RNSG 1343 Med Surg Comprehensive Exam 2 Questions and Answers Rated A+ Guaranteed Satisfaction New update 2023/2024

RNSG 1343 Med Surg Comprehensive Exam 2 Questions and Answers Rated A+ Guaranteed Satisfaction New update 2023/2024RNSG 1343 Med Surg Comprehensive Exam 2 Questions and Answers Rated A+ Guaranteed Satisfaction New update 2023/2024 • A parent whose 12-year-old child has been inhaling paint fumes asks the nurse, "Can he become addicted to paint fumes?" What is the best response for the nurse to provide? A. Only hard drugs like cocaine and heroin can cause problems with addiction. B. C. Any time you use an illegal substance, you are abusing drugs. Correct D. Tell me what you think may have caused him to start inhaling paint fumes. (C) provides accurate information and answers the parent's question. (A) is a common misconception. (B) is not usually an effective treatment strategy, and information should be sought after determining if any other drugs have been taken. (D) does not address the parent's question. Awarded 1.0 points out of 1.0 possible points. • A young adult female is brought to the emergency room by family members who report that she ingested a large quantity of acetaminophen (Tylenol). The nurse should prepare for which treatment to be implemented? A. IV administration of Narcan. B. Gastric lavage with normal saline. C. D. Syrup of ipecac per nasogastric tube. Correct Mucomyst (C) is the antidote for acute acetaminophen (Tylenol) poisoning and is the treatment of choice for an overdose. (A) is used for an overdose of narcotics. (B) is used for ingestion of non-corrosive products such as iron tablets. (D) might also be implemented, depending on the amount of drugs ingested and the time elapsed since ingestion. Awarded 1.0 points out of 1.0 possible points. • An 8-year-old male client with nephrotic syndrome is in remission following treatment with prednisone (Deltasone). The nurse should teach the child to check his urine for whichfinding? A. Glucose. B. White blood cells. C. D. Ketones. Correct Children should be taught to check for protein (albumin) (0) in the urine daily, because a positive reading for protein in the urine is often the only indicator of a relapse of nephrotic syndrome. (A) is an indication of infection. (8 and C) should be assessed while the child is receiving corticosteroid therapy, since corticosteroids increase blood glucose. Awarded 1.0 points out of 1.0 possible points. • When making a home visit to a family with a teething 4-month-old, what information is most important for the nurse to provide the parents? A. A slight fever is often associated with teething, but a fever lasting more than three days requires medical attention. Correct B. No action is required for the common symptoms associated with teething, which include drooling, irritability, and poor sleeping. C. Providing cooled teething toys can help decrease the discomfort associated with tooth eruption. D. Though child development is characterized by individual differences, first teeth usually erupt during the seventh month. A slight fever that persists longer than three days is likely to be associated with a pathological process, not teething, and the parents should seek the attention of their healthcare provider if it occurs (D). (A, B, and C) provide useful information about teething, but do not have the priority of (D). Awarded 1.0 points out of 1.0 possible points. • To treat cystitis, a 14-day course of treatment with cephalexin (Ceclor) is prescribed for a client residing in a long-term care facility. Which action is most important for the nurse to take prior to administering the first dose of this medication? A. Review the client's fasting blood glucose levels for ahyperglycemic trend. B. Restrict the use of dairy products in the client's diet for the next 3 weeks. C. Take the client's vital signs prior to the first dose and once daily for 14 days. D. Correct Most individuals who have an allergy to penic illins (B) are at risk of hypersensitivity to cephalosporins. To prevent a potential hypersensitivity reaction that could cause a life-threatening episode of anaphylactic shock, the nurse must determine if the client has a known penicillin allergy before giving the client a cephalexin (Ceclor) dose . (A, C, and D) are not required interventions for the administration of cephalexin (Ceclor). Awarded 1.0 points out of 1.0 possible points. A staff member tells the charge nurse that a float nurse assigned to work on the unit has made several medication errors in the past, but is currently working with the education department to improve this skill. What action is best for the charge nurse to take? A. Assign the float nurse to function as a UAP for the day. B. Correct C. Dismiss the staff nurse's report about the float nurse because it may be just gossip. D. Call the nursing supervisor and request a different employee be sent to the unit. The float nurse is receiving education, but careful assessment of her or his skills and assistance, as needed, is still warranted, so (D) is the best choice. Though the staff member's report may indeed be gossip, failure to pay attention to the information could constitute negligence on the part of the charge nurse (A). (B) is not the best way to manage the unit. (C) is not the best use of a licensed person and would also eliminate the float nurse's opportunity to improve medication administration skills. Awarded 1.0 points out of 1.0 possible points. 7. The blood pressure readings obtained by a unlicensed assistive personnel (UAP) are consistently different from those obtained by other staff members. What action should the charge nurse take first? A. Make staff members aware of the possible errors in blood pressurereadings. B. Correct C. Counsel the UAP about the inaccurate blood pressure readings. D. Ask the education department to provide additional training for the UAP. The charge nurse should first observe the UAP1s performance (B), then take appropriate action, which might include (A, C and D). Awarded 1.0 points out of 1.0 possible points. 8. A client at 13-weeks' gestation is scheduled for an amniocentesis in one week. The nurse knows that the primary reason for conducting this procedure is to obtain what information? A. Determination of gestational age. B. Level of fetal lung maturity. C. Quantification of alpha-fetoprotein levels. D. Correct Amniocentesis is done at 14 to 16 weeks' gestation to determine chromosomal, genetic, and metabolic disorders (B). Amniocentesis in the third trimester assesses fetal lung maturity (A) by evaluating the lecithin/sphingomyelin (US) ratio and the presence of phosphatidylglycerol (PG). Amniocentesis is performed to quantify alpha-fetoprotein levels(C) after abnormal maternal serum alpha-fetoprotein levels (done at 15 to 18 weeks) are found. While specific levels of creatinine, bilirubin, and lipid cells are present in amniotic fluid only after 35 to 36 weeks' gestation, gestational age (D) is commonly evaluated by ultrasound. Awarded 1.0 points out of 1.0 possible points. 9. A hospitalized 5-year-old boy recovering from surgery refuses to drink fluids. Which intervention is best for the nurse to implement? A. Correct B. Make a game of seeing who can finish a glass of water first--the nurse or the child. C. Tell the child he can go outside after he drinks a full glass of water. D. Ask the parents to participate in encouraging the child's fluid intake. Fluids in popsicle form (C) are an excellent choice for a child, and small children react best when they are provided with possible choices, such as choosing a flavor. (A) is a good intervention, but (C) is better. (B) is manipulative and the nurse must be careful not to make promises that may not be possible. Although (D) may be useful, it may also be manipulative and is not as likely as (C) to obtain the ultimate goal of increasing fluids. Awarded 1.0 points out of 1.0 possible points. 