Top Hat in Class Questions

Week 2
Top Hat Question:
1) The nurse is caring for a hearing-impaired client. Which approach will facilitate
communication?
A. Speak loudly
B. Speak rapidly
C. Speak at a normal volume
D. Speak directly into the impaired ear
Generally, hearing-impaired patients cant hear at a higher frequency or an increased
volume and we think its going to help but it does not (Presbycusis hearing problem
related to age; normal age related change). The nurse should still speak to the hearingimpaired patient at a normal volume and therefore, the ANSWER is C. The nurse should
also keep conversations short and concise, and use different words the second time
around. When then nurse is speaking, make sure the patient can see his/her lips because
sometimes the hearing-impaired patient can read your lips. Sit down and speak to the
patient if he/she is sitting; speak to the patient at their level. Make the environment
therapeutic. A hearing aid amplify the sound waves so they can hear louder.
2) A client with Menieres disease is experiencing severe vertigo. Which instruction
should the nurse give to the client to assist in controlling the vertigo?
a. Increase sodium in the diet
b. Lie still and watch television
c. Avoid sudden head movements
d. Increase fluid intake to 3000 mL a day
Answer =
3) A patient with early dementia exhibits disturbances in her mental awareness and
orientation to reality. The nurse should expect to assess a loss of ability in which of
the following other areas?
a. Speech
b. Judgement
c. Endurance
d. Balance
Dementia is a SYNDROME; pt has impairment in memory and cognitive issues. Therefore,
the ANSWER is B b/c if there is cognitive and memory impairment, then he or she will not
be able to make great judgements. This brings up a safety concern. The patient would
not be able to go home by themselves. Might not be able to turn on the stove, or get off
the bed too fast because their judgement is off, or cant drive.
4) The primary health provider prescribes risperidone (Risperdal) for a patient with
Alzheimers disease. The nurse anticipates andimistering this medication to help
decrease which of the following behaviors?
a. Sleep disturbances
b. Concomitant depression
c. Agitation and assaultiveness
d. Confusion and withdrawl
Altered behavior antipsychotic risperidone for Alzheimer;s disease. Its an off label
drug b/c often used s/s of schizo as well. Therefor the ANSWER is C, Agitation and
assaultiveness troubling symptoms of dementia. These patients can also experience
paranoia as an early symptom which is often misconceived as a mood issue but really an
early indication for screening of dementia. Intervention to help decrease the patients
agitation by getting into the patients reality to figure out his/her need is about what the
patient is concerned about at that point in time. VALIDATION THERAPY! EXPLORE the

patients needs. Some hospitals/nursing homes puts up a STOP sign by the door b/c the
patient does not have the cognitive ability to know they are not allowed to leave their
room; they might think they would need to go to work or go to the toilet. But once they
see the STOP sign, they would turn around and go back to their room.
Week 3
1) Nursing staff are trying to provide the safety to a patient with moderate dementia.
She is wandering at night and has trouble keeping her balance. She has fallen
twice with no injuries. The nurse should:
A. Move the patient to a room near the nurses station and install a bed alarm.
B. Have the patient sleep in a reclining chair across from the nurses station.
C. Help the patient to bed and raise all four bed rails.
D. Ask a family member to stay with the patient at night.
Answer = A. because her priority right now is safety and falls risk. She had two falls with
no injury (v falls with injury) already so we should put the bed in a lower position, making
sure the bed is locked and set accordingly, keeping the floors uncluttered, and keep rails
up instead of a vest restraint because it increases the risk of harm. These are
unrestrictive and decrease the risk for harm. The patient with moderate dementia does
not have good judgement and not independent in ADLs but not curled up in bed as well.
Knowing this we wont do B b/c the nursing station is very stimulated and might make
them more confused and whos at risk for delirium? Those with dementia so we want to
keep a soothing environment for them. Four side rails increase risk for injury b/c they try
to jump over or sneak out through the bottom, only 2 side rails should be up. Asking the
family members to stay with them is wrong b/c its the nurse or the staff responsibility to
delegate for the family member and keep the environment safe for the pt just in case the
family cant stay dont delegate to to family
2) The patient with dementia says to the nurse, I know you, you are Margaret, the
girl who lives down the street from me. Which of the following responses by the
nurse is most therapeutic?
A. Mrs.Jones, I am Rachel, a nurse here at the hospital Answer b/c its a gentle reorientation
B. Now Mrs. Jones, you know who I am.
C. Mrs. Jones, I told you already, Im Rachel and I dont live down the street.
D. I think you forgot that Im Rachel, Mrs. Jones.
3) The nurse is attempting to draw blood from a womean with the DX of delirium. The
patient yalls out, Stop , leave me alone. What are you trying to do to me? Whats
happening ot me? Which response by the nurse is most appropriate?
(CAM used to assess for Delirium inattention and acute onset)
A. The tests of your blood will help us figure out what is happening to you.
ANSWER
B. Please hold still so I dont have to stick you a second time. NO, considered as
a threat and might be heard in clinical
C. After I get your blood, Ill get some medicine to help you calm down
D. Ill tell you everything after I get your blood tests to the laboratory.
4) Which of the following is essential when caring for a patient who is experiencing
delirium?
A. Controlling behavioral symptoms with low dose psychotropics.
B. Identifying the underlying causative condition or illness.

