MSN 277 Exam 1 Questions

After receiving change-of-shift report on the following four patients, which patient should the nurse see first? A. A 60-year old patient with right-sided weakness who has an infusion of tPA prescribed. B. A 50-year old patient who has atrial fibrillation and a new order for warfarin (coumadin). C. A 30-year old patient with a subarachnoid hemorrhage 2 days ago who has nimodipine scheduled. D. A 40-year old patient who experienced a transient ischemic attack yesterday who has a dose of aspirin due

A. A 60-year old patient with right-sided weakness who has an infusion of tPA prescribed.

The nurse is attempting to flush a central line catheter and meets resistance. Which of the following is the best first action to take? A. Ask the patient to change positions and cough B. Apply more pressure when attempting to flush C. Use a smaller syringe to flush the catheter D. Change the dressing, then attempt to flush again

A. Ask the patient to change positions and cough

When a nurse is caring for a patient with type 1 diabetes, what clinical manifestation would be a priority to closely monitor? A. Hypoglycemia B. Hyponatremia C. Ketonuria D. Polyphagia Exam 1 Module 2

A. Hypoglycemia Maybe because hypoglycemia is the most life threatening out of all the manifestations.

A patient with diabetic ketoacidosis has had a large volume of fluid infused for rehydration. What potential complication from rehydration should the nurse monitor for? A. Hypokalemia B. Hypermagnesemia C. Hyperglycemia D. Hypocalcemia Exam 1 Module 2

A. Hypokalemia

A patient is diagnosed with type 1diabetes. What clinical characteristics does the nurse expect to see in this patient? Select all that apply A. Ketosis prone B. Little to no endogenous insulin C. Obesity at diagnosis D. Younger than 30 years old E. Older than 65 years old Exam 1 Module 2

A. Ketosis prone B. Little to no endogenous insulin D. Younger than 30 years old

Which of the following are the nurse's primary concerns when providing end-of-life care for a client and family? (Select all that apply). A. Maintaining client comfort B. Arranging plans for after death C. Supporting family members D. Providing personal care E. Completing a head-to-toe assessment F. Encouraging fluids

A. Maintaining client comfort C. Supporting family members D. Providing personal care Focus on "for a client and family"

The nurse admits a patient who is diagnosed with new onset diabetes mellitus. While performing the initial physical assessment and history, the nurse expects to find which of the following signs and symptoms? A. Polydipsia, polyuria, weight loss B. Weight gain, tiredness, bradycardia C. Irritability, diaphoresis, tachycardia D. Diarrhea, abdominal pain, weight loss Exam 1 Module 2

A. Polydipsia, polyuria, weight loss

The diabetic patient asks the nurse why it is necessary to maintain blood glucose levels no lower than 70 mg/dL. What is the nurse's best response? A. "Glucose is the only fuel form used by body cells to produce energy needed for physiologic activity." B. "The central nervous system, which cannot store glucose, requires a continuous supply of glucose for fuel." C. "Without a minimum level of glucose circulating in the blood, erythrocytes cannot produce ATP." D. "The presence of glucose in the blood counteracts the formation of lactic acid and prevents acidosis." Exam 1 Module 2

B. "The central nervous system, which cannot store glucose, requires a continuous supply of glucose for fuel."

A 70-year old female patient with left-sided hemiparesis arrives by ambulance to the emergency department. Which action should the nurse take first? A. Take the patient's blood pressure B. Check the respiratory rate and effort C. Assess the Glasgow Coma Scale score D. Send the patient for a computed tomography (CT) scan

B. Check the respiratory rate and effor

Which of the following remains the greatest barrier to improving end-of-life care? A. Advances in technology available to prolong life B. Clinician's attitudes toward terminally ill C. Client and family denial about seriousness of the illness D. Focus on managing acute illness to achieve a cure