10. An overweight adolescent girl has been to the school nurse three times in the last two months complaining of vaginal and urinary tract infections. What action should the nurse take first? A. Encourage the girl to see theschool counselor. B. Counsel the girl regarding hygiene. C. Correct D. Teach the girl the importance of practicing safe sex. All actions might be implemented, depending on further assessment findings. However, based on the data presented, the nurse should ask questions directed toward symptoms of diabetes (B). Recurrent vaginal and urinary tract infections are often an early sign of IDDM. (A, C, and D) require further assessment data to support their implementation. Awarded 1.0 points out of 1.0 possible points. 11. About mid-morning, a 10-year-old child reports to the school nurse complaining of nausea, dizziness, and chills. Further assessment reveals that this child is sweating profusely and has a blood glucose level of 57 mg/di. Based on these assessment findings, which food is best for the nurse to encourage the child to eat? A. A pieceof buble gum. 8. A soft drink. C. A chocolate bar. D. Correct Peanut butter crackers (C) provide a complex carbohydrate, plus protein and fat. This child is exhibiting signs and symptoms of mild to moderate hypoglycemia and needs to eat about 15 grams of carbohydrates to increase the blood sugar level. Complex carbohydrates are broken down more slowly and are slower acting than simple sugars, so they prevent the blood glucose level from peaking and then dropping precipitously. (A, 8, and D) contain only simple sugars. Awarded 1.0 points out of 1.0 possible points. 12. When examining the wound of a client who had abdominal surgery yesterday, the nurse finds that the wound edges are close together, there is no sign of redness, and there is a slight amount of bright red blood oozing from the incision. What action should the nurse take? A. Increase the IV fluid rate and encourage the client to eat more ice chips. B. Notify the healthcare provider that the client's wound is producing a sanguineous drainage. C. D. Observe closely for possible dehiscence. Correct These are normal findings for one-day postoperative and indicate that the wound is healing by primary intention (A). Dehiscence (8) is separation of a surgical incision, and there is no indication that this is a possibility at this time. Serosanguineous drainage is thin and red and is composed of serum and blood, and this client is not exhibiting this finding, and even if the wound was producing this drainage, the finding does not warrant (C). There is no indication of dehydration, so (D) is not indicated at this time. Awarded 1.0 points out of 1.0 possible points. 13. When culturing a wound, the nurse should obtain the sample from which part of the wound? A. Any particularly painful area of the wound. B. The outer edges of thewound. C. D. All necrotic sections of the wound. Correct To collect a wound culture, the nurse should first clean the wound to remove skin flora and then insert a sterile swab from a culturette tube into the wound secretions (C), then return the swab to the culturette tube, cap the tube, and crush the inner ampoule so that the medium for the organism growth coats the swab. The culture should not be collected from (A, B, or D). Awarded 1.0 points out of 1.0 possible points. 14. The nurse administers dopamine (lntropin) IV infusion at 3 mcg/kg/min to a critically ill, hypotensive client. What is the intended effect of this treatment? To increase A. urine output to 55 mL/hr. Correct B. pulse to 132 beats/min. C. blood pressure to 140/80. D. respirations to 24 breaths/min. The expected outcome of this treatment is an increase in urine output due to increased renal perfusion (B). Dopamine, a catecholamine, provides renal and mesenteric vasodilation at a low dosage level, such as the 3 mcg/kg/minute infusion that was prescribed for this client. A higher dose of dopamine is needed to affect (A or C) to the levels indicated in a critically ill client who is hypotensive. (D)'s effect would be minimal. Awarded 1.0 points out of 1.0 possible points. 15. Yesterday a female client who is delusional told the nurse that her healthcare provider needs to be released from her case because they are going to get married on her birthday. Which statement made by the client today indicates that the client is less delusional? A. I think I should talk about this in group. B. I really wish that my birthday wasn't so soon. C. • I don't talk about things like that anymore. Correct D. The doctor won't talk with me about this. When the client states that she doesn't want to talk about things like that anymore (B), she is likely less delusional, because when a client begins to question the delusional belief or stops talking about it, the client is becoming less delusional. (A, C and D) lack evidence that the client no longer maintains the delusion. Awarded 1.0 points out of 1.0 possible points. 16. A newborn is brought to the admissions nursery by the nurse and the father of the baby. The baby weighs 9 pounds 3 ounces and measures 21 inches head to toe. Which description is a correct assessment of this infant? A. Macrosomia with an average length. B. Correct C. Above average in weight but below average inlength. D. Above average in weight and length. The baby is definitely above the average weight of 7 1/2 pounds. The average newborn length ranges from 18 to 21 inches, so the baby is in the upper limit of average length (A). (Band C) are both incorrect. (D) is a term used to describe neonates of poorly controlled diabetic mothers and refers to a large body size and birth weight of 4000 g or more. Since this infant is above average in weight but is high average in length, he is most likely a normal, large infant. Determining how large the parents are provides additional worthwhile assessment data. Awarded 1.0 points out of 1.0 possible points. 17. A client has a precipitous delivery attended only by the nurse. What nursing intervention has the highest priority? A. Clamp and cut the umbilical cord. B. Massage the uterine fundus until it is firm. C. D. Assess for signs of placental detachment. Correct Ensuring an adequate airway in the newborn (A} is the priority. (B, C and D) can be delayed until this is accomplished. Awarded 1.0 points out of 1.0 possible points. 18. A new mother asks the nurse why her infant son has yellow liquid coming out of his eyes. Which explanation is correct? A. Conjunctivitis neonatorum is common in newborns. B. Most infants have drainage from their eyes which usually resolves within 2 to 3 days of life. C. D. This type of question should be discussed with your pediatrician. Correct Antibiotic ointments, such as erythromycin ointment, are placed in the lower conjunctiva of each eye to prevent chlamydia and gonorrhea (A). (B) is not a common finding in newborns. (C) is dismissing the mother's questions and may alarm the family because the nurse appears unwilling to discuss the condition. An infant may have yellow drainage related to administration of an antibiotic ointment, but it should be resolved as soon as the infant is bathed (D). Awarded 1.0 points out of 1.0 possible points. 19. A client with severe preeclampsia is receiving magnesium sulfate 2 grams IV hourly. The nurse assesses the client and finds: blood pressure 140/90, pulse 100, respirations 10, deep tendon reflexes 1+, and urinary output 130 mL in 4 hours. The nurse will discontinue the magnesium infusion based on which assessment finding? A. Blood pressure of 140/90. B. Deep tendon reflexes 1+. C. Correct D. Urinary output of 130 ml in 4 hours. With respirations less than 12 (C), the client is at risk for developing respiratory arrest and the magnesium sulfate should be discontinued. Other cardinal signs of magnesium toxicity include urinary output Awarded 1.0 points out of 1.0 possible points. 