1. Plan of care, evaluation, subjective data, and objective data are all parts of

A. a telephone encounter.

B. documentation.

C. the progress note.

D. a clinic visit.

1. Mr. Smith has an appointment with Dr. Johnson at 9:00 A.M. for his annual wellness exam. Mrs. Adams calls the clinic first thing in the morning due to fever, chills, and cough for 3 days and is given an appointment at 9:00 A.M. with Dr. Johnson as well. This is an example of

A. overlap.

B. accommodating.

C. jamming.

D. double-booking.

1. A provider performs _ to signify that everything in the note is correct.

A. technological signature

B. digital signature

C. annotation

D. autograph

1. Dan has made an appointment for review of his medication, as he recently relocated to the area with his family. Before his appointment, he has been asked to fill out and bring _ form.

A. disclosure

B. health history

C. review of systems

D. consent

1. Incident reports are reviewed by the staff to aid in

A. policies.

B. prevention.

C. change.

D. procedures.

1. Which of the following is an appropriate way to reduce no-show appointments?

A. Ensure the patient writes down their appointment.

B. Perform reminder calls one to two days preceding the appointment.

C. There are no good ways to reduce no-shows.

D. Schedule all appointments within seven days of the appointment day.

1. A patient notes that they smoke a half a pack of cigarettes per day and drink a six pack of beer every night. Where would this be documented in the chart?

A. Medical history

B. Social history

C. Chief complaint

D. Problem list

1. Which of the following is not considered an integrated device?

A. Telephone

B. Signature pad

C. Scanners

D. Camera

1. _ allows for disclosure of protected health information (PHI) through phone, fax, or email without specific patient authorization.

A. Confidentiality

B. HIPAA Security Rule

C. HIPAA Privacy Rule

D. Clinic policies and procedures

1. _ is the most important responsibility of all members of the medical office.

A. Communication

B. Accountability

C. Documentation

D. Punctuality

1. All of the following require an incident report to be filed except

A. if the wrong patient is contacted for an appointment reminder.

B. if the employee suffers a needle stick.

C. if the wrong medication is administered to the patient.

D. if the patient falls in the hallway.

1. The process of a data code being unreadable until its destination is reach is called

A. cryptic.

B. jumble.

C. decryption.

D. encryption.

1. The _ is a centralized location for a summary of a patient’s acute and chronic conditions.

A. chief complaint

B. medical history

C. disease list

D. problem list

1. Which of the following are not guidelines for proper telephone etiquette?

A. Answer by the third ring is possible

B. Answer with a pleasant greeting

C. Speak slowly and clearly

D. Keep a straight, professional face

1. Myrtle uses a cane to ambulate. She came to the clinic for an appointment, but before making it inside the building she tripped and fell on the curb. What type of document needs to be created?

A. Incident report

B. Fall report

C. Accident report

D. Injury report

1. Through the use of _ a patient may view open appointments or schedule their own appointment.

A. patient access

B. patient flow

C. patient gateway

D. patient portal

1. Cindy has a hand-written fax number from a patient’s parent to fax a note to the school for use of a medication while at school. Cindy is unable to read all of the fax numbers. What should she do?

A. Avoid sending the note since the correct number wasn’t given

B. Call the patient to confirm the number

C. Send to the closest number

D. Ask other office staff

1. What’s the default landing page in SCMO when entering a patient encounter?

A. Allergies

B. Chief complaint

C. Vital signs

D. Progress note

1. _ is a rundown of organ systems that can be used to pinpoint certain concerns or unusual findings.

End of exam

A. Review of systems

B. Report of symptoms

C. Report of systems

D. Review of symptoms

1. “It feels like an ice pick in my head” and “I’m coughing up a lung” are considered

A. chief complaints.

B. reason for visit.

C. presenting symptom.

D. medical concerns.

Question 1 Statistics for 2008 to 2009 indicated that 20.7% of children lived in poverty. What health implications can be drawn from this statistic?

Select all that apply.

1. These children run a higher risk of poor overall health status.
2. Public health clinics can provide preventive care.
3. Medicaid assistance can enable these children to receive health care.
4. Increased funding for children’s health has resulted from these statistics.

Question 2 Which criterion limits access to health care?

1. No public transportation
2. Employment opportunities
3. Transition programs for newly arrived legal residents
4. Advocacy groups for immigrants

Question 3 A patient in the Emergency Department is concerned about the cost of treatment because of no financial income. What areas would the nurse include when assessing this patient?

