D-Bag #3

<7.35 is alkalosis Select one: True False

Correct Answer: False

A postoperative patient has not voided for 8 hours after return to the clinical unit. Which action should the nurse take first? Select one: a. Encourage increased oral fluid intake. b. Insert a straight catheter. c. Assist the patient to ambulate to the bathroom. d. Perform a bladder scan.

Correct Answer: d. Perform a bladder scan.

Which topic is most important for the nurse to discuss preoperatively with a patient who is scheduled for an open cholecystectomy? Select one: a .Care for the surgical incision b. Medications to be used during surgery c. Oral antibiotic therapy after discharge d. Deep breathing and coughing

Correct Answer: d. Deep breathing and coughing

A patient who had a transverse colectomy for diverticulosis 18 hours ago has nasogastric suction. The patient complains of anxiety and incisional pain. The patient's respiratory rate is 32 breaths/min, and the arterial blood gases (ABGs) indicate respiratory alkalosis. Which action should the nurse take first? Select one: a. Give the patient the PRN IV morphine sulfate 4 mg. b. Notify the health care provider about the ABG results. c. Check to make sure the nasogastric tube is patent. d. Teach the patient how to take slow, deep breaths when anxious.

Correct Answer: a. Give the patient the PRN IV morphine sulfate 4 mg.

When administering a neuromuscular blocking drug, the nurse needs to remember which principle? Select One: a. Artificial mechanical ventilation is required because of paralyzed respiratory muscles. b. Only skeletal muscles are paralyzed; respiratory muscles remain functional. c. It is used instead of general anesthesia during surgery. d. It causes sedation and pain relief while allowing for lower doses of anesthetics.

Correct Answer: a. Artificial mechanical ventilation is required because of paralyzed respiratory muscles.

A patient who takes a diuretic and a b-blocker to control blood pressure is scheduled for breast reconstruction surgery. Which patient information is most important to communicate to the health care provider before surgery? Select one: a. Serum potassium 3.1 mEq/L b. Hematocrit 36% c. Blood pressure 130/80 d. Pulse 58

Correct Answer: Correct Answer: a. Serum potassium 3.1 mEq/L

Measure of H+ ion concentration is pH? Select one: True False

Correct Answer: True

The nurse is caring for a patient the first postoperative day following a laparotomy for a small bowel obstruction. The nurse notices new bright-red drainage about 5 cm in diameter on the dressing. Which action should the nurse take first? Select one: a. Recheck the dressing in 1 hour. b. Take the patient's vital signs. c. Apply an abdominal binder. d. Reinforce the dressing

Correct Answer: b. Take the patient's vital signs.

A patient arrives at the outpatient surgical center for a scheduled laparoscopy under general anesthesia. Which information requires the nurse's preoperative intervention to maintain patient safety? Select one: a. The patient's insurance does not cover outpatient surgery. b. The patient is planning to drive home after surgery. c. The patient had a sip of water 4 hours before arriving. d. The patient has never had general anesthesia.

Correct Answer: b. The patient is planning to drive home after surgery.

A patient's T-tube is draining dark green fluid after gallbladder surgery. What action by the nurse is the most appropriate? Select one: a. Place the patient on bed rest. b. Irrigate the T-tube with sterile normal saline. c. Document the color and amount of drainage. d. Notify the patient's surgeon.

Correct Answer: c. Document the color and amount of drainage.

Metabolic process produce acids that must be neutralized and excreted is Acid-Base Regulation? Select one: True False

Correct Answer: True

The nurse is caring for a patient who has a central venous access device (CVAD). Which action by the nurse is appropriate? Select one: a .Use the push-pause method to flush the CVAD after giving medications. b. Position the patient's face toward the CVAD during injection cap changes. c. Obtain an order from the health care provider to change CVAD dressing. d. Avoid using friction when cleaning around the CVAD insertion site.

Correct Answer: a .Use the push-pause method to flush the CVAD after giving medications.

Which statement by a patient scheduled for surgery is most important to report to the health care provider? Select one: a. "I had a heart valve replacement last year." b. "I have a strong family history of cancer." c. "I have knee pain whenever I walk or jog." d. "I had bacterial pneumonia 3 months ago."

Correct Answer: a. "I had a heart valve replacement last year."

Which statement, if made by a new circulating nurse, reflects understanding of the circulating nurse role? Select one: a. "I will assist in preparing the operating room for the patient." b. "I will remain gloved while performing activities in the sterile field." c. "I will assist with suturing of incisions and maintaining hemostasis as needed." d. "I will don sterile gloves to obtain items from the unsterile field."

