NUR 445 SF-9A1 Comprehensive Final Exam Arizona College School of Nursing.
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Free NUR 445 SF-9A1 Comprehensive Final Exam Arizona College School of Nursing. Questions
The nurse is assessing a client who presents to the emergency department after a snake bite while hiking. The client reports pain, swelling, and bruising at the bite site. What assessment data should the nurse collect? (Select all that apply.)
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Recent travel history
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Client's past history of snakebites
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Type of snake involved
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Insurance coverage
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Date of last tetanus vaccination
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Time of the snakebite
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Presence of systemic symptoms such as dizziness or difficulty breathing
Explanation
Correct Answers: (B) Client's past history of snakebites, (C) Type of snake involved, (E) Date of last tetanus vaccination, (F) Time of the snakebite, and (G) Presence of systemic symptoms such as dizziness or difficulty breathing
A thorough snakebite assessment requires identifying the type of snake to determine venom type and the need for antivenom. Prior snakebite history is relevant because previous antivenom exposure can cause allergic reactions. The time of the bite helps track symptom progression and guides antivenom administration timing. Tetanus vaccination status is necessary as puncture wounds carry tetanus risk. Systemic symptoms such as dizziness, difficulty breathing, or altered mental status indicate venom absorption and systemic toxicity requiring immediate intervention.
Why Other Options are Incorrect:
A. Recent travel history — While travel history is relevant in infectious disease assessments, it is not a priority data point in acute snakebite management. The location of the bite and snake identification are far more clinically relevant.
D. Insurance coverage — Insurance information is an administrative concern and has absolutely no clinical relevance in the emergency assessment and management of a snakebite. It should never be prioritized over clinical data collection in an acute situation.
The healthcare provider prescribes ibuprofen 10 mg/kg/dose PO every 6 hours PRN for pain for a client weighing 154 lbs. How many mg's should the client receive per dose? Round the answer to the nearest whole number.
Explanation
Correct Answer: 700 mg
To solve this calculation:
Step 1: Convert weight from lbs to kg: 154 lbs ÷ 2.2 = 70 kg
Step 2: Multiply weight in kg by the prescribed dose: 70 kg × 10 mg/kg = 700 mg
Therefore, the client should receive 700 mg of ibuprofen per dose.
The nurse is caring for a client with terminal metastatic ovarian cancer who is nearing death. Which assessment findings should the nurse expect? (Select all that apply)
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Increased urinary output
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Periods of apnea
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Sudden increase in appetite
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Bradycardia
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Cool, mottled skin
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Restlessness with increased alertness
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Hypertension
Explanation
Correct Answer: B. Periods of apnea, E. Cool, mottled skin
As death approaches, circulation deteriorates causing cool, mottled skin due to poor peripheral perfusion. Breathing becomes irregular with periods of apnea (Cheyne-Stokes respirations) as the brain's respiratory center loses function.
Why Other Options are Incorrect:
A. Urinary output decreases, not increases, as renal perfusion diminishes near death.
C. Appetite significantly decreases near death, not increases.
D. While the heart rate may become irregular, tachycardia rather than bradycardia is more commonly observed near death.
F. While restlessness can occur, it is accompanied by decreased alertness and confusion, not increased alertness.
G. Blood pressure drops near death due to decreased cardiac output, not hypertension.
The nurse is performing postmortem care for a client who died from an unexpected cardiac event. An autopsy has been ordered. Which actions by the nurse are correct? (Select all that apply.)
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Discourage the family from touching the body to prevent contamination.
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Answer any questions the family may have regarding next steps.
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Apply identification tags according to facility protocol.
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Remove all invasive devices before the body is transported.
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Allow the family to view the body and say goodbye.
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Retain all invasive lines and tubes in place.
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Position the body in a natural alignment before rigor mortis sets in.
Explanation
Correct Answers: (B) Answer any questions the family may have regarding next steps, (C) Apply identification tags according to facility protocol, (E) Allow the family to view the body and say goodbye, (F) Retain all invasive lines and tubes in place, and (G) Position the body in a natural alignment before rigor mortis sets in.
When an autopsy has been ordered, all invasive lines and tubes must be left in place as they are considered evidence for the medical examiner. Identification tags must be applied per facility protocol to ensure proper identification. The body should be positioned in natural alignment before rigor mortis sets in to preserve dignity. Family members should be allowed to view and say goodbye as part of compassionate end-of-life care, and the nurse should answer any questions the family has about next steps.
