Which of the following is the drug of choice for Anthrax?

1. Which of the following is the drug of choice for Anthrax? • Furosemide Lasix…a diuretic • Aminophyllin respiratory medication • Cipro or doxycycline or penicillin • Tamoxifen used for estrogen receptor-positive breast tumors

2. Which of the following is the most appropriate type of isolation precaution for a patient diagnosed with Botulism? • Contact • Universal Precautions • Respiratory • Reverse

3. Which of the following is the most appropriate type of isolation precaution for a patient diagnosed with Botulism? • Contact • Universal Precautions not spread from person to person…use standard precautions. • Respiratory • Reverse

4. Practice Question 41 A nurse is preparing to assist the physician in performing a liver biopsy. The nurse would assist the client to which position for this test? 1. Right lateral side-lying 2. Left lateral side-lying 3. Prone with the hands crossed under the head 4. Supine with the right hand under the head.

5. Practice Question 41 A nurse is preparing to assist the physician in performing a liver biopsy. The nurse would assist the client to which position for this test? 1. Right lateral side-lying anatomical location of the liver makes this choice incorrect 2. Left lateral side-lying anatomical location of the liver makes this choice incorrect 3. Prone with the hands crossed under the head anatomical location of the liver makes this choice incorrect 4. Supine with the right hand under the head. Client is also instructed to remain as still as possible during the procedure.

6. Practice Question 42 The nurse is providing instructions to the client with a gastric ulcer regarding the administration of sucralfate (Carafate).The nurse instructs the client to 1. take the medication after meals & at bedtime with a snack. 2. take the medication with meals & at bedtime with a glass of milk. 3. to space the medication around the clock, taking it very 6 hours. 4. to take the medication 1 hour before meals and at bedtime.

7. The nurse is providing instructions to the client with a gastric ulcer regarding the administration of sucralfate (Carafate).The nurse instructs the client to 1. take the medication after meals & at bedtime with a snack. 2. take the medication with meals & at bedtime with a glass of milk. 3. to space the medication around the clock, taking it very 6 hours. 4. to take the medication 1 hour before meals and at bedtime. • sucralfateforms a protective coating over the gastric ulcer – food intake will stimulate gastric acid production and mechanical irritation • Take at bedtime to provide protective coating during night time hours.

8. Practice Question 43 A client who has returned from a percutaneous liver biopsy should be placed in what position? 1. Left side. 2. Right side. 3. Semi-Fowler’s 4. Supine

9. Practice Question 43 A client who has returned from a percutaneous liver biopsy should be placed in what position? 1. Left side. 2. Right side. 3. Semi-Fowler’s 4. Supine • Client placed on operative side (right side) • Pillow placed under the costal margin to compress the liver • Wt of client’s body will apply pressure to the liver and decr incidence of bleeding

10. Respiratory

11. Causes of Ventilator Alarms High Pressure Alarm: • Increased secretions in the airway • Wheezing or bronchospasm (causing decreased airway size) • Endotracheal tube displaced • Ventilator tubing obstructed • Water in tubing (condensation) • Kink in tubing (under pt, caught in siderail) • Client coughs, gags, bites endotracheal tube • Client anxious and ‘fights” ventilator

12. Causes of Ventilator Alarms Low Pressure Alarm: • Disconnection of ventilator tubing • Leak in the ventilator tubing • Leak in the Endotracheal tube airway cuff • Client stops spontaneous breathing

13. Practice Question 44 A nurse is caring for a client with a tracheostomy tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. The nurse plans to 1. assess for a disconnection. 2. evaluate the cuff for a leak. 3. notify the respiratory therapist. 4. suction secretions from the client.

14. A nurse is caring for a client with a tracheostomy tube attached to a ventilator. The high-pressure alarm sounds on the ventilator. The nurse plans to 1. assess for a disconnection. This would not cause the high pressure alarm to go off. 2. evaluate the cuff for a leak. This would not cause the high pressure alarm to go off. 3. notify the respiratory therapist. Delays necessary tx. 4. suction secretions from the client. High pressure alarm suggests an obstruction. Empty water from tubing…sx pt…check equipment…check pt (could be waking up and fighting the ventilator).

