Which action will the nurse take first?
Select One:
A. Assesses level of consciousness and pupillary reactions
B. Auscultates breath sounds over the trachea and mainstem bronchi
C. Ascertains the time food or liquid was last consumed
D. None of the above
The initial nursing action is to prepare the patient to receive:
Select one:
A. Oxygen through nasal cannula
B. 100% humidified oxygen by face mask
C. Endotracheal intubation and provide 100% oxygen via a ventilator
D. None of the above
Select one:
A. Symptoms of hypoxia secondary to carbon monoxide poisoning
B. Thermal burn injuries to the face, neck, or airway
C. Respiratory distress to inelastic eschar formation around the chest
D. None of the above
Select one:
A. Traumatic pneumothorax
B. Spontaneous pneumothorax
C. Tension pneumothorax
D. None of the above
Select one:
A. Protect yourself from microorganisms in the wound
B. Keep the sterile field free from microorganisms
C. Reduce the number of opportunistic microorganisms to a minimum
D. None of the above
Select one:
A. Pain that occur with squeezing the calf
B. Calf pain associated with dorsiflexion of the leg
C. Pain with abduction of the limb
D. None of the above
Select one:
A. Insertion of a suprapubic catheter
B. An indwelling catheter
C. Intermittent catheterization
D. None of the above
The nurse determines that which of the following glands is most likely responsible for these symptoms:
Select one:
A. Adrenal cortex
B. Thyroid
C. Parathyroid
D. None of the above
I. The patient will complain of
II. Cracked lips
III. Cold and clammy skin
IV. Decrease urinary output
Select one:
A. II, II and IV
B. I, II, III and IV
C. I, II and IV
D. None of the above
The patient develops dyspneaa, tachycardia, and mental confusion, and the nurse suspect fat embolism.
The most appropriate initial action of the nurse is to:
Select one:
A. Reassess the vital signs
B. Place the patient in a supine position
C. Place the patient in a Fowler’s position
D. None of the above
Select one:
A. Establishing IV access with a large-bore catheter
B. Determine the presence of increased ICP
C. Maintaining cervical spine precautions
D. None of the above
Select one:
A. Pain management
B. Fluid and electrolyte imbalance
C. Antiemetics
D. None of the above
Select one:
A. Reticular activating system
B. Thalamus
C. Pyramids
D. None of the above
The patient tells the nurse that she/he is concerned because of voice hoarseness.
The patient asks the nurse if the hoarseness will subside.
The nurse most appropriate tells the patient that the hoarseness:
Select one:
A. Indicates nerve damage
B. Will worsen before it subsides, which may take 6months
C. Is normal during this time and will subside
D. None of the above
Select one:
A. Severe pain
B. Fever
C. Intense thirst
D. None of the above
The burned area appears pink, has blisters, and is very painful.
How will the nurse categorize this injury?
Select One:
A. Partial-thickness superficial
B. Partial-thickness deep
C. Full-thickness
D. None of the above
Select one:
A. Right ventricular bulging
B. Right atria bulging
C. Left ventricular bulging
D. None of the above
What action will the nurse take first?
Select One:
A. Place the client in an upright position
B. Monitor urine output
C. Perform chest physiotherapy
D. None of the above
The client’s mother is a Jehovah’s Witness and refuses to sign the blood permit.
What nursing action is most appropriate?
Select one:
A. Encourage the mother to reconsider
B. Notify the physician of the mother’s refusal
C. Explain the consequences without treatment
D. None of the above
Which of the following nursing intervention will the nurse include in the plan of care?
Select one:
A. Monitor neck circumference every 4 hours
B. Encourage deep breathing exercise and vigorous coughing exercise
C. Maintain a pressure dressing on the operative site
D. None of the above
Select one:
A. Taking pressure of the calves
B. Aiding venous return through the wearing of stockings
C. Preoperative administration of estrogen
D. None of the above
Select one:
A. Vitreous body
B. Canal of Schlemm
C. Lacrimal duct
D. None of the above
Select one:
A. Alteration in renal perfusion related to decrease cardiac output (potential)
B. Alteration in fluid volume and electrolytes balance related to decrease blood volume (potential)
C. Decrease cardiac output related to blood loss
D. None of the above
Select one:
A. Serve prescribe medication for the wound
B. Change dressings and soiled linen
C. Reinforce dressings and observe patient
D. None of the above
Select one:
A. Aortic valve
B. Tricuspid valve
C. Mitral valve
D. None of the above
He ordered for further investigations to confirm the diagnose.