20. A male client, who has a 3-year history of Type 2 diabetes that is controlled by diet, is being discharged postmyocardial infarction with a prescription of nitroglycerin tablets for chest pain and regular insulin for treatment of his diabetes. Following teaching, the client tells the nurse that he will make sure he keeps his nitroglycerin bottle in his pants pocket at all times, that he eats and drinks a snack before going to bed, and that he checks his blood glucose before eating in the morning. This client requires further teaching on which subject? A. Fluid intake. B. Diabetic diet. C. Correct D. Blood glucose monitoring. Nitroglycerin must be kept in the original dark-tinted, glass, screw-top bottle so that contact with air can be avoided, and keeping it in a pants pocket exposes it to body heat (A), which can reduce its effectiveness. The client should keep the medication in a jacket pocket, which would reduce direct body contact with the bottle. He should also check the expiration date on the bottle (it is good for 3 months and tingling in the mouth indicates that the drug is fresh). Some people experience a headache when taking nitroglycerin, due to the vasodilatation effect. The client's habits regarding (B, C, and D) indicate that he understood the teaching, so no further teaching is required. Awarded 1.0 points out of 1.0 possible points. 21. A client who had a cesarean section two weeks ago is admitted to the hospital for an infected surgical abdominal wound. Which room is best for the nurse to assign thisclient? A. A private room on a medical unit. Correct B. A postpartum room in the birthing center. C. A semi-private room on a surgical unit. D. A negative pressure room. To protect others from contamination, the nurse should assign this client to a private room (0). (A) is an isolation room used for clients with TB. (B) should not be assigned because of the possibility of cross-contamination by the infected client. (C) should not be assigned because the 08 unit is considered 11clean. 11 Awarded 1.0 points out of 1.0 possible points. 22. A client with acute pancreatitis is admitted to the medical unit. During the nurse's admission interview, which assessment has the highest priority? A. • Intensity of pain. Correct B. History of alcohol intake. C. Frequency of vomiting. D. Time of last meal. The hallmark sign of pancreatitis is severe abdominal pain (D), due to autodigestion of the pancreas by the enzymes amylase and lipase. (A, B, and C) are also important but are of less priority then (D). Awarded 1.0 points out of 1.0 possible points. 23. Which outcome is best for the nurse to include in the plan of care for a client with impaired social interaction and obsessive-compulsive disorder? A. Participates in one social or recreational activity each morning and afternoon. Correct B . Avoids obsessive verbalizations while interacting with family and staff. C. Describes success in dismissing persistent thoughts that used be bothersome. D. Reports that the obsessions and compulsions experienced are silly. Participation in social/recreational activities (D) is an expected outcome of treatment for a client with impaired social interaction because it indicates that the client is no longer totally immersed in obsessive thoughts and compulsive rituals. (A and C) are outcomes related to disturbed thought processes, rather than social interaction. (B) does not suggest progress since many clients have this understanding but are powerless to change their behavior. Awarded 1.0 points out of 1.0 possible points. 24. While conducting a routine health assessment of a woman who recently immigrated to the U.S. from China, the nurse notes that the client makes little direct eye contact, is deferential to healthcare personnel, and avoids sharing her personal thoughts and feelings. What action should the nurse take? A. Determine if there is a family history of emotional disorders. B. Refer the client to a psychiatric outpatient clinic. C. Encourage the woman to attend citizenship classes. D. Correct The nurse should accept these behaviors as culturally determined and continue with the interview (A). These behaviors are common in the Chinese culture where people are members of strong, cohesive groups that focus on the group rather than the individual. These behaviors are not related to a psychiatric disorder (Band C). Citizenship (D) is an individual choice, while cultural behaviors evolve over time. Awarded 1.0 points out of 1.0 possible points. 25. After the sudden death of a severely injured client while in transport by helicopter, the flight nurse discovers that the oxygen tank that was attached to the oxygen supply was empty during the transport. What action should the flight nurse take? A. Complete an adverse occurrence report and submit it to the nurse-manager Correct B . Advise the flight crew of the situation, then suggest that no further discussion be held. C. Send an anonymous letter explaining the situation to the family of the client. D. Replace the empty tank without reporting the situation to any members of the agency. A medication error occurred, so an adverse occurrence report should be completed and submitted to the nurse-manager (B) for evaluation of the situation, so that measures can be implemented to prevent a repeat of the occurrence. (A, C, and D) do not allow for review of the system to prevent a repeat of the occurrence. Awarded 1.0 points out of 1.0 possible points. 26. A client has a living will and an advance directive specifying no intubation or CPR. The client's spouse and children tell the nurse privately that they want the client resuscitated, if the need arises. How should the nurse respond? A. Every effort must bemade to honor the family's wishes about their loved one. B. Notify the healthcare provider of the family's wishes, so a decision can be made. C. Nurses use their best judgment based on the client's condition. D. Correct The client (B) should be the ultimate decision-maker regarding treatment or refusal of treatment. The client's ethical right to autonomy and legal right to give informed consent for treatment are recognized in both legally created special directives and living wills. Although family members are very important in the care and support of the client, the nurse (A), and healthcare provider (C) must respect the legal document that the client created to direct the course of treatment (D). Awarded 1.0 points out of 1.0 possible points. 27. The charge nurse observes that a demographic screen has been left open on a hallway computer by a nurse who is responding to a call light because the unlicensed assistive personnel (UAP) is involved in a personal phone call. Which action should the charge nurse take first? A. Instruct the UAP to end the phone call immediately. B. Page the unit manager to address the situation. C. Send a UAP into the client's room to relieve the nurse. D. Correct The greatest priority is for the charge nurse to close the computer screen (B), because health information stored in computerized systems is considered to be Protected Health Information (PHI) under HIPAA (Health Insurance Portability and Accountability Act). (A, C, and D) may be indicated, but are of less priority than (B). Awarded 1.0 points out of 1.0 possible points 28. A high school senior is complaining of a persistent cough and admits to smoking 10 to 15 cigarettes daily for the past year. He is convinced that he is hopelessly addicted to tobacco since he tried unsuccessfully to quit smoking last week. Which intervention is best for the nurse to implement? A. Provide the student with the latest research data describing the long-term effects of tobacco use. B. C. Describe cigarette smoking as a habit that requires a strong will to overcome itsaddictiveness. Correct D. Tell the student that he is still young and should continue to try various smoking cessation methods. It is difficult to cease smoking when surrounded by those who smoke, and adolescents are particularly influenced by peers, so (A) is the most important intervention for the nurse to implement. (B) is not likely to be helpful and offers no concrete suggestions for smoking cessation. (C) is condescending. Risks associated with smoking must already be known to this adolescent who is already attempting to stop the habit (D). Awarded 1.0 points out of 1.0 possible points. Which client data is most important for the nurse to obtain prior to beginning a client's blood transfusion of packed redblood cells? A. Weight. B. Oxygen saturation. C . Vital signs. D. Skin turgor. Correct Baseline vital signs (D) are essential to obtain prior to administering a blood transfusion, so that vital signs measured during the transfusion administration can be compared to the baseline to assess for the onset of a transfusion reaction. (A, B, and C) provide less significant data immediately prior to the administration ofthe transfusion. Awarded 1.0 points out of 1.0 possible points. 