Management Quiz #3

The respiratory unit nurse is calculating the shift intake and output for a client diagnosed with right-sided chest tube. The client has received 1500ml of D5W, IVPB of 100ml of 0.9% NS, 12oz water, 6oz milk, and 4oz chicken broth. The client has had a urinary output of 800ml and chest drainage of 125ml. What is the total intake and output for this client?

2160ml intake, 925ml output.

The client has just been told a medical condition cannot be treated successfully and the client has a life expectancy of about 6 months. To whom should the nurse refer the client at this time?

A hospice agency.

The client has ABG values of pH 7.38, PaO2 77, PaCO2 40, HCO3 24. Which intervention should the critical care nurse implement?

Administer oxygen 6L/min via nasal cannula.

The client is getting out of bed, becomes very anxious, and has a feeling of impending doom. The nurse reports these findings to Ms. Gail. Which intervention should Ms. Gail tell the nurse to implement first after placing the client in the high-Fowler's position?

Administer oxygen via nasal cannula.

The hispanic female client diagnosed with bacterial pneumonia is being admitted to the medical unit. The hispanic husband answers questions even though the nurse directly asks the client. Which action should the nurse take?

Continue to allow the husband to answer the wife's questions.

The newly hired nurse manager has identified that whenever a specific staff member is unhappy with an assignment, the entire unit has a bad day. Which action should the unit manager take to correct this problem?

Discuss the staff member's attitude and the way it affects the unit.

The client in the ICU is on a ventilator. Which interventions should the nurse implement?

Ensure there is a manual resuscitation bag at the bedside. Assess the client's respiratory status every 2 hours. Check the ventilator settings every 4 hours. Collaborate with the respiratory therapist.

The nurse is working with a LPN and a UAP to care for a group of clients. Which nursing task should not be delegated or assigned?

Evaluating the client's progress

Which task is most appropriate for the home health nurse to delegate to the UAP?

Getting the client up in a chair three times a day.

The nurse is teaching the parents of a child diagnosed with CF. Which information is priority to teach the parents?

Give pancreatic enzymes with every meal.

The UAP is bathing the client diagnosed with adult acute respiratory distress syndrome who is on a ventilator. The bed is in the high position with the opposite side rail elevated. Which action should the ICU nurse take?

Give the UAP praise for performing the bath safely.

The UAP tells the clinic nurse that the male client in room 1 is "really breathing hard and can't seem to catch his breath." Which instruction should the nurse give to the UAP?

Go with the nurse to the client's room.

The ED nurse is preparing to assist the surgeon to insert chest tubes in a client with a right hemothorax. Which position is appropriate for the procedure?

Have the client sit upright and bend over the bed table.

The client's ABG results are pH 7.34, PaCO2 50, HCO3 24, PO2 87. Which intervention should the nurse implement first?

Have the client turn, cough, and deep breathe.

The 92-year old client has a hospital bed in the home and is on strict bed rest. The UAP cares for the client in the morning 5 days a week. Which statement indicates that the UAP needs additional education by the nurse?

I don't give her a lot of fluids so she won't wet the bed.

The nurse is accidentally stuck with a needle used to administer an intradermal injection for a PPD. Which intervention should the nurse implement first?

Immediately wash the area with soap and water.

The nurse is developing a nursing care plan for a client diagnosed with COPD. What should be the client's priority nursing diagnosis?

Impaired gas exchange.

The client who is 2 days post-op following a left pneumectomy has an apical pulse rate of 128 bpm and a BP of 80/50. Which intervention should the nurse implement first?

Increase the client's IV rate.

In the ICU, the critical care nurse assesses a client diagnosed with an asthma attack who has a respiration rate of 10 and an oxygen saturation of 88%. Which intervention should the nurse implement first?

Increase the oxygen to 10L/min

The UAP enters the elderly female client's room to give the bath, but the client is watching her favorite soap opera. Which instructions should the nurse give to the UAP?

Instruct the UAP to give the bath after the program.

The clinic nurse is scheduling a chest x-ray for a female client who may have pneumonia. Which question is the most important for the nurse to ask the client?

Is there any chance you may be pregnant?

The home health nurse is visiting the client diagnosed with end-stage COPD while the UAP is providing care. Which action by the UAP would warrant intervention by the nurse?

Keeping the bedroom at a warm temperature.

The healthcare facility where the nurse works uses email to notify the staff of in-services and mandatory requirements. Which is important information for the nurse manager to remember when using email to disseminate information?

Make the email notices quick and easy to read.

The female nurse manager is discussing yearly performance evaluation with a male nurse. Which information regarding communication styles should the nurse manager employ when talking with the employee?

Men often see the work environment from a logical, focused perspective.

The client who is 1 day post-op following chest surgery is having difficulty breathing, has bilateral rales, and is confused and restless. Which intervention should the nurse implement first?

Notify the rapid response team.

The husband of a client diagnosed with terminal lung cancer asks the nurse "How am I going to take care of my wife when we go home?" Which action by the nurse is most appropriate?

Notify the social worker about the husband's concerns.

