Games Exam #1 everything you need to know PDF

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Jeopardy Game: Fluid & Electrolytes: The ABG has the following values: pH = 7.21, PaCO2 = 64 mm Hg, HCO3 = 24 mm Hg  Respiratory Acidosis with Compensation During your shift assessment, an elderly client complains of tingling in her lips and fingers whenever anyone takes her blood pressure. She tells you that she gets a spasm in her wrist and hand and that it is very painful. What would the RN suspect?  Tetany; most common characteristic of hypocalcemia and hypomagnesaemia Which IV solution would the RN anticipate infusing as fluid resuscitation for a client with severe diarrhea for 24 hours?  Lactated Ringer Magnesium: 3.89 mg/dL (1.6 mmol/L.) Sodium: 138 mEq/L (138 mmol/L.) Chloride: 100 mEq/L (100 mmol/L.) Potassium: 3.0 mEq/L (3.0 mmol/L.) Phosphate: 5.75 mg/dL (1.8 mEq/L) Calcium: 17.6 mg/dL (4.4 mmol/L.)  All levels are in normal range. Except for potassium is low (hypokalemia) pH: 7.33 PaCO2: 42 mm Hg HCO3: 19 mEq/L (19 mmol/L) PaO2: 95 mm Hg  Metabolic Acidosis Respiratory: How should the RN first respond in a situation where the client has rolled over, and the chest tube has become disconnected from the drainage unit?  Submerge the end of the tube in sterile water. What nursing action is appropriate when constant bubbling is noted in the suction control chamber of chest tubes?  Constant bubbling in the suction control is normal & should be documented; nothing else needs to be done. The RN educator would intervene with client teaching if which action by the staff nurse occurs when teaching voluntary coughing? The nurse...  The client should be sitting upright with feet flat on the floor to be most effective.  The nurse should develop a specific schedule for coughing.  Coughing before meals improves the taste of food and oxygenation.  When combined with deep breathing, coughing is most effective.

Which action by an LVN performing oropharyngeal suctioning on a client would indicate to the RN that the suctioning is being properly performed? The LVN...  The catheter should be placed along the side of the mouth toward the trachea and advanced 3" to 4" to reach the pharynx. 

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In nasopharyngeal suctioning, the catheter should be inserted through the naris and along the floor of the nostril toward the trachea; it should be advanced approximately 5" to 6" to reach the pharynx. Applying lubricant to the first 2 to 3" of the catheter facilitates passage of the catheter and reduces trauma to mucous membranes. Allowing 30-second to 1-minute intervals between suction passes allow for reventilating and reoxygenation of airways.

What information should be provided to the client when he asked when he will be able to eat after a bronchoscopy? "You will...  Nursing interventions for a bronchoscopy include ensuring informed consent, teaching before the procedure, and maintaining n.p.o. status until the gag reflex returns after the procedure. Urinary In what position should the RN place the female client for the insertion of an indwelling catheter who has limited hip mobility due to a total hip replacement?  Sims position After surgery, a postoperative client has not voided for 8 hours. Where would the nurse assess the bladder for distention?  Bladder is distended with urine, it rises above the symphysis pubis and may reach to just below the umbilicus An RN is caring for older adult clients in an assisted-living facility. Which effect of aging should the nurse consider when performing a urinary assessment?  Decreased bladder contractility may lead to urine retention and stasis, which increase the likelihood of urinary tract infection.  The diminished ability of the kidneys to concentrate urine may result in nocturia (urination during the night).  Decreased bladder muscle tone may reduce the capacity of the bladder to hold urine, resulting in increased frequency of urination.  Neuromuscular problems, degenerative joint problems, alterations in thought processes, and weakness may interfere with voluntary control and the ability to reach a toilet in time.  Individuals who view themselves as old, powerless, and neglected may cease to value voluntary control over urination, and simply find toileting too much bother no matter what the setting Incontinence may be the result.

