HYPERTENSION

1. The nurse teaches a client, who has recently been diagnosed with hypertension, about dietary restrictions: a low-calorie, low-fat, low-sodium diet. Which of the following menu selections would best meet the client's needs? a) Mixed green salad with blue cheese dressing, crackers, and cold cuts. b) Ham sandwich on rye bread and an orange. c) Baked chicken, an apple, and a slice of white bread. d) Hot dogs, baked beans, and celery and carrot sticks. C. Processed and cured meat products, such as cold cuts, ham, and hot dogs, are all high in both fat and sodium and should be avoided on a low-calorie, low-fat, low-salt diet. Dietary restrictions of all types are complex and difficult to implement with clients who are basically asymptomatic. 2. Metoprolol (Toprol XL) is added to the pharmacologic therapy of a diabetic female diagnosed with stage 2 hypertension initially treated with Furosemide (Lasix) and Ramipril (Altace). An expected therapeutic effect is:
a) b) c) d) Decrease in heart rate. Lessening of fatigue. Improvement in blood sugar levels. Increase in urine output.

A. The effect of a beta blocker is a decrease in heart rate, contractility, and afterload, which leads to a decrease in blood pressure. The client at first may have an increase in fatigue when starting the beta blocker. The mechanism of action does not improve blood sugar or urine output. PNEUMONIA 3. Which of the following is significant data to gather from a client who has been diagnosed with pneumonia? Select all that apply. 1. Quality of breath sounds. 2. Presence of bowel sounds. 3. Occurence of chest pain. 4. Amount of peripheral edema. 5. Color of nail beds. a) 1,3,4,5 b) 1,3,5 c) 3,4,5 d) 1,2,3,5 B. A respiratory assessment, which includes auscultating breath sounds and assessing the color of the nail beds, is a priority for clients with pneumonia. Assessing for the presence of chest pain is also an important respiratory assessment as chest pain can

interfere with the client's ability to breathe deeply. Auscultating bowel sounds and assessing for peripheral edema may be appropriate assessments, but these are not priority assessments for the client with pneumonia. 4. A client with pneumonia has a temperature of 102.6 F (39.2 C), is diaphoretic, and has a productive cough. The nurse should include which of the following measures in the plan of care? a) Position changes every 4 hours. b) Nasotracheal suctioning to clear secretions. c) Frequent linen changes d) Frequent offering of a bedpan. C. Frequent linen changes are appropriate for this client because of the diaphoresis. Diaphoresis produces general discomfort. The client should be kept dry to promote comfort. Position changes need to be done every 2 hours. Nasotracheal suctioning is not indicated with the client's productive cough. Frequent offering of a bedpan is not indicated by the data provided in this scenario. GASTROENETRITIS
5. While preparing to discharge an 8-month-old infant who is recovering from gastroenteritis and dehydration, the nurse teaches the parents about their infants dietary and fluid requirements. The nurse should include which other topic in the teaching session? A.Nursery schools B.Toilet Training C.Safety guidelines D. Preparation for surgery D. The nurse always should reinforce safety guidelines when teaching parents how to care for their child. By giving anticipatory guidance the nurse can help prevent many accidental injuries. For parents of a 9month-old infant, it is too early to discuss nursery schools or toilet training. Because surgery is not used gastroenteritis, this topic is inappropriate. 6. An infant has been admitted to the hospital with gastroenteritis. The nursing care plan for infant will consider which nursing diagnosis first? a. b. c. d. Acute pain Diarrhea Deficient fluid volume Imbalance nutrition: less then body requirements

R: diarrhea is the first symptom that will be experienced by a patient suffering from gastroenteritis

1. A 24 year old female patient was admitted in the hospital for shingles. The patient asked the nurse what is the cause of the disease. The nurse would be correct if she answers: a. Varicella zoster virus b. Klebsiella c. Eschericia Coli d. Stapylococcus Aureus R: Both chickenpox and shingles are caused by the same virus, the varicella zoster virus (VZV).

2. The patient is asking the student nurse how he acquired shingles? The clinical instructor would intervene if the student nurse replies: Select all that apply. a. It is highly contagious and is acquired through the sneeze of an infected person. b. It cannot be transmitted at all, so it is not possible that you have obtained it from someone infected with the same disease. c. It is not transmitted from person to person, but through reactivation of VZV. d. It is a very transmissible disease that can be passed by an infected person through direct contact. A: a,b B: b,c c. a, d D: b,d R: C. No, shingles cannot be passed from one person to another such as through sneezing, coughing, or casual contact. Shingles occurs when latent VZV reactivates.