Correct Answer: a. "I will assist in preparing the operating room for the patient."

A patient who has not had any prior surgeries tells the nurse doing the preoperative assessment about allergies to avocados and bananas. Which action is most important for the nurse to take? Select one: a. Alert the surgery center about a possible latex allergy. b. Reassure the patient that all allergies are noted on the health record. c. Ask whether the patient uses antihistamines to reduce allergic reactions. d. Notify the dietitian about the specific food allergies.

Correct Answer: a. Alert the surgery center about a possible latex allergy.

The nasogastric (NG) tube is removed on the second postoperative day, and the patient is placed on a clear liquid diet. Four hours later, the patient complains of frequent, cramping gas pains. What action by the nurse is the most appropriate? Select one: a. Assist the patient to ambulate. b. Give the PRN IV opioid. c. Place the patient on NPO status. d. Reinsert the NG tube.

Correct Answer: a. Assist the patient to ambulate.

A patient receives 0.9% NaCl solution for correction of hyponatremia. Which assessment is most important for the nurse to monitor for while the patient is receiving this infusion? Select one: a. Lung sounds b. Urinary output c. Peripheral edema d. Peripheral pulses

Correct Answer: a. Lung sounds

When caring for a patient the second postoperative day after abdominal surgery for removal of a large pancreatic cyst, the nurse obtains an oral temperature of 100.8° F (38.2° C). Which action should the nurse take next? Select one: a. Ask the health care provider to prescribe a different antibiotic. b. Request an order for acetaminophen (Tylenol). c. Have the patient use the incentive spirometer. d. Place ice packs in the patient's axillae.

Correct Answer: c. Have the patient use the incentive spirometer.

Vicodin (acetaminophen/hydrocodone) is prescribed for a patient who has had surgery. The nurse informs the patient that which common adverse effects can occur with this medication? (Select all that apply.) Select one or more: a. Urinary retention b. Diarrhea c. Itching d. Lightheadedness e. Constipation f. Nervousness

Correct Answer: c. Itching e. Constipation

The nurse notes in the patient's medication history that the patient is taking cyclobenzaprine (Flexeril). Based on this finding, the nurse interprets that the patient has which disorder? Select One: a. Epilepsy b. Insomnia c. Agitation d. A musculoskeletal injury

Correct Answer: d. A musculoskeletal injury

pH (7.30) PaCO2 (30 mm Hg) HCO3 (16 mEq/L) PaO2 (95 mm Hg) a. Metabolic Acidosis b. Metabolic Alkalosis c. Respiratory Alkalosis d. Respiratory Acidosis

Correct Answer: a. Metabolic Acidosis

A postoperative patient has a nursing diagnosis of ineffective airway clearance. The nurse determines that interventions for this nursing diagnosis have been successful if which is observed? Select one: a. Patient's breath sounds are clear to auscultation. b. Patient's temperature is less than 100.2°F orally. c. Patient drinks 2 to 3 L of fluid in 24 hours. d. Patient uses the spirometer 10 times every hour.

Correct Answer: a. Patient's breath sounds are clear to auscultation.

A patient who is taking a potassium-wasting diuretic for treatment of hypertension complains of generalized weakness. Which action is appropriate for the nurse to take? Select one: a. Ask the patient about loose stools. b. Assess for facial muscle spasms. c. Recommend the patient avoid drinking orange juice with meals. d. Suggest that the health care provider order a basic metabolic panel.

Correct Answer: d. Suggest that the health care provider order a basic metabolic panel.

The nurse notes a serum calcium level of 7.9 mg/dL for a patient who has chronic malnutrition. Which action should the nurse take next? Select One: a. Check parathyroid hormone level. b. Monitor ionized calcium level. c. Give oral calcium citrate tablets. d. Administer vitamin D supplements.

Correct Answer: b. Monitor ionized calcium level.

A patient is admitted to the emergency department with severe fatigue and confusion. Laboratory studies are done. Which laboratory value will require the most immediate action by the nurse? Select one: a. Arterial oxygen saturation is 91%. b. Serum calcium is 18 mg/dL. c. Serum potassium is 5.1 mEq/L. d. Arterial blood pH is 7.32

Correct Answer: b. Serum calcium is 18 mg/dL.

The surgical unit nurse has just received a patient with a history of smoking from the post-anesthesia care unit. Which action is most important at this time? Select one: a. Remind the patient about harmful effects of smoking. b. Obtain the blood pressure and temperature. c. Auscultate for adventitious breath sounds. d. Ask the health care provider to prescribe a nicotine patch.

Correct Answer: c. Auscultate for adventitious breath sounds.

