Diagnostic/Assessment Test 2 1. Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m.

An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. ,n addition to the headache and hy$ertension, hich of the follo ing sym$toms ould you e-$ect Mr. Reynolds to e-hibit. A* 0* /abored res$iration. Dys$hagia and hemi$legia. (* D* A$hasia. All of the abo&e.

2. Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. The team leader instructs you to remo&e Mr. Reynolds1s dentures. 2ou do so because A* the team leader ill re$ort you if you do not follo directions. 0* the dentures need to be cleaned. (* the dentures might obstruct the res$iratory $assages. D* Mr. Reynolds usually remo&es them for slee$ any ay. 3. Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. 4nres$onsi&e $atients li%e Mr. Reynolds may de&elo$ a drying of the cornea, hich is usually caused by A* $aralysis of the eyelid. (* lac% of humidity in the room. 0* absence of the blin%ing refle- and reduction in tear formation. D* bulging of the eyeballs. 5 Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. The MA,6 ob7ecti&e in the nursing care of the stro%e $atient is to A* $re&ent infection. (* $ro&ide good nutrition. 0* $re&ent com$lications that ill delay rehabilitation. D* $ro&ide relief of $ain. 8 Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. ,n the nursing assessment you note that Mr. Reynolds has lef9 tside $aralysis. :hen Mr. Reynolds is turned on his side, it is im$ortant to A* ele&ate the head and %nee gatch. (* su$$ort the affected arm and leg ith $illo s. 0* ele&ate the foot of the bed. D* su$$ort the unaffected arm and leg ith $illo s. 6 Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained ;age 1 of 22

of a headache before retiring the night before. Mr. Reynolds regains consciousness, but is unable to s$ea%. This disorder is %no n as A* a$honia. 0* atresia. (* a$hasia. D* a$hagia. ! Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. Mr. Reynolds1s $rogram of rehabilitation should begin A* hen he is ready to go home. (* hen he regains consciousness. 0* hen he is able to understand directions. D* on the day he is admitted to the hos$ital. < Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. Mr. Reynolds de&elo$s cyanosis. This may occur because A* he has hy$ertension. 0* secretions ha&e accumulated in his res$iratory $assages and he is unable to breathe ell. (* he has de&elo$ed em$hysema. D* he is anemic. 9 Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. Mr. Reynolds1s $hysician has ordered that intra&enous fluids be administered slo ly in order to A* stimulate diuresis. 0* stimulate $eristalsis. (* $re&ent o&erloading the circulatory system. D* $re&ent res$iratory secretions from accumulating. 1# Mr. Reynolds, 69 years of age, is found unconscious by his ife at !"## a.m. An ambulance is summoned by the $hysician, and Mr. Reynolds is admitted to the medical unit, here you or% as a $ractical nurse, ith a diagnosis of cerebral &ascular accident '()A*. As you assist the team leader ith the admission $rocess, you note a $re&ious history of hy$ertension. +is ife has also re&ealed that Mr. Reynolds com$lained of a headache before retiring the night before. ;ro$er $ositioning of Mr. Reynolds is &ery im$ortant in order to" 1. $re&ent de$endent edema, 2. $re&ent contractures, $re&ent as$iration. A* 5, only. 0* 1, 2, and 3. 3, and 5. 3. im$ro&e circulation, (* 2, 3, and 5. 5. D* 1, 2,

11 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. >he is eagerly antici$ating confirmation of a ho$e9dfor first $regnancy. A oman ho, li%e Mrs. =ran%, is $regnant for the first time is called a A* $rimi$ara. 0* $rimigra&ida. (* multi$ara. D* multigra&ida. 12 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. >he is ;age 2 of 22

eagerly antici$ating confirmation of a ho$e9dfor first $regnancy. 0efore the end of the 3rd month of $regnancy, the $roducts of conce$tion are %no n as the A* fetus. 0* embryo. (* ?ygote. D* $lacenta.

13 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. >he is eagerly antici$ating confirmation of a ho$e9dfor first $regnancy. Mrs. =ran%1s amenorrhea is classified as hich ty$e of sign of $regnancy. A*A $ositi&e sign. 0* A $robable sign. (* A $resum$ti&e sign. D* A negati&e sign. 15 2ou are em$loyed as a $ractical 6urse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. >he is eagerly antici$ating confirmation of a ho$e9dfor first $regnancy. Mrs. =ran%1s estimated date of deli&ery is determined by counting A* 3## days from the first day of the last menstruation. 0* bac% ! months from the first Day of the last menstrual $eriod and adding 3 days. (* bac% 3 months from the first day of the last menstrual $eriod and adding ! days. D* 2## days from the first day of the last menstruation. 18 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. >he is eagerly antici$ating confirmation of a ho$e9dfor first $regnancy. Mrs. =ran%1s $renatal e-amination includes all of the follo ing @A(@;T A* a routine $hysical, including $ast medical history. 0* urinalysis for sugar and albumin. (* a gallbladder series. D* tem$erature, $ulse, res$iration, and blood $ressure. 16 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$e9dfor first $regnancy has been confirmed. Mrs. =ran% confides to you that she has to urinate at freBuent inter&als. 2ou e-$lain that this freBuency of urination usually subsides hen the A* $lacenta is fully de&elo$ed. (* uterus rises into the abdominal ca&ity. 0* fetal %idneys begin to function. D* mother1s %idneys enlarge to accommodate the e-tra aste. 1! 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$e9dfor first $regnancy has been confirmed. During the first half of her $regnancy, the $hysician ill most $robably ish to see Mrs. =ran% e&ery A*1 to 2 ee%s. 0* 2 to 3 ee%s. (* 3 to 5 ee%s. D* 6 to < ee%s. 1< 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$e9dfor first $regnancy has been confirmed. Mrs. =ran% com$lains of nausea and &omiting as ell as heartburn. 2ou recommend that she alter her diet by reducing the inta%e of A* fats. 0* $roteins. (* minerals. D* carbohydrates. 19 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ;age 3 of 22

ho$e9dfor first $regnancy has been confirmed. Mrs. =ran% com$lains of nausea and &omiting. 2ou ad&ise Mrs. =ran% that her nausea and &omiting can be relie&ed if, one9half hour before rising in the morning, she A* drin%s a glass of mil%. (* eats a $iece of fruit. 0* drin%s a cu$ of hot tea. D* eats a $iece of dry toast or a $lain crac%er. 2# 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$e9dfor first $regnancy has been confirmed. Mrs. =ran% com$lains of heartburn. The most $robable cause of Mrs. =ran%1s heartburn is A* an increase in the $roduction of bile. (* a rising of the uterine fundus. 0* an increase in the $roduction of stomach acid. D* a decrease in digesti&e en?ymes. 21 As the uterine fundus rises, it $ushes the stomach and dia$hragm u$, thereby causing some regurgitation. 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$ed9for first $regnancy has been confirmed. To $re&ent or control consti$ation, you encourage Mrs. =ran% to increase all of the follo ing @A(@;T her A* fluid inta%e. 0* roughage. (* e-ercise. D* rest $eriods. 22 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$e9dfor first $regnancy has been confirmed. The $hysician $rescribes mineral oil to relie&e occasional consti$ation. 2ou instruct Mrs. =ran% not to ta%e it at or near mealtimes because mineral oil interferes ith the absor$tion of &itamin A* (. 0* 012. (* A. D* 02. 23 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and has missed t o menstrual $eriods. +er ho$e9dfor first $regnancy has been confirmed. As Mrs. =ran%1s $regnancy $rogresses, the $hysician uses a fetosco$e to chec% for the fetal heart sounds. The nurse first e-$ects to hear fetal heart sounds hen the oman has been $regnant A* < to 1# ee%s. 0* 1# to 12 ee%s. (* 13 to 18 ee%s. D* 1< to 2# ee%s. 25 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and is in her eighth month of $regnancy. Mrs. =ran% has chloasma, hich is best described as A* stretch mar%s on the abdomen. (* dar% rings around the ni$$les. 0* bro n s$ots on the face. D* a dar% &ertical line on the abdomen. 28 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and is in her eighth month of $regnancy. Mrs. =ran% has been e-$eriencing leg cram$s. To relie&e these s$asms, you ad&ise her to $lace the an%le in a $osition of A* rotation, by mo&ing the foot in circles. 0* dorsifle-ion, by mo&ing the toes u$ to ard the %nees. (* e-tension, by mo&ing the foot so the toes $oint u$ to the ceiling. D* $lantar fle-ion, by mo&ing the foot so the toe $oints do n to the floor. 26 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and is in her eighth month of $regnancy. =or hich of the follo ing discomforts of $regnancy that Mrs. =ran% may e-$erience is the $el&ic roc% most often recommended. ;age 4 of 22

A* 6ausea.

