Management Quiz 1 Study
The nurse is preparing to implement teaching about a heart-healthy diet and activity levels for a client who has had a MI and the client's spouse . The client says "I dont see why I need any teaching . I dont think I need to change anything right now." which response is most appropriate?
"Can you tell me why you dont feel that you need to make any changes?"
When receiving discharge instructions, a pt with osteoporosis makes all of these statements . Which statement indicates the need for additional teaching?
"I take my IBU every morning as soon as I get up."
The nurse is preparing to discharge a client whose calcium level was low but is now just barely within the normal range (9-10.5) which statement by the client indicated the need for additional teaching?
"I will avoid dairy products, broccoli, and spinach when I eat."
Which statement by a client with hypovolemia related to dehydration is the best indicator to the nurse of the need for additional teaching?
"I will drink coffee and cola drinks throughout the day"
During morning care, a pt with below the knee amputation asks the UAP about prostheses . How will the nurse instruct the UAP to respond?
"I'll ask the nurse to come in and discuss this with you."
A patient with a right above the knee amputation asks the nurse why he has phantom limb pain . What is the nurse's best response?
"Phantom limb pain is not explained or predicted by any one theory."
The client has a NGT connected to intermittent wall suction . The student nurse asks why the client's respiratory rate and depth has decreased . what is the nurse's best response?
"The client may have a metabolic alkalosis due to the NG suctioning, and the decreased respiratory rate is compensatory mechanism."
The UAP asks the nurse why the client with a chronically low phosphorus level needs so much assistance with activities of daily living . What is the RN's best response?
"The client's skeletal muscles are weak because of the low phosphorus."
The student nurse, under the supervision of an RN, is reviewing a client's arterial blood gas results and notes an acute arterial partial pressure of carbon dioxide (PaCO2) to 51 mmHg compared with the previous results . Which statement by the student nurse indicates accurate understanding of acid-base balance for this client?
"When the PaCO2 is acutely evaluated, the blood pH should be lower than normal."
A client with acute coronary syndrome is receiving a continuous heaprin infusion . The client is to receive 700 units/hour. based on the heparin concentration on the label the nurse will set the infusion pump to deliver
17.5 mL/hr
After the nurse receives change of shift report, which pt should be assessed first?
A 28 y/o pt with a fx who report that the cast is tight .
While working on the cardiac step down unit the nurse precepting a newly graduated RN who has been in a 6 week orientation program. Which client will be best to assign to the new graduate?
A 33 y/o client admitted a week ago with endocarditis who will be receiving a scheduled dose of ceftriaxone 2 g IV
The nurse is providing care for several clients who are at risk for acid-base imbalance . Which client is MOST at risk for respiratory acidosis?
A 68 y/o client with chronic emphysema
The nurse is completing a hx for an older client at risk for an acidosis imbalance . Which question would the nurse be sure to ask? select all that apply.
A. "Which drugs do you take on a daily basis?" B. "Do you have any problems breathing?" D."Have you experienced any activity intolerance or fatigue in the past 24 hours?" F. "Do you have episodes of drowsiness or decreased alertness?"
The charge nurse assigns the nursing care of a pt who has just returned from open carpal tunnel release surgery to an experienced LPN/LVN, who will perform under the supervision of an RN? Which instructions would the RN provide for the LPN role? Select all that apply .
A. Check the pt's VS q15mins in the first hour . B. Check the dressing for drainage and tightness C. elevate the patients hand above the heart E. check the neurovascular status of the fingers every hour
The nurse is working with UAP to provide care for 6 pt . at the beginning of the shift the nurse carefully tells the UAP what pt interventions and tasks he or she is expected to perform . which 4 C's guides the nurse's communication with the UAP? Select all that apply
A. Clear C. Concise E. Correct F. Complete
The nurse is caring for a pt who had a DEXA scan and is now prescribed calcium with vitamin D twice a day . The patient asks the nurse the purpose of this drug . What is the nurse's best response? Select all that apply
A. When your calcium and Vitamin D levels are low, your risk for osteoporosis and osteomalacia increases . C. When your blood calcium is low, calcium is released from your bones, increasing your risk for fx . E. the extra calcium and vitamin D will help protect your bones from damage such as fx
The health care provider prescribes these actions for a client who was admitted with acute substernal chest pain . Which actions are appropriate to assign to an experienced LPN who is working in the ED? Select all that apply .
