NUR 233 EXAM 2 PRACTICE QUESTIONS
The nurse is assessing a client newly diagnosed with mild hypertension. Which
assessment finding should the nurse expect?
A) Auscultating lung sounds
B) monitoring for hepatomegaly
C) palpating for peripheral edema
D) Assessing for jugular vein distention - Answers :A) Auscultating lung sounds
A home care nurse is visiting a client to provide following up evaluation and care of a
leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is
pale and deep and that the surrounding tissue is cool to the touch. The nurse should
document that these findings identify which type of ulcer?
a) stage 1 ulcer
b) vascular ulcer
c) arterial ulcer
d) venous stasis ulcer - Answers :c) arterial ulcer
The nurse is planning to teach a client with peripheral arterial disease about measures
to limit disease progression. Which items should the nurse include on a list of
suggestions for the client? Select all that apply.
a) Soak the feet in hot water daily
b) Be careful not to injure the legs or geet
c) Use a heating pad on the legs to aid vasodilation
d) Walk each day to increase leg circulation
e) Cut down on the amount of fats consumed in the diet - Answers :b) Be careful not to
injure the legs or geet
d) Walk each day to increase leg circulation
e) Cut down on the amount of fats consumed in the diet
The nurse is assessing a client newly diagnosed with mild hypertension. Which
assessment finding should the nurse expect?
a) Asymptomatic
b) SOB
c) Visual disturbance
d) Frequent nosebleeds - Answers :a) Asymptomatic
In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because
vomiting results in
a) fluid movement from the cells into the interstitial space and blood vessels
b) excretion of large amounts of interstitial fluid and depletion of extracellular fluids
c) overload of extracellular fluid with a significant increase in intracellular fluid volume
d) fluid movement from the vascular system into the cells, causing cellular swelling and
rupture - Answers :a) fluid movement from the cells into the interstitial space and blood
vessels
,Clinical assessment of dehydration would be confirmed if you identified:
a) a-1 pound weight loss
b) encouraged neck veins
c) dry mucous membranes
d) full bounding pulse - Answers :c) dry mucous membranes
the nurse is planning the care of a client diagnosed with pneumonia and writes a
problem of "impaired gas exchange". Which is an expected outcome for this problem?
A) performs chest physiotherapy three times a day
B) Able to complete activities of daily living
C) ambulates in the hall several times during each shift
D) Alert and oriented to person, place, time and events - Answers :D) Alert and oriented
to person, place, time and events
A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most
important for the nurse to report to the health care provider?
a. The patient is experiencing stridor.
b. The patient complains of generalized fatigue.
c. The patient's bowels have not moved for 4 days.
d. The patient has numbness and tingling of the lips. - Answers :a. The patient is
experiencing stridor.
The nurse is reviewing a client's laboratory report and notes that the total serum calcium
level is 6.0 mg/dL. The nurse understands that which condition most likely caused this
serum calcium level?
a) prolonged best rest
b) renal insufficiency
c) hyperparathyroidism
d) excessive ingestion of vitamin D - Answers :a) prolonged best rest
It is important for the nurse to assess for which clinical manifestation in a patient who
has undergone a total thyroidectomy
a) weight gain
b) depressed reflexes
c) positive chvostek's sign
d) confusion and personality changes - Answers :c) positive chvostek's sign
A patient has a magnesium level of 1.3 mg/dL. Which assessment would help
the nurse identify a likely cause of this value?
a. Daily alcohol intake
b. Dietary protein intake
c. Multivitamin/mineral use
, d. Over-the-counter (OTC) laxative use - Answers :a. Daily alcohol intake
After receiving change-of-shift report, which patient should the nurse assess first?
a) patient with serum potassium level of 5.0 mEq/L who is complaining of abdominal
b) patient with serum sodium level of 145 mEq/ L who has dry mouth and is asking for a
glass of water
c) patient with serum magnesium level of 1.1 mEq/ L who has tremors and hyperactive
deep tendon reflexes
d) patient with serum phosphorus level of 4.5 mg/ dL who has multiple soft tissue
calcium- phosphate precipitates - Answers :c) patient with serum magnesium level of
1.1 mEq/ L who has tremors and hyperactive deep tendon reflexes
You are assessing a patient suspected of having right-sided heart failure. What
assessment finding may indicate right-sided heart failure?
A) pulmonary edema
B) distended neck veins
C) Dry cough
D) Orthopnea - Answers :B) distended neck veins
The nurse is working in the heart failure clinic will know that teaching for a 74-year-old,
with newly diagnosed heart failure has been effective when the patient...
A) weighs himself twice a week
B) tells the home care nurse that Hydrodiuril (hydrochlorothiazide) is taken daily at
bedtime
C) calls the clinic when the weight increases from 124 to 130 pounds in a week
D) says the nitro-bed (nitroglycerine ointment) will be used for any chest pain that
develops - Answers :C) calls the clinic when the weight increases from 124 to 130
pounds in a week
The nurse is providing instructions to a client with a diagnosis of hypertension regarding
high-sodium items to be avoided. The nurse instructs the client to avoid consuming
which item?
A) bananas
B) antacids
C) brocolli
d) cantaloupe - Answers :B) antacids
A client with a cardiac history is taking a potassium-wasting diuretic (furomeside) and is
seen in the emergency department for complaints of weakness. You expect to evaluate
which laboratory values?
A) Albumin and protein
B) sodium and chloride
C) hemoglobin and hematocrit
D) potassium and blood glucose - Answers :D) potassium and blood glucose
The nurse is assessing a client newly diagnosed with mild hypertension. Which
assessment finding should the nurse expect?
