nursing 1

Lakukan tugas rumah & ujian kamu dengan baik sekarang menggunakan Quizwiz!

15. The nurse is caring for a client who is experiencing an acute asthma attack. Which assessment should the nurse complete first? A. Ask the client about inhaled corticosteroid use B. Determine when the dyspnoea started C. Listen to the client's breath sounds D. Measure the forced expiratory volume flow rate

C. Listen to the client's breath sounds

The nurse has an order to administer cefepime 500 mg in 100 ml of 0.9% normal saline to be infused over 30 minutes. At what rate should the nurse set the pump in ml/hr.? (Use only numbers) Answers 1-1 200.

200

The nurse is to administer ampicillin 0.25g intramuscular every 6 hours. The pharmacy sends ampicillin 500mg per ml. how many milliters will the nurse administer per dose? Fill in the blank with the numerical value only, record the answer to 0ne decimal place and use a leading zero were applicable. Do not use a trailing zero 0.5

0.5

The nurse is caring for a client who has a metered dose inhaler that contains 40 actuations (puffs), and it does not have a dose counter. The client has an order to take two puffs two times a day. If the client does not take any extra doses, identify how many days will this inhaler last at the prescribed dose. Fill in the blank with the numerical value only, round the answer to the nearest whole number and use a leading zero if applicable. Do not use a trailing zero 10

10

100ml of lactated ringers in prescribed for a client to be infused over 8 hours. At what rate will the nurse set the pump to run? Record the answer in milliters/hour (ml/hr.) Answer 1-1 12.5

12.5

19. At 0800 you assess your patient's PIV and verify the rate at 70mL/hr. you notice you have 335mL of the IV fluid left in the bag. What time will you need to hang a new iv. Use military time 1247 20. The physician has ordered Heparin 20,000 units in 250mL NS to be infused at 15Ml/hr. what is the flow rate of the infusion in units/hr? fill in the blank with the numerical only, round the answer to the nearest whole number. 1200

1200

At 0800 you assess your patient's PIV and verify the rate at 70mL/hr. you notice you have 335mL of the IV fluid left in the bag. What time will you need to hang a new iv. Use military time 1247

1247

The physician ordered 2000ml of Normal Saline to be infused in 4 hours. What is the drip rate in ml/hr? fill in the blank with numerical value, record your answer in whole numbers 500

500

The nurse is to administer one unit of red blood cells to be transfused over 4 hours. This unit has a total volume of 350 mL. what is the flow rate in mL/hr to infuse this unit? (Use only numbers) 87.5

87.5

The nurse is caring for an older client who has been diagnosed with chronic obstructive pulmonary disease (COPD), the client states a 10-pound weight gain on the last few days. What is the nurse's initial action? A. Assess for jugular vein distention and peripheral edema B. Contact the physician immediately C. Encourage the client to ambulate D. Monitor the vital signs every 2 hours

A. Assess for jugular vein distention and peripheral edema

18. The community health worker is teaching a class on potential triggers of asthma attacks to a group of parents of young children. Which of the following would be considered a trigger to asthma? Select all that apply. A. Cat hair B. Cockroaches C. Exercise D. Mold E. Wheezing

A. Cat hair B. Cockroaches C. Exercise D. Mold

The nurse is administering intravenous (IV) fluids to a 12-month-old infant. Which intervention is most important at this time A. Continuing the prescribed flow rate B. Calculating a total caloric intake C. Making hourly temperature assessments D. Maintaining the fluid at room temperature

A. Continuing the prescribed flow rate

The nurse is caring for a client who is severely dehydrated with sodium of 149mEq/L. what solution should the nurse recognize for the client's condition? A. Dextrose 5% in water B. Dextrose 5% and lactated ringers C. 0.96% NaCl D. Dextrose 5% with 0.9% NaCl

A. Dextrose 5% in water

The nurse reads the laboratory report and notes that the client has a sodium level of 129 mEq/L. what will the nurse recognize the consistent with this electrolyte imbalance? A. Dizziness B. Bradycardia C. Tetany D. Flushing of the skin

A. Dizziness

The nurse is giving discharge instructions to a client with a history of peripheral artery disease (PAD) on how to limit the progression of the disease. Which of the following statements made by the client would indicate that further teaching is needed? A. "Heating pad on my leg will soothe the pain I am having" B. "I need to eat a well-balanced diet every day" C. "I need to take special care of my feet to prevent injury"

