Multiple Choice
Identify the letter of the choice that best completes the statement or answers the question.
____ 1. What problem or disorder is a major cause of disability in adults under age 54 years in the United States?
a. Accidents
b. Morbid obesity
c. Coronary artery disease
d. Diabetes mellitus type 2
____ 2. How is a handicap different from an impairment, as defined by the World Health Organization?
a. An impairment may be temporary and a handicap is usually permanent.
b. Handicaps only involve mobility and an impairment may involve any organ structure or function.
c. Impairments are physical abnormalities and handicaps are societal values placed on individuals with impairments.
d. Handicaps are societal attempts to improve the functional ability of a person with an impairment, allowing more mainstream integration.
____ 3. The client who is a paraplegic is scheduled to participate in a rehabilitation program. She tells her nurse, “I don't understand why I should do rehabilitation. After all, my paralysis will not go away nor will it get better.” What is the nurse’s best response?
a. “Your doctor, one of the best in the specialty, ordered rehabilitation, and he does know what is best for you.”
b. “When new discoveries are made regarding paraplegia, people in rehabilitation programs will benefit first.”
c. “Rehabilitation will teach you how to maintain the functional ability you have.”
d. “You are right. I will cancel the orders for rehabilitation.”
____ 4. Which statement regarding disability and chronic illness is true?
a. Disabilities and chronic illnesses occur most often in young adults.
b. Accidents are responsible for more chronic and disabling conditions than chronic disease.
c. In the United States, one in seven persons experiences activity limitations because of chronic health problems.
d. Men experience more disability than women, but women experience a higher incidence of chronic illness than men.
____ 5. What is the most important information concerning elimination to assess for the client who is to undergo rehabilitation?
a. What was the client's usual bowel elimination pattern before the injury or illness?
b. Does the client have at least one bowel movement each day?
c. Can the client transfer from the wheelchair to the toilet?
d. Does the client have diarrhea?
____ 6. Which factor determines how independent a client can become with elimination?
a. Complication of the medication regimen
b. Degree of manual dexterity
c. Consistency of the stool
d. Volume of urine
____ 7. Which laboratory test abnormality in a client with a disabling condition alerts a nurse to an increased risk for skin breakdown?
a. Low serum albumin level
b. High serum transferrin level
c. Low serum carboxyhemoglobin
d. High serum hematocrit
____ 8. The client is scheduled for a functional assessment using the Functional Independence Measure (FIM). He asks the nurse, “What is the purpose of the FIM?” What is the nurse’s best response?
a. “It is a tool that is used to determine your level of independence.”
b. “It measures how you should be able to perform various tasks.”
c. “It is a tool to measure the severity of your disability.”
d. “It is a test the nurse manager uses to determine staffing patterns.”
____ 9. What is the priority nursing diagnosis for a client in a rehabilitation program after a stroke that caused extensive right-sided weakness?
a. Self-Care Deficit—Partial
b. Risk for Impaired Skin Integrity
c. Constipation
d. Impaired Physical Mobility
____ 10. Which client condition increases the chance for a problem with the technique needed for learning transfer?
a. The client has gained weight.
b. The client has aphasia.
c. The client is incontinent.
d. The client has minimal sensation in the lower extremities.
____ 11. The nurse is performing passive range-of-joint motion exercises on a semiconscious client and meets resistance while attempting to extend the right elbow more than 45 degrees. What is the nurse’s best action?
a. Splint the joint and continue the passive range of motion to the shoulder only.
b. Progressively increase the joint motion 5 degrees beyond the resistance each day.
c. Apply weights to the right distal extremity before initiating any joint exercise.
d. Move the joint only to the point at which resistance is met.
____ 12. Which intervention should the nurse implement and reinforce to prevent a client with reduced mobility from having increased susceptibility to bone fractures?
a. Apply a foot support when the client is in bed.
b. Encourage the client to perform weight-bearing activities.
c. Increase the amount of calcium-rich foods in the diet.
d. Ensure the continuous use of pressure-relieving devices.
____ 13. The use of intermittent self-catheterization is inappropriate for which of the following clients with a flaccid bladder?
a. The client older than 85 years of age
b. The client who is blind
c. The client who is confused
d. The client who is a paraplegic
____ 14. Which action should the nurse implement to prevent pressure ulcer formation in a bedridden client?
a. Assessing serum albumin and transferrin levels
b. Measuring the ulcer diameter and depth every shift
c. Changing the gauze dressing whenever drainage is observed
d. Applying antibiotic ointment to all excoriated skin areas
____ 15. Which nursing intervention should the nurse implement to prevent venous stasis and thrombus formation in a client undergoing rehabilitation after a stroke?
a. Range-of-motion exercises
b. Foot support while in bed
c. Increased dietary calcium intake
d. Avoidance of sudden position changes
____ 16. Which activity plan would best conserve a client's energy without compromising the client's physical or mental health?
a. Reducing hygiene activities and restricting visitors
b. Ensuring that the client toilets before and after any other planned activity
c. Scheduling energy-intensive activities at the time of day when the client has higher energy levels
d. Scheduling as many activities as possible within a small block of time to allow the client a longer, uninterrupted rest period
____ 17. The client in a rehabilitation program has been using the bladder training techniques of the Valsalva and Credé maneuvers. When a nurse catheterizes this client immediately after voiding, the residual volume is 50 mL. What is the nurse’s best action?
a. Notify the physician.
b. Insert an indwelling catheter.
c. Document the finding as the only action.
d. Modify or extend the bladder-training program.
____ 18. The client at home who is using intermittent self-catheterization is concerned about the cost of sterile straight catheters. What is the nurse’s best response?
a. “I will explore whether or not you qualify for money to purchase these necessary supplies.”
b. “Even though it is expensive, the cost of taking care of urinary tract infections would be even higher.”
c. “If you can treat the catheters by boiling them, you can reuse them up to 10 times each.”
d. “You can reuse the catheters here at home. Only clean technique, rather than sterile technique, is needed.”
____ 19. The client is at risk for a urinary tract infection. Which of the following beverages is the client encouraged to drink?
a. Carbonated beverages
b. Citrus juices
c. Milk
d. Tomato juice
____ 20. The older client is getting out of bed for the first time. The nurse should be alert for which of the following complications?
a. Deep vein thrombosis
b. Dyspnea
c. Orthostatic hypotension
d. Pulmonary embolism
____ 21. Prior to discharge, the case manger or occupational therapist visits the client’s home. Of the following, which one is of primary importance?
a. Accessibility to the home
b. Space requirements
c. Wheelchair accessibility
d. Doorway width
____ 22. What is the normal number of autosomal chromosomes for humans?
a. 42
b. 44
c. 46
d. 48
____ 23. You are looking at a small piece of single-stranded DNA with the base sequence of ACCTGAACGTCGCTA. What would be the sequence of the complementary strand of RNA?
a. TGGACTTGCAGCGAT
b. ACCTGAACGTCGCTA
c. UGGACUUGCAGCGAU
d. ACCUGAACGUCGCUA
____ 24. Approximately how many genes are estimated currently to compose the human genome?
a. 35,000
b. 100,000
c. 500,000
d. Over one million
____ 25. Which substance is present in a nucleotide but not in a nucleoside?
a. Uracil
b. Nitrogen
c. Phosphorus
d. Pentose (ribose) sugar
____ 26. What is the best meaning for the term gene expression?
a. The location of a specific gene allele on a specific autosomal chromosome
b. The specific trait or protein coded for by a single gene is actually present
c. The ability of a single gene to code for more than one trait or characteristic
d. The loss of a trait or characteristic from one family generation to the next generation
____ 27. In which phase of the cell cycle is DNA visible as chromosome structures?
a. G1
b. G2
c. M
d. S
____ 28. What is the expected result of a “silent” point mutation?
a. Total disruption of the gene reading frame, no production of protein
b. Replacement of one amino acid with another in the final gene product
c. Replacement of an amino acid codon with a “stop” codon, resulting in a truncated protein product
d. No change in amino acid sequence and no change in the composition of the protein product
____ 29. What is the function of ribosomes (also known as ribosomal RNA) in protein synthesis?
a. Serves as an adaptor molecule able to transport a specific amino acid to the site of protein synthesis (peptide chain elongation) in the correct sequence
b. Serves as the coordinator molecule to allow proper reading of the mRNA and placement of the correct amino acid in the sequence by the tRNAs
c. Allows interpretation of the two strands of DNA to determine which is the "sense" strand and which is the "antisense" strand
d. Allows further processing of synthesized proteins (post-translational modification) in order to ensure that the final product is physiologically active
____ 30. What makes a “frameshift” mutational event more serious than a “point” mutational event?
a. Frameshift mutations occur primarily in germline cells and point mutations occur only in somatic cells.
b. Frameshift mutations result in the deletion or addition of whole chromosomes (aneuploidy) and point mutations are undetectable at the chromosome level.
c. When the mutations occur in expressed genes, frameshift mutations always result in disruption of the gene function, whereas a point mutation can be silent.
d. The rate of frameshift mutations increases with aging as the function of DNA repair mechanisms declines, whereas the rate of point mutations is unchanged with age.
