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Final exam Essay

SAINT PETER’S UNIVERSITY
SCHOOL OF NURSING
NU 304 NX
FINAL EXAMINATION
SPRING 2014

1. When the immunoglobulin crosses the placenta, what type of immunity does the fetus receive? a. Active
b. Passive
c. Innate
d. Cell-mediated

2. The predominant antibody of a typical primary immune response is: a. IgG
b. IgM
c. IgA
d. IgE

3. While planning care, a nurse recalls seasonal allergic rhinitis is expressed through: a. IgE-mediated reactions
b. Tissue-specific reactions
c. Antigen-antibody complexes
d. Type II hypersensitivity reactions

4. When histamine is released in the body, which of the following responses would the nurse expect? a. Bronchial dilation
b. Edema
c. Vasoconstriction
d. Constipation

5. When thought content and arousal level are intact but a patient cannot communicate, the patient has: a. Cerebral death
b. Locked-in syndrome
c. Dysphagia
d. Cerebellar motor syndrome

6. A 65-year-old male recently suffered a cerebral vascular accident. He is now unable to recognize and identify objects by touch because of injury to the sensory cortex. How should the nurse document this finding? a. Hypomimesis

b. Agnosia
c. Dysphasia
d. Echolalia

7. A 69-year-old male with a history of alcohol abuse presents to the emergency room (ER) after a month-long episode of headaches and confusion. Based on his alcoholism, a likely cause of his neurologic symptoms is: a. Concussion

b. Chronic subdural hematoma
c. Epidural hematoma
d. Subacute subdural hematoma

8. _____ are most at risk of spinal cord injury from minor trauma. a. Infants
b. Men
c. Women
d. The elderly

9. Six weeks ago a female patient suffered a T6 spinal cord injury. She then developed a blood pressure of 200/120, a severe headache, blurred vision, and bradycardia. What does the nurse suspect the patient is experiencing? a. Extreme spinal shock

b. Acute anxiety
c. Autonomic hyperreflexia
d. Parasympathetic areflexia

10. A 23-year-old female begins having problems with tiredness, weakness, and visual changes. Her diagnosis is multiple sclerosis (MS). What is occurring in the patient’s body? a. Depletion of dopamine in the central
nervous system (CNS) b. Demyelination of nerve fibers in the CNS

c. The development of neurofibril webs in the CNS
d. Reduced amounts of acetylcholine at the neuromuscular junction

11. Which statement by a patient indicates teaching was successful regarding myasthenia gravis? Myasthenia gravis results from: a. Viral infection of skeletal muscle
b. Atrophy of motor neurons in the spinal cord
c. Demyelination of skeletal motor neurons
d. Autoimmune injury at the neuromuscular junction

12. If a patient’s posterior pituitary is removed, which hormone would the nurse expect to decrease? a. PRF
b. ADH
c. ACTH
d. GH

13. If a patient had a problem with the adrenal medulla, which of the following hormones should the nurse monitor? a. Cortisol
b. Epinephrine
c. Androgens
d. Estrogens

14. When catecholamines are released in a patient, what should the nurse assess for? a. Nutrient absorption
b. Fluid retention
c. Hypotension
d. Hyperglycemia

15. A 45-year-old female has elevated thyroxine production. Which of the following would accompany this condition? a. Increased thyroid-releasing hormone (TRH)
b. Increased anterior pituitary stimulation
c. Decreased T4
d. Decreased thyroid-stimulating hormone (TSH)

16. A 54-year-old patient with pulmonary tuberculosis (lung infection) is evaluated for syndrome of inappropriate ADH secretion (SIADH). Which of the following electrolyte imbalances would be expected in this patient? a. Hyponatremia

b. Hyperkalemia
c. Hypernatremia
d. Hypokalemia

17. A 22-year-old male is admitted to the intensive care unit with a closed head injury sustained in a motorcycle accident. The injury has caused severe damage to the posterior pituitary. Which of the following complications should the nurse anticipate? a. Dilutional hyponatremia

b. Dehydration from polyuria
c. Cardiac arrest from hyperkalemia
d. Metabolic acidosis

18. While checking the lab results for a patient with Graves disease, the nurse would check the T3 level to be abnormally: a. Low
b. High
c. Variable
d. Absent

19. A 19-year-old female with type 1 DM was admitted to the hospital with the following lab values: serum glucose 500 mg/dl (high), urine glucose and ketones 4+ (high), and arterial pH 7.20 (low). Her parents state that she has been sick with the “flu” for a week. Which of the following statements best explains her acidotic state? a. Increased insulin levels promote protein breakdown and ketone formation. b. Her uncontrolled diabetes has led to renal failure.

c. Low serum insulin promotes lipid storage and a corresponding release of
ketones. d. Insulin deficiency promotes lipid metabolism and ketone formation.

