NUR 114 exam 2 practice questions

HYPOtonic: for dehydration (FVD)

0.45% NS (cellular dehydration), 0.33% NS

contact precautions should be implemented for an adult client who has been hospitalized and has which of the following? a. hep B b. measels c. meningitis d. infectious diarrhea

infectious diarrhea

manifestations consistent with infection

redness, leukocytosis (^ WBC), limited mobility, swelling, pain, heat

a nurse is caring for a client with C difficile. the nurse knows that which of the following represents the "portal of exit"? a. food b. GI tract c. sneezing d. elderly patient

GI tract

a nurse is planning to admit a client who has RSV. which of the following transmission based precautions should the nurse plan to implement? a. protective b. contact c. standard d. airborne

contact

a nurse is assisting with teaching a newly licensed nurse about removing PPE. which of the following items should the nurse instruct to remove first? a. mask b. gloves c. goggles d. face shield

gloves

a client is admitted with severe dehydration and hypernatremia related to persistent nausea and vomiting. which of the following IV fluids would the nurse expect the provider to order? a. 0.9% NS b. 0.45% NS c. D5W d. 3% NS

0.45% NS

a nurse is reviewing prescriptions for a client who needs intravenous fluid replacement therapy due to vomiting and diarrhea. which of the following fluid prescriptions should the nurse expect to initiate? a. 3% sodium chloride solution b. 0.9 % sodium chloride solution c. 0.45% sodium chloride solution d. dextrose 10% in water

0.9 % sodium chloride solution

Isotonic (FVD): increases extracellular fluid volume

0.9% NS, LACTATED RINGERS***

a nurse is reviewing laboratory values for a client. which of the following findings indicates the presence of an infection? a. WBC count 22,000 b. creatine kinase 75 units/L c. Hgb 15 g/dL d. platelet count 200,000

WBC count 22,000

a nurse is caring for a client who states " I feel like I don't have to eat a varied diet when I take my multivitamin." which of the following responses should the nurse make? a. if taken 4 or more day a week a multivitamin provides all the nutrients you need b. as long as you take a multivitamin daily you do not need to eat a varied diet each day c. a multivitamin should not be used in place of a nutritious diet d. as long as the multivitamin isn't generic it can replace unhealthy dietary choices

a multivitamin should not be used in place of a nutritious diet

constipation + fiber

alleviate the issue of constipation, eating more whole grains can promote regular bowel movements, 25-38g of fiber per day

Nurse is teaching about infectious agents. the nurse should include in the teaching that pertussis is transmitted by which of the following modes of transmission? a. direct contact b. droplet c. airborne d. indirect contact

droplet

a nurse is caring for a client who has influenza. the client asks how they acquired the infectious agent. the nurse should inform the client that influenza is transmitted by which of the following modes? a. droplet b. indirect contact c. airborne d. direct contact

droplet

a nurse is caring for a client who is placed on droplet precautions. which of the following actions should the nurse take? a. place a surgical mask on the client when they leave their room b. wear a surgical mask when within 2ft of the client (should be 3 ft) c. move the client to a positive airflow room d. remove fresh flowers from the client's room

place a surgical mask on the client when they leave their room

a nurse is administering an enteral tube feeding to a client. which of the following actions should the nurse take to prevent aspiration? a. flush the feed tube with 30ml of water b. add blue food coloring to the enteral formula c. ensure the formula is at room temp d. place the client in Fowler's position

place the client in Fowler's position

a nurse is caring for a client who is on contact precautions. which of the following actions should the nurse take? a. wear an N95 respirator when caring for the client b. place the client in a private room c. place a mask on the client when they leave their room d. place the client in a negative airflow room

place the client in a private room

which type of exudate would you expect to find in your client with a wound infection? a. serous b. purulent c. clear d. sanguinous

purulent

risk for dehydration in older adult clients

decreased kidney function, decreased thirst response, decreased total body fluid, lower body mass, decreased muscle and bone mass

a nurse is assessing a client who has had diarrhea for several days. Which of the following findings should the nurse expect? a. rigid abdomen b. decreased bowel sounds (should be increased) c. hypothermia (should be elevated temp) d. dehydration (fluid loss)

dehydration

HYPERtonic (FVE): given to pts with cellular edema (used for hyponatremia and hypovolemia)

