Pinoy Blog Machine (Beta)

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It has been a little over a week since yours truly started blogging to earn money. And so far, so good. At least i would like to think so. .

As far as I can recall, here are the things i did the past week on my blog.

For Money-maKing. . .

• Signed up for a number of Ads Providers. . . Bidvertiser, AffiliateBot, AdBrite (just earlier)
• Signed up for a MyLot account.
• Signed up for SlashMySearch
  

For Traffic. . .

• Submitted to quite a number of blog directories.
  
• Added myself to Blogcatalog, MyblogLog and bumpzee.
• Submitted Stories to Digg.com
• Signed up for Associated content which i am yet to write my first article.
• Had Link exchanges with several bloggers.
  

For any Other:

• I added a WeekLy FreEbie feature on my blog which for this week, Harry Potter E-Book is up for Grabs! get your copy now!
  

These, among others were done by my own initiative, dictations, or any other guidance from other people. I did have friends whom i value their advises. And guys, for that, Thanks you! You know who you are. I hope i can make more friends and expand my Horizons.


My Earnings So Far. . .
-Expect not to see thousands, hundreds or even tens for that matter. Hey, afterall, im still starting out. Here's what i Got.

• SlashmySearch - $.246 (this i havent done anything. "Hulog ng langit" as we say. . .)
  
• AffiliateBot - $.91 (Lucky i got a few Clicks. . . Great! )
• Squidoo - $.25 ( Havent updated my Squidoo for ages! )
  
• MyLot -$.06 (I made 6 comments this week. I dont really got time as of now. If you could post/make comments more, You can earn Way More than i could. register here.
• Bidvertiser -$.08 (As you can see, I only have a single add unit. A single snippet. This figure means i need to tweak, tweak, tweak. )
  

Total Money Earned So Far - $1.7

This figure is qutie humble but ill take this as a challenge. I see this as an obstacle that needs to be surpassed. i just bear in mind that success is 1% inspiration and 99% perspiration. Expect more of this to come your way.

Culture Shiok!'s contribution to the "Reflective Thinking - Taking the 8th Habit Challenge: The Top 10 Emerging Influential Blogs in 2007" writing project... (in no particular order)

Project Manila
CokskiBlue
An Apple a Day
Make Money Online with a 13-Year Old
Kubiertos
Nice4Rice
Fruity Oaty
The Anitokid Chronikos
Culture Shiok!
HappySlip

The struggle between online and print journalism continues. I don't really know whether we have a similar memo issued among the papers in the Philippines, but the US-based The Washington Post issued a memo to its staff to avoid misunderstandings between the two departments. Got the info here.

"The Washington Post and its dot-com operation have always had a tricky relationship. Newsroom staffers always complain that their stuff doesn’t get good enough play on the site," writes Erik Wemple here. "Dot-commers reply that the newsies don’t really get the Web. The bitching—er, dialogue—volleys back and forth between Post HQ at 15th and L and the post.com HQ in Arlington." He also posted the full memo in his piece.

Ten Principles for Washington Post Journalism on the Web

1. The Washington Post is an online source of local, national and international news and information. We serve local, national and international audiences on the Web.
2. We will be prepared to publish Washington Post journalism online 24/7. Web users expect to see news as it happens. If they do not find it on our site they will go elsewhere.
3. We will publish most scoops and other exclusives when they are ready, which often will be online.
4. The originality and added value of Post journalism distinguishes us on the Web. We will emphasize enterprise, analysis, criticism and investigations in our online journalism.
5. Post journalism published online has the same value as journalism published in the newspaper. We embrace chats, blogs and multimedia presentations as contributions to our journalism.
6. Accuracy, fairness and transparency are as important online as on the printed page. Post journalism in either medium should meet those standards.
7. We recognize and support the central role of opinion, personality and reader-generated content on the Web. But reporters and editors should not express personal opinions unless they would be allowed in the newspaper, such as in criticism or columns.
8. The newsroom will respond to the rhythms of the Web as ably and responsibly as we do to the rhythms of the printed newspaper. Our deadline schedules, newsroom structures and forms of journalism will evolve to meet the possibilities of the Web.
9. Newsroom employees will receive training appropriate to their roles in producing online journalism.
10. Publishing our journalism on the Web should make us more open to change what we publish in the printed newspaper. There is no meaningful division at The Post between “old media” and “new media.”

Whew. Just had my longest sleep in years. Okay, maybe that's an overstatement. Make that my longest sleep in more than three months.

If I only have all the time in the world, I would probably do this.



White Water Rafting for Indigenous Peoples' Education

Take a thrilling adventure and make it worth a lifetime for a child!

Cartwheel Foundation invites you to experience the renowned Cagayan de Oro River white water rapids and raft for indigenous peoples' education, together with The Red Rafts and Men's Health Magazine. Starting this June until October 2007, raft with The Red Rafts, Cagayan de Oro's premier outfitter, and part of the proceeds of your trip will benefit the educational programs of Cartwheel.

There are an estimated 12 million indigenous peoples (IPs) in the Philippines and they have little or no access to quality education. Cartwheel is committed to bridging the gap and ensuring that they enjoy their right to education that is best suited to their culture and life experience. You, too, can lend your support and have a blast while you're at it-- you might just discover the ride of your life!

Go with your friends or even take the whole office for an outing (special teambuilding activities are included). Reserve your trip now!

Call/text: (0922)454-0021 or (0919)204-3534
Email: action@cartwheelfoundation.org

Note: Cebu Pacific promo of P99 fare to CDO available from June 21 to 27!

About Cartwheel:

Cartwheel Foundation is committed to bringing education to indigenous peoples (IPs), one of the most vulnerable sectors of the Philippines. IPs have long been neglected, isolated, and overtaken by development and suffer from a severe lack of access to basic services, including education. Cartwheel strives to bridge this gap by providing education that is culturally sensitive, appropriate, and relevant to their realities. Through the Pre-School, Alternative Learning, and College Scholarship Programs, Cartwheel works hand in hand with IP communities in allowing them to thrive in their rich culture and equipping them with tools necessary for community leadership and development.

my fellow blogger kirbitz tagged me on his 8 random facts game. each player will write 8 little known facts about himself and in the end will choose 8 bloggers to be tagged. so here it is.

1. i kill roaches the easy way. instead of doing the disgusting slipper splat, i just use a lighter and a flammable spray (perfume, lysol, etc.) and viola. problem solved.

2. i hate spiders. small or big, black or brown, dead or alive, i freak out whenever i see one.

3. i have a crush on shaira luna. nope, she ain't the nerd anymore and she's damn pretty!

4. i don't wear the same jacket on the next day. i have a fetish for jackets.

5. i always name my gadgets. i named my ipod "donna", my videocam "fantasia", my fone "jodie", and my digicam "twinkie".

6. i have a green thumb. yes i have hands that are colored green... no you silly goose, it means i have the passion for gardening.
7. i have never ever purchased a single audio cd. i'm an mp3 junkie.

