Christian University of ThailandCollege of NursingSemester IIIFinal Term Examination Academic Year: 2010BNUR 3306 Nursing Therapeutics for Adult 1Credits 3 (3-0) Thursday June 2, 2011Time: 9:00-12:00 am Total: 3 hours

Instructions: 1. This test paper is consist of two parts with a total of 100 points Part One: Multiple Choice Questions 60 points Part Two: Essay Questions 40 points.2. Mark your answers in the answer sheet provided.3. Do not take the paper out of the classroom.4. Do not leave the examination room 30 minutes before the end of the examination time.5. Dictionaries and notes are not allowed in the exam room.6. Check your answer carefully before you hand in your paper. 7. Breaking the rules or misconduct during the examination will be Punished with the grade of F

Part I. Multiple Choice (60 points).1. The nurse is assessing a 12 year-old who has Hemophilia A. Which finding would the nurse anticipate?1. An excess of red blood cells2. An excess of white blood cells3. A deficiency of clotting factor VIII4. A deficiency of clotting factors VIII and IX

2. Where should the nurse assign the patient diagnosed with thrombocytopenia due to acute lymphocyte leukemia?1. To a private room so the patient will not infect other patients.2. To a private room so the patient will not be infected by other patients.3. To a semi-private room so the patient will have stimulation during the hospitalization. 4. To a private room so that patient will have the opportunity to express her feeling about his illness.

3. Which of the following measures would best address the need of the patient diagnosed with chronic lymphocytic leukemia admitted for treatment of hemolytic anemia? (4)1. Encourage activities with other patients in the day room.2. Isolate him from visitors and patients to avoid infection.3. Provide a diet high in vitamin C.4. Provide a quiet environment to promote adequate rest.

4. The home care nurse plans care for a patient with pernicious anemia. Which of the following is the treatment of choice for the patient? (2)1. Lifelong B12 injections2. Vitamin D supplements3. Iron supplements4. Vitamin K injections

5. Which of the following does not describe anemia? (2)1. Deficiency in the number of erythrocytes.2. Deficiency in the number of hemoglobin.3. Deficiency in the volume of packed RBCs (hematocrit).4. Deficiency in the number of certain clotting factors.

6. Why do patients with hepatic disorders also develop hematologic disorders? (2)1. Because vitamin K, a cofactor of prothrombin, is synthesized in the liver.2. Because liver inhibits the production of thrombin.3. Because liver synthesizes the blood to be thinner.4. Because clotting factors are activated only at the liver.

7. The nurse is caring for a patient diagnosed with anemia. Which nursing diagnosis is not applicable for the patient? (3)1. Activity intolerance2. Altered nutrition: less than body requirements3. Ineffective management of therapeutic regimen4. Risk for injury: bleeding

8. Which measure promotes normal activity for patients with problem in activity tolerance secondary to anemia? (3)1. Limit environmental stimuli.2. Encourage compliance to the regimen.3. Encourage to perform all tasks at once so that the patient can rest at once.4. Alternate activity when patient has most energy with rest.

9. What laboratory result(s) is expected from bone marrow biopsy of a patient with aplastic anemia? (1)1. Decrease bone density. 2. Hypocellular with increase yellow marrow.3. Chromosomal alteration4. Macrocytic and abnormal erythrocyte morphology.

10. Which of the following measures does not prevent sickling in patients with sickle cell anemia? (3)1. Avoid high altitudes and over exertion.2. Avoid dehydration; increase oral fluid intake.3. Treatment of infections promptly.4. Transfuse blood as ordered.

11. Which of the following statements is true about glucose-6-phosphate dehydrogenase (G6PD) deficiency? (1)1. An X-linked enzymatic defect common in blacks.2. The pathology of the disorder is RBCs are destroyed or damaged.3. Men and women are both affected of the disorder.4. The disorder is asymptomatic if not exposed to triggering factors.

12. Which of the following is the best treatment for a patient with glucose-6-phosphate dehydrogenase (G6PD) deficiency? (2)1. Oxygen therapy.2. Fluid resuscitation.3. Limit or avoid exposures to triggering factors.4. Blood transfusion.

