A. digoxin (Lanoxin)
B. diltiazam (Cardizem)
C. nitroglycerine ointment
D. metoprolol (Toprol XL)
The
correct answer is A: digoxin (Lanoxin) Digoxin increases ventricular
irritability and increases the risk of ventricular fibrillation
following cardioversion. The other medications do not increase
ventricular irritability
2. Which
of these clients, who all have the findings of a board-like abdomen,
would the nurse suggest that the health care provider examine first?
A) An elderly client who stated that "My awful pain in my right side suddenly stopped about 3 hours ago."
B) A pregnant woman of 8 weeks newly diagnosed with an ectopic pregnancy
C) A middle-aged client admitted with diverticulitis and has taken only clear liquids for the past week
D) A teenager with a history of falling off a bicycle and did not hit the handle bars
The
correct answer is A: An elderly client who stated that "My awful pain
in my right side suddenly stopped about 3 hours ago." This client has
the highest risk for hypovolemic and septic shock since the appendix has
most likely ruptured as based on the history of the pain suddenly
stopping over three hours ago. Being elderly, there is less reserve for
the body to cope with shock and infection over long periods. The others
are at risk for shock also. However, given that they fall in younger age
groups, they would more likely be able to tolerate an imbalance in
circulation. A common complication of falling off a bicycle is hitting
the handle bars in the upper abdomen often on the left, resulting in a
ruptured spleen.
3. The
nurse manager informs the nursing staff at morning report that the
clinical nurse specialist will be conducting a research study on staff
attitudes toward client care. All staff are invited to participate in
the study if they wish. This affirms the ethical principle of
A) Anonymity
B) Beneficence
C) Justice
D) Autonomy
The
correct answer is D: Autonomy Individuals must be free to make
independent decisions about participation in research without coercion
from others.
4. Which
statement made by a nurse about the goal of total quality management or
continuous quality improvement in a health care setting is correct?
A) “It is to observe reactive service and product problem solving."
B) Improvement of the processes in a proactive, preventive mode is paramount.
C) A chart audits to finds common errors in practice and outcomes associated with goals.
D) A flow chart to organize daily tasks is critical to the initial stages.
The
correct answer is B: Improvement of the processes in a proactive,
preventive mode is paramount. Total quality management and continuous
quality improvement have a major goal of identifying ways to do the
right thing at the right time in the right way by proactive
problem-solving.
5. A
client with chronic obstructive pulmonary disease (COPD) and a history
of coronary artery disease is receiving Aminophylline, 25mg/hour. Which
one of the following findings by the nurse would require immediate
intervention?
A) Decreased blood pressure and respirations.
B) Flushing and headache.
C) Restlessness and palpitations.
D) Increased heart rate and blood pressure.
The correct answer is C: Restlessness and palpitations. Side effects of Aminophylline include restlessness and palpitations
6. When teaching a client about the side effects of fluoxetine (Prozac), which of the following will be included?
A) Tachycardia blurred vision, hypotension, anorexia
B) Orthostatic hypotension, vertigo, reactions to tyramine rich foods
C) Diarrhea, dry mouth, weight loss, reduced libido
D) Photosensitivity, seizures, edema, hyperglycemia
The
correct answer is C: Diarrhea, dry mouth, weight loss, reduced libido
Commonly reported side effects for fluoxetine (Prozac) are diarrhea, dry
mouth, weight loss and reduced libido
7. The
nurse is preparing to administer a tube feeding to a post-operative
client. To accurately assess for agastostomy tube placement, the
priority is to
A) Auscultate the abdomen while instilling 10 cc of air into the tube
B) Place the end of the tube in water to check for air bubbles
C) Retract the tube several inches to check for resistance
D) Measure the length of tubing from nose to epigastrium
The
correct answer is A: Auscultate the abdomen while instilling 10 cc of
air into the tube If a swoosh of air is heard over the abdominal cavity
while instilling air into the gastric tube, this indicates that it is
accurately placed in the stomach. The feeding can begin after assessing
the client for bowel sounds
8. Which of these questions is priority when assessing a client with hypertension?
A) "What over-the-counter medications do you take?"
B) "Describe your usual exercise and activity patterns."
C) "Tell me about your usual diet."
D) "Describe your family's cardiovascular history."
The
correct answer is A: "What over-the-counter medications do you take?"
Over-the-counter medications, especially those that contain cold
preparations can increase the blood pressure to the point of
hypertension.
9. The nurse is teaching parents of a 7 month-old about adding table foods. Which of the following is anappropriate finger food?
A) Hot dog pieces
B) Sliced bananas
C) Whole grapes
D) Popcorn
The
correct answer is B: Sliced bananas Finger foods should be bite-size
pieces of soft food such as bananas. Hot dogs and grapes can
accidentally be swallowed whole and can occlude the airway. Popcorn is
too difficult to chew at this age and can irritate the airway if
swallowed
10. Client
is ordered warfarin sodium (Coumadin) to be continued at home. Which
focus is critical to be included in the nurse’s discharge instruction?
A) Maintain a consistent intake of green leafy foods
B) Report any nose or gum bleeds
C) Take Tylenol for minor pains
D) Use a soft toothbrush
The
correct answer is B: Report any nose or gum bleeds The client should
notify the health care provider if blood is noted in their stools or
urine, or any other signs of bleeding occ
11. The
nurse is assessing a comatose client receiving gastric tube feedings.
Which of the following assessments requires an immediate response from
the nurse?
