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
1. A client is postoperative day 1 following a total thyroidectomy. The nurse notes that the client has mild hoarseness, tingling around the mouth, and muscle twitching. Which medication should the nurse anticipate administering to manage this complication?
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Propylthiouracil (PTU) PO
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Potassium chloride IV
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Levothyroxine IV
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Calcium gluconate IV
Explanation
Explanation:
Correct Answer: (D) Calcium gluconate IV
The combination of tingling around the mouth (circumoral paresthesia), muscle twitching, and hoarseness following total thyroidectomy are classic signs of hypocalcemia caused by inadvertent damage or removal of the parathyroid glands during surgery. The parathyroid glands regulate calcium levels, and their disruption leads to a rapid drop in serum calcium. Calcium gluconate IV is the immediate treatment to restore calcium levels and prevent progression to tetany, laryngospasm, or seizures.
Why Other Options are Incorrect:
A. Propylthiouracil (PTU) PO — PTU is an antithyroid medication used to treat hyperthyroidism. It has no role in managing postoperative hypocalcemia following thyroidectomy.
B. Potassium chloride IV — Potassium replacement is used for hypokalemia. The symptoms described are specific to hypocalcemia, not hypokalemia, and potassium administration would not address this complication.
C. Levothyroxine IV — Levothyroxine is thyroid hormone replacement, which will be needed long-term after total thyroidectomy. However, it does not address the acute complication of hypocalcemia presenting in the immediate postoperative period.
Correct Answer: (D) Calcium gluconate IV
The combination of tingling around the mouth (circumoral paresthesia), muscle twitching, and hoarseness following total thyroidectomy are classic signs of hypocalcemia caused by inadvertent damage or removal of the parathyroid glands during surgery. The parathyroid glands regulate calcium levels, and their disruption leads to a rapid drop in serum calcium. Calcium gluconate IV is the immediate treatment to restore calcium levels and prevent progression to tetany, laryngospasm, or seizures.
Why Other Options are Incorrect:
A. Propylthiouracil (PTU) PO — PTU is an antithyroid medication used to treat hyperthyroidism. It has no role in managing postoperative hypocalcemia following thyroidectomy.
B. Potassium chloride IV — Potassium replacement is used for hypokalemia. The symptoms described are specific to hypocalcemia, not hypokalemia, and potassium administration would not address this complication.
C. Levothyroxine IV — Levothyroxine is thyroid hormone replacement, which will be needed long-term after total thyroidectomy. However, it does not address the acute complication of hypocalcemia presenting in the immediate postoperative period.
2. The nurse is caring for a post-operative client who is at high risk for developing a pulmonary embolism (PE). Which intervention should the nurse implement to help prevent this complication?
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Instruct the client to avoid deep breathing exercises to reduce discomfort
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Encourage early ambulation as soon as possible after surgery
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Limit fluid intake to prevent excess intravascular volume
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Maintain the client on strict bed rest for the first 48 hours
Explanation
Explanation:
Correct Answer: (B) Encourage early ambulation as soon as possible after surgery
Early ambulation is the most effective nursing intervention for preventing postoperative pulmonary embolism. Movement activates the calf muscle pump, promoting venous return from the lower extremities and preventing venous stasis, which is one of the three components of Virchow's triad for thrombus formation. Early mobility is a cornerstone of postoperative DVT and PE prevention protocols.
Why Other Options are Incorrect:
A. Instruct the client to avoid deep breathing exercises — Deep breathing and incentive spirometry are essential postoperative interventions that improve lung expansion and reduce the risk of atelectasis and respiratory complications. Avoiding them increases the risk of pulmonary complications, not reduces them.
C. Limit fluid intake to prevent excess intravascular volume — Adequate hydration is important postoperatively to maintain blood viscosity and reduce the risk of clot formation. Restricting fluids would increase blood viscosity and actually elevate the risk of thrombus formation.
D. Maintain the client on strict bed rest for the first 48 hours — Prolonged bed rest promotes venous stasis in the lower extremities, which significantly increases the risk of DVT and subsequent PE. This is the opposite of evidence-based postoperative care.