15. Practice Question 45 A client has a chest tube attached to a Pleur-evac drainage system. The nurse would ensure that 1. the connection between the chest tube and the drainage system is taped and that an occlusive dressing is maintained at the insertion site. 2. the amount of drainage into the chest tube is noted & recorded every 24 hours in the client’s record. 3. the suction control chamber has sterile water added every shift & that the system is kept below waist level. 4. the water seal chamber has continuous bubbling and that assessment for crepitus is done once a shift.

16. A client has a chest tube attached to a Pleur-evac drainage system. The nurse would ensure that 1. the connection between the chest tube and the drainage system is taped and that an occlusive dressing is maintained at the insertion site. 2. the amount of drainage into the chest tube is noted & recorded every 24 hours in the client’s record. Drainage noted and recorded qhr in the 1st 24 hrs then q8 and prn. 3. the suction control chamber has sterile water added every shift & that the system is kept below waist level. Sterile water is added at initial set up and then only as needed (which is rare) 4. the water seal chamber has continuous bubbling and that assessment for crepitus is done once a shift. Continuous bubbling in the sx chamber. Bubbling in the water seal is a sign of an air leak. Assess for Crepitus q8hrs.

17. Practice Question 46 The nurse caring for a client with a closed chest drainage system notes that the tidaling in the water seal compartment has stopped. Based on this finding, the nurse would suspect that 1. the chest tubes are obstructed. 2. suction needs to be increased. 3. the system needs changing. 4. suction needs to be decreased.

18. Practice Question 46 The nurse caring for a client with a closed chest drainage system notes that the tidaling in the water seal compartment has stopped. Based on this finding, the nurse would suspect that 1. the chest tubes are obstructed.Or the pneumothorax is resolved…fluctuation continues until the thorax is resolved. 2. suction needs to be increased. Amt of sx is irrelevant…controlled via sx control chamber ;usu set at 20. 3. the system needs changing. Only change when drainage collection device is full or the device is damaged in some way. 4. suction needs to be decreased. Sx is often discontinued once drainage stops – waterseal is adequate for the resolution of the pneumothorax.

19. Practice Question 47 The client with tuberculosis asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when 1. 3 sputum cultures are negative. 2. 5 sputum cultures are negative. 3. a sputum culture & a chest x-ray film are negative. 4. a sputum culture & a Mantoux test are negative.

20. Practice Question 47 The client with tuberculosis asks the nurse when it is permissible to return to work. The nurse replies that the client may resume employment when 1. 3 sputum cultures are negative. 2. 5 sputum cultures are negative. 3. a sputum culture & a chest x-ray film are negative. 4. a sputum culture & a Mantoux test are negative. Mantoux will always be positive once it becomes positive. Do not repeat once the pt has a positive.

21. Practice Question 48 Which of the following should be performed prior to drawing arterial blood gases from the radial artery? 1. Allen’s test 2. Babinski’s reflex 3. Brudzinski’s sign. 4. Homans’ sigh

22. Practice Question 48 Which of the following should be performed prior to drawing arterial blood gases from the radial artery? 1. Allen’s test assesses for the adequ of ulnar circulation. 2. Babinski’s reflex performed on the sole of the foot – unrelated to a procedure performed on the radial artery. 3. Brudzinski’s sign. Assessment for nuchal rigidity by bending the head down toward the chest. 4. Homans’ sign sharp dorsiflexion of the feet – used to assess for thrombophlebitis.

23. Practice Question 49 A client with tuberculosis is to be started on rifampin (Rifadin). The nurse provides instructions to the client and tells the client 1. that yellow-colored skin is common. 2. to wear glasses instead of soft contact lens. 3. always to take the medication on an empty stomach. 4. that as soon as the cultures come back negative, the medication may be stopped.

24. A client with tuberculosis is to be started on rifampin (Rifadin). The nurse provides instructions to the client and tells the client 1. that yellow-colored skin is common. Indication of jaundice. Should report jaundice to MD. 2. to wear glasses instead of soft contact lens. Soft contacts may be damaged permanently by the orange discoloration that rifampin causes in body fluids. 3. always to take the medication on an empty stomach. Eliminate because of the word “always”- may take with food if client is unable to tolerate on an empty stomach. 4. that as soon as the cultures come back negative, the medication may be stopped. Client will be on the meds a LONG time – as much as 12 months even if the cultures come back negative.