____ 31. What is the difference between DNA transcription for DNA synthesis and DNA transcription for protein synthesis?
a. Transcription for DNA synthesis is rapidly followed by the process of translation.
b. Transcription for protein synthesis has “greater fidelity” than does transcription for DNA synthesis.
c. Transcription for protein synthesis occurs only in cells undergoing mitosis and transcription for DNA synthesis occurs in both dividing and nondividing cells.
d. Transcription for DNA synthesis occurs with both the “sense” and the “antisense” strands, whereas transcription for protein synthesis occurs with only the “sense” strand.
____ 32. What is the correct interpretation of the statement, “the HFE gene locus is 6p21”?
a. Both alleles of the HFE gene are equally expressed.
b. The HFE gene is inherited from the paternal chromosome line.
c. The HFE gene is located on the “short arm” of chromosome number 6.
d. There is a somatic cell mutation involving gene damage on chromosome 6.
____ 33. Which statement regarding genotype and phenotype is true?
a. For autosomal recessive traits, the phenotype is the same as the genotype.
b. The only trait in which phenotype always follows genotype is physiologic gender.
c. When a phenotype is fully penetrant, the trait is expressed in the heterozygous person.
d. Genotype changes as a person ages, whereas phenotype is not affected by the aging process.
____ 34. What are the expected blood types of children from a mother who is AA for blood type and a father who is BB for blood type?
a. All children will have type O blood.
b. All children will have type AB blood.
c. 50% of the children will have type A blood and 50% of the children will have type B blood.
d. 25% will have type A blood, 50% will have type AB blood, and 25% will have type B blood.
____ 35. Which statement is a criterion for an autosomal dominant pattern of inheritance for a specific trait or characteristic that is highly penetrant?
a. Unaffected family members do not transmit the trait to their children.
b. Genotypes of individuals expressing the trait must be homozygous.
c. The trait appears only among male offspring of female carriers.
d. Carriers for the trait do not necessarily express the trait.
____ 36. How are “gene penetrance” and “gene expressivity” different?
a. With penetrance, the gene is either expressed completely or is not expressed at all. With expressivity, the gene is always expressed but the degree of expression can range from minor to extreme.
b. Penetrance and expressivity are both related to “gene dosage.” With penetrance, only one copy of the gene is expressed and, with expressivity, more than one copy of the gene can be expressed.
c. Gene penetrance and gene expressivity are merely different terms for the same concept, overexpression of recessive alleles.
d. Penetrance refers to the actual gene structure in the DNA and expressivity refers to the chromosome locus of the gene.
____ 37. Which statement or condition best demonstrates the concept of “multifactorial inheritance”?
a. A mutation in a single gene results in the expression of problems in a variety of tissues and organs.
b. The susceptibility to a problem is inherited as a single gene trait but development of the problem is related to environmental conditions.
c. A mutated gene is inherited but the results of expression of that gene are not evident until middle or late adulthood.
d. Several genes are responsible for the mechanism of hearing and a mutation in any one of them results in hearing impairment.
____ 38. When constructing a pedigree around a specific health problem, what is the minimal number of generations needed to assess the presence or absence of a genetic factor in disease development accurately?
a. 1
b. 2
c. 3
d. 4
____ 39. In constructing a pedigree for a man whose maternal grandfather has Huntington’s disease, you include the man’s maternal grandparents, his parents, his mother’s only sister, his three sisters and one brother, and his twin sons. Which pedigree symbol and position would represent his mother’s sister?
a. The circle on the highest horizontal line above the client’s symbol
b. The square on the horizontal line directly above the client’s symbol
c. The circle on the horizontal line above the client’s symbol that does not directly touch the vertical line leading to the client
d. The square on the same horizontal line as the client’s symbol that directly touches the vertical line leading to the client’s mother
____ 40. The client, whose mother has Huntington’s disease, is considering genetic testing but is not sure whether she really wants to know if she has the mutation. She asks what you would do if your mother had the disease. What is your best response?
a. “I would have the test so I could decide whether to have children or to adopt children.”
b. “I can only tell you the benefits and the risks of testing. You must make this decision yourself.”
c. “Because there is no cure for this disease and testing would not be beneficial, I would not have the test.”
d. “You need to check with your brothers and sisters to determine whether testing for this disease would be appropriate for you”
____ 41. The client who has been found to have a mutation in the BRCA1 gene allele and an increased risk for breast and ovarian cancer has asked you to be present when she discloses this information to her grown daughter. What is your role in this situation?
a. Primary health care provider
b. Genetic counselor
c. Client advocate
d. Client support
____ 42. What should you tell the client who has been found to have a genetic mutation that increases the risk for colon cancer who says he does not want any of his family to know about this result?
a. “It is required by law that you inform your siblings and your children about this result so that they also can be tested and monitored for colon cancer.”
b. “It is not necessary to tell your siblings, because they are adults, but you should tell your children so that they can be tested before they decide to have children of their own.”
c. “It is not required that you tell anyone about this result; however, because your siblings and children may also be at risk for colon cancer, you should think about how this information might help them.”
d. “It is your decision to determine with whom, if anyone, you discuss this test result; however, if you do not tell any of your family members and they get colon cancer, you would be responsible for their developing the disease.”
____ 43. Which is the most important goal of triage?
a. Assigning each client to the most appropriate treatment area
b. Giving priority of care to the most critically ill or injured clients
c. Providing a through assessment of the client
d. Obtaining a complete history of the client’s past medical-surgical history
____ 44. What is a correct statement regarding the major role of the triage nurse?
a. Provide a through and comprehensive assessment of each client.
b. Be able to splint and perform minor procedures.
c. Perform rapid assessment to determine priority of care.
d. Provide psychological support to family members.
____ 45. What is the primary survey?
a. Airway, breathing, circulation, head to toe assessment
b. Airway, breathing, circulation, neurologic assessment
c. Airway and cervical spine control, breathing, circulation, disability, exposure
d. Airway and cervical spine control, breathing, circulation, head to toe assessment
____ 46. A 67-year-old male presents to the ED complaining of chest pain. His heart rate is 120 beats/min, his blood pressure is 100/68 mm Hg, and his respiratory rate is 20 breaths/min. His is short of breath and diaphoretic. In a three-tiered triage model, how should the nurse prioritize this client?
a. Emergent
b. Urgent
c. Nonurgent
d. Dormant
____ 47. Which of the following statements is true regarding critical incident stress debriefing (CISD)?
a. CISD should not occur until several months have passed since the incident.
b. CISD consists of a group leader who is the main speaker.
c. CISD encourages group discussion.
d. CISD is limited to health care providers.
____ 48. Which of the following statements are true regarding post-traumatic stress disorder (PTSD)?
a. Individuals suffering from PTSD may display physical manifestations.
b. Professional “burnout” is rare secondary to PTSD.
c. Critical incident stress management is the only method to deal with PTSD.
d. Manifestations of PTSD are purely psychological.
____ 49. A woman presents to the emergency department after working outdoors in the sun all day. The nurse suspects heat exhaustion after his initial interview and assessment of the client. Which of the following symptoms would support his diagnosis?
a. Confusion
b. Normal body temperature
c. Elevated body temperature
d. Hypertension
____ 50. What is the highest priority of care in the prehospital setting for clients suffering from heat exhaustion (after airway assessment)?
a. Start intravenous fluids to hydrate the client.
b. Immerse the client in ice water.
c. Remove the client from physical activity and put him or her in a cool place.
d. Wait for paramedics to arrive and place the client in an air-conditioned vehicle.
____ 51. Which of the following statements is true regarding coral snake envenomation?
a. The toxic effects of coral snake venom are seen immediately.
b. Coagulopathy occurs in severe cases.
c. Pain at the bite site is severe.
d. Early symptoms of envenomation include nausea, vomiting, headache, and pallor.
____ 52. The primary first aid intervention in the prehospital setting for a black widow spider bite is the application of ice. Which statement provides the best rationale for this intervention?
a. Ice inhibits the action of neurotoxin.
b. Ice reduces swelling in the affected extremity.
c. Ice decreases venous return from the affected extremity.
d. Ice decreases the pain associated with spider bites.
