CGFNS

1. CGFNS

2. Following abdominal surgery, a clinical manifestatios that will indicate negative nitrogen balance is • Poor skin turgor from dehydration • Calcium • Chloride • Potassium • D • Rationale : Release of adrenocortical steroids (cortisol) by the stress of surgery causes renal retention of soduim and excretion of potassium. (Although sodium may be depleted by nasogastric suction, retention by the kidneys generally balances this loss. This is not depleted by surgery or urinary excretion)

3. A client has developed disseminated intravascular coagulation (DIC) following a missed abortion. The most critical nursing intervention for this client is to : • Administer ordered medications (heparin) • Alay anxiety provide emotional support • Administer oxygen at 6 L /min • Encourage fluid intake • A • Rationale : In dic the client begins to haemorrhage after the initial hypercoagulability, during which the clotting factors in the blood is used up. Administering heparin, is a critical nursing intervention. Heparin prevents clot formation and increases available fibrinogen, coagulation factors, and platelets. The other actions have lesser priority. Oxygen would be administered at 2 to 3 L / min.

4. An improvement in which of the blood values indicates an effective dialysis? • Low serum creatinine levels • Low haemoglobin • Hypocalcaemia • Hypokalaemia • A • An effective dialysis should bring down serum creatinine value. Anemia is a result of decreased production of erythropoietin by the kidney and is not affected by hemodialysis. Hyperkalaemia and high base bi carbonate levels are present in renal failure clients.

5. Ibuprofen is ordered every 6 hours post operatively for a client aged one year old. It has been 6 hours since the last dose. The parent has requested he receive his pain medication be given because the child is still restless in sleep. The nurse : • Refuses to awaken the child • Wakes the child and gives the medication • Tells the mother to call as soon as soon as the child wakes up • Explains the purpost and use of pain needs to the mother • B • Children may withdraw and sleep to be able to deal with pain. The mother is the best judge of the youg child’s pain.

6. Following prolonged and extensive surgery it is most important for the nurse to observe the client for the depletion of which of the following electrolyte? • Sodium • Calcium • Chloride • Potassium • D • depleted by nasogastric suction, retention bvy the kidneys generally balances this loss. This is not depleted by surgery or urinary excretion)

7. In a client with right sided congestiv e heart failure, which of the following blood chemistry results is expected to be elevated? • Ammonia • Albumin • LDH • CK • C • The liver becomes engorged with blood in right-sided congestive heart failure. Liver function studies, such as the LDH, an enzyme production test for the liver, will be abnormally elevated in 40 percent of the clients. Serum bilirubin is also frequeently increased. Ammonia, albumin and liver tests will not be elevated. CK isoenzymes (CKMB) is a valuable indicator of myocardial infarction.

8. The principle behind the functioning of a portable wound drainage system is : • Gravity causes liquids to flow down a pressure gradient • The diamater of the lumen will determine the flow rate of fluid • Siphonage causes fluids to flow from one level to a lower one • Fluids flow from an area of higher pressure to one of lower pressure. • D • A portable wound drainage system has negative pressure thereby the fluid flows down the pressure gradient from the client to the collection device. Option A is Newton’s law of gravity not the physical principle underlying the functioning of a portable wound drainage system. Although option B is true, this is not what causes the fluid to drain. Siphonage is not the principle underlying the functioning of a portable wound drainage system

9. 20 mEq. of potassium chloride is to be added to the IV solution of a client with diabetic ketoacidosis. The primary purpose for administering this drug is to : • Treat hyperpnoea • Prevent flaccid paralysis • Replace potassium deficit • Treat cardiac dysrrhyhmias ???e ???uld not occur ??? ???, ??? The answer is C

10. 20 mEq. of potassium chloride is to be added to the IV solution of a client with diabetic ketoacidosis. The primary purpose for administering this drug is to : • Treat hyperpnoea • Prevent flaccid paralysis • Replace potassium deficit • Treat cardiac dysrrhyhmias ???e ???uld not occur ??? ???, ??? The answer is C

