NSG 3160 Exam 1 Newest 2025/2026
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The registered nurse (RN) is assessing common complications related to a client's
recent diagnosis, systemic lupus erythematosus (SLE). Which symptom should the
RN instruct the client to report immediately?
Fever related to infection.
Weight loss and anorexia.
Depressed mood.
Break in tissue integrity. - Answer ✓✓Fever related to infection
Secondary infections are a major concern with SLE clients due to the use of
corticosteroids and chemotherapeutic agents, which suppresses the immune
system, so reporting fever and infections should be reported immediately.
After a liver biopsy is performed at the bedside, t he registered nurse (RN) is
assigned the care of the client. Which nursing intervention is most important for
the RN to implement?
Position client on left side with pillow placed under the costal margin.
Assist the client with voiding immediately after the procedure.
Evaluate vital signs q10 to 20 minutes for 2 hours after procedure.
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Ambulate client 3 times in first hour with pillow held at abdomen. - Answer
✓✓Evaluate vital signs q10 to 20 minutes for 2 hours after procedure.
Vital signs should be checked every 10 to 20 minutes to assess for bleeding after
biopsy of the liver, which is highly vascular. The client should be positioned on the
right side with a pillow or sandbag under the costal margin and supporting the
biopsy site. The client should be maintained on bedrest for several hours to
decrease the risk of bleeding from the biopsy site.
A client with cirrhosis of the liver asks the registered nurse (RN) to explain how
varicose veins can occur in the esophagus. Which statement should the RN provide
to teach the client about the physiological etiology?
The enlarged liver presses on the lower half of the esophagus which weakens
blood vessel walls.
Abnormal vessels form as a result of liver damage that causes chronic low serum
protein levels.
Esophageal swelling and tissue damage causes blood to circulate blood back
through the stomach.
Increased portal pressure causes blood flow through liver to be shunted to the
esophageal vessels. - Answer ✓✓Increased portal pressure causes blood flow
through liver to be shunted to the esophageal vessels.
Cirrhotic and fibrosed liver damage causes obstructed blood flow through portal
vessels to the liver which increases the portal pressure causing the blood flow
through the liver to be shunted to the esophageal vessels. The result of this
shunting of blood causes the esophageal vessels (veins) to balloon out and weaken.
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As the portal hypertension increases, these esophageal varices can rupture and
cause bleeding resulting in bloody emesis and black tarry stools.
The registered nurse (RN) is developing the plan of care for a client who is
admitted for alcohol detoxification. Which goal should be most important for the
RN to primarily focus the client's care?
The client maintains optimal nutritional status.
The client will remain alert and oriented.
The client will remain free from injury.
The client will remain alcohol free during hospitalization. - Answer ✓✓The client
will remain free from injury
The client is at highest risk for injury due to altered cognitive and sensory
disturbances as well as delirium tremors during withdrawal. Remaining free from
injury is the most important goal for the acute phase of alcohol withdrawal.
The registered nurse (RN) is making early morning rounds on a group of clients
when a client begins exhibiting symptoms of an acute asthma attack. The RN
administers a PRN prescription for a Beta 2 receptor agonist agent. Which client
response should the RN expect? (select all that applies)
Tachycardia.
Increased blood pressure.
Rapid resolution of wheezing.
Improved pulse oximetry values.
Reduce fever airway inflammation. - Answer ✓✓Resolution of wheezing
Improved pulse oximetry values
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Beta 2 receptor agonist agents should provide immediate return of airflow and
resolve wheezing and improve oxygenation.
The registered nurse (RN) is caring for a client with acute pancreatitis and
assesses the admission laboratory results. What laboratory value should the RN
anticipate being elevated with this diagnosis?
Triglycerides.
Amylase.
Creatinine.
Uric acid. - Answer ✓✓Amylase
While reviewing the client's electronic medical record (EMR), the registered nurse
(RN) assesses a client who is at risk for a possible interaction with an over-the-
counter (OTC) decongestant. Which client health history should the RN report to
the healthcare provider concerning the OTC medication? (Select all that apply).
Type I diabetes mellitus (DM).
Closed angle glaucoma.
Chronic hypertension.
Rheumatoid arthritis.
Crohn's disease. - Answer ✓✓Closed angle glaucoma
Chronic hypertension
The registered nurse (RN) is assessing a male client who arrives at the clinic with
severe abdominal cramping, pain, tenesmus, and dehydration. The RN discovers
that the client has had 14 to 20 loose stools with rectal bleeding. Which condition
should the RN ask the client about his medical history?
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