A. "Heating pad on my leg will soothe the pain I am having"

You are a nurse caring for a patient with chronic renal failure. The patient's potassium level has returned from lab at 7.1mEq/L. which treatment would the nurse expect to provide? Select all that apply A. Administration of calcium gluconate B. Administration of 0.45% NaCl C. Electrocardiogram D. Magnesium supplements E. Hem dialysis

A. Administration of calcium gluconate C. Electrocardiogram

3. The nurse admits a client who is in sickle cell crisis. The nursing management of a client in sickle cell crisis includes which nursing intervention? Select all that apply A. Administration of oxygen therapy B. Assess clients pain level C. Encourage rest with VTE prophylaxis D. Monitor the clients complete blood count (CBC)

A. Administration of oxygen therapy C. Encourage rest with VTE prophylaxis D. Monitor the clients complete blood count (CBC)

1. The emergency room nurse is caring for a client in severe respiratory distress related to asthma. Which medication would the nurse use first in caring for the patient? A. Albuterol nebulizer B. Fluticasone inhaler C. Prednisone orally D. Tiotropium inhaler

A. Albuterol nebulizer

You are the nurse caring for a patient in the ICU with the following laboratory results K+ 3.4 mEq/L, Na+ 129 mEq/L, Cl- 96 mEq/L. on assessment you find crackles in the lungs and the patient reports dyspnea. You anticipate the implementing the following actions. (Select all that apply) A. Fluid restrictions B. Electrocardiogram monitoring C. Monitor serum Na+ results D. Administration of 3% NaCl

A. Fluid restrictions C. Monitor serum Na+ results D. Administration of 3% NaCl

The surgical nurse caring for an elderly female client who is postoperative day 1 following a thyroidectomy. During the shift assessment, the client complains of tingling in the lips and fingers. The client tells the nurse there has been an intermittent wrist and hand spasms and also exhibits increased muscle tone. What electrolyte imbalance should the nurse first suspect? A. Hypocalcaemia B. Hypermagnesemia C. Hyperkalaemia D. Hyponatremia

A. Hypocalcaemia

11. The nurse is aware that which client statement indicates a need for additional instruction about taking oral ferrous sulphate? A. I will call my health care provider if my stools turn black B. I should increase my fluid intake while I am taking iron C. I should take the iron with orange juice about an hour before eating D. I will take a stool softener if I feel constipated

A. I will call my health care provider if my stools turn black

The nurse is caring for an elderly male in the emergency department with signs of dehydration. Which laboratory result will confirm this dehydration? A. Increased serum osmolarity B. Decreased urine specific gravity C. Increased urine tolerance D. Decreased creatinine level

A. Increased serum osmolarity

The nurses teaching a client with COPD how to perform pursed lip breathing. The client asks the nurse to explain the purpose of the breathing effector, which explanation should the nurse provide? A. It helps prevent early airway collapse B. It increases inspiratory muscle strength C. It prolongs the inspiratory phase of respiratory D. It will decrease the use of accessory muscles to breathe.

A. It helps prevent early airway collapse

The nurse is caring for a client who is intubated in the ICU. The nurse collects an ABG sample from the client, the lab calls with the report. How should the nurse interpret the following arterial blood gas results: pH 7.35, Pa02 85 mmHg, and HCO3 19 mEq/L? A. Metabolic acidosis, fully compensated B. Metabolic alkalosis, partially compensated C. Respiratory alkalosis, uncompensated D. Respiratory alkalosis, fully compensated

A. Metabolic acidosis, fully compensated

A client in the ICU had a stat ANBG labs collected and resulted. Hoe should the nurse interpret the [following arterial blood gas resulted: pH 7.58, Pa02 85 mmHg, PaC02 55 mmHg, and HCO3 35mEq/L? A. Metabolic alkalosis, partially compensated B. Respiratory alkalosis, partially compensated C. Respiratory acidosis, uncompensated D. Metabolic acidosis, fully compensated

A. Metabolic alkalosis, partially compensated

The nurse notes the sudden consent of which sign indicates a potentially serious complication for the client receiving an IV infusion? A. Noisy respirations B. Moist skin C. Halitosis D. Papillary constriction

