Ecpi 164 exam 3 with correct answers
A iinurse iireceives iiinformation iiduring iishift iireport iithat iia iipatient iiis iiafebrile. iiWhat
iiaction iiwill iithe iinurse iitake iiin iiresponse?
A. iiChecking iithe iiMAR iifor iiprescribed iiantipyretic iimedication
B. iiReporting iithe iifinding iito iithe iiprimary iicare iiprovider
C. iiTaking iithe iipatient's iitemperature iiusing iia iidifferent iimethod
D. iiNo iiaction iiis iinecessary; iithis iiis iia iinormal iireading ii- iiAnswers ii-D. iiNo iiaction iiis
iinecessary; iithis iiis iia iinormal iireading
A iinurse iiis iiassessing iithe iivital iisigns iiof iia iigroup iiof iipatients iiin iithe iiemergency
iidepartment. iiWhich iipatients iirequire iifollow-up iiby iithe iinurse? iiSelect iiall iithat iiapply.
A. iiInfant iiwhose iitemperature iiis ii100.5°F ii(38.1°C)
B. iiToddler iiwhose iiblood iipressure iiis ii118/80
C. iiSchool-age iichild iiwhose iitemperature iiis ii102.2°F ii(39°C)
D. iiAdolescent iiwhose iipulse iirate iiis ii70 iibeats/min
E. iiAdult iiwhose iirespiratory iirate iiis ii20 iibreaths/min
F. iiOlder iiadult iiwhose iipulse iirate iiis ii42 iibeats/min ii- iiAnswers ii-A. iiInfant iiwhose
iitemperature iiis ii100.5°F ii(38.1°C),
D. iiAdolescent iiwhose iipulse iirate iiis ii70 iibeats/min
E. iiAdult iiwhose iirespiratory iirate iiis ii20 iibreaths/min
F. iiOlder iiadult iiwhose iipulse iirate iiis ii42 iibeats/min
A iinurse iiis iicaring iifor iia iinewborn iiwith iihypothermia. iiWhat iiaction iidoes iithe iinurse
iitake iito iiprevent iiheat iiloss iifrom iiconvection?
A. iiWrapping iithe iinewborn iiin iia iiblanket
B. iiPlacing iithe iinewborn iion iia iiwarmed iisurface
C. iiReducing iithe iitemperature iiin iithe iiroom
D. iiIncreasing iithe iitemperature iiin iithe iiroom ii- iiAnswers ii-A. iiWrapping iithe iinewborn iiin
iia iiblanket
A iicharge iinurse iiworking iion iia iimedical-surgical iiunit iistops iithe iiAP iifrom iitaking iirectal
iitemperatures iion iipatients iiwith iiwhich iiproblems? iiSelect iiall iithat iiapply.
A. iiHypothermia
B. iiPneumonia
C. iiBradycardia
D. iiLeukemia
E. iiThrombocytopenia
F. iiPancreatitis ii- iiAnswers ii-C. iiBradycardia
D. iiLeukemia
E. iiThrombocytopenia
,While iitaking iian iiadult iipatient's iipulse, iia iinurse iiobtains iia iiheart iirate iiof ii140
iibeats/min. iiWhat iishould iithe iinurse iido iinext?
A. iiReassess iithe iipulse iiin ii1 iihour
B. iiMeasure iithe iiblood iipressure
C. iiDocument iithe iiinformation, iinoting iitachycardia
D. iiReport iithe iirate iito iithe iihealth iicare iiprovider ii- iiAnswers ii-D. iiReport iithe iirate iito
iithe iihealth iicare iiprovider
During iiassessment iiof iivital iisigns, iia iipatient iireports iisevere iiabdominal iipain. iiWhich
iipain-related iichanges iiin iivital iisigns iimay iibe iipresent? iiSelect iiall iithat iiapply.
