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Nurs lab 1
RN
| Question | Answer |
|---|---|
| Which individual is at greatest risk for developing hypertension? | A. 45-year-old African-American attorney B. 60-year-old Asian-American shop owned C. 40-year-old Caucasian nurse D. 55-year-old Hispanic teacher |
| A 15-year-old female who ingested 15 tablets of maximum strength acetaminophen 45 minutes ago is rushed to the emergency department. Which of these orders should the nurse do first? | A. Gastric lavage B. Administer acetylcysteine (Mucomyst) orally C. Start an IV Dextrose 5% with 0.33% normal saline to keep the vein open D. Have the patient drink activated charcoal mixed with water |
| Which complication of cardiac catheterization should the nurse monitor for in the initial 24 hours after the procedure? | A. Angina at rest B. Thrombus formation C. Dizziness D. Falling blood pressure |
| A client is admitted to the emergency room with renal calculi and is complaining of moderate to severe flank pain and nausea. The client’s temperature is 100.8 degrees Fahrenheit. The priority nursing goal for this client is | A. Maintain fluid and electrolyte balance B. Control nausea C. Manage pain D. Prevent urinary tract infection |
| What would the nurse expect to see while assessing the growth of children during their school age years? | A. Decreasing amounts of body fat and muscle mass B. Little change in body appearance from year to year C. Progressive height increase of 4 inches each year D. Yearly weight gain of about 5.5 pounds per year |
| At a community health fair, the blood pressure of a 62-year-old client is 160/96 mmHg. The client states “My blood pressure is usually much lower.” The nurse should tell the client to: | A. Go get a blood pressure check within the next 15 minutes B. Check blood pressure again in two (2) months C. See the healthcare provider immediately D. Visit the health care provider within one (1) week for a BP check |
| The hospital has sounded the call for a disaster drill on the evening shift. Which of these clients would the nurse put first on the list to be discharged in order to make a room available for a new admission? | A. A middle-aged client with a history of being ventilator dependent for over seven (7) years and admitted with bacterial pneumonia five days ago. B. A young adult with diabetes mellitus Type 2 for over ten (10) |
| (10) years and admitted with antibiotic-induced diarrhea 24 hours ago. C. An elderly client with a history of hypertension, hypercholesterolemia, and lupus, and was admitted with Stevens-Johnson syndrome that morni | |
| D. An adolescent with a positive HIV test and admitted for acute cellulitis of the lower leg 48 hours ago. | |
| A 25-year-old male client has been newly diagnosed with hypothyroidism and will take levothyroxine (Synthroid) 50 mcg/day by mouth. As part of the teaching plan, the nurse emphasizes that this medication: | A. Should be taken in the morning B. May decrease the client’s energy level C. Must be stored in a dark container D. Will decrease the client’s heart rate |
| A 3 -year-old child was brought to the pediatric clinic after the sudden onset of findings that include irritability, thick muffled voice, croaking on inspiration, hot to touch, sit leaning forward, tongue open next slide | A. Prepare the child for X-ray of upper airways B. Examine the child’s throat C. Collect a sputum specimen D. Notify the healthcare provider of the child’s status |
| protruding, drooling and suprasternal retractions. What should the nurse do first? | |
| In children suspected to have a diagnosis of diabetes, which one of the following complaints would be most likely to prompt parents to take their school-age child for evaluation? | A. Polyphagia B. Dehydration C. Bedwetting D. Weight loss |
| A client comes to the clinic for treatment of recurrent pelvic inflammatory disease. The nurse recognizes that this condition most frequently follows which type of infection? | A. Trichomoniasis B. Chlamydia C. Staphylococcus D. Streptococcus |
| A registered nurse who usually works in a spinal rehabilitation unit is floated to the emergency department. Which of these clients should the charge nurse assign to this RN? | A. middle-aged client who says “I took too many diet pills” and “my heart feels like it is racing out of my chest.” B. A young adult who says “I hear songs from heaven. I need money for beer. I quit drinking two 2 days ago for my family. |
| (2) days ago for my family. Why are my arms and legs jerking?” C. An adolescent who has been on pain medications terminal cancer with an initial assessment finding pupils and a relaxed respiratory rate of 11, | |
