COX Final Exam

A client admitted to the emergency department (ED) with chest injuries following a motor vehicle accident complains that it hurts to breathe. The client's respiratory rate is 12 and very shallow. The nurse would anticipate which results on arterial blood gases (ABGs)?

pH 7.31, PaCO2 49 mmHg, HCO3 24 mEq/L, SaO2 87%

For a client diagnosed with pernicious anemia, the nurse emphasizes the importance of lifelong administration of which vitamin supplement?

Vitamin B 12.

A client received chemotherapy 24 hours ago. Which precautions are necessary when caring for the client?

Wear personal protective equipment when handling blood, body fluids, and feces.

Which set of arterial blood gas (ABG) results requires further investigation?

pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

The clinic nurse is caring for a client who has just been diagnosed with a tumor. The client says to the nurse "The doctor says my tumor is benign. What does that mean?" What is the nurse's best response?

"Benign tumors don't usually cause death."

A father telephones the clinic nurse asking what he should do for his three-year-old son who developed fever, vomiting, and diarrhea today. What would be an appropriate recommendation by the nurse?

"Give small sips of commercial oral rehydration fluids frequently."

The community health nurse is performing a home visit to an older client recovering from hip surgery. The nurse notes that the client seems uncharacteristically confused and has dry mucous membranes. When asked about fluid intake, the client states, "I stop drinking water early in the day because it is just too difficult to get up during the night to go to the bathroom." What would be the nurse's best response?

"Limiting your fluids can create imbalances in your body that can result in confusion. Maybe we need to adjust the timing of your fluids."

The nurse is caring for a client with the diagnosis of colon cancer with metastasis to the liver. Which statement made by the client indicates an understanding of the diagnosis?

"My cancer has now spread to my liver."

The nurse is assisting in a health fair at a senior citizen center. Which instruction should the nurse include when giving an older adult guidelines about remaining hydrated in hot weather?

"Popsicles, gelatin, and ice cream provide fluid intake as well as liquids you drink."

You are caring for a client who has just been told that they have stage IV colon cancer. The client asks you what "stage IV" means. What would be your best response?

"Stage IV means that the cancer has spread to other organs of the body."

The nurse concludes that which statement by a student nurse reflects correct understanding about the client's physiological attempt to restore homeostasis during acidosis?

"The kidneys may not start to function immediately but are very effective as a buffer system to restore the acid-base balance."

The client with respiratory acidosis from COPD asks the nurse why a continuous pulse oximeter is ordered. Which response by the nurse is best?

"The pulse oximeter measures the oxygen saturation in your blood at any given time."

The nurse is preparing to administer 25 mg furosemide (Lasix) intravenously to a client with peripheral edema and lung crackles. The 2 mL vial is labeled 20 mg/mL. How many mL of solution should the nurse draw up? Record your answer rounding to two decimal places.

1.25 mL

A hospital has been the site of an increased incidence of hospital-acquired pneumonia (HAP). What is an important measure for the prevention of HAP?

Administration of pneumococcal vaccine to vulnerable individuals

Which of the following is the most common cause of symptomatic hypomagnesemia in the United States?

Alcoholism

To evaluate a client for hypoxia, the physician is most likely to order which laboratory test?

Arterial blood gas (ABG) analysis

The nurse is caring for a patient who is receiving oxygen therapy for pneumonia. How should the nurse best assess whether the patient is hypoxemic?

Assess the patient's oxygen saturation level.

An oncology client has begun to experience skin reactions to radiation therapy, prompting the nurse to make the diagnosis Impaired Skin Integrity: erythematous reaction to radiation therapy. What intervention best addresses this nursing diagnosis?

Avoid rubbing or scratching the affected area

The nurse is evaluating bloodwork results of a client with cancer who is receiving chemotherapy. The client's platelet count is 60,000/mm3. Which is an appropriate nursing action?

Avoiding the use of products containing aspirin

When a client's ventilation is impaired, the body retains which substance?

Carbon dioxide

The patient diagnosed with thrombocytopenia is at risk for which of the following adverse effects:

Bleeding

A 45-year-old client is receiving a loop diuretic for treatment of edema. The nurse determines the client is experiencing an excessive response to the treatment when the client demonstrates which of the following?

Blood urea nitrogen (BUN) 28 mg/L, hematocrit (Hct) 45%, and an 8-pound weight loss in 24 hours

Which is an insensible mechanism of fluid loss?

