RN Comprehensive Online Practice 2023
B
A nurse is providing discharge instructions to a client who has a new prescription for amitriptyline to
treat depression. The nurse should identify that which of the following client statements indicates an
understanding of the teaching? ANS: "I should watch for common reactions like dry mouth and
constipation."
The nurse should reinforce that increasing dietary fiber, fluid intake, and chewing sugar-free gum can
alleviate the anticholinergic effects of dry mouth and constipation.
A nurse is caring for an adolescent in the emergency department (ED).
Laboratory Results
Sodium 140 mEq/L (136 to 145 mEq/L) Potassium 3.6 mEq/L (3.5 to 5 mEq/L) Chloride 103 mEq/L (98 to
106 mEq/L) BUN 15 mg/dL (10 to 20 mg/dL) Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L) Total calcium 9.5
mg/dL (9 to 10.5 mg/dL) Phosphate 3.7 mg/dL (3 to 4.5 mg/dL) Glucose 80 mg/dL (74 to 106 mg/dL)
Total protein 7 g/dL (6.4 to 8.3 g/dL) Albumin 4.5 g/dL (3.5 to 5 g/dL) WBC count 19,500/mm3 (5,000 to
10,000/mm3) Aspartate aminotransferase (AST) 30 units/L (10 to 40 units/L) Alanine transaminase (ALT)
20 units/L (4 to 36 units/L)
Diagnostic Results
Cerebrospinal fluid examinationPressure: 35 cm H2O (less than 20 cm H2O) Color: Cloudy (clear and
colorless) Blood: None RBC: 0 (0 cells) WBC total: 120 cells/µL (0 to 10 cells/µL) Protein: 90 mg/dL (15 to
45 mg/dL) Glucose: 20 mg/dL (50 to 75 mg/dL)
Medication Administration Record ANS: When recognizing cues, the nurse should recognize that
manifestations of bacterial meningitis can include fever, photophobia, nuchal rigidity, petechial rash,
and impaired consciousness. The adolescent is experiencing these symptoms. Encephalitis is
characterized by fever, nuchal rigidity, and altered mental status. Reye syndrome is characterized
primarily by altered mental status and impaired hepatic function.
,History and Physical
2 months ago:
Client presented to clinic for routine visit. Client reported feeling tired at times but getting through the
workday and walking after work. Reported chronic nonproductive cough. Smokes 1.5 packs of cigarettes
per day.
Today, 1030:
Client reports fatigue over the past several days, spending more time in bed. Reports chronic productive
cough with blood-tinged sputum this morning. Smokes 1 pack of cigarettes per day. Client takes lisinopril
20 mg PO daily, atorvastatin 20 mg PO daily.
Assessment
2 months ago:
Client states, "I sleep in my recliner and that works great." Skin is warm, dry. Lungs clear to auscultation.
Chronic nonproductive cough. Abdomen soft, nondistended. Bowel sounds present. Slight edema in feet
bilaterally.
Today, 1030:
Client states, "I can't catch my breath." Skin pale. Respirations labored. Crackles present in left-lower
lobe. Coughing during assessment. Blood ANS: For each assessment finding noted above, click to specify
if the finding is expected of pneumonia, COPD, or heart failure.
Pneumonia = tobacco use, elevated WBC, productive cough w/ sputum, inc temp, dec O2, resp acidosis
COPD = tobacco use, dec O2 sat
HF = tobacco use, BNP level, dec O2 sat
A nurse is caring for a client who is 1 day postoperative following a total thyroidectomy.
Laboratory Results
,0700:
Sodium 143 mEq/L (136 to 145 mEq/L)
Potassium 3.5 mEq/L (3.5 to 5 mEq/L)
Chloride 104 mEq/L (98 to 106 mEq/L )
BUN 15 mg/dl (10 to 20 mg/dl)
Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L )
Total calcium 8 mg/dL (9 to 10.5 mg/dL)
Phosphate 4.6 mg/dL (3 to 4.5 mg/dL)
Glucose 95 mg/dL (74 to 106 mg/dL)
WBC 9,500/mm3 (5,000 to 10,000/mm3)
Nurses' Notes
0700:
Client alert and oriented to person, place, and time. Respirations even and unlabored with no
adventitious sounds. Bowel sounds active in all 4 quadrants. Surgical dressing dry, slight edema at
incision site noted. Client rates dull pain in neck of 2 on a 0 to 10 scale. Declines pain medication.