| D. An elderly client who reports having taken a “large crack hit” 10 minutes prior to walking into the emergency room. | |
| When teaching a client with coronary artery disease about nutrition, the nurse should emphasize: | A. Eating three (3) balanced meals a day B. Adding complex carbohydrates C. Avoiding very heavy meals D. Limiting sodium to 7 gms per day |
| Which of these findings indicate that a pump to deliver a basal rate of 10 ml per hour plus PRN for pain breakthrough for morphine drip is not working? | A. The client complains of discomfort at the IV insertion site B. The client states “I just can’t get relief from my pain.” C. The level of drug is 100 ml at 8 AM and is 80 ml at noon D. The level of the drug is 100 ml at 8 AM and is 50 ml at nun |
| The nurse is speaking at a community meeting about personal responsibility for health promotion. A participant asks about chiropractic treatment for illnesses. What should be the focus of the nurse’s response? | A. Electrical energy fields B. Spinal column manipulation C. Mind-body balance D. Exercise of joints |
| The nurse is performing a neurological assessment on a client post right cerebrovascular accident. Which finding, if observed by the nurse, would warrant immediate attention? | A. Decrease in level of consciousness B. Loss of bladder control C. Altered sensation to stimuli D. Emotional lability |
| A child who has recently been diagnosed with cystic fibrosis is in a pediatric clinic where a nurse is performing an assessment. Which later finding of this disease would the nurse not expect to see at this time? | A. Positive sweat test B. Bulky greasy stools C. Moist, productive cough D. Meconium ileus |
| The home health nurse visits a male client to provide wound care and finds the client lethargic and confused. His wife states he fell down the stairs two (2) hours ago. The nurse should | A. Place a call to the client’s health care provider for instructions B. Send him to the emergency room for evaluation C. Reassure the client’s wife that the symptoms are transient D. Instruct the client’s wife to call the doctor if his symptom bc w |
| Which of the following should the nurse implement to prepare a client for a KUB (Kidney, Ureter, Bladder) radiography test? | A. Client must be NPO before the examination B. Enema to be administered prior to the examination C. Medicate client with furosemide 20 mg IV 30 minutes prior to the examination D. No special orders are necessary for this examination |
| The nurse is giving discharge teaching to a client seven (7) days post myocardial infarction. He asks the nurse why he must wait six (6) weeks before having sexual intercourse. What is the best response by the nurse to this question? | A. “You need to regain your strength before attempting such exertion.” B. “When you can climb 2 flights of stairs without problems, it is generally safe.” C. “Have a glass of wine to relax you, then you can try to have sex.” D. “If you can |
| maintain an active walking program, you will have less risk.” | |
| A triage nurse has these four (4) clients arrive in the emergency department within 15 minutes. Which client should the triage nurse send back to be seen first? | A. A 2-month-old infant with a history of rolling off the bed and has bulging fontanelle with crying B. A teenager who got a singed beard while camping C. An elderly client with complaints of frequent liquid brown colored stools D. A middle-aged |
| client with intermittent pain behind the right scapula | |
| While planning care for a toddler, the nurse teaches the parents about the expected developmental changes for this age. Which statement by the mother shows that she understands the child’s developmental needs? | A. “I want to protect my child from any falls.” B. “I will set limits on exploring the house.” C. “I understand the need to use those new skills.” D. “I intend to keep control over our child.” |
| The nurse is preparing to administer an enteral feeding to a client via a nasogastric feeding tube. The most important action of the nurse is: | A. Verify correct placement of the tube B. Check that the feeding solution matches the dietary order C. Aspirate abdominal contents to determine the amount of last feeding remaining in stomach D. Ensure that feeding solution is at room temperature |
| The nurse is caring for a client with a serum potassium level of 3.5 mEq/L. The client is placed on a cardiac monitor and receives 40 mEq potassium chloride in 1000 ml of 5% dextrose in water IV. Which of the following EKG patterns indicates to | A. Narrowed QRS complex B. Shortened “PR” interval C. Tall peaked “T” waves D. Prominent “U” waves |
| to the nurse that the infusions should be discontinued? | |