11. 20 mEq. of potassium chloride is to be added to the IV solution of a client with diabetic ketoacidosis. The primary purpose for administering this drug is to : • Treat hyperpnoea • Prevent flaccid paralysis • Replace potassium deficit • Treat cardiac dysrrhyhmias ???e ???uld not occur ??? ???, ??? The answer is C

12. ??? • Sodium • Calcium • Chloride • Potassium • D Rationale : Release of adrenocortical steroids (cortisol) by the stress of surgery causes renal retention of soduim and excretion of potassium. (Although sodium may be depleted by nasogastric suction, retention bvy the kidneys generally balances this loss. This is not depleted by surgery or urinary excretion)

13. 20 mEq. of potassium chloride is to be added to the IV solution of a client with diabetic ketoacidosis. The primary purpose for administering this drug is to : • Treat hyperpnoea • Prevent flaccid paralysis • Replace potassium deficit • Treat cardiac dysrrhyhmias Once treatment with insulin for diabetic ketoacidosis is begun, potassium ions reenter the cell, causing hypokalaemia, therefore potassium, along with the replacement fluids is generally supplied. Potassium would not correct hyperpnea. Flaccid paralysis would not occur in diabetic ketoacidosiss; potassium replaces that which has reentered the cell after insulin therapy. Knowing the relationship ???, the nurse should recognize that treatment with KCl is prophylactic, to abort development of dysrhythmias The answer is C

14. A 2-year ikd client with cerebral palsy is admitted to thehospital. The most important information to consider in planning initial nursing care is a : • Detailed description of previous hospitalizations • List of immunizations received • Family history of illnesses • General description of activities of daily living Rationale : When a child with cerebral palsy or any chronic illness is hospitalized routines utilized at home should be followed to provide continuity of care. The answer is D

15. A 60 – year old female client is admitted to the surgery unit for removal of fibroids. When the nurse checks the lab results for routine blood chemistry, she notes that the erythrocyte sedimentation rate is 29 mm/dl. The appropriate intervention is to: • Ask the client if she has been sick with a fever • Do nothing the value is normal • Notify the physician • Ask the lab to repeat the test Rationale : This is a normal sedimentation rate for a female over age 60. Under age 50 normal is 20 mm/hr. if it were increased, it would indicate presence of infection or inflammation oand surgery might have to be postponed. The answer is B

16. A 60 year old posmenopausal female client suspected of having a myocardial infarction is admitted The isoenzyme values that would be indicative of specific myocardial damage is • CK (formerly) CPK • MB Band • MM Band • BB Band Th CK is a cellular enzyme that is fractionated our into MB, MM, and BB bands. The MB bands are specific to cardiac muscle, the MM bands relate to skeletal muscle, and the BB bands relate to CK in the brain. Although an elevated CK may indicate cardiac muscle damage, it is only the MB portion that is specific to cardiac muscle The answer is B

17. A client admitted to ER has symptoms of nause and vomiting He states that before he came to the hospital, when he tried to lie down, his abdominal pain got worse and was not relieved by antacids. When questioned, he states that he had consumed a large meal and two glasses of wine. The tentative diagnosis is acute pancreatitis. The physician orders lab-work. With this complaint picture and diagnosis, the nurse would expect lab results to include : • Decreased WBC • Elevated serum amylase and lipase • No change in serum bilirubin level • Elevated alkaline phophatase Rationale : These elevated serum levels (amylase and lipase) are the hallmark of acute pancreatitis. Increased WBC and serum bilirubin level is also seen with acute pancreatitis. Elevated alkaline phosphatase is found in chronic pancreatitis. The answer is B

18. A client has a gastric analysis done and results showed that gastric acid was high. This test result would indicate to the nurse that the client may receive the diagnosis : • Pernicious anaemia • Peptic ulcer • Tuberculosis • Duodenal ulcer Rationale : high gastric acid levels may indicate duodenal ulcer. Pernicious anemia (A) would yield low results. Tuberculosis (C) may be diagnosed by gastric washings for acid-fast bacilli, especially if sputum analysis is difficult to procure. The answer is D

