Final Exam Review
16. Eight years after seroconversion, the HIV-infected patient has a CD4 count of 800 and an undetectable viral load. What should the nurse teach the patient?
Answer: Maintain adequate nutrition and exercise
1. A patient, who is lethargic, is exhibiting deep rapid respirations has the following ABGS: pH 7.32, pCO2 37, HCO3 16. How should the nurse interpret these results?
Answer: Metabolic acidosis
17. The nurse will anticipate preparing an older patient who is vomiting coffee-ground emesis for:
Answer: Endoscopy
22. It is important for the nurse providing care for a patient with sickle cell crisis to:
Answer: Evaluate the effectiveness of opioid analgesics.
27. A nurse reviews a plan of care for a patient with a diagnosis of end stage renal disease, who is undergoing hemodialysis. Which part of the plan should the nurse question?
Answer: Furosemide (Lasix)
13. The nurse observes the unlicensed assistive personnel (UAP) taking the following action when caring for a patient with a catheter. Which action requires the nurse to intervene?
Answer: Disconnecting the catheter from the drainage tube to get a specimen
19. The nurse is preparing to teach a 43-year-old man who is newly diagnosed with type 2 diabetes about home management of the disease. Which action should the nurse take first?
Answer: Assess the patient's perception of what it means to have diabetes mellitus.
9. Which information about dietary management should the nurse include with teaching a patient about peptic ulcer disease?
Answer: Avoid foods that cause pain after eating
13. The patient has a long arm plaster cast applied for fraction immobilization. Until the cast is completely dried:
Answer: Avoid handling cast with fingertips
12. A nurse is caring for a newly admitted client with HHNK (hyperglycemic hyperosmolar nonketotic) syndrome. Which initial intervention would the nurse expect the health care provider to order?
Answer: Bolus infusion of intravenous crystalloid fluid
20. The patient is admitted for peptic ulcer disease and is on omeprazole. The nurse realizes the patient is at greatest risk for:
Answer: C. diff
15. The registered nurse needs to make an assignment for the unlicensed assistive personnel (UAP). Which activity would the nurse ask the UAP to perform?
Answer: Check the blood pressure of the 2-hour post-op patient
10. The nurse is caring for a patient who smokes 2 packs/day. To reduce the patient's risk of lung cancer, which action by the nurse is best?
Answer: Discuss the risks associated with cigarettes during every patient encounter.
34. A patient with renal failure is receiving continuous renal replacement therapy (CRRT). What is the difference between this therapy and hemodialysis? (I just made up this question because she didn't finish reading it)
Answer: Choose the answer about CRRT being more gradual and slower compared to hemodialysis
33. The patient who received a kidney transplant 18-months ago is demonstrating progressive azotemia, proteinuria, and hypertension. Which disorder should the nurse expect the client is experiencing?
Answer: Chronic rejection
16. A patient with a right lower leg fracture will be discharged home with an external fixation device in place. What should the nurse expect to teach the client?
Answer: Clean pins daily
19. Which finding will the nurse expect when assessing a patient who has osteoarthritis of the knee?
Answer: Discomfort with joint movement
6. After two months of TB treatment with isoniazid (INH), rifampin, pyrazinamide, and ethambutol, the patient continues to have positive sputum smears. What is the first thing the nurse should ask?
Answer: "Are you taking your meds?"
16. The nurse teaching a class to a community group stresses the importance of weight loss in decreasing the risk of developing type 2 diabetes mellitus. A member from the groups asks why weight loss reduces the risk associated with the development of this health condition? Which response is most appropriate by the nurse?
Answer: "Excess body weight impairs the body's release of insulin."
20. A 52 y.o. patient has a new diagnosis of pernicious anemia. The nurse determines that the patient understands the teaching about the disorder when the patient states,
Answer: "I could choose nasal spray rather than injections of Vitamin B12."
7. A patient with diabetes requiring insulin is admitted to the hospital for severe hypoglycemia and seizures. Which statement by the caregiver identifies the cause of the patient's condition?
Answer: "I give him insulin glargine before meals and lispro before bedtime"
13. Your client is diagnosed with hyperthyroidism. Which of the following comments by the client indicates they understand information you have provided regarding side effects and complications of propranolol which was recently prescribed to them?