Select all that apply.

1. Preventive care
2. Nutritional status
3. Number of accidents
4. Shelter
5. Status of current immunizations

Question 4 While taking the health history, a Black Hispanic patient tells the nurse about having difficulty finding employment. The nurse realizes that which is a factor that causes income disparity within this segment of the population?

1. Shift to labor requiring higher technological skills
2. Increase in the real minimum wage potential
3. Increase in traditional labor skills for these groups
4. Shift of skilled jobs to unskilled labor

Question 5 The nurse notes that a larger number of foreign-born patients are being seen in the hospital. From which countries are the majority of foreign-born legal permanent residents?

Select all that apply.

1. Mexico
2. China
3. India
4. Europe
5. South America

Question 6 A patient explains how a former job has been outsourced to another country. What impact has globalization had on the economy?

1. Increased income inequality for some groups in the United States
2. Improved income for all minority groups in the United States
3. Increased membership in labor unions
4. Decreased immigration

Question 7 Legal permanent residents tend to initially settle in urban areas. What can be inferred from this?

1. Employment may be found but will probably be in lesser-paying jobs.
2. Unemployment will not be a concern.
3. Employment is easy to obtain in urban areas.
4. Income earning potential is higher.

Question 8 A foreign-born patient tells the nurse about preparing for the naturalization exam. What kinds of questions will be on this exam?

Select all that apply.

1. Questions about the Constitution
2. Parts of the US government
3. Who makes federal laws
4. The number of justices on the Supreme Court
5. Words of the US national anthem

Question 9 While shifts in the population profile are occurring, what is an important consideration to address in health care?

1. Cultural health needs of varying groups must be considered.
2. Health care needs to be streamlined for consistent care delivery.
3. More physicians need to be trained to deliver health care.
4. Health care providers need to be younger to care for an aging population.

Question 10 According to the 2010 Census, the percentage of the 65+ population of White non-Hispanics is at 13%. How will health planning needs be affected by this percentage?

1. This population will have greater demands on the health care system as it ages.
2. Planning needs for other segments of the population can be revised downwards.
3. There is no need to increase manufacture of childhood immunizations.
4. Cultural accommodations for other minority groups can be decreased.

Question 11 A patient tells the nurse that she lives in Section 8 housing. The nurse realizes that eligibility for this program is determined by:

1. Low-income guidelines
2. Family size
3. Geographic address
4. Employment history

Question 12 A patient, an immigrant from another country, is waiting to be seen in the Emergency Department. What difficulties is this patient dealing with since coming to a new country?

Select all that apply.

1. Learning a new language
2. Adapting to a new climate
3. Eating new foods
4. Fitting in with the new culture
5. Rejecting old customs in favor of new ones

Question 13 The nurse is comparing the patient population at a health care organization with the US Bureau of the Census population statistics. Which statement would the nurse use to make this comparison?

1. The percentage of US citizens who were people of color in 2010 was 36.3% of the population.
2. The percentage of Black Americans dropped considerably between 2000 and 2010.
3. People of color are the majority population within the United States.
4. People of color as a percentage of the overall US population are decreasing.

Question 14 Prior to completing an admission assessment, a foreign-born patient provides the nurse with a green card. What does this green card represent?

Select all that apply.

1. Proof of legal permanent residency
2. All rights of a US citizen with exceptions
3. Inability to vote
4. Restrictions to become a citizen
5. Automatic US citizenship

Question 15 When determining health care needs for a patient population, the health care organization analyzes the percentage of races represented within the organization with those of the US Census. What was the change in the White population between the 2000 and 2010 censuses?

1. 2.7%
2. 1.2%
3. 0.3%
4. 3.8%

Question 16 While completing demographics for a new admission, the nurse notes that there are separate categories for race and Hispanic origin.What influenced this change to occur in demographic data reporting?

1. Federal guidelines written in 1997 separated race and Hispanic origin as two separate concepts.
2. The number of people identified as non-White was increasing out of proportion to the population.
3. Identifies which health plans the patient is eligible to enroll in
4. Better differentiates categories within the African-American group

Question 17 How might immigration contribute to income inequality in the United States?

1. Many immigrants’ willingness to do jobs for less money than native-born residents
2. Being the primary income earners in the family
3. Advocating for higher minimum wages
4. A willingness to join labor unions as in previous immigrant trends

Question 18 Which characteristic would the nurse assess in a family experiencing multi-generational poverty?

