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RN Comprehensive A 2023 Questions and Answers Infection control nurse is determining if infxn rates dec after policy revision. What type audit is nurse doing? *Outcome -Outcome audit examines data to determine result from nursing intervention Process Audit -examines how nursing care is ...

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RN Comprehensive A 2023 Questions
and Answers
Infection control nurse is determining if infxn rates dec after policy revision. What type
audit is nurse doing? - answer *Outcome
-Outcome audit examines data to determine result from nursing intervention

Process Audit - answer -examines how nursing care is provided

Prospective Audit - answer -prediction about performance in future based on a new
intervention

Structure Audit - answer -evals availability of resources=such as staffing ratios

Nurse caring pt having hemolytic tranfusion reaction & getting Mannitol. Nurse monitor
which therapeutic effects? - answer *Inc diuresis
-Mannitol causes osmotic diuresis for the txt hemolytic tranfusion reaction.

Anaphylactic transfusion reaction montior - answer -Dec wheezing
-Dec rash

Bacterial Infxn reaction - answer -monitor prevention of infxn

PT had right sided CVA; based on chart what is appropriate action by nurse? - answer
-Withold meds till swallow study can be done.
(Pt has drooping mouth & trouble articulating-indicates pt has some paralysis of mouth
& tongue and may have trouble swallowing meds)
*In chart all meds are PO-HINT HINT HINT*

Nurse admin wrong meds to pt, nurse recognized the error and completes incident
report; what needs to be charted in pt medical record? - answer *Time meds were
given
-complete incident report-DONT chart in mar
-document reason for error in the incident report not mar
-dont need to contact pharmacist

Nurse manager preparing staff education program on confidentiality; which actions
should nurse take first? - answer *Determine staffs current knowledge of
confidentiality requirements*
-

Nurse administering Cychlophosphamide/Cytan (med used in chemo) to a toddler who
has a neuroblastoma. Which following is appropriate nursing intervention when

,administering this medication? - answer *need to consume 1-1.5x fluid amt to
prevent hemorrhagic cystitis
-give early day

Nurse teaching group women about ovarian cancer; nurse should instruct group that
mortality rate for ovarian cancer is high because of what? - answer *Clinical signs
are vague in early stage
-chemo is the most common trxt ovarian cancer

Pap tests detect - answer cervical cancer

Nurse caring infant with hydrocephalus and is 6 hours post-insertion following (VP)
Ventriculoperitoneal shunt. Which finding should nurse report to MD? drainage neg
glucose, irritability when being held, hypotonic bowel sounds, urine specific gravity
1.018? - answer *Irritability when being held
-sign ICP increased cranial pressure-complicaiton of VP shunt malfunctioning
-all others are expectd

Nurse developing client education program about men's health, which following
teaching points should nurse add about early detection of prostate cancer? - answer
*annual measurement of prostate specific antigen should be performed for men over 50
-digital rectal exam annually start age 50

Nurse preparing to transfer pt who's post op after pneumonectomy & was recently
weaned from mechanical ventilation and tranfered from ICU to med/surg; what is
necessary to include in transfer report? - answer *Pt last dose of pain medication

Nurse caring pt with closed head injury who has just been placed on SZR precautions.
Which following alterations should the nurse make in the pt's environment? - answer
*Set up suction eqpt at bedside
-side rails up
-do not remove iv's as pt may need meds for szrs
-NO padded tongue blades

Nurse admin oral rehydration solution to child who was admit for severe hypotonic
dehydration; which lab result shows child is responding to treatment? Serum sodium
136, Urine PH 6, urine spec gravity 1.035, serum potassium 3.5 - answer *Serum
Sodium 136
-hypotonic dehydration has serum sodium less 130; 136 responding well
(urine spec gravity-indicates hydration (HIGH IS DRY!)-not responding ok; serum
potassium & urine ph is NOT checked for hydration)

Nurse assng pt who just had vaginal delivery and has heavy lochia & boggy fundus;
what med should nurse admin? - answer *Oxytocin/pitocin
-hormone stimulates contractions to prevent bleeding

, Mg sulfate - answer dec contractions during PTL pre-term labor
smooth muscle relaxant

Terbutaline/smooth muscle relaxer - answer dec contractions during PTL pre-term
labor
smooth muscle relaxant

Nalbuphine/opioid - answer given pain relief during labor

Nurse mgr reviewing newly licenses nurse performance; what method should nurse use
to evaluate nurse time mgmt skills? - answer *Maintain regular notes about the
nurse's time management skills. This provides a comprehensive view of the nurse's
abilities.

Which pt should nurse assess first after getting report? - answer *post op client with
abdominal distention and no bowel sounds

Which of the following client findings indicates to a nurse that a client who is 2 days
postpartum is demonstrating bonding behaviors with her newborn? - answer *Pt tells
visitors how much baby looks like her sister

A client who is receiving CPA postop pain control requires a BP check q10 min. Which
staff can perform this? - answer *CNA who is assisting client back to bed

A nurse is assessing for correct placement of a clients NG tube prior to administering a
bolus feeding. Which of the following nursing actions is the correct procedure to use? -
answer *aspirate contents from the tube and verify the pH
-ph should be btwn 1-4 for proper placement

A charge nurse observes a staff nurse document a dressing change in a clients chart
that was not performed. Which of the following actions should the charge nurse take? -
answer *gather more info about staff nurse's actions
-

A nurse in an outpatient clinic is counseling a client who is experiencing an emotional
crisis. Which is an appropriate nursing intervention to assist the client with coping? -
answer *Assist client in identifying cause of issue
-appropriate step in crisis intervention

A client tells the nurse she wants to review the info in her chart. Which is appropriate
response by nurse? - answer *There is a protocol for reviewing your chart, I can
initiate the process

A nurse is providing teaching about self-administration of insulin to a client who has a
new prescription for short-acting and intermediate acting insulin. Which of the following

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