0ac%aches.

0* +eartburn.

(* (onsti$ation.

D*

2! 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and is e-$eriencing her first $regnancy. Mrs. =ran% should eat hich of the follo ing foods to increase her iron inta%e. A* (heese. (* /ean meat or dried beans. 0* (itrus fruits. D* Creen or yello &egetables. 2< 2ou are em$loyed as a $ractical nurse in an obstetrician1s office. 2ou ha&e 7ust greeted Mrs. =ran% and escorted her to the e-amining room. Mrs. =ran% is 26 years old and is e-$eriencing her first $regnancy. To hel$ ensure an adeBuate calcium inta%e, you encourage Mrs. =ran% to increase her daily mil% inta%e to A* 2 cu$s. 0* 5 cu$s. (* 6 cu$s. D* < cu$s. 29 Mr. >%ully is an <#9year9old resident in a health9related facility. +e suffers from arteriosclerotic heart disease but is ambulatory. +is medications are Digo-in #.28 mg DD daily and /asi- 5# mg 0,D and he is on a sal9t$oor diet. +e has been %no n to snea% out and ander around the neighborhood. +e is unfriendly to the other residents and considers himself su$erior to them. The nurse disco&ers that Mr. >%ully, ho com$lains constantly about the EtastelessE food, has gone out and bought salt and hot, $ic%led $e$$ers to $ut on his food. :hich of the follo ing actions should the nurse ta%e. A* (all Mr. >%ully1s doctor and re$ort this action. 0* (hart the action and re$ort it to the su$er&isor. (* Ta%e the condiments a ay from Mr. >%ully. D* >cold Mr. >%ully and tell him that he is undoing all the staff1s good or%. 3# Mr. >%ully is an <#9year9old resident in a health9related facility. +e suffers from arteriosclerotic heart disease but is ambulatory. +is medications are Digo-in #.28 mg DD daily and /asi- 5# mg 0,D and he is on a sal9t$oor diet. +e has been %no n to snea% out and ander around the neighborhood. +e is unfriendly to the other residents and considers himself su$erior to them. :hen $lanning nursing care for Mr. >%ully, to hich of the follo ing beha&iors is it MD>T im$ortant that the staff be alerted. A* +is constant com$laints. (* +is refusal of meals. 0* +is andering around the neighborhood. D* +is hiding of condiments in his room. 31 Mrs. (o- has an ulcer on her lo er leg. (ontinuous arm, moist com$resses ha&e been ordered. :hen administering these com$resses, it is im$ortant to A* e-$lain the $rocedure to Mrs. (o- carefully so that she can learn to $re$are the com$resses for herself. 0* arm at least one Buart of solution each time because these are continuous com$resses. (* $ut Mrs. (o- in a heelchair so that the com$resses can be a$$lied more easily. D* chec% the moisture of the com$resses freBuently so that they are ne&er dry. 32 Mrs. (o- has an ulcer on her lo er leg. (ontinuous arm, moist com$resses ha&e been ordered. After Mrs. (o-1s ulcer has healed, her $hysician recommends elastic stoc%ings. The $ur$ose of these stoc%ings is to A* 0* increase circulation in the legs. $rotect the legs from in7ury. D* (* $ro&ide armth for the lo er legs. su$$ort the blood &essels in the leg.

33 Mrs. (o- has an ulcer on her lo er leg. After Mrs. (o-1s ulcer has healed, her $hysician recommends elastic stoc%ings. :hen instructing Mrs. (o- in the $ro$er use of these stoc%ings, the nurse should tell her that the stoc%ings should be A* orn 2# hours a day. 0* a$$lied early in the morning before arising from bed. (* held u$ ith circular garters. D* orn only hen she antici$ates standing for long $eriods of time. ;age 5 of 22

35 Mrs. Ri&era has been confined to bed for se&eral ee%s but refuses to change $osition or $erform the e-ercises ordered by her doctor to maintain adeBuate circulation in her legs. Dne day she tells the doctor her legs hurt, and he diagnoses her condition as thrombo$hlebitis. Thrombo$hlebitis is A* inflammation of the &ein caused by a blood clot in the blood &essel. 0* a traumatic inflammation of a blood &essel. (* a bulging of the all of an artery. D* an ulceration ithin the blood &essels. 38 Mrs. Ri&era has been confined to bed for se&eral ee%s but refuses to change $osition or $erform the e-ercises ordered by her doctor to maintain adeBuate circulation in her legs. Dne day she tells the doctor her legs hurt, and he diagnoses her condition as thrombo$hlebitis. The most common sym$tom of thrombo$hlebitis is A*cyanosis of the affected leg. (* se&ere s elling of the an%les. 0*$ain in the calf of the leg. D* bulging of the affected blood &essels. 36 Mrs. Ri&era has been confined to bed for se&eral ee%s but refuses to change $osition or $erform the e-ercises ordered by her doctor to maintain adeBuate circulation in her legs. Dne day she tells the doctor her legs hurt, and he diagnoses her condition as thrombo$hlebitis. A nursing $rocedure that is (D6TRA,6D,(AT@D in thrombo$hlebitis is A* turning the $atient from side to side. 0* ele&ating the head of the bed. (* massaging the legs. D* rubbing the bac%. 3! Mrs. Ri&era has been confined to bed for se&eral ee%s but refuses to change $osition or $erform the e-ercises ordered by her doctor to maintain adeBuate circulation in her legs. Dne day she tells the doctor her legs hurt, and he diagnoses her condition as thrombo$hlebitis. Thrombo$hlebitis is a com$lication of a &ariety of illnesses and can best be a&oided by A* early ambulation and e-ercises to increase circulation. 0* the administration of antibiotics. (* gi&ing the $atient daily doses of &itamin F. D* restricting $hysical acti&ity of any %ind after surgery. 3< Mrs. Ri&era has been confined to bed for se&eral ee%s but refuses to change $osition or $erform the e-ercises ordered by her doctor to maintain adeBuate circulation in her legs. Dne day she tells the doctor her legs hurt, and he diagnoses her condition as thrombo$hlebitis. The doctor tells Mrs. Ri&era to sto$ smo%ing. >he cannot understand hy and says, E,t1s my legs that are bothering me, not my lungs.E As a $ractical nurse, your best re$ly to her ould be A* E2our doctor is afraid your condition ill s$read to your lungs.E 0* E6icotine, hich is $resent in cigarettes, narro s the blood &essels in your body and ma%es your condition orse.E (* E>mo%ing dulls your a$$etite, and $oor nutrition ma%es your condition orse.E D* EThere is no connection bet een smo%ing and your condition, but you ould feel better if you sto$$ed smo%ing.E 39 Mrs. Ri&era has been confined to bed for se&eral ee%s but refuses to change $osition or $erform the e-ercises ordered by her doctor to maintain adeBuate circulation in her legs. Dne day she tells the doctor her legs hurt, and he diagnoses her condition as thrombo$hlebitis. The aim of nursing care for $atients ith thrombo$hlebitis is to A* $re&ent brea%do n of tissues. (* $ro&ide $ro$er rest. 0* $ro&ide $ro$er nutrition. D* $re&ent an embolism. 5# Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. (ongesti&e heart failure is best described as a cardiac condition in hich there is ;age 6 of 22