D10W, D5 0.45% NS, 3% NS

a nurse has received a prescription to administer a medication STAT to a client. Which of the following actions should the nurse take? a. administer the med whenever the client reports manifestations b. administer med at specific times until directed by health care provider c. administer the medication at regular intervals of 4 hr d. administer med within 30 mins of the health care provider prescribing the med

administer med within 30 mins of the health care provider prescribing the med

a nurse is preparing to administer a medication to a client who has an enteral feeding tube. which of the following actions should the nurse take? a. mix the medication with the client's feeding infusion b. flush the feeding tube with 10 ml of water prior to giving med (30ml) c. administer med to the client in liquid form d. place the client in a supine position prior to administering the medication

administer the med to the client in liquid form

Nurse is teaching about infectious agents. the nurse should include in the teaching that tuberculosis is transmitted by which of the following modes of transmission? a. airborne b. droplet c. direct contact d. indirect contact

airborne

a nurse is assisting with teaching a newly licensed nurse about infection control. The nurse should include in the teaching that which of the following types of precautions requires the use of an N95 mask? a. protective isolation b. contact c. droplet d. airborne

airborne

a nurse is caring for a client who has dysphagia. which of the following actions should the nurse take? a. elevate the client's head of the bed to 45 during meals b. instruct the client to tilt their head back while swallowing c. alternate the client's liquids and solids during meals d. turn on the client's television during meals

alternate the client's liquids and solids during meals (promotes swallowing and decreases risk of aspiration)

a charge nurse is reviewing routes of medication administration with a newly licensed nurse when providing care to a client. Which of the following routes of administration should the charge nurse include as having the slowest onset of action? a. intramuscular b. oral c. buccal d. intravenous

b. oral

a nurse is caring for a client who has C. difficile. which of the following actions should the nurse take? a. place the client in a room with negative pressure airflow b. apply a mask on the client when they are outside their room c. clean hands with soap and water after caring for the client d. wash hands for 10 seconds after caring for the client

clean hands with soap and water after caring for the client

a nurse is scheduled to administer a medication to a client who is currently in the bathroom. which of the following actions should the nurse plan to take? a. leave the medication at the client's bedside b. prepare the medication to administer later c. document the medication was given prior to administration d. come back in a few minutes to administer the medication

come back in a few minutes to administer the medication

a nurse is assessing a client who has dehydration. which of the following findings should the nurse expect a. high blood pressure b. distended neck veins c. moist skin d. dark colored urine

dark colored urine

a nurse is assessing a client who has dehydration. which of the following findings should the nurse expect? a. urine osmolality of 200 mOsm/kg b. urine specific gravity of 1.015 c. dark colored urine d. cloudy urine (UTI)

dark colored urine

a nurse caring for a client who is experiencing hypovolemia. which of the following findings should the nurse identify as the priority to report to the provider? a. dry mucous membranes b. decreased urine output c. report of thirst d. decrease in level of consciousness

decrease in level of consiousness

A nurse is providing discharge teaching to a client. which of the following strategies should the nurse include? a. use closed-ended questions b. provide written material at a 9th grade reading level c. use passive listening skills d. encourage the client to ask questions

encourage the client to ask questions

a nurse is teaching a class about nutrients. the nurse should include that which of the following is a function of fats? a. facilitates the absorption of vitamins b. regulates nerve cell transmission c. builds and repairs tissue d. converts to sugar to provide energy

facilitates the absorption of vitamins

a nurse is changing the bed linen for a client who is on contact precautions. which of the following personal protective equipment should the nurse wear? a. N95 respirator b. face shield c. goggles d. gloves

gloves

a nurse is preparing to administer medications to a client who is not wearing and identification bracelet. which of the following actions should the nurse take before administering the medications? a. verify the client's identity using their diagnosis b. use one identifier to confirm the client's identity c. use the client's room # to identify client d. have the client confirm their name and DOB

