Comp Review

1. Comp Review Ana Corona, MSN, FNP-C Nursing Instructor August 2007

2. 1 A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?” A: Green vegetables and liver B: Yellow vegetables and red meat C: Carrots D: Milk

3. Answer 1 (A) Green vegetables and liver are a great source of folic acid

4.  2 A fragile 87 year-old female has recently been admitted to the hospital with increased confusion and falls over last 2 weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed? A: FBC (full blood count) B: ECG (electrocardiogram) C: Thyroid function tests D: CT scan

5. Answer 2 (D) A CT scan would be performed for further investigation of the hemiparesis.

6. 3 The nurse is observing a LPN/LVN administer iron dextran (DexFerrum) IM. It is MOST important for the nurse to give which of the following instructions? “Massage the injection site for one minute after the injection of the medicine.” “Tap out the air bubble prior to administering the medication.” “Release the skin prior to withdrawing the needle.” “Change the needle after drawing up the medication.”

7. Answer 3 (D) Explanation of Answer: This ensures that no solution remains on the outside of the needle.

8. 4 The nurse is teaching a 45-year-old woman how to increase the potassium in her diet. The woman says she knows bananas are high in potassium, but she doesn’t like their taste. What foods should the nurse recommend the client include in her diet? Potatoes, spinach, raisins. Rhubarb, tofu, celery. Carrots, broccoli, yogurt. Onions, corn, oatmeal.

9. Answer 4 (A) potassium content foods: Product Potassium Amount Potatoes 610 mg Carrots 221 mg Spinach 838 mg Broccoli 254 mg Raisins 1089 mg Yogurt 251 mg Rhubarb 548 mg Onions 318 mg Tofu 9 mg Corn 192 mg Celery 114 mg Oatmeal 132 mg

10. 5 The nurse is caring for clients in an orthopedic clinic. Then nurse would be MOST concerned if which of the following was observed? A teenager who is 6’4” tall places the crutches about 6” to the side of his feet when ambulating with crutches. A school-aged child who is 4’8” tall flexes her elbows about 20 degrees when ambulating with crutches. A middle-aged adult, 5’10” tall, advances the crutches first when walking down the stairs. An older adult, 5’6” tall, uses a 4-point gait when ambulating with crutches.

11. Answer 5 (A) Explanation of Answer: Taller people require a broader base of support.

12. 6 The physician orders codeine 60 mg and aspirin grains X PO every four hours, as needed for pain. Each codeine tablet contains 15 mg of codeine. Each aspirin tablet contains 325 mg of aspirin. Which of the following should the nurse administer? 2 codeine tablets and 4 aspirin tablets 4 codeine tablets and 2 aspirin tablets 3 codeine tablets and 3 aspirin tablets 4 codeine tablets and 3 aspirin tablets

13. Answer 6 (B) Explanation of Answer:60/x = 15/1x = 410 grains = 600 mg325/1 = 600/xx = 2

14. 7 The home care nurse is visiting an 82-year-old woman living with her daughter. The client appears malnourished and has multiple bruises on her body. Which of the following actions, if taken by the nurse, is MOST appropriate? Place a home health aide with the patient to document incidents of abuse. Report the situation to the nursing supervisor. Discuss the nurse’s observation with the client’s children. Request that another nurse visit the patient to assess the situation.

15. Answer 7 (B) State law requires this to be reported.

16. 8 The nurse in the same-day surgery department cares for a 77-year-old woman after a sigmoidoscopy. Which of the following symptoms, if exhibited by the woman an hour after the procedure, would MOST concern the nurse? The client complains of fullness and pressure in her abdomen. The client complains of grogginess and thirst. The client complains of lightheadedness and dizziness. The client complains of mild pain and cramping in her abdomen.

17. Answer 8 (C) This could signify hypovolemic shock due to bowel perforation

18. 9 The nurse is caring for a patient one day after an abdominal–perineal resection for cancer of the rectum. The nurse should question which of the following orders? Discontinue the nasogastric tube. Irrigate the colostomy. Place petrolatum gauze over the stoma. Administer Demerol 50 mg IM for pain.

