Fourth Semester Final[1]

Department of Nursing Finals Frenzy Practice Test For students taking the final exam for NUR2744 Directions: Print the exam and allow one hour to complete it. Use paper and pencil to record your answers. Please read each question carefully. Select the BEST possible answer. There is only one correct answer per question. When you are done, click on the answers icon to check results. 1. A patient presents with complaints of anorexia, muscle cramping, decreased urination and weight gain. In addition, the patient states she has been more tired than usual and more forgetful experiencing frequent headaches. What should the nurse do first? a. Assess the Patient’s Medical History b. Obtain Serum Electrolytes c. Assess for Evidence of Peripheral Edema d. Observe for Abdominal Distention 2. A patient with a pituitary tumor has a urine output of more than 300ml per hour for the past two hours. The nurse knows that this indicates Diabetes Insipidus. Which action should the nurse take first. a. Monitor urine output over the next two hours b. Assess the urine for osmolality, glucose, and acetone c. Obtain Serum Electrolytes and Osmolality d. Notify the physician and anticipate an increase in IV fluid rate 3. After sustaining a right ventricular MI, your patient develops cardiogenic shock. Initally, you should expect to administer: a. Nitroglycerine (Tridyl) b. Lopressor (Metoprolol) c. Morphine Sulfate (Morphine) d. Plasmanex (Normal serum albumin)

4. Which of the following statements would be most effective when speaking with a staff member who refused to float to another area as the team leader assigned? a. “You never float when I ask you to, you are causing other staff complaints” b. “I would appreciate your floating in rotation with others, you have work standards that would benefit other units as well as ours” c. “I know you hate to float but you have to take your turn and be flexible” d. “Please just go this time and I promise I won’t ask again” 5. A 82 year old patient sustained an accident resulting in a cervical fracture. After application of a halo traction device, it will be most important for the nurse to apply which safety measure? a. Logrolling to position patient b. Keeping the head of bed at 30-45 degrees. c. Ensuring visibility of the wrench and tool kit at the bedside d. Inserting a nasogastric tube to prevent aspiration 6. A patient admitted with an anterior wall MI 12 hours ago complains of recurring chest pain. What would be the most appropriate nursing action? a. No action is necessary, the patient is experiencing normal reperfusion. b. Obtain a 12 lead EKG and notify the physician c. Administer a thrombolytic and begin heparin therapy d. Adminiser morphine sulfate and lidocaine 7. Which nursing intervention can prevent a patient from experiencing autonomic dysreflexia? a. Administering chloral hydrate (Noctec) b. Assessing laboratory results as ordered c. Placing the patient in a Trendelenberg Position d. Monitoring patency of the patient’s foley catheter

8. A patient with pulmonary edema is monitored with a thermodilution (Swan-Ganz) catheter. The patient exhibits SOB, SaO2 92%, CVP 14, PAP 32/21, SVR 900, HR 100, RR 26. Which would be the highest priority nursing diagnosis? a. Ineffective Breathing Pattern b. Anxiety c. Impaired Gas Exchange d. Decreased Cardiac Output 9. A patient with respiratory acidosis receives an order for endotracheal intubation for an ABG result of pH 7.29, PaO2 68, PCO2 56, NaHCO3 26, on a 100% Non-rebreather mask. Which nursing action is most appropriate post intubation? a. Auscultation of lungs for bilateral breath sounds b. Turning the patient from side to side every two hours c. Monitoring serial arterial blood gasses d. Providing frequent oral hygiene 10. A patient is status post exploratory laparotomy and repair of an intestinal perforation. Twentyfour hours post op, the patient’s blood pressure has dropped to 90/58, is oozing red colored drainage from the central line site and incision, and has developed 3mm petechiae over the arms and legs. The nurse suspects Disseminated Intervascular Coagulation (DIC). To confirm this diagnosis, the nurse should assess for which laboratory finding? a. Patelet count of 90,000mcg/L and HGB 9.1mg/dL b. PT 15 seconds and APTT 80 seconds c. FDP 50mcg/mL and D-Dimer 1:6 dilution d. Creatinine 1.4 mg/dL and Fibrinogen Level 160mg/dL 11. The nurse is caring for an intubated patient receiving TPN at 100cc/hour a 10% Lipid solution at 21cc/hour, dopamine at 10cc/hour (5mcg/kg/min), and propofol (Diprivan) at 50cc/hour (15 mcg/ kg/min). The most priority nursing diagnosis for this patient would be: a. Anxiety: level 4 b. Alteration in nutrition: more than body requirements c. Fluid volume overload d. Risk for infection

