NUR 213 Health Exam

NUR 213 Health Exam

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Free NUR 213 Health Exam Questions

1.

A nurse obtains the health history of a client who is newly admitted to the medical unit. Which statement by the client should alert the nurse to the presence of edema

  • "I wake up to go to the bathroom at night."

  • "My shoes fit tighter by the end of the day."

  • "I seem to be feeling more anxious lately."

  • "I drink at least eight glasses of water a day."

Explanation

Correct Answer:



b. "My shoes fit tighter by the end of the day."



 



Explanation:



Edema refers to the accumulation of excess fluid in the tissues, and it often becomes more noticeable by the end of the day due to gravitational pooling of fluid in the lower extremities. When a client reports that their shoes fit tighter by the end of the day, this is a classic sign of peripheral edema, where fluid builds up in the legs and feet due to standing or sitting for extended periods. This could be indicative of heart failure, kidney disease, or venous insufficiency.



 



Why the Other Choices Are Incorrect:



a. "I wake up to go to the bathroom at night."

This statement is indicative of nocturia, which refers to frequent urination at night. While nocturia can be associated with heart failure due to fluid redistribution when lying down, it does not directly suggest the presence of edema.



c. "I seem to be feeling more anxious lately."

Anxiety can be related to many conditions, but it does not directly point to the presence of edema. Anxiety might be a symptom of other health issues, including heart disease, but it is not a primary indicator of fluid accumulation in the tissues.



d. "I drink at least eight glasses of water a day."

Drinking an adequate amount of water is generally healthy and not a sign of edema. While excessive fluid intake could potentially contribute to fluid retention in some circumstances, this statement does not suggest that the client is experiencing the fluid retention characteristic of edema.



 



Summary:



The correct answer is b. "My shoes fit tighter by the end of the day." because tight-fitting shoes by day's end are a typical sign of peripheral edema, where fluid accumulates in the lower extremities. The other statements—nocturia, anxiety, and fluid intake—do not directly indicate the presence of edema.


2.

A nurse is caring for a client who is experiencing anaphylactic shock in response to the administration of penicillin. Which of the following medications should the nurse administer first

  • Epinephrine

  • Furosemide

  • Dobutamine

  • Methylprednisolone

Explanation

Correct Answer: A



Epinephrine



 



Explanation:



Epinephrine is the first-line treatment for anaphylactic shock because it rapidly reverses airway obstruction, hypotension, and cardiovascular collapse by:




  • Stimulating alpha-adrenergic receptors → Increases blood pressure by causing vasoconstriction

  • Stimulating beta-1 receptors → Increases heart rate and cardiac output

  • Stimulating beta-2 receptors → Relaxes bronchial smooth muscles, relieving bronchospasms and improving breathing



Administration:




  • Given intramuscularly (IM) in the mid-thigh for immediate effect

  • Can be repeated every 5–15 minutes if symptoms persist



 



Why the Other Choices Are Incorrect:



Furosemide (Lasix)




  • A loop diuretic used for fluid overload or hypertension

  • Does not treat the airway constriction, hypotension, or histamine reaction seen in anaphylaxis



Dobutamine




  • A beta-1 agonist that improves cardiac output in heart failure

  • While it increases blood pressure, it does not counteract bronchospasms or histamine release, making it ineffective as a first-line treatment for anaphylaxis



Methylprednisolone (Solu-Medrol)




  • A corticosteroid that reduces inflammation and prevents delayed anaphylactic reactions

  • However, it has a delayed onset (several hours), so it is not effective in an emergency



 



Summary:



For anaphylactic shock, epinephrine should be administered first because it rapidly reverses airway obstruction and hypotension. Other medications, such as antihistamines, corticosteroids, and IV fluids, may be used as adjunct treatments, but epinephrine is the priority intervention.


3.

Mary is 85 years old, lives alone, and is active in her community. She has a long-standing history of hypertension, congestive heart failure (CHF], and controlled atrial fibrillation for which she takes Coumadin. She was admitted to the hospital for a right knee replacement. Her post-operative recovery period was complicated by an exacerbation of CHF, for which her cardiologist ordered Furosemide 20mg IV every 6 hours. Due to the heavy diuresis and limited mobility post-op, the provider ordered an indwelling urinary catheter.

Day 2

1/6 0900 

UAP reports after bathing the client appears confused. Client assessed, UAP to obtain a new set of vital signs. Cloudy urine with heavy sediment noted in the collection bag. Provider notified; urine culture sent.

