NURS 280 Exam 4 with verified
answers(A+ rated)
A nurse documents the following on a client chart: "client manifests difficulties with spatial orientation,
memory 7. language, and changes in personality." What state of arousal/awareness does this describe?
A) Delirium
B) Dementia
C) Confusion
D) Locked-in syndrome - correct answer ✔✔a
A client has an abrupt onset of a cluster of global changes in attention, cognition, and level of
consciousness. What 18. would be the most appropriate nursing diagnosis?
A) Acute Confusion
B) Chronic Confusion
C) Impaired Memory
D) Disturbed Sensory Perception - correct answer ✔✔a
A nurse is caring for a person who is delusional. What is important for the nurse to do while
communicating with the 25. client?
A) Touch the client gently while talking.
B) Avoid arguing about erroneous statements.
C) Reinforce reality for delusional statements.
D) Maintain eye contact at all times. - correct answer ✔✔c
The nurse is caring for a client who suffered a stroke three days ago, and is assessing the client's state of
arousal. The 32. nurse knows that the part of the body responsible for a person being alert or aroused is
which of the following?
A) Reticular activating system
B) Renin-angiotensin-aldosterone system
,C) Cranial nerves
D) Adrenal glands - correct answer ✔✔a
The nurse caring for a client with emphysema has determined that a priority nursing diagnosis for this
client is
"Imbalanced Nutrition: Less Than Body Requirements related to difficulty breathing while eating." Based
upon this 1. diagnosis, which of the following is an appropriate nursing intervention to include in the
client's care plan?
A) Provide six small meals daily.
B) Provide three large meals daily.
C) Encourage the client to eat immediately before breathing treatments.
D) Encourage the client to alternate eating and using a nebulizer during meal time. - correct answer
✔✔a
The nurse is developing a plan of care for a client admitted with pneumonia. The nurse has determined
that apriority
nursing diagnosis for this client is "Ineffective Airway Clearance related to copious and tenacious
secretions." Based 2. upon this nursing diagnosis, what is an appropriate nursing intervention to include
in the client's care plan?
A) Encouraging the client to consume two to three quarts of clear fluids daily
B) Creating an environment that is likely to reduce anxiety
C) Positioning the client supine
D) Encouraging the client to decrease the number of cigarettes smoked daily - correct answer ✔✔a
While the nurse is providing morning hygiene for a client who has a chest tube, the client has rolled over
quickly and the 3. chest tube has become disconnected from the drainage unit. How should the nurse
first respond to this event?
A) Submerge the end of the tube in sterile water.
NURSINGKING.COM
B) Clamp the tube near the end and also near the insertion point.
C) Place the end of the tube on a sterile surface and seek help promptly.
,D) Clean the end of the tube with an alcohol swab and reconnect it to the drainage unit. - correct answer
✔✔a
A client has had a head injury affecting the brain stem. What is located in the brain stem that may affect
respiratory 4. function?
A) Chemoreceptors
B) Stretch receptors
C) Respiratory center
D) Oxygen center - correct answer ✔✔c
Which of the following diseases may result in decreased lung compliance?
A) Emphysema
B) Appendicitis
C) Acne
D) Chronic diarrhea - correct answer ✔✔a
A nurse is caring for a client with pneumonia. The client's oxygen saturation is below normal. What
abnormal 6. respiratory process does this demonstrate?
A) changes in the alveolar-capillary membrane and diffusion
B) alterations in the structures of the ribs and diaphragm
C) rapid decreases in atmospheric and intrapulmonic pressures
D) lower-than-normal concentrations of environmental oxygen - correct answer ✔✔a
In what age group would a nurse expect to assess the most rapid respiratory rate?
A) Older adults
B) Middle adults
C) Adolescents
D) Infants - correct answer ✔✔d
, A father of a preschool-age child tells the nurse that his child "has had a constant cold since going to
daycare." How 8. would the nurse respond?
A) "Your child must have a health problem that needs medical care."
B) "Children in daycare have more exposure to colds."
C) "Are you washing your hands before you touch the child?"
D) "Be sure and have your child wear a protective mask at school." - correct answer ✔✔b
A woman 90 years of age has been in an automobile crash and sustained four fractured ribs on the left
side of her thorax. 9. Based on her age and the injury, she is at risk for what complication?
A) Pneumonia
B) Altered thought processes
C) Urinary incontinence
D) Viral influenza - correct answer ✔✔a
Which individual is at greater risk for respiratory illnesses from environmental causes?
A) A farmer on a large farm
B) A factory worker in a large city
C) A woman living in a small town
D) A child living in a rural area - correct answer ✔✔b
A nurse is beginning to conduct a health history for a client with respiratory problems. He notes that the
client is having 11. respiratory distress. What would the nurse do next?
A) Continue with the health history, but more slowly.
B) Ask questions of the family instead of the client.
C) Conduct the interview later and let the client rest.
D) Initiate interventions to help relieve the symptoms. - correct answer ✔✔d
An emergency room nurse is auscultating the chest of a child who is having an asthmatic attack.
Auscultation reveals the 12. presence of wheezes. During what part of respirations do wheezes occur?
