NURSING 270 COMPREHENSIVE EXAM

Comprehensive Exam 133- Cyclobenzaprine (Flexeril) is prescribed to a client with multiple sclerosis for the treatment of muscle spasms. For which common side effect of this medication does the nurse monitor the client ...

Comprehensive Exam 133- Cyclobenzaprine (Flexeril) is prescribed to a client with multiple sclerosis for the treatment of muscle spasms. For which common side effect of this medication does the nurse monitor the client? A. Diarrhea B. Drowsiness Correct C. Abdominal pain D. Increased salivation 134 - A nurse administers nitroglycerin sublingually to a client with angina pectoris who complains of chest pain. The medication is ineffective, so the nurse prepares to administer a second dose. Before administering the nitroglycerin, which action does the nurse make a priority? A. Checking the client's blood pressure Correct B. Obtaining blood levels of cardiac enzymes C. Asking the client whether he has a headache D. Obtaining a 12-lead electrocardiogram (ECG) 135- Ciprofloxacin hydrochloride (Cipro) is prescribed to a client with a urinary tract infection. The nurse, providing instruction about the medication, tells the client that it is best to take the medication: A. With milk B. With an antacid C. 2 hours after meals Correct D. With aluminum hydroxide 136.- A nurse provides home care instructions to a client with coronary artery disease (CAD) who is being discharged from the hospital. Which statement by the client indicates a need for further instruction?A. "I need to carry my nitroglycerin with me at all times." B. "I need to check my pulse before, during, and after exercise." C. "I need to avoid foods with saturated fats and foods high in cholesterol." D. "I need to participate in aerobic and weightlifting exercise three times a week." Correct 137- A nurse provides information to a client who will be undergoing endoscopic retrograde cholangiopancreatography (ERCP). The nurse tells the client that: A. There is no need to fast (NPO status) before the procedure B. The gallbladder is easily removed during this procedure if gallstones are found C. The procedure is performed specifically to visualize the esophagus, stomach, and duodenum D. Dye may be injected during the procedure to permit visualization of the pancreatic and biliary ducts Correct 138.ID: 383713175 A client who has undergone knee-replacement surgery will be self-administering enoxaparin sodium (Lovenox) at home. The nurse teaches the client about the medication and tells the client to: A. Store the medication in the refrigerator B. Lie down to administer the subcutaneous injection Correct C. Inject the medication in the upper outer aspect of the arm D. Discard the medication if the solution appears pale yellow 139.ID: 383703667 An intravenous dose of adenosine (Adenocard) is prescribed for a client to treat Wolff-ParkinsonWhite syndrome. Which piece of equipment does the nurse make a priority of obtaining before administering the medication? A. Pulse oximeter B. Cardiac monitor CorrectC. Blood-pressure cuff D. Suction catheter and suction machine 140.ID: 383703619 A nurse provides information to a client with coronary artery disease (CAD) about smoking-cessation measures. Which statement by the client indicates a need for further information? A. "A community support group will help me quit." B. "I should drink a cup of coffee if I feel the urge to smoke." Correct C. "Relaxation exercises will help control my urge to smoke." D. "I can try chewing gum or sucking on hard candy if I feel the urge to smoke." 141.ID: 383708584 Captopril (Capoten) is prescribed for a hospitalized client with heart failure. Which action is a priority once the nurse has administered the first dose? A. Checking the client's apical heart rate B. Maintaining the client on bed rest for 3 hours Correct C. Monitoring the client for increased urine output D. Checking the client's breath sounds for decreased wheezing 142.ID: 383706680 A client with heart failure suddenly experiences profound dyspnea, pallor, audible wheezing, and cyanosis, and the nurse suspects pulmonary edema. The nurse would first: A. Obtain a pulse oximetry reading B. Raise the head of the client's bed Correct C. Administer a dose of morphine sulfateD. Obtain a specimen for an arterial blood gas determination 143.ID: 383703665 The nurse administers intravenous morphine sulfate to a client in pulmonary edema. For which intended effect of the medication does the nurse monitor the client? A. Relief of pain B. Relief of anxiety Correct C. Decreased urine output D. Increased blood pressure 144.ID: 383702944 A nurse is providing home care instructions to a client with coronary artery disease (CAD) who will be discharged home and will be taking 1 aspirin daily. The nurse tells the client: A. To stop the aspirin if nausea occurs Incorrect B. To take