C. Manipulating the environment to increase orientation.

D. Decreasing or discontinuing all previously prescribed meds.
Answer = B. Delirium is a MEDICAL EMERGENCY b/c its an acute onset of altered mental
status what to do? Not just treat it but find what CAUSED it (almost always r/t an
underlying medical problem/issue). Priority of care SAFETY, dont leave the patient, VS
to assess ABCs (maybe hypoxic or hypertensive). If we give meds it can increase
confusion (like Haldol) or you can mask the problem

Week 5
1) In teaching the patient with high blood pressure to avoid orthostatic hypotension,
that nurse should emphasize which of the following instructions? SELECT ALL THAT
APPLY
a. Plan regular times for medication administration
b. Arise slowly from bed
c. Avoid standing still for long periods of time
d. Increase sodium intake
ANSWER = Orthostatic HTN patient can fall and if a person with high BP get
orthostatic HTN because of their meds (A) help reduce orthostatic HTN b/c
meds have certain half-lives but teach to take it when taking it at a set time but
take it when theyre less likely to be moving around so that in of itself NOT
PREVENT ORTHOSTATIC HTN. (B) RISE SLOWLY and (C) standing for a long
period of time stasis and watch how theyre changing positions must be
done slowly. (D) we do not recommend only if pt has low sodium and have a
seizure risk to avoid hyponatremia and if pt has chronic HTN dont want to
limit too much sodium.
2) The most important long-term goal for a person with high blood pressure is to:
a. Lose weight
b. Retire from work early
c. Learn how to avoid stress
d. Make a commitment to long-term therapy
ANSWER = (D) make a commitment to long-term therapy management so
they can take their meds everyday to prevent target organ damage
Week 8
1) A patient has a wound on the ankle that is not healing. The nurse assesses the
patient for which of the following risk factors for delayed wound healing? SELECT
ALL THAT APPLY
a. A.Fib dysrhythmia and the heart isnt pumping as effectively; could have an
adequate CO with a.fib so wont be an exact risk for decreased wound healing
b. Advanced age age related changes therefore doesnt have the same
resiliency in their skin
c. DM II chronic hyperglycemic state and vasoconstriction r/t glycemic
injury to the vessel puts pt at risk for an increase risk of infection
d. Smoking vasoconstriction so no good circulation
Answer = B, C, and D; also understand principles of managing wounds such as
handling the underlying problem and do what we can to manage the wound
itself. Whats causing the wound? Treat it topically ; slough or eschar on the