A) Inspiration and expiration
answers(A+ rated)
A nurse documents the following on a client chart: "client manifests difficulties with spatial orientation,
memory 7. language, and changes in personality." What state of arousal/awareness does this describe?
A) Delirium
B) Dementia
C) Confusion
D) Locked-in syndrome - correct answer ✔✔a
A client has an abrupt onset of a cluster of global changes in attention, cognition, and level of
consciousness. What 18. would be the most appropriate nursing diagnosis?
A) Acute Confusion
B) Chronic Confusion
C) Impaired Memory
D) Disturbed Sensory Perception - correct answer ✔✔a
A nurse is caring for a person who is delusional. What is important for the nurse to do while
communicating with the 25. client?
A) Touch the client gently while talking.
B) Avoid arguing about erroneous statements.
C) Reinforce reality for delusional statements.
D) Maintain eye contact at all times. - correct answer ✔✔c
The nurse is caring for a client who suffered a stroke three days ago, and is assessing the client's state of
arousal. The 32. nurse knows that the part of the body responsible for a person being alert or aroused is
which of the following?
A) Reticular activating system
B) Renin-angiotensin-aldosterone system
,C) Cranial nerves
D) Adrenal glands - correct answer ✔✔a
The nurse caring for a client with emphysema has determined that a priority nursing diagnosis for this
client is
"Imbalanced Nutrition: Less Than Body Requirements related to difficulty breathing while eating." Based
upon this 1. diagnosis, which of the following is an appropriate nursing intervention to include in the
client's care plan?
A) Provide six small meals daily.
B) Provide three large meals daily.
C) Encourage the client to eat immediately before breathing treatments.
D) Encourage the client to alternate eating and using a nebulizer during meal time. - correct answer
✔✔a
The nurse is developing a plan of care for a client admitted with pneumonia. The nurse has determined
that apriority
nursing diagnosis for this client is "Ineffective Airway Clearance related to copious and tenacious
secretions." Based 2. upon this nursing diagnosis, what is an appropriate nursing intervention to include
in the client's care plan?
A) Encouraging the client to consume two to three quarts of clear fluids daily
B) Creating an environment that is likely to reduce anxiety
C) Positioning the client supine
D) Encouraging the client to decrease the number of cigarettes smoked daily - correct answer ✔✔a
While the nurse is providing morning hygiene for a client who has a chest tube, the client has rolled over
quickly and the 3. chest tube has become disconnected from the drainage unit. How should the nurse
first respond to this event?
A) Submerge the end of the tube in sterile water.
NURSINGKING.COM
B) Clamp the tube near the end and also near the insertion point.
C) Place the end of the tube on a sterile surface and seek help promptly.
,D) Clean the end of the tube with an alcohol swab and reconnect it to the drainage unit. - correct answer
✔✔a
A client has had a head injury affecting the brain stem. What is located in the brain stem that may affect
respiratory 4. function?
A) Chemoreceptors
B) Stretch receptors
C) Respiratory center
D) Oxygen center - correct answer ✔✔c
Which of the following diseases may result in decreased lung compliance?
A) Emphysema
B) Appendicitis
C) Acne
D) Chronic diarrhea - correct answer ✔✔a
A nurse is caring for a client with pneumonia. The client's oxygen saturation is below normal. What
abnormal 6. respiratory process does this demonstrate?
A) changes in the alveolar-capillary membrane and diffusion
B) alterations in the structures of the ribs and diaphragm
C) rapid decreases in atmospheric and intrapulmonic pressures
D) lower-than-normal concentrations of environmental oxygen - correct answer ✔✔a
In what age group would a nurse expect to assess the most rapid respiratory rate?
A) Older adults
B) Middle adults
C) Adolescents
D) Infants - correct answer ✔✔d
, A father of a preschool-age child tells the nurse that his child "has had a constant cold since going to
daycare." How 8. would the nurse respond?
A) "Your child must have a health problem that needs medical care."
B) "Children in daycare have more exposure to colds."
C) "Are you washing your hands before you touch the child?"
D) "Be sure and have your child wear a protective mask at school." - correct answer ✔✔b
A woman 90 years of age has been in an automobile crash and sustained four fractured ribs on the left
side of her thorax. 9. Based on her age and the injury, she is at risk for what complication?
A) Pneumonia
B) Altered thought processes
C) Urinary incontinence
D) Viral influenza - correct answer ✔✔a
Which individual is at greater risk for respiratory illnesses from environmental causes?
A) A farmer on a large farm
B) A factory worker in a large city
C) A woman living in a small town
D) A child living in a rural area - correct answer ✔✔b
A nurse is beginning to conduct a health history for a client with respiratory problems. He notes that the
client is having 11. respiratory distress. What would the nurse do next?
A) Continue with the health history, but more slowly.
B) Ask questions of the family instead of the client.
C) Conduct the interview later and let the client rest.
D) Initiate interventions to help relieve the symptoms. - correct answer ✔✔d
An emergency room nurse is auscultating the chest of a child who is having an asthmatic attack.
Auscultation reveals the 12. presence of wheezes. During what part of respirations do wheezes occur?
A) Inspiration and expiration
