Tiêu đề RECALLS 8 (NP3) - STUDENT COPY ✅

2 | Page 13. A patient who has recently undergone knee surgery has been receiving Morphine 4 mg IV every 2 hours. Upon assessment, you notice that the patient has a respiratory rate of 8 breaths per minute and is extremely drowsy. Which of the following conditions is the patient at risk for? A. Respiratory acidosis B. Respiratory alkalosis C. Hypokalemia D. Metabolic acidosis 14. A 55-year-old patient presents with signs of acute kidney injury (AKI). Which of the following diagnoses or treatments is most consistent with prerenal AKI? A. Incompatible blood transfusion B. IV tobramycin C. Poststreptococcal glomerulonephritis D. Dissecting abdominal aortic aneurysm 15. A patient is being discharged home after hospitalization with hypocalcemia. Which statement by the patient indicates she understood the dietary instructions? A. "I will avoid sardines." B. "I'll avoid salt and Vitamin-D supplements." C. "I will tell my husband to only purchase skim milk." D. "I will be sure to eat lots of cheese, tofu, and spinach." 16. A patient with Celiac disease is at risk for which of the following? A. Hypokalemia B. Hypocalcemia C. Hypomagnesemia D. Hypercalcemia 17. Facial nerve stimulation causing twitching of the nose or lips in hypocalcemia is known as: A. Trousseau's sign B. Chvostek's sign C. Homan's sign D. Goodell's sign 18. For a patient with a serum calcium level of 7.0 mg/dL, the nursing priority is to: A. Educate about calcium-rich foods B. Initiate seizure precautions C. Administer vitamin D supplements as ordered D. Administer calcitonin 19. Nurse Reiner is assigned to a telemetry unit and is currently reviewing cases involving electrolyte imbalances. One of the patients admitted to the unit has lab results showing elevated potassium levels. Which patient is most likely at risk for hyperkalemia? A. Patient with Parathyroid cancer B. Patient with Cushing's Syndrome C. Patient with Addison's Disease D. Patient with breast cancer 20. Nurse Bertholdt, also a staff nurse in the telemetry unit, observed ECG changes on one of the patient’s monitors. The changes included tall peaked T-waves, flat P-waves, prolonged PR intervals, and widened QRS complexes.These ECG findings are commonly seen in which of the following conditions? A. Hypocalcemia B. Hypercalcemia C. Hypokalemia D. Hyperkalemia 21. A patient with hypokalemia has a potassium level of 3.0 mEq/L. The healthcare provider has advised increasing potassium intake. Which of the following food choices should Nurse Connie encourage? A. Tofu, oatmeal, and peas B. Peanuts, bread, and corn C. Avocados, strawberries, and potatoes D. Cheese, collard greens, and fish 22. A patient with a sodium level of 112 mEq/L is being treated with Lithium for bipolar disorder. Nurse Anya is concerned about the potential for Lithium toxicity. Which of the following actions should be the nursing priority? A. Monitor potassium level due to increased risk of toxicity B. Hold further doses of Lithium C. No priority is needed. 112 is a normal sodium level D. Monitor Lithium drug level due to risk of toxicity 23. A patient with a sodium level of 178 mEq/L is ordered to be started on 0.45% saline. Nurse Yuri is concerned about the risk of fluid shift and potential complications. What is the most important nursing intervention for this patient? A. Maintain patent IV B. Clarify doctor's order because 0.45% saline is contraindicated in hypernatremia C. Give rapidly to ensure fluid levels are shifted properly D. Give slowly and watch for signs and symptoms of cerebral edema 24. After completing diet teaching with a patient who has hypernatremia, which statement by the patient causes concern? A. "I will avoid cooking with butter." B. "I will avoid eating canned foods." C. "I will buy fresh vegetables and fruits." D. "I'm glad I can still tuyo for breakfast." 25. A patient with a sodium level of 115 mEq/L has been ordered Declomycin to help manage the condition. After receiving education about the medication, which statement by the patient would indicate a misunderstanding of how to take the medication? A. "Declomycin is to be taken with food, preferably, milk." B. "Declomycin is an antidiuretic hormone antagonist that treats SIADH." C. "Declomycin is part of the tetracycline family." D. "Declomycin is contraindicated in children and pregnant/nursing women." 