The nurse understands that the diagnosis of oral cancer is confirmed with?
Select one:
A. Gram Stain
B. Biopsy
C. Oral washings for cytology
D. None of the above
Nurse Ann will be more careful in the immediate care by avoiding which of these actions before the diagnosis is made?
Select one:
A. Enemas and sips of water
B. Enemas and analgesics
C. Complete assessment including the lower abdominal palpation
D. None of the above
Which of the following signs and symptoms if noted in a patient will alert the nurse to the presence of this crisis?
Select one:
A. Fever and tachycardia
B. Low-grade fever and tachycardia
C. Agitation and bradycardia
D. None of the above
Select one:
A. Muffled and distant heart sounds with decreasing blood pressure
B. Decreased movement and diminished breath sounds on the affected side
C. Severe respiratory distress and tracheal deviation
D. None of the above
Fractures of the lower ribs are associated with injury to which of the following organs?
Select one:
A. Spleen and liver
B. Kidneys and liver
C. Lungs and heart
D. None of the above
Select one:
A. That coughing should be avoided to prevent pressure on the incision
B. How to support the head with the hands when moving
C. That any tingling around the lips or in the fingers after surgery are expected and temporary
D. None of the above
Which nursing diagnosis is most important for this patient?
Select One:
A. Anxiety related to actual threat to health status
B. Activity intolerance related to fatigue
C. Impaired gas exchange related to airflow obstruction
D. None of the above
During the acute period, the nurse would expect the patient to have:
Select one:
A. Flaccid tetraplegia with loss of pressure sensation
B. Paraplegia with a flaccid paralysis
C. Total hemiplegia with sensory and motor loss
D. None of the above
Select one:
A. Grip the tip of the nose between thumb and forefinger
B. Let client sit up and gently throw the head backward
C. Apply cold compress to the bridge of the nose
D. None of the above
Select one:
A. Superficial veins appear enlarged and prominent
B. Leg size diameter may be reduced
C. Onset is sudden
D. None of the above
When teaching the patient about this drug, the nurse should explain that it may cause:
Select One:
A. Nasal congestion
B. Nervousness
C. Lethargy
D. None of the above
Whiles waiting to have her elective epigastric hernia repair, Karzai unfortunately took porridge.
After how many hours can she have her surgery done?
Select one:
A. 4 hours
B. 5 hours
C. 6 hours
D. None of the above
Which assessment finding indicates that the patient needs another pancuronium dose?
Select One:
A. Fighting the ventilator
B. Finger movement
C. Leg movement
D. None of the above
It is most important that the nurse assess the patient for:
Select one:
A. Presence of pain
B. Swelling of the arm
C. Presence of pulses in the arms
D. None of the above
Select one:
A. Pituitary dysfunction
B. Vasogenic edema
C. Haemorrhage
D. None of the above
which of the following signs and symptoms, if noted in the patient will alert the nurse to the presence of this crisis?
Select one:
A. Fever and tachycardia
B. Pallor and tachycardia
C. Agitation and bradycardia
D. None of the above
A compound fracture is one in which:
Select one:
A. The bone has splintered into several fragments
B. One side of the bone is broken and other side bent
C. There is a break in the skin and underlying soft tissue
D. None of the above
Based on this finding, the nurse:
Select one:
A. Explains to the patient that mechanical ventilation will be necessary to maintain respiratory function
B. Assesses lung sounds and respiratory parameters 1-2 hourly
C. Uses tracheal suctioning to remove secretions
D. None of the above
To achieve the desired outcome of the procedure, which nursing action will be carried out first?
Select One:
A. Removes loose nonviable tissue
B. Applies silver sulfadiazine (Silvadene) ointment
C. Covers the area with an elastic wrap
D. None of the above
The nurse anticipates that which of the following medication route will be prescribed for analgesics for the patient?
Select one:
A. Intramuscular
B. Intravenous
C. Subcutaneous
D. None of the above
It is most important for the nurse to include which information in the teaching plan?
Select One:
A. Keep a smoke detector in each bedroom.
B. Use space heaters instead of gas heaters.
C. Use carbon monoxide detectors only in the garage.
D. None of the above
Which of following is the best time of instruction for preoperative teaching/education?
