Clinical Decision-Making in Nursing Exam Solutions
Course Introduction
Clinical Decision-Making in Nursing explores the complex processes that underpin nurses' ability to assess, diagnose, and implement effective care strategies across diverse healthcare settings. This course emphasizes critical thinking, evidence-based practice, and ethical considerations to guide students in making sound clinical judgments. Through case studies, simulations, and reflective practice, students learn to analyze patient data, prioritize interventions, and collaborate with healthcare teams to achieve optimal patient outcomes. The course also addresses factors influencing decision-making, such as patient preferences, cultural competence, and healthcare policies.
Recommended Textbook
Priorities in Critical Care Nursing 7th Edition by
Linda D. Urden
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42 Chapters
1239 Verified Questions
1239 Flashcards
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Chapter 1: Critical Care Nursing Practice
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20 Verified Questions
20 Flashcards
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Sample Questions
Q1) A physician and nurse are performing a dressing change on an unresponsive patient in room I-14.The physician asks the nurse for an update on the patient in room I-13.The nurse should
A) give the update to the physician.
B) refuse to give the update because of HIPAA requirements.
C) give the update because the patient's unconscious state will not compromise confidentiality.
D) refuse to give the update because of OSHA requirements.
Answer: B
Q2) _____ have a broad depth of knowledge and expertise in their specialty area and manage complex clinical and system issues.
A) SCCMs
B) APNs
C) CNSs
D) AACNs
Answer: B
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Chapter 2: Ethical Issues
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Sample Questions
Q1) Fidelity includes faithfulness and promise-keeping to clients,and it incorporates the added concepts of
A) confidentiality and privacy.
B) truth and reflection.
C) autonomy and paternalism.
D) beneficence and nonmaleficence.
Answer: A
Q2) Failures and inadequacies in the health care facility's operation and organization are often misinterpreted as ethical issues.These issues are known as A) systems problems.
B) social problems.
C) ethical issues.
D) governmental problems.
Answer: A
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Chapter 3: Legal Issues
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Sample Questions
Q1) Which of the following defines the scope of practice for nursing?
A) Hospital policies
B) State Nurse Practice Act
C) State board of nursing
D) State Department of Health
Answer: B
Q2) After admission to the intensive care unit,a patient shares with the nurse a concern that her adult children will not be able to reach agreement on what to do if she is no longer able to make decisions for herself.The nurse informs the patient that it is possible to grant authority to one person to make decisions by procuring a A) court-appointed guardian.
B) do-not-resuscitate order.
C) durable power of attorney for health care.
D) living will.
Answer: C
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Chapter 4: Genetics and Genomics in Critical Care
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Sample Questions
Q1) Hemophilia A is an inherited disease.Which statements would be determined by the family pedigree regarding hemophilia A?
A) It is an X-linked disorder.
B) Sons have a 50% chance of having hemophilia.
C) It is a Y-linked disorder.
D) Daughters have a 50% chance of being a carrier of the trait.
E) Sons have a 25% chance of having hemophilia.
F) Daughters have a 50% chance of having hemophilia.
Q2) An example of direct-to-consumer genomic testing is:
A) genetic testing through amniocentesis.
B) paternity testing from buccal swabs of the child and father.
C) biopsy of a lump for cancer.
D) drug testing using hair follicles.
Q3) The process that is used to make polypeptide chains that constitute proteins can be written as:
A) RNA DNA protein.
B) DNA RNA protein.
C) protein RNA DNA.
D) protein DNA RNA.
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Page 6
Chapter 5: Patient and Family Education
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Sample Questions
Q1) A patient is admitted to the critical care unit with the onset of tuberculosis.He was diagnosed with HIV/AIDS 1 year ago.When talking to the patient about preventing the spread of tuberculosis,the patient tells the nurse that he has not followed precautions regarding tuberculosis for patients with HIV.Which educational objective is BEST stated for this patient?
A) Patient will know at least two ways to prevent the spread of tuberculosis within 1 week.
B) Patient will understand how HIV is spread within 3 days.
C) Patient will realize that improper precautions will spread his disease to others.
D) Patient will verbalize two methods of transmission for tuberculosis within 2 days.
Q2) According to Maslow's hierarchy of needs,the need to know and understand information is considered
A) a high-level need.
