Online Nursing Practice Test about Renal Disorders (8-11)

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Situation: Three year old Carlo has been admitted to the pediatric unit with a tentative diagnosis of nephrotic syndrome.

8. The diagnosis of Idiopathic Nephrotic Syndrome has been confirmed. Which unexpected finding would the nurse report?

a) proteinuria
b) distended abdomen
c) blood in the urine
d) elevated serum lipid levels

9. Carlo's potential for impairment of skin integrity is related to:

a) joint inflammation
b) drug therapy
c) edema
d) generalized body rash

10. Prednisone is prescribed for Carlo. The nurse evaluate its effectiveness by

a) checking his BP every 4 hours
b) checking his urine for protein
c) weighing him each morning before breakfast
d) observing him for behavioral changes

11. At Carlo's last check-up when he was 2 1/2 years old, his BP was 95/60, PR was 110/min and weight was 15 kg. Which unexpected assessment today would the nurse report to help the diagnosis?

a) BP: 95/60
b) weight: 20 kg
c) PR: 110
d) temp: 37 C


8) C
- hematuria is rare in nephrotic syndrome but it is profuse is acute glomerulonephritis.

The manifestations of nephrotic syndrome are:
  • Proteinuria - nephrosis is believed to be due to immunologic response that results in increased permeability of glomerular membrane to proteins resulting in massive protein losses in the urine -- proteinuria and albuminuria (+3 +4), the child losses 50-100 mg/kg weight/day from proteinuria.
  • Hypoalbuminemia - loss of protein in blood results in hypoalbumenimia
  • Edema - cardinal sign and appears first in the periorbital region followed by dependent edema and accompanied by pallor, fatigue and lethargy. Hypoalbuminemia leads to decreased oncotic pressure resulting in fluid shift from intravascular to interstitial causing generalized edema or anasarca.The child has lost appetite but gained weight -- puffiness of the eyes on awakening decreases during the day but appears on the legs and abdomen. Fluid shift causes decreased blood volume that leads to decreased blood supply to kidney. Decreased blood supply to kidney initiates release of aldosterone. Aldosterone causes sodium retention (in interstitial spaces so child will have hyponatremia) and water retention contributing to edema.
  • Hypocholesteronemia and hyperlipidemia - triglycerides and fats are released by the liver in the blood to make up for the protein loss
9) C
- management: reduce protein excretion
Prevention of Skin Breakdown from Edema
  • frequent turning
  • keep nails short to prevent scratching
  • meticulous skin care to dependent and edematous areas - sacrum, scrotum, labia, abdomen, legs
  • loose clothing
Monitor Edema
  • weigh daily and monitor I and O
  • check for pulmonary edema manifested by crackles on auscultation
  • ascites - measure abdominal girth
Prevention of Infection - pulmonary edema predisposes to respiratory infection and generalized edema predisposes to skin breakdown. Avoid contact with persons who have infection.

Diet - usually anorexic because of GI edema
  • high protein diet
  • sodium restriction if with severe edema
  • fluid intake equal to output and insensible loss
  • vitamin and iron supplements
  • small feedings, give favorite foods
10) B
- prednisone is prescribed for CArlo to decrease protein excretion. Proteinuria disappears in one week after intiating treatment. The child is responding favorably to treatment if there is no proteinuria for 2 consecutive days. Steroid therapy is continued until urine is negative for protein and gradually reduced over a period of 1 to 3 weeks

Monitor side effect of prolonged steroid therapy
  • Hyperglycemia - test urine
  • monitor growth of child by checking height because steroid has growth suppressing effect by preventing calcium deposition in the bones
  • Gastric Irritation - give milk or meals, test for occult blood, administer with antacids
  • Avoid exposure to infection because child is immunosuppressed
11) B
- during the toddler period, the child gains 2.5 kg a year. Carlo has gained 5 kg in only 6 months. In nephrotic syndrome, this excessive weight gain is due to edema.

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Violent Behavior Nursing Practice Exam/Test ( 1-10)

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1. Mental health laws in each state specify when restraints can be used and which type of restraints are allowed. Most laws stipulate that restraints can be used:

a) for a maximum of 2 hours
b) as necessary to control the patient
c) if the patient is a present danger to himself or others
d) only with the patient's consent

2. A patient at highest risk for suicide is one who:

a) appears depressed, frequently thinks of dying, and gives away all personal possessions
b) plans a violent death and has the means readily available
c) tells others that he might do something if life does not get better soon
d) talks about wanting to die

3. Which group is considered at high risk for suicide?

a) adolescents, men over age 45, and previous suicide attempters
b) teachers, divorced persons, and substance abusers
c) alcohol abusers, widows, and young married men
d) depressed persons, physicians, and persons living in rural areas

4. Which characteristic is most common among suicidal patients?

a) ambivalence
b) remorse
c) anger
d) psychosis

Situation: L.C., age 29, is brought to the emergency department by her husband, who found her in the bathroom slitting her wrists when he returned home from a job interview. The couple has been married for 8 years. Mr., a previously successful lawyer, was fired from his job 1 year ago. At that time, their marriage became tense and stressful.Mr. C. blames his wife for his job loss and for being unsupportive. Usually responsible and level-headed, L. has been developing low self-esteem and an inability to cope with menial tasks, driving her to despair and feelings of impending doom.
5. On admission to the surgical unit for treatment of deep lacerations to both wrists, L. tells the nurse, "Next time, I'll make sure no one stops me from doing what I plan to do. I don't want to be responsible for anyone's failure." How should the nurse respond?

a) I don't understand, Whose failure are you responsible for?
b) We are here to make sure nothing happens to you. We will protect you from yourself
c) don't you realize how lucky you are that your husband found you before you did more damage?
d) what exactly do you plan to do?

