Department of NursingFinals Frenzy Practice TestFor students taking the final exam for NUR2744Directions: Print the exam and allow one hour to complete it. Use paper and pencil to record your answers. Please read each question carefully. Select the BEST possible answer. There is only one correct answer per question. When you are done, click on the answers icon to check results.

1. A patient presents with complaints of anorexia, muscle cramping, decreased urination and weight gain. In addition, the patient states she has been more tired than usual and more forgetful experiencing frequent headaches. What should the nurse do first?

a. Assess the Patient’s Medical Historyb. Obtain Serum Electrolytesc. Assess for Evidence of Peripheral Edemad. Observe for Abdominal Distention

2. A patient with a pituitary tumor has a urine output of more than 300ml per hour for the past two hours. The nurse knows that this indicates Diabetes Insipidus. Which action should the nurse take first.

a. Monitor urine output over the next two hoursb. Assess the urine for osmolality, glucose, and acetonec. Obtain Serum Electrolytes and Osmolalityd. Notify the physician and anticipate an increase in IV fluid rate

3. After sustaining a right ventricular MI, your patient develops cardiogenic shock. Initally, you should expect to administer:

a. Nitroglycerine (Tridyl)b. Lopressor (Metoprolol)c. Morphine Sulfate (Morphine)d. Plasmanex (Normal serum albumin)

4. Which of the following statements would be most effective when speaking with a staff member who refused to float to another area as the team leader assigned?

a. “You never float when I ask you to, you are causing other staff complaints”b. “I would appreciate your floating in rotation with others, you have work standards that would benefit other units as well as ours”c. “I know you hate to float but you have to take your turn and be flexible”d. “Please just go this time and I promise I won’t ask again”

5. A 82 year old patient sustained an accident resulting in a cervical fracture. After application of a halo traction device, it will be most important for the nurse to apply which safety measure?

a. Logrolling to position patientb. Keeping the head of bed at 30-45 degrees.c. Ensuring visibility of the wrench and tool kit at the bedsided. Inserting a nasogastric tube to prevent aspiration

6. A patient admitted with an anterior wall MI 12 hours ago complains of recurring chest pain. What would be the most appropriate nursing action?

a. No action is necessary, the patient is experiencing normal reperfusion.b. Obtain a 12 lead EKG and notify the physicianc. Administer a thrombolytic and begin heparin therapyd. Adminiser morphine sulfate and lidocaine

7. Which nursing intervention can prevent a patient from experiencing autonomic dysreflexia?a. Administering chloral hydrate (Noctec)b. Assessing laboratory results as orderedc. Placing the patient in a Trendelenberg Positiond. Monitoring patency of the patient’s foley catheter

8. A patient with pulmonary edema is monitored with a thermodilution (Swan-Ganz) catheter. The patient exhibits SOB, SaO2 92%, CVP 14, PAP 32/21, SVR 900, HR 100, RR 26. Which would be the highest priority nursing diagnosis?a. Ineffective Breathing Patternb. Anxietyc. Impaired Gas Exchanged. Decreased Cardiac Output

9. A patient with respiratory acidosis receives an order for endotracheal intubation for an ABG result of pH 7.29, PaO2 68, PCO2 56, NaHCO3 26, on a 100% Non-rebreather mask. Which nursing action is most appropriate post intubation?a. Auscultation of lungs for bilateral breath soundsb. Turning the patient from side to side every two hoursc. Monitoring serial arterial blood gassesd. Providing frequent oral hygiene

10. A patient is status post exploratory laparotomy and repair of an intestinal perforation. Twentyfour hours post op, the patient’s blood pressure has dropped to 90/58, is oozing red colored drainage from the central line site and incision, and has developed 3mm petechiae over the armsand legs. The nurse suspects Disseminated Intervascular Coagulation (DIC). To confirm this diagnosis, the nurse should assess for which laboratory finding?a. Patelet count of 90,000mcg/L and HGB 9.1mg/dLb. PT 15 seconds and APTT 80 secondsc. FDP 50mcg/mL and D-Dimer 1:6 dilutiond. Creatinine 1.4 mg/dL and Fibrinogen Level 160mg/dL

11. The nurse is caring for an intubated patient receiving TPN at 100cc/hour a 10% Lipid solution at 21cc/hour, dopamine at 10cc/hour (5mcg/kg/min), and propofol (Diprivan) at 50cc/hour (15 mcg/ kg/min). The most priority nursing diagnosis for this patient would be:a. Anxiety: level 4b. Alteration in nutrition: more than body requirementsc. Fluid volume overloadd. Risk for infection

12. A patient receives a pacemaker to treat a recurring dysrythmia. When monitoring the cardiac rhythm, the nurse notices several pacer spikes not followed by a beat. The nurse suspects which condition:a. Failure to paceb. Failure to capturec. Failure to sensed. Asystole

