LATEST PNLE III FOR CARE OF CLIENTSWITH PHYSIOLOGIC AND PSYCHOSOCIAL ALTERATIONS QUESTIONS AND ANSWERS WITH RATIONALES

Text Mode – Text version of the exam 1. Nurse Michelle should know that the drainage is normal 4 daysafter a sigmoid colostomy when the stool is: A. Green liquid B. Solid formed C. Loose, bloody D. Semiformed 2. Where would nurse Kristine place the call light for a male client with a right- sided brain attack and left homonymous hemianopsia? A. On the client’s right side B. On the client’s left side C. Directly in front of the client D. Where the client like 3. A male client is admitted to the emergency department followingan accident. What are the first nursing actions of the nurse? A. Check respiration, circulation, neurological response. B. Align the spine, check pupils, and check for hemorrhage. C. Check respirations, stabilize spine, and check circulation. D. Assess level of consciousness and circulation. 4. In evaluating the effect of nitroglycerin, Nurse Arthur should knowthat it reduces preload and relieves angina by: A. Increasing contractility and slowing heart rate. B. Increasing AV conduction and heart rate. C. Decreasing contractility and oxygen consumption. D. Decreasing venous return through vasodilation. 5. Nurse Patricia finds a female client who is post-myocardial infarction (MI) slumped on the side rails of the bed and unresponsiveto shaking or shouting. Which is the nurse next action? A. Call for help and note the time. B. Clear the airway C. Give two sharp thumps to the precordium, and check the pulse. D. Administer two quick blows. PNLE III for Care of Clientswith Physiologic and Psychosocial Alterations (Part 1) 6. Nurse Monett is caring for a client recovering from gastro-intestinal bleeding. The nurse should: A. Plan care so the client can receive 8 hours of uninterruptedsleep each night. B. Monitor vital signs every 2 hours. C. Make sure that the client takes food and medications atprescribed intervals. D. Provide milk every 2 to 3 hours. 7. A male client was on warfarin (Coumadin) before admission, andhas been receiving heparin I.V. for 2 days. The partial thromboplastin time (PTT) is 68 seconds. What should Nurse Carla do? A. Stop the I.V. infusion of heparin and notify the physician. B. Continue treatment as ordered. C. Expect the warfarin to increase the PTT. D. Increase the dosage, because the level is lower than normal. 8. A client undergone ileostomy, when should the drainageappliance be applied to the stoma? A. 24 hours later, when edema has subsided. B. In the operating room. C. After the ileostomy begin to function. D. When the client is able to begin self-care procedures. 9. A client undergone spinal anesthetic, it will be important that thenurse immediately position the client in: A. On the side, to prevent obstruction of airway by tongue. B. Flat on back. C. On the back, with knees flexed 15 degrees. D. Flat on the stomach, with the head turned to the side. 10.While monitoring a male client several hours after a motorvehicle accident, which assessment data suggest increasing intracranial pressure? A. Blood pressure is decreased from 160/90 to 110/70. PNLE III for Care of Clientswith Physiologic and Psychosocial Alterations (Part 1) B. Pulse is increased from 87 to 95, with an occasional skippedbeat. C. The client is oriented when aroused from sleep, and goes backtosleep immediately. D. The client refuses dinner because of anorexia. 11. Mrs. Cruz, 80 years old is diagnosed with pneumonia. Which ofthe following symptoms may appear first? A. Altered mental status and dehydration B. Fever and chills C. Hemoptysis and Dyspnea D. Pleuritic chest pain and cough 12. A male client has active tuberculosis (TB). Which of the followingsymptoms will be exhibit? A. Chest and lower back pain B. Chills, fever, night sweats, and hemoptysis C. Fever of more than 104°F (40°C) and nausea D. Headache and photophobia 13. Mark, a 7-year-old client is brought to the emergency department. He’s tachypneic and afebrile and has a respiratory rateof 36 breaths/minute and has a nonproductive cough. He recently had a cold. Form this history; the client may have which of the following conditions? A. Acute asthma B. Bronchial pneumonia C. Chronic obstructive pulmonary disease (COPD) D. Emphysema 14. Marichu was given morphine sulfate for pain. She is sleeping andher respiratory rate is 4 breaths/minute. If action isn’t taken quickly, she might have which of the following reactions? A. Asthma attack B. Respiratory arrest C. Seizure