EVOLVE: COMPREHENSIVE EXAM 2
1.5A5parent5whose512-year-
old5child5has5been5inhaling5paint5fumes5asks5the5nurse,5"Can5he5become5addicted5to5pai
nt5fumes?"5What5is5the5best5response5for5the5nurse5to5provide?5
A.5Any5time5you5use5an5illegal5substance,5you5are5abusing5drugs.
B.5Tell5me5what5you5think5may5have5caused5him5to5start5inhaling5paint5fumes.
C.5Only5hard5drugs5like5cocaine5and5heroin5can5cause5problems5with5addiction.
D.5Abuse5of5any5of5the5inhalants5can5eventually5lead5to5addiction.5-5ans--
D.5Abuse5of5any5of5the5inhalants5can5eventually5lead5to5addiction.
Any5inhalant5can5become5addictive.5Any5substance5that5is5used5to5alter5perception5can5b
e5addictive5and5is5not5limited5to5the5common5street5drugs.
2.5A5young5adult5female5is5brought5to5the5emergency5room5by5family5members5who5repo
rt5that5she5ingested5a5large5quantity5of5acetaminophen5(Tylenol).5The5nurse5should5prep
are5for5which5treatment5to5be5implemented?
A.5Gastric5lavage5with5normal5saline.
B.5IV5administration5of5Narcan.
C.5Syrup5of5ipecac5per5nasogastric5tube.
D.5Acetylcysteine5(Mucomyst)51405mg/kg.5-5ans---5Acetylcysteine5(Mucomyst)51405mg/
kg.
Mucomyst5(D)5is5the5antidote5for5acute5acetaminophen5(Tylenol)5poisoning5and5is5the5tre
atment5of5choice5for5an5overdose.5(B)5is5used5for5an5overdose5of5narcotics.5(C)5is5used5f
or5ingestion5of5non-
corrosive5products5such5as5iron5tablets.5(A)5might5also5be5implemented,5depending5on5th
e5amount5of5drugs5ingested5and5the5time5elapsed5since5ingestion.
3.5An58-year-
old5male5client5with5nephrotic5syndrome5is5in5remission5following5treatment5with5predniso
ne5(Deltasone).5The5nurse5should5teach5the5child5to5check5his5urine5for5which5finding?
A.5Ketones.
B.5Protein.
C.5White5blood5cells.
D.5Glucose.5-5ans--B.5Protein.
Children5should5be5taught5to5check5for5protein5(albumin)5(B)5in5the5urine5daily,5because5a
5positive5reading5for5protein5in5the5urine5is5often5the5only5indicator5of5a5relapse5of5nephrot
,ic5syndrome.5(C)5is5an5indication5of5infection.5(A5and5D)5should5be5assessed5while5the5ch
ild5is5receiving5corticosteroid5therapy,5since5corticosteroids5increase5blood5glucose.
4.5When5making5a5home5visit5to5a5family5with5a5teething54-month-
old,5what5information5is5most5important5for5the5nurse5to5provide5the5parents?
A.5No5action5is5required5for5the5common5symptoms5associated5with5teething,5which5inclu
de5drooling,5irritability,5and5poor5sleeping.
B.5A5slight5fever5is5often5associated5with5teething,5but5a5fever5lasting5more5than5three5da
ys5requires5medical5attention.
C.5Though5child5development5is5characterized5by5individual5differences,5first5teeth5usuall
y5erupt5during5the5seventh5month.
D.5Providing5cooled5teething5toys5can5help5decrease5the5discomfort5associated5with5toot
h5eruption.5-5ans--
B.5A5slight5fever5is5often5associated5with5teething,5but5a5fever5lasting5more5than5three5da
ys5requires5medical5attention.
A5slight5fever5that5persists5longer5than5three5days5is5likely5to5be5associated5with5a5pathol
ogical5process,5not5teething,5and5the5parents5should5seek5the5attention5of5their5healthcar
e5provider5if5it5occurs5(B).5(A,5C,5and5D)5provide5useful5information5about5teething,5but5do
5not5have5the5priority5of5(B).