A patient comes to the clinic complaining of frequent, watery stools for the past 2 days. Which action should the nurse take first? Select one: a. Ask about extremity numbness or tingling. b. Obtain the baseline weight. c. Check the patient's blood pressure. d. Draw blood for serum electrolyte levels.

Correct Answer: c. Check the patient's blood pressure.

Following a thyroidectomy, a patient complains of "a tingling feeling around my mouth." Which assessment should the nurse complete? Select one: a. Decreased thyroid hormone level b. Bleeding on the patient's dressing c. Presence of the Chvostek's sign d. Abnormal serum potassium level

Correct Answer: c. Presence of the Chvostek's sign

A patient who has a small cell carcinoma of the lung develops syndrome of inappropriate antidiuretic hormone (SIADH). The nurse should notify the health care provider about which assessment finding? Select one: a. Reported weight gain of 2.2 lb (1 kg) b. Serum hematocrit of 42% c. Serum sodium level of 120 mg/dL d.Urinary output of 280 mL during past 8 hours

Correct Answer: c. Serum sodium level of 120 mg/dL

The nurse is working with a graduate nurse to prepare an intravenous dose of potassium. Which statement by the graduate nurse reflects a need for further teaching? Select One: a. "The infusion rate should not go over 10 mEq/hr." b. "The intravenous potassium will be diluted before we give it." c. "We will need to monitor this infusion closely." d. "The intravenous potassium dose will be given undiluted.

Correct Answer: d. "The intravenous potassium dose will be given undiluted.

In the post-anesthesia care unit (PACU), a patient's vital signs are blood pressure 116/72 mm Hg, pulse 74 beats/min, respirations 12 breaths/min, and SpO2 91%. The patient is sleepy but awakens easily. Which action should the nurse take first? Select one: a. Increase the rate of the postoperative IV fluids. b. Prepare to transfer the patient to a clinical unit. c. Encourage the patient to take deep breaths. d. Place the patient in a side-lying position.

Correct Answer: c. Encourage the patient to take deep breaths.

A patient is transferred from the postanesthesia care unit (PACU) to the clinical unit. Which action by the nurse on the clinical unit should be performed first? Select one: a. Read the postoperative orders. b. Orient the patient to the unit. c. Take the patient's vital signs. d. Assess the patient's pain.

Correct Answer: c. Take the patient's vital signs.

When assessing patients in the preoperative area, the nurse knows that which patient is at a higher risk for an altered response to anesthesia? Select One: a. The 40-year-old patient who is to have a kidney stone removed b. The 21-year-old patient who has never had surgery before c. The 82-year-old patient who is to have gallbladder removal d. The 35-year-old patient who stopped smoking 8 years ago

Correct Answer: c. The 82-year-old patient who is to have gallbladder removal

A patient who is just waking up after having hip replacement surgery is agitated and confused. Which action should the nurse take first? Select one: a. Administer the prescribed opioid. b. Take the blood pressure and pulse. c. Apply wrist restraints to secure IV lines. d. Check the oxygen (O2) saturation

Correct Answer: d. Check the oxygen (O2) saturation

A patient with multiple draining wounds is admitted for hypovolemia. Which assessment would be the most accurate way for the nurse to evaluate fluid balance? Select one: a. Urine output b. Edema presence c. Skin turgor d. Daily weight

Correct Answer: d. Daily weight

When monitoring a patient for signs of hypokalemia, the nurse looks for what early sign? Select One: a. Diarrhea b. Cardiac dysrhythmias c. Seizures d. Muscle weakness

Correct Answer: d. Muscle weakness

A patient who was involved in a motor vehicle crash has had a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following arterial blood gas results: pH 7.48, PaO2 85 mm Hg, PaCO2 32 mm Hg, and HCO3 25 mEq/L? Select one: a. Metabolic acidosis b. Respiratory acidosis c. Metabolic alkalosis d. Respiratory alkalosis

Correct Answer: d. Respiratory alkalosis

A patient who has diabetes and uses insulin to control blood glucose has been NPO since midnight before having a knee replacement surgery. Which action should the nurse take? Select one: a. Obtain a blood glucose measurement before any insulin administration. b. Give half the usual dose of insulin because there will be no oral intake before surgery. c. Give the patient the usual insulin dose because stress will increase the blood glucose. d. Withhold the usual scheduled insulin dose because the patient is NPO.

Correct Answer: a. Obtain a blood glucose measurement before any insulin administration.

