RN Concept-Based Assessment Level
2 Online Practice B
A home health nurse is assessing a consumer who has COPD. The patron has a breathing rate
of twenty-two/min and reports shortness of breath. Which of the following movements have to
the nurse take first? - ANS-region the purchaser in excessive-Fowler's position
A hospice nurse is visiting with a client following the demise of her partner 1 month ago. The
customer is tearful and states she does now not see how she can ever be glad again. Which of
the subsequent responses have to the nurse make? - ANS-What are a number of the nice times
along with your companion that you keep in mind?
A nurse a reviewing the laboratory record of a consumer who is taking atorvastatin. Which of the
subsequent findings need to the nurse pick out as a demonstration that the medication is having
an unfavorable impact? - ANS-Aspartate aminotransferase (AST) 45 devices/L
A nurse in a network health hospital is reviewing records from the scientific statistics of four
customers. Which of the following communicable diseases calls for reporting via the nurse?
-Gonorrhea
-Herpes genitalis
-Human papillomavirus
-Bacterial vaginosis - ANS-Gonorrhea
Gonorrhea is an infectious situation listed on the Nationally Notifiable Infectious Conditions
Listing. The nurse must file this communicable ailment to the Centers for Disease Control and
Prevention.
A nurse in a provider's workplace is assessing a consumer who is taking warfarin to treat atrial
fibrillation. Which of the subsequent findings need to the nurse discover as an damaging impact
that need to be pronounced to the provider? - ANS-Black, tarry stools
A nurse in a provider's workplace is reviewing the clinical document of a client who has COPD.
Which of the subsequent findings is the concern for the nurse to report to the provider? -
ANS-Sputum culture suggests gram fine bacteria
A nurse in an emergency branch is assessing a consumer who shows manifestations of a small
bowel obstruction. Which of the following findings must the nurse expect? Select all that
observe - ANS-Abdominal distention, vomiting, hyperactive bowel sounds
,A nurse in an emergency department is being concerned for a patron who has appendicitis.
Which of the following actions ought to the nurse take?
-restrict oral consumption to clear fluids
-region a heating pad at the purchaser's stomach
-place the patron in semi-Fowler's position
-Administer an enema - ANS-Place the client in semi-Fowler's role
The nurse should region the patron in semi-Fowler's position to comprise abdominal drainage in
the decrease stomach and prevent it from seeping into the peritoneum.
A nurse in an emergency department is reviewing the laboratory document of a client who has
hyperventilation. The patron's ABG consequences are pH 7.50, PaCO2 29 mmHg, and HCO3
25 mEq/L. The nurse should interpret that these values are an illustration of which of the
subsequent acid-base imbalances? - ANS-Respiratory alkalosis
A nurse is admitting a consumer who has peptic ulcer sickness and an higher gastrointestinal
bleed. Which of the following manifestations ought to the nurse assume? Select all that practice
- ANS-Dark tarry stools, bright red emesis, elevated coronary heart rate
A nurse is admitting an infant who has pertussis. Which of the subsequent movements need to
the nurse take? - ANS-Initiate droplet precautions for the toddler
A nurse is assessing a 6-month-vintage little one who has bacterial pneumonia. Which of the
following manifestations must the nurse expect? - ANS-nasal flaring
A nurse is assessing a 6-month-antique infant who has gastroenteritis with moderate
dehydration. Which of the subsequent findings have to the nurse assume? - ANS-Capillary top
off more than 2 seconds
A nurse is assessing a patron for manifestations of GERD. Which of the following findings
suggests to the nurse that the consumer may have GERD?
-Decreased salivation
-Diarrhea
-Tonsillitis
-Globus - ANS-Globus
The patron who has manifestations of GERD will have globus, that's a sense of something
being inside the back of the throat.
A nurse is assessing a client for manifestations of warmth stroke. Which of the following findings
need to the nurse expect? - ANS-Oliguria
A nurse is assessing a consumer for manifestations of left-sided heart failure. Which of the
following findings ought to the nurse assume?