A. iiPulse iirate iiof ii102
B. iiBody iitemperature ii98.8°F
C. iiBlood iipressure ii154/86
D. iiIncreased iirespiratory iidepth
E. iiRespiratory iirate iiof ii24
F. iiBody iitemperature ii100.8°F ii- iiAnswers ii-A. iiPulse iirate iiof ii102,
C. iiBlood iipressure ii154/86,
E. iiRespiratory iirate iiof ii24
A iinurse iiis iicaring iifor iia iigroup iiof iipatients iion iia iicardiac iiunit. iiWhich iifinding iiwill
iiprompt iithe iinurse iito iiassess iithe iiapical-radial iipulse?
A. iiBounding iiradial iipulse
B. iiImmediately iipostoperative
C. iiRapid, iiirregular iipulse
D. iiFluid iivolume iideficit ii- iiAnswers ii-A. iiBounding iiradial iipulse
A iinurse iiis iiassessing iithe iiblood iipressure iiof iia iipatient iiwith iitraumatic iiinjuries iiusing
iia iiDoppler iidevice. iiWhich iiinformation iidoes iithe iinurse iiexpect iito iiobtain?
A. iiAmplitude iiof iithe iibrachial iipulse
B. iiMean iiarterial iiblood iipressure
C. iiEstimation iiof iithe iisystolic iiblood iipressure
D. iiApical-radial iipulse iirate ii- iiAnswers ii-B. iiMean iiarterial iiblood iipressure
A iinurse iienters iia iiroom iiand iifinds iia iipatient iiwho iiis iiunable iito iicatch iitheir iibreath,
iihas iia iirespiratory iirate iiof ii28, iiand iiis iiusing iiaccessory iimuscles iito iibreathe. iiWhat
iiintervention iiwill iithe iinurse iiuse iito iirelieve iidyspnea?
A. iiRemove iipillows iifrom iiunder iithe iihead
B. iiRaise iithe iihead iiof iithe iibed
C. iiElevate iithe iifoot iiof iithe iibed
D. iiReassess iithe iirespiratory iirate ii- iiAnswers ii-B. iiraise iithe iihead iiof iithe iibed
A iinurse iihas iiassessed iian iiolder iiadult iifor iiorthostatic iihypotension iias iishown iiin iithe
iielectronic iihealth iirecord ii(EHR). iiWhat iiaction iiwill iithe iinurse iitake?
Exhibit: iiElectronic iihealth iirecord ii(EHR)
Graphic iisheet
8:00 iiAM iiBP iilying ii124/76
, BP iisitting ii118/74
BP iistanding ii98/58
A. iiEncourage iithe iipatient iito iirise iifrom iia iisitting iiposition iiquickly iito iiimprove iiblood
iiflow
B. iiSuggest iithat iiin iithe iifuture iithe iipatient ii"dangle" iifor iia iifew iiminutes iibefore
iistanding
C. iiReturn iithe iipatient iito iibed iiand iiplace iithem iiin iiFowler iiposition
D. iiAdminister iimedication iito iiincrease iiblood iipressure ii- iiAnswers ii-B. iiSuggest iithat iiin
iithe iifuture iithe iipatient ii"dangle" iifor iia iifew iiminutes iibefore iistanding
A iinurse iiis iicaring iifor iia iipostoperative iipatient iiwho iiexperienced iihypovolemic iishock
iinecessitating iitransfer iito iithe iiICU. iiThe iinurse iimanager iireviews iithe iimedical iirecord
iiand iisuspects iiwhich iisituation iicontributed iito iithe iiemergency?
Exhibit: iiElectronic iihealth iirecord ii(EHR)
Graphic iisheet
2:00 iiPM iiT ii99.2, iiP ii88, iiRR ii16, iiBP ii106/54
2:15 iiPM iiT ii99.6, iiP ii94, iiRR ii16, iiBP ii100/52
2:30 iiPM iiT ii99.4, iiP ii110, iiRR ii18, iiBP ii96/50
2:45 iiPM iiT ii99.2, iiP ii120, iiRR ii20, iiBP ii84/48
A. iiUsing iian iiinappropriate iiformat iito iidocument iithe iivital iisigns
B. iiFailing iito iireport iitachycardia iiand iihypotension iito iithe iiprovider
C. iiNot iifollowing iithe iipostoperative iivital iisign iiprotocol
D. iiFailing iito iireflect iia iipain iiassessment iiin iithe iidocumentation ii- iiAnswers ii-B. iiFailing
iito iireport iitachycardia iiand iihypotension iito iithe iiprovider
A iipatient iihas iia iiblood iipressure iireading iiof ii130/90 iimm iiHg iiduring iia iiclinic iivisit.
iiWhat iirecommendation iifor iifollow-up iiwill iithe iinurse iimake?
