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2. There are a number of risk factors associated with coronary artery disease.
Which of the following is a modifiable risk factor?
A. Obesity.
B. Heredity.
C. Gender.
D. Age.
A. Hypertension.
B. Bradycardia.
C. Bounding pulse.
D. Confusion.
10. A hospitalized patient is receiving packed red blood cells (PRBCs) for
treatment of severe anemia. Which of the following is the most accurate
statement?
11. A patient who has received chemotherapy for cancer treatment is given an
injection of Epoetin. Which of the following should reflect the findings in a
complete blood count (CBC) drawn several days later?
A. Weight loss.
B. Increased clotting time.
C. Hypertension.
D. Headaches.
14. A nurse in the emergency department assesses a patient who has been
taking long-term corticosteroids to treat renal disease. Which of the following
is a typical side effect of corticosteroid treatment? Note: More than one
answer may be correct.
A. Hypertension.
B. Cushingoid features.
C. Hyponatremia.
D. Low serum albumin.
15. A nurse is caring for patients in the oncology unit. Which of the following
is the most important nursing action when caring for a neutropenic patient?
16. A patient is undergoing the induction stage of treatment for leukemia. The
nurse teaches family members about infectious precautions. Which of the
following statements by family members indicates that the family needs more
education?
17. A nurse is caring for a patient with acute lymphoblastic leukemia (ALL).
Which of the following is the most likely age range of the patient?
A. 3-10 years.
B. 25-35 years.
C. 45-55 years.
D. over 60 years.
19. The Hodgkin's disease patient described in the question above undergoes
a lymph node biopsy for definitive diagnosis. If the diagnosis of Hodgkin's
disease were correct, which of the following cells would the pathologist
expect to find?
A. Reed-Sternberg cells.
B. Lymphoblastic cells.
C. Gaucher's cells.
D. Rieder's cells
20. A patient is about to undergo bone marrow aspiration and biopsy and
expresses fear and anxiety about the procedure. Which of the following is the
most effective nursing response?
A. Warn the patient to stay very still because the smallest movement will increase her
pain.
B. Encourage the family to stay in the room for the procedure.
C. Stay with the patient and focus on slow, deep breathing for relaxation.
D. Delay the procedure to allow the patient to deal with her feelings.
Answer Key
1. Answer: C
Furosemide, a loop diuretic, does not alter pain. Furosemide acts on the kidneys to
increase urinary output. Fluid may move from the periphery, decreasing edema. Fluid
load is reduced, lowering blood pressure.
2. Answer: A
Obesity is an important risk factor for coronary artery disease that can be modified by
improved diet and weight loss. Family history of coronary artery disease, male gender,
and advancing age increase risk but cannot be modified.
3. Answer: B
4. Answer: C
Exercise is important for all hospitalized patients to prevent deep vein thrombosis.
Muscular contraction promotes venous return and prevents hemostasis in the lower
extremities. This exercise is not sufficiently vigorous to increase physical fitness, nor is
it intended to prevent bedsores or constipation.
5. Answer: D
Cardiogenic shock severely impairs the pumping function of the heart muscle, causing
diminished blood flow to the organs of the body. This results in diminished brain
function and confusion, as well as hypotension, tachycardia, and weak pulse.
Cardiogenic shock is a serious complication of myocardial infarction with a high
mortality rate.
6. Answer: D
A patient with congestive heart failure and dyspnea may have pulmonary edema,
which can cause severe hypertension. Therefore, taking the patient's blood pressure
should be the first action. Lying flat on the exam table would likely worsen the
dyspnea, and the patient may not tolerate it. Blood draws for chemistry and ABG will
be required, but not prior to the blood pressure assessment.
7. Answer: C
8. Answer: A
Three months after surgery and chemotherapy the patient is likely to be feeling the
after-effects, which often includes anemia because of bone-marrow suppression. There
is no evidence that the patient is immunosuppressed, and fatigue is not a typical
symptom of immunosuppression. The information given does not indicate that
depression or dehydration is a cause of her symptoms.
9. Answer: 3
Normal hemoglobin values range from 11.5-15.0. This vegetarian patient is mildly
anemic. When food is prepared in iron cookware its iron content is increased. In
addition, dark green leafy vegetables, such as spinach and kale, and legumes are high
in iron. Mild anemia does not require that animal sources of iron be added to the diet.
Many non-animal sources are available. Coffee and tea increase gastrointestinal
activity and inhibit absorption of iron.
10. Answer: D
Transfusion reaction is most likely during the first 15 minutes of infusion, and a nurse
should be present during this period. PRBCs should be infused through a 19g or larger
IV catheter to avoid slow flow, which can cause clotting. PRBCs must be flushed with
0.45% normal saline solution. Other intravenous solutions will hemolyze the cells.
11. Answer: B
Epoetin is a form of erythropoietin, which stimulates the production of red blood cells,
causing an increase in hematocrit. Epoetin is given to patients who are anemic, often
as a result of chemotherapy treatment. Epoetin has no effect on neutrophils, platelets,
or serum iron.
Polycythemia vera is a condition in which the bone marrow produces too many red
blood cells. This causes an increase in hematocrit and viscosity of the blood. Patients
can experience headaches, dizziness, and visual disturbances. Cardiovascular effects
include increased blood pressure and delayed clotting time. Weight loss is not a
manifestation of polycythemia vera.
13. Answer: A
Side effects of corticosteroids include weight gain, fluid retention with hypertension,
Cushingoid features, a low serum albumin, and suppressed inflammatory response.
Patients are encouraged to eat a diet high in protein, vitamins, and minerals and low in
sodium. Corticosteroids cause hypernatremia, not hyponatremia.
15. Answer: B
The neutropenic patient is at risk of infection. Changing gloves immediately after use
protects patients from contamination with organisms picked up on hospital surfaces.
This contamination can have serious consequences for an immunocompromised
patient. Changing the respiratory mask is desirable, but not nearly as urgent as
changing gloves. Minimizing contact and conversation are not necessary and may
cause nursing staff to miss changes in the patient's symptoms or condition.
16. Answer: C
17. Answer: A
The peak incidence of ALL is at 4 years (range 3-10). It is uncommon after the mid-
teen years. The peak incidence of chronic myelogenous leukemia (CML) is 45-55 years.
The peak incidence of acute myelogenous leukemia (AML) occurs at 60 years. Two-
thirds of cases of chronic lymphocytic leukemia (CLL) occur after 60 years.
18. Answer: B
19. Answer: A
20. Answer: C
Slow, deep breathing is the most effective method of reducing anxiety and stress. It
reduces the level of carbon dioxide in the brain to increase calm and relaxation.
Warning the patient to remain still will likely increase her anxiety. Encouraging family
members to stay with the patient may make her worry about their anxiety as well as
her own. Delaying the procedure is unlikely to allay her fears.