Synthesis Midterm Practice Questions

What is the first intervention for a client experiencing myocardial infarction (MI) ? A - ADMINISTER MORPHINE B - ADMINISTER OXYGEN C - ADMINISTER SUBLINGUAL NITROGLYCERIN D - OBTAIN AN ELECTROCARDIOGRAM (ECG)

- B - Administer oxygen think OMNA instead of MONA

A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the client is confused. The telemetry strip shows first-degree atrioventricular block. The nurse should assess the client for signs of: A- Hyperkalemia B -Digoxin toxicity C - Fluid deficit D - Pulmonary edema

- B - Digoxin toxicity

A client with cirrhosis develops increasing pedal edema and ascites. What dietary modification is most important for the nurse to teach this client? A - Avoid high carbohydrate foods. B - Decrease intake of fat soluble vitamins. C - Decrease caloric intake. D - Restrict fluid and salt intake.

- D - Restrict fluid and salt intake

What are the early signs of cerebral hypoxia? A - Irritability and restlessness B - Nausea and unconsciousness C - Eyes rolling back and fingernail clubbing D - Headache and tachycardia

A - irritability and restlessness

A nurse caring for a 50 yo newly diagnosed with Parkinson's disease would want to educate the client and the family about which of the following symptoms? Select all That Apply A - A mask-like expression B - A shuffling gait C - A wide-based gait D - Difficulty swallowing E - Fluctuating muscle weakness F - Muscle rigidity G - Optic neuritis

A - A mask-like expression B - A shuffling gait D - Difficulty swallowing F - Optic neuritis

The nurse is assessing a client who has a closed head injury. The client presents with confusion, drowsiness, and unequal pupils. Which of the following nursing diagnoses takes priority? A - Altered cerebral perfusion B - Altered level of cognitive function C - High risk for injury D - Sensory perceptual alteration

A - Altered cerebral perfusion - Patient is showings signs of increased ICP

A male patient with COPD becomes dyspneic at rest. His baseline blood gas results are PaO2 70 mm Hg, PaCO2 52 mm Hg, and pH 7.34. What updated patient assessment requires the nurse's priority intervention? A - Arterial pH 7.26 B - PaCO2 50 mm Hg C -Patient in tripod position D - Increased sputum expectoration

A - Arterial pH 7.26 a pt with a pH that low is at risk for coding

The nurse is suctioning an intubated, mechanically ventilated patient. Complications that should be observed for include: A - Dysrhythmias B - Hyperthermia C - Hematuria D - Decreased urinary output

A - Dysrhythmias When suctioning someone, you are pulling oxygen out of their ET tubes- causing low oxygen. Low oxygen causes dysrhythmias

A previously healthy client is hospitalized with left lower lobe (LLL) bacterial pneumonia. The nurse assesses chest pain with inspiration, productive cough of thick rusty sputum, and LLL fine inspiratory crackles and low-pitched expiatory wheezing. Which of the medications that the health care provider prescribes should the nurse question? A - Furosemide 20 mg IV push every day B - Guaifenesin ER 600 mg PO every 12 hours C - Ibuprofen 600 mg PO every 6 hours PRN D - Levofloxacin 500 mg IV every day

A - Furosemide 20 mg IV push every day someone with bacterial pneumonia, you would not want to take fluids out of them

A child is having a generalized tonic-clonic seizure. Which action should the nurse take? A - Move objects out of the child's immediate area B - Quickly slip soft restraints on the child's wrists C - Insert a padded tongue blade between the teeth D - Place in the recovery position before going for help

A - Move objects out of the child's immediate area

A patient has small cell cancer of the lung. Which of the following findings requires immediate intervention by the nurse? A - Serum sodium of 118 meq/L B - Serum potassium of 5.1 meg/L C - Hematocrit of 45% D - BUN 10 mg/dl

A - Serum sodium of 118 meq/L - small cell cancer of the lung will affect the sodium levels, so it is the first thing that would be off in an electrolyte panel

Which of the following client conditions put a client at risk for cardiogenic shock? - Select All That Apply A - Ventricular Fibrillation B - Atrial Fibrillation C - Myocardial Infarction D - Sinus tachycardia E - Ventricular tachycardia

A - Ventricular fibrillation C - Myocardial Infarction E - Ventricular tachycardia

A client with venous thrombus reports having pain in the legs. What should the nurse do first? a. elevate the foot of the bed b. elevate the legs by using a pillow under the knees c. encourage adequate fluid intake d. massage the lower legs

A - elevate the foot of the bed

Which finding indicates to the nurse that the therapeutic effect of nebulized albuterol to treat an acute exacerbation of asthma has been achieved? A - Decreased wheezing. B - Decreased heartrate. C - Increased RR. D - Increased inspiratory effort.

