Kilgore College NURSING 1429041 MODULE 1 AND 2 QUESTIONS AND ANSWERS

Prep- U Week 1 & 2 Which outcomes indicate effective management of a conscious client who is being treated with recombinant tissue plasminogen therapy during the initial phase of an ischemic cerebral vascular accident (CVA)? Select all that apply. o visual disturbances improved o responds to comfort measures o no signs or symptoms of bleeding o dysphagia improved o headache reduced A client has been admitted with a left tibial fracture and extensive soft-tissue injuries, and there is a concern for the development of disseminated intravascular clotting (DIC). Which interventions by the nurse are priorities for this client? Select all that apply. o Improve tissue oxygenation, replace fluids, and correct electrolyte imbalances. o Administer antihypertensives, measure intake and output, and redress the wounds. o Administer packed red blood cells, increase fluid intake, and encourage mobilization. o Assess for any signs of bleeding in the gums and other mucous membranes. o Administer whole blood as ordered and initiate I.V. fluids. The nurse is preparing to perform a fundal massage on a client who is 2 hours postpartum. Order the sequence of events for performing this procedure. All options must be used. o 1 Ask the client to void. o 2 Place the client in supine position. o 3 Place one hand on the abdomen just above the symphysis pubis. o 4 Place one hand around the top of the fundus. o 5 Rotate the upper hand to massage the uterus until firm. o 6 Gently press the fundus between the hands using slight downward pressure. Which instructions should the nurse include when developing a teaching plan for a client being discharged from the hospital on anticoagulant therapy after having deep vein thrombosis (DVT)? Select all that apply. o Avoid surface bumps because the skin is prone to injury. o Use garlic and ginger, which may decrease bleeding time. o Perform foot/leg exercises and walk around the airplane cabin on long flights. o Check urine for bright blood and a dark smoky color. o Prevent DVT because of risk of pulmonary emboli. o Walk daily as a good exercise. A client who is wearing antiembolism stockings should have a plan of care for reducing the risk for which complication? o postoperative hemorrhage o coolness of extremities o urinary incontinence o shortness of breath A client states that after birth, the nurse gave the baby a vitamin K injection and asks why the baby received it. What is the nurse’s most appropriate response? You Selected: o "The medication is given to stimulate growth of intestinal flora." Which signs and symptoms of leukemia would lead the nurse to suspect the client has thrombocytopenia? Select all that apply. o shortness of breath o anorexia o epistaxis o bone pain o fever o petechiae A client is admitted to the hospital with a suspected pulmonary embolus. What actions will the nurse include with client care? Select all that apply. o Monitor the client for blood-tinged sputum. o Monitor the client for thick, green sputum. o Monitor pulse oximetry every 4 hours. o Assess temperature every 4 hours. o Monitor client pain levels. o Apply ice to the chest wall for pain. A 24-month-old child has been diagnosed with pneumococcal pneumonia. The healthcare provider has prescribed penicillin G, 300,000 units IM daily. What site should the nurse use to administer this injection? o ventrogluteal muscle o deltoid muscle o vastus lateralis muscle o dorsogluteal muscle When assisting a client to ambulate after repair of a fractured right hip, what is the best way for the nurse to be positioned to protect the nurse and the client from potential injury if the client becomes weak? o on the client’s left side o in front of the client to protect the client and offer support o behind the client with a walking belt around the client's chest o on the client’s right side During hemodialysis treatment, a client is restless and reports a headache and nausea. Which action should the nurse implement? o Check for orthostatic changes. o Bolus the client with 500 mL of normal saline. o Obtain arterial blood gases. o Turn off the dialysis machine immediately. The nurse is caring for a client with a diagnosis of early postpartum hemorrhage. Which would not be a priority action at this time? o Assess number of perineal pads used during the past shift o Administrator oxytocic medication as prescribed o Inserting an indwelling urinary catheter o Assess fundus of uterus A school-age child is admitted to the hospital with the diagnosis of probable infratentorial brain tumor. During the child's admission to the pediatric unit, which action should the nurse anticipate taking first? o Introduce the child to other clients of the same age. o Implement seizure precautions. o Eliminate the child's anxiety. o Prepare the child and parents for diagnostic procedures. The nurse is assigned to care for an 8-month-old infant with respiratory syncytial virus. The healthcare provider orders palivizumab daily. Which is the nurse's priority action? o Assess the client's vital signs before administration. o Call the healthcare provider. o Administer the drug with a sip of water. o Administer the drug in the morning. A client returns from a laryngectomy and begins t