13. The CT results indicate hemorrhagic stroke for a patient admitted through the ER. When the nurse reviews the medication administration record, the following medications are transcribed: Heparin Sodium 1000u/hr IV, Dexamethasone (Decadron) 8mg q6 hours IVP, Methyldopa (Aldomet) 100mg q6 hours IVPB, Phenytoin (Dilantin) 200mg IVPB. What should the nurse’s first action be?a. Sign off the orders indicating acknowledgementb. Prepare and administer the medications as orderedc. Call the physician to question the ordersd. Check the written physician orders

14. A physician ordered a stat IV and indicated the importance of administering the medication quickly. The nurse prepares to administer the medication but notices the ground on the infusion pump’s plug is broken. What should the nurse do first?a. Use the pump because the doctor wants the medication given quickly.b. Obtain another pump form central supply and use the new pump for the infusion.c. Tape the broken ground to fix the problem then use the pump.d. Call the nursing supervisor to report the problem.

15. Which nursing intervention takes the highest priority when caring for a client who is receiving a blood transfusion?a. Observing the client for itching, swelling or dyspneab. Instructing the patient that transfusions normally take 1-2 hoursc. Documenting blood administration in the patient care recordd. Assessing vital signs when the transfusion ends

16. After undergoing a left upper lobectomy, a patient has a chest tube in place for drainage. When caring for this client, the nurse must:a. Monitor fluctuations in the suction chamberb. Clamp the tube at least once every shiftc. Encourage coughing and deep breathingd. Milk the tubing every two hours

17. Which position would be best for a client showing signs of shock?a. Semi-Fowlers b. High-Fowlersc. Trendelenbergd. Modified Trendelenberg

18. Which instruction should the nurse give a client who is going to have a chest tube removed?a. “Hyperventilate just before the tube is removed”b. “Take a deep breath and hold it”c. “Inhaled as the tube is pulled out”d. “Avoid the valsalva maneuver”

19. A client has a Sengstaken-Blakemore tube in place to treat esophageal varices. Which action is most appropriate to include in the client’s plan of care?a. Observe for restlessness and increased respirationsb. Offer the client sips of water to swallow every two hoursc. Deflate the gastric balloon to prevent an upset stomachd. Check pressure in the balloon by deflating and reinflating every 4 hours

20. The nurse accompanies a client to have an intravenous pyelogram (IVP). During the test, the client experiences angioedema. Suspecting an anaphylactic reaction, the nurse should implement which action first?a. Place O2 on the patient at 2LPM nasal cannulab. Notify the physicianc. Begin cardiopulmonary resuscitationd. Give 2 ampules of epinephrine IV Push

21. A client is several days post op after repair of an abdominal aortic aneurysm. The client’s vital signs include T 100degrees F, P 92, RR 18, BP 128/64. Blood gas results are: pH 7.35; HCO3 30 mEq/L; PCO2 50 mmHg; PO2 90 mmHg. Based on these assessment findings, which intervention by the nurse is appropriate?a. Start the client on 2LPM nasal cannulab. Have the client turn, deep-breathe and cough every 2 hoursc. Send a specimen of the patient’s sputum to the lab for analysisd. Obtain an order to give the client 1 ampule (50mEq) of Sodium Bicarbonate

22. A client with second-degree burns covering 40% of her body has a nursing diagnosis of “altered nutrition: less than body requirements related to lack of desire for food with constant pain and large burn area”. She enjoys all of the following foods. Which choices would be best to help the client regain nutritional balance?a. Steak and French friesb. Peanut butter an raisinsc. Orange juice and carrotsd. Corn and milk

23. A client who has been struck by a car is being ovesrved in the hospital for signs of injury. Present orders read; Vital signs q1h, NPO for 24 hours, Nasal O2 at 2LPM prn, Indwelling urine catheter to straight drainage if needed, D5/0.45NS at 100cc/hr, call physician for any signs ofshock or increased intracranial pressure. The nurse determines that the client is showing early signs of shock. Which action should the nurse take first?a. Call the physicianb. Start the oxygenc. Increase the intravenous fluid rated. Insert the urinary catheter

24. A client with increased intracranial pressure is receiving mannitol. To evaluate the effectiveness of this drug, the nurse should assess the client for which of the following?a. Decreased pulse rateb. Decreased systolic blood pressurec. Increased urine outputd. Increased pupillary reaction

25. A client is in acute renal failure. The nurse should assess the client carefully for which of the following potential complications a. Tetanyb. Hypernatremiac. Vascular collapsed. Cardiac arrythmias

26. A 36 year old client is brought to the hospital complaining of rapid heartbeat, diarrhea, dry mouth and shortness of breath. The client states “I feel like I am having a heart attack”. The immediate nursing action would be to:a. Assess the client’s physical and emotional stateb. Implement an anxiety-reducing activityc. Analyze what triggered the symptomsd. Explore her behavior and feelings