A. Noisy respirations

The nurse is caring for a client is placed on hypocalcaemia precautions after removal of the parathyroid gland for cancer. . The nurse should observe the client for which symptoms? (Select 3 that apply) A. Numbness B. Polyuria C. Aphasia D. Muscle twitching and spasms E. Polydipsia

A. Numbness D. Muscle twitching and spasms E. Polydipsia

The nurse is caring for a client is placed on hypocalcemia precautions after removal of the parathyroid gland for cancer. The nurse should observe the client for which symptoms? (Select 3 that apply) A. Numbness B. Polyuria C. Aphasia D. Muscle twitching and spasms E. Polydipsia

A. Numbness B. Polyuria D. Muscle twitching and spasms

The nurse has admitted an under-weight client with history of alcohol abuse from the emergency department who states," my last drink was a day ago". The client was complaining of muscle weakness and parathesis (numbness) in all extremities. The nurse expects to find which lab result supports this electrolyte imbalance? A. Phosphorous 2.1 mg/dl B. Magnesium 3.8 mg/dl C. Sodium 154 mEq/l D. Calcium 12.6 mg/dl

A. Phosphorous 2.1 mg/dl

You are a nurse caring for a 55-yr old female who was brought to the emergency department of a hospital after she fell from a ladder. Upon arrival at the emergency department (ED) she is tachycardia and tachypnoeic. She rates her pain at 8/10. You obtain an order for analgesics, CBC, BMP, and ABG's. After administering the pain medication, the patient complains she is experiencing muscle cramps, tingling and paraesthesia. The blood gas reveals pH of 7.7, Pa02 101 mmHg, PaC02 33 mmHg, and HCO3 26 mmol/L. you report which result to the provider? A. Respiratory alkalosis, uncompensated B. Respiratory acidosis, uncompensated C. Respiratory acidosis, compensated D. Respiratory alkalosis, partially compensated

A. Respiratory alkalosis, uncompensated

14. The nurse reviews the laboratory results of a client admitted to the floor for excessive fatigue, headaches, and a burning tongue and finds haemoglobin 7g/dL, haematocrit 22%, serum iron 58mcg/dL, and ferritin 10ng/mL. based on the findings and anticipated treatment regimen. What will the nurse include in the client's discharge education/ select all that apply A. Taking the prescribed medication an hour before a meal B. Not to be alarmed if the stools are black in colour C. The importance of drinking excess water each day D. The importance of taking stool softeners

A. Taking the prescribed medication an hour before a meal B. Not to be alarmed if the stools are black in colour C. The importance of drinking excess water each day D. The importance of taking stool softeners

A client has a serum calcium level of 7.0mEq/L. which assessment finding is most important for the nurse to report to the health care provider? A. The client is experiencing hiccups B. The client complains of generalized fatigue C. The client's bowels have not moved for 4 days D. The client has numbness and tingling of the lips

A. The client is experiencing hiccups

The nurse on the medical unit received a client with a history of chronic kidney failure of which has a potassium level of 5.9mEq/L. the nurse informs the physician of the lab results and receives and order for ABG's. Which ABG result supports the diagnosis of Hypokalaemia? A. pH7.48; PCO2 49; HCO3 27 B. Ph 7.32; PC02 52; HCO3 30 C. Ph 7.44; PCO2 34; HCO3 18 D. Ph 7.32; PCO2 31; HCO3 20

A. pH7.48; PCO2 49; HCO3 27

A teenage client has sickle cell disease. Which of the following factors can increase the client's risk of developing sickle cell crisis? A. Eating shellfish B. Hypoxia C. Low altitudes D. Taking a warm shower

B. Hypoxia

Which medications would most appropriate to administer to a client experiencing an acute asthma attack? Select all that apply A. Albuterol (proventil) B. Inhaled hypertonic saline C. Ipratropium (atrovent) D. Montelukast (singular)

C. Ipratropium (atrovent)

You are the nurse caring for a patient complaining of fatigue is 89/72, pulse is weak and thready, mucous membranes are dry eyes are sunken, turgor is decreased. Laboratory results are K+ 3.7 mEq/L, Na+ 145, Mg2+ 2.o mEq/L. which IV solution is the best for this patient? A. Albumin B. 0.45% NaCl C. 3% NaCl D. 0.9% NaCl

B. 0.45% NaCl

9. A nurse is teaching an elderly client about the importance of using a spacer with their inhaler. The nurse should explain that the spacer A. Allows for activating the inhaler by simply inhaling B. Allows for a greater amount of medication to be delivered C. Keeps the mouth piece of the inhaler sterile D. Let's the client see the medication as it is delivered