The nurse has received an order to discontinue an indwelling urinary catheter. Which actions are appropriate when carrying out this order?  Use clean gloves  use appropriate size syringe to empty the balloon  Pinch or kink catheter to prevent backflow  Measure and record the amount of urine output in bag. An RN is delegating the collection of urinary output to an unlicensed assistive personnel (UAP). What should the nurse tell the UAP to do while measuring the urine?  Gloves are used while collecting & addition goggles may be worn if there is a concern of splashing Bowel An RN is documenting the appearance of feces from a client with a permanent ileostomy. Which scenario would she document?  Liquid feces coming from the small intestine An RN is providing discharge instructions for a client with a new colostomy. Which is a recommended guideline for long-term ostomy care?  During the first 6 to 8 weeks after surgery, the nurse should encourage the client with an ostomy to avoid foods high in fiber (e.g., foods with skins, seeds, and shells) as well as any other foods that cause diarrhea or excessive flatus.  By gradually adding new foods, the ostomy client can progress to a normal diet. The nurse should urge clients to drink at least 2 quarts (1.9 L) of fluids, preferably water, daily. The use of liquid, chewable, or injectable forms rather than long-acting, entericcoated, or sustained-release medications is recommended.  Laxatives and enemas are dangerous because they may cause severe fluid and electrolyte imbalance. A nurse assessing a client with an ostomy appliance documents the condition "prolapse" in the client chart and notifies the physician. Which of statement describes this condition?  The stoma is protruding into the bag.  The nurse should have the client rest for 30 minutes and, if the stoma is not back to normal size within that time, notify the physician.  If stoma stays prolapsed, it may twist, resulting in impaired circulation to the stoma. What should the RN do when finding no feces in the colostomy collection bag of a client who is day 1 postoperative for a temporary colostomy?  Due to bowel prep cleansing prior to surgery the client should not be alarmed if there is no feces in the colostomy.  Typically, a colostomy does not produce drainage or feces until normal peristalsis returns after surgery, usually within two to five days.

What appropriate nursing intervention would the RN implement when caring for a client with difficulty defecating?  Use of moist heat soothes the perineal area.  Water is preferred because fluids with caffeine and sugars have a diuretic effect.  When a client is using the bedpan, the head of the bed should be elevated to a minimum of 30 degrees.  A low-fiber diet is recommended for a client with diarrhea.  Clients require regular exercise to aid in defecation; once a week is not enough. Medications: Which action ensures that a medication remains sealed in the tissues when administering an intramuscular injection?  The nurse should pull the tissue laterally until the tissue is taut & applying pressure (NOT massaging) Which technique should the nurse implement in order to ensure safe and complete delivery of the prescribed inhaled bronchodilator?  Utilization of a spacer/extender prevents escape of the medication into the atmosphere and provides the most accurate dose. What would be the RN's best action when administering the first dose of an IV antibiotic to a client?  A reaction to the antibiotic can occur within the first 15 minutes of administration; the nurse should stay with the patient to monitor for s/s of reaction You are assessing your patients' IVs on an hourly basis. When you check the IVs this hour, you find localized pain, redness, warmth, and swelling around the insertion site of a 25-year-old female patient. What would you, as the nurse, do for this patient?  discontinuing the IV infusion  applying a cold compress first to decrease the flow of blood and increase platelet aggregation  then applying a warm compress and elevating the extremity  restarting the line in the opposite extremity. The physician has ordered a peripheral IV to be inserted before the patient goes to the operating room. What should the RN do when selecting a site on the hand or arm for insertion of an IV catheter?  nurse should choose a distal site, not a proximal site.  Selection of a distal site leaves the upper veins available for subsequent cannulations.  Instruct the patient to hold his arm in a dependent position to increase blood flow.  Never leave a tourniquet in place longer than 2 minutes. Order: 2.5 mg/kg of Ampicillin Available: 10 mg/ml

How many ml do you give to a 30 lb child? (round to the nearest whole number)  3mL ***30lb/2.2=13.6363636 X 2.5mg/kg= 34.0909091mg/ 10mg/mL = 3.409= 3.0mL

WHO WANTS TO BE A MILLIONARIE? A tort is a wrongful act that result in injury loss or damage. There are 2 kinds of unintentional torts. One is malpractice, the other is?  Fidelity  Negligence  Beneficence  Normalefience Which of the following is NOT an intentional tort?  Vandalism  Assault  Battery  False imprisonment A client who is involuntarily committed to a psych facility has all the right except what?  To have visitors  To refuse treatments  To leave  To receive sealed mail Clients with a criminal history may continue to participate in treatment on involuntary basis with a conditional release from the hospital through which program?  Mandated outpatient treatment  Repeat offender program  Community outreach release  Involuntary treatment release A client likes to wander, get up out of bed, and often falls. This client has the right to treatment in which of the following options?  Geri Chair with a lap buddy  Seclusion  Mechanical restraints  Least restrictive environment