6. The nursing staff discusses how to implement suicide precautions while L. is on the surgical unit. The most immediate nursing intervention is to:

a) obtain a physician's order for restraints to prevent further suicide attempts
b) assign a nurse to remain with L. and observe her on a one-on-one basis
c) obtain a physician's order to sedate L. to reduce suicidal ideation
d) discuss the need for physician consultation with the physician

7. The nurses should implement all of the following suicide precautions for L. except:

a) restricting all visitors, phone calls, and contact with family members and friends
b) removing all potentially dangerous and sharp objects, such as razors, glass, scissors, electrical cords, and nail files
c) explaining the procedures and reasons for suicide precautions to the patient
d) explaining the procedures for suicide precautions to all persons who have contact with the patient

8. After her wrist wounds have healed sufficiently, L. is transferred to a locked psychiatric unit. Suicide precautions on this unit are most likely to be:

a) continued at he same level as those on the surgical unit
b) discontinued because it is a locked unit
c) changed to 15 minute checks and restriction to the unit
d) modified to allow more time for privacy

9. Mr. C. asks the nurse, "How long will this go on? Why doesn't my wife just snap out of it and pull herself together? She has always been so well organized and responsible. I depend on her." Which response by the nurse is best?

a) you need to understand that your wife has been under great pressure since you lost your job
b) it's really impossible to say how long it will take before she is feeling better. Have you told her how much you miss her?
c) it seems to me that both of you have had a difficult time coping with the changes in your lives over the past year. Have you ever considered therapy for yourself?
d) I'd like to learn more about y our perceptions of what is happening with your wife. When did you first begin to notice a change in her behavior?

10. After 2 weeks on the psychiatric unit, L. appears less depressed. She participates in unit activities, maintains a groomed appearance, and expresses a desire to go home so she can "get on with her life." How should the treatment team respond?

a) continue to observe L. carefully and to monitor her progress
b) discharge L. as soon as possible
c) allow L. to leave the unit unescorted and to go home periodically
d) discontinue L.'s suicide precautions


1) C
- mental health laws in most states set specific guidelines about the use of restraints. Most states allow restraints to be used if the patient presents a danger to himself or others. This danger must be reevaluated every few hours. If the patient is still a danger, restraints can be used until the violent behavior abates. No standing orders for restraints are allowed, and restraints are permitted only until "more humane" methods, such as sedatives, become effective. Violent patients who are intoxicated by drugs or alcohol present a problem because they usually cannot be sedated until the drug or alcohol is metabolized. In such cases, restraints may be needed for longer period, but the patient must be closely observed. Obtaining consent is not always possible, especially when the patient's violent behavior results from psychosis, such as paranoid schizophrenia.

2) B
- a patient at highest risk for suicide is one who plans a violent death (for example, by gunshot, jumping off a bridge, or hanging), has a specific plan (for example, after his wife leaves for work), and has the means readily available (for example, a rifle hidden in the garage). A patient who gives away possessions, thinks about death, or talks about wanting to die or attempting suicide is considered at a lower risk for suicide because his behavior typically serves to alert others that he is contemplating suicide and that he wishes to be helped.

3) A
- studies of those who commit suicide reveal the following high risk groups: men over age 45; previous suicide attempters; divorced, widowed, or separated persons; professionals, such as physicians, dentists, attorneys; students; unemployed persons; persons who are depressed, delusional, or hallucinating; alcohol or substance abusers; and persons who live in urban areas. Although women attempt suicide more often than men do, they typically choose less lethal means and are therefore less likely to succeed in their attempts.

4) A
- suicidal persons have certain common characteristics, regardless of the factors that brought them to suicidal state. One of the most common features is ambivalence - an internal struggle between self-preserving and self-destructive forces. These doubts are expressed when persons threaten or attempt suicide and then try to get help to be saved. When the possible consequences or suicide are discussed with such persons, they often describe life-related outcomes, such as relief from an unhappy situation. Many people may consider suicide as an alternative to their present circumstances, but they may not have considered the implications of not living. Remorse and anger may be associated with depression, but these feelings are not universally present suicidal persons. A psychotic individual may or may not have suicidal tendency.

5) D
- one of the nurse's primary responsibilities when assessing a suicidal patient is to determine whether the patient has a specific plan, what the plan entails, and whether the patient has the means available to act on the plan. A patient with a specific plan and access to lethal means is at high risk for suicide than one who has a vague plan and no available lethal method. Only after making such determinations should the nurse assure the patient that the staff will protect her from self-injury. Exploring the patient's feelings about her relationship with her husband and her feelings of failure will follow as part of the therapeutic relationship. Persuading a despondent, suicidal patient to think about how lucky she is to have survived would further increase her feelings of failure.

