Exam Review
- In managing a patient with disseminated intravascular coagulation (DIC), which of the following interventions should the nurse anticipate? Select all that apply.(SATA)A)Treatment of the underlying causeB)Administration of beta blockersC)Administration of heparinD)Infusion of lactated Ringer's intravenouslyE)Administration of fresh frozen plasma
- Which of the following actions should a nurse take when managing a patient with hyperparathyroidism to prevent complications related to hypercalcemia? Select All that Apply(SATA)A)Reassure the patient that hyperparathyroidism will resolve on its own.B)Encourage the patient to stay well-hydrated by increasing oral fluid intake.C)Monitor for signs of dehydration regularly.D)Schedule regular follow-up lab tests to monitor calcium levels.E)Encourage intake of milk, milk products, and egg yolks.F)Administer calcium supplements with vitamin D as prescribed.G)Educate about dietary restrictions, particularly increasing phosphorus intake.H)Instruct the patient to limit their physical activity completely.
- Which of the following client education points about ibuprofen and acetaminophen should the nurse include? Select all that apply.(SATA)A)You can take an additional dose of ibuprofen if the headache does not subside within 30 minutes.B)You can safely combine ibuprofen with other NSAIDs or aspirin for more effective pain relief.C)Take ibuprofen with food or milk to minimize gastrointestinal upset.D)Acetaminophen does not increase bleeding time and has a low incidence of gastrointestinal (GI) adverse effects.E)Do not exceed a total daily dose of 1.200 mg to avoid toxicity of acetaminophen,F)Monitor for signs of gastrointestinal bleeding, such as black or tarry stools.
- A nurse is caring for a client on a pediatric unit. The client is a 7-year-old male who is admitted with excessive bruising and complaints of joint pain. The nursing team is monitoring his symptoms closely due to his history of bleeding episodes. The client exhibits multiple bruises on legs and arms. Reports pain during movement, especially in the knees. No signs of active bleeding observed, but requires further evaluation. Joint pain reported at 6 out of 10. Client's gait is slightly altered, walking with a limp on the left side. Vital signs are within normal limits. A nurse is caring for a 7-year-old child with hemophilia who presents with excessive bruising and joint pain. Based on this scenario, identify the anticipated nursing actions for the child's care. Select all that apply.(SATA)A)Administer ibuprofen for pain reliefB)Monitor vital signs and bruising progressionC)Encourage activity without protective gearD)Initiate clotting factor replacement
Exam Review
- A nurse is teaching a client prescribed methotrexate about potential dietary restrictions. Which statement indicates the correct understanding of the teaching?A)It is safe to take over-the-counter pain relievers such as NSAIDs while on methotrexate.B)I should consume foods rich in folate to counteract the effects of methotrexate.C)I can continue taking my regular prenatal vitamins while on methotrexateD)I should avoid alcohol while taking methotrexate to protect my liver health.
- Which of the following are appropriate questions to assess the "Precipitating cause or Provocation of a client's pain based on the PQRST mnemonic? (Select all that apply)(SATA)A)Does your pain radiate to other parts of the body?B)How does the pain affect your daily activities?C)What makes your pain worse or better?D)How would you describe your pain (sharp, dull, or burning?E)Is your pain associated with any other symptoms?F)What were you doing when your pain started?
- Which of the following actions should a nurse take during the administration of a blood transfusion to ensure patient safety? Select all that apply.(SATA)A)Perform safety checks to ensure the correct blood product is administered.B)Use a 24-gauge catheter for blood transfusion.C)Verify the client's blood type and match with the donor's blood.D)Start the transfusion immediately without checking the infusion site.E)Administer blood products with dextrose 5% in 0.9% sodium chloride.F)Obtain the signed consent from the client prior to starting the transfusion.
- A nurse is caring for a patient with rheumatoid arthritis who is struggling to perform activities of daily living (ADLs) due to joint pain and stiffness. Which nursing intervention should the nurse prioritize to best assist the patient?A)Provide the patient with assistive devices for personal care.B)Teach the patient range of motion exercises to improve flexibilityC)Encourage the patient to take over-the-counter medications for pain relief.D)Instruct the patient to rest and avoid all physical activity
Exam Review
- A nurse is caring for a client experiencing opioid withdrawal symptoms. Which of the following symptoms should the nurse monitor during this process?A)Constipation and drowsinessB)Hypotension and hyperactivityC)Rhinitis, abdominal cramping, restlessness, agitationD)Bradycardia and respiratory depression
- A nurse is caring for a client who is receiving a blood transfusion and exhibits signs of a transfusion reaction. What is the priority intervention the nurse should take?A)Administer 0.9% sodium chloride through the existing blood transfusion line.B)Notify the provider and document the reaction before any other action.C)Stop the transfusion and maintain IV access by infusing normal saline through new tubing.D)Monitor vital signs every 30 minutes during the transfusion.
- A nurse is caring for a client with myasthenia gravis who is experiencing increased dyspnea and decreased oxygen saturation levels. Which of the following interventions should the nurse prioritize to improve this client's respiratory status?A)Limit fluid intake to reduce the risk of aspiration.B)Position the client's head of the bed at 15 degrees to encourage lung expansion.C)Encourage the client to take deep breaths using incentive spirometry.D)Administer bronchodilators as prescribed to manage bronchospasm.