have the client confirm their name and DOB

a client is 48 hours post op from a total knee replacement. the nurse notes an increase in temp from 98.4 to 101.8 and new purulent drainage at the incision site. The nurse understands that this represents what type of infection? a. health-care associated b. community-based c. immunologic d. root cause

health care associated

a nurse is teaching a client who has constipation. which of the following statements should the nurse include? a. try to defecate at different times of the day (should be same time) b. reduce your daily activity (should increase) c. consume low fiber (should be high fiber) d. increase your daily fluid intake (soften stool and promote peristalsis)

increase your daily fluid intake

a nurse is assessing a client who was brought to the emergency department with an ankle injury. which of the following manifestations should the nurse identify as localized inflammation of the tissues? (5 cardinal signs of infection & inflammation) a. localized warmth at the site of injury b. full range of motion at the site of injury c. 3+ palpable pedal pulses below the affected injury site d. sanguineous drainage at the site of injury

localized warmth at the site of injury

which of the following foo choices are appropriate for a client who is prescribed a full liquid diet? a. plain yogurt b. custard c. ice cream d. mashed potatoes e. pureed meat f. gelatin

plain yogurt, custard, ice cream, gelatin

your client was just place on droplet precautions for a diagnosis of influenza. which of the following would be required? a. N95 mask for client and caregivers b. negative pressure airflow system c. private room and mask for visitors and caregivers d. positive airflow system and HEPA filter

private room and mask for visitors and caregivers

a nurse is teaching a class about reducing the risk of medication errors. which of the following information should the nurse include? a. wait to document meds given to clients until the end of a shift b. provide the nurse administering meds with an identifying vest c. prepare meds for multiple clients at the same time d. remove meds from automatic dispensing systems before they are reviewed by pharmacists

provide the nurse administering meds with an identifying vest

a nurse is caring for a client who has a new diagnosis of C difficile and is placed on contact precautions. which of the following actions should the nurse take? a. use an electronic thermometer to take the client's temperature b. remove the protective gown before leaving the client's room c. remove the protective gown before removing gloves (gloves before) d. shake the bed lines before placing them in a linen bag

remove the protective gown before leaving the client's room

a nurse is caring for a client who acquired an infection after touching a faucet that an infected person had touched. which of the following links in the chain of infection does the faucet represent? a. reservoir b. susceptible host c. portal of entry d. portal of exit

reservoir

a nurse is performing hand hygiene after caring for a client who has C. Diff. which of the following hand hygiene methods should the nurse use? a. alcohol-based sanitizer b. soap and water c. iodine solution d. chlorhexidine solution

soap and water

a nurse is collecting data on a client who is receiving vancomycin IV. the nurse observe the client has a rash on their neck, check, and back. which of the following actions should the nurse take FIRST? a. notify the client's provider b. stop the infusion of the vancomycin c. administer diphenhydramine to the client d. document the incident in the client's chart

stop the infusion of the vancomycin

nurse is assisting with implementing an infection control bundle for clients at risk for catheter-associated urinary tract infections. which of the following interventions should the nurse include in the bundle? a. try to use alternatives before inserting indwelling urinary catheters b. use clean technique for insertion of indwelling urinary catheters (should be aseptic) c. check clients every 2 days to evaluate need for catheters d. disconnect system to obtain urine samples from indwelling urinary catheters

try to use alternatives before inserting indwelling urinary catheters

the nurse is caring for a client who has an infection spread by respiratory droplets and is on droplet precautions. the client asks "can my spouse visit me?" which of the following responses by the nurse is correct? a. yes as long as your spouse wears a masks and maintains a distance of at least 3ft b. yes after we set up the negative pressure system and take a sputum culture c. yes but your spouse must get fitted for an N95 to wear when in the room (airborne) d. yes but your spouse must wear a gown and gloves when in the room (contact)

yes as long as your spouse wears a mask and maintains a distance of at least 3 ft