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NR 341 EXAM 2 -CCATS (100% correct answers) | Chamberlain College of Nursing

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NR 341 EXAM 2 -CCATS Exam 2 NR 341 1. The nurse is caring for a client with hypovolemic shock. The family member asks why the fluids are being warmed. What is the best response by the nurse? • “to prevent complications from hypothermia” 2. The nurse is caring for a newly admitted client diagn...

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  • July 27, 2022
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  • 2021/2022
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NR 341 EXAM 2 -CCATS
Exam 2 NR 341



1. The nurse is caring for a client with hypovolemic shock. The family member asks why
the fluids are being warmed. What is the best response by the nurse?
• “to prevent complications from hypothermia”

2. The nurse is caring for a newly admitted client diagnosed with acute kidney injury. The
nurse understands that the acute kidney injury is most likely related to a history of which
condition?
• Sepsis

3. The nurse is caring for a client being monitored by arterial pressure monitoring. The
nurse notes a systolic pressure of 164 mmHg. What action should the nurse take first?
• Assess the client.

4. The nurse is caring for a client with an arteriovenous (AV) fistula. Upon assessment, the
nurse is unable to auscultate a bruit. What action should the nurse take first?
• Notify the provider

5. The nurse is assessing jugular venous pressure. In what order should the nurse proceed
with the steps in the process? [place the steps in the correct order beginning with the first
step]
• 3.place head of bed between 30-45 degrees.
• 2. Have client turn head slightly to the left.
• 6. Shine a pen light across the neck, assess for jugular venous distension at end of
exhalation.
• 5.observe the highest point of pulsation in the internal jugular vein at end
exhalation.
• 4. Measure the vertical distance between the pulsation and the angle of louis.
• 1. Add 5 cm to the measurement.

6. The nurse is caring for a client with acute kidney injury. The nurse should anticipate
which abnormal assessment finding?
• BUN/creatinine ration 25.1

7. The nurse is caring for a client whose vital signs are monitored using invasive
hemodynamic monitoring. Which action is most important for the nurse to implement to
decrease the risk of infection?
• Strict hand washing

8. The nurse is preparing a client for placement of a catheter for arterial pressure
monitoring. What is the best way for the nurse to assess ulnar circulation prior to catheter
insertion?
• Occlude the radial artery.

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, 9. The nurse is monitoring a client on hemodialysis. The nurse understands that which lab
value has the highest potential to be abnormal and cause complications as a result of
fluid imbalance?
• Electrolytes

10. The nurse is evaluating a client who is being treated for shock. When evaluating a client
being treated for shock, what finding indicated an improvement in the client’s condition?
• Bun of 12 mg/Dl …FOR THE EXAM answer was: Creatine 2.6mg/dL that
to high normal level is: 0.6 to 1.6mg/dL

11. The nurse is assessing a client during hemodialysis. Which finding should the nurse
report to the health care provider immediately?
• Redness at insertion site

12. When developing the plan of care for an older adult client with acute kidney injury, the
nurse understands that it is essential to consider which factor in the client’s history?
• Recent use of antibiotics

13. The nurse is rounding on cloents at the beginning of the shift. Which observation requires
immediate action when caring for a client with a percutaneous catheter for dialysis?
• Gauze dressing over insertion site

14. The nurse is evaluating a client who is being treated for shock. Which findings indicates
an improvement in the client’s condition? [select all that apply]
• Blood pressure 120/70
• Bun of 12 mg/dL

15. Which statement by the client is most important for the nurse to communicate to the
physical therapist when planning discharge care for a client who is recovering from an
acute myocardial infarction?
• “I used to be active when I was younger, but now I just get so weak.”

16. The nurse is assessing the health history of a 61-year old client admitted with a diagnosis
of acute myocardial infarction (AMI) secondary to coronary artery disease (CAD). Which
factors contributes to the client’s condition? [select all that apply]
• Eats a fast food lunch 5 days a week.
• Blood pressure averages 150/90 mmHg.
• Family history of coronary artery disease.
…THIS QUESTION THE OPTIONS WERE CHANGED: LDL 160, EATS A
FAST FOOD 5 DAYS A WEEKS, QUIT SMOKING 30 YRS AGO.. Don’t chose
the red on..

17. A clinic nurse is assessing a client with a history of a myocardial infarction for an annual
health visit. What assessment data would the nurse follow up on in regards to the
possibility of heart failure?



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