1. Repeated cycles of decreased educational opportunities leading to poorer income potential and poorer health outcomes
2. Members not wishing to improve their life circumstances
3. Decreased interest by lawmakers in reducing poverty circumstances
4. Increased government efforts to provide money to improve incomes

Question 19 The health care administrator is comparing the 2000 Census Bureau data with patient demographic data. Which cultural group represented 12.5% of the population in 2000?

1. Hispanic or Latino
2. Asian
3. African American
4. American Indian and Alaskan Native

Question 20 What does the nurse identify as reasons why income influences health?

Select all that apply.

1. Increases access to health care
2. Enables people to live in better neighborhoods
3. Enables people to afford better housing
4. Enables people to live in areas without environmental hazards
5. Reduces despair

The purpose of this paper is to complete a comparative ethical analysis of the case study attached to study George’s situation and decision from the perspective of two worldviews or religions: Christianity and Judaism.

PART 1

In your comparative analysis, address all of the worldview questions in detail for Christianity and the Jewish faith. Refer to the the list of questions below. Once you have outlined the worldview of each religion, begin your ethical analysis from each perspective.

to understand the concept of worldview, answer the following questions:

-What is prime reality?

-What is the nature of the world around us?

-What is a human being?

-What happens to a person at death?

-Why is it possible to know anything at all?

-How do we know what is right and wrong?

-What is the meaning of human history?

PART 2

In 1,500-2,000 words, provide an ethical analysis based upon the different belief systems, reinforcing major themes with insights gained from your research, and answering the following questions based on the research: (USE THE ATTACHED CASE STUDY FOR THIS PART)

How would each religion interpret the nature of George’s malady and suffering? Is there a “why” to his disease and suffering? (i.e., is there a reason for why George is ill, beyond the reality of physical malady?)

In George’s analysis of his own life, how would each religion think about the value of his life as a person, and value of his life with ALS?

What Sorts of values and considerations would each religion focus on in deliberating about whether or not George should opt for euthanasia?

Given the above, what options would be morally justified under each religion for George and why?

Finally, present and defend your own view (Christian but does not practice the faith actively, believes in god and jesus, heaven and hell but more conservative in the ideas to choose our own path and life choices vs. god’s will).

Support your position by referencing at least three academic resources in addition to the course readings, lectures, the Bible, and the textbooks for each religion. Each religion must have a primary source included. A total of six references are required according to the specifications listed above. Incorporate the research into your writing in an appropriate, scholarly manner.

Prepare this assignment according to the guidelines found in the APA Style Guide. An abstract is required

Sources that may be utilized:

Moulton, B., & King, J. S. (2010). Aligning Ethics with Medical Decision-Making: The Quest for Informed Patient Choice. Journal Of Law, Medicine & Ethics, 38(1), 85-97. doi:10.1111/j.1748-720X.2010.00469.x

Richard Jason, C. (2012). Making the case for ethical decision-making models. Nurse Prescribing, 10(12), 607-622.

Puchalski, C. M. (2001). The role of spirituality in health care. Proceedings (Baylor University. Medical Center), 14(4), 352-357.

Called to Care: A Christian Worldview for Nursing. http://gcumedia.com/digital-resources/intervarsity-press/2006/called-to-care_a-christian-worldview-for-nursing_ebook_2e.php

Attached sources from text readings can also be utilized in addition to bible referencing for each religion as well*

Question 1

A 70-year-old woman has received a diagnosis of chronic myelogenous leukemia (CML) after a clinical investigation sparked by the presence of leukocytosis in her routine blood work. What clinical course should her care provider tell her to expect?

Answers:

A. “It’s likely that this will give you chronic fatigue and malaise for the rest of your life, but that will probably be the extent of your symptoms.”

B. “Unfortunately, your leukemia will likely enter a crisis mode within a few weeks if we don’t treat it immediately.”

C. “You could remain the chronic stage of CML for several years before it accelerates and culminates in a crisis.”

D. “You can expect your blood results, fatigue, and susceptibility to infection to gradually worsen over a few years.”

Question 2

Following an injury resulting in a small cut from a knife, the first cells to go to the area of the cut would be the

Answers:

A. erythrocytes.

B. basophils.

C. neutrophils.

D. albumin.

Question 3

Which of the following diagnostic findings is likely to result in the most serious brain insult?