A. attaching cardiac monitor leads D. Obtaining a 12 lead ECG F. having the client chew and swallow aspirin 162mg .
The nurse is preparing a discussion of musculoskeletal health maintenance for a group of older adults . Which key points would the nurse be sure to include? Select all that apply
A. be aware of the consume foods rich in calcium and Vitamin D C. consider exercise with low impact to avoid risk for injury D. if you smoke, consider a smoking cessation program E. excessive alcohol intake can interfere with vitamins and nutrients for bone growth F. weight bearing activities decrease the risk for osteoporosis
Which topics will the nurse plan to include in discharge teaching for a client who has been admitted with heart failure? Select all that apply .
A. how to monitor and record daily weight C symptoms of worsening heart failure . E. How to read food labels for sodium content F. Date and time for follow-up appointments .
While reviewing a hospitalized client's medical record, the nurse obtains this information about cardiovascular risk factors . Which interventions will be important to include in the discharge plan for this client? select all that apply .
A. referral to community program that assist in smoking cessation B. teaching about the impact of family history on cardiovascular risk
The nursing care plan for an older client with dehydration includes interventions for oral health . Which interventions are within the scope of practice for an LPN/LVN being supervised by a nurse? Select all that Apply .
A. reminding the client to avoid commercial mouthwashes B. encouraging mouth rinsing with warm saline . D.) observing lips, tongue, and mucous membranes E.) providing mouth care every 2 hours while the pt is awake .
The nurse is preparing to teach a pt with a new dx of osteporosis about strategies to prevent falls . which teaching points should the nurse be sure to include? select all that apply
A. wear a hip protector when ambulating B. remove throw rugs and other obstacles at home C. exercise to help build your strength E. Rest when you are tired .
The ED nurse receives a call about a pt with a traumatic finger amputation . What instructions does the nurse provide to the pt wife? select all that apply .
A. wrap the completely severed finger in dry sterile gauze (if available) or a clean cloth B. Put the finger in a watertight, sealed plastic bag D. elevate the affected extremity above the patients heart E. Examine the amputation site and apply direct pressure with layers of dry gauze
The charge nurse assigned the care of a client with acute kidney failure and hypernatremia to a new-graduate RN. Which actions can the new-grad RN delegate to the UAP? Select all that apply.
A> provide oral care ever 3 to 4 hours D> record UOP when client voids F> help the client change position ever 2 hours
The cahrge nurse observes an LPN assigned to provide all of these interventions for a pt with paget disease . Which action requires that the charge nurse intervene?
Applying ice and gentle massage to the patient's lower extremities
The nurse is caring for a patient with carpal tunnel syndrome (CTS) who has been admitted for surgery . Which intervention should be delegated to the UAP?
Assisting the patient with daily self-care measures such as bathing and eating .
A client seen in the clinic with SOB and fatigue is being evaluated for a possible diagnosis of HF . Which lab result will be most useful to monitor?
B-type natriuretic peptide .
Which client is best for the coronary care charge nurse to assign to a float RN who has come for the day from the general med/surg unit?
B. a client receiving IB furosemide to treat acute left ventricular failure .
The RN is admitting a client with benign prostatic hyperplasia (BPH) to an acute care unit. The client describes an oral intake of about 1400 mL/day . What is the RN's priority concern?
C.) Ask the client to increase oral intake to 2-3 L/day .
When the nurse is monitoring a 53 y/o client who is undergoing a treadmill stress test, which finding will require the most immediate action?
Chest pain level of 3 (on a scale of 0 to 10)
The nurse is admitting an older adult client to the acute care medical unit . which assessment factor alerts the nurse than this client has a risk for acid-base imbalances?
Chronic renal insufficiency
The nurse makes a home visit to evaluate a HTN client who has been taking enalapril . which finding most important to report to the HCP?
Client complains about a frequent dry cough .
A client who is scheduled for a coronary arteriogram is admitted to the hospital on the day of the procedure . Which client information is most important for the nurse to communicate to the HCP before the procedure?
Client took metformin 500 mg this morning .
The nurse in monitoring the cardiac rhythms of clients in the coronary care unit . Which client will need immediate intervention?