wound is DEAD TISSUE no wound can heal if this is present therefore we need
to debride it and remove it; if someone has an infection we have to treat the
infection; deep cavity wound needs packing; we cant put a band-aid on a stage
4; use an EB scale such as a Braden Score; if person scores an 8 then we need
to implement skin care and include the inter-professional team
2) The cornerstone of moderate persistent asthma drug therapy is the use of:
a. Oral theophylline old med; long acting drug and has a very narrow
therapeutic range and not used a lot anymore; third or fourth line drug
b. Mast cell stabilizers
c. Short-acting beta 2-agonists action is to quickly act (short acting)
bronchodilator which is not something to help someone with persistence dz
(ALBUTEROL OR PROVENTIL) ; rescue inhaler HAVE TO HAVE WITH THEM ALL
THE TIME and when to use it; if we dont rescue someone with acute asthma
attack respiratory failure death ; dont want to use this all the time to
avoid irritants/triggers that flare them and use their SELF-MANAGEMENT PLAN
no smoking, record what their base line and use their PEAK FLOW METER
show their end expiratory volume; IDENTIFY THEIR OWN S/S;
d. Inhaled corticosteroids an ANTIINFLAMMAROTY! Maintenance med takes qd
at the set time
ANSWER = asthma and COPD = chronic airflow limitation dz so we want to take
care of the whole person so they need to have some med therapy to maintain
themselves; understanding this will help us have the knowledge with what type
of med he/she need; need meds to maintain effective air flow therefore D is the
right answer
3) A ventilated patients ABG are as follows: pH 7.16; PaCO2 80 mm Hg; PaO2 46 mm
Hg; HC0e 24 mEq.L; SaO2 81%. The nurse would interpret the results indicating:
a. Metabolic acidosis
b. Metabolic alkalosis
c. RESPIRATORY ACIDOSIS!
i. When can it be a partial compensated is when the pH is closer to
normal but values are not normal. Here the BICARB is not elevated its
normal. Mechanically Ventilated person treat whole patient; know
high alarms and low alarms and what nurse will do to intervene
d. Respiratory alkalosis
4) The client is admitted for an open reduction internal fixation of a fractured hip.
Immediately following surgery, the nurse should give priority to assessing the:
a. Serum collection (Davol) drain (a little drain; but if there is excessive drainage
of blood = ABCs)
b. Clients Pain
c. Nutritional Status
d. Immobilizer
ANSWER = Prioritize ABCs first and then assess the next priority physiological
issue such as PAIN or maybe neurological issue; people can come out of surgery
with a drain to decrease edema (inflammatory response) quicker healing and
reduce pain but answer is PAIN; with osteoporosis the nurse thinks about
fractures and plan of care is how to prevent fractures and what meds to use
with this chronic progressive dz bisphosphonates and selective estrogen

meds; osteoarthritis we think about pain and fnx limitation so help pt manage
this with prevention and tx strategies
5) The home hospice nurse is evaluating a patient who is dying of end-stage COPD.
The patient does not report any pain but requests something to help my
breathing. There is list of standing orders by the hospice physician. Which
prescribed order would be most helpful for this patient?
a. Administer morphine solutions 0.5 mg sublingually every 2 hours as
needed opioids are standard for treatment at end-of-life; when give
morphine it is important to check for respiratory depression and it has an
effect on the pain receptor , but morphine decreases O2 demand which will
help this patient and we also are concerned about low BP since it vasodilate
vessels that feed the lungs; evaluate pros and cons such as benefit burden at
end-of-life since the goal is different (a peaceful comfortable death vs. ABCs);
oxygen might not help with the breathlessness; dyspnea at end-or-life =
pulmonary congestion so the vasodilation of lung vessels might be beneficial
i. End of life due to COPD do we give morphine or o2? End-stage COPD so
goals are the relieve distress and make the patient comfortable
b. Administer lorazepam 2mg orally every 4 hours
c. Place 100% oxygen mask on the patient
d. Administer metoclopramide 10 mg orally as needed
ANSWER = A.
6) The patient asks the nurse, When will the durable power of attorney for healthcare
take effect? On which rationale will the nurse base the response?
a. It goes into effect when the patient needs a financial decision made
b. It will be in effect when the patient has a surgical procedure
c. The patient will state when it goes into effect
d. It becomes valid only when the patient can not make their own decision
ANSWER = D; (MOLST forms a hot pink form that is a set of medical orders
for life sustain tx; use of Abx or state where you would like to be hospitalized)