19. Answer 9 (B) The colostomy begins to function 3–6 days after surgery

20. 10 A 1-year-old girl admitted to the hospital with a fractured femur is placed in Bryant’s traction. The nurse knows that the child should be placed in which of the following positions? Buttocks slightly elevated off the bed. Legs elevated at a 45° angle. Knees slightly flexed. Hips fully extended.

21. Answer 10 (A) The child’s weight provides countertraction

22. 11 A 72-year-old woman is admitted to the nursing home setting. The client is occasionally confused and her gait is often unsteady. Which of the following actions, if taken by the nurse, is MOST appropriate? Ask the woman’s family to provide personal items such as photos and mementos. Select a room with a bed by the door so the woman can look down the hall. Suggest the woman eat her meals in the room with her roommate. Encourage the woman to ambulate in the halls twice a day.

23. Answer 11 (A) Photos and mementos provide visual stimulation to reduce sensory deprivation

24. 12 An 84-year-old man is admitted with a diagnosis of dementia. He attempts several times to pull out his nasogastric tube. An order for cloth-wrist restraints is received by the nurse. Which of the following actions by the nurse is MOST appropriate? Attach the ties of the restraint to the bed frame. Perform circulation checks to the extremities, which are restrained once a shift. Remove the restraints when the patient is up in a wheelchair. Explain the need for the restraints only to the family.

25. Answer 12 (A) Attaching the ties of the restraint to the bed frame allows the raising and lowering of the side rail without causing injury to the patient.

26. 13 A 14-year-old boy is brought to the emergency room with a compound fracture of the left femur. His vital signs are: BP 80/60, pulse 120, respirations 26, temperature 99.0° F (37.2° C). Which of the following fluids would the nurse expect the physician to order initially? D5 in water. D5 in 0.45% NaCl.0.45% NaCl. Lactated Ringer’s

27. Answer 13 (D) You need isotonic fluid to restore circulating blood volume. You may also use 0.9% NaCl.

28. 14  The nurse is caring for a 67-year-old man 4 days after a suprapubic prostatectomy. The physician has removed the Foley catheter. A suprapubic catheter remains in place. Which of the following actions, if taken by the nurse, is MOST appropriate? Encourage the patient to void; measure the amount of urine voided and drained from the suprapubic catheter; document the results. Clamp the suprapubic catheter for two hours, release the clamp, allow it to drain to gravity; measure and document the results. Encourage the patient to void every two hours with the suprapubic catheter clamped; open the clamp, allow the catheter to drain to gravity, and document the results. Clamp the suprapubic catheter; have the patient void; unclamp the catheter, and allow it to drain to gravity; measure and document the results.

29. Answer 14 (D) This checks for residual urine in the bladder after voiding. When residual urine is 75 ml or less the S/P catheter is usually removed.

30. 15 A nurse is supervising a group of elderly clients in a residential home setting. The nurse knows the elderly are at greater risk of developing sensory deprivation for what reason? Increased sensitivity to the side effects of medications. Decreased visual, auditory, and gustatory abilities. Isolation from their families and familiar surroundings. Decreased musculoskeletal function and mobility

31. Answer 15 (B) Gradual loss of sight, hearing, and taste interferes with normal functioning.

32. 16 The nurse is performing discharge teaching on a patient with chronic renal failure. The nurse knows that teaching has been successful if the patient selects which of the following menus? 6 oz roast beef, baked potato, 1/2 broccoli, one orange, and 16 oz of iced tea. 4 oz baked ham, 1/2 potatoes au gratin, 1/2 cup canned green beans, one apple, and 8 oz of milk. 2 oz turkey, 1/2 noodles, 1/2 carrots, 1/2 cup blueberries, and 8 oz cola. Hot dog with bun, 1/2 cup pork and beans, 1 cup of spinach salad, 1 banana, and 8 oz lemonade.