6) B
- L. must not be left alone at this time. She has made a serious suicide attempt and is continuing to verbalize suicidal intent. While the nursing staff collaborates on how best to implement suicide precautions, a nurse or nursing assistant who has been instructed on the necessary observations and appropriate interventions should remain with the patient to observe her on a one-to-one basis. Although a sedative may help to calm the patient and reduce her suicidal ideation, the nurses still need to ensure the patient's safety while obtaining the medication order. Restraints should not be used unless all other available means to protect the patient from injury have failed. Although a psychiatric consultation is appropriate to plan effective care, the nurse's first responsibility is to protect the patient from self-injury.

7) A
- visitors and telephone calls usually are restricted only when requested by the patient or when a specific therapeutic reason exists (for example, if such interaction would be too stressful for the patient). These restrictions usually are lifted once the patient can cope with the feelings generated by such encounters. General and psychiatric hospitals should have clearly stated suicide precautions as part of their policy manuals. Such precautions typically include removing all dangerous objects, such as razors, glass, scissors, electrical cords, and belts from the patient's reach; searching the patient's belongings and visitor's packages and surveying the room and surrounding areas for potentially dangerous objects; securing windows; and assigning the patient a room near the nurse's station. The nurse must explain the suicide precautions to the patient, staff members, and all visitors who have contact with the patient. This explanation is necessary to prevent someone from inadvertently providing the patient with some means (for example, matches, a nail file, or a belt) to carry out suicidal ideas.

8) A
- because L. has been transferred to a new environment with new staff members, maintaining - if not increasing - the level of suicide precautions is wise. The precautions can be modified after the health care team has had a chance to evaluate the patient's suicidal ideation. Being on a locked psychiatric unit is not in itself enough protection against self-destructive behavior. Suicidal patients who are actively suicidal (expressing suicidal ideas and having definite plans of action) should never be left alone. Suicide precautions should be eased only when the suicide risk has decreased and the patient no longer discusses a definite suicide plan.

9) D
- assessing Mr. C.'s perceptions of his wife's problems and learning when he first began to notice a change in her behavior are important for two reasons: the nurse needs to understand Mr. C.'s perception of the situation to respond therapeutically, and Mr. C. may be able to provide some background about his wife's difficulties. Although the patient's problems may be related to her husband's job loss, the nurse should avoid making Mr. C. feel defensive by blaming him for his wife's actions. Mr. C. is asking for help in understanding the crisis he and his wife are facing. The nurse needs to learn more from him before offering guidance about how to approach his wife, her needs, or his possible need for therapy.

10) A
- the treatment team must continue to observe L. carefully and to monitor her progress. Commonly, suicidal patients are ambivalent about living and dying and may appear less depressed once they have decided to kill themselves and have formulated a plan. Allowing increased freedom, discontinuing precautions, and planning for discharge should be done only after the patient has been thoroughly evaluated by the entire treatment team.

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NCLEX Review about Gastrointestinal Distress 1-5

NCLEX Review about Gastrointestinal Distress

1. The client had been diagnosed to have a cholelithiasis. He had undergone laparoscopic cholecystectomy. Which of the following does the nurse recognize as normal signs and symptoms after the surgery?

a) abdominal pain and bloating
b) diminished lung sounds
c) bile-stained vomitus
d) hyperactive bowel sounds

2. The client has been diagnosed to have cancer of the colon. She is for colostomy. The client says, "The doctor told me that there are complications of colostomy." The best initial action by the nurse is

a) discuss complications of colostomy to the patient
b) provide pre-operation teachings
c) ask what are the complications of colostomy
d) ask the client to sign consent form

3. A nurse is caring for a client with colostomy created 3 days earlier. The client is beginning to pass malodorous flatus from stoma. The nurse interprets that:

a) this is normal, expected event
b) this indicates inadequate preoperative bowel preparation
c) the client is experiencing early signs of impaired circulation
d) the client should not have the nasogastric tube movement

4. A client who has gastrostomy tube for feeding refuses to participate in the plan of care, will not make eye contact and does not speak to family or visitors. A nurse assesses that this client is using which type of coping mechanism?

a) self-control
b) distancing
c) problem-solving
d) accepting responsibility

5. A nurse is preparing a diet plan for a post-gastrectomy client to prevent dumping syndrome. Which of the following would not be a component of this teaching plan?

a) lie down after eating
b) drink liquids with meals
c) eat small meals, six times daily
d) avoid concentrated sweets


1) A
- carbon dioxide insufflation of the abdomen is done during laparoscopic cholecystectomy. This leads to abdominal pain and bloating 24 hours post-procedure

2) C
assess what the client knows, before giving teachings. This provides the starting point of discussion

3) A
- passage of flatus indicates return of peristalsis. This is normal, expected event 3 days after colostomy.

