NURS 493 NGN Practice 1 SP 2024 | Questions and Answers (Complete Solutions)
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Course
NURS 493
Institution
NURS 493
NURS 493 NGN Practice 1 SP 2024 | Questions and Answers (Complete Solutions) A nurse is caring for a 45-year-old client in the emergency department. Nurses' Notes Admitted to the emergency accompanied by partner. Alert and oriented x3. Skin warm and dry, no discoloration noted. Client reports s...
A nurse is caring for a 45-year-old client in the emergency department.
Nurses' Notes
Admitted to the emergency accompanied by partner. Alert and oriented x3. Skin warm
and dry, no discoloration noted. Client reports substernal chest pain that radiates to the
left shoulder and neck. Rates pain as 8 on a scale of 0 to 10. Pain increases with
aspiration and when lying down. Client reports decreased pain when sitting upright and
leaning forward. Heart sounds regular with a pericardial friction rub auscultated left
lower sternal border. Lungs clear to auscultation with occasional non-productive cough.
No peripheral edema noted.
Vital Signs
Temperature 38.3° C (101° F)
Heart rate 100/min
Respiration rate 20/min
BP 128/82 mm Hg
Oxygen saturation 98% on room air
Actions to Take
- obtain an echocardiogram
- obtain a prescription for an NSAID such as ibuprofen
Potential Condition
- pericarditis
Parameters to Monitor
- pain level
- pulsus paradoxus
The nurse should obtain an echocardiogram and obtain a prescription for an NSAID
such as ibuprofen because the client is most likely experiencing pericarditis due a
respiratory infection.
The nurse should monitor the client's pain as well as for pulsus paradoxus (a systolic
blood pressure increase of > 10 mm Hg during inspiration) which is a manifestation of
cardiac tamponade and is a medical emergency.
A nurse is reviewing the medical record of a client who has acute leukemia.
Diagnostic Results
Month Three:
WBC count 15,500/mm3 (5,000 to 10,000/mm3)
RBC count 4.0 million/mm3 (4.2 to 5.4 million/mm3)
Hemoglobin 11 g/dL (12 to 16 g/dL)
Hematocrit 33% (37% to 47%)
Platelet count 100,000/mm3 (150,000 to 400,000/mm3)
PT 13.5 seconds (11 to 12.5 seconds)
INR 2.2 seconds (0.8 to 1.1 seconds)
,PTT 85 seconds (60 to 70 seconds)
Sodium 137 mEq/L (136 to 145 mEq/L)
Potassium 4.5 mEq/L (3.5 to 5 mEq/L)
Glucose 98 mg/dL (74 to 106 mg/dL)
BUN 15 mg/dL (10 to 20 mg/dL)
Creatinine 0.8 mg/dL (0.5 to 1 mg/dL)
Calcium 9.5 mg/dL (9 to 10.5 mg/dL)
Vitamin D 65 ng/dL (25 to 80 ng/dL)
Drag words from the choices below to fill in each blank in the following sentence.
Bleeding and infection are correct.
Bleeding is one of the major causes of death for clients who have acute leukemia. The
nurse should note that the client's platelet count has decreased, and the PT, PTT, and
INR levels have all increased, which places the client at a high risk for bleeding.
Infection is also one of the major causes of death for clients who have acute leukemia.
The WBC count can be low, normal, or high in leukemia, but the cells are small and
nonfunctioning. The inability of the client's WBCs to mount an appropriate protection
against invading micro-organisms places the client at a high risk for infection.
Fracture and dysrhythmia are incorrect
A nurse on a cardiac care unit is caring for a preschooler.
Nurses' Notes
2015:
Increase in dyspnea noted with orthopnea. Nasal flaring with respiratory rate of 36/min.
Lung sounds with wheezing noted throughout. Lower extremity edema 3+ to bilateral
lower extremities. Extremities cool with decreased skin pigmentation noted. Peripheral
pulses weak bilateral. Jugular vein distention noted. Provider notified. Received
prescription for additional dose of IV furosemide.
Medication Administration Record
Hospital Day 1:
Furosemide 40 mg IV every 6 hr. Administered at 1755.
Hospital Day 2:
Give digoxin 125 mcg 12 hr after initial dose. Administered at 0608.
Give digoxin 125 mcg 12 hr after second dose. Administered at 1804.
Hypokalemia is correct. The client is receiving furosemide every 6 hr. Furosemide
causes potassium depletion. Therefore, the client is at risk for hypokalemia.
