NUR 227 Practice Exam 1

59. You have on hand hydromorphone (Dilaudid) 4 mg/mL. You need to administer 0.015 mg/kg to a patient who weighs 150 pounds. How many milliliters should you administer? Record your answer using two decimal places. a. ____ mL

0.26 mL

60. You need to administer 250 mg of erythromycin (Erythrocin) PO. You have on hand 0.5 g tablets. How many tablet(s) will you give? a. ____ tablets

0.5 tablets

58. The physician writes a "now" order for codeine 45 mg IM for a patient with a vertebral compression fracture. You have on hand codeine 60 mg/2 mL. How many milliliters should you give? a. _____ mL

1.5 mL

57. A patient has a bottle of warfarin (Coumadin) 5 mg tablets at home. After his most recent international normalized ratio (INR), the doctor calls and tells him to take 7.5 mg/day. How many tablets (scored) should the patient take? a. ____ tablets

1.5 tablets

56. You are caring for a patient at home who must take magnesium hydroxide/aluminum hydroxide (Maalox) 30 mL PO. How will you instruct the patient to measure the dose using ordinary household measuring devices? a. ____ mL

2 mL

61. You have an order to give 50 mg/kg/day of Tylenol to a child weighing 66 pounds. The dose is to be given 4 times per day. The drug comes in a concentration of 375mg/5mL. How many mL will you give per dose? a. ____ mL

5 mL

40. The nurse knows that to apply evidence-based practice to wound healing, he should use which standardized tool to monitor healing of pressure ulcers? a. (Fill in the blank)

PUSH

34. The nurse is teaching the patient about his upcoming bronchoscopy procedure. Which statement by the patient indicates an understanding of the procedure? a. "I will not be allowed to eat or drink for about 6 hours before the procedure." b. "They will administer general anesthesia to me prior to the procedure." c. "I will be allowed to take only small sips of water immediately after the procedure." d. "Any blood-tinged mucus is abnormal and I should notify the nurse immediately if this happens."

a. "I will not be allowed to eat or drink for about 6 hours before the procedure."

20. Name the lesion: "A localized accumulation of pus in the dermis or subcutaneous tissue that is frequently red, warm, and tender." a. Abscess b. Wheal c. Bulla (bullae) d. Cyst

a. Abscess

30. When teaching the patient about his echocardiogram, the nurse should explain that the primary reason for this procedure is to determine which of the following? a. Cardiac structure and movement b. Pressure of the blood inside the heart c. Various sounds with each heartbeat d. Relation between electrical conduction and mechanical pumping in heart

a. Cardiac structure and movement

26. What is the removal of devitalized tissue from a wound called? a. Debridement b. Pressure reduction c. Negative pressure wound therapy d. Sanitization

a. Debridement

You are caring for a client with a pneumothorax and who has had a chest tube inserted notes intermittent gentle bubbling in the suction control chamber. What action is appropriate? a. Do nothing, because this is an expected finding b. Immediately clamp the chest tube and notify the physician c. Check for an air leak because the bubbling should be intermittent d. Increase the suction pressure so that the bubbling becomes vigorous

a. Do nothing, because this is an expected finding

53. The nurse is preparing a discharge teaching plan for the male client who had umbilical hernia repair. What should the nurse include in the plan? a. Drain/wound management b. Avoiding coughing c. Maintaining bed rest d. Restricting pain medication

a. Drain/wound management

22. Your patient is due for a change of his 25mcg Fentanyl patch today. How do you dispose of the old patch before applying the new one? a. Fold in half and place in a tamper proof container (sharps box) or returned to pharmacy in a sealed container b. Cut into several pieces and dispose in trash c. Fold in half, and flush down toilet d. Allow patient to self-dispose

a. Fold in half and place in a tamper proof container (sharps box) or returned to pharmacy in a sealed container