12. A patient receives a pacemaker to treat a recurring dysrythmia. When monitoring the cardiac rhythm, the nurse notices several pacer spikes not followed by a beat. The nurse suspects which condition: a. Failure to pace b. Failure to capture c. Failure to sense d. Asystole 13. The CT results indicate hemorrhagic stroke for a patient admitted through the ER. When the nurse reviews the medication administration record, the following medications are transcribed: Heparin Sodium 1000u/hr IV, Dexamethasone (Decadron) 8mg q6 hours IVP, Methyldopa (Aldomet) 100mg q6 hours IVPB, Phenytoin (Dilantin) 200mg IVPB. What should the nurse’s first action be? a. Sign off the orders indicating acknowledgement b. Prepare and administer the medications as ordered c. Call the physician to question the orders d. Check the written physician orders 14. A physician ordered a stat IV and indicated the importance of administering the medication quickly. The nurse prepares to administer the medication but notices the ground on the infusion pump’s plug is broken. What should the nurse do first? a. Use the pump because the doctor wants the medication given quickly. b. Obtain another pump form central supply and use the new pump for the infusion. c. Tape the broken ground to fix the problem then use the pump. d. Call the nursing supervisor to report the problem. 15. Which nursing intervention takes the highest priority when caring for a client who is receiving a blood transfusion? a. Observing the client for itching, swelling or dyspnea b. Instructing the patient that transfusions normally take 1-2 hours c. Documenting blood administration in the patient care record d. Assessing vital signs when the transfusion ends

16. After undergoing a left upper lobectomy, a patient has a chest tube in place for drainage. When caring for this client, the nurse must: a. Monitor fluctuations in the suction chamber b. Clamp the tube at least once every shift c. Encourage coughing and deep breathing d. Milk the tubing every two hours 17. Which position would be best for a client showing signs of shock? a. Semi-Fowlers b. High-Fowlers c. Trendelenberg d. Modified Trendelenberg 18. Which instruction should the nurse give a client who is going to have a chest tube removed? a. “Hyperventilate just before the tube is removed” b. “Take a deep breath and hold it” c. “Inhaled as the tube is pulled out” d. “Avoid the valsalva maneuver” 19. A client has a Sengstaken-Blakemore tube in place to treat esophageal varices. Which action is most appropriate to include in the client’s plan of care? a. Observe for restlessness and increased respirations b. Offer the client sips of water to swallow every two hours c. Deflate the gastric balloon to prevent an upset stomach d. Check pressure in the balloon by deflating and reinflating every 4 hours 20. The nurse accompanies a client to have an intravenous pyelogram (IVP). During the test, the client experiences angioedema. Suspecting an anaphylactic reaction, the nurse should implement which action first? a. Place O2 on the patient at 2LPM nasal cannula b. Notify the physician c. Begin cardiopulmonary resuscitation d. Give 2 ampules of epinephrine IV Push

21. A client is several days post op after repair of an abdominal aortic aneurysm. The client’s vital signs include T 100degrees F, P 92, RR 18, BP 128/64. Blood gas results are: pH 7.35; HCO3 30 mEq/L; PCO2 50 mmHg; PO2 90 mmHg. Based on these assessment findings, which intervention by the nurse is appropriate? a. Start the client on 2LPM nasal cannula b. Have the client turn, deep-breathe and cough every 2 hours c. Send a specimen of the patient’s sputum to the lab for analysis d. Obtain an order to give the client 1 ampule (50mEq) of Sodium Bicarbonate 22. A client with second-degree burns covering 40% of her body has a nursing diagnosis of “altered nutrition: less than body requirements related to lack of desire for food with constant pain and large burn area”. She enjoys all of the following foods. Which choices would be best to help the client regain nutritional balance? a. Steak and French fries b. Peanut butter an raisins c. Orange juice and carrots d. Corn and milk 23. A client who has been struck by a car is being ovesrved in the hospital for signs of injury. Present orders read; Vital signs q1h, NPO for 24 hours, Nasal O2 at 2LPM prn, Indwelling urine catheter to straight drainage if needed, D5/0.45NS at 100cc/hr, call physician for any signs of shock or increased intracranial pressure. The nurse determines that the client is showing early signs of shock. Which action should the nurse take first? a. Call the physician b. Start the oxygen c. Increase the intravenous fluid rate d. Insert the urinary catheter

24. A client with increased intracranial pressure is receiving mannitol. To evaluate the effectiveness of this drug, the nurse should assess the client for which of the following? a. Decreased pulse rate b. Decreased systolic blood pressure c. Increased urine output d. Increased pupillary reaction 25. A client is in acute renal failure. The nurse should assess the client carefully for which of the following potential complications a. Tetany b. Hypernatremia c. Vascular collapse d. Cardiac arrythmias 26. A 36 year old client is brought to the hospital complaining of rapid heartbeat, diarrhea, dry mouth and shortness of breath. The client states “I feel like I am having a heart attack”. The immediate nursing action would be to: a. Assess the client’s physical and emotional state b. Implement an anxiety-reducing activity c. Analyze what triggered the symptoms d. Explore her behavior and feelings 27. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they: a. Secrete hydrogen ions and sodium b. Secrete ammonia c. Exchange hydrogen and sodium in the kidney tubules. d. Decrease sodium ions, hold on to hydrogen ions and secrete sodium bicarbonate

