Exam 2 Review NR 341

54 Questions

After the insertion of an arteriovenous graft in the right forearm, a patient reports pain and coldness of the right fingers. Which action should the nurse take? A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?

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Round 1

Question 1

After the insertion of an arteriovenous graft in the right forearm, a patient reports pain and coldness of the right fingers. Which action should the nurse take?

Report the patient’s symptoms to the health care provider.

Question 2

A patient admitted with acute kidney injury due to dehydration has oliguria, anemia, and hyperkalemia. Which prescribed action should the nurse take first?

Place the patient on a cardiac monitor.

Question 3

A patient who has acute glomerulonephritis is hospitalized with hyperkalemia. Which information will the nurse monitor to evaluate the effectiveness of the prescribed calcium gluconate IV?

Cardiac rhythm

Question 4

Which assessment finding should the nurse expect when a patient with acute kidney injury (AKI) has an arterial blood pH of 7.30?

Rapid, deep respirations

Question 5

Which action will the nurse include in the plan of care to maintain the patency of a patient’s left arm arteriovenous fistula?

Auscultate for a bruit at the fistula site.

Question 6

A 74-yr-old patient who is progressing to stage 5 chronic kidney disease asks the nurse, “Do you think I should go on dialysis?” Which initial response by the nurse is best?

“Tell me more about what you are thinking regarding dialysis.”

Question 7

During routine hemodialysis, a patient reports nausea and dizziness. Which action should the nurse take first?

Check the blood pressure (BP).

Question 8

A patient is hospitalized with acute kidney injury (AKI). Which information will be most useful to the nurse in evaluating improvement in kidney function?

Glomerular filtration rate (GFR)

Question 9

A patient who has had progressive chronic kidney disease (CKD) for several years has just begun regular hemodialysis. Which information about diet will the nurse include in patient teaching?

More protein is allowed because urea and creatinine are removed by dialysis.

Round 2

Question 1

A patient who has been in the intensive care unit for 4 days has disturbed sensory perception from sleep deprivation. Which action should the nurse include in the plan of care?

Cluster nursing activities so that the patient has uninterrupted rest periods.

Question 2

Which hemodynamic parameter best reflects the effectiveness of drugs that the nurse gives to reduce a patient’s left ventricular afterload?

Systemic vascular resistance (SVR)

Question 3

What action by a new intensive care unit staff nurse would indicate that the nurse educator’s teaching about arterial pressure monitoring has been effective?

Positions the zero-reference stopcock line level with the phlebostatic axis.

Question 4

Which nursing action is needed when preparing to assist with the insertion of a pulmonary artery catheter?

Attach cardiac monitoring leads before the procedure.

Question 5

What is the best initial action by the nurse to verify the correct placement of an oral endotracheal tube (ET) after insertion?

Use an end-tidal CO2 monitor.

Question 6

Which assessment finding by the nurse caring for a patient receiving mechanical ventilation indicates the need for suctioning?

The patient’s respiratory rate is 32 breaths/min.

Question 7

After surgery for an abdominal aortic aneurysm, a patient’s central venous pressure (CVP) monitor indicates low pressures. Which action should the nurse take?

Increase the IV fluid infusion per protocol.

Question 8

A 78-kg patient in septic shock has a pulse rate of 120 beats/min with low central venous pressure and pulmonary artery wedge pressure. After initial fluid volume resuscitation, the patient’s urine output has been 30 mL/hr for the past 3 hours. Which order by the health care provider should the nurse question?

Administer furosemide (Lasix) 40 mg IV.

Question 9

A patient with massive trauma and possible spinal cord injury is admitted to the emergency department (ED). Which assessment finding by the nurse will help confirm a diagnosis of neurogenic shock?

Heart rate 45 beats/min

Round 3

Question 1

A patient with cardiogenic shock has the following vital signs: BP 102/50, pulse 128, respirations 28. The pulmonary artery wedge pressure (PAWP) is high, and cardiac output is low. Which treatment would the nurse expect to be prescribed?

Furosemide

Question 2

The emergency department (ED) nurse receives report that a seriously injured patient involved in a motor vehicle crash is being transported to the facility with an estimated arrival in 5 minutes. What should the nurse obtain in preparation for the patient’s arrival?

A dopamine infusion

Question 3

A nurse is assessing a patient who is receiving a nitroprusside infusion to treat cardiogenic shock. Which finding indicates that the drug is effective?

Skin is warm and pink

Question 4

When the nurse educator is evaluating the skills of a new registered nurse (RN) caring for patients with shock, which action by the new RN indicates a need for more education?

Maintaining a cool room temperature for a patient with neurogenic shock

Question 5

The nurse is caring for a patient who has septic shock. Which assessment finding is most important for the nurse to report to the health care provider?

Skin cool and clammy

Question 6

A patient is admitted to the emergency department (ED) in shock of unknown etiology. What should be the nurse’s first action?

Administer supplemental oxygen.

Question 7

The following interventions are prescribed by the health care provider for a patient who has respiratory distress and syncope after eating strawberries. Which will the nurse complete first?

Administer epinephrine

Question 8

After a patient who has septic shock receives 2 L of normal saline intravenously, the central venous pressure is 10 mm Hg and the blood pressure is 82/40 mm Hg. What medication should the nurse anticipate?

Norepinephrine

Question 9

Which intervention will the nurse include in the plan of care for a patient who has cardiogenic shock?

