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Pretest
1. A 19-year-old male is admitted to the emergency room following an automobile accident. The nurse determines thatthe client has severe flail chest. Which of these would be documented on the physical exam?a.
 
During inspiration, the flail segment will expand and will be pulled inward on expiration.b.
 
During inspiration, the flail segment will be pulled inward; and during expiration, the segment will bulgeoutward.c.
 
During inspiration, the flail segment will not move when the unaffected area is expanded.d.
 
There is no movement of the flail segment on inspiration or expiration.
Flail chest causes a pulling inward during inspiration and bulging outward on expiration. Option #1 isnormal chest movement. Options #3 and #4 are not expected findings in flail chest.
 
2. Which observation by the nurse manager would evaluate the staff's understanding of the prevention of exposure toHIV?a.
 
Using a protective gown upon entering the room.b.
 
Using sterile sheets for the client.c.
 
Wearing gloves when handling blood and body secretions.d.
 
Wearing a gown, gloves, and mask upon entering the room.
HIV is transmitted through blood and body secretions. Options #1, #2, and #4 are not necessary.
 
3. Which statement made by the 70-year-old client indicates he understands how to take his steroid and bronchodilatorinhalers?a.
 
"I will take my steroid first and follow it with my bronchodilator."b.
 
"I will take 2 puffs very quickly and then hold my breath."c.
 
"I will take my bronchodilator first and follow it with my steroid."d.
 
"I will separate the inhalers and rotate when I take them."
The bronchodilator inhaler will open up the bronchioles so the steroid can be effective. Option #1is incorrect. Option #2 is incorrect because the client needs time between the 2 puffs. Option #4 isincorrect.
4. Which nursing action has the highest priority following a cardiac catheterization procedure?a.
 
Place a warm pack to increase the temperature of the left foot.b.
 
Evaluate the vital signs every 2 hours.c.
 
Compare the quality of the pulses on the right and left legs.d.
 
Determine the presence of pulses above the catheterization site.
The two extremities should be compared in relation to the pain, pulse, pallor, temperature, and capillaryfilling time. Option #1 makes no comparison to effectively evaluate the circulation. Option #2 is incorrectbecause vital signs are usually evaluated every 15 minutes after the procedure to identify hypotensionand dysrhythmia. Option #4 should be evaluated distal to the site for equality between the twoextremities.
5. Which nursing action has the highest priority in preparing the client the evening prior to an intrave nous pyelogramprocedure?a.
 
Administer a cathartic enema to cleanse the bowel.b.
 
Identify through a history any client allergies to iodine or food.c.
 
Instruct the client to be NPO after midnight.d.
 
Teach the client that x-rays will be taken at multiple intervals.
Clients who are sensitive to iodine can develop anaphylaxis. The client should be asked specificallyregarding allergy to iodine. Iodine is present in the radiopaque material which is injected intravenously.Options #1, #3, and #4 contain correct information but are not priorities. The test may be canceled if theclient is allergic to iodine.
6. Which equipment is more important for the nurse to have available at the bedside of a client with a history of seizures?a.
 
Pump for IV solutionb.
 
Suction equipmentc.
 
Defibrillator.d.
 
IV cutdown tray.
The suction equipment should be available to facilitate removing the nasal and pharyngeal secretionswhich could lead to airway obstruction. Options # 1 and #4 are not specific to providing safety after aseizure. Option #3 is unnecessary for the disorder.
 
 
7. A 2-year-old is admitted to the Pediatric Unit with numerous bruises, fractured left humerus and several lacerations of unexplained origin. Which nursing action is a priority?a.
 
Report the findings to the Child Protection Agency.b.
 
Share this information only with other health care professionals.c.
 
Document this information in the chart only.d.
 
Share the information with the Pediatric Social Worker.
Any suspicion of child abuse should be reported to the Child Protection Agency. Options #2, #3, and #4do not provide nor plan for protection of the child.
8. Which documentation would be the most accurate when an error has been made on the flow sheet?a.
 
Make the record look neat by using correction fluid.b.
 
Draw several lines through the entry so it is not readable.c.
 
Write the word "error" above or beside the original words with your initials and draw a single line through theentry.d.
 
Cross through the error with correction fluid and write over the entry.
Out of the options, this is the best answer. Options #l and #4
 — 
A breach in the nursing standards of careis alteration of records. The use of correction fluid cannot be used on medical records because it denotesalteration of records. Words covered by correction fluid have been deciphered with x-ray equipment.Insurance companies will not cover nurses who use correction fluid on patient records. Option #2 isincorrect. Errors should never be obliterated or covered up.
9. One hour to discharge, a postpartum client requests more peripads, diapers, tucks, and Americaine spray. Whichresponse made by the nurse would be most appropriate and demonstrate an understanding of cost effectiveness?a.
 
"I will be glad to get these supplies for you."b.
 
"It would be much better if you would just stop and pick them up on your way home."c.
 
"I will be happy to get them for you and pull some extras for you to take home."d.
 
"What items do you need until you leave to go home?"
This option is the most diplomatic response and considers cost effectiveness. Many insurance companiesview extra supplies on the day of discharge as stockpiling, and the client may be stuck with the bill. Whilesome companies may still pay the entire bill as presented, many are becoming dollar-wise and view eachbill with a critical eye. Options #1 and #3 do not consider cost effectiveness. Option #2 is an inappropriateresponse.
 