Correct Answer: (B) Encourage early ambulation as soon as possible after surgery
Early ambulation is the most effective nursing intervention for preventing postoperative pulmonary embolism. Movement activates the calf muscle pump, promoting venous return from the lower extremities and preventing venous stasis, which is one of the three components of Virchow's triad for thrombus formation. Early mobility is a cornerstone of postoperative DVT and PE prevention protocols.
Why Other Options are Incorrect:
A. Instruct the client to avoid deep breathing exercises — Deep breathing and incentive spirometry are essential postoperative interventions that improve lung expansion and reduce the risk of atelectasis and respiratory complications. Avoiding them increases the risk of pulmonary complications, not reduces them.
C. Limit fluid intake to prevent excess intravascular volume — Adequate hydration is important postoperatively to maintain blood viscosity and reduce the risk of clot formation. Restricting fluids would increase blood viscosity and actually elevate the risk of thrombus formation.
D. Maintain the client on strict bed rest for the first 48 hours — Prolonged bed rest promotes venous stasis in the lower extremities, which significantly increases the risk of DVT and subsequent PE. This is the opposite of evidence-based postoperative care.
3. The nurse assesses a client with a brain tumor. The client opens his eyes when the nurse calls his name, uses inappropriate words in response to questions, and follows simple commands. Using the Glasgow Coma Scale (GCS), how should the nurse document this client's assessment?
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GCS 8
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GCS 14
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GCS 10
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GCS 12
Explanation
Explanation
Correct Answer: (D) GCS 12
Using the Glasgow Coma Scale, each response is scored as follows for this client:
Eye Opening Response — Opens eyes to verbal command, speech, or shout = 3 points
Verbal Response — Inappropriate responses, words discernible = 3 points
Motor Response — Obeys commands for movement = 6 points
Total GCS Score = 3 + 3 + 6 = 12
A GCS of 12 falls within the moderate brain injury range (9–12 points), which is consistent with this client's presentation of partial responsiveness and verbal impairment.
Why Other Options are Incorrect:
A. GCS 8 — A score of 8 would indicate severe neurological impairment with minimal responsiveness. This client is responding to voice and following commands, which scores higher than an 8 would suggest.
B. GCS 14 — A score of 14 would indicate near-normal neurological function. This client's inappropriate verbal responses and eye opening only to voice, rather than spontaneously, do not support a score this high.
C. GCS 10 — While this falls in the moderate range, it does not accurately reflect the correct point total when each domain is scored precisely according to the client's described behaviors.
Correct Answer: (D) GCS 12
Using the Glasgow Coma Scale, each response is scored as follows for this client:
Eye Opening Response — Opens eyes to verbal command, speech, or shout = 3 points
Verbal Response — Inappropriate responses, words discernible = 3 points
Motor Response — Obeys commands for movement = 6 points
Total GCS Score = 3 + 3 + 6 = 12
A GCS of 12 falls within the moderate brain injury range (9–12 points), which is consistent with this client's presentation of partial responsiveness and verbal impairment.
Why Other Options are Incorrect:
A. GCS 8 — A score of 8 would indicate severe neurological impairment with minimal responsiveness. This client is responding to voice and following commands, which scores higher than an 8 would suggest.
B. GCS 14 — A score of 14 would indicate near-normal neurological function. This client's inappropriate verbal responses and eye opening only to voice, rather than spontaneously, do not support a score this high.
C. GCS 10 — While this falls in the moderate range, it does not accurately reflect the correct point total when each domain is scored precisely according to the client's described behaviors.
4. The nurse is evaluating arterial blood gas (ABG) results for a client with unstable angina who has been experiencing frequent episodes of chest pain and anxiety. The client's ABG values are:
pH: 7.50 (Normal: 7.35–7.45) PaO2: 85 mmHg (Normal: 80–95 mmHg) PaCO2: 30 mmHg (Normal: 35–45 mmHg) HCO3: 24 mEq/L (Normal: 22–26 mEq/L)
What condition should the nurse suspect?
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Respiratory acidosis uncompensated
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Respiratory alkalosis uncompensated
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Metabolic alkalosis fully compensated
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Metabolic acidosis partially compensated
Explanation
Explanation
Correct Answer: (B) Respiratory alkalosis uncompensated
The pH of 7.50 is elevated (alkalotic). The PaCO2 of 30 mmHg is below normal, indicating that CO2 is being blown off through hyperventilation, which is the respiratory cause of the alkalosis. The HCO3 of 24 mEq/L is completely normal, meaning the kidneys have not yet begun to compensate. This pattern — high pH, low PaCO2, normal HCO3 — is consistent with uncompensated respiratory alkalosis, which is expected in a client hyperventilating from anxiety and chest pain.