B. Clinician's attitudes toward terminally ill

Which information is a top priority to teach a patient about performing self continuous ambulatory peritoneal dialysis? A. Eat adequate amounts of protein B. Maintain sterile technique during exchanges C. Measure abdominal girth daily D. Record blood pressure and weight Exam 1 Module 2

B. Maintain sterile technique during exchanges If sterile technique is not maintained, peritonitis could result.

A patient will attempt oral feedings for the first time after having a stroke. The nurse should assess the gag reflect and then: A. Order a varied pureed diet B. Assess the patient's appetite C. Assist the patient into a chair D. Offer the patient a sip of juice Answer Key:C

C. Assist the patient into a chair

A patient who has a history of transient ischemic attack (TIA) has an order for aspirin 160 mg daily. When the nurse is administering medications, the patient says, "I don't need aspirin today. I don't have a fever." Which action should the nurse take? A. Document that the aspirin was refused by the patient. B. Tell the patient that the aspirin is used to prevent a fever. C. Explain that the aspirin is ordered to decrease stroke risk. D. Call the health care provider to clarify the medication orde

C. Explain that the aspirin is ordered to decrease stroke risk.

A patient is receiving an intravenous antibiotic through a long-term central venous access device that has an open-ended tip. Which of the following is the appropriate method to flush the catheter after administration of the medication? A. Saline B. Heparin C. Saline, then heparin D. Heparin, then saline

C. Saline, then heparin

The nurse is educating a patient about the benefits of fruit vs fruit juices in the diabetic diet. The patient states, "What difference does it make if you drink the juice or eat the fruit? It is all the same." What is the best response by the nurse? A. "Eating the fruit is more satisfying than drinking the juice. You will get full faster." B. "Eating the fruit will give more vitamins and minerals than the juice will." C. "The fruit has less sugar than the juice." D. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." Exam 1 Module 2

D. "Eating the fruit instead of drinking juice decreases the glycemic index by slowing absorption." Because it is a food and will stay in the stomach longer.

What instruction should the nurse emphasize when teaching the diabetic patient about how to alter diabetes management during a period of illness that includes nausea and vomiting. A. "Continue your prescribed exercise regimen." B. "Avoid eating or drinking to reduce vomiting." C. "Do not use insulin or take your oral antidiabetic agent." D. "Monitor your blood glucose levels at least every 4 hours." Exam 1 Module 2

D. "Monitor your blood glucose levels at least every 4 hours."

The patient presents with diaphoresis, palpitations, jitters, and tachycardia approximately 1.5 hours after taking his normal morning insulin dose. What is the most appropriate intervention by the nurse? A. Give nitroglycerin and perform an ECG B. Call the HCP for additional insulin orders C. Restrict salt, administer diuretics D. Check the blood glucose and administer carbohydrates as indicated Exam 1 Module 2

D. Check the blood glucose and administer carbohydrates as indicated The patient is exhibiting signs of hypoglycemia

The nurse is developing a nursing care plan for the patient diagnosed with end stage renal disease. Which nursing problem would have priority for this patient? A. Low self-esteem B. Knowledge deficit C. Activity intolerance D. Excess fluid volume Exam 1 Module 2

D. Excess fluid volume Risk for FVO r/t impaired kidney function

A 20-year-old college student who has type 1 diabetes normally walks each evening as part of her exercise regimen. She now plans to enroll in a swimming class to meet her physical education requirement. The nurse teaches the patient that adjustments to her treatment plan should include: A. Delaying the normal meal before the swimming class until the session is over. B. Adding 10 units of regular insulin to her usual morning dose on the days she plans to swim. C. Timing her morning insulin injection so that the peak action will occur during her swimming class. D. Monitoring her glucose level before, during, and after swimming to determine the need for alterations in food or insulin. Exam 1 Module 2

D. Monitoring her glucose level before, during, and after swimming to determine the need for alterations in food or insulin.

