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NUR 231 Final Exam Questions And Answers 100% Solved What are the normal's for the following labs 1) Urine Specific Gravity 2) Serum Osmolality 3) ABG (pH, HCO3, PaCO2, PaO2) 4) troponin I 5) electrolyte panel( Na+, K+, Ca+, Mg+) 6) BUN & Creatinine 7) CBC ( hgb, hct, RBC, WBC, platelets) ...

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NUR 231 Final Exam Questions And Answers 100%
Solved
What are the normal's for the following labs
1) Urine Specific Gravity
2) Serum Osmolality
3) ABG (pH, HCO3, PaCO2, PaO2)
4) troponin I
5) electrolyte panel( Na+, K+, Ca+, Mg+)
6) BUN & Creatinine
7) CBC ( hgb, hct, RBC, WBC, platelets)
1) 1.000-1.030
2) 270-300
3) pH 7.35-7.45// HC03 22-26// PaCO2 35-45// Pa02 80-100
4) troponin I <0.03 ng/mL
5) Na+ 135-145//K+ 3.5-5// Ca+ 9-10.5//Mg+ 1.2-2
6) BUN 10-20//Creat 0.5-1.2
7) hgb 12-18// hct 37-52%// rbc 4.2-6.1// wbc 5,000-10,000// platelets 150,000-400,000


Match the lab profile with the most likely fluid imbalance like A) Fluid Volume Deficit 2) Fluid Volume
Excess
1) ____Na 148; Hct 40% yesterday, 49% today; serum osmolarity 308
2) ____Hgb 13.2 yesterday, 10.1 today; Urine specific gravity 1.001
3) ____BUN 45; Cr 0.7
1) A
2) B
3) A


The nurse is preparing to administer lisinopril (Zestril) to a patient with acute coronary syndrome.
Which of the following findings should prompt the nurse to hold the medication and consult the
healthcare provider?
a) Serum sodium level 134
b) Serum potassium 5.6
c) Heart rate 58
d) Blood pressure 125/78
b) Serum potassium 5.6
*ACE inhibitors can cause/exacerbate hyperkalemia.


The nurse is caring for a patient who is in hypovolemic shock following an extensive burn injury. What
is the intravenous fluid of choice for this patient in the emergent phase of treatment?
a) Lactated Ringers
b) 0.45 NS with 20 mEq potassium chloride
c) Fresh Frozen Plasma
d) 5% Dextrose in saline
a) Lactated Ringers
*Isotonic solutions (crystalloids) are used to restore fluid volume in patients with shock. Lactated
Ringers is isotonic. Normal saline is also isotonic.


The client on a ventilator is assessed for untoward responses to the therapy. Which of the following
would indicate a possible complication of ventilator therapy?
a) Blood pressure has increased 5mmHg in the last 24 hours
b) Lung sounds absent on one side.

,c) Forceful cough periodically
d) Broncho-vesicular breath sounds throughout peripheral lung fields.
b) Lung sounds absent on one side.
*This may indicate a pneumothorax--a complication caused by barotrauma.


The pressure reading during inspiration on the ventilator of a client receiving mechanical ventilation is
high and alarming intermittently. What is the nurse's first action?
a) Assess the client's oxygenation.
b) Call the RT to check the ventilator settings.
c) Listen for bilateral lung sounds.
d) Determine whether an air leak is present in the client's endotracheal tube cuff.
a) Assess the client's oxygenation.


Which assessment finding best indicates that fluid resuscitation therapy for the patient with
hypertonic dehydration has acheived the desired effect?
a) Peripheral pulses changed from 1+ to 3+
b) Neck veins slightly distended @ 30 degrees
c) Serum sodium level has changed from 151 to 143.
d) Pulse oximetry shows oxygen saturation of 95%
c) Serum sodium level has changed from 151 to 143.


Which intravenous solution should you be prepared to administer to a patient with isotonic
dehydration?
a) 0.45% saline
b) Dextrose 5% in water
c) Dextrose 10% in water
d) 0.9% saline
d) 0.9% saline


A patient is receiving dobutamine [Dobutrex] as a continuous infusion in the immediate postoperative
period. The patient also is receiving a diuretic. What adverse drug reactions are possible in this
patient? (select all that apply)
a)Angina
b)Hypotension
c)Dysrhythmias
d)Oliguria
e)Tachycardia
a)Angina
c)Dysrhythmias
e)Tachycardia

*Is a beta1 aderenergic agonist; general anesthetics can increase the likelihood of dysrhythmias.
Dobutamine elevates BP by increasing CO. Diuretics complement the beneficial effects of dobutamine
on the kidney, so urine output would be increased, not decreased.


A patient who has severe sepsis is receiving an intravenous normal saline infusion. She weighs 78 kgs.
Which of the following is an indicator that the therapeutic goal has been met?
a) 250 mL of urine in the past 6 hours
b) Arterial blood pressure is 90/42
c) Central Venous Pressure is 2 mm Hg
d) Patient's heart rate is 101
a) 250 mL of urine in the past 6 hours

,*Fluid resuscitation goals in sepsis are: MAP > 65, UO . 0.5 mL/kg/hr, and/or CVP 8-12 mm Hg.


