Knowledge and Clinical Judgment Advanced Test Questions

a nurse is reinforcing teaching about a new prescription for cromolyn sodium (intal) metered-dose inhaler (MDI) to a child who has asthma. which statement indicates the child needs further teaching?

"I will use my cromolyn nebulizer before using my albuterol inhaler" intal MDIs are long-term medications designed to improve asthma over a longer period of time. albuterol is prescribed with cromolyn. it is inhaled before cromolyn because it is a bronchodilator so it opens the airways so the cromolyn can reach further into the lungs.

a nurse is caring for a client who has a new colostomy. the client is being discharged and plans to live with her daughter. what response is appropriate when the daughter states she doesn't know how she is going to care for her mother's colostomy?

"what part of your mother's care concerns you?" the use of effective communication techniques fosters trust and therapeutic relationships with clients. clarification encourages the other person to further express concerns so they can be addressed.

a nurse is caring for a client with bipolar disorder and is taking lithium. which serum level indicates the client's dosage is appropriate for maintenance therapy?

0.75 mEq/L need to know about therapeutic serum lithium level levels. to achieve a therapeutic range, give 300-600mg of lithium during the active phase. the therapeutic serum lithium level is between 0.8-1.4mEq/L. maintenance levels of 0.4-1.3mEq/L are the achieved for clients prescribed lithium for long-term therapy.

Pt weighs 132 lb and has been prescribed gentamicin 5mg/kg/day by IV in three equal doses. Available is 40mg/mL that is to be added to 50mL 0.9% sodium chloride. How many mL should the nurse add to the solution per dose?

2.5 mL/dose medication administration math skills

a nurse is caring for a client who is pregnant with a single fetus and has a BMI of 23. how much weight should she gain during pregnancy?

25-35 lb know the appropriate weight gain to BMI ratio for pregancies

a nurse is assigned to care for four clients. the client with which tube is at an increased risk for hypokalemia

NG tube to suction potassium exists in large amounts in the GI fluids and is lost when gastric fluids are lost

A nurse is collecting data on a client who is diagnosed with schizophrenia and is taking clozapine. Which of the following findings indicates the client is experiencing an adverse effect of the medication?

WBC 2,800/mm3. you need nursing knowledge of clozapine to recall adverse SE. Clozapine is a second-gen antipsychotic used to relieve symptoms of schizophrenia and reduce suicidal behaviors in schizophrenic pts. Adverse SE include tachycardia, weight gain, sedation, and agranulocytosis (a decrease in neutrophils which can reduce the ability to fight infection). a WBC level of 2,800/mm3 or lower indicates pt is experiencing an adverse effect

a nursing supervisor is determining bed placement for four clients. which of the following clients should be placed on droplet precautions

a client who has rubella

a nurse is planning to obtain blood pressure on four clients. on which of the following clients should the nurse perform an electronic blood pressure measurement? patient recovering from cardiac catheterization parkinson's patient a patient with a seizure disorder hypoglycemic patient

a client who is recovering from cardiac catheterization electronic bp cuff measurement is attained through a sensor that detects vibrations and if there is other movement from shaking or seizing it could give a false reading

a nurse is caring for a client who has terminal pancreatic cancer. the client is competent and has requested no resuscitative measures be taken in the event of respiratory or cardiac arrest. which of the following is necessary to legally change the client's code status to do-not-resuscitate (DNR)?

a written prescription from the provider this is specific legal knowledge regarding a DNR code status.

a nurse is collecting data on a newborn who was delivered 30 minutes ago at the gestational age of 37 weeks. which of the following findings requires further intervention

abdominal distention abdominal distention that is present at birth indicates a tumor or an abdominal wall defect such as a ruptured viscus. finding should be reported immediately and evaluated further

a school nurse has requested the school board to remove a piece of playground equipment due to a documented increase in injuries that can be linked back to it. the nurse's actions are an example of what

advocacy supporting or seeking a specific course of action for the benefit and on behalf of a person, group, or community

a nurse is caring for a client who is postoperative following a wedge resection of a lung and has a chest tube with a water seal chest tube drainage system. the client reports a burning pain in his chest. which of the following actions by the nurse is approprate

assist the pt to a side-lying position burning sensation/pain can result from the chest tube becoming occluded because it is resting against tissue. it is possible to move the tip of the chest tube away from the tissues by repositioning. chest tubes should never go above the heart.

a nurse is providing education to the parent of an infant who is newly diagnosed with biliary atresia. the nurse should teach the parent that which of the following is a clinical manifestation associated with the illness?

dark urine biliary atresia is a progressive disease that leads to destruction of the biliary tree which has to do with the bile duct and bilirubin. dark urine is a clinical sign of biliary atresia because of conjugated bilirubin escaping from the liver and being excreted in the urine

nurse is caring for a client who is scheduled for a lumbar puncture. the nurse should teach the client that what is a post-procedure complication

headaches the CSF sometimes leaks between the third and fourth and fifth lumbar vertebrae at the puncture sites. the leakage leads to insufficient CSF in the brain which causes inability to maintain appropriate mechanical stabilization of the brain. a headache is a manifestation expereinced by 15-30% of clients following a lumbar puncture

a nurse is caring for a school-age client who was diagnosed with sickle cell anemia and has been admitted for a vaso-occlusive crisis. what has the highest priority

slurred speech sickle cell anemia is characterized by partial or complete replacement of mature hemoglobin with sickled hemoglobin. the sickle shape can block or reduce flow of blood through blood vessels resulting in complications. slurred speech can indicate a cerebrovascular accident which is a severe, life-threatening complication of sickle cell anemia and can lead to neurological impairment

a nurse is caring for a client who is experiencing night sweats and hemoptysis and is suspected to have active pulmonary tuberculosis. which of the following tests is used to confirm this diagnosis?

sputum culture for acid-fast bacillus kowledge of transmission and diagnostic criteria of tuberculosis is needed. x-rays will only show old lesions, not active TB. Mycobacterium tuberculosis is the bacteria that causes TB and is found in the sputum and secretions therefore the presence of acid fast bacillus in the sputum, secretions, or tissues of the client is the only method to confirm the diagnosis of active tuberculosis.

a nurse is reinforcing teaching about diet for dumping syndrome to a client who is postoperative following a gastrectomy. which of the following food selections by the client indicates the teaching was effective

toast with peanut butter need to know which foods are okay to eat or should be avoided with dumping syndrome

a nurse is caring for a toddler who has acute otitis media and is prescribed benzocaine ear drops for pain relief. which of the following actions by the nurse is appropriate when administering them

warm the drops to room temperature to help keep the child patient comfortable as possible warming the drops to room temp helps reduce the shock