27. After the lungs, the kidneys work to maintain body pH. The best explanation of how the kidneys accomplish regulation of pH is that they:a. Secrete hydrogen ions and sodiumb. Secrete ammoniac. Exchange hydrogen and sodium in the kidney tubules.d. Decrease sodium ions, hold on to hydrogen ions and secrete sodium bicarbonate

28. A client admitted to the emergency room following a car accident complains of severe headache and demonstrates nuchal rigidity and Kernig’s sign. The nurse will assess for which complication?a. Subdural Hemorrhageb. Increased intracranial pressurec. Hypovolemic Shockd. Subarachnoid Hemorrhage

29. A 54 year old client with acute renal failure was put on Quinidine to prevent atrial fibrillation. The nurse knows this drug decreases myocardial excitability. When this medication is given in patients with kidney disease the nurse should:a. Call the physician to question the orderb. Administer the medication on timec. Measure the quinine level with the second dosed. Assess for severe hypotension

30. A 24 year old client is admitted to the hospital following an automobile accident. She was brought in unconscious with the following vital signs: BP 130/76, P 100, R 16, T 98F. The nurse observes bleeding from the client’s nose. Which of the following interventions should the nurse perform first?a. Obtain a culture of the specimen using sterile swabs and send to the laboratoryb. Allow the drainage to drip on a sterile gauze and observec. Gently suction the nose with a bulb syringe and send to the laboratoryd. Insert sterile packing into both nares and remove in 24 hours

31. Part of a plan of care for a patient with increased intracranial pressure is to maintain adequate airway and to promote gas exchange. To accomplish these goals, an effective nursing action is to:a. Encourage the client to cough vigorouslyb. Avoid hypercapnia in the patientc. Suction the client nasotracheally at frequent intervalsd. Keep the head of bed flat at all times

32. While on a camping trip a friend sustains a snake bite from a poisonous snake. The most effective initial intervention would be to:a. Place a restrictive band above the snake biteb. Elevate the bite area to the level of the heartc. Position the client in a supine positiond. Immobilize the affected limb

33. A young client hit by a car was fortunate because the level of his injury did not interrupt his respiratory function. The cord segments involved with maintaining respiratory function are:a. Thoracic level 5 and 6b. Thoracic level 2 and 3c. Cervical level 7and 8d. Cervical level 3 and 4

34. Following an accident, a client is admitted with a cervical spine injury. The physician will use crutchfield tongs to decompress the vertebral column. The nurse forms a plan of care that includes which intervention?a. Allow the client to sit up and move without twisting the spineb. Keep the head of the bed at a 45 degree angle at all times without lowering it during turningc. Logroll the patient lifting no more than 15 degrees elevation, avoiding twisting the spined. Maintain the client in the supine position rotating pillows to support the head, arms and feet

35. A 56 year old man has returned from the recovery room after having a tracheostomy and radical neck dissection for the treatment of laryngeal cancer. Which of the following interventions would have the highest priority in the development of the initial nursing care plan?a. Helping the patient to adapt to a new body imageb. Observing for complaints of painc. Obtaining a temperature every 4 hoursd. Measuring pulse every 2 hours

36. Patient teaching for a patient recovering from an acute anterior myocardial infarction would include which of the following discharge instructions regarding exercise?a. Begin with frequent short walksb. Engage in brisk aerobic walking three times per weekc. Eat before walking to provide needed energyd. Take a nitroglycerine tablet before walking

37. A client with CHF is being treated with furosemide 40mg bid and digoxin 0.25mg qd. Which of the following foods would be most helpful in preventing digoxin toxicity?a. Orange juiceb. Tuna fishc. Cottage cheesed. Green beans

38. When assessing a patients right forearm arteriovenous graft, the nurse notes that auscultation reveals a ‘swishing’ sound. Which of the following would the nurse undertake next?a. Proceed with preparations for hemodialysisb. Take the blood pressure readings on both arms and comparec. Notify the physician immediatelyd. Prepare the client for an angiogram

39. A client’s laboratory values show a hemoglobin of 7.9 and a hematocrit of 26.2. The nurse has orders to administer a two units of packed red blood cells for hemoglobin values less than 9.0. What should the nurse do first when preparing to give a blood transfusion before obtaining theblood?a. Recheck the written order for the transfusion in the patient record on the chartb. Explain the procedure to the patient and obtain written consent for blood productsc. Review the record for proper typing and crossmatching of the patientd. Contact the laboratory to ensure the proper blood is available

40. Which of the following interventions would enhance the communication skills of the patient who has expressive aphasia after a stroke?a. Speak loudly so the patient can hear and better understand youb. Supply the appropriate words quickly to avoid patient frustrationc. Calmly and gently correct vulgar or profane languaged. Offer pictures that open discussion and identify needs

