Physiological Adaptation

The nurse is inserting a nasogastric (NG) tube into a patient, when the patient begins to cough, wheeze, and have difficulty breathing. Which of the following is the next most appropriate intervention?

The nurse is called to assist a 29-year-old G1P0 female with a viable intrauterine pregnancy at 42-weeks estimated gestational age who is in active labor. During spontaneous vaginal delivery of the neonate, shoulder dystocia occurs. The nurse should carefully assess the neonate for which of the following common complication of shoulder dystocia?

An infant has undergone surgery for plagiocephaly. No hydrocephalus is present. The nurse anticipates providing education to the parents about which post-surgical intervention?

The neonate experiences respiratory distress immediately after birth and is intubated after receiving bag-mask ventilation. The nurse notes copious oral secretions and is unable to pass a nasogastric tube or an orogastric tube. Upon assessment, the nurse notes the child has small eyes, malformed ears, and a micropenis. Which of the following genetic disorders does this neonate most likely have?

The nurse is called to assist with a 25-year-old G1P0 female with a viable intrauterine pregnancy at 40-weeks gestational age. Patient is already in the second stage of labor and quickly delivers a vigorous, healthy infant without complications. The neonate is placed skin-to-skin with mom and latches well to breastfeed but becomes acutely cyanotic after two minutes of eating. Once separated from the breast, the baby begins to cry, and the cyanosis resolves. Which of the following interventions by the nurse is most appropriate?

A patient in septic shock suffers from acute kidney injury. Which of the following terms most accurately describes the pathophysiology of this patient’s kidney disease?

The patient complains of severe fatigue and joint pain. Upon assessment, the nurse notes the patient’s skin is bronzed. Which of the following physical assessments is most important?

The nurse is providing discharge education to a patient with hemochromatosis. Which of the following statements by the patient indicates teaching was effective?

A child presents with a fever that has lasted for 4 days. Upon assessment, the nurse notes a strawberry tongue, reddened, painful skin on the palms of the hands and soles of the feet, and a diffuse, maculopapular rash. The rash do not blanch when pressure is applied. The nurse suspects which condition?

The nurse is a first responder to the scene of a motor vehicle accident in which the patient experienced burns to 35% of her body. Which action does the nurse take first?

The patient presents to the emergency department following an incident in which he sustained burns to his hands and forearms. The patient responds, “I don’t understand what everyone is concerned about – it doesn’t even hurt that bad.” Upon assessment, the nurse notes the entirety of the dermis has been destroyed and the wound base appears beefy red. The nurse anticipates the patient will be diagnosed with which type of burn?

The nurse in the emergency department is performing a primary assessment on a patient who has sustained significant burn injuries. Which of the following physical assessments does the nurse include in the primary survey?

The patient in the burn unit is being treated for third-degree burns that extend circumferentially around each arm up to the elbow. Which of the following physical assessments is most important for this patient?

The nurse is creating a care plan for a patient receiving fluid resuscitation after sustaining extensive third-degree burns. Which of the following outcomes is most appropriate to use to guide fluid resuscitation in this patient?

A child has third-degree burns on the front of the torso and on both arms. What is the total body surface area affected in this child?

A child suffered burns after pulling a boiling pot of water off the stove. The child’s head, torso, and right arm have third-degree burns. What is the total percentage of body surface area affected in this patient? Input your answer using a whole number.

The nurse in the burn unit is educating graduate nurses on the Rule of Nines for estimation of total body surface area of burns. Which statement by the student nurses indicates a need for further teaching?

The nurse in the burn unit anticipates the patient with which of the following burns will likely require the most pain medication to tolerate dressing changes?

The patient presents to the emergency department after particularly strenuous weight-lifting at the gym complaining of severe muscle pain, inability to remain standing for more than a couple of minutes, and dark urine. The nurse anticipates the patient will be diagnosed with which of the following conditions?

The patient is diagnosed with rhabdomyolysis after suffering from heatstroke while running a marathon. Which of the following interventions will be most helpful in preventing acute kidney injury?

Which of these patients is least likely to develop disseminated intravascular coagulation (DIC)?

A patient found a lump in her breast during her monthly breast self-exam. Further testing revealed a tumor that is 15 mm in diameter. No regional lymph nodes are involved, and no other metastases are found. Which of the following is the proper term used to describe the stage of this patient’s breast cancer?

During a well-woman exam, a lump was palpated in the patient’s right breast. The patient undergoes further testing, which reveals a tumor that is 40 mm in diameter. A right axillary lymph node is determined to be involved but no other lymph nodes or distant metastases are noted. The lymph node is ipsilateral to the tumor and is movable. Which of the following describes the stage of breast cancer in this patient?

A 75-year-old male patient presents with altered mental status and lethargy secondary to chronic severe hyponatremia due to syndrome of inappropriate antidiuretic hormone (SIADH). Which treatment is the most appropriate for this patient’s condition?

A 23-year-old patient presents with chest pain. Which additional finding would point to cocaine abuse as the cause of the chest pain?