A. iiFollow-up iimeasurements iiof iiblood iipressure
B. iiImmediate iitreatment iiby iia iihealth iicare iiprovider
C. iiNo iiaction, iibecause iithe iinurse iiconsiders iithis iireading iiis iidue iito iianxiety
D. iiChange iiin iidietary iiintake ii- iiAnswers ii-A. iiFollow-up iimeasurements iiof iiblood
iipressure
A iinurse iiparticipating iiin iicommunity iiblood iipressure iiscreening iitells iithe iipatient iitheir
iiblood iipressure iiis ii120/80 iimm iiHg. iiWhen iithe iipatient iiasks iiwhat iithe iinumbers
iimean, iiwhat iiinformation iidoes iithe iinurse iiprovide?
A. iiRhythmic iidistention iiof iithe iiarterial iiwalls iifrom iiincreased iipressure iidue iito iisurges
iiof iiblood iiwith iiventricular iicontraction
B. iiSystolic iipressure iirepresents iiventricular iicontraction iicausing iihigh iipressure iion
iiarterial iiwalls; iithe iibottom iinumber iior iidiastolic iipressure iireflects iiventricular
iirelaxation iiwith iia iilower iipressure iion iithe iiarteries
C. iiNormal iiblood iipressure
D. iiDifference iibetween iithe iipressure iion iiarterial iiwalls iiwith iiventricular iicontraction
iiand iirelaxation ii- iiAnswers ii-C. iiNormal iiblood iipressure
A iinurse iireceives iiinformation iiduring iishift iireport iithat iia iipatient iiis iiafebrile. iiWhat
iiaction iiwill iithe iinurse iitake iiin iiresponse?
A. iiChecking iithe iiMAR iifor iiprescribed iiantipyretic iimedication
B. iiReporting iithe iifinding iito iithe iiprimary iicare iiprovider
C. iiTaking iithe iipatient's iitemperature iiusing iia iidifferent iimethod
D. iiNo iiaction iiis iinecessary; iithis iiis iia iinormal iireading ii- iiAnswers ii-D. iiNo iiaction iiis
iinecessary; iithis iiis iia iinormal iireading
A iinurse iiis iiassessing iithe iivital iisigns iiof iia iigroup iiof iipatients iiin iithe iiemergency
iidepartment. iiWhich iipatients iirequire iifollow-up iiby iithe iinurse? iiSelect iiall iithat iiapply.
A. iiInfant iiwhose iitemperature iiis ii100.5°F ii(38.1°C)
B. iiToddler iiwhose iiblood iipressure iiis ii118/80
C. iiSchool-age iichild iiwhose iitemperature iiis ii102.2°F ii(39°C)
D. iiAdolescent iiwhose iipulse iirate iiis ii70 iibeats/min
E. iiAdult iiwhose iirespiratory iirate iiis ii20 iibreaths/min
F. iiOlder iiadult iiwhose iipulse iirate iiis ii42 iibeats/min ii- iiAnswers ii-A. iiInfant iiwhose
iitemperature iiis ii100.5°F ii(38.1°C),
D. iiAdolescent iiwhose iipulse iirate iiis ii70 iibeats/min
E. iiAdult iiwhose iirespiratory iirate iiis ii20 iibreaths/min
F. iiOlder iiadult iiwhose iipulse iirate iiis ii42 iibeats/min
A iinurse iiis iicaring iifor iia iinewborn iiwith iihypothermia. iiWhat iiaction iidoes iithe iinurse
iitake iito iiprevent iiheat iiloss iifrom iiconvection?