4) B
- when a client refuses to communicate, he/she is using distancing as coping mechanism.

5) B
- to prevent dumping syndrome, the client should drink fluids after meals, not with meals. This is to prevent rapid emptying of the stomach.

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Test Prep for Nursing Exam about Obstetric Nursing (1-5)


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Situation: Julia, primagravida is brought to the labor room with the following PE findings: Cervical dilation 8cm, fully effaced +1, AOG: 39-40 weeks.

1. When is the first stage of labor considered to be achieved?

a) presenting part is at station +1
b) cervix is 10 cm dilated
c) uterine contractions occur every 2-3 min. interval
d) cervix is gully effaced

2. Upon admission to the labor room, which of the following is not a routine procedure considering her cervical dilation

a) mini prep. of the perineal area
b) keep on NPO
c) monitor vital signs and FHT
d) cleansing enema

3. Which of the following observation requires the nurse to refer stat to the obstetricians?

a) frequent urination
b) blood-streak mucus in the vaginal discharge
c) sudden gush of amniotic fluid from the vagina
d) FHT is 110 during uterine contractions but returns to 130 after 10 seconds following contract

4. Which of the following signs indicate that delivery is near?

1. Julie verbalized her desire to defecate
2. uterine contractions increased in frequency duration and intensity
3. the perineum is bulging
4. bloody show is increased

a) 1,2,3,4
b) 1,2,3
c) 1,2,4

5. After the delivery of the baby, which of the following indicate placental separation?

1. protrusion of three or more inches of the umbilical cord
2. gradual descent of the uterus further into the pelvis
3. uterus becomes more firm and rounded
4. sudden spurt of blood from the vagina

a) 1,3,4
b) 1,2,4
c) 2,3,4
d) 1,2,3


1) B
- First Stage/Cervical Stage - the period from onset of true labor contractions until full cervical dilation and effacement is achieved. The most important events during this time are cervical dilatation and effacement.
  • Cervical Effacement is the shortening of the cervical canal from a length of about 1 to 2 cm until it is paper thin. In primiparas, dilatation begins when cervix is completely effaced. In multiparas, dilatation and effacement takes place at the same time. Effacement is expressed in percentage.
  • Cervical dilatation refers to the enlargement or widening of cervical os. The cervix is completely dilated when its diameter is already 10 cm
Second Stage/Expulsive Stage - the stage from full cervical dilatation until the birth of the baby. The main event of this period is the birth of the baby.

Third Stage/Placental Stage - the period from delivery of the baby to the expulsion of placenta. The main event in this period is the delivery of the placenta

Fourth Stage/Immediate Postpartum Period - the period from delivery of placenta until the condition of the woman has stabilized.

2) D
- Enema - is not a routine procedure in the preparation of woman in labor. Commonly used enemas are tap water enema, fleet enema and prepacked disposable type enema. Soap suds enema is not recommended because they have been associated with several complications. Suppositories are also included.

Enema is a procedure of emptying the colon of fecal matter to:
prevent infection - expulsion of feces during the second stage predispose mother and infant infection
facilitate descent of fetus
stimulate uterine contractions

Contraindication to Enema
  • not given during active phase
  • vaginal bleeding
  • ruptured bag of water
  • abnormal fetal presentation and position
  • fetus not yet engaged
  • premature labor because of the danger of cord prolapse
  • abnormal fetal heart rate pattern
3) C
- when the bag of water has ruptured, the nurse should call the physician. Remember, the first action to take when the bag of water has ruptured is to check the FHT as the danger at this time is cord prolapse and compression.

The abnormal signs that should be reported to the physician are:
  1. Signs of fetal distress (tachycardia, bradycardia)
  2. Red stained amniotic fluid (abruptio placenta)
  3. cord prolapse
  4. Maternal tachy cardia, hypertension and hypotension (PIH)
  5. Pallor, cold clammy skin
  6. Elevated temperature, foul smelling vaginal discharge (chrioamnionitis)
  7. bleeding
Blood streaked mucus is show and it is a normal signs of labor. It is normal for a woman to have frequency of urination. It is expected for the FHT to decrease during uterine contraction. This is an effect of fetal head compression when the uterus contracts.

4) A
- all signs that delivery is near. The desire to defecate is due to the stimulation of the sacral nerves as the fecal head presses against the sacrum. Uterine contractions reach its maximum intensity during the transition and second stage of labor. The bulging of perineum is due to the fetal pushing behind it. Show is increased as the remaining operculum is dislodged by the complete dilatation of the cervix.

5) D
- the signs of placental separation usually appear within 5 minutes after baby's birth:
  • Calkin's Sign - usually the first sign of placental separation
  • the uterus becomes firm and globular rising to the level of umbilicus
  • sudden gush of blood from the vagina
  • lengthening of the cord

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Psychotic Disorder Practice Exam/Test (33-43)

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Situation: H., age 40, is brought to the hospital by his wife, who states that for the past week her husband has refused all meals and accused her of trying to poison him. She claims that before this drastic change in behavior, he became withdrawn, forgetful, and inattentive and had frequent mood swings. During the initial interview, H. appears suspicious. His speech, which is only partly comprehensible, reveals that his thoughts are controlled by delusions of possession by the devil. He claims that the devil told him that people around him are trying to destroy him and that he should trust no one. The physician diagnoses paranoid schizophrenia and admits the patient to the psychiatric unit.