the aspirin on an empty stomach C. That the aspirin is a short-term treatment and will probably be discontinued in 2 weeks 145.ID: 383713112 A client receiving parenteral nutrition (PN) suddenly experiences chest pain and dyspnea, and the nurse suspects an air embolism. The nurse immediately places the client in a lateral Trendelenburg position, on the left side. What action does the nurse take next? A. Auscultating heart sounds B. Clamping the intravenous catheter Correct C. Checking the client's blood pressureD. Obtaining an arterial blood gas specimen 146.ID: 383711448 A nurse is teaching a client with left-side weakness how to walk with the use of a quad-cane. The nurse ensures that: A. The client places the cane on the left side B. The top of the cane is level with the client's waist C. 30-degree flexion of the client's elbow is maintained when the client is holding the cane Correct D. The client leans on the cane and places as much weight as possible on the cane when moving it forward 147.ID: 383702961 A nurse is preparing the room of a client in skeletal traction who will be admitted to the nursing unit. Which item for use by the client does the nurse identify as the most important? A. Telephone B. Television C. Trapeze bar Correct D. Bedside commode 148.ID: 383702975 A nurse taking the vital signs of a client immediately after she has delivered a newborn notes that the client's heart rate is 110 beats/min. The nurse would first: A. Document the findings B. Offer the client oral fluids C. Recheck the heart rate in 1 hour D. Check the uterus and amount of lochia discharge Correct149.ID: 383708504 A client is receiving an intravenous infusion of alteplase (tissue plasminogen activator, recombinant; tPA). For which adverse effect of the medication does the nurse monitor the client most closely? A. Bleeding Correct B. Hearing loss C. Decreased urine output D. Increased blood pressure 150.ID: 383708596 View video. The nurse is performing a sterile change of an abdominal dressing. Once the dressing has been removed and discarded in a waterproof bag, which action should the nurse take next? A. Assessing the wound Correct B. Donning sterile gloves C. Cleansing the wound D. Setting up the sterile field 151.ID: 383706038 A nurse is providing morning care to a client who has undergone surgery to repair a fractured left hip. Which item is most important for the nurse to use in turning the client from side to side to change the bed linens? A. Trapeze bar B. Sliding board C. Adduction device D. Abduction device Correc 152.ID: 383710526A nurse provides dietary instructions to a client with osteoporosis who has sustained a fracture about foods that will promote healing. The nurse tells the client that it is best to consume foods that are high in: A. Fats B. Vitamin C Correct C. Carbohydrates D. Concentrated sugar 153.ID: 383710520 A nurse in a physician's office is talking to a client who underwent mastectomy of the right breast 2 weeks ago. The client says to the nurse, "I hate looking at this incision. I feel that I'm not even myself anymore." The nurse interprets this statement to mean that the client is experiencing which problem? A. Inability to cope B. Distorted body image Correct C. Inability to care for self D. Inability to maintain health 154.ID: 383703639 A nurse discovers that a client receiving heparin sodium by way of continuous intravenous (IV) infusion has removed the IV tubing from the infusion pump to change his hospital gown. After assessing the client and placing the tubing back in the infusion pump, which medication does the nurse check for in the medication room in case a heparin overdose has occurred? A. Protamine sulfate Correct B. Enoxaparin (Lovenox) C. Phytonadione (vitamin K) D. Aminocaproic acid (Amicar)155.ID: 383703663 The mother of a newborn found to have a congenital diaphragmatic hernia asks the nurse to explain the diagnosis. The nurse tells the mother that in this condition: A. The esophagus terminates before it reaches the stomach B. Gastric contents are regurgitated back into the esophagus C. Abdominal contents herniate through an opening of the diaphragm Correct D. A portion of the stomach protrudes through the esophageal hiatus of the diaphragm 156.ID: 383710522 A nurse is performing an assessment of a newborn with a diagnosis of esophageal atresia (EA) and tracheoesophageal fistula (TEF). Which findings does the nurse expect to note in the infant? Select all that apply. A. Drooling Correct B. Wheezing C. Hiccuping D. Short periods of apnea E. Excessive oral secretions Correct F. Bowel sounds over the chest 157.ID: 383711493 A nurse is reviewing the medical record of an infant in whom hypertrophic pyloric stenosis (HPS) is suspected. Which characteristics associated with the disorder does the nurse expects see documented in the infant’s medical record? Select