B) a low-level need.
C) a physiologic need.
D) not important in a critical care setting.
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Chapter 6: Psychosocial and Spiritual Alterations and Management
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Sample Questions
Q1) A patient has been admitted to the critical care unit with a severed spinal cord injury at the T2 level.The patient has been in halo traction with immobilization for the past week.The patient continually tries to get out of bed and states,"My legs are only sleeping." Which of the following nursing diagnoses would be appropriate for the patient?
A) Disturbed body image
B) Powerlessness
C) Situational low self-esteem
D) Ineffective role performance
Q2) Which of the following concepts supports patients and helps them endure the physical and psychological insults of their critical illness?
A) Regression
B) Denial
C) Hope
D) Trust
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8
Chapter 7: Sleep Alterations and Management
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Sample Questions
Q1) The patient has been in the critical care unit for 3 weeks and has been on an intra-aortic balloon pump for the past 3 days.The patient's condition has been serious,and hourly assessments and vital signs have been necessary.The nursing staff has noted that the patient has been unable to achieve sleep for more than 30 minutes at a time.The patient has been given diazepam (Valium)prn.The anticipated effect of diazepam on the patient's sleep is
A) a decrease in NREM stage 1.
B) an increase in NREM stage 3.
C) total NREM suppression.
D) REM suppression in larger doses.
Q2) _____ is the external element that has the most significant effect on circadian rhythms.
A) Lower body temperature
B) Light
C) Melatonin cycle
D) Background noise
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9
Chapter 8: Nutrition Alterations and Management
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Sample Questions
Q1) Sodium and fluid restrictions ordered for the patient with heart failure are primarily aimed at reducing
A) use of medications.
B) weight.
C) cardiac workload.
D) serum lipids.
Q2) The patient history plays an important role in assessing the patient's nutritional status.Significant laboratory and clinical findings in the patient with cardiovascular disease include
A) low levels of high-density lipoprotein (HDL) cholesterol and transferrin.
B) elevated low-density lipoprotein (LDL) cholesterol and decreased subcutaneous fat.
C) elevated sodium levels and a soft, fatty liver on palpation.
D) normal triglyceride levels and the presence of S3 on auscultation.
Q3) The nutritional alteration most frequently encountered in hospitalized patients is A) respiratory quotient (RQ).
B) protein-calorie malnutrition.
C) fat-calorie malnutrition.
D) gluconeogenesis.
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Chapter 9: Pain and Pain Management
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Sample Questions
Q1) The subjective characteristic implies that pain is
A) an uncomfortable experience present only in the patient with an intact nervous system.
B) an unpleasant experience accompanied by crying and tachycardia.
C) activation of the sympathetic nervous system from an injury.
D) whatever the patient experiencing it says it is, occurring when that patient says it does.
Q2) A patient underwent a thoracotomy 12 hours ago.The patient currently has an epidural catheter in place and is receiving continuous epidural analgesia with morphine.In addition to closely monitoring the patient for side effects and complications,which of the following interventions might enhance her pain control?
A) Maintain her flat in bed during the infusion.
B) Position her on her right side to encourage flow of the medication across the dura.
C) Limit visitors and remove any distractions such as television and music.
D) Consider administration of adjunct medication such as antidepressants or NSAIDs.
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Chapter 10: Sedation,Agitation,Delirium: Assessment and Management
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Sample Questions
Q1) The two scales that are recommended for assessment of agitation and sedation in adult critically ill patients are the
A) Ramsay Scale and Riker Sedation-Agitation Scale (SAS).
B) Ramsay Scale and Motor Activity Assessment Scale (MAAS).
C) Riker Sedation-Agitation Scale (SAS) and the Richmond Agitation-Sedation Scale (RASS).
D) Richmond Agitation-Sedation Scale (RASS) and Motor Activity Assessment Scale (MAAS).
Q2) A patient was admitted into the critical care unit 3 days ago.She has just been weaned from mechanical ventilation.She suddenly becomes confused,seeing nonexistent animals in her room and pulling at her gown.The drug of choice for treating this patient is
A) diazepam.
B) haloperidol.
C) lorazepam.
D) propofol.
