NR341 CJE MED SURG: ADULT HEALTH
270 QUESTIONS AND EXPERT VERIFIED
ANSWERS 2024/2025
A client arrives at the emergency department with stridor and hoarseness. Which
priority action should the nurse anticipate at this time?
A Prepare for endotracheal intubation
B Prepare for chest needle decompression
C Insert two large bore intravenous catheters (IVs)
D Administer prescribed pain medication
A nurse is providing education to a client about palliative care. Which statement by
the client indicates a need for further teaching?
A "Palliative care will provide me with symptom relief and comfort."
B "Palliative care means I will not make it more than 6 more months."
,C "While on palliative care, I will still be able to perform activities I enjoy."
D "While on palliative care, my family will also receive support from the team."
A nurse is caring for a client with the following assessment findings (see exhibit
below). What action should the nurse take first?
Heart rate 125, RR 29, BP 90/65, Sa02 88% on Non-Rebreather Mask Neuro:
Oriented to self only
A 500 mL NS fluid bolus
B Rapid sequence intubation
C Continuous renal replacement
D Central line placement
A nurse is caring for a client with acute respiratory failure. Which finding(s)
should the nurse anticipate? Select all that apply.
A Severe dyspnea
,B Hypertension ??
C Decreased level of consciousness
D Nausea
E Agitation
A nurse is caring for a client recovering from surgery three days ago. Upon
assessment, the nurse observes that the client is confused, agitated, trying to climb
out of bed, and reports seeing non-existent people in the room.
Which complication should the nurse suspect the client is experiencing?
A Postoperative delirium
B Senile dementia
C Polypharmacy
D Postoperative infection
, A nurse is caring for a client who was recently intubated and placed on mechanical
ventilation. Which action (s) should the nurse include in the client's plan of care?
Select all the apply.
A Implement the ventilator acquired pneumonia (VAP) bundle
B Suction the endotracheal tube every hour.
C Assess the face for skin breakdown around the tube.
D Document the correct position of the endotracheal tube.
E Administer prescribed pain medication as needed.
A client is receiving a continuous infusion of dexedetomidine at 0.6mcq/kg/hr for
severe agitation. The nurse would anticipate decreasing the infusion rate for which
clinical manifestation (s)? Select all that apply.
A Triglyceride level 302 mg/dL
B Blood pressure 86/48 mmHg
C Heart rate 102 beats per minute
D Blood pressure 142/78 mmHg
E Heart rate 54 beats per minute
270 QUESTIONS AND EXPERT VERIFIED
ANSWERS 2024/2025
A client arrives at the emergency department with stridor and hoarseness. Which
priority action should the nurse anticipate at this time?
A Prepare for endotracheal intubation
B Prepare for chest needle decompression
C Insert two large bore intravenous catheters (IVs)
D Administer prescribed pain medication
A nurse is providing education to a client about palliative care. Which statement by
the client indicates a need for further teaching?
A "Palliative care will provide me with symptom relief and comfort."
B "Palliative care means I will not make it more than 6 more months."
,C "While on palliative care, I will still be able to perform activities I enjoy."
D "While on palliative care, my family will also receive support from the team."
A nurse is caring for a client with the following assessment findings (see exhibit
below). What action should the nurse take first?
Heart rate 125, RR 29, BP 90/65, Sa02 88% on Non-Rebreather Mask Neuro:
Oriented to self only
A 500 mL NS fluid bolus
B Rapid sequence intubation
C Continuous renal replacement
D Central line placement
A nurse is caring for a client with acute respiratory failure. Which finding(s)
should the nurse anticipate? Select all that apply.
A Severe dyspnea
,B Hypertension ??
C Decreased level of consciousness
D Nausea
E Agitation
A nurse is caring for a client recovering from surgery three days ago. Upon
assessment, the nurse observes that the client is confused, agitated, trying to climb
out of bed, and reports seeing non-existent people in the room.
Which complication should the nurse suspect the client is experiencing?
A Postoperative delirium
B Senile dementia
C Polypharmacy
D Postoperative infection
, A nurse is caring for a client who was recently intubated and placed on mechanical
ventilation. Which action (s) should the nurse include in the client's plan of care?
Select all the apply.
A Implement the ventilator acquired pneumonia (VAP) bundle
B Suction the endotracheal tube every hour.
C Assess the face for skin breakdown around the tube.
D Document the correct position of the endotracheal tube.
E Administer prescribed pain medication as needed.
A client is receiving a continuous infusion of dexedetomidine at 0.6mcq/kg/hr for
severe agitation. The nurse would anticipate decreasing the infusion rate for which
clinical manifestation (s)? Select all that apply.
A Triglyceride level 302 mg/dL
B Blood pressure 86/48 mmHg
C Heart rate 102 beats per minute
D Blood pressure 142/78 mmHg
E Heart rate 54 beats per minute
