CLOSE DOOR 2
問題一覧
1
which of the following nursing interventions Should nurse Dino do first when a patient who was found to have been beaten by a stray dog, arrives at the clinic?
Cleanse the bite with soap and running water
2
Duday, 35y/o female, game, product clinic, complaining of burning sensation while urinating, and feeling the need to urinate more often. she was diagnosed with urolithiasis. when ask if there is an herbal medicine she could use, which of the following should the nurse advise her to take?
Sambong
3
The nurse is teaching Duday How to take the herbal medicine, which of the following statement made by Duday Will indicate understanding of the health teaching?SAMBONG
“ I will make sure to chop and boil. It leaves in water for 15 minutes until one glass full remains.”
4
Situation : A patient came to the ER, presenting with reability, lower back pain, headache, Fever for four days, Muscle cramps. The patient reports accidentally stepping on the nail, while gardening about two weeks ago. The patient was diagnosed with tetanus.
Question: The nurse was asked on the way tetanus can be transmitted, which of the following responses will demonstrate the nurses understanding of the disease?
“ tetanus can be transmitted through contamination of wounds”
5
Michael, a 45y/o male is admitted at Mariwasa Medical Clinic complaining intense pain at the lower left part of his abdomen. He said he’s having diarrhea defecating about 10 to 20 liquids stools. he also noticed that his faces have traces of red blood in them nurse Maria knows that the patient is having clinical manifestations of.
Ulcerative colitis
6
which of the following is not done by a patient with anorexia nervosa
Recognize that their body image is abnormal
7
Patient kirby Would be most at for developing what electrolyte imbalance? vomiting
Hypokalemia
8
What is the criteria to be diagnosed for bulimia?
Binging and purging once a week for three months
9
Situation : Patient Fish Is in the psychiatric wired, and has been undergoing treatment after being diagnosed with schizophrenia. Nurse Bennett Has been assigned as patient Fish primary nurse
question: Patient presents with positive symptoms of schizophrenia. Nurse should expect the following statement except?
“ I don’t find my old hobbies as enjoyable as before”
10
Nurse Bennett reviewed patient fish medication, history and found out that she has been on antipsychotics for nearly 6 months. Patient fish is at most at address for what condition if she continues using her antipsychotics?
Tardive dyskinesia
11
What neurotransmitters is affected in schizophrenia?
Dopamine
12
if patients fish psychosis lasts for more than one month, but subsides before six months, Nurse Bennett would classify this as?
Schizophreniform
13
A few weeks after undergoing treatment, Patient presents with evolution. Nurse Bennett knows that this is:
Lack of motivation
14
When providing health teaching to patient fish regarding her medications, nurse Bennett should instruct the following, except ?
Stand up immediately after lying down for a long time
15
Nurse Bennett Natis, that patient fish present with symptoms of extra pyramidal symptoms caused by her medication’s. Nurse Bennett will expect the following except?
Catatonia
16
Situation : Nurse Barbara is an emergency nurse and is experience with handling patients with different levels of anxiety. One day Accident occurs and caused a surge of patients in the emergency room
Question: Patient is brought in the emergency department who seems to be the only survivor in the vehicle she was in. Assessment IM valium Is ordered; Nurse Barbara knows that this is given to patient with what level of anxiety
Severe
17
another patient is brought to the emergency department. Despite Having a nonlife threatening injury, the patient is found pacing and only focus on answering a few of the assessment questions. What level of unsighted does the patient present?
Moderate
18
A patient comes to the emergency department with severe difficulty of beating. The patient verbalizes that she hears loud ringing in her ear, aggressive, and cannot focus nor answer, Any of the questions nurse Barbara is asking. What level of anxiety is this?
Panic
19
What neurotransmitter is affected in patients diagnosed with anxiety disorders ?
GABA
20
Nurse Maria is aware that patient Michael’s condition is characterized as : Ulcerative colitis
Multiple ulcerations, Diffuse inflammation, And desquamation or shedding of the colonic epithelium That starts from rectum
21
The following are complications that may arise if the progression of ulcerative colitis worsens, except”colon”
Gastric ulceration
22
patient, Michael’s inflammation and ulceration were sense and Progressed up to the transverse colon. Nurse Maria Anticipate which procedure will be performed to relieve the patient symptoms?