1100:
Client alert and oriented to person, place, and time. Respirations even and unlabored with no
adventitious sounds. Bowel sounds active in all 4 quadrant ANS: the client is at highest risk for
developing hypocalcemia as evidenced by client's report of muscle spasms, numbness around lips, and
dec calcium level.
Hypocalcemia is more likely to occur in clients who have experienced a thyroidectomy, due to accidental
damage to the parathyroid. Numbness around the lips is a clinical manifestation specific to
hypocalcemia. Hypocalcemia presents as muscle spasms and can lead to cardiac dysrhythmias.
Hypocalcemia is the highest priority, as it requires immediate treatment with calcium gluconate to avoid
dysrhythmias and other complications.
A nurse is caring for a client who has abdominal pain.
, Nurses' Notes
0900:
Client reports loss of appetite, weight loss, and fatigue for 1 week. Reports abdominal pain, 6 on a scale
from 0 to 10, for 2 days. Client is a perioperative nurse, returned 1 week ago from a 2-week mission trip
to an underdeveloped country.
1200:
Results of antibody studies obtained. Provider prescription for antiviral medication pending.
Physical Examination
0930:
Lung sounds clear bilaterally. Skin warm to touch and jaundiced. Dry skin noted on extremities. Sclera
yellow bilaterally. Bowel sounds normoactive in four quadrants. Client reports right upper quadrant pain
upon palpation. Urine specimen obtained for urinalysis, dark yellow in color.
Vital Signs
0900:
Temperature 36.9° C (98.5° F) Heart rate 84/min Respiratory rate 18/min Blood pressure 118/78 mm Hg
Oxygen saturation 98% on room air
Diagnostic Results
1100:
Aspartate aminot ANS: For each condition, click to specify if the characteristic is consistent with an acute
infection of hepatitis A, hepatitis B, or hepatitis C. Each characteristic may support more than one
disease process.
Manifestations of Hep A, Hep B, & Hep C = jaundice, yellow sclera, RUQ pain on palpation, dark yellow
urine, inc AST & ALT levels
B
A nurse is providing discharge instructions to a client who has a new prescription for amitriptyline to
treat depression. The nurse should identify that which of the following client statements indicates an
understanding of the teaching? ANS: "I should watch for common reactions like dry mouth and
constipation."
The nurse should reinforce that increasing dietary fiber, fluid intake, and chewing sugar-free gum can
alleviate the anticholinergic effects of dry mouth and constipation.
A nurse is caring for an adolescent in the emergency department (ED).
Laboratory Results
Sodium 140 mEq/L (136 to 145 mEq/L) Potassium 3.6 mEq/L (3.5 to 5 mEq/L) Chloride 103 mEq/L (98 to
106 mEq/L) BUN 15 mg/dL (10 to 20 mg/dL) Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L) Total calcium 9.5
mg/dL (9 to 10.5 mg/dL) Phosphate 3.7 mg/dL (3 to 4.5 mg/dL) Glucose 80 mg/dL (74 to 106 mg/dL)
Total protein 7 g/dL (6.4 to 8.3 g/dL) Albumin 4.5 g/dL (3.5 to 5 g/dL) WBC count 19,500/mm3 (5,000 to
10,000/mm3) Aspartate aminotransferase (AST) 30 units/L (10 to 40 units/L) Alanine transaminase (ALT)
20 units/L (4 to 36 units/L)
Diagnostic Results
Cerebrospinal fluid examinationPressure: 35 cm H2O (less than 20 cm H2O) Color: Cloudy (clear and
colorless) Blood: None RBC: 0 (0 cells) WBC total: 120 cells/µL (0 to 10 cells/µL) Protein: 90 mg/dL (15 to
45 mg/dL) Glucose: 20 mg/dL (50 to 75 mg/dL)
Medication Administration Record ANS: When recognizing cues, the nurse should recognize that
manifestations of bacterial meningitis can include fever, photophobia, nuchal rigidity, petechial rash,
and impaired consciousness. The adolescent is experiencing these symptoms. Encephalitis is
characterized by fever, nuchal rigidity, and altered mental status. Reye syndrome is characterized
primarily by altered mental status and impaired hepatic function.