Answers:

A. Moderate decrease in brain tissue volume secondary to a brain tumor removal

B. High intracellular concentration of glutamate

C. Increased ICP accompanied by hyperventilation

D. Mean arterial pressure (MAP) that equals intracranial pressure (ICP)

Question 4

Which of the following patients would be most likely to be experiencing an increase in renal erythropoietin production?

Answers:

A. A 70-year-old woman admitted with dehydration secondary to an overdose of her potassium-wasting diuretic

B. A 21-year-old man with acute blood loss secondary to a motor vehicle accident 3 hours prior

C. A 68-year-old man with a long-standing diagnosis of polycythemia vera

D. A 71-year-old smoker admitted to hospital with exacerbation of his chronic obstructive pulmonary disease (COPD)

Question 5

A college student has been experiencing frequent headaches that he describes as throbbing and complaining of difficulty concentrating while studying. Upon cerebral angiography, he is found to have an arteriovenous malformation. Which of the following pathophysiological concepts is likely responsible for his symptoms?

Answers:

A. Localized ischemia with areas of necrosis noted on CT angiography

B. High pressure and local hemorrhage of the venous system

C. Hydrocephalus and protein in the cerebral spinal fluid

D. Increased tissue perfusion at the site of the malformation

Question 6

A group of nursing students were studying for their pathophysiology exam by quizzing each other about disorders of WBCs and lymphoid tissue. When asked what the first chromosomal abnormality that identified cancer was, one student correctly answered Answers:

A. interleukin cells.

B. Philadelphia.

C. PSA.

D. BRCA-1.

Question 7

A 47-year-old woman was diagnosed with amyotrophic lateral sclerosis 3 years ago and has experienced a progressive onset and severity of complications. She has been admitted to a palliative care unit due to her poor prognosis? What assessments and interventions should the nursing staff of the unit prioritize in their care?

Answers:

A. Regular pain assessment and administration of opioid analgesics as needed

B. Cardiac monitoring and administration of inotropic medications

C. Assessment and documentation of cognitive changes, including confusion and restlessness

D. Assessment of swallowing ability and respiratory status

Question 8

A 53-year-old man presents with inability to concentrate, itching in his fingers and toes, elevated blood pressure, and unexplained weight loss. He is diagnosed with primary polycythemia. What will be the primary goal of his treatment?

Answers:

A. To increase the amount of oxygen distributed by his red blood cells

B. To reduce the viscosity of his blood

C. To reduce the mean size of his red cells

D. To control his hypertension

Question 9

During a late night study session, a pathophysiology student reaches out to turn the page of her textbook. Which of the following components of her nervous system contains the highest level of control of her arm and hand action?

Answers:

A. Thalamus

B. Cerebellum

C. Frontal lobe

D. Basal ganglia

Question 10

The family members of an elderly patient are wondering why his “blood counts” are not rising after his last GI bleed. They state, “He has always bounced back after one of these episodes, but this time it isn’t happening. Do you know why?” The nurse will respond based on which of the following pathophysiological principles?

Answers:

A. “Don’t worry about it. We can always give him more blood.”

B. “Due to stress, the red blood cells of older adults are not replaced as promptly as younger people.”

C. “Everything slows down when you get older. You just have to wait and see what happens.”

D. “The doctor may start looking for another cause of his anemia, maybe cancer of the bone.”

Question 11

A 44-year-old female patient presents to the emergency department with abnormal bleeding and abdominal pain that is later attributed to gallbladder disease. Which of the following diagnoses would the medical team be most justified in suspecting as a cause of the patient’s bleeding?

Answers:

A. Hemophilia B

B. Vitamin K deficiency

C. Excess calcium

D. Idiopathic immune thrombocytopenic purpura (ITP)

Question 12

Your ESRD patient is receiving 2 units of packed red blood cells for anemia (Hgb of 8.2). Twenty minutes into the first transfusion, the nurse observes the patient has a flushed face, hives over upper body trunk, and is complaining of pain in lower back. His vital signs include pulse rate of 110 and BP drop to 95/56.What is the nurse’s priority action? Answers:

A. Recheck the type of blood infusing with the chart documentation of patient’s blood type. B. Discontinue the transfusion and begin an infusion of normal saline.

C. Slow the rate of the blood infusion to 50 mL/hour.

D. Document the assessment as the only action.

Question 13

A 5th grade elementary student asks the school nurse how much blood is in an entire body. The nurse should respond that the average grown-up adult has

Answers:

A. 2 to 4 cups of blood in his or her body.

B. 5 to 6 L of blood throughout his or her body.

C. 3 pints of blood in total.

D. 3 to 4 quarts of blood in his or her body.

Question 14

The geriatrician providing care for a 74-year-old man with diagnosis of Parkinson disease has recently changed the client’s medication regimen. What is the most likely focus of the pharmacologic treatment of the man’s health problem?

