• Embed Doc
  • Readcast
  • Collections
  • 1
    CommentGo Back
Download
 
 
Safe and Effective Care
1.
 
The physcian's order reads: "100cc D5W with80 mEQ of KCL to infuse in 1/2 hour." Your first action will be to:a.
 
assess urine output.b.
 
ensure the patency of the IV line.c.
 
request an order for Lidocaine to be added to the IVd.
 
check the accuracy of the order.
Potassium chloride must be diluted and administered at a rate no faster than 20mEq/hr. Options #1 and #2 are correct afterthe order has been corrected. Option #3, Lidocaine, should not be added to this IV.
 
2.
 
A client diagnosed with acquired immunodeficiency syndrome (AIDS) is admitted to a medical unit for treatment of dehydration secondary to diarrhea. Which nursing action is necessary to prevent nosocomial infection?a.
 
Provide room with an intercom.b.
 
Use sterile sheet whenever possible.c.
 
Use chux to prevent skin irritation.d.
 
Use a doughnut foam ring on coccyx.
Diarrhea predisposes AIDS clients to decubiti which can lead to significant infection. Therefore, sterile sheets are indicated toreduce risk. Options #1, #3, and #4 do not decrease the risk of infection.
 
3.
 
The nurse is changing a dressing on an infected abdominal wound with Penrose drains and a large amount of purulentdrainage. What is the best way to perform this procedure?a.
 
Obtain clean gloves and dressings, remove the soiled dressing, and use another pair of clean gloves to dress thewound.b.
 
Use clean gloves to remove the soiled dressings, change to sterile gloves and use sterile dressings to cover thewound.c.
 
Use the sterile gloves to remove the dressing, obtain clean gloves and sterile dressing to reapply to the wound.
d.
 
Initiate protective isolation, utilize only sterile gloves when removing the dressing, and reapply using steriletechnique.
 
Sterile gloves and dressings are used in the application of dressings to wounds. Option #4 is incorrect because protectiveisolation is not appropriate for this client. Sterile gloves are not necessary for removing the soiled dressings.
4.
 
A client with a history of cardiac disease is admitted to the hospital with a diagnosis of congestive heart failure. The doctor'sorders are: continue all previous medications which include digoxin (Lanoxin) .25 mg po each AM, and propranolol (Inderal)20 mg po tid; oxygen at 4L/minute via nasal cannula, establish an IV and give furosemide (Lasix) 40 mg IV now, bathroomprivileges, full liquid diet. Which part of the order would be apriority for the nurse to discuss with the doctor?a.
 
Digoxin (Lanoxin) 0.25 mg PO in AM.b.
 
Level of oxygen concentration.c.
 
Propranolol (Inderal) 20 mg tid.d.
 
How fast should the IV infuse.
Inderal is contraindicated in clients with CHF. It is possible the doctor overlooked this in reordering all of the client's previousmedications. The oxygen, and digoxin are appropriate. There is no specific order regarding the rate of infusion or any fluids tobe infused. Since the client is on po fluids, this is probably a heparin/saline lock. This order should be clarified. However,Option #3 is a priority.
 
5.
 
Which assignment is the most appropriate for a client in the burn unit who has a cytomegalovirus (CMV) infection? A nursewhoa.
 
has an upper respiratory infection. c. is CMV negative.b.
 
is eight weeks pregnant. d. has thirty years experience.
This option is most appropriate due to a decreased risk of being infected. Option #1 is incorrect because those with acytomegalovi-rus positive titer are often immunosuppressed clients who should be protected from other pathogens. Option #2is incorrect because CMV is fetotoxic, and those who are pregnant should not care for CMV+ clients. Option #3 is incorrectbecause those with no protective titer are an increased risk for developing the disease if exposed.
6.
 
Which measure should a nurse take to prevent the spread of active pulmonary tuberculosis?a.
 
Restrict visitors to immediate family only.b.
 
Wear gown and gloves at all times.c.
 
Wear mask and gloves when in direct contact.d.
 
Dispose of waste articles more frequently.
Respiratory precautions call for masks and gloves to be worn to prevent the spread of the causative organism. Options #1, #2,and #4 are not essential in respiratory isolation.
7.
 
A postoperative nursing goal is to maintain ad equate nutrition and elimination. Which nursing order would beappropriate?a.
 
Assess for peristalsis; do not begin PO fluids until bowel sounds are present.b.
 
Maintain client NPO until passing flatus; maintain normal urine output.c.
 
Catheterize client; place retention catheter if unable to void 4 hours after surgery.d.
 