Considering the provider orders, which should the nurse monitor most closely for possible complications, given the client's history and condition

  • Lactated Ringers at 170mL/hr

  • Placement of sequential compression stockings

  • Famotidine 20mg IV

  • Cefepime 2gm IV every 12 hours

Explanation

Answer: Lactated Ringer’s at 170 mL/hr



Rationale (Step-by-Step Analysis):



1. Review of Key Patient Factors:




  • 85 years old – Higher risk for fluid overload and complications.

  • History of CHF (Congestive Heart Failure) – Fluid balance is critical to prevent exacerbation.

  • On Furosemide 20 mg IV q6h – High-dose diuretic therapy suggests active fluid management.

  • Indwelling catheter with cloudy urine – Likely UTI contributing to confusion.

  • Current symptoms: Confusion, cloudy urine, heavy sediment – May indicate infection, dehydration, or worsening CHF.



2. Evaluating Each Provider Order for Potential Risk:



Placement of Sequential Compression StockingsLOW RISK




  • Helps prevent DVT due to limited mobility post-op.

  • Does not pose immediate harm.



Famotidine 20 mg IVLOW RISK




  • Given to prevent stress ulcers in hospitalized patients.

  • No significant risk related to CHF, kidney function, or infection.



Cefepime 2 gm IV q12hLOW RISK




  • Broad-spectrum antibiotic likely given for UTI.

  • Should be monitored for renal function adjustment but does not pose immediate danger.



 Lactated Ringer’s (LR) at 170 mL/hrHIGHEST RISK (Monitor Closely!)




  • CHF patients are prone to fluid overloadThis high IV fluid rate may worsen heart failure!

  • Diuresis from furosemide is removing fluid, but giving high-volume LR can counteract this effect.

  • Signs of worsening CHF:

    • Increased confusion (fluid shifting, cerebral edema, hypoxia).

    • Possible pulmonary congestion (shortness of breath, crackles in lungs).

    • Swelling, worsening urine output, weight gain from retained fluid.





3. Nurse’s Priority Action:




  • Monitor closely for fluid overload:


    • Lung sounds (crackles, dyspnea)

    • Edema, weight gain

    • Oxygenation, worsening confusion



  • Contact provider to reassess IV fluid rate:

    • CHF patients often require fluid restriction, not aggressive hydration.

    • The provider may switch to a slower rate or consider using normal saline instead of LR (which contains electrolytes that could affect acid-base balance).





 



Final Conclusion:



Lactated Ringer’s at 170 mL/hr is the order that should be monitored most closely due to the high risk of fluid overload in a patient with CHF.


4.

A patient is in the primary infection stage of HIV. What is true of this patient's current health status

  • The patient's HIV antibodies are successfully, but temporarily, killing the virus.

  • The patient is infected with HIV but lacks HIV-specific antibodies.

  • The patient's risk for opportunistic infections is at its peak.

  • The patient may or may not develop long-standing HIV infection.

Explanation

Correct Answer:



B) The patient is infected with HIV but lacks HIV-specific antibodies.



 



Explanation:



The primary infection stage of HIV, also called acute HIV infection or acute retroviral syndrome, occurs 2 to 4 weeks after exposure to the virus. During this time:




  • The virus rapidly replicates in the body.

  • The immune system has not yet produced detectable HIV-specific antibodies, meaning standard HIV antibody tests (such as ELISA) may not detect the infection.

  • Some patients experience flu-like symptoms (fever, swollen lymph nodes, rash, sore throat), while others remain asymptomatic.

  • The viral load is very high, making the person highly infectious even if they feel well.



This stage progresses into the chronic (latent) phase once the immune system begins producing antibodies.



 



Why the Other Choices Are Incorrect:




  • A) "The patient's HIV antibodies are successfully, but temporarily, killing the virus."


    • Incorrect. The immune system has not yet produced HIV-specific antibodies during the primary infection stage. Antibody production occurs weeks later in the chronic phase. Additionally, while the immune system fights the virus, it cannot eliminate HIV completely.



  • C) "The patient's risk for opportunistic infections is at its peak."

    • Incorrect. Opportunistic infections (e.g., Pneumocystis pneumonia, Kaposi’s sarcoma) occur in late-stage HIV/AIDS, when the CD4+ T-cell count falls below 200 cells/mm³. In the primary infection stage, the immune system is still functioning relatively well, so the risk for opportunistic infections is low.



