Which of the following is not an early symptom of head neck cancer

1. Which of the following is not an early symptom of head & neck cancer? Hoarseness Change in fit of dentures Mouth ulcers that do not heal Decreased mobility of tongue DD

2. Nursing management of the pt immediately after a total laryngectomy includes all of the following except Changing the surgical dressing Monitoring function of the drainage tubes Ensuring that the NG tube is patent Placing the pt in semi-Fowler’s position aa

3. When assessing a pt w/ pneumococcal pneumonia, the nurse recognized that clinical manifestations of this condition include: Fever, chills, & productive cough w/ rust-colored sputum Nonproductive cough & night sweats that are usually self-limiting Gradual onset of nasal stuffiness, sore throat & purulent productive cough Abrupt onset of fever, nonproductive cough & formation of lung abscess aa

4. An appropriate nursing intervention for a pt w/ pnemonia w/ the nursing diagnosis of ineffective airway clearance r/t thick secretions & fatigue would be to: Perform postural drainage every hour Provide analgesics as ordered to promote pt comfort Administer O2 as prescribed to maintain optimal oxygen levels Teach pt how to cough effectively to bring secretions to mouth dd

5. Pt w/ TB has nursing diagnosis of noncompliance. RN recognizes the most common etiologic factor for this dx is: Fatigue & lack of energy to manage self-care Lack of knowledge about how the disease is transmitted Little or no motivation to adhere to long-term drug regimen Feelings of shame & the response to the social stigma associated w/ TB dd

6. The RN identifies a flail chest in a trauma pt when: Multiple rib fractures are determined by x-ray Tracheal deviation to unaffected side is present Paradoxic chest movement occurs during respiration There is dec’d movement of involved chest wall cc

7. RN notes tidaling of water level in the tube sumerged in the water-seal chamber in a pt w/ closed chest-tube drainage. The RN should: Continue to monitor this normal nding Check all connections for a leak in system Lower drainage collector further from chest Clamp tubing at progressively distal points away from pt until tidaling stops aa

8. A nursing measure that should be instituted after a pneumonectomy is Monitoring chest-tube drainage & functioning Positioning pt on unaffected side or back ROM on affected upper extremity Auscultating frequently for lung sounds on the affected side cc

9. Guillain-Barre syndrome causes respiratory problems primarily by Depressing the CNS Deforming chest-wall muscles Paralyzing the diaphragm secondary to trauma Interrupting nerve transmission to respiratory muscles dd

10. Pt w/ COPD asks why the heart is affected by respiratory disease. The nurs’es response to the pt is based on t the knowledge that cor pulmonale is characterized by: Pulmonary congestion secondary to left ventricular failure Excess serous fluid collection in the alveoli caused by retained respiratory secretions Right ventricular hypertrophy secondary to increased pulmonary vascular resistance Right ventricular failure secondary to compression of heart by hyperinflated lungs cc

11. In responding to a pt w/ emphysema who asks about the possibility of a lung transplant, the nurse knows that lung transplantation is contraindicated in pts: w/ cor pulmonale Who currently smoke Older than 50 years of age w/ end-stage lung disease bb

12. In evaluating the asthmatic pt’s knowledge of self-care, the nurse recognizes that additional instruction is needed when the pt says: I use my corticosteroid inhaler when I feel SOB I get a flu shot every year & see my HCP if I have an upper resp infection I use my bronchodilator inhaler before I visit my aunt who has a cat, but I only visit for a few minutes because of my allergies I walk 30mins every day but sometimes I hae to use my bronchodilator before walking to prevent me from getting SOB aa

13. A plan of care for the pt w/ COPD would include: Chronic corticosteroid therapy Reduction of risk factors for infection High flow rate O2 administration Lung exercises that involve inhaling longer than exhaling bb

14. pt w/ MI of anterior wall of left ventricle most likely has an occlusion of Right marginal artery Left circumflex artery Left anterior descending artery Right anterior descending artery cc

15. When assessing the pt, the nurse notes a palpable precordial thrill. This finding may be caused by: Heart murmurs Gallop rhythms Pulmonary edema Right ventricular hypertrophy aa

16. When assessing CV system of 79yr old, nurse expects to find: A narrowed pulse pressure Diminished carotid artery pulses Difficulty in isolating the apical pulse An increased heart rate in response to stress cc

17. An important nursing responsibility for pt having an invasive cardiovascular diagnostic study is: Checking peripheral pulses & percutaneous site Instructing pt about radioactive isotope injection Informing pt that general anesthesia will be given Assisting pt to do a surgical scrub of the insertion site aa

18. If pt has decreased CO caused by fluid volume deficit & marked vasodilation, the regulatory mechanism that will increase the BP by improving both of these is: Release of ADH Secretion of prostaglandins Stimulation of sympathetic nervous system Activation of renin-angiotensin-aldosterone system dd

19. Pt admitted in hypertensive crisis. RN recognizes that the hypertensive urgency differs from hypertensive emergency in that: The BP is always higher in hypertensive emergency Hypertensive emergencies are associated w/ evidence of target organ damage Hypertensive urgency is treated w/ rest & tranquilizers to lower BP Hypertensive emergencies require intraarterial catheter measurement of BP B B