4. The nurse is educating their patient about an upcoming Pleurodesis procedure planned for the morning. Which information is most likely going to be found in the patient's medical history? a. History of multiple pleural effusions b. History of pneumothorax c. History of intractable pleurisy d. History of Pulmonary Embolism

a. History of multiple pleural effusions

48. The patient is admitted with facial trauma, including a broken nose, and has a history of gastric reflux. Which tube will the nurse anticipate being placed in the patient for feeding? a. Jejunostomy Tube b. Nasointestinal Tube c. PEG Tube d. Nasogastric Tube

a. Jejunostomy Tube

21. When performing an assessment about medication in the acute care setting, the drug history should include: Select all that apply a. Last set of vital signs b. Does the client take OTC medications? c. Last physical therapy appointment d. Allergies/intolerances e. Full head to toe assessment f. Knowledge about the medication

a. Last set of vital signs b. Does the client take OTC medications? d. Allergies/intolerances f. Knowledge about the medication

9. The nurse is treating a stage IV pressure ulcer on a client. Which of the following would not be appropriate to include in that treatment? a. Tegaderm (clear transparent film) b. Collagen dressing c. Wound filler/packing d. Debriding agents

a. Tegaderm (clear transparent film)

54. A patient has an acute upper GI hemorrhage. Your interventions include: a. Treating hypovolemia. b. Treating hypervolemia. c. Controlling the bleeding source. d. Treating shock and diagnosing the bleeding source.

a. Treating hypovolemia.

19. Describe the Lesions associated with Herpes zoster (shingles) (Select all that apply) a. Very painful rash that may burn, tingle, or itch, even if there are no vesicles present b. Plaques form in the areas surrounding the lesions c. Rash emerges in a linear stripe pattern that appears most commonly on the torso, but may occur on other parts of the body, including the face d. Rash may be accompanied by low fever, chills, headache, or fatigue

a. Very painful rash that may burn, tingle, or itch, even if there are no vesicles present c. Rash emerges in a linear stripe pattern that appears most commonly on the torso, but may occur on other parts of the body, including the face d. Rash may be accompanied by low fever, chills, headache, or fatigue

17. The nurse is caring for a critically ill patient. What are the contraindications for administering medications by the oral route for this patient? (Select all that apply.) a. Vomiting b. Unconsciousness c. Fractured Femur d. Allergy to Penicillin e. Diarrhea

a. Vomiting b. Unconsciousness

27. The nurse receives report on a patient who has a left pleural chest tube connected to underwater seal. When making initial rounds, the nurse observes that the drainage system is functioning correctly when tidaling/fluctuation is noted in which compartment of the system? a. Water seal chamber b. Collection chamber c. Air-leak chamber d. Suction control chamber

a. Water seal chamber

41. The nurse is explaining the purpose of a wound vacuum assisted closure device to a client with a chronic wound. Which of the following statements would require correction? a. "The localized negative pressure draws the edges of the wound together." b. "It will decrease circulation to the wound bed." c. "It removes fluid surrounding the wound." d. "It will decrease the number of bacteria in the wound."

b. "It will decrease circulation to the wound bed."

1. On auscultation, which finding suggests a right pneumothorax? a. Bilateral inspiratory and expiratory crackles b. Absence of breaths sound in the right thorax c. Inspiratory wheezes in the right thorax d. Bilateral pleural friction rub

b. Absence of breaths sound in the right thorax

8. The patient is being admitted for suspected vascular compromise to his lower extremities. The APRN has ordered an Ankle Brachial Index study. Which of the following statements are true regarding this test? Select all that apply. a. When calculating, use the lower of the two upper extremity systolic BP numbers b. An ABI < 0.9 is abnormal c. This test assists in the diagnostics of arterial vascular problems d. When calculating, use the higher of the two upper extremity diastolic numbers e. An ABI requires at least a 2+ pulse in each extremity to be accurate

b. An ABI < 0.9 is abnormal c. This test assists in the diagnostics of arterial vascular problems

28. The nurse received a patient from the post-anesthesia care unit (PACU) who has a chest tube to a closed drainage system. Report from the PACU nurse included drainage in the chest tube at 80 mL of bloody fluid over the last 4 hours. Within fifteen minutes after transfer from the PACU, the chest tube drains another 400 mL. The patient is reporting pain at "4" on a scale of 0 to 10. The first intervention of the nurse is to: a. Notify the healthcare provider. b. Assess the pulse and blood pressure. c. Administer the prescribed pain medication. d. Document the findings.

b. Assess the pulse and blood pressure.