25. Practice Question 50 A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. The nurse develops a plan of care for the client and includes which of the following? 1. Providing the client with short, frequent walks. 2. Measuring the client’s pulse each shift. 3. Eliminating sources of caffeine from meal trays. 4. Limiting fluids given orally and IV.

26. A client with an acute respiratory infection is admitted to the hospital with a diagnosis of sinus tachycardia. The nurse develops a plan of care for the client and includes which of the following? 1. Providing the client with short, frequent walks. Exercise will not alleviate tachycardia. 2. Measuring the client’s pulse each shift. Will not alleviate s/s and HR should be measured more freq. than qshift. 3. Eliminating sources of caffeine from meal trays. Cause exacerbation of the s/s. Caffeine is a stimulate. 4. Limiting fluids given orally and IV. Exercise will not alleviate tachycardia.

27. Practice Question 51 A client is experiencing an acute asthmatic attack. Which nursing action would improve the respiratory status of the client? 1. Help the client to attain a slow, prolonged expiration. 2. Have client forcefully exhale. 3. Provide rest by leaving client alone and in supine position. 4. Assist the client to breathe into a paper bag.

28. A client is experiencing an acute asthmatic attack. Which nursing action would improve the respiratory status of the client? 1. Help the client to attain a slow, prolonged expiration. This allows the client to exhale a greater volume and facilitates incr oxygenation. 2. Have client forcefully exhale. Used to measure peak airflow. 3. Provide rest by leaving client alone and in supine position. Client should be sitting or in high-Fowler’s position. Do not leave alone. 4. Assist the client to breathe into a paper bag. This will incr PCO2 and not improve the pt’s overall condition.

29. Practice Question 52 A client with a pneumothorax has a chest tube inserted & connected to gravity drainage. When assessing the drainage system for proper function, what will the nurse expect to observe? 1. Continuous bubbling in the water-seal chamber. 2. Slight fluctuation of the water in the water-seal chamber. 3. Increased bloody drainage in the collection chamber. 4. Constant bubbling in the collection chamber.

30. A client with a pneumothorax has a chest tube inserted & connected to gravity drainage. When assessing the drainage system for proper function, what will the nurse expect to observe? 1. Continuous bubbling in the water-seal chamber. In the sx control chamber OK – in water seal suggests an air leak. 2. Slight fluctuation of the water in the water-seal chamber. Should fluctuate with breathing. 3. Increased bloody drainage in the collection chamber. Incr bloody drainage is never normal. 4. Constant bubbling in the collection chamber. Bubbling in the sx control chamber OK – collection chamber should not have bubbling.

31. Water seal chamber B A Fluid/drainage collection chamber C Suction control chamber

32. Practice Question 53 The nurse would anticipate which nursing observation in the client with symptoms of early laryngotracheobronchitis? 1. Elevated temperature & prostration. 2. Flushed face & labored expirations. 3. Kussmaul respirations & bradycardia. 4. Tachypnea & inspiratory stridor.

33. Practice Question 53 The nurse would anticipate which nursing observation in the client with symptoms of early laryngotracheobronchitis? 1. Elevated temperature & prostration. Temperature not charactoristic 2. Flushed face & labored expirations. Could occur – but are not charactoristic – esp. early. 3. Kussmaul respirations & bradycardia. Deep rapid resp but are not noisy 4. Tachypnea & inspiratory stridor. Rapid, noisy resp. Occurs as air is drawn through a narrowed airway.

34. Practice Question 54 What are the nursing precautions during a tubing change of a central venous pressure (CVP) line? 1. Flush catheter with 3 ml of NS & then heparin before disconnecting the line. 2. Position client on right side & then have him take a deep breath. 3. Elevate HOB & disconnect tubing from fluid container before disconnecting from client. 4. Position client flat & have him take a deep breath & hold it while the line is disconnected & a new one connected.

35. Practice Question 54 What are the nursing precautions during a tubing change of a central venous pressure (CVP) line? 1. Flush catheter with 3 ml of NS & then heparin before disconnecting the line. Not necessarily. 2. Position client on right side & then have him take a deep breath. Position flat. 3. Elevate HOB & disconnect tubing from fluid container before disconnecting from client. Position flat. 4. Position client flat & have him take a deep breath & hold it while the line is disconnected & a new one connected. Increases intrathoracic pressure and so decr possibility that the client will experience an air embolus during the tubing change.

