NUR 231 Exam 2 Finger Lakes Community College
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Free NUR 231 Exam 2 Finger Lakes Community College Questions
A client with chronic pancreatitis is being discharged. The nurse should anticipate teaching the client about which medication to help with their nutritional needs?
- Probiotics
- Ondansetron
- Lactulose
- Pancrelipase (digestive enzymes)
Explanation
Correct Answer: D) Pancrelipase (digestive enzymes)
In chronic pancreatitis, the pancreas is progressively damaged and loses its ability to produce sufficient digestive enzymes — including lipase, amylase, and protease — needed to break down fats, carbohydrates, and proteins.
This leads to malabsorption, steatorrhea (fatty stools), and nutritional deficiencies. Pancrelipase is a pancreatic enzyme replacement therapy (PERT) taken with every meal and snack to compensate for this exocrine insufficiency and allow proper digestion and nutrient absorption.
Probiotics support gut flora but do not address the enzyme deficiency that drives malnutrition in chronic pancreatitis. Ondansetron is an antiemetic used to manage nausea and vomiting and has no role in nutritional support.
Lactulose is an osmotic laxative used to treat constipation or hepatic encephalopathy and is not indicated for the nutritional needs of a client with chronic pancreatitis.
A client with multiple sexual partners has been assessed for symptoms of dysuria and green, malodorous vaginal discharge. The nurse administers an injection of ceftriaxone and an oral dose of azithromycin. The client asks why two drugs are needed. What answer by the nurse is best?
- "Giving two medications increases the chance of curing the infection"
- "Some people are not affected by the injection and need more medication"
- "This will prevent you from needing a 3-month follow-up test"
- "It is very common to be infected with both gonorrhea and chlamydia"
Explanation
Correct Answer: D) "It is very common to be infected with both gonorrhea and chlamydia"
The combination of ceftriaxone (IM) and azithromycin (oral) is the standard dual-therapy regimen for treating gonorrhea and chlamydia simultaneously. This is because coinfection with both gonorrhea and chlamydia is extremely common — studies show that a significant percentage of patients diagnosed with gonorrhea are also infected with chlamydia.
Treating both simultaneously prevents complications such as pelvic inflammatory disease, infertility, and further transmission. This explanation is the most accurate, educational, and clinically relevant response. The other options are inaccurate — dual therapy is about treating two different pathogens, not about increasing cure rates for one infection or avoiding follow-up.
The nurse is caring for a primigravida client at 34 4/7 weeks gestation, who has come in for a prenatal appointment. Which of the findings would alert the nurse that this patient may be developing preeclampsia?
- Pitting edema at the end of the day
- Urine dipstick for 300 mg or 3+ protein
- Weight gain of 2 pounds in the past 2 weeks
- Blood pressure (BP) increase to 138/84 mmHg
Explanation
Correct Answer: B) Urine dipstick for 300 mg or 3+ protein and D) Blood pressure (BP) increase to 138/84 mmHg
Preeclampsia is characterized by new-onset hypertension (BP ≥ 140/90 mmHg on two occasions) after 20 weeks gestation, often accompanied by proteinuria. A BP of 138/84 mmHg is approaching the diagnostic threshold and is a significant warning sign requiring close monitoring. Proteinuria of 300 mg or more in a 24-hour period (or 3+ on dipstick) is a hallmark feature of preeclampsia reflecting glomerular damage from the disease process.
Pitting edema at the end of the day is a common and expected finding in normal pregnancy due to increased fluid retention and venous pressure — it is not specific to preeclampsia. A weight gain of 2 pounds over 2 weeks is also within normal range for the third trimester and does not independently indicate preeclampsia.