Client who has had an acute MI and has SR at a rate of 76 beats/min with frequent premature ventricular contractions
The nurse in the cardiovascular clinic receives phone calls from four clients . Which client should be scheduled to be seen most urgently>
Client with a-fib who reports episodes if lightheadedness and syncope .
The unlicensed assistive personnel (UAP) reports to the nurse that a client's urine output for the past 24 hours has been only 360 mL . What is the nurse's priority action at this time?
Contact and notify the health care provider immediately .
The health care provider has written these orders for a client with a diagnosis of pulmonary edema . The client's morning assessment reveals bounding peripheral pulses, weight gain of 2 lb, pitting ankle edema, and moist crackles bilaterally . Which order takes priority at this time?
D.) administer furosemide 40mg IV push
A client in the ED who is being monitored with a portable cardiac monitor/defibrillator develops this rhythm . Which action will the nurse take first?
Defib at 200 joules
The nurse is developing a standard care plan for the post-op care of clients undergoing cardiac surgery . The unit is staffed with RN, LPN, and UAPs . which nursing activity will need to be perforned by RN staff members?
Developing an individual plan for discharge teaching based on discharge medications and needed lifestyle changes .
The nurse is preparing a pt who had carpal tunnel release surgery for discharge . Which information is important to provide for this patient>
Do not lift any heavy objects
The client described in question 3 (UOP in 24 hours was only 360mL) is also at risk for poor perfusion related to decreased plasma volume . Which assessment finding supports this risk?
Flattened neck veins when the client is in the supine position
Which order prescribed for a client with hypercalcemia would the nurse be sure to question?
Hydrochlorothiazide (HCTZ) 25mg orally each morning .
A client is admitted to the unit with a diagnosis of syndrome of inappropriate antidiuretic hormone secretion (SIADH) . For which electrolyte abnormality would the nurse be sure to monitor?
Hyponatremia
The HCP calls the nurse with prescriptions for a client with angina who is already taking ASA . which med is mosti mportant to clarify further with HCP?
IBU 200 mg q4hrs PRN
The nurse obtains this information about a client who is taking warfarin after having a deep vein thrombosis . Whihc finding is most indicative of a need for a change in therapy?
INR 1.2
The RN is providing care for a client diagnosed with dehydration and hypovolemic shock . Which prescribed intervention from the HCP should the RN question?
IV 5% dextrose in water D5W to run at 250 ml/hr .
Which specific instruction does the charge nurse give the UAP helping to provide care for a client who is at risk for metabolic acidosis?
Inform the nurse immediately if the client's respiratory rate and depth increases .
The nurse is reviewing the lab results for a client with an elevated cholesterol level who is taking atorvastatin . Which result is most important to discuss with the health care provider>
LDL cholesterol is 170 mg/dl
Based on this information in a clients medical record, which topic is the highest priority for the nurse to include in the initial teaching plan for a 26 y/o client who has blood pressures ranging from 150/84 to 162/90?
Low-sodium food choices when eating out .
A patient who has endocarditis with vegetation on the mitral valve suddenly reports severe left foot pain . The nurse notes that no pulse is palpable in the left foot and that it is cold and pale . Which action should the nurse take next?
Notify HCP about the change in status
The nurse has give nmorphine sulfate 4 mg IV to a client who is having an acute MI . when evaluating the client's response 5 minutes after giving the medication, which finding indicates a need for immediate further action?
Persisting chest pain at a level of 1 (on a scale of 0 to 10)
The nurse has been floated to the telemetry unit for the day . the monitor technician informs the nurse that the client developed prominent U waves . Which laboratory value should be checked immediately?
Potassium
The client has fluid volume deficit related to excessive fluid loss . Which action related to fluid management should be delegated by the RN to unlicensed assistive personnel (UAP)
Providing straws and offering fluids between meals
A client with lung CA has received oxycodone 10 mg orally for pain . WHen the student nurse assesses the client, which finding would the nurse instruct the student to report immediately?
RR of 8-10 breaths/min .
An experienced LPN/LVN reports to the RN that a client's blood pressure and heart rate have decreased. and when his face was assessed, one side twitches . what action should the RN take at this time?
Review the client's morning Calcium level .
The nurse delegates the measurement of vital signs to an experienced UAP . Osteomyelitis has been diagnosed in a pt . which vital sign value would the nurse instruct the UAP to report immediately for this patient?