A- decreased wheezing

When developing a discharge plan to manage the care of a client with COPD, the nurse should anticipate that the client will do which of the following? A. Develop infections easily B. Maintain current status C. Require less supplemental oxygen D. Show permanent improvement.

A. Develop infections easily

The nurse is caring for a client hospitalized with acute exacerbation of chronic obstructive pulmonary disease. Which findings would the nurse expect to note on assessment of this client? Select all that apply. A - A low arterial PCo2 level B - A hyperinflated chest noted on the chest x-ray C - Decreased oxygen saturation with mild exercise D - A widened diaphragm noted on the chest x-ray E - Pulmonary function tests that demonstrate increased vital capacity

B - A hyperinflated chest noted on the chest x-ray C - Decreased oxygen saturation with mild exercise

Which patient below is at MOST risk for increased intracranial pressure? A. A patient who is experiencing severe hypotension. B. A patient who is admitted with a traumatic brain injury. C. A patient who recently experienced a myocardial infarction. D. A patient post-op from eye surgery.

B - A patient who is admitted with a traumatic brain injury

What is the first intervention for a client experiencing myocardial infarction (MI) ? A - ADMINISTER MORPHINE B - ADMINISTER OXYGEN C - ADMINISTER SUBLINGUAL NITROGLYCERIN D - OBTAIN AN ELECTROCARDIOGRAM (ECG)

B - ADMINISTER OXYGEN - think OMNA instead of MONA

A nurse is caring for a client who is postoperative lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? (Select ALL that apply) A - Use the Glascow Coma Scale when assessing the client. B - Assist the client to the supine position. C - Encourage the client to increase fluid intake. D - Instruct the client to perform deep breathing and coughing exercises. E - Administer an opioid medication.

B - Assist the client to the supine position. C - Encourage the client to increase fluid intake. E - Administer an opioid medication.

The nurse is conducting a nutrition class for a group of clients with congestive heart failure (CHF). It would be most important for the nurse to explain the importance of: A - Restricting fluid intake. B - Choosing fresh vegetables instead of canned ones. C - Eating a low caloric diet to reduce weight. D - Recognizing which products are high in cholesterol.

B - Choosing fresh vegetables instead of canned ones. - Canned vegetables are often high in salt and with HF salt intake must be reduced

Which of the following nursing interventions is of the highest priority in helping a patient expectorate thick secretions related to pneumonia? A- Humidify the oxygen as able B- Increase fluid intake to 3L/day if tolerated. C- Administer cough suppressant q4hr. D- Teach patient to splint the affected area.

B - Increase fluid intake to 3L/day if tolerated

A patient who is in cardiogenic shock has a urine output of 20 mL/hour. When further assessing the patient's renal function, what additional findings are anticipated? Select all that apply. A - Decreased urine specific gravity. B - Increased blood urea nitrogen (BUN) C - Decreased urine sodium D - Decreased serum creatinine.

B - Increased BUN C - Decreased urinary sodium

A nurse is taking care of a 54 year old male with a history of right sided heart failure. Which of the following assessment findings is consistent with systemic congestion related to the patient's diagnosis? (Select All That Apply) A - Paroxsymal nocturnal dyspnea B - Increased blood pressure C - Weight gain D - Jugular venous distention E - Cool extremities

B - Increased blood pressure C - Weight gain D - Jugular venous distention

Your client is a 79 year old male with a history of lung cancer, COPD and diabetes mellitus, type II. He has been receiving chemotherapy and radiation therapy intermittently over the past several months. He is also being treated with oral corticosteroids to minimize episodes of dyspnea related to COPD. His chemotherapy has been placed on hold due to leukopenia. Which of the following statements best summarizes the client's current condition? A - The greatest risk to the client at this time is holding chemotherapy as planned because his cancer could get worse. B - The client is at extremely high risk for infection at this time for multiple reasons. C -The client is at risk to develop an auto-immune disease. D - An elevated WBC count in this client is indicative of active infection.

B - The client is at extremely high risk for infection at this time for multiple reasons. - The pt is at an extremely high risk of infection due to chemo, radiation, and taking steroids--> immunosuppression

A nurse is caring for a client who is receiving parenteral nutrition (PN) through a central line. Which action on the part of the nurse will decrease the client's risk of infection while receiving this therapy? A - Assessing vital signs at 4 hour intervals. B - Using aseptic technique in handling the PN nutrition and tubing. C - Administering acetaminophen before changing the central line dressing. D - Instructing the client to perform the Valsalva maneuver during IV tubing changes.

