NUR 233 PRACTICE EXAM GUIDE
QUESTIONS WITH COMPLETE
ANSWERS
The nurse is caring for a patient with a diagnosis of hypernatremia. The following
orders are written on the client's chart. Which order should the nurse question? -
ANSWER-Restrict oral intake to 900ml every 24hrs
A patient at risk for hypernatremia is one who - ANSWER-Has impaired
consciousness and decreased thirst sensitivity
The nurse assesses a patient who has been hospitalized for 2 days. The patient has
been receiving normal saline IV at 100 mL/hr, has a nasogastric tube to low suction,
and is NPO. Which assessment finding would be a priority for the nurse to report to
the health care provider? - ANSWER-Gradually decreasing level of consciousness
(LOC)
The nurse is administering a sustained-release capsule to a new patient. The patient
insists that he cannot swallow pills. What is the nurse's next best course of action? -
ANSWER-Ask the prescriber to change the order
The client is being prescribed alendronate (Fosamax) to slow the progression of her
osteoporosis. You know she will need more patient teaching when she says: -
ANSWER-"Now that I am taking this medication, I will not need to take vitamin D with
my calcium supplement."
The nurse is working on an orthopedic floor. Which client should the nurse assess
first after the change-of-shift report? - ANSWER-The 64-year-old female with a left
total knee replacement who has confusion.
The nurse is discharging a patient who had a total hip replacement. Which statement
indicates that further teaching is needed? - ANSWER-"After three (3) weeks I do not
have to worry about infections."
Which intervention is an example of secondary prevention when discussing
osteoporosis? - ANSWER-Obtain a bone density evaluation test.
The nurse is discussing osteoporosis with a group of women. Which factor will the
nurse identify as a nonmodifiable risk factor? - ANSWER-female gender
The nurse is caring for the following clients. After receiving shift report, which client
should the nurse assess first? - ANSWER-The client with a total knee replacement
that is complaining of a cold foot.
Which client goal is most appropriate for a client diagnosed with osteoarthritis? -
ANSWER-Maintain optimal functional ability
, The client tells the nurse, "Every time I come in the hospital you hand me one of
these advance directives (AD). Why should I fill one of these out?" Which statement
by the nurse is most appropriate? - ANSWER-"An AD lets you participate in
decisions about your health care."
The spouse of a client dying from lung cancer states, "I don't understand this death
rattle. She has not had anything to drink in days. Where is the fluid coming from?"
Which is the hospice care nurse's best response? - ANSWER-"The body produces
about two (2) teaspoons of fluid every minute on its own."
The client is on the ventilator and has been declared brain dead. The spouse refuses
to allow the ventilator to be discontinued. Which collaborative action by the nurse is
most appropriate? - ANSWER-Discuss referral of the case to the ethics committee.
The client who is terminally ill called the significant others to the room and said good-
bye, then dismissed them and now lies quietly and refuses to eat. The nurse
understands the client is in what stage of the grieving process? - ANSWER-
acceptance
The nurse caring for a client diagnosed with Parkinson's disease writes a problem of
"impaired nutrition." Which nursing intervention would be included in the plan of
care? - ANSWER-Offer six (6) meals per day with a soft consistency.
The daughter of a patient with early familial Alzheimer's disease (AD) asks how AD
is different from forgetfulness. You describe early warning signs of AD, including -
ANSWER-Having no memory of preparing a meal and forgetting to serve or eat it
D.B. is admitted to a long-term care facility. He has a nursing diagnosis of impaired
memory related to effects of dementia. An appropriate nursing intervention for him is
to - ANSWER-maintain familiar routines of sleep, meals, drug administration, and
activities.
You administer the Confusion Assessment Method (CAM) tool to K.P. to differentiate
among various cognitive disorders, primarily because - ANSWER-delirium can be
reversed by treating the underlying causes.
The client diagnosed with Parkinson's disease (PD) is being admitted with a fever
and patchy infiltrates in the lung fields on the chest x-ray. Which clinical
manifestations of PD would explain these assessment data? - ANSWER-Difficulty
swallowing and immobility.
The client newly diagnosed with Parkinson's Disease (PD) asks the nurse, "Why
can't I control these tremors?" Which is the nurse's best response? - ANSWER-"The
tremors are caused by a lack of the chemical dopamine in the brain; medication may
help."
The nurse is presenting an in-service discussing do not resuscitate (DNR) orders
and advance directives. Which statement should the nurse discuss with the class? -
ANSWER-The health-care provider must write the DNR order in the client's chart.