A* an abnormality in the structure of the heart. 0* a decreased flo of blood through the heart and great &essels, resulting from failure of the heart to function as a $um$. (* a blood clot ithin one of the heart chambers. D* a sudden s$asm of the heart muscle due to a decreased blood su$$ly. 51 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen1s doctor orders com$lete bed rest for him. This means that Mr. Creen A* is encouraged to rest as much as $ossible. 0* is confined to bed but can assume res$onsibility for much of his $ersonal care. (* is confined to bed but is allo ed to get in u$ to go to the bathroom as necessary. D* must remain as Buiet as $ossible and e&erything in&ol&ing the slightest $hysical effort must be done for him. 52 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen is suffering from se&ere dys$nea. The $osition in hich he ill be most comfortable is A* >ims1 left lateral $osition. (* the Trendelenburg $osition. 0* =o ler1s $osition. D* the su$ine $osition. 53 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. 0ac% care for Mr. Creen is A* not indicated because a cardiac $atient must ha&e absolute rest. 0* less im$ortant than for most $atients because the edema E$adsE the bony $rominences of the body. (* more im$ortant than for most $atents because a cardiac $atient often has edematous tissue, hich readily brea%s do n. D* im$ortant hen the $atient1s s%in sho s signs of de&elo$ing ulcerations. 55 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. (ardiac $atients li%e Mr. Creen are sometimes not $ermitted to ha&e cold drin%s or iced foods because A* they act as a stimulant to the heart. 0* e-treme cold has a constricting effect on blood &essels and may increase the or%load of the heart. (* cold decreases circulation and o&erburdens the heart. D* cold drin%s cause the formation of gas and lead to stomach cram$s 58 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen is gi&en a lo 9sodium diet. :hen edema is $resent, the inta%e of sodium is restricted because it A* slo s the heartbeat. (* decreases the urinary out$ut. 0* causes hardening of the arteries. D holds fluid in the tissues. 56 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen is gi&en a lo 9sodium diet. Dne food substance that contains sodium and is commonly $art of the a&erage $erson1s diet is A* fruit. 0* sugar. (* table salt. D* coffee. 5! Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen is gi&en a lo 9sodium diet. :hich of the follo ing foods is /D:@>T in sodium content. A* (itrus fruits. (* Mil% and mil% $roducts. 0* (anned meats and fish. D* 0acon. 5< Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen is gi&en a lo 9sodium diet. 0ecause there may be EhiddenE sources of sodium, hich of the follo ing should be carefully chec%ed by reading the label to see if sodium is $resent. 1. (anned or $rocessed foods. A* 1, 2, 3, and 5. 2. Tooth$astes and mouth ashes. 0* 2 and 5. ;age 7 of 22

3. 5.

;ac%aged ba%ery $roducts. ;atent medicines.

(* 1 and 3. D* 1, 3, and 5.

59 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. To $re&ent de$letion of $otassium by the diuretics Mr. Creen is ta%ing, the nurse ad&ised him to eat A* $otatoes. 0* bananas. (* chocolate chi$ coo%ies. D* s$inach. 8# Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen1s doctor $laces him on digitalis. This drug is classified as a A* heart stimulant. 0* cerebral stimulant. (* coagulant. D* res$iratory stimulant. 81 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen1s doctor $laces him on digitalis. The chief action of digitalis is to A* lo er the blood $ressure. (* increase the $ulse rate. 0* $re&ent the formation of blood clots. D* slo and strengthen the heartbeat. 82 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen1s doctor $laces him on digitalis. 0efore each dose of digitalis is administered to Mr. Creen, you must remember to A* chec% his $ulse. (* ta%e his blood $ressure. 0* chec% his res$iration. D* chec% ith the lab to see hether a test of bleeding time has been done. 83 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Mr. Creen1s doctor $laces him on digitalis. Digitalis must not be gi&en ithout the s$ecific direction of the doctor hene&er A* the systolic 0/; is abo&e 1## (* the $ulse is 6# or belo . 0* the rectal tem$erature is subnormal. D* the $atient is flushed and $ers$iring. 85 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. Drugs that are sometimes gi&en to increase the urinary out$ut and relie&e edema are called A* urinary stimulants. (* diuretics. 0* heart stimulants. D* urinary disinfectants. 88 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. The doctor has ordered a daily eight chec% for Mr. Creen. The reason for this is to determine the loss of A* body fat. 0* a$$etite. (* tissue fluid. D* blood &olume. 86 Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. The doctor has ordered a daily eight chec% for Mr. Creen. :hen eighing Mr. Creen, you should A* 0* (* D* use the treatment9room scales, hich are accurate. eigh him in the late afternoon each day. eigh him at the same time e&ery day, on the same scales, and ith the same amount of clothing. as% the orderly to eigh him because it is difficult to get the $atient out of bed.

8! Mr. Creen, aged 62, is assigned to you for morning care. +is diagnosis is congesti&e heart failure. 6itroglycerin tablets, hich are often $rescribed for cardiac $atients li%e Mr. Creen, are gi&en sublingually. This means that the tablets are A* dissol&ed and gi&en under the s%in. (* ta%en by mouth ith a small amount of ater. ;age 8 of 22

0*

held under the tongue until dissol&ed.

D*

in7ected into the gluteal muscle.

8< Mrs. Russo, a 589year9old mother of three, has e-$erienced bleeding bet een her menstrual $eriods for se&eral months. >he ma%es an a$$ointment for an e-amination by a gynecologist. The office nurse confirming the a$$ointment for Mrs. Russo should caution her against A* choosing a date on hich she e-$ects to ha&e &aginal bleeding. 0* ta%ing a douche immediately before coming to the doctor1s office. (* ta%ing a tub bath immediately before coming to the office. D* ta%ing any foods or fluids for < hours before coming to the office. 89 Mrs. Russo, a 589year9old mother of three, has e-$erienced bleeding bet een her menstrual $eriods for se&eral months. >he has made an a$$ointment for an e-amination by a gynecologist. 0efore Mrs. Russo is gi&en a $el&ic e-amination in the gynecologist1s office, it is most im$ortant for the nurse to A* direct the $atient to the bathroom to em$ty her bladder. 0* administer a lo enema. (* catheteri?e the $atient for a s$ecimen. D* scrub the $erineal area ith $+isohe- for 8 minutes. 6# Mrs. Russo, a 589year9old mother of three, has e-$erienced bleeding bet een her menstrual $eriods for se&eral months. 0efore Mrs. Russo is gi&en a $el&ic e-amination in the gynecologist1s office, the nurse directs the $atient to the bathroom to em$ty her bladder. The main reason for the nurse1s suggestion is to A* obtain a stool s$ecimen. 0* remo&e flatus and feces from the intestinal tract. (* sterili?e the s%in around the &agina. D* $re&ent discomfort for the $atient and enable the $hysician to $al$ate the $el&ic organs more easily. 61 Mrs. Russo, a 589year9old mother of three, has e-$erienced bleeding bet een her menstrual $eriods for se&eral months. >he has made an a$$ointment for an e-amination by a gynecologist. Mrs. Russo ill be more rela-ed and coo$erati&e during the gynecological e-amination if the nurse ill A* lea&e the room during the e-amination. 0* inform the $atient that all the instruments ha&e been sterili?ed. (* e-$lain the $rocedure to the $atient if she does not %no hat to e-$ect. D* remind the $atient that modesty is not im$ortant during any ty$e of $hysical e-amination. 62 Mrs. Russo, a 589year9old mother of three, has e-$erienced bleeding bet een her menstrual $eriods for se&eral months. >he has made an a$$ointment for an e-amination by a gynecologist. The $hysician e-$lains to Mrs. Russo that he ill do a ;a$anicolaou ';a$* smear of the cer&ical secretions. The $ur$ose of this test is to A* determine the $resence of microorganisms that may be the cause of a disease. 0* rule out the $ossibility of a &enereal disease. (. rule out or confirm $regnancy. D* determine the $resence of malignant cells in the cer&ical secretions. 63 Mrs. Russo, a 589year9old mother of three, has e-$erienced bleeding bet een her menstrual $eriods for se&eral months. >he has made an a$$ointment for an e-amination by a gynecologist. After the e-amination Mrs. Russo1s gynecologist recommends that she be admitted to the hos$ital for further diagnostic tests. After her admission she is scheduled for a dilatation and curettage. This $rocedure in&ol&es A* dilatation of the cer&i- and scra$ing of the uterus. 0* remo&al of se&eral sam$les of cer&ical tissue. (* A9ray e-amination of the re$roducti&e tract. D* &isual e-amination of the interior of the uterus.