____ 53. When caring for a client who has suffered a spider bite, which medication order might the nurse expect from the physician?
a. Antibiotics
b. Antispasmodics
c. Antimalarials
d. Tetanus toxoid
____ 54. Which of the clients listed below would be most susceptible to hypothermia?
a. A 17-year-old female with type 2 diabetes
b. A 10-year-old female with asthma
c. A 56-year-old male with a history of alcohol and tobacco abuse
d. A 76-year-old male with hypertension
____ 55. Mild hypothermia is defined a core body temperature of
a. 35° to 37° C
b. 32° to 35° C
c. 28° to 32° C
d. 24° to 28° C
____ 56. A 60-year-old male presents to the emergency department with hypothermia. He is shivering, has muscular incoordination, and is slow to respond questions. What stage of hypothermia is manifested by this client?
a. Frostbite
b. Mild hypothermia
c. Moderate hypothermia
d. Severe hypothermia
____ 57. A client suffering from severe hypothermia also is noted to have a cool, numb foot. The foot is blue in color and does not blanch. What degree of frostbite would this be?
a. First-degree frostbite
b. Second-degree frostbite
c. Third-degree frostbite
d. Fourth-degree frostbite
____ 58. The key factor in the pathophysiology of a near drowning in salt water is that aspirated water
a. Washes surfactant out of the lungs
b. Causes an osmotic gradient that draws water into the alveoli
c. Decreases lung compliance
d. Increases the work of breathing, leading to hypoxia
____ 59. A 50-year-old mountain climber is brought to the emergency department after a climb complaining of headache, nausea and vomiting, and “feeling winded.” The nurse suspects which altitude-related illness?
a. High-altitude cerebral edema (HACE)
b. Acute mountain sickness (AMS)
c. High-altitude pulmonary edema (HAPE)
d. High-altitude mountain sickness (HAMS)
____ 60. A 50-year-old mountain climber is brought to the emergency department after a climb complaining of headache, nausea and vomiting, and “feeling winded.” What medication would the nurse expect the physician to order?
a. Furosemide (Lasix)
b. Acetazolamide (Diamox, Apo-Acetazolamide)
c. Atropine sulfate
d. Ketorolac tromethamine (Toradol)
Answer Section
MULTIPLE CHOICE
1. ANS: A
Although stroke is the leading cause of disability in the United States, costing more than $30 billion each year in medical costs and loss of productivity, many younger adults are disabled from accidents rather than from disease.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
2. ANS: C
A handicap is a preventable and reversible disturbance at the societal level that is experienced by a person with a disability or impairment. It is a negative value that is ascribed to the person, the disability, or the impairment. A handicap is often described by what a person is perceived to be unable to perform.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Psychosocial Integrity
3. ANS: C
There are many purposes for participating in rehabilitation programs, including disability prevention, maintenance of functional ability, and restoration of function. Without the special knowledge learned through rehabilitation, the client with a newly acquired disability may never learn the skills needed to prevent long-term problems or conserve energy.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
4. ANS: C
In the United States, approximately 50% of the population has one or more chronic health problems, and about 35 million people (one in seven) experience some activity limitations because of their chronic health problems.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
5. ANS: A
Rehabilitation strategies for bowel training or habits are established based on what is normal for that specific client.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
6. ANS: B
Being able to manage independently the steps involved in toileting requires a high degree of manual dexterity with regard to the arms and hands.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
7. ANS: A
A low serum albumin level indicates less than adequate nutrition, especially of proteins, which greatly increases the risk for skin breakdown and reduces the rate of wound healing. Protein is a critical nutrient for stimulating DNA synthesis, cell division, and tissue repair.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
8. ANS: C
The Functional Independence Measure is a uniform data set used for outcome data collection in the United States. The FIM attempts to quantify what the person actually does, whatever the diagnosis or impairment. Categories for assessment are self-care, sphincter control, mobility, locomotion, communication, and cognition.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Physiological Integrity
9. ANS: B
The client already has a self-care deficit and impaired physical mobility related to the stroke. These problems greatly increase the risk for the client to experience skin breakdown, complicating or interfering with the recovery and rehabilitation efforts.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Physiological Integrity
10. ANS: A
With impaired mobility and use of a wheelchair, the client tends to gain weight. The increased weight requires greater upper body strength for movement and hinders the client's ability to become independent in transfer.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
11. ANS: D
Moving a joint beyond the point at which either the client feels pain or resistance is met can damage the joint.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
12. ANS: B
Although increasing the intake of calcium is good, this alone will not reduce the client's susceptibility to bone fractures. Weight-bearing activity reduces bone mineral loss and promotes bone uptake of calcium, contributing to maintenance of bone density and reducing the risk for bone fractures.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
13. ANS: C
Clients of any age with a variety of impairments and disabilities can participate in intermittent self-catheterization. The two main requirements are that the client be cognitively intact and can reach the area.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
14. ANS: A
Assessing serum and transferrin levels helps determine the client's nutritional status and allows the care providers to alter diet, as needed, to prevent pressure ulcers. All other actions on this list are treatment-oriented rather than prevention-oriented.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
15. ANS: A
Range-of-motion exercises involve skeletal muscle contraction of the upper and lower extremities. Muscle contraction promotes venous return, preventing stasis and thrombus formation.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
16. ANS: C
Some of the best techniques for energy conservation include spacing activities with a rest period in between and individualizing the scheduling of more energy-intensive activities to the time of day when the client knows or feels that his or her energy levels are higher.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
17. ANS: C
The goals of a bladder-training program are to avoid the use of an indwelling catheter and keep the residual volume at less than 100 mL.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Physiological Integrity
18. ANS: D
At home, clean technique for intermittent self-catheterization is sufficient to prevent cystitis and other urinary tract infections.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
19. ANS: D
Some organisms, such as Escherichia coli, grow best in an acidic environment. Fluids that promote an acidic urine include cranberry juice, prune juice, bouillon, tomato juice, and water.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
20. ANS: C
The older client with cardiac disease or on antihypertensive medications is particularly at risk for this complication.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
21. ANS: A
The most important requirement is the ability to get the client inside the home.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
22. ANS: B
Humans have 46 chromosomes (23 pairs). One pair, the sex chromosomes, codes for the sexual differentiation and development of the individual. The other 22 pairs (44 chromosomes) code for everything other than sexual differentiation and are known as autosomes.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
23. ANS: C
RNA is similar to DNA except that it is single-stranded and the base thymine (T) does not exist in RNA. Instead, every place the base thymine would be present in DNA, the base uracil (U) is placed in RNA. The RNA complementary to a segment of DNA would have an A wherever the DNA strand has a T, a C wherever the DNA strand has a G, a G wherever the DNA has a C, and a U wherever the DNA strand has an A.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
24. ANS: A
The amount of DNA present in human cells is enormous; however, most of it (about 95%) consists of noncoding regions. Only about 5% of human cellular DNA makes up the genes. It appears that we have, at most, about 35,000 genes and not the millions originally thought by the amount of DNA present.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
25. ANS: C
A nucleoside is an individual base connected to a pentose sugar. In order to have nucleosides form a strand of DNA by connecting them together, phosphorus is added, converting the nucleoside into a nucleotide.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
26. ANS: B
All human genes are present in every cell that has a nucleus; however, not all genes are active in all cells. Even though skin cells contain the gene for insulin, this gene is only turned on (active) in pancreatic beta cells. We know this because we can only find the protein insulin in those cells. Thus, the gene for insulin in pancreatic beta cells is expressed, but it is silent in skin cells (not expressed).
