Pre-Board Exam Drill

SITUATION 1: A patient just arrived in the Oncology unit from the Post Anesthesia Care Unit (PACU) following a Left Modified Radical Mastectomy because of Inflammatory Breast Cancer (IBC). She has a pressure dressing over the surgical site and two drains. Assessment shows her vital signs are stable, fully awake and claims that pain is under control. Fortune is the nurse assigned to the patient.
1. From the following data obtained from the chart by Fortune, which is NOT a risk factor which could have predisposed the patient to breast cancer:
a. Age – 55
b. Height 5’2”, weight 160 lbs.
c. Menarche at age 13
d. Mother died of colon cancer
2. Fortune read a literature which says that by the time Inflammatory Breast Cancer (IBC) is diagnosed, 50% - 75% have palpable auxiliary nodes; as many as 30% have gross distant metastasis; and as few as 30% of patients have an underlying breast mass. Which of the following is the APPROPRIATE interpretation of this research findings.
a. Auxiliary nodes were palpated on 20 out of 30 women positive for IBC3
b. Out of the 20 women who were positive for IBC, only 5 have metastasis
c. If there were 10 women diagnosed with IBC, 3 have positive lymph nodes
d. Breast mass was identified on 8 out of 30 women positive for IBC
3. Fortune recognizes that adjuvant chemotherapy for breast cancer may include any of the following EXCEPT:
a. Monoclonal antibody
b. Antibiotics
c. Proton inhibitors – this is a drug for ulcer
d. Antiestrogen – tamoxifen

4. Fortune understands that when the antineoplastic  agent leaks through the peripheral vascular access during chemotherapy procedure, which of the following is expected to be done FIRST?
a. Refer to the physician
b. Stop the chemotherapy infusion
c. Cleanse site with saline solution
d. Call another nurse to check the intravenous site

5. A clinical trial is currently being undertaken to test treatments for Inflammatory Breast Cancer (IBC). The research team leader wishes to include the patient as a participant in the study. As a patient advocate, which of the following will Fortune do FIRST?
a. Obtain informed consent from the patient
b. Explain to the patient the scope of the clinical trial
c. Inquire from the team leader benefits for the patient
d. Read more related literatures
SITUATION 2: During a staff meeting in the Intensive Care Unit, the nurse manager reported a list of procedures that need to be reviewed and updated. One of these procedures is the precautionary measures related to ventilator associated pneumonia.- on mechanical ventilation through an endotracheal or tracheostomy tube for at least 48 hours
6. While brainstorming, the group mentioned the use of evidence-based techniques. Which of the following statements given by the members of the group reflect evidence-based methods?
a. “Let us ask opinions of experts”
b. “The experiences of the nurses must be obtained”
c. “Review of related literature will be very helpful”
d. “We must agree on a common procedure”
7. The nurse manager assigned a group to develop a project intended to improve the existing procedure related to the prevention of ventilator associated pneumonia among ICU patients. A first team leader was selected by the group. Which of the following will the team leader do FIRST?
a. Tell the group to state their objectives
b. Formulate a list of desired outcomes
c. Set a target
d. State actions to be done by each member of the group
8. Which of the following definitions best describes pneumonia?
 A. Inflammation of the large airways
B. Severe infection of the bronchioles
C. Inflammation of the pulmonary parenchyma
D. accumulation of fluids in the lungs
9. The nurse is preparing her plan of care for her patient diagnosed with pneumonia. Which is the most appropriate nursing diagnosis for this patient?
        A. Fluid volume deficit
        B. Decreased tissue perfusion.
        C. Impaired gas exchange.
        D. Risk for infection