The client diagnosed with a community-acquired pneumonia is being admitted to the unit. Which HCP order should be implemented first?

Obtain a sputum specimen for culture and sensitivity.

The primary nurse in the critical care respiratory unit is very busy. Which nursing task should be the nurse's priority?

Obtain a tracheostomy tray for a client who is exhibiting air hunger.

The nurse is admitting a patient diagnosed with pneumonia. Which healthcare provider's order should be implemented first?

Obtain sputum for gram stain and culture.

Which client should the medical unit nurse assess first after receiving the shift report?

The 84-year-old client diagnosed with pneumonia who is afebrile but getting restless.

The new graduate has accepted a position at a facility that is accredited by the Joint Commission. Which statement describes the purpose of this organization?

The Commission reviews facilities for compliance with standards of care.

The nurse is preparing to make rounds after receiving shift report. Which client should the nurse assess first?

The patient diagnosed with a DVT who is requesting an anti-anxiety medication.

The nurse on a medical unit has a client with adventitious breath sounds, but the nurse is unable to determine the exact nature of the situation. Which multidisciplinary team member should the nurse consult first?

The respiratory therapist.

The wife of a client diagnosed as terminal is concerned that the client is not eating or drinking. Which is the home health nurse's best response?

This is normal at the end of life; the dehydration produces a type of euphoria.

The hospice client asks the nurse, "What should I do about my house? My son and daughter are fighting over it." Which statement is the nurse's best response?

"What do you want to happen to your house? It's your decision."

The client involved in a motor vehicle accident is being prepped for surgery when the client asks the ED nurse, "What happened to my child?" The nurse knows the child is dead. Which statement is an example of the ethical principle of nonmaleficence?

"I will find out for you and let you know after surgery."

The female charge nurse on the respiratory unit tells the male nurse, "you are really cute and have a great body. Do you work out?" Which action should be taken by the make nurse if he thinks he is being sexually harassed?

Ask the charge nurse to stop making comments like this.

In the local restaurant, the nurse overhears another hospital staff member talking to a friend about a client. The staff member discloses that the client was just diagnosed with lung cancer. What is the most appropriate action by the nurse?

Ask the staff member not to discuss anything about the client.

The clinic nurse encounters a client who does not respond to verbal stimuli and initiates CPR. What should the nurse do? Prioritize the nurse's actions from first to last.

Assess the client for unresponsiveness. Perform compressions at a 30:2 rate. Open the client's airway. Pinch the nose and give 2 breaths. Check the client's carotid pulse.

The nurse is caring for a client who has a chest tube. What should the nurse do? Prioritize the nurse's actions from first to last.

Assess the client's lung sounds. Make sure that the chest tube is securely taped. Check the chest tube dressing for drainage. Note the amount of suction being used. Place a bottle of sterile saline at the bedside.

The client with a right-sided chest tube is complaining of pain rated 6 on a pain scale of 1 to 10. Which intervention should the nurse implement first?

Assess the client's respiratory status and chest tube insertion site.

The nurse is caring for a client diagnosed with flail chest who has had a chest tube for 3 days. The nurse notes there is no tidaling in the water-seal compartment. Which initial action should be taken by the nurse?

Auscultate the client's posterior breath sounds.

At 1700, the HCP is yelling at the nursing staff because the early morning lab work is not available for a client's chart. Which is the most appropriate response by the charge nurse?

Call the lab and have the lab supervisor talk with the HCP.

The client with a right-sided pneumothorax had chest tubes inserted 2 hours ago. There is no fluctuation in the water-seal chamber of the Pleurovac. Which intervention should the nurse implement first?

Check for any kinks in the tubing.

The client diagnosed with abdominal pain of unknown etiology has a NG tube draining green bile and reports abdominal pain of 8 on a scale of 1 to 10. The client's ABG values are pH 7.48, PaO2 98, PaCO2 36, HCO3 28. Which intervention should the nurse implement based on the client's ABGs?

Check the amount of suction on the client's NG tube.

The ICU nurse is caring for a client on a ventilator who is exhibiting respiratory distress. The ventilator alarms are going off. Which intervention should the nurse implement first?

Check the ventilator to resolve the problem.

The day surgery admission nurse is obtaining operative permits for clients having surgery. Which client should the nurse question signing the consent form?

The 39-year-old client diagnosed with paranoid schizophrenia.

Which tasks are appropriate to assign to the UAP? Select all that apply.

Perform mouth care on the client with pneumonia. Take the empty blood bag back to the laboratory.

Ms. Gail is discussing the care of a client with a right-sided chest tube secondary to a pneumothorax with a graduate nurse. Which interventions should Ms. Gail discuss with the graduate nurse? Select all that apply.

Place the client in the high-Fowler's position. Ensure the tubing has no dependent loops. Mark the collection chamber for drainage every shift.

The client diagnosed with an exacerbation of COPD is in respiratory distress. Which intervention should the nurse implement first?

Place the client in the orthopedic position.

The client in the ICU has been on a ventilator for 2 weeks with an endotracheal tube in place. Which intervention should the nurse prepare the client for next?