| A nurse prepares to care for a 4-year-old newly admitted for rhabdomyosarcoma. The nurse should alert the staff to pay more attention to the function of which area of the body? | A. All striated muscles B. The cerebellum C. The kidneys D. The leg bones |
| During an assessment of a client with cardiomyopathy, the nurse finds that the systolic blood pressure has decreased from 145 to 110 mm Hg and the heart rate has risen from 72 to 96 beats per minute and the client complains of period | A. Increase fluids that are high in protein B. Restrict fluids C. Force fluids and reassess blood pressure D. Limit fluids to non-caffeine beverages |
| periodic dizzy spells. The nurse instructs the client to: | |
| The nurse prepares the client for insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client th | A. Stroke volume B. Cardiac output C. Venous pressure D. Left ventricular functioning |
| A nurse enters a client’s room to discover that the client has no pulse or respirations. After calling for help, the first action the nurse should take is: | A. Start a peripheral IV B. Initiate high-quality chest compressions C. Establish an airway D. Obtain the crash cart |
| A client is receiving digoxin (Lanoxin) 0.25 mg daily. The health care provider has written a new order to give metoprolol (Lopressor) 25 mg B.I.D. In assessing the client prior to administering the medications, which of the | |
| which of the following should the nurse report immediately to the health care provider? | A. Blood pressure 94/60 mm Hg B. Heart rate 76 bpm C. Urine output 50 ml/hour D. Respiratory rate 16 bpm |
| While assessing a one-month-old infant, which of the findings warrants further investigation by the nurse? Select all that apply. | A. Abdominal respirations B. Irregular breathing rate C. Inspiratory grunt D. Increased heart rate with crying E. Nasal flaring F. Cyanosis G. Asymmetric chest movement |
| The nurse practicing in a maternity setting recognizes that the postmature fetus is at risk due to: | A. Excessive fetal weight B. Low blood sugar levels C. Depletion of subcutaneous fat D. Progressive placental insufficiency |
| The nurse is caring for a client who had a total hip replacement seven (7) days ago. Which statement by the client requires the nurse’s immediate attention? | A. I have bad muscle spasms in my lower leg of the affected extremity. B. “I just can’t ‘catch my breath’ over the past few minutes and I think I am in grave danger.” C. “I have to use the bedpan to pass my water at least every 1 to 2 hours.” |
| D. “It seems that the pain medication is not working as well today.” | |
| A 33-year-old male client with heart failure has been taking furosemide for the past week. Which of the following assessment cues below may indicate the client is experiencing a negative side effect from the medication? | A. Weight gain of 5 pounds B. Edema of the ankles C. Gastric irritability D. Decreased appetite |
| The nurse is caring for a 27-year-old female client with venous stasis ulcer. Which nursing intervention would be most effective in promoting healing? | A. Apply dressing using sterile technique B. Improve the client’s nutrition status C. Initiate limb compression therapy D. Begin proteolytic debridement |
| A nurse is to administer meperidine hydrochloride (Demerol) 100 mg, atropine sulfate (Atropisol) 0.4 mg, and promethazine hydrochloride (Phenergan) 50 mg IM to a preoperative client. List the order in which the nurse must carry out the | 1. Have the client empty bladder 2. Instruct the client to remain in bed 3. Raise the side rails on the bed 4. Place the call bell within reach |
| carry out the following actions prior to the administration of preoperative medications. | |
| Which of these statements best describes the characteristics of an effective reward-feedback system? | A. Specific feedback is given as close to the event as possible B. Staff is given feedback in equal amounts over time C. Positive statements are to precede a negative statement D. Performance goals should be higher than what is attainable |
| The nurse is providing information to a client with multiple sclerosis on performing exercises and physical activities. The nurse determines the client needs additional teaching if the client makes which statements? Select all that apply. | A. “I can lift weights and do resistance training.” B. “I should exercise to the point of exhaustion.” C. “I can include aerobic exercises in my routine.” D. “Proper stretching should be done before starting my routine.” |
| E. “I should exercise continuously without rest.” | |
| During the evaluation of the quality of home care for a client with Alzheimer’s disease, the priority for the nurse is to reinforce which statement by a family member? | A. “At least two (2) full meals a day are eaten.” B. “We go to a group discussion every week at our community center.” C. “We have safety bars installed in the bathroom and have 24-hour alarms on the doors.” |