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Chapter 11: End-Of-Life Issues
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Sample Questions
Q1) A patient was admitted to the critical care unit after having a CVA and MI.The patient has poor activity tolerance,falls in and out of consciousness,and has poor verbal skills.The patient has been resuscitated four times in the past 6 hours.The patient does not have advance directives.Family members are at the bedside.Who should the physician approach to discuss decisions of care and possible DNR status?
A) The patient
B) The family
C) The hospital legal system
D) The hospital ethics committee
Q2) Which of the following are considerations when making the decision to allow family at the bedside during resuscitation efforts?
A) The patient's wishes
B) Experience of the staff
C) The family's need to participate in all aspects of the patient's care
D) State regulatory issues
E) Seeing the resuscitation may confirm the impact of decisions made or delayed
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13
Chapter 12: Cardiovascular Anatomy and Physiology
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Sample Questions
Q1) The hemodynamic effects of a pericardial effusion include
A) increased ventricular ejection.
B) decreased ventricular filling.
C) myocardial ischemia.
D) increased afterload.
Q2) Which statement regarding the autonomic nervous system's role in the regulation of heart rate is true?
A) Parasympathetic influences increase heart rate.
B) Sympathetic influences are predominantly present.
C) Parasympathetic influences are only compensatory.
D) Both sympathetic and parasympathetic influences are normally active.
Q3) An echocardiogram reveals an ejection fraction of 55%.On the basis of this information,the patient's cardiac function is
A) adequate.
B) mildly decreased.
C) moderately decreased.
D) severely decreased.
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14
Chapter 13: Cardiovascular Clinical Assessment
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Sample Questions
Q1) _____ are created by the turbulence of blood flow through a vessel caused by constriction of the blood pressure cuff.
A) Korotkoff sounds
B) Pulse pressures
C) Murmurs
D) Gallops
Q2) The presence of a carotid or femoral bruit may be evidence of
A) left-sided heart failure.
B) blood flow through a partially occluded vessel.
C) the early onset of pulmonary embolism.
D) myocardial rupture.
Q3) A patient was admitted to the ICU 3 days ago with a diagnosis of myocardial infarction.The patient is complaining of increased chest pain when coughing,swallowing,and changing positions.The nurse hears a systolic scratching sound upon auscultation of the apical pulse.The nurse notifies the physician.Based on the symptoms,the physician suspects a(n)
A) acute mitral regurgitation.
B) aortic insufficiency.
C) chronic mitral regurgitation.
D) pericardial friction rub.
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Chapter 14: Cardiovascular Diagnostic Procedures
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75 Flashcards
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Sample Questions
Q1) Pulsus paradoxus may be seen on intra-arterial blood pressure monitoring when
A) there is a decrease of more than 10 mm Hg in the arterial waveform before inhalation.
B) there is a single, nonperfused beat.
C) the waveform demonstrates tall, tented T waves.
D) the pulse pressure is greater than 20 mm Hg on exhalation.
Q2) Which of the following is most indicative of decreased left ventricular preload?
A) Increased PAOP/PAWP
B) Decreased PAOP/PAWP
C) Increased CVP
D) Decreased CVP
Q3) When performing a 12-lead ECG,how many wires are connected to the patient?
A) 3
B) 5
C) 10
D) 12
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16
Chapter 15: Cardiovascular Disorders
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Sample Questions
Q1) One differentiating factor between stable angina and unstable angina is that stable angina
A) responds predictably well to nitrates.
B) is not precipitated by activity.
C) has a low correlation to CAD.
D) is a result of coronary artery spasm.
Q2) Which medication may be administered to the patient with hypertensive crisis?
A) Digitalis
B) Vasopressin
C) Verapamil
D) Sodium nitroprusside
Q3) Assessment of a patient with pericarditis may reveal which of the following signs and symptoms?
A) Ventricular gallop and substernal chest pain
B) Narrowed pulse pressure and shortness of breath
C) Pericardial friction rub and pain
D) Pericardial tamponade and widened pulse pressure
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Chapter 16: Cardiovascular Therapeutic Management
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Sample Questions
Q1) Which of the following would indicate successful reperfusion after administration of a fibrinolytic agent?
A) Gradual decrease in chest pain
B) Intermittent, multifocal premature ventricular contractions
C) Rapid resolution of ST elevation
D) Rapid rise in creatine kinase MB fraction
Q2) The current standard of care for PCI typically includes dual antiplatelet therapy with oral
A) aspirin and Clopidogrel (Plavix).