30. A healthcare provider tells the nurse that a certain medication will be prescribed for a client. After the prescription is written, the nurse notes that the provider has prescribed another medication that sounds similar to the medication that the provider and nurse originally discussed. What action should the nurse implement? A. Write the correct prescription as a verbal order received from the healthcare provider. B. Contact the healthcare provider to clarify the prescription intended for the client. Correct C. Consult with the pharmacist to determine the best medication for the client. D. Correct the misspelled medicat ion in the written prescription and initial the change. Since the nurse received contradictory information, the provider should be contacted (D) to clarify the intended prescription. (A) may result in a medication error. The nurse does not have the authority to alter prescriptions (8). The pharmacist (C) cannot determine the best medication for a client. Awarded 1.0 points out of 1.0 possible points. 31. Which action should the nurse take first when performing tracheostomy care? A. B. Cleanse around the stoma. C. Secure the new neckstrap. D. Suction the tracheostomy. Correct Hyperinflation with 100% oxygen (C) helps minimize hypoxia and atelectasis during the suctioning procedure, so the nurse should take this action first, before (A, 8, or D). Awarded 1.0 points out of 1.0 possible points. 32. Current assessment findings for a client who is withdrawing from barbiturates are: blood pressure 135/90, temperature 97.6° F, pulse rate of 98 beats/minute, and respiratory rate 22 breaths/minute. The client is also experiencing insomnia, restlessness, confusion, and pronounced muscle twitching. What action should the nurse take? A. Place the client in a vest-type restraining jacket. B. Assess vital signs q15 minutes until stable. C. Correct D. Encourage the client to take a warm bath to help relax. The healthcare provider should be notified (A) so that medications can be prescribed to prevent seizures. Grand mal seizures sometimes occur during barbiturate withdrawal, and pronounced muscle twitching can herald seizure activity. (B) does not prevent seizures. (C) is not indicated simply because the client is confused and restless. (D) does not treat these symptoms. Awarded 1.0 points out of 1.0 possible points. 33. When preparing to insert an indwelling urinary catheter, the nurse applies sterile gloves and then tests the catheter balloon for patency. What action should the nurse implement next? A. Place a sterile drape under the client's buttocks. B. C. Discard the gloves and apply new sterile gloves. D. Instruct the client to inhale and then exhale slowly. Correct After testing the balloon for patency, the nurse should next lubricate the end of the catheter (D). The sterile drape should already be positioned under the client's buttocks (A). The client is instructed in breathing (B) just prior to insertion, not at this point in the procedure, since the nurse has not yet cleansed the meatus. New sterile gloves are not necessary (C) unless the nurse contaminates the original gloves. Awarded 1.0 points out of 1.0 possible points. 34. Which biological practices are federally regulated for healthcare workers? (Select all that apply.) A. As Low as Reasonably Allowable standard (ALARA). B. v C. 1 D. E. , F. Biological product exposure limit (BPEL). Correct Correct responses are (A, B, C, and E). Basic standards for healthcare workers, as delineated by Occupational Safety and Health Administration (OSHA), include standard precautions (A), droplet precautions using N-95 respiratory particulate masks (B) when caring for a client who is positive for tuberculosis, and required annual updates for healthcare workers about blood-borne pathogen transmission (C), methods of minimizing exposure, and employee rights. (E) requires labeling, storage, transportation, and disposal of biological waste according to federal standards. (F) is an occupational health concept implemented to minimize employee and environmental exposures and may not be consistent with an OSHA recommendation. (D) is not an applicable mandate. Awarded 1.0 points out of 1.0 possible points. 35. Which contextual factors are considered external environmental influences in the framework for occupational health programs and services? (Select all that apply.) A. Socio-economic status. B. Workforce. C. , Legislation/regulation . Correct D. Interventions. E. v Technology. Correct F. Correct Correct selections are (A, C, and F). (A) affects the health of the company and its workforce productivity, in terms of profitability, growth, and expansion. (C) adds to an industry's capacity to develop and implement new or improved work processes. (F) in the workplace, such as the blood- borne pathogen standard, affects the workforce in terms of requirements, administration, and control strategies. Occupational safety programs are built around the workforce (B) to strive for maximum internal productivity. (D) are internal environmental influences of an occupational health and safety program. (E) is a demographic variable commonly used in epidemiology. Awarded 1.0 points out of 1.0 possible points. 36. Which client requires the most immediate intervention by the nurse? A. A client with low back pain who is experiencing tolerance to the effects of an analgesic. B. An adolescent with a history of drug addiction who is requesting a sedative. C. Correct D. A client with a chronic renal disease who is demonstrating a therapeutic response to a diuretic. An anaphylactic response (D) is a severe allergic reaction that may result in airway constriction and shock, so the nurse should first respond to this potentially life-threatening situation. Drug tolerance (A) occurs when there is a decreased physiological response after repeated administration of a drug, so the client may be experiencing pain, but this is of less priority than (D). Possible drug-seeking behaviors (B) and diuresis, the therapeutic response to a diuretic (C), require intervention by the nurse but are of less priority than (D). Awarded 1.0 points out of 1.0 possible points. 37. A nurse is caring for a male client with paranoid schizophrenia who believes that his antipsychotic medications are poison. Which intervention is best for the nurse to implement? A. Offer the medication in a concentrated form. B. C. Discard the medication and document the client's refusal. D. Describe the needfor consistently taking medications. Correct Delusions of persecution and fear of being controlled by others are characteristic of those with paranoid schizophrenia, but these feelings fluctuate, and in 30 minutes the client may be willing to take the medications (D). (A) is an attempt to manipulate the client. (B) is unlikely to be successful based on the client's current delusions. If the client still refuses the medication after a second attempt, (C) should be implemented. Awarded 1.0 points out of 1.0 possible points. 