41. A patient has been taking procainamide (Pronestyl) for three months to control atrial fibrillation. She states that she is starting to experience a facial rash, severe joint pain and fatigue. The nurse should instruct her to:a. Increase the dose according to preset guidelinesb. Take aspirin to relieve these symptoms while continuing the therapyc. Continue on the drug for two more weeks because these symptoms will subsided. Notify the physician immediately

42. The patient who has had an MI hopes to resume sexual intercourse. Which of the following would indicate that the patient understands the instructions given?a. “I should assume the top-lying position during intercourse”b. “I should substitute masturbation for foreplay and intercourse”c. “I should wait at least three hours after a meal before having intercourse”d. “I should avoid all sexual activity for at least three months after my heart attack”

43. When planning meals for a patient on hemodialysis, which of the following food selections made by the patient would the nurse consider to indicate patient understanding?a. Bananasb. Red meatsc. Legumesd. Apple juice

44. After teaching a patient about cardiac catheterization, the nurse assesses the patient’s level of understanding before the procedure. Which of the following patient statements indicate evidence of understanding the information about contrast medium injection?a. “I should expect shortness of breath and a slow heart rate”b. “I will expect some nausea and palpitations”c. “I would expect to have some itchy skin and might get lightheaded”d. “I might expect a cool clammy sensation”

45. When managing a kidney transplant patient, which of the following drugs would the nurse expect prescribed to prevent or minimize transplant rejection?a. Acyclovir (Zovirax)b. Cyclosporine (Cyclosporine A)c. Hydromorphone (Dilaudid)d. Megestrol (Megace)46. After a right middle lobe resection, the patient has a chest tube in place with continuous suction. The nurse enters the room and notices the water seal drainage chamber bubbling vigorously. Which of the following interventions would the nurse perform first?a. Decrease the suction level in the suction control chamberb. Call the doctorc. Check connections from the patient to the drainage systemd. Auscultate the lungs on the right side

47. A female client is admitted with a diagnosis of seizure disorder. The nurse enters the room and notices the client is exhibiting the tonic—clonic muscle activity common with a grand-mal seizure. A priority in protecting the client against injury during the seizure would be to:a. Restrain the armsb. Use a padded tongue blade between the teethc. Call for help to hold the client downd. Position the client in the sidelying position

48. While monitoring a client receiving a transfusion of a unit of AB- packed red blood cells, the nurse notes 2cm diameter welts on the patient’s chest and the patient is complaining of itching that started about 5 minutes into the transfusion. The client’s vitals signs are: T98.8, P 100, R 20,BP 116/64. Suspecting a hemolysis reaction, what should the nurse do first?a. Stop the transfusionb. Administer IV Benadrylc. Send a blood sample too the laboratory and fill out transfusion reaction formsd. Notify the physician

49. A 42 year old client has been diagnosed with a right-sided acoustic neuroma. The tumor is large and has impaired the function of the seventh and eighth cranial nerves. Which of the following nursing actions should be carried out to prevent complications?a. Keeping a suction machine availableb. Use of an eye patch or eye shield on the right eyec. Use of only cool water when washing the face or bathingd. Positioning the client in a high fowlers position

50. Following abdominal surgery, which of the following clinical manifestations will be indicative of negative nitrogen balance?a. Poor skin turgor from dehydrationb. Edema or ascites of the abdomen and flankc. Pale color to skind. Diarrhea

51. The nurse is assigned to care for eight clients. Two unlicensed assistive personnel are assigned to work with the nurse. Which statement is valid in this situation?a. The nurse may assign the two unlicensed personnel to work independently with a clientassignmentb. Then nurse is responsible to supervise the unlicensed personnelc. The unlicensed personnel are not responsible for their actionsd. Unlicensed personnel do not require training before working with clients

52. A patient is transferred to the intensive care after evacuation of a sub dural hematoma (SDH). Which nursing intervention would reduce the patient’s risk of increased ICP?a. Encourage oral fluid intake for rehydrationb. Orally and nasally suction the patient every four to eight hoursc. Elevate head of bed to ninety degrees to promote arterial flowd. Administer a stool softener as prescribed

53. After an MVA a patient is admitted to the medical surgical nursing unit with a cervical collar in place. The cervical spinal x-rays have not been read so the nurse does not know if the patient has a spinal cord injury. Until injury is ruled out, the nurse should restrict this patient to which position?a. Trendelenbergb. Supine with HOB at 30 degreesc. Flat except for log rolling as neededd. HOB elevated to 90 degrees to prevent cerebral edema

54. A patient is hospitalized with Guillain-Barre syndrome. Which nursing assessment finding is significant?a. Warm dry skinb. Urine output less than 40cc/hourc. Soft, non-distended abdomend. Even, unlabored respirations