When would short-term use of restraints or seclusion NOT be justified?  When client is immensely aggressive

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When client is dangerous to elf & others When client needs to be taught a lesson When all other means to calm and subdue fail

How often must the nurse monitor a client in restraints?  Every 15 mins  Every 30 mins  1:1 continuous  Hourly checks, with 24 hour video surveillance As soon as possible staff members must inform the client of behavioral criteria that will be used to determine whether to decrease the use of restraint or seclusion which of the following is NOT criteria?  Ability to verbalize feelings rationally  Demonstrate decreased muscle tension  Ability to explain why they acted out  Demonstrate self-control What is called when you have threats made to an identifiable 3rd party and you can legally break confidentiality to warn them?  Duty to warn  Threat violation rule  Third party threat warning  Confidentiality clause If a nurse makes a client fear bring touched in way that is offensive, insulting, or physically injurious without consent or authority, what could the nurse be charged with?  Assault  Battery  False imprisonment  Breach of duty Which of the following options are NOT part of the 4 elements needed to prove malpractice?  Breach of duty  Causation  Intention  Injury or damage

Which of the following options are NOT part of the 3 elements needed to prove liability for intentional tort?  Act was will fill &voluntary  Nurse intended to bring about the action

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Act was substantial factor in causing the injury Nurse was acting outside of the scope of practice

A conservator or legal guardian is needed in all the following cases except?  People are gravely disabled  People in familial disputes  People found to be incompetent  People who cannot act in their best interests A client who needs medication to resolve symptoms of their disease process, refuses all of their medication. Which of the following actions should the nurse take?  Educated the client, but allow the refusal  For the client to take the medication  Tell the client they need to consult with their doctor  Talk the client into taking it The goal of seclusion is to give the client a chance to regain physical and emotion self-control. Seclusion serves to do all the following but…?  Decreases stimulation  Protect others from the client  Punishes the client  Prevent property destruction

EXAM #1 RECAP QUESTIONS A client who was receiving enteral feedings in the hospital has been started on a regular diet and is almost ready for discharge. The client will be self-administering supplemental tube feedings between meals for a short time after discharge. When the client expresses concern about his or her ability to perform this procedure at home, the nurse would best respond with which of the following? A. “Tell me more about your concerns about going home” B. “Do you want to stay in the hospital a few more days?” C. “Maybe a friend will do the feeding for you” D. “Have you discussed your feelings with your family and doctor?” The client with pancreatitis is being weaned from parenteral nutrition (PN). The client asks the nurse why the PN cannot just be stopped. The nurse includes in a response to the client that which of the following complications could occur with sudden termination of PN formula? A. Dehydration B. Hypokalemia C. Hypernatremia

D. Rebound hypoglycemia A client is scheduled for insertion of a peripherally inserted central catheter (PICC) and the nurse explains the advantages of this catheter. The nurse determines that the client needs additional information about the catheter if the client makes which statement? A. “It is reasonable in cost” B. “There is less pain and discomfort than other types of catheters” C. “This type of catheter is very reliable” D. “It is specifically designed for short-term use” The nurse caring for a newly admitted client is reviewing the medication prescription sheet in preparation for administering medications to the client. The nurse notes that the physician has prescribed a medication dose that is twice the amount that the client has reported taking prior to admission. The most appropriate nursing action is to: A. Contact the physician directly B. Administer the medication as prescribed C. Question the client regarding the accuracy of the reported dosage D. Ask the physician about the prescription the next time the physician makes rounds The nurse is providing instructions to a client regarding the use of ice packs to treat an eye injury. The nurse instructs the client to: A. Place the ice pack directly on the eye B. Avoid the use of commercially prepared ice bags C. Keep the ice pack on the eye continuously for 24 hours D. Wrap a plastic bag filled with ice with a pillowcase and place it on the eye The nurse is assigned to care for a chemically dependent client who has the potential for violent episodes. In planning to care for the client, which of the following actions is the priority? The nurse: A. Speaks slowly to the client B. Moves slowly when approaching the client C. Bargains with the client to prevent the volent episodes D. Projects an attitude of calmness when caring for client

