Capstone Quiz review
During physical assessment, the nurse should further assess the client for signs of atrial fibrillation when palpation of the radial pulse reveals: A. Two regular beats followed by one irregular beat. B. Pulse rate below 60 C. A weak, thready pulse D. An irregular rhythm with a pulse rate > 100
An irregular rhythm with a pulse rate > 100
A client with Graves disease underwent radioactive iodine therapy 3 months ago. At the most recent clinic visit, the client's thyroid-stimulating hormone (TSH) level was 6.7 mIU/L, and free thyroxine was 0.6 ng/dL. Which treatment will the nurse anticipate based on these laboratory data? A. Repeat radioactive iodine therapy for subtherapeutic response. B. Give levothyroxine for iatrogenic hypothyroidism. C. No treatment is indicated; these levels are therapeutic. D. Give methimazole for continued thyroid suppression.
Give levothyroxine for iatrogenic hypothyroidism. Rationale: The data in the question indicate that the client is now in a hypothyroid state as evidenced by the high TSH and low free T4. The client will now require exogenous thyroid hormone replacement in the form of the synthetic hormone levothyroxine. Methimazole and radioactive iodine are not indicated at this time as the client is no longer in a hyperthyroid state.
A client with heart failure is due for the following medications: digoxin, spironolactone, lisinopril, and furosemide. Over the past 3 days, the client has gained 2 pounds and reports worsening shortness of breath. Physical assessment reveals jugular vein distention of 5 cm, 2+ pitting edema, and heart rate of 52 beats/minutes. What is the priority action by the nurse? A. Hold the furosemide and contact the provider. B. Administer all medications and document assessment findings. C. Hold the digoxin and administer all other medications as ordered. D. Apply oxygen via nasal cannula and withhold all medications.
Hold the digoxin and administer all other medications as ordered. Rationale: The client's signs and symptoms indicate worsening heart failure. For this reason, the furosemide, spironolactone, and lisinopril should be continued, but dose adjustments may be required upon discussion with the prescriber. The nurse should hold the digoxin for client heart rate < 60 beats/minute. Furosemide should not be held, as this would worsen edema and shortness of breath. Withholding all medications may result in acute exacerbation of symptoms. Administering all medications could result in severe bradycardia caused by the digoxin.
A client with peptic ulcer disease has been taking omeprazole for the past 10 years and is concerned about long-term effects of the medication. Which are potential long-term effects the nurse should discuss with the client? Select all that apply. A. Stomach cancer B. Renal insufficiency C. Hyperkalemia D. Hypomagnesemia E. Osteopenia
Hypomagnesemia, Osteopenia Rationale: Prolonged use of proton pump inhibitors (PPIs) such as omeprazole can lead to decreased absorption of certain electrolytes, such as magnesium and calcium. The client should be made aware of the potential effects of decreased absorption of calcium, such as osteopenia, osteoporosis, and bone fractures. Hyperkalemia, stomach cancer, and renal insufficiency are not long-term effects associated with PPIs.
A client arrives in the emergency department and is diagnosed with an ischemic stroke. Because the healthcare team is considering administering tissue plasminogen activator (t-PA), the nurse should first: A. Complete a history and health assessment. B. Ask what medications the client is taking. C. Identify the time of onset of the stroke. D. Determine if the client is scheduled for any surgical procedures.
Identify the time of onset of the stroke.
The client is experiencing severe diarrhea and has a serum potassium level of 3.3 mEq/L. Which intervention should the nurse implement first? A. Notify the client's HCP. B. Place the patient on cardiac telemetry. C. Prepare to administer IV potassium. D. Assess the client for leg cramps.
Place the patient on cardiac telemetry.
The critical care nurse is caring for a client with a head injury secondary to a motorcycle accident. On the first assessment of the morning, the client is responsive to painful stimuli and assumes decorticate posturing. Two hours later, which data would warrant immediate intervention by the nurse? A. The client has purposeful movement when the nurse rubs the sternum B. The client is able to squeeze the nurse's hand on verbal command. C. The client extends the upper and lower extremities in response to painful stimuli. D. The client thrashes in the bed when a noxious stimulus is applied.
The client extends the upper and lower extremities in response to painful stimuli.