A. iiWrapping iithe iinewborn iiin iia iiblanket
B. iiPlacing iithe iinewborn iion iia iiwarmed iisurface
C. iiReducing iithe iitemperature iiin iithe iiroom
D. iiIncreasing iithe iitemperature iiin iithe iiroom ii- iiAnswers ii-A. iiWrapping iithe iinewborn iiin
iia iiblanket
A iicharge iinurse iiworking iion iia iimedical-surgical iiunit iistops iithe iiAP iifrom iitaking iirectal
iitemperatures iion iipatients iiwith iiwhich iiproblems? iiSelect iiall iithat iiapply.
A. iiHypothermia
B. iiPneumonia
C. iiBradycardia
D. iiLeukemia
E. iiThrombocytopenia
F. iiPancreatitis ii- iiAnswers ii-C. iiBradycardia
D. iiLeukemia
E. iiThrombocytopenia
,While iitaking iian iiadult iipatient's iipulse, iia iinurse iiobtains iia iiheart iirate iiof ii140
iibeats/min. iiWhat iishould iithe iinurse iido iinext?
A. iiReassess iithe iipulse iiin ii1 iihour
B. iiMeasure iithe iiblood iipressure
C. iiDocument iithe iiinformation, iinoting iitachycardia
D. iiReport iithe iirate iito iithe iihealth iicare iiprovider ii- iiAnswers ii-D. iiReport iithe iirate iito
iithe iihealth iicare iiprovider
During iiassessment iiof iivital iisigns, iia iipatient iireports iisevere iiabdominal iipain. iiWhich
iipain-related iichanges iiin iivital iisigns iimay iibe iipresent? iiSelect iiall iithat iiapply.
A. iiPulse iirate iiof ii102
B. iiBody iitemperature ii98.8°F
C. iiBlood iipressure ii154/86
D. iiIncreased iirespiratory iidepth
E. iiRespiratory iirate iiof ii24
F. iiBody iitemperature ii100.8°F ii- iiAnswers ii-A. iiPulse iirate iiof ii102,
C. iiBlood iipressure ii154/86,
E. iiRespiratory iirate iiof ii24
A iinurse iiis iicaring iifor iia iigroup iiof iipatients iion iia iicardiac iiunit. iiWhich iifinding iiwill
iiprompt iithe iinurse iito iiassess iithe iiapical-radial iipulse?
A. iiBounding iiradial iipulse
B. iiImmediately iipostoperative
C. iiRapid, iiirregular iipulse
D. iiFluid iivolume iideficit ii- iiAnswers ii-A. iiBounding iiradial iipulse
A iinurse iiis iiassessing iithe iiblood iipressure iiof iia iipatient iiwith iitraumatic iiinjuries iiusing
iia iiDoppler iidevice. iiWhich iiinformation iidoes iithe iinurse iiexpect iito iiobtain?
A. iiAmplitude iiof iithe iibrachial iipulse
B. iiMean iiarterial iiblood iipressure
C. iiEstimation iiof iithe iisystolic iiblood iipressure
D. iiApical-radial iipulse iirate ii- iiAnswers ii-B. iiMean iiarterial iiblood iipressure
A iinurse iienters iia iiroom iiand iifinds iia iipatient iiwho iiis iiunable iito iicatch iitheir iibreath,
iihas iia iirespiratory iirate iiof ii28, iiand iiis iiusing iiaccessory iimuscles iito iibreathe. iiWhat
iiintervention iiwill iithe iinurse iiuse iito iirelieve iidyspnea?
A. iiRemove iipillows iifrom iiunder iithe iihead
B. iiRaise iithe iihead iiof iithe iibed
C. iiElevate iithe iifoot iiof iithe iibed
D. iiReassess iithe iirespiratory iirate ii- iiAnswers ii-B. iiraise iithe iihead iiof iithe iibed
A iinurse iihas iiassessed iian iiolder iiadult iifor iiorthostatic iihypotension iias iishown iiin iithe
iielectronic iihealth iirecord ii(EHR). iiWhat iiaction iiwill iithe iinurse iitake?
