mdc4-exam-2-questions

1. A client with a pulmonary embolism may have which of the following interventions? a. IVC filter- catches blood clot and stops from moving to heart and lungs b. Embolectomy- surgical removal of emboli c. Chest tube placement d. Heparin drug therapy- anticoagulant e. Thoracotomy 2. An older adult client arrives in the emergency department after falling off a roof. The nurse observes “sucking inward” of the loose chest area during inspiration and a “puffing out” of the same area during expiration. Arterial blood gas results show severe hypoxemia and hypercarbia. Which procedure does the nurse prepare for? a. Chest tube insertion X b. Endotracheal intubation- protect airway c. Needle thoracotomy d. Tracheostomy 3. A nurse in a burn treatment center is caring for a client admitted with severe burns to both lower extremities and is scheduled for an escharotomy. The client’s spouse asks the nurse what the procedure entails. Whish nursing statement is appropriate? a. Large, surgical incision will be made in the hardened dermal layer to improve circulation b. This procedure involves placing the client into a shower and removing the dead tissue c. A piece of healthy skin will be removed from an unburned area and grafter over the burned area d. Surgical incisions will be made into the deep tissue, possibly to the bone, to permit better circulation 4. A nurse is caring for a client who has burn injuries to his trunk. The nurse is explaining what to expect from the prescribed hydrotherapy. Which of the following statements by the client indicates an understanding of the teaching? a. I will be on a special shower table to enhance wound inspection and debridement b. The water temperature will be hot to improve blood flow and healing X c. The nurse will use a wire brush to remove loose skin d. The nurse will use scissors to open small blisters 5. Calculate the mean arterial pressure in mmHg for a client with a blood pressure of 84/46 mmHg. a. 59 mmHg- systolic + (2) diastolic/ 3 6. Which if the following interventions is not appropriate for a client diagnosed with a pneumothorax? a. Apply wet to dry dressing on wound b. Monitor respiratory and circulatory function c. Assess for tracheal deviation (tension pneumothorax) d. Provide analgesics 7. A client in the intensive care unit was recovering from moderate burns and smoke inhalation. His condition was improving, and plans were made to transfer him to a step- down unit. On the morning of the transfer, the client began to experience elevated temperatures and shortness of breath. Urine output decreased to 10ml/hr. labs were drawn and indicated elevated WBC, GFR, creatinine, and liver enzymes. The client is experiencing which medical complication? a. Acute respiratory failure X b. Acute kidney injury c. Disseminated intravascular coagulation d. Multiple organ dysfunction syndrome- 2 or more organ system deterioration 8. A nurse is assessing a client who sustained superficial partial thickness and deep partial thickness burns 38 hours ago. Which finding should the nurse report to the provider? a. Edema in the burned extremities (expected) b. Severe pain at the burn site (expected in partial thickness burns) c. Urine output of 65ml/hr over 2 hours (more than 30 ml/hr is good) d. ABG pH 7.31, PaCO2 37 mmHg, HCO3 31 mEq/L 9. A nurse is caring for a client who has sustained burns over 37% of total body surface area. The client’s voice has become hoarse, a brassy cough has developed, and the client is drooling. The nurse should identify these findings as indications that the client has which of the following? a. Pulmonary edema b. Bacterial pneumonia c. Inhalation injury d. Carbon monoxide poisoning 10. A nurse is assisting the provider in caring for a client who has developed a tension pneumothorax. Which actions should be performed first? a. Assess the clients pain b. Prepare for large bore needle thoracotomy- release the air c. Administer lorazepam d. Prepare for chest tube insertion 11. When assessing a client who has suffered a burn injury, the nurse classifies the burn as a full thickness burn based on observing which characteristics? a. Painful, reddened skin (partial thickness) b. Charred skin with milky areas c. Erythema and blisters (partial thickness) d. Erythema, pain, and swelling (partial thickness) 12. A client with 55% total body surface area burns arrives in the emergency department. The client weighs 160 #. Using the parkland burn formula calculate the hourly rate of lactate ringer during the first 8 hours of fluid resuscitation. a. 1000- 4mL x 55% x (160/2.2)= 16,000/2= 8,000 1st 8 hrs= 1000mL/hr 13. A nurse is caring for a group of clients. Which client is at most risk for a pulmonary embolism? a. Client who has a body mass index of 24 b. An active postmenopausal female c. A long distance truck driver- sitting for extended time d. A client who consumes alcohol 14. After receiving report of four client, the nurse determines the order of care of the clients. Based on report, the nurse will prioritize the clients to see which one first? a. Newborn with mottling of extremities- common b. 72 year old with dry skin with