B. Allows for a greater amount of medication to be delivered

4. When assessing a client who is being admitted to the unit with chronic obstructive pulmonary disease (COPD), what is the nurse expected to find when the client is inspected? A. No vibration when tactile fremitus performed B. Appearance of a barrel chest C. Wheezing upon expiration D. Crackles in lower lobes

B. Appearance of a barrel chest

A client with acute asthma showing inspiratory and expiratory wheezes and decreased expiratory volumes should be treated with which of the following medication right away? A. Beta adrenergic blockers B. Bronchodilators C. Inhaled corticosteroids D. Leukotriene modifiers

B. Bronchodilator

the nurse is conducting a health history on a client. Which question is the most appropriate to ask the client regarding fluid volume status? A. Do you eat enough fruit and vegetables daily B. Do you have any difficulty with urination C. How do you feel when your calcium is low? D. Describe any problems with constipation

B. Do you have any difficulty with urination

The nursing instructor is giving a lecture on dietary modifications for a client with chronic obstructive pulmonary disease to a group of nursing students. Which dietary modification helps meet the nutritional needs of clients with COPD? A. Avoiding foods that require a lot of chewing B. Drinking a lot of fluids with meals to promote digestion C. Eating a high carbohydrate diet

B. Drinking a lot of fluids with meals to promote digestion

The nurse is caring for an elderly client with congestive heart failure (CHF) with signs of oedema, confusion, and orthopnoea. Which diagnosis is most important for this client A. Fluid volume deficit related to congestive heart failure B. Excess fluid volume related to poor cardiac function C. Fluid volume excess related to decreased sodium and potassium D. Congestive heart failure related to edema

B. Excess fluid volume related to poor cardiac function

The nurse has received lab results for a client and notes the sodium level is 119mEq/L. The nurse should be prepared to administer which type of IV solution? A. Hypotonic fluids B. Hypertonic fluids C. Isotonic fluids D. Colloid fluids

B. Hypertonic fluids

The nurse is completing the admission assessment on a client with asthma. Which of the following nursing diagnosis has the highest priority for a client with asthma attack? A. Anxiety related to difficulty breathing B. Impaired gas exchange related to bronchoconstriction C. Ineffective breathing pattern related to anxiety D. Ineffective health maintenance related to lack of knowledge of asthma triggers

B. Impaired gas exchange related to bronchoconstriction

The nurse is assessing a patient with peripheral artery disease (PAD). which assessment would cause the nurse to suspect that the patient has atherosclerosis? A. Change in bowel movements B. Intermittent claudication C. Venous stasis ulcers D. Verbal complaints of a headache

B. Intermittent claudication

The nurse is preparing to admini8ster 3% NaCl solution to a client for correction of Hyponatremia. Which assessment is most important for the nurse to monitor while the client is receiving this infusion? A. Vision changes B. Lung sounds C. GI motility D. Pedal pulses

B. Lung sounds

A client who is lethargic and exhibits deep, rapid respirations has the following arterial blood gas (ABG) results; pH 7.32, Pa02 88 mmHg, PaCO2 37 mmHg, and HCO3 16mEq/L. how should the nurse interpret these results? A. Respiratory acidosis B. Metabolic acidosis C. Metabolic alkalosis D. Respiratory alkalosis

B. Metabolic acidosis

The nurse has drawn arterial blood gases ABG for a client with continuous diarrhoea. The results are pH 7.50, PCO2 35, HCO3 80, what acid/base does the client have? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

B. Metabolic alkalosis

the nurse notes an elevated blood pressure, rales and dyspnoea while performing an assessment on a client. What is an important action for the nurse to take considering these symptoms? A. Monitor specific gravity B. Monitor intake and output for 24 hrs C. Monitor weight daily D. Monitor for decreased skin turgor

B. Monitor intake and output for 24 hrs

Which action will the urgent care clinic nurse anticipate taking for a 24-year-old client who is dehydrated after a long run and has a pulse rate of 103 and blood pressure 102/56 mmHg? A. Give fluid boluses through a nasogastric tube B. Offer oral fluids in frequent intervals C. Administer intravenous antimetric medications D. Insert a peripheral intravenous line for fluid infusion