26. Nurse Loid is preparing to administer a hypotonic solution to a patient. Which patient below would not be a candidate for a hypotonic solution? A. Patient experiencing Hyperosmolar Hyperglycemia B. Patient with increased intracranial pressure C. Patient with Diabetic Ketoacidosis D. All of the options are correct 27. A patient is being admitted with dehydration due to prolonged nausea and vomiting. The healthcare provider orders intravenous fluid therapy. Which fluid would you expect the patient to be started on? A. 5% Dextrose in 0.9% Saline B. 0.33% saline C. 0.9% Normal Saline D. 0.225% saline 28. A client with a hiatal hernia chronically experiences heartburn following meals. Nurse Nightfall is planning to teach the client strategies to manage this condition. Which of the following actions should the nurse advise the client to avoid, as it is contraindicated with a hiatal hernia? A. Raising the head of the bed on 6-inch blocks B. Taking H2-receptor antagonist medication C. Taking in small, frequent, bland meals D. Lying recumbent following meals 29. Nurse Ella is reviewing the medication record of a female client who has been diagnosed with acute gastritis. Which of the following medications, if noted on the client's record, should the nurse question? A. Indomethacin (Indocin) B. Propranolol hydrochloride (Inderal) C. Digoxin (Lanoxin) D. Furosemide (Lasix)
3 | Page 30. Nurse Lani is preparing a client diagnosed with GERD for discharge after an esophagogastroduodenoscopy. Which statement made by the client indicates understanding of the discharge instructions? A. "I should avoid orange juice and eating tomatoes until my esophagus heals." B. "I can lie down whenever I want after a meal. It won't make a difference." C. "The stomach contents won't bother my esophagus but will make me nauseous." D. "I should not eat for at least one (1) day following this procedure." 31. Nurse Cornelia is assessing a client suspected of having a gastric ulcer. Which of the following assessment findings supports the diagnosis of a gastric ulcer? A. Sharp pain in the upper abdomen after eating a heavy meal B. Complaints of epigastric pain 30 to 60 minutes after ingesting food C. Presence of blood in the client's stool for the past month D. Reports of a burning sensation moving like a wave 32. Nurse Sylvia is assessing a client diagnosed with Peptic Ulcer Disease (PUD). Which physical examination should the nurse implement first? A. Palpate the abdominal area for tenderness B. Auscultate the client's bowel sounds in all four quadrants C. Assess the tender area progressing to nontender D. Percuss the abdominal borders to identify organs 33. A patient with a history of peptic ulcer disease presents to the emergency department with severe abdominal pain and a rigid, boardlike abdomen. The healthcare team suspects a perforated ulcer. In managing this patient, which action should Nurse Bond anticipate? A. Providing IV fluids and inserting a nasogastric tube B. Administering oral bicarbonate and testing the patient's gastric pH level C. Performing a fecal occult blood test and administering IV calcium gluconate D. Starting parenteral nutrition and placing the patient in high-Fowler's position 34. A patient who recently underwent gastric surgery to treat a peptic ulcer is now experiencing symptoms of dumping syndrome. During a follow-up visit, the patient makes the following statements. Which one should prompt the nurse to provide further dietary teaching? A. I should avoid drinking fluids with my meals. B. I should eat bread with each meal. C. I should eat smaller meals more frequently. D. I should lie down after eating. 35. A Filipino patient diagnosed with cholecystitis seeks dietary advice during a follow-up consultation. Which of the following food choices, when made by the patient, demonstrates that the nurse's dietary teaching has been successful? A. Low-fat, high-carbohydrate meals B. 4-6 small meals of low-carbohydrate foods daily C. High-fat, low-protein meals D. High-fat, high-carbohydrate meals 36. A 45-year-old female patient is admitted with a diagnosis of acute cholecystitis. Upon assessment, Nurse Mido anticipates which of the following clinical manifestations in this patient? A. Nausea, vomiting, and anorexia B. Acute right lower quadrant (RLQ) pain, diarrhea, and dehydration C. Ecchymosis, petechiae, and coffee-ground emesis D. Jaundice, dark urine, and steatorrhea 37. Baku, a 45-year-old woman, is admitted to the hospital with a diagnosis of acute pancreatitis. Nurse Go is reviewing her care plan. Which of the following interventions should the nurse include in her care plan? A. Preparation for a paracentesis and administration of diuretics B. Administration of vasopressin and insertion of a balloon tamponade C. Dietary plan of a low-fat diet and increased fluid intake to 2,000 ml/day D. Maintenance of nothing-by-mouth status and insertion of nasogastric (NG) tube with low intermittent suction 38. Todo, a 50-year-old man, has been managing chronic pancreatitis for several years. During his latest follow-up visit, Nurse Roki is reviewing his lifestyle and medical history to help him manage the condition more