10. What action should the nurse take in assisting Mr. Ramos in doing deep breathing and coughing exercise?
A. Recognize that the patient is too sick to cough at this time
B. Splint the patient’s chest while he coughs
C. Turn Mr. Ramos to the unaffected side and ask him to cough
D. Encourage her to cough and then give her pain medication as ordered
11. Ms. Sy undergoes surgery and the abdominal aortic aneurysm is resected and  replaced with a graft. When she arrives in the RR she is still in shock. The nurse's priority should be
         A. placing her in a trendeleburg position
         B. putting several warm blankets on her
         C. monitoring her hourly urine output
         D. assessing her VS especially her RR

12. Ana's postoperative vital signs are a blood pressure of 80/50 mm Hg, a pulse of 140, and respirations of 32. Suspecting shock, which of the following orders would the nurse question?
         A. Put the client in modified Trendelenberg's position.
         B. Administer oxygen at 100
         C. Monitor urine output every hour.
         D. Administer Demerol 50mg IM q4h

13. When assessing Luther for hypovolemic shock, which of the following data indicates that he is in IRREVERSIBLE stage of shock?
a. Restless, anxious and confused
b. Anuria
c. Skin, cool, pale and moist- compensatory stage
d. Pulse rapid and weak – reversible stage
14. The physician ordered colloid solution such as Dextran 40. During the infusion, Luther complained of dyspnea. Upon auscultation, you noted wheezes. Which of the following will you do FIRST?
a. Discontinue the infusion
b. Place Luther on a Fowler’s position..
c. Decrease infusion rate
d. Call the attending physician

15. Luther’s central venous pressure is monitored every hour. When you measure the CVP using a water manometer, you are expected to observe which of the following to ensure accuracy of CVP measurement?
a. Maintain the client on a Fowler’s position
b. Use a one way stopcock to regulate flow of IV fluids to the water manometer
c. Immobilize client’s right arm
d. Keep the zero point of the manometer in level with the client’s right atrium
SITUATION 4: You are caring for Warren, 58 years old, who is diagnosed with Laryngeal cancer
16. Warren, who is scheduled for a total laryngectomy and radical neck dissection for cancer of the larynx, asks you, “How will I talk after the surgery?” as his nurse your BEST response will be:
a. “You will breathe through a permanent opening in your neck, but you will not be able to communicate orally”
b. “You won’t be able to talk right after surgery, but you will be able to speak again once the tracheostomy tube is removed”
c. “You will have a permanent opening in your neck, and you will need to have rehabilitation for some type of voice restoration”
d. “You won’t be able to speak as you used to but there are artificial voice devices that will give you the ability to speak normally”
17. Warren returns from surgery with a tracheostomy tube after a total laryngectomy and radical neck dissection. In caring for Warren during the first 24 hours after surgery, your PRIORITY nursing action is to:
a. Avoid changing tracheostomy ties
b. Monitor for bleeding around stoma
c. Assess the airway patency and breath sounds
d. Clean the inner cannula every 8 hours
18. After doing assessment, one of the nursing diagnosis you identified is “Body image disturbance related to loss of control of personal care.” To evaluate effectiveness of your interventions, the expected outcome for the problem that Warren should demonstrate is that he:
a. Lets his wife provide hygiene and stoma care
b. Wears clothing that minimizes the disfigurement caused by surgery
c. Asks that only family members be allowed to visit
d. Learns to remove and clean the laryngectomy tube independently
19. Warren is scheduled to start radiation therapy. You have just taught Warren all about radiation therapy. Which of the following statements by Warren would indicate that your teaching has been EFFECTIVE?
a. “I can use lotions to moisturize the skin on my throat”
b. “I will need to buy a water bottle to carry with me”
c. “I need to use alcohol-based mouthwashes to help clean oral ulcers”
d. “I may experience diarrhea, I may have diarrhea until radiation is complete”
20. After completing the discharge instructions for Warren, you  determine that ADDITIONAL instruction is needed when he says:
a. “I can participate in most of my prior fitness activities except swimming”
b. “I should wear a Medic Alert Bracelet that identifies me as a neck breather”
c. “I must keep the stoma covered with a loose sterile dressing at all times”
d. “I need to eat nutritious meals even though I can’t smell or taste very well”