Nurse Moose
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    Exam Review

    1. Two hours before a client's scheduled surgery, the nurse is completing the preoperative checklist. Which information requires immediate action by the nurse? Reference Range: Potassium (3.5 to 5 mEq/L (3.5 to 5 mmol/L)]
      A)Preoperative chest x-ray report is not available.
      B)Preoperative serum potassium level is 2.8 mEq/L (2.8 mmol/L)
      C)Surgical consent form is not signed.
      D)Client's pulse oximeter reading is 96%.
    2. Patient Data Exhibits Choose the most likely options for the information missing from the statement(s) by selecting from the lists of options provided. The nurse recognizes that the client has ▾ Appendicitis as evidenced by ▾ computed tomography (CT) scan results and ▾ white blood cell count (WBC) .
      Dropdown 1:
      Option 1: Cholecystitis
      Option 2: Appendicitis
      Option 3: Gastroenteritis
      Dropdown 2:
      Option 1: fever
      Option 2: computed tomography (CT) scan results
      Option 3: nausea and vomiting
      Option 4: white blood cell count (WBC)
      Option 5: constipation
      Dropdown 3:
      Option 1: fever
      Option 2: computed tomography (CT) scan results
      Option 3: nausea and vomiting
      Option 4: white blood cell count (WBC)
      Option 5: constipation
    3. A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the nurse to report to the healthcare provider?
      A)Bile stained emesis.
      B)Radiating, sharp pain in right shoulder.
      C)Clay colored stool.
      D)Distended, hard, and rigid abdomen.
    4. An older adult client who experienced a cerebrovascular accident (CVA) has difficulty with visual perception and eats only half of the food on the meal tray. The client's family expresses concern about the client's nutritional status. How should the nurse respond to the family's concern?
      A)Demonstrate the use of visual scanning during meals to the client and family.
      B)Suggest that the family bring foods from home that the client enjoys eating.
      C)Explain that weight loss will be reversed after the acute phase of the stroke has ended.
      D)Encourage the family to offer to feed the client when she does not eat her entire meal.
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    Exam Review

    1. The nurse is obtaining the admission history for a client with suspected peptic ulcer disease (PUD). Which subjective data reported by the client supports this medical diagnosis?
      A)Upper midabdominal pain described as gnawing and burning
      B)Severe abdominal cramps and diarrhea after eating spicy foods.
      C)Marked loss of weight and appetite over the last 3 or 4 months
      D)Frequent use of chewable and liquid antacids for indigestion.
    2. A male client who had abdominal surgery 5 days ago, and hospitalized because of a surgical wound infection, tells the nurse that he feels like his insides just spilled out when he coughed. Which action should the nurse take first?
      A)Visualize the abdominal incision
      B)Obtain sterile towels soaked in saline.
      C)Assure the client that such feelings occur with wound infections.
      D)Notify the healthcare provider.
    3. Which client has the highest risk for developing skin cancer?
      A)A 70-year-old fair-skinned client who works as a secretary.
      B)A 25-year-old dark-skinned client whose mother had skin cancer.
      C)A 65-year-old fair-skinned client who is a construction worker.
      D)A 16-year-old dark-skinned client who tans in tanning beds once a week.
    4. A client with a gram positive bacterial skin infection is receiving daptomycin 500 mg IV every 24 hours. The pharmacy delivers a secondary infusion of 0.9% sodium chloride with daptomycin 500 mg/100 mL to be infused in 30 minutes. How many mL/hour should the nurse program the infusion pump? (Enter the numerical value only.)
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    Exam Review

    1. A client tells the clinic nurse about experiencing burning on urination, and assessment reveals that the client had sexual intercourse four days ago with a person who was a casual acquaintance. Which action should the nurse implement?
      A)Assess for perineal itching, erythema, and excoriation.
      B)Obtain a specimen of urethral drainage for culture.
      C)Observe the perineal area for a chancroid-like lesion.
      D)Identify all sexual partners in the last four days.
    2. When explaining dietary guidelines to a client with acute glomerulonephritis (AGN), which instruction should the nurse include in the dietary teaching?
      A)Select a protein-rich food daily.
      B)Eat high-potassium foods.
      C)Avoid foods high in carbohydrates.
      D)Restrict sodium intake.
    3. A client experiences an ABO incompatibility reaction after multiple blood transfusions. Which finding should the nurse report immediately to the healthcare provider?
      A)Arthritic joint changes and chronic pain,
      B)Lower back pain and hypotension.
      C)Acute rhinitis and nasal stuffiness.
      D)Delayed painful rash with urticaria.
    4. Patient Data Exhibits
      (Highlight — findings requiring follow-up are marked)

      Patient Data

      Exhibits
      Click to highlight the findings that require follow up

      Assessment

      Neurological: Alert and oriented. Agitated. Denies headaches.