The nurse is caring for an infant who has experienced persistent vomiting. The nurse would anticipate which of the following lab results? Select All that Apply. Select one or more: a. Sodium 120 meq/L b. BUN 28 mg/dl c. Elevated Chloride of 110 meq/dl d. Decreased magnesium of 2.8 meq/dl e. Potassium 3.2 meq/L

Correct Answer: a. Sodium 120 meq/L b. BUN 28 mg/dl e. Potassium 3.2 meq/L

Which actions will the nurse include in the surgical time-out procedure before surgery (select all that apply)? Select one or more: a. Have the surgeon identify the patient. b. Ask the patient to state the surgical procedure. c. Verify the patient identification band number. d. Have the patient state name and date of birth. e. Check for patency of IV lines.

Correct Answer: b. Ask the patient to state the surgical procedure. c. Verify the patient identification band number. d. Have the patient state name and date of birth.

During a fishing trip, a patient pierced his finger with a large fishhook. He is now in the emergency department to have it removed. The nurse anticipates that which type of anesthesia will be used for this procedure? Select one: a. Topical benzocaine spray on the area b. Infiltration of the puncture wound with lidocaine c. Topical prilocaine (EMLA) cream around the site d. No anesthesia

Correct Answer: b. Infiltration of the puncture wound with lidocaine

A patient is being prepared for an oral endoscopy, and the nurse anesthetist reminds him that he will be awake during the procedure but probably will not remember it. What type of anesthetic technique is used in this situation? Select one: a. Topical anesthesia b. Moderate sedation c. Spinal anesthesia d. Local anesthesia

Correct Answer: b. Moderate sedation

The nurse notes that a patient who was admitted with diabetic ketoacidosis has rapid, deep respirations. Which action should the nurse take? Select one: a. Start the prescribed PRN oxygen at 2 to 4 L/min. b. Encourage the patient to take deep slow breaths. c. Give the prescribed PRN lorazepam (Ativan). d. Administer the prescribed normal saline bolus and insulin.

Correct Answer: d. Administer the prescribed normal saline bolus and insulin.

During the immediate postoperative period, the Post Anesthesia Care Unit nurse is assessing a patient who had hip surgery. The patient is experiencing tachycardia, tachypnea, and muscle rigidity, and his temperature is 103° F (39.4° C). The nurse will prepare for what immediate treatment? Select one: a. An anticholinesterase drug, such as neostigmine b. Cardiopulmonary resuscitation (CPR) and intubation c. Naltrexone hydrochloride (Narcan) injection, an opioid reversal drug d. Dantrolene (Dantrium) injection, a skeletal muscle relaxant

Correct Answer: d. Dantrolene (Dantrium) injection, a skeletal muscle relaxant

A patient will be discharged with a 1-week supply of an opioid analgesic for pain management after abdominal surgery. The nurse will include which information in the teaching plan? Select one: a. The importance of taking the drug on an empty stomach b. The importance of taking the drug only when the pain becomes severe c. How to prevent dehydration due to diarrhea d. How to prevent constipation

Correct Answer: d. How to prevent constipation

The nurse is reviewing ABG results on a group of patients on the Unit. Which set of arterial blood gas (ABG) results requires further intervention? Select one: a. H 7.35, PaCO2 40 mm Hg, PaO2 91 mm Hg, and HCO3- 22 mEq/L b. pH 7.46, PaCO2 43 mm Hg, PaO2 99 mm Hg, and HCO3- 26 mEq/L c. pH 7.38, partial pressure of arterial carbon dioxide (PaCO2) 36 mm Hg, partial pressure of arterial oxygen (PaO2) 95 mm Hg, bicarbonate (HCO3-) 24 mEq/L d. pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

Correct Answer: d. pH 7.49, PaCO2 30 mm Hg, PaO2 89 mm Hg, and HCO3- 18 mEq/L

After receiving change-of-shift report, which patient should the nurse assess first? Select one: a. Patient with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes b. Patient with serum potassium level of 5.0 mEq/L who is complaining of abdominal cramping c. Patient with serum phosphorus level of 4.5 mg/dL who has multiple soft tissue calcium-phosphate precipitates d. Patient with serum sodium level of 145 mEq/L who has a dry mouth and is asking for a glass of water

Correct Answer: After receiving change-of-shift report, which patient should the nurse assess first? Select one: a.Patient with serum magnesium level of 1.1 mEq/L who has tremors and hyperactive deep tendon reflexes

A patient who had knee surgery received IV ketorolac 30 minutes ago and continues to complain of pain at a level of 7 (0 to 10 scale). Which action is most effective for the nurse to take at this time? Select one: a. Administer the prescribed PRN IV morphine sulfate. b. Notify the health care provider about the ongoing pain. c. Reassure the patient that postoperative pain is expected after knee surgery. d. Teach the patient that the effects of ketorolac typically last about 6 to 8 hours.

