Title KEY - R12 NP3.docx ✅

D. Strengthening contractions of the heart Answer: B Ratio: Nitroglycerin dilates coronary arteries, improves collateral blood flow to ischemic areas within myocardium. IV form of this drug produces peripheral vasodilation. Therapeutic Effect: Decreases myocardial oxygen demand. Reduces left ventricular preload, afterload. Source: Saunders Nursing Drug Handbook 2019, pg. 1868 Situation: Disturbances in the gastrointestinal tract, such as nausea or cramps, can disrupt digestion and cause discomfort. These issues often require attention to diet and sometimes medical treatment to restore normal function. 56. Razell, who had a total gastrectomy, is given instructions on measure to prevent the developing of dumping syndrome. Which of the following statements, if made by the patient, would indicate a correct understanding of the instructions? A. "I will have a bedtime snack." B. "I will rest one hour before each meal." C. "I will avoid concentrated sugar." D. “I will include high-carbohydrate foods in my diet” Answer: C Ratio: Dumping syndrome is a condition in which food, especially food high in carbohydrates, moves from your stomach into your small bowel too quickly after you eat (Rapid gastric emptying). Concentrated sugars/simple sugars like table sugar (sucrose) & fruits (fructose) is avoided. 57. Which of the following laboratory values should Nurse Razell expect to be elevated in a patient who has pancreatitis? A. Red blood cell count B. Blood urea nitrogen C. Glycosylated hemoglobin D. Serum amylase Answer: D Ratio: Pancreatitis is inflammation of the pancreas. Presence of digestive enzymes (serum amylase, serum lipase) in the blood indicates inflammation of the pancreatic tissue causing its leakage. 58. Which of the following statements, if made by Jam who has had a cholecystectomy, would indicate a correct understanding of dietary instructions? A. "I should limit my intake of citrus products.” B. "I must avoid carbonated beverages.” C. "I will Increase high-fiber foods in my diet" D. "I can eat whatever I can tolerate” Answer: D Ratio: There are usually no special dietary instructions in patients who had cholecystectomy other than to maintain a nutritious diet and avoid excessive fats. 59. The nurse should expect to prepare a patient who has bleeding esophageal varices for which of these procedures initially? A. Nasogastric tube feeding B. Normal saline lavage C. Electro cauterization D. X-ray Answer: D Ratio: To stop the bleeding and prevent hemorrhagic shock, the first procedure to be done in patients with bleeding esophageal varices is Balloon Tamponade. The placement of the balloon is confirmed via x-ray 60. Nurse Tres is caring for a patient with acute Hepatitis B. To which of the following measures should she give priority when caring for her patient? A. Using disposable dishes and cutlery for the patient B. Placing the patient in a private room C. Promoting bed rest D. Limiting fluid intake Answer: C. See photo below.
Situation: A chest tube thoracostomy is a medical procedure where a tube is inserted into the chest cavity to remove air, fluid, or pus and allow the lungs to fully expand. It’s often used to treat conditions like pneumothorax (air in the chest), pleural effusion (fluid in the chest), or empyema (infected fluid in the chest). 61. Maku returned from thoracic surgery 3 hours ago with two chest tubes placed at 20cm suction. Which findings would be considered abnormal? A. Bubbling in the suction control chamber B. 350 cc of sanguineous drainage in the drainage chamber over the last 3 hours C. No fluctuation in the water seal chamber D. Small amount of sanguineous drainage on the chest tube dressing Answer: C Ratio: No fluctuations in the water seal chamber may mean that there is obstruction on the chest tube system (bad indication) or lungs have re-expanded (good indication). 