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
Blood Pressure: 82/50 mmHg Heart Rate: 48 beats/minute Respiratory Rate: 8 breaths/minute Temperature: 95.1°F (35.1°C) Oxygen Saturation: 88% on room air
Which intervention should be the nurse's priority?
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Administer intravenous fluids
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Apply warming blankets to raise body temperature
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Monitor for cardiac dysrhythmias
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Administer intravenous levothyroxine
Explanation
Correct Answer: (D) Administer intravenous levothyroxine
This client is presenting with myxedema coma, a life-threatening complication of severe untreated hypothyroidism. The classic triad of altered mental status, hypothermia, and hemodynamic instability (hypotension and bradycardia) alongside a critically low oxygen saturation confirms this diagnosis. The definitive and priority treatment is the administration of intravenous levothyroxine to replace the severely deficient thyroid hormone, as without it all other supportive measures will be insufficient to reverse the underlying cause.
Why Other Options are Incorrect:
A. Administer intravenous fluids — IV fluids may be used as supportive care for hypotension in myxedema coma, but they do not address the underlying thyroid hormone deficiency and are not the priority intervention.
B. Apply warming blankets to raise body temperature — Passive rewarming is a supportive measure for hypothermia in myxedema coma but does not treat the root cause. Active external rewarming can also cause vasodilation and worsen hypotension if done aggressively.
C. Monitor for cardiac dysrhythmias — Cardiac monitoring is important given the bradycardia and hemodynamic instability, but monitoring alone is not an intervention and does not address the critical need for thyroid hormone replacement.
A client in the intensive care unit (ICU) is being treated for cardiogenic shock. The provider orders a pulmonary artery catheter (Swan-Ganz catheter) to assess oxygen delivery and utilization. The nurse reviews the mixed venous oxygen saturation (SvO2) results. Which SvO2 value should the nurse expect? Normal mixed venous oxygen saturation (SvO2): 60-80%
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68%
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50%
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76%
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88%
Explanation
Correct Answer: B. 50%
In cardiogenic shock, the heart cannot pump sufficient blood to meet tissue oxygen demands. Tissues compensate by extracting more oxygen than normal, resulting in a lower SvO2 below the normal range of 60-80%. A value of 50% reflects this increased oxygen extraction due to poor cardiac output.
Why Other Options are Incorrect:
A. 68% falls within the normal SvO2 range and would not be expected in cardiogenic shock. C. 76% is also within normal range, indicating adequate oxygen delivery which is not present in cardiogenic shock. D. 88% is above normal, which would suggest conditions like septic shock where oxygen utilization is impaired, not cardiogenic shock.
The nurse is caring for a client who is 2 days post-operative following ventricular drainage. Current vital signs include heart rate 98 beats/minute, occasional premature ventricular contractions, oxygen saturation 94% on 2L oxygen by nasal cannula, and chest pain rated 4/10. During the shift the chest tube output totaled 95 mL of dark brown drainage. What should the nurse do first?
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Draw labs in order to assess hemoglobin and hematocrit
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Notify the provider and anticipate a possible intervention
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Increase the oxygen flow to 4 liters by nasal cannula
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Administer a fluid bolus of 500 mL 0.9% normal saline
Explanation
Correct Answer: (B) Notify the provider and anticipate a possible intervention
Dark brown chest tube drainage of 95 mL combined with chest pain, oxygen desaturation to 94%, and premature ventricular contractions in a post-operative cardiac client are collectively concerning for possible hemothorax, retained blood, or cardiac complication. The most important first action is to notify the provider immediately so that further assessment, diagnostic workup, and intervention can be initiated promptly before the situation deteriorates further.
Why Other Options are Incorrect:
A. Draw labs to assess hemoglobin and hematocrit — While lab work is important and will likely be ordered, it should not precede provider notification. The clinical picture warrants immediate escalation before waiting for lab results.
C. Increase oxygen flow to 4 liters — Adjusting oxygen may be appropriate as a supportive measure, but it does not address the underlying cause of the dark drainage and cardiac symptoms and is not the priority first action.
D. Administer a fluid bolus — A fluid bolus is not indicated without provider orders and a clear clinical indication. It could potentially worsen cardiac stress in a post-operative cardiac client without proper assessment.
A client reports experiencing sudden, severe facial pain that feels like an electric shock. The pain is triggered by eating, talking, or touching the face. The nurse recognizes that these symptoms are most consistent with which condition?
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Multiple sclerosis
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Myasthenia gravis
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Bell's palsy
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Trigeminal neuralgia
Explanation
Trigeminal neuralgia is characterized by sudden, severe, electric shock-like facial pain triggered by everyday activities such as eating, talking, or touching the face. It affects the trigeminal nerve (cranial nerve V) and is one of the most painful conditions known.
Why Other Options are Incorrect:
A. Multiple sclerosis can cause facial pain but primarily presents with motor and sensory deficits, vision changes, and fatigue rather than isolated electric shock-like facial pain. B. Myasthenia gravis is characterized by progressive muscle weakness, particularly affecting the eyes and swallowing, not facial pain. C. Bell's palsy involves sudden unilateral facial muscle weakness or paralysis due to facial nerve inflammation, not severe electric shock-like pain.