Breathing

An 87-year-old patient has been hospitalized with pneumonia. Which nursing action would be a priority in this patient's plan of care?

Cautious hydration

Which of the following terms refers to lung tissue that has become more solid in nature due to a collapse of alveoli or an infectious process?

Consolidation

The nurse is caring for a client with laboratory values indicating dehydration. Which clinical symptom is consistent with the dehydration?

Dark, concentrated urine

A client was admitted to the hospital unit after 2 days of vomiting and diarrhea. The client's spouse became alarmed when the client demonstrated confusion and elevated temperature, and reported "dry mouth." The nurse suspects the client is experiencing which condition?

Dehydration

The nurse is caring for a client who has just been given a 6-month prognosis following a diagnosis of extensive stage small-cell lung cancer. The client states that he would like to die at home, but the team believes that the client's care needs are unable to be met in a home environment. What might the nurse suggest as an alternative?

Discuss a referral for hospice care

A client is taking spironolactone to control hypertension. The client's serum potassium level is 6 mEq/L. What is the nurse's priority during assessment?

Electrocardiogram (ECG) results

To confirm an acid-base imbalance, it is necessary to assess which findings from a client's arterial blood gas (ABG) results? Select all that apply.

HCO3 PaCO2 pH

Arterial blood gases on a client with pneumonia indicate the client is in respiratory acidosis. In order to best improve this acid-base imbalance, the nurse implements which of the following nursing interventions? Select all that apply.

Encourage frequent cough and deep breathing exercises Medicate with a non-opiate pain medication frequently for intercostal muscle pain

A client on the oncology unit is receiving carmustine, a chemotherapy agent, and the nurse is aware that a significant side effect of this medication is thrombocytopenia. Which symptom should the nurse assess for in clients at risk for thrombocytopenia?

Epistaxis

Which nerve is implicated in the Chvostek's sign?

Facial

You've been invited to speak to the Hospital Guild of the hospital where you practice nursing. You've been asked to address "Communicable Diseases of Winter" and are speaking to a large group of volunteer women, most of whom are older than 60 years. What practices should you encourage in these women, who are at the risk of pneumococcal and influenza infections? Select all that apply.

Hand antisepsis Receiving vaccinations Techniques for incentive spirometry

The nurse is assessing the client for the presence of a Chvostek sign. What electrolyte imbalance would a positive Chvostek sign indicate?

Hypocalcemia

A client is receiving an intravenous (IV) infusion of 0.0225% sodium chloride at 50 mL/hour. It is most important for the nurse to monitor which of the following to detect complications of therapy?

Mental status and orientation

The nurse assesses a client with uncontrolled Type I Diabetes Mellitus (DM) for which primary acid-base imbalance?

Metabolic acidosis

The nurse would closely monitor a client with renal failure for which of the following primary acid-base imbalances?

Metabolic acidosis

A priority nursing intervention for a client with hypervolemia involves which of the following?

Monitoring respiratory status for signs and symptoms of pulmonary complications.

A patient newly diagnosed with cancer is scheduled to begin chemotherapy treatment and the nurse is providing anticipatory guidance about potential adverse effects. When addressing the most common adverse effect, what should the nurse describe?

Nausea and vomiting

The nurse evaluates the hydration status of a client who has been receiving intravenous (IV) fluids at 150 mL/hour. The nurse identifies that the client has fluid volume excess after assessing which of the following? Select all the apply.

Neck veins are distended when head of the bed is elevated 45 degrees Client becomes short of breath when ambulating Pitting edema is present over tibia

A 64-year-old client is brought in to the clinic with thirsty, dry, sticky mucous membranes, decreased urine output, fever, a rough tongue, and lethargy. Serum sodium level is above 145 mEq/L. Should the nurse start salt tablets when caring for this client?

No, sodium intake should be restricted.

A gerontologic nurse is teaching a group of medical nurses about the high incidence and mortality of pneumonia in older adults. What is a contributing factor to this that the nurse should describe?

Older adults often lack the classic signs and symptoms of pneumonia.

A nurse is teaching a community class about how to decrease the risk of cancer. Which food should the nurse recommend?

Oranges

Which of the following is a key characteristic of pleurisy?

Pain

The calcium concentration in the blood is regulated by which mechanism?

Parathyroid hormone (PTH)

Which type of pneumonia has the highest incidence in AIDS patients and patients receiving immunosuppressive therapy for cancer?

