Baton Rouge Community College NU335 Spring 2026 Final.
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Free Baton Rouge Community College NU335 Spring 2026 Final. Questions
During preoperative teaching to a patient scheduled for a transsphenoidal hypophysectomy for treatment of a pituitary adenoma, the nurse includes which instruction?
- Position flat in bed with sandbags at head
- Cough vigorously and deep breathe every 2 hours
- Take replacement growth hormone for a few months
- Report clear drainage from nose
Explanation
Correct Answer: D) Report clear drainage from nose
Following a transsphenoidal hypophysectomy, clear nasal drainage must be reported immediately as it may indicate a cerebrospinal fluid (CSF) leak, which is a serious postoperative complication resulting from a dural tear. CSF leakage increases the risk of meningitis and requires prompt medical evaluation.
Positioning flat is incorrect — the head of bed should be elevated 30 degrees to reduce ICP and promote drainage. Vigorous coughing is contraindicated as it increases intracranial pressure and risks disrupting the surgical site. While hormone replacement may be needed long-term, growth hormone replacement specifically for a few months is not a standard preoperative teaching point.
A nurse is caring for a patient 4 hours after a thyroidectomy. Which assessment finding requires immediate intervention?
- Neck swelling and stridor
- Oxygen saturation of 95%
- Pain at the incision site
- Hoarseness
Explanation
Correct Answer: A) Neck swelling and stridor
Neck swelling and stridor following thyroidectomy indicate airway compromise due to hematoma formation or tracheal compression — a life-threatening surgical emergency requiring immediate intervention. The nurse must act at once to protect the airway, which may involve opening the surgical wound at bedside to relieve compression. An O2 saturation of 95% and hoarseness are concerning but not immediately life-threatening. Incision site pain is an expected postoperative finding. Airway compromise is always the highest priority.
The nurse is caring for a patient who has had a mitral valve replacement. What information does the nurse need to include in the discharge instructions?
- Good dental hygiene
- Activity restrictions
- Diet modifications
- Long term antibiotics
Explanation
Correct Answer: A) Good dental hygiene
Patients with prosthetic heart valves are at high risk for infective endocarditis, which can be triggered by bacteremia from dental procedures or poor oral hygiene. Good dental hygiene is a critical component of discharge teaching as it reduces the risk of bacterial seeding of the prosthetic valve. While activity restrictions and diet modifications may also be relevant post-surgery, the most specifically important and unique teaching point for a valve replacement patient is dental hygiene and the need for antibiotic prophylaxis before dental procedures.
A patient who is unconscious after a head injury has cerebral edema. Which nursing intervention will be included in the plan of care?
- Keep the head of the bed elevated to 30 degrees
- Position the patient with knees and hips flexed
- Administer pain medications at frequent intervals
- Encourage coughing and deep breathing
Explanation
Correct Answer: A) Keep the head of the bed elevated to 30 degrees
Elevating the head of the bed to 30 degrees promotes venous drainage from the brain, helping to reduce intracranial pressure (ICP) in a patient with cerebral edema. This is a standard and evidence-based intervention for ICP management. Positioning with knees and hips flexed is contraindicated as it increases intra-abdominal pressure, which in turn raises ICP. Administering pain medications at frequent intervals without assessment is inappropriate and may mask neurological changes. Coughing and deep breathing are contraindicated as they increase intrathoracic pressure and consequently raise ICP.
The patient has D5 1/2NS with 20 mEq KCl infusing through a peripheral IV site. The physician orders Protonix 40mg IVP daily. Which is the most appropriate action for the nurse?
- Flush the primary line with saline before and after administering the Protonix
- Hold the Protonix until the physician rounds
- Call the physician to request an alternate route to administer the Protonix
- Administer the Protonix through the primary line at the "Y" port
Explanation
Correct Answer: A) Flush the primary line with saline before and after administering the Protonix
Protonix (pantoprazole) is incompatible with many solutions, including dextrose-containing and potassium-containing IV fluids. The correct practice when administering an IVP medication through a line running an incompatible solution is to flush the line with normal saline before and after the medication administration.
This clears the tubing of the incompatible solution, allows safe delivery of the Protonix, and then restores the primary infusion. Holding the medication until the physician rounds is unnecessary and delays care. Calling for an alternate route is not needed when proper flushing technique can be used. Administering directly through the Y-port without flushing risks drug-fluid incompatibility.
The nurse cares for the client in the intensive care unit. Review the electronic health record. Which actions should the nurse implement? Select all that apply.