Why Other Options are Incorrect:
A. Discourage the family from touching the body — Families are generally permitted to touch and be with their loved one unless there is a specific infection control concern. Discouraging this interaction without cause is not appropriate and violates compassionate care principles.
D. Remove all invasive devices before transport — When an autopsy is ordered, all invasive devices must remain in place and must not be removed, as they serve as forensic evidence for the medical examiner.
The nurse is reviewing the chart of a client admitted with cardiogenic shock. Based on the information provided, which orders should the nurse prioritize? (Select all that apply)
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Monitor urine output hourly
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Place the client in Trendelenburg position
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Prepare for possible intra-aortic balloon pump insertion
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Administer sublingual nitroglycerin every 5 minutes as needed
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Administer IV dobutamine as prescribed
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Administer 1,000mL IV fluid bolus
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Encourage ambulation to prevent deep vein thrombosis
Explanation
Correct Answer: A. Monitor urine output hourly, C. Prepare for possible intra-aortic balloon pump insertion, E. Administer IV dobutamine as prescribed
In cardiogenic shock, the heart fails to pump adequately, leading to decreased cardiac output and organ hypoperfusion. Monitoring urine output reflects renal perfusion, intra-aortic balloon pump mechanically supports cardiac function, and dobutamine increases cardiac contractility.
Why Other Options are Incorrect:
B. Trendelenburg position is contraindicated in cardiogenic shock as it increases preload and worsens the condition. D. Sublingual nitroglycerin every 5 minutes is used for angina management, not cardiogenic shock. F. A 1,000mL IV fluid bolus would dangerously increase preload, worsening pulmonary congestion. G. Encouraging ambulation is inappropriate as the client requires strict bed rest and hemodynamic stabilization.
The nurse manager of the intensive care unit is planning activities to help support the staff when a client, who is well known to them, dies of a terminal illness. What strategies can be planned for the staff to support this loss? (Select all that apply.)
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Plan regularly scheduled unit debriefings.
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Sending the family a card acknowledging their loss.
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Supporting staff to complete postmortem care together.
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Distracting the staff by changing client assignments.
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Discourage the staff from sharing their feelings in the workplace.
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Encouraging the staff to spend time with the family.
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Facilitating a moment of silence to remember this client.
Explanation
Correct Answers: (A) Plan regularly scheduled unit debriefings, (B) Sending the family a card acknowledging their loss, (C) Supporting staff to complete postmortem care together, (F) Encouraging the staff to spend time with the family, and (G) Facilitating a moment of silence to remember this client.
Compassionate and proactive grief support for ICU staff is essential for preventing burnout and moral distress. Regular debriefings provide a structured space for staff to process emotions collectively. Sending condolences to the family honors the therapeutic relationship. Performing postmortem care together promotes closure and mutual support among colleagues. Spending time with the family allows staff to pay their respects, and a moment of silence is a meaningful ritual that acknowledges the significance of the loss.
Why Other Options are Incorrect:
D. Distracting the staff by changing client assignments — Distraction does not support healthy grief processing. Abruptly changing assignments without acknowledgment of loss may cause staff to feel dismissed and can worsen emotional distress over time.
E. Discourage the staff from sharing their feelings in the workplace — Suppressing emotional expression is harmful to staff wellbeing and increases the risk of compassion fatigue and burnout. Encouraging open communication and emotional support is the evidence-based approach to managing grief in healthcare settings.
A trauma client is brought into the emergency department after a diving accident in which they hit their head on the bottom of a pool. The client is unresponsive and apneic, and the nurse performs the jaw thrust maneuver to open the airway. Why is the jaw thrust maneuver the appropriate choice in this scenario?
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It is the fastest method to establish an airway
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It promotes better oxygenation than other airway maneuvers
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It prevents further movement of the cervical spine
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It allows better visualization of the vocal cords
Explanation
Correct Answer: C. It prevents further movement of the cervical spine
In trauma patients, especially those with a diving accident involving head impact, cervical spine injury must be assumed. The jaw thrust maneuver opens the airway without extending the neck, thereby preventing further cervical spine movement and reducing the risk of spinal cord injury.
Why Other Options are Incorrect:
A. Speed of establishing an airway is not the reason for choosing the jaw thrust; the head-tilt chin-lift can be performed just as quickly but is contraindicated in suspected spinal injury.