Pneumocystis

A client with pancreatic cancer has the following blood chemistry profile: Glucose, fasting: 204 mg/dl; blood urea nitrogen (BUN): 12 mg/dl; Creatinine: 0.9 mg/dl; Sodium: 136 mEq/L; Potassium: 2.2 mEq/L; Chloride: 99 mEq/L; CO2: 33 mEq/L. Which result should the nurse identify as critical and report immediately?

Potassium

Which of the following should a nurse encourage in patients who are at the risk of pneumococcal and influenza infections?

Receiving vaccination

A 16-year-old female client experiences alopecia resulting from chemotherapy, prompting the nursing diagnoses of disturbed body image and situational low self-esteem. The nurse should determine that the client is meeting the goal of improved body image and self-esteem when the client:

Requests that her family bring her makeup and wig.

A client who is being treated for pneumonia reports sudden shortness of breath. An arterial blood gas (ABG) is drawn, yielding the following values: pH 7.21, PaCO2 64 mm Hg, HCO3 = 24 mm Hg. What does the ABG reflect?

Respiratory acidosis

After being seen in the oncology clinic, a client with severe bone marrow suppression is admitted to the hospital. The client's cancer therapy consisted of radiation and chemotherapy. When developing the care plan for this client, which nursing diagnosis takes priority?

Risk for infection

The nurse is helping the client with iron-deficiency anemia to select appropriate menu choices. Which diet choices indicate that teaching has been effective?

Roast beef, steamed spinach, tomato soup, and orange juice.

A client with a nursing diagnosis of excess fluid volume has been treated with diuretics and fluid restriction. Which findings would best indicate to the nurse that fluid volume balance has not yet been totally achieved?

S3 heart sounds and moist lung crackles resolving

A nurse is caring for a client with prostate cancer and assesses bleeding gums and hematuria. What serum indicator should the nurse relate the bleeding?

platelet count of 60,000/mm3

A client receiving intravenous (IV) sodium bicarbonate for treatment of metabolic acidosis develops muscle twitching and an irregular pulse. Which action should be taken by the nurse initially?

Stop the infusion and notify the physician

A client calls the oncology office nurse and reports nausea and vomiting one week after receiving chemotherapy. What action should the nurse recommend?

Taking prescribed ondansetron

When providing patient teaching regarding taking iron pills, the nurse would include which instructions? (Select all that apply.)

Teaching about potential constipation. Keep this potentially toxic medication away from children. Your stools may be green colored.

Which of the following is the single largest preventable cause of cancer?

Tobacco

1. A client has a serum calcium level of 7.2 mg/dl (1.8 mmol/L). During the physical examination, the nurse expects to assess:

Trousseau's sign

Which of the following comfort techniques does a nurse teach to a patient with pleurisy to assist with splinting the chest wall?

Turn onto the affected side

Which of the following would be inconsistent as a common side effect of chemotherapy?

Weight gain

A 57-year-old client is admitted with a diagnosis of acute myocardial infarction. Arterial blood gas (ABG) results are pH 7.36, PaCO2 29, HCO3 20, SaO2 100%. The nurse draws which conclusion about this client's status?

Well oxygenated with compensated metabolic acidosis

Clients diagnosed with hypervolemia should avoid sweet or dry food because it

increases the client's desire to consume fluid

According to the TNM classification system, T0 means there is

no evidence of primary tumor

A client with Guillain-Barré syndrome develops respiratory acidosis as a result of reduced alveolar ventilation. Which combination of arterial blood gas (ABG) values confirms respiratory acidosis?

pH 7.25; PaCO2 50mmHg

Which of the following arterial blood gases (ABGs) would the nurse expect to see when a client has apnea and develops acidosis?

pH 7.29, PaCO2 62 mmHg, HCO3 23 mEq/L

Which of the following ABG results would the nurse expect to see when a client is admitted with diarrhea that has lasted for four days?

pH 7.30, PaCO2 40 mmHg, HCO3 18 mEq/L

What disadvantages of chemotherapy should the patient be informed about prior to starting the regimen?

It targets normal body cells as well as cancer cells.

The clinic nurse is caring for a 42-year-old male oncology patient. He complains of extreme fatigue and weakness after his first week of radiation therapy. What response by the nurse would best reassure this patient?

"These symptoms usually result from radiation therapy; however, we will continue to monitor your laboratory and X-ray studies."

A nurse is preparing instructions for a patient with a lung abscess regarding dietary recommendations. Which of the following statements would be included in the plan of care?

"You must consume a diet rich in protein, such as chicken, fish, and beans."

