A patient is diagnosed with diabetic ketoacidosis. The nurse would expect the physician to prescribe:
A. Regular insulin IV
B. NPH insulin SC
C. Glucagon IM
D. Mixed insulin SC
A newborn infant is assessed using the Apgar assessment tool and scores 6. The infant has a heart rate of 95, slow and irregular respiratory effort, and some flexion of extremities. The infant is pink, but has a weak cry. The nurse should know that this Apgar score along with the additional symptoms indicates the neonate is:
A. Functioning normally
B. Needing immediate life-sustaining measures
C. Needing special assistance
D. Needing to be warmed
Which of the following tasks requires specialized education and should be performed by the nurse only after the training has been completed?
A. Administering a dose of promethazine (Phenergan) via intravenous push (IVP)
B. Applying a transdermal fentanyl (Duragesic)
C. Instilling tobramycin (Tobrex) ophthalmic solution
D. Beginning an intravenous infusion of cyclophosphamide (Cytoxan)
An elderly patient is admitted to the hospital with swollen ankles. The best way to limit edema of the feet is for the nurse to:
A. Restrict fluids
B. Apply bandages
C. Elevate the legs
D. Do passive range of motion exercises (ROM)
The apical pulse can be best auscultated at the:
A. Left 2nd intercostal space lateral to the mid clavicular line
B. Left 2nd intercostal space at the left sternal border
C. Left 5th intercostal space at the mid clavicular line
D. Left 5th intercostal space at the mid axillary line
The nurse is preparing teaching plans for several patients. The nurse should recognize which of the following patients is at greatest risk for fluid and electrolyte imbalance?
A. A 2-year-old patient who is receiving gastrostomy feedings
B. A 20-year-old patient with a sigmoid colostomy
C. A 40-year-old patient who is 3 days post-operative with an ileostomy
D. A 60-year-old patient who is 8 hours post-renal arteriography
The patient with liver cirrhosis receives 100 ml of 25% serum albumin intravenously. Which of the following findings would best indicate that the albumin is having its desired effect?
A. Decreased blood pressure
B. Increased serum albumin level
C. Increased urine output
D. Improved breathing pattern
The police bring a prisoner into the emergency department who is in severe pain. When the nurse is assigned to this patient, the nurse should:
A. Ignore the prisoner because he deserves to be in pain
B. Give the prisoner the minimum amount of pain medication ordered
C. Tell the prisoner to be quiet, as he is disturbing the other patients
D. Implement nursing interventions to relieve the prisoner's pain
Which of the following actions is the most appropriate when the nurse is responding to a patient during a tonic-clonic seizure?
A. Restrain the patient
B. Protect the patient from harm
C. Minimize noise and light stimulus
D. Apply oxygen by mask or nasal cannula
The patient did not sleep well last night and is anxious about having a bronchoscopy later this morning. The priority nursing intervention would be to:
A. Reassure and encourage expression of feelings
B. Administer the premedication a little earlier
C. Keep the patient occupied until the procedure
D. Explain the purpose of the bronchoscopy
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