A) Auscultating lung sounds
B) monitoring for hepatomegaly
C) palpating for peripheral edema
D) Assessing for jugular vein distention - Answers :A) Auscultating lung sounds
A home care nurse is visiting a client to provide following up evaluation and care of a
leg ulcer. On removing the dressing from the leg ulcer, the nurse notes that the ulcer is
pale and deep and that the surrounding tissue is cool to the touch. The nurse should
document that these findings identify which type of ulcer?
a) stage 1 ulcer
b) vascular ulcer
c) arterial ulcer
d) venous stasis ulcer - Answers :c) arterial ulcer
The nurse is planning to teach a client with peripheral arterial disease about measures
to limit disease progression. Which items should the nurse include on a list of
suggestions for the client? Select all that apply.
a) Soak the feet in hot water daily
b) Be careful not to injure the legs or geet
c) Use a heating pad on the legs to aid vasodilation
d) Walk each day to increase leg circulation
e) Cut down on the amount of fats consumed in the diet - Answers :b) Be careful not to
injure the legs or geet
d) Walk each day to increase leg circulation
e) Cut down on the amount of fats consumed in the diet
The nurse is assessing a client newly diagnosed with mild hypertension. Which
assessment finding should the nurse expect?
a) Asymptomatic
b) SOB
c) Visual disturbance
d) Frequent nosebleeds - Answers :a) Asymptomatic
In a patient with prolonged vomiting, the nurse monitors for fluid volume deficit because
vomiting results in
a) fluid movement from the cells into the interstitial space and blood vessels
b) excretion of large amounts of interstitial fluid and depletion of extracellular fluids
c) overload of extracellular fluid with a significant increase in intracellular fluid volume
d) fluid movement from the vascular system into the cells, causing cellular swelling and
rupture - Answers :a) fluid movement from the cells into the interstitial space and blood
vessels
,Clinical assessment of dehydration would be confirmed if you identified:
a) a-1 pound weight loss
b) encouraged neck veins
c) dry mucous membranes
d) full bounding pulse - Answers :c) dry mucous membranes
the nurse is planning the care of a client diagnosed with pneumonia and writes a
problem of "impaired gas exchange". Which is an expected outcome for this problem?
A) performs chest physiotherapy three times a day
B) Able to complete activities of daily living
C) ambulates in the hall several times during each shift
D) Alert and oriented to person, place, time and events - Answers :D) Alert and oriented
to person, place, time and events
A patient has a serum calcium level of 7.0 mEq/L. Which assessment finding is most
important for the nurse to report to the health care provider?
a. The patient is experiencing stridor.
b. The patient complains of generalized fatigue.
c. The patient's bowels have not moved for 4 days.
d. The patient has numbness and tingling of the lips. - Answers :a. The patient is
experiencing stridor.
The nurse is reviewing a client's laboratory report and notes that the total serum calcium
level is 6.0 mg/dL. The nurse understands that which condition most likely caused this
serum calcium level?
a) prolonged best rest
b) renal insufficiency
c) hyperparathyroidism
d) excessive ingestion of vitamin D - Answers :a) prolonged best rest
It is important for the nurse to assess for which clinical manifestation in a patient who
has undergone a total thyroidectomy
a) weight gain
b) depressed reflexes
c) positive chvostek's sign
d) confusion and personality changes - Answers :c) positive chvostek's sign
A patient has a magnesium level of 1.3 mg/dL. Which assessment would help
the nurse identify a likely cause of this value?
a. Daily alcohol intake
b. Dietary protein intake
c. Multivitamin/mineral use
, d. Over-the-counter (OTC) laxative use - Answers :a. Daily alcohol intake
After receiving change-of-shift report, which patient should the nurse assess first?
a) patient with serum potassium level of 5.0 mEq/L who is complaining of abdominal
b) patient with serum sodium level of 145 mEq/ L who has dry mouth and is asking for a
glass of water
c) patient with serum magnesium level of 1.1 mEq/ L who has tremors and hyperactive
deep tendon reflexes
d) patient with serum phosphorus level of 4.5 mg/ dL who has multiple soft tissue
calcium- phosphate precipitates - Answers :c) patient with serum magnesium level of
1.1 mEq/ L who has tremors and hyperactive deep tendon reflexes
You are assessing a patient suspected of having right-sided heart failure. What
assessment finding may indicate right-sided heart failure?
A) pulmonary edema
B) distended neck veins
C) Dry cough
D) Orthopnea - Answers :B) distended neck veins
The nurse is working in the heart failure clinic will know that teaching for a 74-year-old,
with newly diagnosed heart failure has been effective when the patient...
A) weighs himself twice a week
B) tells the home care nurse that Hydrodiuril (hydrochlorothiazide) is taken daily at
bedtime
C) calls the clinic when the weight increases from 124 to 130 pounds in a week
D) says the nitro-bed (nitroglycerine ointment) will be used for any chest pain that
develops - Answers :C) calls the clinic when the weight increases from 124 to 130
pounds in a week
The nurse is providing instructions to a client with a diagnosis of hypertension regarding
high-sodium items to be avoided. The nurse instructs the client to avoid consuming
which item?
A) bananas
B) antacids
C) brocolli
d) cantaloupe - Answers :B) antacids
A client with a cardiac history is taking a potassium-wasting diuretic (furomeside) and is
seen in the emergency department for complaints of weakness. You expect to evaluate
which laboratory values?
A) Albumin and protein
B) sodium and chloride
C) hemoglobin and hematocrit
D) potassium and blood glucose - Answers :D) potassium and blood glucose