| D. “The medication is not a problem to have it taken three (3) times a day.” | |
| A nurse is reviewing a patient’s medication during shift change. Which of the following medications would be contraindicated if the patient were pregnant? Select all that apply. | A. Warfarin (Coumadin) B. Finasteride (Propecia, Proscar) C. Celecoxib (Celebrex) D. Clonidine (Catapres) E. Transdermal nicotine (Habitrol) F. Clofazimine(Lamprene) |
| A patient tells you that her urine is starting to look discolored. If you believe this change is due to medication, which of the following of the patient’s medication does not cause urine discoloration? | A. Sulfasalazine B. Levodopa C. Phenolphthalein D. Aspirin |
| You are responsible for reviewing the nursing unit’s refrigerator. Which of the following drugs, if found inside the fridge, should be removed? | A. Nadolol (Corgard) B. Opened (in-use) Humulin N injection C. Urokinase (Kinlytic) D. Epoetin alfa IV (Epogen) |
| A 34-year-old female has recently been diagnosed with an autoimmune disease. She has also recently discovered that she is pregnant. Which of the following is the only immunoglobulin that will provide protection to the fetus in the womb? | A. IgA B. IgD C. IgE D. IgG |
| A second-year nursing student has just suffered a needlestick while working with a patient that is positive for AIDS. Which of the following is the most significant action that the nursing student should take? | A. Immediately see a social worker B. Start prophylactic AZT treatment C. Start prophylactic Pentamidine treatment D. Seek counseling |
| A thirty-five-year-old male has been an insulin-dependent diabetic for five years and now is unable to urinate. Which of the following would you most likely suspect? | A. Atherosclerosis B. Diabetic nephropathy C. Autonomic neuropathy D. Somatic neuropathy |
| You are taking the history of a 14-year-old girl who has a (BMI) of 18. The girl reports inability to eat, induced vomiting and severe constipation. Which of the following would you most likely suspect? | A. Multiple sclerosis B. Anorexia nervosa C. Bulimia nervosa D. Systemic sclerosis |
| A 24-year-old female is admitted to the ER for confusion. This patient has a history of a myeloma diagnosis, constipation, intense abdominal pain, and polyuria. Based on the presenting signs and symptoms, which of the following would you most likely s | A. Diverticulosis B. Hypercalcemia C. Hypocalcemia D. Irritable bowel syndrome |
| Rhogam is most often used to treat____ mothers that have a ____ infant. | A. RH positive, RH positive B. RH positive, RH negative C. RH negative, RH positive D. RH negative, RH negative |
| A new mother has some questions about phenylketonuria (PKU). Which of the following statements made by a nurse is not correct regarding PKU? | A. A Guthrie test can check the necessary lab values. B. The urine has a high concentration of phenylpyruvic acid C. Mental deficits are often present with PKU D. The effects of PKU are reversible |
| A patient has taken an overdose of aspirin. Which of the following should a nurse must closely monitor during acute management of this patient? | A. Onset of pulmonary edema B. Metabolic alkalosis C. Respiratory alkalosis D. Parkinson’s disease type symptoms |
| A 50-year-old blind and deaf patient has been admitted to your floor. As the charge nurse, your primary responsibility for this patient is? | A. Let others know about the patient’s deficits. B. Communicate with your supervisor your patient safety concerns. C. Continuously update the patient on the social environment. D. Provide a secure environment for the patient. |
| A patient is getting discharged from a skilled nursing facility (SNF). The patient has a history of severe COPD and PVD. The patient is primarily concerned about his ability to breathe easily. Which of the following would be the best instruction for pati | A. Deep breathing techniques to increase oxygen levels. B. Cough regularly and deeply to clear airway passages. C. Cough following bronchodilator utilization. D. Decrease CO2 levels by increased oxygen take output during meals. |
| A nurse is caring for an infant that has recently been diagnosed with a congenital heart defect. Which of the following clinical signs would most likely be present? | A. Slow pulse rate B. Weight gain C. Decreased systolic pressure D. Irregular WBC lab values |
| A mother has recently been informed that her child has Down’s syndrome. You will be assigned to care for the child at shift change. Which of the following characteristics is not associated with Down’s syndrome? | A. Simian crease B. Brachycephaly C. Oily skin D. Hypotonicity |