33. Schizophrenia is best described as a disorder characterized by:

a) disturbed relationships related to an inability to communicate and think clearly
b) severe mood swings and periods of low to high activity
c) multiple personalities, one of which is more destructive than the others
d) auditory and visual hallucinations

34. The nursing assessment of H. should include careful observation of his:

a) thinking, perceiving, and decision-making skills
b) verbal and nonverbal communication processes
c) affect and behavior
d) psychomotor activity

35. The patient's thought content can be evaluated on the basis of which assessment area?

a) presence or absence of delusions
b) unbiased information from the parent's psychiatric history
c) degree of orientation to person, place and time
d) ability to think abstractly

36. Nursing care for psychotic patient must be based on valid psychiatric and nursing theories. The nurse's interpersonal communication with the patient ans specific nursing interventions must be:

a) flexible enough for the nurse to adjust the nursing care plan as the situation warrants
b) clearly identified, with boundaries and specifically defined roles
c) warm and nonthreatening
d) centered on clearly defined limits and expression of empathy

37. After 2 days on the unit, H. continues to refuse to eat any hospital meals. He has been observed drinking soda and juices bought from a vending machine in the hospital lobby. Which approach is best at this time?

a) have staff members eat meals with H., encouraging him to eat and demonstrating that the food is not poisoned
b) set firm limits with H., restricting his access to vending machine items until he begins to eat at least part of his meals
c) express concern to H. about his refusal to eat but allow him to control what and when he eats while continuing to observe and monitor him
d) ignore H.'s refusal to eat and recognize that he will eat when he is hungry

38. Although H. refuses to eat, he continues to take his medication. Considering his suspicious behavior and delusions, what is the best way to administer his medication?

a) administer all medications parenterally to ensure adequate dosage
b) administer medication only in liquid form to eliminate the possibility of the patient not swallowing his tablets
c) administer a combination of liquid and tablets to ensure that the patient is getting at least some medication
d) administer the medication in the same form each time

39. The nurse observes H. pacing in his room. He is alone but talking in an angry tone. When asked what he was experiencing, he replies, " The devil is yelling in my ear. He says people here want to hurt me." The nurse's best response is:

a) can you tell me more about what the devil is saying to you?
b) how do you feel when the devil says such things to you?
c) I don't hear any voice, H. are you afraid right now?
d) H., the devil cannot talk to you

40. H. has been hearing voices for many years. An approach that has proven effective is for the hallucinating patient to:

a) practice saying "Go away" or "Stop" when he hears voices
b) take an as-needed dose of his psychotropic medication whenever he hears voices
c) sing loudly to drown out voices and to distract himself
d) go to his room until the voices go away

41. H. requests that his room be changed. He states that his roommate is homosexual and has been making advances to him. He wants to be in a private room. How should the nurse reply?

a) remind H. that he is in a hospital and not a hotel and tell him that patients are assigned to rooms on the basis of need
b) tell H. that his request will be discussed that morning and if a room is available he will be moved
c) inform H. that his roommate is not homosexual and that he should get to know him better
d) ask H. if he physically attracted to his roommate

42. Physical activity is an important part of the schizophrenic patient's treatment plan. Assuming H. is capable of the following activities, which one is most appropriate for him?

a) taking a daily brisk walk with a staff member
b) playing a basketball game
c) participating in touch football
d) shooting basketballs with another patient and a staff member

43. Plans are being made for H.'s discharge. His wife expresses concern over whether her husband will continue to take his prescribed medication. The nurse should inform her that:

a) her concern is valid but H. is an adult and has the right to make his own decisions
b) she can easily mix the medication in H.'s food if he stops taking it
c) H. can be given a long-acting medication that is administered every 1 to 4 weeks
d) H. knows that he must take his medication as prescribed to avoid future hospitalizations.


33) A
- Rationale: Schizophrenia can best be described as one of a group of psychotic reactions characterized by disturbances in an individual's relationship with people and an inability to communicate and think clearly. Schizophrenic thoughts, feelings, and behavior are commonly evidenced by withdrawal, fluctuating moods, disordered thinking, and regressive tendencies. Severe mood swings and periods of low to high activity are typical of bipolar disorder. Multiple personality, which is sometimes confused with schizophrenia, is a dissociative personality disorder, not a psychotic illness. many schizophrenic patients have auditory, not visual, hallucinations. Visual hallucinations are more common in organic or toxic disorders.

34) A
- Rationale: the nursing assessment of a psychotic patient requires careful inquiry about and observation of his thinking, perceiving, symbolizing, and decision-making skills and abilities. Assessment of such a patient typically reveals alterations in thought content and process, perception, affect, and psychomotor behavior, changes in personality, coping, and sense of self, lack of self-motivation, presence of psychosocial stressors, and degeneration of adaptive functioning. Although assessing the patient's communication processes, affect, behavior, and psychomotor activity would reveal important information about the patient's condition, the nurse should concentrate on determining whether the patient is hallucinating by assessing his thought processes and decision-making ability.