The nurse is caring for Mrs. B, who has a pulmonary embolus. She is started on a heparin drip and 4
hours later the aPTT is 70 seconds (lab control or "normal" value is 40 secs). The nurse should:
a) Notify the provider and request an order for warfarin (Coumadin).
b) Notify the provider and request a decrease in the heparin dose.
c) Continue the present order for heparin.
d) Hold the heparin and notify the physician.
c) Continue the present order for heparin.

*The aPTT is therapeutic for a heparinized patient with a PE. A therapeutic aPTT for a heparinized
patient is 1.5-2x the "normal" or "control" value. Review also the heparin protocol calculations. We
did an example on the PE case study.


A patient with a diagnosis of myocardial infarction is admitted to your unit. Which of the patient's
statements would alert you to the possibility of acute heart failure?
a) "I think my dose of digoxin may need to be increased."
b) "I have noticed a lack of appetite lately."
c) "I have trouble remembering things lately."
d) "I'm feeling short of breath when I walk to the bathroom."
d) "I'm feeling short of breath when I walk to the bathroom."

*Activity intolerance is a symptom of heart failure, due to dyspnea on exertion.


The nurse is caring for patients on a cardiac unit. Which patient should the nurse assess first?
a) The patient diagnosed with Heart Failure who has bilateral 3+ peripheral edema.
b) The patient diagnosed with mitral valve regurgitation who has dyspnea on exertion.
c) The patient diagnosed with angina who is reporting chest pain.
d) The patient diagnosed with pericarditis who has a temperature of 100 degrees F.
c) The patient diagnosed with angina who is reporting chest pain.

*A patient with a history of angina should be pain-free. If he/she is not, then there may be myocardial
ischemia occurring. All of the other choices represent expected, but non-lifethreatening findings for
the diagnosis.


The nurse is caring for a patient with Diabetic Ketoacidosis. Which of the following is the most
concerning assessment finding?
a) Blood pressure is 103/78.
b) Blood sugar is 565.
c) Urine is dark and cloudy.
d) Patient is confused and agitated.
d) Patient is confused and agitated.

*A patient in DKA is at risk for impaired central perfusion, secondary to hypovolemia. Confused and
agitated is an indicator of poor perfusion to the brain and is the priority issue. Blood pressure is
acceptable, but note the narrowed pulse pressure indicating compensatory vasoconstriction.


You are monitoring the patient undergoing exercise EKG (stress test). Which of the following criteria
would indicate that the test should be stopped prematurely?
a) If the patient's respiratory rate exceeds 24 breaths/minute
b) When the incline of the treadmill reaches 10% elevation

, c) If the patient's EKG indicates significant ST segment depression
d) When the patient's heart rate reaches 120 beats/minute
c) If the patient's EKG indicates significant ST segment depression

*ST depression may indicate cardiac ischemia. All other choices are expected.


A patient is admitted to the intensive care unit for treatment of shock. The prescriber orders
norepinephring (Levophed). The nurse expects this drug to increase tissue perfusion in this patient by
primarily activating:
a) alpha1 receptors to cause vasodilation.
b) beta2 receptors to cause bronchodilation.
c) beta1 receptors to cause a positive inotropic effect.
d) alpha1 receptors to increase blood pressure.
d) alpha1 receptors to increase blood pressure.


A patient comes into the emergency department with extensive bleeding from face, arm, and chest
wounds. What is the earliest manifestation of hypovolemic shock likely to be detected in this patient?
a) Increased respiratory rate.
b) Increased heart rate.
c) Decreased blood pressure.
d) Cool, pale skin.
b) Increased heart rate.


Your patient had sudden, sharp chest pain and is breathing rapidly. The provisional diagnosis is acute
pulmonary embolism. Which of the following arterial blood gas results would you expect to see
during the first 20 minutes after the start of this episode?
a) pH 7.30 HCO3 22 PCO2 60 PO2 66
b) pH 7.46 HCO3 28 PCO2 65 PO2 75
c) pH 7.38 HCO3 22 PCO2 45 PO2 96
d) pH 7.47 HCO3 22 PCO2 25 PO2 70
d) pH 7.47 HCO3 22 PCO2 25 PO2 70

*Remember that a patient with a PE will be tachypneic, which leads to an increased excretion
(blowing off) of CO2, which causes a respiratory alkalosis. Additionally, hypoxemia would be expected.


The patient is diagnosed with heart failure. The nurse finds the patient lying in bed, short of breath,
unable to talk, and with buccal cyanosis. Which intervention should the nurse implement first?
a) Call Rapid Response Team.
b) Assist the patient to a sitting position.
c) Assess the patient's vital signs.
d) Asuscultate the patient's lung sounds.
b) Assist the patient to a sitting position.

*Sitting the patient up will decrease venous return, thereby reducing preload and therefore reducing
the workload of the heart. It will also maximize lung expansion. This hopefully will alleviate some of
the patient's respiratory distress. The nurse may need to call RRT if sitting the patient up doesn't
alleviate the distress, or if further assessment warrants--but it's not the first action. More assessment
is not needed at this time. There is enough assessment data in the stem of the question to make a
decision.


The nurse is caring for a post-operative patient who suddenly reports sharp chest pain and dyspnea.
She is tachycardic. What is the nurse's priority action?

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