Answer: "I will be sure to change positions slowly and report any dizziness."
8. Which information obtained during the nurse's assessment of a patient's nutritional-metabolic pattern may indicate an increased risk for musculoskeletal problems?
Answer: 5'2 and weighs 180 lb.
22. Which patient seen by the nurse in the outpatient clinic is most likely to require teaching about ways to reduce osteoarthritis?
Answer: 56-year-old woman who works in an automotive assembly line
2. A patient with systemic bacterial infection feels cold and shaking chills. Which assessment finding should the nurse expect next?
Answer: A rise in body temperature
5. The patient with diverticulosis has a large bowel obstruction. The nurse will monitor for:
Answer: Abdominal distention
5. Which laboratory test will the nurse use to determine whether filgrastim is effective for a patient with acute lymphocytic leukemia who is receiving chemotherapy?
Answer: Absolute neutrophil count
4. A diabetic patient admitted to the floor is found on the bathroom floor unconscious. Which intervention should the nurse implement first?
Answer: Administer D50 intravenous push (IVP)
23. A patient comes to the ER following a bee sting. The patient is exhibiting signs of anaphylaxis and has used an auto-injector of epinephrine. Which action should the nurse take next? (I made this question up because she didn't finish reading it)
Answer: Administer epinephrine IM
11. Before assisting a patient with ambulation 2 days after hip arthroplasty, which action is most important for the nurse to take?
Answer: Administer pain medications
32. The nurse discusses the risk for developing chronic kidney disease with a group of nursing students. Which population should the nurse emphasize?
Answer: African-Americans
3. An older patient reports chronic constipation. To promote bowel evacuation, the nurse should suggest to attempt defecation:
Answer: After eating breakfast
21. An appropriate nursing intervention for a hospitalized patient with severe hemolytic anemia is to:
Answer: Alternate periods of rest and activity
7. A 74-year-old patient is seen in the health clinic with new development of stooped posture, shuffling gait, and pill-rolling tremor. What should the nurse expect to teach the patient about?
Answer: Antiparkinsonian drugs
3. A patient with pancytopenia has a bone marrow aspiration from the left posterior iliac crest. Which action would be important for the nurse to take after the procedure?
Answer: Apply a sterile dressing to the site and have the patient lie on the left side
15. The nursing action that will be most useful in assisting college students to adhere to a new regimen is to:
Answer: Arrange schedule of meds around their class schedule
15. Which action will the nurse take in order to evaluate the effectiveness of Buck's traction for a patient who has an intracapsular fracture of the right femur?
Answer: Assess for hip pain
29. The nurse is administering peritoneal dialysis to a patient with renal failure. The nurse notes the presence of cloudy dialysate on return. Which action should the nurse take?
Answer: Do a culture
11. The charge nurse is explaining to the student nurse the pathophysiology of emphysema in relation to abnormal ventilation-perfusion ratios. The student nurse demonstrates understanding when they provide which of the following statements?
Answer: Because of the increased dead space, there is a decrease in PaO2.
22. A patient newly diagnosed with hyperparathyroidism presents to the emergency room with muscular weakness, decreased deep tendon reflexes, anorexia, and constipation. The nurse would anticipate which collaborative therapy to be included in the patient's treatment plan?
Answer: Bed-rest
10. A patient is discharged 4 days after a hip arthroplasty using a posterior approach. Which patient action requires intervention by the nurse?
Answer: Bending over to put on socks and shoes
4. When assessing the respiratory system of an older patient, which finding indicates that the nurse should take immediate action?
Answer: Bilateral crackles at the bases
21. A patient who has arthroscopic surgery of the right knee 7 days ago is admitted with a red, swollen hot knee. Which assessment finding should the nurse report?
Answer: Blood pressure is 86/50
6. A 62-year-old patient who has Parkinson's disease is taking pramipexole. Which information obtained by the nurse may indicate a need for a decrease in the dosage?
Answer: Blood pressure is 92/52
19. Which activity in the care of a patient with a new colostomy could the nurse delegate to the UAP?
Answer: Emptying the colostomy bag
22. The nurse is caring for a patient who has extensive deep tissue damage. The nurse knows that the patient is also vegan. Which dietary information should the nurse teach this patient to enhance the healing process?