19. A client has been advised to take colestid (a bile acid sequestrant) to lower his LDL. It comes in powder form or tablets. The nurse should inform the client that if he chooses tablet form, he should : • Take milk with the medication • Take upto 30 tablets per day for the medication to effective • Take tablet every 6 hours • Not take the medication with citric acid (orange juice) Rationale : if the client chooses to take the tablets rather than the powder, he will have to take upto 30 tablets a day. The powder can be taken with a beverage or cereal. The answer is B

20. A client has just arrived at the recovery room from surgery. Which of the following is the priority assessment? • Assess the client’s need for oxygen • Check the gag reflex • Assesss vital signs • Assess airway for patency The priority assessment is to determine if the airway is patent. All of the other nursing actions will follow this assessement : need for oxygen, gag reflex and vital signs. The answer is D

21. A client in whom intestinal obstruction is susptected has a nasogaastric tube in place and aattached to suction. Critical assessment of this client includes observations for : • Edema • Belching • Dehydration • Excessive salivation dehydration is a danger because of fluid loss with GI suction Based on the data provided, the other symptom are not likely to occur. The answer is C

22. A client is admitted to the hospital for evaluation. His physician writes in the chart “ rule out liver cancer” and schedule a liver biopsy. Before the procedure, the nurse reviews the PT results just back from the lab: 30 seconds. The nurse also notes that this client is not on an anticoagulant. The nursing intervention is to : • Do nothing the results of the PT are normal • Notify the physician before the biopsy procedure • Ask the lab to repeat the test tomorrow and notify the ohysician • Ask the client if he has been eating foods high in vitamin K because the client is not on anticoagulant therapy, the results are abnormal (normal PT is 11 – 15 seconds.)it us important to notify the physician before the biopsy; bleeding could be life threatening. The client will probably be given vitamin K therapy and when the PT results return to the normal range, theprocedure can be done . The prolonged PT is probably caused by liver disease. The answer is B

23. A client is admitted with diarrhoea, anorexia, weight loss, and abdominal cramps. A diagnosis of colitis is made. The symptoms of fluid and electrolyte imbalance caused by this condition that the nurse should report immediately are: • Skin rash, diarrhoea, and diplopia • Extreme muscle weakness and tachycardia • Development of tetany with muscle spasms • Nausea, vomiting, and leg and stomach cramps Rationale : Potassium, the major intracelular cation functions with sodium and calcium to regulate neuromuscular activity and contraction od muscle fibres, particularly the heart muscle. In hypokalemia the symptoms that develop are extreme muscle weakness and tachycardia. Skin rash, diarrhoea, and diplopia do not indicate and electrocyte imbalance. Tetany with mscle spasms would indicate hypocalcemia, which does not generally occur in colitis. Nausea and vomiting might occur with prolonged potassium deficit; however, this not an early sign; leg and abdominal cramps occur with potassium excess, not deficit. The answer is B

24. A client is brought into the recovery room following spinal anaesthesia. Which of the following assessment data indicates a complication of anaesthesia has developed? • Hiccoughs • Numbness in legs • Headache • No urge to void Rationale : When spinal fluid is lost through a leak or the ‘client is dehydrated, a severe headache can occur, which may last several days. The complication od hiccoughs can be associated with abdominal surgery, but is not attributable to spinal anaesthesia. Numbness and no urge to void would be expected with spinal anaesthesia unless it continues for several hours postop. The answer is C

25. A client is in a state of uncompensated acidosis. The nurse would expect the arterial blood pH to be approximately: • 6.9 • 7.2 • 7.45 • 7.48 Rationale : the pH of blood is maintained within the narrow range of 7.35 to 7.45. when there is an increase in hydrogen ions, acidosis results and is feflected in a lower pH. A pH of 6.9 is too acidotic and may not be compatible with life. A pH of 7.45 is within normal range for pH. A pH of 7.48 is slightly alkaline. The answer is B

