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NSG 223 Mod 2 - Practice Exam Comprehensive Questions (Frequently Tested) and Complete Solutions Graded A+

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NSG 223 Mod 2 - Practice Exam Comprehensive Questions (Frequently Tested) and Complete Solutions Graded A+

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NSG 223 Mod 2 - Practice Exam
Comprehensive Questions
(Frequently Tested) and Complete
Solutions Graded A+
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The nurse is caring for a client suspected of having acute
respiratory distress

syndrome (ARDS). What is the most likely diagnostic test ordered
in the early stages of

,this disease to differentiate the client's symptoms from those of a
cardiac etiology?

A. Carboxyhemoglobin level

B. Brain natriuretic peptide (BNP) level

C. C-reactive protein (CRP) level

D. Complete blood count - Answer: ANS: B Rationale: Common
diagnostic tests performed for clients with potential ARDS include
plasma brain natriuretic peptide (BNP) levels, echocardiography,
and pulmonary artery catheterization. The BNP level is helpful in
distinguishing ARDS from cardiogenic pulmonary edema. The
carboxyhemoglobin level will be increased in a client with an
inhalation injury, which commonly progresses into ARDS. CRP and
CBC levels do not help differentiate from a cardiac problem.



The perioperative nurse is writing a care plan for a client who has
returned from

surgery 2 hours ago. Which measure should the nurse implement
to most decrease the

client's risk of developing pulmonary emboli (PE)?

A. Early ambulation

B. Increased dietary intake of protein

C. Maintaining the client in a supine position

,D. Administering aspirin with warfarin - Answer: ANS: A
Rationale: For clients at risk for PE, the most effective approach
for prevention is to prevent deep vein thrombosis. Active leg
exercises to avoid venous stasis, early ambulation, and use of
elastic compression stockings are general preventive measures.
The client does not require increased dietary intake of protein
directly related to prevention of PE, although it will assist in
wound healing during the postoperative period. The client should
not be maintained in one position, but frequently repositioned
unless contraindicated by the surgical procedure. Aspirin should
never be given with warfarin because it will increase the client's
risk for bleeding.



A client presents to the emergency department after being in a
boating accident

about 3 hours ago. Now the client reports headache, fatigue, and
the feeling of not being

able to breathe enough. The nurse notes that the client is restless
and tachycardic with an

elevated blood pressure. This client may be in the early stages of
which respiratory

problem?

A. Pneumoconiosis

B. Pleural effusion

, C. Acute respiratory failure

D. Pneumonia - Answer: ANS: C Rationale: Early signs of acute
respiratory failure are those associated with impaired oxygenation
and may include restlessness, fatigue, headache, dyspnea, air
hunger, tachycardia, and increased blood pressure. As the
hypoxemia progresses, more obvious signs may be present,
including confusion, lethargy, tachycardia, tachypnea, central
cyanosis, diaphoresis, and, finally, respiratory arrest. Pneumonia
is infectious and would not result from trauma. Pneumoconiosis
results from exposure to occupational toxins. A pleural effusion
does not cause this constellation of symptoms.



A client is receiving thrombolytic therapy for the treatment of
pulmonary emboli.

What is the best way for the nurse to assess the client's
oxygenation status at the

bedside?

A. Obtain serial ABG samples.

B. Monitor pulse oximetry readings.

C. Perform chest auscultation.

D. Monitor incentive spirometry volumes. - Answer: ANS: B
Rationale: The nurse assesses the client with pulmonary emboli
frequently for signs of hypoxemia and monitors the pulse
oximetry values to evaluate the effectiveness of the oxygen

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