Which is the proper treatment for subclinical hyperthyroidism in a pregnant patient?

A patient recently diagnosed with amyotrophic lateral sclerosis asks the nurse how this disease occurs. While the etiology of ALS is unknown, the nurse bases the response on an understanding of epigenetic effects on which protein?

The nurse learns that a patient is suspected to have a lysosomal storage disease. The nurse prepares to assist with testing for which disease(s)? Select all that apply.

The couple learns their struggle to conceive is related to impaired motility of the sperm. The nurse knows that this is caused by a defect in which cellular structure?

Which electrolyte imbalance will decrease the ability of the patient’s muscle cells to reach the action potential and contract?

The patient presents to the emergency department with atrioventricular nodal reentry tachycardia (AVNRT). The provider instructs the nurse to stimulate the patient’s diving reflex. Which action by the nurse is appropriate?

A patient presents to the emergency department with respiratory distress syndrome. The patient’s respiratory rate is 28 breaths per minute and oxygen saturation is 80% on room air. At the cellular level, the nurse knows which molecule is present in relative overabundance?

The nurse uses an understanding of which physiologic process to explain why the patient feels out of breath at high altitudes?

The nurse is assigned to care for an infant diagnosed with Down syndrome. The nurse understands that this chromosomal abnormality was most likely caused by which of the following events?

The nurse is assigned to the care of an adolescent patient. On physical assessment, the patient has less than expected muscle tone, slight gynecomastia, and microorchidism. The patient’s karyotype is 47,XXY. Which of the following syndromes does this patient have?

An 18-year-old male patient presents to the clinic. On physical assessment, the nurse notes the patient is exceptionally tall, has a soft, high-pitched voice, female-like breasts, and minimal male secondary sex characteristics. Additionally, the patient is found to have mild-moderate mental impairment. The nurse anticipates genetic testing will be positive for which of the following conditions?

The nurse is assisting with genetic counseling for a couple with a history of hemophilia A in their families. Which of the following statements by the nurse is true regarding X-linked diseases like hemophilia A?

The nurse is educating the parents of a child diagnosed with maple syrup urine disease. The nurse asks the parent, “Which nutrient should you avoid giving your child?” Which of the following responses by the parents indicates a need for further teaching?

A neonate’s newborn screen has tested positive for phenylketonuria. While diagnostic testing is performed, the nurse educates the parents to avoid foods high in which nutrient?

The nurse is providing dietary education to a patient with nephrotic syndrome. Which dietary change does the nurse counsel the patient to make?

The nurse is taking care of a patient undergoing a lumbar puncture. Following the test, the patient complains of a severe headache. Which of the following responses by the nurse is the most appropriate?

The nurse is assessing a neonate who presents with fever and irritability. The nurse notes the patient is quiet when laying in bed but cries when anyone holds her. Which of the following terms should the nurse use to document this assessment?

The nurse is asked to help treat a patient brought in by ambulance in cardiogenic shock secondary to an acute ST-elevation myocardial infarction. The patient is cyanotic with significant jugular venous distention, peripheral edema, and dyspnea from pulmonary edema. Which of the following treatments would be most appropriate for this patient?

The nurse is assigned to a patient with acute lymphocytic leukemia (ALL) about to undergo his first round of chemotherapy. The patient’s WBC is 120,000/uL and his LDH is 3 times the upper limit of normal. Which intervention is most important?

The nurse is assigned to a patient with chronic alcoholism and alcoholic cirrhosis. Examination of the patient is significant for dilated tortuous veins around his umbilicus and internal hemorrhoids. On the morning of his third day of the current admission, the patient acutely begins to vomit up large amounts of blood. Which describes the pathophysiology that most likely caused this event?

The nurse is assigned a patient with long-standing type 1 diabetes mellitus who has severe pneumonia. Before dinner, the patient receives a larger than normal dose of her insulin NPH by mistake. The following morning, the patient is hyperglycemic. How does the nurse explain this phenomenon to the patient?

The nurse is assigned to a patient with malignant hypertension. The patient acutely develops mid-sternal “tearing” chest pain that radiates to the back. Which of the following additional clinical signs is most likely to be present in this patient?

The nurse is assigned a patient with Hodgkin’s lymphoma undergoing initial treatment. On the patient’s second day, he develops an acute painful swelling and erythema of the right gastrocnemius. The following morning, the patient develops an acute shortness of breath and pleuritic chest pain. Within minutes, the patient loses consciousness and dies. Which of the following interventions would most likely have prevented this patient’s death?

The nurse is assigned to a patient who is suffering from acute pericarditis. The patient suddenly becomes hypotensive with signs of peripheral vascular insufficiency. On exam, the patient has significant jugular venous distention and muffled heart sounds. Which statement best describes the pathophysiology of this patient’s condition?

A nurse is assigned to a 75-year-old patient with head trauma secondary to falling down the stairs at home. The patient is stable initially, complaining of headache and some dizziness, but no focal neurologic signs. That evening, the patient acutely becomes altered and rapidly loses consciousness. Which of the following most likely explains this patient’s condition?