20. After teaching about ways to decrease risk factors for CAD, the nurse recognizes that additional instruction is needed when the pt says: I would like to add weight lifting to my exercise program I can’t keep my BP normal w/o medication I can change my diet to decrease my intake of saturated fats I will change my lifestyle to reduce activities that increase my stress aa

21. In planning activity for the pt recovering from an MI, the nurse recognizes that the healing heart wall is most vulnerable to stress 3 weeks after infarct 4-6 days after infarct 10-14 days after infarct When healing is complete at 6-8 wks cc

22. Pt admitted to CCU w/ CP for 24hrs, ECG consistent w/ acute MI, & occasional ventricular arrhythmias. Nurse plans care for pt based on expectation that pt will be managed w/ Endotracheal intubation Subq nitro Continuous ECG monitoring Thrombolytic therapy w/ tPa cc

23. The most common pathologic finding in individuals w/ sudden cardiac death is: Cardiomyopathies Mitral valve disease Atherosclerotic heart disease Left ventricular hypertrophy cc

24. Nurse recognizes that primary manifestations of systolic ventricular failure include: ? afterload & ?LVEDP ?ejection fraction & PAWP ?PAWP & ?left ventricular ejection fraction ?Pulmonary HTN associated w/ normal ejection fraction bb

25. A compensatory mechanism involved in CHF that leads to inappropriate fluid retention & additional workload of heart is: Ventricular dilation Ventricular hypertrophy Neurohormonal response Sympathetic nervous system activation cc

26. The drug used in management of acute pulmonary edema that will decrease both preload & afterload & provide relief of anxiety is: Morphine Amrinone Dobutamine Aminophylline aa

27. Nurse plans care for pt w/ dilated cardiomyopathy based on knowledge that Family members may be at risk because of infectious nature of disease Medical management of disorder focuses on treatment of underlying cause Prognosis of pt is poor, & emotional support is a high priority The condition may be successfully treated w/ surgical ventriculomyotomy & myectomy cc

28. Pt w/ stable BP & no symptoms has following ECG: atrial rate 74 & regular, ventr rate 62 & irregular, P wave normal contour, PR interval lenghtens progressively until a P wave is not conducted, QRS normal contour. Nurse expects what tx Epi 1mg IVP Isoproterenol IV continuous drip Immediate insertion of temporary pacer Careful observation for symptoms of hypotension dd

29. ECG for pt in CCU following acute MI indicates ventr bigeminy. Nurse anticipates Performing defibrillation Treatment w/ IV lidocaine Insertion of temporary pacemaker Continuing monitoring w/o other treatment bb

30. nurse plans care for pt w/ implantable cardioverter-defibrillator based on knowledge that Antiarrhythmia drugs can be discontinued All members of pt’s family should learn CPR Pt should not drive until 1 month after ICD has been implanted Pt is usually relieved to have device implanted to prevent arrhythmias bb

31. Nurse suspects cardiac tamponade in pt w/ acute pericarditis based on the finding of CP Pulsus paradoxus Mitral valve murmur Pericardial friction rub bb

32. Which of the following findings is indicative of accentuated left ventricular filling in a pt w/ chronic mitral regurgitation? Audible third heart sound & late diastolic murmur Midsystolic click f/b early systolic murmur Audible third heart sound & pansystolic or holosystolic murmur Audible third heart sound & middiastolic click w/ late diastolic murmur cc

33. Pt admitted w/ aortic stenosis has nursing dx of activity intolerance r/t insufficient O2 secondary to dec’d CO. an appropriate nursing intervention for pt is Monitor ECG to assess cardiac output Maintain on bed rest to reduce tissue oxygen demands Progressively increase activity to increase cardiac tolerance Use a semi-Fowler position to decrease venous return & increase respiratory excursion cc

34. Pt being prepared for AAA repair. Nurse suspects rupture when Pt becomes dizzy & SOB Pt c/o sudden, severe back pain Bruit & thrill are present at site of aneurysm Pt develops blue, patchy mottling of feet & toes bb

35. Pt w/ infective endocarditis develops sudden left leg pain w/ pallor, paresthesia, & loss of peripheral pulses. Nurse’s initial action should be to Notify physician Elevate leg to promote venous return Wrap leg in blanket to provide warmth Perform passive ROM to stimulate circulation to leg aa

36. Pt w/ highest risk of DVT 25yo obese woman 3 days postpartum 40yo woman who smokes & uses oral contraceptives 62yo man who had stroke w/ left sided hemiparesis 72yo man who had suprapubic prostatectomy for CA of prostate bb

37. Nursing interventions indicated in plan of care for pt w/ acute lower extremity DVT include Applying elastic compression stockings Administering anticoagulants as ordered Positioning the leg dependently to promote arterial circulation Encouraging walking & leg exercises to promote venous return bb

38. Pt w/ DVT suddenly develops dyspnea, tachypnea, & CP. Initially the most appropriate action is Auscultate for abnormal lung sounds Administer O2 & notify physician Ask pt to CDB to clear airways Elevate HOB 30-45 degrees to facilitate breathing dd