Total colectomy
23
The doctor ordered oral azithromycin For patient Nezuko due in the morning to manage her UTI. After nurse tanjiro prepares the medication She receives a call light from multiple patients asking for her assistance. She realizes that as she tends to other patients urgent concerns her medication to patient Violetta will be delayed since her unit is understaffed her best action is to.
Delegate and endorse the task of medication administration to another registered nurse
24
Patient Billy arrives at the emergency room, complaining of weakness, fatigue, leg, numbness, and tingling sensations. He Has a diagnosis of left sided heart failure and was given Lasix prior to occurring symptoms. Laboratory result showed that he has sodium level of 137mEq/dL Potassium levels of 2.8 mEq/dL And calcium levels of 9mg/dL. Based from this findings :
Hypokalemia
25
An order was given by the doctor to provide IV potassium to improve the patient’s billy’s potassium level and alleviate his occurring symptoms. Nurse Isabella is now monitoring for science of possible access, potassium levels. Which of the following requires immediate intervention in Monitoring for hypokalemia.
Placing the patient on cardiac Monitor
26
Charmaine a newly registered nurse was tasked to be IV potassium chloride the patient jerry with hypokalemia. She was instructed by her preceptor never give IV potassium via IV push. She asked why and her preceptor would answer the following. except:
It may have lesser effect in the body
27
patient floor was Rushed To the emergency room showing signs of extreme muscle weakness, paralysis, and nausea. She was attached to a cardiac monitor And it showed peaked T waves, Depressed ST segment, and a short QT interval. nurse Mariel is aware that the patient hyperkalemic. The following our medications that should be given to the patient Except:
Calcium chloride
28
sarah, a 1week postoperative patient was observed to be having symptoms of muscle, rigidity and tingling sensations of extremities. When nurse jes touch her cheek, she immediately twitched nurse jes is aware that the patient has :
Hypocalcemia
29
One of the management to treat the patient Sarah symptoms is to provide calcium replenishment. The doctor ordered to give calcium to treat the muscle spasms. The following medications can be given to treat hypocalcemia, except.
Calcitonin
30
Nurse Beatrix is assessing various patience in medical surgical ward he determines, which of the following is not at risk for increased calcium levels
a 63 years old patient with renal failure
31
patiently, well, who is diagnosed with hyperthyroidism is Rushed To the hospital with symptoms of muscle weakness, and anorexia Nausea and vomiting. Laboratory results indicate which of the following calcium level is correct?
calcium levels of 15 mg/dl
32
Mary, a high school student is currently admitted in the AB ward she complains of intense, abdominal pain, bloating, and alternate periods of constipation and diarrhea. She reports that she felt it recently before taking an examination. Laboratory studies showed no findings present in the abdomen. Nurse and can infer that the patient is having.
Irritable bowel syndrome
33
Nurse and is aware that the management for the patient marries symptoms are focus on proper stress management, exercise and appropriate diet. The following should not be included in the patient’s diet except
Oatmeal
34
Dumping syndrome occurs in which of the following patients select all that apply
1. Patients who had Bill roth one or two
2. patient who had a vagotomy
3. Patient was currently on tube feeding
4. Patient who had a colectomy
123
35
patient Rancy was transferred to the medical surgical word after a bilroth 2 procedure. Nurse Jovi would suspect dumping syndrome if the patient showed which of the following early sign or symptoms expect
Weakness
36
In order to prevent patients Rancy to have recurring episode of dumping syndrome, nurse Jovi should
Let the patient lay down in left sideline position
37
Patient Maman is admitted with a recent history of sexual intercourse with a person positive with HIV, which of the following are signs and symptoms of acute stage of HIV?
Mild fever, headaches, sore throat
38
Handling a patient diagnosed with HIV requires which type of Precaution?
Standard precaution
39
Which of the following Patient exposure would most likely affect the nurse if the patient HIV diagnosed is suspected but not confirmed?
Needle stick injury with the needle and syringe with the patient’s blood
40
Nurse Twinnie is giving IV medication’s to the patient when she is suddenly breaked by the needle . The patient was diagnosed with HIV upon admission. Nurse will know if she required the virus when she will have which diagnostic test.
EIA/Elisa
41
The following a risk factor associated with development of cervical cancer, except
Late age of first sexual intercourse
42
Patient bubbles is currently admitting on suspected cervical cancer. Which of the following would indicate possible science and symptoms that may support the diagnosis.