,History and Physical
2 months ago:
Client presented to clinic for routine visit. Client reported feeling tired at times but getting through the
workday and walking after work. Reported chronic nonproductive cough. Smokes 1.5 packs of cigarettes
per day.
Today, 1030:
Client reports fatigue over the past several days, spending more time in bed. Reports chronic productive
cough with blood-tinged sputum this morning. Smokes 1 pack of cigarettes per day. Client takes lisinopril
20 mg PO daily, atorvastatin 20 mg PO daily.
Assessment
2 months ago:
Client states, "I sleep in my recliner and that works great." Skin is warm, dry. Lungs clear to auscultation.
Chronic nonproductive cough. Abdomen soft, nondistended. Bowel sounds present. Slight edema in feet
bilaterally.
Today, 1030:
Client states, "I can't catch my breath." Skin pale. Respirations labored. Crackles present in left-lower
lobe. Coughing during assessment. Blood ANS: For each assessment finding noted above, click to specify
if the finding is expected of pneumonia, COPD, or heart failure.
Pneumonia = tobacco use, elevated WBC, productive cough w/ sputum, inc temp, dec O2, resp acidosis
COPD = tobacco use, dec O2 sat
HF = tobacco use, BNP level, dec O2 sat
A nurse is caring for a client who is 1 day postoperative following a total thyroidectomy.
Laboratory Results
,0700:
Sodium 143 mEq/L (136 to 145 mEq/L)
Potassium 3.5 mEq/L (3.5 to 5 mEq/L)
Chloride 104 mEq/L (98 to 106 mEq/L )
BUN 15 mg/dl (10 to 20 mg/dl)
Magnesium 1.5 mEq/L (1.3 to 2.1 mEq/L )
Total calcium 8 mg/dL (9 to 10.5 mg/dL)
Phosphate 4.6 mg/dL (3 to 4.5 mg/dL)
Glucose 95 mg/dL (74 to 106 mg/dL)
WBC 9,500/mm3 (5,000 to 10,000/mm3)
Nurses' Notes
0700:
Client alert and oriented to person, place, and time. Respirations even and unlabored with no
adventitious sounds. Bowel sounds active in all 4 quadrants. Surgical dressing dry, slight edema at
incision site noted. Client rates dull pain in neck of 2 on a 0 to 10 scale. Declines pain medication.
1100:
Client alert and oriented to person, place, and time. Respirations even and unlabored with no
adventitious sounds. Bowel sounds active in all 4 quadrant ANS: the client is at highest risk for
developing hypocalcemia as evidenced by client's report of muscle spasms, numbness around lips, and
dec calcium level.
Hypocalcemia is more likely to occur in clients who have experienced a thyroidectomy, due to accidental
damage to the parathyroid. Numbness around the lips is a clinical manifestation specific to
hypocalcemia. Hypocalcemia presents as muscle spasms and can lead to cardiac dysrhythmias.
Hypocalcemia is the highest priority, as it requires immediate treatment with calcium gluconate to avoid
dysrhythmias and other complications.
A nurse is caring for a client who has abdominal pain.
, Nurses' Notes
0900:
Client reports loss of appetite, weight loss, and fatigue for 1 week. Reports abdominal pain, 6 on a scale
from 0 to 10, for 2 days. Client is a perioperative nurse, returned 1 week ago from a 2-week mission trip
to an underdeveloped country.
1200:
Results of antibody studies obtained. Provider prescription for antiviral medication pending.
Physical Examination
0930:
Lung sounds clear bilaterally. Skin warm to touch and jaundiced. Dry skin noted on extremities. Sclera
yellow bilaterally. Bowel sounds normoactive in four quadrants. Client reports right upper quadrant pain
upon palpation. Urine specimen obtained for urinalysis, dark yellow in color.
Vital Signs
0900:
Temperature 36.9° C (98.5° F) Heart rate 84/min Respiratory rate 18/min Blood pressure 118/78 mm Hg
Oxygen saturation 98% on room air
Diagnostic Results
1100:
Aspartate aminot ANS: For each condition, click to specify if the characteristic is consistent with an acute
infection of hepatitis A, hepatitis B, or hepatitis C. Each characteristic may support more than one
disease process.
Manifestations of Hep A, Hep B, & Hep C = jaundice, yellow sclera, RUQ pain on palpation, dark yellow
urine, inc AST & ALT levels