5.5To5treat5cystitis,5a514-
day5course5of5treatment5with5cephalexin5(Ceclor)5is5prescribed5for5a5client5residing5in5a5l
ong-
term5care5facility.5Which5action5is5most5important5for5the5nurse5to5take5prior5to5administer
ing5the5first5dose5of5this5medication?
A.5Take5the5client's5vital5signs5prior5to5the5first5dose5and5once5daily5for5145days.
B.5Determine5if5the5client5has5ever5had5a5hypersensitivity5reaction5to5penicillins.
C.5Review5the5client's5fasting5blood5glucose5levels5for5a5hyperglycemic5trend.
D.5Restrict5the5use5of5dairy5products5in5the5client's5diet5for5the5next535weeks.5-5ans--
B.5Determine5if5the5client5has5ever5had5a5hypersensitivity5reaction5to5penicillins.
Most5individuals5who5have5an5allergy5to5penicillins5(B)5are5at5risk5of5hypersensitivity5to5ce
phalosporins.5To5prevent5a5potential5hypersensitivity5reaction5that5could5cause5a5life-
threatening5episode5of5anaphylactic5shock,5the5nurse5must5determine5if5the5client5has5a5
known5penicillin5allergy5before5giving5the5client5a5cephalexin5(Ceclor)5dose.5(A,5C,5and5D
)5are5not5required5interventions5for5the5administration5of5cephalexin5(Ceclor).
6.5A5staff5member5tells5the5charge5nurse5that5a5float5nurse5assigned5to5work5on5the5unit5
has5made5several5medication5errors5in5the5past,5but5is5currently5working5with5the5educati
on5department5to5improve5this5skill.5What5action5is5best5for5the5charge5nurse5to5take?
A.5Arrange5for5someone5to5be5available5to5assess5and5assist5the5float5nurse.
B.5Assign5the5float5nurse5to5function5as5a5UAP5for5the5day.
,C.5Dismiss5the5staff5nurse's5report5about5the5float5nurse5because5it5may5be5just5gossip.
D.5Call5the5nursing5supervisor5and5request5a5different5employee5be5sent5to5the5unit.5-
5ans--A.5Arrange5for5someone5to5be5available5to5assess5and5assist5the5float5nurse.
The5float5nurse5is5receiving5education,5but5careful5assessment5of5her5or5his5skills5and5as
sistance,5as5needed,5is5still5warranted,5so5(A)5is5the5best5choice.5Though5the5staff5memb
er's5report5may5indeed5be5gossip,5failure5to5pay5attention5to5the5information5could5constit
ute5negligence5on5the5part5of5the5charge5nurse5(C).5(D)5is5not5the5best5way5to5manage5th
e5unit.5(B)5is5not5the5best5use5of5a5licensed5person5and5would5also5eliminate5the5float5nur
se's5opportunity5to5improve5medication5administration5skills.
7.5The5blood5pressure5readings5obtained5by5a5unlicensed5assistive5personnel5(UAP)5are5
consistently5different5from5those5obtained5by5other5staff5members.5What5action5should5th
e5charge5nurse5take5first?
A.5Ask5the5education5department5to5provide5additional5training5for5the5UAP.
B.5Observe5the5UAP5performing5blood5pressure5measurements.
C.5Make5staff5members5aware5of5the5possible5errors5in5blood5pressure5readings.
D.5Counsel5the5UAP5about5the5inaccurate5blood5pressure5readings.5-5ans--
B.5Observe5the5UAP5performing5blood5pressure5measurements.
The5charge5nurse5should5first5observe5the5UAP's5performance5(B),5then5take5appropriat
e5action,5which5might5include5(A,5C5and5D).
8.5A5client5at513-
weeks'5gestation5is5scheduled5for5an5amniocentesis5in5one5week.5The5nurse5knows5that5
the5primary5reason5for5conducting5this5procedure5is5to5obtain5what5information?
A.5Quantification5of5alpha-fetoprotein5levels.
B.5Level5of5fetal5lung5maturity.
C.5Presence5of5genetic5disorders.
D.5Determination5of5gestational5age.5-5ans--C.5Presence5of5genetic5disorders.