  • D) "The patient may or may not develop long-standing HIV infection."

    • Incorrect. Once infected, a person will have HIV for life unless they receive an extremely rare, complete HIV cure (e.g., through experimental treatments like bone marrow transplants). The infection does not "go away", though antiretroviral therapy (ART) can control it.





 



Summary:



In the primary infection stage of HIV, the virus is actively replicating, but HIV-specific antibodies are not yet detectable (B is correct). Opportunistic infections are not a concern at this stage, and HIV infection is lifelong once acquired.


5.

A client is receiving an infusion of tissue plasminogen activator (t-PA). The nurse assesses the client to be disoriented to person, place, and time. What action by the nurse is best

  • Assess the client's pupillary responses.

  • Request a neurologic consultation.

  • Stop the infusion and call the provider.

  • Take and document a full set of vital signs.

Explanation

Correct Answer:



(c) Stop the infusion and call the provider.



 



Explanation:



Tissue plasminogen activator (t-PA) is a clot-busting medication used to treat ischemic strokes, myocardial infarctions, and pulmonary embolisms by dissolving blood clots. However, it carries a major risk of intracranial hemorrhage (brain bleed).




  • New-onset disorientation (confusion to person, place, and time) is a critical sign of a possible hemorrhagic stroke or bleeding in the brain.

  • The priority action is to STOP the infusion immediately to prevent further bleeding.

  • The next step is to call the provider STAT for urgent evaluation and possible reversal of t-PA effects.



 



Why the Other Options Are Incorrect:




  • (a) Assess the client's pupillary responses – Incorrect


    • While assessing pupils is important, it is not the priority.

    • The first action must be to stop the t-PA to prevent worsening bleeding.



  • (b) Request a neurologic consultation – Incorrect

    • A neurology consult may be needed, but it delays immediate intervention.

    • Stopping the infusion takes priority.



  • (d) Take and document a full set of vital signs – Incorrect

    • Vital signs are important, but stopping t-PA must come first.

    • Bleeding can progress rapidly, so the infusion must be stopped immediately.





 



Key Takeaway:



Any sudden neurologic change in a client receiving t-PA is a medical emergency. The nurse must immediately stop the infusion and call the provider to prevent further complications.


6.

A client has hemodynamic monitoring after a myocardial infarction. What safety precaution does the nurse implement for this client

  • Document pulmonary artery wedge pressure (PAWP) readings and assess their trends.

  • Ensure the balloon does not remain wedged.

  • Keep the client on strict NPO status.

  • Maintain the client in a semi-Fowler's position.

Explanation

Correct Answer: b. Ensure the balloon does not remain wedged.

Explanation (Why This Answer is Correct)

Hemodynamic monitoring involves the use of a pulmonary artery (PA) catheter
, which can measure pulmonary artery wedge pressure (PAWP) to assess left ventricular function. The catheter has a balloon at the tip that, when inflated, momentarily occludes the pulmonary artery to obtain a pressure reading. If the balloon remains inflated (wedged), it can obstruct blood flow to the lungs, potentially causing pulmonary infarction or arterial rupture. The nurse must ensure the balloon is deflated after obtaining PAWP readings to prevent complications.

Why the Other Options Are Incorrect

a. Document PAWP readings and assess their trends

While monitoring PAWP trends is important for managing heart failure or shock, preventing a wedged balloon is a higher priority because a prolonged occlusion can cause serious complications.

c. Keep the client on strict NPO status

NPO status is not required for hemodynamic monitoring. Clients may have dietary restrictions if they are critically ill, but this is not a standard safety precaution for PA catheter management.

d. Maintain the client in a semi-Fowler’s position

Semi-Fowler’s position (30–45 degrees) is beneficial for clients with heart failure or respiratory distress, but positioning does not directly relate to PA catheter safety. Preventing a wedged balloon is more critical.

Summary

The most important safety precaution for a client with hemodynamic monitoring
is ensuring the PA catheter balloon does not remain wedged. A prolonged wedge position can obstruct blood flow, leading to serious complications. Monitoring trends, positioning, or dietary restrictions do not directly prevent this life-threatening risk.


7.