      Cardiovascular: Reported chest pain described as pressure and tightness that is unrelieved with rest. Rapid regular rhythm. Normal heart tones. Radial and pedal pulses 2+. Capillary refill 2 seconds.

      Respiratory: Rapid and shallow breaths. Clear breath sounds throughout bilateral lungs

      Gastrointestinal: Within normal limits (WNL).

      Genitourinary: WNL

      Musculoskeletal: WNL

      Pain: Reported 7 on a 0 to 10 scale, tightness and pressure in chest. Started approximately 2 hours ago and got progressively worse, unrelieved by rest.

    Page 3 of 5

    Exam Review

    1. Patient Data Exhibits The healthcare provider places prescriptions for further diagnostics.Click to indicate if the listed symptoms are consistent with angina, myocardial infarction, or both. Each column must have at least one response option selected.
      Myocardial infarctionAngina
      Epigastric distress✓✓
      Occurring without cause✓
      Pain relived by nitroglycerin✓
      Pain only relieved by opioids✓
      Chest pain radiating down arm✓✓
      Feelings of fear✓✓
    2. Patient Data Exhibits Choose the most likely options for the information missing from the statement by selecting from the lists of options provided. The nurse determines that the client has ▾ new onset angina as evidenced by ST depression on electrocardiogram and normal ▾ troponin level level.
      Dropdown 1:
      Option 1: new onset angina
      Option 2: aortic aneurysm
      Option 3: myocardial infacrtion
      Dropdown 2:
      Option 1: Prothrombin time
      Option 2: INR
      Option 3: troponin level
    3. Exhibits The client was given oxygen, sublingual nitroglycerin, and aspirin. After one dose of nitroglycerin, the client's pain decreased to a reported 2 on a 0 to 10 scale with squeezing pain. The client was admitted for observation and percutaneous coronary intervention (PCI) to be completed later within the evening. The client asks the nurse to explain why a PCI is being completed. If healthcare providers see a narrowed heart vessel while performing a percutaneous coronary intervention (PCI), they may perform a balloon angioplasty to compress the plaque against the vessel wall and hold it there with a stent, which of the following will be lessened as a result.(SATA)
      A)pain
      B)dysrhythmias
      C)heart blocks
      D)vasospasms
    4. Exhibits The nurse has provided discharge teaching to the client to manage his chest pain at home. Which 2 statements from the client should the nurse recognize as a need for further education?(SATA)
      A)I will lie down or sit if I start to feel any chest discomfort.
      B)I will wear a medication alert bracelet to indicate my history of heart problems.
      C)I will wait 5 minutes after taking my nitroglycerin to see if the pain improves.
      D)I will keep my nitroglycerin tablets with me all the time.
      E)I will take the nitroglycerin 1 or 2 more times 10 minutes apart if pain does not get better.
      F)I will chew my nitroglycerin tabs as soon as pain begins.
      G)I will call 911 if there is no improvement in my chest pain after taking nitroglycerin.
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    Exam Review

    1. While performing a neurovascular assessment distal to a client's fracture site, the nurse determines that the client's pulse is present, regular, and full force. Which nursing action should be taken next?
      A)Notify the healthcare provider of assessment finding
      B)Document the neurovascular assessment as normal.
      C)Discontinue elevating the client's affected extremity.
      D)Observe the color of the extremity.
    2. A client with pernicious anemia takes supplemental folate and self-administers monthly vitamin B2 injections. The client reports feeling increasingly fatigued. Which laboratory value should the nurse review?
      A)Serum electrolytes.
      B)Platelet count.
      C)Complete blood count.
      D)Liver enzymes.
    3. A client with urolithiasis is preparing for discharge after lithotripsy. Which intervention should the nurse include in the client's postoperative discharge instructions?
      A)Report when hematuria becomes pink tinged.
      B)Use incentive spirometer.
      C)Monitor urinary stream for decrease in output.
      D)Restrict physical activities.
    4. A client with eczema is applying 10% urea cream onto the affected skin areas. Which finding reflects the expected therapeutic response?
      A)Hydration of affected dry skin areas.
      B)Reduced pain in eczematous areas.
      C)Healing with a return to normal skin appearance.
      D)Decreased weeping of ulcerations in affected areas.
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