Digitalis toxicity is correct. The client is receiving digitalis every 12 hr. The margin of
safety is very small, 0.8 to 2 mcg/L. Therefore, the client is at risk for digitalis toxicity.
A nurse is caring for a client in the labor room.
Medical History
Gravida 2 Para 1
38 weeks gestation
Pregnancy complicated by gestational diabetes and hydramnios.
Spontaneous vaginal delivery 1 year ago.
No significant past medical history.
,No history of surgeries.
Spontaneous onset of labor
Nurses Notes
1020:
Client pushing effectively. Crowning. Provider present at bedside.
Contraction pattern: occurring every 4- 5 min; lasting 75-90 seconds; palpate strong.
Fetal heart rate 150/min. Average variability. Spontaneous accelerations noted. Variable
decelerations noted when pushing.
1025:
Spontaneous vaginal delivery.
2nd degree lacerations with repair.
Apgar scores: 8 at 1 min and 9 at 5 min
Birth weight 7 lb 8 oz (3,402 g).
Box 1
Postpartum hemorrhage is correct.
Overdistention of the uterus during pregnancy can impact the ability of the uterine
muscles to tightly contract following delivery. This can result in excessive blood loss
following delivery. Clients who have high parity, fetal macrosomia, multiple gestations,
and hydramnios are more likely to experience uterine atony. Therefore, the client has
the greatest risk of developing a postpartum hemorrhage due to hydramnios.
Box 2
Hydramnios is correct.
Hydramnios or polyhydramnios is an excessive amount of amniotic fluid that causes
overdistention of the uterus. This complication can develop during the third trimester in
women who have diabetes mellitus. This can impair the ability of the uterus to tightly
contract.
A nurse is caring for a client who is at 34 weeks of gestation.
Complete the diagram by dragging from the choices below to specify what condition the
client is most likely experiencing, 2 actions the nurse should take to address that
condition, and 2 parameters the nurse should monitor to assess the client’s progress.
Diagnostic Results
Fasting blood glucose 140 mg/dL (60 to 105 mg/dL)
HbA1c 10% (less than 6.5%)
Urinalysis:
Appearance cloudy (clear)
Color amber yellow (amber yellow)
pH 4.8 (4.6 to 8.0)
Positive urine glucose (negative)
3+ ketones (negative)
Urine specific gravity 1.010 (1.005 to 1.030)
Actions to Take
- obtain fasting blood glucose levels
- perform a nonstress test
Potential Condition
, - gestational diabetes mellitus
Parameters to Monitor
- monitor the client's hemoglobin A1c
- fetal well-being
The nurse should obtain fasting blood glucose levels and perform a nonstress test
because the client is most likely experiencing gestational diabetes mellitus because the
client has a blood glucose level above the expected reference range, glucosuria, and
ketonuria. The nurse should monitor the client's hemoglobin A1c because it evaluates
past glycemic control and assists the provider in evaluating how well the client is
adhering to any future treatment plan. Also, fetal well-being should be monitored to
determine how the client's diabetes mellitus is affecting the fetus and if additional
studies or testing should be performed on the fetus in addition to nonstress testing.
A nurse is caring for a client who is in the second stage of labor.
Medical History
0800: 28-year-old client; G2 P1; at 39 weeks of gestation.
Client has history of insulin dependent gestational diabetes mellitus with current
pregnancy.
Client admitted to the facility in the latent phase of labor at 4 cm, 70% effaced, and -1
station.
Nurse's Notes
1300: Client reports need to have a bowel movement. Sterile vaginal examination (SVE)
performed; 10 cm, 100% effaced, and +1 station. Fetal heart rate 130’s with moderate
variability, occasional variable decelerations observed. Provider notified of cervical
assessment. Client actively pushing with contractions.
1503: Provider at bedside. Fetal head crowning.
Actions to Take
- flex the client’s legs against the abdomen
- apply suprapubic pressure
Potential Condition
- dystocia
Parameters to Monitor
- movement of the newborn's upper extremities
- maternal perineum
The nurse should flex the client’s legs against the abdomen and apply suprapubic
pressure because the client is most likely experiencing shoulder dystocia. Flexing the
clients legs against the abdomen straightens the maternal pelvis, helping to free the
trapped anterior shoulder of the fetus. Applying suprapubic pressure also helps free the
anterior shoulder, allowing for birth of the newborn's body. The nurse should monitor the
movement of the newborn's upper extremities because newborns who experience a
shoulder dystocia are at a greater risk for brachial plexus injuries. The nurse should also
monitor the maternal perineum because mothers who experience shoulder dystocia are
at a greater risk for trauma to the vagina, perineum, and rectum.
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