Why Other Options are Incorrect:
A. Respiratory acidosis uncompensated — Respiratory acidosis would present with a low pH and elevated PaCO2, the opposite of what is seen here.
C. Metabolic alkalosis fully compensated — Metabolic alkalosis would show elevated HCO3 as the primary disturbance with compensatory rise in PaCO2. Here, HCO3 is normal and PaCO2 is low, ruling this out.
D. Metabolic acidosis partially compensated — Metabolic acidosis would present with low pH and low HCO3, with the lungs compensating by lowering PaCO2. The pH here is elevated, not acidotic, ruling this out entirely.
Correct Answer: (B) Respiratory alkalosis uncompensated
The pH of 7.50 is elevated (alkalotic). The PaCO2 of 30 mmHg is below normal, indicating that CO2 is being blown off through hyperventilation, which is the respiratory cause of the alkalosis. The HCO3 of 24 mEq/L is completely normal, meaning the kidneys have not yet begun to compensate. This pattern — high pH, low PaCO2, normal HCO3 — is consistent with uncompensated respiratory alkalosis, which is expected in a client hyperventilating from anxiety and chest pain.
Why Other Options are Incorrect:
A. Respiratory acidosis uncompensated — Respiratory acidosis would present with a low pH and elevated PaCO2, the opposite of what is seen here.
C. Metabolic alkalosis fully compensated — Metabolic alkalosis would show elevated HCO3 as the primary disturbance with compensatory rise in PaCO2. Here, HCO3 is normal and PaCO2 is low, ruling this out.
D. Metabolic acidosis partially compensated — Metabolic acidosis would present with low pH and low HCO3, with the lungs compensating by lowering PaCO2. The pH here is elevated, not acidotic, ruling this out entirely.
5. A client with end-stage liver failure is admitted to the intensive care unit (ICU) with hepatic encephalopathy. Which intervention should the nurse anticipate for this client?
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Obtaining blood cultures and initiating broad-spectrum antibiotics to treat suspected sepsis.
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Initiating continuous renal replacement therapy (CRRT) to manage fluid and electrolyte imbalances.
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Administering intravenous vasopressors to improve blood pressure and perfusion to vital organs.
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Administering oral lactulose to reduce serum ammonia levels and improve mental status.
Explanation
Explanation
Correct Answer: (D) Administering oral lactulose to reduce serum ammonia levels and improve mental status.
Hepatic encephalopathy occurs when the failing liver cannot convert ammonia to urea for excretion, leading to toxic ammonia accumulation in the bloodstream that impairs brain function. Lactulose is the primary treatment, as it acidifies the colon to trap ammonia as ammonium ions, prevents its absorption, and promotes its elimination through the stool. This directly addresses the underlying cause of the encephalopathy and is the most anticipated intervention for this condition.
Why Other Options are Incorrect:
A. Obtaining blood cultures and initiating antibiotics — This intervention is appropriate when sepsis is suspected, but the clinical scenario describes hepatic encephalopathy as the primary problem, not sepsis. There is no indication of infection presented here.
B. Initiating CRRT — CRRT is used for acute kidney injury with severe fluid and electrolyte disturbances. While renal complications can occur in end-stage liver disease, CRRT is not the primary intervention for hepatic encephalopathy.
C. Administering IV vasopressors — Vasopressors are indicated for hemodynamic instability and septic or distributive shock. They are not the anticipated treatment for hepatic encephalopathy in the absence of documented shock.
Correct Answer: (D) Administering oral lactulose to reduce serum ammonia levels and improve mental status.
Hepatic encephalopathy occurs when the failing liver cannot convert ammonia to urea for excretion, leading to toxic ammonia accumulation in the bloodstream that impairs brain function. Lactulose is the primary treatment, as it acidifies the colon to trap ammonia as ammonium ions, prevents its absorption, and promotes its elimination through the stool. This directly addresses the underlying cause of the encephalopathy and is the most anticipated intervention for this condition.