B) aspirin and Abciximab (ReoPro).
C) aspirin and Eptifibatide (Integrilin).
D) aspirin and Tirofiban (Aggrastat).
Q3) In caring for a postoperative cardiovascular patient,the nurse knows that the most frequent cause of a decreased cardiac output is A) reduced preload.
B) increased afterload.
C) increased contractility.
D) bradycardia.
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Chapter 17: Pulmonary Anatomy and Physiology
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Sample Questions
Q1) Alveolar type II cells secrete which of the following lipoproteins?
A) Trypsin
B) Chyme
C) Amylase
D) Surfactant
Q2) The central chemoreceptors are stimulated by
A) decreased PaO<sub>2</sub>.
B) increased PaO<sub>2</sub>.
C) decreased SaO<sub>2</sub>.
D) increased PaCO<sub>2</sub>.
Q3) The movement of air into and out of the lungs is termed A) ventilation.
B) respiration.
C) diffusion.
D) perfusion.
Q4) Which of the following arteries has the lowest oxygen concentration?
A) Aorta
B) Subclavian
C) Carotid
D) Pulmonary
Page 19
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Chapter 18: Pulmonary Clinical Assessment
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Sample Questions
Q1) Deviation of the trachea occurs in which of the following conditions?
A) Pneumothorax
B) Pulmonary fibrosis
C) Chronic obstructive pulmonary disease
D) Emphysema
E) Pleural effusion
Q2) The creation of sound waves across the body surface to determine abnormal densities is known as
A) inspection.
B) palpation.
C) percussion.
D) auscultation.
Q3) Why would the nurse perform an inspection of the oral cavity during a complete pulmonary assessment?
A) To provide evidence of hypoxia
B) To provide evidence of dyspnea
C) To provide evidence of dehydration
D) To provide evidence of nutritional status
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Chapter 19: Pulmonary Diagnostic Procedures
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Sample Questions
Q1) For which of the following conditions is a bronchoscopy indicated?
A) Pulmonary edema
B) Ineffective clearance of secretions
C) Upper gastrointestinal bleed
D) Instillation of surfactant
Q2) Nursing management of a patient undergoing a diagnostic procedure involves
A) positioning the patient for the procedure.
B) monitoring the patient's responses to the procedure.
C) monitoring vital signs.
D) teaching the patient about the procedure.
E) medicating the patient before and after procedure.
Q3) A patient presents with the following values: pH,7.20; pO<sub>2</sub>,106 mm Hg; pCO<sub>2</sub>,35 mm Hg; and HCO<sub>3</sub>-,11 mEq/L.These values are most consistent with
A) uncompensated respiratory acidosis.
B) uncompensated metabolic acidosis.
C) uncompensated metabolic alkalosis.
D) uncompensated respiratory alkalosis.
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Chapter 20: Pulmonary Disorders
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Sample Questions
Q1) A patient was admitted to the critical care unit after a left pneumonectomy.The patient is receiving 40% oxygen via a simple facemask.The morning chest radiography study reveals right lower lobe pneumonia.After eating breakfast,the patient suddenly vomits and aspirates.The patient becomes agitated,has decreased level of consciousness,and has an inability to maintain saturation.The nurse expects the next action will include
A) placing the patient on a mechanical ventilator.
B) change in antibiotics to control infection.
C) suctioning and repositioning.
D) administering a sedative to control anxiety.
Q2) Which of the following conditions develops when air enters the pleural space from the lung on inhalation and cannot exit on exhalation?
A) Tension pneumothorax
B) Sucking chest wound
C) Open pneumothorax
D) Pulmonary interstitial empyema
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Chapter 21: Pulmonary Therapeutic Management
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Sample Questions
Q1) A patient was taken to surgery for a left lung resection earlier today.The patient has been in the postoperative care unit for 30 minutes.When you are completing your assessment,you notice that the chest tube has drained 125 cc of red fluid in the past 30 minutes.The nurse contacts the physician and suspects that the patient has developed
A) pulmonary edema.
B) hemorrhage.
C) acute lung failure.
D) bronchopleural fistula.
Q2) Nursing management of the patient receiving a neuromuscular blocking agent should include
A) withholding all sedation and narcotics.