38. Which action should the nurse implement when implementing a physical assessment of an older client? A. Speak loudly and slowly when telling the client how to assist. B. Avoid unnecessary touching while interacting with the client. C. Apply additional pressure to palpate the hepatic edge. D. Correct Adaptations of the physical examination sequence that limits the amount of position changes (C) during the exam are often useful for an older adult who may have age-related problems, such as decreased mobility, limited energy, or perceptual changes. (A and 8) are unnecessary. (D) and is not always indicated, and may be interpreted as an example of assumed ageism. Awarded 1.0 points out of 1.0 possible points 39. What is the most effective way to implement a teaching plan? A. • Correct B. Provide the client with written material to review before teaching sessions. C. Streamline the teaching plan to include only essential information. D. Present to the client all the information necessary to meet the objectives. Teaching is most effective when it responds to the learner's needs, and learning begins when a person identifies a need for knowing or acquiring an ability to do something (A). (Band C) provide widely varied amounts of content, each of which should consider an individual's learning styles, level of education, reading ability, culture, age, and readiness to learn. Providing written information (D) may or may not be the best way to teach when various learning styles and other client factors are considered. Awarded 1.0 points out of 1.0 possible points. 40. Which assessment is most important for the nurse to implement when performing a comprehensive assessment for an older adult? A. B. Chronic illnesses. Correct C. Immunologic function. D. Physical signs of aging. The focus of a geriatric assessment is to determine the older client’s functional abilities (8), so appropriate interventions can be planned and implemented to maintain and enhance independence. Although (A, C, and D) impact functional ability, a client 's adaptation to normal aging and common pathophysiological conditions vary and impacts an individua'l’s functional abilities differently. Awarded 1.0 points out of 1.0 possible points. 41. The nurse is assessing an older adult client's living arrangements and care. Which situation should the nurse identify as contributing the most to the client's vulnerability for elder abuse? A. Programs for older adults are not being utilized. B. The client does not appreciate the care provided by the family. C. Correct D. Several generations in the family are providing care. The intensity and complexity of caregiving places a caregiver at risk for high levels of stress which contribute to being overwhelmed (A), invoking feelings of inadequacy, powerlessness, depression, or anger, and may be displaced to the older client (A). (B, C and D) may influence the stress within the family but are less likely to contribute to elder abuse by the caregiver Awarded 1.0 points out of 1.0 possible points. 42. A male client who is two days postoperative for a bowel resection moves as little as possible and does not use the incentive spirometer unless specifically reminded. The client reports his pain level at an 8 on a 10-point scale, but refuses a PRN dose of an opioid analgesic and tells the nurse that he can "tough it out." What response is best for the nurse to provide? A. Very few clients become addicted to opioids when using them for pain control. B. There are multiple options of medications that can be offered if one drug does not relieve the pain. C. Side effects are not a concern because they usually decrease over time. D. Correct Unrelieved pain can result in increased morbidity as a result of respiratory dysfunction, increased heart rate, cardiac workload, increased muscular contraction and spasm, decreased gastrointestinal motility and transit, and increased catabolism (D). (A, B, and C) do not give the client sufficient information to ensure compliance with the postoperative plan of care. Awarded 1.0 points out of 1.0 possible points. 43. A client is transferred to the postoperative unit after 2 hours in the postanesthesia care unit (PACU). What is the priority nursing action? A. Determine the client's pain. B. Calculate the IV infusion rate. C. Check the postop prescriptions. D. • Take the client's vital signs. Correct After the client is transferred from the PACU stretcher to the hospital bed and the PACU nurse reports the client's condition, the client's vital signs should be obtained first (B), so a change in the client's status can be determined. Vital sign changes are a primary indicator of cardiopulmonary complications and bleeding in the first hours postoperatively. Then, (A, C, and D) should be implemented. Awarded 1.0 points out of 1.0 possible points. 44. A client with glaucoma is scheduled for surgery. Which pre-operative prescription should the nurse question? A. Betaxolol (Betoptic) one drop in each eye the morning of surgery. B. Benzodiazepine (Valium) 5 mg by mouth the morning of surgery. C. Morphine sulfate 5 mg IV on call to operating room. D. Atropine sulfate 0.4 mg IM on call to operating room. Correct Many ophthalmic agents used to reduce intraocular pressure (IOP) in glaucoma cause miosis, which increases the outflow of aqueous humor. Atropine is an anticholinergic agent that causes mydriasis, which can increase IOP and counteracts the action of ?-blocking agents, so (B) should be brought to the attention of the healthcare provider. A common ophthalmic agent, betaxolol (Betoptic) (C), a selective ?-blocking drug, causes miosis and reduces the production of aqueous humor to consequently reduce IOP. Morphine (A) causes miosis and with Valium (D) are common adjuvant peri-operative sedative and antianxietyagents. Awarded 1.0 points out of 1.0 possible points. 45. An older adult client begins wearing binaural hearing aids due to presbycusis. Which instruction should the nurse provide to assist the client in adapting to the new hearing aids? A. B. Keep the volume on low until the conditions with noises are audible. Correct C. Wear the hearing aids for an hour a day at first, gradually increasing the time. D. Use one hearing aid until comfortable, then add the second aid. Initially, the use of hearing aids should be restricted to quiet situations in the home (A). As adjustments occur, the client should gradually be exposed to conditions with background noise and the outdoors. Time restriction (B) is not necessary. (C and D) do not help the client adjust as well as gradually introducing various sound conditions. Awarded 1.0 points out of 1.0 possible points. 46. The nurse inflates the cuff on a tracheostomy tube to minimal occlusion pressure for a client who is breathing spontaneously. Which action should the nurse follow? A. Use a manometer to maintain cuff pressure between 25 and 30 mmHg. B. • C . Check the pilot balloon to ensure that it is firm. Correct D. Verify the healthcare provider 's prescription for therequired cuff pressure. To achieve minimal pressure (minimal occlusion volume technique) against the tracheal wall, inject air into the tracheostomy tube cuff while auscultating with a stethoscope placed over the larynx (over the cuff) during inhalation (D). At the point when sounds of air movement cease, inflation is stopped, indicating that the cuff is sealed against the tracheal wall. (A, B, and C) are not effective. Awarded 1.0 points out of 1.0 possible points. 