B. Offer oral fluids in frequent intervals

The nurse has been assigned to a client that has fluid volume deficit. Which of the following symptoms is the client likely to exhibit on assessment? (Select 4 that apply) A. Edema B. Oliguria C. Confusion D. Cool clammy skin E. Hypertension F. Urine specific gravity 1.028

B. Oliguria C. Confusion D. Cool clammy skin F. Urine specific gravity 1.028

2. During initial inspection of a client admitted to the unit with chronic obstructive pulmonary disease (COPD), what does the nurse expect to observe? Select all that apply A. No vibration when tactile fremitus performed B. The appearance of a barrel chest C. Crackles in the lower lobes D. Coughing

B. The appearance of a barrel chest C. Crackles in the lower lobes D. Coughing

the nurse is monitoring a client receiving magnesium sulphate while in the acute care unit. The client over time becomes less arousable, incoherent, and deep tendon reflexes are absent. The nurse plans to administer.....................................stat A. kayexalate B. calcium gluconate C. regular insulin D. protamine sulphate

B. calcium gluconate

the nurse is providing care to the client who was in a motor vehicle crash and has a tracheostomy placed to allow for continued mechanical ventilation. How should the nurse interpret the following ABGs; pH 7.48, PaO2 85 mmHg, PaCO2 mmHg and HCO3 35 mEq/L A. metabolic alkalosis B. respiratory alkalosis C. metabolic acidosis D. respiratory acidosis

B. respiratory alkalosis

The nurse is assessing a client with cor pulmonate. Which assessment finding is seen with cor pulmonate? A. Distended neck veins B. Low urinary output C. Productive cough of yellow sputum D. Weight loss

Distended neck veins

83. You are the nurse caring for the patients in the pre-operative unit. Which one of these patients is at the greatest risk for developing fluid and electrolyte imbalances during the post-operative period? A. 79 yr old with a history of asthma for an abdominal hysterectomy B. A 55 yr old with a history of heart failure scheduled for an open cholecystectomy procedure C. A 82 yr old with a history of vomiting and diarrhoea for 2 days who is exploratory laparotomy D. A 49 yr old type 2 diabetic with abdominal pain for the last 48 hrs who is scheduled for an appendectomy

C. A 82 yr old with a history of vomiting and diarrhea for 2 days who is exploratory laparotomy

7. The nurse receives a change of shift report on the following clients with chronic pulmonary disease (COPD), which client should the nurse assess first? A. A client with a productive cough of thick, green mucus B. A client with a respiratory rate of 40 breaths/min C. A client with jugular venous distention and peripheral edema D. A client with loud expiratory wheezes

C. A client with jugular venous distention and peripheral edema

13. The nurse is caring for several clients on a respiratory unit. Which client will the nurse see first? A. A client with anaemia with complaints of fatigue and weakness B. A client with COPD on 2L of O2 via nasal cannula with a pulse oximetry reading of 88% C. An asthmatic client with a pulse oximetry reading of 85% on room air D. An older client with a history of smoking with a productive cough of yellow sputum

C. An asthmatic client with a pulse oximetry reading of 85% on room air

The nurse is caring for a client is receiving spironolactone for treat of bilateral lower extremely oedema. The nurse should instruct the client to make which nutritional modification to prevent an electrolyte imbalance? A. Increase intake of dairy products B. Increase foods high in sodium C. Decrease food high in potassium D. Restrict fluid intake to 1000 mL per day

C. Decrease food high in potassium

17. The nurse is performing am assessment on a client with severe anaemia. Which assessment finding is of the most concern to the nurse? A. Anorexia B. Bone pain C. Dyspnea at rest D. Hepatomegaly

C. Dyspnea at rest

12. The nurse is caring for a client who is experiencing a sickle cell crisis. Which nursing intervention should the nurse perform at this time? A. Administration of continuous opioid analgesics B. Application of antiembolism hose C. Frequent ambulation D. Restriction of sodium and oral fluids

C. Frequent ambulation

The nurse asses a client who has been hospitalized for 2 days. The client has been receiving normal saline IV at 100 ml/hr, has a nasogastric tube to low suction and is NPO. Which assessment finding would be a priority for the nurse to report to the heath care provider A. Oral temperature 0f 99.1 degrees Fahrenheit B. Serum sodium level of 138 mEq/L C. Gradual increasing level of confusion D. Weight gain of 2 pounds