B - Using aseptic technique in handling the PN nutrition and tubing. - important to think about infection and sterility when there is TPN

11 - The nurse has completed an assessment on a client with a decreased cardiac output. Which finding should receive the highest priority? A - BP 110/62 mmHg, atrial fibrillation with HR 82, bilateral basilar crackles B - Confusion, urine output 15 mL over the last 2 hours, orthopnea C - SpO2 92 on a 2 L nasal cannula, respirations 20, 1+ edema of lower extremities D - Weight gain of 1 kg in 3 days, BP 130/80, mild dyspnea with exercise

B- Confusion, urine output 15 mL over the last 2 hours, orthopnea

With acute pulmonary emboli, what do you expect to see on ABGs? A - Hypoxemia, hypercapnia, acidemia B - Hypoxemia, hypocapnia, alkalemia C- Hyperoxemia, hypocapnia, alkalemia D -Hyperoxemia, hypocapnia, alkalemia

B- Hypoxemia, hypocapnia, alkalemia

Twenty-four hours after having had surgery a client reports pain in the calf. What should the nurse do when the assessment reveals redness and swelling at the site of discomfort? A - Keep both legs dependent. B - Notify the health care provider. C - Apply a warm soak to the left calf. D - Administer the prescribed analgesic.

B- Notify the HCP

What will the nurse expect to assess in a patient with respiratory failure and hypoxemia? A - Exertional dyspnea, circumoral cyanosis, distal cyanosis B - Subcutaneous emphysema, absent breath sounds, sharp chest pain C - Agitation, disorientation, lethargy, chest pain D - Rales, distended neck veins, orthostatic hypotension

C - Agitation, disorientation, lethargy, chest pain - hypoxia leads to less blood flow to the brain causing confusion

What will the nurse expect to assess in a patient with respiratory failure and hypoxemia? A - Exertional dyspnea, circumoral cyanosis, distal cyanosis B - Subcutaneous emphysema, absent breath sounds, sharp chest pain C - Agitation, disorientation, lethargy, chest pain D - Rales, distended neck veins, orthostatic hypotension

C - Agitation, disorientation, lethargy, chest pain Hypoxia causes less blood flow tot he brain causing confusion- irritability- restlessness

The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action should the nurse tell the client to take when providing discharge instructions? A - Avoid driving the car for a few days B - Restrict fluid intake to prevent incontinence C - Avoid lifting objects heavier than 20 lb for at least 6 weeks D - Notify the health care provider if small blood clots are noticed during urination

C - Avoid lifting objects heavier than 20 lb for at least 6 weeks

The nurse is assessing the client diagnosed with bacterial meningitis. Which clinical manifestation would support the diagnosis of bacterial meningitis? A - Positive Babinski's sign and peripheral paresthesia B - Negative Chvostek's sign and facial tingling C - Positive Kernig's sign and nuchal rigidity D - Negative Trousseau's sign and nystagmus

C - Positive Kernig's sign and nuchal rigidity

While reviewing the patient's chart, the nurse notes that the patient takes digoxin, for CHF. Which of the following early findings on the patient's EKG would alert the nurse to a possible digoxin toxicity? A - Bradycardia B - Premature atrial contractions (PACs) C- Premature ventricular contractions (PVCs) D - Tachycardia

C- Premature ventricular contractions (PVCs) - Too much digoxin will increase contractility so the heart is constantly contracting therefore causing PVCs

A nurse is caring for a client who displays signs of stage III Parkinson's disease. Which of the following actions should the nurse include in the plan of care? A - Recommend a community support group. B - Integrate a daily exercise routine. C - Provide a walker for ambulation D - Perform ADLs for the client.

C- Provide a walker for ambulation - Most important safety issues with Stage 3 are falls and choking

A nurse is assessing a client to see if he is comatose. Which of the following GCS is indicative of a coma? A - Nine B - One C - Six D - Zero

C- Six

A nurse is caring for a client experiencing hypovolemic shock. Which findings should the nurse expect to assess? a. Blood pressure of 132/85 mmHg, heart rate of 116, urine output of 45 ml/hr, and warm skin B . Blood pressure of 149/92 mmHg, heart rate of 59, urine output of 57 ml/hr, and cold skin C. Blood pressure of 87/58 mmHg, heart rate of 123, urine output of 20 ml/hr, and clammy skin D. Blood pressure of 91/63 mmHg, heart rate of 99, urine output of 35 ml/hr, and pale skin

C. Blood pressure of 87/58 mmHg, heart rate of 123, urine output of 20 ml/hr, and clammy skin

An asthmatic patient who has a new prescription for Advair Diskus (combined fluticasone and salmeterol) asks the nurse the purpose of using two drugs. The nurse explains that A. Advair is a combination of long-acting and slow-acting bronchodilators. B. The two drugs work together to block the effects of histamine on the bronchioles. C. One drug decreases inflammation, and the other is a bronchodilator. D. The combination of two drugs works more quickly in an acute asthma attack.

