ASCORERS STUVIA
UNIT 2 EXAM NP 235 EXAM MULTIPLE CHOICE
QUESTIONS WITH CORRECT ANSWERS
ALREADY GRADED A+
Multiple Choice
1. A 3-month-old infant is at increased risk for developing anemia. The nurse would identify which principle contributing to this risk?
a. The infant is becoming more active.
b. There is an increase in intake of breast milk or formula.
c. The infant is unable to maintain an adequate iron intake.
d. A depletion of fetal hemoglobin occurs. ANS: d. A depletion of fetal hemoglobin occurs.
2. A 56-yr-old patient who has no previous history of hypertension or other health problems suddenly develops a blood pressure (BP) of 198/110 mm Hg. After reconfirming the BP, it is appropriate for the nurse to tell the patient that
a. a BP recheck should be scheduled in a few weeks.
b. dietary sodium and fat content should be decreased.
c. diagnosis, treatment, and ongoing monitoring will be needed.
d. there is an immediate danger of a stroke, requiring hospitalization. ANS: c. diagnosis, treatment, and ongoing monitoring will be needed. ASCORERS STUVIA
3. A 63-yr-old patient who began experiencing right arm and leg weakness is admitted to the emergency department. In which order will the nurse implement these actions included in the stroke protocol? Select all that apply.
a. Obtain CT scan without contrast.
b. Infuse tissue plasminogen activator (tPA).
c. Administer oxygen to keep O2 saturation >95%.
d. Use National Institute of Health Stroke Scale to assess patient. ANS: a. Obtain CT scan without contrast.
b. Infuse tissue plasminogen activator (tPA).
c. Administer oxygen to keep O2 saturation >95%.
d. Use National Institute of Health Stroke Scale to assess patient.
4. A 70-yr-old female patient with left-sided hemiparesis arrives by ambulance to the emergency department. Which action should the nurse take first?
a. Take the patient's blood pressure.
b. Check the respiratory rate and effort.
c. Assess the Glasgow Coma Scale score.
d. Send the patient for a computed tomography (CT) scan. ANS: b. Check the respiratory rate and effort.
5. A common parental reaction to a child with special needs is parental overprotection. Parental behavior suggestive of this includes:
a. Giving inconsistent discipline. ASCORERS STUVIA
b. Providing consistent, strict discipline.
c. Forcing child to help self, even when not capable.
d. Encouraging social and educational activities not appropriate to child's level of capability. ANS: a. Giving inconsistent discipline.
6. A diabetic patient who is hospitalized tells the nurse, "I don't understand why I can keep my blood sugar under control at home with diet alone, but when I get sick, my blood sugar goes up." Which response by the nurse is appropriate?
a. "It is probably just coincidental that your blood sugar is high when you are ill."
b. "Stressors such as illness cause the release of hormones that increase blood sugar."
c. "Increased blood sugar occurs because the kidneys are not able to metabolize glucose as well during stressful
times."
d. "Your diet is different here in the hospital than at home, and that is the most likely cause of the increased
glucose level." ANS: b. "Stressors such as illness cause the release of hormones that increase blood sugar."
7. A diabetic patient's arterial blood gas (ABG) results are pH 7.28; PaCO2 34 mm Hg; PaO2 85 mm Hg; HCO3- 18 mEq/L. The nurse would expect which finding?
a. Intercostal retractions b. Kussmaul respirations c. Low oxygen saturation (SpO2) ASCORERS STUVIA
d. Decreased venous O2 pressure ANS: b. Kussmaul respirations
8. A female patient who had a stroke 24 hours ago has expressive aphasia. An appropriate nursing intervention to help the patient communicate is to
a. ask questions that the patient can answer with "yes" or "no."
b. develop a list of words that the patient can read and practice reciting.
c. have the patient practice her facial and tongue exercises with a mirror.
d. prevent embarrassing the patient by answering for her if she does not respond. ANS: a. ask questions that the patient can answer with "yes" or "no."
9. A left-handed patient with left-sided hemiplegia has difficulty feeding himself. Which intervention should the nurse include in the plan of care?
a. Provide a wide variety of food choices.
b. Provide oral care before and after meals.
c. Assist the patient to eat with the right hand.
d. Teach the patient the "chin-tuck" technique. ANS: c. Assist the patient to eat with the right hand.
10. A male patient who has right-sided weakness after a stroke is making progress in learning to use the left hand for feeding and other activities. The nurse observes that when the patient's wife is visiting, she
feeds and dresses him. Which nursing diagnosis is most appropriate for the patient?
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