20. A patient with Addison disease has weakness and easy fatigability. A nurse recalls this is due to: a. Hyperkalemia
b. Hypoglycemia
c. Hypocortisolism
d. Metabolic acidosis

21. A nurse wants to determine if there is kidney dysfunction in a patient with diabetes. Which of the following is the earliest manifestation? a. Polyuria
b. Glycosuria
c. Microalbuminuria
d. Decreased glomerular filtration

22. Which condition will cause a patient to secrete erythropoietin? a. Low blood pressure
b. Hypercarbia
c. Inflammation
d. Hypoxia

23. While planning care for a patient with urinary problems, the nurse recalls that the renin-angiotensin system will be activated by: a. Increased blood volume
b. Elevated sodium concentrations
c. Decreased blood pressure in the afferent arterioles
d. Renal hypertension

24. A 55-year-old male presents reporting urinary retention. Tests reveal that he has a lower urinary tract obstruction. Which of the following is of most concern to the nurse? a. Vesicoureteral reflux and pyelonephritis

b. Formation of renal calculi
c. Glomerulonephritis
d. Increased bladder compliance

25. A 15-year-old male was diagnosed with pharyngitis. Eight days later he developed acute glomerulonephritis. While reviewing the culture results, which of the following is the most likely cause of this disease? a. Klebsiella

b. Human immunodeficiency virus (HIV)
c. Genital herpes virus
d. Group A ß-hemolytic streptococcus

26. A 30-year-old male is demonstrating hematuria with red blood cell casts and proteinuria exceeding 3 to 5 g/day, with albumin being the major protein. The most probable diagnosis the nurse will see documented on the chart is: a. Cystitis

b. Chronic pyelonephritis
c. Acute glomerulonephritis
d. Renal calculi

27. A 54-year-old female is diagnosed with nephrotic syndrome. Which of the following is a common symptom of this disease? a. Hematuria
b. Dysuria
c. Oliguria
d. Proteinuria

28. A 45-year-old female presents with hypertension, anorexia, nausea and vomiting, and anemia. She is diagnosed with chronic renal failure. When the patient asks what caused this anemia, how should the nurse respond? Your anemia is caused by: a. Red blood cells being lost in the urine

b. Inadequate production of erythropoietin
c. Inadequate iron absorption in the gut
d. Red blood cells being injured as they pass through the glomerulus

29. A 50-year-old male is experiencing reflux of chyme from the stomach. He is diagnosed with gastroesophageal reflux. This condition is caused by: a. Fibrosis of the lower third of the esophagus

b. Sympathetic nerve stimulation
c. Loss of muscle tone at the lower esophageal sphincter
d. Reverse peristalsis of the stomach

30. A 10-month-old is brought to the pediatrician by the mother who states the baby has been experiencing colicky pain followed by vomiting, sweating, nausea, and irritability. Testing reveals a condition in which one part of the intestine telescopes into another. From which type of intestinal obstruction is he suffering? a. Hernia

b. Ileus
c. Torsion
d. Intussusception

31. A 54-year-old male is diagnosed with peptic ulcer disease. This condition is most likely caused by: a. Hereditary hormonal imbalances with high gastrin levels
b. Breaks in the mucosa and presence of corrosive secretions c. Decreased vagal activity and vascular engorgement
d. Gastric erosions related to high ammonia levels and bile reflux

32. A 39-year-old female with chronic intermittent pain in the epigastric area 2 to 3 hours after eating is diagnosed with a duodenal ulcer. Which of the following behaviors may have contributed to the development of the ulcer? a. Cigarette smoking

b. Drinking caffeinated beverages
c. Consuming limited fiber
d. Antacid consumption

33. A 54-year-old male complains that he has been vomiting blood. Tests
reveal portal hypertension. Which of the following is the most likely cause of his condition? a. Thrombosis in the spleen
b. Cirrhosis of the liver
c. Left ventricular failure
d. Renal stenosis

