DMC exit814 2020/2021 Comprehensive Exit Exam with quetions and answers Graded A+

08.05 Comprehensive Exit Exam Multiple Choice Identify the choice that best completes the statement or answers the question. ____ 1. The child with seizure disorder is being treated with phenytoin (Dilantin). Which of the following statements by the patient's mother indicates to the nurse that the patient is experiencing a common side effect of Dilantin therapy? a. "She is very irritable lately." b. "I have trouble getting her to sleep." c. "Her gums look too big for her teeth." d. "She has gained about 10 pounds in the last six months." ANS: C ____ 2. The prescriber orders tranylcypromine sulfate (Parnate)10 mg twice a day for a client with major depression. The nurse should teach the client to refrain from eating foods containing tyramine because it may cause: a. Melanoma. b. Hyperthermia. c. Hypertension. d. Urinary retention. ANS: C ____ 3. The prescriber orders captopril (Capoten) 25mg by mouth three times daily for a client with hypertension. Which of the following adverse reactions can occur with administration of Capoten? a. Tinnitus. b. Persistent cough. c. Muscle weakness. d. Diarrhea. ANS: B ____ 4. A client who has been taking phenazopyridine (Pyridium) for symptoms of urethritis and cystitis comes to the clinic because her urine is reddish-orange. Which question should the practical nurse ask to determine if the medication has been effective? a. How much water have you been drinking each day? b. Does the urine color stain your toilet bowl or undergarments? c. Have you had any relief from urinary pain, burning, or urgency? d. Did your urine appear cloudy or have a foul odor on voiding? ANS: C ____ 5. The nurse is visiting a home health client with osteoporosis. The client has a new prescription for alendronate (Fosamax). Which instruction should be given to the client? a. Avoid rapid movements after taking the medication. b. Rest in bed after taking the medication for at least 30 minutes. c. Take the medication with water only. d. Allow at least 1 hour between taking the medicine and taking other. ANS: C ____ 6. ANS: B A client receives a prescription for an oral opioid analgesic for post-operative pain. Which adverse effect should the nurse monitor for with the client? a. Photosensitivity b. Constipation. c. Decreased heart rate. d. Frequent urination. ____ 7. ANS: C A postoperative client receiving a transfusion of packed red blood cells develops chills, fever, headache, and anxiety 35 minutes after the transfusion is started. After stopping the transfusion, what action should the nurse take? a. Draw blood for a new crossmatch. b. Send a urine specimen to the laboratory. c. Administer PRN acetaminophen (Tylenol). d. Give the PRN diphenhydramine (Benadryl). ____ 8. ANS: C After abdominal surgery, a client with protein calorie malnutrition is receiving total parenteral nutrition (TPN). Which is the best indicator that the client is receiving adequate nutrition? a. Serum albumin level is 3.5 mg/dL. b. Fluid intake and output are balanced. c. Surgical incision is healing normally. d. Blood glucose is less than 110 mg/dL. ____ 9. ANS: B A client who is having a tunneled central venous catheter inserted begins to report chest pain and difficulty breathing. What action does the nurse take first? a. Administer the PRN pain medication. b. Prepare to assist with chest tube insertion. c. Place a sterile dressing over the IV site. d. Place the client in the Trendelenburg position. ____ 10. A nurse is changing the administration set on a client’s central venous catheter. Which intervention is most important for the nurse to complete? a. Have the client hold his breath during the set change. b. Keep the slide clamp on the catheter extension open. c. Position the client in a high Fowler’s position. d. Position in the client in a semi-Fowler’s position. ANS: A ____ 11. When an IV pump alarms because of pressure, what action does the nurse take first? a. Check for kinking of the catheter. b. Flush the catheter with a thrombolytic enzyme. c. Get a new infusion pump. d. Remove the IV catheter. ANS: A ____ 12. The nurse is working in the pediatric unit and receives a phone order from the doctor for a 10-year-old client who weighs 40 kg. The order is for ceftazidime (Fortaz) 1.5 gm every 8 hours IV. The therapeutic dosage range is 90-150 mg/kg/24 hr. What would be the best nursing action? a. Administer the medication because it is within the therapeutic