Capstone Exam 1
A Nurse is caring for a clients on the med-surg unit. Which client is
most at risk
develop to
a nosocomial
infection?
A- clinet with alcohol abuse admitted for
detox
B- Client with Type I diabetes and peripheral
neuropathy
C- Client recovering from a
choleystectomy
D- Client with full thickness burns, an NG tube and a Foley Correct
answers D-
thickness Full NG tube and
burn,
Foley
*Think immunosupression and avenues for
infection
A nurse is caring for clients in the ICU. Which client may be transferred
to
downthe neuro
step-
unit?
A- Client with head injury and
seizure
B- Client with an ischemic stroke 4 days ago with
confusion
C- Client who is 1-day post op after a transshpenoidal craniotomy with a
cerebrospinal
fluid
leak
D-Client with bacterial meningitis and a Glasgow coma sale of 7 Correct
answers
client B- an ischemic stroke 4 days ago with
with
confusion.
*Think what is normal and what is abnormal- who is
most stable
After a change of shift, you are assinged to care for the following clients,
Which
should client
you assess
first?
A- 60 year old client on a ventilator for whom a sterile sputum specimen
must be sent to
the
lab
B- 55 year old with COPD and a pulse oximetry reading from the previous
shift
C- 70ofyear
90%old with pneumonia who needs to be started on IV
antibiotics
D- 50 year old with asthma who complains of shortness of breath
after using a Correct answers D- 50 year old with asthma who complains of
bronchodilator
shortness
of breath after using a
*Think ABCs, also not the desired effect of the brochodilator treatment;
brochodilator
should be
improve
d.
The nurse just received report on the surgical ward. Which client should be
assessed
first
?
A- Peptic ulcer disease scheduled for a laparosopic choleycystectomy
in 4Multiple
B- hours injuries after a motor vehicle
crash
C- Graves disease scheduled for a
thyroidectomy
, D- Post-appendectomy waiting for discharge Correct answers B-
multiple injuries
following a motor vehicle
crash
*think who is most
unstable
A hospital will receive a large number of clients because of a magor disaster
in the city.
Which client can be discharged
first?
A- 49 year old female 24 hours postop after
hysterectomy
B- 66 year old male 5 days post op after total hip
replacement
C- 79 year old female admitted 12 hours ago with
pyrlonephritis
D- 82 year old female admitted 5 days ago with a stage 3 pressure
ulcer Correct
answers B- 66 year old male 5 days post op after total hip
replacement
*think who is most stable and would be safest to
go home
A nurse just received report on her client's at the first of the shift. Which
client should be
assessed
first?
A- 45 year old woman with a BP of 90/60 and hot,
dry37
B- skin
year old man with BP 130/70, sleeping quietly in
his25
C- bedyear old woman with fruity breath, excessive thrist and
polyphagia
D- 16 year old boy with irritability and tremor Correct answers C- 25 year
old woman
with fruity breath, excessive thirst and
polyphagia
*who is showing definite signs of a problem not just
questionable ones
The staff nurse receives on her assignment for the shift. Which client should
she assess
first
?
A- A client reporting a headache with a pain
score
B- 3/10 with frequent watery diarrhea, abdominal
A client
pain,
C- nausea
A client with respirations of 20 and O2 sat of 94% on
room
D- A client
ait with nausea after taking oral contrast for abdominal CT
scan Correct
answers B- A client with frequent watery diarrhea, abdominal pain
and nausea
*think about dehyration and electrolyte
inbalance
The client with COPD tells the CNA that he did not get his annual flu shot
this not
has yearhadanda pneumonia vaccination. You would be sure to instruct the
CNA toofreport
which
these?
A- Blood pressure of 152/84
mmHg
B- Respiratory rate of 27 breaths per
minute
C- Heart rate of 92
beats/min
D- Oral temperature of 38.4 Correct answers D- Oral
temperature
*most of 38.4
indicitive of
infection
When assessing a 22-year old client who required emergency surgery
and multiple3 days ago, you find that the client looks anxious and
transfusion
has labred
A Nurse is caring for a clients on the med-surg unit. Which client is
most at risk
develop to
a nosocomial
infection?