Answers:

A. Preventing demyelination of the efferent cerebellar pathways

B. Preventing axonal degradation of motor neurons

C. Maximizing acetylcholine release from synaptic vesicles at neuromuscular junctions

D. Increasing the functional ability of the underactive dopaminergic system

Question 15

A student makes the statement to a colleague, “Blood plasma is essentially just a carrier for the formed elements like red blood cells and white blood cells.”What would be the most accurate response to this statement?

Answers:

A. “Not really. Plasma also contributes to the processes of protein synthesis and hematopoiesis.”

B. “Actually, plasma plays a significant role in nutrient and waste transport.”

C. “Actually, plasma is integral to the proper function of the liver and maintenance of acid–base balance.”

D. “That’s not really true. Plasma is crucial in the immune and inflammatory responses.”

Question 16

Several months ago, a 20-year-old male suffered a spinal cord injury brought about by a snowboard trick gone wrong. The lasting effects of his injury include a flaccid bowel and bladder and the inability to obtain an erection. While sensation has been completely preserved in his legs and feet, his motor function is significantly impaired. What type of incomplete spinal cord injury has the man most likely experienced?

Answers:

A. Central cord syndrome

B. Conus medullaris syndrome

C. Brown-Séquard syndrome

D. Anterior cord syndrome

Question 17

A client with a gastrointestinal bleed secondary to alcohol abuse and a hemoglobin level of 5.8 g/dL has been ordered a transfusion of packed red blood cells. The client possesses type B antibodies but lacks type D antigens on his red cells. Transfusion of which of the following blood types would be least likely to produce a transfusion reaction?

Answers:

A. A–

B. A

C. B–

D. B

Question 18

Which of the following clients’ signs and symptoms would allow a clinician to be most justified in ruling out stroke as a cause? An adult

Answers:

A. has vomited and complained of a severe headache.

B. states that his left arm and leg are numb, and gait is consequently unsteady.

C. has experienced a sudden loss of balance and slurred speech.

D. has had a gradual onset of weakness, headache, and visual disturbances over the last 2 days.

Question 19

Amniocentesis has suggested that a couple’s first child will be born with sickle cell disease. The parents are unfamiliar with the health problem, and their caregiver is explaining the complexities. Which of the following statements by the parents would suggest a need for further teaching or clarification?

Answers:

A. “Our baby’s red cells are prone to early destruction because of his or her weak membranes.”

B. “Our son or daughter likely won’t show the effects of sickling until he or she is school-aged because of the different hemoglobin in babies.”

C. “Not all of his or her red cells will be sickled, but low oxygen levels can cause them to become so.”

D. “Sickled cells can block his or her blood vessels, especially in the abdomen, chest, and bones.”

Question 20

During science class, a student asks, “What’s the difference between plasma and serum in the blood?” The nurse responds that the primary difference between plasma and serum is that plasma contains

Answers:

A. hydrogen ions.

B. heparin.

C. white blood cells.

D. fibrinogen.

Question 21

During a flu shot clinic, one of the questions the student nurse asks relates to whether the patient has had Guillain-Barré syndrome in his medical history. The patient asks, “What is that?” How should the nursing student reply?

Answers:

A. “A type of paralysis that affects movement on both sides of the body that may even involve the respiratory muscles”

B. “Influenza-like illness where you had fever and chills for 2 to 3 days after your last flu shot”

C. “A degenerative disease where you have trouble walking without the help of a cane or walker”

D. “Swelling of your arm where you got your flu shot, and maybe your eyes and lips had some swelling as well”

Question 22

A 22-year-old female college student is shocked to receive a diagnosis of myasthenia gravis. What are the etiology and most likely treatment for her health problem?

Answers:

A. Excess acetylcholinesterase production; treatment with thymectomy

B. A decline in functioning acetylcholine receptors; treatment with corticosteroids and intravenous immunoglobulins

C. Cerebellar lesions; surgical and immunosuppressive treatment

D. Autoimmune destruction of skeletal muscle cells; treatment with intensive physical therapy and anabolic steroids

Question 23

A baseball player was hit in the head with a bat during practice. In the emergency department, the physician tells the family that he has a “coup”injury. How will the nurse explain this to the family so they can understand?