Amniocentesis5is5done5at5145to5165weeks'5gestation5to5determine5chromosomal,5genetic,
5and5metabolic5disorders5(C).5Amniocentesis5in5the5third5trimester5assesses5fetal5lung5m
aturity5(B)5by5evaluating5the5lecithin/sphingomyelin5(L/
S)5ratio5and5the5presence5of5phosphatidylglycerol5(PG).5Amniocentesis5is5performed5to5q
uantify5alpha-fetoprotein5levels5(A)5after5abnormal5maternal5serum5alpha-
fetoprotein5levels5(done5at5155to5185weeks)5are5found.5While5specific5levels5of5creatinine,
5bilirubin,5and5lipid5cells5are5present5in5amniotic5fluid5only5after5355to5365weeks'5gestation
,5gestational5age5(D)5is5commonly5evaluated5by5ultrasound.
9.5A5hospitalized55-year-
old5boy5recovering5from5surgery5refuses5to5drink5fluids.5Which5intervention5is5best5for5the
5nurse5to5implement?
, A.5Ask5the5parents5to5participate5in5encouraging5the5child's5fluid5intake.
B.5Offer5the5child5a5popsicle5and5allow5him5to5pick5the5flavor5he5prefers.
C.5Tell5the5child5he5can5go5outside5after5he5drinks5a5full5glass5of5water.
D.5Make5a5game5of5seeing5who5can5finish5a5glass5of5water5first--the5nurse5or5the5child.5-
5ans--B.5Offer5the5child5a5popsicle5and5allow5him5to5pick5the5flavor5he5prefers.
Fluids5in5popsicle5form5(B)5are5an5excellent5choice5for5a5child,5and5small5children5react5b
est5when5they5are5provided5with5possible5choices,5such5as5choosing5a5flavor.5(D)5is5a5go
od5intervention,5but5(B)5is5better.5(C)5is5manipulative5and5the5nurse5must5be5careful5not5t
o5make5promises5that5may5not5be5possible.5Although5(A)5may5be5useful,5it5may5also5be5
manipulative5and5is5not5as5likely5as5(B)5to5obtain5the5ultimate5goal5of5increasing5fluids.
10.5An5overweight5adolescent5girl5has5been5to5the5school5nurse5three5times5in5the5last5tw
o5months5complaining5of5vaginal5and5urinary5tract5infections.5What5action5should5the5nur
se5take5first?
A.5Counsel5the5girl5regarding5hygiene.
B.5Ask5if5she5is5going5to5the5bathroom5frequently.
C.5Teach5the5girl5the5importance5of5practicing5safe5sex.
D.5Encourage5the5girl5to5see5the5school5counselor.5-5ans--
B.5Ask5if5she5is5going5to5the5bathroom5frequently.
All5actions5might5be5implemented,5depending5on5further5assessment5findings.5However,5
based5on5the5data5presented,5the5nurse5should5ask5questions5directed5toward5symptom
s5of5diabetes5(B).5Recurrent5vaginal5and5urinary5tract5infections5are5often5an5early5sign5of
5IDDM.5(A,5C,5and5D)5require5further5assessment5data5to5support5their5implementation.
11.5About5mid-morning,5a510-year-
old5child5reports5to5the5school5nurse5complaining5of5nausea,5dizziness,5and5chills.5Furthe
r5assessment5reveals5that5this5child5is5sweating5profusely5and5has5a5blood5glucose5level5
of5575mg/
dl.5Based5on5these5assessment5findings,5which5food5is5best5for5the5nurse5to5encourage5t
he5child5to5eat?
A.5A5piece5of5bubble5gum.
B.5Peanut5butter5crackers.
C.5A5chocolate5bar.
D.5A5soft5drink.5-5ans--B.5Peanut5butter5crackers.
Peanut5butter5crackers5(B)5provide5a5complex5carbohydrate,5plus5protein5and5fat.5This5c
hild5is5exhibiting5signs5and5symptoms5of5mild5to5moderate5hypoglycemia5and5needs5to5e
at5about5155grams5of5carbohydrates5to5increase5the5blood5sugar5level.5Complex5carbohy
drates5are5broken5down5more5slowly5and5are5slower5acting5than5simple5sugars,5so5they5
prevent5the5blood5glucose5level5from5peaking5and5then5dropping5precipitously.5(A,5C,5an
d5D)5contain5only5simple5sugars.
