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1. A nurse is caring for an adolescent who is 1 hour post-operative following
an appendectomy. Which of the following findings should the nurse report to the
provider?
a. Heart rate 63 / minute
b. muscle rigidity
c. temperature 36.4 Celsius (97.5 Fahrenheit)
d. abdominal pain
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- 4)The nurse completes an admission assessment on an older adult patient. The nurse identifies which factor that may contribute to falls A) Poly pharmacy b) exposure to sunlight c)taking antacids d)increased fluid intakeAfter receiving the third dose of a new oral anticoagulant prescription, Which action should the nurse implement? Select all A. Obtain a soft Bristol toothbrush B. Provide a PRN NSAID for gum discomfort C. Review most recent coagulation lab values D. Complete a medication variance report E. Report findings to healthcare providerWhen the nurse is talking with a client who is experiencing "lightening." the client would most likely state which of the following? a. "lcan breathe easier now." b. I don't have to urinate as often now." c. My lower back pain is gone now. d. My feet are more swollen than before."
- 1. When assisting a patient to a chair from hip replacement surgery, the proper position for this patient is to sit with A. Hips higher than the knees B. Hips lower than the knees C. Hips even with the knees D. No specific position is necessary 2. To prevent the incidence of the development of a DVT for a patient after orthopedic surgery, which of the following interventions would the nurse employ? (SATA) A. Maintain strict bed rest with bathroom privileges only. B. Increase oral fluids C. Administer anticoagulant medications as ordered D. Ensure sequential compression devices are in use when patient is non-ambulatory E. Minimize flexing of the lower extremity without a physical therapist present3.While palpating a client’s upper quadrant, the nurse would expect to find which of the following structures? a. Sigmoid colon b. Appendix c. Spleen d. LiverAn elderly patient is receiving antihistamine therapy. What interventions specific to this medication does the nurse implement? (Select all that apply). A. Assess the patient for delirium, confusion and dizziness. B. Auscultate the patient's breath sounds C. Provide a low residue diet. D. Encourage the patient to ambulate E. Monitor the patient's urine output
- 1). Due to the client’s diagnosis of low back pain, cyclobenzaprine is prescribed. Which instructionsshould the nurse teach the client? Select all that applyA. Take the medication just before leaving home for work each day.B. Drink a full glass of water with each dose of medication.C. The medication can cause drowsiness that will make driving unsafe.D. Divide the dose of medication between early morning and bedtime.E. Encourage the client to change positions slowly. 2).The nurse working in the postanesthesia care unit (PACU) recovering a male client after anexploratory laparotomy administers the prescribed hydromorphone intravenously. Five minuteslater the nurse assess the client’s respirations at 8 breaths per minute. Which interventionshould the nurse implement first?A. Ask the anesthesiologist to come and assess the client.B. Administer naloxone intravenously.C. Re-assess the client’s respiratory status in 20 minutes.D. Use an ambu bag and ventilate the client. 3).An adolescent…A toddler is admitted to the pediatric unit with a diagnosis of croup. The nurse anticipates implementing which intervention to relieve respiratory distress associated with croup? a) Administration of oral antibiotics b) Administration of antipyretics c) Administration of corticosteroids d) Placement of a warm compress on the chestA patient with diabetes mellitus presents with a wound on the foot that is slow to heal. The nurse identifies which nursing diagnosis as most appropriate? a) Impaired Skin Integrity b) Ineffective Tissue Perfusion c) Risk for Infection d) Impaired Physical Mobility
- 1. An elderly client had recent surgery and is on bed rest. When planning care for the client, which nursing intervention is included in the care plan? a. Daily assessment of the wound site b. Foot and ankle range-of-motion(ROM) exercises c. Wound cleaning with hydrogen peroxide d. Coughing and deep breathing in the prone positionDuring therapy with the cytotoxic antibiotic bleomycin, the nurse will assess for a potentially serious adverse effect by monitoring a )blood urea nitrogen and creatinine levels.b )cardiac ejection fraction.c )respiratory functiond )cranial nerve function.Which of the following assessments should the nurse prioritize when caring for a patient with suspected compartment syndrome? a) Capillary refill b) Pedal pulses c) Skin temperature d) Range of motion