;age 9 of 22

65 Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. After an e-amination Mrs. Russo1s gynecologist recommended that she be admitted to the hos$ital for further diagnostic tests. Mrs. Russo1s condition is diagnosed as non in&asi&e carcinoma of the cer&i-. >he is immediately scheduled for a &aginal hysterectomy. This $rocedure in&ol&es surgical remo&al of the A* uterus and &agina through an abdominal incision. 0* uterus by ay of the &agina. (* uterus, tubes, and o&aries through an abdominal incision. D* cer&i- and tubes by ay of the &agina. 68 Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. +er condition as diagnosed as non in&asi&e carcinoma of the cer&i- and she as immediately scheduled for a &aginal hysterectomy. The e&ening before surgery Mrs. Russo recei&es a ?e$hiran douche. The $ur$ose of this $rocedure is to A*hel$ minimi?e &aginal bleeding. (* remo&e malignant cells from the &aginal canal. 0*cleanse the &aginal canal. D* sterili?e the o$erati&e area. 66 Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. +er condition as diagnosed as non in&asi&e carcinoma of the cer&i- and she as immediately scheduled for a &aginal hysterectomy. During the immediate $osto$erati&e $eriod it is most im$ortant for the nurse to A* obser&e Mrs. Russo carefully for hemorrhage, hich is a common com$lication of &aginal surgery. 0* %ee$ Mrs. Russo in the Trendelenburg $osition to a&oid strain on the sutures. (* irrigate the o$erati&e area ith normal saline to $re&ent infection. D* catheteri?e Mrs. Russo e&ery 5 hours to $re&ent o&ere-$ansion of the bladder. 6! Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. +er condition as diagnosed as non in&asi&e carcinoma of the cer&i- and she as immediately scheduled for a &aginal hysterectomy. Mrs. Russo is to recei&e $erineal irrigations beginning the first $osto$erati&e day. 0efore administering the irrigations, the nurse should A* arm the solution to room tem$erature. 0* assist the $atient onto the commode for the $rocedure. (* $osition the $atient on her abdomen. D* remo&e any soiled $ads or dressings and discard them in the $atient1s astebas%et. 6< Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. +er condition as diagnosed as non in&asi&e carcinoma of the cer&i- and she as immediately scheduled for a &aginal hysterectomy. Mrs. Russo is to recei&e $erineal irrigations beginning the first $osto$erati&e day. During the $erineal irrigation the nurse must remember to A* use one cotton ball for each stro%e hen cleansing the area. 0* hold the irrigating can at least 1< inches abo&e the $atient. (* i$e to ard the rectal area so as to a&oid contamination of the o$erati&e area. D* instruct the $atient to &oid as soon after the $rocedure as $ossible.

69 Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. +er condition as diagnosed as non in&asi&e carcinoma of the cer&i- and she as immediately scheduled for a &aginal hysterectomy. Mrs. Russo seems orried about the aftereffects of her surgery and as%s hether she ill continue to ha&e menstrual $eriods. The $ractical nurse %no s that for menstruation to ta%e $lace the organ's* that must be $resent and functioning is 'are* A* the uterus and fallo$ian tubes. (* the uterus and at least $art of one o&ary. 0* the uterus only. D* the fallo$ian tubes and one or both o&aries. ;age 10 of 22

!# Mrs. Russo, a 589year9old mother of three, e-$erienced bleeding bet een her menstrual $eriods for se&eral months. +er condition as diagnosed as non in&asi&e carcinoma of the cer&i- and she as immediately scheduled for a &aginal hysterectomy. After the surgery, Mrs. Russo tells the nurse that the surgeon informed her he had not remo&ed her o&aries. +is reason for lea&ing the o&aries intact as to A* allo for future $regnancies. 0* $ro&ide for continuing secretion of the o&arian hormones. (* ma%e the surgical $rocedure less difficult and $rolonged. D* lessen the danger of hemorrhage in the $osto$erati&e $eriod. !1 2ou are assigned to care for Miss 2u, aged 39, ho has 7ust returned from surgery. >he has had a radical mastectomy for treatment of a malignant tumor of the breast. A radical mastectomy in&ol&es remo&al of A* a fibroid tumor and its ca$sule. 0* the entire breast, the ad7acent lym$h nodes under the arm, and the $ectoralis ma7or and minor. (* both breasts. D* the tumor and ad7acent fatty tissue. !2 2ou are assigned to care for Miss 2u, aged 39, ho has 7ust returned from surgery. >he has had a radical mastectomy for treatment of a malignant tumor of the breast. Miss 2u has a $ressure dressing o&er the surgical area. :hen chec%ing the dressing for hemorrhage, it ill be necessary for you to A* remo&e the u$$ermost layers of the dressing each hour. 0* turn the $atient freBuently in order to chec% the dressings. (* remo&e the entire dressing to obser&e the o$erati&e site. D* al ays %ee$ the $atient turned onto the side o$$osite the o$erati&e side so that bleeding can be obser&ed readily. !3 2ou are assigned to care for Miss 2u, aged 39, ho has 7ust returned from surgery. >he has had a radical mastectomy for treatment of a malignant tumor of the breast. ,f, during the first 25 hours after surgery, Miss 2u com$lains of numbness and s elling of the lo er arm on the o$erati&e side, you should %no that A* this is most unusual for $atients ho ha&e had a radical mastectomy. 0* this is usual for $atients ho ha&e had a radical mastectomy. (* this is one of the first signs of hemorrhage from the o$erati&e area. D* there has $robably been some damage to the ner&es in the arm and $aralysis is ine&itable. !5 2ou are assigned to care for Miss 2u, aged 39, ho has 7ust returned from surgery. >he has had a radical mastectomy for treatment of a malignant tumor of the breast. Dne of the sim$lest ays for Miss 2u to obtain necessary e-ercise after a mastectomy is A* eight lifting. 0* brushing her hair. (* mo$$ing the floor. D* dusting furniture. !8 2ou are assigned to care for Miss 2u, aged 39, ho has 7ust returned from surgery. >he has had a radical mastectomy for treatment of a malignant tumor of the breast. There are times during the $osto$erati&e $eriod hen Miss 2u becomes de$ressed and ithdra n. As a $ractical nurse, you reali?e that A* 0* (* D* Miss 2u is $robably sho ing the early sym$toms of a $sychosis. this is a difficult time of ad7ustment for most $atients ho ha&e had a mastectomy. Miss 2u is &ery &ain and needs flattery to get her out of this mood. it ill be best to lea&e Miss 2u alone at this time and let her sol&e her o n $ersonal $roblems.

!6 2ou are assigned to care for Miss 2u, aged 39, ho has 7ust returned from surgery. >he has had a radical mastectomy for treatment of a malignant tumor of the breast. Miss 2u as%s you hen she ill be able to obtain a $rosthesis and begin earing it. The best ans er to this Buestion ould be A* E:hen you can afford one.E 0* EThis ill de$end on the amount of scar tissue you ill ha&e.E (* EThe $hysician must decide hen healing is sufficient and the $rosthesis can be orn comfortably.E ;age 11 of 22

D*

E>ome $eo$le can ne&er ad7ust to a $rosthesis after a mastectomy.E

!! Mr. D10rien, aged !2, has been e-$eriencing difficulty in urinating for the $ast se&eral months. +e is e-amined by his family $hysician and found to ha&e an enlarged $rostate gland. An enlarged $rostate gland interferes ith urination because the gland A* is located near the %idneys and $resses against them. 0* encircles the urethra 7ust belo the nec% of the bladder. (* secretes a substance im$ortant in the formation of urine. D* controls the s$hincter muscle at the end of the urethra. !< Mr. D10rien, aged !2, has been e-$eriencing difficulty in urinating for the $ast se&eral months. +e is e-amined by his family $hysician and found to ha&e an enlarged $rostate gland. Mr. D10rien is admitted to the hos$ital and scheduled for a transurethral $rostatic resection. ,n this $rocedure A* an incision is made into the $erineum and the entire gland is remo&ed. 0* the $rostate gland is remo&ed through an incision. (* a lo abdominal incision is made and the $rostate is remo&ed. D* $art of the $rostate gland is remo&ed by ay of the urethra. !9 Mr. D10rien, aged !2, as e-amined by his family $hysician and found to ha&e an enlarged $rostate gland. +e as admitted to the hos$ital and had a transurethral $rostatic resection. :hich of the follo ing should be re$orted $rom$tly if noticed during Mr. D10rien1s immediate $osto$erati&e $eriod. A* A $in%ish drainage from the o$erati&e site. 0* 0its of clots and tissue $assing through the catheter and into the drainage bottle. (* /arge amounts of urine $assing through the catheter. D* 0right red blood in the catheter and drainage bottle. <# Mr. D10rien, aged !2, as e-amined by his family $hysician and found to ha&e an enlarged $rostate gland. +e as admitted to the hos$ital and had a transurethral $rostatic resection. ,f Mr. D10rien com$lains of se&ere $ain in the bladder region, the nurse1s first action should be to A* chec% to see hether the catheter is o$en and draining freely. 0* administer another dose of an analgesic medication because elderly $atients reBuire large amounts of sedation. (* clam$ the catheter and gently massage the bladder region. D* call the $hysician immediately. <1 Mr. D10rien, aged !2, as e-amined by his family $hysician and found to ha&e an enlarged $rostate gland. +e as admitted to the hos$ital and had a transurethral $rostatic resection. =reBuent irrigations of the bladder are usually ordered follo ing a $rostatectomy. The chief $ur$ose of these irrigations is to A* $re&ent infection in the bladder by destroying most bacteria. 0* %ee$ the urinary tract free of scar tissue. (* control hemorrhage from the bladder. D* remo&e blood clots and shreds of tissue that may obstruct the catheter. <2 (ollecting data, the first ste$ in the nursing $rocess, is 0@>T defined as A* loo%ing at the $atient1s $hysical needs. (* discussing the $atient ith the su$er&ising nurse. 0* discussing the case ith the $hysician. D* obser&ing the $atient1s health needs. <3 ;lanning is 0@>T defined as" A* documenting obser&ations in the $atient1s chart. 0* establishing goals for nursing inter&entions. (* ma%ing $lans ith the registered nurse for necessary treatment, and scheduling the &arious $rocedures. D* as%ing the doctor hat sort of treatment he/she $lans. ;age 12 of 22

<5 A* 0* <8

,m$lementation is 0@>T defined as follo ing the doctor1s orders. (* establishing a nursing diagnosis.

orderly collection of the $atient1s sym$toms. D* administration of the nursing care $lan.