1.5A5parent5whose512-year-
old5child5has5been5inhaling5paint5fumes5asks5the5nurse,5"Can5he5become5addicted5to5pai
nt5fumes?"5What5is5the5best5response5for5the5nurse5to5provide?5
A.5Any5time5you5use5an5illegal5substance,5you5are5abusing5drugs.
B.5Tell5me5what5you5think5may5have5caused5him5to5start5inhaling5paint5fumes.
C.5Only5hard5drugs5like5cocaine5and5heroin5can5cause5problems5with5addiction.
D.5Abuse5of5any5of5the5inhalants5can5eventually5lead5to5addiction.5-5ans--
D.5Abuse5of5any5of5the5inhalants5can5eventually5lead5to5addiction.
Any5inhalant5can5become5addictive.5Any5substance5that5is5used5to5alter5perception5can5b
e5addictive5and5is5not5limited5to5the5common5street5drugs.
2.5A5young5adult5female5is5brought5to5the5emergency5room5by5family5members5who5repo
rt5that5she5ingested5a5large5quantity5of5acetaminophen5(Tylenol).5The5nurse5should5prep
are5for5which5treatment5to5be5implemented?
A.5Gastric5lavage5with5normal5saline.
B.5IV5administration5of5Narcan.
C.5Syrup5of5ipecac5per5nasogastric5tube.
D.5Acetylcysteine5(Mucomyst)51405mg/kg.5-5ans---5Acetylcysteine5(Mucomyst)51405mg/
kg.
Mucomyst5(D)5is5the5antidote5for5acute5acetaminophen5(Tylenol)5poisoning5and5is5the5tre
atment5of5choice5for5an5overdose.5(B)5is5used5for5an5overdose5of5narcotics.5(C)5is5used5f
or5ingestion5of5non-
corrosive5products5such5as5iron5tablets.5(A)5might5also5be5implemented,5depending5on5th
e5amount5of5drugs5ingested5and5the5time5elapsed5since5ingestion.
3.5An58-year-
old5male5client5with5nephrotic5syndrome5is5in5remission5following5treatment5with5predniso
ne5(Deltasone).5The5nurse5should5teach5the5child5to5check5his5urine5for5which5finding?
A.5Ketones.
B.5Protein.
C.5White5blood5cells.
D.5Glucose.5-5ans--B.5Protein.
Children5should5be5taught5to5check5for5protein5(albumin)5(B)5in5the5urine5daily,5because5a
5positive5reading5for5protein5in5the5urine5is5often5the5only5indicator5of5a5relapse5of5nephrot
,ic5syndrome.5(C)5is5an5indication5of5infection.5(A5and5D)5should5be5assessed5while5the5ch
ild5is5receiving5corticosteroid5therapy,5since5corticosteroids5increase5blood5glucose.
4.5When5making5a5home5visit5to5a5family5with5a5teething54-month-
old,5what5information5is5most5important5for5the5nurse5to5provide5the5parents?
A.5No5action5is5required5for5the5common5symptoms5associated5with5teething,5which5inclu
de5drooling,5irritability,5and5poor5sleeping.
B.5A5slight5fever5is5often5associated5with5teething,5but5a5fever5lasting5more5than5three5da
ys5requires5medical5attention.
C.5Though5child5development5is5characterized5by5individual5differences,5first5teeth5usuall
y5erupt5during5the5seventh5month.
D.5Providing5cooled5teething5toys5can5help5decrease5the5discomfort5associated5with5toot
h5eruption.5-5ans--
B.5A5slight5fever5is5often5associated5with5teething,5but5a5fever5lasting5more5than5three5da
ys5requires5medical5attention.
A5slight5fever5that5persists5longer5than5three5days5is5likely5to5be5associated5with5a5pathol
ogical5process,5not5teething,5and5the5parents5should5seek5the5attention5of5their5healthcar
e5provider5if5it5occurs5(B).5(A,5C,5and5D)5provide5useful5information5about5teething,5but5do
5not5have5the5priority5of5(B).