Correct Answer: a. Administer the prescribed PRN IV morphine sulfate.

Which action should the nurse take first when a patient complains of acute chest pain and dyspnea soon after insertion of a centrally inserted IV catheter? Select one: a. Auscultate the patient's breath sounds. b. Give prescribed PRN morphine sulfate IV. c. Notify the health care provider. d. Offer reassurance to the patient.

Correct Answer: a. Auscultate the patient's breath sounds.

IV potassium chloride (KCl) 60 mEq is prescribed for treatment of a patient with severe hypokalemia. Which action should the nurse take? Select One: a. Infuse the KCl at a rate of 10 mEq/hour b. Administer the KCl as a rapid IV bolus. c. Only give the KCl through a central venous line. d. Discontinue cardiac monitoring during the infusion.

Correct Answer: a. Infuse the KCl at a rate of 10 mEq/hour

Which action will the perioperative nurse take after surgery is completed for a patient who received ketamine as an anesthetic agent? Select one: a. Provide a quiet environment in the post-anesthesia care unit. b. Anticipate the need for higher than usual doses of analgesic agents. c. Question the order for giving a benzodiazepine. d. Ensure that atropine is available in case of bradycardia.

Correct Answer: a. Provide a quiet environment in the post-anesthesia care unit.

The nurse is caring for a client with a serum calcium level of 7.0 mEq/L. Which assessment finding is most important for the nurse to report to the health care provider? Select one: a. The patient is experiencing laryngeal stridor. b. The patient's bowels have not moved for 4 days. c. The patient has numbness and tingling of the lips. d. The patient complains of generalized fatigue.

Correct Answer: a. The patient is experiencing laryngeal stridor.

The Buffer System includes the following (select all that apply) a. Slowest-acting system b. Act chemically to change strong acids to weak acids or binds acid c. Primary regulator of acid-base balance

Correct Answer: b. Act chemically to change strong acids to weak acids or binds acid c. Primary regulator of acid-base balance

The nurse is caring for a patient who has a calcium level of 12.1 mg/dL. Which nursing action should the nurse include on the care plan? Select One: a. Auscultate lung sounds every 4 hours. b. Encourage fluid intake up to 4000 mL every day. c. Maintain the patient on bed rest. d. Monitor for Trousseau's and Chvostek's signs

Correct Answer: b. Encourage fluid intake up to 4000 mL every day.

The nurse is preparing to administer a barbiturate. Which conditions or disorders would be a contraindication to the use of these drugs? (Select all that apply.) a. Severe liver disease b. Epilepsy c. Diabetes mellitus d. Gout e. Severe chronic obstructive pulmonary disease f. Pregnancy

Correct Answer: b. Epilepsy d. Gout e. Severe chronic obstructive pulmonary disease

During an infusion of albumin, the nurse monitors the patient closely for the development of which adverse effect? Select One: a. Transfusion reaction b. Fluid volume overload c. Hypernatremia d. Fluid volume deficit

Correct Answer: b. Fluid volume overload

A patient who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results: pH 7.32, PaO2 88 mm Hg, PaCO2 37 mm Hg, and HCO3 16 mEq/L. How should the nurse interpret these results? Select one: a. Metabolic alkalosis b. Metabolic acidosis c. .Respiratory alkalosis d. Respiratory acidosis

Correct Answer: b. Metabolic acidosis

Patient has the following ABG results pH (7.48) PaO2 (86) PaCO2 (44 mm Hg) HCO3 (29 mEq/L) Upon assessment, what would the RN expect the patient to have? a. Warm Flushed Skin b. Muscle Cramping c. Respiratory Rate of 36 d. Blood Pressure of 94/52

Correct Answer: b. Muscle Cramping

After receiving change-of-shift report about these postoperative patients, which patient should the nurse assess first? Select one: a. Patient who has 30 mL of sanguineous drainage in the wound drain 10 hours after hip replacement surgery b. Obese patient who had abdominal surgery 3 days ago and whose wound edges are separating c. Patient who continues to have incisional pain 15 minutes after hydrocodone and acetaminophen (Vicodin) was given d. Patient who has bibasilar crackles and a temperature of 100° F (37.8 °C) on the first postoperative day after chest surgery

Correct Answer: b. Obese patient who had abdominal surgery 3 days ago and whose wound edges are separating

An older adult patient who is malnourished presents to the emergency department with a serum protein level of 5.2 g/dL. The nurse would expect which clinical manifestation? Select one: a. Restlessness b. Confusion c. Edema d. Pallor

Correct Answer: c. Edema