B) protecting the patient from the environment.
C) keeping the patient supine.
D) speaking to the patient only when necessary.
Q3) Long-term ventilator management over 21 days is best handled through use of a(n)
A) oropharyngeal airway.
B) esophageal obturator airway.
C) tracheostomy tube.
D) endotracheal intubation.
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Page 23
Chapter 22: Neurologic Anatomy and Physiology
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Sample Questions
Q1) Which areas of the spinal cord have tenuous blood supply and are especially vulnerable to circulatory embarrassment?
A) C2 to C3
B) C5 to C6
C) T8 to T10
D) L4 to L5
Q2) Obstructive hydrocephalus can occur in the presence of
A) blockage in the arachnoid villi.
B) malformation of the falx cerebelli.
C) blockage of CSF flow in the ventricular system.
D) increased production of CSF with poor outlet.
Q3) Which of the following structures form(s)the blood-brain barrier?
A) Postsynaptic terminals
B) Pia mater
C) Vascular endothelial cells
D) Myelin sheath
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Chapter 23: Neurologic Clinical Assessment and Diagnostic Procedures
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Sample Questions
Q1) Successful completion of digital subtraction angiography requires what participation on the part of the patient?
A) Responding appropriately to various commands
B) Repositioning at appropriate intervals
C) Remaining motionless
D) Holding inspiration during imaging
Q2) The initial history for the neurologically impaired patient needs to be
A) limited to the chief complaint.
B) comprehensive, including events preceding hospitalization.
C) directed to level of consciousness and pupillary reaction.
D) information that only the patient can provide.
Q3) According to the 2007 Brain Trauma Foundation guidelines,the recommended CPP range is
A) 10 to 30 mm Hg.
B) 30 to 50 mm Hg.
C) 50 to 70 mm Hg.
D) 70 to 85 mm Hg.
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Page 25
Chapter 24: Neurologic Disorders and Therapeutic Management
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Sample Questions
Q1) A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.Patient assessment includes T 98.7°F,P 98 beats/min and thready,R 8 breaths/min,and BP 168/100 mm Hg.The patient's initial treatment plan should involve A) placing her in the Trendelenburg position.
B) administering an antihypertensive agent.
C) initiating induced hypertensive therapy.
D) intubation to support airway and breathing.
Q2) A 76-year-old right-handed patient has been admitted to the critical care unit with an intracerebral hemorrhage.A CT of her head reveals a large left parietal area bleed.While assisting the patient with her personal care,it is noted that she is unable to comb her hair with her left hand.The patient may have A) agnosia.
B) apraxia.
C) Broca aphasia.
D) Wernicke aphasia.
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26
Chapter 25: Kidney Anatomy and Physiology
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Q1) For micturition to occur,stimulation from what receptor(s)will cause the parasympathetic messages to contract the detrusor muscle of the bladder?
A) Bladder wall and ureters
B) Bladder wall and urethra
C) Ureters and urethra
D) Urethra
Q2) Where does the concentration and dilution of urine occur?
A) In the juxtamedullary nephrons
B) In the cortical nephrons
C) In the peritubular capillaries
D) In the internal nephron
Q3) The initial filtering of the blood occurs in which structure?
A) The distal tubule
B) The proximal tubule
C) The glomerulus
D) The collecting tubule
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Chapter 26: Kidney Clinical Assessment and Diagnostic Procedures
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Q1) Differentiating ascites from distortion caused by solid bowel contents in the distended abdomen is accomplished by
A) assessing for bowel sounds in four quadrants.
B) palpation of the liver margin.
C) measuring abdominal girth.
D) the presence of a fluid wave.
Q2) A patient is admitted to the critical care unit in congestive heart failure secondary to renal insufficiency.The patient reports that over the past few weeks,his urine output has decreased,and he has developed peripheral edema and ascites.A diagnosis of renal failure is made.The nurse would expect to see elevated values in the following laboratory results: .
A) BUN.
B) creatinine.
C) glucose.
D) hemoglobin and hematocrit.
E) protein.
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Chapter 27: Kidney Disorders and Therapeutic Management
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Q1) One therapeutic measure for treating hyperkalemia is the administration of dextrose and regular insulin.How do these agents lower potassium?