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
27. ANS: C
During the reproductive resting state of G0 and during the interphase of the cell cycle, the DNA is present in a loose helix that is not dense and is so fine that it cannot be seen with an ordinary microscope. During the M phase of the cell cycle, when the cell actually divides, the DNA coils up very tightly into thick, dense, temporary structures that can be stained and seen with an ordinary microscope.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
28. ANS: D
Some amino acids have more than one DNA code or triplet of bases. For example, glycine is coded for by the triplets CCA, CCG, CCT, and CCC. If a mutation in the DNA changed the “normal” triplet for glycine from CCT to CCA, the resulting mutated triplet would still code for glycine. Thus, there would be no amino acid difference in the final protein even though one base was exchanged for another as a result of a mutation in the DNA.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
29. ANS: B
Ribosomes are present in the cytoplasm and uncover the codons on the mRNA so that the correct amino acids are placed into newly synthesized protein chains.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
30. ANS: C
A point mutation is a single-base substitution. Often, this substitution does not disrupt protein synthesis, although the expressed protein may have one amino acid different than a protein made from a nonmutated gene. Frameshift mutations either delete one or more bases from the gene (most common) or add one or more bases to a gene. This deletion or addition of bases disrupts the correct “reading” of the gene and the wrong amino acids are placed into the protein. The protein made in this way does not resemble the correct protein and will not function.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
31. ANS: D
Transcription for both DNA synthesis and RNA synthesis uses many of the same enzymes and three of the four same bases. When transcription occurs for DNA synthesis, both strands (the sense and the antisense strands) of DNA are completely copied. For protein synthesis, only the strand that actually contains the gene (the sense strand) is copied. The entire strand isn’t copied—only the area where the specific gene is located.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
32. ANS: C
The gene locus is the specific chromosome location of a particular gene.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
33. ANS: A
Genotype refers to the exact alleles of a single gene trait. Phenotype refers to the observable characteristics present when a gene is expressed. For recessive traits, because both alleles must be the same (homozygous) for the gene to be expressed, the phenotype and the genotype are the same. Dominant traits are expressed in the phenotype, even when the person’s genotype is heterozygous for the alleles.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
34. ANS: B
Because the parents are each homozygous for the two blood type alleles, each parent will contribute a different allele for blood type. The mother will always contribute an A allele and the father with always contribute a B allele. Thus, the genotypes for blood type for any of their children will always be heterozygous with one A allele and one B allele. The A and B alleles for blood type are each dominant (co-dominant) and would both be expressed in the child’s phenotype as type AB blood.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
35. ANS: A
With a highly penetrant dominant trait, if a person has one allele, he or she would express the trait and have a 50% risk of transmitting it to his or her children. A person who does not express the trait does not have the allele and could not transmit the trait to his or her children.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
36. ANS: A
A dominant gene may be present and normal (or abnormal) and not expressed consistently in all people who have that gene or allele. This situation is referred to as reduced penetrance. The gene is present but either is or is not expressed. Expressivity refers to variation in degree of expression. The gene (and its alleles) is present and expressed, but in some people the phenotype may be so slight that the trait is barely seen, and in other people the phenotype may be so strong it cannot be missed.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
37. ANS: A
Multifactorial inheritance indicates an interaction between a genetic predisposition and the environment. Although the predisposition to developing a health problem may be inherited, whether or not the problem is ever expressed is determined by environmental influences, including lifestyle. Such disorders tend to appear more frequently in families but are not expressed as traditional inheritance patterns. The presence of these problems is also called “familial clustering.” Some common adult health problems that are multifactorial include hypertension, obesity, diabetes mellitus, and some types of cancer.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
38. ANS: C
At least three generations of family members need to be explored to even begin to rule in (or out) a possible genetic origin to a health problem. Such a problem could be identified in three generations if it had an autosomal dominant pattern of inheritance. If the problem is the result of a recessive gene or an X-linked gene, more than three generations would be needed to establish a pattern of inheritance.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
39. ANS: C
Squares are the symbols for males and circles symbolize the females in a kinship. Therefore, B and D are incorrect because they do not indicate the correct gender. All people who belong to one generation in a family share a horizontal line. The client’s mother’s sister would be on the same line as the client’s mother. His mother and her sister can be distinguished in this pedigree because only his mother would be part of the vertical line connecting this generation to the client.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
40. ANS: B
Any level of genetic counseling requires the counselor to be “nondirective.” The counselor must ensure that the client has adequate and accurate information upon which to base the decision but cannot suggest or direct the client to test or not to test. The client may wish to discuss the issue with his or her family but, ultimately, the decision about testing can only be made by the client.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity
41. ANS: D
You are supporting the client emotionally while she tells her daughter the information she has learned about the test results. You are not interpreting the results nor are you counseling the client or her daughter about what steps to take next.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity
42. ANS: C
This situation represents an ethical dilemma. The client does have the right to disclose or not disclose the information discovered by genetic testing. However, in this instance, disclosure could allow other people to check their health status and take preventive actions against the development of cancer. The client cannot be forced to disclose the results but should be encouraged to consider disclosure. The response described in C keeps the issue open for discussion later. There is no national or final legal point of view on the resolution of this controversy.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity
43. ANS: B
The concept of emergency department (ED) triage is based upon sorting clients into priority levels depending on illness or injury severity. The key concept is that the most serious clients who present to the ED receive the quickest evaluation and treatment.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and Maintenance;
44. ANS: C
The triage nurse should perform a rapid assessment to determine triage priority. The triage nurse should not be assigned tasks or have responsibilities to specific clients that will draw him or her away from the triage area.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and Maintenance;
45. ANS: C
The primary survey for a trauma client organizes the approach to the client so that life-threatening injuries are rapidly identified and managed. The primary survey is based on the standard mnemonic ABC, with an added D and E. A, airway and cervical spine control, B, breathing, C, circulation, D, disability, E, exposure.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
46. ANS: A
In a three-tiered triage model of emergent, urgent, and nonurgent, the client in the emergent triage category has a condition that may pose an immediate threat to life or limb and is given the highest priority. The urgent triage category is for clients who should be treated quickly but who do not have an immediate threat to life if they are not. Clients categorized as nonurgent generally can tolerate several hours of waiting time without a significant risk of deterioration.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
47. ANS: C
CISD is comprised of a team of specially trained individuals who come together quickly to deal with the emotional needs of health team members who have participated in a devastating or disturbing incident. Sessions generally last from 1 to 3 hours. CISD group leaders encourage group discussion by asking a series of questions designed to make everyone involved explain their part of the story and/or how the incident personally affected them.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Evaluation
MSC: Client Needs Category: Psychosocial Integrity
48. ANS: A
PTSD may occur in health care providers after an extremely emotional incident. It may be manifested by multiple psychological and physical effects such as flashbacks, avoidance, diminished interest in previously enjoyable events, detachment, and physical manifestations including rapid heart rate and insomnia and other physiologic effects of anxiety. Individuals suffering from PTSD may have difficulty in relating in their usual way to family and friends and may ultimately experience professional “burnout.”
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Evaluation
MSC: Client Needs Category: Psychosocial Integrity
49. ANS: B
In heat exhaustion, clients have normal mental status with the presence of flu-like symptoms. The client may have orthostatic hypotension and tachycardia. The client’s body temperature is not significantly elevated.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
50. ANS: C
Initial treatment of a client suffering from heat exhaustion consists of terminating the physical activity that promoted the exhaustion and moving the individual to a cool place.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
51. ANS: D
The toxic effects of coral snake venom are not seen immediately. The effects may be delayed for up to 12 to 13 hours after a bite, but then rapid clinical deterioration occurs. Unlike pit viper envenomation, pain at the bite site may be only mild and transient. Swelling is unlikely. Early symptoms consist of headache, nausea, vomiting, pallor, and abdominal pain. Paresthesias, numbness, and mental status changes also occur. Total flaccid paralysis may occur late. The victim may have difficulty speaking, swallowing, and breathing.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
52. ANS: A
Ice inhibits the action of neurotoxin and should be the first intervention provided to a client bitten by a black widow spider.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Psychological Integrity
53. ANS: D
Tetanus toxoid should be administered to any person suffering a bite, regardless of type. If the client has had a tetanus toxoid booster in the past 5 years, this is not necessary.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
54. ANS: C
Risk factors for cold injuries are obviously clients who do not have protection from the cold (e.g., the homeless). Clients with poor nutrition, fatigue, and multiple chronic illnesses are at greater risk. Clients who smoke, consume alcohol, or have impaired peripheral circulation have a higher incidence of frostbite. Any previous history of frostbite also increases a client’s susceptibility to a cold-related injury.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance
55. ANS: B
Mild hypothermia is considered a core body temperature of 32° to 35° C. Moderate hypothermia is considered a core body temperature of 28° to 32° C. Severe hypothermia is a core body temperature below 28° C.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
56. ANS: B
Mild hypothermia is manifested by shivering, dysarthria, muscular incoordination, and impaired cognitive abilities. Clients with moderate to severe hypothermia may be confused, stuporous, or even unconscious. Shivering has stopped. Bradycardia and hypotension may be present.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Physiological Integrity
57. ANS: C
Third-degree frostbite appears as small blisters that contain dark fluid. The affected body part is cool, numb, blue or red, and does not blanch. First-degree frostbite involves hyperemia and edema formation. With second-degree frostbite, large fluid-filled blisters develop, with some skin necrosis. In fourth-degree frostbite, there are no blisters or edema and the body part is numb, cold, and bloodless.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
58. ANS: B
Salt water is a hypertonic fluid that creates an osmotic gradient, which draws protein-rich fluid from the vascular space into the alveoli. This causes impaired alveolar ventilation and resultant intrapulmonary shunting, which compounds the hypoxic state.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity
59. ANS: B
The typical client with acute mountain sickness complains of throbbing headache and nausea and vomiting, and may also complain of feeling chilled, irritable, and apathetic. The syndrome produces effects similar to those of an alcohol-induced hangover. The client may complain of dyspnea, both on exertion and at rest.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
60. ANS: B
The oral medication acetazolamide (Diamox, Apo-Acetazolamide) is used to prevent and treat acute mountain sickness. Acetazolamide is a carbonic anhydrase inhibitor that acts by causing a bicarbonate diuresis that induces metabolic acidosis. The acidotic state increases respiratory rate and helps clients acclimate faster to a high altitude. Dexamethasone (Decadron, Deronil) may also be helpful in the treatment of moderate to severe acute mountain sickness.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
Identify the letter of the choice that best completes the statement or answers the question.
