AND PRACTICE EXAM TEST BANK WITH A STUDY GUIDE
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1-
Enalapril maleate (Vasotec) is prescribed for a hospitalized client. Which assessment does
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the nurse perform as a priority before administering the medication?
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A. Checking the client's blood pressure
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B. Checking the client's peripheral pulses
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C. Checking the most recent potassium level
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D. Checking the client's intake-and-output record for the last 24 hours - ans-
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A. Checking the client's blood pressure
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Checking the client's blood pressure xz xz xz xz xz
Enalapril maleate is an angiotensin- xz xz xz xz
converting enzyme (ACE) inhibitor used to treat hypertension. One common side effect is p
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ostural hypotension. Therefore the nurse would check the client's blood pressure immediat
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ely before administering each dose. Checking the client's peripheral pulses, the results of t
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he most recent potassium level, and the intake and output for the previous 24 hours are not
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specifically associated with this mediation. xz xz xz xz
2-
A client is scheduled to undergo an upper gastrointestinal (GI) series, and the nurse provid
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es instructions to the client about the test. Which statement by the client indicates a need for
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further instruction?
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A. "The test will take about 30 minutes."
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B. "I need to fast for 8 hours before the test."
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C. "I need to drink citrate of magnesia the night before the test and give myself a Fleet enem
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a on the morning of the test."
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D. "I need to take a laxative after the test is completed, because the liquid that I'll have to dri
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nk for the test can be constipating." - ans-
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C. "I need to drink citrate of magnesia the night before the test and give myself a Fleet enem
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a on the morning of the test."
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An upper GI series involves visualization of the esophagus, duodenum, and upper jejunum
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by means of the use of a contrast medium. It involves swallowing a contrast medium (usuall
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y barium), which is administered in a flavored milkshake. Films are taken at intervals during
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the test, which takes about 30 minutes. No special preparation is necessary before a GI seri
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,es, except that NPO status must be maintained for 8 hours before the test. After an upper GI
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series, the client is prescribed a laxative to hasten elimination of the barium. Barium that re
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mains in the colon may become hard and difficult to expel, leading to fecal impaction.
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3-
A nurse on the evening shift checks a physician's prescriptions and notes that the dose of a
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prescribed medication is higher than the normal dose. The nurse calls the physician's answ
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ering service and is told that the physician is off for the night and will be available in the morn
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ing. The nurse should: xz xz xz
A. Call the nursing supervisor
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B. Ask the answering service to contact the on-call physician
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C. Withhold the medication until the physician can be reached in the morning
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D. Administer the medication but consult the physician when he becomes available - ans-
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B. Ask the answering service to contact the on-call physician
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4.An emergency department (ED) nurse is monitoring a client with suspected acute myocar
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dial infarction (MI) who is awaiting transfer to the coronary intensive care unit. The nurse no
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tes the sudden onset of premature ventricular contractions (PVCs) on the monitor, checks t
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he client's carotid pulse, and determines that the PVCs are not resulting in perfusion. The a
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ppropriate action by the nurse is: xz xz xz xz xz
A. Documenting the findings
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B. Asking the ED physician to check the client
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C. Continuing to monitor the client's cardiac status
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D. Informing the client that PVCs are expected after an MI - ans-
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B. Asking the ED physician to check the client
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5.NPO status is imposed 8 hours before the procedure on a client scheduled to undergo ele
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ctroconvulsive therapy (ECT) at 1 p.m. On the morning of the procedure, the nurse checks t xz xz xz xz xz xz xz xz xz xz xz xz xz xz xz
he client's record and notes that the client routinely takes an oral antihypertensive medicati
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on each morning. The nurse should:
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A. Administer the antihypertensive with a small sip of water
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B. Withhold the antihypertensive and administer it at bedtime
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C. Administer the medication by way of the intravenous (IV) route
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D. Hold the antihypertensive and resume its administration on the day after the ECT - ans-
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A. Administer the antihypertensive with a small sip of water
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6 A client who recently underwent coronary artery bypass graft surgery comes to the physic
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ian's office for a follow- xz xz xz xz
up visit. On assessment, the client tells the nurse that he is feeling depressed. Which respo
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nse by the nurse is therapeutic?
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A. "Tell me more about what you're feeling."
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B. "That's a normal response after this type of surgery."
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,C. "It will take time, but, I promise you, you will get over this depression."
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D. "Every client who has this surgery feels the same way for about a month." - ans-
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A. "Tell me more about what you're feeling."
