NUR 265 EXAM 4 COMPREHENSIVE STUDY GUIDE
QUESTIONS AND ANSWERS
The nurse is working in the ED is traiging pt who has presented with chest pain,
SOB, productive cough, reports night sweats. the pt's health hx includes
presence of AIDS and a recent laboratory results that reveal a low CD4+ count.
Airborne precautions have been initated. which of the following actions should
the nurse take next
a. assess the pt for shingles
b. obtain a throat culture
c. prepare the pt for insertion of chest tube
d. check pt's temp
d. check pt's temp
The newly hired nurse is developing a POC for a pt who has AIDS and was just
diganosed with pneumocystis jiroveci pneumonia (PJP) and pain. which of the
following interventions should the nurse preceptor question
a. telling the pt to keep the door to the room closed at all times
b. offering the pt foods high in calories and protein
c. instruciting the pt to drink at least 2-3L of fluid throughout the day
d. placing the client on pressure-relieving mattress
a. telling the pt to keep the door to the room closed at all times
The nurse is caring for a pt with ADS who has just been cryptoccal meningitis.
which of the following actions should the nurse take
a. initate airborne precuations for the next 72 hours
b. initate seizure precautions with padded siderails
c. thicken the pt's liquid to honey consistency
d. administer IV pentamidine isethionate
b. initate seizure precautions with padded siderails
The nurse had provided med instructions to a pt who has HIV and has been
prescribed cART. which of the following pt statements indicates a correct
understanding of teaching
a. "i can avoid developing drug resistance if I take 90% of my drugs on time"
b. "i am less likely to develop oportunistic infections once i begin my prescribed
medications"
c. "i understand that this combo of drugs will kill the virus"
d. "i should discontinue my medications if i develop sever diarrhea"
a. "i can avoid developing drug resistance if I take 90% of my drugs on time"
The nurse is working in a community health center has instructed a group of pts
who have AIDS about ways to prevent infections. which of the following
statement by a pt would indicate the need for additional teaching
a. "i should clean my toothbrush by running it through the dishwater"
,b. "i will wear a surgical mask when i change my cat's litter box"
c. "i will notify my PCP if my temp is greater than 100"
d. "i will avoid drinking water that has been standing for longer than 1 hour"
b. "i will wear a surgical mask when i change my cat's litter box"
The nurse is preparing a newly hired nurse who is caring for a pt who has AIDS
and has developed Kaposi Sarcome. It requires additional teaching by the
preceptor if the newly hired nurse
a. instructs the pt that make-up can be applied to lesion that are open
b. applies surgical mask before enetering pt's room
c. keeps open weeping lesions clean and covered with prescribed dressing
d. inspect the pt's mouth at least once every 8 hours
b. applies surgical mask before enetering pt's room
The nurse is caring for a pt who had a heart transplant 24 hours ago. which of the
following findings indicates the pt is developing complications
a. hypotension
b. urticaria
c. prothrombin time of 11 sec
d. facial flushing
a. hypotension
The nurse is caring for a pt who had a lung transplant 10 days ago. it would be a
priority for the nurse to notify the PCP if the pt has
a. developed sputum that is yellow-tinged
b. refused to get out of bed for the past 24 hours
c. a pain rating of 7 when taking a deep breath
d. only used the incentive spirometer once since last eveninig
a. developed sputum that is yellow-tinged
The nurse is caring for a pt who had a liver transplant 48 hours ago. which