The nurse is assessing the client during the transfusion of O positive packed red blood cells (PRBCs) that began 15 minutes ago. The client complains of a headache and chills. Current vital signs: Blood pressure 111/58, Heart Rate 106, Respirations 22, and Temperature 100.9° F. What action(s) will the nurse take at this time? (Select all that apply)
- Call the provider
- Stop the transfusion
- Monitor vital signs
- Return all tubing and blood products to the Blood Bank
- Flush the current IV tubing with 0.9% normal saline
Explanation
Correct Answer: A) Call the provider, B) Stop the transfusion, C) Monitor vital signs, D) Return all tubing and blood products to the Blood Bank, and E) Flush the current IV tubing with 0.9% normal saline
The client is showing classic signs of a transfusion reaction — fever, chills, headache, tachycardia, and hypotension occurring within 15 minutes of starting the transfusion. The priority is to stop the transfusion immediately to prevent further exposure to the incompatible blood product.
The IV line must then be flushed with 0.9% normal saline using new tubing to keep venous access open without infusing any remaining blood from the current tubing. The provider must be notified promptly, and all blood products and tubing must be returned to the blood bank for analysis to identify the type and cause of the reaction.
Vital signs are continuously monitored to track the client's hemodynamic status and detect deterioration.
A 30-year-old female client is admitted with complaints of numbness and tingling in extremities, and double vision which has occurred 2-3 times in the past month. Which question is important for the nurse to ask the client?
- "Have you noticed a rash across the bridge of your nose?"
- "Do you get tired easily and sometimes have problems swallowing?"
- "Are you taking birth control pills to prevent pregnancy?"
- "Have you experienced any difficulty with your menstrual cycle?"
Explanation
Correct Answer: B) "Do you get tired easily and sometimes have problems swallowing?"
The clinical presentation — numbness and tingling in the extremities, double vision (diplopia), and recurring episodic symptoms in a young female — is highly suggestive of multiple sclerosis (MS). The most important follow-up question targets additional hallmark symptoms of MS: fatigue and dysphagia (difficulty swallowing), which reflect demyelination affecting the cranial nerves and descending motor pathways. These symptoms, combined with the presenting complaints, would strengthen the clinical suspicion for MS.
A malar (butterfly) rash across the nose is associated with systemic lupus erythematosus (SLE), not MS. Birth control use and menstrual cycle questions are not priority assessments in this neurological presentation.
A client with multiple sclerosis asks the nurse how to avoid exacerbation of the disease. What statement is the most appropriate response by the nurse?
- "Wear a patch on your affected eye"
- "Drink one and a half to two quarts of fluid daily"
- "Sleep eight hours each night"
- "Take a hot bath to relax"
Explanation
Correct Answer: B) "Drink one and a half to two quarts of fluid daily"
Adequate hydration is essential for MS patients because urinary tract infections (UTIs) are a major trigger for MS exacerbations. Maintaining adequate fluid intake of 1.5–2 quarts (approximately 1.5–2 liters) daily helps flush the urinary tract and prevent UTIs, thereby reducing the risk of disease flares.
Wearing an eye patch manages the symptom of diplopia but does not prevent exacerbations. Sleeping eight hours is beneficial general advice but is not the most specific or important preventive measure.
Hot baths are specifically contraindicated in MS — heat worsens neurological symptoms (Uhthoff's phenomenon), where elevated body temperature temporarily worsens existing deficits.
A nurse is caring for a patient with a new diagnosis of rheumatoid arthritis. What 4 assessment findings will the nurse recognize as early signs of the disease? Select 4 correct answers.
- Patient reporting pain of 5/10 to right and left finger joints
- Persistent temperature of 100.1–100.4 degrees Fahrenheit
- Pericarditis
- Elevated erythrocyte sedimentation rate (ESR)
- Generalized fatigue and weight loss
- Cervical joint subluxation
Explanation
Correct Answers: A) Bilateral finger joint pain, B) Persistent low-grade fever, D) Elevated ESR, E) Generalized fatigue and weight loss
Rheumatoid arthritis (RA) is a systemic autoimmune inflammatory disease with characteristic early manifestations. Bilateral, symmetric small joint pain (especially the finger joints) is one of the hallmark early findings of RA.