8. i daydream a lot. and if you could only see it, you'd probably think i'm insane.

here are the ones that i tag:
2. kellecker
3. paper tiger
4. uncle oli
5. jumble-jan
6. rachi
7. twisted banana
8. thunker and keep

RESPIRATORY – 5 items

1. Mr. A., a patient with status asthmaticus, becomes less responsive. Arterial blood gas analysis reveals a partial pressure of carbon dioxide in arterial blood (PaCO2) of 60mmHg and PaO2 of 55mmHg. The data most likely indicate acute:

A. Pneumonitis
B. Respiratory failure
C. Pulmonary edema
D. Pulmonary embolism

Rationale:
B. A patient with status asthmaticus occasionally develops acute respiratory failure late in attack. This may occur with infections or pulmonary air leak, but it commonly occurs without evident complications. Exhaustion, coma, and deteriorating pulmonary function indicate a lack of response to therapy or deterioration. ; altered arterial blood gas levels ( partial pressure of carbon dioxide in arterial blood [PaCO2] below 50mmHg, partial pressure of oxygen in arterial blood [PaO2] below 50mmHg on 50% oxygen) indicate acute respiratory failure. The patient may need intubation or supportive ventilation. Acute pulmonary embolism causes initial sharp pain, hyperinflation, and respiratory alkalosis followed by respiratory acidosis. Acute pulmonary edema causes orthopnea, crackles, paroxysmal dyspnea, and pink, frothy sputum. Pneumonitis causes temperature elevation and purulent sputum.


M., a 19-year-old college student, is on the varsity football team. During a game, he is tackled and sustains fractured ribs on the right side of the chest. He is taken to the emergency department in a local hospital.

2. Which initial manifestation should the nurse expect with this patient?

A. Shallow, painful breathing
B. Diminished breath sounds on the affected side
C. A clicking sensation during inspiration
D. Paradoxical respirations

Rationale:
A. Initial assessment to a patient with fractured ribs reveals a shallow breathing to minimize pain accompanying any movement. Paradoxical respirations, in which the chest expands on expiration and contracts on inspiration, would be present only if the ribs sustain multiple fractures. Diminished breath sounds on affect side, would be present only if the patient has pneumothorax. A clicking sensation would be present only with costochondrial separation.


3. Which condition would most likely indicate that M.’s chest tube should be removed?

A. Lung reexpansion on chest x-ray
B. 120 ml of chest tube drainage in 24 hours
C. Cessation of pain and dyspnea
D. Absence of fluid fluctuation in the water-seal chamber

Rationale:
A. A chest x-ray must confirm lung reexpansion before chest tubes can be removed. The amount of chest tube drainage and the cessation of pain and dyspnea are not indications for removal. The presence of chest tubes itself may be irritating and painful; the pain may increase the patient’s dyspnea. Absence of fluid fluctuation in the water-seal chamber indicates lung reexpansion, but it could also mean that the chest tubes are obstructed or the drainage system is not working.


4. Which method would best prevent the air from entering the pleural cavity after removal of M.’s chest tubes?

A. Breathing with an open mouth
B. Breathing through pursed lips
C. Performing Valsalva maneuver
D. Breathing quickly and shallowly (panting)

Rationale:
C. Valsalva’s maneuver causes bearing-down effect, increasing pressure through the cavity and preventing air from entering the pleural cavity. Breathing through pursed lips, quickly and shallowly, or with an open mouth will not prevent air from entering when chest tubes are removed.


Mr. S., a 65-year-old retired steel mill worker, is admitted to the unit with dyspnea upon exertion. He has a long history of smoking. Initial assessment includes barrel chest, ankle edema, persistent cough with copious sputum production, and variable wheezing on expiration. Laboratory test results include a hematocrit greater than 60% and a partial pressure of carbon dioxide in arterial blood gas (PaCO2) of 65mmHg. The physician diagnosed chronic obstructive pulmonary disease (COPD).

5. Mr. S.’s, ankle edema and respiratory problem would make the nurses suspect hypertrophy of the which heart chamber?

A. Left ventricle
B. Right ventricle
C. Right atrium
D. Left atrium

Rationale:
B. Chronic obstructive pulmonary disease (COPD) can cause hypoxemia and pulmonary hypertension. Hypoxemia causes increased production of red blood cells, making the blood more viscous. The increased viscosity combined with increased pressure forces the right side of the heart to work harder than usual, resulting in right ventricular hypertrophy. Ankle edema is a common assessment finding in this situation. The right atrium may decompensate as the hypertrophy worsens; the left atrium and left ventricle are not affected.

CARDIAC SYSTEM

1 Intermittent claudication is an indication of which condition?

A. Mitral regurgitation
B. Venous insufficiency
C. Arterial insufficiency
D. Phlebitis

Rationale:
C. Intermittent claudication typically is the first symptom of arterial insufficiency. It is not associated with phlebitis, venous insufficiency, or mitral regurgitation.


2 Which statement does not accurately describe Raynaud’s disease?

A. It is precipitated by exposure to cold air or by emotional stress
B. Its is characterized by episodic digital vasospasm associated with skin color changes
C. It usually occurs in men ages 40 to 60
D. It is typically seen in fingers and toes

Rationale:
C. Raynaud’s disease usually occurs in woman ages 16 to 40, not older men. Intermittent constriction of cutaneous blood vessels, precipitated by exposure to cold or by emotional stress, produces cyanosis and pallor of the fingers or toes; reactive hyperemia after vasoconstriction causes redness.

Mr. S., age 36, is admitted to the hospital with a diagnosis of congestive heart failure (CHF). The

3 When assessing Mr. S., for signs and symptoms of digoxin toxicity, the nurse should watch all of the following except:

A. Anorexia, nausea and vomiting, diarrhea, and abdominal pain
B. Bradycardia, tachycardia, bigeminy, ectopic beats, and pulse deficits
C. Abdominal distention, weakness, paralysis, apathy, depression, and hallucinations
D. Headache, double or blurred vision, drowsiness, confusion, restlessness, and muscle weakness.

Rationale:
C. Abdominal distention, weakness, apathy, paralysis, depression and hallucinations are signs of potassium and calcium overdose, not digoxin toxicity. The rest are all signs and symptoms of digoxin toxicity.


Mrs. J., a 58-year-old patient with long standing hypertension, is admitted for shortness of breath. During morning rounds the nurse notices that Mrs. J. has developed an S4 gallop, crackles, and diminished breath sounds, which indicate CHF.
4 Mrs. J., is admitted a year later with a diagnosis of malignant hypertension.

Which drug is commonly used to treat this disorder?

A. ACE inhibitors and diuretics administered orally
B. Vasodilators and diuretics administered intravenously
C. Beta blockers and angiotensin converting enzymes (ACE) inhibitors administered orally
D. Adrenergic blockers and vasodilators administered intravenously

Rationale:
B. Malignant hypertension-rapid progression of primary or secondary hypertension-commonly is treated with potent vasodilator and loop diuretic. Nitroprusside (Nipride), the vasodilator of choice, can be titrated for pressure reduction when monitoring is available; diazoxide (Hyperstat), which acts directly on the peripheral arteriolar smooth muscle, may be given instead. Treatment must include a loop diuretic, usually furosemide. These drugs are given IV; their onsets of action are extremely fast. ACE inhibitors (which reduces peripheral arterial resistance without affecting heart rate or cardiac workload) and alpha-adrenergic blockers (which block peripheral vascular adrenergic receptors an cause vessel wall relaxation, resulting in peripheral vasodilation) as well as beta-adrenergic blockers (which decrease sympathetic stimulation and rennin secretion by the kidneys) may be used to treat primary or essential hypertension but not medical emergency like malignant hypertension.


Mr. T., a 57-year-old steelworker with a history of angina, has been having more frequent attacks of chest pain. He is admitted to the ED with chest pain unrelieved by three nitroglycerin tablets. The physician diagnosis Prinzmetal’s variant angina.

