NURS 171 UNIT 3 EXAM REVIEW
Which are examples of health behaviors that affect overall status of health? - Answers-
Tobacco use
Sedentary lifestyle
Use of recreational drugs
Which dietary changes should the nurse instruct a client with hypertension to make to
control electrolyte and fluid balance? - Answers- Limit sodium intake
Increase calcium intake - prevent osteoporosis and maintain serum Ca/P levels
Increase potassium consumption
An unlicensed assistive personnel (UAP) could be safely entrusted to perform which
type of suctioning? - Answers- Oral cavity suctioning
Turn, cough, deep breath, use of an incentive spriometer and early ambulation are ways
to prevent the post-op complications of atelectasis and pneumonia - Answers- true
The nurse finds the client sitting upright and leaning on her arms or elbows, and
documents: - Answers- The client has assumed the tripod position
The nurse is choosing a suction catheter for a client with a 6 mm tracheostomy tube in
place. What size suction catheter would be the largest possible choice? - Answers- 12
French
When documenting that the client's water seal is fluctuating up and down with each
inspiration and expiration, the nurse uses the proper term, which is - Answers- Tidaling
The nasal cannula can deliver __________liters of oxygen per minute - Answers- 2 - 6
liters/min
Your patient has a chest tube. The chest tube drainage system contain three chambers.
Which of the following is NOT a function of one of the chambers of a chest tube
drainage system? - Answers- Wet or dry Heimlich chamber
3 chambers of the chest tube drainage system - Answers- Wet or dry water seal
chamber
Wet or dry suction chamber
Collection of drainage chamber
The nurse needs to deliver the highest concentration of oxygen (95-100%). What type
of oxygen delivery device would the nurse choose? - Answers- Nonrebreather mask
The nurse knows that the most effective method for suctioning a patient with a
tracheostomy tube is to - Answers- Limit the length of suctioning to 10 seconds.
, The whistle tipped catheter is less irritating to respiratory tissues - Answers- true
When discontinuing the nasogastric tube, the nurse instructs the client to: - Answers-
Take a deep breath and hold it.
The nurse is checking the client's nasogastric tube for placement prior to administering
a tube feeding. The most accurate means of assessing placement is - Answers-
Obtaining an x-ray.
The nurse is preparing several medications to administer via nasogastric tube. Which of
the following would demonstrate correct technique? - Answers- Give one medication at
a time, flush the tube with water, and then administer another medication.
The nurse is administering a bolus tube feeding. Which of the following strategies will be
most effective to reduce the risk of a clogged feeding tube? - Answers- Flush tubing
with water before and after feedings and medications.
when deciding if parenteral nutrition should be given peripherally or centrally, the nurse
recognizes which of the following is true? - Answers- The maximum percentage of
dextrose that can be given peripherally is 10-12%.
Which of the following clients would the nurse consider a candidate for an enteral
access device? Select all that apply. - Answers- -The client who has dysphagia, and is
unable to eat orally
-The client who overdosed on an oral medication
-The postoperative client who returns to the unit following bowel resection who is
unconscious secondary to sedation
The nurse working in an oncology clinic is caring for a client diagnosed with breast
cancer. The client reports anorexia and weight loss. The client's serum albumin is low,
and there is visible muscle and fat wasting. The nurse recognizes what this client is
exhibiting would best be described as - Answers- Protein-calorie malnutrition
The nurse receives a bag of total Parenteral nutrition (TPN) for the client. Prior to
hanging the solution, a priority nursing action is to: (Select all that apply.) - Answers- -
Check the expiration date.
-Apply a timing tape to the solution container.
-Check the nutrients in the bag against the order written by the primary care provider
with another licensed nurse.
The nurse has just inserted a nasogastric tube. All of the following methods are
acceptable means of assessing placement except: - Answers- Auscultate the
epigastium while instilling 60 mL of air
Which are examples of health behaviors that affect overall status of health? - Answers-
Tobacco use
Sedentary lifestyle
Use of recreational drugs
Which dietary changes should the nurse instruct a client with hypertension to make to
control electrolyte and fluid balance? - Answers- Limit sodium intake
Increase calcium intake - prevent osteoporosis and maintain serum Ca/P levels
Increase potassium consumption
An unlicensed assistive personnel (UAP) could be safely entrusted to perform which
type of suctioning? - Answers- Oral cavity suctioning
Turn, cough, deep breath, use of an incentive spriometer and early ambulation are ways
to prevent the post-op complications of atelectasis and pneumonia - Answers- true
The nurse finds the client sitting upright and leaning on her arms or elbows, and
documents: - Answers- The client has assumed the tripod position
The nurse is choosing a suction catheter for a client with a 6 mm tracheostomy tube in
place. What size suction catheter would be the largest possible choice? - Answers- 12
French
When documenting that the client's water seal is fluctuating up and down with each
inspiration and expiration, the nurse uses the proper term, which is - Answers- Tidaling
The nasal cannula can deliver __________liters of oxygen per minute - Answers- 2 - 6
liters/min
Your patient has a chest tube. The chest tube drainage system contain three chambers.
Which of the following is NOT a function of one of the chambers of a chest tube
drainage system? - Answers- Wet or dry Heimlich chamber
3 chambers of the chest tube drainage system - Answers- Wet or dry water seal
chamber
Wet or dry suction chamber
Collection of drainage chamber
The nurse needs to deliver the highest concentration of oxygen (95-100%). What type
of oxygen delivery device would the nurse choose? - Answers- Nonrebreather mask
The nurse knows that the most effective method for suctioning a patient with a
tracheostomy tube is to - Answers- Limit the length of suctioning to 10 seconds.
, The whistle tipped catheter is less irritating to respiratory tissues - Answers- true
When discontinuing the nasogastric tube, the nurse instructs the client to: - Answers-
Take a deep breath and hold it.
The nurse is checking the client's nasogastric tube for placement prior to administering
a tube feeding. The most accurate means of assessing placement is - Answers-
Obtaining an x-ray.
The nurse is preparing several medications to administer via nasogastric tube. Which of
the following would demonstrate correct technique? - Answers- Give one medication at
a time, flush the tube with water, and then administer another medication.
The nurse is administering a bolus tube feeding. Which of the following strategies will be
most effective to reduce the risk of a clogged feeding tube? - Answers- Flush tubing
with water before and after feedings and medications.
when deciding if parenteral nutrition should be given peripherally or centrally, the nurse
recognizes which of the following is true? - Answers- The maximum percentage of
dextrose that can be given peripherally is 10-12%.
Which of the following clients would the nurse consider a candidate for an enteral
access device? Select all that apply. - Answers- -The client who has dysphagia, and is
unable to eat orally
-The client who overdosed on an oral medication
-The postoperative client who returns to the unit following bowel resection who is
unconscious secondary to sedation
The nurse working in an oncology clinic is caring for a client diagnosed with breast
cancer. The client reports anorexia and weight loss. The client's serum albumin is low,
and there is visible muscle and fat wasting. The nurse recognizes what this client is
exhibiting would best be described as - Answers- Protein-calorie malnutrition
The nurse receives a bag of total Parenteral nutrition (TPN) for the client. Prior to
hanging the solution, a priority nursing action is to: (Select all that apply.) - Answers- -
Check the expiration date.
-Apply a timing tape to the solution container.
-Check the nutrients in the bag against the order written by the primary care provider
with another licensed nurse.
The nurse has just inserted a nasogastric tube. All of the following methods are
acceptable means of assessing placement except: - Answers- Auscultate the
epigastium while instilling 60 mL of air
