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NUR3411C CARE MANAGEMENT EXAM Q & A 2024
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NUR3411C CARE MANAGEMENT EXAM Q & A 2024
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NUR3411CCARE MANAGEMENT
EXAM Q & A
2024
1. A nurse is assigned to care for a patient with chronic obstructive pulmonary disease (COPD) who is
experiencing an acute exacerbation. The nurse reviews the patient's care plan and notes that the
patient has a goal of maintaining oxygen saturation above 90%. Which of the following interventions
should the nurse prioritize to achieve this goal?
a) Administer bronchodilators as prescribed
b) Encourage pursed-lip breathing and diaphragmatic breathing
c) Monitor vital signs and oxygen saturation frequently
d) Provide supplemental oxygen as ordered
*Answer: D. Provide supplemental oxygen as ordered*
Rationale: Providing supplemental oxygen as ordered is the most effective intervention to maintain oxygen
saturation above 90% in a patient with COPD who is experiencing an acute exacerbation. Oxygen
therapy can reduce hypoxemia, dyspnea, and work of breathing, and improve gas exchange and tissue
oxygenation. The other interventions are also important, but they are not as urgent as oxygen therapy.
2. A nurse is caring for a patient with heart failure who has been prescribed furosemide, a loop diuretic.
The nurse knows that this medication can cause hypokalemia, which can increase the risk of cardiac
arrhythmias. Which of the following actions should the nurse take to prevent this complication?
a) Monitor serum potassium levels regularly
b) Teach the patient to eat foods rich in potassium
c) Administer potassium supplements as prescribed
d) All of the above
*Answer: D. All of the above*
,Rationale: All of the above actions are appropriate to prevent hypokalemia in a patient taking furosemide.
Loop diuretics increase the excretion of sodium and water, but also potassium and other electrolytes.
Hypokalemia can impair cardiac conduction and contractility, leading to arrhythmias such as ventricular
tachycardia or fibrillation. Monitoring serum potassium levels can help detect hypokalemia early and
adjust the dose of furosemide or potassium supplements accordingly. Teaching the patient to eat foods
rich in potassium, such as bananas, oranges, potatoes, spinach, and yogurt, can help maintain adequate
potassium intake. Administering potassium supplements as prescribed can help replenish potassium
losses and prevent hypokalemia.
3. A nurse is caring for a patient with diabetes mellitus who has been admitted for diabetic ketoacidosis
(DKA). The nurse understands that DKA is a life-threatening condition that results from insulin
deficiency and increased production of ketones. Which of the following signs and symptoms would the
nurse expect to find in this patient?
a) Hyperglycemia, polyuria, polydipsia, polyphagia
b) Hypoglycemia, confusion, sweating, tremors
c) Hyperglycemia, kussmaul respirations, fruity breath odor, metabolic acidosis
d) Hypoglycemia, nausea, vomiting, abdominal pain
*Answer: C. Hyperglycemia, kussmaul respirations, fruity breath odor, metabolic acidosis*
Rationale: Hyperglycemia, kussmaul respirations, fruity breath odor, and metabolic acidosis are classic
signs and symptoms of DKA. Hyperglycemia occurs because insulin deficiency prevents glucose from
entering cells and causes glucose to accumulate in the blood. Polyuria and polydipsia are also common
due to osmotic diuresis caused by hyperglycemia. Kussmaul respirations are deep and rapid breathing
that occur as a compensatory mechanism to eliminate excess carbon dioxide and acid from the body.
Fruity breath odor is caused by the presence of acetone, a ketone body that is produced when fatty
acids are broken down for energy in the absence of insulin. Metabolic acidosis occurs because ketones
are acidic and lower the pH of the blood.
4. A nurse is caring for a patient with hypertension who has been prescribed lisinopril, an angiotensin-
converting enzyme (ACE) inhibitor. The nurse knows that this medication can cause angioedema, which
is a serious allergic reaction that involves swelling of the face, tongue, or throat. Which of the following
actions should the nurse take if the patient develops angioedema?
a) Discontinue lisinopril immediately and notify the provider
b) Administer epinephrine intramuscularly as ordered
c) Monitor blood pressure and pulse oximetry closely
d) All of the above
*Answer: D. All of the above*
Rationale: All of the above actions are appropriate if the patient develops angioedema due to lisinopril.
Angioedema is a rare but potentially life-threatening adverse effect of ACE inhibitors that can occur at
any time during therapy. It is caused by the accumulation of bradykinin, a peptide that causes
vasodilation and increased vascular permeability. Discontinuing lisinopril immediately and notifying the
provider can help prevent further exposure and worsening of the reaction. Administering epinephrine
intramuscularly as ordered can help reverse the effects of bradykinin and reduce the swelling and
inflammation. Monitoring blood pressure and pulse oximetry closely can help assess the patient's
hemodynamic status and oxygenation, as angioedema can cause hypotension and respiratory distress.