A) Decreased breath sounds in right lower lobe
B) Aspiration of a residual of 100cc of formula
C) Decrease in bowel sounds
D) Urine output of 250 cc in past 8 hours
The correct answer is A: Decreased breath sounds in right lower lobe
The
most common problem associated with enteral feedings is atelectasis.
Maintain client at 30 degrees during feedings and monitor for signs of
aspiration. Check for tube placement prior to each feeding or every 4 to
8 hours if continuous feeding
12. The
nurse is talking with the family of an 18 months-old newly diagnosed
with retinoblastoma. A priority in communicating with the parents is
A) Discuss the need for genetic counseling
B) Inform them that combined therapy is seldom effective
C) Prepare for the child's permanent disfigurement
D) Suggest that total blindness may follow surgery
The
correct answer is A: Discussing the need for genetic counseling The
hereditary aspects of this disease are well documented. While the
parents focus on the needs of this child, they should be aware that the
risk is high for future offspring
13. The
nurse is performing an assessment on a client who is cachectic and has
developed an enterocutaneous fistula following surgery to relieve a
small bowel obstruction. The client's total protein level is reported as
4.5. Which of the following would the nurse anticipate?
A) Additional potassium will be given IV
B) Blood for coagulation studies will be drawn
C) Total parenteral nutrition (TPN) will be started
D) Serum lipase levels will be evaluated
The
correct answer is C: Total parenteral nutrition (TPN) will be started
The client is not absorbing nutrients adequately as evidenced by the
cachexia and low protein levels. (A normal total serum protein level is
6.0-8.0.) TPN will maintain a positive nitrogen balance in the client
who is unable to digest and absorb nutrients adequately.
14. The
nurse is teaching about nonsteroidal anti-inflammatory drugs to a group
of arthritic clients. To minimize the side effects, the nurse should
emphasize which of the following actions?
A) Reporting joint stiffness in the morning
B) Taking the medication 1 hour before or 2 hours after meals
C) Using alcohol in moderation unless driving
D) Continuing to take aspirin for short term relief
The
correct answer is B: Taking the medication 1 hour before or 2 hours
after meals Taking the medication 1 hour before or 2 hours after meals
will result in a more rapid effect.
15. Which approach is a priority for the nurse who works with clients from many different cultures?
A) Speak at least 2 other languages of clients in the neighborhood
B) Learn about the cultures of clients who are most often encountered
C) Have a list of persons for referral when interaction with these clients occur
D) Recognize personal attitudes about cultural differences and real or expected biases
E)
Your
response was "A". The correct answer is D: Recognize personal attitudes
about cultural differences and real or expected biases The nurse must
discover personal attitudes, prejudices and biases specific to different
cultures. Sensitivity to these will affect interactions with clients
and families across cultures.
16. A
35-year-old client of Puerto Rican-American descent is diagnosed with
ovarian cancer. The client states “I refuse both radiation and
chemotherapy because they are 'hot.'” The next action for the nurse to
take is to
The correct response is "D".
A) Document the situation in the notes
B) Report the situation to the health care provider
C) Talk with the client's family about the situation
D) Ask the client to talk about the concerns about the "hot" treatments
The
correct answer is D: Ask the client to talk about the concerns about
the "hot" treatments The "hot-cold" system is found among
Mexican-Americans, Puerto Ricans, and other Hispanic-Latinos. Most
foods, beverages, herbs, and medicines are categorized as hot or cold,
which are symbolic designations and do not necessarily indicate
temperature or spiciness. Care and treatment regimens can be negotiated
with clients within this framework.
17. During
a routine check-up, an insulin-dependent diabetic has his glycosylated
hemoglobin checked. The results indicate a level of 11%. Based on this
result, what teaching should the nurse emphasize?
a. Rotation of injection sites
b. Insulin mixing and preparation
c. Daily blood sugar monitoring
d. Regular high protein diet
The
correct answer is C: Daily blood sugar monitoring Normal hemoglobin A1C
(glycosylated hemoglobin) level is 7 to 9%. Elevation indicates
elevated glucose levels over time.
18. The nurse is assigned to care for 4 clients. Which of the following should be assessed immediately after hearing the report?
A) The client with asthma who is now ready for discharge
B) The client with a peptic ulcer who has been vomiting all night
C) The client with chronic renal failure returning from dialysis
D) The client with pancreatitis who was admitted yesterday
The
correct answer is B: The client with a peptic ulcer who has been
vomiting all night A perforated peptic ulcer could cause nausea,
vomiting and abdominal distention, and may be a life threatening
situation. The client should be assessed immediately and findings
reported to the health care provider
19. To
prevent drug resistance common to tubercle bacilli, the nurse is aware
that which of the following agents are usually added to drug therapy?
A) Anti-inflammatory agent
B) High doses of B complex vitamins
C) Aminoglycoside antibiotic
D) Two anti-tuberculosis drugs
The
correct answer is D: Two anti-tuberculosis drugs Resistance of the
tubercle bacilli often occurs to a single antimicrobial agent.
Therefore, therapy with multiple drugs over a long period of time helps
to ensure eradication of the organism.
20. While
assessing the vital signs in children, the nurse should know that the
apical heart rate is preferred until the radial pulse can be accurately
assessed at about what age?
A) 1 year of age
B) 2 years of age
C) 3 years of age
D) 4 years of age
The correct answer is B: 2 years of age A child should be at least 2 years of age to use the radial pulse to assess heart rate.
SOURCE: NCSBN
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