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Adult Health 2B Final Exam Practice Questions with Detailed Answers
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Adult Health 2B Final Exam PracticeQuestions with Detailed Answers
Two months ago, an adult client experienced a complete transection injury at
L4. The nurse plans a client education program in anticipation of the client's
discharge one week from now. The nurse would assign the highest priority to
teaching strategies for...
A. Managing dysreflexic episodes
B. transferring in and out of automobiles
C. maintaining bowel and bladder elimination
D. creating alternatives for sexual expression - -C. Since it is a complete
transection injury it will never get better. Maintaining bowel and bladder
elimination is priority. Dysreflexia is not of concern because that only occurs
when the injury is above T6.
-A client with Bell's palsy has all of the following problems. Which is of the
greatest immediate concern?
A. The client cannot close their eyes on the affected side
B. chewing on the unaffected side in difficult
C. The client has socially isolated themselves because of their appearance
D. the client shows early signs of muscle tone loss on the affected side - -A.
Corneal ablation can occur and lead to blindness that would be permanent.
All of the other's can occur but would be temporary and better once the
Bell's Palsy went away.
-A patient with Addison's disease comes to the emergency department with
complaints of nausea, vomiting, diarrhea, and fever. The nurse would expect
the physician to write an order for...
A. parenteral injection of ACTH
B. IV administration of vasopressors
C. IV administration of hydrocortisone
D. IV administration of D5W with 20 mEq KCl. - -C. For an addisonian crisis,
need to give steroids as quickly as possible. Giving ACTH would take the
body too long to make steroids. Next give fluids before giving vasopressors.
-The nurse is reviewing the orders for a client admitted to the hospital with a
gianosis of acute pancreatitis. Which interventions would the nurse expect to
be ordered for this client? Select all that apply.
A. Maintain NPO status
B. Encourage coughing and deep breathing
, C. Give small, frequent, high-calorie meals
D. Maintain the client in a supine and flat position
E. Give hydromorphone IV as prescribed for pain - -A, B, and E. Eating will
cause release of digestive enzymes thus more pain so don't want them to
eat. TCBD is good for any patient. They will likely want to be in fetal position,
there's no benefit of keeping them flat. Hydromorphone will help treat the
pain.
-A patient is diagnosed as having a bowel tumor. The nurse should monitor
the patient for which complications of this type of tumor? Select all that
apply.
A. Flatulence
B. Peritonitis
C. Hemorrhage
D. Fistula formation
E. Bowel perforation
F. Lactose intolerance - -B, C, D, and E. Flatulencne and lactose intolerance
are more GI disorders, no relation to obstruction. perforation if tumor
stretches out bowel wall, hemorrhage if tumor rupture through, fistula
formation and adhesions when tissue tries to heal itself, and peritonitis if
leakage of gastric contents.
-A nurse is caring for a client experiencing spinal shock after a spinal cord
injury. Which clinical manifestation indicates the resolution of spinal shock?
A. return of reflex activity
B. normalization of the pupillary reflex
C. return of bowel and bladder continence
D. tingling in the extremities below the lesion - -A. Spinal shock is a flaccid
paralysis, pupillary reflex should not be affected, we don't know if bowel or
bladder function was ever lost. Return of spinal reflexes shows that this is
better. Tingling may occur during the spinal shock, not necessarily indicative
it is better.
-Which assessment finding of a 42 year old patient who had a bilateral
adrenalectomy is the highest priority and requires rapid action by the nurse?
A. blood glucose is 176 mg/dL
B. lungs has bibasilar crackles
C. patient reports 5/10 incisional pain
D. Blood pressure is 86/50 mmHg - -D. this could mean patient is going into
hypovolemic shock or hemorrhaging, abnormal it would be so low after
receiving fluids in surgery. Pain after surgery is expected and high BG is
likely due to stress response. Crackles could be due to immobility and can be
cleared by TCDB.
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