effectively. Which of the following nursing interventions should Nurse Roki prioritize in Todo's care plan? A. Counseling to stop alcohol consumption B. Encouraging daily exercise C. Modifying dietary protein D. Allowing liberalized fluid intake 39. Iida, a 60-year-old woman, has just been diagnosed with pernicious anemia, a condition that developed due to her long- standing chronic gastritis. Nurse Shoto is preparing to educate Clara about managing her condition. Which of the following should Nurse Shoto emphasize during the teaching session? A. A monthly injection of medication is required. B. Vitamin K supplements will be administered. C. Cells producing esophageal acid have been damaged. D. Increased production of intrinsic factor is occurring. 40. Zoro, a 50-year-old man with a diagnosis of cirrhosis, has been experiencing increased confusion and weakness. During his assessment, Nurse Nami reviews his chart and notices documentation of asterixis. To confirm the presence of this sign, which of the following actions should Nurse Nami take? A. Ask the patient to extend the arms B. Ask the patient to extend the arms and observe for irregular flapping movements C. Instruct the patient to lean forward and observe for tremors D. Dorsiflex the foot and look for signs of abnormal movement 41. Papa, a 58-year-old woman, is admitted with massive ascites secondary to cirrhosis. Nurse Sa is reviewing her condition and planning appropriate interventions. Which of the following complications should Nurse Sa be most vigilant about while monitoring Rosa’s condition? A. Bruising due to low platelet count B. Hematemesis due to absence of clotting factors C. Increased ascites due to sodium and water retention D. Bleeding due to fragile, thin-walled veins 42. Magta, a 65-year-old man with cirrhosis, has been complaining of severe pruritus. Nurse Top is preparing to address his symptoms and improve his comfort. Which of the following interventions should Nurse Top prioritize when managing pruritus in this patient? A. Use lots of soap and hot water to cleanse the skin B. Apply lotion to soothe the patient's skin C. Assess the patient for signs of skin infection D. Encourage the patient to use distraction, such as guided imagery, to avoid scratching 43. Shaun, a 51-year-old male, is being prepared for surgery to treat his acute appendicitis. Nurse Murphy reviews his case and formulates a nursing diagnosis of "Risk for infection related to inflammation, perforation, and surgery." What is the primary rationale for selecting this nursing diagnosis in Shaun’s case? A. Infection of the appendix diminishes necrotic arterial blood flow and increases venous drainage. B. The appendix may develop gangrene and rupture, especially in a middle-aged client. C. Obstruction of the appendix reduces arterial flow, leading to ischemia, inflammation, and rupture of the appendix. D. Obstruction of the appendix may increase venous drainage and cause the appendix to rupture.
4 | Page 44. Sheldon had just returned from a science conference where he presented a paper on string theory, and to celebrate his success, he decided to prepare a complicated gourmet dinner. He spent hours in the kitchen, carefully following his precise instructions for each dish, but in his usual fashion, he might have overdone it with a bit too much spice. After enjoying his meal, he suddenly started to feel a sharp pain in his abdomen, along with nausea and vomiting. Initially, he thought it was just indigestion from the overly rich meal or perhaps a result of his rigorous exercise routine, but the pain persisted. Concerned, Sheldon called Nurse Amy, who works at the hospital, and she quickly checked him into the emergency department for evaluation. While assessing him, Nurse Amy palpates his left lower abdominal quadrant. To her surprise, Sheldon complains of pain in the right lower quadrant instead. Which of the following signs is Nurse Amy likely to document in Sheldon's case? A. Referred pain B. Rovsing sign C. Chvostek's sign D. Rebound tenderness 45. Mr. Liu, a 28-year-old man, arrives at the emergency department with sharp abdominal pain. He mentions that the pain started earlier in the day but has been progressively getting worse. Upon palpation, the nurse notices the pain is concentrated in a specific area. Which of the following would best confirm a diagnosis of appendicitis? A. The pain is in the left lower quadrant. B. Mr. Liu describes the pain as occurring 2 hours after eating. C. The pain subsides after eating. D. The pain is localized at a position halfway between the umbilicus and the right iliac crest. 