Administration of the nursing care $lan in&ol&es A* being res$onsible for the nursing care of e&ery assigned $atient. 0* delegating some $arts of the care to others. (* ma%ing friends ith the $atient. D* documenting all sym$toms. Documentation is necessary because it A* sho s hat s%ills the $ractical nurse has. 0* $ro&ides a record of the medications, $rocedures, and other treatment the $atient has had. (* hel$s in the assessment of the $atient. D* establishes outcome criteria. :hen de&elo$ing the nursing $lan for a $atient, the nurse should ta%e into consideration the fact that A* most $atients are difficult to manage. 0* each $atient has his o n uniBue $roblems irres$ecti&e of the diagnosis. (* the needs of a $atient de$end solely on the diagnosis. D* most $atients feel entirely hel$less and &ery de$ressed. An e-cellent nursing care $lan A* assigns $riorities to the nursing diagnoses. 0* adheres to hos$ital $olicies. (* organi?es the or% efficiently. D* considers the staff a&ailable. The first thing that the $ractical nurse should do before carrying out a nursing $rocedure is A* re&ie in her/his mind ho the $rocedure should be carried out. 0* e-$lain the $rocedure to the $atient. (* chec% ith the su$er&isor to be sure the $rocedure has not been canceled. D* assemble the necessary eBui$ment.

<6

<!

<<

<9

9# 6ineteen9year9old >tanley 0rods%y is ta%en to the emergency room of a hos$ital after being hit by a car and thro n about 2# feet. +e has many bleeding lacerations and abrasions on his body, as ell as a bro%en arm, and is unconscious u$on arri&al. +e also has a head in7ury and sho s signs of increasing intracranial $ressure. +e is accom$anied by his roommate and another friend. :hich of the follo ing can legally $ermit the doctor to treat him. A* A signed consent from his roommate. 0* A signed consent from his other friend. (* A court order. D* The ritten o$inion of the hos$ital director that treatment is necessary. 91 6ineteen9year9old >tanley 0rods%y is ta%en to the emergency room of a hos$ital after being hit by a car and thro n about 2# feet. +e has many bleeding lacerations and abrasions on his body, as ell as a bro%en arm, and is unconscious u$on arri&al. +e also has a head in7ury and sho s signs of increasing intracranial $ressure. +e is accom$anied by his roommate and another friend. :hen >tanley arri&es in the emergency room, the +,C+@>T $riority is gi&en to A* ta%ing and recording his &ital signs. 0* determining hether he has a bro%en nec%. (* establishing an air ay. D* controlling the bleeding from lacerations and abrasions. ;age 13 of 22

92 6ineteen9year9old >tanley 0rods%y is ta%en to the emergency room of a hos$ital after being hit by a car and thro n about 2# feet. +e has many bleeding lacerations and abrasions on his body, as ell as a bro%en arm, and is unconscious u$on arri&al. +e also has a head in7ury and sho s signs of increasing intracranial $ressure. +e is accom$anied by his roommate and another friend. A &ery im$ortant nursing function for $atients li%e >tanley ith head in7uries is A* careful obser&ation. (* forcing fluids. 0* chec%ing the $ulse. D* $ositioning the $atient correctly. 93 6ineteen9year9old >tanley 0rods%y is ta%en to the emergency room of a hos$ital after being hit by a car and thro n about 2# feet. +e has many bleeding lacerations and abrasions on his body, as ell as a bro%en arm, and is unconscious u$on arri&al. +e also has a head in7ury and sho s signs of increasing intracranial $ressure. +e is accom$anied by his roommate and another friend. :hich of the follo ing obser&ations by the nurse does 6DT indicate that >tanley is e-$eriencing increasing intracranial $ressure. A* The $atient is increasingly restless. (* The $u$ils react uneBually to light. 0* The $ulse $ressure is increasing. D* The dee$ tendon refle-es are decreasing. 95 6ineteen9year9old >tanley 0rods%y is ta%en to the emergency room of a hos$ital after being hit by a car and thro n about 2# feet. +e has many bleeding lacerations and abrasions on his body, as ell as a bro%en arm, and is unconscious u$on arri&al. +e also has a head in7ury and sho s signs of increasing intracranial $ressure. +e is accom$anied by his roommate and another friend. Df hat $ossible additional in7uries must the nurse be a are in ma%ing her/his assessment in head in7ury cases. A* ;ulmonary atelectasis. (* >$inal cord in7uries. 0* Retinal detachment. D* >$lenic contusion. 98 6ineteen9year9old >tanley 0rods%y is ta%en to the emergency room of a hos$ital after being hit by a car and thro n about 2# feet. +e has many bleeding lacerations and abrasions on his body, as ell as a bro%en arm, and is unconscious u$on arri&al. +e also has a head in7ury and sho s signs of increasing intracranial $ressure. +e is accom$anied by his roommate and another friend. ;ost craniotomy nursing care for >tanley ill include A* $lacing him in a 7ac%et restraint. 0* $lacing him on his right side in a lying $osition. (* chec%ing his tem$erature at freBuent inter&als. D* administering Demerol for $ain and sedation.

96 @ighteen9year9old Gennifer Felly comes to the clinic ith sym$toms of $ainful urination, &aginal itching, and a greenish9yello discharge. >he states that she has been se-ually acti&e for some time. A tentati&e diagnosis of gonorrhea is made. A definite diagnosis of gonorrhea in Gennifer ill be obtained by A* culturing the gonococcus from a s$ecimen of &aginal discharge. 0* noting the sym$toms of $rofuse &aginal discharge and $ainful urination. (* testing the $atient1s blood for gonococci. D* A9ray e-amination of the $el&ic organs. 9! @ighteen9year9old Gennifer Felly comes to the clinic ith sym$toms of $ainful urination, &aginal itching, and a greenish9yello discharge. >he states that she has been se-ually acti&e for some time. A tentati&e diagnosis of gonorrhea is made. Conorrhea is a &enereal disease that A* is incurable once it reaches the fallo$ian tubes. 0* can be treated successfully ith $enicillin or stre$tomycin. (* can be caught only once, after hich an indi&idual becomes immune to the disease. D* is not classified as an infectious disease.

;age 14 of 22

9< @ighteen9year9old Gennifer Felly comes to the clinic ith sym$toms of $ainful urination, &aginal itching, and a greenish9yello discharge. >he states that she has been se-ually acti&e for some time. A tentati&e diagnosis of gonorrhea is made. :hen caring for Gennifer or other $atients ith gonorrhea, the nurse must be es$ecially careful to a&oid A* contact ith the $atient1s nasal secretions. 0* contact ith the &aginal discharge. (* handling syringes and needles used for in7ections for the $atient. D* contact ith the s%in lesion of the $atient. 99 >arah Gensen, 2 years old, is admitted to the $ediatric unit ith a fractured femur. >he is $laced in 0ryant1s traction. :hile com$leting the nursing admission assessment, the $ractical nurse notes multi$le bruises scattered o&er the child1s body. The nurse also notes that the mother is guarded in relating the child1s $re&ious medical history. ,n concluding, the mother states that >arah is a clumsy child ho is al ays falling. Dn the basis of the admission history, the $ractical nurse sus$ects that >arah may suffer from A* osteo$orosis. (* battered child syndrome. 0* idio$athic thrombocyto$enia. D* astrocytoma. 1## >arah Gensen, 2 years old, is admitted to the $ediatric unit ith a fractured femur. >he is $laced in 0ryant1s traction. :hile com$leting the nursing admission assessment, the $ractical nurse notes multi$le bruises scattered o&er the child1s body. The nurse also notes that the mother is guarded in relating the child1s $re&ious medical history. ,n concluding, the mother states that >arah is a clumsy child ho is al ays falling. The $ractical nurse ould ta%e her findings to the charge nurse. :hich of the follo ing recommendations ould the charge nurse be e-$ected to ma%e. 1. (ontinue to assess >arah for further e&idence of abuse and to record s$ecifics in the medical record. 2. A&oid dra ing $remature conclusions. 3. Dbser&e and record the $arent child interaction. 5. Huestion the child e-tensi&ely to find out ho the fracture occurred. A*l and 2. 1 0* 2, 3, and 5. (* 1, 2, 3, and 5. D* 1, 2, and 3. 1#1 >arah Gensen, 2 years old, is admitted to the $ediatric unit ith a fractured femur. >he is $laced in 0ryant1s traction. :hile com$leting the nursing admission assessment, the $ractical nurse notes multi$le bruises scattered o&er the child1s body. The nurse also notes that the mother is guarded in relating the child1s $re&ious medical history. ,n concluding, the mother states that >arah is a clumsy child ho is al ays falling. The $ractical nurse1s ;R,MAR2 goal in managing >arah1s care ill be to A* 0* (* D* notify the a$$ro$riate authorities that the Gensens are child abusers. maintain >arah1s 0ryant traction in a$$ro$riate $osition. arrange for a (AT scan to ascertain >arah1s neurologic integrity. send laboratory sli$s for a $latelet count on >arah.

