MS 2 Final Exam Review Questions
A pt has a Mantoux skin test prior to being placed on an immunosuppressant for their Crohns Disease. Which is NOT significant for holding this medication: A. 0-4mm B. 7-8 mm C. 5-6 mm D. 9 mm
0-4mm
A client who just experienced a suspected ischemic stroke is brought to the ED by ambulance. On what should the nurse's primary assessment focus? Select one: a. Cardiac and respiratory status b. Fluid and electrolyte balance c. Pain d. Seizure activity
A
A concern exists about fluid accumulation in the lungs. What areas of the lungs will the nurse focus on during her assessment? A. Bilateral lower lobes B. Posterior bronchioles C. Left lower lobe D. Anterior bronchioles
A
A nurse is administering client Lasix 40 mg daily. What time of day should the nurse plan to give this medication? Select one: a. morning b. before dinner. c. bedtime d. after lunch
A
A nurse is caring for a client Postop with lung cancer recovering from thoracotomy. Which data require immediate intervention by the nurse. A. Client is coughing up pink frothy sputum B. The client has crackles that clears with a cough C. The client refused to perform shoulder exercises D. The client complains of sore throat and is hoarse.
A
A nurse is planning meals for a patient on hemodialysis and fluid restriction which snack should the nurse include: A. A small apple B. Ham sandwich C. milk D. banana
A
A pt has ESRD, which finding is appropriate in pts with ESRD? A. GFR less than 15 B. Urinary output of less than 100mL in 24 hours C BUN greater than 100 D. creatinine greater than 12
A
A pt has chronic bronchitis which of the following should the nurse tell the pt to do: A. Increase fluid intake B. Increase amount of bedrest C. Decrease Kcals intake D. Reduce O rate
A
A pt has tb, which of the following means the pt needs further teaching regarding the disease? A. Ill stay in isolation for 6 weeks B. Ill always have a Positive TB test C. This disease may come back later If I am under stress D. Ill have to take this medication for up to a year
A
A pt is breathing faster than normal upon assessment. What should the nurse do? A. Count the Respiratons B. Assist the client to lie down C. Inquire if there has been any stressful visitors D> Assess the radial Pulse
A
A pt is in hospital for Renal trauma. The nurse should assess for s/s of which complication FIRST? A. Internal Bleeding B. Electrolyte imbalance C. Anuria D. HTN
A
Client has newly dx renal cell carcinoma. Which specific sign should the nurse look for? A. Flank pain and hematuria B. Suprapubic pain and foul smelling urine C. Abd pain and dysuria D. Hematuria and nocturia
A
Hydrochlorothiazide ( diuretic) is prescribed to treat high blood pressure. The nurse knows that the client understands the dietary modifications she needs to make if she states that she will increase her intake of which food in her diet? Select one: a. fresh oranges b. cranberry juice c. cold cereals d. cola drinks
A
Nurse is assessing a clients right groin puncture after a renal angiogram and finds a saturated, bloody dressing on the sheets. What should be the nurses priority: A. Glove and apply firm pressure directly over the dressing B. Reinforce the dressing with a compression dressing C. Remove the dressing D have client flex right leg to control bleeding
A
Nurse is going to give a pt a medication for short term mild pain. Which med should the nurse give? A. Acetaminophen B. Merperidine C. Morphine D. Ibuprofen
A
The client about the COPD self care at a community health class, asks a nurse why the participants are being taught about the " lip breathing" The nurse should respond by explaining that pursed lip breathing can help to: A. Strengthen respiratory muscles B. Reduce upper airway inflamation C. Reduce anxiety through humor D. Increase effectiveness of inhaled medications
A
The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on the assessment finding of... Select one: a. fever ,chill and diaphoresis b. urine output less than 30 ml c. increase pulse rate with activity d. petechiae of the bucchal muscosa
A
The nurse is caring for a client who had a hemorrhagic stroke. What assessment finding constitutes an early sign of deterioration? Select one: a. Alteration in level of consciousness b. Tonic-clonic seizures c. Generalized pain d. Shortness of breath
A
The nurse is caring for a client with Guillain-Barré syndrome (GBS). The client also has an ascending paralysis. Knowing the potential complications of the disorder, what should the nurse keep always ready at the bedside? Select one: a. Intubation tray and suction apparatus b. Nebulizer and thermometer c. Incentive spirometer d. Blood pressure apparatus
A
The nurse is caring for a client with trigeminal neuralgia (tic douloureux). The care plan for this client reflects the client's problem eating due to jaw pain. To assist the client in meeting the adequate nutritional needs, what should the nurse suggest? Select one: a. Take small meals of soft consistency b. Include additional servings of fruits and raw vegetables c. Include fish, liver, and chicken in diet d. Increase the intake of calcium and proteins.
