Practice Multiple Choice Questions 1.

During the preoperative assessment of a patient scheduled for a cholecystectomy at an outpatient centre, the patient tells the nurse that she uses St Johns wort to keep her spirits up. The nurse notifies the anaesthesia care provider because St Johns wort may: 1. increase the risk of bleeding 2. prolong the effects of anaesthetics 3. cause serious elevations in blood pressure 4. depress the immune system response, delaying healing Answer: 2 2. A patient is to receive preoperative medications of fentanyl and atropine before surgery. The nurse explains to the patient that these medications are used to: 1. produce sleep and amnesia 2. prevent nausea and vomiting and produce sedation 3. decrease the amount of anaesthetic required and dry secretions 4. prevent complications that can occur during the administration of anaesthetics Answer: 3 3. On admission of a patient to the postanaesthesia recovery unit (PARU) from surgery, the nurse places the highest priority on assessing the: 1. condition of the surgical site 2. patients level of consciousness 3. adequacy of respiratory function 4. status of fluid and electrolyte balance Answer: 3 4. In planning interventions to promote ambulation, coughing, deep breathing and turning by a postoperative patient, the nurse knows that desired outcomes will most readily be met if the patient: 1. understands the rationale for these activities 2. receives praise when the activities are completed 3. receives enough analgesics to promote relative freedom from pain 4. is warned about complications that can occur if the activities are not performed Answer: 3 5. To teach a postoperative patient to deep breathe and cough, the nurse instructs the patient to: 1. take a deep breath, hold it 5 seconds, and force the air from the lungs in a cough 2. use a spirometer to measure the depth of inhalation and cough into the spirometer, noting the amount of air coughed out 3. place the hands on the upper abdomen and inhale slowly through the nose 1012 times an hour, coughing after each deep breath 4. inhale slowly through the nose, hold the breath a few seconds, and exhale slowly through the mouth, coughing after every four to six breaths

Answer: 4
6. Respiratory stridor is a low sound commonly heard:

1. At the beginning of the respiratory cycle indicating narrowing of the large airways, 2. At the end of respiratory cycle indicating narrowing of the large airways, 3. At the beginning of the respiratory cycle indicating mucus in the small airways, 4. At the end of the respiratory cycle indicating mucus in the small airways. Answer: 1 7. A university student has undergone a rhinoplasty to correct nasal deformities resulting from trauma during a motor vehicle accident. The nursing intervention that is most appropriate postoperatively is to: 1. reassure the patient that his/her appearance will return to normal when the swelling subsides 2. instruct the patient to maintain a semi-Fowlers position for 48 hours to prevent an increase in oedema 3. teach the patient that he/she may use a mild analgesic, such as aspirin, to control the postoperative pain and inflammation 4. remind the patient that the nasal packing will not be removed for several weeks because it provides a form for shaping the nose Answer: 2 8. The doctor orders a transfusion with packed red blood cells for a patient who has severe anaemia resulting from a bleeding peptic ulcer. The most important action by the nurse to prevent a transfusion reaction when administering the blood is to: 1. verify and document patient identification 2. keep the blood chilled during administration 3. administer the blood at a rate of no more than 2 mL/min 4. stay with the patient during the first 15 minutes of the transfusion Answer: 1 9. A patient receiving a whole blood transfusion develops chills and fever, headache and anxiety 30 minutes after the transfusion is started. The nurse recognises these symptoms as characteristic of: 1. a mild allergic reaction 2. a febrile transfusion reaction 3. an anaphylactic transfusion reaction 4. an acute haemolytic transfusion reaction Answer: 2

10. A patient with leukaemia has a nursing diagnosis of risk of infection. The most important nursing intervention in the prevention of transmission of harmful pathogens to the patient is: 1. prohibiting the oral intake of fresh fruits and vegetables 2. maintaining strict administration schedules of prophylactic antibiotics 3. strict and frequent hand-washing by all persons having contact with the patient 4. creation of a sterile environment for the patient with the use of laminar airflow (LAF) rooms 5. Answer: 3 11. The most appropriate nursing intervention to assess for the presence of infection in a patient with neutropenia is to monitor the: 1. WBC count daily 2. temperature every 4 hours 3. skin for temperature and diaphoresis 4. mouth and perianal area at every shift for signs of redness and swelling Answer: 2

12. A patient receiving chemotherapy for acute lymphocytic leukaemia has profound bone marrow depression, and granulocyte colonystimulating factor (G-CSF) and granulocytemacrophage colonystimulating factor (GM-CSF) are prescribed. The nurse recognises that the expected outcome of the use of these agents is: 1. remission of the leukaemia 2. enhanced phagocytic and cytotoxic activities of neutrophils 3. replacement of abnormal stem cells in the bone marrow with normal cells 4. prevention of haemorrhage complications in patients with thrombocytopenia Answer: 2

13. A patient with non-Hodgkins lymphoma develops a platelet count of 10 109/L during chemotherapy. An appropriate nursing intervention for the patient, based on this finding, is to: 1. provide oral hygiene every 2 hours 2. check the temperature every 4 hours 3. check all stools for occult blood 4. encourage fluids to 3000 mL/day

Answer: 3 14. During assessment of a patient with chest pain, the nurse recognises that chest pain associated with stable angina is: 1. severe, persistent and unrelieved by rest 2. usually abrupt in onset and accompanied by a feeling of doom 3. aggravated by inspiration, coughing and movement of the upper body 4. accompanied by a residual soreness in the chest, which lasts for several days Answer: 2

15. While observing the ECG monitor of a patient admitted to the emergency department with chest pain, the nurse suspects that the patient is having a myocardial infarction rather than angina upon finding: 1. sinus tachycardia 2. depressed R wave 3. ST segment elevation 4. occasional premature ventricular contractions Answer: 3 16. In developing a teaching plan for a patient who has stable angina and is started on sublingual glyceryl trinitrate, the nurse identifies an expected patient outcome of: 1. states glyceryl trinitrate is to be taken only if chest pain develops 2. lists the side-effects of glyceryl trinitrate as gastric upset and dry mouth 3. identifies the need to seek medical attention if chest pain is unrelieved by three glyceryl trinitrate tablets 4. identifies the need for lifelong use of glyceryl trinitrate to prevent the development of a myocardial infarction Answer: 3 17. The admission diagnosis for a patient transferred to the ward is acute coronary syndrome. He is currently experiencing chest pain. The recent guidelines from the Australian Heart Foundation and Cardiac Society recommend: 1. Oxygen should always be administered routinely 2. Oxygen should be used in hypoxia <93% SpO2 or evidence of shock

3. Oxygen should only be used if the patient is having a myocardial infarction 4. Oxygen should never be used Answer 2.