5 Mr.T.’s MI extends, and begins to show signs of left ventricular failure. Which sign would appear first?

A. An S3 heart sound
B. An S4 heart sound
C. Pink, frothy sputum
D. Crackles an cough

Rationale:
A. The third heart sound (S3) is the first objective sign of left ventricular failure. Crackles and cough and pink, frothy sputum are late signs, signifying congestion from heart failure and pulmonary edema. A fourth heart sound (S4) is not a sign of left ventricular failure.


NEUROSENSORY SYSTEM 5 ITEMS

1. Which medication is not appropriate for a patient with a craniotomy?

A. Phenytoin (Dilantin)
B. Codeine
C. Meperidine (Demerol)
D. Dexamethasone (decadron)

Rationale:
C. Meperine (Demerol) is not given postoperatively to a craniotomy patient because it may mask the neurologic problems, such as changes in level of consciousness and abnormal pupillary reactions or size; the drug may also cause respiratory depression. Dexamethasone (Decadron) is given to control cerebral edema. Phenytoin (Dilantin) is given to prevent generalized tonic-clonic seizures. Codeine is used as an analgesic for severe headache; this mild narcotic’s activity does not interfere with neurologic assessment.

2. All of the following signs indicate increased intracranial pressure except:

A. Decreased level of consciousness
B. Papilledema
C. Vomiting
D. Tachycardia

Rationale:
D.Bradycardia, not tachycardia, accompanied by hypertension is a sign of increased intracranial pressure (ICP). Other signs include nausea and vomiting, decreased level of consciousness, and headache; papilledema is a late sign.


3. Which assessment most strongly suggest Meniere’s disease?

A. Vertigo
B. Nausea
C. Neurosensory hearing loss
D. Tinnitus

Rationale:
A. The strongest indication of Meniere’s disease is vertigo, a sensation of irregular or whirling motion of oneself or of surrounding objects. Nausea commonly accompanies vertigo, but nausea by itself may be caused by many disease. Tinnitus (a buzzing sound in the eras) and neurosensory hearing loss occur in Meniere’s disease because of cochlear labyrinth disturbances (although hearing loss may not occur early in the disease); however, these findings also could result from other diseases. Vertigo accompanied tinnitus and neurosensory hearing loss confirms the diagnosis of Meniere’s disease.


4Characteristic clinical manifestation of ALS do not include:

A. Uncontrolled outburst of crying
B. Aphagia and dysarthria
C. Loss of bowel and urine control
D. Fasciculation of the involved muscles

Rationale:
C. The patient with ALS usually does not lose urinary and bowel sphincter control because the disease does not affect the spinal nerves controlling these muscles. However, other muscles that control the neck, pharynx, larynx, trunk, and legs atrophy from the gradual degeneration of motor neurons; this can lead to aphagia, dysarthria, uncontrolled outburst of laughing or crying, and fasciculation of the involved muscles.


5. rs. D.’s physician orders myelogram using a water-soluble contrast medium. Which nursing activity is most appropriate for Mrs.D after his procedure?

A. Monitoring level of consciousness
B. Restricting fluids for 6 to 10 hours
C. Placing the patient in a recumbent position for 12 to 24 hours
D. Elevating the head of the bed 15 to 30 degrees

Rationale:
D. After the patient has had a myelogram using a water-soluble contrast medium, the nurse should elevate the head of the bed 15 to 30 degrees to reduce the medium’s rate of upward dispersion, preventing such complications, such as seizures and transient encephalopathy. The nurse should encourage high fluid intake after myelogram to replenish CSF leakage and to maintain adequate hydration. Monitoring the patient’s level of consciousness is not necessary because myelogram will not alter it. The physician may specify a recumbent position for 12 to 24 hours after the procedure if oil-based iodine is used; this position helps prevent headache and may help reduce CSF leakage.


(Musculo) 5 items

1. A 15-year-old is treated in the emergency room for a fractured right ankle. A plaster walking cast is applied and the client is instructed to walk with the aid of crutches once the cast has dried. While instructing the client to ambulate with crutches the nurse most appropriately teaches the client to:

A. Move both crutches and the right foot forward simultaneously followed by the left foot
B. Move the right foot and the left foot forward together followed by the left foot and right crutch
C. Move crutches and feet in the following sequence: right crutch, left foot, left crutch, right foot
D. Place the crutches under the arms, bear weight on the axilla, and position both crutches 8-10 inches in front of the body

Rationale:
A. This is the three point gait, which is used when one leg is injured or weak and the other leg is capable of supporting the client’s full body weight. Most of the body weight is placed on the crutches when the fractured rib is moved forward.


2. The nurse is assisting a client who has broken ankle with crutch walking. The nurse knows the client understands the instructions when the client:

A. Leans on the crutch pads to relieve pressure on the affected foot
B. Advances both crutches and the affected leg at the same time
C. Puts partial weight on the affected side
D. Advances both crutches and the unaffected leg at the same time

Rationale:
B. The three point gait is the appropriate gait for someone with a broken ankle as it allows no weight bearing on the affected leg. The client advances both crutches and the affected leg at the same time. The client then swings the involved extremity to the crutches while the body’s weight is supported by the crutches and the unaffected leg.


3. A 2-day-old infant is diagnosed as having congenital hip dysplasia of the right hip. The infant is fitted with a Pavlick harness. Which of the following would not be included in the instructions for home care of the patients?

A. Turn her every 3-4 hours
B. Watch for signs of skin breakdown
C. Keep her off the affected side
D. Give her sponge baths, not tub baths

Rationale:
C. The infant in a Pavlick harness can be turned from back to abdomen but should not be positioned to other side.


Mrs. D., a 32-year-old homemaker, is admitted to the hospital with a history of urine retention. Her physician suspects multiple sclerosis (MS).

4 Which diagnostic tool helps confirm the diagnosis of MS?

A. Skull x-rays
B. Cerebrospinal fluids
C. Electromyography
D. Electroencephalography

Rationale:
B. Cerebrospinal fluid (CSF) analysis showing increased lymphocytes and oligoclonal immunoglobulin G helps confirm the diagnosis of MS. Other helpful diagnostic procedures include CT, nuclear magnetic resonance, and magnetic resonance imaging. Skull x-rays, electroencephalography, and electromyography do not diagnose MS.


Mr. C., a 65-year-old retired assembly line worker, is admitted to the hospital with a diagnosis of Parkinson’s disease.

5 The physician orders 1 mg of benztropine mesylate (Cogentin) P.O. daily for Mr. C., which finding suggests a favorable effect from this medication?

A. Decreased tremors
B. Decreased muscle rigidity
C. Decreased confusion
D, Decreased dizziness

Rationale:
A. Anticholinergics, such as benztropine mesylate (Cogentin), reduce the cholinergic activity caused by decreased dopamine levels and decrease tremors. Muscle rigidity typically is treated with amantadine (Symmetrel) or carbodopa-levodopa (Sinemet). Possible adverse effect of anticholinergic drugs includes increased dizziness and confusion; benztropine therapy will not decrease this symptoms.





GASTROINTESTINAL SYSTEM

1. A client who is experiencing ascites is admitted to the hospital and will be undergoing a paracentesis. What should be included in the nursing care plan?

