NR 464 - Exam 4 questions with complete
solutions 2024
1. jThe jnurse jis jevaluating ja jpatient's jlaboratory jresults. jBased jupon jthe
jlaboratory jfindings, jwhat jresults jwill jcause jthe jrelease jof jan jantidiuretic
jhormone j(ADH)?
a. jIncreased jserum jsodium
b. jDecreased jserum jsodium
c. jDecrease jin jserum josmolality
d. jDecrease jin jthirst j- jANS✓✓-A
2. jYour jpatient jhas jalcoholism, jand jyou jmay jsuspect jduring jyour jassessment
jthat jhis jserum jmagnesium jis jlow. jWhat jwill jthe jnurse jpotentially jexpect jto
jassess jto jhypomagnesemia? j
a. jTremor
b. jPruritus j
c. jEdema
d. jDecreased jblood jpressure j- jANS✓✓-A
3. jA jnurse jsees ja jvariety jof jpatients jin jthe jcommunity jhealth jclinic. jWhich jof
jthe jfollowing jpatients jwould jbe jat jthe jgreatest jrisk jof jdehydration?
a. jAn j18 jyear jold jbasketball jplayer jwith ja jstress jfracture jof jthe jright jfoot j
b. jAn jinfant jwith jdiarrhea j
c. jA j45 jyear jold jwith jstomach jflu j
d. jAn jelderly jpatient jliving jalone j- jANS✓✓-B
4. jThe jnurse jis jcaring jfor ja jpost-thyroidectomy jpatient jat jrisk jfor
jhypocalcemia. jWhat jaction jshould jthe jnurse jtake jwhen jassessing jfor
jhypocalcemia?
a. jMonitor jlaboratory jdaily jfor jan jelevated jthyroid-stimulating jhormone j
b. jObserve jfor jswelling jof jthe jneck, jtracheal jdeviation jand jsevere jpain
c. jEvaluate jthe jquality jof jthe jpatient's jvoice jpostoperatively, jnoting jany jdrastic
jchanges j
,d. jObserve jfor jmuscle jtwitching jand jnumbness jor jtingling jof jthe jlips, jfingers
jand jtoes j- jANS✓✓-D
5. jThe jnurse jin jthe jintensive jcare junit jreceives jarterial jblood jgases j(ABG) jwith
ja jpatient jwho jis jcomplaining jof jbeing j"short jof jbreath." jThe jABG jhas jthe
jfollowing jvalues: jpH j= j7.21, jPaCO2 j= j64 jmmHg, jHCO3 j= j24 jmmHg. jThe jlabs
jreflect:
a. jRespiratory jacidosis j
b. jMetabolic jalkalosis j
c. jRespiratory jalkalosis j
d. jMetabolic jacidosis j- jANS✓✓-A
6. jA jnursing jintervention jto jassess jthe jhemodynamic jeffects jof jdysrhythmia jon
jthe jpatient jwould jbe jto:
a. jObtain jan jECG jrhythm jstrip
b. jObtain ja jblood jlevel jof jdrugs jadministered
c. jAssess jthe jpatients jlevel jof janxiety j
d. jAssess jthe jpatients jBP jand jpulse jrate j- jANS✓✓-D
7. jThe jtriage jnurse jnotes jupon jassessment jin jthe jemergency jroom jthat jthe
jpatient jwith janxiety jis jhyperventilating. jThe jnurse jis jaware jhat jhyperventilation
jis jthe jmost jcommon jcause jof jwhich jacid-base jimbalance?
a. jRespiratory jacidosis j
b. jRespiratory jalkalosis j
c. jIncrease jPaCO2
d. jCentral jnervous jsystem j(CNS) jdistubances j- jANS✓✓-B
8. jThe jnurse jcaring jfor ja jpatient jon jthe jtelemetry jfloor jwho jis jexperiencing
jsymptomatic jsinus jbradycardia jis jaware jthe jmedication jof jchoice jfor jtreatment
jof jthis jdysthymia jis jatropine. jWhat jguidelines jwill jthe jnurse jfollowing jwhen
jadministering jatropine?