1#2 >arah Gensen, 2 years old, is admitted to the $ediatric unit ith a fractured femur. >he is $laced in 0ryant1s traction. :hile com$leting the nursing admission assessment, the $ractical nurse notes multi$le bruises scattered o&er the child1s body. The nurse also notes that the mother is guarded in relating the child1s $re&ious medical history. ,n concluding, the mother states that >arah is a clumsy child ho is al ays falling. :hich of the follo ing interactions bet een the child and her $arents ould the $ractical nurse caring for >arah e-$ect to obser&e. A* (hild ill not see% comfort from, or contact ith, $arents. 0* (hild ill only allo $arents to feed her. (* (hild ill ha&e a tem$er tantrum hen $arents go home. D* (hild ill demonstrate a trustful relationshi$ ith $arents. 1#3 >arah Gensen, 2 years old, is admitted to the $ediatric unit ith a fractured femur. >he is $laced in 0ryant1s traction. :hile com$leting the nursing admission assessment, the $ractical nurse notes multi$le bruises scattered o&er the child1s body. The nurse also notes that the mother is guarded in relating the child1s ;age 15 of 22

$re&ious medical history. ,n concluding, the mother states that >arah is a clumsy child ho is al ays falling. (hildren ho suffer from battered child syndrome are children ith s$ecial characteristics. :hich of the follo ing ould the $ractical nurse e-$ect to be true of >arah. A* (hild is &ie ed as different or difficult. (* (hild is normal in achie&ing de&elo$mental goals. 0* (hild is $hysically unattracti&e. D* (hild res$onds to strangers in an age9a$$ro$riate manner. 1#5 Faren Arons%y, a 359year9old e$ile$tic, is brought to the emergency room follo ing a motor &ehicle accident. >he is alert and res$onsi&e. As the $ractical nurse enters Ms. Arons%y1s room, the nurse obser&es that the $atient is ha&ing a sei?ure. The ,MM@D,AT@ nursing action ould be to A* establish an air ay. (* hold the $atient1s arms and legs to $re&ent in7ury. 0* call a $hysician. D* force the $atient onto her bac%. 1#8 :hen Faren Arons%y, a 359year9old e$ile$tic, as brought to the emergency room follo ing a motor &ehicle accident, she as alert and res$onsi&e. As the $ractical nurse enters the room, the nurse obser&es that the $atient is ha&ing a sei?ure. During the sei?ure, the $ractical nurse ould be res$onsible for monitoring all of the follo ing @A(@;T A* the duration of sei?ure. (* incontinence. 0* res$iration. D* an aura. 1#6 :hen Faren Arons%y, a 359year9old e$ile$tic, as brought to the emergency room follo ing a motor &ehicle accident, she as alert and res$onsi&e, ho e&er she had a sei?ure shortly thereafter. Ms. Arons%y is admitted to a medical unit and $laced on Dilantin '$henytoin sodium* 3## mg $o DD. The $harmacy dis$enses four 18#9mg ca$sules into Ms. Arons%y1s medication dra er. +o many ca$sules ould the nurse administer daily. A* 1/2. 0* 1. (* 2. D* 5. 1#! :hen Faren Arons%y, a 359year9old e$ile$tic, as brought to the emergency room follo ing a motor &ehicle accident, she as alert and res$onsi&e, ho e&er she had a sei?ure shortly thereafter. Ms. Arons%y as admitted to a medical unit and $laced on Dilantin '$henytoin sodium* 3## mg $o DD. =or hich of the follo ing side effects of Dilantin thera$y ould the $ractical nurse monitor Ms. Arons%y. 1. Agranulocytosis. A* 1, 2, and 3. 2. A$lastic anemia. 0* 1, 2, 3, and 5. 3. Cum hy$ertro$hy. (* 1 and 5. 5. /eu%o$enia D* 3 only. 1#< :hen Faren Arons%y, a 359year9old e$ile$tic, as brought to the emergency room follo ing a motor &ehicle accident, she as alert and res$onsi&e, ho e&er she had a sei?ure shortly thereafter. Ms. Arons%y as admitted to a medical unit and $laced on Dilantin '$henytoin sodium* 3## mg $o DD. :hen $re$aring for Ms. Arons%y1s discharge, the $ractical nurse ould include hich of the follo ing in the $atient1s discharge $lan. A* Tell her that regular hours of slee$ are unim$ortant. 0* @ncourage daily com$liance ith the medication regime. (* ,nform her that there is no need for follo 9u$ blood studies. D* ,nstruct her to limit acti&ity. 1#9 Ms. 0enita Come?, 5< years old, is admitted to the hos$ital ith a diagnosis of hy$erthyroidism. >he is scheduled the ne-t day for a subtotal thyroidectomy. During the admitting assessment, the $ractical nurse ould e-$ect Ms. Come? to com$lain of hich of the follo ing clinical sym$toms. A* 6er&ousness, eight loss, heat intolerance. (* ;olyuria, e-o$hthalmus, tachycardia. 0* Alo$ecia, eight gain, intolerance to cold. D. Clycosuria, $uffy tongue, scaly s%in.

;age 16 of 22

11# Ms. 0enita Come?, 5< years old, is admitted to the hos$ital ith a diagnosis of hy$erthyroidism. >he is scheduled the ne-t day for a subtotal thyroidectomy. ,n $ic%ing u$ the $reo$ orders, the $ractical nurse ould e-$ect to see hich of the follo ing diet orders for Ms. Come?. A* /o 9calorie, high9$rotein, regular diet. (* /o 9calorie, high9carbohydrate, regular diet. 0* +igh9calorie, high9carbohydrate, soft diet. D* +igh9calorie, high9$rotein, soft diet. 111 Ms. 0enita Come?, 5< years old, as admitted to the hos$ital ith a diagnosis of hy$erthyroidism and as scheduled the ne-t day for a subtotal thyroidectomy. After surgery, Ms. Come? is returned to the surgical unit. The $ractical nurse ill $lace her in hich of the follo ing $ositions. A* >emi9=o ler1s. 0* +igh =o ler1s. (* Trendelenburg. D* >u$ine. 112 Ms. 0enita Come?, 5< years old, as admitted to the hos$ital ith a diagnosis of hy$erthyroidism and as scheduled the ne-t day for a subtotal thyroidectomy. After surgery, Ms. Come? as returned to the surgical unit. :hich of the follo ing items of eBui$ment ill the $ractical nurse ma%e sure is %e$t at Ms. Come?1s bedside. A* 0lood $ressure cuff and stethosco$e. (* Rectal thermometer and dressing change %it. 0* )a$ori?er and suction eBui$ment. D* Tracheotomy set and suction eBui$ment. 113 Ms. 0enita Come?, 5< years old, as admitted to the hos$ital ith a diagnosis of hy$erthyroidism and as scheduled the ne-t day for a subtotal thyroidectomy. After surgery, Ms. Come? as returned to the surgical unit. Ms. Come? is recei&ing intra&enous fluids. The doctor orders 1### cc lactated Ringer1s solution e&ery < hours. The solution administration set deli&ers 18 gtts $er cc. To ensure that Ms. Come? ill get the correct amount of solution, her ,.). should be regulated at A* 88 gtts $er minute. 0* 2< gtts $er minute. (* 31 gtts $er minute. D* 51 gtts $er minute. 115 Ms. 0enita Come?, 5< years old, as admitted to the hos$ital ith a diagnosis of hy$erthyroidism and as scheduled the ne-t day for a subtotal thyroidectomy. After surgery, Ms. Come? as returned to the surgical unit. Ms. Come? is recei&ing intra&enous fluids. The doctor orders 1### cc lactated Ringer1s solution e&ery < hours. The solution administration set deli&ers 18 gtts $er cc. The $ractical nurse cannot regulate Ms. Come?1s ,.). at the desired rate. ,t a$$ears to be clogged. :hich of the follo ing actions should the $ractical nurse ta%e. 1. (hec% the site of the ,.). infusion. A* 1 and 5. 2. ;lace 2 cc of sterile saline into the ,.). site. 0* 1 and 2. 3. 6otify the charge nurse. (* 1 and 3. 5. ;ull the ,.). D* 6one of the abo&e. 118 Ms. 0enita Come?, 5< years old, as admitted to the hos$ital ith a diagnosis of hy$erthyroidism and had a subtotal thyroidectomy. Ms. Come? is being discharged. +er discharge $lan ill include instructions for A* $lanned rest $eriods. (* testing her urine for sugar and acetone. 0* small, freBuent feedings. D* increase her oral inta%e to 18## cc $er day. 116 A tilt table is most useful in increasing s%in and &ascular tone. ,n hich of the follo ing conditions ould it 6DT be useful. A* >$inal cord in7uries. (* Diabetic acidosis. 0* 0rain damage. D* Drthostatic hy$otension. 11! 4$on recei&ing a $atient in the reco&ery room from the anesthesiologist and the circulating nurse, the =,R>T action that the nurse must ta%e is to A* determine the $atient1s &ital signs. (* &erify the $atient1s identity. 0* a$$raise the $atient1s air9e-change status. D* chec% the $atient1s dressing for bleeding. 11< A com$lication that often occurs after lo er abdominal o$eration is ;age 17 of 22