Light bleeding or watery vaginal discharge
43
Francis 834 year old male went to the clinic, complaining of intense joint pain in the fingers of the hand and feet. He claims to have recently Been in a bowl fight with his family and he ate a lot of fried tilapias. The nurse suspects, which of the following?
Gouty arthritis
44
The following are appropriate, pharmacological management for patient with gout, except
Metoprolol
45
patient, Aristotle, diagnosed with gout is currently experiencing pain in the left great toe and is given oral ibuprofen to manage the pain. Which of the following assessment should nurse Socrates, observed that might Necessitate Intervention?
Black tarry stool
46
patient Danilo, who is confined in the hospital for a three weeks For multiple chronic illness develops acute gouty arthritis. As he takes multiple medication for his illnesses, nurse fen would warrant immediate intervention, if the patient decide to take which of the following medication.
Furosemide
47
an upcoming hip, prepare for Gina surgical procedure and is questioned by the nurse in the pre admissions screening lab. According to the clients desire to donate her own blood in the approaching surgery, the nurse ought to
Notify the office of the surgeon
48
Which of the following client should the nurse anticipate receiving a request for single donor platelets?
A patient getting several platelet transfusions
49
Which test outcome should the nurse examine to determine whether the blood from to this donors incompatible
indirect coombs
50
causes of analytic transfusion response that may lead to hemolytic shock include :
Rh or ABO incompatibility
51
The client is having blood transfusion therapy and the nurse is taking care of them. What clinical signs should the nurse look for the suspect a hemolytic reaction to transfusion?
1. Headache
2. Tachycardia
3. Hypertension
4. Apprehension
5. Enlarged neck vein
6. Sense of impending doom
1246
52
due to an acute hemolytic transfusion reaction, a clients red blood cells transfusion was stopped. Which of the following tactics should the nurse do to reduce the likelihood of such a reaction the best?
Before hanging the blood unit, the nurse confirms all client identifying information in accordance with hospital practice
53
Fandi a 26y/o woman is undergoing blood transfusion, however wrong blood, matching and typing happened, which is the first sign of analytic transfusion reaction?
Low back pain
54
Jana is brought to the ER with a BP of 70/45, and is diagnosed with septic shock. Which assessment should validate the diagnosis.
40.9° C Temp temperature and pulse rate of beats per minute 138
55
The most common and frequent cause of septic shock is infection with
Grap-positive bacteria
56
With patient will not exhibit the expected assessment in response to septic shock ?
janji taking atenolol for hypertension
57
The nurse checks the atenatal History of several patient in early labor. The following are factors documented in the history, as having potential factors increased risk for septic shock after delivery, except.
A. Asian in decent
B. during the third trimester prenatal care was started
C. Spontaneous membrane rupture 24 hours ago
D. A dietary examination revealed unhealthful eating pattern
E. prior usage of drugs during pregnancy
F. Prior two miscarriages
AF
58
Who, among the following children should MMR vaccine not be given?
Dundee who has HIV
59
After being given a dose of penicillin, the clients experiences an anaphylactic reaction. Which nursing intervention for this client is for the most importance?
Maintain patent airway clearance
60
820-year-old patient who suffered a hornets sting is brought To the emergency room. Which science point to an anaphylactic reaction in the patient?
1. Wheezing
2. Rhinorrhea
3.Urticaria
4.Localized Edema
5.Angioedema
6.Generalized pruritus
12356
61
Which of the following actions should the nurse perform first after providing first treatment to a patient who has asthma, and is on the verge of anaphylaxis due to a medication hypertensity
administer bronchodilators as ordered
62
Which kind of hypertensity is related to anaphylactic shock?
Type 1 hypertensity
63
The patient in a local community is being treated by the nurse for gout. What laboratory result with the nurse anticipate seeing in the patient?
Uric acid : 9.0mg/dL
64
sheena a 45y/o female has Gouty arthritis. she is being created with allopurinol. the client is taught by the nurse which action to do in the event of an acute attack occurs
add NSAID or colchicine to the treatment plan
65
Indometacin therapy is explained to the client who has been diagnosed with acute gouty arthritis by Fiona, the community health nurse. When the client says, what does the nurse decide that more instruction is necessary?
“ whenever I need to really pain, I can take a pill “
66
Allopurinol 250mg PO daily was prescribed to patient Emelda. After three weeks of continued daily retirement, she decided to go back to the clinic. Which of the following statements by the nurse emelda indicates that the teaching was affective?
