PN3 Final Exam 2023 UPDATE SCORED {85%} QUESTIONS AND ANSWERS LATEST VERSION

PN3 Final Exam 2023 UPDATE SCORED {85%} QUESTIONS AND ANSWERS LATEST VERSION 1. The nurse, planning care for a mechanically ventilated client, would plan to administer pantoprazole. The nurse understands this medication is to prevent the onset of which of the following complications? Thrombophlebitis Hypertension Hyperglycemia Stress Ulcers 2. A client is diagnosed with cardiogenic shock. The nurse should plan immediate interventions to address which of the following complications of this disorder? Pulmonary Embolism Deep vein thrombosis Acute renal failure Disseminated intravascular coagulation 3. A patient in the emergency department is experiencing a hemorrhagic stroke. The nurse anticipates which of the following symptoms may have been present at the onset? SATA Vomiting Limited mobility worse in the morning Severe, sudden headache Increased appetite Change in mental status 4. A nurse is caring for an end-of-life terminally ill client, experiencing very shallow and rapid breathing with periods of apnea. After evaluating the client, which action by the nurse would be most appropriate? Reduce the number of people in the client's room Reorient the client as needed Place the client in supine position Elevate the clients HOB 5. A nurse is admitted to the hospital with an infected postoperative surgical wound. The practitioner orders vancomycin IV. Order: Vancomycin 1 gram in 500 ml dextrose 5% water (D5W) to infuse over 2 hours via infusion pump. Calculate the flow rate in ml/hr. 250 6. A nurse assesses a client who sustained a basal skull fracture and notes a thin stream of clear drainage coming from the client'sright nostril. Which of the following actions should the nurse take first? Palpate the clients head for the presence of fractures Assess the drainage from eyes and ears Assess the drainage and test the drainage to rule out cerebral spinal fluid Ask the client to keep their head elevate 7. An emergency department nurse triages a client with diabetes mellitus who has fractured her wrist. Which action would the nurse take first? Remove the medical alert bracelet from the fractured arm Place the client in a supine position with a warm blanket Cover any open areas with a sterile dressing Immobilize the arm by splinting the fracture 8. A nurse cares for a client who has obstructive jaundice. The client asks, " Why is my skin so itchy?" How would the nurse respond? "Bile salts accumulate in the skin and cause the itching." "Toxins released from an inflamed gallbladder lead to itching." "Itching is caused by the release of calcium into the skin." "Itching is caused by a hypersensitivity reaction. 9. A nurse is caring for a client on mechanical ventilation and finds the client agitated and restless. What action by the nurse is most appropriate? Reassure the client that they are safe Restrain the clients' legs and arms Sedate the client immediately Assess the cause of the agitation 10. A nurse obtains the health history of a client with a fractured femur. Which factor identified in the client's history would the nurse recognize as an aspect that may delay healing? Osteoporosis Oral contraceptives Sedentary lifestyle Current smoking history 11. The nurse is notified that the clients monitor is showing artifact. What does the nurse do next? Troubleshoot the equipment Check the status of the client Monitor and document the artifact Notify the physician for orders 12. A nurse is monitoring a client who has an acute kidney injury. Which of the following laboratory findings should the nurse expect? Hypokalemia Metabolic acidosis Hypercalcemia Elevated BUN and creatinine 13. A client in the intensive care unit is scheduled for a lumbar puncture today. On assessment, the nurse finds the client breathing irregularly with one pupil fixed and dilated. Which of the following nursing actions is the best? Ensure that informed consent is on the chart. Document these findings in the client’s record. Give the prescribed preprocedural sedation. Call a rapid response team 14. The nurse is concerned that a client may develop neurogenic shock when which of the following is assessed? Decreased sympathetic nerve impulses cause a low mean arterial pressure (MAP) Jugular vein distension caused by an elevated mean arterial pressure (MAP) Fractured lower extremity Sluggish bowel sounds 15. The nurse is the emergency department is using triage system because this system ranks clients by Name Age Body system involved The severity of illness or injury 16. A nurse cares for a client who is recovering from hypophysectomy. What action should the nurse take first? Instruct the client to cough, turn, and deep breath Assess for clear or light-yellowdrainage from the nose Keep the head of the bed flat and the client supine Apply petroleum jelly to lips to avoid dryness 17. What is the rationale for chemotherapy as a cancer treatment? Decreases the client'srisk for life threatening complications To disrupt one or more steps necessary for cancer to develop Less expansive and safer than radiation Concentrates in secondary lymphoid tissues and prevents widespread metastasis. 