Select one:
A. Afternoon or evening before the surgery
B. Relatively close to the time of surgery
C. Morning or 4 hours before surgery
D. None of the above
Which of the following is not a component of protective isolation?
Select one:
A. Wearing protective mast, cap, shoe covers, gloves, scrub clothes, and plastic apron
B. Strict hand washing
C. Wearing gloves and a gown only when caring for the patient
D. None of the above
Select One:
A. Use of space heaters
B. Use of sunscreen agents
C. Cooking with a microwave oven
D. None of the above
Select one:
A. I, II and III
B. I, II and IV
C. I, III and IV
D. None of the above
Select one:
A. Provide a means of elevating the potency of the bile duct
B. Allow bile to drain until sufficient healing occurs
C. Permit drainage of excess fluid from the surgical site
D. None of the above
An appropriate nursing intervention for the patient is:
Select one:
A. Clustering nursing activities to provide periods of uninterrupted rest
B. Maintaining hyperventilation to a partial pressure of carbon dioxide of 15-20 mmHg
C. Avoiding positioning the patient with neck and hip flexion
D. None of the above
Assessment revealed fracture of the spine which has resulted in an incomplete spinal cord injury.
An initial incomplete spinal cord injury often results in complete cord damage because of:
Select one:
A. Continued trauma to the cord resulting from damage to stabilizing ligaments
B. Infarction and necrosis of the cord caused by edema, hemorrhage, and metabolites
C. Mechanical transaction of the cord by sharp vertebral bone fragments after the initial injury
D. None of the above
Which response of the nurse would stimulate further discussion between the patient and the nurse?
Select one:
A. Let me tell you about the amount of pain you can expect
B. If it is any help, anyone is nervous before surgery
C. Can you share with me your fears about surgery?
D. None of the above
The nurse should first:
Select one:
A. Take the patient’s vital signs
B. Find out when the last analgesic was given
C. Administer the prescribed prn analgesic
D. None of the above
Select One:
A. Bilateral inspiratory and expiratory crackles
B. Bilateral pleural friction rub
C. Absence of breaths sound in the right thorax
D. None of the above
Select one:
A. Thrombolytic
B. Adjuvant
C. Anticoagulation
D. None of the above
Select one:
A. Allowing the patient to cough
B. Palpate the right iliac region whiles he is on lie on the left
C. Pressing the Mcburney’s point to illicit rebound tenderness
D. None of the above
Select one:
A. Scarring
B. Kussmaul's sign
C. Contracture
D. None of the above
Which laboratory value will the nurse monitor?
Select One:
A. Sodium
B. Creatinine
C. Magnesium level
D. None of the above
Select one:
A. Decreased vascular oncotic pressure
B. Loss of sodium to the interstitium
C. Increased capillary permeability
D. None of the above
Select one:
A. High fibre, low protein
B. High carbohydrate, low sodium
C. Low residue, high protein
D. None of the above
The residual limb was wrapped with an elastic compression bandage and has fallen off.
The nurse immediately:
Select one:
A. Rewraps the stump with an elastic compression bandage
B. Applies ice to the site
C. Applies a sterile dressing and elevates it on pillow
D. None of the above
Select one:
A. Calf pain associated with dorsiflexion of the leg
B. Pain with abduction of the limb
C. Pain that occur with squeezing the calf
D. None of the above
A. Anaemia and haemorrhage
B. Black water fever
C. Congested lung
D. Impaired peristalsis
I.Pain with obvious on – going peripheral pathology
II.Chronic benign pain that may have peripheral or central pathology
III.Pain that subsides and gradually disappears
IV.Recurrent acute pain
A. I, II and III
B. I, II and IV
C. II, III and IV
D. I, II, III and IV
A. Broad beans
B. Maize
C. Soya beans
D. Wheat
A. Continuous dyspepsia
B. Diuretic therapy
C. Inadequate oral intake
D. Sodium restriction
A. Assess the patient for flank pain
B. Encourage extra oral fluid intake
C. Observe urine for remaining contrast material
D. Encourage ambulation 2 to 3 hours after the study
A. Uric acid calculi and nephrolithiasis
B. Renal sugar – crystal calculi and cyst
C. Lipid deposits in the glomeruli and nephrons
D. Thickening of the glomerular basement membrane and glomerulosclerosis.
A. Apathy, weakness, abdominal distension
B. Oedema, bounding pulse, confusion
C. Spasms, diarrhoea, irregular pulse rate
D. Sunken eyeballs, Kussmauls breathing, thirst
A. Augment the immune response
B. Potentiate the effect of antacids
C. Reduce hydrochloric acid secretion
D. Treat Helicobacter pylori infection
A. Encourage deep breathing and coughing exercise
B. Limit the patient’s fluid intake
C. Massage the legs twice daily
D. Teach the patient to move the legs when in bed
A. Decreased hydrostatic pressure with pressure shift from the interstitium to the vasculature
B. Increased hydrostatic pressure with plasma shift from vasculature to the interstitium
C. Increased oncotic pressure with plasma shift from the interstitium to the vasculature
D. Decreased oncotic pressure with plasma shift from vasculature to the interstitium
Select One:
A. Elevated blood pressure
B. Increased pulse rate
C. Precordial pain
D. None of the above
Select One:
A. Spider haemangioma
B. Nausea and vomiting
C. Hiccups and anorexia
D. None of the above
Select One:
A. Hematemesis
B. Increased chest motion
C. Unilateraol chest pain
D. None of the above
Select One:
A. Increased sweating
B. Generalised hyperpigmentation
C. Antecubital space
D. None of the above
Select One:
A. The need to call the hospital or clinical unit to report any abnormal signs or symptoms
B. A time frame for when physical activities can be resumed
C. The rationale for abstinence from sexual intercourse for 4 – 6 weeks
D. None of the above
Select One:
A. Developing an individualised plan of nursing care for the patient
B. Ensuring that the patient has been assessed for safe administration of anaesthesia
C. Carrying out specific tasks related of surgical policies and procedures
D. None of the above
Select One:
A. Holds the visceral and parietal pleural membranes together
B. Increases diffusion rates in the lungs
C. Prevents the lungs from overinflating
D. None of the above
Select One:
A. Inflammation
B. Dehydration
C. Shock
D. None of the above
Select One:
A. Pulse
B. Blood pressure
C. Urine output
D. None of the above
Select One:
A. Teaching self – injection of erythropoietin
B. Monitoring urine intake and output
C. Instructions on high iron intake
D. None of the above
Select One:
A. I, III and V
B. IV and V
C. All of the above
D. None of the above
Select One:
A. Thrombin
B. Factor VIII
C. Factor VII
D. None of the above
Select One:
A. Hypoperfusion of the kidneys
B. Enlargement due to hydronephrosis
C. Renal calculi
D. None of the above
Select One:
A. Low
B. Normal
C. High
D. None of the above
Select One:
A. Pulmonary circulation
B. Systemic circulation
C. Coronary circulation
D. None of the above
Select One:
A. Urine with high specific gravity and low sodium concentration
B. Pulmonary oedema and electrical changes in cardiac activity
C. Hypernatraemia and Central Nervous System
D. None of the above
Select One:
A. 3% saline
B. 0.33% saline
C. Ringers Lactate solution
D. None of the above
Select One:
A. Increased oncotic pressure with plasma shifts from the interstitium to the vasculature
B. Decreased hydrostatic pressure with pressure shifts from the interstitium to the vasculature
C. Decreased oncotic pressure with plasma shifts from the vasculature to the interstitium
D. None of the above
Select one:
A. Ceftriaxone alone.
B. Benzathine Penicillin G.
C. Azithromycin plus ceftriaxone.
D. None of the above
Select one:
A. Methotrexate.
B. Oral prednisone.
C. Indomethacin.
D. None of the above
Select one:
A. Increased blood pressure.
B. Dysrhythmias.
C. Drowsiness.
D. None of the above
Select one:
A. Tablet soluble Aspirin, 300mg stat.
B. IM Pethidine 50mg stat.
C. IV Nitroglycerine 2.5mg stat.
D. None of the above
Select one:
A. Splenomegaly.
B. Erythrocytosis.
C. Elevated sedimentation rate.
D. None of the above
Select one:
A. Daily intake of ascorbic acid.
B. Frequent intake of iodized salt.
C. Daily intake of 400IU of vitamin D.
D. None of the above
Select one:
A. Checking his response to verbal stimulant.
B. Monitoring his reaction to painful stimuli.
C. Examining the pupillary reaction to light.
D. None of the above
Select one:
A. I, II and III.
B. I, III and IV.
C. II and III.
D. None of the above
Social Plugin