Nursing 120 final exam 2024 (100% Accurate Answers)
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Course
Nursing 120
Institution
Nursing 120
A nurse answers a call light and finds the client anxious, short of breath, and reporting chest pain. The client states it's a stabbing pain". What action by the nurse takes priority?
A.
Take a full set of vital signs and document
B.
Reassure the patient that the appropriate measures will be ta...
Nursing 120 final exam 2024 (100% Accurate Answers)
A nurse answers a call light and finds the client anxious, short of breath, and reporting chest pain. The client states it's a stabbing pain". What action by the nurse takes priority?
A.
Take a full set of vital signs and document
B.
Reassure the patient that the appropriate measures will be taken
C.
Notify the rapid response team
D.
Listen to the patient's breath sounds correct answers C. Notify the rapid response team
The MD order states: Administer 50mg of Metoprolol PO
Available: Metoprolol 100mg/tab
How many tablets will the nurse administer?
A.
0.5 tab
B.
1 tab
C.
1.5 tabs
D.
2 tabs correct answers A. 0.5 tabs
The nurse is providing nutritional education to a client with a new diagnosis of heart failure (HF). What will the nurse be sure to include in her teaching?
A.
"Take a salt supplement in order to keep your sodium (N+) level normal"
B.
"Be sure and add any salt flavoring to food while it is cooking"
C.
"You will need to strictly limit your salt intake"
D.
"You can have all the salt you want, as long as you are voiding regularly" correct answers C. "You will need to strictly limit your salt intake"
The MD order states: Administer 1000ml of NS IV over 20 hours
What will the nurse set as the pump infusion rate?
A.
65 mL/hr
B.
50 mL/hr
C.
120 mL/hr D.
70 mL/hr correct answers B. 50 mL/hr
The nurse knows that which client is at the highest risk for developing varicose veins?
A.
The 30 y/o male who works in construction
B.
The 55 y/o retired female who is considering hormone replacement
C.
A 25 y/o male who works out 6 times a week
D.
The 42 y/o overweight female who works standing in retail sales correct answers D. The 42 y/o overweight female who works standing in retail sales
The nursing student is caring for a client with peripheral vascular disease (PVD). When speaking
with the student, the nursing instructor asks him/her to explain the difference between arterial and venous insufficiency. The student nurse would be correct in stating that:
A.
Arterial insufficiency causes bounding pulses while venous insufficiency causes absent pulses
B.
Venous insufficiency causes congestion and blood stasis while arterial insufficiency can lead to ischemic ulcers and gangrene
C.
Venous insufficiency is characterized by pain with activity
D.
Arterial insufficiency is caused by varicose veins and blood clots correct answers B. Venous insufficiency causes congestion and blood stasis while arterial insufficiency can lead to ischemic ulcers and gangrene
The student nurse correctly identifies the different types of heart failure as which of the following:
A.
Multi-system, Hypovolemic, and Right-sided
B.
Left-sided, High Output, and Multi-system
C.
High output, Left-sided, and Right-sided
D.
Right-sided, Left-sided, and Hypovolemic correct answers C. High output, Left-sided, and Right-sided
A nurse is assessing a client who has just arrived to the emergency department. During the assessment, she notes pulmonary crackles, anxiety and restlessness, and cough. Which diagnosis would she expect to see?
A.
Left- sided Heart Failure B.
Digitalis Toxicity
C.
Right- sided Heart Failure
D.
Hypertensive Crisis correct answers A. Left- sided Heart Failure
A nurse is caring for a client with right-sided heart failure who is complaining about having to weigh every day. How should the nurse respond?
A.
"Daily weights allow us to adequately monitor edema in your extremities"
B.
"You will need to lose weight to decrease the incidence of heart failure"
C.
"Daily weights allow us to monitor whether or not you are eating properly"
D.
"Daily weights allow us to monitor whether or not you are gaining or losing fluid" correct answers D. "Daily weights allow us to monitor whether or not you are gaining or losing fluid"
The nurse is caring for a client diagnosed with primary hypertension (HTN). What risk factors contribute to primary HTN? Select all that apply
A.
Smoking
B.
Kidney Disease
C.
African American
D.
High Caffeine Consumption correct answers A.
Smoking
C.
African American
D.
High Caffeine Consumption
What is the most common site of origin for a blood clot to occur, causing a pulmonary embolism
(PE)?
A.
Antecubital vein in the upper extremities
B.
Right side of the heart
C.
Subclavian veins
D. Deep veins of the legs and pelvis correct answers D.
Deep veins of the legs and pelvis
The nurse is caring for four hypertensive patients. Which drug-laboratory value combination should the nurse report immediately to the health care provider?
A.
Hydrochlorothiazide (Hydrodiuril); Potassium: 4.2 mEq/L
B.
Atenolol (Tenormin); Sodium: 142 mEq/L
C.
Spironolactone (Aldactone); Potassium: 3.4 mEq/L
D.
Furosemide (Lasix); Potassium: 2.1 mEq/L correct answers D. Furosemide (Lasix); Potassium: 2.1 mEq/L
During post-op care of a client who had an arterial revascularization, the nurse assesses the client's affected extremity. The nurse notes that the affected extremity is warm to touch, has redness, and some edema. The nurse's next action should include:
A.
Continue to monitor the site as ordered as this is an expected finding
B.
Place a compression stocking on the operative leg
C.
Notify the doctor immediately (STAT), as this is a medical emergency
D.
Wrap the affected extremity with gauze correct answers A.
Continue to monitor the site as ordered as this is an expected finding
The MD order states: Administer 250mg Ampicillin PO every 6 hours at 0600, 1200, 1800, and 2400"
Available: Ampicillin 125 mg/tab
How many total tablets will the patient receive over 24 hours?
A.
4 tablets
B.
2 tablets
C.
6 tablets
D.
8 tablets correct answers D. 8 tablets
The nurse is evaluating the blood pressure of a 75-year-old woman. Based on current research, which finding is the best indicator of heart disease risk for this client?
A.
Blood pressure of 138/68 mm Hg
B.
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