28. A client admitted to the emergency room following a car accident complains of severe headache and demonstrates nuchal rigidity and Kernig’s sign. The nurse will assess for which complication? a. Subdural Hemorrhage b. Increased intracranial pressure c. Hypovolemic Shock d. Subarachnoid Hemorrhage 29. A 54 year old client with acute renal failure was put on Quinidine to prevent atrial fibrillation. The nurse knows this drug decreases myocardial excitability. When this medication is given in patients with kidney disease the nurse should: a. Call the physician to question the order b. Administer the medication on time c. Measure the quinine level with the second dose d. Assess for severe hypotension 30. A 24 year old client is admitted to the hospital following an automobile accident. She was brought in unconscious with the following vital signs: BP 130/76, P 100, R 16, T 98F. The nurse observes bleeding from the client’s nose. Which of the following interventions should the nurse perform first? a. Obtain a culture of the specimen using sterile swabs and send to the laboratory b. Allow the drainage to drip on a sterile gauze and observe c. Gently suction the nose with a bulb syringe and send to the laboratory d. Insert sterile packing into both nares and remove in 24 hours 31. Part of a plan of care for a patient with increased intracranial pressure is to maintain adequate airway and to promote gas exchange. To accomplish these goals, an effective nursing action is to: a. Encourage the client to cough vigorously b. Avoid hypercapnia in the patient c. Suction the client nasotracheally at frequent intervals d. Keep the head of bed flat at all times

32. While on a camping trip a friend sustains a snake bite from a poisonous snake. The most effective initial intervention would be to: a. Place a restrictive band above the snake bite b. Elevate the bite area to the level of the heart c. Position the client in a supine position d. Immobilize the affected limb 33. A young client hit by a car was fortunate because the level of his injury did not interrupt his respiratory function. The cord segments involved with maintaining respiratory function are: a. Thoracic level 5 and 6 b. Thoracic level 2 and 3 c. Cervical level 7and 8 d. Cervical level 3 and 4 34. Following an accident, a client is admitted with a cervical spine injury. The physician will use crutchfield tongs to decompress the vertebral column. The nurse forms a plan of care that includes which intervention? a. Allow the client to sit up and move without twisting the spine b. Keep the head of the bed at a 45 degree angle at all times without lowering it during turning c. Logroll the patient lifting no more than 15 degrees elevation, avoiding twisting the spine d. Maintain the client in the supine position rotating pillows to support the head, arms and feet 35. A 56 year old man has returned from the recovery room after having a tracheostomy and radical neck dissection for the treatment of laryngeal cancer. Which of the following interventions would have the highest priority in the development of the initial nursing care plan? a. Helping the patient to adapt to a new body image b. Observing for complaints of pain c. Obtaining a temperature every 4 hours d. Measuring pulse every 2 hours

36. Patient teaching for a patient recovering from an acute anterior myocardial infarction would include which of the following discharge instructions regarding exercise? a. Begin with frequent short walks b. Engage in brisk aerobic walking three times per week c. Eat before walking to provide needed energy d. Take a nitroglycerine tablet before walking 37. A client with CHF is being treated with furosemide 40mg bid and digoxin 0.25mg qd. Which of the following foods would be most helpful in preventing digoxin toxicity? a. Orange juice b. Tuna fish c. Cottage cheese d. Green beans 38. When assessing a patients right forearm arteriovenous graft, the nurse notes that auscultation reveals a ‘swishing’ sound. Which of the following would the nurse undertake next? a. Proceed with preparations for hemodialysis b. Take the blood pressure readings on both arms and compare c. Notify the physician immediately d. Prepare the client for an angiogram 39. A client’s laboratory values show a hemoglobin of 7.9 and a hematocrit of 26.2. The nurse has orders to administer a two units of packed red blood cells for hemoglobin values less than 9.0. What should the nurse do first when preparing to give a blood transfusion before obtaining the blood? a. Recheck the written order for the transfusion in the patient record on the chart b. Explain the procedure to the patient and obtain written consent for blood products c. Review the record for proper typing and crossmatching of the patient d. Contact the laboratory to ensure the proper blood is available