The patient on an intensified insulin regimen consistently has a fasting blood glucose between 80 and 90 mg/dL and a Glycosylated Hemoglobin level of 5.5%. What is the nurse's interpretation of these findings? A. The patient is at increased risk for developing hypoglycemia. B. The patient is at increased risk for developing hyperglycemia. C. The patient is demonstrating signs of insulin resistance. D. The patient is demonstrating good control of blood glucose. Exam 1 Module 2

D. The patient is demonstrating good control of blood glucose. Glucose levels are within normal range and the A1C is in ideal range (less than 7%)

Which information will be included when the nurse is teaching self-management to a patient who is receiving peritoneal dialysis (select all that apply)? a. Avoid commercial salt substitutes b. Restrict fluid intake to 1000 mL daily c. Take phosphate binders with each meal d. Choose high-protein foods for most meals e. Have several servings of dairy products daily

a. Avoid commercial salt substitutes c. Take phosphate binders with each meal d. Choose high-protein foods for most meals Patients who are receiving peritoneal dialysis should have a high-protein diet. Phosphate binders are taken with meals to help control serum phosphate and calcium levels. Commercial salt substitutes are high in potassium and should be avoided. Fluid intake is not limited unless weight and blood pressure are not controlled. Dairy products are high in phosphate and usually are limited.

A patient with a history of polycystic kidney disease is admitted to the surgical unit after having shoulder surgery. Which of the routine postoperative orders is most important for the nurse to discuss with the health care provider? a. Give ketorolac 10 mg PO PRN for pain b. Infuse 5% dextrose in normal saline at 75 mL/hr c. Order regular diet after patient is awake and alert d. Draw blood urea nitrogen (BUN) and creatinine in 2 hours

a. Give ketorolac 10 mg PO PRN for pain The nonsteroidal antiinflammatory drugs (NSAIDs) should be avoided in patients with decreased renal function because nephrotoxicity is a potential adverse effect. The other orders do not need any clarification or change.

1. A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, "Do you think I should go on dialysis? Which initial response by the nurse is best? a. "It depends on which type of dialysis you are considering." b. "Tell me more about what you are thinking regarding dialysis." c. "You are the only one who can make the decision about dialysis." d. "Many people your age use dialysis and have a good quality of life."

b. "Tell me more about what you are thinking regarding dialysis." The nurse should initially clarify the patient's concerns and questions about dialysis. The patient is the one responsible for the decision, and many people using dialysis do have good quality of life, but these responses block further assessment of the patient's concerns. Referring to which type of dialysis the patient might use only indirectly responds to the patient's question.

A patient has a parenteral nutrition infusion of 25% dextrose. A student nurse asks the nurse why a peripherally inserted central catheter was inserted. Which response by the nurse is accurate? a. "The prescribed infusion can be given more rapidly when the patient has a central line." b. "The hypertonic solution will be more rapidly diluted when given through a central line." c. "There is a decreased risk for infection when 25% dextrose is infused through a central line." d. "The required blood glucose monitoring is based on samples obtained from a central line." Module 4 CVAD NCLEX Questions

b. "The hypertonic solution will be more rapidly diluted when given through a central line." The 25% dextrose solution is hypertonic. Shrinkage of red blood cells can occur when solutions with dextrose concentrations greater than 10% are administered IV. Blood glucose testing is not more accurate when samples are obtained from a central line. The infection risk is higher with a central catheter than with peripheral IV lines. Hypertonic or concentrated IV solutions are not given rapidly.

1. A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching? a. Increased calories are needed because glucose is lost during hemodialysis b. More protein is allowed because urea and creatinine are removed by dialysis c. Dietary potassium is not restricted because the level is normalized by dialysis d. Unlimited fluids are allowed because retained fluid is removed during dialysis

b. More protein is allowed because urea and creatinine are removed by dialysis When the patient is started on dialysis and nitrogenous wastes are removed, more protein in the diet is encouraged. Fluids are still restricted to avoid excessive weight gain and complications such as shortness of breath. Glucose is not lost during hemodialysis. Sodium and potassium intake continues to be restricted to avoid the complications associated with high levels of these electrolytes.