Exhibit: iiElectronic iihealth iirecord ii(EHR)
Graphic iisheet
8:00 iiAM iiBP iilying ii124/76
, BP iisitting ii118/74
BP iistanding ii98/58
A. iiEncourage iithe iipatient iito iirise iifrom iia iisitting iiposition iiquickly iito iiimprove iiblood
iiflow
B. iiSuggest iithat iiin iithe iifuture iithe iipatient ii"dangle" iifor iia iifew iiminutes iibefore
iistanding
C. iiReturn iithe iipatient iito iibed iiand iiplace iithem iiin iiFowler iiposition
D. iiAdminister iimedication iito iiincrease iiblood iipressure ii- iiAnswers ii-B. iiSuggest iithat iiin
iithe iifuture iithe iipatient ii"dangle" iifor iia iifew iiminutes iibefore iistanding
A iinurse iiis iicaring iifor iia iipostoperative iipatient iiwho iiexperienced iihypovolemic iishock
iinecessitating iitransfer iito iithe iiICU. iiThe iinurse iimanager iireviews iithe iimedical iirecord
iiand iisuspects iiwhich iisituation iicontributed iito iithe iiemergency?
Exhibit: iiElectronic iihealth iirecord ii(EHR)
Graphic iisheet
2:00 iiPM iiT ii99.2, iiP ii88, iiRR ii16, iiBP ii106/54
2:15 iiPM iiT ii99.6, iiP ii94, iiRR ii16, iiBP ii100/52
2:30 iiPM iiT ii99.4, iiP ii110, iiRR ii18, iiBP ii96/50
2:45 iiPM iiT ii99.2, iiP ii120, iiRR ii20, iiBP ii84/48
A. iiUsing iian iiinappropriate iiformat iito iidocument iithe iivital iisigns
B. iiFailing iito iireport iitachycardia iiand iihypotension iito iithe iiprovider
C. iiNot iifollowing iithe iipostoperative iivital iisign iiprotocol
D. iiFailing iito iireflect iia iipain iiassessment iiin iithe iidocumentation ii- iiAnswers ii-B. iiFailing
iito iireport iitachycardia iiand iihypotension iito iithe iiprovider
A iipatient iihas iia iiblood iipressure iireading iiof ii130/90 iimm iiHg iiduring iia iiclinic iivisit.
iiWhat iirecommendation iifor iifollow-up iiwill iithe iinurse iimake?
A. iiFollow-up iimeasurements iiof iiblood iipressure
B. iiImmediate iitreatment iiby iia iihealth iicare iiprovider
C. iiNo iiaction, iibecause iithe iinurse iiconsiders iithis iireading iiis iidue iito iianxiety
D. iiChange iiin iidietary iiintake ii- iiAnswers ii-A. iiFollow-up iimeasurements iiof iiblood
iipressure
A iinurse iiparticipating iiin iicommunity iiblood iipressure iiscreening iitells iithe iipatient iitheir
iiblood iipressure iiis ii120/80 iimm iiHg. iiWhen iithe iipatient iiasks iiwhat iithe iinumbers
iimean, iiwhat iiinformation iidoes iithe iinurse iiprovide?
A. iiRhythmic iidistention iiof iithe iiarterial iiwalls iifrom iiincreased iipressure iidue iito iisurges
iiof iiblood iiwith iiventricular iicontraction
B. iiSystolic iipressure iirepresents iiventricular iicontraction iicausing iihigh iipressure iion
iiarterial iiwalls; iithe iibottom iinumber iior iidiastolic iipressure iireflects iiventricular
iirelaxation iiwith iia iilower iipressure iion iithe iiarteries
C. iiNormal iiblood iipressure
D. iiDifference iibetween iithe iipressure iion iiarterial iiwalls iiwith iiventricular iicontraction
iiand iirelaxation ii- iiAnswers ii-C. iiNormal iiblood iipressure