“ I need to consume at least eight glasses of water each day”
67
A patient with a gout diagnosis is given colchicine. Knowing that this drug should only be used in certain disorders, the nurse looks over the clients, medical history.
Chronic kidney disease
68
The nurse is arranging for peritoneal dialysis to be administered to a client with hemolytic uremic syndrome who has previously been anuric. What action should the nurse prepare to take?
Restrict fluid as prescribed
69
The nurse is explaining peritoneal dialysis to a client who has diabetes mellitus. The client is informed by the nurse that maintaining the prescribed time for the dialysis is crucial due to the danger of this complication?
Hyperglycemia
70
An indwelling peritoneal catheter for peritoneal dialysis is present in the abdomen of a patient with chronic renal disease. The patient accidentally wet the abdominal dressing, while, taking a bath. What should the nurse do to ensure the client safety the most effectively?
Change the dressing
71
Peritonial dialysis is being carried out by a nurse who injects 2L of dialysis into peritoneal cavity. only 1 L of the solution is returned by the client after 30 minutes having passed. the nurse ought to?
Reposition the patient and have him roll from side to side
72
The client and family are being instructed by the nurse Irma about peritoneal dialysis, which will be carried out at home. The most important discharge instruction is.
Indicators that a peritoneal infection is present
73
kim chay an ER nurse, endorse patient Tibet, a 40 year-old female who is admitted to the hospital for high phosphorus level due to having an stage renal disease. She is receiving, continuous, ambulatory peritoneal dialysis and her attending doctor ordered continued management during admission. Which of the following should nurse June the word nurse should do.
Use sterile procedures, and permanent peritoneal catheter while weighing the patient at the same time each day
74
What medication is used to treat patient with anorexia nervosa?
Risperidone
75
The nurse wants to create a nursing diagnosis for a patient with a erection nervous. Which of the following with the priority nursing diagnosis?
Fluid and electrolyte imbalance
76
The nurse finds the patient doing push-ups and jumping jacks in her room. What should the nurse do?
Stop the patient and invite the patient for a walk
77
The female patient with an erection nervosa would most likely have which of the following signs and symptoms regarding her menstrual cycle?
Amenorrhea
78
The following family dynamics would put a dollar sense at risk for an erection nervosa, except?
The parents have maladaptive communication with their child
問題一覧
1
which of the following nursing interventions Should nurse Dino do first when a patient who was found to have been beaten by a stray dog, arrives at the clinic?
Cleanse the bite with soap and running water
2
Duday, 35y/o female, game, product clinic, complaining of burning sensation while urinating, and feeling the need to urinate more often. she was diagnosed with urolithiasis. when ask if there is an herbal medicine she could use, which of the following should the nurse advise her to take?
Sambong
3
The nurse is teaching Duday How to take the herbal medicine, which of the following statement made by Duday Will indicate understanding of the health teaching?SAMBONG
“ I will make sure to chop and boil. It leaves in water for 15 minutes until one glass full remains.”
4
Situation : A patient came to the ER, presenting with reability, lower back pain, headache, Fever for four days, Muscle cramps. The patient reports accidentally stepping on the nail, while gardening about two weeks ago. The patient was diagnosed with tetanus.
Question: The nurse was asked on the way tetanus can be transmitted, which of the following responses will demonstrate the nurses understanding of the disease?
“ tetanus can be transmitted through contamination of wounds”
5
Michael, a 45y/o male is admitted at Mariwasa Medical Clinic complaining intense pain at the lower left part of his abdomen. He said he’s having diarrhea defecating about 10 to 20 liquids stools. he also noticed that his faces have traces of red blood in them nurse Maria knows that the patient is having clinical manifestations of.
Ulcerative colitis
6
which of the following is not done by a patient with anorexia nervosa
Recognize that their body image is abnormal
7
Patient kirby Would be most at for developing what electrolyte imbalance? vomiting
Hypokalemia
8
What is the criteria to be diagnosed for bulimia?
Binging and purging once a week for three months
9
Situation : Patient Fish Is in the psychiatric wired, and has been undergoing treatment after being diagnosed with schizophrenia. Nurse Bennett Has been assigned as patient Fish primary nurse
question: Patient presents with positive symptoms of schizophrenia. Nurse should expect the following statement except?
“ I don’t find my old hobbies as enjoyable as before”
10
Nurse Bennett reviewed patient fish medication, history and found out that she has been on antipsychotics for nearly 6 months. Patient fish is at most at address for what condition if she continues using her antipsychotics?