A. Place client in Trendelenberg position for the procedure
B. Monitor client closely for evidence of vascular collapse
C. Have client remain on bed rest for 24 hours following the procedure
D. Encourage the client to drink plenty of fluids to distend the bladder prior to procedure

Rationale:
B. Removing large amounts of fluids may cause hypotension leading to vascular collapse. The client should be monitored closely for decrease in blood pressure, increase in pulse and pallor.

2. A woman is admitted for a suspected duodenal ulcer. The nurse is interviewing her for an admission history. Which description of her pain would be most characteristic of duodenal ulcer?

A. Right upper quadrant that increases after meals
B. Aching in the epigastric area that wakens her from sleep
C. A sensation of painful pressure in the midsternal area
D. Sharp pain in the epigastric area that radiates to the right shoulder

Rationale:
B. Pain from a duodenal ulcer is often aching or burning in character. Pain occurs when the stomach is empty. In addition, in persons who develop duodenal ulcers often hyper secrete gastric acid during REM sleep, with a resulting increase in pain that wakens them from sleep.


Mr. F., age 60, is admitted to the hospital with ascites and jaundice to rule out cirrhosis of the liver.

3 The physician schedules Mr.F., for a liver biopsy to confirm the diagnosis of cirrhosis. Which crucial information should the nurse tell Mrs.F before the procedure?

A. The procedure is painless
B. He should hold his breath on exhalation when biopsy needle is inserted
C. Pressure will be applied to his right side after the procedure
D. He must maintain a side-lying position after the procedure

Rationale:
B. to prevent puncture of the diaphragm, the nurse should tell the patient to hold his breath on exhalation when the needle is inserted. Because the patient may feel discomfort during needle insertion, he should not be told that the procedure is painless. After the procedure, the patient should lie in his right side on a pillow or a sandbag to arrest bleeding; however, this information is not crucial for the patient to know before the procedure.


Mr. M., a 42-year-old accountant, is admitted to the hospital with intestinal obstruction. A flat-plate x-ray of the abdomen shows a mass, which may be malignant.

4 Which type of tube will Mr. M.’s physician require for intestinal decompression?

A. Levin
B. Salem sump
C. Ewald
D. Miller-Abbott

Rationale:
D. The physician will use the Miller-Abbott tube, a double-lumen tube with an inflatable balloon, to decompress the patient’s intestine. The Levin tube is a single-lumen nasogastric tube used to decompress the stomach. The Salem sump tube is a double-lumen tube used for stomach decompression. The Ewald tube is a large-bore tube used to evacuate the stomach.



Mr. O., a 50-year-old postal worker, is admitted to the hospital with acute pancreatitis.

5 If Mr. O., begins to exhibit muscle twitching and irritability, the nurse should:

A. Call the physician because the patient may have hypocalcemia
B. Administer analgesics because the symptoms may be caused by pain
C. Check his serum amylase level
D. Reassure the patient that this is common among people who abuse alcohol

Rationale:
A. The nurse should call the physician immediately, because muscle twitching and irritability are signs of hypocalcemia, which commonly accompanies acute pancreatitis; other signs and symptoms include tetany, jerking, and positive Trousseau’s sign and Chvostek’s signs. Hypocalcemia results from the fixation of calcium by the fatty acids where fat necrosis has occurred and from the increased calcium loss in the urine.


ENDOCRINE and ONCOLOGY

1. Which medication is not an oral hypoglycemic agent?

A. Glipizide (Glucotrol)
B. Tolbutamide (Orinase)
C. Chlorpropamide (Diabinese)
D. Diazoxide (Hyperstat)

Rationale:
D. Diazoxide (Hyperstat) is a benzothiadiazide that causes hyperglycemia by inhibiting insulin secretions; it is used to treat hypoglycemia by excessive insulin production. Chlorpropamide (Diabinase), Glipizide (Glucotrol), and Tolbutaline (Orinase) are oral hypoglycemic agents used to treat type II (non-insulin-dependent) diabetes mellitus. Chlorpropamide and tolbutamide are first-generation sulfonylureas that have been extensively used since 1965. Glipizide is a second-generation sulfonylurea approved for use in the United States in 1984; this medication is more potent than the first-generation ones and is associated with fewer complications.


2. When caring for Mrs. B., a diabetic patient starting prednisone (Deltasone) therapy for severe arthritis, the nurse should expect:

A. Worsened diabetes control
B. No effect on diabetes control
C. Improved diabetes control
D. Frequent hypoglycemic reactions

Rationale:
A. Diabetes control worsens with the use of prednisone (Deltasone), a glucocorticoids and insulin antagonist. This drug increases glucose production by the liver and inhibits glucose use by the peripheral tissues; therefore, it increases the blood glucose level in diabetic patients and impairs diabetic control. Prednisone therapy may cause frequent hyperglycemic, not hypoglycemic, reactions by increasing blood glucose levels.

3. Parenteral injections of cortisol for patients with Addison’s disease should be injected:

A. After the patient eats
B. Deep into the deltoid muscle
C. Deep into the gluteal muscle
D. Into the subcutaneous tissue

Rationale:
C. Because sufficient muscle mass is necessary for acute injection of Parenteral cortisol preparations, the nurse should inject them deep into the gluteal muscle. Cortisol should not be injected subcutaneously, because it may cause sterile abscesses, tissue atrophy, and pigmentation abnormalities. Steroid therapy causes GI disturbances with oral administration, not IM injection; therefore, the patient does not need to have food in his stomach before administration.


4 According to current American Cancer Society recommendations, women age 50 and over should have a routine mammography:

A. Every 2 years
B. Every year
C. Only if symptomatic
D. Every 5 years

Rationale:
B. Because the risk of breast cancer begins to rise at age 40 and progressively increases through age 80, all women age 50 and over should follow the American Cancer Society recommendation for yearly mammography examinations.


5 Which assessment finding to a patient with prostatic cancer indicates metastasis?

A. Pus in urine
B. Urinary frequency and decreased urinary stream
C. Decrease serum alkaline phosphatase level
D. A complaint of lumbosacral pain

Rationale:
D. A complaint of lumbosacral pain indicates metastasis; the most common form of metastasis by the hematogenous route is osseous, and the most common sites are the pelvis, lumbar spine, and ribs. Pus in the urine indicates urinary tract infection, not metastasis. Urinary frequency and decreased urinary stream are caused by urinary obstruction, not metastasis. The serum alkaline phosphatase level would be elevated, not decreased, with metastasis as a result of increased bone activity.


Mr. V., age 55, is admitted to the hospital with a diagnosis of chronic lymphocytic leukemia

6.During routine care, the patient asks the nurse,”How can I be anemic if this disease causes increased white cell production?” the nurse’s response would be that increased number of white blood cells (WBC):

A. Are not responsible for the anemia
B. Crowd out red blood cells
C. Have an abnormally short life span
D. Use nutrients from other cells

Rationale:
B. Uncontrolled proliferation of granulocytes and monocytes causes leukemia, in which WBC’s are produced at a rapid rate, crowding out RBC’s. this reduces the amount of oxygen-transporting hemoglobin, resulting in anemia. The WBC’s do not use nutrients from other cells ar have abnormal life span.

