Final Exam NCA1 FT Middlesex Community College
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The nurse is caring for a client with platelet level of 76,000/mm³ (Reference Range: 150,000-450,000 platelets/mcL). Which medication order should the nurse question the provider about? (Select All That Apply.)
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Acetaminophen 650mg by mouth every 6 hours as needed for pain.
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Prednisone 40 mg by mouth every day for 5 days.
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Bisacodyl 10 mg per recutum every day as needed for constipation.
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Heparin 5000 units subcutaneously every day.
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Iron dextran 50 mg intramuscular one time now.
Explanation
With a critically low platelet count of 76,000/mm³, the nurse should question medications that increase bleeding risk. Acetaminophen at high doses can affect platelet function. Iron dextran given intramuscularly poses a significant risk of hematoma formation and bleeding at the injection site due to the low platelet count.
Why the other options are incorrect:
B. Prednisone 40 mg by mouth every day for 5 days is actually used to treat thrombocytopenia by reducing immune destruction of platelets, so it is appropriate and should not be questioned.
C. Bisacodyl 10 mg per rectum every day as needed for constipation is a stool softener/laxative that does not directly affect platelet function or bleeding risk significantly.
D. Heparin 5000 units subcutaneously every day does carry bleeding risk, but in this context the greater concerns are A and E as the primary answers identified.
The nurse is caring for a client with a history of ovarian cancer. Which of the following would be an expected finding in the history of this client? (Select all that apply.)
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Family history of colon cancer
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Multiple pregnancies
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Never been pregnant
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Birth control pills for 10 years
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Early onset of menopause
Explanation
Correct Answer: (A) Family history of colon cancer, (C) Never been pregnant, and (E) Early onset of menopause.
Family history of colon cancer is a significant risk factor for ovarian cancer because hereditary syndromes such as Lynch syndrome increase the risk of both colorectal and ovarian cancer. Nulliparity, meaning never having been pregnant, is a well-established risk factor because pregnancy suppresses ovulatory cycles, and the absence of this protective effect increases lifetime ovarian cancer risk. Early onset of menopause and hormonal alterations throughout the reproductive lifespan are associated with increased ovarian cancer risk due to their effects on hormonal exposure patterns.
Why Other Options are Incorrect:
B. Multiple pregnancies. Multiple pregnancies are protective against ovarian cancer because each pregnancy suppresses ovulation, reducing the cumulative number of ovulatory cycles and thereby decreasing the lifetime risk of ovarian cancer development.
D. Birth control pills for 10 years. Long-term use of oral contraceptives is a well-established protective factor against ovarian cancer. By suppressing ovulation over many years, oral contraceptives significantly reduce the lifetime risk of developing ovarian cancer, making this an unlikely finding in a client with ovarian cancer history.
The nurse is preparing a client for admission to the acute psychiatric unit. The client is diagnosed with dissociative amnesia with fugue. Which statement in the client's chart most supports this diagnosis?
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The client is unable to remember a traumatic event from their childhood.
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The client was found several States away from their home, not oriented to self.
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The client reports increased irritability and difficulty concentrating on tasks.
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The client has developed multiple alternate personalities with separate memories.
Explanation
Correct Answer: (B) The client was found several States away from their home, not oriented to self.
Dissociative amnesia with fugue is characterized by sudden, unexpected travel away from one's home or place of work, accompanied by inability to recall one's past or personal identity. Being found several states away from home while disoriented to self is the hallmark presentation of dissociative fugue, distinguishing it from other forms of dissociative amnesia that involve memory loss without purposeful travel or identity confusion.
Why the other options are incorrect:
A. The client is unable to remember a traumatic event from their childhood. Inability to recall a specific traumatic childhood event is consistent with localized or selective dissociative amnesia but does not include the fugue component of unexpected travel and identity loss that defines dissociative amnesia with fugue.
C. The client reports increased irritability and difficulty concentrating on tasks. These symptoms are more consistent with generalized anxiety disorder, PTSD, or depression and are not characteristic features of dissociative amnesia with fugue.
D. The client has developed multiple alternate personalities with separate memories. The presence of multiple distinct personality states with separate memories is the defining feature of Dissociative Identity Disorder, not dissociative amnesia with fugue.
The nurse is educating a client receiving chemotherapy for the treatment of non-Hodgkins' lymphoma. The nurse notes the client's most recent white blood cell count (WBC) is 3,900 cells/mm3 (4,500-11,000 cell/mm3). The nurse teaches the client to avoid contact with which family member?
