NUR 185 TEST 1 HONDROS (100% CORRECT ANSWERS
AND GRADED A+)
Nurse admits patient to med surg unit. Resp rate of 38. Patient using chest muscles to
breathe, pulse ox of 87 on room air, pink frothy sputum. What intervention would you
implement first? - ANSWER-O2 at 2 Liters/Min
Caring for pt. who is intubated and receiving mechanical ventilation. What action by the
nurse would decrease the patient's incidence of developing ventilator associated
pneumonia? - ANSWER-Put head of bed at 30-45 degrees.
The nurse is administering acetylcysteine (muca-mist) as nebulizer treatment to patient.
Which should the nurse have available for adverse effect on the patient? - ANSWER-
Suction equipment
Patient coming in with SOB and resp. rate of 32. ABG results PH 7.3 (acid), Co2-50
Bicarb-28, PO2-70
Resp. Acidosis, what orders do you anticipate carrying out? - ANSWER-Apply O2 and
give med-neb treatment.
You have 4 patients in a long term care facility. Which would you check first? -
ANSWER-COPD patient with resp rate of 30, O2 of 87 and on 3 Liters of O2
complaining of dyspnea.
Caring for newly intubated patient getting mechanical ventilation. Pt.'s wife was not at
hosp. when this occurred. Wife appears angry and states "What have you all done to
him?" What would be your response as a nurse? - ANSWER-Explain to the patient why
the patient had to be intubated, continue to update patient's wife on condition and plan
of care, I'm sorry that you walked in on him like that, I understand this must have been
very frightening.
Patient has SOB, edema in legs and face and has the following labs: BUN-95 (high),
Creatinine of 9.2, Potassium of 6.0 (high). What are you going to do - ANSWER-Give
Kexolate, prepare the patient a central line for dialysis. Cardiac monitoring.
Working with a UAP, what task can be delegated? - ANSWER-Instill non-prescription
eye drops in patient's eyes.
Nurse is caring for patient who had total knee replacement yesterday. Patient up in
chair stating he feels good. Pain is 3/10. Resp. 16, pulse is 75, bp is 110/78. Pulse ox
88 reading is after incentive spirometer. What actions would you take at this time? -
ANSWER-Move pulse ox to another finger on the other hand and recheck.
AND GRADED A+)
Nurse admits patient to med surg unit. Resp rate of 38. Patient using chest muscles to
breathe, pulse ox of 87 on room air, pink frothy sputum. What intervention would you
implement first? - ANSWER-O2 at 2 Liters/Min
Caring for pt. who is intubated and receiving mechanical ventilation. What action by the
nurse would decrease the patient's incidence of developing ventilator associated
pneumonia? - ANSWER-Put head of bed at 30-45 degrees.
The nurse is administering acetylcysteine (muca-mist) as nebulizer treatment to patient.
Which should the nurse have available for adverse effect on the patient? - ANSWER-
Suction equipment
Patient coming in with SOB and resp. rate of 32. ABG results PH 7.3 (acid), Co2-50
Bicarb-28, PO2-70
Resp. Acidosis, what orders do you anticipate carrying out? - ANSWER-Apply O2 and
give med-neb treatment.
You have 4 patients in a long term care facility. Which would you check first? -
ANSWER-COPD patient with resp rate of 30, O2 of 87 and on 3 Liters of O2
complaining of dyspnea.
Caring for newly intubated patient getting mechanical ventilation. Pt.'s wife was not at
hosp. when this occurred. Wife appears angry and states "What have you all done to
him?" What would be your response as a nurse? - ANSWER-Explain to the patient why
the patient had to be intubated, continue to update patient's wife on condition and plan
of care, I'm sorry that you walked in on him like that, I understand this must have been
very frightening.
Patient has SOB, edema in legs and face and has the following labs: BUN-95 (high),
Creatinine of 9.2, Potassium of 6.0 (high). What are you going to do - ANSWER-Give
Kexolate, prepare the patient a central line for dialysis. Cardiac monitoring.
Working with a UAP, what task can be delegated? - ANSWER-Instill non-prescription
eye drops in patient's eyes.
Nurse is caring for patient who had total knee replacement yesterday. Patient up in
chair stating he feels good. Pain is 3/10. Resp. 16, pulse is 75, bp is 110/78. Pulse ox
88 reading is after incentive spirometer. What actions would you take at this time? -
ANSWER-Move pulse ox to another finger on the other hand and recheck.
