After undergoing a cardiac catheterization, Tracy has a large puddle of blood under his buttocks. Which of the following steps should the nurse take first? A. Call for help. B. Obtain vital signs. C. Ask the client to “lift up”. D. Apply gloves and assess the groin site. … Read More »
The nurse is monitoring a client following a lung resection. The hourly output from the chest tube was 300mL. The nurse should give priority to: A. Turning the client to the left side B. Milking the tube to ensure patency C. Slowing the intravenous infusion D. Notifying the physician … Read More »
Which of the following blood tests is most indicative of cardiac damage? A. Lactate dehydrogenase B. Complete blood count C. Troponin I D. Creatine kinase Correct Answer: C. Troponin I Troponin I levels rise rapidly and are detectable within 1 hour of myocardial injury. Troponin I levels aren’t detectable… Read More »
The nurse prepares the client for the insertion of a pulmonary artery catheter (Swan-Ganz catheter). The nurse teaches the client that the catheter will be inserted to provide information about: A. Stroke volume B. Cardiac output C. Venous pressure D. Left ventricular functioning Correct Answer: D. Left… Read More »
A nurse is evaluating a postoperative patient and notes a moderate amount of serous drainage on the dressing 24 hours after surgery. Which of the following is the appropriate nursing action? A. Notify the surgeon about evidence of infection immediately. B. Leave the dressing intact to avoid disturbing the wound site. C.… Read More »
A patient returns to the emergency department less than 24 hours after having a fiberglass cast applied for a fractured right radius. Which of the following patient complaints would cause the nurse to be concerned about impaired perfusion to the limb? A. Severe itching under the cast. B. Severe pain in the right… Read More »
Nurse Bea should instruct the male client with an ileostomy to report immediately which of the following symptoms? A. Absence of drainage from the ileostomy for 6 or more hours B. Passage of liquid stool in the stoma C. Occasional presence of undigested food D. A temperature of 37.6 °C … Read More »
Nurse Lynette is preparing a site for the insertion of an I.V. catheter. The nurse should treat excess hair at the site by: A. Leaving the hair intact B. Shaving the area C. Clipping the hair in the area D. Removing the hair with a depilatory Correct… Read More »
Nurse Nikki knows that laboratory results supports the diagnosis of systemic lupus erythematosus (SLE) is: A. Elevated serum complement level B. Thrombocytosis, elevated sedimentation rate C. Pancytopenia, elevated antinuclear antibody (ANA) titer D. Leukocytosis, elevated blood urea nitrogen (BUN) and creatinine levels Correct Answer: C. Pancytopenia, elevated… Read More »
After a liver biopsy, place the patient in which of the following positions? A. Left side-lying, with the bed flat B. Right side-lying, with the bed flat C. Left side-lying, with the bed in semi-Fowler’s position D. Right side-lying, with the bed in semi-Fowler’s position Correct Answer:… Read More »