CMSRN 346 EXAM QUESTIONS AND ANSWERS

1. While performing a hospital admission assessment, the nurse identifies which of the following factors that increases the patient's risk for tuberculosis? a. Immunocompromised state b. Presence of pneumonia and systemic lupus erythematosus (SLE) c. Refusal of the influenza vaccine during the current flu season d. African-American race - Answer-1. Correct answer: A. An immunocompromised state is a risk factor for tuberculosis; normal defense mechanisms are not functioning to combat infection. Patients who have pneumonia, or are of the African-American race, do not receive the flu vaccine are not at increased risk for developing TB. (PD) 2. The nurse is evaluating results of the tuberculin skin test using the purified protein derivative (PPD). Which of the following patients would the nurse de- termine to have a ion with a response of 5 mm induration? a. 32-year-old patient who moved from Ecuador last year b. 30-year-old patient with end-stage kidney dis- ease c. 27-year-old patient who uses injectable drugs d. 24-year-old patient with active HIV infection - Answer-2. Correct answer: D. A patient with HIV infection has a positive response to PPD skin testing with an induration (area of hardness) of 5 mm or more. Anyone who moved within the last 5 from a country with prevalence of years with TB (e.g., Ecuador) would have a positive response induration of 10 mm or more. 3. A patient recently diagnosed with mild obstructive sleep apnea asks the nurse if he can make lifestyle changes to improve his condition. Which of the fol- lowing changes does the nurse identify as con- tributing to improvement in symptoms? a. Daytime napping b. Weight loss c. Use of sedatives at bedtime d. Decrease in activity level - Answer-3. Correct answer: B. Mild obstructive sleep apnea can be improved by weight loss. Sedatives and alcohol should be avoided 3-4 hours before bedtime. Daytime napping and decreased activity do not have an effect on sleep apnea. (PT) 4. A patient expresses frustration to the nurse about the inability to tolerate the mask for her treatment with continuous positive airway pressure (CPAP). The nurse expects the patient may be more tolerant of BIPAP (bi-level positive airway pressure) treat- ment because: and higher expiratory a. lower inspiratory pressure pressure can be used. b. BIPAP provides improved symptom relief. and lower expiratory c. higher inspiratory pressure pressure can be used. D. Mean pressure is higher using BIPAP. - Answer-4. Correct answer: C. The patient may be more tolerant of BIPAP because it can deliver higher inspiratory pres- sure and lower expiratory pressure, resulting in lower mean pressure that often is tolerated better. BIPAP and CPAP both may provide symptom relief. (PD) 5. In screening a 72-year-old patient to receive in- fluenza and pneumococcal vaccinations, the nurse determines both vaccines are indicated. What would be the