A persistent low-grade fever (100.1–100.4°F) reflects the systemic inflammatory response occurring early in the disease. An elevated ESR is an early laboratory indicator of inflammation and is consistently elevated in active RA.
Generalized fatigue and weight loss are early systemic constitutional symptoms that precede or accompany joint involvement. Pericarditis and cervical joint subluxation are late extra-articular complications of long-standing, severe RA — not early signs of the disease.
A client at 38 6/7 weeks gestation is referred to the prenatal clinic for evaluation of blood pressure and lab work. After analysis of the lab results, how does the nurse interpret these results?
Lab Results:
- WBC: 9.9 (Normal range: 4500-11000/mL)
- Hemoglobin: 11.1 g/dL (Normal range: 12-16 g/dL)
- AST: 33 (Normal range: 8-33 U/L)
- ALT: 28 (Normal range: 4-36 U/L)
- Platelets: 188K/L (Normal range: 150K-400K/L)
- LDH: 116 (Normal range: 140-280 U/L)
- Uric acid: 4.5 mg/dL (Normal range: 3.5-7.2 mg/dL)
- Protein: 50 mg (<100 mg)
- Lab values are within normal range for pregnancy
- Lab values are suggestive of gestational hypertension
- Lab values are suggestive of preeclampsia
- Lab values indicate early signs of HELLP syndrome
Explanation
Correct Answer: A) Lab values are within normal range for pregnancy
Upon reviewing the patient's lab results, all the values fall within the normal range for pregnancy. WBC count, hemoglobin, liver enzymes (AST, ALT), platelet count, LDH, uric acid, and protein levels are within normal thresholds for this stage of gestation, indicating no abnormalities or concerns for gestational hypertension, preeclampsia, or HELLP syndrome.
The nurse is teaching a prenatal class about the effects of substance abuse during pregnancy. What potential outcome(s) will the nurse include? (Select all that apply)
- Decreased maternal weight gain
- Intrauterine growth restricted infant
- Increased neonatal pain tolerance
- Placental abruption
- Preterm delivery
Explanation
Correct Answer: A) Decreased maternal weight gain, B) Intrauterine growth restricted infant, D) Placental abruption, and E) Preterm delivery
Substance abuse during pregnancy is associated with poor maternal nutrition leading to decreased weight gain, reduced uteroplacental blood flow causing intrauterine growth restriction, vasoconstriction that increases the risk of placental abruption, and uterine irritability that can trigger preterm labor and delivery.
Increased neonatal pain tolerance is incorrect — infants exposed to substances in utero actually have increased pain sensitivity and are prone to neonatal abstinence syndrome (NAS), characterized by heightened irritability, tremors, and hypersensitivity, not increased tolerance.
A client diagnosed with anorexia nervosa began severely restricting their calorie intake 5 months ago and lost 25% of body weight. A nurse asks, "Describe what you think about your present weight and how you look." Which response by the client is most consistent with the diagnosis?
- "I'm a few pounds overweight, but I can live with it."
- "What I think about myself is my business."
- "I'm grossly underweight, but that's what I want."
- "I am fat and ugly."
Explanation
Correct Answer: D) "I am fat and ugly."
This response is most consistent with anorexia nervosa because it reflects the hallmark feature of the disorder — severely distorted body image. Despite having lost 25% of body weight and being significantly underweight, the client perceives themselves as fat, demonstrating a profound disconnect between actual body appearance and self-perception. This distorted body image drives the continued restriction of food intake and is a defining diagnostic criterion of anorexia nervosa.
Acknowledging being a few pounds overweight suggests mild distortion but not the severe misperception seen in anorexia. Refusing to discuss self-perception is evasive but not diagnostic. Acknowledging being grossly underweight while stating it is desired reflects awareness of the low weight and would be more consistent with a client who has some insight, which is atypical for anorexia nervosa.
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