Question

The nurse is admitting an older patient from a nursing home to the medical surgical unit. During the physical examination, the nurse observes a shallow open reddish, pink wound bed without slough on the patient's buttocks (see below). How will the nurse stage this pressure injury?

Answer 1

Correct Answers:

Stage II

Rationale :

🩹A Stage II pressure injury involves partial-thickness skin loss with exposed dermis.

👁️It presents as a shallow open wound with a red or pink wound bed and no slough.

⚠️The injury in the image matches this description, showing exposed dermis without deeper tissue involvement.

📋Stages III and IV involve full-thickness tissue loss, which is not present here.

📌Core Message

Stage II pressure injuries show partial-thickness skin loss with exposed dermis.

Answer 2

Correct Answers:

The patient took tie prescribed metformin today.

Rationale :

💊Metformin can interact with contrast dye used in arteriograms, increasing risk of lactic acidosis.

🧠This is especially dangerous in patients with reduced renal function after the procedure.

⚠️The provider must be informed to hold the drug before and after the procedure.

📋Other findings like HbA1C or glucose are not immediately dangerous for this test.

📌Core Message

Metformin must be withheld before contrast studies to prevent lactic acidosis.

Answer 3

Correct Answers:

Oral ibuprofen 800 mg

Rationale :

💊Pericarditis pain is relieved best with NSAIDs like ibuprofen, which reduce inflammation.

🧠NSAIDs target the pericardial inflammation causing pain with breathing.

⚠️Opioids do not treat the underlying inflammatory process.

📋Anti-inflammatory therapy speeds symptom relief and recovery.

📌Core Message

NSAIDs relieve pericarditis pain by reducing inflammation.

Answer 4

Correct Answers:

Pruritis
Dark colored urine
Light clay colored stool

Rationale :

🧠The icteric phase of hepatitis shows hyperbilirubinemia symptoms.

⚠️Pruritus occurs due to bile salt deposition in the skin.

💧Dark urine results from bilirubin excretion in urine.

💁‍♂️Clay-colored stools occur due to lack of bile pigment in the intestine.

📌Core Message

The icteric phase causes pruritus, dark urine, and clay stools from hyperbilirubinemia.

Answer 5

Correct Answers:

deep diffuse chest pain radiating to interscapular area

Rationale :

💁‍♂️A thoracic aortic aneurysm often causes deep chest pain radiating to the back.

🧠Pain is due to pressure on surrounding thoracic structures.

⚠️Sudden tearing pain may suggest dissection, a medical emergency.

📋Early recognition helps prevent rupture or dissection.

📌Core Message

Thoracic aneurysms cause deep chest pain radiating to the back.

Answer 6

Correct Answers:

Oprelvekin

Rationale :

💊Oprelvekin stimulates platelet production in bone marrow.

🧠It is used for chemotherapy-induced thrombocytopenia.

⚠️Filgrastim and epoetin alfa stimulate WBC and RBC production, not platelets.

📋Correct therapy reduces risk of bleeding in low platelet counts.

📌Core Message

Oprelvekin increases platelet production in thrombocytopenia.

Answer 7

Correct Answers:

“l will acetaminophen when I need medicine for pain, fever or a headache.”

Rationale :

💊Acetaminophen is hepatotoxic and should be avoided in cirrhosis.

🧠Clients with liver disease cannot metabolize it effectively, increasing risk of liver injury.

⚠️Safer alternatives must be discussed with the provider.

📋Education prevents drug-induced liver failure.

📌Core Message

Acetaminophen is unsafe in cirrhosis due to hepatotoxicity.

Answer 8

Correct Answers:

“A plastic anemia is caused by a suppression of all bone marrow elements.”

Rationale :

🩸Aplastic anemia involves failure of bone marrow to produce RBCs, WBCs, and platelets.

🧠This pancytopenia results from marrow suppression.

⚠️Causes can include toxins, drugs, infections, or autoimmune disease.

📋Treatment focuses on removing the cause and restoring marrow function.

📌Core Message

Aplastic anemia is from bone marrow suppression causing pancytopenia.

Answer 9

Correct Answers

Blank 1 Correct Option: unstable angina
Blank 2 Correct Option: Nitroglycerin SL

Rationale :

💔Unstable angina is chest pain that worsens in frequency, severity, or occurs at rest.

🧠It reflects incomplete coronary artery occlusion and requires urgent care.

💊Nitroglycerin SL relieves pain by dilating coronary arteries.

📋Prompt treatment prevents progression to myocardial infarction.

📌Core Message

Unstable angina is treated with sublingual nitroglycerin for pain relief.

