Simulated Test Part 2
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- 1.Situation:Nurse Madonna is entrusted with the task of promoting nursing care in clients with disturbances in the respiratory pattern. 1. When a chest tube is being removed, the nurse should instruct the client to:
- A.
Cough vigorously
- B.
Deep breath
- C.
Inhale and hold breath
- D.
Exhale deeply
- 2.Which of the following equipment does not interfere with eating or talking and can best deliver oxygen in a hypoxic client?
- A.
Oxygen tent
- B.
Oxygen mask
- C.
Nasal Cannula
- D.
Endotracheal tube
- 3.Which reading of pulmonary capillary wedge pressure( in mmHg) needs to be reported to the physician immediately?
- A.
5-10 mmHg
- B.
15-20 mmHg
- C.
25-30 mmHg
- D.
35-40 mmHg
- 4.Which of the following clients is at most risk for tuberculosis?
- A.
A 35-year-old newly married
- B.
A 86-year-old client
- C.
A 12-year-old child
- D.
A 17-year old adolescent
- 5.Which of the following statements best describes the primary purpose of pursed-lip-breathing:
- A.
Increase oxygen inhalation
- B.
Maximize diaphragmatic extension
- C.
Facilitate elimination of carbon dioxide
- D.
Minimize the use of intercostal muscles
- 6.Which assessment finding best indicates deterioration of liver function?
- A.
Anorexia
- B.
Constipation
- C.
Weight gain
- D.
Lethargy
- 7.Which of the following aspects of care should have the highest priority for a client admitted due to cholecystitis?
- A.
Comfort
- B.
Hydration
- C.
Heath instructions
- D.
Obtaining thorough history.
- 8.Which of the following laboratory values is NOT expected in a client with pancreatitis?
- A.
Serum Magnesium: 3.2 mEq/L
- B.
Serum Glucose: 45mg/dL
- C.
Serum potassium: 5.5 mEq/L
- D.
Serum Calcium: 8 mg/dL
- 9.Which client is best candidates for rthe use of insulin pump?
- A.
A 42-year-old businessman
- B.
A 35-year-old working single mother
- C.
A 12-year-old mentally retarded
- D.
An 82-year-old cognitively impaired.
- 10.Which statement made by a client with ulcer indicates understanding of the medication therapy?
- A.
"Antacids can be taken with other drugs"
- B.
"Tagamet will decrease the acids in my stomach"
- C.
" Maalox will coat my stomach"
- D.
" I can take my antacids with aspirin"
- 11.To decrease the anxiety of the client and his/her family about an impending surgery, the nurse should:
- A.
Describe the details of the surgery to the client and family.
- B.
Provide general information and answer appropriate questions of the client and family.
- C.
Empower the client to make decision by obtaining the client's consent.
- D.
Give full reassurance that the surgical team is experienced to handle the surgery.
- 12.Which of the following procedure for using an incentive spirometer is appropriate for the nurse to provide the client with during preoperative instructions?
- A.
Inhale completely and exhale rapidly through the spirometer.
- B.
Exhale completely, take slow deep breath through the spirometer, hold breath then exhale through purse lip.
- C.
Inhale completely through the spirometer, exhale and hold breath.
- D.
Exhale through the spirometer, hold breath then then inhale.
- 13.The stages of surgical anesthesia proceeds in which of the following order?
- A.
Excitement, surgical anesthesia, loss of consciousness, danger stage
- B.
Loss of consciousness, excitement, surgical anesthesia, danger stage.
- C.
Surgical anesthesia, excitement, loss of consciousness, danger stage.
- D.
Loss of consciousness, surgical anesthesia excitement, danger stage.
- 14.What common side effect should the nurse monitor in a client who just received epidural anesthesia?
- A.
Fever
- B.
Bradycardia
- C.
Hypotension
- D.
Pallor
- 15.Which of the following complications can result from the use of general anesthesia during surgery.?
- A.
Fluid loss
- B.
Peripheral fluid retention
- C.
Atelectasis
- D.
Muscle rigidity
- 16.Physical preparation for a client scheduled for cystectomy and ileal conduit includes the administration of:
- A.
Intravenous vitamin C
- B.
Neomycin sulfate
- C.
Bladder Analgesic
- D.
Urinary antibiotic
- 17.Which of the follwing methods of assessment is correct to assess distension in a post operative client?
- A.
Palpate the perineal area
- B.
Palpate the epigastric area
- C.
Percuss and palpate the lower abdomen
- D.
Percuss and palpate the upper abdomen
- 18.After thyroidectomy, which of the following interventions is the highest priority of the nurse?
- A.
Monitor the client's vital sign every 4h.
- B.
Observe the dressing at the back of the neck for the presence of blood
- C.
Press gently around the incision to assess for subcutaneous emphysema
- D.
Position the client laterally to promote drainage of secretions from the mouth.
- 19.Following cataract extraction, which client activity is allowed.?
- A.
Coughing deeply to prevent pneumonia
- B.
Bending from the waist to prevent contracture deformity
- C.
Remaining in a lying down supine position for 48 h after surgery
- D.
Deep breathing to promote lung expansion.
- 20.What is the highest priority, in terms of goal of cvare, by the nurse after a client's prostatectomy?
- A.
To prevent infection
- B.
To prevent bleeding
- C.
To prevent impotence
- D.
To prevent respiratory distress.
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