7. Diagnostic assessment of Ms. V., would probably not reveal:

A. Leukocytois with a shift from the left
B. Abnormal blast cells in the marrow
C. An elevated thrombocyte count
D. A predominance of lymphocytes

Rationale:
C. Assessment of the patient with leukemia typically reveals thrombocytopenia, rather than elevated thrombocyte count; with leukemia, an increase number in immature WBC’s are produced, crowding out platelets and RBC’s. Another common clinical manifestation of leukemia is an increased WBC count with increased release of band (immature) cells by the bone marrow-leukocytosis with a shift to the left. Blast cells, which are precursors of WBC’s, accumulate in the bone marrow with leukemia.

8. Several days after admission Mr.V., becomes disoriented and complains of frequent headaches. The nurse first action would be to:

A. Raise the rails of the bed
B. Call the physician
C. Document the patient’s status on detail in her chart
D. Prepare oxygen equipment

Rationale:
A. Leukemia causes disorientation and headaches in the patient through WBC infiltration of the central nervous system (CNS); the nurse should raise the bed’s side rails to prevent falls. The nurse should document the assessment finding after taking action to prevent injury. Administering oxygen will not remove WBC’s from the CNS. The nurse should notify the physician of the patient’s condition change after ensuring her safety.


9. Which statement about bone marrow transplantation-the treatment of choice for patients under age 40 with leukemia-is not correct?

A. The bone marrow aspirated is mixed with heparin
B. The patient is under local anesthesia
C. The recipient receives cyclophosphasmide (cytoxan) for 4 consecutive days
D. The aspiration site is the posterior or anterior iliac crest

Rationale:
B. The patient is under general or spinal anesthesia during bone marrow transplantation. The procedure involves the aspiration of approximately 600ml of bone marrow from the iliac crest; the marrow is mixed with heparin or frozen until given intravenously to the patient. Recipients are “primed” to prevent rejection by receiving cyclophosphasmide (cytoxan0 for 4 days before the transplant. The drug’s exact action is unknown; it has been found to have an immunosuppressive effect.


Mrs. R., age 53 has been experiencing bone pain, recurrent infections and abdominal pain for the past 5 years. After ordering a battery of tests, including x-ray studies, the physician diagnosed multiple myeloma.

10.The physician orders the administration of melphalan (Alkeran) for Mrs.R., because this drug causes pancytopenia, the nurse should assess the patient for:

A. Decreased WBC count
B. Alopecia
C. Skin pigmentation
D. Thrombophlebitis

Rationale:
A. Pancytopenia refers to depression in all blood’s cellular elements; the patient on melphalen (Alkeran) therapy would probably have a reduced WBC count. Skin pigmentation is governed by melanocytes, which are controlled by pituitary gland; because melphalan affects bone marrow production of blood cells, the drug would cause skin pigmentation changes. Temporary alopecia and mild thrombophlebitis at the infusion site are adverse effects of melphalen therapy, but they are not related to pancytopenia.




HEMATOLOGIC AND INFECTIOUS 5 items


Ms. X., age25, complains of chronic fatigue, particularly after menstrual periods, which she says sometimes last for 6 days; her sanitary pads often are saturated in 2 hours. After a general prescribed oral ferrous sulfate (Feosol) therapy, Ms. X., remained fatigued and pale, and tiny bruises appear on her arms. An internist refers her then to a hematologist, who diagnosed idiopathic thrombocytopenic purpura (ITP) and admitted her to the hospital.

1. Which assessment finding is not typical of ITP?

A. Prolonged activated partial thromboplastin time
B. Prolonged bleeding
C. Decreased platelet count
D. Increased capillary fragility

Rationale:
A. Prolonged partial thromboplastin time is not a typical of ITP. Thrombocytopenia refers to platelet count below 100,000/mm3, which is caused by premature platelet destruction. Normally, platelets survive 9 to 10 days; with thrombocytopenia, the survival rate is 2 to 3 days. Bone marrow aspiration reveals normal or increased megakaryocytes (precursor to platelets). Platelets form temporary clots, release incomplete thromboplastin, and maintain capillary integrity; they help close opening in the capillary walls and improve clot strength and retraction. Because of the low platelet count, bleeding is prolonged, capillary fragility is increased, and megakaryocytes are normal or increased. Platelets alone do not control bleeding, other coagulation factors from the intrinsic and extrinsic systems are necessary for homeostasis. Because these factors are intact, coagulation time is not affected; the activated partial thromboplastin is normal.


Mr. V., age 24, is an AIDS patient with a diagnosis of Pneumocytis carinii pneumonia. During 2 weeks of hospitalization with isolation precautions, he has had no visitors.

2. The patient with AIDS-related complex typically has a history of:

A. Hairy leukoplakia of the tongue and a chronic cough
B. Oral candidiasis, molluscum, contagiosum, and bullous impetigo
C. Sever fatigue, lymphadenopathy, and diarrhea
D. Memory loss, night sweats, and disorientation

Rationale:
C. Although a patient with HIV infection may experience no ill effects, the history of a patient with AIDS-related complex typically includes severe fatigue, lymphadenopathy, bouts of diarrhea, malaise, weight loss, night sweats, oral thrush, or several of these disorders. Oral candidiasis, molluscum contagiosum, bullous impetigo, and memory loss by themselves do not necessarily imply HIV infection. Hairy leukoplakia indicates full-blown AIDS.

3. Which type of infection control does an extremely ill hospitalized patient with AIDS require?

A. Blood and body fluid precautions
B. Respiratory isolation
C. Reverse isolation
D. Contact isolation

Rationale:
A. The patients with HIV infection requires blood and body fluid precautions because HIV is found in the blood and body fluid of infected persons. Therefore, health care providers wear gloves and gown to prevent contamination with feces, urine, bronchial secretions, or other body fluids. Because HIV is not transferred by droplet inspiration and casual contact, respiratory isolation and contact isolation are inappropriate. Reverse isolation, which protects the patient against infection from caregivers and visitors, are unnecessary.

4. How is Lyme disease treated?

A. Antibiotic treatment with doxycycline or amoxicillin for 7-10 days.
B. Antibiotic treatment with cefuroxime axetil or erythromycin for 7-10 days.
C. There is no treatment; the disease must run its course.
D. Antibiotic treatment with doxycycline or amoxicillin for 3-4 weeks.

Rationale:
D. According to treatment experts, antibiotic treatment for 3-4 weeks with doxycycline or amoxicillin is generally effective in early disease. Cefuroxime axetil or erythromycin can be used for persons who are allergic to penicillin or who can not take tetracyclines. Later disease, particularly with objective neurologic manifestations, may require treatment with intravenous ceftriaxone or penicillin for 4 weeks or more, depending on disease severity. In later disease, treatment failures may occur and retreatment may be necessary.
A. Antibiotic treatment for 3-4 weeks with doxycycline or amoxicillin is generally effective in early disease.
B. Cefuroxime axetil or erythromycins are for those people who are allergic to penicillin or who cannot take tetracyclines. However, treatment lasts 3-4 weeks , not 7-10 days.
C. The proper antibiotic treatment for Lyme disease is an important strategy to avoid the morbidity and cost of complicated and late-stage illness.

5. A 30-year-old nonsmoking patient who is in general good health is diagnosed with acute bronchitis and is now being discharged. Which of the following patient responses indicate a need for further patient education?

A. “I need to drink 8 to 10 glasses of water daily until I’m over this.”
B. “I should get a flu shot in about 6 weeks so I don’t get this again.”
C. “I can take over-the-counter cough suppressants to reduce my coughing at night.”
D. “I should come back to the hospital or see my doctor if my sputum turns rusty colored.”

