NUR 320 FINAL
A client hospitalized for treatment of hypertension is being
prepared for discharge. Which teaching topic should the nurse
should be sure to cover? Correct Answers Maintaining a low-
sodium diet
A client with a history of chronic renal failure receives
hemodialysis treatments three times per week through an
arteriovenous (AV) fistula in the left arm. Which intervention
should the nurse include in the care plan? Correct Answers
Assess the AV fistula for a bruit and thrill.
A community health nurse is organizing community training on
healthy behavior change. Which action will the nurse focus on
when using the transtheoretical model of change as guidance for
the teaching? Correct Answers Motivation of Individuals
A nurse is caring for a client with acute myeloid leukemia who
is preparing to undergo induction therapy. In preparing a plan of
care for this client, the nurse should assign the highest priority to
which nursing diagnosis? Correct Answers Risk for infection
Agency policies are important to achieve culturally competent
care. When reviewing a hospital's current policy framework,
what action has the most potential to improve the overall level
of culture competence? Correct Answers Creating greater
flexibility in visiting hours
During the physical assessment of a client with hypertension,
what would the nurse expect to be the most obvious finding?
,Correct Answers Sustained increase of either one or both
systolic or diastolic measurements.
Early signs of hypervolemia Correct Answers increased
breathing effort and weight gain.
The nurse assesses a patient for a possible pulmonary embolism.
What frequent sign of pulmonary embolus does the nurse
anticipate finding on assessment? Correct Answers Tachypnea
The nurse is assessing a client who had an ileostomy created
three days ago for the treatment of irritable bowel disease. The
nurse observes that the client's stoma is bright red and there are
scant amounts of blood on the stoma. What is the nurse's best
action? Correct Answers Document these expected assessment
findings
The nurse is assessing a client with acute coronary syndrome
(ACS). The nurse includes a careful history in the assessment,
especially with regard to signs and symptoms. What signs and
symptoms are suggestive of ACS? Select all that apply. Correct
Answers Dyspnea, unusual fatigue, syncope
The nurse is assessing several clients. Which client does the
nurse determine is most likely to have Hodgkin lymphoma?
Correct Answers The client with enlarged lymph nodes in the
neck.
The nurse is caring for a client in heart failure with signs of
hypervolemia. Which vital sign is indicative of the disease
process? Correct Answers Elevated BP
, The nurse is caring for a patient in the emergency department
with a diagnosed epidural hematoma. What procedure will the
nurse prepare the patient for? Correct Answers Burr holes
The nurse is creating a plan of care for a client with acute
coronary syndrome. What nursing action should be included in
the client's care plan? Correct Answers Administer
supplementary Oxygen, as needed.
The nurse is working with a colleague who has a delayed
hypersensitivity (type IV) allergic reaction to latex. Which
statement describes the clinical manifestations of this reaction?
Correct Answers Symptoms are localized to the area of
exposure, usually the back of the hands.
What is a characteristic of the intrarenal category of acute renal
failure? Correct Answers Increased BUN
Which instruction should a nurse provide a client with a history
of rheumatic fever before the client has any dental work done?
Correct Answers To take prophylactic antibiotics
Which intervention should the nurse implement when caring for
the client who complains of phantom limb pain two months after
amputation? Correct Answers Reassure the client that phantom
pain is common.
alprozolam (Xanax)
A client hospitalized for treatment of hypertension is being
prepared for discharge. Which teaching topic should the nurse
should be sure to cover? Correct Answers Maintaining a low-
sodium diet
A client with a history of chronic renal failure receives
hemodialysis treatments three times per week through an
arteriovenous (AV) fistula in the left arm. Which intervention
should the nurse include in the care plan? Correct Answers
Assess the AV fistula for a bruit and thrill.
A community health nurse is organizing community training on
healthy behavior change. Which action will the nurse focus on
when using the transtheoretical model of change as guidance for
the teaching? Correct Answers Motivation of Individuals
A nurse is caring for a client with acute myeloid leukemia who
is preparing to undergo induction therapy. In preparing a plan of
care for this client, the nurse should assign the highest priority to
which nursing diagnosis? Correct Answers Risk for infection
Agency policies are important to achieve culturally competent
care. When reviewing a hospital's current policy framework,
what action has the most potential to improve the overall level
of culture competence? Correct Answers Creating greater
flexibility in visiting hours
During the physical assessment of a client with hypertension,
what would the nurse expect to be the most obvious finding?
,Correct Answers Sustained increase of either one or both
systolic or diastolic measurements.
Early signs of hypervolemia Correct Answers increased
breathing effort and weight gain.
The nurse assesses a patient for a possible pulmonary embolism.
What frequent sign of pulmonary embolus does the nurse
anticipate finding on assessment? Correct Answers Tachypnea
The nurse is assessing a client who had an ileostomy created
three days ago for the treatment of irritable bowel disease. The
nurse observes that the client's stoma is bright red and there are
scant amounts of blood on the stoma. What is the nurse's best
action? Correct Answers Document these expected assessment
findings
The nurse is assessing a client with acute coronary syndrome
(ACS). The nurse includes a careful history in the assessment,
especially with regard to signs and symptoms. What signs and
symptoms are suggestive of ACS? Select all that apply. Correct
Answers Dyspnea, unusual fatigue, syncope
The nurse is assessing several clients. Which client does the
nurse determine is most likely to have Hodgkin lymphoma?
Correct Answers The client with enlarged lymph nodes in the
neck.
The nurse is caring for a client in heart failure with signs of
hypervolemia. Which vital sign is indicative of the disease
process? Correct Answers Elevated BP
, The nurse is caring for a patient in the emergency department
with a diagnosed epidural hematoma. What procedure will the
nurse prepare the patient for? Correct Answers Burr holes
The nurse is creating a plan of care for a client with acute
coronary syndrome. What nursing action should be included in
the client's care plan? Correct Answers Administer
supplementary Oxygen, as needed.
The nurse is working with a colleague who has a delayed
hypersensitivity (type IV) allergic reaction to latex. Which
statement describes the clinical manifestations of this reaction?
Correct Answers Symptoms are localized to the area of
exposure, usually the back of the hands.
What is a characteristic of the intrarenal category of acute renal
failure? Correct Answers Increased BUN
Which instruction should a nurse provide a client with a history
of rheumatic fever before the client has any dental work done?
Correct Answers To take prophylactic antibiotics
Which intervention should the nurse implement when caring for
the client who complains of phantom limb pain two months after
amputation? Correct Answers Reassure the client that phantom
pain is common.
alprozolam (Xanax)