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- Maintain head of bed elevation at 15 degrees or less
- Provide oxygen therapy to maintain oxygen saturation above 95%
- Keep lights dim in client's room to accommodate photophobia
- Assess the client for headaches and behavior changes frequently
- Minimize suctioning or hyper-oxygenate client before suctioning
- Keep the television on in the client's room to avoid constant silence
Explanation
Correct Answers: B) Provide oxygen therapy to maintain oxygen saturation above 95%, C) Keep lights dim in client's room to accommodate photophobia, D) Assess the client for headaches and behavior changes frequently, E) Minimize suctioning or hyper-oxygenate client before suctioning
Based on the EHR, this client had an ischemic stroke and is now in the ICU post-surgery for increased intracranial pressure (ICP). Maintaining O₂ saturation above 95% prevents hypoxia, which worsens cerebral ischemia. Keeping lights dim reduces stimulation for a patient with photophobia and elevated ICP. Frequent assessment for headaches and behavior changes allows early detection of neurological deterioration. Minimizing or pre-oxygenating before suctioning prevents dangerous ICP spikes. The head of bed should be elevated at 30 degrees (not 15 or less) to facilitate venous drainage and reduce ICP. Keeping the television on increases stimulation and can worsen ICP — the environment should remain calm and quiet.
The nurse cares for the client in the intensive care unit. Review the electronic health record. Which actions should the nurse implement? Select all that apply.
[IMAGE_2]
- Maintain head of bed elevation at 15 degrees or less
- Provide oxygen therapy to maintain oxygen saturation above 95%
- Keep lights dim in client's room to accommodate photophobia
- Assess the client for headaches and behavior changes frequently
- Minimize suctioning or hyper-oxygenate client before suctioning
- Keep the television on in the client's room to avoid constant silence
Explanation
Correct Answers: B) Provide oxygen therapy to maintain oxygen saturation above 95%, C) Keep lights dim in client's room to accommodate photophobia, D) Assess the client for headaches and behavior changes frequently, E) Minimize suctioning or hyper-oxygenate client before suctioning
Based on the EHR, this client had an ischemic stroke and is now in the ICU post-surgery for increased intracranial pressure (ICP). Maintaining O₂ saturation above 95% prevents hypoxia, which worsens cerebral ischemia. Keeping lights dim reduces stimulation for a patient with photophobia and elevated ICP. Frequent assessment for headaches and behavior changes allows early detection of neurological deterioration. Minimizing or pre-oxygenating before suctioning prevents dangerous ICP spikes. The head of bed should be elevated at 30 degrees (not 15 or less) to facilitate venous drainage and reduce ICP. Keeping the television on increases stimulation and can worsen ICP — the environment should remain calm and quiet.
A patient in ICU for a diagnosis of stage IV wound to the sacrum goes into Septic Shock. The nurse receives an order to begin a norepinephrine infusion 18 ml/hr. The patient weighs 158 lbs. The norepinephrine is supplied in a concentration of 4mg in 250 ml of D5W. What is the norepinephrine dose in mcg/kg/min? Place your answer to thousandths.
- 0.004 mcg/kg/min
- 344.640 mcg/kg/min
- 4.800 mcg/kg/min
- 0.067 mcg/kg/min
Explanation
Correct Answer: D) 0.067 mcg/kg/min
Step 1 — Convert weight: 158 lbs ÷ 2.2 = 71.8 kg.
Step 2 — Convert concentration: 4 mg/250 mL = 0.016 mg/mL = 16 mcg/mL.
Step 3 — Calculate mcg/min: 18 mL/hr ÷ 60 min/hr = 0.3 mL/min × 16 mcg/mL = 4.8 mcg/min.
Step 4 — Calculate mcg/kg/min: 4.8 mcg/min ÷ 71.8 kg = 0.067 mcg/kg/min.
A patient's ECG monitor shows an accelerated junctional rhythm at a rate of 78 beats/minute. What is the nurse's priority intervention?
- Administer ordered digoxin
- Begin a continuous diltiazem infusion
- Prepare for cardioversion
- Continue monitoring the patient
Explanation
Correct Answer: D) Continue monitoring the patient
An accelerated junctional rhythm at 78 beats/minute falls within a near-normal heart rate range and is generally hemodynamically stable. This rhythm occurs when the AV junction fires faster than its intrinsic rate of 40–60 bpm but is typically not an emergency requiring immediate pharmacological or electrical intervention.
The priority action is to continue monitoring the patient while assessing for any underlying cause such as digoxin toxicity, hypoxia, or electrolyte imbalance. Administering digoxin could be dangerous as this rhythm is commonly caused by digoxin toxicity. Diltiazem and cardioversion are not indicated for a stable, near-normal rate junctional rhythm.
The emergency department nurse is assessing a patient who has been in an automobile accident. Which clinical manifestation illustrates a tension pneumothorax?
- Paradoxic movement of the chest is noted
- Sucking sound with each patient breath
- Wheezes are audible throughout both lungs
- Tracheal deviation to the unaffected side
Explanation
Correct Answer: D) Tracheal deviation to the unaffected side
Tension pneumothorax occurs when air accumulates under pressure in the pleural space, collapsing the affected lung and shifting mediastinal structures — including the trachea — away from the affected side toward the unaffected side. This tracheal deviation is the hallmark sign of tension pneumothorax and represents a life-threatening emergency requiring immediate needle decompression. Paradoxic chest movement is characteristic of flail chest. A sucking chest wound indicates an open pneumothorax. Bilateral wheezing suggests bronchospasm or asthma, not pneumothorax.
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