KAPLAN 1 FINAL EXAM

1. The male client asks the nurse, “Why am I experiencing erectile dysfunction (ED)?” The nurse reviews the client’s medications. The nurse recognizes that which classification increases the risk for ED? a. Non-steroi ...

1. The male client asks the nurse, “Why am I experiencing erectile dysfunction (ED)?” The nurse reviews the client’s medications. The nurse recognizes that which classification increases the risk for ED? a. Non-steroidal anti-inflammatory drugs. b. Antihypertensive medications. c. Anticoagulant medications. d. Histamine H2 inhibitors. Answer: B 2. The nurses care for the client diagnosed with tuberculosis. Before discontinuing airborne precautions, the nurse must confirm which? a. The tuberculin skin test is negative b. No acid-fast bacteria are in the sputum. c. The client has received anti-tuberculin medication for three days. d. The client’s temperature has returned to normal. Answer: B 3. The risk management department plans a program to reduce errors. Which is the most common cause of errors in medication administration? a. Failure to follow routine policy and procedures. b. Caring for too many clients. c. Responsible for administering numerous medications. d. Unfamiliar with monk of the new pharmaceuticals ordered. Answer: A 4. The nurse prepared to administer buspirone 15 mg to the client. The nurse recognized this medication is MOST appropriate for which client? 1. The 45 year old woman diagnosed with pancreatitis reporting nausea and vomiting. 2. The 27 year old woman diagnosed with panic attacks. 3. The 60 year old man diagnosed with coronary artery disease with a blood pressure of 172/94. 4. The 38 year old man diagnosed with schizophrenia reporting auditory hallucinations. Answer#2 5. The home care nurse instructs the client receiving long-term prednisone therapy. Which information should the nurse include? a. There is an increased risk for developing infections. b. There is a resistance to developing infections. c. The client should follow a high-protein diet. d. There are changes in fat distribution over several areas of the body. Answer: D 6. After receiving report from the evening shift charge nurse, which client should the nurse see FIRST? KAPLAN 1 FINAL EXAM 1. A 69-year –old diagnosed with chronic obstructive pulmonary disease requesting a sleeping pill. 2. A 52-year old client diagnosed with pancreatitis reporting abdominal pain. 3. A 67-year old client diagnosed with pneumonia with a pulse oximeter reading of 88% 4. A 78 year old client diagnosed with coronary artery disease with a blood pressure of 155/88. Answer#3 SAO2 95-99% 7. The nurse cares for the client diagnosed with spinal cord injury at the level of T1. The nurse notes the client is flushed and sweating profusely. The client reports a headache and nausea. The vital signs are blood pressure 140/98 and heart rate 38 beats per minute. Which action should the nurse take FIRST? 1. Administer antihypertensive medication. 2. Palpate the client’s bladder. 3. Position the client in a supine position. 4. Place the client on a cardiac monitor. Answer#2 ASSESS FIRST ;IPPA (she inspected and now palpate) 8. The nurse cares for the client just admitted to the surgical unit from recovery after a total hip replacement. It is MOST important for the nurse to take which action? 1. Elevate the affected extremity on pillows. 2. Position the client in high Fowler’s position. 3. Place the client in Buck’s traction. 4. Position the client with the legs abducted. Answer#4 ABDUCTION SPLINTER OR TWO PILLOWS BETWEEN LEGS 9. The nurse shows a teenager how to use a metered dose inhaler of ipratropium (Atrovent). Which statement, if made by the client to the nurse, indicates teaching is effective? 1. “I should use this medicine to stop the coughing that leads to an asthma attack” 2. “I should use this medicine if I begin to have an asthma attack” 3. “I should use this medicine right after I have an asthma attack” 4. “I should use this medicine to prevent an asthma attack” Answer#4 10. The nurse instructs the client about stable angina. The nurse determines teaching is effective if the client makes which statement? a. Angina pain usually feels like being stabbed with a knife b. Each time I have angina, my heart is damaged. c. My chest pain can occur if I overexert myself. d. If I have chest pain, then I’m probably having another heart attack. Answer: C 11. The nurse on a medical-surgical unit received report. Which clients should the nurse see FIRST? 