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NEW QUESTION # 72
When taking care of a patient who has undergone open reduction and internal fixation of a fractured left tibia, the nurse should keep the leg:
- A. Adducted to attain alignment
- B. Elevated to minimize venous stasis
- C. Straight to reduce flexion deformities
- D. Immobilized to enhance bone healing
Answer: B
NEW QUESTION # 73
Which of the following tasks requires specialized education and should be performed by the nurse only after the training has been completed?
- A. Administering a dose of promethazine (Phenergan) via intravenous push (IVP)
- B. Instilling tobramycin (Tobrex) ophthalmic solution
- C. Beginning an intravenous infusion of cyclophosphamide (Cytoxan)
- D. Applying a transdermal fentanyl (Duragesic)
Answer: C
NEW QUESTION # 74
The mother of a child with nephrotic syndrome asks why her child must be weighed each morning. The nurse's response should be based on the fact that this is important to determine the:
- A. Water retention
- B. Nutritional status
- C. Blood volume
- D. Medication doses
Answer: A
NEW QUESTION # 75
A patient with a central venous line develops sudden clinical manifestations that include a decrease in blood pressure, an elevated heart rate, cyanosis, tachypnea, and changes in mental status. Which of the following is the most likely cause of these symptoms?
- A. An air embolism
- B. Developing bacteremia
- C. Venous thrombosis
- D. Circulatory overload
Answer: A
NEW QUESTION # 76
In preparing the patient for electroencephalogram (EEG), the nurse should:
- A. Withhold breakfast
- B. Shave the hair
- C. Give sleeping pills the night before
- D. Restrict intake of coffee
Answer: D
NEW QUESTION # 77
The nurse knows that the greatest risk for a patient with a ruptured ectopic pregnancy is:
- A. Adhesions and scarring from blood in the abdomen
- B. Hemorrhage leading to hypovolemic shock
- C. Infertility resulting from treatment with a salpingectomy
- D. Strictures and scarring of the fallopian tube
Answer: B
NEW QUESTION # 78
The best example of documentation of patient teaching regarding wound care is:
- A. "The patient was instructed about care of wound and dressing changes"
- B. "The patient demonstrated correct technique of wound care following instruction"
- C. "The patient and family verbalize that they understand the purposes of wound care"
- D. "Written instructions regarding wound care and dressing changes were given to the patient"
Answer: B
NEW QUESTION # 79
When caring for a patient with impaired mobility that occurred as a result of a stroke (right sided arm and leg weakness). The nurse would suggest that the patient use which of the following assistive devices that would provide the best stability for ambulating?
- A. Walker
- B. Crutches
- C. Single straight-legged cane
- D. Quad cane
Answer: D
NEW QUESTION # 80
The best time for the nurse to teach an anxious patient about the patient controlled
analgesic (PCA) pump would be during which of the following stages of patient care?
- A. Intraoperative
- B. Post anesthesia
- C. Post-operative
- D. Pre-operative
Answer: D
NEW QUESTION # 81
Extrapyramidal adverse effects and symptoms are most often associated with which of the following drug classes?
- A. Antidepressants
- B. Antipsychotics
- C. Antihypertensives
- D. Antidysrhythmics
Answer: B
NEW QUESTION # 82
Whilst recovering from surgery a patient develops deep vein thrombosis. The sign that would indicate this complication to the nurse would be:
- A. Pitting edema of the area
- B. Localized warmth and tenderness of the site
- C. Severe pain when raising the legs
- D. Intermittent claudication
Answer: B
NEW QUESTION # 83
Salem has Alzheimer's disease. He is agitated and repeatedly asks to go home. The most appropriate nursing intervention for him is to:
- A. Find activities to keep him occupied
- B. Isolate him in a single room
- C. Administer a minor tranquillizer
- D. Ask the physician to discharge him
Answer: A
NEW QUESTION # 84
A patient is admitted to the emergency department with a possible allergic reaction to a bee sting. What is the first action the nurse should take?
- A. Observe the patient for signs of anaphylaxis
- B. Quickly use tweezers to remove the stinger
- C. Squeeze the venom sac to remove additional venom
- D. Apply warm compresses to the site of local reaction
Answer: A
NEW QUESTION # 85
A patient with pneumonia is coughing up purulent thick sputum. Which one of the following nursing measures is most likely helpful to loosen the secretions?
- A. Postural drainage
- B. Percussion over the affected lung
- C. Coughing and deep breathing exercises
- D. Breathing humidified air
Answer: D
NEW QUESTION # 86
When preparing to administer a medication the nurse should first:
- A. Ensure that the medication is on the medication cart
- B. Determine the expiry date of the medication
- C. Check the patient's identification armband
- D. Verify the physician order for accuracy
Answer: D
NEW QUESTION # 87
A registered nurse delegates care to a practical nurse. The person most responsible for the safe performance of the care is the:
- A. The practical nurse assigned to provide the care
- B. Head nurse who is in-charge of the unit
- C. The registered nurse who delegated the care to the practical nurse
- D. The nursing care coordinator who is the supervisor of the unit
Answer: C
NEW QUESTION # 88
Which of the following interventions should the nurse implement if a patient complains of cramps while irrigating the colostomy?
- A. Remove the irrigation tube
- B. Have the patient sit up in bed
- C. Reduce the flow of solution
- D. Insert the tube further into the colon
Answer: C
NEW QUESTION # 89
A patient becomes angry and threatens to leave the hospital unless the physician reviews the reason for the patient's delay in discharge. The patient has a medication order for agitation available p.m.. but refuses the medication and requests a drink of orange juice instead. What should the nurse do?
- A. Secretly slip the p.r.n. medication into the orange juice and give it to the patient
- B. Inform the patient that nothing can be done until the morning
- C. Give the patient the orange juice and tell the patient that a staff member is attempting to call the physician
- D. Inform the patient that staff is unable to force anyone to stay in the hospital
Answer: C
NEW QUESTION # 90
A patient who has just had a miscarriage at 8 weeks of gestation is admitted to hospital. In
caring for this patient, the nurse should be alert for signs of:
- A. Subinvolution
- B. Hemorrhage
- C. Dehydration
- D. Hypertension
Answer: B
NEW QUESTION # 91
A construction worker was brought to the emergency department and admitted with the diagnosis of heat stroke due to strenuous physical activity during hot weather conditions. Which action should the nurse take?
- A. Immediately immerse the patient in cold water to reduce the patient's temperature
- B. Encourage foods and oral fluids that contain carbohydrates and electrolytes
- C. Place ice packs to the neck, axillae, scalp and groin
- D. Administer an antipyretic such as aspirin or acetaminophen
Answer: C
NEW QUESTION # 92
The nurse teaches a patient recovering from a total hip replacement that it is important to avoid:
- A. Sitting with the legs crossed
- B. Bearing weight exercises on the affected leg for 6 weeks
- C. Putting a pillow between the legs while sleeping
- D. Abduction exercises of the affected leg
Answer: A
NEW QUESTION # 93
A patient with deep partial-thickness and full-thickness burns of the face and chest is admitted to the emergency department. The nurse must be particularly alert for:
- A. Severity of pain
- B. Respiratory distress
- C. Paralytic ileus
- D. Strong burn odor
Answer: B
NEW QUESTION # 94
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