Complex Final!!!!!

Question 1

cardiogenic shock from heart attack, which medication will nurse anticipate preparing?SATA

Accepted Answer

dopamine, digoxin

Question 2

manifestations of right side stroke

Accepted Answer

left hemiparesis, left side neglect, behavioral changes, lack of impulse control

Question 3

nurse is caring for a pt who had subtotal thyroidectomy. which postop assessment is highest priority?

Accepted Answer

swallowing reflex

Question 4

which will the nurse anticipate following surgery for stage 1 esophageal cancer?

Accepted Answer

jejunal feeding tube

Question 5

S/S SIRS; NEED 2 OF 4

Accepted Answer

tachypnea, WBC, tachycardia, temp

Question 6

assessing chest tube drainage of pt w hemothorax following MVA. which findings are expected in normal chest tube systems

Accepted Answer

presence of an occlusive dressing over the insertion area, tidaling in the water-seal chamber with respirations

Question 7

pt has chest tube. nurse notices that the thoracic catheter has dislodged. what action would the nurse take next?

Accepted Answer

cover insertion site w petroleum jelly, apply firm pressure, notify HCP

Question 8

Which diabetes med is held for procedures with dye?

Accepted Answer

Metformin

Question 9

MI care

Accepted Answer

morphine, 12 lead ECG, cardiac enzyme, oxygen, aspirin, nitro

Question 10

care of pts w increased ICP

Accepted Answer

give osmotic diuretic (mannitol), headache, pupil changes, Causes; sneeze, cough, BM, straw, disorentation, irritable

Question 11

a nurse receives a client status post kidney transplatation. which clinical signs graft rejection will the nurse monitor

Accepted Answer

pain over grafted kidney, a 2-3lb weight gain in 24 hrs, edema, hypertension

Question 12

nurse is caring for pt w acute pancreatitis notices a caarpal spasm while assessing BP. which action will nurse do

Accepted Answer

call HCP for calcium level STAT

Question 13

care of pt with wound dehisced ; cover with towel

Accepted Answer

False

Question 14

nurse assessing pt w hx of cirrhosis and report abdomen enlarged by 3cm over 24hr.

Accepted Answer

muffled heart sounds

Question 15

a client w DM type 1 admitted with DKA ask nurse, what causes DKA to happen?nurse correctly explains which common causes

Accepted Answer

personal stress, such as starting college, having a recent stomach virus, a recent, serious infection

Question 16

ambulance brings pt w multiple bee stings. exhibiting dyspnea, hives, hypotension. implement what as priority?

Accepted Answer

epinephrine

Question 17

a pt is admitted for acute pancreatitis. which symptoms will the nurse expect the client to demonsrate?

Accepted Answer

abdominal pain with radiation to the back

Question 18

the nurse is caring for pt in ICU for DKA. which 3 priority tx are critical during DKA?

Accepted Answer

fluid replacement, insulin therapy, electrolyte correction

Question 19

nurse caring for a postop pt 24hr after partial thyroidectomy for persistent hyperthyroidism. what do u report to dr?

Accepted Answer

change in temp 99F to 100.2F

Question 20

pt on rehab unit goes to hemodialysis for 4 hr. after dialysis, temp is 100.3F. what is the appropriate action?

Accepted Answer

continue to monitor since this is normal

Question 21

IRON

Accepted Answer

can make poop black, constipation can occur, take with vitamin c

Question 22

care of post op CABG

Accepted Answer

DVT prevention, monitor for dysrhthmias, incentive spirometer, pain management, assess bleeding and fluid status. replace electrolytes prn

Question 23

while

Accepted Answer

use skin marker to identify borders of the redness and continue to monitor

Question 24

spinal cord injury is related to what shock

Accepted Answer

neurogenic

Question 25

which steps help to manage infection control w PICC line dressing change? SATA

Accepted Answer

don sterile gloves after removing previous dressing, use alcohol sponge to clean skin around statlock, scrub skin w chlorhexidine using sterile guaze to hold the line in place, ensure client and nurse wear a mask prior to beginning the dressing change

Question 26

compensated shock has normal vitals, but decrerased LOC and urine output

Accepted Answer

True

Question 27

manifestations of left sided stroke

Accepted Answer

right hemiparesis, right side neglect, dysphagia, reading or writing problems

Question 28

care of pt with a fracture

Accepted Answer

neuro checks

Question 29

mass casualty priority patients are yellow

Accepted Answer

False

Question 30

medications for patients on a vent?

Accepted Answer

propofol, sedatives, paralytics, pancuronium

Question 31

T5 spinal cord injury from car wreck. which vital signs should nurse expect?

Accepted Answer

HR 50, RR 32, BP 78/45

Question 32

Spinal Cord injury s/s; increased BP RR, flushed, diaphoretic

Accepted Answer

True

Question 33

you dont need to monitor bleeding for thrombocytopenia

Accepted Answer

False

Question 34

nurse performing discharge teach to a pt diagnosed w acute pancreatitis. which symptom should client report to HCP

Accepted Answer

clay-colored stools

Question 35

nurse explains to pt which medical history places the client at an increased risk for esophageal cancer?