13. What procedure is performed to remove excess iron in the body, usually done by withdrawing 500ml of blood / week for 2 3 years until iron level is normal? (1)1. hemodialysis 2. bone marrow biopsy3. phlebotomy 4. hematopoetic stem cell transplant

14. The major effect of acidosis is of the nervous system, whereas a major effect of alkalosis is characterized by of the nervous system. (2)1. depression, hyperexcitability2. hyperexcitability, depression3. depression, depression4. hyperexcitability, hyperexcitability

15. An elderly woman was admitted to the medical unit with dehydration. Which clinical indication best confirm the diagnosis? (3)1. Weak, thready pulse.2. Poor skin turgor.3. Weight loss.4. Accurate intake and output assessment.

16. A patient who has undergone thyroidectomy should be assessed for which of the following clinical manifestation? (3)1. positive Chvosteks sign2. weight gain3. increased blood pressure4. confusion and personality changes

17. Which client would be at great risk for the potential development of hypermagnesemia? (3)1. 83-year old man with lung cancer and hypertension2. 65-year old woman with hypertension taking -adrenergic blockers3. 42-year old woman with systemic lupus erythematosus and renal failure4. 50-year old man with benign prostatic hyperplasia and urinary tract infection

18. Which mineral should the nurse anticipate that a patient with hyperphosphatemia secondary to renal failure will require?(3)1. calcium supplements2. potassium supplements3. magnesium supplements4. phosphorus supplements

Situation: A 32-year old woman was brought to the ER because of abdominal pain accompanied by nausea and vomiting. A complaint of dizziness and numbness of extremities was noted. RR is 24 cpm. Refer to questions 18 and 19.

19. What is the indication of the assessment findings? (3)1. metabolic acidosis2. metabolic alkalosis3. respiratory acidosis4. respiratory alkalosis

20. Which nursing intervention should the nurse anticipate that the patient will require? (3)1. Oxygen therapy at 2 L/min via nasal cannula.2. Administer IV Chlorine containing solution as ordered.3. Let the patient breathe into a paper bag.4. Treat the underlying cause.

21. The pH is 7.25, HCO3 is 16 mEq/L, and PaCO2 is 31 mmHg. What is the compensatory mechanism? (3)1. metabolic acidosis2. metabolic alkalosis3. respiratory acidosis4. respiratory alkalosis

22. The pH is 7.25, HCO3 is 16 mEq/L, and PaCO2 is 31 mmHg. What is the level of compensation? (2)1. no compensation (N/A)2. incomplete compensation3. complete compensation4. none of the above answers

23. The pH is 7.37, HCO3 is 26 mEq/L, and PaCO2 is 41 mmHg. What is the interpretation? (2)1. Fully compensated respiratory alkalosis2. Uncompensated metabolic alkalosis3. Respiratory alkalosis, no compensation4. Normal

24. Which of the following ABG results indicates incompletely compensated metabolic acidosis? (3)1. pH 7.35, HCO3 28 mEq/L, PaCO2 35 mmHg2. pH 7.25, HCO3 19 mEq/L, PaCO2 55 mmHg3. pH 7.45, HCO3 29 mEq/L, PaCO2 35 mmHg4. pH 7.28, HCO3 19 mEq/L, PaCO2 25 mmHg

25. What is the most reliable tool for identifying abnormalities in intracellular potassium level? (1)1. Detailed history2. Thorough physical assessment3. Electrocardiogram4. Determining extracellular potassium level

26. Potassium supplement was ordered by the physician for the patient with potassium level of 3 mEq/L. Which of the following interventions must the nurse do when administering the potassium supplement? (2)1. Dilute in IV fluids.2. Give via IM route.3. Administer via IVTT.4. Administer rapidly.