C. Gradual increasing level of confusion

You are a nurse caring for a patient with a serum phosphorous level of 5.0 mg/dL. Based on this value, what secondary electrolyte disturbance may bathe patient be experiencing? A. Hypokalaemia B. Hypermagnesemia C. Hypocalcaemia D. Hypernatremia

C. Hypocalcaemia

The nurse is called to a client's room by a family member echo voices concern about the client's status. On assessment, the nurse finds the client tachycardia, lethargic, confused and 2 + pitting oedema. What electrolyte imbalance is most plausible cause of this client's signs and symptoms? A. Hypocalcaemia B. Hypermagnesemia C. Hyponatremia D. Hypokalaemia

C. Hyponatremia

The nurse has an order to administer......................... fluids to a client. The nurse understands these fluids will lower serum osmolality with in the vascular space by causing fluid to shift out of the blood into the cells and tissue spaces A. Isotonic B. Hypertonic C. Hypotonic D. colloid

C. Hypotonic

If I reduce my cigarette smoking to four packs per day, then I won't feel short of breath B. If I restrict my fluid intake to one litre per day, then I would feel better C. I need to get an influenza vaccine every year, even if there is a shortage D. I want to increase my intake of carbohydrates, so that I can feel better

C. I need to get an influenza vaccine every year, even if there is a shortage

The nurse receives a laboratory report for a client indicating a potassium level of 5.4 mEq/L. when notifying the provider, the nurse should expect which of the following actions? A. Consulting with the dietician to increase the amount of potassium containing foods B. Starting an IV infusion of 0.9% sodium chloride C. Initiating continuous cardiac monitoring D. Preparing the client for gastric lavage

C. Initiating continuous cardiac monitoring

The nurse is caring for a client with the following arterial blood gases: pH 7.34; PO2 80 mmHg, PCO2 49 mEq/L; HCO3 24mEq/L. based on these results, which intervention should the nurse implement? A. Encourage the client to cough and deep breathe B. Do nothing, the ABG results are within normal ranges C. Instruct the client to breathe in a paper bag D. Administer low-flow oxygen

C. Instruct the client to breathe in a paper bag

The nurse is caring for a client with asthma that is poorly controlled. The client states using rescue inhaler four times a week. In addition, the client's asthma is not responding to other treatments. The nurse receives a physician's order to administer a medication that blocks the role of immunoglobulin IgE. Which medication will the nurse administer? A. Cromolyn B. Montelukast C. Omalizumab D. Salmeterol

C. Omalizumab

The nurse in the neurologic ICU has orders to infuse a hypertonic solution into a client with increased intracranial pressure. This solution will increase the number of dissolved particles in the client's blood, creating pressure for fluids in the tissues to shift into the capillaries and increase the blood volume. This process is best described as which of the following? A. Hydrostatic pressure B. Diffusion C. Osmosis D. Active transport

C. Osmosis

8. The nurse is caring for a client with the following ABG results of 7.30, Pa02 of 50, PCO2 of 48 and HCO3 of 26. What is the nurse's interpretation of the clients ABG results? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

C. Respiratory acidosis

The nurse is providing staff education on the management of acute asthma exacerbations. Which information is most important for the staff to know and understand about treating acute asthma exacerbation? A. Acute exacerbations are classified by clinical presentation only B. Methylprednisolone is only given in cases of respiratory arrest C. Short acting beta 2 agonists are often included in the first line of treatment D. Supplemental oxygen is generally not indicated for acute exacerbations

C. Short acting beta 2 agonists are often included in the first line of treatment

A client who is taking furosemide (Lasix) for treatment of hypertension complains of generalized weakness. Which action is appropriate for the nurse to take? A. Ask the client about loose stools B. Assess for facial muscle spasms C. Suggest that the heath care provider order electrolyte labs D. Recommend the client avoid drinking orange juice with meals

C. Suggest that the heath care provider order electrolyte labs

The nurse is discharging a client with iron deficiency anaemia. Which discharge instruction should the nurse include in the discharge plan? A. Call the doctor is stools turn black B. Drink milk while taking iron supplement with meals C. Take iron supplement with orange juice for better absorption D. Taking antacids with iron before meals will avoid complications