26. A client is on IV infusion. If the IV infusion infilrates, the nurse should first : • Elevate the IV site • Discontinue the infusion • Attempt to flush the tube • Apply warm, moist soaks Rationale : when an IV infusion is infiltrated, it should be removed to prevent swelling of the tissues and pain. Elevation doesn not change the position the IV cannula; the infusion must be discontinued. Flushing the tube would add to the infiltration of fluid. Moist soaks may be applied, if ordered after the iv is removed. The answer is B

27. A client is scheduled for a carotid endarterectomy in 3 days. Which of the following preadmission lab test results must be immediately reported to the physician? • Sodium of 151 mEq/L • Chloride of 105mEq/L • Potassium of 3.8 mEq/L • Bicarbonate of 23 mEq/L Rationale : serum sodium is the only abnormal value. The normal range of electrolyte values for an adult are as follows: sodium of 135-145 mEq/L, chloride of 100-106 mEq/L , potassium of 3.5-5.0 mEq/L and bicarbonate of 22 – 29 mEq/L The answer is A

28. A client is scheduled for surgery in the AM. Pre-operative orders have been written. The nurse would prioritize care delivery after balance in the body: • Removing all jewelry • Having lab work done • Informing family or next of kin • Having all consent papers signed Rationale : Consent forms must be signed by the client, family, or guardian with medical power of attorney before any procedure can be done on the client The answer is D

29. A client is to receive 2000 ml of IV fluid in 12 hours. The drop factor is 10 gtt/ml. the nurse should regulate the flow so the number of drops per minute is approximately: • 27 -29 • 30 - 32 • 40 - 42 • 48 - 50 20000 / 720 min = 27 drops The answer is A

30. A clinet who is on steroid therapy should be taught to • Increase sugar intake • Increase dose as needed • Not to discontinue medication abruptly • Increase food consumption to keep weight on Rationale : not to discontinue steroids abruptly because it causes adrenal insufficiency. The answer is C

31. A clientwho sustained head trauma in a motor vehicle accident has been diagnosed and treated for having syndrome of inappropriate antidiuretic hormone (SIADH) secretion. Which of the following urine specific gravity values would indicate that the situation is not resolved? • 1.005 • 1.018 • 1.025 • 1.035 Rationale : this value is above normal limits ( the normal range of a urine specific gravity is 1010 – 1025). A value of 1005 may be seen when the client was in the diuretic phase of a head injury or insult values of 1018 and 1025 are within normal limits. The answer is D

32. A client who takes Lasix and has a potassium of 3.2 mEq/L , need to be advised by the nurse that he should: • Avoid apple juice, orange juice, and instant coffee • Eat three servings daily of fruits and meat or fish • Maintain a fluid intake of 2 L / day • Avoid driving or operating electrical equipment Rationale : The normal potassium level is 3.5 – 5.0 mEq/L. the clinet’s potassium level is low, and he needs to replenish potassium that will ve lost as a result of taking Lasix. In addition to taking potassium supplements, the client should be given a list of he appropriate foods that have an average of 7 mEq potassium per serving. Fruit, meat, fish, instant coffee, and milk are high in potassium. The answer is C

33. A client with a long-standing history of alcoholic cirrhosis with ascites is admitted to the hospital. His diagnosis is acute bleeding from oesophageal varices secondary to cirrhosis with portal hypertension. Which of the following laboratory findings indicate that blood is being digested and absorbed by the GI tract? : • Elevated BUN • Elevated serum ammonia • Decreased hemoglobin • Elevated bilirubin Rationale : As blood is digested, the BUN rises rapidly. A result of bleeding may also be a lowered haemoglobin, but this does not indicate digestion and absorption of blood nitrogen. An elevation of serum ammonia may ensue if the liver is unable to handle the protein load of digested blood The answer is A