A
The nurse is caring for an adult who is being treated for a myocardial infarction. Oxygen is ordered. Administering oxygen to this client is related to which of the following client problems? Select one: a. Ineffective myocardial perfusion b. Chest pains c. Alteration in heart rate, rhythm, or conduction d. Anxiety
A
The nurse is preparing medications for a patient experiencing an acute myocardial infarction. Which medication will dilate the patients coronary blood vessels? Select one: a. Nitroglycerin b. Fibrinolytics c. Beta Blockers d. Heparin
A
The nurse recognizes health promotion efforts to decrease the risk for ischemic stroke involve encouraging a healthy lifestyle, including Select one: a. a low-fat, low-cholesterol diet and increased exercise.a low-fat, low-cholesterol diet and increased exercise.a low-fat, low-cholesterol diet and increased exercise. b. a high-protein diet and increased weight-bearing exercise. c. eating fish no more than once a month. d. a low-cholesterol, low-protein diet and decreased aerobic exercise.
A
To prevent possible complication, which of the following question should a nurse ask a client prior to a cardiac catherization? Select one: a. Can you eat shellfish? b. Do you understand the procedure? c. Have you had a heart attack? d. Have you ever had a catherization before?
A
Which intervention should nurses teach older adults about preventing infection: A. Receive vaccinations B. Exercise daily C. Drink 6 glasses of water D. take prescribed medications
A
Which of these prescriptions written by the health care provider for a patient admitted with infective endocarditis (IE) and a fever should the nurse implement first? Select one: a. Order blood cultures drawn from two sites. b. Obtain a transesophageal echocardiogram. c. Administer ceftriaxone (Rocephin) 1 g IV. d. Give acetaminophen (Tylenol) PRN for fever.
A
While admitting an 80-year-old with heart failure to the hospital, the nurse learns that the patient lives alone and sometimes confuses the "water pill" with the "heart pill." When planning for the patient's discharge the nurse will facilitate Select one: a. referral to home health b. arrangements for 24 hour care c. transfer to dementia unit d. tell the physician that the patient is incompetent
A
o assist the patient with coronary artery disease (CAD) in making appropriate dietary changes, which of these nursing interventions will be most effective? Select one: a. Provide the patient with a list of low-sodium, low-cholesterol foods that should be included in the diet. b. Assist the patient to modify favorite high-fat recipes by using monosaturated oils when possible. c. Emphasize the increased risk for cardiac problems unless the patient makes the dietary changes. d. Instruct the patient that a diet containing no saturated fat and minimal sodium will be necessary.
A
A client is post op following a partial laryngectomy. The pt is about to start tube feedings, which interventions should the nurse include: A. Provide thick fluids as the first introduction of food B. Obtain results of a swallowing study C. Order a regular diet tray D. Facility privacy while eating
A, B
Select all the medications used to treat pneumonia that are narrow spectrum: A. Macrolides B. Penicillin C. Fluroquinolones D. Tamiflu
A, B
A nurse is caring for a client who developed acute renal failure or which finding support the nurses conclusion that the client is in the recovery phase? A. Decreased K b. Increased urine specific gravity C. Decreased creatinine E. absence of urine
A, B C
A nurse is teaching a client who has heart failure about the need to limit sodium in the diet to 2,000 mg daily. Which of the following foods should the nurse recommend for the client ? Select all that apply Select one or more: a. 3 oz baked salmon b. 3 oz roasted chicken breast c. 1 slice cheddar cheese d. 2 oz baked hamextremities.