The nurse's plan of care for a patient with stage 3 HIV addresses the diagnosis of Risk for Impaired Skin Integrity Related to Candidiasis. What nursing intervention best addresses this risk

  • Providing thorough oral care before and after meals

  • Administering prophylactic antibiotics

  • Promoting nutrition and adequate fluid intake

  • Applying skin emollients as needed

Explanation

Correct Answer:



A) Providing thorough oral care before and after meals



 



Explanation:



In stage 3 HIV (AIDS), candidiasis (thrush) is a common opportunistic infection that affects the oral mucosa, skin folds, and genital areas. Proper oral care helps reduce fungal overgrowth, prevent discomfort, and maintain skin integrity by preventing irritation and secondary infections. Brushing with a soft toothbrush, using antifungal mouth rinses (like nystatin), and avoiding irritating foods are key interventions.



 



Why the Other Choices Are Incorrect:




  • B) Administering prophylactic antibiotics:


    • Incorrect. Candidiasis is a fungal infection, not a bacterial one, so antibiotics are not effective. In fact, excessive antibiotic use can increase the risk of fungal overgrowth by killing beneficial bacteria.



  • C) Promoting nutrition and adequate fluid intake:

    • Partially correct but not the best choice. Good nutrition and hydration support immune function and tissue repair, but they do not directly prevent skin breakdown from candidiasis like proper oral care does.



  • D) Applying skin emollients as needed:

    • Incorrect. While moisturizing the skin can help with dryness and irritation, it does not specifically address candidiasis-related skin breakdown. Antifungal treatments (such as clotrimazole or nystatin) are more appropriate for managing fungal infections.





 



Summary:



For HIV/AIDS patients with candidiasis, thorough oral care (A) is the best nursing intervention to prevent impaired skin integrity, reduce fungal overgrowth, and maintain oral and skin health. Antibiotics are not useful, and while nutrition and skin hydration are helpful, they are not the most direct intervention for candidiasis-related skin risks.


8.

An occupational health nurse provides monthly lunch and learning sessions to employees of a rail transportation manufacturer. This month, they are providing education on the risk factors for peptic ulcer disease. Which risk factors should the nurse include in the educational session

  • Active lifestyle and smoking

  • Six-month history of H. Pylori

  • Alcohol abuse and smoking

  • Eating spicy foods and laid-back attitude

  • Occasional alcohol and cocaine use

Explanation

Correct Answers: B, C. 



Six-month history of H. pylori

Alcohol abuse and smoking



 



Why These Answers Are Correct:



Six-month history of H. pylori

H. pylori infection is the most common cause of peptic ulcer disease (PUD). The bacteria weaken the protective mucosal lining of the stomach and duodenum, allowing stomach acid to create ulcers. Chronic infection can lead to gastritis, ulcers, and even stomach cancer if left untreated.



Alcohol abuse and smoking

Both alcohol and smoking increase the risk of PUD. Alcohol irritates the stomach lining and stimulates acid production, worsening ulcer formation. Smoking reduces blood flow to the stomach, impairs healing, and increases the risk of ulcer complications like bleeding and perforation.



 



Why the Other Choices Are Incorrect:



Active lifestyle and smoking

Smoking is a risk factor, but an active lifestyle does not contribute to PUD. Exercise generally benefits digestive health and does not cause ulcers.



Eating spicy foods and laid-back attitude

Spicy foods do not cause ulcers, though they may irritate existing ulcers. Stress and personality type ("laid-back attitude") are not direct causes of PUD, though chronic stress can worsen symptoms.



Occasional alcohol and cocaine use

Occasional alcohol consumption does not significantly increase PUD risk, unlike chronic alcohol abuse. Cocaine is not a direct risk factor for PUD, though it can reduce blood flow to the digestive tract, leading to ischemic ulcers in extreme cases.



 



Summary:



The primary risk factors for peptic ulcer disease include H. pylori infection, alcohol abuse, and smoking. Spicy foods, an active lifestyle, and occasional alcohol use do not significantly contribute to ulcer formation.


9.

A patient with HIV infection has begun experiencing severe diarrhea. What is the most appropriate nursing intervention to help alleviate the diarrhea

  • Administer antidiarrheal medications on a scheduled basis, as ordered.

  • Encourage the patient to eat three balanced meals and a snack at bedtime.

  • Increase the patient's oral fluid intake.

  • Encourage the patient to increase his or her activity level.

Explanation

Correct Answer: A) Administer antidiarrheal medications on a scheduled basis, as ordered.