A 45-year-old client with fluid volume excess become of acute kidney dysfunction is placed on a 1000 mL fluid restriction per 24-hour period. The client asks the nurse, "Why is there such a severe fluid restriction when I already have dry lips and mouth?" Which response by the nurse is the best?

"Your kidneys cannot eliminate extra fluid right now, so intake must be limited to protect your heart and lungs from being overloaded with fluid."

Which is considered an isotonic solution?

0.9% normal saline

A 28-year-old client is admitted with severe bleeding from a fractured femur. Which intravenous (IV) fluid does the nurse anticipate as the most appropriate for use to replace potential fluid losses?

0.9% sodium chloride (0.9% NaCl)

A client hospitalized for gastrointestinal (GI) bleeding has orders for nasogastric tube placement with irrigations until the returns are clear. Which prescribed solution should the nurse plan on using?

0.9% sodium chloride (NaCl)

The nurse knows which is the normal serum value for potassium?

3.5-5.0 mEq/L

Which of the following pH values would the nurse expect to see in an anxious client?

7.50

Which of the following would be LEAST likely to contribute to a case of hospital-acquired pneumonia?

A nurse washes her hands before beginning patient care.

An adult client in the clinic reports a cough, fever, feeling weak and dizzy, and having nausea and vomiting for three days. Examination reveals dry tongue and oral mucosa, and concentrated urine. To best assess the client's fluid status, the nurse checks which assessment parameters?

BP and pulse in lying and standing positions

A client's most recent laboratory results show a slight decrease in potassium. The health care provider has opted to forgo drug therapy but has suggested increasing the client's dietary intake of potassium. What should the nurse recommend?

Bananas

A client with severe hypervolemia is prescribed a loop diuretic and the nurse is concerned with the client experiencing significant sodium and potassium losses. What drug was most likely prescribed?

Furosemide

What action should the nurse take initially to avoid acid-base imbalance which a client becomes anxious and starts to hyperventilate?

Give the client a paper bag to breathe into

The nurse is helping a client who was recently placed on a low-sodium diet to reduce fluid retention to choose foods for lunch. The nurse recommends which lunch menu that would be most beneficial for this client?

Grilled chicken sandwich on white bread, apple, salad and iced tea

What foods should the nurse suggest that the patient consume less of in order to reduce nitrate intake because of the possibility of carcinogenic action?

Ham and bacon

The nurse is caring for a client admitted with heart failure (HF). When assessing the client's risk for fluid imbalances, the nurse should check with laboratory values? Select all that apply.

Hemoglobin (Hgb) Hematocrit (Hct) Blood glucose

A 78-year-old client is admitted with dehydration and urinary tract infection. After IV infusion of 750 mL normal saline, the client begins to cough and asks for the head of the bed to be raised to ease breathing. The nurse assess jugular vein distention (JVD) and increased respiratory rate. How should the nurse interpret this data?

Hypervolemia is developing

The nurse is caring for a patient at risk for atelectasis. The nurse implements a first-line measure to prevent atelectasis development in the patient. What is an example of a first-line measure to minimize atelectasis?

Incentive spirometry

A critical-care nurse is caring for a patient diagnosed with pneumonia as a surgical complication. The nurse's assessment reveals that the patient has an increased work of breathing due to copious tracheobronchial secretions. What should the nurse encourage the patient to do?

Increase oral fluids unless contraindicated.

The nurse is assessing residents at a summer picnic at the nursing facility. The nurse expresses concern due to the high heat and humidity of the day. Although the facility is offering the residents plenty of fluids for fluid maintenance, the nurse is most concerned about which?

Insensible fluid loss

A client recovering from an acute asthma attack experiences respiratory alkalosis. The nurse measures a respiratory rate of 46 breaths/minute, a heart rate of 110 beats/minute, a blood pressure of 162/90 mm Hg, and a temperature of 98.

Instruct the client to breathe into a paper bag.

Your client has a diagnosis of hypervolemia. What would be an important intervention that you would initiate?

Limit sodium and water intake.

A 36-year-old female is admitted with vomiting and dehydration after having the flu for three days. Arterial blood gas (ABG) results are pH 7.46, PaCO2 50, HCO3 33, SaO2 95%. What do these values indicate to the nurse?

Metabolic alkalosis, partially compensated

When caring for an adult receiving an intravenous (IV) infusion of 3% sodium chloride (NaCl), the nurse places priority on monitoring which of the following to detect complications of therapy? Select all that apply.

