Exam (elaborations)
RNPEDIA; PNLE NP1 TEST 1 QUESTIONS AND ANSWERS
RNPEDIA; PNLE NP1 TEST 1 QUESTIONS AND ANSWERS
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RNPEDIA; PNLE NP1 TEST 1
QUESTIONS AND ANSWERS
1. jThe jnurse jIn-charge jin jlabor jand jdelivery junit jadministered ja jdose jof jterbutaline jto
ja jclient jwithout jchecking jthe jclient's jpulse. jThe jstandard jthat jwould jbe jused jto
jdetermine jif jthe jnurse jwas jnegligent jis:
A. jThe jphysician's jorders.
B. jThe jaction jof ja jclinical jnurse jspecialist jwho jis jrecognized jexpert jin jthe jfield.
C. jThe jstatement jin jthe jdrug jliterature jabout jadministration jof jterbutaline.
D. jThe jactions jof ja jreasonably jprudent jnurse jwith jsimilar jeducation jand jexperience. j-
j✔✔Answer: j(D) jThe jactions jof ja jreasonably jprudent jnurse jwith jsimilar jeducation jand
jexperience. j
The jstandard jof jcare jis jdetermined jby jthe javerage jdegree jof jskill, jcare, jand jdiligence
jby jnurses jin jsimilar jcircumstances.
2. jNurse jTrish jis jcaring jfor ja jfemale jclient jwith ja jhistory jof jGI jbleeding, jsickle jcell
jdisease, jand ja jplatelet jcount jof j22,000/μl. jThe jfemale jclient jis jdehydrated jand
jreceiving jdextrose j5% jin jhalf-normal jsaline jsolution jat j150 jml/hr. jThe jclient jcomplains
jof jsevere jbone jpain jand jis jscheduled jto jreceive ja jdose jof jmorphine jsulfate. jIn
jadministering jthe jmedication, jNurse jTrish jshould javoid jwhich jroute?
A. jI.V
B. jI.M
C. jOral
D. jS.C j- j✔✔Answer: j(B) jI.M. j
With ja jplatelet jcount jof j22,000/μl, jthe jclients jtends jto jbleed jeasily. jTherefore, jthe
jnurse jshould javoid jusing jthe jI.M. jroute jbecause jthe jarea jis ja jhighly jvascular jand jcan
jbleed jreadily jwhen jpenetrated jby ja jneedle. jThe jbleeding jcan jbe jdifficult jto jstop.
3. jDr. jGarcia jwrites jthe jfollowing jorder jfor jthe jclient jwho jhas jbeen jrecently jadmitted
j"Digoxin j.125 jmg jP.O. jonce jdaily." jTo jprevent ja jdosage jerror, jhow jshould jthe jnurse
jdocument jthis jorder jonto jthe jmedication jadministration jrecord?
A. j"Digoxin j.1250 jmg jP.O. jonce jdaily"
B. j"Digoxin j0.1250 jmg jP.O. jonce jdaily"
C. j"Digoxin j0.125 jmg jP.O. jonce jdaily"
D. j"Digoxin j.125 jmg jP.O. jonce jdaily" j- j✔✔Answer: j(C) j"Digoxin j0.125 jmg jP.O. jonce
jdaily" j
,The jnurse jshould jalways jplace ja jzero jbefore ja jdecimal jpoint jso jthat jno jone jmisreads
jthe jfigure, jwhich jcould jresult jin ja jdosage jerror. jThe jnurse jshould jnever jinsert ja jzero
jat jthe jend jof ja jdosage jthat jincludes ja jdecimal jpoint jbecause jthis jcould jbe jmisread,
jpossibly jleading jto ja jtenfold jincrease jin jthe jdosage.
4. jA jnewly jadmitted jfemale jclient jwas jdiagnosed jwith jdeep jvein jthrombosis. jWhich
jnursing jdiagnosis jshould jreceive jthe jhighest jpriority?
A. jIneffective jperipheral jtissue jperfusion jrelated jto jvenous jcongestion.
B. jRisk jfor jinjury jrelated jto jedema.
C. jExcess jfluid jvolume jrelated jto jperipheral jvascular jdisease.
D. jImpaired jgas jexchange jrelated jto jincreased jblood jflow. j- j✔✔Answer: j(A)
jIneffective jperipheral jtissue jperfusion jrelated jto jvenous jcongestion. j
Ineffective jperipheral jtissue jperfusion jrelated jto jvenous jcongestion jtakes jthe jhighest
jpriority jbecause jvenous jinflammation jand jclot jformation jimpede jblood jflow jin ja jclient
jwith jdeep jvein jthrombosis.
5. jNurse jBetty jis jassigned jto jthe jfollowing jclients. jThe jclient jthat jthe jnurse jwould jsee
jfirst jafter jendorsement?
A. jA j34-year-old jpost joperative jappendectomy jclient jof jfive jhours jwho jis jcomplaining
jof jpain.