Which laboratory data should the nurse in the long-term care unit notify the healthcare provider (HCP) about? A. The client receiving digoxin who has a digoxin level of 2.6. B. The client receiving ticlopidine (Ticlid) who has a platelet count of 160,000. C. The client receiving enoxaparin (Lovenox) who has a PT of 12.9 seconds. D. The client receiving furosemide (Lasix) who has a potassium level of 4.2 mEq/L.
The client receiving digoxin who has a digoxin level of 2.6.
The charge nurse on the neuro floor is reviewing laboratory results for clients on the floor. Which client would require the charge nurse to intervene? A. The client with multiple sclerosis on prednisone who has a glucose level of 208 mg/dL. B. The client with a seizure disorder who has a divalproex (Depakote) level of 75 micrograms/mL. C. The client receiving phenytoin (Dilantin) who has a serum level of 24 mg/dL D. The client diagnosed with a CVA who has a platelet count of 250,000.
The client receiving phenytoin (Dilantin) who has a serum level of 24 mg/dL
The nurse on the rehabilitation unit received report on the following four patients. Which one should they assess first? A. The client diagnosed with systemic allergies on prednisone dose pack who has a glucose level of 189. B. The client who had a right hip open reduction, internal fixation (ORIF) who has a hemoglobin and hematocrit of 8/24. C. The client diagnosed with rheumatoid arthritis who has a positive rheumatoid factor (RF). D. The client diagnosed with a Stage IV pressure ulcer who has a white blood cell (WBC) count of 14,000.
The client who had a right hip open reduction, internal fixation (ORIF) who has a hemoglobin and hematocrit of 8/24.
The clinic nurse is reviewing laboratory results for clients seen in the respiratory clinic. Which client requires additional assessment by the nurse? A. The client who has a WBC count of 9.0. B. The client who has a serum sodium level of 137 mEq/L. C. The client who has a hemoglobin of 9 and a hematocrit of 29%. D. The client who has a serum potassium level of 4.9 mEq/L.
The client who has a hemoglobin of 9 and a hematocrit of 29%.
A nurse on the endocrine unit is checking the morning laboratory results for their clients. Which laboratory result should the nurse alert the HCP for? A. The client with Cushing's disease who has a decreased urine cortisol level. B. The client with hypoparathyroidism who has a decreased serum calcium level. C. The client with diabetes insipidus who has a low urine specific gravity. D. The client with hyperthyroidism who has an increased TSH level.
The client with hyperthyroidism who has an increased TSH level.
A client is newly diagnosed with Type II diabetes mellitus and has been prescribed metformin. The client works overnight as a security guard. What is the appropriate education for the client for this medication regimen? A. "Metformin should not be taken if the client is going to skip a meal." B. "The client should take the metformin prior to an overnight shift to avoid drops in blood sugar." C. "Metformin can be taken without regard to meals, and doses should not be skipped." D. "Metformin can result in hypoglycemia, and blood sugars should be checked daily."
"Metformin can be taken without regard to meals, and doses should not be skipped." Rationale: Metformin decreases glucose production without increasing insulin production, causing no risk of hypoglycemia. The blood sugar value does not need to checked daily while taking metformin unless it is combined with insulin or another medication that risks hypoglycemia. It may be taken without regard to meals, and doses should not be skipped to allow for maximum effect.
A client taking acetaminophen for a soft tissue injury states that they realized they were taking double the prescribed dose for the past 2 days; as a result they took 4800 mg a day for 2 days. Upon further questioning, the client did experience nausea, diarrhea, and abdominal pain. What is the correct response by the nurse? A. "The abdominal pain may persist. You should take the medication with food for the remainder of the treatment." B. "The symptoms you are describing may be Stevens-Johnson syndrome for which you should seek immediate medical attention." C. "You may be experiencing early signs of poisoning, which can progress into liver damage if not treated. You need to seek immediate medical attention." D. "As long as you return to your prescribed dose, the nausea, diarrhea, and abdominal pain will diminish and no further issues should occur."
"You may be experiencing early signs of poisoning, which can progress into liver damage if not treated. You need to seek immediate medical attention."