47. A 60-year-old homeless man who complains of a cough, late-afternoon fever, and night sweats has a 10 mm induration after receiving a purified protein derivative (PPD) skin test. Which action should the nurse implement? A. Refer for further diagnostic evaluation. Correct B . Determine exposure of others to the tuberculosis. C. Quarantine or isolate to control communicability. D. Begin anti-tubercular drug therapy. The PPD skin test results is indicative of exposure or latent Mycobacterium tuberculosis infection (LTBI), which this client is in a high-risk category for exposure in a homeless environment. Although productive prolonged cough, fever, and night sweats are common early symptoms, persons suspected of LTBI should not begin treatment until active TB disease has been excluded. Further diagnostic evaluation should be implemented (A). Although exposed populations (B) should be identified, differential diagnosis for this client should be determined. A small proportion of persons (about 10%) with LTBI will develop active TB, which requires drug therapy (C). LTBI (usually in the lungs) is a dormant form that neither causes disease nor is communicable, so (D) may not be indicated. Awarded 1.0 points out of 1.0 possible points. 48. The nurse is analyzing the waveforms of a client's electrocardiogram. What finding indicates a disturbance in electrical conduction in the ventricles? A. T wave of 0.16 second. B. QT interval of 0.34 second. C. PR interval of 0.18 second. D. ORS interval of 0.14 second. Correct The normal duration of the ORS is 0.04 to 0.12 second, so a prolonged ORS (D) indicates an electrical anomaly in the ventricles. The T wave is normally 0.16 seconds (A). The PR interval range is 0.12 to 0.20 second (B). The QT interval should be 0.31 to 0.38 second (C). Awarded 1.0 points out of 1.0 possible points. 49. Duplex scanning confirms the presence of a deep venous thrombosis for a client with swelling and pain of the lower leg. While the client is receiving continuous heparin infusion, what actions should the nurse implement? A. Correct B. Notify the healthcare provider if the partial thromboplastin time is greater than 50 seconds. C. Have vitamin K available in the event the client begins to bleed. D. Start instruction for self-administered SC heparin injections for long-term home therapy. Bleeding precautions for a client receiving anticoagulant treatment include minimizing IV punctures and avoiding IM injections (A). Heparin inactivates prothrombin and prevents the formation of thromboplastin, which is monitored by the serum PTT results (normal range between 60 and 70 seconds) during heparin therapy, and (C) is not indicative of a therapeutic response (2 times the norm). Protamine sulfate (B), not vitamin K, is the antidote for heparin. For long-term anticoagulant therapy, oral warfarin (Coumadin) is used for home therapy (D). Awarded 1.0 points out of 1.0 possible points. A male client is receiving total parenteral nutrition (TPN) through a central venous catheter (CVC) in the right subclavian vein and is reluctant to move his right arm or turn his head toward the CVC site. What nursing action should the nurse implement first? A. B. Provide passive range of motion to the right arm and neck. Correct e. Flush the catheter to maintain patency of the eve access. D. Reassure the client that the TPN administration is temporary. A client's anxiety or fear about a treatment or procedure is commonly the result of a lack of knowledge, so providing information, such as drawings or pictures, and explanations about the catheter (B), may help the client understand the catheter's function and decrease his anxiety regarding its presence. The client's anxiety should be addressed before implementing (A, e, and D). Awarded 1.0 points out of 1.0 possible points. 51. The nurse is caring for a client with ulcerative colitis and formulates a nursing diagnosis of, 11impaired skin integrity related to diarrhea." What client behavior demonstrates that the teaching regarding perianal care is effective? A. Applies witch hazel compresses to provide relief from anal irritation. B. Takes prescribed antidiarrheal medication after each diarrheastool. C. Soaks in a sitz bath for 40 minutes after each diarrhea stool. D. Correct To remove bacteria, provide comfort, stimulate circulation, and prevent skin breakdown, the client is demonstrating effective perianal care when the perianal area is cleansed after each bowel movement with mild soap and warm water (D), and then dried thoroughly. (A, B, and C) do not demonstrate the most effective care for this client. Awarded 1.0 points out of 1.0 possible points. 52. A client with a markedly distended bladder is diagnosed with hydronephrosis and left hydroureter after an IV pyelogram. The nurse catheterizes the client and obtains a residual urine volume of 1650 ml. This finding supports which pathophysiological cause of the client's urinary tract obstruction? A. Obstruction at the urinary bladder neck. Correct B. Ureteropelvic junction stricture. C. Ureteral calculi obstruction. D. Partial post-renal obstruction due to ureteral stricture. Hydroureter (dilation of the renal pelvis), vesicoureteral reflux (backward movement of urine from the lower to upper urinary tracts), and hydronephrosis (dilation or enlargement of the renal pelvis and calyces) result from post-renal obstruction which can consequently result in chronic pyelonephritis and renal atrophy. Ascending urinary reflux occurs when normal ureteral peristaltic pressure is met with an increase in urinary pressure occurring during bladder filling if the urinary bladder neck is obstructed (A). A large residual urine does not occur with (B, C, and D) because the urine cannot get to the bladder. Awarded 1.0 points out of 1.0 possible points. 53. A woman visits the clinic for confirmation of pregnancy. All of her children from prior pregnancies are living. One was born at 39-weeks' gestation, twins at 34-weeks' gestation, and another singleton at 35-weeks' gestation. How should the nurse record her gravity and parity using the GTPAL system? A. B. 3-1-1-1-3. Correct C. 3-0-3-0-3. D. 4-2-1-0-3. Using the GPTAL system, (C) is the correct record of gravity and parity. G reflects the total number of times the woman has been pregnant; she is pregnant for the 4th time. T indicates the number of pregnancies carried to term, not the number of deliveries at term; she has had only one pregnancy after 37-weeks' gestation. P is the number of pregnancies that resulted in a preterm birth, not the number of infants born; she has had two pregnancies before 37-weeks 1 gestation. A signifies elected abortions or miscarriages prior to the period of viability (20-weeks). L signifies the number of children born that are currently living. (A, B, and D) are incorrect. Awarded 1.0 points out of 1.0 possible points. 54. A client at 26-weeks' gestation comes to the labor and delivery unit and complains, "Something is not right." Which finding should the nurse assess further? A. Irregular mild uterine contractions occurring daily. B. Estriol is absent from the maternal saliva. C. Fetal fibronectin is absent in vaginal secretions. D. The cervix is effacing and dilated to 2 cm. Correct Cervical changes (B), such as shortened endocervical length, effacement, and dilation accompanied by regular contractions indicate labor at any gestation period, so the client should be monitored for pre-term labor. Estriol is a form of estrogen found in plasma at 9-weeks' gestation, and increased levels of salivary estriol, not (A), have been shown to occur before preterm birth. The presence of fetal fibronectin in vaginal secretions, not (C), between 24 and 36 weeks of gestation has a 20% to 40% positive predictive value for preterm labor. Irregular mild contractions (D) that do not cause cervical change indicate Braxton Hicks contractions or false labor. Awarded 1.0 points out of 1.0 possible points. A client who delivered a 9 pound 2 ounce infant 3 hours ago is experiencing uterine atony. Which action should the nurse implement first? A. Massage the fundus. Correct B . Catheterize the bladder. C. Establish venous access. D. Prep for surgical intervention. The initial management for uterine atony is fundal massage (A) to prevent postpartum hemorrhage. (8 and D) are actions that can be implemented if fundal massage is unsuccessful. A client who is 3-hours post-delivery usually has IV fluids infusing, so the venous access (C) may only need to be assessed. Awarded 1.0 points out of 1.0 possible points. 