a. jAdminister jatropine j0.5 jmg jrapidly jas jan jIV jbolus jevery j3-5 jminutes jto ja
jmaximum jtotal jdose jof j3 jmg
b. jAdminister jatropine j0.5 jmg jslowly jas jan jIV jbolus jevery jminute jto ja
jmaximum jtotal jdose jof j3 jmg
, c. jAdminister jatropine j1.0 jmg jrapidly jas jan jIV jbolus jevery j3-5 jminutes jto ja
jmaximum jtotal jdose jof j3 jmg
d. jAdminister jatropine j1.0 jmg jslowly jas jan jIV jbolus jevery jminute jto ja
jmaximum jtotal jdose jof j3 jmg j- jANS✓✓-A
9. jThe jnurse jcaring jfor ja jpatient jin jthe jcritical jcare junit jwho jhas ja jcentral
jvenous jpressure j(CVP) jmonitoring jsystem jnotes jthat jthe jpatient's jCVP jis
jincreasing jand jis jaware jthat jthis jincreased jpressure jmay jbe jindicative jof:
a. jHypovolemia
b. jHypervolemia
c. jHypermagnesemia j
d. jHypomagnesemia j- jANS✓✓-B
10. jThe jnurse jis jaware jthat jteaching jrelated jto jthe jprevention jof jHIV jshould
jfocus jon:
a. jVaccinating jall jindividual jto jdecrease jtheir jrisk jof jcontracting jHIV j
b. jProviding jeducational jprograms jthat jfocus jon jcontrol jand jprevention j
c. jInstructing jsexually jactive jindividuals jon jthe jproper jusage jof jnon-latex
jcondoms
d. jInstructing jsexually jactive jindividuals jon jthe juse jof jmicrobicide, jnonoxynol-
9 j(N-9) j- jANS✓✓-B
11. jA j20 jyear jold jwoman jinfected jwith jHIV jis jseen jin jan joutreach jclinic
jsymptoms jassociated jwith jher jdisease. jThe jpatient jis ja jknown jIV jdrug juser
jand jhas jadmitted jto jseveral jsexual jpartners jin jthe jlast jyear. jWhich jof jthe
jfollowing jstatements jwould jindicate jthat jthe jpatient junderstands jthe jrisk
jfactors jrelated jto jHIV?
a. j"I jshould jnot jshare jcigarettes jwith jpeople" j
b. j"I jcan juse ja jcondom jlubricated jwith jpetroleum jjelly jfor jsexual jintercourse"
c. j"I jcan jhave junprotected joral jsex"
d. j"If jI jbecome jpregnant, jI jcould jpass jthe jvirus jto jmy junborn jchild" j- jANS✓✓-
D
12. jWhich jnursing jintervention jtakes jhighest jpriority jfor jthe jnurse jcaring jfor jan
junconscious jpatient? j
solutions 2024
1. jThe jnurse jis jevaluating ja jpatient's jlaboratory jresults. jBased jupon jthe
jlaboratory jfindings, jwhat jresults jwill jcause jthe jrelease jof jan jantidiuretic
jhormone j(ADH)?
a. jIncreased jserum jsodium
b. jDecreased jserum jsodium
c. jDecrease jin jserum josmolality
d. jDecrease jin jthirst j- jANS✓✓-A
2. jYour jpatient jhas jalcoholism, jand jyou jmay jsuspect jduring jyour jassessment
jthat jhis jserum jmagnesium jis jlow. jWhat jwill jthe jnurse jpotentially jexpect jto
jassess jto jhypomagnesemia? j
a. jTremor
b. jPruritus j
c. jEdema
d. jDecreased jblood jpressure j- jANS✓✓-A
3. jA jnurse jsees ja jvariety jof jpatients jin jthe jcommunity jhealth jclinic. jWhich jof
jthe jfollowing jpatients jwould jbe jat jthe jgreatest jrisk jof jdehydration?
a. jAn j18 jyear jold jbasketball jplayer jwith ja jstress jfracture jof jthe jright jfoot j
b. jAn jinfant jwith jdiarrhea j
c. jA j45 jyear jold jwith jstomach jflu j
d. jAn jelderly jpatient jliving jalone j- jANS✓✓-B
4. jThe jnurse jis jcaring jfor ja jpost-thyroidectomy jpatient jat jrisk jfor
jhypocalcemia. jWhat jaction jshould jthe jnurse jtake jwhen jassessing jfor
jhypocalcemia?