Monitor breath sounds frequently.

Round 4

Question 1

Which assessment information is most important for the nurse to obtain when evaluating whether treatment of a patient with anaphylactic shock has been effective?

Oxygen saturation

Question 2

Which nursing action prevents cross contamination when the patient’s full-thickness burn wounds to the face are exposed?

Wearing gown, cap, mask, and gloves during care.

Question 3

A patient with burns covering 40% total body surface area (TBSA) is in the acute phase of burn treatment. Which snack would be best for the nurse to offer to this patient?

Vanilla milkshake

Question 4

A patient who has burns on the arms, legs, and chest from a house fire has become agitated and restless 8 hours after being admitted to the hospital. Which action should the nurse take first?

Use pulse oximetry to check oxygen saturation.

Question 5

A patient who was found unconscious in a burning house is brought to the emergency department by ambulance. The nurse notes that the patient’s skin color is bright red. Which action should the nurse take first?

Place the patient on 100% O2 using a nonrebreather mask.

Question 6

The emergency department (ED) triage nurse is assessing four victims involved in a motor vehicle collision. Which patient has the highest priority for treatment?

A patient with paradoxical chest motion

Question 7

Family members of a patient who has a traumatic brain injury ask the nurse about the purpose of the ventriculostomy system being used for intracranial pressure monitoring. Which response by the nurse is best for this situation?

“The monitoring system helps show whether blood flow to the brain is adequate.”

Question 8

Admission vital signs for a patient who has a brain injury are blood pressure of 128/68 mm Hg, pulse of 110 beats/min, and of respirations 26 breaths/min. Which set of vital signs, if taken 1 hour later, will be of most concern to the nurse?

Blood pressure 154/68 mm Hg, pulse 56 beats/min, respirations 12 breaths/min

Question 9

When a brain-injured patient responds to nail bed pressure with internal rotation, adduction, and flexion of the arms, how should the nurse report the response?

Decorticate posturing

Round 5

Question 1

The nurse has administered prescribed IV mannitol (Osmitrol) to an unconscious patient. Which parameter should the nurse monitor to determine the medication’s effectiveness?

Intracranial pressure

Question 2

A patient who is unconscious has ineffective cerebral tissue perfusion and cerebral tissue swelling. Which nursing intervention will be included in the plan of care?

Keep the head of the bed elevated to 30 degrees.

Question 3

To prevent autonomic dysreflexia, which nursing action should the home health nurse include in the plan of care for a patient who has paraplegia at the T4 level?

Assist to plan a prescribed bowel program.

Question 4

Which topic is most important to include in teaching for a 41-yr-old patient diagnosed with early alcoholic cirrhosis?

Avoiding all alcohol use

Question 5

A serum potassium level of 3.2 mEq/L (3.2 mmol/L) is reported for a patient with cirrhosis who has scheduled doses of spironolactone (Aldactone) and furosemide (Lasix) due. Which action should the nurse take?

Administer the spironolactone.

Question 6

What is most important for the nurse to monitor to detect possible complications in a patient with severe cirrhosis who has bleeding esophageal varices?

Ammonia levels

Question 7

A patient with cirrhosis has ascites and 4+ edema of the feet and legs. Which nursing action will be included in the plan of care?

Place the patient on a pressure-relief mattress.

Question 8

A patient who has cirrhosis and esophageal varices is being treated with propranolol (Inderal). Which finding is the best indicator to the nurse that the medication has been effective?

Stools test negative for occult blood.

Question 9

Which finding indicates to the nurse that demeclocycline is effective for a patient with syndrome of inappropriate antidiuretic hormone (SIADH)?

Urinary output is increased.

Round 6

Question 1

Which patient statement indicates to the nurse that additional instruction is needed for a patient with chronic syndrome of inappropriate antidiuretic hormone (SIADH)?

“I need to shop for foods low in sodium and avoid adding salt to food.”

Question 2

Which problem should the nurse anticipate for a patient admitted to the hospital with diabetes insipidus?

Disturbed sleep pattern

Question 3

Which nursing action will be included in the plan of care for a patient with Graves’ disease who has exophthalmos?

Elevate the head of the patient’s bed to reduce periorbital fluid.

Question 4

A patient is being admitted with a diagnosis of Cushing syndrome. Which finding will the nurse expect during the assessment?

Purplish streaks on the abdomen

Question 5

Which prescribed medication should the nurse expect will have rapid effects on a patient admitted to the emergency department in thyroid storm?

Propranolol (Inderal)

Question 6

The nurse admits a patient to the hospital in Addisonian crisis. Which patient statement supports the need to plan additional teaching?

“I had the flu earlier this week, so I couldn’t take the hydrocortisone.”

Question 7

An unresponsive patient who has type 2 diabetes is brought to the emergency department and diagnosed with hyperosmolar hyperglycemia syndrome (HHS). What should the nurse anticipate doing?

Inserting an IV catheter

Question 8

A 27-yr-old patient admitted with diabetic ketoacidosis (DKA) has a serum glucose level of 732 mg/dL and serum potassium level of 3.1 mEq/L. Which action prescribed by the health care provider should the nurse take first?

Place the patient on a cardiac monitor.

Question 9

The nurse has administered 4 oz of orange juice to an alert patient whose blood glucose was 62 mg/dL. Fifteen minutes later, the blood glucose is 67 mg/dL. Which action should the nurse take next?

Give the patient 4 to 6 oz more orange juice.

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