A* 119

shoc%. a$$rehension.

0*hemorrhage.

(*

$hlebitis.

D*

A $atient ith cirrhosis of the li&er reBuires good s%in care to A* relie&e the itching caused by 7aundice. (* $re&ent com$lications. 0* minimi?e the danger of infection. D* $re&ent hemorrhaging.

12# The beha&ior $attern in hich a $erson a&oids acce$ting full res$onsibility for his/her o n actions by blaming someone else is called A* rationali?ation. (* $ro7ection. 0* com$ensation D* re$ression. 121 A&oiding un$leasant $ast e-$eriences by EforgettingE them and $retending they ne&er ha$$ened is an e-am$le of A* identification. 0* re$ression. (* regression. D* com$ensation. 122 ;sychothera$y is a form of treatment in hich the $atient is A* gi&en dosages of medication to induce slee$ and rest. 0* gi&en occu$ational thera$y. (* encouraged to tal% about him9/herself and his/her $roblems and therefore face reality. D* $laced in isolation. ;sychothera$y is $ossible only if the $atient is A* illing to listen to ad&ice from others. 0* sedated and restrained so he/she ill coo$erate. (* admitted to a mental hos$ital. D* able to communicate ith others and e-$ress his/her true feelings. The acute communicable disease that can cause serious deformities in the de&elo$ing fetus is chic%en$o-. 0* $neumonia. (* rubella. D* tuberculosis.

123

125 A*

128 A 959year9old man has been hos$itali?ed and treated for $neumonia. At the end of his hos$itali?ation, his family decide that they can no longer care for him because he is com$letely de$endent in all acti&ities of daily li&ing and has become incontinent. To meet this $atient1s needs, >ocial >er&ices ill a$$ly for A* institutional room and board. (* intermediate nursing care. 0* intermediate su$er&ised $ersonal care. D* s%illed nursing care. 126 Mrs. ,rene 0urton, an <89year9old ido , is ta%en to the local multiser&ice center by her neighbors. >he has been andering around the grounds of her coo$erati&e a$artment and a$$ears confused and disoriented. @ach time anyone enters Mrs. 0urton1s room, she as%s that $erson hat $lace she is in. The nurse recogni?es that this re$eated Buestioning is ty$ical of A* $oor memory. 0* confusion. (* disorientation. D* faulty 7udgment. 12! Mrs. ,rene 0urton, an <89year9old ido is, ta%en to the local multiser&ice center by her neighbors. >he has been andering around the grounds of her coo$erati&e a$artment and a$$ears confused and disoriented. Mrs. 0urton ets herself before she can get to the bathroom. >he is &ery u$set and starts to cry. The nurse should A* tell Mrs. 0urton that she must start sooner hereafter. 0* tell her not to orry, that incontinence ha$$ens freBuently. (* tell her to go into her room and change her clothes. D* hel$ Mrs. 0urton ash u$ and change her clothes. 12< Mrs. ,rene 0urton, an <89year9old ido is, ta%en to the local multiser&ice center by her neighbors. >he has been andering around the grounds of her coo$erati&e a$artment and a$$ears confused and disoriented. ;age 18 of 22

The nurse notes fecal staining on Mrs. 0urton1s under ear. :hen Buestioned Mrs. 0urton com$lains of rectal $ain and states that she has been unable to mo&e her bo els. The $ractical nurse assesses the $roblem as A* mild consti$ation. 0* diarrhea. (* rectal s$hincter s$asm. D* fecal im$action. 129 Mrs. ,rene 0urton, an <89year9old ido is, ta%en to the local multiser&ice center by her neighbors. >he has been andering around the grounds of her coo$erati&e a$artment and a$$ears confused and disoriented. The nurse notes fecal staining on Mrs. 0urton1s under ear. :hen Buestioned Mrs. 0urton com$lains of rectal $ain and states that she has been unable to mo&e her bo els. The $ractical nurse re$orts her obser&ation to the su$er&isor, ho orders her to A* $re$are the $atient for a lo saline enema. (* $re$are the $atient for an oil enema. 0* $re$are the $atient for a fecal disim$action. D* insert a glycerin su$$ository into the $atient1s rectum. 13# Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2I= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. The nurse %no s that otitis media is A* an inflammation of the left nasal sinuses. (* an inflammation of the tonsils and adenoids 0* an inflammation of the middle ear. D* an u$$er res$iratory infection. 131 Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. Dtitis media occurs in infants and toddlers li%e Daniel because A* the eustachian tube is shorter and straighter in these children than in an adult. 0* the sinuses of small children are not fully de&elo$ed. (* the eustachian tube is not fully de&elo$ed in small children. D* small children are unable to cough u$ sufficient mucus to clear out the nasal $assages. 132 Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5J=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8J=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. :hich of the follo ing nursing inter&entions is 6DT indicated. A* :atching for side effects of ,.). antibiotics. (* Ci&ing Daniel te$id ater s$onge baths. 0* ;ositioning Daniel carefully to lessen nec% $ain. D* @ncouraging family &isits. 133 Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5J=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8J=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. :hat sign should the $ractical nurse recogni?e as indicating a com$lication in Daniel1s condition. A* (om$laints that the light hurts his eyes. (* Altered res$irations 0* +eadache D* ,rritability. 135 Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5J=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8J=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. Daniel1s mother becomes hysterical, crying to the nurse, E, %no that my child is going to die.E :hich of the follo ing should be the nurse1s ans er. A* E0e calm. Daniel is being gi&en a$$ro$riate treatment.E ;age 19 of 22

0* (* D*

EDaniel needs a Buiet, rela-ing atmos$here, and you are u$setting him by your crying.E E2ou are getting yourself u$set unnecessarily.E EDaniel ill get orse before he gets better.E

138 Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5 0=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8#=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. ,n de&elo$ing a nursing $lan for the treatment of Daniel, the nurse tentati&ely lists the follo ing" 1. (ontrol tem$erature. 2. ;re&ent sei?ures. 3. (ontrol $ain. 5. Treat infection. :hich of the items listed should be included in the final $lan. A* 1, 2, and 3. 0* 1, 3, and 5. (* 2, 3, and 5. D* 1, 2, 3, and 5. 136 Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5J=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8J=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. Daniel1s aunt comes to the $ediatric unit to &isit. The nurse notices that she has a loose cough and constantly i$es her nose. :hat should the nurse say. A* E2ou may see Daniel but don1t cough around him.E 0* E2ou may go in to see Daniel, but you must $ut on a mas% and go n.E (* E2ou may not go in to see Daniel.E D* EDaniel needs a Buiet, rela-ing atmos$here, $referably ithout &isitors. Also, ith your cold, it is better for you that you ait until he is discharged.E 13! Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5J=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8J=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. The $ediatrician orders a $ill for Daniel that the child refuses to ta%e. The nurse should then A* tell Daniel to che u$ the $ill. (* dissol&e the $ill in ater. 0* crush the $ill and mi- it ith a$$lesauce, hich Daniel li%es. D* $ush the $ill bet een his li$s. 13< Daniel > eeney, age 3 years, is ta%en to the clinic by his mother. +e has a cold, is irritable, and has had a tem$erature of 1#2J= for a fe hours. A $urulent discharge is draining from his left ear. A diagnosis of otitis media, acute, is made. :hile in the clinic, Daniel1s tem$erature goes to 1#5J=, and the child begins to &omit and is &ery restless. +e is admitted to the hos$ital. The morning after admission his tem$erature rises to 1#8J=. After e-amination, a diagnosis of meningitis is made. The $hysician orders ,.). fluids and ,.). antibiotics. Daniel im$ro&es ith treatment and is discharged from the hos$ital. +is mother is instructed to %ee$ him home for a fe ee%s and to $ro&ide $eriodic rest for him. ,n $ro&iding rest for Daniel, his mother is ad&ised to A* %ee$ him in a dar%ened room. 0* $ro&ide a Buiet atmos$here in the home and a&oid noise and confusion. (* allo him to atch T) se&eral hours during the day. D* allo three of his friends to come to &isit e&ery day. 139 Angel (ru?, a hea&y smo%er aged 88, has had a harsh, $roducti&e cough ith scanty s$utum for se&eral years. Recently he has been troubled by intermittent hee?ing. +is ife $ersuades him to go to the ;age 20 of 22