Tardive dyskinesia
11
What neurotransmitters is affected in schizophrenia?
Dopamine
12
if patients fish psychosis lasts for more than one month, but subsides before six months, Nurse Bennett would classify this as?
Schizophreniform
13
A few weeks after undergoing treatment, Patient presents with evolution. Nurse Bennett knows that this is:
Lack of motivation
14
When providing health teaching to patient fish regarding her medications, nurse Bennett should instruct the following, except ?
Stand up immediately after lying down for a long time
15
Nurse Bennett Natis, that patient fish present with symptoms of extra pyramidal symptoms caused by her medication’s. Nurse Bennett will expect the following except?
Catatonia
16
Situation : Nurse Barbara is an emergency nurse and is experience with handling patients with different levels of anxiety. One day Accident occurs and caused a surge of patients in the emergency room
Question: Patient is brought in the emergency department who seems to be the only survivor in the vehicle she was in. Assessment IM valium Is ordered; Nurse Barbara knows that this is given to patient with what level of anxiety
Severe
17
another patient is brought to the emergency department. Despite Having a nonlife threatening injury, the patient is found pacing and only focus on answering a few of the assessment questions. What level of unsighted does the patient present?
Moderate
18
A patient comes to the emergency department with severe difficulty of beating. The patient verbalizes that she hears loud ringing in her ear, aggressive, and cannot focus nor answer, Any of the questions nurse Barbara is asking. What level of anxiety is this?
Panic
19
What neurotransmitter is affected in patients diagnosed with anxiety disorders ?
GABA
20
Nurse Maria is aware that patient Michael’s condition is characterized as : Ulcerative colitis
Multiple ulcerations, Diffuse inflammation, And desquamation or shedding of the colonic epithelium That starts from rectum
21
The following are complications that may arise if the progression of ulcerative colitis worsens, except”colon”
Gastric ulceration
22
patient, Michael’s inflammation and ulceration were sense and Progressed up to the transverse colon. Nurse Maria Anticipate which procedure will be performed to relieve the patient symptoms?
Total colectomy
23
The doctor ordered oral azithromycin For patient Nezuko due in the morning to manage her UTI. After nurse tanjiro prepares the medication She receives a call light from multiple patients asking for her assistance. She realizes that as she tends to other patients urgent concerns her medication to patient Violetta will be delayed since her unit is understaffed her best action is to.
Delegate and endorse the task of medication administration to another registered nurse
24
Patient Billy arrives at the emergency room, complaining of weakness, fatigue, leg, numbness, and tingling sensations. He Has a diagnosis of left sided heart failure and was given Lasix prior to occurring symptoms. Laboratory result showed that he has sodium level of 137mEq/dL Potassium levels of 2.8 mEq/dL And calcium levels of 9mg/dL. Based from this findings :
Hypokalemia
25
An order was given by the doctor to provide IV potassium to improve the patient’s billy’s potassium level and alleviate his occurring symptoms. Nurse Isabella is now monitoring for science of possible access, potassium levels. Which of the following requires immediate intervention in Monitoring for hypokalemia.
Placing the patient on cardiac Monitor
26
Charmaine a newly registered nurse was tasked to be IV potassium chloride the patient jerry with hypokalemia. She was instructed by her preceptor never give IV potassium via IV push. She asked why and her preceptor would answer the following. except:
It may have lesser effect in the body
27
patient floor was Rushed To the emergency room showing signs of extreme muscle weakness, paralysis, and nausea. She was attached to a cardiac monitor And it showed peaked T waves, Depressed ST segment, and a short QT interval. nurse Mariel is aware that the patient hyperkalemic. The following our medications that should be given to the patient Except:
Calcium chloride
28
sarah, a 1week postoperative patient was observed to be having symptoms of muscle, rigidity and tingling sensations of extremities. When nurse jes touch her cheek, she immediately twitched nurse jes is aware that the patient has :
Hypocalcemia
29
One of the management to treat the patient Sarah symptoms is to provide calcium replenishment. The doctor ordered to give calcium to treat the muscle spasms. The following medications can be given to treat hypocalcemia, except.