A, B, C
Nurse is assessing the client with renal stones. What parameters should the nurse assess during admit: A. medication Hx B. diet hx .C. Fam hx of renal stones D. Surgical hx
A, B, C
Pt has a newly placed internal arteriovenous fistula for hemodialysis in the L arm. Which interventions should the nurse plan to implement? A. Instruct about hand exercises that start in about a week B. Check left radial pulse, finger movement, and sensation C. Tell the NA to take the BP in the R arm D. Aspirate blood from the fistula for lab tests E. Palpate for a thrill over the left forearm.
A, B, C, E
Following a thoracotomy to remove a lung tumor, the nurse is preparing the pt for discharge. Which Teaching points are important for this pt: A. Build up exercise endurance B. make time for freq rest periods and activity C. Expect to return to normal acitivy within one month D. Avoid lifting greater than 20 lbs
A, B, D
The nurse is planning care for a client who is in heart failure. Which of the following goals are appropriate? Select all that apply Select one or more: a. An increase in cardiac output b. A reduction in the hearts workload c. A decrease in myocardial contractility d. An elevation in renal blood flow
A, B, D
Which of the following are r/t preventing Upper Resp infections: A. Wash hands often B. Covering the nose and mouth when coughing C. Taking acetaminophen as ordered D. Avoid sharing utensils with others
A, B, D
the nurse is admitting the client with possible renal trauma. In caring for this client the nurses actions should include which of the following? A. Palpate both flanks for asymmetry B. Prepare the client for a CT scan C. tach the client signs of a UT D. Inspect the abdomen and urethra for gross bleeding E. Report any abnormal lab findings
A, B, D, E
Which states the pt understands discharge teaching for their asthma medication? A. I need to take singular, a leukotriene, every day to prevent alleric asthma attacks B. I need to take PO corticosteroids every day C. If I have an asthma attack, I need to use my albuterol, a beta 2 agonist inhaler D> I will only watch for asthma attacks when I am exercising
A, C
A nurse is admitting a client to the coronary care unit following placement of a temporary pacemaker. Which of the following nursing actions should the nurse use to promote client safety? Select all that apply Select one or more: a. Minimize clients shoulder movements b. Keep the lead wire taut and secure c. verify the use of three pronged grounding plugs d. Wear gloves when handling pacemaker leads
A, C, D
A pt has a decrease in glomerular filtration. What lab values should the nurse expect to follow? A. BUN increase B. hypophosphatemia C. Hypokalemia D. Creatinine clearance decreases E. Creatinine increases
A, D, E
Which of the following are most at risk for pneumonia: A. 53 yo female recovering from ABD surgery B. 18 yo college kid who smokes weed C. 42 yo male with COPD on oxygen D. A 59yo who has all his vaccines
A. C
A client is newly diagnosed with relapsing-remitting multiple sclerosis (RRMS). Which instruction should the nurse provide? Select one: a. "Your type of MS is the least common, making it difficult to manage." b. "You must avoid stress and extreme fatigue, because these can trigger a relapse." c. "You will have a steady and gradual decline in function.""You will have a steady and gradual decline in function." d. "You should take your medications only during times of relapse."
B
A nurse is caring for a client who has heart failure and reports increased shortness of breath. The nurse increases the oxygen per protocol. Which of the following actions should the nurse take first? Select one: a. Auscultate lung sounds b. Assist the client into high Fowlers position c. Check oxygen saturation with pulse oximeter d. Obtain the clients weight
B
A nurse is instructing a client who has angina about a new prescription for metoprolol (Lopressor) . Which of the following statements by the client indicates understanding of the teaching? Select one: a. "I will report ringing in my ears" b. "I will check with my doctor if my pulse rate is less than 60" c. "I should place the tablet under my tongue" d. " I need to check my clotting time frequently"
B
A nurse is teaching a client about discharge instructions regarding a total laryngectomy. Which of the following states the pt does not accept their new surgery? A. I prob will not be able to swim B. I will schedule an appt for closure of the track C. I will check the batteries on smoke detectors D> I will make sure to carry an extra supply of facial tissues with me>
B
A nurse is teaching a patient who has a new prescription for Plavix. Which of the following should be included in the teaching? Select one: a. Effects may be apparent in days b. Monitor for black, tarry stools c. Schedule a weekly PT test d. Teach the patient about food containing K.