The nurse is caring for a client who has just returned from having a percutaneous transluminal balloon angioplasty with femoral artery access. In which order, from first to last, should the nurse obtain information about the client? 1. Vital signs and oxygen saturation 2. Pedal pulses 3. Catheterization site 4. Color and sensation of extremity
1. Vital signs and oxygen saturation 2. Pedal pulses 3. Catheterization site 4. Color and sensation of extremity
A client is receiving morphine to treat postoperative pain. Order: morphine 12.5 mg IV push every 4 hours On hand: morphine 10 mg/mL How many mL will the nurse give for each dose? Do not round answer.
1.25
Which client is at greatest risk for developing coronary artery disease? A. A 65-year-old female who is obese with an LDL of 188. B. A 43-year-old male with a family history of CAD and cholesterol level of 158. C. A 56-year-old male with an HDL of 60 who takes atorvastatin. D. A 32-year-old female with mitral valve prolapse who quit smoking 10 years ago.
A 65-year-old female who is obese with an LDL of 188.
Furosemide is administered intravenously to a client with heart failure. How soon after administration should the nurse begin to see evidence of the drug's desired effect? A. 2-4 hours B. 30-60 minutes C. 6-8 hours D. 5-10 minutes
5-10 minutes
A pediatric client weighing 38 lb. is prescribed promethazine 0.1 mg/kg every 6 hours. Calculate the total daily dose. Round your answer to the nearest tenth.
6.9 mg/day. Rationale: First, convert pounds to kilograms: 38/2.2 = 17.3 kg. Next, calculate the dose: 0.1 x 17.3 = 1.73 mg Next, calculate the total daily dose: every 6 hours = 4 doses in 24 hours: 1.73 x 4 doses = 6.9 mg/day.
A nurse is assessing a client with increasing intracranial pressure. What is the client's mean arterial pressure (MAP) when blood pressure is 120/60 mmHg?
80
A client with a history of asthma is admitted to the emergency department. The nurse notes that the client is dyspneic, with a respiratory rate of 35 breaths/minute, has nasal flaring, and is using accessory muscles. Auscultation of the lung fields reveals greatly diminished breath sounds. Which of the ordered interventions should the nurse do first? A. Encourage the client to relax and breathe slowly through the mouth. B. Initiate oxygen therapy and reassess client in 10 minutes. C. Administer bronchodilators. D. Draw blood for ABGs.
Administer bronchodilators.
A client admitted for a myocardial infarction (MI) develops cardiogenic shock. An arterial line is inserted. Which of the following orders from the HCP should the nurse question before implementing? A. Prepare for pulmonary artery catheter insertion B. Administer metoprolol 5 mg. IV push C. Call for urine output < 30 mL/h for 2 consecutive hours D. Titrate dobutamine to keep systolic BP > 100 mm Hg.
Administer metoprolol 5 mg. IV push
The nurse is preparing to administer medications to their assigned clients on the neurological unit. Which medication should the nurse administer first? A. An anticholinesterase medication to a client diagnosed with myasthenia gravis. B. An antacid to a client with GERD who has called several times over the intercom. C. A steroid to a client experiencing an acute exacerbation of multiple sclerosis. D. Pain medication to a client complaining of a headache rated 8 on a 1-10 pain scale.
An anticholinesterase medication to a client diagnosed with myasthenia gravis.
The nurse is caring for a group of clients on a pulmonary unit. The nurse can delegate which task to unlicensed assistive personnel (UAP)? A. Assessing a client for the best method of oxygen delivery. B. Assisting the client with adjusting his or her nasal cannula. C. Making adjustments to flow rates based on client responses. D. Monitoring a client for adverse effects of oxygen therapy.
Assisting the client with adjusting his or her nasal cannula.
A client who underwent a lobectomy and has a water seal chest drainage system is breathing with more effort and at a faster rate than 1 hour ago. The client's pulse rate is also increased. The nurse should: A. Ensure that the chest tube has two clamps on it to prevent air leaks. B. Check the tubing to ensure that the client is not lying on it or kinking it. C. Lower the drainage system 2-3 feet below the level of the client's chest. D. Increase the suction to the chest tube.
Check the tubing to ensure that the client is not lying on it or kinking it.
The nurse is caring for a client who recently experienced a myocardial infarction and has been started on clopidogrel. The nurse should develop a teaching plan that includes which points? Select all that apply. A. Clopidogrel works by preventing platelets from sticking together and forming a clot. B. The client should take clopidogrel with food. C. The client may bruise more easily and may experience bleeding gums. D. The client should drink a glass of water after taking clopidogrel. E. The client should report unexpected bleeding or bleeding that lasts a long time.