A- clinet with alcohol abuse admitted for
detox
B- Client with Type I diabetes and peripheral
neuropathy
C- Client recovering from a
choleystectomy
D- Client with full thickness burns, an NG tube and a Foley Correct
answers D-
thickness Full NG tube and
burn,
Foley
*Think immunosupression and avenues for
infection
A nurse is caring for clients in the ICU. Which client may be transferred
to
downthe neuro
step-
unit?
A- Client with head injury and
seizure
B- Client with an ischemic stroke 4 days ago with
confusion
C- Client who is 1-day post op after a transshpenoidal craniotomy with a
cerebrospinal
fluid
leak
D-Client with bacterial meningitis and a Glasgow coma sale of 7 Correct
answers
client B- an ischemic stroke 4 days ago with
with
confusion.
*Think what is normal and what is abnormal- who is
most stable
After a change of shift, you are assinged to care for the following clients,
Which
should client
you assess
first?
A- 60 year old client on a ventilator for whom a sterile sputum specimen
must be sent to
the
lab
B- 55 year old with COPD and a pulse oximetry reading from the previous
shift
C- 70ofyear
90%old with pneumonia who needs to be started on IV
antibiotics
D- 50 year old with asthma who complains of shortness of breath
after using a Correct answers D- 50 year old with asthma who complains of
bronchodilator
shortness
of breath after using a
*Think ABCs, also not the desired effect of the brochodilator treatment;
brochodilator
should be
improve
d.
The nurse just received report on the surgical ward. Which client should be
assessed
first
?
A- Peptic ulcer disease scheduled for a laparosopic choleycystectomy
in 4Multiple
B- hours injuries after a motor vehicle
crash
C- Graves disease scheduled for a
thyroidectomy
, D- Post-appendectomy waiting for discharge Correct answers B-
multiple injuries
following a motor vehicle
crash
*think who is most
unstable
A hospital will receive a large number of clients because of a magor disaster
in the city.
Which client can be discharged
first?
A- 49 year old female 24 hours postop after
hysterectomy
B- 66 year old male 5 days post op after total hip
replacement
C- 79 year old female admitted 12 hours ago with
pyrlonephritis
D- 82 year old female admitted 5 days ago with a stage 3 pressure
ulcer Correct
answers B- 66 year old male 5 days post op after total hip
replacement
*think who is most stable and would be safest to
go home
A nurse just received report on her client's at the first of the shift. Which
client should be
assessed
first?
A- 45 year old woman with a BP of 90/60 and hot,
dry37
B- skin
year old man with BP 130/70, sleeping quietly in
his25
C- bedyear old woman with fruity breath, excessive thrist and
polyphagia
D- 16 year old boy with irritability and tremor Correct answers C- 25 year
old woman
with fruity breath, excessive thirst and
polyphagia
*who is showing definite signs of a problem not just
questionable ones
The staff nurse receives on her assignment for the shift. Which client should
she assess
first
?
A- A client reporting a headache with a pain
score
B- 3/10 with frequent watery diarrhea, abdominal
A client
pain,
C- nausea
A client with respirations of 20 and O2 sat of 94% on
room
D- A client
ait with nausea after taking oral contrast for abdominal CT
scan Correct
answers B- A client with frequent watery diarrhea, abdominal pain
and nausea
*think about dehyration and electrolyte
inbalance
The client with COPD tells the CNA that he did not get his annual flu shot
this not
has yearhadanda pneumonia vaccination. You would be sure to instruct the
CNA toofreport
which
these?
A- Blood pressure of 152/84
mmHg
B- Respiratory rate of 27 breaths per
minute
C- Heart rate of 92
beats/min
D- Oral temperature of 38.4 Correct answers D- Oral
temperature
*most of 38.4
indicitive of
infection
When assessing a 22-year old client who required emergency surgery
and multiple3 days ago, you find that the client looks anxious and
transfusion
has labred