27. Seizure is common on patients with electrolyte imbalances. Which of the following nursing actions could help reduce risk of injury? (2)1. Monitor and report abnormal levels and its manifestations.2. Identify risk factors through history taking and physical examination.3. Check vital signs q 4 hours and report abnormalities noted.4. Keep bed at lowest position with padded side rails up.

28. The physician orders to check the serum potassium level of the patient with hyperkalemia. The following actions prevent pseudohyperkalemia, except: (3)1. Avoiding prolonged tourniquet.2. Preventing hemolysis of blood sample.3. Squeezing the finger tip several times before withdrawing the blood. 4. Avoiding getting blood sample above KCl infusion.

29. Which of the following is not a clinical manifestation of sphenoid sinus infection? (2)1. Earache2. Neck pain3. Stuffy nose4. Aching top of the head

30. Amoxicillin is an antibiotic of choice for sinus infection. How long must it be administered? (1)1. 5-10 days2. 6-10 days3. 7-10 days4. 8-10 days

31. In which of the following respiratory conditions should the nurse promote air humidification in the home and use steam inhalation? (3)1. Sinusitis2. Laryngitis3. Tonsillitis4. Acute Pharyngitis

32. What is the most common causative organism associated with acute Pharyngitis? (1)1. Group A streptococci2. Streptococcus aurelius3. Group C streptococci4. Group G streptococci

33. Warm liquids such as soup or broth, honey, and foods rich in Vit. C constitute a nutritional therapy for which of the following respiratory conditions? (3)1. Sinusitis2. Laryngitis3. Tonsillitis4. Acute Pharyngitis

34. Which of the following is a nursing management for laryngitis? (2)1. The nurse must instruct the patient to exercise two times a week.2. The nurse must instruct the patient to stay in bed during the febrile stage.3. The nurse must instruct the patients to avoid swimming and diving during acute infection.4. The nurse must instruct the patient to rest the voice and maintain a well humidified environment.

35. In the immediate period after tonsillectomy, what is the most comfortable position for the patient?(3)1. Supine (patient lying on his back) to allow drainage from the mouth and pharynx.2. Prone with head turned to the side to allow drainage from the mouth and pharynx.3. Right Lateral Recumbent (the patient is lying on their right side), to allow drainage from the mouth and pharynx.4. Fowler's Position, (patient sitting straight up or leaning slightly back) to allow drainage from the mouth and pharynx.36. Which of the following is not a clinical manifestation of nasopharyingeal cancer? (1)1. A lump in the nose or neck2. A sore throat.3. Trouble breathing or speaking. 4. High fever and weight loss

37. Writing, lip-speaking, word boards, are communication methods that the nurse teaches to the patient experiencing_______________. (3)1. CA nasopharynx2. CA larynx3. Lung cancer4. Chest tumor

38. In which of the following conditions should the nurse teach the patient and the family to be careful in using too cool or too dry air condition because it is too irritating.(2)1. Laryngectomy2. Pharyngitis3. Lung cancer4. Chest tumor

39. A particulate respirator mask is used by the nurse caring for a client with TB because: (1)1. Regular masks allow the tubercle bacilli to pass through.2. This mask is comfortable for long-term use.3. This type of mask allows the nurse to be in close contact with the client for prolonged periods of time.4. There is no need of this type of mask when caring for clients with TB.

40. Bronchodilators are used to treat bronchiectasis in order to: (1)1. Dilate airways that are in bronchospasm due to an antigen-antibody reaction.2. Dilate airways that have lost their elasticity.3. Dilate airways that are clogged with secretions.4. Dilate airways that are chronically narrowed.

41. Asthma is characterized by: (1)1. Chronic narrowing of the airways.2. Intermittent airflow obstruction.3. Chronic dilation of the airways.4. Fibrosis of the alveoli.

42. The client with a pnuemothorax experiences hypoxia due to: (2) 1. The entry of air into the thoracic cavity.2. Compression of the lung tissue underlying the pnuemothorax.3. Impairment of gas exchange.4. A lack of surfactant.

