NURSING 108 - EXAM ONE (UNIT 1 SHERPATH QUIZZES)
QUESTIONS WITH ACCURATE ANSWERS
A 6-year-old girl is carried into the emergency department (ED) by her mother.
The child is gasping for breath and wheezing. The child's vital signs are
respirations 30 bpm, pulse 120 bpm, SpO2 92%, BP 90/50 mmHg. The nurse takes
which actions?
1. Place the child in a sitting position on the bed with support for her back.
2. Ask the mother for a medical history including any medications.
3. Call for the appropriate care provider to quickly evaluate.
4. Explain to the mother that the ED is very busy and to have a seat in the waiting
room with the child.
5. Initiate standing protocols for childhood asthmatic until the appropriate care
provider arrives. correct answer -Place the child in a sitting position on the bed
with support for her back.
-Ask the mother for a medical history including any medications.
-Call for the appropriate care provider to quickly evaluate.
-Initiate standing protocols for childhood asthmatic until the appropriate care
provider arrives.
A 17-year-old male suffered an injury during football practice. He was diagnosed
with an ACL tear and was told he will not be able to play for the rest of the
football season. The patient is distraught, will not speak to anyone who
approaches him, refuses to eat, and is not able to concentrate. He is angry and
irritable regarding his situation. Which is an appropriate nursing diagnosis for the
patient?
,1. Acute Pain related to knee injury as evidenced by feelings of distress and
refusal to speak.
2. Ineffective Coping related to severe pain as evidenced by lack of appetite and
poor concentration.
3. Chronic Pain related to deformity of joints as evidenced by lack of appetite and
poor concentration.
4. Anxiety related to fear of increasing pain levels as evidenced by feelings of
distress and refusal to speak. correct answer - Ineffective Coping related to severe
pain as evidenced by lack of appetite and poor concentration.
A 21-year-old college football player has been in the hospital 24 hours for
observation following a concussion. His BP has been stable at 118/62, but
suddenly he complains of a severe headache and his BP is 170/94.The nurse
orders vital sign monitoring with what frequency?
1. Every 4 hours
2. Every 5 minutes
3. Every 8 hours
4. Every shift correct answer -Every 5 minutes
A 26-year-old female who was in a car accident one month prior is meeting with a
pain specialist. The patient indicates that neck pain related to the accident has
subsided and expresses a wish to decrease her prescribed dosage of pain
medication. Which diagnosis is appropriate for the patient?
1. Readiness for Enhanced Comfort as evidenced by inquiry regarding decreasing
dosage of pain medication.
,2. Acute Pain related to neck injury as evidenced by inquiry regarding decreasing
dosage of pain medication.
3. Chronic Pain related to neck injury as evidenced by inquiry regarding
decreasing dosage of pain medication.
4. Anxiety related to alterations in pain level as evidenced by inquiry regarding
decreasing dosage of pain medication. correct answer - Readiness for Enhanced
Comfort as evidenced by inquiry regarding decreasing dosage of pain medication.
A 34-year-old male patient who suffered a back injury at work seven years ago
has experienced lower back pain ever since. His pain has gotten to the point that
he is considering applying for disability insurance because he is no longer able to
perform all of his work duties as a plumber. He presents to his primary care
provider's office because his current pain regimen is no longer working. Which
nursing diagnosis is appropriate for the patient?
1. Ineffective coping related to severe pain as evidenced by inquiry regarding pain
medication.
2. Readiness for Enhanced Comfort as evidenced by inquiry regarding pain
medication.
3. Acute Pain related to back injury as evidenced by inability to work at place of
employment.
4. Chronic Pain related to back injury as evidenced by inability to work at place of
employment. correct answer - Chronic Pain related to back injury as evidenced by
inability to work at place of employment.
A 35-year-old woman delivered a 9 lb 7 oz boy 24 hours ago via cesarean section.
Her vital signs were stable, pulse 74 bpm and temperature 99° F, 4 hours ago. The
UAP reports to the nurse that this patient's pulse is now 100 bpm and her
temperature is 101.8° F and she is complaining of chills. The room temperature is
73° F. The nurse interprets the data and takes which action?
, 1. The patient is showing signs of likely infection. The nurse verifies the vital signs
and notifies the appropriate care provider.
2. The UAP is advised to wait one hour and repeat vital signs measurement.
3. The patient is advised to take a shower to freshen up.
4. The maintenance department is notified to increase the room temperature.
correct answer -The patient is showing signs of likely infection. The nurse verifies
the vital signs and notifies the appropriate care provider.
A 36-year-old female who was in a motor vehicle accident presents to the ER with
a primary complaint of facial pain after her airbag was triggered by the crash. Her
blood pressure and pulse rate are elevated, and she is moaning in pain and
holding her nose. She rates her pain 10 out of 10 and is asking for pain
medication. Which is an appropriate nursing diagnosis for the patient?
1. Ineffective Coping related to severe pain as evidenced by elevated pulse and
request for pain medication.
2. Anxiety related to fear of increasing pain levels as evidenced by pain with
movement and request for pain medication.
3. Acute Pain related to long bone fracture as evidenced by pain with movement,
reported pain of 10 of 10, and increased blood pressure.
4. Chronic Pain related to inflammatory process as evidenced by pain with
movement, reported pain of 10 of 10, and increased blood pressure. correct
answer - Acute Pain related to long bone fracture as evidenced by pain with
movement, reported pain of 10 of 10, and increased blood pressure.
A 45-year-old male patient complains of upper abdominal pain. Which pain
assessment tool would be most appropriate to use when evaluating his
condition?
