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
Explanation
Correct Answer: 10 mL/hr
To solve this, calculate the volume needed to deliver 2 units per hour using the available concentration:
Concentration = 20 units ÷ 100 mL = 0.2 units/mL
Rate = Desired dose ÷ Concentration
Rate = 2 units/hour ÷ 0.2 units/mL = 10 mL/hr
The nurse should program the IV pump to infuse at 10 mL/hr.
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"My family member will lose interest in activities."
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Propylthiouracil (PTU) PO
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Levothyroxine IV
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Calcium gluconate IV
Explanation
Correct Answer: (A) "My family member will lose interest in activities."
In the late stage of dying, clients characteristically withdraw from the external world and lose interest in activities, food, social interactions, and previously enjoyed hobbies. This withdrawal is a natural and expected part of the dying process as the body conserves energy and the person turns inward. A family member who understands this demonstrates accurate comprehension of what to expect during the final stage of life, which helps them provide appropriate support without forcing engagement or feeling that the withdrawal is personal rejection.
Why Other Options are Incorrect:
Options B, C, and D (PTU, Levothyroxine IV, and Calcium gluconate IV) are medication options that are entirely unrelated to end-of-life education or the dying process. They appear to be a display error from a previous question and do not represent valid answer choices for this question about the late stage of dying.
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Coughing up pink-tinged sputum
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Bruising over the sternum
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Pain with deep inspiration
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Tracheal deviation to the left
Explanation
Correct Answer: (D) Tracheal deviation to the left
Tracheal deviation following chest trauma is a hallmark sign of tension pneumothorax, where air accumulates under pressure in one side of the pleural space and pushes the mediastinum, including the trachea, toward the opposite side. This represents a life-threatening emergency requiring immediate needle decompression. Among all the findings listed, tracheal deviation indicates the most critical and immediately fatal complication.
Why Other Options are Incorrect:
A. Coughing up pink-tinged sputum — This may indicate pulmonary contusion or early pulmonary edema and warrants monitoring, but it is not as immediately life-threatening as tracheal deviation.
B. Bruising over the sternum — Sternal bruising is an expected finding after blunt chest trauma and indicates surface injury. While it warrants assessment for underlying fractures, it is not the most concerning finding.
C. Pain with deep inspiration — Pleuritic chest pain is common after chest trauma and may indicate rib fractures or pleural irritation, but it does not represent an immediately life-threatening emergency compared to tracheal deviation.
Assessment Findings (24 Hours Later): Blood pressure: 126/74 mmHg, Heart rate: 94 beats/minute, Respiratory rate: 18 breaths/minute Persistent nausea, increasing fatigue, intermittent muscle twitching
Initial Lab Results (04/20/25 0700): Potassium: 6.5 mmol/L (Normal: 3.5-5.0 mmol/L) Calcium: 6.8 mg/dL (Normal: 8.5-10.2 mg/dL) Uric Acid: 9.6 mg/dL (Normal: 3.5-7.2 mg/dL) Creatinine: 2.3 mg/dL (Normal: 0.74-1.35 mg/dL)
Current Lab Results (04/21/25 0700): Potassium: 6.5 mmol/L (Normal: 3.5-5.0 mmol/L) Calcium: 6.9 mg/dL (Normal: 8.5-10.2 mg/dL) Uric Acid: 9.6 mg/dL (Normal: 3.5-7.2 mg/dL) Creatinine: 2.6 mg/dL (Normal: 0.74-1.35 mg/dL)
How should the nurse interpret these findings?
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The client is improving because uric acid is below 10 mg/dL, which suggests treatment is taking effect.
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The client is stable because there have been no significant changes in calcium levels.
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The client is improving because potassium has only decreased slightly from the initial value.
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The client is deteriorating because potassium and uric acid levels remain elevated, and creatinine has worsened.
Explanation
Correct Answer: D. The client is deteriorating because potassium and uric acid levels remain elevated, and creatinine has worsened.
Despite 24 hours of treatment, potassium remains critically elevated at 6.5 mmol/L, uric acid remains above normal at 9.6 mg/dL, and creatinine has worsened from 2.3 to 2.6 mg/dL indicating progressive renal deterioration. The persistent symptoms of nausea, fatigue, and new muscle twitching further confirm clinical deterioration consistent with worsening tumor lysis syndrome.
Why Other Options are Incorrect:
A. Although uric acid is below 10 mg/dL, it remains above the normal range and has not improved with treatment, so this does not indicate the treatment is taking effect.
B. Calcium has not significantly changed but remains below normal (hypocalcemia), which is dangerous and not a sign of stability.
C. Potassium has not decreased at all; it remains critically elevated at 6.5 mmol/L, which is not a sign of improvement.
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Response
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Preparedness
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Mitigation
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Recovery
Explanation
Correct Answer: (A) Response
The Response phase of the disaster cycle occurs immediately after a disaster event and involves direct actions taken to address the immediate effects of the disaster. Triaging clients, managing limited resources, and providing emergency care are all hallmark activities of the Response phase, as healthcare workers are actively addressing the acute needs of victims during and immediately following the disaster.
Why Other Options are Incorrect:
B. Preparedness — The Preparedness phase occurs before a disaster and involves planning, training, stockpiling supplies, and conducting drills to ensure readiness. The nurse in this scenario is responding to an active event, not preparing for a future one.
C. Mitigation — The Mitigation phase involves actions taken to reduce or eliminate the long-term risk and impact of disasters before they occur, such as building flood barriers or reinforcing infrastructure. This phase happens prior to the disaster, not during active emergency care.
D. Recovery — The Recovery phase begins after the immediate threat has passed and focuses on restoring the community and healthcare systems to normal functioning. Since the nurse is actively triaging incoming clients amid an ongoing emergency, this is not yet the recovery phase.
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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.
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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.
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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
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.
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Apply a cool compress to the bite site
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Incise and drain the wound immediately
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Encourage vigorous exercise of the affected area
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Administer antibiotics prophylactically
Explanation
Correct Answer: (D) Administer antibiotics prophylactically
Bite wounds, whether from humans or animals, carry a high risk of polymicrobial infection due to the bacteria present in saliva. Prophylactic antibiotics are a standard component of bite wound management to prevent the development of serious soft tissue infections, cellulitis, and in severe cases, sepsis. Amoxicillin-clavulanate is commonly prescribed as the first-line prophylactic antibiotic for bite injuries.
Why Other Options are Incorrect:
A. Apply a cool compress to the bite site — While cool compresses may reduce swelling, they do not address the infection risk associated with bite wounds and are not the priority management action.
B. Incise and drain the wound immediately — Incision and drainage is reserved for established abscesses. Fresh bite wounds should be irrigated and cleaned, not incised, as this can introduce further contamination.
C. Encourage vigorous exercise of the affected area — Vigorous exercise of a bite wound site would increase blood flow and inflammation, potentially spreading infection and delaying healing. Rest and wound care are recommended instead.
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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.
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