56. The nurse begins a physical assessment of an 8-month-old. The child is sitting contentedly on the mother's lap, chewing on a toy. Which action should the nurse implement first? A. Auscultate heart and lungs. Correct B. Examine eyes, ears, and mouth. C. Take an axillary temperature. D. Elicit reflexes. The sequence for physical examination in a quiet child begins with auscultation of heart and lungs to enable the nurse to hear the breath and heart sounds clearly (8). Actions used to assess (A, C, and D) may induce crying, which will obscure auscultation and alter pulmonary and cardiac rates. Awarded 1.0 points out of 1.0 possible points. 57. Parents of a toddler tell the nurse that their child eats little at mealtime, sits at the table with the family only briefly, and wants snacks "all the time." What recommendation should the nurse provide? A. Explain to the child in a firm manner what is expected. B. Correct C. Offer rewards for eating at mealtimes. D. Avoid snacks so the child is hungry at mealtimes. At approximately 18 months of age, most toddlers manifest lower nutritional need and decreased appetite, a phenomenon known as "physiologic anorexia" which is often manifested as a picky, fussy eater with strong taste preferences, and erratic eating patterns. Toddlers are learning to differentiate self and social boundaries and may be disruptive while sitting at the table, so offering nutritious finger foods (A) is a good way to ensure proper nutrition during this stage. Although rewards (B) act as reinforcers, children may eat for nonnutritive reasons, which may effect subsequent eating habits. (C) does not ensure that the toddler will eat at mealtime. Explanations about expectations (D) are ineffective at this age. Awarded 1.0 points out of 1.0 possible points. 58. The nurse asks an older female client with cognitive impairment who has been hospitalized for three days how her previous evening was. The client replies, "I had the best time. My husband took me out to dinner and then to a concert. The music was wonderful." Which term should the nurse document to best describe the client's response? A. Circumstantiality. B. C. Delusions. D. Concretization. Correct Confabulation (8) describes the client1s story that is made-up to fill in the gaps of memory when one is unable to remember something that might have happened. (A) is a manifestation of a false belief. (C) is the inability to abstract with overemphasis on detail. (0) is a disturbance in thought that provides discussion in an excessive amount of detail that is often tangential or irrelevant. Awarded 1.0 points out of 1.0 possible points. 59. A young adult female comes to the health clinic to confirm a positive home pregnancy test. After determining the client's last menstrual period (LMP) as February 14, what expected date of birth (EDB) should the nurse calculate? A. December 11. B. October 17. C. January 7. D. Correct Nägele's rule for calculation of EDS is determined by adding 7 days to the first day of the LMP and then subtracting 3 months, so (C) is the correct calculation. (A, B, and D) incorrectly apply Nägele's rule. Awarded 1.0 points out of 1.0 possible points 60. A multigravida at 41-weeks' gestation is receiving an oxytocin (Pitocin) infusion for induction of labor. The nurse notes the fetal heart rate (FHR) drops sharply from the baseline for 30 seconds during the peak of a contraction and then returns to the baseline before the end of the contraction. What action should the nurse implement at this time? A. Notify the healthcare provider. B. Correct C. Discontinue the oxytocin (Pitocin) infusion. D. Administer 10 L of oxygen via facemask. A sharp drop in the FHR from the baseline that returns quickly to the FHR baseline is a variable deceleration. Variable deceleration occurs when the umbilical cord is being compressed, so the nurse should change the client's position (D) to determine if this resolves the cord compression. (A, B, and C) are actions that can be implemented if the FHA patterns indicates fetal stress, such as decreased variability in the FHR, but are not indicated at this time. Awarded 1.0 points out of 1.0 possible points. 61. The new parents express concern that they did not have the opportunity to hold and bond with their infant immediately after birth because the mother received anesthesia during an emergency cesarean delivery. What information should the nurse provide? A. Early contact is essential for optimum parent-infant relationships. B. The baby is healthy and they should not worry about the delay between birth and their first visit. C. The time immediately after birth is the critical period for human attachment. D. Bonding is a process that occurs over time and begins with the first parent-newborn contact. Correct Bonding is a gradual emotional process and begins when the parents first make contact with the infant (D). It does not have to begin in the first minutes after birth. Telling the parents not to worry since their child is healthy (A) dismisses their concerns. The time immediately after birth is not a critical period for human attachment (Band C), but telling the parents otherwise is not indicated and may increase their anxiety. Awarded 1.0 points out of 1.0 possible points. 62. The nurse is caring for a client with a nursing problem of, "Infection, risk for, related to inadequate primary defenses as evidenced by surgical incision and IV access." What nursing intervention should the nurse implement? A. Maintain "clean" technique in the change of wound dressing and IV site. B. C. Limit visitors to immediate family to decrease exposure to infection. Correct D. Require the use of a face mask by staff when providing care requiring close contact. Early identification of infection leads to prompt treatment and decreased nosocomial transmission to others, so the condition of any invasive lines or breaks in the skin should be assessed and documented (C) during each shift. (A and D) are not indicated for care of this client. Sterile technique is used in the dressing change or IV site change, not (B). Awarded 1.0 points out of 1.0 possible points. A male client is on contact precautions due to an infected draining wound and is being discharged home. The client lives at home with his wife and their adolescent daughter. What discharge instruction should the nurse include for the client? A. Use disposable plates and utensils. B. Others who are in the same room with the client should wear a mask. C. D. Stay in a room with the door closed. Correct Contact precautions require the use of a barrier that prevents contact with wound secretions on soiled dressings, which are best disposed of in tightly closed plastic bags (C). (A) is not necessary with contact precautions. (Band D) should be implemented for airborne, droplet precautions, or protective environments. Awarded 1.0 points out of 1.0 possible points. 64. Which responsibility best describes the role of a nurse asmanager? A. Development of long range career goals. B. Assignment of nursing personnel andresources. C. Maintenance of harmony within the agency. D. Correct The nurse manager is accountable for organizing direct and indirect client care functions that necessitate delegation and assignment to competent unit staff, personnel management, quality improvement of client care, and system coordination to achieve agency goals (D). (A, B, and C) are components of professional nursing practice. Awarded 1.0 points out of 1.0 possible points. 65. The nurse is assigned a client with numerous treatments and decides it is not possible to complete all the needed treatments in the time scheduled for this shift. Which process should the nurse use? A. Delegate tasks to competent team members. B. Start with the easiest treatment first. C. Report the incomplete treatments to next shift nurse. D. Prioritize tasks with the most crucial needs first. Correct Planning care for a client with numerous treatments should be prioritized with the most crucial client needs first (8) to the least. (A and C) displace the nurse's responsibility to provide care. (D) is an inefficient utilization of time in meeting critical client needs. Awarded 1.0 points out of 1.0 possible points. 