QUESTIONS WITH ACCURATE ANSWERS
A 6-year-old girl is carried into the emergency department (ED) by her mother.
The child is gasping for breath and wheezing. The child's vital signs are
respirations 30 bpm, pulse 120 bpm, SpO2 92%, BP 90/50 mmHg. The nurse takes
which actions?
1. Place the child in a sitting position on the bed with support for her back.
2. Ask the mother for a medical history including any medications.
3. Call for the appropriate care provider to quickly evaluate.
4. Explain to the mother that the ED is very busy and to have a seat in the waiting
room with the child.
5. Initiate standing protocols for childhood asthmatic until the appropriate care
provider arrives. correct answer -Place the child in a sitting position on the bed
with support for her back.
-Ask the mother for a medical history including any medications.
-Call for the appropriate care provider to quickly evaluate.
-Initiate standing protocols for childhood asthmatic until the appropriate care
provider arrives.
A 17-year-old male suffered an injury during football practice. He was diagnosed
with an ACL tear and was told he will not be able to play for the rest of the
football season. The patient is distraught, will not speak to anyone who
approaches him, refuses to eat, and is not able to concentrate. He is angry and
irritable regarding his situation. Which is an appropriate nursing diagnosis for the
patient?
,1. Acute Pain related to knee injury as evidenced by feelings of distress and
refusal to speak.
2. Ineffective Coping related to severe pain as evidenced by lack of appetite and
poor concentration.
3. Chronic Pain related to deformity of joints as evidenced by lack of appetite and
poor concentration.
4. Anxiety related to fear of increasing pain levels as evidenced by feelings of
distress and refusal to speak. correct answer - Ineffective Coping related to severe
pain as evidenced by lack of appetite and poor concentration.
A 21-year-old college football player has been in the hospital 24 hours for
observation following a concussion. His BP has been stable at 118/62, but
suddenly he complains of a severe headache and his BP is 170/94.The nurse
orders vital sign monitoring with what frequency?
1. Every 4 hours
2. Every 5 minutes
3. Every 8 hours
4. Every shift correct answer -Every 5 minutes
A 26-year-old female who was in a car accident one month prior is meeting with a
pain specialist. The patient indicates that neck pain related to the accident has
subsided and expresses a wish to decrease her prescribed dosage of pain
medication. Which diagnosis is appropriate for the patient?
1. Readiness for Enhanced Comfort as evidenced by inquiry regarding decreasing
dosage of pain medication.
,2. Acute Pain related to neck injury as evidenced by inquiry regarding decreasing
dosage of pain medication.
3. Chronic Pain related to neck injury as evidenced by inquiry regarding
decreasing dosage of pain medication.
4. Anxiety related to alterations in pain level as evidenced by inquiry regarding
decreasing dosage of pain medication. correct answer - Readiness for Enhanced
Comfort as evidenced by inquiry regarding decreasing dosage of pain medication.
A 34-year-old male patient who suffered a back injury at work seven years ago
has experienced lower back pain ever since. His pain has gotten to the point that
he is considering applying for disability insurance because he is no longer able to
perform all of his work duties as a plumber. He presents to his primary care
provider's office because his current pain regimen is no longer working. Which
nursing diagnosis is appropriate for the patient?
1. Ineffective coping related to severe pain as evidenced by inquiry regarding pain
medication.
2. Readiness for Enhanced Comfort as evidenced by inquiry regarding pain
medication.
3. Acute Pain related to back injury as evidenced by inability to work at place of
employment.
4. Chronic Pain related to back injury as evidenced by inability to work at place of
employment. correct answer - Chronic Pain related to back injury as evidenced by
inability to work at place of employment.
A 35-year-old woman delivered a 9 lb 7 oz boy 24 hours ago via cesarean section.
Her vital signs were stable, pulse 74 bpm and temperature 99° F, 4 hours ago. The
UAP reports to the nurse that this patient's pulse is now 100 bpm and her
temperature is 101.8° F and she is complaining of chills. The room temperature is
73° F. The nurse interprets the data and takes which action?
, 1. The patient is showing signs of likely infection. The nurse verifies the vital signs
and notifies the appropriate care provider.
2. The UAP is advised to wait one hour and repeat vital signs measurement.
3. The patient is advised to take a shower to freshen up.
4. The maintenance department is notified to increase the room temperature.
correct answer -The patient is showing signs of likely infection. The nurse verifies
the vital signs and notifies the appropriate care provider.
A 36-year-old female who was in a motor vehicle accident presents to the ER with
a primary complaint of facial pain after her airbag was triggered by the crash. Her
blood pressure and pulse rate are elevated, and she is moaning in pain and
holding her nose. She rates her pain 10 out of 10 and is asking for pain
medication. Which is an appropriate nursing diagnosis for the patient?
1. Ineffective Coping related to severe pain as evidenced by elevated pulse and
request for pain medication.
2. Anxiety related to fear of increasing pain levels as evidenced by pain with
movement and request for pain medication.
3. Acute Pain related to long bone fracture as evidenced by pain with movement,
reported pain of 10 of 10, and increased blood pressure.
4. Chronic Pain related to inflammatory process as evidenced by pain with
movement, reported pain of 10 of 10, and increased blood pressure. correct
answer - Acute Pain related to long bone fracture as evidenced by pain with
movement, reported pain of 10 of 10, and increased blood pressure.
A 45-year-old male patient complains of upper abdominal pain. Which pain
assessment tool would be most appropriate to use when evaluating his
condition?
