BSN BS-Nursing General 5 — Questions and Answers
Question 1: A nurse is reviewing a patient's medication list and notes that warfarin and aspirin are both prescribed. What is the priority concern?
- Decreased anticoagulant effect of warfarin
- Significantly increased risk of bleeding (Correct answer)
- Risk of warfarin-induced nephropathy
- Development of heparin-induced thrombocytopenia
Correct answer: Significantly increased risk of bleeding
Aspirin inhibits platelet aggregation while warfarin inhibits clotting factors; together they substantially raise bleeding risk.
Question 2: A patient is admitted with suspected meningitis. Which intervention should be completed first?
- Administer prescribed IV antibiotics immediately
- Obtain a lumbar puncture specimen
- Complete blood culture specimens before starting antibiotics (Correct answer)
- Perform a CT scan of the head
Correct answer: Complete blood culture specimens before starting antibiotics
Blood cultures must be drawn before antibiotic administration to maximize the chance of identifying the causative organism.
Question 3: A patient who had a thyroidectomy 12 hours ago reports tingling around the mouth and muscle cramps in the hands. The nurse should assess for which complication?
- Hypocalcemia due to parathyroid damage (Correct answer)
- Respiratory obstruction from hematoma
- Thyroid storm
- Hyponatremia from SIADH
Correct answer: Hypocalcemia due to parathyroid damage
Parathyroid glands may be inadvertently removed or damaged during thyroidectomy, leading to hypocalcemia with tetany symptoms.
Question 4: When using a PCA (patient-controlled analgesia) pump, which action by the patient's family member requires immediate nurse intervention?
- Keeping a pain diary on behalf of the patient
- Pressing the PCA button while the patient is sleeping (Correct answer)
- Reminding the patient to press the button before ambulation
- Reporting unrelieved pain to the nursing staff
Correct answer: Pressing the PCA button while the patient is sleeping
Only the patient should activate the PCA; proxy dosing by a family member bypasses the safety mechanism and can cause respiratory depression.
Question 5: A patient with a urinary tract infection is prescribed trimethoprim-sulfamethoxazole (TMP-SMX). Which allergy history is a contraindication to this medication?
- Penicillin allergy
- Sulfa drug allergy (Correct answer)
- Aspirin-exacerbated respiratory disease
- Contrast dye allergy
Correct answer: Sulfa drug allergy
TMP-SMX contains a sulfonamide component; a documented sulfa allergy is a contraindication due to the risk of severe hypersensitivity reactions.
Question 6: Which assessment finding indicates a complication of a plaster (non-fiberglass) cast requiring immediate notification of the provider?
- Mild itching under the cast
- Warmth over the cast for the first 24 hours during drying
- Pallor, pulselessness, and pain distal to the cast (Correct answer)
- Capillary refill of 2 seconds distal to the cast
Correct answer: Pallor, pulselessness, and pain distal to the cast
Pallor, pulselessness, and pain are signs of acute compartment syndrome or neurovascular compromise, a surgical emergency.
Question 7: A nurse is performing a focused assessment on a patient with appendicitis. Which finding is consistent with Rovsing's sign?
- Pain at McBurney's point on direct palpation
- Right lower quadrant pain elicited by palpating the left lower quadrant (Correct answer)
- Pain upon release of pressure in the right lower quadrant (rebound tenderness)
- Hip flexion producing right lower quadrant pain (psoas sign)
Correct answer: Right lower quadrant pain elicited by palpating the left lower quadrant
Rovsing's sign is RLQ pain produced by palpation of the LLQ, suggesting peritoneal irritation from an inflamed appendix.
BSN BS-Nursing General 5
A nurse is reviewing a patient's medication list and notes that warfarin and aspirin are both prescribed.
What is the priority concern?