Why Other Options are Incorrect:
A. Obtaining blood cultures and initiating antibiotics — This intervention is appropriate when sepsis is suspected, but the clinical scenario describes hepatic encephalopathy as the primary problem, not sepsis. There is no indication of infection presented here.
B. Initiating CRRT — CRRT is used for acute kidney injury with severe fluid and electrolyte disturbances. While renal complications can occur in end-stage liver disease, CRRT is not the primary intervention for hepatic encephalopathy.
C. Administering IV vasopressors — Vasopressors are indicated for hemodynamic instability and septic or distributive shock. They are not the anticipated treatment for hepatic encephalopathy in the absence of documented shock.
6. A client with Cushing's syndrome is admitted to the medical-surgical unit with uncontrolled hypertension, hyperglycemia, and new-onset confusion. The nurse also notes generalized weakness and an irregular heart rhythm on telemetry. Which intervention should the nurse prioritize for this client?
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Assessing and treating severe hypokalemia
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Administering an antihypertensive medication
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Monitoring blood glucose and administering insulin as needed
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Providing education on fluid and sodium restriction
Explanation
Explanation
Correct Answer: (A) Assessing and treating severe hypokalemia
In Cushing's syndrome, excess cortisol causes increased renal excretion of potassium, leading to hypokalemia. The combination of generalized weakness and an irregular heart rhythm on telemetry are classic signs of severe hypokalemia, which can precipitate life-threatening cardiac dysrhythmias. Addressing this electrolyte imbalance is the most immediately life-threatening complication and therefore the highest priority intervention.
Why Other Options are Incorrect:
B. Administering an antihypertensive medication — While hypertension is present, it is not the most immediately life-threatening finding. The cardiac dysrhythmia caused by hypokalemia takes priority over blood pressure management.
C. Monitoring blood glucose and administering insulin — Hyperglycemia is an important concern in Cushing's syndrome but does not carry the same immediate risk of fatal cardiac arrhythmia as severe hypokalemia does in this clinical picture.
D. Providing education on fluid and sodium restriction — Patient education is important for long-term management but is never the priority intervention when a patient is exhibiting acute, potentially life-threatening symptoms.
Correct Answer: (A) Assessing and treating severe hypokalemia
In Cushing's syndrome, excess cortisol causes increased renal excretion of potassium, leading to hypokalemia. The combination of generalized weakness and an irregular heart rhythm on telemetry are classic signs of severe hypokalemia, which can precipitate life-threatening cardiac dysrhythmias. Addressing this electrolyte imbalance is the most immediately life-threatening complication and therefore the highest priority intervention.
Why Other Options are Incorrect:
B. Administering an antihypertensive medication — While hypertension is present, it is not the most immediately life-threatening finding. The cardiac dysrhythmia caused by hypokalemia takes priority over blood pressure management.
C. Monitoring blood glucose and administering insulin — Hyperglycemia is an important concern in Cushing's syndrome but does not carry the same immediate risk of fatal cardiac arrhythmia as severe hypokalemia does in this clinical picture.
D. Providing education on fluid and sodium restriction — Patient education is important for long-term management but is never the priority intervention when a patient is exhibiting acute, potentially life-threatening symptoms.
7. A client with a history of coronary artery disease is admitted with acute chest pain and dyspnea. The client suddenly becomes hypotensive, tachycardic, and diaphoretic. Current assessment findings include:
Blood Pressure: 78/48 mmHg Heart Rate: 132 beats/minute Respiratory Rate: 28 breaths/minute Oxygen Saturation: 89% on 4L nasal cannula Urine Output: 5 mL/hr Serum BNP: 950 pg/mL (Normal: <100 pg/mL)
What condition should the nurse suspect based on these findings?
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Cardiogenic shock
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Neurogenic shock
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Obstructive shock
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Septic shock
Explanation
Explanation:
Correct Answer: (A) Cardiogenic shock
This client's presentation is classic for cardiogenic shock. The severely elevated BNP of 950 pg/mL indicates significant cardiac stress and heart failure. The combination of profound hypotension, tachycardia, tachypnea, hypoxia, diaphoresis, and critically low urine output of 5 mL/hr all reflect severely impaired cardiac output and end-organ hypoperfusion. In the context of a known history of coronary artery disease and acute chest pain, cardiogenic shock from myocardial infarction is the most likely diagnosis.