QUESTIONS WITH COMPLETE
ANSWERS
The nurse is caring for a patient with a diagnosis of hypernatremia. The following
orders are written on the client's chart. Which order should the nurse question? -
ANSWER-Restrict oral intake to 900ml every 24hrs
A patient at risk for hypernatremia is one who - ANSWER-Has impaired
consciousness and decreased thirst sensitivity
The nurse assesses a patient who has been hospitalized for 2 days. The patient has
been receiving normal saline IV at 100 mL/hr, has a nasogastric tube to low suction,
and is NPO. Which assessment finding would be a priority for the nurse to report to
the health care provider? - ANSWER-Gradually decreasing level of consciousness
(LOC)
The nurse is administering a sustained-release capsule to a new patient. The patient
insists that he cannot swallow pills. What is the nurse's next best course of action? -
ANSWER-Ask the prescriber to change the order
The client is being prescribed alendronate (Fosamax) to slow the progression of her
osteoporosis. You know she will need more patient teaching when she says: -
ANSWER-"Now that I am taking this medication, I will not need to take vitamin D with
my calcium supplement."
The nurse is working on an orthopedic floor. Which client should the nurse assess
first after the change-of-shift report? - ANSWER-The 64-year-old female with a left
total knee replacement who has confusion.
The nurse is discharging a patient who had a total hip replacement. Which statement
indicates that further teaching is needed? - ANSWER-"After three (3) weeks I do not
have to worry about infections."
Which intervention is an example of secondary prevention when discussing
osteoporosis? - ANSWER-Obtain a bone density evaluation test.
The nurse is discussing osteoporosis with a group of women. Which factor will the
nurse identify as a nonmodifiable risk factor? - ANSWER-female gender
The nurse is caring for the following clients. After receiving shift report, which client
should the nurse assess first? - ANSWER-The client with a total knee replacement
that is complaining of a cold foot.
Which client goal is most appropriate for a client diagnosed with osteoarthritis? -
ANSWER-Maintain optimal functional ability
, The client tells the nurse, "Every time I come in the hospital you hand me one of
these advance directives (AD). Why should I fill one of these out?" Which statement
by the nurse is most appropriate? - ANSWER-"An AD lets you participate in
decisions about your health care."
The spouse of a client dying from lung cancer states, "I don't understand this death
rattle. She has not had anything to drink in days. Where is the fluid coming from?"
Which is the hospice care nurse's best response? - ANSWER-"The body produces
about two (2) teaspoons of fluid every minute on its own."
The client is on the ventilator and has been declared brain dead. The spouse refuses
to allow the ventilator to be discontinued. Which collaborative action by the nurse is
most appropriate? - ANSWER-Discuss referral of the case to the ethics committee.
The client who is terminally ill called the significant others to the room and said good-
bye, then dismissed them and now lies quietly and refuses to eat. The nurse
understands the client is in what stage of the grieving process? - ANSWER-
acceptance
The nurse caring for a client diagnosed with Parkinson's disease writes a problem of
"impaired nutrition." Which nursing intervention would be included in the plan of
care? - ANSWER-Offer six (6) meals per day with a soft consistency.
The daughter of a patient with early familial Alzheimer's disease (AD) asks how AD
is different from forgetfulness. You describe early warning signs of AD, including -
ANSWER-Having no memory of preparing a meal and forgetting to serve or eat it
D.B. is admitted to a long-term care facility. He has a nursing diagnosis of impaired
memory related to effects of dementia. An appropriate nursing intervention for him is
to - ANSWER-maintain familiar routines of sleep, meals, drug administration, and
activities.
You administer the Confusion Assessment Method (CAM) tool to K.P. to differentiate
among various cognitive disorders, primarily because - ANSWER-delirium can be
reversed by treating the underlying causes.
The client diagnosed with Parkinson's disease (PD) is being admitted with a fever
and patchy infiltrates in the lung fields on the chest x-ray. Which clinical
manifestations of PD would explain these assessment data? - ANSWER-Difficulty
swallowing and immobility.
The client newly diagnosed with Parkinson's Disease (PD) asks the nurse, "Why
can't I control these tremors?" Which is the nurse's best response? - ANSWER-"The
tremors are caused by a lack of the chemical dopamine in the brain; medication may
help."
The nurse is presenting an in-service discussing do not resuscitate (DNR) orders
and advance directives. Which statement should the nurse discuss with the class? -
ANSWER-The health-care provider must write the DNR order in the client's chart.