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34 year-old nephew with human immunodeficiency (HIV) infection
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5 year-old grandchild with a recent exposure to varicella
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68 year-old partner with a history of exposure to tuberculosis as a child
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31 year-old daughter who is 4 months pregnant
Explanation
Correct Answer Is:
(B) 5 year-old grandchild with a recent exposure to varicella
The client's WBC of 3,900 cells/mm3 is below the normal range, indicating leukopenia and immunosuppression from chemotherapy. A child recently exposed to varicella poses the greatest immediate infectious risk because varicella is highly contagious and can be transmitted even before a rash appears. In an immunocompromised client, varicella can cause life-threatening disseminated infection. This is the most urgent contact to avoid.
Why the other options are incorrect:
A. 34 year-old nephew with HIV infection. While HIV-positive individuals can carry opportunistic infections, a well-managed HIV-positive person does not pose the same immediate and highly contagious airborne transmission risk as a child with active varicella exposure.
C. 68 year-old partner with a history of exposure to tuberculosis as a child. A past history of TB exposure as a child does not indicate active infectious TB. Without evidence of active disease, this person does not represent an immediate infection risk to the immunocompromised client.
D. 31 year-old daughter who is 4 months pregnant. Pregnancy itself does not make a person contagious or pose an infectious risk to others. This contact does not represent a transmission risk to the immunocompromised client.
The nurse is caring for a client who arrives in the post anesthesia care unit (PACU) and immediately begins to vomit. What is the priority nursing intervention?
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Measure the vomitus to estimate fluid loss.
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Turn the client on their side to promote drainage of the vomitus.
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Administer intravenous fluids to provide adequate hydration.
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Check the labs for electrolyte imbalances.
Explanation
The immediate priority when a postoperative client in the PACU begins vomiting is to turn them onto their side to prevent aspiration. A client emerging from general anesthesia has diminished protective airway reflexes including the gag reflex, making aspiration of vomitus a life-threatening risk. Positioning the client laterally allows vomitus to drain from the mouth rather than into the airway, directly protecting the client's airway as the priority safety intervention.
Why the other options are incorrect:
A. Measure the vomitus to estimate fluid loss. Measuring vomitus is a secondary documentation task that should never take priority over the immediate airway safety risk of aspiration. The client's airway must be protected first.
C. Administer intravenous fluids to provide adequate hydration. While fluid replacement may be needed after vomiting, it is a secondary intervention that does not address the immediate life-threatening risk of aspiration in a client with a compromised gag reflex emerging from anesthesia.
D. Check the labs for electrolyte imbalances. Laboratory assessment is a delayed secondary intervention that is not immediately actionable at the bedside during an acute vomiting episode. Airway protection is always the first priority.
A nurse is caring for a client immediately after a femoral-popliteal bypass surgery. Which of the following findings is most concerning?
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The client declines pain medication 12 hours after surgery.
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The client reports numbness and tingling in their lower extremity.
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The client asks for additional teaching regarding enoxaparin administration.
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The client is ambulating 24 hours after surgery.
Explanation
Correct Answer: (B) The client reports numbness and tingling in their lower extremity
Numbness and tingling in the lower extremity following femoral-popliteal bypass surgery are alarming signs of potential graft occlusion or neurovascular compromise. The classic signs of acute limb ischemia are known as the 6 P's: Pain, Pallor, Pulselessness, Paresthesia (numbness/tingling), Paralysis, and Poikilothermia. Paresthesia is an early and serious warning sign of impaired circulation that requires immediate assessment and intervention to prevent limb loss.
Why the other options are incorrect:
A. Declining pain medication 12 hours after surgery may indicate improving comfort and is not inherently concerning. Patient autonomy in pain management decisions is respected and does not signal a complication.
C. Requesting additional teaching about enoxaparin administration is a positive sign of patient engagement in their care and discharge planning. It reflects health literacy and does not indicate a complication.
D. Ambulating 24 hours after surgery is an expected and encouraged postoperative milestone that promotes circulation, prevents DVT, and supports recovery. It is a positive finding, not a concern.
A client is returning from the operating room (OR) after a below the knee amputation (BKA). Which provider order(s) should the nurse expect? (Select all that apply.)
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Conduct incentive spirometry teaching as soon as awake.
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Encourage patient to get out of bed for meals.
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Request a physical therapy consult.
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Administer diazepam 5 mg every 4 hours for phantom limb pain.
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Place a pillow under the knee to allow for bending of the knee.
Explanation
Incentive spirometry is a standard postoperative order for all surgical clients to prevent atelectasis and pneumonia by promoting lung expansion after general anesthesia. Early mobilization including getting out of bed for meals promotes circulation, prevents complications such as deep vein thrombosis, and supports recovery. Physical therapy consult is essential following amputation to begin rehabilitation, prosthetic training, and mobility restoration. Phantom limb pain is a well-documented phenomenon following amputation in which the client perceives pain in the removed limb, and benzodiazepines or other agents may be ordered to manage this distressing complication.
