NSC 378 Written Exam.

NSC 378 Written Exam. The nurse administers lactulose to an adult client hospitalized with liver cirrhosis. Which finding would indicate that the medication was effective? A. Increased stool output B. Normal serum amylase C. Decrease in abdominal girth D. Alert and oriented mental status - CORRECT ANSWER Alert and oriented mental status A client with a history of liver cirrhosis is in the emergency department with nausea, vomiting, and acute confusion, the client is positive for right upper quadrant tenderness and ascites. BP 104/58, HR 108, RR 22. Which order does the nurse question for this client? Select all that apply. A. Morphine sulfate 2-6mg IV every 1 hour PRN pain B. Insert NG tube to low intermittent suction C. LR's IV at 75 mL/hour D. Nothing by mouth E. Electrocardiogram - CORRECT ANSWER Morphine sulfate 2-6mg IV every 1 hour PRN pain Insert NG tube to low intermittent suction LR's IV at 75 mL/hour A client is diagnosed with pancreatitis. Which assessment finding would be of most concern to the nurse? A. Increased serum amylase B. Moderate right upper quadrant pain C. Low grade fever D. Bluish discoloration in periumbilical area - CORRECT ANSWER Bluish discoloration from periumbilical area When teaching a multigravida client diagnosed with mild preeclampsia about nutritional needs, the nurse should discuss which type of diet? A. High residue B. Low sodium C. Regular D. High protein - CORRECT ANSWER Regular The nurse is administering IV magnesium sulfate as prescribed for a client at 34 weeks gestation with severe preeclampsia. What are the desired outcomes of this therapy? Select all that apply. A. Temp 98F, HR 72, RR 14 B. UOP less than 30 mL/hour C. FHR with late decelerations D. BP less than 140/90 mmHg E. Deep tendon reflexes 2+ F. Magnesium level = 5.6 mg/dL (2.8 Mmol/L) - CORRECT ANSWER Temp 98F, HR 72, RR 14 DTR's 2+ Mag level = 5.6 mg/dL What intervention is needed to restore equilibrium of inadequate thyroid function? - CORRECT ANSWER Levothyroxine for thyroid replacement therapy What lab data is used to monitor the status of an individuals thyroid function? - CORRECT ANSWER TSH, T3, and T4 What is the most serious complication that can occur if the client does not receive adequate treatment for hypothyroidism? - CORRECT ANSWER Myxedema coma What is the priority of nursing care for a client experiencing depression? - CORRECT ANSWER Ask if the client has thoughts of hurting themselves and if they have a plan For what type of patients should benzos and TCAs be avoided? - CORRECT ANSWER Older adults and/or individuals with potential or known respiratory and/or cardiac disorders What are the common known side effects of atypical antipsychotics? - CORRECT ANSWER BBW for development of DM due to hyperglycemia and hyperlipidemia Acute extrapyramidal symptoms can occur Chronic tardive dysknesia What nutritional guideline is a priority for a patient diagnosed with COPD? - CORRECT ANSWER Smaller, more frequent meals due to being out of breath and aspiration risk. Increase fruits and vegetables as well as a diet with high fat and low carbs What should the nurse expect to find while assessing the vital signs of a client with HF who has abruptly stopped taking his beta blocker drug? A. Low BP B. Irregular pulse C. Low grade fever D. Decreased RR - CORRECT ANSWER Irregular pulse