35) A
- Rationale: because delusions constitute the major disturbance in thought content, the nurse should base her assessment on their presence or absence. Although patients may report delusions spontaneously, specific questioning usually is required. Clues suggesting the presence of delusions are evasiveness, suspicion, and other indications of sensitivity to interview questions. The nurse cannot effectively evaluate the patient's thought content from his history. A patient can be oriented to person, place, and time yet still have delusions. Abstract thinking, the ability to infer beyond the literal and concrete meaning of words, reflects the patient's type of thinking, not its content.

36) A
- Rationale: a flexible care plan is needed for any patient who behaves in a suspicious, withdrawn, or regressed way or who has thought disorder. Because such a patient communicates at different levels and is in control of himself at various times, the nurse must be able to adjust the nursing care as the situation warrants. The nurse's role should be clear, however, the boundaries or limits of her role should be flexible enough to meet patient needs. Because a schizophrenic patient fears closeness and affection, a warm approach may be too threatening at this time. Expressing empathy is important, but centering interventions on clearly defined limits is impossible because the patient's situation can change without warning.

37) C
- Rationale: the nurse must avoid a power struggle with H. about his eating habits to prevent any further escalation of paranoia. The patient should be allowed to eat what he chooses as long as no coexisting medical problem, such as diabetes or a compromised fluid and electrolyte status, is present. However, the nurse should monitor the patient's physical status closely. As H. begins to trust the environment and those in it and his psychotic symptoms subside with medication, he will begin to eat. H.'s delusions about food poisoning probably will not be corrected by having staf members eat with him or by setting firm limits. Theses activities may heighten his suspicion and augment his paranoid behavior. The nurse should not ignore H.'s behavior or assume that he will eat eventually, doing so could place the patient at risk for dehydration and malnutrition.

38) D
- Rationale: paranoid patients are hypersensitive to changes in routines and established patients. Consistency on the part of the nurse and other staff members fosters trust and security. Medication should be administered in the same form each time -- for example, the same number of tablets with the same type of juice. Parenteral routes are generally used only when the patient refuses oral medication or is extremely agitated. Liquid psychotropic agents can be distasteful but may be ordered if the nurse suspects that the patient is not swallowing his tablets. The nurse should not give the patient a combination of liquid and tablets because it may confuse him.

39) C
- Rationale: when dealing with hallucinating patient, the nurse should assess the patient's needs and reflect reality by telling him that she does not hear or share his perception. Because hallucinations are generally projections of the patient's own unconscious thoughts and feelings, the nurse should not deny the patient's experience. However, asking about the voices in a way that implies the nurse agrees with their reality is nontherapeutic. Telling H. that the devil cannot talk to him is confrontational and judgmental.

40) A
- Rationale: researchers have found that the most patients can learn to control bothersome hallucinations by telling the voices to go away or stop. Since H. has been hearing voices for many years, this approach would be appropriate for him. Taking an as-needed dose of psychotic medication whenever he hears voices may lead to overmedication and put him at risk for adverse effects, such as extrapyramidal symptoms. Because it is unlikely that H. will become totally free of the voices, he must learn to deal with the hallucinations without relying on medication. Although distraction is helpful, singing loudly may upset other patients and will be socially unacceptable after the patient is discharged. Hallucinations are most bothersome when it is quiet and the patient is alone, so going to his room would increase rather than decrease the hallucinations.

41) B
- Rationale: telling H. that his request for a room change will be discussed with other team members is an honest and factual response. Paranoid patients are commonly disturbed by doubts about gender identity, which is expressed as beliefs that others think they are homosexual or that others are making homosexual advances to them. A change of room would be appropriate if possible. Responding by telling the patient that he is not in a hotel would be inappropriate and only serve to alienate him from the staff. Attempting to dissuade the patient from his beliefs by telling him that his roommate is not homosexual or confronting him about his possible attraction to his roommate would further increase his anxiety.

42) A
- Rationale: the patient should encouraged to participate in noncompetitive and nonthreatening physical activity. A brisk walk with a staff member best meets H.'s activity needs at this time. Activities such as basketball and touch football should be avoided because they require the patient to have physical contact with others, particularly other men. Since H. has already expressed some homosexual concerns, these activities would be threatening to him.

43) C
- Rationale: medications such as fluphenazine decanoate (Prolixin Decanoate), fluphenazine enanthate (Prolixin enanthate), and haloperidol decanoate (haldol decanoate) are long-acting psychotropic drugs that are given by depot injection every 1 to 4 weeks. These agents are especially useful for noncompliant patients because they are not given daily and their effect can be monitored when the patient receives his injection at the outpatient clinic. This arrangement also puts less stress on family members by alleviating the burden of having to monitor the patient's compliance with the medication regimen. A patient has the right to refuse medication, but this issue is not the focus of discussion at this time. Medication should never be hidden in food or drink to trick the patient into taking it. Besides destroying the patient's trust, it places the patient at risk for overmedication or undemedication because the amount administered is difficult to determine. Assuming that the patient knows he must take his medication as prescribed to avoid future hospitalizations is unrealistic; many schizophrenic patients are noncompliant and require close monitoring by family members.