A) They force potassium out of the cells and into the serum, lowering it on a cellular level.
B) They promote higher excretion of potassium in the urine.
C) They bind with resin in the bowel and are eliminated in the feces.
D) They force potassium out of the serum and into the cells, thus causing potassium to lower.
Q2) Which of the following laboratory values is the most help in evaluating a patient for acute renal failure?
A) Serum sodium
B) Serum creatinine
C) Serum potassium
D) Urine potassium
Q3) To control azotemia,the recommended nutritional intake of protein is
A) .5 to 1.0 g/kg/day.
B) 1.2 to 1.5 g/kg/day.
C) 1.7 to 2.5 g/kg/day.
D) 2.5 to 3.5 g/kg/day.
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Chapter 28: Gastrointestinal Anatomy and Physiology
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Sample Questions
Q1) The liver receives nutrient-rich blood from the gut,pancreas,spleen,and stomach from the
A) hepatic artery.
B) hepatic vein.
C) portal vein.
D) intralobular veins.
Q2) The role of the liver in response to glycogen is to A) decrease blood sugar levels when insulin production is inadequate. B) synthesize amino acids.
C) break down the glycogen to glucose to maintain blood sugar levels. D) produce amino acids.
Q3) What is the pH of gastric juices prior to being mixed with food?
A) 1.0
B) 3.0
C) 5.0
D) 7.0
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Chapter 29: Gastrointestinal Clinical Assessment and Diagnostic Procedures
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Q1) The best diagnostic test for the determination of upper gastrointestinal bleeding is A) endoscopic retrograde cholangiopancreatography (ERCP).
B) colonoscopy.
C) endoscopy.
D) angiography.
Q2) Which test would be used to assess blood vessels and blood flow in the body?
A) CT scan
B) MRI
C) MRA
D) MRCP
Q3) Upon auscultation,the nurse hears borborygmi.This is a change in the patient's condition.The nurse suspects the patient may be experiencing
A) a complete ileus.
B) early intestinal obstruction.
C) abnormality of blood flow.
D) peritonitis.
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Chapter 30: Gastrointestinal Disorders and Therapeutic Management
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Q1) A patient with a 10-year history of alcoholism was admitted to the critical care unit with the diagnosis of acute pancreatitis.The patient is complaining of a pain in the left upper quadrant.Using a 1- to 10-point pain scale,the patient states the current level is at an 8.To properly manage the patient's pain,the priority of nursing interventions is to
A) administer antiemetics around the clock.
B) administer analgesics around the clock.
C) educate the patient and family on lifestyle changes.
D) teach relaxation techniques.
Q2) Verification of feeding tube placement includes
A) auscultation for position.
B) aspiration of stomach contents.
C) x-ray study for confirmation.
D) gastric pH measurement.
Q3) The patient at risk for GI hemorrhage should be monitored for which of the following signs and symptoms?
A) Metabolic acidosis and hypovolemia
B) Decreasing hemoglobin and hematocrit
C) Hyperkalemia and hypernatremia
D) Hematemesis and melena
Page 32
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Chapter 31: Endocrine Anatomy and Physiology
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Q1) The nurse knows that when levels of T? and T? are elevated,the pituitary gland inhibits
A) thyroglobulin.
B) thyroid-releasing hormone (TRH).
C) thyroid-stimulating hormone (TSH).
D) calcitonin.
Q2) Which of the following best describes the effects of somatostatin?
A) It stimulates the release of antidiuretic hormone and oxytocin.
B) It suppresses the release of pancreatic polypeptide.
C) It inhibits the release of insulin and glucagon.
D) It inhibits the release of thyroid-stimulating hormone and thyroid hormone.
Q3) A patient is brought to the hospital with a stab wound after a fight at a local bar.His alcohol level is twice the normal limit.The nurse would expect his serum osmolality to be A) elevated.
B) decreased.
C) unaffected.
D) equal to his sodium level.
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Chapter 32: Endocrine Clinical Assessment and Diagnostic
Procedures
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Q1) A patient is admitted with an acute myocardial infarction and a history of thyroid dysfunction.The nurse knows that
A) no cardiac medications will affect the thyroid hormone levels.
B) heparin may decrease TSH.
C) dopamine may increase TSH.
D) morphine may decrease TSH.