- A nurse is caring for a client who presents with unexplained bruising and fatigue. The client is a 30-year-old female who reports a recent increase in menstrual bleeding, During the assessment, the nurse notes that the client has petechiae on her lower extremities. Complete the diagram by dragging from the choices below to specify 1 potential condition the client is most likely experiencing, 2 actions the nurse would take to address that condition, and 2 parameters the nurse would monitor to assess the client's progress.
Exam Review
- A patient with myasthenia gravis presents to the emergency department in a myasthenic crisis. Which of the following assessments would be the top priority for the nurse to perform first?A)Evaluate the patient's muscle strength in extremities.B)Assess the patient's respiratory status and ability to breathe.C)Obtain a complete health history to identify triggers.D)Check the patient's blood glucose levels.
- A nurse is educating a 35-year-old client with hyperthyroidism about the use of radioactive iodine-131 for treatment. Which statement made by the client indicates a correct understanding of this treatment?A)Clients receiving this treatment do not require any follow-up evaluations after initial therapy.B)This treatment permanently destroys thyroid cells, reducing hormone production.C)Radioactive iodine-131 can be used during pregnancy without risks to the fetus.D)Radioactive iodine-131 is the first line of treatment before trying any antithyroid medications,
- A nurse is caring for a client on an orthopedic unit. The client is experiencing joint discomfort and stiffness, particularly in the morning. The healthcare team is monitoring the client closely for any changes in mobility or overall well-being. Complete the diagram by dragging from the choices below to specify 1 potential condition the client is most likely experiencing, 2 actions the nurse would take to address that condition, and 2 parameters the nurse would monitor to assess the client's progress.
- A patient with rheumatoid arthritis is prescribed hydroxychloroquine. Which of the following statements by the patient indicates a need for further education regarding the medication?A)I can safely receive live vaccines while taking hydroxychloroquine.B)I should undergo a routine eye exam during the first year and regularly afterward.C)I can consume unlimited amounts of alcohol while on hydroxychloroquine since it has no known interactionsD)If I experience visual changes while taking this medication, it is important to report it to my healthcare provider immediately.
Exam Review
- A patient diagnosed with hyperparathyroidism is being managed for hypercalcemia. Which intervention should the nurse prioritize to mitigate the risk of complications associated with this condition?A)Administer intravenous fluids to promote renal excretion of calciumB)Encourage high calcium intake through dietary sources.C)Schedule the patient for a parathyroidectomy immediately.D)Initiate a high-dose calcium supplement regimen.
- A nurse is caring for a patient with rheumatoid arthritis who is experiencing a flare-up. The patient has received corticosteroid injections in the past but is concerned about potential side effects. Which of the following side effects should the nurse inform the patient to monitor for when using glucocorticoids?A)Enhanced muscle strengthB)Decreased risk of infectionC)Hyperglycemia and hypertensionD)Improved joint mobility
- A patient with idiopathic thrombocytopenic purpura (ITP) presents with heavy lochia and petechiae. As the nurse, which priority intervention would be most appropriate to prevent complications?A)Monitor the patient's platelet count regularly.B)Instruct the patient to take vitamin K supplements.C)Administer platelet transfusionsD)Encourage the patient to engage in physical activity.E)Administer a high dose of aspirin for pain relief.
- In managing a patient experiencing thyroid storm, which of the following interventions should the nurse prioritize? Select all that apply.A)Encourage the patient to ambulate to prevent complications.B)Provide oxygen support to ensure adequate oxygenation.C)Administer propylthiouracil or methimazoleD)Prepare the patient for potential surgery to remove the thyroid gland.E)Educate the patient on home care requirements post-stabilization.F)Administer beta-blockers such as propranolol to control heart rate.G)Continuous monitoring of vital signs and laboratory results for significant changesH)Initiate intravenous fluid therapy.
Exam Review
- A nurse is assessing a client diagnosed with rheumatoid arthritis who reports morning stiffness lasting for more than an hour. Which characteristic best distinguishes rheumatoid arthritis from osteoarthritis?A)Joint swelling and redness are localized to specific areas.B)Joint stiffness improves with activity throughout the day.C)Pain occurs at rest and during inactivity,D)The disease doesn't cause deformities in the hands and feet.
- A nurse is providing discharge education to a client who has been prescribed levothyroxine for hypothyroidism. Which of the following statements by the client indicates a need for further teaching?A)I can stop taking this medication if my levels normalize.B)I need to have my thyroid blood levels monitored regularly after starting this medication.C)I will take this medication every day even if I feel better.D)I should take my medication on an empty stomach, in the morning before breakfast.
- A patient who has been prescribed pyridostigmine for myasthenia gravis presents with excessive sweating vomiting, and bradycardia. Which of the following nursing actions should be prioritized to address these symptoms suspected to be from a cholinergic crisis?A)Provide fluids and monitor vital signs onlyB)Administer atropine as prescribedC)Increase the dosage of pyridostigmineD)Assess the patient's neurological status every hour
- A nurse is caring for a client with myasthenia gravis who has been prescribed pyridostigmine. Which nursing intervention is most important to include in the care plan for this client?A)Monitor for signs of cholinergic crisis, such as excessive salivation and muscle twitching.B)Advise the client to discontinue the medication once they experience increased muscle strength.C)Encourage the client to take the medication on an empty stomach to enhance absorption.D)Teach the client to self-administer pyridostigmine via intramuscular injection.