B. Both maneuvers provide similar oxygenation when performed correctly; oxygenation quality is not the distinguishing factor here.
D. The jaw thrust does not improve visualization of the vocal cords; direct laryngoscopy or video laryngoscopy is used for that purpose.
A client receiving a dopamine infusion has a heart rate of 128 beats/minute (baseline was 88 beats/minute), blood pressure of 140/90 mmHg, and reports feeling "jittery." What is the nurse's most appropriate action?
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Decrease the dopamine infusion rate and notify the provider
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Increase the dopamine infusion to improve cardiac output
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Stop the infusion and prepare for a rapid response
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Maintain the current rate and reassess in 1 hour
Explanation
Correct Answer: (A) Decrease the dopamine infusion rate and notify the provider
The client is demonstrating signs of dopamine toxicity or excessive sympathomimetic effect, including tachycardia (128 bpm, significantly above the baseline of 88 bpm), hypertension, and subjective feelings of jitteriness. These are classic adverse effects of dopamine at higher doses due to its beta-1 and alpha-adrenergic stimulation. The appropriate nursing action is to decrease the infusion rate to reduce the adverse cardiovascular effects and notify the provider for further orders and assessment.
Why Other Options are Incorrect:
B. Increase the dopamine infusion to improve cardiac output — Increasing the rate would worsen tachycardia and hypertension, potentially leading to dangerous dysrhythmias or myocardial ischemia. This is contraindicated given the current presentation.
C. Stop the infusion and prepare for a rapid response — Abruptly stopping a vasopressor infusion can cause sudden hemodynamic instability. The appropriate action is to titrate down, not immediately discontinue, unless the situation becomes immediately life-threatening.
D. Maintain the current rate and reassess in 1 hour — Waiting an hour while the client has a heart rate of 128 and is symptomatic is not appropriate. The adverse effects require timely intervention, not delayed reassessment.
A client with acute leukemia is experiencing dyspnea, confusion, and blurred vision. The provider suspects leukostasis. Which diagnostic finding would confirm this condition?
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Extremely elevated white blood cell count
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Increased clotting times and low platelets
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Elevated blood urea nitrogen (BUN) and creatinine
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Elevated serum calcium level
Explanation
Correct Answer: (A) Extremely elevated white blood cell count
Leukostasis is a life-threatening complication of acute leukemia caused by an extremely elevated white blood cell count, typically above 100,000 cells/mcL. The massive accumulation of leukemic blasts increases blood viscosity and causes sluggish blood flow, leading to microvascular occlusion in vital organs such as the brain and lungs, which explains the dyspnea, confusion, and blurred vision described.
Why Other Options are Incorrect:
B. Increased clotting times and low platelets — These findings are consistent with disseminated intravascular coagulation (DIC) or thrombocytopenia, not leukostasis.
C. Elevated BUN and creatinine — These indicate renal impairment or tumor lysis syndrome, not leukostasis.
D. Elevated serum calcium level — Hypercalcemia can occur in some hematologic malignancies but is not the diagnostic marker for leukostasis.
The nurse is triaging clients after a school bus crash. Using the SALT system, how should the nurse categorize a client who is walking around the scene with superficial cuts and abrasions but no significant injuries?
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Expectant (gray)
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Immediate (red)
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Minor (green)
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Delayed (yellow)
Explanation
Correct Answer: (C) Minor (green)
In the SALT (Sort, Assess, Lifesaving Interventions, Treatment/Transport) triage system, clients who are able to walk are immediately categorized as Minor (green). The ability to ambulate indicates that the client does not have life-threatening injuries requiring immediate intervention. Superficial cuts and abrasions further support a minor injury classification, meaning this client can wait for treatment after more critically injured patients have been addressed.
Why Other Options are Incorrect:
A. Expectant (gray) — This category is reserved for clients with injuries so severe that survival is unlikely even with maximal intervention. A walking client with superficial injuries does not meet this criteria.
B. Immediate (red) — This category is for clients with life-threatening but survivable injuries requiring immediate intervention. A client who is ambulatory with only superficial wounds does not meet this classification.
D. Delayed (yellow) — This category is for clients who are not walking but have injuries that are serious yet not immediately life-threatening. Since this client is walking, they are classified as Minor (green), not Delayed.
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