7. A 74 year old female presents to the ER with complaints of dyspnea, persistent cough, and unable to sleep at night due to difficulty breathing. On assessment, you note crackles throughout the lung fields, respiratory rate of 25, and an oxygen saturation of 90% on room air. Which of the following lab results confirm your suspicions of heart failure? a. K+ = 5.6 b. BNP = 820 c. BUN = 10 d. Troponin = 0.02

b. BNP = 820

29. The nurse is ambulating the patient with a chest tube down the hall. The patient inadvertently steps on a dependent loop of the tubing and pulls the chest tube tubing apart. The chest tube itself is still in place inside the patient's chest, but the tubing to the underwater seal device is lying on the floor. The nurse should immediately summon someone to bring him/her a/n: a. Portable oxygen tank b. Bottle of sterile normal saline c. New drainage system d. Occlusive dressing

b. Bottle of sterile normal saline

14. Which of the following diagnostic tests are definitive for TB? Select all that apply. a. Mantoux test b. Chest X-Ray c. Sputum Culture d. Tuberculin Test e. CT Scan

b. Chest X-Ray c. Sputum Culture

3. When using a passy-muir speaking valve, the tracheostomy cuff should be: a. Inflated b. Deflated c. Remove the Trach d. Passy-Muir's should be avoided in trach patients

b. Deflated

52. While caring for a client with peptic ulcer disease, the client reports that he has been nauseated most of the day and is now feeling lightheaded and dizzy. Based upon these findings, which nursing actions would be most appropriate for the nurse to take? Select all that apply. a. Administering an antacid hourly until nausea subsides. b. Monitoring the client's vital signs c. Notifying the physician of the client's symptoms d. Initiating oxygen therapy e. Reassessing the client in an hour

b. Monitoring the client's vital signs c. Notifying the physician of the client's symptoms d. Initiating oxygen therapy

50. A patient with a peptic ulcer who has a nasogastric (NG) tube to wall suction develops sudden, severe, upper abdominal pain, diaphoresis, and a rigid and board-like abdomen. Which action should the nurse take next? a. Irrigate the NG tube. b. Obtain the vital signs. c. Administer pain medication d. Auscultate bowel sounds.

b. Obtain the vital signs.

23. What is the ideal patient position for administration of a rectal medication? a. Prone b. Sim's Position c. Fowler's d. Right lateral recumbent

b. Sim's Position

39. A client with a cervical spinal cord injury presents to the clinic with a sacral pressure ulcer that is a partial- thickness skin loss involving the epidermis. This ulcer would be staged as: a. Stage 1 b. Stage 2 c. Stage 3 d. Stage 4

b. Stage 2

36. Which patient should the nurse go see first? a. A patient who complains of burning at his peripheral IV site b. A patient who spikes an unexpected fever. c. A patient who has a new onset of unexplained restlessness d. A patient who is having severe nausea

c. A patient who has a new onset of unexplained restlessness

47. Which patient would benefit from a Nasogastric Tube? a. A patient with a Platelet count of 50 b. A patient who had a left leg amputation c. A stroke victim who failed their swallow evaluation d. A patient with Congestive Heart Failure

c. A stroke victim who failed their swallow evaluation

24. You have scheduled 0900 dose of 12.5mg of Metoprolol. The patient is 69 years old, admitted for CHF. Vitals are as follows: Temp = 98.9 RR = 20 HR 61 BP 112/84 a. Hold the medication b. Give ½ dose and recheck BP in one hour c. Check order set for any HR/BP parameters before administration d. Call the provider

c. Check order set for any HR/BP parameters before administration

45. The RN is preparing to administer medication through a nasogastric tube that is connected to suction. To administer the medication, the nurse would: a. Position the client supine to assist in medication absorption b. Aspirate the nasogastric tube after medication administration to maintain patency c. Clamp the nasogastric tube for 30 minutes following administration of the medication d. Change the suction setting to low intermittent suction for 30 minutes after medication administration

c. Clamp the nasogastric tube for 30 minutes following administration of the medication