Calcitonin
30
Nurse Beatrix is assessing various patience in medical surgical ward he determines, which of the following is not at risk for increased calcium levels
a 63 years old patient with renal failure
31
patiently, well, who is diagnosed with hyperthyroidism is Rushed To the hospital with symptoms of muscle weakness, and anorexia Nausea and vomiting. Laboratory results indicate which of the following calcium level is correct?
calcium levels of 15 mg/dl
32
Mary, a high school student is currently admitted in the AB ward she complains of intense, abdominal pain, bloating, and alternate periods of constipation and diarrhea. She reports that she felt it recently before taking an examination. Laboratory studies showed no findings present in the abdomen. Nurse and can infer that the patient is having.
Irritable bowel syndrome
33
Nurse and is aware that the management for the patient marries symptoms are focus on proper stress management, exercise and appropriate diet. The following should not be included in the patient’s diet except
Oatmeal
34
Dumping syndrome occurs in which of the following patients select all that apply
1. Patients who had Bill roth one or two
2. patient who had a vagotomy
3. Patient was currently on tube feeding
4. Patient who had a colectomy
123
35
patient Rancy was transferred to the medical surgical word after a bilroth 2 procedure. Nurse Jovi would suspect dumping syndrome if the patient showed which of the following early sign or symptoms expect
Weakness
36
In order to prevent patients Rancy to have recurring episode of dumping syndrome, nurse Jovi should
Let the patient lay down in left sideline position
37
Patient Maman is admitted with a recent history of sexual intercourse with a person positive with HIV, which of the following are signs and symptoms of acute stage of HIV?
Mild fever, headaches, sore throat
38
Handling a patient diagnosed with HIV requires which type of Precaution?
Standard precaution
39
Which of the following Patient exposure would most likely affect the nurse if the patient HIV diagnosed is suspected but not confirmed?
Needle stick injury with the needle and syringe with the patient’s blood
40
Nurse Twinnie is giving IV medication’s to the patient when she is suddenly breaked by the needle . The patient was diagnosed with HIV upon admission. Nurse will know if she required the virus when she will have which diagnostic test.
EIA/Elisa
41
The following a risk factor associated with development of cervical cancer, except
Late age of first sexual intercourse
42
Patient bubbles is currently admitting on suspected cervical cancer. Which of the following would indicate possible science and symptoms that may support the diagnosis.
Light bleeding or watery vaginal discharge
43
Francis 834 year old male went to the clinic, complaining of intense joint pain in the fingers of the hand and feet. He claims to have recently Been in a bowl fight with his family and he ate a lot of fried tilapias. The nurse suspects, which of the following?
Gouty arthritis
44
The following are appropriate, pharmacological management for patient with gout, except
Metoprolol
45
patient, Aristotle, diagnosed with gout is currently experiencing pain in the left great toe and is given oral ibuprofen to manage the pain. Which of the following assessment should nurse Socrates, observed that might Necessitate Intervention?
Black tarry stool
46
patient Danilo, who is confined in the hospital for a three weeks For multiple chronic illness develops acute gouty arthritis. As he takes multiple medication for his illnesses, nurse fen would warrant immediate intervention, if the patient decide to take which of the following medication.
Furosemide
47
an upcoming hip, prepare for Gina surgical procedure and is questioned by the nurse in the pre admissions screening lab. According to the clients desire to donate her own blood in the approaching surgery, the nurse ought to
Notify the office of the surgeon
48
Which of the following client should the nurse anticipate receiving a request for single donor platelets?
A patient getting several platelet transfusions
49
Which test outcome should the nurse examine to determine whether the blood from to this donors incompatible
indirect coombs
50
causes of analytic transfusion response that may lead to hemolytic shock include :
Rh or ABO incompatibility
51
The client is having blood transfusion therapy and the nurse is taking care of them. What clinical signs should the nurse look for the suspect a hemolytic reaction to transfusion?
1. Headache
2. Tachycardia
3. Hypertension
4. Apprehension
5. Enlarged neck vein
6. Sense of impending doom
1246
52
due to an acute hemolytic transfusion reaction, a clients red blood cells transfusion was stopped. Which of the following tactics should the nurse do to reduce the likelihood of such a reaction the best?
Before hanging the blood unit, the nurse confirms all client identifying information in accordance with hospital practice
53
Fandi a 26y/o woman is undergoing blood transfusion, however wrong blood, matching and typing happened, which is the first sign of analytic transfusion reaction?
Low back pain
54
Jana is brought to the ER with a BP of 70/45, and is diagnosed with septic shock. Which assessment should validate the diagnosis.