43. Admission orders include heparin 2,000 units per hour in 5% dextrose in water for patient admitted with a diagnosis of deep vein thrombosis (DVT). Which medications should the nurse have? (3)1. Propanolol (beta blocker)2. Protamine Zinc (long-acting insulin)3. Protamine sulfate (coagulant)4. Vitamin K

44. A client is taking warfarin sodium (Coumadin) 2 mg PO daily. Which of the following statements indicates that further teaching is necessary? (3)1. I have been brushing my teeth using soft-bristle toothbrush.2. I eat a lot of green leafy vegetables.3. Im observing my stool for any changes in color.4. I take aspirin when I have headache.45. For a female client with newly diagnosed cancer, the nurse formulates a nursing diagnosis of Anxiety related to the threat of death secondary to cancer diagnosis. Which expected outcome would be appropriate for this client? (3)1. Client verbalizes feelings of anxiety.2. Client doesnt guess at prognosis.3. Client uses any effective method to reduce tension.4. Client stop seeking information

46. A client with hypoparathyroidism complains of numbness and tingling in his fingers and around the mouth. The nurse would assess for what electrolyte imbalance? ( 3)1. Hyponatremia2. Hypocalcemia3. Hyperkalemia4. Hypermagnesemia

47. The nurse is preparing to administer a unit of blood to a client who's anemic. After its removal from the refrigerator, the blood should be administered within: (1)

1. 1 hour.2. 2 hours.3. 4 hours.4. 6 hours.48. Cyanosis (a bluish color of the skin and mucous membranes) indicates a higher than normal blood concentration of: (2)1. carbon dioxide2. carbon monoxide3. hydrogen ion4. reduced hemoglobin

49. A client in the final stages of terminal cancer tells his nurse: "I wish I could just be allowed to die. I'm tired of fighting this illness. I have lived a good life. I only continue my chemotherapy and radiation treatments because my family wants me to." What is the nurse's best response?1. "Would you like to talk to a psychologist about your thoughts and feelings?"2. "Would you like to talk to your minister about the significance of death?"3. "Would you like to meet with your family and your physician about this matter?"4. "I know you are tired of fighting this illness, but death will come in due time."

50. Which client has the highest risk of ovarian cancer?1. A 30-year-old woman taking oral contraceptives2. 45-year-old woman who has never been pregnant3.40-year-old woman with three children4. 36-year-old woman who had her first child at age 22For Questions number 51-60, Identify the following oncologic terminologies.51. It is the spreading of cancer cells into other tissues or organs. (1)1. Sarcoma2. Metastasis3. Carcinoma4. Dysplasia

52. It is a form of cancer that composed by epithelia cells, develops in tissues covering or lining the organs of the body, such as the skin, the uterus and breast. (1)1. Carcinoma2. Sarcoma3. Benign Neoplasm4. Hyperplasia

53. These are tumor cells that are completely undifferentiated and bear no resemblance to the cells in the tissue of origin. (1)1. Carcinoma in situ2. Anaplastic3. Cancer4. Hyperplasia

54. It is an increase in the number of normal cells in a normal arrangement in a tissue or organ, normally leads to an increase of the size of the part and an increase in the functional activity. (1)1. Cancer2. Sarcoma3. Dysplasia4. Hyperplasia

55. An alteration in the size, shape, and organization of differentiated cells. Cells lose their regularity and show variability in size and shape. (1)1. Cancer2. Carcinoma in Situ3. Dysplasia4. Hyperplasia

56. The early stage of cancer in which the tumor is still confined to the local area, before it has grown to a significant size or has spread. (1)1. Cancer2. Carcinoma in Situ3. Sarcoma4. Dysplasia

57. It is also known as malignant neoplasm. (1)1. Cancer2. Hyperplasia3. Adenocarcinoma4. Sarcoma

58. Cancer that arises from grandular tissues: ex. Breast, lung, colon, pancreas. (1)1. Benign Carcinoma2. Adenocarcinoma3. Sarcoma4. Cancer

59. It is a harmless growth that does not invade or harm other tissues. (1)1. Benign neoplasm2. Dysplasia3. Hyperplasia4. Cancer