40. Which of the following interventions would enhance the communication skills of the patient who has expressive aphasia after a stroke? a. Speak loudly so the patient can hear and better understand you b. Supply the appropriate words quickly to avoid patient frustration c. Calmly and gently correct vulgar or profane language d. Offer pictures that open discussion and identify needs 41. A patient has been taking procainamide (Pronestyl) for three months to control atrial fibrillation. She states that she is starting to experience a facial rash, severe joint pain and fatigue. The nurse should instruct her to: a. Increase the dose according to preset guidelines b. Take aspirin to relieve these symptoms while continuing the therapy c. Continue on the drug for two more weeks because these symptoms will subside d. Notify the physician immediately 42. The patient who has had an MI hopes to resume sexual intercourse. Which of the following would indicate that the patient understands the instructions given? a. “I should assume the top-lying position during intercourse” b. “I should substitute masturbation for foreplay and intercourse” c. “I should wait at least three hours after a meal before having intercourse” d. “I should avoid all sexual activity for at least three months after my heart attack” 43. When planning meals for a patient on hemodialysis, which of the following food selections made by the patient would the nurse consider to indicate patient understanding? a. Bananas b. Red meats c. Legumes d. Apple juice

44. After teaching a patient about cardiac catheterization, the nurse assesses the patient’s level of understanding before the procedure. Which of the following patient statements indicate evidence of understanding the information about contrast medium injection? a. “I should expect shortness of breath and a slow heart rate” b. “I will expect some nausea and palpitations” c. “I would expect to have some itchy skin and might get lightheaded” d. “I might expect a cool clammy sensation” 45. When managing a kidney transplant patient, which of the following drugs would the nurse expect prescribed to prevent or minimize transplant rejection? a. Acyclovir (Zovirax) b. Cyclosporine (Cyclosporine A) c. Hydromorphone (Dilaudid) d. Megestrol (Megace) 46. After a right middle lobe resection, the patient has a chest tube in place with continuous suction. The nurse enters the room and notices the water seal drainage chamber bubbling vigorously. Which of the following interventions would the nurse perform first? a. Decrease the suction level in the suction control chamber b. Call the doctor c. Check connections from the patient to the drainage system d. Auscultate the lungs on the right side 47. A female client is admitted with a diagnosis of seizure disorder. The nurse enters the room and notices the client is exhibiting the tonic—clonic muscle activity common with a grand-mal seizure. A priority in protecting the client against injury during the seizure would be to: a. Restrain the arms b. Use a padded tongue blade between the teeth c. Call for help to hold the client down d. Position the client in the sidelying position

48. While monitoring a client receiving a transfusion of a unit of AB- packed red blood cells, the nurse notes 2cm diameter welts on the patient’s chest and the patient is complaining of itching that started about 5 minutes into the transfusion. The client’s vitals signs are: T98.8, P 100, R 20, BP 116/64. Suspecting a hemolysis reaction, what should the nurse do first? a. Stop the transfusion b. Administer IV Benadryl c. Send a blood sample too the laboratory and fill out transfusion reaction forms d. Notify the physician 49. A 42 year old client has been diagnosed with a right-sided acoustic neuroma. The tumor is large and has impaired the function of the seventh and eighth cranial nerves. Which of the following nursing actions should be carried out to prevent complications? a. Keeping a suction machine available b. Use of an eye patch or eye shield on the right eye c. Use of only cool water when washing the face or bathing d. Positioning the client in a high fowlers position 50. Following abdominal surgery, which of the following clinical manifestations will be indicative of negative nitrogen balance? a. Poor skin turgor from dehydration b. Edema or ascites of the abdomen and flank c. Pale color to skin d. Diarrhea 51. The nurse is assigned to care for eight clients. Two unlicensed assistive personnel are assigned to work with the nurse. Which statement is valid in this situation? a. The nurse may assign the two unlicensed personnel to work independently with a client assignment b. Then nurse is responsible to supervise the unlicensed personnel c. The unlicensed personnel are not responsible for their actions d. Unlicensed personnel do not require training before working with clients

52. A patient is transferred to the intensive care after evacuation of a sub dural hematoma (SDH). Which nursing intervention would reduce the patient’s risk of increased ICP? a. Encourage oral fluid intake for rehydration b. Orally and nasally suction the patient every four to eight hours c. Elevate head of bed to ninety degrees to promote arterial flow d. Administer a stool softener as prescribed 53. After an MVA a patient is admitted to the medical surgical nursing unit with a cervical collar in place. The cervical spinal x-rays have not been read so the nurse does not know if the patient has a spinal cord injury. Until injury is ruled out, the nurse should restrict this patient to which position? a. Trendelenberg b. Supine with HOB at 30 degrees c. Flat except for log rolling as needed d. HOB elevated to 90 degrees to prevent cerebral edema 54. A patient is hospitalized with Guillain-Barre syndrome. Which nursing assessment finding is significant? a. Warm dry skin b. Urine output less than 40cc/hour c. Soft, non-distended abdomen d. Even, unlabored respirations