Medications
The nurse identifies which patient as being at highest risk for slow drug metabolism?
A. A 2-year-old boy who is prescribed an oral antibiotic
B. A 14-year-old girl who takes four prescription drugs
C. A 56-year-old man who has chronic hepatic disease
D. A 76-year-old woman who has an elevated temperature
The nurse assesses clients' breath sounds. Which one requires immediate medical attention? A client who has:
1) Crackles
2) Rhonchi
3) Stridor
4) Wheezes
What is Stridor?
A male client is admitted to the hospital with blunt chest trauma after a motor vehicle accident. The first nursing priority for this client would be to:
A. Assess the client's airway
B. Provide pain relief
C. Encourage deep breathing and coughing
D. Splint the chest wall with a pillow
A. Assess the client's airway
Lab measuring Coumadin dosing
A client is admitted to the psychiatric unit with active psychosis. The physician diagnoses schizophrenia after ruling out several other conditions. Schizophrenia is characterized by:
C. Disturbances in affect, perception, and thought content and form
The provider verbally orders a heparin drip without realizing the patient was allergic to heparin. What medication should the nurse suggest as an alternative?
The nurse is assessing an African American client diagnosed with sickle cell crisis. Which assessment datum is most pertinent when assessing for cyanosis in clients with dark skin?
1. Assess the client's oral mucosa.
2. Assess the client's metatarsals.
3. Assess the client's capillary refill time.
4. Assess the sclera of the client's eyes.
A. Assess the client's oral mucosa
blood test that measure the clot formation and lysis that results from the degradation of fibrin
D-Dimer
The nurse and an unlicensed assistive personnel (UAP) are caring for clients on an oncology floor. Which nursing task would be delegated to the UAP?
1. Assess the urine output on a client who has had a blood transfusion reaction.
2. Take the first 15 minutes of vital signs on a client receiving a unit of PRBCs.
3. Auscultate the lung sounds of a client prior to a transfusion.
4. Assist a client who received 10 units of platelets in brushing the teeth.
4. Assist a client who received 10 units of platelets in brushing the teeth
Oral iron supplements are prescribed for a 6-year-old child with iron deficiency anemia. The nurse instructs the mother to administer the iron with which best food item?
1. Milk
2. Water
3. Apple juice
4. Orange juice
What is Orange Juice?
Signs and symptoms of a stroke
BEFAST
27. The client is scheduled for a right femoral
cardiac catheterization. Which nursing
intervention should the nurse implement after
the procedure?
1. Perform passive range-of-motion exercises.
2. Assess the client's neurovascular status.
3. Keep the client in high Fowler's position.
4. Assess the gag reflex prior to feeding the
client.
2. Assess the client's neurovascular status
The nurse checks the laboratory result for a serum digoxin level that was prescribed for a client earlier in the day and notes that the result is 2.4 ng/mL. The nurse should take which immediate action?
1. Check the client's last pulse rate
2. Notify the health care provider
3. Record the normal value on the client's flow sheet
4. Administer the next dose of the medication as scheduled
2. Notify healthcare provider
The HCP orders two (2) units of blood to be administered over eight (8) hours each for a client diagnosed with heart failure. Which intervention(s) should the nurse take?
1. Call the HCP to question the order because blood must infuse within four
(4) hours.
2. Retrieve the blood from the laboratory and run each unit at an eight (8)-hour rate.
3. Notify the lab to split each unit into half-units and infuse each half for four
(4) hours.
4. Infuse each unit for four (4) hours, the maximum rate for a unit of blood.
3. Notify the lab to split each unit into half-units and infuse each half for four
(4) hours.
A nurse is caring for a client after thyroidectomy and notes that calcium gluconate is prescribed for the client. The nurse determines that this medication has been prescribed to:
1. Treat thyroid storm.
2. Prevent cardiac irritability.
3. Treat hypocalcemic tetany.
4. Stimulate the release of parathyroid hormone.
An 76-year old female client comes in the Emergency Department complaining of shortness of breath. When listening to the client's lungs, the nurse hears crackles during inspiration. What conditions might cause the nurse to hear crackles upon auscultation? Select all that apply.
A) Acute respiratory distress syndrome (ARDS)
B) Asthma
C) Pneumonia
D) Pulmonary edema
E) Pectus Carinatum
ACD
ARDS, PNA, Pulmonary Edema
A client arrives in the emergency department with an ischemic stroke and receives tissue plasminogen activator (t-PA) administration. Which is the priority nursing assessment?
A. Time of onset of current stroke
The nurse notices the following labs on their patient and concludes may have what disease process?
WBC 14
BG 355
K 3.7
7Na 143
Anion Gap 17
CO2V 14
Phos 2.5
Mag 1.6
What is diabetic ketoacidosis?
When a client abuses a CNS depressant, withdrawal symptoms will be caused by which of the following?
D. Norepenephrine rebound
A nurse is reinforcing teaching for a client regarding how to mix regular insulin and NPH insulin in the same syringe. Which of the following actions, if performed by the client, indicates the need for further teaching?
1. Withdraws the NPH insulin first
2. Withdraws the regular insulin first
3. Injects air into NPH insulin vial first
4. Injects an amount of air equal to the desired dose of insulin into the vial
1. Withdraws the NPH insulin first
uestion 2:
The client diagnosed with peptic ulcer disease has a blood pressure of 88/42, an apical pulse of 132, and respirations are 28. The nurse writes the nursing diagnosis “altered tissue perfusion related to decreased circulatory volume.” Which intervention should the nurse implement first?
1. Notify the laboratory to draw a type & crossmatch.
2. Assess the client’s abdomen for tenderness.
3. Insert an 18-gauge catheter and infuse lactated Ringer’s.
4. Check the client’s pulse oximeter reading.
3. Insert 18 gauge catheter and infuse lactated ringers
It appears your patient has bradycardia. His heart rate appears as low as 38. What is the priority interventions for the nurse?
1. Give atropine
2. Assess patient
3. Call a rapid
4. Obtain ECG
Which blood lab value would the nurse anticipate when providing care for a client who is diagnosed with liver disease? Select all that apply.
ALT 54 IU/L
Ammonia 75 mcg/dL.
AST 200 IU/L.
Bilirubin 30 mg/dL.
Prothrombin (PT) time 21 seconds.
Ammonia
AST
Bilirubin
PT