Accepted Answer

tobacco and alcohol use, GERD, human papillomaviruse, Barrett&#x27;s esophagus

Question 36

which of te following treat cholecystitis? SATA

Accepted Answer

laparoscopic cholecystectomy., lithotripsy, open cholecystectomy

Question 37

nurse is assessing HCP in removal of chest tube. how will nurse instruct client during the procedure?

Accepted Answer

hold beath and bear down as tube is being removed to keep air from entering

Question 38

why should PICC line be changed every 7 days and PRN?

Accepted Answer

client is at high risk for infection at insertion site

Question 39

pt brought in for smoke inhalation d/t house fire. nurse will monitor for what signs of acute resp distress syndrome?

Accepted Answer

low oxygen sat w oxygen delivery at 80% FiO2, tachypnea and use of accessory muscles, bluish nailbeds and restlessness

Question 40

which client is at the highest risk for pancreatitis?

Accepted Answer

35yo male with long-standing alcohol abuse

Question 41

:(

Accepted Answer

A

Question 42

pt admitted w angina. spouse expresses understanding of condition when nurse overhears family making which statement

Accepted Answer

the heart valve is blocked and causing pain in his heart

Question 43

dc ed on fluid balance monitoring to client w new diagnosis of right side HF. nurse will stress which priority instruct

Accepted Answer

weigh daily, same time, similiar clothes

Question 44

client questions the nure abt his famotidine for peptic ulcers. which statement by nurses appropriately explains the med

Accepted Answer

famotidine works by decreasing stomach acid production

Question 45

pt in vfib; dont dfib

Accepted Answer

False

Question 46

TPA can be given 3 to 4.5 hr after s/s start

Accepted Answer

True

Question 47

42F arrives in ED w RUQ pain radiating to R shoulder, chills, tachycardia, vomiting. nurse suspects what condition?

Accepted Answer

cholecystitis

Question 48

Nurse is scheduling client for cardiac cath. client has T2 DM & takes metformin. what action will nurse take prior?

Accepted Answer

hold metformin 24 hr before and 48 hr after procedure

Question 49

assess elderly admit for chronic heart failure. spouse ask primary cause for HF, nurse responds that it maybe caused by

Accepted Answer

atherosclerosis

Question 50

home care nurse observe pt levothyroxine has 20 extra doses. what findings would be most consistent underuse of levothy

Accepted Answer

constipation and fatigue, feeling cold and depressed

Question 51

client has ascites & finds the client has abdominal girth has increased 7cm in 3 days. what reasons for increased size?

Accepted Answer

liver unable to synthesize albumin&decreased colloid oncoticpressure occurs, blood proteins are pushed out of the blood vessel, causing leakage, hyperaldosteronism increase sodium and fluid retention

Question 52

caring for older pt w extreme weak, dizziness, orthopnea. HF diagnose confirmed. which tests is helpful in confirming HF

Accepted Answer

brain natriuretic peptide (BNP)

Question 53

assess on pt w hx of cardio disease, DM, hypertn, hypothyroid. experiencing exhaustion, short ambu, 5lb wt gain. 4+edema

Accepted Answer

right-side heart failure

Question 54

unstable angina; relieved with rest

Accepted Answer

False

Question 55

What do you say to a patient when extubated?

Accepted Answer

relax and don&#x27;t talk

Question 56

Ulcerative Colitis pts; keep electrolytes balanced, bland foods, BRAT diet, rest bowel

Accepted Answer

True

Question 57

care for a client w admit diagnose of right side HF. which assessment finding is most consistent w diagnosis?

Accepted Answer

distended neck veins

Question 58

full thick burns to front&back of both legs,back of R arm,anterior trunk.pt weight 63kg.how much IV fluids first 24hr

Accepted Answer

14,742 mL

Question 59

ED pt w full thickness burns covering hands, arms, and front trunk. what is the client&#x27;s total body surface area(TBSA)

Accepted Answer

36%

Question 60

underwent thyroidectomy w removal of parathyroid tissue. twitches and spasms along L lateral facial area. what adverse?

Accepted Answer

hypocalcemia

Question 61

MODS is evidence of 2 or more organs failing

Accepted Answer

True

Question 62

pt on tele unit w complaints of increasing SOB, pink tinged frothy sputum. hx of left side HF. s/s of which health prob

Accepted Answer

acute pulmonary edema

Question 63

nurse is caring for pt w pneumothorax and observes continous bubbling in water seal chamber. which action by nurse best

Accepted Answer

notify HCP

Question 64

complications of emboli stroke is Afib

Accepted Answer

True

Complex Final!!!!!

Questions 77

Complex Final!!!!!

Questions 77