1. The client diagnosed with heart failure and dementia trying to get out of bed. 2. The client two days after a total hip replacement with a hemoglobin of 12.9 gm/dl. 3. The client receiving one unit of packed red blood cells with an IV pump sounding an alarm. 4. The client 12 hours after a laparoscopic cholecystectomy states, “My shoulder hurts”. Answer#3 12. The nurse cares for the unconscious client diagnosed with a closed head injury. There is no family present. What is the MOST appropriate action for the nurse to take? 1. Wait until a family member is contacted before treating the client. 2. Request the attending health care provider to sign the consent form. 3. Begin treatment on the client under the doctrine of implied emergency consent. 4. Delegate the unit secretary to call every number listed on the client’s cell phone. Answer#3 13. The client diagnosed with type 1 diabetes reports to the nurse, “I feel really nervous and jittery all over”. The nurse notes regular insulin was administered two hours ago. Which action should the nurse take FIRST? 1. Review all medications the client has received. 2. Determine the client’s recent dietary intake. 3. Administer a simple carbohydrate. 4. Request laboratory draw serum blood glucose. Answer#2 14. The parent of an adolescent diagnosed with hemophilia calls the nurse to discuss the adolescent’s desire to participate in sports. Which activity should the nurse recommend? a. Soccer b. Gymnastics c. Swimming d. Snowboarding Answer: C 15. The nurse cares for a client diagnosed with superficial partial thickness burn. The nurse should assign the client to a room with which client? A. A client diagnosed with Cushing’s Syndrome. B. A client Diagnosed with cellulitis of the left leg. C. A Client diagnosed with acute peritonsillar abscess. D. A client diagnosed with acute pelvic inflammatory disease. Answer: A 16. The school nurse identifies several children who have food allergies. Which sequence should the nurse teach the staff to follow if an allergic reaction is observed in a child? 1. Call 911, call the physician, administer EpiPen, call the parents 2. Administer the EpiPen, call 911, call the physician, call the parents v 3. Call the physician, administer the EpiPen, call 911, call the parents 4. Call the parents, administer the EpiPen, call the physician Answer#2 17. The psychiatric nursing team consists of one registered nurse and three nursing assistants. Which patient should be assigned to the registered nurse? 1. A 56-year-old male alcoholic who will attend his first Alcoholics Anonymous meeting tomorrow. 2. A 16-year-old girl with anorexia nervosa who is showing a daily weight gain. 3. A 40-year-old man receiving clozapine (Clozaril) who is complaining of a sore throat and fine hand tremors. 4. A 50-year-old woman with a history of depression who received her third dose of amitriptyline (Elavil) yesterday. Answer#3 18. A client is admitted to the emergency department with deep partial-thickness burns of the arms and chest sustained in a house fire. The nurse notes that the client is very restless and anxious. Which action should the nurse take FIRST? 1. Administer morphine 5 mg IV 2. Ask the patient to verbalize what is bothering her. 3. Teach the patient diaphragmatic and pursed-lip breathing. 4. Listen to breath sounds Answer#4 19. A client diagnosed with type 1 diabetes comes to the outpatient clinic with complaints of pain of the right leg and foot. If a diagnosis of peripheral arterial occlusion is made, which of the following symptoms does the nurse expect to see? 1. The skin on the right lower leg appears flushed and diaphoretic. 2. The patient cannot distinguish between sharp and dull pressure on his right leg. 3. The patient says his right leg is larger than his left leg. 4. The patient has moderate swelling distal to the malleols on his right foot. Answer#2 20. A patient is admitted to the psychiatric unit with depression and suicidal ideation. Which action is MOST important for the nurse to take? 1. Instruct the patient to check in with the staff every 15 minutes, and encourage her to comply 2. Ask the staff to assess the patient’s suicidal thoughts every 30 minutes 3. Observe the patient every 15 minutes, and add several unscheduled observations 4. Establish a schedule for the staff to check the patient every 15 minutes Answer#3 21. The physician order phenytoin (Dilantin) 200 mg PO daily for a teenager. It is MOST important for the nurse to include which of the following instructions when teaching the client? 1. Visit your dentist frequently 2. If you miss a dose, take an extra one the next day 3. Avoid contact sports for the next several weeks 4. Be sure to take the medication between meals Answer#1 (causes gingival hyper