B
A patient who has been receiving diuretic therapy is admitted to the emergency department with a serum potassium level of 3.1 mEq/L. Which of the following medications that the patient has been taking at home, the nurse will be most concerned about? Select one: a. Lopressor ( Metoprolol) 25 mg po daily b. Lanoxin 0.25 mg daily c. Acetaminophen 81 MG PO daily d. Motrin 400 mg q 6 hours
B
A patient with a venous thromboembolism (VTE) is started on enoxaparin (Lovenox) and warfarin (Coumadin). The patient asks the nurse why two medications are necessary. Which response by the nurse is accurate? Select one: a. "Lovenox will start to dissolve the clot, and Coumadin will prevent any more clots from occurring ever." b. "The Lovenox will work immediately, but the Coumadin takes several days to have an effect on coagulation." c. "Administration of two anticoagulants prevent any future problems" reduces the risk for recurrent venous prevents recurrent thrombus d. "Because of the potential for a pulmonary embolism, it is important for you to have more than one anticoagulant."
B
A pt has recently started anti-TB medications and reports orange stains on paper towels when she urinates. Which should the nurse do first? A. Refer the pt to ED B. Ask the pt what she thinks is happening C. Obtain a urine specimen D. Notify HCP
B
After a diagnosis of CRF, the pt was started on epoeitin alfa. Which finding indicates the med is working? A. Decrease in BP B. Increase in HCt C. Increase in WBC D. Decrease in Creatinine
B
An adult has developed angina pectoris secondary to coronary artery disease. A low fat, low cholesterol diet is prescribed for the client. The nurse should praise the client for a wise choice if which of the following was selected for an evening snack? Select one: a. Cheese and crackers b. Jell-O mold with fresh fruit c. Yogurt with fresh strawberries d. Half tuna fish salad sandwich
B
An adult is admitted to the coronary care unit to rule out a myocardial infarction. The client states, " I am not sure if it is just angina, and I cannot understand the difference between angina and heart attack pain." which response is most appropriate for the nurse to make? Select one: a. Anginal pain produces clenching of the fist pain while MI pain does not b. Anginal pain usually lasts only 3-5 minutes c. Anginal pain requires morphine for relief. d. Anginal pain radiates to the left arm while acute MI pain does not
B
Pt is 3 days post op for a laryngectomy. Family asks when the pt can eat, what is your response: A. We are going to start with a feeding tube, but eventually he will need to learn a different way to swallow B. We are going to start a feeding tube but eventually he will be able to eat normally C. he will prob always have to be fed through a gastronomy tube D. Bc of this surgery it will be several more days before his GI tract begins functioning again
B
The healthcare provider write orders for the newly hospitalized client who has Polycystic kidney disease and dull flank pain nocturia and low urine specific gravity which admission order should the nurse clarify with the healthcare provider.. A. Fluid intake if of at least 2000mL B. Restrict Na to 500mg C. Initate referral D. Beta blocker PO
B
The nurse is aware that the amount of respiratory dead space increases with age. What is the effect of this physiologic change? A. Decreased shunting of blood B. Decreased diffusion capacity for O C. Increase in O D. Increase diffusion of gases
B
The nurse is caring for a pt with a possible hospital acquired UTI. Which nursing action should the nurse perform first? A. Prepare the client for removal of urinary Cath B. Obtain a ring specimen for C & S C. Teach the client how to wipe front to back D. Administer antibiotics
B
The nurse knows that it is Most important for which of the following clients to receive their scheduled medication on time? Select one: a. A client diagnosed with bipolar disordeer receiving Lithium b. a client diagnosed with myasthenia gravis receiving pyridostignine bromide (Mestinon) c. A client diagnosed with Parkinson's receiving levodopa (L-Dopa) d. A client diagnosed with tuberculosis receiving INH
B
The pt is concerned about his brown colored urine after taking nitrofurantoin. Which response by the nurse is most appropriate? A. Stop taking med and make an appt for a urine culture B. This drug usually does discolor urine, continue taking it as prescribed C. You probably have blood in ur urine D. Your urine is too concentrated
B
The pt is going for a renal/bladder US. Which explanation is most appropriate? A. Void immediately before the US B. Do not void before the procedure C. You will be asked to void during the US D. A urinary Cath is used
B
Thrombolytic therapy should be initiated within what time frame of an ischemic stroke to achieve the best functional outcome? Select one: a. 24 hours b. 3 hours c. 9 hours d. 6 hours
B
What is an important measure in preventing HAP? A. Obtaining C & S swabs from all new its B. Administering pneumonoccal vaccine to vulnerable individuals C. Administer an antiretroviral med to pt over 65yo D. Administer prophylactic antibiotics
B
Which ABG represents Resp acidosis? A. pH 7.55 paCo2 63 HCo3 19 PO2 85 B. pH 7.29 PaCo2 55 Hco3 23 Po2 85