12. Miriam, a college student with acute rhinitis sees the campus nurse because of excessive nasal drainage. The nurse asks the patient about the color of the drainage. In acute rhinitis, nasal drainage normally is: a. Yellow b. Green c. Clear d. Grey

c. Clear

25. Which description best fits that of serous drainage from a wound? a. Fresh bleeding b. Thick and yellow c. Clear, watery plasma d. Beige to brown and foul smelling

c. Clear, watery plasma

33. A patient with lung cancer develops a large pleural effusion in the left lower lobe (LLL). During chest auscultation, which breath sound should the nurse expect to hear in that lobe? a. Stridor b. Rhonchi c. Decreased breath sounds d. Wheezes

c. Decreased breath sounds

32. When caring for a patient with leg ulcers, the positioning of the legs depends on whether the patient's ulcer is arterial or venous in origin. How should the nurse position a patient who has leg ulcers that are venous in origin? a. Keep the patient's legs flat without the knees raised. b. Keep the patient's knees at a 45-degree angle. c. Elevate the patient's lower extremities. d. Dangle the patient's legs over the side of the bed.

c. Elevate the patient's lower extremities.

55. Kevin has a history of peptic ulcer disease and vomits coffee-ground emesis. What does this indicate? a. He has fresh, active upper GI bleeding. b. He needs immediate saline gastric lavage. c. His gastric bleeding occurred at least 2 hours earlier. d. He needs a transfusion of packed RBC's.

c. His gastric bleeding occurred at least 2 hours earlier.

11. What effect does hemoglobin amount have on oxygenation status? a. No effect b. More hemoglobin reduces the client's respiratory rate c. Low hemoglobin levels cause reduces oxygen-carrying capacity d. Low hemoglobin levels cause increased oxygen-carrying capacity.

c. Low hemoglobin levels cause reduces oxygen-carrying capacity

38. The nurse is caring for a patient with a stage II pressure ulcer. The patient is on bedrest and being turned every 2 hours to prevent the development of additional pressure ulcers. In addition, the nurse should: a. Insert an indwelling (Foley) urinary catheter. b. Monitor the white blood cell count. c. Monitor serum albumin d. Insert a rectal tube if diarrhea develops.

c. Monitor serum albumin

37. The patient has a tracheostomy. Upon initial assessment, the nurse notes there is no obturator at the bedside. What is the next best nursing action? a. Assess the patient's EMV (eye motor verbal)/Glasgow Coma scale. b. Notify the health care practitioner STAT. c. Obtain an obturator from the supply room. d. Determine whether an obturator is necessary for this type of trach.

c. Obtain an obturator from the supply room.

49. The hospitalized client with GERD is complaining of chest discomfort that feels like heartburn following a meal. After administering an ordered antacid, the nurse encourages the client to lie in which of the following positions? a. Supine with the head of the bed flat b. On the stomach with the head flat c. On the left side with the head of the bed elevated 30 degrees d. On the right side with the head of the bed elevated 30 degrees.

c. On the left side with the head of the bed elevated 30 degrees

15. A pulse oximetry gives what type of information about the client? a. Amount of carbon dioxide in the blood b. Amount of oxygen in the blood c. Percentage of hemoglobin carrying oxygen d. Respiratory rate

c. Percentage of hemoglobin carrying oxygen

6. Myocardial oxygen consumption increases as which of the following parameters increase? a. Preload, afterload, and cerebral blood flow b. Preload, afterload, and renal blood flow c. Preload, afterload, contractility, and heart rate. d. Preload, afterload, cerebral blood flow, and heart rate.

c. Preload, afterload, contractility, and heart rate.

