NSG 4800 MAIN EXAM WITH
COMPLETE ANSWERS
The nurse is monitoring a client in the immediate postpartum period for signs of
b b b b b b b b b b b b b
hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss?
b b b b b b b b b b b b b b
A .temperature of 100.4°F (38°C)
b b b b
B. An increase in the pulse rate from 88 to 102 beats/minute
b b b b b b b b b b b
C. A blood pressure change from 130/88 to 124/80 mm Hg
b b b b b b b b b b
D. An increase in the respiratory rate from 18 to 22 breaths/minute - correct answer-B,
b b b b b b b b b b b b bb b
During the fourth stage of labor, the maternal blood pressure, pulse, and respiration
b b b b b b b b b b b b b
should be checked every 15 minutes during the first hour. An increasing pulse is an
b b b b b b b b b b b b b b b
early sign of excessive blood loss because the heart pumps faster to compensate for
b b b b b b b b b b b b b b
reduced blood volume. A slight increase in temperature is normal. The blood pressure
b b b b b b b b b b b b b
decreases as the blood volume diminishes, but a decreased blood pressure would not
b b b b b b b b b b b b b
be the earliest sign of hemorrhage. The respiratory rate is slightly increased from
b b b b b b b b b b b b b
normal.
b
The nurse in the ambulatory care unit is providing home care instructions to a client
b b b b b b b b b b b b b b
after cryotherapy for the treatment of malignant skin lesions. Which statement would
b b b b b b b b b b b b
be most appropriate for the nurse to include in the home care instructions for this
b b b b b b b b b b b b b b b
client?
b
"Apply ice to the site to prevent swelling."
b b b b b b b
, "Clean the site with alcohol 3 times daily."b b b b b b b
"Apply a warm, damp washcloth if discomfort occurs."
b b b b b b b
"Avoid showering or taking baths until seen by the health care provider in 1 week." -
b b b b b b b b b b b b b b b b
correct answer-3, Cryotherapy involves the local application of liquid nitrogen to the
b b b b b b b b b b b b
lesion; this causes cell death and tissue destruction. Tissue freezing is followed in 1 to
b b b b b b b b b b b b b b b
2 days by hemorrhagic blister formation; therefore, ice is not applied to the site. The
b b b b b b b b b b b b b b b
application of a warm, damp washcloth intermittently to the site will provide relief of
b b b b b b b b b b b b b b
any discomfort. The nurse instructs the client to clean the site with the prescribed
b b b b b b b b b b b b b b
solution to prevent secondary infection. A topical antibiotic also may be prescribed.
b b b b b b b b b b b b
Alcohol would cause irritation to the skin. There is no reason for the client to avoid
b b b b b b b b b b b b b b b b
showering or bathing.
b b b
The registered nurse is caring for the following clients. It would be a priority for the
b b b b b b b b b b b b b b b
nurse to initiate a multidisciplinary conference for the client who is
b b b b b b b b b b b
A.12 years old with Autism who is starting a new school and recently had a URI (upper
b b b b b b b b b b b b b b b b
respiratory tract infection)
b b b
B.39 years old, has type 2 Diabetes Mellitus, is homeless and had a recent
b b b b b b b b b b b b b
Hemoglobin A1c of 13%
b b b b
C.52 years old, with Myasthenia Gravis, recently prescribed Mestinon (pyridostigmine)
b b b b b b b b b
and is employed as a mail carrier
b b b b b b b
D.79 years old, has bipolar and schizophrenia, lives alone and reports hearing non
b b b b b b b b b b b b
threatening voices. - correct answer-B
b b b bb b
A client with uncontrolled Diabetes Mellitus would require the greatest number of
b b b b b b b b b b b
disciplines (multidisciplinary) to manage their care i.e. Medicine, Nursing, Social Work,
b b b b b b b b b b b
Nutritionist; the other choices do not require as many providers of care to meet their
b b b b b b b b b b b b b b b
needs.
b
A client is scheduled to begin therapy with carbamazepine. The nurse should assess
b b b b b b b b b b b b
the results of which test(s) before administering the first dose of this medication to the
b b b b b b b b b b b b b b b
client?
b
Liver function tests b b
Renal function tests b b
Pancreatic enzyme studies b b
Complete blood cell count - correct answer-D. Carbamazepine may be used to treat a
b b b b bb b b b b b b b b
seizure disorder. It can cause leukopenia, anemia, thrombocytopenia, and, very
b b b b b b b b b b
rarely, fatal aplastic anemia. To reduce the risk of serious hematological effects, a
b b b b b b b b b b b b b
complete blood cell count should be done before treatment and periodically thereafter.
b b b b b b b b b b b b
This medication should be avoided in clients with preexisting hematological
b b b b b b b b b b
abnormalities. The client also is told to report the occurrence of fever, sore throat,
b b b b b b b b b b b b b b
pallor, weakness, infection, easy bruising, and petechiae. The results of the remaining
b b b b b b b b b b b b
tests listed in the options are not associated with the use of this medication.
b b b b b b b b b b b b b b
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The
b b b b b b b b b b b b b b
binitial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV)
b b b b b b b b b b b b
binfusion of short-acting insulin is initiated, along with IV rehydration with normal saline.
b b b b b b b b b b b b
bThe serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse
b b b b b b b b b b b b b
bwould next prepare to administer which medication?
b b b b b b
An ampule of 50% dextrose
b b b b
NPH insulin subcutaneously
b b
IV fluids containing dextrose
b b b
COMPLETE ANSWERS
The nurse is monitoring a client in the immediate postpartum period for signs of
b b b b b b b b b b b b b
hemorrhage. Which sign, if noted, would be an early sign of excessive blood loss?