Answer: High carbohydrates, and high protein diet
21. The nurse reinforces medication teaching to a patient for metronidazole. Which patient statement indicates a need for further teaching?
Answer: I need to decrease the amount of alcohol I'm drinking while on this medication.
30. The patient with renal failure will be discharged home within the next few days. When conducting dietary instructions, the nurse teaches the patient which proteins are high in biological value. Which client statement indicates that the teaching has been effective?
Answer: I will be sure to include eggs in my diet.
21. Spironolactone is prescribed for a patient. Which statement by the patient indicates that teaching for this medication was effective?
Answer: I will drink apple juice instead of orange juice.
13. The nurse is reviewing discharge instructions with a patient newly diagnosed with COPD. Which statement indicates the need for further teaching?
Answer: I will eat three large meals daily.
23. The nurse is reviewing discharge instructions with a patient recently placed on Lasix. Which patient statement would indicate the need for further teaching?
Answer: I will take my water pill in the evening so my daily activities are not disrupted.
3. A nurse is teaching a patient about pulmonary function testing. Which statement is made by the patient that indicates they need further teaching?
Answer: I will use my inhaled bronchodilator right before the procedure.
25. An adult patient with stage-3 chronic kidney disease is scheduled for an IV pyelogram. Which order for the patient will the nurse question?
Answer: Ibuprofen 800 mg
11. Which action by the nurse will be most effective in decreasing the spread of pertussis?
Answer: Immunizations
8. A patient with pneumonia has a fever 101.4 F, non-productive cough, and O2 sat. of 88%, with complaints of weakness, fatigue, and needs assistance getting out of bed. Which nursing diagnosis should the nurse assign as a priority?
Answer: Impaired gas exchange related to respiratory congestion
18. The healthcare provider prescribes antacids and sucralfate (Carafate) for treatment of a patient's peptic ulcer. Which statement reflects why a patient would receive sucralfate for the treatment of PUD?
Answer: Increases production of prostaglandin and protects the ulcer from the acid
3. Which information will the nurse include when teaching a patient about peptic ulcer disease about the effect of ranitidine (Zantac)?
Answer: It decreases the acid secretions
2. A patient with chronic cough has a bronchoscopy. After the procedure, which intervention is most appropriate?
Answer: Keep the patient NPO until their gag reflex returns
4. The patient who has chronic constipation asks the nurse about the use of psyllium (Metamucil). Which information will the nurse include in response?
Answer: Large amounts of fluid should be taken to prevent impaction or bowel obstruction
5. A patient is seen in the clinic for a bladder infection and describes the following symptoms. Which information is most important for the nurse to report?
Answer: Left-sided flank pain
20. Diagnostic tests used to diagnose MS:
Answer: MRI, CT, CSF analysis
17. During report, the nurse learns that a client with tumor lysis syndrome is receiving an IV infusion containing insulin. Which assessment should the nurse complete first?
Answer: Monitor the patient's serum potassium and blood glucose levels.
9. A patient who has had an open reduction internal fixation (ORIF) of left lower leg fracture continues to complain of severe pain in the leg 15 minutes after receiving prescribed IV morphine. Pulses are fairly palpable and the foot is cool to the touch. What should the nurse do immediately?
Answer: Notify the healthcare provider
7. Which goal has the highest priority in the plan of care for a 26-year-old patient, who is homeless and admitted with viral hepatitis, severe anorexia, and fatigue?
Answer: Nutrition (coordinate meals with them after they are discharged)
14. Which diet choice by the patient with an acute exacerbation of IBD indicates a need for teaching?
Answer: Oatmeal
16. The nurse is caring for a patient with extracellular fluid volume deficit. Which assessment would the nurse anticipate finding?
Answer: Oliguria
23. Which menu choice indicates that the patient understands the nurse's teaching about recommended dietary choices for iron-deficiency anemia?
Answer: Omelet and whole wheat toast
14. Capillary glucose monitoring is being performed every 4 hours for a female patient diagnosed with Diabetic Ketoacidosis (DKA). Insulin is administered using a scale of regular insulin according to glucose results. At 2 PM, the patient has a capillary glucose level of 250 mg/dl for which she receives 8 units of regular insulin. The nurse should expect which of the following?