____ 1. What problem or disorder is a major cause of disability in adults under age 54 years in the United States?
a. Accidents
b. Morbid obesity
c. Coronary artery disease
d. Diabetes mellitus type 2
____ 2. How is a handicap different from an impairment, as defined by the World Health Organization?
a. An impairment may be temporary and a handicap is usually permanent.
b. Handicaps only involve mobility and an impairment may involve any organ structure or function.
c. Impairments are physical abnormalities and handicaps are societal values placed on individuals with impairments.
d. Handicaps are societal attempts to improve the functional ability of a person with an impairment, allowing more mainstream integration.
____ 3. The client who is a paraplegic is scheduled to participate in a rehabilitation program. She tells her nurse, “I don't understand why I should do rehabilitation. After all, my paralysis will not go away nor will it get better.” What is the nurse’s best response?
a. “Your doctor, one of the best in the specialty, ordered rehabilitation, and he does know what is best for you.”
b. “When new discoveries are made regarding paraplegia, people in rehabilitation programs will benefit first.”
c. “Rehabilitation will teach you how to maintain the functional ability you have.”
d. “You are right. I will cancel the orders for rehabilitation.”
____ 4. Which statement regarding disability and chronic illness is true?
a. Disabilities and chronic illnesses occur most often in young adults.
b. Accidents are responsible for more chronic and disabling conditions than chronic disease.
c. In the United States, one in seven persons experiences activity limitations because of chronic health problems.
d. Men experience more disability than women, but women experience a higher incidence of chronic illness than men.
____ 5. What is the most important information concerning elimination to assess for the client who is to undergo rehabilitation?
a. What was the client's usual bowel elimination pattern before the injury or illness?
b. Does the client have at least one bowel movement each day?
c. Can the client transfer from the wheelchair to the toilet?
d. Does the client have diarrhea?
____ 6. Which factor determines how independent a client can become with elimination?
a. Complication of the medication regimen
b. Degree of manual dexterity
c. Consistency of the stool
d. Volume of urine
____ 7. Which laboratory test abnormality in a client with a disabling condition alerts a nurse to an increased risk for skin breakdown?
a. Low serum albumin level
b. High serum transferrin level
c. Low serum carboxyhemoglobin
d. High serum hematocrit
____ 8. The client is scheduled for a functional assessment using the Functional Independence Measure (FIM). He asks the nurse, “What is the purpose of the FIM?” What is the nurse’s best response?
a. “It is a tool that is used to determine your level of independence.”
b. “It measures how you should be able to perform various tasks.”
c. “It is a tool to measure the severity of your disability.”
d. “It is a test the nurse manager uses to determine staffing patterns.”
____ 9. What is the priority nursing diagnosis for a client in a rehabilitation program after a stroke that caused extensive right-sided weakness?
a. Self-Care Deficit—Partial
b. Risk for Impaired Skin Integrity
c. Constipation
d. Impaired Physical Mobility
____ 10. Which client condition increases the chance for a problem with the technique needed for learning transfer?
a. The client has gained weight.
b. The client has aphasia.
c. The client is incontinent.
d. The client has minimal sensation in the lower extremities.
____ 11. The nurse is performing passive range-of-joint motion exercises on a semiconscious client and meets resistance while attempting to extend the right elbow more than 45 degrees. What is the nurse’s best action?
a. Splint the joint and continue the passive range of motion to the shoulder only.
b. Progressively increase the joint motion 5 degrees beyond the resistance each day.
c. Apply weights to the right distal extremity before initiating any joint exercise.
d. Move the joint only to the point at which resistance is met.
____ 12. Which intervention should the nurse implement and reinforce to prevent a client with reduced mobility from having increased susceptibility to bone fractures?
a. Apply a foot support when the client is in bed.
b. Encourage the client to perform weight-bearing activities.
c. Increase the amount of calcium-rich foods in the diet.
d. Ensure the continuous use of pressure-relieving devices.
____ 13. The use of intermittent self-catheterization is inappropriate for which of the following clients with a flaccid bladder?
a. The client older than 85 years of age
b. The client who is blind
c. The client who is confused
d. The client who is a paraplegic
____ 14. Which action should the nurse implement to prevent pressure ulcer formation in a bedridden client?
a. Assessing serum albumin and transferrin levels
b. Measuring the ulcer diameter and depth every shift
c. Changing the gauze dressing whenever drainage is observed
d. Applying antibiotic ointment to all excoriated skin areas
____ 15. Which nursing intervention should the nurse implement to prevent venous stasis and thrombus formation in a client undergoing rehabilitation after a stroke?
a. Range-of-motion exercises
b. Foot support while in bed
c. Increased dietary calcium intake
d. Avoidance of sudden position changes
____ 16. Which activity plan would best conserve a client's energy without compromising the client's physical or mental health?
a. Reducing hygiene activities and restricting visitors
b. Ensuring that the client toilets before and after any other planned activity
c. Scheduling energy-intensive activities at the time of day when the client has higher energy levels
d. Scheduling as many activities as possible within a small block of time to allow the client a longer, uninterrupted rest period
____ 17. The client in a rehabilitation program has been using the bladder training techniques of the Valsalva and Credé maneuvers. When a nurse catheterizes this client immediately after voiding, the residual volume is 50 mL. What is the nurse’s best action?
a. Notify the physician.
b. Insert an indwelling catheter.
c. Document the finding as the only action.
d. Modify or extend the bladder-training program.
____ 18. The client at home who is using intermittent self-catheterization is concerned about the cost of sterile straight catheters. What is the nurse’s best response?
a. “I will explore whether or not you qualify for money to purchase these necessary supplies.”
b. “Even though it is expensive, the cost of taking care of urinary tract infections would be even higher.”
c. “If you can treat the catheters by boiling them, you can reuse them up to 10 times each.”
d. “You can reuse the catheters here at home. Only clean technique, rather than sterile technique, is needed.”
____ 19. The client is at risk for a urinary tract infection. Which of the following beverages is the client encouraged to drink?
a. Carbonated beverages
b. Citrus juices
c. Milk
d. Tomato juice
____ 20. The older client is getting out of bed for the first time. The nurse should be alert for which of the following complications?
a. Deep vein thrombosis
b. Dyspnea
c. Orthostatic hypotension
d. Pulmonary embolism
____ 21. Prior to discharge, the case manger or occupational therapist visits the client’s home. Of the following, which one is of primary importance?
a. Accessibility to the home
b. Space requirements
c. Wheelchair accessibility
d. Doorway width
____ 22. What is the normal number of autosomal chromosomes for humans?
a. 42
b. 44
c. 46
d. 48
____ 23. You are looking at a small piece of single-stranded DNA with the base sequence of ACCTGAACGTCGCTA. What would be the sequence of the complementary strand of RNA?
a. TGGACTTGCAGCGAT
b. ACCTGAACGTCGCTA
c. UGGACUUGCAGCGAU
d. ACCUGAACGUCGCUA
____ 24. Approximately how many genes are estimated currently to compose the human genome?
a. 35,000
b. 100,000
c. 500,000
d. Over one million
____ 25. Which substance is present in a nucleotide but not in a nucleoside?
a. Uracil
b. Nitrogen
c. Phosphorus
d. Pentose (ribose) sugar
____ 26. What is the best meaning for the term gene expression?
a. The location of a specific gene allele on a specific autosomal chromosome
b. The specific trait or protein coded for by a single gene is actually present
c. The ability of a single gene to code for more than one trait or characteristic
d. The loss of a trait or characteristic from one family generation to the next generation
____ 27. In which phase of the cell cycle is DNA visible as chromosome structures?
a. G1
b. G2
c. M
d. S
____ 28. What is the expected result of a “silent” point mutation?
a. Total disruption of the gene reading frame, no production of protein
b. Replacement of one amino acid with another in the final gene product
c. Replacement of an amino acid codon with a “stop” codon, resulting in a truncated protein product
d. No change in amino acid sequence and no change in the composition of the protein product
____ 29. What is the function of ribosomes (also known as ribosomal RNA) in protein synthesis?
a. Serves as an adaptor molecule able to transport a specific amino acid to the site of protein synthesis (peptide chain elongation) in the correct sequence
b. Serves as the coordinator molecule to allow proper reading of the mRNA and placement of the correct amino acid in the sequence by the tRNAs
c. Allows interpretation of the two strands of DNA to determine which is the "sense" strand and which is the "antisense" strand
d. Allows further processing of synthesized proteins (post-translational modification) in order to ensure that the final product is physiologically active
____ 30. What makes a “frameshift” mutational event more serious than a “point” mutational event?
a. Frameshift mutations occur primarily in germline cells and point mutations occur only in somatic cells.
b. Frameshift mutations result in the deletion or addition of whole chromosomes (aneuploidy) and point mutations are undetectable at the chromosome level.
c. When the mutations occur in expressed genes, frameshift mutations always result in disruption of the gene function, whereas a point mutation can be silent.
d. The rate of frameshift mutations increases with aging as the function of DNA repair mechanisms declines, whereas the rate of point mutations is unchanged with age.