5.5To5treat5cystitis,5a514-
day5course5of5treatment5with5cephalexin5(Ceclor)5is5prescribed5for5a5client5residing5in5a5l
ong-
term5care5facility.5Which5action5is5most5important5for5the5nurse5to5take5prior5to5administer
ing5the5first5dose5of5this5medication?
A.5Take5the5client's5vital5signs5prior5to5the5first5dose5and5once5daily5for5145days.
B.5Determine5if5the5client5has5ever5had5a5hypersensitivity5reaction5to5penicillins.
C.5Review5the5client's5fasting5blood5glucose5levels5for5a5hyperglycemic5trend.
D.5Restrict5the5use5of5dairy5products5in5the5client's5diet5for5the5next535weeks.5-5ans--
B.5Determine5if5the5client5has5ever5had5a5hypersensitivity5reaction5to5penicillins.
Most5individuals5who5have5an5allergy5to5penicillins5(B)5are5at5risk5of5hypersensitivity5to5ce
phalosporins.5To5prevent5a5potential5hypersensitivity5reaction5that5could5cause5a5life-
threatening5episode5of5anaphylactic5shock,5the5nurse5must5determine5if5the5client5has5a5
known5penicillin5allergy5before5giving5the5client5a5cephalexin5(Ceclor)5dose.5(A,5C,5and5D
)5are5not5required5interventions5for5the5administration5of5cephalexin5(Ceclor).
6.5A5staff5member5tells5the5charge5nurse5that5a5float5nurse5assigned5to5work5on5the5unit5
has5made5several5medication5errors5in5the5past,5but5is5currently5working5with5the5educati
on5department5to5improve5this5skill.5What5action5is5best5for5the5charge5nurse5to5take?
A.5Arrange5for5someone5to5be5available5to5assess5and5assist5the5float5nurse.
B.5Assign5the5float5nurse5to5function5as5a5UAP5for5the5day.
,C.5Dismiss5the5staff5nurse's5report5about5the5float5nurse5because5it5may5be5just5gossip.
D.5Call5the5nursing5supervisor5and5request5a5different5employee5be5sent5to5the5unit.5-
5ans--A.5Arrange5for5someone5to5be5available5to5assess5and5assist5the5float5nurse.
The5float5nurse5is5receiving5education,5but5careful5assessment5of5her5or5his5skills5and5as
sistance,5as5needed,5is5still5warranted,5so5(A)5is5the5best5choice.5Though5the5staff5memb
er's5report5may5indeed5be5gossip,5failure5to5pay5attention5to5the5information5could5constit
ute5negligence5on5the5part5of5the5charge5nurse5(C).5(D)5is5not5the5best5way5to5manage5th
e5unit.5(B)5is5not5the5best5use5of5a5licensed5person5and5would5also5eliminate5the5float5nur
se's5opportunity5to5improve5medication5administration5skills.
7.5The5blood5pressure5readings5obtained5by5a5unlicensed5assistive5personnel5(UAP)5are5
consistently5different5from5those5obtained5by5other5staff5members.5What5action5should5th
e5charge5nurse5take5first?
A.5Ask5the5education5department5to5provide5additional5training5for5the5UAP.
B.5Observe5the5UAP5performing5blood5pressure5measurements.
C.5Make5staff5members5aware5of5the5possible5errors5in5blood5pressure5readings.
D.5Counsel5the5UAP5about5the5inaccurate5blood5pressure5readings.5-5ans--
B.5Observe5the5UAP5performing5blood5pressure5measurements.
The5charge5nurse5should5first5observe5the5UAP's5performance5(B),5then5take5appropriat
e5action,5which5might5include5(A,5C5and5D).
8.5A5client5at513-
weeks'5gestation5is5scheduled5for5an5amniocentesis5in5one5week.5The5nurse5knows5that5
the5primary5reason5for5conducting5this5procedure5is5to5obtain5what5information?
A.5Quantification5of5alpha-fetoprotein5levels.
B.5Level5of5fetal5lung5maturity.
C.5Presence5of5genetic5disorders.
D.5Determination5of5gestational5age.5-5ans--C.5Presence5of5genetic5disorders.