Answer: Onset to be at 2:30 PM and its peak to be at 4 PM
20. An elderly patient who is taking furosemide (Lasix) for treatment of fluid volume excess complains of generalized weakness. It is most appropriate for the nurse to take which action?
Answer: Order a BMP
10. A patient who has just been admitted with community-acquired pneumococcal pneumonia has a temperature of 101.6 F, with frequent cough, and complaining of pleuritic pain. Which prescribed medication would the nurse give first?
Answer: Piperacillin/Tazobactam (Zosyn; the antibiotic)
19. A newly admitted patient is diagnosed with hypernatremia. When making room assignments, the charge nurse should take which action?
Answer: Place patient close to the nurse's station
26. An elderly patient is admitted with acute kidney injury due to dehydration, oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?
Answer: Place them on a cardiac monitor
12. After reviewing the information shown in the accompanying figure for a patient with pneumonia and sepsis, which information is most important to report to the healthcare provider?
Answer: Platelet count and petechiae
11. A 26 year-old male with no medical history is brought into the ER by EMS for severe abdominal pain, weakness, and confusion. Your assessment reveals a dry oral mucosa, fruity-smelling breath, tachypnea, clear lung sounds, and tachycardia. His oral temperature is 99°F. A finger stick glucose reading indicates a blood sugar of 326 mg/dL. Which initial therapy does the nurse anticipate?
Answer: Regular insulin via intravenous infusion
10. What can patients who use inhaled corticosteroids do to reduce the risk of candidiasis?
Answer: Rinse the mouth after every use
8. A patient receiving head and neck radiation has ulcerations over the oral mucosa and tongue and thick, ropey saliva. The nurse will teach the patient to:
Answer: Rinse the mouth as needed with an isotonic saline solution to clean the mouth.
17. A day after the 60-year-old patient has open reduction and internal fixation (ORIF) for an open displaced tibial fracture. The nurse identifies the priority nursing diagnosis:
Answer: Risk for infection
31. The nurse is caring for a patient from another country who was admitted with HTN, chronic renal failure. The patient is receiving hemodialysis three times a week. The nurse is assessing the patient's diet, and the patient reports the use of salt-substitutes. When teaching the patient to avoid salt-substitutes, which rationale supports the teaching point?
Answer: Salt-substitutes contain potassium, making the patient at risk for developing hyperkalemia.
28. A patient with renal failure is receiving peritoneal dialysis. The nurse is explaining the process to the patient. Which statement would the nurse include?
Answer: She talked too much, so just choose the answer that says something about "semi-permeable membrane".
14. The patient with a complex pelvic fracture from a motor vehicle crash is on bed rest. Which nursing assessment indicates finding of a potential complication?
Answer: Shortness of breath and petechial rash
18. A patient is admitted to the emergency department with a left femur fracture. Which information obtained by the nurse is MOST important to get to the healthcare provider?
Answer: Slow capillary refill
7. Reviewing information about this patient from the table (58-year-old male). Which risk factor modification is most important to teach the patient?
Answer: Smoking cessation
9. A patient with diabetes comes to the office in tears because last night she woke up in the middle of the night and didn't know where she was. She informs the HCP that her sheets were soaked with sweat and she noticed her hands shaking when she got some juice. The HCP notes her last Hgb-A1c was 5.6%. What is the likely cause of the patient's symptoms and how should her therapy be adjusted?
Answer: Somogyi Effect; decrease evening insulin dose
15. A patient with a past medical history of alcohol abuse, dyslipidemia, cirrhosis, and portal vein hypertension begins vomiting frank blood after dinner. All of the following therapies may be done emergently to treat the crisis EXCEPT:
Answer: TIPS procedure (A TIPS procedure is an involved surgical procedure that will only be done with a stable patient.)
18. A patient's admission urinalysis shows that the specific gravity value of 1.039. Which of these findings would the nurse expect to find during the physical assessment?
Answer: Tachycardia
17. The nurse is caring for a patient with serum potassium of 3.2. The patient is placed on a cardiac monitor and started on an IV infusion of 40 mEq of potassium in a liter of dextrose 5% in water (D5W). Which ECG finding indicates the infusion of potassium should be stopped?
Answer: Tall, peaked T-waves
6. A patient with COPD has a nursing diagnosis of impaired breathing pattern related to anxiety. Which nursing action is most appropriate to include in their plan of care?