B
Which activities prevent occurrence of postoperative PNa in a client? A. Administer O, coughing and deeply breathing, and maintain bed rest B. Coughing breathing deeply, frequent repositioning and using an incentive spirometer C. Administering pain meds, freq repositioning and limiting fluids D. Coughing deeply breathing maintaining bed rest and using Incentive spirometer
B
Which clinical manifestation would be exhibited by a client following a hemorrhagic stroke of the right hemisphere? Select one: a. Neglect on the right side b. Neglict on the left side c. Inability to move right arm d. Expressive aphasia
B
Which is an adverse effect of Vanco and causes you to hold further doses and notify HCP? A. Im seeing yellow halos around the light B. I have this constant ringing in my ears C. My head hurts D> My mouth tastes like metal
B
Which of the following statements by a client to the nurse indicates a risk factor for coronary artery disease? Select one: a. "I love hot dogs" b. "I smoke 1 pack of cigarettes in one month" c. "I exercise every day" d. "My cholesterol is 189"
B
Which of these statements made by a patient with coronary artery disease after the nurse has completed teaching about the therapeutic lifestyle changes (TLC) diet indicates that further teaching is needed? Select one: a. "I will switch from whole milk to 1% or nonfat milk." b. "I can have a cup of coffee if I want" c. "I will miss my peanut butter sandwiches" d. " I'm going to eat fresh salmon more often"
B
What 2 factors are used to calculate cardiac output? a. BP b. Stroke volume c. HR d. mean arterial pressure
B C
Female client has a new onset of sudden urge to void (bladder incontinence). Which interventions should the nurse do? A. Ensure the pt is taken to the bathroom q 4 hours B. Avoid caffeine or foods and beverages that can contain aspartame C. Give diuretics at supper time D. Avoid lifting when possible and do pelvic exercises
B and D
An older client has a UTI, what are the s/s? A. Thirsty B. New onset of confusion C. Fever D. Upper abdominal Pain
B, C
A pt Is about to go for an extracorpeal shock wave lithotripsy. Which actions should the nurse include in the plan of care IMMEDIATELY following the procedure? A. Give no fluids or foods for 24 hours post ESWL B. Check for flank ecchymosis on the affected side C. Instruct on the need to strain all urine D. Assess the incision for Clean, dry, and intactness.
B, C,
A nurse is reviewing the health record of a client who is being evaluated for possible valvular heart disease. The nurse should recognize which of the following data as risk factors for this condition? Select all that apply. Select one or more: a. Weigh gain of 10 lb in past year b. Diastolic murmur present c. Hypertension for 5 years d. Ineffective endocarditis
B, C, D
Which drugs are Primary tx for a pt with TB? A. ofloxacin B. Isoniazid C. Rifmampin D. Pyrazinamide
B, C, D
Which s/s are apart of the dx of Acute glomerulonephritis? A. Polyuria B. Coke Cola colored urine C. Edema D. Proteinuria E. RBC in urine
B, C, D, E,
A nurse is teaching the client about protein needs when on dialysis. Which of the following should the nurses include in the teaching: A. a protein consumption decreases Ph intake B. To maintain protein stores the client should consume 35kg of body weight C. Amino acids are protein and are lost in the dialysate D. Pro intake should include eggs, milk, meat, and fish, poultry and soy
B, D
Albuterol is a
Bronchodilator
80% of UTi cases are caused by this bacteria? A. Staph A B. Strep C. E. coli D. Klebisella
C
A client complains of pain in his right lower extremity. The physician orders codeine 60mg and aspirin grains XPO every four hours, as needed for pain. Each codeine tablet contains 15mg of codeine. Each aspirin tablet contains 325mg of aspirin. Which of the following should the nurse administer? Select one: a. 2 codeine tablets and 4 aspirin tablets b. 4 codeine tablets and 2 aspirin tablets c. 4 codeine tablets and 3 aspirin tablets d. 3 codeine tablets and 3 aspirin tablets
C
A client has asthma and is being prepared for discharge. Which of the following should the nurse include in the teaching? A. Contact HCP only if night wheezing becomes a concern B. Use peak flow meter only if s/s are worsening C. Limit exposure to sources that trigger an attack D. Use inhaled steroid med as rescue inhaler
C
A client is to receive 1,000ml if 5% dextrose in 0.45 NA///cl intravenous solution in an 8-hour period. The intravenous set delivers 15 drops per milliliter. The nurse should regulate the flow rate so it delivers how many drops of fluid per minute? Select one: a. 45 b. 60 c. 31 d. 15
C
A client with TB is being treated with medications. When will the client be safe from infecting others approx how long after initiation of medication therapy? A. within 48 hours B. After completion of 6 mo of drug therapy C. 2-3 weeks after initiation of meds D. results vary w each pt
C
A client with a tentative diagnosis of myasthenia gravis is admitted for a diagnostic workup. Myasthenia gravis is confirmed by: Select one: a. Brudzinski's sign. b. Kernig's sign. c. a positive edrophonium (Tensilon) test. d. positive sweat chloride test.
