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ADULT HEALTH 2 EXAM -REVISION GUIDE

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ADULT HEALTH 2 EXAM -REVISION GUIDE 1. The nurse assists the provider with a liver biopsy at the bedside. Which position does the nurse put the patient in after the biopsy? Supine with head elevated on one pillow Semi-fowlers with two pillows under the leg Right side lying with a folded towel un...

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  • June 10, 2021
  • 28
  • 2020/2021
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ADULT HEALTH 2 EXAM- LATEST RELIABLE GUIDE.
1.The nurse assists the provider with a liver biopsy at the bedside. Which position does the nurse put the patient in after the biopsy?
Supine with head elevated on one pillow Semi-fowlers with two pillows under the leg
Right side lying with a folded towel under the puncture site
Left side lying with a small pillow under the puncture site
2.A patient is hospitalized for severe anorexia, fatigue, mild jaundice, hepatomegaly, and abnormal liver
function tests. The physician suspects viral hepatitis. In planning care, which patient outcome does the nurse assign the highest priority?
Maintains adequate nutrition Maintains usual exercise regimen Adapts to changes in appearance
Definitely identifies source of exposure to hepatitis virus
3.Select all the potential causes for hepatic inflammation Virus
Penicillin Acetaminophen
Alcohol Chocolate
4.A patient admitted to the hospital with a diagnosis of cirrhosis has a massive ascites’s and
difficulty breathing. The nurse performers which intervention as a priority measure to assist the
patient with breathing?
Reposition side to side every 2 hours Auscultate the lung sounds every 4hours Encourage deep breathing exercises Elevate the head of the bed 60 degrees
5.A home health nurse visits a patient who was recently diagnosed with cirrhosis and provides home
care management instructions to the patient. Which statement by the patient indicates the need for
further instructions?
I will obtain adequate rest
I should monitor my weight regularly
I should include sufficient carbs in my diet
I will take acetaminophen (Tylenol) if I get a headache
6.The nurse administers lactulose to a patient with cirrhosis the patient complains of diarrhea. The nurse explains that it is important to take the drug for which effect?
Prevention of constipation
Promotion of fluid loss
Reduction in serum ammonia levels Prevention of gastrointestinal bleeding
7.A patient with liver cancer has severe ascites and shortness of breath. The physician plans a paracentesis. The nurse prepares the patient for the paracentesis with which action?
Have client empty bladder
Position patient flat on right side
Have them lie flat with a small pillow under the small of his back Sedate the client with versed
8.The patient is admitted to the ED with vomiting of bright red blood. Which info is most important for the nurse to obtain during assessment?
Vital signs and symptoms of hypovolemia
History of prior bleeding Medication client is taking Current medical problems
9.A nurse is educating a patient in anticipation of a procedure that will require a
water-sealed chest drainage system. What should the nurse tell the patient and the
family that this drainage system is used for?
A)Maintaining positive chest-wall pressure
B)Monitoring pleural fluid osmolarity
C)Providing positive intrathoracic pressure
D)Removing excess air and fluid
10. A patient is exhibiting signs of a pneumothorax following tracheostomy. The surgeon
inserts a chest tube into the anterior chest wall. What should the nurse tell the family is the
primary purpose of this chest tube?
A)To remove air from the pleural space
B)To drain copious sputum secretions
C)To monitor bleeding around the lungs
D)To assist with mechanical ventilation
11.While assessing the patient, the nurse observes constant bubbling in the water-seal chamber of the patients closed chest-drainage system. What should the nurse conclude?
The system is functioning normally. The patient has a pneumothorax.
The system has an air leak.
The chest tube is obstructed. 12.. The nurse is caring for a patient who is scheduled for a lobectomy for a diagnosis
of lung cancer. While assisting with a subclavian vein central line insertion, the nurse notes the clients oxygen saturation rapidly dropping. The patient complains of shortness of breath and becomes tachypneic. The nurse suspects a pneumothorax has developed. Further assessment findings supporting the presence of a pneumothorax include what?
A)Diminished or absent breath sounds on the affected side
B)Paradoxical chest wall movement with respirations
C)Sudden loss of consciousness
D)Muffled heart sounds
13. The nurse at a long-term care facility is assessing each of the residents. Which resident most likely faces the greatest risk for aspiration?
70 Years old man who aspirated before
A resident with mid-stage Alzheimers disease
A 92-year-old resident who needs extensive help with ADLs
A resident with severe and deforming rheumatoid arthritis
14. The nurse is addressing condom use in the context of a health promotion workshop. When discussing the correct use of condoms, what should the nurse tell the attendees?
A)Attach the condom prior to erection.
B)A condom may be reused with the same partner if ejaculation has not occurred.
C)Use skin lotion as a lubricant if alternatives are unavailable.
D)Hold the condom by the cuff upon withdrawal.
15.A nurse is working with a patient who was diagnosed with HIV several months earlier. The nurse should recognize that a patient with HIV is considered to have AIDS
at the point when the CD4+ T-lymphocyte cell count drops below what threshold?
A)75 cells/mm3 of blood
B)200 cells/mm3 of blood
C)325 cells/mm3 of blood
D)450 cells/mm3 of blood
16.A nurse is performing an admission assessment on a patient with stage 3 HIV. After assessing the patients gastrointestinal system and analyzing the data, what is most likely to be the priority nursing diagnosis?

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