3. The nurse in the OPD department is taking the history a patient being diagnosed with ovarian cyst. One risk factor that could be related to the said diagnosis would be: a. b. c. d. I have been diagnosed of hypothyroidism 2 years ago. I had my first intercourse when I was only 16. My menses started when I was 17 years old. I have given birth for 3 children already, and is currently 5 months pregnant.

R: A. Thyroid gland needs enough iodine to function properly. In a low iodine state, the ovaries may enlarge, and grow nodules and cysts. Premarital sex is not related to ovarian cyst. Early menarche and infertility are the other risk factors of ovarian cyst and not late menarche and pregnancy. 4. A Theca lutein cyst is a type of bilateral functional ovarian cyst filled with clear, straw-colored fluid. History shows that the patient has been on a therapy to induce ovulation and infertility. As a nurse in the OB-GYN department, you expect that the initial possible treatment would be: a. No treatment is feasible b. Excision of the cyst c. Discontinuation of hCG therapy d. Culdocentesis
R: C. Theca-Lutein Cysts are cysts that develop as a result of an overstimulation by the

hormone human chorionic gonadotropin (hCG). When hCG level drops, the cysts may resolve spontaneously. To induced ovulation and treat infertility, hCG therapy is commonly prescribed. So discontinuation should initially be done to treat the disease. Excision is

prescribed for persistent ovarian cyst not for theca lutein cyst. In follicular cyst type of ovarian cancer, no treatment is possible because cysts commonly disappear spontaneously

within one to two menstrual cycles. And culdocentesis is used to drain intraperitoneal fluid in ruptured ovarian cyst.

5. . A client with a diagnosis of extraintestinal amoebiasis has been admitted in the

hospital. As a nurse, you know that the drug of choice for this disease is? a. bacitracin (Baci-IM) b. fluconazole (Diflucan) c. metronidazole (Flagyl) d. ethambutol (Myambutol)

C. metronidazole. an antibiotic drug used to treat certain parasitic and bacterial

infections. Amoebiasis is caused by a parasitic organism. Fluconazole is antifungal. Bacitracin is a topical antibiotic and ethambutol is a bacteriostatic antimycobacterial drug prescribed to treat tuberculosis.
6. Nurse Sharinah is reviewing on what type of organism is the one causing Amoebiasis. That organism is a? a. b. c. d. Commensal organism Parasitic organism Mycobacterium Both A and B B. Entamoeba species are unicellular eukaryotes that parasitise all

classes of vertebrates and some invertebrates. Only three species of Entamoeba have been proven to cause disease and sometimes death in their hosts: Entamoeba histolytica, a parasite of humans, Entamoeba nuttalli, a parasite of nonhuman primates and Entamoeba invadens, a parasite of reptiles. Other species appear to live as commensals in their hosts and do not cause evident disease.
7. A patient was admitted in the hospital due to frequent chronic epistaxis and nasal obstruction. The diagnosis was found to be juvenile nasopharyngeal angiofibroma (JNA) Type II, a benign tumor that tends to bleed and occurs in the nasopharynx of prepubertal and adolescent males. The nurse understands that Type II of this disease is characterized by: Select all that apply:

a. b. c. d.

Lesion extends into the infratemporal fossa, cheek region, or orbital cavity Calabashlike, massive tumor lobe in the middle cranial fossa Tumor localized in the nasal cavity, paranasal sinus, nasopharynx, or pterygopalatine fossa. Lesion with anterior and/or minimal middle cranial fossa extension but intact dura mater

R: A and D. Choice B is of Type III and C is of Type I. 8. A patient who had undergone Le Fort osteotomy as the surgical treatment for Juvenile Nasopharyngeal Angiofibroma is about to be discharged from the hospital. Which of the following statements if made by the client indicates that teaching has been effective? a. I need to carry with me my pain medication everytime. But it is not necessary to take it if the pain is only mild. Breathing exercises would do help. b. I have to wear a dental head gear for 12 weeks to keep my bones in place. c. I will be sent home with a device called distractor to help in pulling my bones farther apart. d. If I feel dizzy or drowsy after taking my pain medication. I should call my physician immediately. R: C. Le Fort osteotomy is upper jaw surgery that involves sectioning and repositioning the
maxilla, or upper jaw, to correct its abnormal position. A patient may be sent home with a device called a distractor. A distractor is attached to the head and to help pull bones farther apart. A dental head gear is to be worn for 6 months or 24 weeks after discharge. Pain medication is taken before the onset of a severe pain not during. Dizziness and drowsiness are normal side effects of pain medications, it is not necessary to report it immediately to the physician.