Which information in a patient's history indicates to the nurse that the patient is not an appropriate candidate for kidney transplantation? a. The patient has type 1 diabetes b. The patient has metastatic lung cancer c. The patient has a history of chronic hepatitis C infection d. The patient is infected with human immunodeficiency virus

b. The patient has metastatic lung cancer Disseminated malignancies are a contraindication to transplantation. The conditions of the other patients are not contraindications for kidney transplant.

1. The nurse is titrating the IV fluid infusion rate immediately after a patient has had kidney transplantation. Which parameter will be most important for the nurse to consider? a. Heart rate b. Urine output c. Creatinine clearance d. Blood urea nitrogen (BUN) level

b. Urine output Fluid volume is replaced based on urine output after transplant because the urine output can be as high as a liter an hour. The other data will be monitored but are not the most important determinants of fluid infusion rate.

Which statement by a patient with stage 5 chronic kidney disease (CKD) indicates that the nurse's teaching about management of CKD has been effective? a. "I need to get most of my protein from low-fat dairy products." b. I will increase my intake of fruits and vegetables to 5 per day." c. "I will measure my urinary output each day to help calculate the amount I can drink." d. "I need to take erythropoietin to boost my immune system and help prevent infection."

c. "I will measure my urinary output each day to help calculate the amount I can drink." The patient with end-stage renal disease is taught to measure urine output as a means of determining an appropriate oral fluid intake. Erythropoietin is given to increase the red blood cell count and will not offer any benefit for immune function. Dairy products are restricted because of the high phosphate level. Many fruits and vegetables are high in potassium and should be restricted in the patient with CKD.

Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? a. Notify the health care provider. b. Offer reassurance to the patient. c. Auscultate the patient's breath sounds. d. Give prescribed PRN morphine sulfate IV. Module 4 CVAD NCLEX Questions

c. Auscultate the patient's breath sounds. The initial action should be to assess the patient further because the history and symptoms are consistent with several possible complications of central line insertion, including embolism and pneumothorax. The other actions may be appropriate, but further assessment of the patient is needed before notifying the health care provider, offering reassurance, or administration of morphine.

After the insertion of an arteriovenous graft (AVG) in the right forearm, a patient complains of pain and coldness of the right fingers. Which action should the nurse take? a. Teach the patient about normal AVG function b. Remind the patient to take a daily low-dose aspirin tablet c. Report the patient's symptoms to the health care provider d. Elevate the patient's arm on pillows to above the heart level

c. Report the patient's symptoms to the health care provider The patient's complaints suggest the development of distal ischemia (steal syndrome) and may require revision of the AVG. Elevation of the arm above the heart will further decrease perfusion. Pain and coolness are not normal after AVG insertion. Aspirin therapy is not used to maintain grafts.

1. Which action by a patient who is using peritoneal dialysis (PD) indicates that the nurse should provide more teaching about PD? a. The patient leaves the catheter exit site without a dressing b. The patient plans 30 to 60 minutes for a dialysate exchange c. The patient cleans the catheter while taking a bath each day d. The patient slows the inflow rate when experiencing abdominal pain

c. The patient cleans the catheter while taking a bath each day Patients are encouraged to take showers rather than baths to avoid infections at the catheter insertion side. The other patient actions indicate good understanding of peritoneal dialysis.

Which finding for a patient admitted with glomerulonephritis indicates to the nurse that treatment has been effective? a. The patient denies pain with voiding b. The urine dipstick is negative for nitrites c. The antistreptolysin-O (ASO) titer has decreased d. The periorbital and peripheral edema are resolved

d. The periorbital and peripheral edema are resolved Because edema is a common clinical manifestation of glomerulonephritis, resolution of the edema indicates that the prescribed therapies have been effective. Nitrites will be negative and the patient will not experience dysuria because the patient does not have a urinary tract infection. Antibodies to streptococcus will persist after a streptococcal infection.