Amniocentesis5is5done5at5145to5165weeks'5gestation5to5determine5chromosomal,5genetic,
5and5metabolic5disorders5(C).5Amniocentesis5in5the5third5trimester5assesses5fetal5lung5m
aturity5(B)5by5evaluating5the5lecithin/sphingomyelin5(L/
S)5ratio5and5the5presence5of5phosphatidylglycerol5(PG).5Amniocentesis5is5performed5to5q
uantify5alpha-fetoprotein5levels5(A)5after5abnormal5maternal5serum5alpha-
fetoprotein5levels5(done5at5155to5185weeks)5are5found.5While5specific5levels5of5creatinine,
5bilirubin,5and5lipid5cells5are5present5in5amniotic5fluid5only5after5355to5365weeks'5gestation
,5gestational5age5(D)5is5commonly5evaluated5by5ultrasound.
9.5A5hospitalized55-year-
old5boy5recovering5from5surgery5refuses5to5drink5fluids.5Which5intervention5is5best5for5the
5nurse5to5implement?
, A.5Ask5the5parents5to5participate5in5encouraging5the5child's5fluid5intake.
B.5Offer5the5child5a5popsicle5and5allow5him5to5pick5the5flavor5he5prefers.
C.5Tell5the5child5he5can5go5outside5after5he5drinks5a5full5glass5of5water.
D.5Make5a5game5of5seeing5who5can5finish5a5glass5of5water5first--the5nurse5or5the5child.5-
5ans--B.5Offer5the5child5a5popsicle5and5allow5him5to5pick5the5flavor5he5prefers.
Fluids5in5popsicle5form5(B)5are5an5excellent5choice5for5a5child,5and5small5children5react5b
est5when5they5are5provided5with5possible5choices,5such5as5choosing5a5flavor.5(D)5is5a5go
od5intervention,5but5(B)5is5better.5(C)5is5manipulative5and5the5nurse5must5be5careful5not5t
o5make5promises5that5may5not5be5possible.5Although5(A)5may5be5useful,5it5may5also5be5
manipulative5and5is5not5as5likely5as5(B)5to5obtain5the5ultimate5goal5of5increasing5fluids.
10.5An5overweight5adolescent5girl5has5been5to5the5school5nurse5three5times5in5the5last5tw
o5months5complaining5of5vaginal5and5urinary5tract5infections.5What5action5should5the5nur
se5take5first?
A.5Counsel5the5girl5regarding5hygiene.
B.5Ask5if5she5is5going5to5the5bathroom5frequently.
C.5Teach5the5girl5the5importance5of5practicing5safe5sex.
D.5Encourage5the5girl5to5see5the5school5counselor.5-5ans--
B.5Ask5if5she5is5going5to5the5bathroom5frequently.
All5actions5might5be5implemented,5depending5on5further5assessment5findings.5However,5
based5on5the5data5presented,5the5nurse5should5ask5questions5directed5toward5symptom
s5of5diabetes5(B).5Recurrent5vaginal5and5urinary5tract5infections5are5often5an5early5sign5of
5IDDM.5(A,5C,5and5D)5require5further5assessment5data5to5support5their5implementation.
11.5About5mid-morning,5a510-year-
old5child5reports5to5the5school5nurse5complaining5of5nausea,5dizziness,5and5chills.5Furthe
r5assessment5reveals5that5this5child5is5sweating5profusely5and5has5a5blood5glucose5level5
of5575mg/
dl.5Based5on5these5assessment5findings,5which5food5is5best5for5the5nurse5to5encourage5t
he5child5to5eat?
A.5A5piece5of5bubble5gum.
B.5Peanut5butter5crackers.
C.5A5chocolate5bar.
D.5A5soft5drink.5-5ans--B.5Peanut5butter5crackers.
Peanut5butter5crackers5(B)5provide5a5complex5carbohydrate,5plus5protein5and5fat.5This5c
hild5is5exhibiting5signs5and5symptoms5of5mild5to5moderate5hypoglycemia5and5needs5to5e
at5about5155grams5of5carbohydrates5to5increase5the5blood5sugar5level.5Complex5carbohy
drates5are5broken5down5more5slowly5and5are5slower5acting5than5simple5sugars,5so5they5
prevent5the5blood5glucose5level5from5peaking5and5then5dropping5precipitously.5(A,5C,5an
d5D)5contain5only5simple5sugars.
