NUR2571 Exam 2- Professional Nursing II Exam 2-with 100% verified solutions.docx, Exams of Nursing

Download NUR2571 Exam 2- Professional Nursing II Exam 2-with 100% verified solutions.docx and more Exams Nursing in PDF only on Docsity! NUR2571 Exam 2- Professional Nursing II Exam 2-with 100% verified solutions A client is admitted with abdominal aortic aneurysm. For which of the following complications should the nurse be concerned? -Aneurysm rupture A nurse is caring for a client who has an endotracheal tube and is receiving mechanical ventilation. Which of the following interventions should the nurse take to specifically reduce the risk for ventilation associated pneumonia? -Turn the client every 4 hours to facilitate mobilization of secretion Which ABG values are expected with anxiety induced hyperventilation? pH 7.29; PaCO2 55 mm Hg A client comes into the ER with acute shortness of breath and a cough that produces pink, frothy sputum. Admission assessment reveals crackles and wheezes, a BP 85/46, a HR of 122 BPM, and a respiratory rate of 38 breaths/minute. The client's medical history included DM, HTN, and a heart failure. Which of the following disorders should the nurse suspect? -Pulmonary edema A nurse is caring for a client who arrived at an emergency department with status asthmaticus. Based on the progress Note: BP 140/90, P 104, and Temp 98.4 F, RR 34, audible wheezing, ABG results pH 7.22, PaCO2 69, and HCO3-26. The nurse suspects that the client has what abnormality? Respiratory acidosis A nurse is assessing a patient who has right heart ventricular failure. Which of the following findings should the nurse expect? -Hepatomegaly Which of the following should the nurse instruct a client who is newly diagnosed with hypertension It is a lifelong process A client diagnosed with heart failure is prescribed furosemide (Lasix). Which of the following should this client be monitored for because of this medication? (Select all that apply.) Dehydration -Hyponatremia -Hypokalemia A client with acute asthma is prescribed short-term corticosteroid therapy. Which is the expected outcome for the use of steroids in clients with asthma? -Have an anti-inflammatory effect A client asks the nurse if there is an antihistamine that does not cause drowsiness. Which of the following medications would this client most likely prefer to treat allergic rhinitis? - -Fexofenadine A client is admitted to the emergency department after a syncopal episode while exercising. All of the following symptoms are consistent with a diagnosis of Mitral Valve Prolapse except Swelling of the feet and ankles Which diagnostic test will be most useful to the nurse in determining whether a patient admitted with acute shortness of breath has heart failure? -B-type natriuretic peptide (BNP The nurse should include which instruction when developing a teaching plan for a client who is receiving isoniazid and rifampin for treatment of tuberculosis? Avoid Alcohol A client is having laboratory tests conducted to confirm a diagnosis of arteriosclerosis. Which of the following laboratory values would support this client's medical diagnosis? (Select all that apply) A. Low- density lipoprotein (LDL) 145 mg/Dl C. Triglycerides 400 mg/d D. Serum cholesterol 300 mg/dL A. High-density lipoprotein (HDL) 25 mg /Dl A client has a history of heart failure and has been prescribed furosemide, digoxin, and potassium chloride. The client has nausea, blurred vision, headache, and weakness. The nurse notes that the A home health nurse visits a client who has COPD and receives oxygen at 2L/min via nasal cannula. The client reports having difficulty breathing. Which of the following actions is the nurse's priority -Assess the client's respiratory status 34. A client receiving a heparin infusion is demonstrating of acute bleeding. Which of the following should the nurse prepare to administer to this client? Protamine sulfate 36. The nurse is assessing a client diagnosed with asthma. The client's initial breath sounds heard by the nurse consisted of wheezing but have diminishing until no audible sounds are heard. This has occurred due to which of the following? -Increased airway constriction is blocking the airway A patient is admitted to the hospital with a diagnosis of chronic venous insufficiency. Which of these statements by the patient is most consistent with the diagnosis? "I can't get my shoes on at the end of the day." The nurse is assessing a 48-year-old client with a history of smoking during a routine clinic visit. The client, who exercises regularly, reports having pain in the calf during exercise that disappears at rest. Which finding requires further evaluation? Ankle-brachial index of 0.65 A client is prescribed Lisinopril for control of hypertension. What health teaching will the nurse provide to this patient? (Select all that apply) -"This medication can cause increased potassium levels." - "It's important to change positions slowly when you start this medication." - "This medication may cause you to develop a persistent, non-productive cough." - "Be sure to monitor your BP regularly while taking this medication." A nurse is reviewing the labs for a newly admitted heart failure patient and notes a K+ level of 5.6. Upon reviewing the patient's medications, the nurse realizes which of the following medications most likely contributed to this electrolyte imbalance? -Spironolactone Of the following client assignments made by the charge nurse, which would you question? The LPN with 20 years of experience caring for a diabetic client complaining of a headache and with blood pressure of 210/150 A client is surprised to learn that she has high blood pressure. Which of the following should the nurse assess in this client? The presence or occurrence of: Headache The nurse notes that the international normalized ratio (INR) of a client with atrial fibrillation who is taking warfarin is 3.2. What is the priority intervention at this time? Hold the next scheduled dose and notify the provider. A patient who has just been admitted with pneumococcal pneumonia has a temperature of 100.6 F with a frequent cough and is complaining of severe pleuritic chest pain. Which of these prescribed medications should the nurse give first? Azithromycin A nurse is assessing a male client who has a new diagnosis of peripheral artery disease (PAD). Which of the following findings should the nurse expect to find on the affected extremity? (Select all that apply) -Pain, Pulselessness, Paresthesia, Paralysis, Pallor Which of the following would the nurse most likely assess in a client diagnosed with right-sided heart failure? -Distended neck veins The RN and nursing assistant are working together to provide care for a group of clients. Which of these nursing activities could the ZRN delegate to the nursing assistant? -Reinforce the use of slow expiration through pursed lips to maximize gas exchange for a client with COPD. The health care provider has just prescribed the client with a deep vein thrombosis (DVT) warfarin sodium. The nurse knows that this client is still receiving intravenous heparin. Which is the nurse's best action? Administer the medications as prescribed. When a patient with hypertension who has a new prescription for atenolol returns to the health clinic after 2 weeks for a follow-up visit, the BP is unchanged from the previous visit. Which action should the nurse take first? Question the patient about whether the medication is actually being taken. Which findings are significant data to gather from a client who has been diagnosed with pneumonia? (Select all that apply) -Quality of breath sounds -Occurrence of chest pain -Color of nail beds which of the following conditions is most commonly responsible for right heart failure? C. Left heart failure A nurse assesses a client in preparation for receiving a blood transfusion Pre-transfusion vitals are temperature 98.2 F, heart rate 82 beats/minute, respirations 18 breaths/minute, blood pressure 102/76 mm Hg, oxygen saturation 96% on room air. Fifteen minutes after starting the transfusion, the nurse measures the following vital signs. Which of the following is the highest priority for action? D. Temperature 100.6F The nurse identifies the nursing diagnosis of decreased cardiac output related to valvular insufficiency for the patient with infective endocarditis (IE) based on which assessment finding(s)? *b. Blood pressure of 85/48 mmHg A patient is diagnosed with heart failure and is prescribed digoxin (Lanoxin) and furosemide (Lasix). Before administering the furosemide to the patient, which laboratory result should the healthcare provider to review? . Serum potassium