Q2) Glycosylated hemoglobin levels provide information about
A) the average blood glucose level over the previous 3 to 4 months.
B) blood glucose levels in comparison with serum hemoglobin.
C) serial glucose readings after ingestion of a concentrated glucose solution.
D) the difference between serum and urine glucose levels.
Q3) Clinical signs and symptoms of Cushing syndrome include A) hirsutism.
B) rounded face.
C) hypotension.
D) decreased libido.
E) scleroderma.
F) fatigue and weakness.
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Chapter 33: Endocrine Disorders and Therapeutic Management
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Q1) The nurse knows that during the resuscitation of a patient with diabetic ketoacidosis,the IV line should be changed to a solution containing glucose when the A) patient becomes more alert.
B) IV insulin has been infusing for 4 hours.
C) blood glucose drops to 200 mg/dL.
D) blood glucose drops to 100 mg/dL.
Q2) Patients with myxedema are at high risk for any surgical procedure because of A) decrease cardiac output.
B) overhydration.
C) thrombocytopenia.
D) respiratory failure.
Q3) When a patient in diabetic ketoacidosis (DKA)has insulin infusing intravenously,the nurse expects a drop in the serum levels of A) sodium and potassium.
B) potassium and phosphate.
C) bicarbonate and calcium.
D) sodium and phosphate.
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Chapter 34: Trauma
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Q1) A patient's condition has deteriorated.Changes in condition include trachea shift,absence of breath sounds on the left side,and hypotension.The nurse suspects that the patient has developed a(n)
A) cardiac tamponade.
B) hemothorax.
C) open pneumothorax.
D) ruptured diaphragm.
Q2) The AVPU is a way for the nurse to quickly assess a patient's A) respiratory status.
B) circulatory status.
C) pain status.
D) level of consciousness.
Q3) A patient is admitted to the ICU with a C5-C6 subluxation fracture.He is able to move his legs better than he can move his arms.Which of the following statements is true about his spinal cord injury?
A) He is likely to be in supraventricular tachycardia.
B) Hyperthermia is common in patients with spinal cord injury.
C) These patients do not usually require mechanical ventilation.
D) The patient has a central cord syndrome.
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Chapter 35: Shock,sepsis,and Multiple Organ Dysfunction Syndrome
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Q1) The main cause of cardiogenic shock is
A) an inability of the heart to pump blood forward.
B) hypovolemia, resulting in decreased stroke volume.
C) disruption of the conduction system when re-entry phenomenon occurs.
D) an inability of the heart to respond to inotropic agents.
Q2) A patient has been on the medical floor for 1 week after a vaginal hysterectomy.A urinary catheter was inserted.Complete blood cell count results have revealed escalating white blood cell counts.The patient is transferred to the critical care unit when her condition deteriorates.Septic shock is diagnosed.Which of the following is the pathophysiologic mechanism that results in septic shock?
A) Bacterial toxins lead to vasodilation.
B) Increased white blood cells are released to fight invading bacteria.
C) Microorganisms invade organs such as the kidneys and heart.
D) An increase of white blood cells leads to decreased red blood cell production and anemia.
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Chapter 36: Burns
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Q1) A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The nurse should have a high suspicion for myoglobinuria with which type of burn injury?
A) Chemical burn
B) Tar burn
C) Electrical burn
D) Carbon monoxide poisoning
Q2) A patient is brought to the emergency department after a house fire.He fell asleep with a lit cigarette,and the couch ignited.TBSA burn is estimated at 25% deep partial-thickness burns to areas of the chest,back,and left arm and 20% full-thickness burns to the right arm,right upper leg,and areas on the face.The patient is placed on mechanical ventilator support.The nurse is aware that inhalation injury predisposes the patient to the development of A) tension pneumothorax.
B) ARDS.
C) a collapsed lung.
D) methicillin-resistant Staphylococcus aureus.
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Chapter 37: Organ Donation and Transplantation
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Q1) Not every patient with end-stage liver disease is a candidate for receiving a transplant.Which of the following conditions are contraindications to a kidney transplant?
A) Malignancy during the past 5 years
B) Active infectious process
C) Advanced cardiopulmonary disease
D) Recreational drug use
E) Nonadherence to current medical regimen
Q2) The Model for End-Stage Liver Disease (MELD)formula is used to
A) calculate risk of 3-month mortality in patients 12 years old or older.