Temperature of 101F
Which finding in client with aortic stenosis will be most important for the nurse to report to the health care provider?
Temperature of 102.1 F
The nurse is caring for a client who has heart failure and has a new prescription for sacubitril-valsartan . Which client information is most important to discuss with the health care provider before adminsitration of the medication?
The client receives lisinopril 10 mg/day
A pt has a fx femur . Which finding would the nurse instruct the uAP to report?
The pt appears confused
The cahrge nurse is assigning the nursing care of a pt who had a left below the knee amputation 1 day ago to an experienced LPN/LVN, who will function under an RN's supervision . WHat will the RN tell the LPN is the major focus for the patient's care today?
To monitor for signs of sufficient tissue perfusion
A client who has just arrived in the ED reports substernal and left are discomfort that has been going on for about 3 hours . Which lab test will be most useful in determining whether the nurse should anticipate implementing the acute coronary syndrome standard protocol?
Troponin I level
During a home visit to an 88y/o patient who is taking digoxin 0.25 mg/day to treat HF and A-fib, the nurse obtains assessment information . Which finding is most important to communicate to the health care provider?
Vision that is becoming "fuzzy"
The nurse is preparing to administer the following medications to a client with multiple health problems who has been hospitalized with DVT. Which medication is most important to double-check with another licensed nurse?
Warfarin 2.5 mg PO
The nurse has just received a change of shift report about these clients on the coronary step-down unit which one will the nurse assess first?
a 45 y/o with constrictive cardiomyopathy who developed acute dyspnea and agitation about 1 hour before the shift change .
Which client would the charge nurse assign to the step-down unit nurse who was floated to the ICU for the day?
a 72 y/o client with COPD and normal ABG values who is ventilator dependent.
The charge nurse is making assignments for the day shift . Which patient should be assigned to the nurse who was floated from the PACU for the day?
a 72 y/o pt with Paget disease who has just returned from surgery for total knee replacement
The client has an order for HCTZ 10 mg orally QID. What should the nurse be sure to include in the teaching plan for this drug? Select all that apply.
a. Take this medication in the morning D. inform your prescriber if you notice weight gain or increased swelling E. You should expect your urine output to increase F. Your HCP may also prescribe a potassium supplement .
THe nurse is ambulating a cardiac surgery patient whose heart rate suddenly increases to 146 bpm . in which order will the nurse take the following actions?
a: call the client HCP (fourth) b: have the client sit down (first) C: CHeck the cleints BP (Third) D: ADminister PRN O2 by NC (Second)
A client's potassium level is 6.7 . which intervention should the nurse delegate to the first-year student nurse whom he or she is supervising?
administer sodium plysystrene sulfonate 15 g orally .
The ED nurse is caring for a client who was just admitted with left anterior chest pain and possible acute MI . Which action will the nurse take first?
administer sublingual nitroglycerin
The nurse is working with an experienced UAP and an LPN on the telemetry unit . A client who had an acute MI 3 days ago has been reporting fatigue and chest discomfort when ambulating . Which nursing activity included in the care plan is nest assigned to the LPN
administering nitroglycerin 0.4 mg sublingually if chest discomfort occurs during client activities .
The nurse assesses a client who has just returned to the recover area after undergoing coronary arteriography . Which information is most concern
apical pulse of 122 beats/min and regular .
During the initial post-op assessment of a cleint who has just been transferred to the postanesthesia care unit after repair of an abd aortic aneurysm, the nurse obtains this data . Which finding has the most immediate implications for the clients care?
arterial line indicates a blood pressure of 190/112
A client whose systolic blood pressure is always higher than 140 mmHg in the clinic tells the nurse "My blood pressure at home is always fine!" what action should the nurse take next?
ask the client to obtain blood pressures twice daily with an automatic blood pressure cuff at home and bring the results to the clinic in a week .
A resident in a long term facility who has venous stasis ulcers is treated with an Unna boot . Which nursing activity included in the resident's care is best for the nurse to delegate to the UAP?
assisting the client in cleaning around the Unna boot .
The nurse is caring for a pt with osteoporosis who is at increased risk for falls . Which intervention should the nurse delegate to the UAP?
assisting the pt with ambulation to the bathroom and in the halls
Which actions should the nurse delegate to a UAP for the client with DKA? select all that apply
b record intake and output every hour c. measure VS q 15 mins F. assisting the client to reposition every 2hours
A client with stable angina has a prescription for ranolazone 500 mg twice a day . Which client finding is most important for the nurse to discuss with the HCP?
client reports having chronic constipation .