C
A client with tb is being treated with medication. Which of the following indicate the medications are effective: A. The skin test is now negative B. Decrease in WBC in the sputum C. The s/s are improving D. No change in the client Xray
C
A nurse is teaching a client who has pre stage chronic kidney disease about dietary management which of the following information to nurse include in the instructions: A. limit dairy products to one cup a day Maintain a high phosphorus diet restrict protein intake increase intake of foods high in potassium
C
A nurse is teaching about the risk factor fs for Kidney disorders. Which of the following is INAPPROPRIATE to teach? A. Pregnancy B. DM C. Hypotension D. Neuromuscular disorders
C
A patient who has cardiac heart failure and is on a diuretic, an ACE-inhibitor, and a low-sodium diet tells the home health nurse about a 5-pound weight gain in the last 3 days. The nurse's first action will be to Select one: a. Assess for atrial fibrillation b. Question the patient about prescribed prescriptions c. Assess the patient for clinical manifestations of acute heart failure. d. Ask the patient to recall dietary for the last 3 days
C
A pt has COPD and is shocked bc the only s/s the pt has is a a cough. What are some other s/s the nurse can best respond with: A. You can expect weight gain B. As your COPD develops, you freq develop infections C. other s.s you may develop are SOB on exertion and sputum production D. There are not other s.s
C
A pt has a pulmonary contusion in due to a MVA and develops a PE. What is the PRIORITY nursing concern with this client: A. Acute pain B. Activity Intolerance C. Ineffective breathing pattern D. Excess fluid volume
C
A pt was admitted to ICU48 hours ago for a gunshot wound. Pt develops productive cough, high temp. The pt is breathing on their own and doesn't need a vent. Pt has coarse crackles in the LLL. A chest Xray shows infiltrate in the RLL. What type of pneumonia is this? A. Community acquired B. Aspiration PNA C. Hospital Acquired PNA D. Ventilator Acquired PNA
C
A pt with an advanced laryngeal tumor is undergoing radiation. The pt states If I have radiation I will not need surgery, which should be the pts response: A. That is correct B. F no C. Radiation is used to shrink the tumor size and is used as an adjunct to surgery D. All pt have radiation before surgery
C
Nurse is teaching about diet restrictions who has AKI and is on hemodialysis. The nurse should include; A. Limit Na to 4.5 g a day B. Limit Ca intake to 3500 mg day C. decrease K intake to 65 D. Decrease total fat intake to 45% of daily calories
C
Pt passes a calcium oxalate stone. To prevent further stones which food should the pt avoid? A. Beans b. Cheese C. Chocolate D. Lettuce
C
Pt with COPD and Emphysema will most likely have which acid base imbalance: A. Low O, Low CO2 B. High O and high CO2 C. Low O and high CO2 D. High O and Low Co2
C
The nurse is concerned that a patient with heart failure is decompensating. What assessment finding supports the nurses clinical decision? Select one: a. Increased urine output b. Weak peripheral pulse c. Dyspnea and coughing d. Dry persistent cough
C
Three weeks after developing ARF following trauma, the client has increased urinary output. Which assessment finding should the nurse report? A. K level of 3.7 B. Absence of adventitious breath sounds C. Drop in Bp and increase in pulse D. A 3 pound weight loss over 24 hours
C
Which of the following is NOT a s/s of chronic bronchitis... A hyperventilation B. productive cough C. Barrel chest D. cyanosis
C
Which of the following positions should the nurse tell the pt to do when they have a nosebleed? A. lie down with feet elevated B Sitting up with neck fully extended C. Sitting up leaning slightly forward D. Lying down with a pillow under head
C
few days after an acute myocardial infarction (MI), a patient complains of stabbing chest pain that increases with deep breathing. Which action will the nurse take first? Select one: a. Give the ordered acetaminophen (Tylenol). b. Check the patient's oral temperature. c. Notify the patient's health care provider. d. Auscultate the heart sounds.