C. One drug decreases inflammation, and the other is a bronchodilator.

Which of the following assessment findings is an early indication of hypovolemic shock? A. Diminished bowel sounds B. Increased urinary output C. Tachycardia D. Hypertension

C. Tachycardia - BP goes down so the heart compensates by going tachy

A 27 yr. old with asthma suffers from bronchospasm that requires him to take his albuterol inhaler 4 to 5 times per week. He takes no other medications for asthma. The nurse anticipates which change in the client's plan of care? A - Add Theophylline B - Increase the dose of his present inhaler. C - Add a cromolyn sodium inhaler. D - Add an inhaled corticosteroid.

D - Add an inhaled corticosteroid. - Remember the pt must rinse mouth to prevent oral thrush

Bacterial meningitis alters intracranial physiology, causing A - Cerebral edema B - Increased permeability of the blood-brain barrier C -Raised intracranial pressure D - All of the above changes

D - All of the above changes

Which strategy is most important for the nurse to include in the plan of care for use when teaching a cognitively impaired teen about self-care for diabetes? A - Encourage the teen to post questions on social media sites specialized for children with chronic illness. B - Ask the teen what works best for learning complicated material. C - Reinforce previously taught information only when the parent is present along with the teen. D - Check the teen's understanding of the information frequently during each teaching session.

D - Check the teen's understanding of the information frequently during each teaching session.

What is the primary reason for administering morphine to a client with MI? A - TO SEDATE THE CLIENT B - TO DECREASE THE CLIENT'S PAIN C -DECREASE THE CLIENT'S ANXIETY D - DECREASE OXYGEN DEMAND ON THE CLIENT'S HEART

D - DECREASE OXYGEN DEMAND ON THE CLIENT'S HEART - reducing oxygen demand will increase oxygen consumption

Your client has a long history of chronic obstructive pulmonary disease. You are most likely to observe: A - unequal chest expansion B - increased tactile fremitus C - atrophied neck and trapezius muscles. D - an anteroposterior to transverse chest diameter of 1:1

D - an anteroposterior to transverse chest diameter of 1:1

The night nurse understands that certain factors need to be considered before delegating tasks to others. These factors include the: A - complexity of the task and the age of the delegate. B - potential for benefit and the complexity of the task. C - potential for benefit and the number of staff. D - complexity of the task and the potential for harm

D - complexity of the task and the potential for harm

The nurse walks into the room and observes the client experiencing a tonic-clonic seizure. Which intervention should the nurse implement first? A - Restrain the client to protect from injury B - Flex the neck to ensure stabilization C - Use a tongue blade to open the airway D - Turn the client on the side to aid ventilation

D- Turn the client on the side to aid ventilation

The nurse has just finished teaching a hypertensive patient about the newly prescribed quinapril (Accupril). Which patient statement indicates that more teaching is needed? A. "The medication may not work as well if I take any aspirin." B. "The doctor may order a blood potassium level occasionally." C. "I will call the doctor if I notice that I have a frequent cough." D. "I won't worry if I have a little swelling around my lips and face."

D. "I won't worry if I have a little swelling around my lips and face."

A patient is admitted tot e ED after sustaining abdominal injuries and a broken femur form a motor vehicle accident. Patient is pale, diaphoretic and is not talking coherently. Vitals upon admission are temp. @ 98 degrees F, HR 130 bpm, respiratory rate 34 breaths/minute, BP @50/40 mmHg. The health care provider is suspecting what kind of shock? A. Distributive B. cardiogenic C. neurogenic D. hypovolemic

D. Hypovolcemic

A 75 year old client will be undergoing a mitral valve replacement for severe mitral stenosis. When reviewing the patients chart, which infectious diseases would likely be present in this client's history? A - Meningitis B - Rheumatic fever C - Varicella (chicken pox) D - Haemphilus influenzae

Rheumatic fever

The nurse teaches a 33-year-old male patient with asthma how to administer fluticasone (Flovent HFA) by metered-dose inhaler (MDI). Which statement by the patient to the nurse indicates correct understanding of the instructions? a. "I should not use a spacer device with this inhaler." B. "I will rinse my mouth each time after I use this inhaler." C. "I will feel my breathing improve over the next 2 to 3 hours." D. "I should use this inhaler immediately if I have trouble breathing."

b. "I will rinse my mouth each time after I use this inhaler."