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Exam (elaborations)

Nur 254 Exam 3 Review Question Set With Accurate Answers

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Nur 254 Exam 3 Review Question Set With Accurate Answers

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NUR 254 EXAM 3 REVIEW QUESTION SET
WITH ACCURATE ANSWERS


◉ 2. A 78-year-old male client needs to complete a 24-hour urine
specimen. In planning his care, the nurse realizes that which
measure is most important? 1. Instruct the client to empty his
bladder and save this voiding to start the collection.
2. Instruct the client to use sterile individual containers to collect
the urine.
3. Post a sign stating "Save All Urine" in the bathroom.
4. Keep the urine specimen in the refrigerator.
Answer: Answer: 3. Rationale: Option 3 is the most important
nursing measure. This will inform the staff that the client is on a
24-hour urine collection. Option 1 is not appropriate since the
first voided specimen is to be discarded. Option 2 is not an
appropriate nursing measure since the specimen container is
clean not sterile, and one container is needed—not individual
containers. Option 4 is inappropriate because some 24-hour urine
collections do not require refrigeration.


◉ 3. The client has a urinary health problem. Which procedure is
performed using indirect visualization? 1. Intravenous
pyelography (IVP)
2. Kidneys, ureter, bladder (KUB)
3. Retrograde pyelography

,4. Cystoscopy
Answer: Answer: 2. Rationale: A KUB is an x-ray of the kidneys,
ureters, and bladder. This does not require direct visualization.
Option 1 is an IVP, an intravenous pyelogram, which requires the
injection of a contrast media. Option 3 is a retrograde
pyelography, which requires the injection of a contrast media.
Option 4 is a cystoscopy, which uses a lighted instrument
(cystoscope) inserted through the urethra, resulting in direct
visualization.


◉ 4. Which noninvasive procedure provides information about
the physiology or function of an organ?
1. Angiography
2. Computerized tomography (CT)
3. Magnetic resonance imaging (MRI)
4. Positron emission tomography (PET)
Answer: Answer: 4. Rationale: This type of nuclear scan
demonstrates the ability of tissues to absorb the chemical to
indicate the physiology and function of an organ. Option 1 is an
invasive procedure that focuses on blood flow through an organ.
Options 2 and 3 provide information about density of tissue to
help distinguish between normal and abnormal tissue of an organ.


◉ 5. When assisting with a bone marrow biopsy, the nurse should
take which action?
1. Assist the client to a right side-lying position after the
procedure.

, 2. Observe for signs of dyspnea, pallor, and coughing.
3. Assess for bleeding and hematoma formation for several days
after the procedure.
4. Stand in front of the client and support the back of the neck and
knees.
Answer: Answer: 3. Rationale: Bone marrow aspiration includes
deep penetration into soft tissue and large bones such as the
sternum and iliac crest. This penetration can result in bleeding.
The client should be observed for bleeding in the days following
the procedure. Option 1 is a nursing action during a liver biopsy.
Option 2 is a nursing action for a thoracentesis, and Option 4 is a
nursing action for a lumbar puncture.


◉ 6. During an assessment, the nurse learns that the client has a
history of liver disease. Which diagnostic tests might be indicated
for this client? Select all that apply.
1. Alanine aminotransferase (ALT)
2. Myoglobin
3. Cholesterol
4. Ammonia
5. Brain natriuretic peptide or B-type natriuretic peptide (BNP)
Answer: Answer: 1 and 4. Rationale: ALT is an enzyme that
contributes to protein and carbohydrate metabolism. An increase
in the enzyme indicates damage to the liver. The liver contributes
to the metabolism of protein, which results in the production of
ammonia. If the liver is damaged, the ammonia level is increased.
Options 2, 3, and 5 (myoglobin, cholesterol, and BNP) are relevant
for heart disease.

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