Answer: Teach the patient how to effectively use pursed lip breathing
14. The nurse is caring for a patient with a potassium level of 5.9. The provider prescribes both glucose and insulin for the patient. The patient's spouse asks, "Why is insulin needed?" Which response by the nurse is most appropriate?
Answer: The insulin will cause his extra potassium to move into his cells, which lowers the potassium in the blood.
5. The nurse teaches a patient with chronic bronchitis about a new prescription for Advair, which is a dry-powdered inhaler. Which activity by the patient would indicate to the nurse that teaching about the medication administration was successful?
Answer: The patient rapidly inhales the medication
8. The patient has a new order for an oral form of dexamethasone due to exacerbation of COPD. What should the nurse understand about this medication?
Answer: The patient should avoid being around people who are sick or have infection.
18. Which information is most important for the nurse to report to the health care provider before a patient with type 2 diabetes is prepared for a coronary angiogram?
Answer: The patient took the prescribed metformin today.
2. After the change-of-shift report, which patient should the nurse assess first?
Answer: The patient with a urethral stricture who has not voided for 12 hours
9. The charge nurse is observing a student nurse conducting an admission assessment on a patient with COPD. Which action by the student nurse requires immediate intervention by the charge nurse?
Answer: The student nurse is observed continuing to ask admission questions despite the patient demonstrating difficulty breathing and signs of respiratory impairment
24. A patient with chronic renal failure asks the nurse why he is anemic. What is the nurse's best response?
Answer: They are not producing the hormone that tells your body to make more blood.
23. The 70-year-old man with BPH was prescribed tamsulosin (Flomax). Which should the nurse include in the teaching for this medication?
Answer: This can decrease blood pressure and cause dizziness
4. The patient is admitted with active TB. The nurse should question the HCP's order to d/c precautions unless which assessment finding is documented?
Answer: Three negative sputum smears
1. Which information will the nurse include in teaching a patient who had a proctocolectomy and an ileostomy for ulcerative colitis?
Answer: Use care when eating high-fiber foods to avoid obstructing the ileum
12. Which information will the nurse teach seniors at the community recreation center about ways to prevent a fracture?
Answer: Use comfortable shoes with support
12. The nurse is instructing a patient on a new medication prescribed Ipratropium bromide (Atrovent) for COPD. Which point should be included in the patient education?
Answer: Use hard candy or drink fluids to help with dry mouth
1. Following rectal surgery, the patient voids about 50 mL every 30 to 60 minutes for the first 4 hours. Which action by the nurse is most appropriate?
Answer: Use ultrasound to check post-void residual
6. A nurse is checking on a patient with a history of obesity, hypertension, and depression who was admitted 5 days ago with diabetic ketoacidosis. The patient appears visibly upset because the provider has informed her that she has liver damage that is quite serious. The patient does not understand how this could be since she does not drink alcohol. The nurse explains that:
Answer: fatty deposits in the liver have caused scarring to occur
2. A patient newly diagnosed with Diabetes Mellitus Type II has a very hectic work schedule in which they work long hours and often have to skip meals. Which therapy prescribed by the doctor would raise concern and be questioned by the nurse?
Answer: glyburide
1. A patient who has received chemotherapy for cancer treatment is given an injection of erythropoietin. Which of the following should reflect the findings in a complete blood count (CBC) drawn 2 weeks later? An increase in:
Answer: hemoglobin
25. The nurse plans a presentation for the community on how to decrease the risk for antibiotic-resistant infections? Which information should the nurse include in the plan of teaching? Select all that apply
Answers: o Continue taking the antibiotics until all the prescription is gone o Throw away unused antibiotics o Antibiotics may sometimes be prescribed to prevent infections (prophylactically)
28. A patient recently diagnosed is prescribed carbidopa-levodopa. Which of the following statements should the nurse include in medication education?
Answers: o Divide protein throughout the day o Can cause darkening of the urine, which is not harmful o May take months to see improvement in signs and symptoms
27. The nurse reviews the medication orders and lab results from assigned patients. Which of the following should the nurse question?
Answers: o Furosemide (Lasix) to a patient with an acute kidney injury and hypokalemia o Vancomycin for patient with BUN of 42 mg/dL o Isoniazid (INH) for patient with elevated liver enzymes
28. The nurse is caring for a patient on the post-anesthesia care unit following a gastroduodenostomy (Billroth I). Which of the following nursing interventions are appropriate?