B. jA j44-year-old jmyocardial jinfarction j(MI) jclient jwho jis jcomplaining jof jnausea.
C. jA j26-year-old jclient jadmitted jfor jdehydration jwhose jintravenous j(IV) jhas jinfiltrated.
D. jA j63-year-old jpost joperative's jabdominal jhysterectomy jclient jof jthree jdays jwhose
jincisional jdressing jis jsaturated jwith jserosanguinous jfluid. j- j✔✔Answer: j(B) jA j44 jyear-
old jmyocardial jinfarction j(MI) jclient jwho jis jcomplaining jof jnausea. j
Nausea jis ja jsymptom jof jimpending jmyocardial jinfarction j(MI) jand jshould jbe jassessed
jimmediately jso jthat jtreatment jcan jbe jinstituted jand jfurther jdamage jto jthe jheart jis
javoided.
6. jNurse jGail jplaces ja jclient jin ja jfour-point jrestraint jfollowing jorders jfrom jthe
jphysician. jThe jclient jcare jplan jshould jinclude:
A. jAssess jtemperature jfrequently.
B. jProvide jdiversional jactivities.
C. jCheck jcirculation jevery j15-30 jminutes.
D. jSocialize jwith jother jpatients jonce ja jshift. j- j✔✔Answer: j(C) jCheck jcirculation jevery
j15-30 jminutes. j
Restraints jencircle jthe jlimbs, jwhich jplace jthe jclient jat jrisk jfor jcirculation jbeing
jrestricted jto jthe jdistal jareas jof jthe jextremities. jChecking jthe jclient's jcirculation jevery
j15-30 jminutes jwill jallow jthe jnurse jto jadjust jthe jrestraints jbefore jinjury jfrom
jdecreased jblood jflow joccurs.
7. jA jmale jclient jwho jhas jsevere jburns jis jreceiving jH2 jreceptor jantagonist jtherapy.
jThe jnurse jIn-charge jknows jthe jpurpose jof jthis jtherapy jis jto:
, A. jPrevent jstress julcer
B. jBlock jprostaglandin jsynthesis
C. jFacilitate jprotein jsynthesis.
D. jEnhance jgas jexchange j- j✔✔Answer: j(A) jPrevent jstress julcer. j
Curling's julcer joccurs jas ja jgeneralized jstress jresponse jin jburn jpatients. jThis jresults
jin ja jdecreased jproduction jof jmucus jand jincreased jsecretion jof jgastric jacid. jThe jbest
jtreatment jfor jthis jprophylactic juse jof jantacids jand jH2 jreceptor jblockers.
8. jThe jdoctor jorders jhourly jurine joutput jmeasurement jfor ja jpostoperative jmale jclient.
jThe jnurse jTrish jrecords jthe jfollowing jamounts jof joutput jfor j2 jconsecutive jhours: j8
ja.m.: j50 jml; j9 ja.m.: j60 jml. jBased jon jthese jamounts, jwhich jaction jshould jthe jnurse
jtake?
A. jIncrease jthe jI.V. jfluid jinfusion jrate
B. jIrrigate jthe jindwelling jurinary jcatheter
C. jNotify jthe jphysician
D. jContinue jto jmonitor jand jrecord jhourly jurine joutput j- j✔✔Answer: j(D) jContinue jto
jmonitor jand jrecord jhourly jurine joutput. j
Normal jurine joutput jfor jan jadult jis japproximately j1 jml/minute j(60 jml/hour). jTherefore,
jthis jclient's joutput jis jnormal. jBeyond jcontinued jevaluation, jno jnursing jaction jis
jwarranted.
9. jTony, ja jbasketball jplayer jtwist jhis jright jankle jwhile jplaying jon jthe jcourt jand jseeks
jcare jfor jankle jpain jand jswelling. jAfter jthe jnurse japplies jice jto jthe jankle jfor j30
jminutes, jwhich jstatement jby jTony jsuggests jthat jice japplication jhas jbeen jeffective?
A. j"My jankle jlooks jless jswollen jnow".
B. j"My jankle jfeels jwarm".
C. j"My jankle jappears jredder jnow".
D. j"I jneed jsomething jstronger jfor jpain jrelief" j- j✔✔Answer: j(A) j"My jankle jlooks jless
jswollen jnow"
Ice japplication jdecreases jpain jand jswelling. jContinued jor jincreased jpain, jredness,
jand jincreased jwarmth jare jsigns jof jinflammation jthat jshouldn't joccur jafter jice
japplication
10. jThe jphysician jprescribes ja jloop jdiuretic jfor ja jclient. jWhen jadministering jthis jdrug,
jthe jnurse janticipates jthat jthe jclient jmay jdevelop jwhich jelectrolyte jimbalance?
A. jHypernatremia
B. jHyperkalemia
C. jHypokalemia
D. jHypervolemia j- j✔✔Answer: j(B) jHyperkalemia. j
A jloop jdiuretic jremoves jwater jand, jalong jwith jit, jsodium jand jpotassium. jThis jmay
jresult jin jhypokalemia, jhypovolemia, jand jhyponatremia.