b b b b b b b b b b b b b b
A .temperature of 100.4°F (38°C)
b b b b
B. An increase in the pulse rate from 88 to 102 beats/minute
b b b b b b b b b b b
C. A blood pressure change from 130/88 to 124/80 mm Hg
b b b b b b b b b b
D. An increase in the respiratory rate from 18 to 22 breaths/minute - correct answer-B,
b b b b b b b b b b b b bb b
During the fourth stage of labor, the maternal blood pressure, pulse, and respiration
b b b b b b b b b b b b b
should be checked every 15 minutes during the first hour. An increasing pulse is an
b b b b b b b b b b b b b b b
early sign of excessive blood loss because the heart pumps faster to compensate for
b b b b b b b b b b b b b b
reduced blood volume. A slight increase in temperature is normal. The blood pressure
b b b b b b b b b b b b b
decreases as the blood volume diminishes, but a decreased blood pressure would not
b b b b b b b b b b b b b
be the earliest sign of hemorrhage. The respiratory rate is slightly increased from
b b b b b b b b b b b b b
normal.
b
The nurse in the ambulatory care unit is providing home care instructions to a client
b b b b b b b b b b b b b b
after cryotherapy for the treatment of malignant skin lesions. Which statement would
b b b b b b b b b b b b
be most appropriate for the nurse to include in the home care instructions for this
b b b b b b b b b b b b b b b
client?
b
"Apply ice to the site to prevent swelling."
b b b b b b b
, "Clean the site with alcohol 3 times daily."b b b b b b b
"Apply a warm, damp washcloth if discomfort occurs."
b b b b b b b
"Avoid showering or taking baths until seen by the health care provider in 1 week." -
b b b b b b b b b b b b b b b b
correct answer-3, Cryotherapy involves the local application of liquid nitrogen to the
b b b b b b b b b b b b
lesion; this causes cell death and tissue destruction. Tissue freezing is followed in 1 to
b b b b b b b b b b b b b b b
2 days by hemorrhagic blister formation; therefore, ice is not applied to the site. The
b b b b b b b b b b b b b b b
application of a warm, damp washcloth intermittently to the site will provide relief of
b b b b b b b b b b b b b b
any discomfort. The nurse instructs the client to clean the site with the prescribed
b b b b b b b b b b b b b b
solution to prevent secondary infection. A topical antibiotic also may be prescribed.
b b b b b b b b b b b b
Alcohol would cause irritation to the skin. There is no reason for the client to avoid
b b b b b b b b b b b b b b b b
showering or bathing.
b b b
The registered nurse is caring for the following clients. It would be a priority for the
b b b b b b b b b b b b b b b
nurse to initiate a multidisciplinary conference for the client who is
b b b b b b b b b b b
A.12 years old with Autism who is starting a new school and recently had a URI (upper
b b b b b b b b b b b b b b b b
respiratory tract infection)
b b b
B.39 years old, has type 2 Diabetes Mellitus, is homeless and had a recent
b b b b b b b b b b b b b
Hemoglobin A1c of 13%
b b b b
C.52 years old, with Myasthenia Gravis, recently prescribed Mestinon (pyridostigmine)
b b b b b b b b b
and is employed as a mail carrier
b b b b b b b
D.79 years old, has bipolar and schizophrenia, lives alone and reports hearing non
b b b b b b b b b b b b
threatening voices. - correct answer-B
b b b bb b
A client with uncontrolled Diabetes Mellitus would require the greatest number of
b b b b b b b b b b b
disciplines (multidisciplinary) to manage their care i.e. Medicine, Nursing, Social Work,
b b b b b b b b b b b
Nutritionist; the other choices do not require as many providers of care to meet their
b b b b b b b b b b b b b b b
needs.
b
A client is scheduled to begin therapy with carbamazepine. The nurse should assess
b b b b b b b b b b b b
the results of which test(s) before administering the first dose of this medication to the
b b b b b b b b b b b b b b b
client?
b
Liver function tests b b
Renal function tests b b
Pancreatic enzyme studies b b
Complete blood cell count - correct answer-D. Carbamazepine may be used to treat a
b b b b bb b b b b b b b b
seizure disorder. It can cause leukopenia, anemia, thrombocytopenia, and, very
b b b b b b b b b b
rarely, fatal aplastic anemia. To reduce the risk of serious hematological effects, a
b b b b b b b b b b b b b
complete blood cell count should be done before treatment and periodically thereafter.
b b b b b b b b b b b b
This medication should be avoided in clients with preexisting hematological
b b b b b b b b b b
abnormalities. The client also is told to report the occurrence of fever, sore throat,
b b b b b b b b b b b b b b
pallor, weakness, infection, easy bruising, and petechiae. The results of the remaining
b b b b b b b b b b b b
tests listed in the options are not associated with the use of this medication.
b b b b b b b b b b b b b b
A client is admitted to a hospital with a diagnosis of diabetic ketoacidosis (DKA). The
b b b b b b b b b b b b b b
binitial blood glucose level is 950 mg/dL (54.2 mmol/L). A continuous intravenous (IV)
b b b b b b b b b b b b
binfusion of short-acting insulin is initiated, along with IV rehydration with normal saline.
b b b b b b b b b b b b
bThe serum glucose level is now decreased to 240 mg/dL (13.7 mmol/L). The nurse
b b b b b b b b b b b b b
bwould next prepare to administer which medication?
b b b b b b
An ampule of 50% dextrose
b b b b
NPH insulin subcutaneously
b b
IV fluids containing dextrose
b b b