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Online Nursing Practice Test/Exam about Endocrine (31-35)

Situation: Miss Eleanor is a 25 year old woman who is being treated in the endocrine clinic for adult-onset Myxedema.

31. While taking a nursing history, the nurse should expect Miss Eleanor to assess:

a) facial puffiness
b) intolerance to heat
c) exopthalmus
d) heart palpitations

32. The physician has ordered serum thyroxine (T4) concentration and serum cholesterol test. Which finding should the nurse expect?

a) decreased serum T4 and decreased serum cholesterol
b) decreased serum T4 and increased serum cholesterol
c) increased serum T4 and increased serum cholesterol
d) increased serum T4 and increased serum cholesterol

33. Which of the following manifestations does the nurse expect in a client with myxedema?
a) increased heart rate
b) edema
c) weight loss
d) intolerance to heat

34. Which of the following are most important to monitor in a client who had undergone total thyroidectomy?

a) pulse and temperature
b) serum electrolyte levels
c) weight and food intake
d) hoarseness of the voice and ability to swallow

35. Which of the following should be included when giving health teachings to a client with hyperthyroidism.

a) wear long-sleeved clothing
b) use artificial tears to the eyes as necessary
c) increase fibers in the diet
d) take medications with milk


31) A
- Hypothyroidism
is due to absence or deficiency in thyroid hormone that causes a decline in the metabolic rate. It is classified according to the time or life in which it occurs:
  • Cretinism - hypothyroidism in infants and young children
  • Hypothyroidism without myxedema - mild degree of thyroid failure in older children and adult
  • Hypothyroidism with myxedema - severe degree of thyroid failure or hypothyroidism in adults
Manifestations of hypothyroidism are associated with the slowing of the metabolic rate and include:
  • Patient's with myxedema exhibits nonpitting edema in connective tissues all over the body, including the face which appears puffy and the tongue which is enlarged. The edema is due to accumulation of mucoprotein and water retention.
  • Goiter - enlargement of the thyroid gland may or may not be present. Goiter occurs from excessive stimulation of TSH from the pituitary because of continuous deficient or lack thyroxine. Hypothyroidism caused by lack of TSH does not cause goiter.
  • Bradycardia, hypotension, dysrrhythmias, enlarged heart
  • Apathy, slow and slurred speech, lethargy
  • Decreased heat production-sensitivity to cold
  • Decreased nutrient requirements: poor appetite
  • Decreased sweat and sebaceous gland function: dry scaly skin
  • Altered protein, fat and carbohydrate metabolism: weight gain (edema) slow wound healing, decreased blood glucose, hypoalbuminemia
  • Decreased erythropoietin production: anemia
32) B
- Hypothyroidism is due to deficient thyroxine hormone so naturally serum T4 will be below normal.

Thyroxine regulates fat or lipid metabolism. Deficiency in thyroxine will result in slow metabolic activity resulting in slowing of lipid metabolism which increases serum cholesterol and triglyceride levels making the patient at risk for atherosclerosis and cardiac disorders.


1. Prevention - prevention of iodine deficiency

2. Replacement therapy throughout life
a. Drugs used:
  • Sodium L-thyroxine/levothyroxine (Synthroid, Levoid)
  • Sodium L-triidothyroxine (Cytomel, Trionine)
  • Synthetic combination of T3 and T4 (Euthroid, thyrolar)
  • Natural combination of T3 and T4 extract
b. Major Side Effects:
  • Inadequate treatment - show recurrence/persistence of signs of hypothyroidism
  • Excessive treatment - show signs of hyperthyroidism
  • Too fast increase in drug dose - angina, palpitations, tachycardia
  • Bone loss and decreased bone density
c. During initiation of therapy - patient is seen by physician every 2-4 weeks until condition is stable and then thyroid therapy is monitored annually.

3. Nursing Care:
  • Activity Intolerance - limit activity to patient's tolerance. If patient develops tachycardia or chest pain, stop activity
  • Constipation - increase fiber and fluids
  • Hypothermia - maintain comfortable environmental temperature, use blankets as necessary
  • Use frequent stimulation at dusk and nightfall - use nightlights to prevent confusion
  • maintain safe environment
  • promote positive body image - educate about reversible body changes
4. Surgery - may be performed for large goiters especially if it causes dysphagia, chocking sensation, inspiratory stridor, hoarseness and positive Pemberton's sign (elevation of arms results in dizziness and syncope) caused by pressure on veins that venous return from the head.

33) B
- myxedema is manifested by hypothyroidism. (A, C, and D are manifestations of hyperthyroidism)

34) A
- thyroid crisis /storm/thyroidtoxicosis is the most life-threatening postop complication of thyroid surgery. It is characterized by hyperthermia and tachycardia. Therefore it is necessary to monitor the client's pulse and temperature.