34. A client with coronary artery disease has an LDL cholesterol level of 140 mg/dl. His physician has ordered Mevacor to lower the LDL level and slow the progression of atherosclerosis. In counselling the client, the nurse should emphasize: • Taking this medication with niacin to lower the LDL level • Notifying the physician if the client’s gums begin to bleed • Reporting a rash, myalgia, or blurred vision • Photosensitization effects of the drug, hence the need for sunscreen and protective clothing Photosensitization is a risk factor for clients taking hepatic hydroxymethylglutaryl coenzyme A (HMGCOA) reductase inhibitors (Mevacor). Niacin is usually given with bile acid sequestrants because they work synergistically. Bleeding from the gums or rectum is a sign of vitamin K deficiency from bile acid sequestrants (Questran). Rash, myalgia and blurred vision are adverse effects of fibric acid derivatives, which are not very efective in lowering LDL. The answer is D

35. A client with damaged or impaired lungs cannot remove all of the CO2 from the body. When the excess CO2 combines with H2O, it will form : • H2CO3 • HCO3 • H+ • CO2 Excess CO2 in the blood, combines with water to form H2CO3 (carbonic acid). Depending on the amount of acid in the blood, thelungs will increase or decrease ventilation to remove excess CO2. The kidneys can excrete or retain H+ and HCO3; thus the equation representing homeostasis is : CO2 + H2O  H2CO3  H+ + HCO3- The answer is A

36. A client with oesophageal cancer is to receive total parenteral nutrition. A right subclavian catheter is inserted by the physician. The primary reason for using a central line is that : • It prevents the development of phlebitis • There is less chance of this infusion infiltrating • It is more convenient to clients so use their hands • The large amount of blood helps to dilute the concentrated solution Unless diluted the highly concentrated solution can cause hperosmolar diuresis. The potential of phlebitis is not the primary reason. Option B and C are not the primary reasons; although the infusion at this site is more secure and promotes free use of the arms and hands The answer is D

37. A client who has recently undergone outpatient surgery on his knee is admitted to the ER with the following symptoms ; marked shortness of breath, tachycardia, chest pain and severe anxiety. The nurse will recognize that these symptoms must be reported immediately to the physician. The next intervention will be to prepare to administer : • sxygen • heparin • urokinase • Coumadin The client’s condition suggests pulmonary embolism, which is not uncommon following orthopedic surgery on the knee. The physician will order urokinase delivered through a PICC to dissolve the clot (the primary goal in treating PE). Heparin and coumadin (the oral form of warfarin) are anticoagulants and will only prevent further clots from forming. Oxygen may well be ordered, but the critical intervention is the thrombolytic agent, which must be given within a few hurs of the onset of the symptoms The answer is C

38. A nurse administers an intravenous solution of 0.45 % sodium chloride. With respect to human blood cells, this solution is: • istonic • isomeric • hypotonic • hypertonic Hypotonic solutions are less concentrated (contain less thatn 0.85 g of sodium chloride in each 100 ml) than body fluids. Isotonic solutions are those that cause no change in the cellular volume or pressure, because their concentration is equivalent to that of body fluid The answer is C

39. 20 mEq. of potassium chloride is to be added to the IV solution of a client with diabetic ketoacidosis. The primary purpose for administering this drug is to : • Treat hyperpnoea • Prevent flaccid paralysis • Replace potassium deficit • Treat cardiac dysrrhyhmias ???e ???uld not occur ??? ???, ??? The answer is C

40. A school health nurse, working with sexually active teenagers, incorporates the concept secondary prevention into practice by : • Setting up a birth-control clinic in the school health office • Attending health curriculum meetings to assure that contraceptive information is included in a unit on sexuality. • Teaching a group of parents about the problems of adolescent pregnancy • Referring a pregnant teenager for prenatal care Rationale : The nurse knows that secondary prevention efforts are directed toward promoting early case finding so that prompt intervention can be in instituted. The answer is D

41. A solution that contains 1 mole of solute in 1 litre of solution is called : • Molar solution • Normal solution • Isotonic solution • Saturated solution The answer is A

42. A solution that contains 1 mole of solute in 1 litre of solution is called : • Molar solution • Normal solution • Isotonic solution • Saturated solution Rationale : A molar (1 M) solution solution contains 1 grammolecular weight of solute per litre of solution. Molarity is not as informative as nimality because the latte is based on the actual chemical combining properties of the substance involved. A normal (1 N ) solution is defined as containing I gram equivalent weight of solute per liter of solution. The answer is A

43. In human body fluids the milliequivalent (1/1000 of the gram- equivalent is more convenient term for expressing concentration, because the gram equivalent is rather large. The term isotonic solution deals with the osmotic pressure of two liquids; isotonic solutions have equal osmotic pressure. A solution holding all the solute it can at a given temperature and presure is saturated solution.

