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COMBINED NUR 215 FINAL EXAMS A+ GRADED 100% PASS GUARANTEED
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2024-2025 COMBINED NUR 215 FINAL EXAMS A+ GRADED100% PASS GUARANTEED
The staff nurse is precepting a new graduate nurse. The new graduate is assigned to
care for a client who has chronic pain. Which statement by the new graduate nurse
indicates the need for further teaching about the management of pain?
1. "I will make sure to ask my client what his level of pain is, on a scale of 0 to 10."
2."I know that I have to do a follow-up after the medication is given to guarantee the
efficiency of the medication."
3."I should be aware to catch any cue that would show the exaggeration of pain the
client is suggesting.
4."I understand that pain for the geriatric client can manifest as sleep disturbance or
depression." - ANSWER 3."I will be certain to pick up any cues that the client may be
exaggerating their pain."
The nurse is providing instruction to an assistive personnel (AP) on the appropriate
methods for obtaining an accurate temperature. Which method, if identified by the UAP
as a correct method, would need further instruction?
1. Taking a rectal temperature of a client who has undergone nasal surgery
2. Taking an oral temperature of a client who is coughing and experiencing nasal
congestion
3. Taking an axillary temperature of a client who has just consumed hot coffee
4. Getting an electronic temperature on the neck, behind the ear of a diaphoretic client -
ANSWER 2. Getting an oral temperature for a client with a cough and nasal congestion
The nurse is providing care for a postoperative client who is receiving demand-dose
hydromorphone via a patient-controlled analgesia (PCA) pump for pain. The nurse
enters the client's room and finds the client somnolent and records the following vital
signs: temperature 97.2° F (36.2° C) orally, pulse 52 beats per minute, blood pressure
,101/58 mm Hg, respiratory rate 11 breaths per minute, and SpO2 of 93% on 3 liters of
oxygen via nasal cannula. Which action should the nurse take next?
1.Document the findings.
2.Try to arouse the client.
3.Inform the PHCP immediately.
4.Compare the PCA pump medication administration history. - ANSWER 2.Arouse the
client.
The nurse is going to insert a nasogastric tube on a client. In which position should the
nurse place the client for the insertion?
1.Right side
2.Low-Fowler's
3.High-Fowler's
4.Supine with the head flat - ANSWER 3.High-Fowler's
The nurse is preparing to remove the client's nasogastric tube. The client is positioned
appropriately and the tube is flushed with 15 mL of air to aspirate secretions. Which
statement would be appropriate for the nurse to say while preparing to remove the
tube?
1."Take a deep breath when I tell you, and hold it while I remove the tube."
2."Take a deep breath when I tell you, and bear down while I remove the tube."
3."Take a deep breath when I tell you, and slowly exhale while I remove the tube."
4."Take a deep breath when I tell you, and breathe normally while I remove the tube."
ANS 1."Take a deep breath when I tell you, and hold it while I remove the tube."
The nurse has explained the preparation of an enema to the preoperative client. Which
client statement would indicate that this client needs additional teaching?
,1."The enema will be given while I am sitting on the toilet."
2."I should try and hold the fluid as long as possible after it is run in."
3."I do know that some cramping may occur after the solution has been run in."
4."I would have to notify the nurse if cramping occurs during the running of fluid."
-ANWER 1."Positioning would be such that the enema will be given while I am sitting on
the toilet".
A client is ordered to receive an oxygen delivery system to provide appropriate oxygen
concentration for the treatment of chronic obstructive pulmonary disease. Which
oxygen delivery system would the nurse plan for the client?
1_face tent
2_ Venturi mask
3_aerosol mask
4_tracheostomy collar - ANSWER 2.Venturi mask
A client who is mouth breathing is receiving oxygen by face mask. The assistive
personnel (AP) asks the registered nurse (RN) why a water bottle is attached to the
oxygen tubing near the wall oxygen outlet. The RN responds that this feature facilitates
which purpose?
1.Prevents the client from getting a nosebleed 2.Gives the client added fluid via the
respiratory tree
3.Humidifies the oxygen that is bypassing the client's nose
4.Prevents fluid loss from the lungs during mouth breathing - ANSWER 3.Humidifies the
oxygen that is bypassing the client's nose
The nurse is reinforcing instructions to a client regarding the use of an incentive
spirometer. The nurse asks the client to hold the inhaled breath for 3 seconds. The
client asks the nurse why this action is taken, and the nurse responds with which
identifies the major benefit?
, 1.Dilate the major bronchi.
2.Stimulate surfactant production.
3.Sustain inflation of the alveoli.
4.Enhance ciliary action in the tracheobronchial tree. - ANSWER 3.Prevent atelectasis,
or maintain inflation of the alveoli.
A patient with chronic obstructive pulmonary disease, COPD, is beginning oxygen
therapy and asks how to adjust the rate of oxygen administration. How should the nurse
reply to the patient?
1.Not more than 1 L/min.
2.Not more than 2 L/min.
3.Titrate the oxygen based on SpO2. 4.Titrate the oxygen based on respiratory rate. -
ANSWER 3.Titrate the oxygen based on SpO2.
The nurse is caring for a client with a diagnosis of emphysema who is receiving oxygen
via nasal cannula. The nurse assesses the oxygen flow rate utilized by the client and
finds that the client is receiving 2 L/min. The client's SpO2 is 86%. What action by the
nurse is appropriate based on this assessment?
1. Increase to 3 L/min and titrate until SpO2 reaches 95%.
2. Increase to 3 L/min and titrate until the SpO2 reaches 88%.
3. Put client on a non-rebreather mask on 100% FiO2.
4. Keep at 2 L/min and order respiratory therapy for a breathing treatment. - ANSWER 2.
Increase to 3 L/min and titrate until the SpO2 reaches 88%.
The nurse caring for an Orthodox Jewish client plans a diet that is consistent with the
client's religion. While planning the client's care, the nurse determines that the listed
practices and principles are consistent with dietary kosher laws. Select all those that
are congruent.
1. The mixing of meat and milk is permissible to eat together.
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