Answers:

A. “It’s like squeezing an orange so tight that the juice runs out of the top.”

B. “When the bat hit his head, his neck jerked backward causing injury to the spine.”

C. “Your son has a contusion of the brain at the site where the bat hit his head.”

D. “Your son has a huge laceration inside his brain where the bat hit his skull.”

Question 24

Which of the following glycoproteins is responsible for treating such diseases as bone marrow failure following chemotherapy and hematopoietic neoplasms such as leukemia? Answers:

A. Growth factors and cytokines

B. T lymphocytes and natural killer cells

C. Neutrophils and eosinophils

D. Natural killer cells and granulocytes

Question 25

While being on subcutaneous heparin injections for deep vein thrombosis during her latter pregnancy, a patient begins to experience major side effects. Her OB-GYN physician has called in a specialist who thinks that the patient is experiencing heparin-induced thrombocytopenia. The nurse should anticipate which of the following orders?

Answers:

A. Immediately discontinue the heparin therapy

B. Switch to Coumadin 2.5 mg once/day

C. Decrease the dose of heparin from 5000 units b.i.d to 3000 units b.i.d

D. Infuse FFP stat

Question 26

Which of the following individuals would most likely experience global ischemia to his or her brain?

Answers:

A. A woman who is being brought to hospital by ambulance following suspected carbon monoxide poisoning related to a faulty portable heater

B. A male client who has just had an ischemic stroke confirmed by CT of his head

C. A woman who has been admitted to the emergency department with a suspected intracranial bleed

D. A man who has entered cardiogenic shock following a severe myocardial infarction

Question 27

A new mother and father are upset that their 2-day-old infant is requiring phototherapy for hyperbilirubinemia. The pediatrician who has followed the infant since birth is explaining the multiplicity of factors that can contribute to high serum bilirubin levels in neonates. Which of the following factors would the physician be most likely to rule out as a contributor?

Answers:

A. Transitioning of hemoglobin F (HbF) to hemoglobin A (HbA)

B. Hepatic immaturity of the infant

C. Hypoxia

D. The fact that the infant is being breast-fed

Question 28

A 14-year-old boy has been diagnosed with infectious mononucleosis. Which of the following pathophysiological phenomena is most responsible for his symptoms?

Answers:

A. Viruses are killing some of his B cells and becoming incorporated into the genome of others.

B. The Epstein-Barr virus (EBV) is lysing many of the boy’s neutrophils.

C. The virus responsible for mononucleosis inhibits the maturation of myeloblasts into promyelocytes.

D. The EBV inhibits the maturation of white cells within his peripheral lymph nodes.

Question 29

A 16-year-old female has been brought to her primary care physician by her mother due to the girl’s persistent sore throat and malaise. Which of the following facts revealed in the girl’s history and examination would lead the physician to rule out infectious mononucleosis?

Answers:

A. Chest auscultation reveals crackles in her lower lung fields bilaterally.

B. Her liver and spleen are both enlarged.

C. Blood work reveals an increased white blood cell count.

D. The girl has a temperature of 38.1°C (100.6°F) and has enlarged lymph nodes.

Question 30

A 30-year-old woman who has given birth 12 hours prior is displaying signs and symptoms of disseminated intravascular coagulation (DIC). The client’s husband is confused as to why a disease of coagulation can result in bleeding. Which of the nurse’s following statements best characterizes DIC?

Answers:

A. “The same hormones and bacteria that cause clotting also cause bleeding.”

B. “Massive clotting causes irritation, friction, and bleeding in the small blood vessels.”

C. “So much clotting takes place that there are no available clotting components left, and bleeding ensues.”

D. “Excessive activation of clotting causes an overload of vital organs, resulting in bleeding.”

Question 31

A 20-year-old has been diagnosed with an astrocytic brain tumor located in the brain stem. Which of the following statements by the oncologist treating the client is most accurate?