findings from the box is a priority for the nurse to report to the PCP
1. decrese in urine output from 50 to 30mL/hr since surgery
2. an increase in a AST form 28 to 32 units/L in the past 24 hours
3. a pulse rate that has decreased from 88 to 72 over the last 8 hours
4. a PT of 20 seconds
5. an INR of 2.5 seconds
6. an increase in serum bilirubin levels over the last 12 hours
7. a decreased in alkaline phosphatase levels
a. 2,3,5
b. 1,3,7
c. 1,4,6,7
d. 2,4,5,6,
d. 2,4,5,6,
The nurse is caring for a pt who had kindey trasnplant 2 weeks ago. which of the
following findings should the nurse correlate to possible organ rejection
, a. BUN of 15
b. BP 172/96
c. serum creatinie level of 0.9
d. UA that is postive for protein
b. BP 172/96
The nurse is assessing a pt who is suspected of having superior vena cava
syndrome (SVCS). which of the following findings would be consisent with this
diagnosis
a. swelling around the pt's eyes upon wakening
b. petechia noted on the upper chest and arms
c. a BP that is higher in one arm when compared to the other
d. the presence of enlarged nodes in the pt's axilla
a. swelling around the pt's eyes upon wakening
The nurse is caring for a pt who has a diagnosis of advanced oral cancer and has
had extensive surgery. which of the following pt statements indicates that the
diagnosis has been accepted
a. i need to call my children to come home from college for a visit
b. when this is all over with, i'm taking my family on a big vacation
c. the biopsy test results will be confirmed again next week
d. i will be a better husband and father if i can just get through this
a. i need to call my children to come home from college for a visit
The nurse working in a PHCP office just administered a routine immunization to a
pt. the clinet is asked to wait in the waiting room for the next 15 mins. five mins.
later the pt develops swelling of the eyes and reports feeling anxious, SOB, and
dizzy. which of the follwing actions should the nurse take first
a. prepare to administer dipenhyramine
b. elevate the pt's feet and legs
c. obtain full set of VS
d. perfrom a respiratory assessment
d. perfrom a respiratory assessment
The nurse is caring for a pt who just recieved pneumococcal polysaccharide
vaccine. the pt reports feeling anxious, SOB, dizzy and has audible wheezing.
which actions from the box below should the nurse take
1. initate oxygen via a nonrebreather mask
2. obtain IV access with a large-bore IV
3. administer IM epinephrine 0.3mL
4. have a crash cart available in the pt's room
5. complet a facility incident report
6. administer 0.5mg of lorazepam PO
a. 1,2,5
QUESTIONS AND ANSWERS
The nurse is working in the ED is traiging pt who has presented with chest pain,
SOB, productive cough, reports night sweats. the pt's health hx includes
presence of AIDS and a recent laboratory results that reveal a low CD4+ count.
Airborne precautions have been initated. which of the following actions should
the nurse take next
a. assess the pt for shingles
b. obtain a throat culture
c. prepare the pt for insertion of chest tube
d. check pt's temp
d. check pt's temp
The newly hired nurse is developing a POC for a pt who has AIDS and was just
diganosed with pneumocystis jiroveci pneumonia (PJP) and pain. which of the
following interventions should the nurse preceptor question
a. telling the pt to keep the door to the room closed at all times
b. offering the pt foods high in calories and protein
c. instruciting the pt to drink at least 2-3L of fluid throughout the day
d. placing the client on pressure-relieving mattress
a. telling the pt to keep the door to the room closed at all times
The nurse is caring for a pt with ADS who has just been cryptoccal meningitis.