Why Other Options are Incorrect:
B. Neurogenic shock — Neurogenic shock results from spinal cord injury disrupting sympathetic tone, causing bradycardia and vasodilation with warm, dry skin. This client has tachycardia and diaphoresis, which are inconsistent with neurogenic shock.
C. Obstructive shock — Obstructive shock is caused by a physical obstruction to blood flow such as tension pneumothorax or cardiac tamponade. While it can present similarly, the markedly elevated BNP and history of CAD with acute chest pain more specifically point to cardiogenic etiology.
D. Septic shock — Septic shock is caused by systemic infection and typically presents with fever, warm flushed skin, and evidence of infection. There is no indication of infectious etiology in this clinical scenario.
Correct Answer: (A) Cardiogenic shock
This client's presentation is classic for cardiogenic shock. The severely elevated BNP of 950 pg/mL indicates significant cardiac stress and heart failure. The combination of profound hypotension, tachycardia, tachypnea, hypoxia, diaphoresis, and critically low urine output of 5 mL/hr all reflect severely impaired cardiac output and end-organ hypoperfusion. In the context of a known history of coronary artery disease and acute chest pain, cardiogenic shock from myocardial infarction is the most likely diagnosis.
Why Other Options are Incorrect:
B. Neurogenic shock — Neurogenic shock results from spinal cord injury disrupting sympathetic tone, causing bradycardia and vasodilation with warm, dry skin. This client has tachycardia and diaphoresis, which are inconsistent with neurogenic shock.
C. Obstructive shock — Obstructive shock is caused by a physical obstruction to blood flow such as tension pneumothorax or cardiac tamponade. While it can present similarly, the markedly elevated BNP and history of CAD with acute chest pain more specifically point to cardiogenic etiology.
D. Septic shock — Septic shock is caused by systemic infection and typically presents with fever, warm flushed skin, and evidence of infection. There is no indication of infectious etiology in this clinical scenario.
8. The nurse is assessing a critically ill client with MODS. The client has developed oliguria, jaundice, and altered mental status. The nurse should recognize that these findings are most likely due to which pathophysiologic mechanism?
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Activation of the parasympathetic nervous system
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Increased immune response leading to cytokine release
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Compensatory vasoconstriction improving organ function
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Impaired tissue perfusion and organ failure
Explanation
Explanation
Correct Answer: (D) Impaired tissue perfusion and organ failure
Multiple Organ Dysfunction Syndrome (MODS) occurs when two or more organ systems fail as a result of critically impaired tissue perfusion and oxygen delivery. Oliguria indicates renal failure, jaundice indicates hepatic failure, and altered mental status indicates cerebral dysfunction — all signs of progressive organ failure due to inadequate perfusion. This is the defining pathophysiologic mechanism of MODS.
Why Other Options are Incorrect:
A. Activation of the parasympathetic nervous system — The parasympathetic nervous system is responsible for rest-and-digest functions and does not drive the systemic inflammatory cascade or organ failure seen in MODS.
B. Increased immune response leading to cytokine release — While cytokine storm contributes to the initiation of MODS, the specific clinical findings of oliguria, jaundice, and altered mental status reflect the end result of organ failure from impaired perfusion, not the immune mechanism itself.
C. Compensatory vasoconstriction improving organ function — Compensatory vasoconstriction is an initial physiological response to maintain perfusion to vital organs, but it does not improve organ function in MODS. Sustained vasoconstriction ultimately worsens tissue ischemia and contributes to further organ deterioration.
Correct Answer: (D) Impaired tissue perfusion and organ failure
Multiple Organ Dysfunction Syndrome (MODS) occurs when two or more organ systems fail as a result of critically impaired tissue perfusion and oxygen delivery. Oliguria indicates renal failure, jaundice indicates hepatic failure, and altered mental status indicates cerebral dysfunction — all signs of progressive organ failure due to inadequate perfusion. This is the defining pathophysiologic mechanism of MODS.
