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#1. A client with COPD is in respiratory failure. Which of the following results would be the most sensitive indicator that the client requires a mechanical ventilator?
Answer C is correct. The pH is an accurate indicator of acute ventilatory failure and a need for mechanical ventilation. An elevated PCO2, as in answer A, is not an adequate criterion for instituting ventilator support. Answer B, oxygen saturation of 90, would not be very abnormal for a COPD client. Answer D is normal.
#2. The nurse is caring for a client post-myocardial infarction on the cardiac unit. The client is exhibiting symptoms of shock. Which clinical manifestation is the best indicator that the shock is cardiogenic rather than anaphylactic?
Answer B is correct. Clients with cardiogenic shock often have chest pain. This symptom is not related to anaphylactic shock. Answers A and C can occur with both types of shock, but are not specific to the cardiogenic type. Answer D is a normal temperature reading.
#3. A client is being evaluated for carpel tunnel syndrome. The nurse is observed tapping over the median nerve in the wrist and asking the client if there is pain or tingling. Which assessment is the nurse performing?
Answer B is correct. Assessing for Tinel’s sign is done to check for paresthesia in the median nerve. An abnormal result would be pain or tingling as this procedure is done. This test can also be performed by inflating a blood pressure cuff to the client’s systolic pressure, resulting in pain and tingling. Answer A is another test in which the nurse asks the client to place the backs of the hands together and flex them at the same time. If the client experiences paresthesia within 60 seconds of performing the test, it is a positive result indicating carpel tunnel syndrome. Answers C and D are both assessment procedures for meningeal irritation.
#4. The nurse has just received a report from the previous shift. Which of the following clients should the nurse visit first?
Answer B is correct. The nurse should prioritize these clients and decide to see the client with the shortness of breath because this could be a possible alteration in breathing. The client in answer A has an abnormal PCO2 (normal 35–45), but this would be expected in a client with COPD. The client’s condition in answer C can be corrected by pain medication that someone else could administer. Answer D is incorrect because a temperature elevation of this level would not be a reason for great concern in a client after gallbladder surgery
#5. The nurse is caring for a 70-year-old client with hypovolemia who is receiving a blood transfusion. Assessment findings reveal crackles on chest auscultation and distended neck veins. What is the nurse’s initial action?
Answer A is correct. The client is exhibiting symptoms of fluid volume excess; slowing the rate is the proper action. The nurse would not stop the infusion of blood, as in answer C, and answers B and D would not help.
#6. A nurse is triaging in the emergency room when a client enters complaining of muscle cramps and a feeling of exhaustion after a running competition. Which of the following would the nurse suspect?
Answer B is correct. Athletes can sometimes consume large amounts of water when competing. This can lead to decreased sodium levels. Symptoms of hyponatremia include an altered mental status, anorexia, muscle cramps, and exhaustion. Answers A, C, and D do not correlate with the history or the symptoms given.
#7. The nurse is assessing an adult female client for hypovolemia. Which laboratory result would help the nurse in confirming a volume deficit?
Answer A is correct. Hematocrit levels are elevated with hypovolemia. Answers B, C, and D are all normal levels. Potassium (normal 3.5–5.3mEq/L) levels can be either increased or decreased with hypovolemia; BUN (normal 5–25mg/dL) and specific gravity (1.005–1.030) levels would be elevated with hypovolemia.
#8. A student nurse is observing a neurological nurse perform an assessment. When the nurse asks the client to “stick out his tongue,” the nurse is assessing the function of which cranial nerve?
#9. A client with a head injury has an intracranial pressure (ICP) monitor in place. Cerebral perfusion pressure calculations are ordered. If the client’s ICP is 22 and the mean pressure reading is 70, what is the client’s cerebral perfusion pressure?
Answer D is correct. The cerebral perfusion pressure is obtained by subtracting the ICP from the mean arterial pressure (MAP). A client must have a CPP of 70–100 to have a normal reading and adequate cerebral perfusion. Answers A, B, and C are all incorrect calculations.
#10. A client with a fractured leg is exhibiting shortness of breath, pain upon deep breathing, and hemoptysis. What do these clinical manifestations indicate to the nurse?
Answer B is correct. Hemoptysis is a hallmark symptom of a pulmonary embolus, and this client’s fracture history and other clinical manifestations lead to this conclusion. The clinical manifestations do not correlate with the diagnoses in answers A, C, and D.