which of the following actions should the nurse take
a. initate airborne precuations for the next 72 hours
b. initate seizure precautions with padded siderails
c. thicken the pt's liquid to honey consistency
d. administer IV pentamidine isethionate
b. initate seizure precautions with padded siderails
The nurse had provided med instructions to a pt who has HIV and has been
prescribed cART. which of the following pt statements indicates a correct
understanding of teaching
a. "i can avoid developing drug resistance if I take 90% of my drugs on time"
b. "i am less likely to develop oportunistic infections once i begin my prescribed
medications"
c. "i understand that this combo of drugs will kill the virus"
d. "i should discontinue my medications if i develop sever diarrhea"
a. "i can avoid developing drug resistance if I take 90% of my drugs on time"
The nurse is working in a community health center has instructed a group of pts
who have AIDS about ways to prevent infections. which of the following
statement by a pt would indicate the need for additional teaching
a. "i should clean my toothbrush by running it through the dishwater"
,b. "i will wear a surgical mask when i change my cat's litter box"
c. "i will notify my PCP if my temp is greater than 100"
d. "i will avoid drinking water that has been standing for longer than 1 hour"
b. "i will wear a surgical mask when i change my cat's litter box"
The nurse is preparing a newly hired nurse who is caring for a pt who has AIDS
and has developed Kaposi Sarcome. It requires additional teaching by the
preceptor if the newly hired nurse
a. instructs the pt that make-up can be applied to lesion that are open
b. applies surgical mask before enetering pt's room
c. keeps open weeping lesions clean and covered with prescribed dressing
d. inspect the pt's mouth at least once every 8 hours
b. applies surgical mask before enetering pt's room
The nurse is caring for a pt who had a heart transplant 24 hours ago. which of the
following findings indicates the pt is developing complications
a. hypotension
b. urticaria
c. prothrombin time of 11 sec
d. facial flushing
a. hypotension
The nurse is caring for a pt who had a lung transplant 10 days ago. it would be a
priority for the nurse to notify the PCP if the pt has
a. developed sputum that is yellow-tinged
b. refused to get out of bed for the past 24 hours
c. a pain rating of 7 when taking a deep breath
d. only used the incentive spirometer once since last eveninig
a. developed sputum that is yellow-tinged
The nurse is caring for a pt who had a liver transplant 48 hours ago. which
findings from the box is a priority for the nurse to report to the PCP
1. decrese in urine output from 50 to 30mL/hr since surgery
2. an increase in a AST form 28 to 32 units/L in the past 24 hours
3. a pulse rate that has decreased from 88 to 72 over the last 8 hours
4. a PT of 20 seconds
5. an INR of 2.5 seconds
6. an increase in serum bilirubin levels over the last 12 hours
7. a decreased in alkaline phosphatase levels
a. 2,3,5
b. 1,3,7
c. 1,4,6,7
d. 2,4,5,6,
d. 2,4,5,6,
The nurse is caring for a pt who had kindey trasnplant 2 weeks ago. which of the
following findings should the nurse correlate to possible organ rejection
, a. BUN of 15
b. BP 172/96
c. serum creatinie level of 0.9
d. UA that is postive for protein
b. BP 172/96
The nurse is assessing a pt who is suspected of having superior vena cava
syndrome (SVCS). which of the following findings would be consisent with this
diagnosis
a. swelling around the pt's eyes upon wakening
b. petechia noted on the upper chest and arms
c. a BP that is higher in one arm when compared to the other
d. the presence of enlarged nodes in the pt's axilla
a. swelling around the pt's eyes upon wakening
The nurse is caring for a pt who has a diagnosis of advanced oral cancer and has
had extensive surgery. which of the following pt statements indicates that the
diagnosis has been accepted
a. i need to call my children to come home from college for a visit
b. when this is all over with, i'm taking my family on a big vacation
c. the biopsy test results will be confirmed again next week
d. i will be a better husband and father if i can just get through this
a. i need to call my children to come home from college for a visit
The nurse working in a PHCP office just administered a routine immunization to a
pt. the clinet is asked to wait in the waiting room for the next 15 mins. five mins.
later the pt develops swelling of the eyes and reports feeling anxious, SOB, and
dizzy. which of the follwing actions should the nurse take first
a. prepare to administer dipenhyramine
b. elevate the pt's feet and legs
c. obtain full set of VS
d. perfrom a respiratory assessment
d. perfrom a respiratory assessment
The nurse is caring for a pt who just recieved pneumococcal polysaccharide
vaccine. the pt reports feeling anxious, SOB, dizzy and has audible wheezing.
which actions from the box below should the nurse take
1. initate oxygen via a nonrebreather mask
2. obtain IV access with a large-bore IV
3. administer IM epinephrine 0.3mL
4. have a crash cart available in the pt's room
5. complet a facility incident report
6. administer 0.5mg of lorazepam PO
a. 1,2,5