5. A nurse is caring for a patient with chronic kidney disease (CKD) who is undergoing hemodialysis three
times a week. The nurse knows that hemodialysis is a process that uses an artificial membrane to filter
waste products, excess fluid, and electrolytes from the blood. Which of the following nursing
interventions should the nurse perform to ensure safe and effective hemodialysis?
a) Assess the patient's weight, blood pressure, and temperature before and after each dialysis session
b) Check the patency and function of the vascular access site regularly
c) Educate the patient about dietary and fluid restrictions
d) All of the above
*Answer: D. All of the above*
Rationale: All of the above nursing interventions are important to ensure safe and effective hemodialysis.
Assessing the patient's weight, blood pressure, and temperature before and after each dialysis session
can help evaluate the patient's fluid status, blood volume, and potential complications such as
hypotension, infection, or fever. Checking the patency and function of the vascular access site regularly
, can help prevent thrombosis, infection, or bleeding, which can compromise the dialysis process.
Educating the patient about dietary and fluid restrictions can help prevent fluid overload, electrolyte
imbalances, or uremia, which can worsen the patient's condition and increase the risk of complications.
6. A nurse is caring for a patient with rheumatoid arthritis (RA) who has been prescribed methotrexate, a
disease-modifying antirheumatic drug (DMARD). The nurse knows that this medication can reduce
inflammation and slow down the progression of joint damage in RA. Which of the following instructions
should the nurse give to the patient to prevent adverse effects of methotrexate?
a) Take folic acid supplements as prescribed
b) Avoid alcohol consumption
c) Report any signs of infection, such as fever, sore throat, or cough
d) All of the above
*Answer: D. All of the above*
Rationale: All of the above instructions are appropriate to prevent adverse effects of methotrexate.
Methotrexate is an immunosuppressant that inhibits the synthesis of folic acid, a vitamin that is
essential for DNA replication and cell division. Taking folic acid supplements as prescribed can help
prevent folic acid deficiency, which can cause anemia, leukopenia, or thrombocytopenia. Avoiding
alcohol consumption can help prevent hepatotoxicity, which is a common adverse effect of
methotrexate that can cause liver damage or failure. Reporting any signs of infection, such as fever,
sore throat, or cough, can help detect infection early and initiate appropriate treatment, as
methotrexate can increase the risk of infection due to its immunosuppressive effect.
7. A nurse is caring for a patient with schizophrenia who has been prescribed clozapine, an atypical
antipsychotic. The nurse knows that this medication can treat positive and negative symptoms of
schizophrenia, but also has a high risk of causing agranulocytosis, which is a severe reduction in white
blood cells that can lead to life-threatening infections. Which of the following actions should the nurse
take to monitor for this complication?
a) Obtain a complete blood count (CBC) with differential before and during therapy
b) Teach the patient to report any signs of infection, such as fever, chills, or sore throat
c) Advise the patient to avoid contact with people who are sick or have infections
d) All of the above
*Answer: D. All of the above*
Rationale: All of the above actions are appropriate to monitor for agranulocytosis due to clozapine.
Obtaining a CBC with differential before and during therapy can help measure the number and type of
white blood cells in the blood and detect agranulocytosis early. The frequency of CBC monitoring
depends on the duration of therapy and the level of white blood cells. Teaching the patient to report
any signs of infection, such as fever, chills, or sore throat, can help identify infection promptly and
initiate appropriate treatment. Advising the patient to avoid contact with people who are sick or have
infections can help prevent exposure to pathogens that could cause infection.
B:
1. A nurse is evaluating levels and functions of trauma centers. Which function is
appropriatelypaired with the level of the trauma center?
a. Level I Located within remote areas and provides advanced life support within resource
capabilities
b. Level II Located within community hospitals and provides care to most injured clients
c. Level III Located in rural communities and provides only basic care to clients
d. Level IV Located in large teaching hospitals and provides a full continuum of trauma care
for all clients
ANS: B
Level I trauma centers are usually located in large teaching hospital systems and provide a full
continuum of trauma care for all clients. Both Level II and Level III facilities are usually located in
, community hospitals. These trauma centers provide care for most clients and transport to Level I
centers when client needs exceed resource capabilities. Level IV trauma centers are usually
located in rural and remote areas. These centers provide basic care, stabilization, and advanced
life support while transfer arrangements to higher-level trauma centers are made.
2. Emergency medical technicians arrive at the emergency department with an
unresponsiveclient who has an oxygen mask in place. Which action should the nurse
take first?
a. Assess that the client is breathing adequately.
b. Insert a large-bore intravenous line.
c. Place the client on a cardiac monitor.
d. Assess for the best neurologic response.
ANS: A
The highest-priority intervention in the primary survey is to establish that the client is breathing
adequately. Even though this client has an oxygen mask on, he or she may not be breathing, or
may be breathing inadequately with the device in place.
3. A trauma client with multiple open wounds is brought to the emergency department
in cardiacarrest. Which action should the nurse take prior to providing advanced cardiac
life support?
a. Contact the on-call orthopedic surgeon.
b. Don personal protective equipment.
c. Notify the Rapid Response Team.
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