Clopidogrel works by preventing platelets from sticking together and forming a clot. The client may bruise more easily and may experience bleeding gums. The client should report unexpected bleeding or bleeding that lasts a long time.
The client diagnosed with lung cancer has the follow laboratory values. Which action should the nurse implement? -Hemoglobin & hematocrit of 13.4/40.1. -WBC count 7800. -Neutrophil count of 62%. A. Continue to monitor the client. B. Make sure no fresh flowers are taken into the room. C. Notify the HCP. D. Place the client in reverse isolation.
Continue to monitor the client.
A nurse is assessing a client with chronic emphysema. Which finding requires immediate intervention? A. Using pursed-lip breathing and prolonged expiration. B. Appearance of a barrel chest. C. Circumoral cyanosis. D. Crackles auscultated posteriorly halfway up the left lung
Crackles auscultated posteriorly halfway up the left lung
To reduce the risk of nephrotoxicity caused by amphotericin, the nurse will avoid concurrent administration of which medications? Select all that apply. A. Cyclosporine B. Fexofenadine C. Ibuprofen D. Acetaminophen E. Gentamicin
Cyclosporine, Ibuprofen, Gentamicin
The nurse is assisting a client with a stroke who has homonymous hemianopia. The nurse should understand that the client will: A. Eat food on only half of the plate. B. Prefer foods high in salt. C. Forget the names of foods. D. Not be able to swallow liquids.
Eat food on only half of the plate.
A nurse working the day shift on a cardiac unit receive the following shift report: Client 1: Admitted yesterday morning with hypokalemia. Labs were drawn at 0600 and we are awaiting electrolyte results. Client 2: Experienced chest pain at 0630. Pain was resolved after 2 SL NTG. Client 3: Scheduled for metoprolol at 0900. Incontinent of urine during the night. Client 4: Scheduled for coronary artery bypass graft (CABG) surgery at 0800. The client's family is in the room. At the conclusion of shift report, it is 0710. Put the clients in order, from first to last, in the order the nurse should plan to assess them.
First: Client 2 Second: Client 4 Third: Client 3 Fourth: Client 1
Which mental status change may occur initially when a client with pneumonia is first experiencing hypoxia? A. Irritability B. Coma C. Apathy D. Depression
Irritability
A young adult is admitted to the emergency department after an automobile accident. The client has severe pain in the right chest from contact with the steering wheel. What should the nurse do first? A. Decrease chest pain by administering morphine IV. B. Maintain adequate oxygenation. C. Maintain adequate circulating volume. D. Reduce the client's anxiety.
Maintain adequate oxygenation.
A client has just returned from the post-anesthesia care unit (PACU) after undergoing a laryngectomy. Which instruction should the nurse include in the plan of care? A. Teach the client how to use esophageal speech. B. Initiate small feedings of soft foods. C. Maintain the head of the bed at 30-40 degrees. D. Irrigate drainage tubes as needed.
Maintain the head of the bed at 30-40 degrees.
A patient with a glioblastoma multiforme is receiving palliative care. What does the nurse understand to be true about palliative care? Select all that apply. A. Is not an option for a patient with a GBM. B. Management of symptoms. C. Early identification of spiritual needs of the patient. D. Provides comfort care. E. Does not include pain management; that is done by Hospice care.
Management of symptoms. Early identification of spiritual needs of the patient. Provides comfort care.
The nurse is assessing a client admitted with a diagnosis of bacterial meningitis. The nurse knows that the signs and symptoms of meningeal irritation include which of the following? Select all that apply. A. Ptosis B. Aphasia and motor weakness C. Photophobia D. Kernig and Brudzinski signs E. Nuchal rigidity and headache.
Photophobia Kernig and Brudzinski signs Nuchal rigidity and headache.
A client with newly diagnosed chronic obstructive pulmonary disease (COPD) is to be discharged home with oxygen per nasal cannula. Which teaching points should the nurse include in this client's discharge plan? Select all that apply. A. Increase oxygen flow at night during hours of sleep. B. Avoid use of a microwave oven when using oxygen. C. Apply Vaseline to lips and nose to prevent dryness and irritation. D. Place gauze pad between the ears and oxygen tubing to prevent skin irritation as needed. E. Request a large, pressurized oxygen tank for use during car travel. F. Avoid areas where people are smoking cigarettes or cigars.
