures with diazepam, phenobarbital, or phenytoin; cardiac monitoring; monitoring of vital signs; and discontinuing the medication. Emetics are contraindicated.

Heading: Anticonvulsant Drugs: Carbamazepine, Ethosuximide, Lamotrigine, Phenobarbital, Phenytoin, Primidone, Valproic Acid
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Analysis [Analyzing]
Concept: Neurological Regulation
Page: 150
Difficulty: Difficult

PTS:	1	CON:	Neurological Regulation

	8.	ANS:	1, 3, 4
Feedback: The nurse should scrub, elevate, and wrap the extremity with an elastic bandage from the distal portion of the extremity to the proximal portion to drain as much blood from the limb as possible. The nurse should place the joint in a 45° angle, not a 15° angle, to administer a local anesthetic. A pneumatic tourniquet is placed around the proximal portion of the limb and inflated, and the elastic bandage is removed. The nurse should ensure the patient has complied with food and fluid restrictions for at least 6 to 8 hours prior to the procedure, not 1 hour.

Heading: Arthroscopy
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Basic Care and Comfort
Cognitive Level: Application [Applying]
Concept: Mobility
Page: 179
Difficulty: Moderate

PTS:	1	CON:	Mobility

	9.	ANS:	1, 2, 3, 5
Feedback: Potential complications associated with renal angiography include allergic reactions to the contrast medium, blood clot formation related to thrombus formation near the catheter, nerve injury by the catheter, or infection by bacteria introduced at the puncture site. Myocardial infarction, or heart attack, is not a potential complication associated with renal angiography.

Heading: Angiography, Renal
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Clotting
Page: 107
Difficulty: Moderate

PTS:	1	CON:	Clotting

	10.	ANS:	1, 2, 5
Feedback: Ductography is a procedure used to visualize and assess the breast ducts for disease and malignancy in women with nipple discharge. An iodine-based contrast medium is injected into the duct with the discharge and then the breast is radiographed. This procedure is contraindicated for the following: pregnancy, due to the risk of radiation exposure to the fetus and mother; patients younger than age 25 years, because the density of the breast tissue is such that diagnostic x-rays are of limited value; and patients with bleeding disorders, such as hemophilia, because the puncture site may not stop bleeding. Nipple discharge is an indication for the procedure, not a contraindication. Sore or swollen breasts are not a contraindication for this procedure.

Heading: Ductography
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Cellular Regulation
Page: 717
Difficulty: Moderate

PTS:	1	CON:	Cellular Regulation	

	11.	ANS:	1, 2, 4
Feedback: Total iron-binding capacity is decreased in hemolytic anemias (transferrin becomes saturated, and the iron-binding capacity is significantly decreased), neoplastic diseases, and cirrhosis (transferrin is a negative acute-phase reactant protein, and during periods of inflammation it will demonstrate decreased levels). It is increased in iron-deficiency anemias (insufficient circulating iron levels to saturate binding sites) and late pregnancy.

Heading: Iron-Binding Capacity (Total), Transferrin, and Iron Saturation
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Hematological Regulation
Page: 1001
Difficulty: Moderate

PTS:	1	CON:	Hematological Regulation

	12.	ANS:	2, 3, 5
Feedback: Under medical direction, the patient should avoid diuretics, antihypertensive drugs and herbals, and cyclic progestogens and estrogens for two to four weeks before the test. The patient should also be advised to avoid consuming anything that contains licorice for two weeks before the test. Avoidance of shellfish and antidiabetic drugs are not required before this test.

Heading: Aldosterone
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Metabolism
Page: 33
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	13.	ANS:	2, 3, 4
Feedback: Arterial puncture should not be performed in cases in which the patient has inadequate circulation, a significant or uncontrolled bleeding disorder, infection at the puncture site, or congenital or acquired abnormalities of the skin or blood vessels in the area of the anticipated puncture site. The test is performed to assist in assessing oxygen delivery and diagnosing causes of hypoxemia, such as pulmonary edema, acute respiratory distress syndrome, and pulmonary fibrosis, so symptoms of respiratory distress and bronchospasm would not be contraindications for the test.

Heading: Alveolar/Arterial Gradient and Arterial/Alveolar Oxygen Ratio
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Oxygenation
Page: 42
Difficulty: Moderate

PTS:	1	CON:	Oxygenation

	14.	ANS:	2, 3, 4
Feedback: Insulin blood level is increased in alcohol use (related to stimulation of insulin production), obesity (related to development of insulin resistance; body does not respond to insulin being produced), and severe liver disease. It is decreased in beta cell failure (pancreatic beta cells produce insulin; therefore, damage to these cells will decrease insulin levels) and type 1 diabetes (related to lack of endogenous insulin).