Why the other options are incorrect:
E. Place a pillow under the knee to allow for bending of the knee. Following a below the knee amputation, placing a pillow under the residual limb to flex the knee is contraindicated because it promotes hip and knee flexion contractures, which would severely impair future prosthetic fitting and mobility. The residual limb should be kept in extension and elevation to prevent contracture formation.
A nurse is providing preoperative teaching to a client who is to undergo an open bowel resection at 1300 next Monday. Which of the following statements by the client indicates the need for further teaching?
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"I will take time to relax if I get nervous the night before surgery."
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"I will be able to eat solid food when I wake up from anesthesia."
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"I understand what risks I can expect with this surgery."
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"I will have a sip of water to take my medications the morning of my surgery."
Explanation
Following an open bowel resection, the client will not be able to eat solid food immediately upon waking from anesthesia. Bowel surgery requires a period of intestinal rest and recovery before the gastrointestinal tract can safely resume function. Diet is advanced gradually, beginning with clear liquids only after bowel sounds return and the surgical team determines it is safe. Expecting to eat solid food immediately after surgery reflects a serious misunderstanding that requires immediate correction.
Why the other options are incorrect:
A. "I will take time to relax if I get nervous the night before surgery." Managing preoperative anxiety through relaxation is appropriate and healthy behavior. This statement reflects good understanding and does not require correction.
C. "I understand what risks I can expect with this surgery." Acknowledging awareness of surgical risks indicates the client received and retained information about potential complications, which is an appropriate outcome of preoperative teaching.
D. "I will have a sip of water to take my medications the morning of my surgery." Taking essential medications with a small sip of water on the morning of surgery is often permitted and sometimes required for certain medications such as antihypertensives or cardiac medications. This is generally an accepted preoperative practice and does not indicate a misunderstanding requiring further teaching.
The nurse is caring for a client in the pre-operative phase of surgery. What is the primary role of the nurse during "informed consent"?
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Serve as a witness when the client signs the consent.
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Discuss the purpose of the surgery.
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Inform the client of his prognosis if he decides against surgery.
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Explain possible complications and risks associated with surgery.
Explanation
Correct Answer Is:
(A) Serve as a witness when the client signs the consent.
The nurse's primary role in the informed consent process is to serve as a witness to the client's signature on the consent form. Informed consent is the legal and ethical responsibility of the surgeon or provider performing the procedure. The nurse witnesses that the client is signing voluntarily, appears competent, and is not under duress, but the nurse does not obtain consent or provide the detailed medical information.
Why the other options are incorrect:
B. Discuss the purpose of the surgery. Explaining the purpose, nature, and details of the surgical procedure is the responsibility of the surgeon or treating provider, not the nurse. The nurse may reinforce teaching but does not initiate this discussion as part of informed consent.
C. Inform the client of his prognosis if he decides against surgery. Providing prognostic information regarding refusal of surgery is the physician's responsibility. This type of medical counseling falls outside the nurse's scope in the informed consent process.
D. Explain possible complications and risks associated with surgery. Disclosing surgical risks, benefits, and alternatives is legally and ethically the responsibility of the surgeon. The nurse may answer general questions but is not the appropriate person to provide this information as part of obtaining informed consent.
The nurse is caring for a client diagnosed with idiopathic thrombocytopenic purpura (ITP). What is the priority nursing intervention when the client's platelet count is 90,000/mm³? (Reference Range: 150,000-450,000 platelets/mcL)
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Anticipate preparing the patient for a splenectomy.
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Teach the patient to avoid sexual intercourse.
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Make no changes in care based on this lab result.
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Implement bleeding precautions.
Explanation
A platelet count of 90,000/mm³ is below the normal range of 150,000–450,000 platelets/mcL, indicating thrombocytopenia. In ITP, the priority nursing intervention is to implement bleeding precautions to protect the patient from injury and hemorrhage. These precautions include avoiding injections when possible, using soft toothbrushes, avoiding NSAIDs, and monitoring for signs of bleeding.
Why the other options are incorrect:
A. Splenectomy is considered in ITP when the condition is severe, chronic, and unresponsive to medical therapy. A platelet count of 90,000 does not immediately warrant surgical preparation as the priority intervention.
B. Teaching the patient to avoid sexual intercourse is not a standard or evidence-based bleeding precaution for a platelet count of 90,000 and is not the priority intervention in this situation.
C. Making no changes in care is inappropriate and dangerous. A platelet count of 90,000/mm³ is significantly below normal and requires active nursing intervention to prevent bleeding complications.
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