33. Answer 16 (C) This meal has the appropriate amount of HBV protein, low potassium fruit, and a protein-free drink.

34. 17 Which of the following is not considered a fat soluble vitamin? Vitamin A Vitamin B1 Vitamin K Vitamin E

35. Answer 17 (B) Vitamin B1

36. 18 Which of the following is not considered a water soluble vitamin? Vitamin B3 Vitamin C Vitamin D Vitamin B12

37. Answer 18 (C) Vitamin D

38. 19 Which of the following is not an underlying cause of hypercalcemia? Paget’s disease Hyperparathyroidism Hartnup disease Sarcoidosis

39. Answer 19 (C) Hartnup disease

40. 20 Which of the following is caused by a B5 deficiency? Ectopic pregnancy Nausea Dermatitis Fever

41. Answer 20 (C) dermatitis

42. 21 Which of the following is caused by a B6 deficiency? Excessive irritability Nonproductive cough Dry mouth Depression

43. Answer 21 (A) Excessive irritability

44. 22 Which of the following is caused by a B12 deficiency? Glossitis Fever Hypertension Edema

45. Answer 22 (A) Glossitis

46. 23 Which of the following is caused by a Vitamin C deficiency? Fever Anemia Headaches Nausea

47. Answer 23 (B) Anemia

48. 24 Which of the following is caused by a Vitamin D deficiency? Edema Anemia Lupus Rickets

49. Answer 24 (D) Rickets

50. 25 Which of the following is caused by a Vitamin K deficiency? Bruising Optic Nerve degeneration Anemia Hemorrhage (infants)

51. Answer 25 (D) Hemorrhage (infants)

52. 26 Another name for Vitamin B1 is ____ . Thiamine Riboflavin Pyridoxine Cobalamin

53. Answer 26 (A) Thiamine

54. 27 Which of the following foods is not high in potassium? Oranges Bananas Tomatoes Turnips

55. Answer 27 (D) Turnips

56. 28 1 gram of protein is equal to ____ of energy. 3 kcals 4 kcals 5 kcals 6 kcals

57. Answer 28 (B) 4 kcals

58. 29 A protein restricted diet requires only ______ grams/day. 20-40 30-50 40-60 50-70

59. Answer 29 (C) 40-60 GRAMS/DAY

60. 30 Which of the following vitamins will be the most common in: oils from cereal seeds, salad oils, margarine and shortenings? Vitamin A Vitamin D Vitamin E Vitamin K

61. Answer 30 (C) Vitamin E

62. 31 Which of the following vitamins will be the most common in: leafy green vegetables, egg yolk and soy oil? Vitamin A Vitamin D Vitamin E Vitamin K

63. Answer 31 (D) Vitamin K

64. 32 Which of the following vitamins will be the most common in: fish liver oils, milk, and egg yolk? Vitamin A Vitamin D Vitamin E Vitamin K

65. Answer 32 (D) Vitamin K

66. 33 Another name for Vitamin B12 is ____ Pantothenic Acid Cyanocobalamin Niacin Riboflavin

67. Answer 33 (B) Cyanocobalamin

68. 34 Which of the following does not contain a high concentration of Niacin? Yeast Meat Liver Corn

69. Answer 34 (D) CORN

70. 35 Which of the following does not contain a high concentration of Vitamin A? Strawberries Oranges Green Vegetables Yellow Vegetables

71. Answer 35 (C) Green Vegetables

72. 36 A client hospitalized with a fractured mandible is to be discharged. Which piece of equipment should be kept on the client with a fractured mandible? Wire cutters Oral airway Pliers Tracheostomy set

73. Answer 36 Answer A is correct. The client with a fractured mandible should keep a pair of wire cutters with him at all times to release the device in case of choking or aspiration. Answer B is incorrect because the wires would prevent insertion of an oral airway. Answer C is incorrect because it would be of no use in releasing the wires. Answer D is incorrect because it would be used only as a last resort in case of airway obstruction.