C. Take iron supplement with orange juice for better absorption

The home health nurse is visiting a client with chronic obstructive pulmonary disease (COPD). Which nursing action is appropriate to implement for a nursing diagnosis of impaired breathing pattern related to anxiety? A. Discuss a high protein, high calorie diet with the client B. Suggest the use of the over-the-counter sedative medications C. Teach the client how to perform pursed lip breathing D. Titrate the client's oxygen level to keep saturations at least 90%

C. Teach the client how to perform pursed lip breathing

The nurse is caring for a client experiencing an acute asthma attack. The client stops wheezing and breath sounds aren't audible. The nurse notes that this client has occurred because A. Crackles are noted instead of wheezing in the client's lungs B. Swelling has decreased within the client's airways C. The client's airways are so swollen that no air can get through D. The client's asthma attack is over.

C. The client's airways are so swollen that no air can get through

The home care client reports weakness and leg cramps to the physician. Per order, the nurse draws blood and requests a potassium level. What is the rationale for this order? A. The nurse is concerned the client's diet has caused sodium loss B. The client is seeking attention from the nurse C. The nurse recognizes the signs and symptoms of Hypokalaemia D. The client had bananas and orange juice for breakfast

C. The nurse recognizes the signs and symptoms of Hypokalaemia

5. When a nurse assesses a client who presents to the urgent centre with asthma exacerbation. What is the expected assessment finding? A. Increased breath sounds on auscultation B. Inspiration that is prolonged C. Wheezing on expiration D. Oxygen saturation 99%

C. Wheezing on expiration

the nurse is providing care to post-operative client who was received multiple boluses of IV fluids. Wich of these findings would support the nursing diagnosis of "fluid volume excess"? A. increased serum sodium B. increased serum haematocrit C. increased pulmonary congestion D. increased urine specific gravity

C. increased pulmonary congestion

48. The nurse is creating a plan of care for a client with chronic obstructive pulmonary disease. Which of the following nursing interventions should be included in the plan of care? A. Avoiding use of oxygen therapy B. Encouraging client to eat a low-calorie diet C. Promoting activity restrictions D.

D

the nurse is caring for a client with a magnesium level of 2.7 mg/dl. Which intervention should the nurse implement at this time? A. Hold calcium channel blocker medication B. Administer magnesium sulphate as ordered C. Hold IV magnesium sulphate D. Administer calcium gluconate as ordered

D. Administer calcium gluconate as ordered

You are the nurse caring for a patient who has been out in the heat of the day working road construction. The patient's temp is 100 degrees F. what hormone will the patient's body release to help them retain water A. Renin B. Cortisol C. Atrial natriuretic peptide (ANP) D. Antidiuretic hormone (ADH)

D. Antidiuretic hormone (ADH)

A client has a magnesium level of 1.0 mg/dL. Which assessment finding would help the nurse identify a likely cause of this value? A. Decreased dietary protein intake B. Nothing, since the value is normal C. Supplemental oral magnesium replacement D. Daily alcohol intake

D. Daily alcohol intake

The nurse is providing discharge instructions for a client regarding the use of loop diuretics. What is the most significant nursing diagnosis regarding loop diuretics for the educational plan? A. Impaired urinary elimination B. Impaired skin integrity C. Urinary retention D. Fluid volume deficit

D. Fluid volume deficit

The nurse is assessing a client who is restless and agitated, has dry mucous membranes, and has intense thirst. The nurse should assess the client further for which electrolyte imbalance? A. Hypocalcaemia B. Hypermagnesemia C. Hypokalaemia D. Hypernatremia

D. Hypernatremia

The nurse is evaluating a newly admitted client's laboratory results, which include values that are outside of reference ranges. Which of the following would cause the release of antidiuretic hormone (ADH)? A. Increased magnesium B. Decreased platelets C. Decreased hemoglobin D. Increased sodium

D. Increased sodium

A client newly diagnosed with anaemia begins to complain of dyspnoea when ambulating in the hall. Which intervention should the nurse implement first? A. Apply oxygen to the client B. Assist the client in ambulation to the client's room C. Call the physician D. Obtain a chair for the client to sit

D. Obtain a chair for the client to sit

6. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse recommends a nursing diagnosis of imbalanced nutrition less than body requirements. Which intervention would be most appropriate for the nurse to include in the plan of care? A. Assist the client in choosing foods with high vegetable content B. Encourage increased intake of whole grains C. Increase the client's intake of fruits and fruit juices D. Offer high calorie protein snacks between meals and at bed time