, -Weight gain
-Enlarged liver
-Distended abdomen
-Cool extremities - ANS-Cool extremities
The nurse must assume to find cool extremities within the customer who has left-sided heart
failure because of a decreased cardiac output main to impaired tissue perfusion.
A nurse is assessing a purchaser for manifestations of proper-sided heart failure. Which of the
subsequent findings have to the nurse anticipate?
-Jugular vein distention
-Fatigue
-Angina
-Hacking cough - ANS-Jugular vein distention
The nurse need to count on to locate jugular vein distention (JVD) inside the customer who has
right-sided coronary heart failure because of proper ventricular failure and pressure constructing
inside the venous system.
A nurse is assessing a client in the triage room of an emergency branch. Based on the
customer findings, which of the subsequent actions ought to the nurse take? - ANS-Place a
surgical mask on the customer
A nurse is assessing a client who has a new diagnosis of hypothyroidism. Which of the following
manifestations ought to the nurse anticipate? - ANS-Cold intolerance
A nurse is assessing a client who has a partial obstruction of the large bowel. Which of the
subsequent manifestations need to the nurse assume? - ANS-Ribbon-like stools
A nurse is assessing a purchaser who has acute cholecystitis. Which of the following findings
should the nurse assume? Select all that apply - ANS-Fever, Dyspepsia, Eructation
A nurse is assessing a customer who has acute pyelonephritis. Which of the following findings
must the nurse assume? - ANS-Urinary burning
A nurse is assessing a consumer who has an external fixator to the right lower arm following
musculoskeletal trauma. Which of the following findings have to indicate to the nurse that the
client has developed compartment syndrome?
-Serous drainage is present on the pin web page dressings
-Flushing of the pores and skin at the right arm
-Bounding pulse palpated inside the radial artery
-Numbness to the hands at the proper arm - ANS-Numbness to the fingers on the right arm
2 Online Practice B
A home health nurse is assessing a consumer who has COPD. The patron has a breathing rate
of twenty-two/min and reports shortness of breath. Which of the following movements have to
the nurse take first? - ANS-region the purchaser in excessive-Fowler's position
A hospice nurse is visiting with a client following the demise of her partner 1 month ago. The
customer is tearful and states she does now not see how she can ever be glad again. Which of
the subsequent responses have to the nurse make? - ANS-What are a number of the nice times
along with your companion that you keep in mind?
A nurse a reviewing the laboratory record of a consumer who is taking atorvastatin. Which of the
subsequent findings need to the nurse pick out as a demonstration that the medication is having
an unfavorable impact? - ANS-Aspartate aminotransferase (AST) 45 devices/L
A nurse in a network health hospital is reviewing records from the scientific statistics of four
customers. Which of the following communicable diseases calls for reporting via the nurse?
-Gonorrhea
-Herpes genitalis
-Human papillomavirus
-Bacterial vaginosis - ANS-Gonorrhea
Gonorrhea is an infectious situation listed on the Nationally Notifiable Infectious Conditions
Listing. The nurse must file this communicable ailment to the Centers for Disease Control and
Prevention.
A nurse in a provider's workplace is assessing a consumer who is taking warfarin to treat atrial
fibrillation. Which of the subsequent findings need to the nurse discover as an damaging impact
that need to be pronounced to the provider? - ANS-Black, tarry stools
A nurse in a provider's workplace is reviewing the clinical document of a client who has COPD.
Which of the subsequent findings is the concern for the nurse to report to the provider? -
ANS-Sputum culture suggests gram fine bacteria
A nurse in an emergency branch is assessing a consumer who shows manifestations of a small
bowel obstruction. Which of the following findings must the nurse expect? Select all that
observe - ANS-Abdominal distention, vomiting, hyperactive bowel sounds
,A nurse in an emergency department is being concerned for a patron who has appendicitis.