Heading: Insulin and Insulin Response to Glucose
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Metabolism
Page: 978
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	15.	ANS:	2, 4
Feedback: The “2013 Guideline on Lifestyle Management to Reduce Cardiovascular Risk” published by the American College of Cardiology and the AHA in conjunction with the National Heart, Lung, and Blood Institute recommends a “Mediterranean”-style diet rather than a low-fat diet. The new guideline emphasizes inclusion of vegetables, whole grains, fruits, low-fat dairy, nuts, legumes, and nontropical vegetable oils (e.g., olive, canola, peanut, sunflower, flaxseed) along with fish and lean poultry. A similar dietary pattern known as the DASH diet makes additional recommendations for the reduction of dietary sodium. Both dietary styles emphasize a reduction in consumption of red meats, which are high in saturated fats and cholesterol, as well as a reduction in other foods containing sugar, saturated fats, trans fats, and sodium.

Heading: Insulin and Insulin Response to Glucose
Integrated Processes: Teaching and Learning
Client Need: Health Promotion and Maintenance
Cognitive Level: Application [Applying]
Concept: Nutrition
Page: 980
Difficulty: Moderate

PTS:	1	CON:	Nutrition

	16.	ANS:	2, 3, 5
Feedback: Production of GH is modulated by numerous factors, including stress, exercise, sleep, nutrition, and response to circulating levels of GH. GH level is increased in acromegaly, anorexia nervosa, and exercise. It is decreased in dwarfism (pituitary; related to GH deficiency) and hypopituitarism (related to lack of production).

Heading: Growth Hormone, Stimulation and Suppression Tests
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Metabolism
Page: 891
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	17.	ANS:	2, 3, 4
Feedback: A positive result on the group A streptococcal bacteria screen is associated with rheumatic fever, scarlet fever, and strep throat. Tuberculosis is caused by a different bacterium (Mycobacterium tuberculosis). Influenza is a virus, not a bacterium.

Heading: Group A Streptococcal Screen
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Infection
Page: 887
Difficulty: Moderate

PTS:	1	CON:	Infection

	18.	ANS:	1, 3, 5
Feedback: Glucagon is produced in the pancreas and excreted by the kidneys; conditions that affect the pancreas and cause cellular destruction or conditions that impair the ability of the kidneys to remove glucagon from circulation will result in elevated glucagon levels. Glucagon is increased in glucagonoma (related to excessive production by the tumor), hypoglycemia (related to response to decreased glucose level), and trauma (related to stress-induced release of catecholamines, which stimulates glucagon production). Glucagon is decreased in chronic pancreatitis and cystic fibrosis due to decreased pancreatic function.

Heading: Glucose
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Digestion
Page: 853
Difficulty: Moderate

PTS:	1	CON:	Digestion

	19.	ANS:	1, 3, 4
Feedback: The nurse should inform the patient that a report of the results will be made available to the requesting health-care provider. The patient should drink increased, not decreased, amounts of fluids for 24 to 48 hours after the test. The patient should apply cold compresses to the puncture site as needed to reduce discomfort or edema. The patient should immediately flush the toilet and meticulously wash hands with soap and water after each voiding for 48 hours after the procedure. Breast-feeding women should discontinue breast-feeding their infants until the radionuclide has been eliminated, which could take as long as 3 days. She should express the milk and discard it during the 3-day period to prevent cessation of milk production.

Heading: Adrenal Gland Scan
Integrated Processes: Teaching and Learning
Client Need: Safe and Effective Care Environment: Management of Care
Cognitive Level: Application [Applying]
Concept: Metabolism
Page: 9
Difficulty: Moderate

PTS:	1	CON:	Metabolism

	20.	ANS:	1, 2, 4
Feedback: Increased gastric emptying rate is associated with anorexia nervosa, gastroesophageal reflux, and diabetes. Decreased gastric emptying rate is associated with dumping syndrome and malabsorption syndromes.

Heading: Gastric Emptying Scan
Integrated Processes: Nursing Process
Client Need: Physiological Integrity: Reduction of Risk Potential
Cognitive Level: Application [Applying]
Concept: Digestion
Page: 836
Difficulty: Moderate

PTS:	1	CON:	Digestion