Neurological status Lung sounds Serum sodium level

The nurse is reviewing client lab work for a critical lab value. Which value is called to the physician for additional orders?

Potassium: 5.8 mEq/L

The nurse has been caring for a client who has become extremely anxious and agiatated. When assessing the client, the nurse would expect to find which of the following that could ultimately lead to an acid-base imbalance?

Rapid, shallow respiratory pattern

During a community health fair, a nurse is teaching a group of seniors about health promotion and infection prevention. Which intervention would best promote infection prevention for senior citizens who are at risk of pneumococcal and influenza infections?

Receive vaccinations

The nurse prepares to administer synthetic erythropoietin to a client with renal failure. The nurse expects the therapeutic effect of this treatment to be the stimulation of the production of which cell or substance?

Red blood cells.

During intershift report, the nurse is told that a client who has suffered a stroke has also developed diabetes insipidus (DI). The nurse concludes this client is now at risk for which of the following?

Severe deficient fluid volume because of excess urine output

A 70-year-old client with a past medical history of hypertension and myocardial infarction is postoperative after stomach surgery. Vital signs have been stable with an IV of D51/2NS infusing at 100 mL/hour. The client now reports dyspnea, has a moist cough, and oxygen saturation has fallen to 92%. What action should the nurse take first?

Slow the intravenous rate to 10 to 20 mL/hour

The nurse caring for a patient recently diagnosed with lung disease encourages the patient not to smoke. What is the primary rationale behind this nursing action?

Smoking damages the ciliary cleansing mechanism.

Influenza, an annual epidemic in the U.S., creates a significant increase in hospitalizations and an increase in the death rates of pneumonia and cardiovascular disease. Besides death, what is the most serious complication of influenza?

Staphylococcal pneumonia

What does the nurse understand is the primary method by which fluid volume is regulated?

Urine excretion

A client is receiving radiation therapy and asks the nurse about oral hygiene. What teaching specific to the client's situation should the nurse include?

Use a soft toothbrush and allow it to air dry before storing.

A newly graduated nurse is admitting a patient with a long history of emphysema. The new nurse's preceptor is going over the patient's past lab reports with the new nurse. The nurse takes note that the patient's PaCO2 has been between 56 and 64 mm Hg for several months. The preceptor asks the new nurse why they will be cautious administering oxygen. What is the new nurse's best response?

Using oxygen may result in the patient developing carbon dioxide narcosis and hypoxemia.

A client in a full cardiac arrest is admitted to the emergency department (ED). Arterial blood gases (ABGs) indicate a respiratory acidosis. How does the nurse respond to correct this condition?

Ventilate client to "blow off" excess CO2

Palliation refers to

relief of symptoms of disease and promotion of comfort and quality of life.

A 17-year-old client who sustained a head injury in a motorcycle collision two days ago is responsive only to pain. Which intravenous (IV) fluid order would the nurse question because it could increase the risk of complications?

5% dextrose in water (D5W)

The nurse determines that which client is at highest risk for developing fluid volume deficit (FVD)?

A 76-year-old client wo has a NG tube to low suction following surgery for colon cancer

The nurse caring for the following group of clients considers which client to be at highest risk for developing deficient fluid volume?

A 76-year-old male who has a nasogastric (NG) tube to intermittent suction following colon resection

The nurse identifies which of the following clients to be at risk for developing metabolic alkalosis? Select all the apply.

A client who has a nasogastric tube to continuous suction A client who takes antacids frequently for heartburn

Oral intake is controlled by the thirst center, located in which of the following cerebral areas?

Hypothalamus

A 71-year-old client develops hypertension, tachycardia, and increased respirations two days after surgery. Arterial blood gas (ABG) results are pH 7.29, PaCO2 52, HCO3 24, SaO2 95%. The nurse interprets that these results indicate which of the following?

Respiratory acidosis, uncompensated

A client with COPD is admitted to the hospital with an exacerbation of the disease. Arterial blood gas (ABG) results are pH 7.30, PaCO2 51, and HCO3 25. How would the nurse interpret these results?

Respiratory acidosis, uncompensated

The arterial blood gas results of a 68-year-old client admitted with pneumonia are pH 7.46, PaCO2 30, HCO3 19, SaO2 72%. How should the nurse interpret these results?

Respiratory alkalosis, partially compensated

The nurse anticipates which of the following responses in a client who develops metabolic acidosis?

Respiratory rate will increase