51. Your patient with peritonitis is NPO and complaining of thirst. What is your priority? a. Increase the I.V. infusion rate. b. Use diversion activities. c. Provide frequent mouth care. d. Give ice chips every 15 minutes.

c. Provide frequent mouth care.

13. For a female patient with chronic obstructive pulmonary disease, which nursing intervention would help maintain a patent airway? a. Restricting fluid intake to 1,000 ml per day b. Enforcing absolute bed rest c. Teaching the patient how to perform controlled coughing d. Administering prescribe sedatives regularly and in large amounts

c. Teaching the patient how to perform controlled coughing

10. A patient is visiting the emergency department because of persistent bleeding from the nose that will not stop. Blood is on the patient's shirt, and bleeding from the nose continues. The nurse intervenes by: a. Instructing the patient to tilt the head back with ice applied to the nose. b. Pinching the hard/bony portion at the base of the nose. c. Telling the patient to sit upright with the head tilted forward while pinching the top of the nasal cavity. d. Applying pressure to the nose for 30 seconds.

c. Telling the patient to sit upright with the head tilted forward while pinching the top of the nasal cavity.

16. Continuous positive airway pressure (CPAP) can be provided through an oxygen mask to improve oxygenation in hypoxic patients by which of the following methods? a. The mask provides 100% oxygen to the client b. The mask provides continuous air that the client can breathe. c. The mask provides pressurized oxygen so the client can breathe more easily. d. The mask provides pressurized at the end of expiration to open collapsed alveoli

c. The mask provides pressurized oxygen so the client can breathe more easily.

5. Which of the following blood tests is most indicative of cardiac damage? a. Lactate dehydrogenase b. Complete blood count (CBC) c. Troponin I d. Creatine kinase (CK)

c. Troponin I

31. The nurse is caring for a patient with a leg ulcer caused by arterial insufficiency. The nurse knows that a recommended treatment for arterial insufficiency of the leg is: a. TED hose b. Sequential compression devices (SCD) c. Vascular reconstruction by surgery d. Ace wrap bandaging

c. Vascular reconstruction by surgery

43. Wet-to-dry dressings for mechanical debridement of a wound should: a. be removed when totally dry b. cause slight bleeding when removed c. be only moist, not wet when applied d. be left in place for at least12 hours before being removed

c. be only moist, not wet when applied

46. The nurse is monitoring a female client with a diagnosis of peptic ulcer. Which assessment findings would most likely indicate perforation of the ulcer? a. Bradycardia b. Numbness in the legs c. Nausea and vomiting d. A rigid, board-like abdomen

d. A rigid, board-like abdomen

42. The most important nursing intervention for treating chronic wounds, regardless of staging, is: a. Use sterile techniques when changing dressings b. Draw edges of the wound together c. Remove fluid away from the area to decrease infection d. Decrease and redistribute pressure to the tissues

d. Decrease and redistribute pressure to the tissues

35. The nurse receives in report that the elderly patient admitted to the progressive care unit for pneumonia during the night is also experiencing cognitive changes. Which situation will the nurse suspect first as the reason for this finding? a. Hypertension b. Malnutrition c. Medication allergy d. Infection

d. Infection

18. A female client sees a dermatologist for a skin problem. Later, the nurse reviews the client's chart and notes that the chief complaint was intertrigo. This term refers to which condition? a. Spontaneously occurring wheals b. A fungus that enters the underneath the dermal layer, causing infection c. Inflammation of a hair follicle d. Irritation of opposing skin surfaces caused by friction

d. Irritation of opposing skin surfaces caused by friction

44. The RN is teaching the patient and family that peptic ulcers are: a. Caused by a stressful lifestyle and other acid-producing factors such as H. Pylori b. Inherited within families and reinforced by bacterial spread of Staphylococcous Aureus in childhood c. Promoted by factors that tend to cause over secretion of acid, such as excess dietary fats, smoking, and H. Pylori d. Promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.

d. Promoted by a combination of factors that may result in erosion of the gastric mucosa, including certain drugs and alcohol.