a. jMonitor jlaboratory jdaily jfor jan jelevated jthyroid-stimulating jhormone j
b. jObserve jfor jswelling jof jthe jneck, jtracheal jdeviation jand jsevere jpain
c. jEvaluate jthe jquality jof jthe jpatient's jvoice jpostoperatively, jnoting jany jdrastic
jchanges j
,d. jObserve jfor jmuscle jtwitching jand jnumbness jor jtingling jof jthe jlips, jfingers
jand jtoes j- jANS✓✓-D
5. jThe jnurse jin jthe jintensive jcare junit jreceives jarterial jblood jgases j(ABG) jwith
ja jpatient jwho jis jcomplaining jof jbeing j"short jof jbreath." jThe jABG jhas jthe
jfollowing jvalues: jpH j= j7.21, jPaCO2 j= j64 jmmHg, jHCO3 j= j24 jmmHg. jThe jlabs
jreflect:
a. jRespiratory jacidosis j
b. jMetabolic jalkalosis j
c. jRespiratory jalkalosis j
d. jMetabolic jacidosis j- jANS✓✓-A
6. jA jnursing jintervention jto jassess jthe jhemodynamic jeffects jof jdysrhythmia jon
jthe jpatient jwould jbe jto:
a. jObtain jan jECG jrhythm jstrip
b. jObtain ja jblood jlevel jof jdrugs jadministered
c. jAssess jthe jpatients jlevel jof janxiety j
d. jAssess jthe jpatients jBP jand jpulse jrate j- jANS✓✓-D
7. jThe jtriage jnurse jnotes jupon jassessment jin jthe jemergency jroom jthat jthe
jpatient jwith janxiety jis jhyperventilating. jThe jnurse jis jaware jhat jhyperventilation
jis jthe jmost jcommon jcause jof jwhich jacid-base jimbalance?
a. jRespiratory jacidosis j
b. jRespiratory jalkalosis j
c. jIncrease jPaCO2
d. jCentral jnervous jsystem j(CNS) jdistubances j- jANS✓✓-B
8. jThe jnurse jcaring jfor ja jpatient jon jthe jtelemetry jfloor jwho jis jexperiencing
jsymptomatic jsinus jbradycardia jis jaware jthe jmedication jof jchoice jfor jtreatment
jof jthis jdysthymia jis jatropine. jWhat jguidelines jwill jthe jnurse jfollowing jwhen
jadministering jatropine?
a. jAdminister jatropine j0.5 jmg jrapidly jas jan jIV jbolus jevery j3-5 jminutes jto ja
jmaximum jtotal jdose jof j3 jmg
b. jAdminister jatropine j0.5 jmg jslowly jas jan jIV jbolus jevery jminute jto ja
jmaximum jtotal jdose jof j3 jmg
, c. jAdminister jatropine j1.0 jmg jrapidly jas jan jIV jbolus jevery j3-5 jminutes jto ja
jmaximum jtotal jdose jof j3 jmg
d. jAdminister jatropine j1.0 jmg jslowly jas jan jIV jbolus jevery jminute jto ja
jmaximum jtotal jdose jof j3 jmg j- jANS✓✓-A
9. jThe jnurse jcaring jfor ja jpatient jin jthe jcritical jcare junit jwho jhas ja jcentral
jvenous jpressure j(CVP) jmonitoring jsystem jnotes jthat jthe jpatient's jCVP jis
jincreasing jand jis jaware jthat jthis jincreased jpressure jmay jbe jindicative jof:
a. jHypovolemia
b. jHypervolemia
c. jHypermagnesemia j
d. jHypomagnesemia j- jANS✓✓-B
10. jThe jnurse jis jaware jthat jteaching jrelated jto jthe jprevention jof jHIV jshould
jfocus jon:
a. jVaccinating jall jindividual jto jdecrease jtheir jrisk jof jcontracting jHIV j
b. jProviding jeducational jprograms jthat jfocus jon jcontrol jand jprevention j
c. jInstructing jsexually jactive jindividuals jon jthe jproper jusage jof jnon-latex
jcondoms
d. jInstructing jsexually jactive jindividuals jon jthe juse jof jmicrobicide, jnonoxynol-
9 j(N-9) j- jANS✓✓-B
11. jA j20 jyear jold jwoman jinfected jwith jHIV jis jseen jin jan joutreach jclinic
jsymptoms jassociated jwith jher jdisease. jThe jpatient jis ja jknown jIV jdrug juser
jand jhas jadmitted jto jseveral jsexual jpartners jin jthe jlast jyear. jWhich jof jthe
jfollowing jstatements jwould jindicate jthat jthe jpatient junderstands jthe jrisk
jfactors jrelated jto jHIV?
a. j"I jshould jnot jshare jcigarettes jwith jpeople" j
b. j"I jcan juse ja jcondom jlubricated jwith jpetroleum jjelly jfor jsexual jintercourse"
c. j"I jcan jhave junprotected joral jsex"
d. j"If jI jbecome jpregnant, jI jcould jpass jthe jvirus jto jmy junborn jchild" j- jANS✓✓-
D
12. jWhich jnursing jintervention jtakes jhighest jpriority jfor jthe jnurse jcaring jfor jan
junconscious jpatient? j
