Decreasing level of consciousness is a symptom of which of the following physiological phenomena?

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Pharmacology and the Nursing Process Test Bank Questions

Question 1 of 9

Decreasing level of consciousness is a symptom of which of the following physiological phenomena?

Correct Answer: A

Rationale: The correct answer is A: Increased ICP. Decreasing level of consciousness is a classic sign of increased intracranial pressure (ICP) due to the compression of the brain. As ICP rises, it impairs cerebral perfusion leading to altered mental status. Parasympathetic response (B) and sympathetic response (C) are related to autonomic nervous system functions, not consciousness. Increased cerebral blood flow (D) might lead to conditions like hyperemia but does not directly cause a decreased level of consciousness.

Question 2 of 9

A client undergoes a biopsy of a suspicious lesion. The biopsy report classifies the lesion according to the TNM staging system as follows: TIS, NO, MO. What does this classification mean?

Correct Answer: B

Rationale: Step 1: TIS stands for carcinoma in situ, which means cancer cells are present only in the layer of cells where they first developed. Step 2: N0 indicates no abnormal regional lymph nodes are involved. Step 3: M0 signifies no evidence of distant metastasis. Therefore, the correct answer is B because it accurately interprets the TNM staging system for the biopsy report. Summary: A: Incorrect - TIS indicates carcinoma in situ, not no evidence of primary tumor. C: Incorrect - TIS already assesses tumor presence, ruling out this option. D: Incorrect - TIS is not about ascending degrees of distant metastasis.

Question 3 of 9

During a routine checkup, the nurse assesses a client with acquired immunodeficiency syndrome (AIDS) for signs and symptoms of cancer. What is the common AIDS-related cancer?

Correct Answer: D

Rationale: The correct answer is D: Kaposi’s sarcoma. This is a common AIDS-related cancer caused by Human Herpesvirus 8 (HHV-8) in immunosuppressed individuals. It presents as purplish lesions on the skin and mucous membranes. Squamous cell carcinoma (A) is not specific to AIDS. Leukemia (B) and Multiple myeloma (C) are not commonly associated with AIDS. Kaposi’s sarcoma is the hallmark cancer seen in AIDS patients due to their weakened immune system.

Question 4 of 9

The nurse is caring for a patient who has an open wound and is evaluating the progress of wound healing. Which priority action will the nurse take?

Correct Answer: C

Rationale: The correct answer is C because measuring the wound and observing for redness, swelling, or drainage are essential steps in evaluating wound healing progress. Measuring the wound provides objective data on its size changes, while observing for signs of infection like redness, swelling, or drainage helps identify complications. - Choice A is incorrect because the nursing assistive personnel may not have the necessary knowledge to assess wound healing accurately. - Choice B is incorrect because documenting progress as "better" without objective data is subjective and does not provide a clear picture of the wound status. - Choice D is incorrect because leaving the dressing off can expose the wound to contaminants and compromise healing, making it a potentially harmful action.

Question 5 of 9

A client is admitted for postoperative assessment and recovery after surgery for a kidney tumor. The nurse needs to assess for signs of urinary tract infection. Which of the ff measures can be used to help detect UTI?

Correct Answer: B

Rationale: The correct answer is B: Monitor temperature every 4hrs. This is crucial in detecting signs of urinary tract infection as fever is a common symptom. Monitoring temperature regularly allows for early detection and appropriate intervention. A: Encouraging the client to breathe deeply and cough every 2hrs is a measure to prevent respiratory complications postoperatively, not related to UTI detection. C: Splinting the incision when repositioning the client is important for wound care, not for detecting UTI. D: Irrigating tubes as ordered is a specific intervention for tube care, not for monitoring UTI symptoms.

Question 6 of 9

A client with suspected lymphoma is scheduled for lymphangiography. The nurse should inform the client that this procedure may cause which harmless, temporary change?

Correct Answer: B

Rationale: The correct answer is B: Redness of the upper part of the feet. During lymphangiography, a contrast dye is injected into the lymphatic vessels. This may cause temporary redness in the upper part of the feet due to the dye spreading throughout the lymphatic system. Purplish stools (A), bluish urine (C), and coldness of the soles (D) are not expected side effects of lymphangiography and do not have a direct correlation with the procedure.

Question 7 of 9

An adult is receiving NSAID. Which of the following would the nurse include in the teaching about this medication?

Correct Answer: B

Rationale: The correct answer is B: Take the NSAID with meals. Taking NSAIDs with meals helps reduce stomach irritation and risk of developing ulcers. Food acts as a protective barrier and helps in the absorption of the medication. Incorrect Choices: A: Taking NSAID with aspirin can increase the risk of stomach irritation and bleeding due to combined antiplatelet effects. C: Orange juice does not potentiate the effect of NSAIDs and may even worsen stomach irritation due to its acidity. D: NSAIDs do not coat the stomach lining; in fact, they can irritate the stomach lining and increase the risk of ulcers.

Question 8 of 9

For a 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?

Correct Answer: C

Rationale: The correct answer is C because it focuses on the client actively engaging in reducing tension, which is essential in managing anxiety. This outcome is measurable and client-centered. A: Verbalizing feelings is important, but it does not necessarily lead to reduction in anxiety. B: Not guessing prognosis is helpful, but it does not address the active management of anxiety. D: Stopping seeking information may not be beneficial as knowledge can empower the client in coping with the diagnosis.

Question 9 of 9

When administering a blood transfusion to a client with multiple traumatic injuries, the nurse monitors closely for evidence of a transfusion reaction. Shortly after the transfusion begins, the client complains of chest pain, nausea and itching. When urticarial, tachycardia, and hypotension develop, the nurse stops the transfusion and notifies the physician. The nurse suspects which type of hypersensitivity reaction?

Correct Answer: A

Rationale: The correct answer is A: Type I (immediate, anaphylactic) hypersensitivity reaction. In this scenario, the client experiences symptoms shortly after the transfusion starts, such as chest pain, nausea, itching, urticaria, tachycardia, and hypotension, which are indicative of an immediate hypersensitivity reaction. Type I reactions involve the release of histamine and other inflammatory mediators from mast cells and basophils, leading to the symptoms described. The nurse's prompt action of stopping the transfusion and notifying the physician aligns with managing this type of reaction. Incorrect choices: B: Type II (cytolytic, cytotoxic) hypersensitivity reaction - This type of reaction involves antibodies targeting specific cells, leading to their destruction. The symptoms described in the scenario are not consistent with this type of reaction. C: Type III (immune complex) hypersensitivity reaction - This type of reaction involves the formation of immune complexes that deposit in tissues, causing

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