Rationale:
B. A flu shot is helpful for individuals who are at high risk for respiratory complications. These include the elderly, people with chronic disease problems, and immunocompromised patients. The patient should understand that the timing is related not to the current episode but to seasonal exposure to infectious agents and that it takes several weeks to achieve immunity.





RENAL 5 items

1. A nurse is caring for a client who has had renal biopsy. Which of the following intervention would the nurse AVOID in the care of the client after this procedure?

1. Ambulating the client in the room and hall for short distances.
2. Forcing fluids to at least 3 liters in the first 24 hours.
3. Administering PRN narcotics.
4 Testing serial samples with dipstick for occults blood.

Rationale:
1. After renal biopsy the nurse ensures that the client should remain in bed rest for at least 24 hors. Vital signs and puncture site assessments are done more frequently during this time. Forcing fluids is done to reduce possible clot formation at the biopsy site. Serial urine samples are hematested with urine dipsticks to evaluate bleeding. Narcotic analgesics are often needed to manage renal colic pain that some clients feel after the procedure.

2. The nurse is receiving in transfer from post anesthesia care unit client who has had percutaneous ultrasonic lithotripsy for calculi in the renal pelvis. The nurse anticipates that the client’s care will involve monitoring which of the following?

1. Jackson-Pratt drain
2. Ureteral stent
3. Suprapubic tube
4. Nephrostomy tube

Rationale:
4. A nephrostomy tube is put in place after percutaneous ultrasonic lithotripsy to treat calculi in the renal pelvis. The client may also have Foley catheter to drain urine produced by the other kidney. The nurse monitors the drainage from each of the tubes, and strains the urine to detect elimination of the calculus fragments.

3. A client is admitted to an emergency department following a motor-vehicle accident. The client was wearing a lap seat belt when the accident occurred. The client has hematuria and lower abdominal pain. To further determine whether the pain is due to bladder trauma, a nurse asks the client if the pain is referred to which of the following areas?

1. Umbilicus
2. Shoulder
3. Hip
4. Costovertebral angle

Rationale:
2. Bladder trauma or injury should be considered or suspected in the clients who have low abdominal pain and hematuria .Renal cancer would not cause pain that is felt in the low abdomen; rather it would be in the flank area. Glomerulonephritis and pyelonephritis is associated with fever, and are thus not applicable to the client in this question.

4. A client with chronic renal failure (CRF) returns to the nursing unit after following a hemodialysis treatment. On assessment the nurse notes that the client’s temperature is 100.20C. which of the following is the most appropriate nursing action?

1. Encourage fluids
2. Continue to monitor vital signs
3. Notify the physician
4. Monitor the site of the shunt for infection

Rationale:
2. The client may have elevated temperature after the dialysis because the dialysis machine warms the blood slightly. If the temperature remains excessive extensively, and remains elevated, sepsis would be suspected and a blood sample should be obtained as prescribed for culture and sensitivity determinations.

5. A client passes a urinary stone, and laboratory analysis of the stone indicates that the stone is composed of calcium oxalate. On the basis of this analysis, the nurse would include which of the following in the client’s dietary instructions?

1. Avoid green leafy vegetables, such as spinach
2. Avoid citrus fruits and citrus juices
3. Increase intakes of meat, fish, plum and cranberries
4. Increase intake of dairy products

rationale:
1. Oxalate is found in dark green food such as spinach. Other foods that raise urinary oxalate are rhubarb, strawberries, chocolates, whet bran, nuts, beets, and teas.

Fluid & Electrolytes- 5 items

1. Your post-operative client is to receive potassium chloride. Regarding the administration of IV potassium, you know:

1. potassium may be given as a straight intravenous push to avoid fluid overload
2. potassium is usually mixed 1000 mEq/1000 cc of IV fluid
3. intravenous potassium may only be mixed in normal saline
4. intravenous potassium should be administered through a large vein

A: 4. To avoid irritation, a large IV bore into a large vein is recommended when administering potassium (K). IV potassium is very irritating to tissues & veins & may cause irritation @ the injection pathway.
1. Potassium given intravenously must always be diluted. Each dose should be diluted & mixed in 100 to 1000 ml of sol’n. The mix is usually 40-80 mEq/l depending upon the degree of hypokalemia.
2. K given intravenously is usually mixed 40-80 mEq/l depending upon the degree of hypokalemia.
3. K given intravenously can be mixed w/ many IV sol’ns, including D5W, normal saline, & Ringer’s sol’n
Pregnancy Category: C
Client Need: Safe, Effective Care Environment

2. A client with DM is admitted with a UTI. The initial assessment reveals T-102.5, P-98, BP-97/65, and blood glucose 300 mg/dL. Prescriptions read: Intravenous fluids 5 % dextrose in water to infuse @ 100 mL/ hr, cefoxitin (Mefoxin) 1 gm intravenously q 4 hrs, acetaminophen (Tylenol) 650 mg by mouth every 4 hrs for temp. greater than 101.5 deg. F or pain, & sliding scale insulin for elevated blood glucose. Which prescriptions will be questioned?

1. cefoxitin (Mefoxin) 1 gm intravenously q 4 hrs
2. D5W intravenous infusing 100 mL/hr
3. acetaminophen (Tylenol) 650 mg by mouth q 4 hrs
4. sliding scale insulin

A: 2. The administration of D5W should be questioned in this situation. D5W contains glucose, so it is an inappropriate IV sol’n for a diabetic client. The client’s blood glucose is 3oo mg/dl. Giving additional glucose would elevate the blood glucose level further. A hypotonic sol’n of ).45% NaCl is preferred. An intravenous rate of 100 ml/hr is appropriate for rehydration.
1. Cefoxitin (Mefoxin) is the drug of choice for UTI & would not be questioned
3. Tylenol can be given as an antipyrewtic or analgesic & is appropriate for the client’s condition.
4.Sliding scale insulin is an appropriate regimen prescribed for short-term mngt. Of elevated bld glucose
Pregnancy Category: C
Client Need: Physiological Integrity

3. A client with diabetes is experiencing DKA & is to receive intravenous fluids containing sodium bicarbonate. Regarding the administration of this intravenous fluid you know:

1. sodium bicarbonate administration may result in alkalosis
2. most medications are compatible with sodium bicarbonate
3. sodium bicarbonate may not be given as an intravenous bolus or push
4. sodium bicarbonate may only be given IM

A: 1. Administering sodium bicarbonate (NaHCO3) may cause alkalosis. NaHCO3 is an electrolytereplenisher & alkalizing agent. Acidotic clients (pH<7.35) are given Na HCO3 to raise the pH. Excessive administration may cause alkalosis (pH>7.45).
2. Many meds are incompatible w/ Na HCO3.
3. NaHCO3 may be given as an IV push.
4. NaHCO3 is usually only given by mouth or intravenously.
Pregnancy Category (PC): C
Client Need (CN): Physiological Integrity

4. A client enters the hospital in acute renal failure. The client complains of drowsiness, nausea & has Kussmaul’s breathing. Lab tests show a serum potassium of 6.8, serum sodium of 120, & bld pH of 7.2. W/c of the ff MD’s prescriptions should be questioned?