A nurse is conducting a basic life support (BLS) recertification class and is discussing automated external defibrillation (AED) when a member of the class asks the nurse to identify the correct location for the placement of conductive gel pads to treat ventricular fibrillation. The nurse correctly responds with: A. Bilaterally, under the right-sided and left-sided clavicles B. Parallel, between the umbilicus and the left-sided nipple C. Centered on the upper and lower halves of the sternum

D. Under the right-side clavicle and to the left of the nipple in the midaxillary line A nurse walking in a downtown business area witnesses a worker fall from a ladder. The nurse rushes to the victim, who is unresponsive. The nurse then opens the victim’s airway by using the: A. Head tilt-chin lift B. Head tilt-jaw thrust C. Jaw thrust maneuver D. Chin lift position The preoperative client expresses anxiety to the nurse about the upcoming surgery. Which of the following statements by the nurse is most likely to stimulate further discussion between the client and the nurse? A. “If it’s any help, everyone is nervous before surgery” B. “I will be happy to explain the entire surgical procedure to you” C. “Can you share with me what you’ve been told about your surgery” D. “Let me tell you about the care you’ll receive after surgery and the amount of pain you can anticipate” The nurse has just reassessed the condition of the postoperative client who was admitted 1 hour ago to the surgical unit. The nurse monitors which of the following parameters during the next hour most carefully? A. Urinary output of 20mL/hr B. Temperature of 37.6C (99.6F) C. Blood pressure of 116/78mmHg D. Serous drainage on the surgical dressing When performing a surgical dressing change of a client’s abdominal dressing, the nurse notes an increase in the amount of drainage and separation of the incision line. The underlying tissue is visible to the nurse. The priority nursing action at this time is to: A. Apple a povidone-iodine (Betadine)-soaked sterile dressing B. Leave the incision exposed to the air to dry the area C. Apply a sterile dressing soaked with normal saline D. Irrigate the wound, and apply a sterile dressing

The client with right-sided pleural effusion by chest x-ray is being prepared for a thoracentesis. The nurse assists the client to which of the following positions for the procedure? A. Sims position, with the head of the bed flat B. Left side-lying position, with the head of the bed elevated 45 degrees C. Prone, with the head turned to the side supported by a pillow D. Right side-lying position, with the head of the bed elevated 45 degrees

The nurse is inserting an indwelling urinary catheter into a male client. As the catheter is inserted into the urethra, urine begins to flow into the tubing. The nurse notes the urine beginning to flow and next: A. Immediately inflates the balloon B. Inserts the catheter 2.5-5cm father, then inflates the balloon C. Insert the catheter until resistance is met, then inflates the balloon D. Withdraws the catheter approximately 1 inch, then inflates the balloon The nurse caring for a client who has a pneumothorax notes continuous bubbling in the water seal chamber of the client’s closed-chest drainage system. The nurse determines that which of the following is occurring? A. The pneumothorax is resolving B. The drainage chamber is full C. The suction to the system is shut off D. There is an air leak somewhere in the system Which client would the emergency department triage nurse classify as emergent? A. A client with a displace fracture B. A client with a temperature of 101F C. A client with a simple laceration and soft tissue injury D. A client with crushing substernal pain who is short of breath The nurse working as a case manager understands that case management is often needed when the client A. Cannot afford to stay in the hospital B. Has no one at home to help with client’s care C. Has complex acute or chronic health care needs D. Is too sick to care for oneself The outpatient care nurse is discussing postoperative dismissal teaching with an Asian-American client. During the discussion, the client looks at the floor, smiles at times, and nods his head. The nurse interprets this nonverbal behavior as A. An acceptance of the dismissal instructions B. An understanding of the material taught C. A reflection of cultural values D. An ability to follow through with instruction The nurse is caring for a client receiving parenteral nutrition (PN) via a central line. The nurse should monitor which of the following to detect the development of the most common complication of PN? A. Temperature B. Daily weight C. Intake and output (I&O) D. Serum blood urea nitrogen (BUN) level

The nurse is providing care to a client wi...