chest clinic for an e-amination. The first tests ordered for Mr. (ru? are blood chemistries, (0(, and urinalysis. E,t is my throat that hurts. :hy must blood be ta%en.E he com$lains to the nurse. +er 0@>T ans er is A* E,t is clinic $olicy.E 0* E2ou may ha&e a serious infection that ill sho u$ in the blood e-amination.E (* EThe doctor ordered it.E D* EThere could be many reasons for your cough and hee?ing. ,n order for you to ha&e a com$lete e-amination, e must ha&e the blood count done.E 15# Angel (ru?, a hea&y smo%er aged 88, has had a harsh, $roducti&e cough ith scanty s$utum for se&eral years. Recently he has been troubled by intermittent hee?ing. +is ife $ersuades him to go to the chest clinic for an e-amination. The first tests ordered for Mr. (ru? are blood chemistries, (0(, and urinalysis. After the blood is dra n, the nurse ta%es Mr. (ru? to the radiology de$artment for a chest9Aray. =or this e-amination, Mr. (ru? A* has a dye in7ected into an arm &ein. (* is gi&en a barium solution to drin%. 0* has to remo&e his shirt and undershirt. D* is told to lie on the A9ray table. 151 Angel (ru?, a hea&y smo%er aged 88, has had a harsh, $roducti&e cough ith scanty s$utum for se&eral years. Recently he has been troubled by intermittent hee?ing. +is ife $ersuades him to go to the chest clinic for an e-amination. The first tests ordered for Mr. (ru? are blood chemistries, (0(, and urinalysis. After the blood is dra n, the nurse ta%es Mr. (ru? to the radiology de$artment for a chest9Aray. Mr. (ru? is told to return to the clinic the ne-t day for a bronchosco$y. +is instructions are to eat nothing after midnight. :hen Mr. (ru? returns to his room after the bronchosco$y, the nurse ill A* gi&e him si$s of cool ater. (* urge him to eat a soft diet. 0* atch for the return of the gag refle-. D* ta%e him into the sitting room. 152 Angel (ru?, a hea&y smo%er aged 88, has had a harsh, $roducti&e cough ith scanty s$utum for se&eral years. Recently he has been troubled by intermittent hee?ing. +is ife $ersuades him to go to the chest clinic for an e-amination. The first tests ordered for Mr. (ru? are blood chemistries, (0(, and urinalysis. After the blood is dra n, the nurse ta%es Mr. (ru? to the radiology de$artment for a chest9Aray. :hen Mr. (ru? is discharged, the nurse ill tell him that A* he may continue to smo%e. 0* he should smo%e only one half a $ac%age of cigarettes daily. (* he should sto$ smo%ing. D* he should sto$ smo%ing and che tobacco instead. 153 Mrs. Anna Miles, 89 years old, &isits her $hysician because of $rolonged, unusual fatigue, intermittent consti$ation and diarrhea, and burning of her tongue. During the course of e-aminations, a gastric analysis is done and an absence of hydrochloric acid re$orted. A diagnosis of $ernicious anemia is made. :hich of the follo ing sym$toms that usually accom$any the acute stage of $ernicious anemia reBuires s$ecial nursing inter&entions. A* 4nusual fatigue. (* 0urning of the tongue and sore mouth. 0* ,ntermittent consti$ation and diarrhea. D* ;allor. 155 Mrs. Anna Miles, 89 years old, &isits her $hysician because of $rolonged, unusual fatigue, intermittent consti$ation and diarrhea, and burning of her tongue. During the course of e-aminations, a gastric analysis is done and an absence of hydrochloric acid re$orted. A diagnosis of $ernicious anemia is made. The treatment $rescribed for Mrs. Miles is &itamin 012 by intramuscular in7ection. Mrs. Miles as%s hen she can sto$ ta%ing in7ections of the &itamin. The nurse1s ans er is A* E:hen the disease is cured.E (* E0et een remissions.E 0* E,n 2 months.E D* E6e&erK you ill need them for the rest of your life.E 158 Mrs. Anna Miles, 89 years old, &isits her $hysician because of $rolonged, unusual fatigue, intermittent consti$ation and diarrhea, and burning of her tongue. During the course of e-aminations, a gastric analysis is done and an absence of hydrochloric acid re$orted. A diagnosis of $ernicious anemia is made. The treatment $rescribed for Mrs. Miles is &itamin 012 by intramuscular in7ection. During the discussion about the medication, ;age 21 of 22

Mrs. Miles states that she ould rather ta%e the &itamin 012 by $ill than by in7ection. The nurse e-$lains that this ill not be $ossible because A* oral $re$arations destroy the effecti&eness of the &itamin. 0* resistance to &itamin 012 can de&elo$ if oral $re$arations are used. (* oral $re$arations of &itamin 012 are ra$idly e-creted from the body. D* oral $re$arations of &itamin 012 cannot be absorbed from the small intestine. 156 Mrs. Anna Miles, 89 years old, &isits her $hysician because of $rolonged, unusual fatigue, intermittent consti$ation and diarrhea, and burning of her tongue. During the course of e-aminations, a gastric analysis is done and an absence of hydrochloric acid re$orted. A diagnosis of $ernicious anemia is made. The treatment $rescribed for Mrs. Miles is &itamin 012 by intramuscular in7ection. ,n discussing the $ro$er diet for Mrs. Miles, the nurse ill indicate that the foods from hich the body normally can e-tract the most &itamin 012 are A* multigrain breads and ba%ery $roducts. (* fresh fruits. 0* green and yello &egetables. D* meats and dairy $roducts. 15! 2ou ha&e acce$ted a $osition in a nursing home as a licensed $ractical nurse. >ince you ha&e chosen geriatric nursing, you re&ie the $hysiologic as$ects of aging and the general nursing care of the aged. Aging can best be defined as a A* gradual onset of senility. (* normal, gradual slo ing of body functions. 0* degenerati&e disease. D* decrease in the ill to li&e. 15< 2ou ha&e acce$ted a $osition in a nursing home as a licensed $ractical nurse. >ince you ha&e chosen geriatric nursing, you re&ie the $hysiologic as$ects of aging and the general nursing care of the aged. The basic needs of the aged include 1. a clean, safe $lace to li&e. A* 1 and 3. 2. recreation. 0* 1, 3, and 5. 3. good nutrition. (* 1, 2, and 3. 5. someone to care about them. D* 1, 2, 3, and 5. 159 2ou ha&e acce$ted a $osition in a nursing home as a licensed $ractical nurse. >ince you ha&e chosen geriatric nursing, you re&ie the $hysiologic as$ects of aging and the general nursing care of the aged. (om$lete daily bed baths are considered unnecessary for the elderly because A* they are much less acti&e than younger $ersons. 0* their oil and s eat glands are no longer as acti&e. (* the elderly do not li%e to bathe. D* the elderly do not ha&e body odor. 18# 2ou ha&e acce$ted a $osition in a nursing home as a licensed $ractical nurse. >ince you ha&e chosen geriatric nursing, you re&ie the $hysiologic as$ects of aging and the general nursing care of the aged. ;hysiologic changes related to the normal aging $rocess include 1. sluggish bo el functions. A* 1, 2, and 5. 2. arteriosclerosis. 0* 1 and 3. 3. reduced circulation. (* 2, 3, and 5. 5. obesity. D* 1, 2, 3, and 5.

;age 22 of 22