ECPI 164 exam 3 Questions and Answers 2024
A nurse receives information during shift report that a patient is afebrile. What action will the nurse take in response?
A. Checking the MAR for prescribed antipyretic medication
B. Reporting the finding to the primary care provider
C. Taking the pati...
A nurse receives information during shift report that a patient is afebrile. What action will
the nurse take in response?
A. Checking the MAR for prescribed antipyretic medication
B. Reporting the finding to the primary care provider
C. Taking the patient's temperature using a different method
D. No action is necessary; this is a normal reading - answerD. No action is necessary;
this is a normal reading
A nurse is assessing the vital signs of a group of patients in the emergency department.
Which patients require follow-up by the nurse? Select all that apply.
A. Infant whose temperature is 100.5°F (38.1°C)
B. Toddler whose blood pressure is 118/80
C. School-age child whose temperature is 102.2°F (39°C)
D. Adolescent whose pulse rate is 70 beats/min
E. Adult whose respiratory rate is 20 breaths/min
F. Older adult whose pulse rate is 42 beats/min - answerA. Infant whose temperature is
100.5°F (38.1°C),
D. Adolescent whose pulse rate is 70 beats/min
E. Adult whose respiratory rate is 20 breaths/min
F. Older adult whose pulse rate is 42 beats/min
A nurse is caring for a newborn with hypothermia. What action does the nurse take to
prevent heat loss from convection?
A. Wrapping the newborn in a blanket
B. Placing the newborn on a warmed surface
C. Reducing the temperature in the room
D. Increasing the temperature in the room - answerA. Wrapping the newborn in a
blanket
A charge nurse working on a medical-surgical unit stops the AP from taking rectal
temperatures on patients with which problems? Select all that apply.
A. Hypothermia
B. Pneumonia
C. Bradycardia
D. Leukemia
E. Thrombocytopenia
F. Pancreatitis - answerC. Bradycardia
, D. Leukemia
E. Thrombocytopenia
While taking an adult patient's pulse, a nurse obtains a heart rate of 140 beats/min.
What should the nurse do next?
A. Reassess the pulse in 1 hour
B. Measure the blood pressure
C. Document the information, noting tachycardia
D. Report the rate to the health care provider - answerD. Report the rate to the health
care provider
During assessment of vital signs, a patient reports severe abdominal pain. Which pain-
related changes in vital signs may be present? Select all that apply.
A. Pulse rate of 102
B. Body temperature 98.8°F
C. Blood pressure 154/86
D. Increased respiratory depth
E. Respiratory rate of 24
F. Body temperature 100.8°F - answerA. Pulse rate of 102,
C. Blood pressure 154/86,
E. Respiratory rate of 24
A nurse is caring for a group of patients on a cardiac unit. Which finding will prompt the
nurse to assess the apical-radial pulse?
A. Bounding radial pulse
B. Immediately postoperative
C. Rapid, irregular pulse
D. Fluid volume deficit - answerA. Bounding radial pulse
A nurse is assessing the blood pressure of a patient with traumatic injuries using a
Doppler device. Which information does the nurse expect to obtain?
A. Amplitude of the brachial pulse
B. Mean arterial blood pressure
C. Estimation of the systolic blood pressure
D. Apical-radial pulse rate - answerB. Mean arterial blood pressure
A nurse enters a room and finds a patient who is unable to catch their breath, has a
respiratory rate of 28, and is using accessory muscles to breathe. What intervention will
the nurse use to relieve dyspnea?
A. Remove pillows from under the head
B. Raise the head of the bed
C. Elevate the foot of the bed
D. Reassess the respiratory rate - answerB. raise the head of the bed
A nurse has assessed an older adult for orthostatic hypotension as shown in the
electronic health record (EHR). What action will the nurse take?
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