Tiêu đề RECALLS 1 (NP3) - STUDENT COPY ✅

1. Redness 2. Swelling 3. Tenderness 4. Induration A. 1, 2, & 3 B. 2 & 4 C. 1, 2, 3, & 4 D. 1 & 2 12. Mr. Ken has been anxious regarding his diagnosis as well as the reaction to the insulin therapy. As a nurse, the PRIORITY nursing actions to overcome this anxiety behavior is to _____. A. conduct a family conference for the concern of the patient B. refer to the physician for an order of tranquilizer C. express your empathy and respect for his feelings D. take time to explain his disease process and effects of insulin 13. When a patient is suffering from Ketoacidosis, you expect that the entry of Nurse assessment findings in the chart will include the following clinical manifestations EXCEPT ________. A. kussmaul respiration B. cheyne stokes breathing C. lethargy. D. acetone breath odor 14. Nurse Gina who is on morning shift was making her rounds when observed Mr. Jeff, who is suffering from Congestive heart failure is complaining of heaviness of his legs. She observed the patient with an edema of his lower extremities. If the edema is 3+, what do expect the nurse to write in her assessment findings? A. Deeper pit, rebounds in 30 seconds. B. Barely the pit is not perceptible. C. Deeper pit, rebounds in only few seconds. D. Deep pit, rebounds in 10-20 seconds. 15. When auscultating the breadth sounds of patients with respiratory disorder they are instructed to breath through their mouth. A possible complaint the nurse has to watch and be written in her documentation when performing this procedure is which of the following? A. Palpitation B. Dizziness C. Tachycardia D. Bradycardia Situation: Nurse Mita admits Ben, 67 year-old, due to severe abdominal and back pain and vomiting after attending a party. He had positive alcohol breath and was tentatively diagnosed with pancreatitis. He was scheduled for diagnostic laparotomy to further confirm the diagnosis. 16. Nurse Mita gathers more appropriate data from Patient Ben. Which of the following APPROPRIATE questions should Nurse Mita asks? 1."Can you describe your pain?" 2. "Is your urine yellow?" 3. "Is your stool clay colored?" 4."Do you drink alcohol often?" A. 2 and 4 B. 1 and 4 C. 1, 2 and 4 D. 1, 2 and 3 17. Patient Ben asks Nurse Mita, "Why can't the surgeon just take out my pancreas?". The BEST response of Nurse Mita is ____. A. "your body needs to function well with your pancreas" B. "your attack will soon be overcome when you are at rest" C. "if your pancreas is removed, you can never eat fat andfried foods again" D. "antibiotic will relieve signs of infection" 18. Before Surgery, Patient Ben is on nothing per orem status (NPO). She tells Nurse Mita that he is thirsty and hungry. Which of the following is the BEST response of Nurse Virgo? A. "You can sip only this amount of water to moisten your mouth" B. "An NGT will be insertedto remove gastric secretions alleviate your thirst" C. "I will give you ice chips to relive your thirst" D. "Oral and fluid intake stimulates pancreatic enzymes and pain" 19. Nurse Mita asks Patient Ben how she can help to reduce pain while waiting for his operation. Which is the MOST appropriate question of Nurse Virgo? A. "Are you ready for the operation? The pain will soon be over." B. "After the operation, everything will be alright." C. "Is your present position reducing pain?" D. "Does exercise reduce your pain?" 20. Which of the statements of Patient Ben will convince Nurse Mita that his instructions for the prevention of pancreatitis were understood by the patient? I will _________. A. "increase my intake of high protein products" B. "try to stop drinking alcohol" C. "follow a high fat diet faithfully D. "be careful of exposing myself to infection" Situation: An alert 67 year-old woman with diabetes mellitus is discharged from the hospital. A referral is made to a community nursing agency. You are asked to reinforce the teaching program started in the hospital. The patient is using sulfonylurea compound tolbutamide (Orinase). 21. When the patient turned 69 years old. Orinase was discontinued and NPHinsulin was prescribed for her. After several months, she is determined to be suffering from the Somogyi effect. Which of the following conditions will most likely result when the patient is receiving too much insulin? A. Developing an elevation of the blood glucose level B. Producing even more insulin C. Becoming resistant to insulin D. Conserving excessive amount of fluid 22. A few days later, the patient comes into the emergency department via ambulance stretcher and reveals a work-up of a blood sugar level at 800mg/dl, ketones are absent in the urine, she is dehydrated, and has an altered mental status. Based on the data, the patient is most likely suffering from what specific medical condition? A. Hyperosmolar nonketotic coma (HNKC) B. Diabetic retinopathy C. Acute renal failure D. Diabetic ketoacidosis (DKA) 23. Upon interview, the patient reported that she often felt nauseated,restless, perspired a lot, felt fatigued, and was often hungry when she was younger. What do these signs indicate? A. Diabetic nephropathy B. Hyperglycemia C. Hypoglycemia D. Diabetic retinopathy 24. Upon further assessment, you noticed that she had many scratches on her right ankle, a resulting infection and cellulitis. When you ask her about the scratches the patient states. "Oh, my cat must have been using my leg as a scratching post again and I did not even feel it”. Which diabetic complications suspect the patient to have? A. Neuropathy B. Macroangiopathy C. Retinopathy D. Ephropathy 25. You should check the patient for suspect disturbed thought processes related to depressed metabolism and altered cardiovascular and respiratory status. What is the rationale for orienting the patient to time, place, date, and events? A. Shows improved cognitive functioning B. Provides reality orientation to patient C. Permits evaluation of the effectiveness of treatment D. Lets the patient identify the time, place, date and eventscorrectly Situation: Mr. Reynard is tasked to conduct a study to determine the level of patient satisfaction on the care they received from the hospital. In doing so, he plans to include: all adult patients admitted from May-October, first admission, with an average length of hospital confinement of 4-5 days, and with no complications. 26. Which of the following is an EXTRANEOUS of the study? A. Age of patients. B. Absence of complications. C. Length of stay 4-5 days. 2 | Page