Which of the following actions ought to the nurse take?
-restrict oral consumption to clear fluids
-region a heating pad at the purchaser's stomach
-place the patron in semi-Fowler's position
-Administer an enema - ANS-Place the client in semi-Fowler's role
The nurse should region the patron in semi-Fowler's position to comprise abdominal drainage in
the decrease stomach and prevent it from seeping into the peritoneum.
A nurse in an emergency department is reviewing the laboratory document of a client who has
hyperventilation. The patron's ABG consequences are pH 7.50, PaCO2 29 mmHg, and HCO3
25 mEq/L. The nurse should interpret that these values are an illustration of which of the
subsequent acid-base imbalances? - ANS-Respiratory alkalosis
A nurse is admitting a consumer who has peptic ulcer sickness and an higher gastrointestinal
bleed. Which of the following manifestations ought to the nurse assume? Select all that practice
- ANS-Dark tarry stools, bright red emesis, elevated coronary heart rate
A nurse is admitting an infant who has pertussis. Which of the subsequent movements need to
the nurse take? - ANS-Initiate droplet precautions for the toddler
A nurse is assessing a 6-month-vintage little one who has bacterial pneumonia. Which of the
following manifestations must the nurse expect? - ANS-nasal flaring
A nurse is assessing a 6-month-antique infant who has gastroenteritis with moderate
dehydration. Which of the subsequent findings have to the nurse assume? - ANS-Capillary top
off more than 2 seconds
A nurse is assessing a patron for manifestations of GERD. Which of the following findings
suggests to the nurse that the consumer may have GERD?
-Decreased salivation
-Diarrhea
-Tonsillitis
-Globus - ANS-Globus
The patron who has manifestations of GERD will have globus, that's a sense of something
being inside the back of the throat.
A nurse is assessing a client for manifestations of warmth stroke. Which of the following findings
need to the nurse expect? - ANS-Oliguria
A nurse is assessing a consumer for manifestations of left-sided heart failure. Which of the
following findings ought to the nurse assume?
, -Weight gain
-Enlarged liver
-Distended abdomen
-Cool extremities - ANS-Cool extremities
The nurse must assume to find cool extremities within the customer who has left-sided heart
failure because of a decreased cardiac output main to impaired tissue perfusion.
A nurse is assessing a purchaser for manifestations of proper-sided heart failure. Which of the
subsequent findings have to the nurse anticipate?
-Jugular vein distention
-Fatigue
-Angina
-Hacking cough - ANS-Jugular vein distention
The nurse need to count on to locate jugular vein distention (JVD) inside the customer who has
right-sided coronary heart failure because of proper ventricular failure and pressure constructing
inside the venous system.
A nurse is assessing a client in the triage room of an emergency branch. Based on the
customer findings, which of the subsequent actions ought to the nurse take? - ANS-Place a
surgical mask on the customer
A nurse is assessing a client who has a new diagnosis of hypothyroidism. Which of the following
manifestations ought to the nurse anticipate? - ANS-Cold intolerance
A nurse is assessing a client who has a partial obstruction of the large bowel. Which of the
subsequent manifestations need to the nurse assume? - ANS-Ribbon-like stools
A nurse is assessing a purchaser who has acute cholecystitis. Which of the following findings
should the nurse assume? Select all that apply - ANS-Fever, Dyspepsia, Eructation
A nurse is assessing a customer who has acute pyelonephritis. Which of the following findings
must the nurse assume? - ANS-Urinary burning
A nurse is assessing a consumer who has an external fixator to the right lower arm following
musculoskeletal trauma. Which of the following findings have to indicate to the nurse that the
client has developed compartment syndrome?
-Serous drainage is present on the pin web page dressings
-Flushing of the pores and skin at the right arm
-Bounding pulse palpated inside the radial artery
-Numbness to the hands at the proper arm - ANS-Numbness to the fingers on the right arm