Placement of a tracheostomy.

The client diagnosed with acute respiratory distress syndrome is having increased difficulty breathing. The ABG indicates an arterial oxygen level of 54% on O2 at 10L/min. Which intervention should the ICU nurse implement first?

Prepare the client for intubation.

The clinic nurse is scheduling a 14-year-old for a tonsillectomy. Which intervention should the clinic nurse implement?

Request the lab to draw a PT and PTT.

While the nurse is caring for a client on a ventilator the ventilator alarm sounds. What is the first action taken by the nurse?

Silence the ventilator alarm.

The client is admitted to the ED with an apical pulse rate of 134, respiration rate of 28, and BP of 92/56, and the skin is pale and clammy. What action should the nurse perform first?

Start 2 IVs with large-bore catheters.

The client in a critical care unit died. What action should the nurse implement first?

Stay with the significant other.

The clinic nurse is evaluating vital signs for clients being seen in the outpatient clinic. Which client would require nursing intervention?

The 24-week gestational woman who has a BP of 142/96.

One of Ms. Gail's staff nurses is preparing to administer morning medications to clients. Which medication should the nurse question administering to the client?

The aminoglycoside antibiotic to the client with an elevated trough level.

The client calls the clinic nurse and asks, "What is the best way to prevent getting influenza?"Which statement is the nurse's best response?

The best way to prevent getting influenza is get a yearly flu vaccine.

The healthcare provider ordered the loop diuretic, bumetanide (Bumex), to be administered STAT to a client diagnosed with pulmonary edema. After 4 hours, which of the following assessment data indicates the client may be experiencing a complication of the medication?

The client complains of painful leg cramps.

The nurse is assessing clients on a respiratory unit. Which client should be the nurse's first priority?

The client diagnosed with CF who has a pulse oximeter reading of 91%.

Which client should the charge nurse on the respiratory unit assign to the graduate nurse who just completed orientation?

The client diagnosed with bronchiolitis who has a wheezy cough and rapid breathing.

Which client should the charge nurse assign to the new graduate on the respiratory unit?

The client diagnosed with tuberculosis who has a non-productive cough and orange colored urine.

The nurse assists with the insertion of a chest tube in a client diagnosed with a spontaneous pneumothorax. Which data indicates that the treatment has been effective?

The client has bilateral breath sounds.

Which client should Ms. Gail assign to the LPN?

The client who had a laryngectomy 2 days ago and has crepitus.

The clinic nurse is reviewing lab results for a client seen in the clinic. Which client requires additional assessment by the nurse?

The client who has a hemoglobin of 9 g/dL and a hematocrit of 29%.

The charge nurse in the ICU asks a nurse to float from the med-surg unit to the ICU. Which client should the charge nurse assign to the float nurse?

The client who is diagnosed with bacterial pneumonia.

Ms. Gail is making client assignments. Which client should Ms. Gail assign to the LPN?

The client who is scheduled for a bronchoscopy to rule out lung cancer.

The charge nurse of the respiratory care unit is making assignments. Which clients should be assigned to the intensive care nurse who is working on the respiratory care unit for the day? Select all that apply.

The client who will be moved to the ICU when a bed is available. The client who is on multiple IV medications needed to be titrated.

Ms. Gail is making shift assignments. Which client should be assigned to the most experienced RN?

The client whose pulse oximeter reading keeps decreasing after receiving high levels oxygen via nasal cannula.

Ms. Gail and the UAP are caring for the following clients. Which information provided by the UAP requires immediate intervention by Ms. Gail?

The client with a left-sided pneumothorax has 200ml of blood in the collection chamber of the Pleuravac.

The nurse is working in an outpatient clinic along with a LPN. Which client should the nurse assign to the LPN?

The client with acute bronchitis who has a chronic clear mucous cough and low fever.

Which client requires the immediate attention of the ICU nurse?

The client with acute respiratory distress syndrome who has difficulty breathing.

The charge nurse on the critical care respiratory unit is evaluating ABG values of several clients. Which client would require an immediate intervention by the charge nurse?

The client with reactive airway disease with a pH 7.48, PaO2 80, PaCO2 30, HCO3 23.

The clinic nurse is returning phone messages from clients. Which phone message should the nurse return first?

The elderly client with pneumonia who reports being dizzy when getting up.

The nurse has been made the chairperson of a quality improvement committee. Which statement is an example of effective group process?

The nurse involves all committee members in the discussion.

The client in the post-anesthesia care unit has noisy and irregular respirations with a pulse oximeter reading of 89%. Which intervention should the PACU nurse implement first?

Tilt the head back and push forward on the angle of the lower jaw.

The home health client is diagnosed with chronic obstructive disease. The UAP tells the home health nurse that the client has trouble breathing when the client lies in a supine position. Which priority instruction should the nurse provide to the UAP?

To allow the client to sleep in a recliner.

The client diagnosed with active tuberculosis tells the public health nurse, "I am not going to take any more medications. I am tired of them." Which statement is the nurse's best response?

You must take your TB medications. It is not an option.