Answers:

A. “Our treatment plan will depend on whether your tumor is malignant or benign.”

B. “This is likely a result of a combination of heredity and lifestyle.”

C. “The major risk that you face is metastases to your lungs, liver, or bones.”

D. “Your prognosis will depend on whether we can surgically resect your tumor.”

Question 32

A patient diagnosed with low-risk chronic lymphocytic leukemia (CLL) has recently developed thrombocytopenia. One of the medications utilized to treat this would be Answers:

A. cisplatin, a chemotherapeutic.

B. vincristine, a Vinca alkaloid.

C. dexamethasone, a corticosteroid.

D. doxorubicin, a cytotoxic antibiotic.

Question 33

Two nursing students are attempting to differentiate between the presentations of immune thrombocytopenic purpura (ITP) and thrombotic thrombocytopenic purpura (TTP). Which of the students’ following statements best captures an aspect of the two health problems? Answers:

A. “ITP can be either inherited or acquired, and if it’s acquired, it involves an enzyme deficiency.”

B. “Both of them involve low platelet counts, but in TTP, there can be more, not less, hemostasis.

C. “TTP can be treated with plasmapheresis, but ITP is best addressed with transfusion of fresh frozen plasma.”

D. “Both diseases can result from inadequate production of thrombopoietin by megakaryocytes.”

Question 34

A physician is explaining to a 40-year-old male patient the importance of completing his course of antibiotics for the treatment of tuberculosis. The physician explains the damage that could occur to lung tissue by Mycobacterium tuberculosis. Which of the following phenomena would underlie the physician’s explanation?

Answers:

A. Tissue destruction results from neutrophil deactivation.

B. Neutrophils are ineffective against the Mycobacterium tuberculosis antigens.

C. Macrophages form a capsule around the Mycobacterium tuberculosis bacteria, resulting in immune granulomas.

D. Nonspecific macrophage activity leads to pulmonary tissue destruction and resulting hemoptysis.

Question 35

A teenager, exposed to West Nile virus a few weeks ago while camping with friends, is admitted with headache, fever, and nuchal rigidity. The teenager is also displaying some lethargy and disorientation. The nurse knows which of the following medical diagnoses listed below may be associated with these clinical manifestations?

Answers:

A. Encephalitis

B. Lyme disease

C. Rocky Mountain spotted fever

D. Spinal infection

Question 36

A patient has been diagnosed with anemia. The physician suspects an immune hemolytic anemia and orders a Coombs test. The patient asks the nurse what this test will tell the doctor. The nurse replies,

Answers:

A. “They are looking for the presence of antibody or complement on the surface of the RBC.”

B. “They will look at your RBCs under a microscope to see if they have an irregular shape (poikilocytosis).”

C. “They will wash your RBCs and then mix the cells with a reagent to see if they clump together.”

D. “They will be looking to see if you have enough ferritin in your blood.”

Question 37

A 29-year-old construction worker got a sliver under his fingernail 4 days ago. The affected finger is now reddened, painful, swollen, and warm to touch. Which of the following hematological processes is most likely occurring in the bone marrow in response to the infection?

Answers:

A. Phagocytosis by myelocytes

B. Increased segmented neutrophil production

C. High circulatory levels of myeloblasts

D. Proliferation of immature neutrophils

Question 38

A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?

Answers:

A.“We think that his spleen is inhibiting the production of platelets by his bone marrow.”

B.“We believe that your son’s spleen is causing the destruction of many of his blood platelets, putting him at a bleeding risk.”

C.“Your son’s spleen is holding on to too many of his platelets, so they’re not available for clotting.”

D.“Your son’s spleen is inappropriately filtering out the platelets from his blood and keeping them from normal circulation.”

Question 39 A nurse practitioner is providing care for a client with low levels of the plasma protein gamma globulin. The nurse would recognize that the client is at risk of developing which of the following health problems?

Answers:

A. Anemia

B. Blood clots

C. Jaundice

D. Infections

Question 40

A 32-year-old woman presents at her neighborhood health clinic complaining of weakness and a feeling of abdominal fullness. She reports that 6 months earlier she noticed that she had difficulty in maintaining the high level of energy she has relied on during her aerobic workouts over the past few years. Because she felt that she was in overall good health, but knew that women often need additional iron, she added a multiple vitamin with iron and some meat and leafy greens to her diet. She followed her plan carefully but had no increase in energy. Upon examination, her spleen is noted to be enlarged. Which of the following is most likely to be the cause?

Answers:

A. CLL

B. Accelerated CML

C. Infectious mononucleosis

D. Stage A Hodgkin disease

Question 41

A nurse is providing care for several patients on an acute medical unit of a hospital.Which of the following patients would be most likely to benefit from hematopoietic growth factors?

