NUR 112 - EXAM 1
A 17 year old pt with a leg fracture is sched. for surgery. She reports that she is living w/a friend and is an emancipated
minor. She has a statement from the court for verification. Which intervention is most appropriate?
a. witness the permit after consent is obtained by the surgeon
b. call a parent or legal guardian to sign the permit, since the pt is under 18
c. obtain verbal consent, since written consent is not necessary for emancipated minors
d. investigate your states nurse practice act r/t emancipated minors and informed consent - ANS -a
\A 59 year old man is sched. for herniorrhaphy in 2 days. During the preop evaluation he reports that he takes ginkgo
daily. What is the priority intervention?
a. inform the surgeon, since since the procedure may need to be resched,
b. notify the anesthesia care provider, since this herb interferes with anesthetics
c. ask the pt if he has noticed any side effects from taking this herbal supplement
d. tell the pt to continue to take the herbal supplement up to the day before surgery - ANS -a
\A 70 kg postoperative pt has an average urine output of 25 ml/hour during the first 8 hours. the priority nursing
intervention given this assessment would be to
a. preform a straight catheterization to measure the amount of urine in the bladder.
b. notify the physician and anticipate obtaining blood work to evaluate renal function.
c. continue to monitor the pt bc this is a normal finding during this time period.
d. evaluate the pts fluid volume status since surgery and obtain a bladder ultrasound - ANS -d
\A adolescent pt has the following lab results: pH 7.3, PaCO2 60, HCO3 25, PaO2 90. Which of the following actions
should the nurse anticipate?
a. administering albuterol (ventolin) aersol
b. increasing the adolescents IV fluids
c. preparing sodium bicarbonate infusion
d. encouraging adolescent to breathe into a paper bag - ANS -a
,\A charge nurse is leading a staff education about caring for a pt who has hypocalcemia. Which of the following
statements by a staff nurse indicates the need for further teaching.
a. "I should monitor for hand spasms during B/P cuff inflation. "
b. "Pt who have a Vit D deficiency are at risk."
c. "Pt who have hypocalcemia are at risk for pathologic fractures."
d. "I should implement seizure precautions for a pt with hypocalcemia." - ANS -c
\A client diagnosed with acute heart failure is prescribed furosemide (Lasix) daily. During the client's morning assessment,
he tells the nurse that he is "feeling weak in the legs." Which of the following should the nurse take first?
a. Withhold the furosemide
b. Review the daily laboratory results
c. Notify the primary care provider of the client's symptoms
d. Provide an adequate breakfast for the client - ANS -b
\A client is admitted with isotonic dehydration following 2 days of vomiting and diarrhea. Which of the following laboratory
results should indicate to the nurse that the client has responded to fluid therapy?
a. BUN 26 mg/dl
b. Serum sodium 138 mEq/L
c. Hct 56%
d. Urine specific gravity 1.035 - ANS -b
\A client with heart failure is admitted following 3 days of vomiting. he is currently taking 40 mg of furosemide (Lasix) and
0.125 mg of dignxin (Lanoxin) daily. the nurse suspects hypokalemia. Which of the following should the nurse anticipate
administering?
a. Sodium polystyrene sulfonate (Kayexalate) 30g/day
b. Normal saline with 40 mEq/L potassium at 100ml/hr
c. Digoxin 0.125 mg/day
d. Lactated Ringer's solution at 100 ml/hr - ANS -b
\A nurse has administered midazolam (Versed) IV bolus to a pt before a procedure. The pts BP is 86/40 and pulse is
134/min. Which of the following is an appropriate action by the nurse?
a. administer naloxone (Narcan) IV
, b. administer morphine IV
c. administer 0l9% sodium chloride IV bolus
d. administer atropine IV - ANS -c
\A nurse in a provider's office is collecting data from the mother of a 1 year old child. The pt states that her child is old
enough for potty training. Following an education session by the nurse, the pt now states that her earlier ideas has
changed. She is now willing to postpone potty training until the child is older. Learning has occurred in which of the
following domains?
a. cognitive
b. affective
c. psychomotor
d. kinesthetic - ANS -b
\A nurse in the ICU is caring for a pt who has acute respiratory distress (ARDS) and is receiving mechanical ventilation via
endotracheal tube. The provider plans to extubate her within the next 24hr. Which of the following is an important criterion
for extubating this pt?
a. ability to cough effectively
b. adequate tidal volume w/o positive pressure
c. no indications of infection
d. no need for supplemental oxygen - ANS -b
\A nurse in the preop unit is assessing a pts lab values before surgery. Which of the following should the nurse report to
the provider? (select all that apply)
a. potassium 3.9
b. sodium chloride 145
c. creatinine 2.8
d. blood glucose 235
e. WBC 17,850 - ANS -c, d, e
\A nurse is admitting a pt who has been vomiting for 24 hr. Arterial blood gases are obtained. Based on the lab findings,
which of the following conditions should the nurse expect?