40.9° C Temp temperature and pulse rate of beats per minute 138
55
The most common and frequent cause of septic shock is infection with
Grap-positive bacteria
56
With patient will not exhibit the expected assessment in response to septic shock ?
janji taking atenolol for hypertension
57
The nurse checks the atenatal History of several patient in early labor. The following are factors documented in the history, as having potential factors increased risk for septic shock after delivery, except.
A. Asian in decent
B. during the third trimester prenatal care was started
C. Spontaneous membrane rupture 24 hours ago
D. A dietary examination revealed unhealthful eating pattern
E. prior usage of drugs during pregnancy
F. Prior two miscarriages
AF
58
Who, among the following children should MMR vaccine not be given?
Dundee who has HIV
59
After being given a dose of penicillin, the clients experiences an anaphylactic reaction. Which nursing intervention for this client is for the most importance?
Maintain patent airway clearance
60
820-year-old patient who suffered a hornets sting is brought To the emergency room. Which science point to an anaphylactic reaction in the patient?
1. Wheezing
2. Rhinorrhea
3.Urticaria
4.Localized Edema
5.Angioedema
6.Generalized pruritus
12356
61
Which of the following actions should the nurse perform first after providing first treatment to a patient who has asthma, and is on the verge of anaphylaxis due to a medication hypertensity
administer bronchodilators as ordered
62
Which kind of hypertensity is related to anaphylactic shock?
Type 1 hypertensity
63
The patient in a local community is being treated by the nurse for gout. What laboratory result with the nurse anticipate seeing in the patient?
Uric acid : 9.0mg/dL
64
sheena a 45y/o female has Gouty arthritis. she is being created with allopurinol. the client is taught by the nurse which action to do in the event of an acute attack occurs
add NSAID or colchicine to the treatment plan
65
Indometacin therapy is explained to the client who has been diagnosed with acute gouty arthritis by Fiona, the community health nurse. When the client says, what does the nurse decide that more instruction is necessary?
“ whenever I need to really pain, I can take a pill “
66
Allopurinol 250mg PO daily was prescribed to patient Emelda. After three weeks of continued daily retirement, she decided to go back to the clinic. Which of the following statements by the nurse emelda indicates that the teaching was affective?
“ I need to consume at least eight glasses of water each day”
67
A patient with a gout diagnosis is given colchicine. Knowing that this drug should only be used in certain disorders, the nurse looks over the clients, medical history.
Chronic kidney disease
68
The nurse is arranging for peritoneal dialysis to be administered to a client with hemolytic uremic syndrome who has previously been anuric. What action should the nurse prepare to take?
Restrict fluid as prescribed
69
The nurse is explaining peritoneal dialysis to a client who has diabetes mellitus. The client is informed by the nurse that maintaining the prescribed time for the dialysis is crucial due to the danger of this complication?
Hyperglycemia
70
An indwelling peritoneal catheter for peritoneal dialysis is present in the abdomen of a patient with chronic renal disease. The patient accidentally wet the abdominal dressing, while, taking a bath. What should the nurse do to ensure the client safety the most effectively?
Change the dressing
71
Peritonial dialysis is being carried out by a nurse who injects 2L of dialysis into peritoneal cavity. only 1 L of the solution is returned by the client after 30 minutes having passed. the nurse ought to?
Reposition the patient and have him roll from side to side
72
The client and family are being instructed by the nurse Irma about peritoneal dialysis, which will be carried out at home. The most important discharge instruction is.
Indicators that a peritoneal infection is present
73
kim chay an ER nurse, endorse patient Tibet, a 40 year-old female who is admitted to the hospital for high phosphorus level due to having an stage renal disease. She is receiving, continuous, ambulatory peritoneal dialysis and her attending doctor ordered continued management during admission. Which of the following should nurse June the word nurse should do.
Use sterile procedures, and permanent peritoneal catheter while weighing the patient at the same time each day
74
What medication is used to treat patient with anorexia nervosa?
Risperidone
75
The nurse wants to create a nursing diagnosis for a patient with a erection nervous. Which of the following with the priority nursing diagnosis?
Fluid and electrolyte imbalance
76
The nurse finds the patient doing push-ups and jumping jacks in her room. What should the nurse do?
Stop the patient and invite the patient for a walk
77
The female patient with an erection nervosa would most likely have which of the following signs and symptoms regarding her menstrual cycle?
Amenorrhea
78
The following family dynamics would put a dollar sense at risk for an erection nervosa, except?
The parents have maladaptive communication with their child