____ 31. What is the difference between DNA transcription for DNA synthesis and DNA transcription for protein synthesis?
a. Transcription for DNA synthesis is rapidly followed by the process of translation.
b. Transcription for protein synthesis has “greater fidelity” than does transcription for DNA synthesis.
c. Transcription for protein synthesis occurs only in cells undergoing mitosis and transcription for DNA synthesis occurs in both dividing and nondividing cells.
d. Transcription for DNA synthesis occurs with both the “sense” and the “antisense” strands, whereas transcription for protein synthesis occurs with only the “sense” strand.
____ 32. What is the correct interpretation of the statement, “the HFE gene locus is 6p21”?
a. Both alleles of the HFE gene are equally expressed.
b. The HFE gene is inherited from the paternal chromosome line.
c. The HFE gene is located on the “short arm” of chromosome number 6.
d. There is a somatic cell mutation involving gene damage on chromosome 6.
____ 33. Which statement regarding genotype and phenotype is true?
a. For autosomal recessive traits, the phenotype is the same as the genotype.
b. The only trait in which phenotype always follows genotype is physiologic gender.
c. When a phenotype is fully penetrant, the trait is expressed in the heterozygous person.
d. Genotype changes as a person ages, whereas phenotype is not affected by the aging process.
____ 34. What are the expected blood types of children from a mother who is AA for blood type and a father who is BB for blood type?
a. All children will have type O blood.
b. All children will have type AB blood.
c. 50% of the children will have type A blood and 50% of the children will have type B blood.
d. 25% will have type A blood, 50% will have type AB blood, and 25% will have type B blood.
____ 35. Which statement is a criterion for an autosomal dominant pattern of inheritance for a specific trait or characteristic that is highly penetrant?
a. Unaffected family members do not transmit the trait to their children.
b. Genotypes of individuals expressing the trait must be homozygous.
c. The trait appears only among male offspring of female carriers.
d. Carriers for the trait do not necessarily express the trait.
____ 36. How are “gene penetrance” and “gene expressivity” different?
a. With penetrance, the gene is either expressed completely or is not expressed at all. With expressivity, the gene is always expressed but the degree of expression can range from minor to extreme.
b. Penetrance and expressivity are both related to “gene dosage.” With penetrance, only one copy of the gene is expressed and, with expressivity, more than one copy of the gene can be expressed.
c. Gene penetrance and gene expressivity are merely different terms for the same concept, overexpression of recessive alleles.
d. Penetrance refers to the actual gene structure in the DNA and expressivity refers to the chromosome locus of the gene.
____ 37. Which statement or condition best demonstrates the concept of “multifactorial inheritance”?
a. A mutation in a single gene results in the expression of problems in a variety of tissues and organs.
b. The susceptibility to a problem is inherited as a single gene trait but development of the problem is related to environmental conditions.
c. A mutated gene is inherited but the results of expression of that gene are not evident until middle or late adulthood.
d. Several genes are responsible for the mechanism of hearing and a mutation in any one of them results in hearing impairment.
____ 38. When constructing a pedigree around a specific health problem, what is the minimal number of generations needed to assess the presence or absence of a genetic factor in disease development accurately?
a. 1
b. 2
c. 3
d. 4
____ 39. In constructing a pedigree for a man whose maternal grandfather has Huntington’s disease, you include the man’s maternal grandparents, his parents, his mother’s only sister, his three sisters and one brother, and his twin sons. Which pedigree symbol and position would represent his mother’s sister?
a. The circle on the highest horizontal line above the client’s symbol
b. The square on the horizontal line directly above the client’s symbol
c. The circle on the horizontal line above the client’s symbol that does not directly touch the vertical line leading to the client
d. The square on the same horizontal line as the client’s symbol that directly touches the vertical line leading to the client’s mother
____ 40. The client, whose mother has Huntington’s disease, is considering genetic testing but is not sure whether she really wants to know if she has the mutation. She asks what you would do if your mother had the disease. What is your best response?
a. “I would have the test so I could decide whether to have children or to adopt children.”
b. “I can only tell you the benefits and the risks of testing. You must make this decision yourself.”
c. “Because there is no cure for this disease and testing would not be beneficial, I would not have the test.”
d. “You need to check with your brothers and sisters to determine whether testing for this disease would be appropriate for you”
____ 41. The client who has been found to have a mutation in the BRCA1 gene allele and an increased risk for breast and ovarian cancer has asked you to be present when she discloses this information to her grown daughter. What is your role in this situation?
a. Primary health care provider
b. Genetic counselor
c. Client advocate
d. Client support
____ 42. What should you tell the client who has been found to have a genetic mutation that increases the risk for colon cancer who says he does not want any of his family to know about this result?
a. “It is required by law that you inform your siblings and your children about this result so that they also can be tested and monitored for colon cancer.”
b. “It is not necessary to tell your siblings, because they are adults, but you should tell your children so that they can be tested before they decide to have children of their own.”
c. “It is not required that you tell anyone about this result; however, because your siblings and children may also be at risk for colon cancer, you should think about how this information might help them.”
d. “It is your decision to determine with whom, if anyone, you discuss this test result; however, if you do not tell any of your family members and they get colon cancer, you would be responsible for their developing the disease.”
____ 43. Which is the most important goal of triage?
a. Assigning each client to the most appropriate treatment area
b. Giving priority of care to the most critically ill or injured clients
c. Providing a through assessment of the client
d. Obtaining a complete history of the client’s past medical-surgical history
____ 44. What is a correct statement regarding the major role of the triage nurse?
a. Provide a through and comprehensive assessment of each client.
b. Be able to splint and perform minor procedures.
c. Perform rapid assessment to determine priority of care.
d. Provide psychological support to family members.
____ 45. What is the primary survey?
a. Airway, breathing, circulation, head to toe assessment
b. Airway, breathing, circulation, neurologic assessment
c. Airway and cervical spine control, breathing, circulation, disability, exposure
d. Airway and cervical spine control, breathing, circulation, head to toe assessment
____ 46. A 67-year-old male presents to the ED complaining of chest pain. His heart rate is 120 beats/min, his blood pressure is 100/68 mm Hg, and his respiratory rate is 20 breaths/min. His is short of breath and diaphoretic. In a three-tiered triage model, how should the nurse prioritize this client?
a. Emergent
b. Urgent
c. Nonurgent
d. Dormant
____ 47. Which of the following statements is true regarding critical incident stress debriefing (CISD)?
a. CISD should not occur until several months have passed since the incident.
b. CISD consists of a group leader who is the main speaker.
c. CISD encourages group discussion.
d. CISD is limited to health care providers.
____ 48. Which of the following statements are true regarding post-traumatic stress disorder (PTSD)?
a. Individuals suffering from PTSD may display physical manifestations.
b. Professional “burnout” is rare secondary to PTSD.
c. Critical incident stress management is the only method to deal with PTSD.
d. Manifestations of PTSD are purely psychological.
____ 49. A woman presents to the emergency department after working outdoors in the sun all day. The nurse suspects heat exhaustion after his initial interview and assessment of the client. Which of the following symptoms would support his diagnosis?
a. Confusion
b. Normal body temperature
c. Elevated body temperature
d. Hypertension
____ 50. What is the highest priority of care in the prehospital setting for clients suffering from heat exhaustion (after airway assessment)?
a. Start intravenous fluids to hydrate the client.
b. Immerse the client in ice water.
c. Remove the client from physical activity and put him or her in a cool place.
d. Wait for paramedics to arrive and place the client in an air-conditioned vehicle.
____ 51. Which of the following statements is true regarding coral snake envenomation?
a. The toxic effects of coral snake venom are seen immediately.
b. Coagulopathy occurs in severe cases.
c. Pain at the bite site is severe.
d. Early symptoms of envenomation include nausea, vomiting, headache, and pallor.
____ 52. The primary first aid intervention in the prehospital setting for a black widow spider bite is the application of ice. Which statement provides the best rationale for this intervention?
a. Ice inhibits the action of neurotoxin.
b. Ice reduces swelling in the affected extremity.
c. Ice decreases venous return from the affected extremity.
d. Ice decreases the pain associated with spider bites.