44. Acetoacetic acid is buffered in the blood chiefly by: • potassium • bicarbonate • Carbon dioxide • Sodium chloride Rationale : Sodium bicarbonate is a base and one of the major buffers in the body Poeassium is not a buffer; only a base can buffer an acid. Carbon dioxide is carried in aqueous solution as carbonic acid (H2CO3); an acid does not buffer another acid. Sodium chloride is not a buffer; it is a salt. The answer is B

45. Ammonia excretion by he kidney help to maintain: • Osmotic pressure of the blood • Acid-base balance of the body • Low bacterial levels in the urine • Normal red blood cell production Ammonia excretion by the kidney combines with hydrogen ions in the glomerular filtrate to form ammonium ions, which are excreted from the body. This mechanism helps the body to get rid of excess hydrogen, maintaining acid base balance. Osmotic pressure is not affected by excretion of ammonia. Ammonia is formed by the decomposition of bacteria in the urine; ammonia exdretion is not related to the process and does not control bacterial levels. Ammonia excretion does not affecte haemopoiesis. The answer is B

46. An 80 year old client admitted to the hospital is having influenza and dehydration. Which of the following blood urea nitrogen (BUN) levels would indicate to the nurse that he client has received adequate fluid volume replacement? • 40 mg/dL • 29 mg/dL • 17 mg/dL • 3 mg/dL The normal range of BUN is 10-20 mg/dL. BUN values of 40 mg/dL and 29 mg/dL indicate fluid overload unresolved dehydration. BUN value of 3 mg/dL is signigicantly lower than normal and may indicate fluid overload. The answer is C

47. An accurate blood pressure of a client can be obtained by: • A cuff that covers the upper one-third of the client’s arm • Positioning the cuff approximately 4” above the antecubital space • Use a cuff that is wide enough to coveer the two-third of the client’s arm • Identify the Korotkoff sounds, and take systolic reading at 10 mm Hg after the first sound To obtain an accurate reading in an adult, the blood pressure cuff should cover the two thirds of the client’s arm and should be positioned approximately 2” above the ante-cubital space. The systolic reading is obtained with the first of the Korotkoff sounds. The answer is C

48. An adult female is scheduled for a total hip replacement. The nurse initiates the interview by: : • Sitting quietly until the client initiates the conversation • Start the interview with easy questions to build a rapport • Try not to seem too friendly too soon • Do not dwell on the diagnosis and its effect on the client the best approach to a good interview is to start with the easy less personal questions while building a rapport. The answer is B

49. An intravenous piggyback (IVPB) OF CEFAZOLIN SODIUM (Kefzol) 500 mg in 50ml of 5 % dextrose in water is to be administered over a 20 minute period. The tubing has a drop factor of 15 drops per milliliter. The nurse should regulate the infusion to run at: • 28 gtt/min • 38gtt/min • 58 gtt/min • 76 gtt/min ???e ???uld not occur ??? ???, ??? The answer is B

50. At the physician’s office, the client’s random plasma glucose test is 250 mg/dL. The client asked the office nurse why the doctor told him to come back the next day to repeat the test. The best answer is: • The doctor always repeats this test • You may have diabetes and the doctor wants to be sure • This test must be done at least twice for accurate results • It was a little high so the doctor wants to check the results The best answer is to be truthful but not to firghten the client by telling him that he may have diabetes(this is the domain of the physician). Levels of more that 200 mg/dl. On more than one occasion would, however, be diagnosis of diabetes,so the doctor would order at least two tests. The answer is C