a. respiratory acidosis
b. respiratory alkalosis
A 17 year old pt with a leg fracture is sched. for surgery. She reports that she is living w/a friend and is an emancipated
minor. She has a statement from the court for verification. Which intervention is most appropriate?
a. witness the permit after consent is obtained by the surgeon
b. call a parent or legal guardian to sign the permit, since the pt is under 18
c. obtain verbal consent, since written consent is not necessary for emancipated minors
d. investigate your states nurse practice act r/t emancipated minors and informed consent - ANS -a
\A 59 year old man is sched. for herniorrhaphy in 2 days. During the preop evaluation he reports that he takes ginkgo
daily. What is the priority intervention?
a. inform the surgeon, since since the procedure may need to be resched,
b. notify the anesthesia care provider, since this herb interferes with anesthetics
c. ask the pt if he has noticed any side effects from taking this herbal supplement
d. tell the pt to continue to take the herbal supplement up to the day before surgery - ANS -a
\A 70 kg postoperative pt has an average urine output of 25 ml/hour during the first 8 hours. the priority nursing
intervention given this assessment would be to
a. preform a straight catheterization to measure the amount of urine in the bladder.
b. notify the physician and anticipate obtaining blood work to evaluate renal function.
c. continue to monitor the pt bc this is a normal finding during this time period.
d. evaluate the pts fluid volume status since surgery and obtain a bladder ultrasound - ANS -d
\A adolescent pt has the following lab results: pH 7.3, PaCO2 60, HCO3 25, PaO2 90. Which of the following actions
should the nurse anticipate?
a. administering albuterol (ventolin) aersol
b. increasing the adolescents IV fluids
c. preparing sodium bicarbonate infusion
d. encouraging adolescent to breathe into a paper bag - ANS -a
,\A charge nurse is leading a staff education about caring for a pt who has hypocalcemia. Which of the following
statements by a staff nurse indicates the need for further teaching.
a. "I should monitor for hand spasms during B/P cuff inflation. "
b. "Pt who have a Vit D deficiency are at risk."
c. "Pt who have hypocalcemia are at risk for pathologic fractures."
d. "I should implement seizure precautions for a pt with hypocalcemia." - ANS -c
\A client diagnosed with acute heart failure is prescribed furosemide (Lasix) daily. During the client's morning assessment,
he tells the nurse that he is "feeling weak in the legs." Which of the following should the nurse take first?
a. Withhold the furosemide
b. Review the daily laboratory results
c. Notify the primary care provider of the client's symptoms
d. Provide an adequate breakfast for the client - ANS -b
\A client is admitted with isotonic dehydration following 2 days of vomiting and diarrhea. Which of the following laboratory
results should indicate to the nurse that the client has responded to fluid therapy?
a. BUN 26 mg/dl
b. Serum sodium 138 mEq/L
c. Hct 56%
d. Urine specific gravity 1.035 - ANS -b
\A client with heart failure is admitted following 3 days of vomiting. he is currently taking 40 mg of furosemide (Lasix) and
0.125 mg of dignxin (Lanoxin) daily. the nurse suspects hypokalemia. Which of the following should the nurse anticipate
administering?
a. Sodium polystyrene sulfonate (Kayexalate) 30g/day
b. Normal saline with 40 mEq/L potassium at 100ml/hr
c. Digoxin 0.125 mg/day
d. Lactated Ringer's solution at 100 ml/hr - ANS -b
\A nurse has administered midazolam (Versed) IV bolus to a pt before a procedure. The pts BP is 86/40 and pulse is
134/min. Which of the following is an appropriate action by the nurse?
a. administer naloxone (Narcan) IV
, b. administer morphine IV
c. administer 0l9% sodium chloride IV bolus
d. administer atropine IV - ANS -c
\A nurse in a provider's office is collecting data from the mother of a 1 year old child. The pt states that her child is old
enough for potty training. Following an education session by the nurse, the pt now states that her earlier ideas has
changed. She is now willing to postpone potty training until the child is older. Learning has occurred in which of the
following domains?
a. cognitive
b. affective
c. psychomotor
d. kinesthetic - ANS -b
\A nurse in the ICU is caring for a pt who has acute respiratory distress (ARDS) and is receiving mechanical ventilation via
endotracheal tube. The provider plans to extubate her within the next 24hr. Which of the following is an important criterion
for extubating this pt?
a. ability to cough effectively
b. adequate tidal volume w/o positive pressure
c. no indications of infection
d. no need for supplemental oxygen - ANS -b
\A nurse in the preop unit is assessing a pts lab values before surgery. Which of the following should the nurse report to
the provider? (select all that apply)
a. potassium 3.9
b. sodium chloride 145
c. creatinine 2.8
d. blood glucose 235
e. WBC 17,850 - ANS -c, d, e
\A nurse is admitting a pt who has been vomiting for 24 hr. Arterial blood gases are obtained. Based on the lab findings,
which of the following conditions should the nurse expect?
a. respiratory acidosis
b. respiratory alkalosis