66. Which type of management style is a case management model for nursing care delivery? A. Clinical pathways and patient classifications. B. Centralized and decentralized systems models. C. Clinically oriented and business oriented. D. Correct A client classification or acuity system is used in many acute care hospitals to estimate the intensity of nursing care required to meet patient needs. Case management is patient focused and provides primary nursing (A). (B) is a business model of organizational decision making. (C) are management strategies or models of organizational decision making, such as shared governance which is a decentralized model. Clinical pathways (B) are interdisciplinary plans of care that outline the optimal sequencing and timing of interventions for clients with a particular diagnosis, procedure, or symptoms. Awarded 1.0 points out of 1.0 possible points. Which type of delivery of nursing care is organized around tasks? A. Team nursing. B. Functional nursing. C. Primary nursing. D. Case management. Correct Functional nursing (D) is a care delivery model that provides client care by assignment for functions or tasks. Team nursing (A) is a care delivery model where assignments to a group of clients are provided by a mixed-staff team. Primary nursing (8) is a model of delivery of care where one nurse is accountable for 24-hour care for specific clients from hospital admission through discharge. Case management (C) is the delivery of care that uses a collaborative process of assessment, planning, facilitation and advocacy for options and services to meet an individual's health needs that promotes quality cost-effective outcomes. Awarded 1.0 points out of 1.0 possible points. 68. A healthcare provider (HCP) asks the nurse to give a medication to a client, and the nurse tells the HCP that the client is allergic to the medication. The HCP says, "Give the medication or I will report this to your supervisor." What response should the nurse provide? A. Give the prescribed medication and document the situation. B. Walk away and ignore the threatening statement. C. Respond that this client is not assigned to the nurse. D. Correct Conflict resolution between staff and HCP is best resolved with a mediator (C) who can address facts, not emotional reactions. (A and D) ignore the conflict, which may escalate. (B) is unsafe practice. Awarded 1.0 points out of 1.0 possible points. 69. A client with ulcerative colitis is scheduled for surgical creation of an ileoanal reservoir (J pouch). As part of preoperative teaching, what information should the nurse provide? A. Stool is eventually expelled through the rectum. Correct B. Daily irrigation is started after the J pouchheals. C. The transverse loop ostomy is permanent. D. Easily removable appliances allow independence in self-care. An ileal pouch-anal anastomosis (also known as the J pouch) is a surgically created ileoanal reservoir in the anal canal that preserves the rectal sphincter muscle, so that (D) is the eventual result. To promote healing of the anastomosed parts of the colon, a temporary loop ostomy is created, not a permanent one (A). Although appliances that are easy to use (B) are advantageous, the ostomy is reversed after healing takes place. Stool drains into the reservoir, so (C) is not usually indicated. Awarded 1.0 points out of 1.0 possible points. 70. A client is responding to auditory hallucinations and shakes a fist at a nurse and says, "Back off, witch!" The nurse follows the client into the day room. What action should the nurse implement? A. Ensure that there is physical space between the nurse and client. Correct B . Position self within an arm's length of the client. C. Move to a position that allows the client to be closest to the room's door. D. Sit down in a chair near the client. Personal space needs increase when a client feels anxious and threatened, so adequate social space (4 to 12 feet) between the nurse and the client should be maintained to minimize the client's escalation. An arm's length distance from the client (B) may be within the client's intimate space (0 to 1.5 feet) or personal space (1.5 to 3 feet) and increases the risk for physical contact. A posture at the same level of eye contact minimizes a threatening physical presence, so sitting (A) is inadvisable, unless the client is sitting. Allowing the client to block the nurse's exit from the room (D) places the nurse at risk for injury. Awarded 1.0 points out of 1.0 possible points. 71. A child weighing 44 pounds is receiving a bolus of Ringer's Lactate solution for fluid replacement at 20 mL/kg. How many ml should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest whole number.) 400 Correct Correct Responses 1. 400 Isotonic crystalloid solution (normal saline or lactated Ringer's solution) is usually the first choice for fluid replacement in children and is given in IV boluses of 10 to 20 mL/kg over 10 to 15 minutes and repeated as necessary. First convert the pounds to kg, then multiply by 20 mL 44 pounds7 2.2 pounds/kg = 20 kg x 20 ml = 400 ml. Awarded 1.0 points out of 1.0 possible points. 72. The nurse calculates the mean arterial pressure (MAP) for a client whose blood pressure is 152/90. What is the MAP in mm Hg? (Enter numeric value only. If rounding is required, round to the nearest whole number.) Correct Correct Responses 1. 111 MAP is calculated by adding the systolic pressure to twice the diastolic pressure and dividing by 3. 152 + 180 = 332 7 3 = 110.66 = 1 1 1 mm Hg Awarded 1.0 points out of 1.0 possible points. 73. A client is receiving an intramuscular injection at the ventrogluteal site. At what angle should the nurse insert the needle? (Enter numeric value only. If rounding is required, round to the nearest whole number.) 90 Correct Correct Responses 1. 90 The angle for needle insertion when performing intramuscular injections is 90 degrees. Awarded 1.0 points out of 1.0 possible points. 74. A client with chronic kidney disease (CKD) and severe anemia refuses blood transfusions. The healthcare provider prescribes epoetin alfa. Which action should the nurse explain to the client about the medication's therapeutic response? A. Accelerates neutrophil production, maturation, and activation. B. Activates the immune system with development of T and B cells and natural killer cells. C. D. Increases production and maturation of granulocytes and macrophages. Correct Epoetin alfa is a biological response modifier that is used to stimulate the formation of red blood cells (C). (A) describes agents, such as filgrastim, used to decrease the risk for infection in clients with chemotherapy-induced neutropenia. lmmunomodulators, a subtype of biologic response modifiers, such as interferon, provide a specified action in the immune system (B) used in chemotherapeutic protocols. (0) specifies the therapeutic response of agents, such as sargramostim, which also inhibits neutrophil migration and is primarily used to accelerate myeloid recovery during bone marrow transplantation. Awarded 1.0 points out of 1.0 possible points. 75. An adult male with a history of heart failure tells the nurse that his lower extremities and feet swell when he sits at his computer all day. Which response is best for the nurseto provide? A. Limit the amount of table salt that you add to your meals. B. Elevate your feet every night to reduce swelling. C. Take a daily vitamin with minerals to correct imbalances. D. Correct Edema and swelling in the lower extremities results from gravitational pooling of blood and are common after extended periods of standing or sitting. (C) is a common recommendationto stimulate