62. Nurse Gen is caring for Justine, a client who has just undergone a left pneumonectomy, knows that she should position Justine on: A. The back with the head of the bed flat B. The left side with the head of the bed flat C. The left side with the head of the bed elevated D. The right side with the head of the bed elevated Answer: B Ratio: Left side-lying in supine position permits ventilation of the remaining lung and prevent fluid from draining into sutured bronchial stump. This allows the fluid left in the operated space to consolidate and prevents the remaining lung and the heart from shifting (mediastinal shift) toward the operative side. 63. While Nurse Gen is assessing the client who has a chest tube, she notes that the tubing is kinked between the bedrails. Nurse Gen knows that this places the client at increased risk for: A. Tension pneumothorax B. Air leak C. Hemorrhage D. Cardiac tamponade Answer: A Ratio: Kinking, looping, or pressure on the drainage tubing can produce back-pressure, which may force fluid back into the pleural space or impede the removal of trapped air (w/c can cause tension pneumothorax) 64. Dianhel is rushed to the emergency department due to a pneumothorax secondary to a gunshot wound. She complains of shortness of breath and exhibits tracheal and mediastinal shifts to the left. For which procedure should her nurse prepare Dianhel? A. Intubation with an endotracheal tube B. Insertion of a closed chest drainage tube C. Paracentesis D. MRI of the chest Answer: B Ratio: Patient should be prepared for chest tube insertion to remove the accumulated air and blood/fluids and to relieve the pressure on the trachea and mediastinum. 65. Dr. Rocky is preparing to remove the chest tube from the client's left chest. To prepare for the procedure, the nurse should advise the client to: A. Breathe normally B. Hold his breath and bear down C. Take a deep breath D. Sneeze on command Answer: B Ratio: When assisting in the chest tube’s removal, instruct the patient to perform a gentle Valsalva maneuver or to breathe quietly. This is done to prevent air from entering the pleural cavity as the tube is withdrawn. Situation: Nurse Neil is reviewing his knowledge regarding Pancreatitis for his upcoming board examination this November.
66. Nurse Neil knew that the initial diagnosis of pancreatitis is confirmed if the client's blood shows a significant in elevation which of the following serum values? A. Amylase B. Calcium C. Potassium D. Trypsin Answer: A Ratio: Pancreatitis is inflammation of the pancreas. Elevated presence of digestive enzymes (serum amylase, serum lipase) in the blood indicates inflammation of the pancreatic tissue causing its leakage. 67. In a client with acute pancreatitis, Nurse Neil should anticipate observing the following signs and symptoms: A. Diarrhea B. Jaundice C. Hypertension D. Ascites Answer: D 68. Nurse Neil reviews the client's latest laboratory results. What findings would indicate a diagnosis of acute pancreatitis? A. Hyperglycemia B. Leukopenia C. Thrombocytopenia D. Hyperkalemia Answer: A Ratio: Serum glucose is increased because of impaired excretion of insulin d/t pancreatic injury 69. Nurse Neil reviews initial plan for a client with pancreatitis would most likely focus on which of the following as a priority? A. Resting the gastrointestinal tract B. Ensuring adequate nutrition C. Maintaining fluid and electrolyte balance D. Preventing the development of an infection Answer: A Ratio: Question is asking about the initial plan. Initial plan is to put the patient in NPO to rest the GIT, prevent stimulation of pancreas and prevent further painful distention in the patient. 70. Nurse Neil knows that if a client is diagnosed with acute pancreatitis, he should carefully monitor the client for which of the following complications? A. Congestive heart failure B. Duodenal Ulcer C. Cirrhosis D. Pneumonia Answer: D Ratio: The patient with acute pancreatitis is prone to complications associated with the respiratory system. Pneumonia, atelectasis, and pleural effusion are examples of respiratory complications that can develop as a result of pancreatic enzyme exudate. Pancreatitis does not cause heart failure, ulcer formation, or cirrhosis. Situation: Nurse Anne, an infectious control nurse, is caring for a client with Pulmonary Tuberculosis. 71. Which client has special risk factors that warrant testing for tuberculosis? A. 45-year-old Caucasian man who has been homeless for 2 years B. 15-year-old Caucasian woman with asthma C. 72-year-old woman who is a recent immigrant from Russia D. 50-year-old Iowa farmer Answer: A Ratio: One of the risk factors for TB is any person without adequate health care (the homeless, impoverished; minorities, particularly children under age 15 and young adults between ages 15 and 44) Source: Brunner & Suddarth’s Textbook of Medical-Surgical Nursing, Twelfth Ed., pg.567