____ 53. When caring for a client who has suffered a spider bite, which medication order might the nurse expect from the physician?
a. Antibiotics
b. Antispasmodics
c. Antimalarials
d. Tetanus toxoid
____ 54. Which of the clients listed below would be most susceptible to hypothermia?
a. A 17-year-old female with type 2 diabetes
b. A 10-year-old female with asthma
c. A 56-year-old male with a history of alcohol and tobacco abuse
d. A 76-year-old male with hypertension
____ 55. Mild hypothermia is defined a core body temperature of
a. 35° to 37° C
b. 32° to 35° C
c. 28° to 32° C
d. 24° to 28° C
____ 56. A 60-year-old male presents to the emergency department with hypothermia. He is shivering, has muscular incoordination, and is slow to respond questions. What stage of hypothermia is manifested by this client?
a. Frostbite
b. Mild hypothermia
c. Moderate hypothermia
d. Severe hypothermia
____ 57. A client suffering from severe hypothermia also is noted to have a cool, numb foot. The foot is blue in color and does not blanch. What degree of frostbite would this be?
a. First-degree frostbite
b. Second-degree frostbite
c. Third-degree frostbite
d. Fourth-degree frostbite
____ 58. The key factor in the pathophysiology of a near drowning in salt water is that aspirated water
a. Washes surfactant out of the lungs
b. Causes an osmotic gradient that draws water into the alveoli
c. Decreases lung compliance
d. Increases the work of breathing, leading to hypoxia
____ 59. A 50-year-old mountain climber is brought to the emergency department after a climb complaining of headache, nausea and vomiting, and “feeling winded.” The nurse suspects which altitude-related illness?
a. High-altitude cerebral edema (HACE)
b. Acute mountain sickness (AMS)
c. High-altitude pulmonary edema (HAPE)
d. High-altitude mountain sickness (HAMS)
____ 60. A 50-year-old mountain climber is brought to the emergency department after a climb complaining of headache, nausea and vomiting, and “feeling winded.” What medication would the nurse expect the physician to order?
a. Furosemide (Lasix)
b. Acetazolamide (Diamox, Apo-Acetazolamide)
c. Atropine sulfate
d. Ketorolac tromethamine (Toradol)
Answer Section
MULTIPLE CHOICE
1. ANS: A
Although stroke is the leading cause of disability in the United States, costing more than $30 billion each year in medical costs and loss of productivity, many younger adults are disabled from accidents rather than from disease.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
2. ANS: C
A handicap is a preventable and reversible disturbance at the societal level that is experienced by a person with a disability or impairment. It is a negative value that is ascribed to the person, the disability, or the impairment. A handicap is often described by what a person is perceived to be unable to perform.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Psychosocial Integrity
3. ANS: C
There are many purposes for participating in rehabilitation programs, including disability prevention, maintenance of functional ability, and restoration of function. Without the special knowledge learned through rehabilitation, the client with a newly acquired disability may never learn the skills needed to prevent long-term problems or conserve energy.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
4. ANS: C
In the United States, approximately 50% of the population has one or more chronic health problems, and about 35 million people (one in seven) experience some activity limitations because of their chronic health problems.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
5. ANS: A
Rehabilitation strategies for bowel training or habits are established based on what is normal for that specific client.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
6. ANS: B
Being able to manage independently the steps involved in toileting requires a high degree of manual dexterity with regard to the arms and hands.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
7. ANS: A
A low serum albumin level indicates less than adequate nutrition, especially of proteins, which greatly increases the risk for skin breakdown and reduces the rate of wound healing. Protein is a critical nutrient for stimulating DNA synthesis, cell division, and tissue repair.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
8. ANS: C
The Functional Independence Measure is a uniform data set used for outcome data collection in the United States. The FIM attempts to quantify what the person actually does, whatever the diagnosis or impairment. Categories for assessment are self-care, sphincter control, mobility, locomotion, communication, and cognition.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Physiological Integrity
9. ANS: B
The client already has a self-care deficit and impaired physical mobility related to the stroke. These problems greatly increase the risk for the client to experience skin breakdown, complicating or interfering with the recovery and rehabilitation efforts.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Physiological Integrity
10. ANS: A
With impaired mobility and use of a wheelchair, the client tends to gain weight. The increased weight requires greater upper body strength for movement and hinders the client's ability to become independent in transfer.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
11. ANS: D
Moving a joint beyond the point at which either the client feels pain or resistance is met can damage the joint.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
12. ANS: B
Although increasing the intake of calcium is good, this alone will not reduce the client's susceptibility to bone fractures. Weight-bearing activity reduces bone mineral loss and promotes bone uptake of calcium, contributing to maintenance of bone density and reducing the risk for bone fractures.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
13. ANS: C
Clients of any age with a variety of impairments and disabilities can participate in intermittent self-catheterization. The two main requirements are that the client be cognitively intact and can reach the area.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
14. ANS: A
Assessing serum and transferrin levels helps determine the client's nutritional status and allows the care providers to alter diet, as needed, to prevent pressure ulcers. All other actions on this list are treatment-oriented rather than prevention-oriented.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
15. ANS: A
Range-of-motion exercises involve skeletal muscle contraction of the upper and lower extremities. Muscle contraction promotes venous return, preventing stasis and thrombus formation.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
16. ANS: C
Some of the best techniques for energy conservation include spacing activities with a rest period in between and individualizing the scheduling of more energy-intensive activities to the time of day when the client knows or feels that his or her energy levels are higher.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
17. ANS: C
The goals of a bladder-training program are to avoid the use of an indwelling catheter and keep the residual volume at less than 100 mL.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Evaluation
MSC: Client Needs Category: Physiological Integrity
18. ANS: D
At home, clean technique for intermittent self-catheterization is sufficient to prevent cystitis and other urinary tract infections.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
19. ANS: D
Some organisms, such as Escherichia coli, grow best in an acidic environment. Fluids that promote an acidic urine include cranberry juice, prune juice, bouillon, tomato juice, and water.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
20. ANS: C
The older client with cardiac disease or on antihypertensive medications is particularly at risk for this complication.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
21. ANS: A
The most important requirement is the ability to get the client inside the home.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
22. ANS: B
Humans have 46 chromosomes (23 pairs). One pair, the sex chromosomes, codes for the sexual differentiation and development of the individual. The other 22 pairs (44 chromosomes) code for everything other than sexual differentiation and are known as autosomes.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
23. ANS: C
RNA is similar to DNA except that it is single-stranded and the base thymine (T) does not exist in RNA. Instead, every place the base thymine would be present in DNA, the base uracil (U) is placed in RNA. The RNA complementary to a segment of DNA would have an A wherever the DNA strand has a T, a C wherever the DNA strand has a G, a G wherever the DNA has a C, and a U wherever the DNA strand has an A.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
24. ANS: A
The amount of DNA present in human cells is enormous; however, most of it (about 95%) consists of noncoding regions. Only about 5% of human cellular DNA makes up the genes. It appears that we have, at most, about 35,000 genes and not the millions originally thought by the amount of DNA present.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
25. ANS: C
A nucleoside is an individual base connected to a pentose sugar. In order to have nucleosides form a strand of DNA by connecting them together, phosphorus is added, converting the nucleoside into a nucleotide.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
26. ANS: B
All human genes are present in every cell that has a nucleus; however, not all genes are active in all cells. Even though skin cells contain the gene for insulin, this gene is only turned on (active) in pancreatic beta cells. We know this because we can only find the protein insulin in those cells. Thus, the gene for insulin in pancreatic beta cells is expressed, but it is silent in skin cells (not expressed).