18. A client diagnosed with cholecystitis asks the nurse what happened. The nurse correctly identifies which one of the following risk factors? A client with low body weight A client on a vegetarian diet An obese fertile client over the age of 40 A client on testosterone supplements 19. When educating clients on liver disease, the nurse correctly identifies the most common cause of cirrhosis in the United States as being which of the following? SATA Nonalcoholic steatohepatitis (NASH) Chronic viral hepatitis Bacterial hepatitis High protein diets Chronic alcoholism 20. The client with atrial fibrillation suddenly develops dyspnea, chest pain, hemoptysis, and a feeling of impending doom. The nurse recognizes these symptoms as which complication? Pulmonary embolism Absence of atrial kick Increased cardiac output Embolic stroke 21. A nurse cares for a client that was prescribed lactulose. The client states I do not want to take this medication because it causes diarrhea. How would the nurse respond? Diarrhea is expected; that’s how your body gets rid of ammonia Do not take any more of the medication until your stool firms up We will need to send a stool specimen to the laboratory You may take an antidiarrheal medication for loose stools 22. A 40-year-old obese client arrived with complaints of right upper quadrant pain radiating to the right scapula. The nurse expects which of the following conditions? Cholelithiasis Pancreatitis Gastritis Appendicitis 23. A client has a brain tumor and is receiving fosphenytoin. The spouse questions the drug use saying that the client does not have a seizure disorder. Which of the following is the best response by the nurse? Increased pressure from the brain tumor can cause seizures Seizures frequently occur in clients with brain tumors This drug is used to sedate the client with a brain tumor Preventing febrile seizures with a brain tumor is important 24. The nurse is assessing a client for the adequacy of ventilation. What assessment findings would indicate the client has good ventilation? Nail beds are pink with good capillary refill There are quiet and effortless breaths sounds at the lung base bilaterally The oxygen sat level is 98% Respiratory rate is 24 breaths/minute The trachea is just left to the sternal notch The right side of the thorax expands slightly more than the left 25. When diagnosed with Cushing syndrome. The manifestations are most likely related to an excess production of which hormone? Cortisol Antidiuretic hormone (ADH) Insulin Prolactin 26. A nurse is assessing the arteriovenous (AV) fistula of end in end-stage failure. The nurse documents the following “ bruit auscultated, and thrill palpated at left arm AV fistula” the nurse next step is to complete which of the following? Maintain the extremity in an elevated position Contact the nephrologist and notify them the fistula is not working Document the AV fistula is patent Assess the site using a 20-guage IV catheterfor administration of fluids 27. A client with septic shock is breathing at a rate of 32 breaths per minute with accessory muscle use. Which of the following is the nurse’s priority? Determine the cause of sepsis Assess and provide interventions to maintain the clients’ airways Start an IV and give vancomycin after obtaining blood cultures Assess capillary refill 28. Which client is at risk for developing secondary adrenal insufficiency? Client who suddenly stops taking high-dose steroid therapy Client deficient in ADH Client with an adrenal tumor causing excessive secretion of ACTH Client who tapers the dosages of steroid therapy 29. A nurse is developing a teaching plan for client who just been diagnosed with breast cancer, which medication is used as a hormone-based therapy? SATA Tamoxifen Letrozole Cyclophosphamide Denosumab Alendronate 30. A client complains of having an irregular heartbeat in his chest. The nurse applies the cardiac monitor and correctly identifies the