Anticipate abdominal distention; place nasogastric tube PRN every 4 hours.
To prevent abdominal distention, PO fluids should not be started until bowel sounds are present or there is other evidence of active peristalsis. Option #2 is incorrect because the client does not have to be NPO until bowel sounds are established. Option#3 is incorrect because catheterization should be avoided unless absolutely necessary. Option #4 is incorrect because
 
 
nasogastric tubes are not placed on a PRN bases.
 
8.
 
A 54-year-old client with tertiary syphilis is admitted to a nursing unit exhibiting signs of marked dementia anddisorientation. Which nursing action should be done initially?a.
 
Place the nurse call bell within reachb.
 
Frequently observe client behaviorc.
 
Apply a vest-type restraint.d.
 
Provide an around-the-clock sitter.
Placing the client on frequent observation status would be the first action to ensure the client's safety. Option #1 is incorrectbecause it should not be assumed that the client will be able to use the call light appropriately. Option #3 should never be thefirst option used by a professional nurse. Current standards require not only a physician's order, but a time limit, exact type of restraint to be used, and the specific rationale for restraint. Option #4 may be suggested to the family at a later time.
9.
 
A client with a necrotizing spider bite is to perform dressing changes at home. Which statement made by the clientindicates a correct understanding of aseptic technique?a.
 
"I need to buy sterile gloves to redress this wound."b.
 
"I should wash my hands before redressing my wound."c.
 
"I should not expose the wound to air at all."d.
 
"I should use an over-the-counter antimicrobial ointment."
The hallmark of asepsis is hand-washing. Option #1 is incorrect because the question addresses medical aseptic technique, notsterile procedure. Option #3 is not necessary. Option #4 is incorrect because the client should use only prescribed medicationson the wound.
10.
 
Before administering pin site care to a client in skeletal traction, the nurse should check:a.
 
correct alignmentb.
 
appearance of pin sites.c.
 
tightness of screws.d.
 
client vital signs.
Prior to pin site care, each pin site should be examined carefully for drainage or redness since they represent direct access tobone. Options #1, #3, and #4 are unnecessary with respect to site care.
 
11.
 
Which observation indicates the need for a nurse to stay with a client admitted to the emergency room following a carwreck?a.
 
Disorientation and irregular vital signs.b.
 
Irregular vital signs and hostility.c.
 
Rapid respirations and agitation.d.
 
Elevated vital signs and apprehension.
A disoriented client with irregular vital signs represents a grave safety risk. Options #2, #3, and #4 may increase the need fornursing interaction/assessment and are secondary to Option #1.
 
12.
 
In planning the debridment of a burn, a nurse would give priority to which action?a.
 
Assemble all necessary supplies and medicationsb.
 
Organize time for dressing change and provide emotional support.c.
 
Prepare the client and family for the pain the client will experience during and after the procedure.d.
 
Limit visitation prior to procedure to reduce client stress.
Prior planning for burn wound treatment should include organizing and planning for the mechanics of the procedure as wellas the emotional support necessary for the client. Options #1, #3, and #4 may be appropriate but do not take priority overOption #2.
13.
 
Prior to performing a physical assessment on a client who speaks little English, which nursing action is the mostappropriate?a.
 
Attempt to prepare client with hand signals.b.
 
Show the client pictures of the physical exam process.c.
 
Contact an employee who speaks client's primary language to translate.d.
 
Speak slowly as you explain what you are doing.
Staff who speak other languages are usually noted by nursing administration for such instances where a translator is thebest option. Options #1, #2, and #4 would be less effective.
 
14.
 
During the insertion of a central venous pressure monitor, the tip of the monitor device brushes the underside of thesterile field. Which nursing action is most appropriate?a.
 
Wipe the tip with alcohol before connecting to systemb.
 
Notify the physician of the occurrence so an antibiotic can be given.c.
 
Back-flush catheter for several seconds before connectingd.
 
Obtain a new monitor device, and prepare for a second attempt.
Contamination of equipment mandates new equipment be employed. Options #1 and #3 are not adequate
 — 
the catheter isstill contaminated. Option #2 may be appropriate later, but obtaining a new monitoring device is a priority.
 
15.
 
Which postoperative nursing goal will assist in preventing deep vein thrombosis?a.
 
Decrease the flow of the venous blood.b.
 
Increase the coagulation of the blood.c.
 
Increase the flow of the venous blood.
 
 
d.
 