36. Practice Question 55 A client has thick pulmonary secretions. The nurse would anticipate which classification of medication to be ordered? 1. Antihistamine 2. Bronchodilator. 3. Decongestant. 4. Expectorant.

37. Practice Question 55 A client has thick pulmonary secretions. The nurse would anticipate which classification of medication to be ordered? 1. Antihistamine block the release of histamine – used to tx mild allergic disorders. 2. Bronchodilator. Indicated when airways are inflamed and narrowed. 3. Decongestant. Produce vasoconstriction of dilated arterioles – leads to reduction in congestions. 4. Expectorant. Stimulate secr and reduce the viscosity of the mucus.

38. Practice Question 56 The nurse is monitoring a client who is receiving IV theophylline (aminophylline) for control of an acute episode of his chronic respiratory condition.What nursing observations would cause the nurse the most concern? 1.Blurred vision, halos around lights and diplopia. 2. HypoKalemia, diarrhea, and bradycardia. 3. Restlessness, tachycardia, nausea, and vomiting. 4. Tachycardia, pulse oximetry of 90%, irregular respirations.

39. The nurse is monitoring a client who is receiving IV theophylline (aminophylline) for control of an acute episode of his chronic respiratory condition.What nursing observations would cause the nurse the most concern? 1.Blurred vision, halos around lights and diplopia. Does not relate to theophylline use. 2. Hypokalemia, diarrhea, and bradycardia. Does not relate to theophylline use. 3. Restlessness, tachycardia, nausea, and vomiting. Indicates toxic levels of theophylline. Lab work must be done to monitor the theophylline levels. Normal range is 10-20 mcg/ml. 4. Tachycardia, pulse oximetry of 90%, irregular respirations. Does not relate to theophylline use.

40. Practice Question 57 A nurse has an order to remove the NG tube from a first postoperative day surgery client. The nurse would question the order if which of the following was noted on assessment of the client? 1. Abdomen is slightly distended. 2. Bowel sounds are absent. 3. NG tube drainage is Hematest negative. 4. The client is drowsy.

41. A nurse has an order to remove the NG tube from a first postoperative day surgery client. The nurse would question the order if which of the following was noted on assessment of the client? 1. Abdomen is slightly distended. Cause for concern – but if active BS the distention should be resolved soon. 2. Bowel sounds are absent. GI system will continue to produce secretions even if pt is NPO – if no BS present they will remain in abdomen and present as an aspiration risk. 3. NG tube drainage is Hematest negative. This indicates a normal finding. 4. The client is drowsy. Drowsiness is not an indication for an NG tube

42. Adult Health II Developed by Dare Domico, RN, DSN Revised by: Jill Ray

43. Cardiovascular

44. Practice Question 1 A nurse is preparing to defibrillate a client in ventricular fibrillation. After placing the paddles on the client's chest and before discharging them, which of the following should be done? • Ensure that the client has been intubated • Set the defibrillator to the “synchronize” mode • Administer lidocaine hydrochloride (Xylocaine). • Confirm that the rhythm is actually ventricular fibrillation.

45. Practice Question 1 A nurse is preparing to defibrillate a client in ventricular fibrillation. After placing the paddles on the client's chest and before discharging them, which of the following should be done? • Ensure that the client has been intubated does not have to be intubated to defibrillate • Set the defibrillator to the “synchronize” mode synchronize mode used with cardioversion • Administer lidocaine hydrochloride (Xylocaine). Can be administered after defibrillation • Confirm that the rhythm is actually ventricular fibrillation.

46. Practice Question 2 Which of the following best describes the rhythm represented on the EKG strip? • Normal sinus rhythm • Ventricular tachycardia • Atrial fibrillation • Ventricular fibrillation

47. Practice Question 2 Which of the following best describes the rhythm represented on the EKG strip? • Normal sinus rhythm note the presence of a P wave before ea qrs • Ventricular tachycardia • Atrial fibrillation • Ventricular fibrillation

50. Practice Question 3 A nurse is administering a dose of hydralazine (Apresoline) IV to a client. The nurse ensured that which of the following items is in place before injecting the medication? 1. Central line. 2. Foley catheter 3. Pulse oximeter 4. Blood pressure cuff.