midterm medsurg IV Questions 2024 With Correct Answers Following a stroke, a patient is experiencing expressive aphasia. Which n ursing intervention is most helpful in promoting communication? A. Writing directions so the patient can read them. B. Speaking in short sentences to the patient. C. Speaking loudly to the patient. D. Using a "picture board" so the patient can point to pictures. - right answer --D. Using a "picture board" so the patient can point to pictures. The arterial blood gases (ABGs) listed below represent which of the following acid -base imbalances? pH 7.19 paCO2 69 mmHg HCO3 23 mEq/L paO2 46 mmHg A. Compensate d Metabolic Alkalosis. B. Uncompensated Respiratory Acidosis. C. Compensated Respiratory Acidosis. D. Uncompensated Respiratory Alkalosis. - right answer --B. Uncompensated Respiratory acidosis. Which clinical manifestation is the nurse likely to see in a patient with third -degree AV (complete) heart block with a ventricular rate of 38 bpm? A. Tachycardia. B. Hemiparesis. C. Syncope. D Headache. - right answer --C. syncope A patient who is oral ly intubated and mechanically ventilated has a nursing diagnosis of "Risk for Aspiration related to Artificial Airway". Which nursing interventions are appropriate to decrease the risk for aspiration in this patient? (Select all that apply). *EPE* A. Ele vate head of bed to at least 30 degrees. B. Ensure proper endotracheal tube cuff inflation. C. Clear ventilator tubing of water condensation. D. Assess for presence of gag reflex. E. Provide oropharyngeal suctioning every hour. - right answer --A. Eleva te head of bed to at least 30 degrees. B. Ensure proper endotracheal tube cuff inflation. E. Provide oropharyngeal suctioning every hour. A patient is admitted with an acute anterior wall myocardial infarction (MI). While the nurse is preparing the pati ent for transport to the cardiac catheterization lab, the patient becomes unresponsive and the monitor shows the following rhythm: High quality CPR is started, followed by defibrillation with 200 joules, and epinephrine is administered. Which anti -arrhyth mic drug may be considered to help treat this rhythm if defibrillation and epinephrine remain ineffective? A. Epinephrine (Adrenalin). B. Amiodarone (Cordarone). C. Adenosine (AdenoCard). D. Atropine sulfate (Atropine). - right answer --B. Amiodarone ( Cordarone.) The nursing management plan for a patient with full -thickness burns includes which intervention? A. Surgical skin graf B. Daily wound care with premedication C. Weekly wound care until all eschar is debrided D. Daily replacement of autografts - right answer --B. Daily wound care with premedication When caring for a patient who has Guillain -Barré syndrome (GBS), which assessment data obtained by the nurse will require the most immediate action? A. The patients quadriceps and triceps reflexes are absent B. The patient c/o severe tingling pain in feet C. The patient's bp is 100/50 mmHg. D. The patient has continuous drooling of saliva - right answer --D. The patient has continuous drooling of saliva Intrapulmona ry shunt is a diagnosis on a mechanically ventilated patient with acute respiratory distress syndrome (ARDS). The nurse would expect which of the following conditions? A. Clear chest x -ray. B. Refractory hypoxemia. C. Metabolic acidosis. D. Refractory h ypercapnia. - right answer --B. Refractory hypoxemia A patient is admitted with traumatic brain injury to the intensive care unit. Which nursing measure(s) will help control intracranial pressure (ICP)? (Select all that apply) A. Reposition patient from s ide-to-side every hour. B. Decrease environmental stimuli. C. Perform neurological assessment with noxious stimuli every hour. D. Maintain patient's head in a neutral position. - right answer --B. Decrease environmental stimuli. D. Maintain patient's head in a neutral position. A client diagnosed with acute ischemic stroke is a candidate for thrombolytic therapy. The client is to receive a total of 0.9 mg/kg of Activase (alteplase), a tissue plasminogen activator (tPA), intraveno usly. Ten percent (10%) of the dose is to be delivered as a bolus. The client weighs 152 pounds. The dose is supplied as 90 mg in 100 mL normal saline solution. How many milliliters (mL) of tPA will the nurse administer for the bolus dose? Enter a numeri c value only. Do not include units of measurement. Round the answer to the first decimal place. - right answer --6.9 A patient with a T1 spinal cord injury is admitted to the intensive care unit. What will the nurse will teach the patient and family about functional ability? A. Elevations in the HR are common B. Full function of the patient's arms will be retained C. Only use of the shoulders will be preserved D. Loss of respiratory function may occur temporarily - right answer --B. Full function of the pa tient's arms will be retained A 73-year-old patient with a stroke experiences facial drooping on the right side and right-sided arm and leg paralysis. When admitting the patient, which clinical manifestation will the nurse expect to find? A. Right -sided neglect B. Difficulty comprehending instructions C. Impulsive behavior D. Hyperactive left -sided tendon reflexes - right answer --B. Difficulty comprehending instructions What is the most important modifiable risk factor to overall stroke prevention? A. Controlling hypertension B. Preventing AFIB C. Smoking cessation D. Managing diabetes - right answer --A. Controlling hypertension The nurse interprets which of the following clinical manifestations as an EARLY sign of acute respiratory distress syndro me (ARDS) in a patient?
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