1. polystyrene sodium sulfonate (Kayexalate) 50 mg per rectum as enema
2. 2000-calorie, high carbohydrate, high protein diet when nausea subsides
3. hypertonic glucose (25%) 300 cc w/ regular insulin per IV infusion over 1 hour
4. limit po fluids per 8 hrs to no more than 100cc above the urinary output for the previous 8 hrs

A: 2. Dietary protein is usually eliminated in acute renal failure to decrease nitrogenous metabolic waste products.
1. Kayexalate reduces serum potassium by exchanging sodium for potassium ions in the GIT. Inasmuch as this client is hyperkalemic & hyponatremic, this is a reasonable prescription.
3. Hypertonic glucose & insulin promote mov’t of potassium into the cells, reducing hyperkalemia.
4. Fluid balance must be carefully monitored. Intake should be slightly more than output per 24 hrs as rapid changes may occur. Intake is frequently based on the prior 8-hr fluid output.
PC: N/A
CN: Health Promo’n/ Maintenance

5. A blunt trauma patient with a descending thoracic aortic tear has been rapidly transfused with 12 units of packed RBC. Based on the observation, the ED nurse should anticipate which of the following blood products?

BP 96/64 mmHg PT 38 sec Hct 30%
HR 132/min PTT 105 sec
Respirations 19/min PLT 88,000/mm3
Hgb 11g/dl

A. Fresh frozen plasma
B. Cryoprecipitate
C. Platelets
D. Packed red blood cells

Rationale:
A. fresh frozen plasma expands vascular volume and restores a wide variety of clotting factors to correct the PT/PTT.
B. Cryoprecipitate restores some clotting factors but is more expensive and more complicated to prepare and administer than fresh frozen plasma. It does not expand vascular volume and is not used as an initial treatment for prolonged PT/PTT.
C. This patient’s platelet count is adequate.
D. Packed red blood cells contain no clotting factors and would not correct PT/PTT.





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Anatomy & Physiology, FAMILY PLANNING & Childbearing (10 items)

1. When teaching a patient about the cervical mucus contraceptive method, the nurse should instruct her to avoid sexual intercourse when her cervical mucus is:

A. Clear and elastic
B. Cloudy and thick
C. Clear and thick
D. Cloudy and elastic

Rationale:
A. The patient using cervical mucus method of birth control should avoid sexual intercourse when her mucus is clear, thin, and elastic. This indicates that estrogen levels have decreased to the point that ovulation is imminent. During the preovulatory and postovulatory phases of the menstrual cycle, cervical mucus is cloudy, thick, and inelastic.

2. Which patient assessment finding contraindicates the use of a cervical cap?

A. Lactation
B. Diabetes mellitus
C. An abnormal Papanicolau (Pap) test result
D. Recurrent cystitis

Rationale:
C. The Food and Drug Administration (FDA) recommends that the cervical cap be used only by patients with normal Papaniculaou (Pap) test results; abnormal results may indicate preinvasive or invasive cervical cancer. Because use of cervical cap is associated with cervical changes and abnormal Pap test results, the FDA recommends one Pap test at the beginning of the use., then another test after 3 months of use. The cervical cap is not contraindicated in patients with diabetes mellitus or recurrent cystitis or one who is lactating.

3. Which contraceptive method does NOT provide protection against sexually transmitted disease?

A. Cervical cap and spermicide
B. Rubber condom
C. Diaphragm and spermicide
D. Intrauterine device (IUD)

Rationale:
D. An intrauterine device (IUD) prevents pregnancy by creating a local, sterile inflammatory reaction; it provides no protection against sexually transmitted diseases (STD’s). Condoms prevent STD’s, and rubber condoms are more effective than collagenous or animal tissue condoms. Mechanical barrier contraceptive methods, such as diaphragm and cervical cap, provide protection against STD’s when used with a spermicide.

4. A patient who has been taking oral contraceptive for the past 3 years, ask the nurse if how long she should wait before attempting to become pregnant. Which advice should the nurse give?

A. She should wait for at least 1 month
B. She should wait for at least 6 months
C. She can try to conceive immediately
D. She should wait for at least 3 months.

Rationale:
D. The patient should wait for at least 3 months before she can conceive to give enough time for the estrogen and progesterone levels to return to normal.

Mrs.W.,age 24 has been taking a combined oral contraceptive fro 3 months after the birth of her second son. She reports to the clinic nurse that she feels bloated and that her ring and shoes feel tight.

5. Combined oral contraceptives prevent pregnancy by inhibiting the production of:

A. Luteinizing hormone (LH) and estrogen
B. Follicle-stimulating hormone (FSH) and prolactin
C. Estrogen and progesterone
D. FSH and LH

Rationale:
D. combined oral contraceptives prevent ovulation by inhibiting the anterior pituitary production of FSH and LH, which are essential in the maturation and rupture of a follicle. Oral contraceptives do not inhibit prolactin, estrogen, or progesterone production.

6. Which instruction about proper diaphragm use is INCORRECT?

A. Store the diaphragm in a cool, dry place
B. Use a water-soluble jelly
C. Be refitted for a new one after a weight gain or loss of 15 lb (6.8 kg) or more
D. Check the diaphragm for tears or holes after each use

Rationale:
D. the patient should check the diaphragm for tears or holes before using to determine if she must use an alternative contraceptive method. Using no-water-soluble jelly, such as petrolatum, or storing the diaphragm in a location that is not cool and dry may cause the rubber to deteriorate. To ensure proper fit, the patient must be refitted fro a new diaphragm after a weight gain or loss of 15 lb (6.8 kg) or more.

Mrs. K., a 27-year-old gravida 3 para 2012, has been elected to have an intrauterine device (IUD) inserted today in the clinic.

7. Which factor in Mrs. K.’s history indicates that she is a good candidate for an IUD?

A. Marital status
B. Parity
C. Age
D. Gravidity

Rationale:
B. Parity-the condition of a woman with regard to her having produced viable offspring-helps determine the patient’s suitability for IUD use. A nulliparous patient (one with no living children) who wishes to become pregnant later should not use an IUD because of possible adverse effects that could alter her future fertility. Age, gravidity (the condition of being pregnant without regard to the outcome), and marital status are irrelevant to the patient’s suitability for IUD.

8. Although exact mechanism of action is unknown, the IUD is thought to achieve contraception by inhibiting all of the following except:

A. Fertilization
B. Spermatozoa transport
C. Ovulation
D. Implantation of the fertilized ovum

Rationale:
C. Experts believe that IUD creates a local sterile, inflammatory reaction within the uterus. This reaction increases the number of uterine leukocytes, whose by-products are toxic to spermatozoa and embryonic cells. The copper ions in certain IUD’s may later the spermatozoa motility, capacitation, and survival. If fertilization does not occur, the inflammatory process within the uterus may prevent implantation of the fertilized ovum.

9. Which assessment finding is NOT a contraindication for IUD use?

A. History of ectopic pregnancy
B. History of PID
C. AIDS
D. History of preterm labor

Rationale:
D. History of preterm labor is not a contraindication for IUD use, although the physiologic factors responsible for the onset of preterm labor are complex and not fully understood. Because IUD users are at increased risk for developing PID or ectopic pregnancy, patients with either disorder is not advised to use IUD. PID is the most common serious complication of IUD use; a woman who uses an IUD has a 50% greater chance of developing PID than sexually active woman using no contraception. Ectopic pregnancy is another serious complication associated with IUD’s; the patient with a damage fallopian tube from a previous ectopic pregnancy should avoid using an IUD to help prevent damage to the remaining tube. Because AIDS results in a suppressed immune system, a patient with this disease should avoid using IUD to prevent possible complications, such as PID, which may be life-threatening.