Why Other Options are Incorrect:
A. Activation of the parasympathetic nervous system — The parasympathetic nervous system is responsible for rest-and-digest functions and does not drive the systemic inflammatory cascade or organ failure seen in MODS.
B. Increased immune response leading to cytokine release — While cytokine storm contributes to the initiation of MODS, the specific clinical findings of oliguria, jaundice, and altered mental status reflect the end result of organ failure from impaired perfusion, not the immune mechanism itself.
C. Compensatory vasoconstriction improving organ function — Compensatory vasoconstriction is an initial physiological response to maintain perfusion to vital organs, but it does not improve organ function in MODS. Sustained vasoconstriction ultimately worsens tissue ischemia and contributes to further organ deterioration.
9. The nurse is learning about the ABCDE survey during trauma assessment. What does the "C" in the ABCDE approach stand for?
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Consciousness
-
Cranial nerves
-
Circulation
-
Chest compressions
Explanation
Explanation
Correct Answer: (C) Circulation
The ABCDE approach is a systematic framework used in trauma and emergency assessment. Each letter represents a priority area: A — Airway, B — Breathing, C — Circulation, D — Disability (neurological status), and E — Exposure/Environment. Circulation assessment includes evaluating for hemorrhage control, pulse quality, blood pressure, and signs of shock, making it a critical step immediately following airway and breathing assessment.
Why Other Options are Incorrect:
A. Consciousness — Consciousness and neurological status are assessed under D (Disability) in the ABCDE framework, not under C.
B. Cranial nerves — Cranial nerve assessment is a detailed neurological examination that is not part of the primary ABCDE trauma survey. It may be performed during secondary assessment.
D. Chest compressions — Chest compressions are part of CPR and cardiac arrest management. They are not what the C in the ABCDE primary survey stands for, although circulation assessment may lead to interventions including CPR if no pulse is found.
Correct Answer: (C) Circulation
The ABCDE approach is a systematic framework used in trauma and emergency assessment. Each letter represents a priority area: A — Airway, B — Breathing, C — Circulation, D — Disability (neurological status), and E — Exposure/Environment. Circulation assessment includes evaluating for hemorrhage control, pulse quality, blood pressure, and signs of shock, making it a critical step immediately following airway and breathing assessment.
Why Other Options are Incorrect:
A. Consciousness — Consciousness and neurological status are assessed under D (Disability) in the ABCDE framework, not under C.
B. Cranial nerves — Cranial nerve assessment is a detailed neurological examination that is not part of the primary ABCDE trauma survey. It may be performed during secondary assessment.
D. Chest compressions — Chest compressions are part of CPR and cardiac arrest management. They are not what the C in the ABCDE primary survey stands for, although circulation assessment may lead to interventions including CPR if no pulse is found.
10. The nurse is educating a client with advanced liver cirrhosis on dietary recommendations to help manage ascites and fluid retention. Which dietary modification should the nurse encourage the client to follow?
-
High-fat diet
-
Low-sodium diet
-
Increased fluid intake
-
High-protein diet
Explanation
Explanation:
Correct Answer: B. Low-sodium diet
In advanced liver cirrhosis, portal hypertension and decreased albumin production cause fluid to accumulate in the abdomen (ascites). Sodium restriction reduces fluid retention by limiting water reabsorption in the kidneys, helping manage ascites and edema.
Why Other Options are Incorrect:
A. A high-fat diet is not recommended as cirrhotic patients often have impaired fat metabolism and bile production. C. Increased fluid intake would worsen fluid retention and ascites in a client who is already retaining fluids. D. While protein is important, a very high-protein diet can worsen hepatic encephalopathy in advanced cirrhosis due to impaired ammonia metabolism.
Correct Answer: B. Low-sodium diet
In advanced liver cirrhosis, portal hypertension and decreased albumin production cause fluid to accumulate in the abdomen (ascites). Sodium restriction reduces fluid retention by limiting water reabsorption in the kidneys, helping manage ascites and edema.
Why Other Options are Incorrect:
A. A high-fat diet is not recommended as cirrhotic patients often have impaired fat metabolism and bile production. C. Increased fluid intake would worsen fluid retention and ascites in a client who is already retaining fluids. D. While protein is important, a very high-protein diet can worsen hepatic encephalopathy in advanced cirrhosis due to impaired ammonia metabolism.
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