all that apply. A. Weight loss CorrectB. Facial edema C. Metabolic acidosis D. Projectile vomiting Correct E. Distended upper abdomen Correct 158.ID: 383703641 A client with a history of angina pectoris tells the nurse that the chest pain usually occurs with moderate to prolonged exertion and is generally relieved by nitroglycerin or rest. Which type of angina does the nurse recognize in the client’s description? A. Stable Correct B. Variant C. Unstable D. Crescendo 159.ID: 383706082 Methylergonovine (Methergine) is prescribed for a client to control postpartum bleeding. Which action does the nurse take before administering the medication? A. Checking the episiotomy site B. Palpating the client's bladder C. Checking the client's blood pressure Correct D. Ensuring that the uterus is contracted160.ID: 383706068 A nurse is teaching a client with angina pectoris who is being discharged from the hospital about managing chest pain at home. Which statement by the client indicates a need for further teaching? A. "I need to keep fresh nitroglycerin available in case I need it." B. "I need to check the expiration date on the nitroglycerin bottle." C. "If I have any chest pain, I need to stop what I am doing and sit or lie down." D. "If I get chest pain, I should put 3 nitroglycerin tablets under my tongue and then go to the emergency department if that doesn’t work." Correct 161.ID: 383707949 A nurse develops a list of home care instructions for a client who is wearing a halo fixation device after sustaining a cervical fracture. Which instructions should the nurse include? Select all that apply. A. Use a straw to drink. Correct B. Avoid sexual activity while the vest is in place. C. Apply powder under the vest to prevent irritation. D. Use caution when leaning forward or backward. Correct E. Wear snug clothing to prevent the device from shifting. F. Do not drive, because full range of vision is impaired with the device. Correct 162.ID: 383710057 A nurse is assessing a client who is experiencing chest pain. Which of the following observations indicates to the nurse that the pain is most likely a result of angina?A. The pain is relieved by rest and nitroglycerin. Correct B. The pain is relieved by the administration of an antacid. C. The pain is relieved by the administration of an antiinflammatory medication. D. The pain is relieved with an upright sitting position and the administration of an analgesic. 163.ID: 383706640 A nurse has provided nutrition instructions to a mother of an infant. Which statement by the mother indicates to the nurse that the mother requires further instruction? A. "It’s best to use cow's milk, as long as it’s whole milk and not skim." Correct B. "When I start feeding solid foods, I might need to add water to the food." C. "When the baby starts to take juices, I shouldn’t warm the juice, because that will destroy the vitamin C." D. "The baby will get the right nutrition if I feed breast milk or store-bought formula that’s been fortified with iron.” 164.ID: 383703671 A pediatric nurse is caring for a hospitalized toddler. Which of the following activities does the nurse deem the most appropriate for the toddler? A. Singing games B. Watching videos C. Simple board games D. Large building blocks Correct165.ID: 383709206 A nurse in a physician's office is reviewing the medical record of a child with a diagnosis of lactose intolerance. Which of the following findings does the nurse expect to see documented in the child's record? A. Fatty stools B. Episodes of foul-smelling ribbonlike stools C. Episodes of profuse watery diarrhea and vomiting D. Episodes of cramping abdominal pain and excessive flatus Correct 166.ID: 383712470 A nurse is providing dietary instructions to the mother of a child with celiac disease. The nurse tells the mother that it is acceptable to give the child: A. Boiled rice Correct B. Cooked pasta C. Warm oatmeal D. Baked macaroni and cheese 167.ID: 383713110 A nurse admitting a newborn to the nursery notes that the physician has documented that the newborn has a gastroschisis. The nurse performs an assessment, expecting to note that the viscera are: A. Inside the abdominal cavity and under the skin B. Inside the abdominal cavity and under the dermis C. Outside the abdominal cavity, not covered with a sac Correct D. Outside the abdominal cavity but inside a translucent sac covered with peritoneum and amniotic membrane168.ID: 383707998 A nurse is monitoring a child with intussusception for signs of peritonitis. For which of the following findings, indicative of this complication, does the nurse notify the physician? A. Increased alertness B. Increased heart rate Correct C. A sausage-shaped abdominal mass D. Diarrhea and the passage of bloody mucous stool 169.ID: 383713179 The nurse, auscultating the breath sounds of a client, hears these sounds. What are they?