35) B
- hyperthyroidism may cause exopthalmos. To prevent corneal ulceration, artificial tears will be instilled into the eyes as necessary. The client usually develops diarrhea so, high fiber diet is not indicated. The medication should not be taken with antacid. Antacid inhibits absorption of anti thyroid drugs.

To strengthen your knowledge about this topic, we recommend the Online Nursing Classes Fundamentals E-Book

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NCLEX Review about Bowel Disorders 6-8

NCLEX Review about Bowel Disorders

Situation: Mr. Greg, a 49 year old CEO is diagnosed as having ulcer disease.

6. Mr. Greg's ulcer perforates into the peritoneal cavity. To relieve the pain caused by perforation, Mr. Greg is most likely to:

a) lie on his left side
b) turn into his stomach
c) rigidly maintain the supine position
d) draw his knees up to his abdomen

7. Mr. Greg is placed on the bland diet and receives medications to decrease gastric acidity. Which medication reduces hydrochloride acid secretion?

a) cimetidine (tagamet)
b) sucralfate (carafets)
c) aluminum hydroxide (amphogel)
d) aspirin

8. Mr. Greg is scheduled for an upper GI series. Which intervention should the nurse perform after procedure?

a) testing stool for occult blood
b) give the patient a laxative
c) assessing for the gag reflex
d) administer double dose of antacids to prevent excessive HCL production


6) D
- Ulcer is the ulceration of the mucosa and underlying structures of the upper gastrointestinal tract caused by conditions in which there is increased acidic gastric secretions or decrease mucus production. Common complication of peptic ulcer are perforation, hemorrhage and obstruction.

Perforation often occurs in duodenal ulcer. When it happens, gastric content is emptied into the peritoneal cavity causing peritonitis (gastric content is acidic, irritates peritoneal cavity and cause inflammation), bacterial septicemia (microorganism from stomach invade peritoneum and gain access to blood) and shock (from bleeding)

When ulcer perforates, the patient experiences sudden severe excruciating and stabbing pain at the epigastrium that spreads to the entire abdomen. The severe abdominal pain caused by perforated ulcer makes the patient assume the fetal position by drawing the knees up in an effort to lessen abdominal muscle tension with the hand clutching the abdomen. The abdominal area becomes tender and rigid.

On examination, the patient will also have a rigid boardlike abdomen with absent bowel sounds. Because after perforation peristalsis diminishes and the patient develops paralytic ileus.

7) A
- Medications for Ulcer

Histamine Receptor Antagonists - Block release of histamine, a hormone which stimulates HCL secretion.
It includes:
  • Cimetidine (tagamet)
  • Ranitidine (zantac) -side effect free
  • Famotidine (pepcid) - given if patient develop adverse reaction with tagamet
  • Nizatidine (axid) - newest and most expensive
Side Effects:
  • diarrhea - instruct to increase fluids and take with meals
  • abdominal cramps
  • confusion, dizziness, weakness - avoid driving
  • antiandrogenic effect in men: gynecomastia, low libido, impotence

- neutralizes HCL.
It includes:
  • amphojel, alternaGEL, dialume, alucap
  • aluminum hydroxide is the antacid of choice because:
  • a) it neutralizes hydrochloric acid
  • b) inhibit pepsin activity
  • c) stimulate prostaglandin synthesis
Side Effects:
  • constipating - advise to increase fluids
  • if with sodium may cause edema
  • decreases absorption of phosphate
  • if antacid contains calcium, may cause hypercalcemia

Misoprostol (Cytotec)
- the drug used for cancer prevention and given to patients on long term aspirin medication. Acts like prostaglandin.

Side Effects:
  • crampy abdominal pain
  • diarrhea
  • contraindicated in pregnant women because it causes uterine contraction
Agents that coat the gastric mucosa such as sulcrafate and bismuth compounds form protective barriers to promote ulcer healing.

- to inhibit H. pylori
  • Bismuth compounds - (Pepto-Bismul) - antibacterial effect
  • amoxicillin or tetracycline
  • metronidazole (flagyl, protostat)
8) B
- Upper GI series, also known as barium swallow, is the x-ray visualization of the esophagus, stomach, duodenum, and upper duodenum. It can detect 80% of peptic ulcers and is the first diagnostic procedure employed as it is also less costly and less invasive than gastroscopy.
  • barium swallow - only esophagus is x-rayed
  • low bowel series - only small intestines is x-rayed
The purpose of this test is to:
  • examination of the structure, position, peristalsis and motility of organs
  • detects malposition, tumors, ulceration, inflammation and abnormal anatomy
  • tell patient barium is white and has chalky taste
  • NPO 6 hours
  • allow to swallow barium prepared in milk shake form
  • entire tests is about 45 minutes
  • films are taken at intervals
After Test:
  • give patient laxative to prevent constipation (barium may become hard and difficult to expel)
  • expect the stool to be whitish for the next 48-72 hours because of barium
  • assess the abdomen for distention and constipation because barium is constipating. Absence of bowel sounds on auscultation may result in barium impaction.
    Go to the next page ---> NCLEX Review about Bowel Disorders 9-15  

    Or go back to NCLEX Review about Bowel Disorders 1-5 to start the test from the beginning.