60. A cancer of supportive or connective tissues such as cartilage, bone, muscle. (1)1. Carcinoma2. Sarcoma3. Cancer4. Benign neoplasm

I.D. Number:________________Name:_______________________________________________Date:_________________Part II. Essay Questions 40 pointsInstruction: Please write your answers to the following questions on the space provided.1. What is the most numerous type of white blood cell (WBC)? (1 point)____________________________________________________________________________________________________________________________________________________________

2. A client is diagnosed with megaloblastic anemia caused by vitamin B deficiency. What substance influence vitamin B absorption? (1 point)____________________________________________________________________________________________________________________________________________________________3. A client receiving ferrous sulfate (Fer-Iron) therapy to treat an iron deficiency reports taking an antacid frequently to relieve heartburn. Which instruction should the nurse provide? (2 points)____________________________________________________________________________________________________________________________________________________________4. A client must receive a blood transfusion of packed RBCs for severe anemia. What IV fluid should the nurse use to prime the tubing before hanging this blood product? (2 points)____________________________________________________________________________________________________________________________________________________________5. Determine the normal value of complete blood count. Complete the table below. (4 points)

Normal Values

Red Blood Cell /l

White Blood Cell/l

Hematocrit (average)%

Platelets/l

6. List down 2 adventitious breath sounds perceived during auscultation of patients with respiratory disorders. (1 point)____________________________________________________________________________________________________________________________________________________________

7. What are the 3 medications administered as a combination for a period of two months to a patient with active tuberculosis? (1 point)____________________________________________________________________________________________________________________________________________________________

8. What types of clients with pneumonia should be treated with antiviral agents such as Acyclovir Sodium (Zovirax)? (1 point).____________________________________________________________________________________________________________________________________________________________

9. What is the nursing management for a patient with lung abscess? (List down at least 3 nursing management interventions). (1 point)____________________________________________________________________________________________________________________________________________________________

10. This question is about a patient with longstanding COPD and who is under oxygen therapy. Why is monitoring his oxygen administration becomes a priority? (1 point)____________________________________________________________________________________________________________________________________________________________

11. Why are bronchodilators prescribed to a patient with chronic bronchitis? (Give at least 2 reasons). (1 point)____________________________________________________________________________________________________________________________________________________________________

12.What are the two main types of emphysema? (1 point)____________________________________________________________________________________________________________________________________________________________________

13. The patient with asthma, is instructed to avoid the causative agents whenever possible. Write down at least 4 causative agents. (2 points)____________________________________________________________________________________________________________________________________________________________________

14. Why are Acetylcysterine (mucomyst) and other mucolytic agents administered to patients with bronchiectasis? 1 point)____________________________________________________________________________________________________________________________________________________________________

15. There are 4 main categories of Acute Respiratory Failure (ARF). Write down at least 3 of them. (3 points)____________________________________________________________________________________________________________________________________________________________________

16.How can thrombus formation be prevented in a patient with pulmonary embolism? List down at least 4 instructions to the patient. (2 points)____________________________________________________________________________________________________________________________________________________________________

17. Enumerate 4 tips in teaching the patient and his family members to prevent lung cancer? (2 points)____________________________________________________________________________________________________________________________________________________________________

18. In the secondary prevention of cancer prevention (Early Detection), what are the three methods involved in early detection of cancer? (3 points)____________________________________________________________________________________________________________________________________________________________________

19. What two organs in the body serve as a compensatory function to maintain acid base balance? (2 points)____________________________________________________________________________________________________________________________________________________________________

20. Which diagnostic test will give the information needed to determine if the primary disturbance of acid-base balance is respiratory or metabolic in nature? (2 points)____________________________________________________________________________________________________________________________________________________________________

21. Determine the normal values of the electrolytes. Complete the table. (6 points)

Normal Value

Sodium (Na+)

Potassium (K+)

Calcium (Ca++ or Ca2+)

Magnesium (Mg++ or Mg2+)

Chloride (Cl-)

Phosphate (PO43-)