Answers - NR 302 Final Exam Latest d d d d d d d
Chamberlain College of Nursing 100% Correct Q & d d d d d d d
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1. While making rounds, the nurse finds a patient on the floor in the hall. Which should be
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d the nurse's initial response?
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a. Inspect the patient for injury d d d d
b. Transfer the patient back to bed d d d d d
c. Move the patient to the closest chair
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d. Report the patient's condition to the nurse manager - ANSWER>>a
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2. Which should the nurse do to avoid patient accidents?
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a. Provide a cane for walking if the patient is weak
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b. Determine the strength of a patient before walking d d d d d d d
c. Apply a vest restraint when a patient is using the wheelchair
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d. Keep the overbed table in front of a patient sitting in a chair - ANSWER>>b
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3. Which assessment by the nurse most likely indicates that a patient is having difficulty
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d breathing?
a. 18 breaths per minute and inhaled through the mouth
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b. 20 breaths per minute and shallow in character
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c. 16 breaths per minute and deep in character
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d. 28 breaths per minute and noisy - ANSWER>>d
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4. Which should a nurse always do when taking a rectal temperature?
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a. Allow self-insertion of the thermometer
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b. Position the patient on the left side d d d d d d
c. Use an electronic thermometer
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d. Lubricate the thermometer - ANSWER>>d d d d d
,5. A nurse is assessing a patient's ideal body weight. Which significant factor should be
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d taken into consideration when performing this assessment?
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a. Daily intake d
b. Body height d
c. Clothing size d
d. Food preference - ANSWER>>b
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6. A nurse asks a patient's wife specific questions about the patient's health status
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d before admission. When collecting this information, the nurse is seeking information for a:
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a. Primary source d
b. Tertiary source d
c. Subjective source d
d. Secondary source - ANSWER>>d d d d
7. A nurse is performing a physical assessment of a newly admitted patient. Which
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d patient statement communicates subjective data?
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a. "I have sores between my toes"
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b. "I dye my hair but it is really gray"
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c. "My joints hurt when I get up in the morning"
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d. "My left leg drags the floor when I am walking" - ANSWER>>c
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8. Which is an example of nonverbal communications?
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a. Letter
b. Holding hands d
c. Noise in the room d d d
d. Telephone message - ANSWER>>b d d d
9. A nurse takes a patient's blood pressure and records a diastolic pressure of 120 mm
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d Hg. Which should the nurse do first?
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,a. Notify the primary health-care provider
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b. Retake the blood pressure d d d
c. Notify the nurse in charge
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d. Take the other vital signs - ANSWER>>b
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10. A patient returns to the surgical unit from the post anesthesia care unit after
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d abdominal surgery. The primary health-care provider orders intravenous fluids, oxygen
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d via nasal cannula at 2 L/min, I&O, and vital signs every 2 hours. Two hours after surgery
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d the patient voids 400 mL of amber urine. What should the nurse do with this information?
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a. Report this information to the primary health-care provider.
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b. Record this amount on the patient's intake and output flow sheet
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c. Document this information on the patient's vital signs flow sheet
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d. Communicate this event verbally to the other members of the health-care team. -
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d ANSWER>>b
11. A patient had a brain attack (i.e., stroke, cerebrovascular accident) that resulted in
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d paralysis of the right side. When clustering data, the nurse grouped the following data
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d together: drooling of saliva and slurred speech. Which information is most significant to
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d include with this clustered data.
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a. Receptive aphasia d
b. Inability to ambulate d d
c. Difficulty swallowing d
d. Incontinence of bowel movements - ANSWER>>c d d d d d
12. A nurse understands that pressure ulcers are most often associated with patients
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d who:
a. Are immobilized
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b. Have psychiatric diagnoses
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c. Experience respiratory distress d d
d. Need close supervision for safety - ANSWER>>a
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, 13. A nurse is caring for a dying patient who has a loss of appetite (anorexia), difficulty
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d falling asleep (insomnia), and decreased interest in activities of daily living. Which
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d feeling reflects these clinical findings?
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a. Anger
b. Denial
c. Depression
d. Acceptance - ANSWER>>c d d
14. A patient who is debilitated and unsteady when standing insists on walking to the
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d bathroom without calling for assistance. This behavior best reflects a need to be:
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a. Alone
b. Accepted
c. Independent
d. Manipulative - ANSWER>>c d d
15. A nurse assesses that a postoperative patient has a decreased blood pressure and
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d weak, thready pulse and concludes that the patient may be hemorrhaging. For which
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d additional signs of hemorrhage should the nurse assess the patient?
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a. Pain
b. Jaundice
c. Tachycardia
d. Hyperthermia - ANSWER>>c d d
16. A patient who experience a brain attack (i.e., stroke, cerebrovascular accident) has
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d left-sided hemiparesis and is incontinent of urine. Which is an appropriately worded
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d nursing diagnosis for this patient?
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a. The patient has a need to maintain skin integrity
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b. The patient has a stroke evidenced by hemiparesis and incontinence.
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c. The patient will be clean and dry and will receive range-of-motion exercises ever four
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d hours