Answer 10

Correct Answers:

Numbness and tingling of extremities

Rationale :

💊Some antitubercular drugs like isoniazid can cause peripheral neuropathy.

🧠This is felt as numbness and tingling in the hands and feet.

⚠️This should be reported promptly to prevent permanent nerve damage.

📋Vitamin B6 supplementation can help prevent this adverse effect.

📌Core Message

Antitubercular drugs can cause peripheral neuropathy needing prompt reporting.

1 :
The nurse is admitting an older patient from a nursing home to the medical surgical unit. During the physical examination, the nurse observes a shallow open reddish, pink wound bed without slough on the patient's buttocks (see below). How will the nurse stage this pressure injury?

2 :
A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which information obtained by the nurse is most important to report to the health care provider before the procedure?

3 :
A patient who has had recent cardiac surgery develops pericarditis and complains of level 3 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer?

4 :
A patient diagnosed with in the icteric phase (jaundiced phase) With bilirubin, Select the three (3) associated signs and symptoms the nurse expects during this phase? Select all that apply

5 :
The patient with a thoracic aorta aneurysm describes the classic symptoms of this disorder to the nurse. How did the patient describe the symptoms?

6 :
A patient who has received chemotherapy has a critically low platelet count. The nurse expects Which drug or drug class to be used to stimulate platelet cell production?

7 :
The home health nurse visits the patient who was recently diagnosed with cirrhosis to begin a home-care education program. Which statement by the patient indicates the need for further instructions?

8 :
The patent asks the nurse to explain the pathologic mechanism involved in aplastic anemia. Which of the following statements correctly explains aplastic anemia?

9 :
A nurse is caring for a client.

Correct Answers

10 :
The nurse is discussing adverse effects of antitubercular drugs with a patient Who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber?

1 : The nurse is admitting an older patient from a nursing home to the medical surgical unit. During the physical examination, the nurse observes a shallow open reddish, pink wound bed without slough on the patient's buttocks (see below). How will the nurse stage this pressure injury?

2 : A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which information obtained by the nurse is most important to report to the health care provider before the procedure?

3 : A patient who has had recent cardiac surgery develops pericarditis and complains of level 3 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer?

4 : A patient diagnosed with in the icteric phase (jaundiced phase) With bilirubin, Select the three (3) associated signs and symptoms the nurse expects during this phase? Select all that apply

5 : The patient with a thoracic aorta aneurysm describes the classic symptoms of this disorder to the nurse. How did the patient describe the symptoms?

6 : A patient who has received chemotherapy has a critically low platelet count. The nurse expects Which drug or drug class to be used to stimulate platelet cell production?

7 : The home health nurse visits the patient who was recently diagnosed with cirrhosis to begin a home-care education program. Which statement by the patient indicates the need for further instructions?

8 : The patent asks the nurse to explain the pathologic mechanism involved in aplastic anemia. Which of the following statements correctly explains aplastic anemia?

9 : A nurse is caring for a client.

Correct Answers

10 : The nurse is discussing adverse effects of antitubercular drugs with a patient Who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber?

1 :
The nurse is admitting an older patient from a nursing home to the medical surgical unit. During the physical examination, the nurse observes a shallow open reddish, pink wound bed without slough on the patient's buttocks (see below). How will the nurse stage this pressure injury?

2 :
A patient with type 2 diabetes is admitted for an outpatient coronary arteriogram. Which information obtained by the nurse is most important to report to the health care provider before the procedure?

3 :
A patient who has had recent cardiac surgery develops pericarditis and complains of level 3 (0 to 10 scale) chest pain with deep breathing. Which of these ordered PRN medications will be the most appropriate for the nurse to administer?

4 :
A patient diagnosed with in the icteric phase (jaundiced phase) With bilirubin, Select the three (3) associated signs and symptoms the nurse expects during this phase? Select all that apply

5 :
The patient with a thoracic aorta aneurysm describes the classic symptoms of this disorder to the nurse. How did the patient describe the symptoms?

6 :
A patient who has received chemotherapy has a critically low platelet count. The nurse expects Which drug or drug class to be used to stimulate platelet cell production?

7 :
The home health nurse visits the patient who was recently diagnosed with cirrhosis to begin a home-care education program. Which statement by the patient indicates the need for further instructions?

8 :
The patent asks the nurse to explain the pathologic mechanism involved in aplastic anemia. Which of the following statements correctly explains aplastic anemia?

9 :
A nurse is caring for a client.

10 :
The nurse is discussing adverse effects of antitubercular drugs with a patient Who has active tuberculosis. Which potential adverse effect of antitubercular drug therapy should the patient report to the prescriber?