Nursing Comprehensive Exit Exam Questions and Answers
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Course
RN Comprehensive
Institution
RN Comprehensive
A nurse is caring for a client in the emergency department who complains of epigastric pain and feeling lightheaded. The client has a blood pressure of 140/80 mmHg with a heart rate of 75/min while supine and 110/65 mmHg sitting with a heart rate of 100/min. Which of the following tasks should the ...
Nursing Comprehensive Exit Exam
Questions and Answers
A nurse is caring for a client in the emergency department who complains of epigastric
pain and feeling lightheaded. The client has a blood pressure of 140/80 mmHg with a
heart rate of 75/min while supine and 110/65 mmHg sitting with a heart rate of 100/min.
Which of the following tasks should the nurse perform next? - Answer-Anticipate
administration of intravenous crystalloid solution.
A nurse is caring for a 62-year-old client who has been diagnosed with emphysema.
The nurse understands that the client is at high-risk for pulmonary infection. Which of
the following conditions predisposes the client to infection? - Answer-Pooling of
respiratory secretions.
Which of the following methods of oxygen delivery should a nurse use to administer
oxygen for a client with a drop in oxygen saturation from 96% to 88% on room air after
receiving morphine to relieve pain after colon resection? (The client is resting but
remains oriented and can be easily aroused by verbal stimuli.) - Answer-Nasal cannula
A nurse is caring for a woman who has undergone a radical mastectomy for breast
cancer. She tells the nurse, "I'm worried because my spouse won't touch me since my
breast was removed." Which of the following is the most appropriate response by the
nurse? - Answer-"How do you feel about your mastectomy?"
A nurse is caring for a client who took an overdose of antidepressants and was
discovered by his spouse. What is the best response by the nurse when the spouse
states, "If I hadn't come home early from my business trip, my spouse might have died.
I'm in a state of shock."? - Answer-"This is a very overwhelming situation for you. Can
you tell me what you are feeling now?"
Which of the following pediatric clients would require prompt reporting to the authorities
by the nurse? - Answer-A 4-year-old who fell from a swing set with 1 fracture of the ulna
and 2 healed fractures of the humerus on X-ray
A nurse is caring for a client who has a chest tube connected to a closed drainage
system and needs to be transported to the x-ray department. Which of the following
actions should the nurse take? - Answer-Keep the drainage system below the level of
the client's chest at all times.
Which of the following risk factors are part of the Braden Scale for Predicting Pressure
Sore Risk? (Select all that apply.) - Answer-Friction and shear
Nutrition
, The risk factors associated with the Braden Scale include sensory perception, moisture,
activity, mobility, nutrition, and friction and shear.
A nurse is planning care for a client who has acute respiratory distress syndrome.
Which of the following interventions should the nurse include in the plan? - Answer-
Place in prone position
Respiratory cards following - Answer-
A nurse is caring for a postoperative client who has a chest tube connected to suction
and a water seal drainage system. Which of the following indicates to the nurse that the
chest tube is functioning properly? - Answer-Fluctuation of the fluid level within the
water seal chamber
nurse is monitoring a client who has a chest tube in place connected to wall suction due
to right sided pneumothorax. The client complains of chest burning. Which of the
following actions should the nurse take? - Answer-reposition the client
A nurse is caring for a client who has a three- chamber closed chest tube system.
Which of the following actions should the nurse take after noticing a rise in the water
seal chamber with client inspiration? - Answer-continue to monitor the client
A nurse is observing the closed chest drainage system of a client who is 24 hr post
thoracotomy. The nurse notes slow, steady bubbling in the suction control chamber.
Which of the following actions should the nurse take? - Answer-Continue to monitor
client's respiratory status
A nurse is assessing a client who will undergo abdominal surgery in 2 hr. The client
reports being nervous about the surgery, last had food and fluids at 2330 the previous
evening, and signed the surgical consent 2 days ago. Which of the following is an
appropriate nursing action regarding these findings? - Answer-Document the findings in
the client's medical record.
A nurse in the post-anesthesia care unit is caring for a client who is postoperative
following a thoracotomy and lobectomy. Which of the following postoperative
assessments should the nurse give highest priority to? - Answer-Arterial blood gases.
The effectiveness of oxygenation is monitored using pulse oximetry and arterial blood
gases.
A nurse is assessing a client following a bronchoscopy. Which of the following findings
should the nurse report to the provider? - Answer-Bronchospasms
Bronchospasms can indicate the client is having difficulty maintaining a patent airway.
Blood-tinged sputum, a dry, nonproductive cough, and a sore throat are expected
findings following a bronchoscopy.
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