tenting- dehydrated c. 35 year old athlete with bradycardia- normal bc athlete d. Healthy 18 year old with rapid shallow respirations- ABCs 15. A client is receiving warfarin after pulmonary embolism. The nurse evaluates the lab results and notifies the physician that the clients warfarin level is therapeutic when which of the following numbers is reported? a. INR 2.8- therapeutic range 2 to 3 b. PTT 24 seconds c. INR 1.1 d. PT 14 seconds 16. A nurse is assessing four clients. Which of the following clients should the nurse assess first? a. A client who has 2 rib fracture in 8/10 pain requestion pain meds b. An intubated client with a flail chest awaiting surgical fixation c. A client that has self extubated his endotracheal tube d. A client with a compound fracture and weak distal pulses 17. A client who has an endotracheal tube is being considered for a tracheostomy. Which of the following criteria would support the placement of a tracheostomy in this client? a. Client is unable to maintain airway when extubated b. Client has been on the ventilator for 24 hours c. Client has been diagnosed with diabetes d. Client is coughing and bucking the endotracheal tube- indicates a client can maintain an airway 18. The nurse is caring for a client who suffered a third degree burn to his hands after a house fire. He presented with an airway injury secondary to smoke inhalation and has been intubated. The client is currently on the ventilator with 100% FiO2. Based on the information, which of the following would be a sign or symptom of acute respiratory distress syndrome? a. Respiratory rate 14 breaths per min- expected reference range b. Arterial blood gas results show PaO2 50mmhg- respiratory acidosis c. Fatigue and weakness d. Urine output 580 ml last shift 19. Which actions are essential for the nurse caring for a mechanically ventilated client to prevent ventricular acquired pneumonia? (got this based on fitz review) a. Keep the head of the bed elevated at least 30 degrees b. Perform oral care every 12 hours- fitz says every 2 hours c. Prevent aspiration d. Suction every 1-2 hours around the clock- or prn e. Turn and reposition the client every 2 hours f. Prevent pressure ulcers around the mouth 20. The pathophysiology of acute respiratory distress syndrome is characterized by which of the following? a. Refractory hypoxemia b. Increased lung compliance c. Increased surfactant production d. Hypertension 21. During change of shift report, the nurse learns that a client has been admitted with dehydration and hypotension after having vomiting and diarrhea for 3 days. Which finding is most important for the nurse to report to the health care provider? a. Decreased bowel sounds b. Apical pulse 110 beats/min c. Pale, cool, and dry extremities d. New onset of confusion and agitation- mental status change 22. When the charge nurse is evaluating the skills of a new RN, which action by the new RN indicated a need for further education in the care of clients with shock? a. Placing the pulse oximeter on the ear for a client with septic shock b. Keeping the head of the bed flat for a patient with hypovolemic shock c. Decreasing the room temperature to 68 F for a patient with neurogenic shock- can’t regulate temp (poikilothermia) d. Increasing the nitroprusside (Nipride) infusion rate for a patient with high SVR 23. A nurse is reviewing the health records of clients. Which client is at least risk for developing acute respiratory distress syndrome? a. A client who experienced a near drowning incident in freshwater b. A client following coronary artery bypass graft surgery c. A client who has hemoglobin of 10.1 mg/dl post 1 unit PRBC d. A client who is experiencing acute pancreatitis and vomiting 24. The provider ordered dopamine 20mcg/kg/min IV infusion. The bag is labeled dopamine 100mg/50ml. the client weighs 88 #. What is the infusion rate in ml/hr? a. 24ml/hr 25. A client is admitted to the emergency department with a full thickness burn to the right arm. Upon assessment, the arm is edematous, fingers are mottled, and radial pulse is now absent. The client states that the pain is 8 on a scale of 1 to 10. The nurse should perform which of the following? a. Administer morphine sulfate IV push for severe pain b. Call the healthcare provider to report the loss of the radial pulse c. Continue to assess the arm every hour for any additional changes d. Instruct the client to exercise the fingers and wrist 26. A nurse is teaching a client who has septic shock about the development of disseminated intravascular coagulation. Which statement indicates the nurses correct understanding of DIC? a. DIC is controllable with lifelong heparin usage b. DIC is a genetic disorder characterized by an elevated factor VII count c. DIC is caused by abnormal coagulation involving fibrinogen d. DIC is a genetic disorder involving a vitamin K deficiency 27. A client begins to show signs of shock. How should the client be positioned? a. With the head lower than the body b. Flat with legs elevated c. High fowlers position d. In a side lying position 28. The nurse is caring for a ventilated client. Which intervention is appropriate for this client?