Place gauze pad between the ears and oxygen tubing to prevent skin irritation as needed. Avoid areas where people are smoking cigarettes or cigars.
The charge nurse on the critical care respiratory unit is evaluating arterial blood gas (ABG) results of several clients. Which client should the charge nurse assess first? A. The client with reactive airway disease with a pH of 7.48, PaCO2 30, HCO3 23. B. The client with a pneumothorax with pH 7.41, PaCO2 43, HCO3 25. C. The client with ARDS with pH 7.35, PaCO2 50, HCO3 26. D. The client with COPD with pH 7.34, PaCO2 55, HCO3 24.
The client with reactive airway disease with a pH of 7.48, PaCO2 30, HCO3 23.
A client with acute chest pain is receiving IV morphine. Which is a positive effect of morphine? Select all that apply. A. Reduces blood pressure and heart rate B. Reduces myocardial oxygen consumption C. Promotes reduction in respiratory rate D. Prevents ventricular remodeling E. Reduces anxiety and fear
Reduces blood pressure and heart rate, Reduces myocardial oxygen consumption, Reduces anxiety and fear
A client with multiple sclerosis (MS) is receiving baclofen. The nurse determines that the drug is effective when it: A. Reduces the urine bacterial count. B. Stimulates the client's appetite. C. Induces sleep. D. Relieves muscle spasticity.
Relieves muscle spasticity.
A client with bacterial pneumonia is to be started on IV antibiotics. Which diagnostic test must be completed before antibiotic therapy begins? A. Urinalysis B. Red blood cell (RBC) count C. Chest X-ray D. Sputum culture
Sputum culture
The nurse notices that a client with Parkinson's disease is coughing frequently when eating. Which intervention should the nurse consider? A. Place the client on a clear liquid diet. B. Tell the client to place the chin firmly against the chest when eating. C. Thicken all liquids before offering to the client. D. Have the client hyperextend the neck when swallowing.
Thicken all liquids before offering to the client.
The charge nurse in a long-term care facility is reviewing a male resident's laboratory data and notes the following results: -Hemoglobin & hematocrit 13/39. -WBC count 5.25. -Platelet count 39. Which instruction should the nurse give to the UAP caring for the client? A. Administer oxygen during strenuous activity. B. Place the resident in reverse isolation immediately. C. Use an electric razor to shave the resident. D. Check the resident's temperature every 4 hours
Use an electric razor to shave the resident.
An older client with diabetes who has been maintained on metformin has been scheduled for cardiac catheterization. The nurse should verify that the healthcare provider has written an order to: A. Give the metformin before breakfast prior to the cardiac catheterization B. Limit the amount of protein in the diet prior to the cardiac catheterization C. Withhold the metformin prior to the cardiac catheterization D. Administer the metformin with only a sip of water prior to the cardiac catheterization
Withhold the metformin prior to the cardiac catheterization
The nurse is walking with a client in the hallway who begins to have a seizure. What should the nurse do in order from first to last? First: Ease the client to the floor Second: Maintain a patent airway Third: Obtain vital signs Fourth: Document the seizure activity observed
First: Ease the client to the floor Second: Maintain a patent airway Third: Obtain vital signs Fourth: Document the seizure activity observed
The charge nurse on the vascular unit is reviewing laboratory results. Which result warrants intervention by the charge nurse first? A. The client whose INR is 2.3. B. The client whose H/H is 11/36. C. The client whose RBC count is 4.8. D. The client whose platelet count is 65,000.
The client whose platelet count is 65,000.
Which are indications that a client with a history of left-sided heart failure is developing pulmonary edema? Select all that apply. A. Coarse crackles B. Anorexia C. Distended jugular veins D. Tachycardia E. Dependent edema
Coarse crackles, Tachycardia
The nurse is caring for a client who has been placed on droplet precautions. Which personal protective equipment (PPE) is required to take care of this client? Select all that apply. Gloves Respirator Eye protection Surgical mask Gown Shoe covers
Gloves, Eye protection, Surgical mask, Gown