10. The physician prescribes 100mg of clomiphene citrate (Clomid) for 5 days starting on day 5 of Mrs.H’s menstrual cycle. Which statement indicates that Mrs. H understands the instructions about this drug?

A. “I will maintain basal body temperature (BBT) chart to determine temperature changes”
B. “I will abstain from sexual intercourse during the 5 days I’m taking the drug”
C. “Slight abdominal bloating and painful breasts indicate that the drug is effective”
D. “This drug will not cause any changes in my cervical mucus”

Rationale:
A. Clomiphene citrate (Clomid) stimulates ovulation, which is indicated by a drop in body temperature followed by a rise of 0.50 to 10F. This temperature raise is caused by an increase in progesterone secreted by the corpus luteum. Because progesterone is thermogenic, this temperature increase is maintained during the second half of the menstrual cycle. Abstaining from intercourse during this time is unnecessary. Clomiphene causes thickening of the cervical mucus but should not cause painful breasts or bloating.

ANTEPARTAL PERIOD (10 items)

A 36-year-old female who is 32 weeks pregnant by dates present to the ED with her chief complaint of sudden vaginal bleeding, severe low abdominal cramping, and low back pain for the past 6 hours. The patient has been saturating one pad per hour. She also reports decrease in fetal movement over the past few hours. The patient has had no prenatal care during this pregnancy. Vital signs are BP 100/60 mmHg, HR 112/min, RR 24/min, and temperature 101.2 degrees F( 38.4 degrees C) orally.

1. You suspect that this patient has:

A. Placenta previa
B. Pelvis inflammatory disease
C. Abruptio placenta
D. Threatened abortion

Rationale:
C. Abruptio placenta is typically characterized by vaginal bleeding and is associated with low abdominal, pelvic, or back pain or a combination. The amount of bleeding in abruption placentae is variable, as bleeding may be concealed in the uterus. Uterine tenderness is present in abruption placenta.
A. Placenta previa is typically characterized by painless, bright-red vaginal bleeding. There is usually no report of a decrease in fetal movement.
B. Pelvic inflammatory disease does not cause onset of vaginal bleeding
D. “Threatened abortion” is a term used for vaginal bleeding before viability of the fetus (20 to 24 weeks).

2. The most appropriate nursing diagnosis for a patient who is bleeding from abruption placentae is:

A. Pain
B. Fluid volume deficit
C. Impaired gas exchange
D. altered tissue perfusion

Rationale:
Therefore, fluid volume deficit is the highest priority nursing diagnosis for this patient.
A. Pain is an important secondary nursing diagnosis.
C. Impaired gas exchange is an important secondary nursing diagnosis.
D. Altered tissue perfusion is an important secondary nursing diagnosis.

3. Your initial documented assessment of this patient (question #1) would include all of the following except:

A. Fetal heart tones
B. Orthostatic vital signs
C. Temperature
D. Respiratory rate

Rationale:
A. Fetal heart tones are detectable by Doppler methods at 10-12 weeks gestation. Based on the patient’s last menstrual cycle, if she were found to be pregnant, she would be approximately 7 weeks gestation.
B. This would be assessed for and documented.
C. This would be assessed for and documented.
D. This would be assessed for and documented.

4. Heparin is the preferred anticoagulant for pregnant cardiac patient because it:

A. Can be administered orally
B. Has a serum half-life of 3 to 4 days
C. Does not affect the patients active partial thromboplastin time (APPT)
D. Does not cross the placental barrier

Rationale:
D. Heparin is the preferred anticoagulant agent for pregnant women because it is composed of large molecules and does not cross the placental barrier; therefore, it does not affect coagulation in fetus. Heparin prolongs the patient’s activated partial thromboplastin time (APPT); in fact results of the daily APTT is used to determine the drugs dosage. Heparin’s serum half-life (the time it takes for the half of the serum concentration to decrease) is 1 to2 hours, not 3 to 4 days. Heparin is not administered orally, because it is broken down by the digestive system; it is administered intravenously or subcutaneously.

5. During the second trimester, the nurse would expect Mrs. N. to :

A. Realistically prepare for childbirth
B. Anticipate labor and delivery
C. Identify the fetus as a separate human being
D. Feels ambivalent about the pregnancy

Rationale:
C. During the second trimester, when fetal movement and the fetal heartbeat become detectable, the mother typically views her fetus as a separate being. Ambivalence is common during first trimester, because the mother’s though usually are centered on herself, she may find reasons why she should not be pregnant. Anticipating labor and delivery and realistically preparing for childbirth are common during the third trimester.

6. At 36 week’s gestation, Mrs.N’s. hemoglobin level has fallen to 11.2 g/dl from her pregnant level of 14.5g/dl. This decrease is probably the result of:

A. An expanded plasma volume
B. Increased fibrinogen levels
C. A low vit. C intake
D. Iron deficiency anemia

Rationale:
A. Plasma volume begins to increase during the 6th to the 10th week of gestation and peaks during the 32nd week; the RBC mass also increases, but because this occurs later in pregnancy, hemoglobin level drops. Iron deficiency anemia, which affects 15% of all pregnant women , causes hemoglobin levels to fall below 11.0g/dl and serum ferritin levels (which reflects iron source) to fall below 12cgm/liter. Decrease Vit. C intake would not cause the hemoglobin level to drop; neither would increase fibrinogen levels, which help prevent maternal hemorrhage during childbirth. Other factors that would affect the patient’s hemoglobin level include the rate of RBC breakdown and iron neutralization by the bone marrow, dietary iron intake, and the ability of the gastrointestinal tract to absorb iron.


Mrs. S., a 26-year-old mother of 5-year-old twin sons, is making her initial visit to the antepartal clinic. Her obstetric history reveals the birth of a stillborn infant in the 38th week of gestation and the birth of her twins in the 35th week of gestation. The physician has confirmed her current pregnancy and estimated at to be 16 week’s of gestation.

7. Based on Mrs. S’.s obstetric history, the nurse should classify her as:

A. Gravida 3 para 1201
B. Gravida 2 para1102
C. Gravida 4 para 1202
D. Gravida 3 para 1102

Rationale:
D. Because the patient has had two previous pregnancies, her current classification is gravida 3. because her first pregnancy went to term, her second pregnancy resulted in preterm birth (twins) at 35th weeks gestation, and her history indicates no abortions and two living children, the rest of her classification is para 1102.

8. Mrs. S.’s blood is Rh-negative. The physician would schedule the administration of human Rh0(D) immune globulin (RhoGAM) at the 28th week of gestation if Mrs. S had a:

A. Negative indirect Coomb’s test result
B. Negative direct Coomb’s result
C. Positive indirect Coomb’s result
D. Positive direct Coomb’s result

Rationale:
A. An indirect Coomb’s test determines whether an Rh-negative patient has a circulating antibodies against Rh-positive RBC’s; a negative result calls for one 300-mcg dose of human Rh0(D) immune globulin (RhoGAM) IM at 26 to 28 weeks gestation. If the fetus is Rh-positive, the Rh0(D) immune globulin will suppress the patient’s immune response to the Rh-positive RBC’s; this prevents Rh isoimmunization, a serious blood incompatibility that may lead to fetal and neonatal anemia; jaundice ;liver, heart and spleen enlargement; and fetal hypoxia and death. If the neonate’s blood is identif