Improve the oxygen capacity of the blood.
It is important to prevent venous Stasis by increasing the flow of venous return. Options # 1 and #2 will increase the riskassociated with DVT. Option #4 will not affect the course of deep vein thrombosis.
16.
 
Ipecac syrup has been given to a client after accidental ingestion of a poisonous plant. Which nursing observation ismost important to report to the next shift?a.
 
No vomiting has occurred after dose was given.b.
 
An antiemetic has been ordered and given.c.
 
A slight increase in temperature has been noted.d.
 
The client will be NPO until the next day.
No response to Ipecac after the dose should be reported to next shift and the physician for further action. Options #2 and#3 are nones-sential. Option #4 is not a high priority
17.
 
A client with chronic lung disease is admitted to the acute pulmonary unit with: respiratory rate of 50; pulse of 140 andirregular; skin pale and cool to touch; client confused as to place and time. Orders are: oxygen per nasal cannula at4L/minute, bedrest, soft diet and pulmonary function tests in the AM. What is the best sequence of nursing activities?a.
 
Place in semi-Fowler's position, begin the oxygen, have someone stay with the client, then notify the doctorregarding the current status of the client.b.
 
Begin the oxygen, call the nursing supervisor, keep the bed flat to maintain blood pressure, and stimulateclient to take deep breathsc.
 
Call the nursing supervisor, discuss with the family if the client has experienced this problem before, offer theclient sips of clear liquidsd.
 
Advise respiratory therapy of the client's problem, place the client in semi-Fowler's position, and begin theoxygen.
The doctor's orders do not address the seriousness of the client's condition. The doctor should be notified immediately.However, the client should not be left alone. Options #2, #3, and #4 do not address the seriousness of the client'simmediate needs.
18.
 
The nurse arrives for the day shift and receives her assignments around 7:30 a.m. The assignment includes:
• a man with a diagnosis of rule
-out an MI. He is on a monitor and having 4-6 premature beats per hour.
• an elderly lady who is confused and h
as constant urinary dribbling.
• a pneumonia client with increasing confusion and a temperature of 104° at 6:30 a.m.
 
• a diabetic client who experienced a restless night and 7:00 a.m. blood sugar was 170mg%.
Which client is a priority and how should the nurse plan her care?a.
 
The pneumonia client has priority; his condition should be assessed immediately.b.
 
The elderly lady is probably wet and uncomfortable and should be taken care of first. Then obtain a stat bloodglucose to determine the diabetic client's current blood sugar level.c.
 
The cardiac client should be assessed immediately as the monitor indicates cardiac irritability. Then thetemperature on the pneumonia client should be reassessed.d.
 
The diabetic client should be seen immediately to assess for evidence of hyperglycemia. Then the pneumoniaclient should be assessed for patency of airway.
The sickest client is the pneumonia client, and his needs should be addressed first. This client has an increased temperature,which may indicate his pneumonia is getting worse; and his confusion may be indicative of hypoxia. His status should beevaluated immediately. Premature beats of 4
 — 
6 per hour are benign and not unusual for a cardiac client. The elderly ladymay be uncomfortable, but the respiratory status of the pneumonia client is priority. A blood sugar of 170 mg% is abnormallyhigh and should be addressed. However, the respiratory status of the pneumonia client is the highest priority.
19.
 
Which nursing observation is most important to report to the physician on a client with a second-degree thermal injury toright arm?a.
 
Pain around the periphery of injury.b.
 
Gastric pH less than 6.0.c.
 
Increased edema of right arm.d.
 
An elevated hematocrit.
A decrease in gastric pH could indicate the hypersecretion of hydrogen ions
 — 
a predisposing factor to stress ulcer formation.Options #1, #3, and #4 are expected findings in burn wound resolution.
 
20.
 
In planning health teaching about the Recombivax immunization against Hepatitis, it is most important to include:a.
 
recombivax is given at specific intervals in a series of three.b.
 
the immunization can only be given IM.c.
 
allergic reactions are possible since human plasma is used.d.
 
recombivax has been associated with AIDS
The necessity of completing the series of three injections is an important factor to include in education concerning immuniza-tion with Recombivax. Options #2, #3, and #4 contain false information.
21.
 
A postoperative client is receiving bupivacaine hydrochloride (Marcaine) for pain through an epidural catheter. Whichresponse should the nurse recognize as desirable for this pain management technique?a.
 
Decreased respirations.b.
 
Somnolence.c.
 
Decreased restlessness.d.
 
Decreased blood pressure.
of 00

Leave a Comment

You must be to leave a comment.
Submit
Characters: ...
You must be to leave a comment.
Submit
Characters: ...