NSG 460 Exam 6 Practice Questions with correct answers

NSG 460 Exam 6 Practice Questions with
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correct answers |\




The physician has ordered a solumedrol infusion for a pt with a
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spinal cord injury. Solumedrol has been shown to be effective in:
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A. decreasing cerebral edema
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B. preventing stress ulcers
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C. decreasing spinal injury spasticity
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D. improving motor and sensory functioning - CORRECT
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ANSWERS ✔✔D. improving motor and sensory functioning
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Solumedrol is given within the first 8 hours of injury |\ |\ |\ |\ |\ |\ |\ |\ |\




A pt with a T6 injury 3 months ago develops facial flushing and a
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BP of 210/106. After elevating the HOB, which is the most
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appropriate nursing action? |\ |\




A. increase IV fluids
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B. assess for a distended bladder
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C. apply oxygen at 4L/min
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D. notify the physician - CORRECT ANSWERS ✔✔B. assess for a
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distended bladder |\




When the pt is in neurogenic shock, the nurse will assess for:
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A. mental confusion and tachycardia
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,B. bradycardia and hypotension
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C. unilateral pupil dilation and hypotension
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D. hypertension and tachypnea - CORRECT ANSWERS ✔✔B.
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bradycardia and hypotension |\ |\




Which of the following is descriptive of a concussion?
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A. venous blood collects in the subdural space
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B. petechial hemorrhages cause intermittent amnesia
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C. a lesion develops opposite the site of trauma
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D. it is a transient neuronal dysfunction - CORRECT ANSWERS
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✔✔D. it is a transient neuronal dysfunction
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Autonomic dysreflexia is an emergency because: |\ |\ |\ |\ |\




A. severe vasoconstriction occurs
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B. hypoxia results from regurgitation
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C. spasticity produces joint deformity
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D. airway spasm occurs - CORRECT ANSWERS ✔✔A. severe
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vasoconstriction occurs |\




Your client is transported to the ED after sustaining head, back
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and chest injuries when he fell 25 ft from a tree. The primary
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survey has been completed. His BP drops to 80/40, HR is 56, RR
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is 20. BBS are equal and clear. SaO2 is 99%. This data is most
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consistent with: |\




A. neurogenic shock
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B. tension pneumothorax
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,C. hypovolemic shock
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D. closed head injury - CORRECT ANSWERS ✔✔A. neurogenic
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shock


A client who sustained a spinal cord injury at the T2 level should
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be assessed for signs of autonomic dysrefelxia because:
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A. the injury results in loss of the reflex arc
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B. there has been a partial transaction of the cord
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C. there is a flaccid paralysis of the lower extremities
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D. the injury is above the 6th thoracic vertebrae - CORRECT
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ANSWERS ✔✔D. the injury is above he 6th thoracic vertebrae
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A client is admitted to the hospital 24 hrs ago after sustaining
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blunt trauma. For which early clinical manifestation of acute
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respiratory distress syndrome (ARDS) should the nurse monitor
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for?
A. crackles throughout lung fields
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B. increase in respiratory rate from 18 to 24 breaths/min
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C. "white-out" appearance of lungs on chest radiograph
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D. cyanosis and pallor - CORRECT ANSWERS ✔✔B. increase in
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respiratory rate from 18 to 24 breaths/min |\ |\ |\ |\ |\ |\




The nurse is caring for a client who required tube insertion for a
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pneumothorax. The nurse is aware that the best test to assess |\ |\ |\ |\ |\ |\ |\ |\ |\ |\ |\


for pneumothorax resolution is:
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A. ABG|\




B. pulse ox
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, C. CXR
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D. breath sounds - CORRECT ANSWERS ✔✔C. CXR
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An adult arrives in the ED after being assaulted with a baseball
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bat. He is intubated and becoming progressively more difficult to
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ventilate. Suddenly he becomes unresponsive and pulseless.
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What is the priority intervention?
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A. defibrillation
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B. transporting pt for angioplasty
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C. relieving the tension pneumothorax
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D. correcting the internal bleed - CORRECT ANSWERS ✔✔C.
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relieving the tension pneumothorax |\ |\ |\




Mr. T is admitted to the SICU following an MVC. The initial
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drainage from a right chest tube inserted in the ED is 400cc. The
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following hour the chest tube drains 300cc of blood. Which the
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most appropriate action by the nurse?
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A. elevate the HOB
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B. notify the physician
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C. continue to monitor VS
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D. "milk" the chest tube - CORRECT ANSWERS ✔✔B. notify the
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physician


>200cc/hr should be reported |\ |\ |\




Your trauma pt has a spinal cord transection at the T-1 level. The
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primary nursing concern is: |\ |\ |\