dosage range. b. Call the doctor to clarify the order because it is outside the therapeutic dosage range. c. Call the hospital pharmacist and ask him or her to calculate the dosage. d. Notify the nursing supervisor and request assistance. ANS: A ____ 13. The prescriber orders an IV piggyback of Cefotan 1 gm in 100 mL D5W to run over 30 minutes. The drop factor for the tubing is 10 gtt/mL. At what rate in drops per minute would the nurse run the IV? a. 12. b. 25. c. 33. d. 50. ANS: C ____ 14. At the shift hand-off report, a nurse is told that one of her clients is becoming tolerant to his pain medication. What nursing observation would be in agreement with this conclusion? a. The current medication order, which has previously been effective, is no longer providing adequate pain relief. b. The client becomes irritable and confused before the next scheduled dose of medication. c. Pain medication is being administered every 3 to 4 hours around the clock for adequate pain relief. d. The client is sleeping, arouses with physical and verbal stimulation, but is very lethargic. ANS: A ____ 15. The nurse is administering medications to a group of clients. One client is an older adult and hard of hearing. The client seems confused when the nurse asks her to state her name and does not give her name. What is the best nursing action? a. Confirm the name, birth date, and hospital number on the client's armband and administer the medication. b. Request the family that is present to validate the information on the client's medication administration record. c. Determine the cause of the confusion and hearing problem before administering any medication. d. Hold the medication and notify the doctor that the client cannot be safely identified if she cannot state her name. ANS: A ____ 16. ANS: D The nurse is verifying whether to give a medication to a client. What would be the first nursing action? a. Check the client's name and hospital number. b. Validate the expiration date of the drug. c. Determine the appropriate route of delivery. d. Review the orders on the medication administration record. ____ 17. ANS: B The doctor has indicated that ampicillin (Omnipen-N) and gentamicin (Garamycin) are to be given piggyback in the same hour, every 6 hours (12-6 –12-6). How would the nurse administer these drugs? a. Give both drugs together IV push. b. Give each drug separately, flushing between drugs. c. Retrograde both drugs into the tubing. d. Give 1 drug every 4 hours and the other every 6 hours ____ 18. ANS: A The nurse understands that the development of an adverse drug reaction is dependent on which factors? a. Client's age, prior drug reactions, genetic factors, and degree of exposure. b. Client's gender, oral route of administration, and history of atrophic disease. c. Client's age, gender, and genetic factors. d. Genetic factors, prior drug reactions, and client's gender. ____ 19. ANS: D The nurse is administering lorazepam (Ativan) to an irritated, anxious client. The client asks what the medication is and why he is receiving it. What would be the best nursing response? a. Advise him that the doctor ordered the medication and he should discuss the reason for the medication with the doctor. b. Discuss with the client the confidentiality of medication administration and that this information cannot be shared with the client. c. Notify the charge nurse and advise him or her of the problem and the increasing client irritation regarding medications. d. Tell the client the name of the medication and explain it has been ordered to help to decrease his anxiety and make him more comfortable. ____ 20. It is 4 pm and the nurse is admitting a client with a fractured femur from the emergency room (ER). The client received 10 mg morphine subcutaneous (subQ) at 11 am in the ER for pain. The client is scheduled for surgery, and no further pain orders have been written. The client is complaining of severe leg pain, and the physician cannot be contacted. The nurse administers 5 mg morphine subQ for the pain, and the client is comfortable within 30 minutes. What is best interpretation of the nurse's action? a. The nurse made an appropriate nursing judgment by giving a lesser amount of the drug. b. The nurse acted correctly because the client was in pain and the doctor could not be contacted. c. The drug had been previously ordered; therefore, the nurse's actions were correct. d. The nurse is legally liable for administering a medication without an order. ANS: D