Answers: o Keep the patient NPO until you can hear bowel sounds o Apply sequential compression devices (SCDs) o Encourage splinting of the incision when coughing
25. A patient with Parkinson's disease is admitted to the hospital for treatment of pneumonia. Which nursing interventions will be included in the daily plan of care?
Answers: o Observe for sudden signs of exacerbation of symptoms (for pneumonia) o Note: She didn't read the answers aloud, but she said the only WRONG answer is: Serving high-protein foods at breakfast ONLY
26. The nurse reviews new prescriptions for assigned patients. Which of the following orders should the nurse question?
Answers: o Oxybutynin - pt. with a history of acute angle glaucoma o Alendronate - pt. with new diagnosis of peptic ulcer disease o Interferon beta 1a - pt. with new diagnosis of MS who has history of depression and attempted suicide
29. The nurse is completing the discharge sheet for a patient with a hip fracture who is treated by insertion of a prosthetic using a posterior approach. Which instructions should be given to the patient before discharge?
Answers: o Place chair in the shower or tub o Keep surgical hip in neutral, straight patient when sitting or lying o Inform the dentist about the prosthetic
26. The nurse is caring for a patient infected with HIV, who has been diagnosed with asymptomatic chronic HIV. Which prophylactic measure will the nurse include in the plan of care? Select all that apply
Answers: o Pneumococcal vaccine o Influenza vaccine o Hepatitis B vaccine
36. The nurse is performing a respiratory assessment on a young adult. Which findings are considered an alteration of oxygenation?
Answers: o Tachypneic o Retractions o Dyspnea o Orthopnea
24. A 23 year-old patient who is obese has been diagnosed with pre-diabetes. The patient states that they feel healthy and don't understand why the provider is so concerned. Which long term effects associated with diabetes would you include in your patient education? Select all that apply
Answers: o kidney failure o cardiac disease o nerve damage o loss of eyesight
26. A registered nurse is providing education to a recent graduate nurse on the care of a patient with internal radiation. Which responses by the graduate nurse indicate effective teaching? Select all that apply
Answers: o "I will place appropriate signage on the patient's door." o "I will apply the principles of time, distance, and shielding."
28. The client is in end stage liver failure with a vitamin K deficiency. Which interventions should the nurse implement? Select all that apply
Answers: o Avoid rectal temperatures o Only use an oral sponge or soft bristle toothbrush to brush teeth o Monitor platelet count o Encourage the patient to eat carrots with meals
24. Which information would the nurse include when teaching the patient how to avoid chronic constipation? Select all that apply
Answers: o Bulk-forming laxatives are an excellent source of fiber o Some of your medications can cause constipation o Walking or cycling with help with bowel motility o Good time is after breakfast
27. Which of these interventions are appropriate teaching points to cover with a patient regarding skin care after receiving radiation therapy? Select all that apply
Answers: o Clean radiation site with a mild soap and water o If needed use an electric razor for shaving o Expose the area often to air
25. A patient develops neutropenia after receiving chemotherapy. Which information about ways to prevent infection will the nurse include in the teaching plan? Select all that apply
Answers: o Cook food thoroughly before eating o Avoid public transportation such as buses o Decrease exposure to pets, plant, including cut or dried flowers o Perform meticulous hand hygiene
24. According to the CDC guidelines, which PPE will the nurse put on before assessing a patient who has contact precautions for C. diff? Select all that apply
Answers: o Gown o Gloves
37. A patient with chronic kidney disease has a potassium level of 6.5. Which orders should the nurse anticipate receiving for this patient?
Answers: o IV 50% dextrose solution o Regular insulin IV o Sodium polystyrene sulfonate (Kayexalate)
35. The nurse is assessing an 8-year-old client with anatomical differences. Which should the nurse expect to find compared to an adult? (Select all that apply)
Answers: o Smaller nasopharynx o Small mouth, big tongue o Soft tracheal cartilage
27. A patient recently diagnosed with osteoporosis is prescribed alendronate. Which of the following statements should the nurse include in medication education? Select all that apply
Answers: o Stay upright for 30 minutes o Take on an empty stomach o Take with full glass of water