What is the first step in managing heat exhaustion?
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Providing oral electrolyte replacement
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Administering intravenous normal saline
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Moving to a shaded or air-conditioned environment
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Applying cold packs to the groin and axillae
Explanation
Correct Answer: (C) Moving to a shaded or air-conditioned environment
The first and most immediate step in managing heat exhaustion is removing the client from the hot environment and moving them to a cool, shaded, or air-conditioned location. This stops ongoing heat exposure and allows the body to begin cooling. All subsequent interventions — including rehydration and cooling measures — are built upon this foundational first step.
Why Other Options are Incorrect:
A. Providing oral electrolyte replacement — Oral rehydration is an important subsequent step in heat exhaustion management, but it comes after the client has been removed from the heat source and is alert enough to safely swallow.
B. Administering intravenous normal saline — IV fluid replacement is indicated for severe cases or when the client cannot tolerate oral fluids. It is not the first step and requires clinical assessment following removal from the environment.
D. Applying cold packs to the groin and axillae — Cold pack application is a cooling technique used after the client has been moved to a cool environment. It is a secondary intervention, not the first priority action.
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.
A client with a newly placed pacemaker reports to the unlicensed assistive personnel that they are "feeling dizzy and is about to faint." Which of the following should the nurse do first?
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Notify the provider of the change in condition
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Perform an electrocardiogram (ECG)
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Assess the client's blood glucose for hypoglycemia
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Raise the client's head of the bed to 45 degrees
Explanation
Correct Answer: B. Perform an electrocardiogram (ECG)
In a client with a newly placed pacemaker reporting dizziness and near-syncope, the priority is to immediately perform an ECG to assess pacemaker function and cardiac rhythm. These symptoms may indicate pacemaker malfunction, failure to capture, or a dangerous arrhythmia requiring urgent intervention.
Why Other Options are Incorrect:
A. While the provider will need to be notified, the nurse must first gather objective data through an ECG before calling to report a change in condition.
C. Assessing blood glucose is not the priority as the client has a newly placed pacemaker, making a cardiac cause far more likely and urgent.
D. Raising the head of the bed could worsen dizziness and near-syncope by further reducing cerebral perfusion; this action is not appropriate as a first response.
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.
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Levothyroxine
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Acetaminophen
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Zoledronate
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Sodium bicarbonate
Explanation
Correct Answer: (C) Zoledronate
Zoledronate is a bisphosphonate medication used to treat hypercalcemia, particularly hypercalcemia of malignancy. It works by inhibiting osteoclast activity, reducing bone resorption and the release of calcium from bones into the bloodstream. It is one of the most potent and commonly prescribed agents for lowering elevated serum calcium levels in hospitalized clients, especially those with cancer-related bone involvement.
Why Other Options are Incorrect:
A. Levothyroxine — Levothyroxine is thyroid hormone replacement therapy used to treat hypothyroidism. It has no role in managing calcium levels and would actually worsen hypercalcemia if given inappropriately, as excess thyroid hormone can increase bone turnover and elevate calcium.
B. Acetaminophen — Acetaminophen is an analgesic and antipyretic medication. It has no pharmacological effect on serum calcium levels and is not indicated for the treatment of hypercalcemia.
D. Sodium bicarbonate — Sodium bicarbonate is used to treat metabolic acidosis or to alkalinize the urine in certain overdose situations. It does not lower serum calcium levels and is not indicated for hypercalcemia management.
The nurse notes a variety of symptoms in a client admitted with possible sepsis. Which symptom is most likely to indicate the development of disseminated intravascular coagulation (DIC)?
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Temperature remains at 38.6°C (101.5°F) despite the administration of acetaminophen
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Blood pressure goes from 108/60 mmHg to 94/52 mmHg over a 2-hour period
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The client develops 4+ pitting edema in both legs after the administration of a fluid bolus
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The client develops a petechial rash over the trunk and legs bilaterally
Explanation
Correct Answer: (D) The client develops a petechial rash over the trunk and legs bilaterally
DIC is a life-threatening coagulation disorder characterized by simultaneous widespread clotting and bleeding throughout the body. As clotting factors are consumed, uncontrolled bleeding occurs in the microvascular system, presenting as petechiae (small pinpoint hemorrhages under the skin) and purpura distributed across the trunk and extremities. This is a hallmark clinical sign of DIC and distinguishes it from other sepsis complications.
Why Other Options are Incorrect:
A. Persistent fever despite acetaminophen — Fever is a nonspecific sign of ongoing infection or inflammation in sepsis and does not specifically indicate DIC. It reflects the inflammatory process rather than coagulopathy.
B. Declining blood pressure over 2 hours — Progressive hypotension is consistent with septic shock and hemodynamic deterioration but is not specific to DIC. It may occur independently of coagulation abnormalities.
C. 4+ pitting edema after fluid bolus — Dependent edema following fluid resuscitation reflects fluid shifts and capillary leak syndrome common in sepsis. While this is concerning, it is not a specific indicator of DIC.
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