46. A graduating student nurse currently in her last clinical duty is discussing rebound tenderness with her Clinical Instructor while reviewing a patient with suspected appendicitis. Which of the following statements made by the student nurse correctly describes rebound tenderness? A. "Rebound tenderness is when the patient feels pain when the examiner applies pressure to the abdomen and releases it quickly." B. "Rebound tenderness occurs when pain is felt immediately after palpating the abdomen." C. "Rebound tenderness refers to the pain felt only during the palpation of the left lower quadrant." D. "Rebound tenderness is when the patient reports discomfort upon continuous pressure to the abdomen." 47. Mrs. Dela Rosa, diagnosed with acute diverticulitis, is complaining of severe abdominal pain and has a fever of 38.9°C. Upon assessment, Nurse Penny finds her abdomen hard and rigid. Which intervention should Nurse Penny implement first? A. Notify the physician B. Administer an antipyretic suppository C. Continue to monitor the client closely D. Prepare to administer a Fleet's enema 48. Mr. Arise, a 60-year-old man, is admitted with acute diverticulitis, experiencing severe abdominal pain and fever. Nurse Jinwoo suspects the physician will need to intervene quickly. Which intervention would Nurse Jinwoo anticipate? A. Maintain on a high-fiber diet and increase fluids. B. Administer total parenteral nutrition. C. Maintain NPO and nasogastric tube. D. Obtain consent for abdominal surgery. 49. Which of the following signs and symptoms would not be expected in a patient with a magnesium level of 3.6? A. Respiratory failure B. Hyperreflexia of the deep tendons C. Hypotension D. Profound lethargy 50. The patient’s magnesium level came back at 0.8 mEq/L. Their ECG suddenly begins to reveal abnormalities. You, as the newly registered nurse, are called to assess by the ICU head nurse. What arrhythmia do you suspect to see in the ECG? A. Bradycardia B. Normal sinus rhythm C. Heart block D. Torsades de pointes Situation: A patient was brought to the emergency room complaining of dizziness, blood-streaked vomit, and is tachycardic. A complete blood count was ordered and the results shows a decreased RBC count and hemoglobin level. Upon history taking, the patient has a history of liver cirrhosis and he was admitted with a diagnosis of anemia due to bleeding esophageal varices. The physician explained that a blood transfusion may be required if heavy bleeding persists. 51. The patient’s hemoglobin level keeps in decreasing from a baseline of 10.2 g/dL to 9.8 g/dL. As the nurse continues to care for the patient, the physician ordered for a blood transfusion. Which of the following, if done by the nurse once the transfusion was initiated, would require further instruction? A. Initially run the transfusion slowly at a rate not faster than 5 mL/min. B. Check if the client’s blood has been cross-matched. C. Monitor the client frequently for signs of circulatory overload. D. Time the transfusion and make sure that it will not exceed four hours. 52. The nurse creates a care plan for the patient, addressing the problem regarding fatigue due to decreased levels of hemoglobin. Which of the following outcomes will be expected of the patient? A. Vital signs are within the normal range. B. Verbalizes understanding regarding the use of supplements as prescribed. C. Follows a daily plan with a balance between rest and activity. D. Avoids activities of daily living to prevent being fatigued. 53. The patient shares that one of his relatives was diagnosed with a form of anemia, which is aplastic anemia. He mentioned that during his relative’s hospitalization, the nurse followed a “neutropenic precaution” and the patient asked what is being done under that precaution. The nurse is correct if she mentions the following, except: A. Fresh flowers are not allowed inside the patient’s room. B. Maintain a fluid intake of 3000 mL daily (unless contraindicated). C. Good hand hygiene must be followed at all times. D. Instruct to avoid any form of contact sports. 54. The nurse provides health teaching to the patient who is taking iron supplement. Apart from providing important information such as the expected side effects, the nurse also emphasized that the diet would consist of: A. High in fiber, preferably with yogurt and citrus fruits B. Low in fiber and increased fluid intake, preferably with milk C. High in fiber, preferably with tomato juice D. Low in fiber and increased fluid intake, with vitamin C 55. The patient was hooked to 1L of NSS given at a rate of 125 mL/hr. After several minutes, the patient clicked the call button and reported feelings of dyspnea and upon further assessment, there is the presence of crackles and JVD. The nurse’s initial reaction should be: A. Slow down the IV infusion. B. Discontinue the infusion. C. Increase the rate of infusion. D. Immediately call the attention of the physician.