Explanation:

Severe diarrhea in HIV/AIDS patients
can be caused by opportunistic infections (e.g., Cryptosporidium, CMV, Mycobacterium avium complex), medication side effects, or HIV enteropathy. Uncontrolled diarrhea can lead to dehydration, malnutrition, and electrolyte imbalances, making its management a priority. Administering antidiarrheal medications (e.g., loperamide, diphenoxylate/atropine) on a scheduled basis, as prescribed, is the most effective way to manage persistent diarrhea and improve the patient’s quality of life.

Why the Other Choices Are Incorrect:

B) Encourage the patient to eat three balanced meals and a snack at bedtime:

 While proper nutrition is important, small, frequent meals with bland, low-fiber foods
(such as bananas, rice, applesauce, and toast) are better tolerated than large meals in patients with severe diarrhea.

C) Increase the patient's oral fluid intake:

Partially correct but not the best choice. Hydration is important to replace fluid losses, but without addressing the cause of diarrhea, the patient will continue losing fluids. Fluid replacement should be combined with antidiarrheal medications for effective management.

D) Encourage the patient to increase his or her activity level:

Increasing activity can worsen fatigue and fluid loss, leading to further dehydration in a patient with severe diarrhea. Rest and proper management of symptoms are more appropriate.

Summary:

For HIV/AIDS patients with severe diarrhea
, administering antidiarrheal medications on a scheduled basis (A) is the most appropriate nursing intervention. Hydration and dietary adjustments are helpful but should not replace medication management. Increased activity is not recommended as it may exacerbate dehydration and fatigue.


10.

Mary is 85 years old, lives alone, and is active in her community. She has a long-standing history of hypertension, congestive heart failure (CHF], and controlled atrial fibrillation for which she takes Coumadin. She was admitted to the hospital for a right knee replacement. Her post-operative recovery period was complicated by an exacerbation of CHF, for which her cardiologist ordered Furosemide 20mg IV every 6 hours. Due to the heavy diuresis and limited mobility post-op, the provider ordered an indwelling urinary catheter.

Day 2

1/6 0900 

UAP reports after bathing the client appears confused. Client assessed, UAP to obtain a new set of vital signs. Cloudy urine with heavy sediment noted in the collection bag. Provider notified; urine culture sent.

Based upon the day 3 lab results, which order should the nurse bring to the provider's attention

  • Discontinue indwelling catheter

  • Warfarin 5 mg by mouth

  • Potassium 10 mg IV mini bag

  • Regular insulin 5 units subcutaneously

Explanation

Correct Answer: ✅ Potassium 10 mg IV mini bag



Rationale (Step-by-Step Breakdown):



1. Reviewing the Patient's Risk Factors:




  • Elderly (85 years old) → Increased risk for medication errors, kidney impairment, and electrolyte imbalances.

  • On Coumadin (warfarin) → Needs monitoring for bleeding risk.

  • Receiving Furosemide (Lasix) IV → Causes potassium loss → High risk for hypokalemia.

  • Indwelling urinary catheter → Likely developed a UTI, which may contribute to confusion.



2. Evaluating the Medication Orders:



Discontinue indwelling catheterAppropriate




  • UTIs are common with catheters, and removing it reduces infection risk.



Warfarin 5 mg POAppropriate but needs INR monitoring




  • The dose itself is within a normal range, but the infection may increase INR levels, requiring closer monitoring.



Regular insulin 5 units SCAppropriate




  • Likely ordered for stress-induced hyperglycemia from infection or post-op recovery.



 Potassium 10 mg IV mini bagINCORRECT UNIT (Potentially Fatal Error!)




  • Potassium is NEVER dosed in mg, only in milliequivalents (mEq).

  • 10 mg ≠ 10 mEqA dose of 10 mg is not a recognized IV potassium dose!

  • IV potassium can be lethal if overdosed → Must be administered slowly with cardiac monitoring.



3. Correct Nursing Action:



🚨 Call the provider IMMEDIATELY to clarify and correct the potassium order!




  • The provider likely meant 10 mEq instead of 10 mg.

  • Administering potassium incorrectly can cause fatal cardiac arrhythmias.



 



Conclusion:



🔹 The most urgent issue is the incorrect potassium dose, as this is a medication error that could be life-threatening.

🔹 While Warfarin monitoring is important, the potassium order poses an immediate safety risk.

🔹 Always verify high-risk medications like potassium before administering.


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