10. In a 7-month-oid infant, which is the best way to detect fluid retention?a.
 
Weigh the child daily.b.
 
Test the urine for hematuriac.
 
Measure abdominal girth weekly.d.
 
Count the number of wet diapers.
Fluid retention is best detected by weighing^ daily .and noting a gaining trend. Options #2 and #3 areincorrect and will not provide information regarding fluid retention. Option #4 can provide an estimationof the amount of urine output but not about fluid retention.
11. Which nursing approach would be most appropriate for obtaining a specimen from a retention catheter?a.
 
Disconnect the drain at the bottom of the draining bag and drain urine into a sterile container.b.
 
Disconnect the tubing between the catheter and the drainage bag and drain urine into a sterile container.c.
 
Clamp the drainage tube. When fresh urine collects, open the tubing and drain into a sterile container.d.
 
Use a sterile syringe and needle to obtain urine from the porthole.
This represents the appropriate process in collecting a "sterile" urine specimen. Options #1 and #2 opena closed system which allows bacteria to be introduced. Option #3 is incorrect information.
12. Which evaluation would best determine if fluid is amniotic versus urine?a.
 
Digital evaluationb.
 
pH determination of fluid.c.
 
Urinalysis by lab.d.
 
Glucose determination.
Amniotic fluid is alkaline; test with phena-phthazine (nitrazine) paper which turns blue if it is amnioticfluid. Normal vaginal and urinary secretions are acidic. Option #1 will assist in evaluating a prolapsedcord or dilation. Options #3 and #4 are incorrect.
 
13. The nurse would determine the client understands the collection of urine specimen for culture and sensitivity whenhe states:a.
 
"I will call the lab before I collect my urine."b.
 
"I will drink several glasses of water before the urine is collected."
 
c.
 
"I will call the nurse to help me with aseptic technique."d.
 
"I will discard my first voiding in the morning."
Aseptic techniques decrease the possibility of contamination with organisms. Options #1, #2, and #4 areincorrect.
14. Which nursing observation would most likely indicate an early side effect of the elderly client taking digoxin(Lanoxin)?a.
 
Confusion.b.
 
Bradycardia.c.
 
Constipation.d.
 
Hyperkalemia.
The elderly are particularly prone to digoxin-induced confused states which can occur in the presenceofsubtoxic digoxin levels and without other signs oftoxicity. Option #2 occurs as a late side effect. Option#3 and #4 are incorrect.
 
15. Which initial observation is most important following a tonsillectomy in an 8-year-old?a.
 
Heart rate of 88 beats per minute.b.
 
Bright red secretions.c.
 
30 ml of dark brown secretions.d.
 
Infrequent swallowing.
Secretions which are bright red indicate a sign of hemorrhage. Option #1 is a normal rate for an 8-year-old. Option #3 is to be expected due to the surgical procedure. Option #4 is expected after the surgery dueto the discomfort.
 
16. Which statement by a client would indicate an understanding of when to take the medication, cromolyn sodium(Intal)?a.
 
"I will take the medicine with my meals."b.
 
"It is important that I take the medication before going to bed."c.
 
"If I experience respiratory distress, I will take the medicine."d.
 
"I will take the medication before I begin any vigorous exercise."
Cromolyn sodium (Intal) is used to prevent the release of histamine and other allergy- triggeringsubstances. Options #1 and #2 contain inappropriate information. Option #3 is incorrect because it isineffective.
 
17. In pre-eclampsia, the nurse would expect to assess which symptoms?a.
 
Blurred vision and proteinuria.b.
 
Epigastric pain and headache.c.
 
Facial swelling and proteinuria.d.
 
Polyuria and hypertonic reflexes.
Option #3 represents 2 of the 3 assessments in pre-eclampsia. The third is hypertension. Option #1 is onlypartially correct. Blurred vision appears later with eclampsia. Option #2 contains signs of eclampsiaprior to seizure. Option #4 is incorrect because oliguria would be seen later with eclampsia versuspolyuria.
18. Which assessment indicates a neonate with an infection is not fully recovered?a.
 
Heart rate of 150.b.
 
Axillary temperature of 98.6°F.c.
 
Weight increase of 4 oz.d.
 
Resting respiratory rate of 65.
The normal respiratory rate of a neonate is 30-50. Tachypnea is a sign of sepsis or hy-poxia with aneonate. Option #1 is incorrect because it is within the normal range. Option #2 is not significant. Option#3 is incorrect. Neonates normally experience between a 5-10 percent loss of weight within the first few-days of life.
 
19. Which order should be questioned on a client in vasoocclusive crisis due to sickle cell anemia.a.
 
Place client on bed rest with bathroom privileges.b.
 
Administer 2 liters oxygen via nasal cannula.c.
 
Maintain IV rate at keep open.d.
 
Administer analgesics as ordered.
The keep-open rate is too slow. Adequate hydration must be maintained to prevent sickling and clumpingof the affected cells. Options #1, #2, and #4 are appropriate orders for this client.
 
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