Answers:

A. A 61-year-old female patient with end-stage renal cancer

B. A 55-year-old obese male patient with peripheral neuropathy secondary to diabetes

C. A 51-year-old female patient with liver failure secondary to hepatitis

D. A 44-year-old man with a newly diagnosed brain tumor

Question 42

Misinterpreting her physician’s instructions, a 69-year-old woman with a history of peripheral artery disease has been taking two 325 mg tablets of aspirin daily. How has this most likely affected her hemostatic status?

Answers:

A. The binding of an antibody to platelet factor IV produces immune complexes.

B. The patient’s prostaglandin (TXA2) levels are abnormally high.

C. Irreversible acetylation of platelet cyclooxygenase activity has occurred.

D. She is at risk of developing secondary immune thrombocytopenic purpura (ITP).

Question 43 Which of the following teaching points would be most appropriate with a client who has a recent diagnosis of von Willebrand disease?

Answers:

A. “Make sure that you avoid taking aspirin.”

B. “Your disease affects your platelet function rather than clot formation.”

C. “Clotting factor VIII can help your body compensate for the difficulty in clotting.”

D. “It’s important that you avoid trauma.”

Question 44

A nurse at a long-term care facility provides care for an 85-year-old man who has had recent transient ischemic attacks (TIAs). Which of the following statements best identifies future complications associated with TIAs? TIAs

Answers:

A. are caused by small bleeds that can be a warning sign of an impending stroke.

B. are a relatively benign sign that necessitates monitoring but not treatment.

C. are an accumulation of small deficits that may eventually equal the effects of a full CVA. D. resolve rapidly but may place the client at an increased risk for stroke.

Question 45

Following a motor vehicle accident 3 months prior, a 20-year-old female who has been in a coma since her accident has now had her condition declared a persistent vegetative state. How can her care providers most accurately explain an aspect of her situation to her parents?

Answers:

A. “If you or the care team notices any spontaneous eye opening, then we will change our treatment plan.”

B. “Your daughter has lost all her cognitive functions as well as all her basic reflexes.”

C. “Though she still goes through a cycle of sleeping and waking, her condition is unlikely to change.”

D. “Your daughter’s condition is an unfortunate combination with total loss of consciousness but continuation of all other normal brain functions.”

Question 46

A couple who is expecting their first child has been advised by friends to consider harvesting umbilical cord blood in order to have a future source of stem cells. The couple has approached their caregiver with this request and is seeking clarification of exactly why stem cells are valuable and what they might expect to gain from harvesting it. How can their caregiver best respond to the couple’s enquiry? Stem cells can

Answers:

A. “be used as source of reserve cells for the entire blood production system.”

B. “help treat some cancers and anemias, but they must come from your child himself or herself.”

C. “be used to regenerate damaged organs should the need ever arise.”

D. “help correct autoimmune diseases and some congenital defects.”

Question 47 A surgeon is explaining to the parents of a 6-year-old boy the rationale for the suggestion of removing the boy’s spleen. Which of the following teaching points would be most accurate?

Answers:

A. “Ferritin is a protein–iron complex that allows your red blood cells to make use of the iron that you consume in your diet.”

B. “Ferritin is the activated and usable form of iron that your red blood cells can use to transport oxygen.”

C. “Ferritin is the form of iron that is transported in your blood plasma to red blood cells that need it.”

D. “Ferritin is a stored form of iron that indirectly shows me whether you would benefit from iron pills.”

Question 48

A 13-year-old African American boy comes to the ER complaining of fatigue and a rapid heartbeat. In conversation with the father, it becomes apparent to you that the boy has grown 2 inches in the previous 5 months. What is the first problem the health care team would attempt to rule out?

Answers:

A. Aplastic anemia

B. Sickle cell anemia

C. Thalassemia

D. Iron deficiency anemia

Question 49

In which of the following patients, would diagnostic investigations least likely reveal increased thrombopoietin production?

Answers:

A. A 55-year-old man with dehydration secondary to Crohn disease

B. An 81-year-old woman with diagnoses of rheumatoid arthritis and failure to thrive

C. A 66-year-old woman with a diagnosis of lung cancer with bone metastases

D. A 21-year-old woman awaiting bone marrow transplant for myelogenous leukemia

Question 50

A hospital laboratory technologist is analyzing the complete blood count (CBC) of a patient. Which of the following statements best reflects an aspect of the platelets that would constitute part of the CBC?

Answers:

A. New platelets are released from the bone marrow into circulation.

B. The half-life of a platelet is typically around 8 to 12 days.

C. Platelets originate with granulocyte colony–forming units (CFU).

D. The α-granules of platelets contribute primarily to vasoconstriction.