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
27. ANS: C
During the reproductive resting state of G0 and during the interphase of the cell cycle, the DNA is present in a loose helix that is not dense and is so fine that it cannot be seen with an ordinary microscope. During the M phase of the cell cycle, when the cell actually divides, the DNA coils up very tightly into thick, dense, temporary structures that can be stained and seen with an ordinary microscope.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
28. ANS: D
Some amino acids have more than one DNA code or triplet of bases. For example, glycine is coded for by the triplets CCA, CCG, CCT, and CCC. If a mutation in the DNA changed the “normal” triplet for glycine from CCT to CCA, the resulting mutated triplet would still code for glycine. Thus, there would be no amino acid difference in the final protein even though one base was exchanged for another as a result of a mutation in the DNA.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
29. ANS: B
Ribosomes are present in the cytoplasm and uncover the codons on the mRNA so that the correct amino acids are placed into newly synthesized protein chains.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
30. ANS: C
A point mutation is a single-base substitution. Often, this substitution does not disrupt protein synthesis, although the expressed protein may have one amino acid different than a protein made from a nonmutated gene. Frameshift mutations either delete one or more bases from the gene (most common) or add one or more bases to a gene. This deletion or addition of bases disrupts the correct “reading” of the gene and the wrong amino acids are placed into the protein. The protein made in this way does not resemble the correct protein and will not function.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
31. ANS: D
Transcription for both DNA synthesis and RNA synthesis uses many of the same enzymes and three of the four same bases. When transcription occurs for DNA synthesis, both strands (the sense and the antisense strands) of DNA are completely copied. For protein synthesis, only the strand that actually contains the gene (the sense strand) is copied. The entire strand isn’t copied—only the area where the specific gene is located.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
32. ANS: C
The gene locus is the specific chromosome location of a particular gene.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
33. ANS: A
Genotype refers to the exact alleles of a single gene trait. Phenotype refers to the observable characteristics present when a gene is expressed. For recessive traits, because both alleles must be the same (homozygous) for the gene to be expressed, the phenotype and the genotype are the same. Dominant traits are expressed in the phenotype, even when the person’s genotype is heterozygous for the alleles.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
34. ANS: B
Because the parents are each homozygous for the two blood type alleles, each parent will contribute a different allele for blood type. The mother will always contribute an A allele and the father with always contribute a B allele. Thus, the genotypes for blood type for any of their children will always be heterozygous with one A allele and one B allele. The A and B alleles for blood type are each dominant (co-dominant) and would both be expressed in the child’s phenotype as type AB blood.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
35. ANS: A
With a highly penetrant dominant trait, if a person has one allele, he or she would express the trait and have a 50% risk of transmitting it to his or her children. A person who does not express the trait does not have the allele and could not transmit the trait to his or her children.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
36. ANS: A
A dominant gene may be present and normal (or abnormal) and not expressed consistently in all people who have that gene or allele. This situation is referred to as reduced penetrance. The gene is present but either is or is not expressed. Expressivity refers to variation in degree of expression. The gene (and its alleles) is present and expressed, but in some people the phenotype may be so slight that the trait is barely seen, and in other people the phenotype may be so strong it cannot be missed.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
37. ANS: A
Multifactorial inheritance indicates an interaction between a genetic predisposition and the environment. Although the predisposition to developing a health problem may be inherited, whether or not the problem is ever expressed is determined by environmental influences, including lifestyle. Such disorders tend to appear more frequently in families but are not expressed as traditional inheritance patterns. The presence of these problems is also called “familial clustering.” Some common adult health problems that are multifactorial include hypertension, obesity, diabetes mellitus, and some types of cancer.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
38. ANS: C
At least three generations of family members need to be explored to even begin to rule in (or out) a possible genetic origin to a health problem. Such a problem could be identified in three generations if it had an autosomal dominant pattern of inheritance. If the problem is the result of a recessive gene or an X-linked gene, more than three generations would be needed to establish a pattern of inheritance.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
39. ANS: C
Squares are the symbols for males and circles symbolize the females in a kinship. Therefore, B and D are incorrect because they do not indicate the correct gender. All people who belong to one generation in a family share a horizontal line. The client’s mother’s sister would be on the same line as the client’s mother. His mother and her sister can be distinguished in this pedigree because only his mother would be part of the vertical line connecting this generation to the client.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: N/A
40. ANS: B
Any level of genetic counseling requires the counselor to be “nondirective.” The counselor must ensure that the client has adequate and accurate information upon which to base the decision but cannot suggest or direct the client to test or not to test. The client may wish to discuss the issue with his or her family but, ultimately, the decision about testing can only be made by the client.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity
41. ANS: D
You are supporting the client emotionally while she tells her daughter the information she has learned about the test results. You are not interpreting the results nor are you counseling the client or her daughter about what steps to take next.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity
42. ANS: C
This situation represents an ethical dilemma. The client does have the right to disclose or not disclose the information discovered by genetic testing. However, in this instance, disclosure could allow other people to check their health status and take preventive actions against the development of cancer. The client cannot be forced to disclose the results but should be encouraged to consider disclosure. The response described in C keeps the issue open for discussion later. There is no national or final legal point of view on the resolution of this controversy.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation
MSC: Client Needs Category: Health Promotion and Maintenance/Psychosocial Integrity
43. ANS: B
The concept of emergency department (ED) triage is based upon sorting clients into priority levels depending on illness or injury severity. The key concept is that the most serious clients who present to the ED receive the quickest evaluation and treatment.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and Maintenance;
44. ANS: C
The triage nurse should perform a rapid assessment to determine triage priority. The triage nurse should not be assigned tasks or have responsibilities to specific clients that will draw him or her away from the triage area.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Safe, Effective Care Environment/Health Promotion and Maintenance;
45. ANS: C
The primary survey for a trauma client organizes the approach to the client so that life-threatening injuries are rapidly identified and managed. The primary survey is based on the standard mnemonic ABC, with an added D and E. A, airway and cervical spine control, B, breathing, C, circulation, D, disability, E, exposure.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
46. ANS: A
In a three-tiered triage model of emergent, urgent, and nonurgent, the client in the emergent triage category has a condition that may pose an immediate threat to life or limb and is given the highest priority. The urgent triage category is for clients who should be treated quickly but who do not have an immediate threat to life if they are not. Clients categorized as nonurgent generally can tolerate several hours of waiting time without a significant risk of deterioration.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
47. ANS: C
CISD is comprised of a team of specially trained individuals who come together quickly to deal with the emotional needs of health team members who have participated in a devastating or disturbing incident. Sessions generally last from 1 to 3 hours. CISD group leaders encourage group discussion by asking a series of questions designed to make everyone involved explain their part of the story and/or how the incident personally affected them.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Evaluation
MSC: Client Needs Category: Psychosocial Integrity
48. ANS: A
PTSD may occur in health care providers after an extremely emotional incident. It may be manifested by multiple psychological and physical effects such as flashbacks, avoidance, diminished interest in previously enjoyable events, detachment, and physical manifestations including rapid heart rate and insomnia and other physiologic effects of anxiety. Individuals suffering from PTSD may have difficulty in relating in their usual way to family and friends and may ultimately experience professional “burnout.”
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Evaluation
MSC: Client Needs Category: Psychosocial Integrity
49. ANS: B
In heat exhaustion, clients have normal mental status with the presence of flu-like symptoms. The client may have orthostatic hypotension and tachycardia. The client’s body temperature is not significantly elevated.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
50. ANS: C
Initial treatment of a client suffering from heat exhaustion consists of terminating the physical activity that promoted the exhaustion and moving the individual to a cool place.
DIF: Cognitive Level: Application or higher
TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Physiological Integrity
51. ANS: D
The toxic effects of coral snake venom are not seen immediately. The effects may be delayed for up to 12 to 13 hours after a bite, but then rapid clinical deterioration occurs. Unlike pit viper envenomation, pain at the bite site may be only mild and transient. Swelling is unlikely. Early symptoms consist of headache, nausea, vomiting, pallor, and abdominal pain. Paresthesias, numbness, and mental status changes also occur. Total flaccid paralysis may occur late. The victim may have difficulty speaking, swallowing, and breathing.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
52. ANS: A
Ice inhibits the action of neurotoxin and should be the first intervention provided to a client bitten by a black widow spider.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Psychological Integrity
53. ANS: D
Tetanus toxoid should be administered to any person suffering a bite, regardless of type. If the client has had a tetanus toxoid booster in the past 5 years, this is not necessary.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
54. ANS: C
Risk factors for cold injuries are obviously clients who do not have protection from the cold (e.g., the homeless). Clients with poor nutrition, fatigue, and multiple chronic illnesses are at greater risk. Clients who smoke, consume alcohol, or have impaired peripheral circulation have a higher incidence of frostbite. Any previous history of frostbite also increases a client’s susceptibility to a cold-related injury.
DIF: Cognitive Level: Application or higher TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Health Promotion and Maintenance
55. ANS: B
Mild hypothermia is considered a core body temperature of 32° to 35° C. Moderate hypothermia is considered a core body temperature of 28° to 32° C. Severe hypothermia is a core body temperature below 28° C.
DIF: Cognitive Level: Knowledge TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
56. ANS: B
Mild hypothermia is manifested by shivering, dysarthria, muscular incoordination, and impaired cognitive abilities. Clients with moderate to severe hypothermia may be confused, stuporous, or even unconscious. Shivering has stopped. Bradycardia and hypotension may be present.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Analysis
MSC: Client Needs Category: Physiological Integrity
57. ANS: C
Third-degree frostbite appears as small blisters that contain dark fluid. The affected body part is cool, numb, blue or red, and does not blanch. First-degree frostbite involves hyperemia and edema formation. With second-degree frostbite, large fluid-filled blisters develop, with some skin necrosis. In fourth-degree frostbite, there are no blisters or edema and the body part is numb, cold, and bloodless.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
58. ANS: B
Salt water is a hypertonic fluid that creates an osmotic gradient, which draws protein-rich fluid from the vascular space into the alveoli. This causes impaired alveolar ventilation and resultant intrapulmonary shunting, which compounds the hypoxic state.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: N/A
MSC: Client Needs Category: Physiological Integrity
59. ANS: B
The typical client with acute mountain sickness complains of throbbing headache and nausea and vomiting, and may also complain of feeling chilled, irritable, and apathetic. The syndrome produces effects similar to those of an alcohol-induced hangover. The client may complain of dyspnea, both on exertion and at rest.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Assessment
MSC: Client Needs Category: Physiological Integrity
60. ANS: B
The oral medication acetazolamide (Diamox, Apo-Acetazolamide) is used to prevent and treat acute mountain sickness. Acetazolamide is a carbonic anhydrase inhibitor that acts by causing a bicarbonate diuresis that induces metabolic acidosis. The acidotic state increases respiratory rate and helps clients acclimate faster to a high altitude. Dexamethasone (Decadron, Deronil) may also be helpful in the treatment of moderate to severe acute mountain sickness.
DIF: Cognitive Level: Comprehension TOP: Nursing Process Step: Implementation/Intervention
MSC: Client Needs Category: Health Promotion and Maintenance