74. 37 An elderly client who experiences nighttime confusion wanders from his room into the room of another client. The nurse can best help decrease the client's confusion by: Assigning a nursing assistant to sit with him until he falls asleep Allowing the client to room with another elderly client Administering a bedtime sedative Leaving a nightlight on during the evening and night shifts

75. Answer 37 Answer D is correct. Leaving a nightlight on during the evening and night shifts helps the client remain oriented to the environment and fosters independence. Answers A and B will not decrease the client’s confusion. Answer C will increase the likelihood of confusion in an elderly client.

76. 38 Which of the following conditions is most likely related to the development of renal calculi? Gout Pancreatitis Fractured femur Disc disease

77. Answer 38 Answer A is correct. Gout and renal calculi are the result of increased amounts of uric acid. Answer B is incorrect because it does not contribute to renal calculi Answers C and D can result from decreased calcium levels. Renal calculi are the result of excess calcium; therefore, answers C and D are incorrect

78. 39 An elderly client is hospitalized for a transurethral prostatectomy. Which finding should be reported to the doctor immediately? Hourly urinary output of 40–50cc Bright red urine with many clots Dark red urine with few clots Requests for pain med q 4 hrs.

79. Answer 39 Answer B is correct. Bright red bleeding with many clots indicates arterial bleeding that requires surgical intervention. Answer A is within normal limits; therefore, it is incorrect. Answer C indicates venous bleeding, which can be managed by nursing intervention; therefore, it is incorrect. Answer D does not indicate excessive need for pain management that requires the doctor’s attention; therefore, it is incorrect.

80. 40 Which of the following nursing interventions has the highest priority for the client scheduled for an intravenous pyelogram? Providing the client with a favorite meal for dinner Asking if the client has allergies to shellfish Encouraging fluids the evening before the test Telling the client what to expect during the test

81. Answer 40 Answer B is correct. The contrast media used during an intravenous pyelogram contains iodine, which can result in an anaphylactic reaction. Answers A, C, and D do not relate specifically to the test; therefore, they are incorrect.

82. 41 The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are highest in B12? Meat, eggs, dairy products Peanut butter, raisins, molasses Broccoli, cauliflower, cabbage Shrimp, legumes, bran cereals

83. Answer 41 Answer A is correct. Meat, eggs, and dairy products are foods high in vitamin B12. Answer B is incorrect because peanut butter, raisins, and molasses are sources rich in iron. Answer C is incorrect because broccoli, cauliflower, and cabbage are sources rich in vitamin K. Answer D is incorrect because shrimp, legumes, and bran cereals are high in magnesium.

84. 42 The renal medulla is composed of tissue called ______. Renal pyramids Nephrons Renal sinus Renal pelvis

85. Answer 42 (A) Renal pyramids

86. 43 Which is found in the highest concentration in the urine? Uric acid Urea Glucose Creatinine

87. Answer 43 (B) UREA

88. 44 The primary function of the ascending loop of Henle in the kidney is? The active re-absorption of sodium The active re-absorption of chloride ions The passive re-absorption of potassium The passive re-absorption of urea

89. Answer 44 (B) The active re-absorption of chloride ions

90. 45 The micturition reflex center is located in the _____. Pons Midbrain Lumbar plexus Sacral plexus

91. Answer 45 (D) Sacral plexus

92. 46 Which of the following match with the definition: a poor output of urine? Oliguria Pyruia Enuresis Diuresis

93. Answer 46 (A) OLIGURIA

94. 47 The primary function of the descending loop of Henle in the kidney is? Reabsorption of sodium ions Reabsoption of water by osmosis Secretion of hydrogen ions Secretion of potassium ions

95. Answer 47 (B) Reabsoption of water by osmosis

96. 48 Which of the following is not considered a component of kidney stones? Calcium phosphate Uric Acid Calcium oxalate HCO3

97. Answer 48 (D) HCO3

98. 49 Which of the following is not considered a loop diuretic? Bumetadine (BUMEX) Furosemide (LASIX) Chlorthiazide (DIURIL) Ethacrynic Acid (EDECRIN)

99. Answer 49 (C) Chlorthiazide (DIURIL)