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7 A client in labor experiences spontaneous rupture of the membranes. The nurse immedia
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tely counts the fetal heart rate (FHR) for 1 full minute and then checks the amniotic fluid. Th
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e nurse notes that the fluid is yellow and has a strong odor. Which of the following actions sh
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ould be the nurse's priority? xz xz xz xz
A. Contacting the physician
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B. Documenting the findings
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C. Checking the fluid for protein
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D. Continuing to monitor the client and the FHR - ans-A. Contacting the physician Correct
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8 A nurse has assisted a physician in inserting a central venous access device into a client
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with a diagnosis of severe malnutrition who will be receiving parenteral nutrition (PN). After i
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nsertion of the catheter, the nurse immediately plans to: xz xz xz xz xz xz xz xz
A. Call the radiography department to obtain a chest x-ray
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B. Check the client's blood glucose level to serve as a baseline measurement
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C. Hang the prescribed bag of PN and start the infusion at the prescribed rate
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D. Infuse normal saline solution through the catheter at a rate of 100 mL/
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hr to maintain patency - ans-A. Call the radiography department to obtain a chest x-ray
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9 A rape victim being treated in the emergency department says to the nurse, "I'm really wor
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ried that I've got HIV now." What is the appropriate response by the nurse?
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A. "HIV is rarely an issue in rape victims."
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B. "Every rape victim is concerned about HIV."
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C. "You're more likely to get pregnant than to contract HIV."
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D. "Let's talk about the information that you need to determine your risk of contracting HIV."
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- ans-
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D. "Let's talk about the information that you need to determine your risk of contracting HIV."
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10 A client is taking prescribed ibuprofen (Motrin), 300 mg orally four times daily, to relieve j
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oint pain resulting from rheumatoid arthritis. The client tells the nurse that the medication is
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causing nausea and indigestion. The nurse should tell the client to:
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A. Contact the physician
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B. Stop taking the medication
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C. Take the medication with food
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D. Take the medication twice a day instead of four times - ans-
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C. Take the medication with food
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11 A client's oral intake of liquids includes 120 mL on the night shift, 800 mL on the day shift,
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and 650 mL on the evening shift. The client is receiving an intravenous (IV) antibiotic every
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, 12 hours, diluted in 50 mL of normal saline solution. The nurse empties 700 mL of urine fro
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m the client's Foley catheter at the end of the day shift. Thereafter, 500 mL of urine is emptie
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d at the end of the evening shift and 325 mL at the end of the night shift. Nasogastric tube dr
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ainage totals 155 mL for the 24-hour period, and the total drainage from the Jackson-
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Pratt device is 175 mL. What is the client's total intake during the 24-hour period?
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Type your answer in the space provided.
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Answer: ________mL - ans-Correct Responses: "1670" xz xz xz xz xz
12 Lorazepam (Ativan) 1 mg by way of intravenous (IV) injection (IV push) is prescribed for
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a client for the management of anxiety. The nurse prepares the medication as prescribed a
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nd administers the medication over a period of:
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A. 3 minutes xz xz
B. 10 seconds xz xz
C. 15 seconds xz xz
D. 30 minutes - ans-A. 3 minutes Correct
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13 A nurse, conducting an assessment of a client being seen in the clinic for symptoms of a
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sinus infection, asks the client about medications that he is taking. The client tells the nurse
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that he is taking nefazodone hydrochloride (Serzone). On the basis of this information, the
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nurse determines that the client most likely has a history of:
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A. Depression xz
B. Diabetes mellitus
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C. Hyperthyroidism
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D. Coronary artery disease - ans-A. Depression
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14 Phenelzine sulfate (Nardil) is prescribed for a client with depression. The nurse provides
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information to the client about the adverse effects of the medication and tells the client to co
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ntact the physician immediately if she experiences:
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A. Dry mouth xz xz
B. Restlessness xz
C. Feelings of depression
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D. Neck stiffness or soreness - ans-D. Neck stiffness or soreness Correct
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15 Risperidone (Risperdal) is prescribed for a client hospitalized in the mental health unit fo
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r the treatment of a psychotic disorder. Which finding in the client's medical record would pr
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ompt the nurse to contact the prescribing physician before administering the medication?
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A. The client has a history of cataracts.
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B. The client has a history of hypothyroidism.
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C. The client takes a prescribed antihypertensive.
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D. The client is allergic to acetylsalicylic acid (aspirin). - ans-
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C. The client takes a prescribed antihypertensive.
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