D. sodium level 44. While Mrs. Kelly is on TPN she suddenly complains of slight chest pain, dyspnea and appears cyanotic. You suspect that she is experiencing what possible IMMEDIATE complication? A. Sepsis due to IV line B. Air embolism C. Hyperglycemia D. Allergic reaction to TPN Ratio: SX ARE RELATED TO AIR EMBOLISM. CLINICAL SX IS RASHES/Petechiae AT THE CHEST 45. What PRIORITY nursing action should you do with the presenting clinical manifestations of the patient? A. Report to the physician status of the patient at once. B. Take Blood pressure and respiratory rate. C. Stop temporarily the Total Parenteral Nutrition D. Administer Oxygen inhalation. Situation: A housewife, appearing jaundiced, complaining of abdominal pain,nausea and bloated sensation was rushed to the hospital. The patient was examined by the physician and ordered for admission due to a suspected stone in the gall bladder. You are the nurse on duty that day. 46. When performing an interview, which is the BEST initial question you should ask when a patient is in pain? A. How often do you feel the pain? B. How would you describe your pain? C. Did you take any drug to relieve the pain? D. When did you first feel the abdominal pain? 47. Which of the following imaging tests that use a transducer will likely be ordered by the physician to detect gallstones? A. Computed Tomography B. Abdominal X-ray C. Abdominal Ultrasound D. Doppler sonography 48. The test revealed the presence of gallstones and inflamed gall bladder. Thepatient was advised to undergo open cholecystectomy. This operation compared to laparoscopic cholecystectomy are _________. I. invasive II. less pain III. longer recovery IV. shorter hospital stay A. I, II, & IV B. I & II C. I, II & III D. I & III 49. After 2 hours post-operatively, the nurse observed reddish drainage from the operative area of the patient. Which of the following nursing actions should you performed FIRST? A. Check if stitches from the operation have come apart. B. Check where the source of possible bleeding is. C. Cover the operative area with sterile gauze bandage. D. Put your hand as a pressure on the operative area. 50. After several days in the hospital, the physician ordered for the patient to be discharged. Which of the following is PRIORITYrestriction that you should emphasize when he goes home? A. Stool softener to induce bowel elimination. B. Driving while using narcotic drug. C. Take a shower even if it is still with a surgical drain. D. Lifting of objects not more than 10 lbs. Situation: Marichan, a hairstylist is experiencing peri-umbilical pain, feeling feverish and nauseated while at work. She was rushed to the hospital as the pain is becoming intense at the right lower quadrant of the abdomen. She was advised by the ER physician to be admitted for further work-up. 51. Nurse Bela admitted the patient and started to do her assessment. What sign is elicited by the nurse when a deep palpation of the left iliac fossa is done and causes pain on the right iliac fossa of the patient? A. Obturator sign B. Blumberg sign C. Psoas sign D. Rovsing sign 52. After a thorough physical examination, laboratory and diagnostic test the physician ordered an emergency open appendectomy due to a suspected ruptured appendicitis. This is done to prevent which of the following MAJOR complications? A. A Thrombosis B. Sepsis C. Perforation D. Bleeding 53. The nurse prepares the patient for surgery. The overall goals by the surgical team for the patient going for operation include which of the following? I. Relief of pain II. Preventing fluid volume deficit III. Reducing anxiety reaction IV. Eliminating infection A. I, II, III, & IV B. I, II, & III C. II & IV D. I &II 54. As a safety alert, which of the following nursing measures should be AVOIDED by the nurse prior to appendectomy? A. Observe nothing by mouth B. Administration of enema. C. Removal of nail polish D. Instruct to urinate. 55. In wound care management, the nurse is aware NOT to perform which of the following intervention? A. Allow the wound to drain freely. B. Maintenance of an acidic or neutral PH C. Application of cold pack solutions. D. Maintenance for a moist wound environment. Situation: Janah, 18 years old, a teller from a bank is admitted to a tertiary hospital due to hypertension and frequent hematoma of the lower extremities every time she bumps herself in the workplace. The physician who examined her gave an impression of Cushing disease. 56. Which of the following characteristics of Cushing disease is TRUE? I. The disease occurs in women between 20 to 40 years of age. II. The use of corticosteroids for multiple immune conditions is a cause of the disease process. III. The condition is aggravated by excessive production of ACTH. IV. The surgical treatment of choice in Transphenoid hypophysectomy A. II & III B. I, II, & III C. I, II, III, & IV D. I & II 57. When one has a Cushing disease the focal structure affected is the __________. A. hypothalamus B. pituitary gland C. adrenal gland D. para thyroid gland 58. Which of the following clinical manifestations will NOT be a complaint from janah's condition? A. Edema of the extremities B. Poor wound healing C. Decrease libido D. Absence of growth in the pubic area 59. The attending physician ordered a Magnetic Resonance Imaging (MRI) to patient Janah in order to validate the medical impression. This imaging technique is done to detect ________. A. hemorrhagic injury in the brain B. electrical impulse in the brain C. level of oxygen in the brain D. non-hemorrhagic injury in the brain 60. While patient Janah is confined in the hospital, the safety measure tobe observed by the nurses is prevention from fall. This is brought about by the patient being prone to fracture as a result of ____. A. aging process B. change in vision C. osteoporosis D. hematologic condition 4 | Page