34. A 60-year-old female with a history of alcoholism complains of recent weight gain and right flank pain. Physical examination reveals severe ascites. This condition is caused by decreased: a. Albumin and lack of cellular integrity

b. Capillary filtration pressure
c. Capillary permeability
d. Antidiuretic hormone secretion

35. A 31-year-old female presents with midabdominal pain. She is expected to have acute pancreatitis. Which of the will be part of the treatment plan? (Select all that apply.) a. Narcotic analgesics

b. Restriction of food intake
c.Nasogastric suctioning
d. Antibiotics
e. IV fluids

36. Cholecystitis is inflammation of the gallbladder wall usually caused by: a. Accumulation of bile in the hepatic duct
b. Obstruction of the cystic duct by a gallstone
c. Accumulation of fat in the wall of the gallbladder
d. Viral infection of the gallbladder

37. While planning care for a patient with an extradural hematoma, which principle should the nurse remember? The main source of bleeding in extradural (epidural) hematomas is: a. Arterial
b. Venous
c. Capillary
d. Sinus

38. A 30-year-old white male recently suffered a cerebrovascular accident. Which of the following is the most likely factor that contributed to his stroke? a. Age
b. Gender
c. Diabetes
d. Race

39. A 72-year-old male demonstrates left-sided weakness of upper and lower extremities. The symptoms lasted 4 hours and resolved with no evidence of infarction. The patient most likely experienced a(n): a. Stroke in evolution

b. Arteriovenous malformation
c. Transient ischemic attack
d. Cerebral hemorrhage

40. A 25-year-old female presents to her primary care provider reporting fever, headache, nuchal rigidity, and decreased consciousness. She was previously treated for sinusitis. Which of the following is the most likely diagnosis? a. Aseptic meningitis

b. Bacterial meningitis
c. Fungal meningitis
d. Nonpurulent meningitis

41. A patient is admitted with amyotrophic lateral sclerosis (ALS). Which classic assessment findings will support the diagnosis of ALS? a. Progressive dementia
b. Muscle weakness and atrophy
c. Severe paresthesias
d. Autonomic dysfunctions

42. Which information indicates the nurse understands assessment findings of an aneurysm? a. A headache is the most common symptom
b. The majority are asymptomatic
c. Nosebleeds are an early symptom
d. Epidural hemorrhage occurs in over 80% of patients

43. A 50-year-old male patient is deficient in ADH production. Which of the following assessment findings would the nurse expect to find? a. Increased blood volume
b. Increased urine osmolality
c. Increased urine volume
d. Increased arterial vasoconstriction

44. Diabetes insipidus, diabetes mellitus (DM), and SIADH share which of the following assessment manifestations? a. Polyuria
b. Edema
c. Vomiting and abdominal cramping
d. Thirst

45. A 22-year-old female has a low level of TSH. What condition does the nurse expect the patient is experiencing? a. Primary hypothyroidism
b. Secondary hypothyroidism
c. Autoimmune hypothyroidism
d. Atypical hypothyroidism

46. A 45-year-old female with Graves disease underwent surgical removal of her thyroid gland. During the postoperative period, her serum calcium was low. The most probable reason for her low serum calcium is: a. Hyperparathyroidism secondary to Graves disease

b. Myxedema secondary to surgery
c. Hypoparathyroidism caused by surgical injury to the parathyroid glands d. Hypothyroidism resulting from lack of thyroid replacement

47. A 12-year-old female is newly diagnosed with type 1 DM. When the parents ask what causes this, what is the nurse’s best response? a. A familial, autosomal dominant gene defect
b. Obesity and lack of exercise
c. Immune destruction of the pancreas
d. Hyperglycemia from eating too many sweets

48. When a nurse is assessing the physical features of individuals with Cushing syndrome, these findings will include: a. Weight loss and muscle wasting
b. Truncal obesity and moon face
c. Pallor and swollen tongue
d. Depigmented skin and eyelid lag

49. A 45-year-old male complains of heartburn after eating and difficulty swallowing. He probably has: a. Pyloric stenosis
b. Gastric cancer
c. Achalasia
d. Hiatal hernia

50. The primary causes of duodenal ulcers include (select all that apply): a. Consumption of spicy foods
b. Nonsteroidal anti-inflammatory drugs (NSAIDs)
c. H. pylori infection
d. Trauma
e. Side effects of antibiotics


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