B) calculate risk of 3-month mortality in patients 11 years or younger.
C) calculate risk of 6-month mortality in patient 18 years or older.
D) calculate risk of 6-month mortality in patient 17 years or younger.
Q3) A patient has had a kidney transplant.The nurse knows that monitoring which of the following would have the highest priority?
A) Fluid volume
B) Electrolytes
C) Complete blood count
D) Temperature
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Chapter 38: Hematologic Disorders and Oncologic Emergencies
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Q1) Which of the following nursing interventions would be used if a patient was put under bleeding precautions?
A) Avoid injections as appropriate.
B) Encourage the patient to eat foods high in calcium and vitamin C
C) Use a soft toothbrush or toothettes for oral care.
D) Provide a therapeutic mattress and pad side rails.
E) Use an electric razor for shaving.
Q2) A patient was admitted to the critical care unit with gram-negative sepsis 5 days ago.Today there is continual oozing from his intravenous sites,and ecchymosis of the skin is noted beneath his automatic blood pressure cuff.On his laboratory work,his platelets are normal,and his international normalized ratio is elevated.The primary treatment goal for this patient is to
A) maintain adequate organ perfusion.
B) suppress antibody response that is destroying platelets.
C) treat life-threatening metabolic disturbances.
D) begin hypothermic therapy to prevent cerebral hemorrhage.
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Chapter 39: The Obstetric Patient
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Q1) Which medication is not commonly used during pulmonary dysfunction that occurs during pregnancy?
A) Antibiotics
B) ?-Adrenergic
C) Theophylline
D) Ipratropium
Q2) The mnemonic tone,tissue,trauma,and thrombosis refers to potential causes of A) hypoxia.
B) abruptio placentae.
C) postpartum hemorrhage (PPH).
D) trauma.
Q3) The second leading cause of maternal death in the United States is A) sepsis.
B) hemorrhage.
C) hypertensive disease.
D) disseminated intravascular coagulation.
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Chapter 40: The Pediatric Patient
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Q1) Which of the following methods can be used to establish an endotracheal tube size for a child younger than 2 years of age?
A) The endotracheal tube size is matched to the infant's age.
B) Take the child's age, add 16, and divide by 4.
C) Measure the length of the child's little finger and divide by 2.
D) Only one size is available; thus, no method is needed.
Q2) The upper airway of an infant is different from that of an adult in that the infant's A) epiglottis is located lower than an adult's.
B) tongue is larger, and it fills the oral cavity.
C) larynx is tubular shaped with its narrowest portion at the epiglottis.
D) airway is more rigid than an adult's.
Q3) Which of the following anatomic and physiologic findings are normal in infants younger than 1 year old?
A) The epiglottis is large and floppy.
B) The basal metabolic rate is lower than that of an adult.
C) The size of the head is smaller compared with the rest of the body.
D) The hormonal and metabolic response to pain is the same as that of an adult.
E) A positive Babinski response is a normal finding.
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Chapter 41: The Older Adult Patient
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Q1) Which of the following nonsteroidal anti-inflammatory drugs (NSAIDs)has the side effect of renal failure,HTN,heart failure,and GI bleed in the elderly population?
A) Indomethacin
B) Ketorolac
C) Aspirin greater than 325 mg
D) Naproxen
Q2) Which of the following sounds may be difficult for an older person to hear?
A) Telephone ringing
B) Clothes dryer running
C) Car horn honking
D) Child crying
Q3) An older patient is admitted to the hospital with an acute onset of mental changes and recent falls.The nurse knows that the most common cause of mental changes is A) hypoxia.
B) infection.
C) cerebrovascular accident.
D) electrolyte imbalance.
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Chapter 42: The Perianesthesia Patient
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Q1) What medication may be used to treat laryngeal edema?
A) Racemic epinephrine
B) Succinylcholine
C) Albuterol
D) Morphine
Q2) When a patient emerges in a very restless state,the nurse must first assess for A) anxiety.
B) hypoxia.
C) hyponatremia.
D) gastric distention.
Q3) Snoring,stridor,nostril flaring,and intercostal retractions are clinical manifestations of A) angina.
B) airway obstruction.
C) pain.
D) sedation.
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