| A patient asks a nurse, “My doctor recommended I increase my intake of folic acid. What type of foods contain the highest concentration of folic acids?” | A. Green vegetables and liver B. Yellow vegetables and red meat C. Carrots D. Milk |
| A nurse is putting together a presentation on meningitis. Which of the following microorganisms has not been linked to meningitis in humans? | A. S. pneumoniae B. H. influenzae C. N. meningitidis D. Cl. difficile |
| A nurse is administering blood to a patient who has a low hemoglobin count. The patient asks how long do red blood cells live in my body? The correct response is: | A. The life span of RBC is 45 days B. The life span of RBC is 60 days C. The life span of RBC is 90 days D. The life span of RBC is 120 days |
| A 65-year-old man has been admitted to the hospital for spinal stenosis surgery. When should the discharge training and planning begin for this patient? | A. Following surgery B. Upon admission C. Within 48 hours of discharge D. Preoperative discussion |
| A 5-year-old child and has been recently admitted to the hospital. According to Erik Erikson’s psychosocial development stages, the child is in which stage? | A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame and doubt D. Intimacy vs. isolation |
| A toddler is 26 months old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the toddler in? | A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame and doubt D. Intimacy vs. isolation |
| A young adult is 20 years old and has been recently admitted to the hospital. According to Erikson, which of the following stages is the adult in? | A. Trust vs. mistrust B. Initiative vs. guilt C. Autonomy vs. shame D. Intimacy vs. isolation |
| A nurse is making rounds taking vital signs. Which of the following vital signs is abnormal? | A. 11-year-old male: 90 BPM, 22 RPM, 100/70 mmHg B. 13-year-old female: 105 BPM, 22 RPM, 105/50 mmHg C. 5-year-old male: 102 BPM, 24 RPM, 90/65 mmHg D. 6-year-old female: 100 BPM, 26 RPM, 90/70 mmHg |
| When you are taking a patient’s history, she tells you she has been depressed and is dealing with an anxiety disorder. Which of the following medications would the patient most likely be taking? | A. Amitriptyline (Elavil) B. Calcitonin C. Pergolide mesylate (Permax) D. Verapamil (Calan) |
| Which of the following conditions would a nurse not administer erythromycin? | A. Campylobacteriosis infection B. Legionnaires disease C. Pneumonia D. Multiple Sclerosis |
| A patient’s chart indicates a history of hyperkalemia. Which of the following would you not expect to see with this patient if this condition were acute? | A. Decreased HR B. Paresthesias C. Muscle weakness of the extremities D. Migraines |
| A patient’s chart indicates a history of ketoacidosis. Which of the following would you not expect to see with this patient if this condition were acute? | A. Vomiting B. Extreme Thirst C. Weight gain D. Acetone breath smell |
| A patient’s chart indicates a history of meningitis. Which of the following would you NOT expect to see with this patient if this condition were acute? | A. Increased appetite B. Vomiting C. Fever D. Poor tolerance of light |
| A nurse is reviewing a patient’s chart and notices that the patient suffers from conjunctivitis. Which of the following microorganisms is related to this condition? | A. Yersinia pestis B. Helicobacter pylori C. Vibrio cholerae D. Haemophilus aegyptius |
| A nurse is reviewing a patient’s chart and notices that the patient suffers from Lyme disease. Which of the following microorganisms is related to this condition? | A. Borrelia burgdorferi B. Streptococcus pyogenes C. Bacillus anthracis D. Enterococcus faecalis |
| A fragile 87-year-old female has recently been admitted to the hospital with increased confusion and falls over the last two (2) weeks. She is also noted to have a mild left hemiparesis. Which of the following tests is most likely to be performed? | A. CBC (Complete blood count) B. ECG (electrocardiogram) C. Thyroid function tests D. CT scan |
| An 85-year-old male has been losing mobility and gaining weight over the last two (2) months. The patient also has the heater running in his house 24 hours a day, even on warm days. Which of the following tests is most likely to be performed? | A. CBC (complete blood count) B. ECG (electrocardiogram) C. Thyroid function tests D. CT scan |
| A 20-year-old female attending college is found unconscious in her dorm room. She has a fever and a noticeable rash. She has just been admitted to the hospital. Which of the following tests is most likely to be performed first? | A. Blood sugar check B. CT scan C. Blood cultures D. Arterial blood gases |
Created by:
Faith111