following rhythm as which of the following? Normal sinus rhythm Atrial fibrillation Sinus tachycardia Atrial flutter 31. A nurse plans care for a client with acute pancreatitis. Which priority intervention will the nurse include in this client plan of care? Place the client in semi-fowlers position with the head of bed elevated Provide small, frequent feedings with no concentrated sweets Administer morphine sulfate intravenously every 4 hours Maintain nasogastric suctioning at a low-intermittent level except for during administration of oral meds 32. A nurse is caring for four clients in the neurologic intensive care unit. Which client would the nurse assess first? Clientwho has been diagnosed withmeningitis with a feverof 101°F (38.3° C) Clientwho had a transientischemic attack and isin warfarin waiting forINRabove 2.0 Clientreceiving tissue plasminogen activator(t-PA) whohas a change nosebleed Clientwho iswaiting forsubarachnoid boltinsertion with the consentformalreadysigned 33. A client has 50% burns following a car fire. In the initial resuscitation phase of care, which of the following are considered essential? Educating the client on skin care Prevention of contractures Airway management Fluid resuscitation Pain management 34. The nurse is preparing to administerIV heparin to the client. Order: 1500 units/hour. Available: 25000 units in 250 ml of normal saline. IV pump set to 15 ml/hour 35. A nurse supervises the application of electrocardiographic monitoring performed by unlicensed assistivepersonnel. Which statement would the nurse provide to the UAP related to this procedure? Turn off the wall oxygen before monitoring the client Add gel to the electrodes before applying them Clean the skin and clip her before applying the electrodes Place the electrodes on the posterior chest 36. Afterteaching a client about advanced directives, a nurse assessed the clients understanding. Which statement indicates that the client correctly understandsthe teaching? An advance directive will allow me to keep my money out of the reach of my family An advance directive will keep my children from selling my home when I'm old An advanced directive will specify what I want we done when I can no longer make decisions about health care An advance directive will be completed as soon as I'm incapacitated and can't think for myself 37. An intensive care unit nurse is caring for a client on a ventilator. The client develops a mucus plug and requires suctioning.Which of the following will cause a low-pressure alarm? Excessive coughing Mucus plug Disconnected tubing Extensive condensation of humidified water 38. What type of stroke is caused by occlusion of a cerebral or carotid artery and treated with fibrinolytic therapy? Hemorrhagic stroke Ischemic stroke Transient ischemic attack Arteriovenous malformation 39. The Hospice nurse is caring for a dying client and her family members what intervention does the nurse implement? SATA Teach family members about physical signs of impending death Avoid spirituality because the clients and the nurses'beliefs may not be congruent Encourage reminiscence by both client and family members Encouraged the management of adverse symptoms Request that the family limits visits with the client 40. A client presents complaining of abdominal pain and bloody stools.His skin is ashen conjunctivapale and delayed capillary refill. Pulse is weak and thready. The nurse correctly categorizes this client as? Nonurgent (green) Terminal (black) Urgent (yellow) Emergent (red) 41. A client who is recovering from laparoscopic cholecystectomy surgery. The client reports pain in his shoulder blades. how would the nurse respond? You should cough and deep breathe every hour Ambulating in the hallway twice a day will help I will apply a cold compress to the painful area on your back Drinking a warmbeverage can relieve this referred pain 42. A nurse is caring for a client diagnosed with an ST-elevation myocardial infarction (STEMI). The nurse anticipates which of the following interventions would the nurse give first? Morphine Nitrates Oxygen Aspirin 43. Client scenario describes the best example of professional collaboration? The nurse physical therapist and physician have all developed separate plan cares for client The nurse mentions to the physical therapist that the client may benefit from a muscle-strengthening evaluation The nurse and physician discussed the clients muscle weakness and initiate a referral for physical therapy The nurse physician and physical therapist have all visited separately with the client