The nurse is providing care for a pt with a rotator cuff tear . What treatment does the nurse expect the HCP will prescribe first for this pt?
conservative therapies such as NSAIDs and physical therapy
The nurse is supervising a new grad RN caring for a pt with a fx of the right ankle who is at risk for complications of immobility. For which action should the supervising nurse intervene?
encourage the pt to go from a lying to a standing position
An 80 y/o client on the coronary step-down unit tells the nurse "I do not need to take the docusate . I never get constipated!" which action by the nurse is most important?
explain that his decreased activity level may cause constipation
The client with respiratory failure is receiving mechanical ventilation and continues to produce arterial blood gas results indicate respiratory acidosis . Which change in ventilator setting should the nurse expect to correct this problem
increase in ventilator rate from 6 to 10 breaths
The charge nurse in a long term care facility that employs RN/s LPN/s, and UPAs has developed a plan for the ongoing assessment of all residents with a diagnosis of heart failure . Which activity included in the plan is most appropriate to assign to an LPN/LVN team member?
listening to lung sounds and checking for edema each week .
The nurse is working in an outpatient clinic where many vascular diagnostic tests are performed . Which task associated with vascular testing is most appropriate to delegate to experienced UAP?
measuring ankle brachial pressures in a cleint for whom the ankle-brachial index is to me calculated .
The nurse is caring for a client who experiences frequent generalized tonic-clonic seizures associated with periods of apnea . The nurse must be alert for which acid-base imbalance?
metabolic acidosis
A patient is scheduled for endoscopic carpal tunnel release surgery in the morning . What would the nurse be sure to teach the patient?
pain and numbness are expected to be experienced for several days to weeks
The nurse is caring for a hospitalized patient with heart failure who is receiving captopril and spironolactone . Which lab value will be most important to monitor?
potassium level
Which blood test result would the nurse be sure to monitor for the client taking HCTZ?
potassium level . *HCTZ is a thiazide diuretic .
At 1000 AM, a hospitalized patient recieves a new order for transesophageal echocardiography as soon as possible . which action will the nurse take first?
put the client on NPO .
A client is admitted to the oncology unit for chemotherapy . to prevent an acid-base problem, which finding would the nurse instruct the UAP to report?
repeat episodes of n/v
The nurse observes the UAP performing all of these interventions for a patient with carpal tunnel syndrome (CTS) . which action requires that the nurse intervene immediately?
replacing the pt splint in hyperextension position
The UAP reports to the nurse that a client seems very anxious and VS measurement included a RR of 38 breaths/min . Which acid-base imbalance should the nurse suspect?
respiratory alkalosis
The RN is reviewing the client's morning lab results . which of these results is of most concern?
serum Mg level of 0.8 mEq/L
Two weeks ago a client with heart failure received a new prescription for carvedilol 12.5 mg orally . Which finding by the nurse who is evaluating the client in the cardiology clinic is of most concern?
sinus bradycardia at a rate of 48 beats/min
The nurse is participating as a team member in the resuscitation of a patient who has a hd a cardiac arrest . The health care provider who is directing the resuscitation asks the nurse to administer epinephrine 1 mg IV . After giving the medication, which action should the nurse take next?
state "epinephrine 1 mg IV has been given."
The clinical nurse is evaluating a client who had coronary artery stenting through the right femoral artery a week previously and is taking metorpolol, clopidrogel, and ASA . Which information reported by the client is MOST important to report to the HCP?
stools have been black in color
The nurse's assessment reveals all of this data when a pt with Paget disease is admitted to the acute care unit . Which finding should the nurse notify the HCP about first?
the base of the skill is invaginated (platybasia)
At 9 PM the nurse admits a 63 y/o client with a diagnosis of acute myocardial infarction . Which finding is most important to communicate to the health care provider who is considering the use of fibrinolytic therapy with tissue plasminogen activator (alteplase) for the client?
the client reports having continuous CP since 0800 .
A pt with a fx fibula is receiving skeletal traction and has skeletal pins in place What would the nurse instruct the UAP to report immediately?
the traction weights are resting on the floor .