C
hich assessment finding by the nurse who is caring for a patient who has had coronary artery bypass grafting using a right radial artery graft is most important to communicate to the physician? Select one: a. Crackles audible at both lung bases b. Complaints of chest pain c. Pallor and weakness of the right hand d. Pallor and weakness of the left hand
C
The nurse is caring for a patient who is receiving IV furosemide (Lasix) and morphine for the treatment of acute decompensated heart failure (ADHF) with severe orthopnea. When evaluating the patient response to the medications, the best indicator that the treatment has been effective is? Select all that apply Select one: a. Decreased dyspnea with the head of bed at 30 degrees. b. Hourly output greater than 60 ml per hour c. Weight loss of 2 lbs overnight d. Reduction in patient complaints of chest pain.
C B
A patient who comes to the community clinic for a wellness visit has a blood pressure of 164/92 mm Hg. What additional information should the nurse assess from this patient? Select all that apply Select one or more: a. Bowel sounds b. Neurological system c. BMI and waist circumference d. Heart Rate
C, D
Prednisone is a
Corticosteroid
A 45yo male, obese complains about daytime sleepiness, difficulty going to sleep at night and snoring. Which of the following does the client have? A. Laryngeal cancer B. Chronic tonsilitis C. Adenitis D. Obstructive Sleep Apnea
D
A client is 3 days Postop with COPD. the client has required 10L of O2 by mask during the day to keep his O2 higher than 88. Which action should be taken by the evening nurse? A. Call respiratory therapy for Neb tx B. Administer dose of ordered pain med C, Work to wean oxygen down to 3L D. Check Resp rate and notify HCP
D
A client is being assessed to rule out cardiovascular problem. The nurse understands that some of the common symptoms associated with cardiovascular disease are Select one: a. fatigue, weight changes, mood swings b. mood swings, headaches, fainting c. dyspnea, chest discomfort, sputum production d. shortness of breath, chest discomfort, palpitations e. fainting, chest pain, anxiety, tremors
D
A client is receiving baclofen for management of symptoms associated with multiple sclerosis. The nurse evaluates the effectiveness of this medication by assessing which of the following? Select one: a. Appetite b. Mood and affect c. Sleep pattern d. Muscle spasms
D
A client is transferred to an nursing home following a CVA. The client has right sided paralysis and has been experiencing dysphagia. The nurse observes an aide prepare the client to eat lunch. which of the following situations would require and intervention by the nurse? Select one: a. The aide puts the food in the back of his mout on the unaffected side b. The client is in bed in high -Fowlers position c. The client's head and neck are positioned slightly forward d. The aide liquifies the pudding to help the client swallow. Feedback
D
A client with asthma has pronounced wheezing on auscultation. Susupecting an impending asthma attack, the nurse should: A. have the client lay on his right side B. Have the pt cough and deep breathe C. Prepare to intubate D. Prepare to administer NeB beta 2 adrenergic agonist
D
A patient is diagnosed with carotid artery disease. For which potential health problem should the nurse prepare teaching for this patient? Select one: a. Dyslipedmia b. Hypertension c. Diabetes d. Stroke
D
A pt had end stage COPD and has diagnosis for Impaired Gas exchange. Which assessment finding shows the interventions have been effective? A. Pt is able to move in bed wo difficulty B. pt appears comfy C. pt is coughing up white sputum D. Pt SpO2 is 97% on 2L of O
D
A pt is having an asthma attack and is prescribed methylprednisone (IV). Which action should the nurse take: A. Encourage client to decrease calories due to increase appetite B. Aspirates for blood return before injecting medication C. Inform the client to limit fluid intake d/t fluid retention D. Monitor blood glucose
D
An adult client has a history of coronary artery disease and angina pectoris. After walking to the bathroom, she complains of aching substernal pain that radiates to her left shoulder. The nurse should Select one: a. Administer a prn dose of nitroglycerin po b. Administer a dose of nitroglycerin post an ECG to rule out a MI c. Assist her to lay down and call the physician d. Administer a prn dose of nitroglycerin sublingually
D
During the acute phase of a cerebrovascular accident(CVA) , the nurse should maintain the client in which of the following positions? Select one: a. Semi prone with the head of the bed elevated 60-90 degrees b. Prone , with the head of the bed flat. c. Lateral, with the head of the bed flat d. Supine, with the head of the bed elevated 30-45 degrees.