D. Offer high calorie protein snacks between meals and at bed time

10. The nurse is caring for a client with chronic obstructive pulmonary disease (COPD) and observes a barrel chest. Which data below best supports the observation? A. Decreased residue volume B. FEV1/FVC ratio of 85% C. Hgb 9.0 D. PCO2 65

D. PCO2 65

The nurse is caring for a client with the following arterial blood gases (ABG) results, pH 7.60, PCO2 25, PaO2 80, HCO3 24. What is the nurse's interpretation of the ABG result? A. Metabolic acidosis B. Metabolic alkalosis C. Respiratory acidosis D. Respiratory alkalosis

D. Respiratory alkalosis

The nurse is caring for a client with chronic obstructive pulmonary disease (COPD). The nurse recognizes which of the following assessment finding is consistent with respiratory distress? A. Decreased urinary output B. Hypotension and tachycardia C. Increased mucous production D. Restlessness and tachypnea

D. Restlessness and tachypnea

The nurse writes a nursing diagnosis of effective tissue perfusion for a client diagnosed with anemia. Which intervention should not be included in the plan of care? A. Assess the client for numbness and tingling B. Encourage the client to drink fluids C. Monitor the client's haemoglobin and haematocrit levels D. Restrict the client's dietary intake of green vegetables

D. Restrict the client's dietary intake of green vegetables

24. The nurse is giving discharge instructions to a client newly diagnosed with sickle cell disease. What instruction should the nurse include in the discharge plan? A. Avoid humid weather B. Eliminate exercise from daily routine C. Limit fluid intake D. Seek early medical intervention for upper respiratory infections

D. Seek early medical intervention for upper respiratory infections

The nurse is caring for a client with iron deficiency anaemia. When discussing appropriate food choices with the client, the nurse will encourage the patient to increase the dietary intake of A. Almonds B. Bananas C. Milk D. Spinach

D. Spinach

The nurse is assessing a client who is taking albuterol (proventil) nebulizer treatments for acute asthma. Which assessment finding would assist the nurse to pose the side effect of this medication? A. Blurry vision B. Hyperglycaemia C. Hypotension D. Tachycardia

D. Tachycardia

16. The nurse is administering an inhaled corticosteroid to a client with a COPD exacerbation. What important instruction does the nurse read to include in the client teaching regarding the use of this medication? A. Inform the client not to hold breath after using inhaler B. Instruct the client that muscle tremors are a side effect C. One side effect of the medication is vomiting D. The need to rinse mouth after using the inhaler

D. The need to rinse mouth after using the inhaler

The nurse is caring for a client who is having a sickle cell crisis and asks the nurse why the sickling causes such pain. What is the nurse's best option? A. The pain of sickling is caused by deposition of sickled red cells in the bone marrow B. The pain of sickling is caused by infectious processes in the body's organs C. The pain of sickling is caused by spasms of the blood cells as they change shape D. The pain of sickling is caused by tissue hypoxia caused by small blood vessel occlusion

D. The pain of sickling is caused by tissue hypoxia caused by small blood vessel occlusion

The nurse is instructing a client on the use of dry powder inhaler (DPI). What is a disadvantage in using a DPI for medication administration? A. Hard to use B. Less manual dexterity C. No spacer is needed D. The powder may clump

D. The powder may clump

An adult client with chronic anaemia is experiencing increased fatigue and occasional palpitations at rest. Which laboratory data would the nurse identify as consistent with these symptoms? A. Hemoglobin (Hgb) of 7.6 g/dl B. Haematocrit (Hct) of 40% C. Red blood cell count of 4.7 million cells/mcl D. White blood cell count of 6500 cells/mcl

Hemoglobin (Hgb) of 7.6 g/dl

The nurse assesses three client's lower extremities and documents the assessment finding for one client as "4 + pitting oedema". Which image corresponds to this assessment finding? Please use your cursor to identify the correct image. Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To remove a pin, click it once.

To remove a pin, click it once.


Set pelajaran terkait

Adenoma-Carcinoma sequence in Colorectal cancer.

View Set

mother baby chapter 3 practice questions

View Set

McGraw Hill Advertising Chapter 10 Smartbook

View Set

A&P Chapter 6: Bone Tissue and the Skeletal System

View Set

Pharmacological Methods of Pain Relief Sherpath

View Set