D
Pt Is taking theophylline for long term control of asthma. Client education r/t this pt include: A. Taking the med at least 1 hour prior to meals B. development of Hyperkalemia C. Monitor liver function D, The importance of blood tests to monitor for serum concentrations
D
The nurse Is caring for a several older clients who should the nurse be alert for s/s pyelonephritis: A. pt with urinary tumor B pt with ARF C. pt with CRF D. pt with urinary obstruction
D
The nurse assesses that the client was a ARF has a potassium level of 6.8 what med, if prescribed should the nurse plan to administer NOW? A. Erythropoietin B. Plasmalyte C. potassium D. Kayexalate E. Vitamins
D
Upon discharge teaching the nurse is teaching the pt about diet and fluid restrictions for their calcium oxalate based renal stone. Which of the following should the nurse include in the teaching? A. Increase intake of juice rich in vitamin C B. Decrease broccoli intake C. Limit consumption of whole grain foods D. Reduce intake of strawberries
D
Which drug will be ordered for a pt with bacterial pharyngitis? A. Morphine B. Tylenol C. Robitussin DM D. Penicilin
D
Which of the following assessment finding by the nurse indicates right ventricular failure in a client? Select one: a. Paroxysmal nocturnal dyspnea b. shortness of breath c. crackles d. Jugular venous distention
D
Which of the following should the nurse include in the plan of care for a post op coronary arteriogram client? Select one: a. Assess lung sounds b. Provide early ambulation c. Monitor vital signs every 8 hours d. Assess pedal pulses
D
Which finding should a nurse expect when completing an assessment on a client with chronic bronchitis? A. Minimal sputum production B. Pink frothy sputum C. Stridor expiration D. Barrel chest
D Barrel Chest
Which factors affect stroke volume: A. Heart Rate B, Afterload C. BP D. Preload E Contractility
Preload, Afterload, and Contracility
A pt with asthma is tx with epinephrine. He Is agitated, diaphoretic, and O sat of 92%. Breath sounds are diminished and wheezing is absent. Based on info which acid base imbalance does the nurse anticipate? A Resp alkalosis B. Metabolic Acidosis C. Resp acidosis D. Metabolic alkalosis
Resp Acidosis
A client is admitted for ureteral colic secondary to urolithiasis. What are s/s of that support this diagnosis? A. Diarrhea B. Urinary frequency C. Acute Pain D. High fever E. hematuria
Urinary freq acute pain hematuria
Ciproflaxin is a
antibiotic
Pt with pyelonephritis of the left side is hospitalized. What should the nurse monitor for? A. Right quadrant rebound tenderness B. Low grade fever C. Left sided flank pain D. Bradycardia
c
Client has CRF. Which statement should the nurse document as an appropriate outcome in the plan of care? Eats three large meals daily Reduced albumin Daily weight gain of no more than 3lbs no evidence of bleeding
no evidence of bleeding
A pt has a PE. Which of the following indicated respiratory alkalosis: A. pH 7.60, PaCo2 48, and HCO3 24 B. Ph 7.35, PaCo2 35 and HCo3 22 C. pH 7.54 PaCo2 25 HCo3 24 D. pH 7.50 PaCo2 40 HCo3 28
pH 7.54 PaCO2 25 HCO3 24
