NP3 Flashcards

1
Q

What should the nurse do first when a hospitalized client tells the nurse about feeling a strong shock when turning on an electric dryer?

  • Assess apical pulse
  • Disconnect the hairdryer from electrical outlet
A

Disconnect the hairdryer from electrical outlet

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2
Q

The client was ordered to have cimetidine IV. The client’s family asks why this drug is being given, what is the nurse’s best response?

  • To stimulate intestinal movement and prevent abdominal bloating
  • To decrease hydrochloric acid production in the stomach and prevent ulcers.
A

To decrease hydrochloric acid production in the stomach and prevent ulcers.

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3
Q

The nurse is caring for a toddler with 2nd degree burn and 3rd degree burns over 20% of the body 8 hours post injury. The most critical nursing diagnosis for this patient is?

  • Risk for infection
  • Deficient fluid volume
A

Deficient fluid volume

(Main problem before the risk diagnosis)

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4
Q

A nurse is assessing a 16 yr old adolescent in an emergency department who has been admitted because of burns over 25% of the client’s body. Upon initial examination, the nurse makes several observations. Which observation should be most concerning to the nurse?

  • Areas on upper extremities are mottled
  • Areas on lower extremities are waxy
  • Areas on upper extremities are moist and red
A

Areas on lower extremities are waxy

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5
Q

A client is brought to the emergency department after a severe burn caused by a fire at home. The burns are extensive, covering greater than 25% of the total body surface area. When the nurse reviews the laboratory results drawn on the client which value should the nurse most likely to expect to note?

  • Hct 65%
  • Albumin 4.5g/dL
  • Na 145 mEq/L
  • WBC 7000 cells/mm3
A

Hct 65%

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6
Q

Prioritize which client should you attend first

1: Unresponsive with penetrating head injury

2: A client with sucking chest wound

3: A client with third-degree burns over 65% of the body surface area

4: A client with a maxilla fracture and a facial wounds without airway compromise.

A

A client with third-degree burns over 65% of the body surface area

Unresponsive
Partially unresponsive
Without airway compromise

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7
Q

Which medication should a nurse apply topically in a client with second and third degree burns to treat bacterial and yeast infections?

  • Gold sodium thiomalate
  • Bismuth subsalicylate
  • Silver sulfadiazine
  • Arsenic trioxide
A

Silver sulfadiazine

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8
Q

Identify the extent of the patient’s injury:

  • Upper half arm
  • Anterior torso
  • Lower half of both arms
    anterior of the head
  • Upper half of the posteriro torso
A

31.5%

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9
Q

What is the flow rate during the First 8hrs ml/Hr based on the total you calculated?

  • front and back of the right and left leg
  • front of the right arm
  • Anterior trunk
  • Patient weight: 63 kg
A

921 ml/hr

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10
Q

Health counseling of patient with hiatal hernia. Which info should you include?

  • Restrict high carbohydrate foods
  • Eat 3 regualr meals a day
  • Increase fiber intake
  • Increase fat intake
A

Increase fiber intake

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11
Q

After Billroth II surgery, a client experiences weakness, diaphoresis, anxiety, and palpitations 2 hours after a high carbohydrate meal. The nurse would interpret that these symptoms indicate the development of?

  • Duodenal reflux
  • Gerd
  • Post prandial hypoglycemia
A

Post prandial hypoglycemia

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12
Q

The serum ammonia level of a patient with cirrhosis is elevated. As a priority, a nurse should plan to:

  • Observe for increasing confusion
  • Measure the urine specific gravity
  • Restrict the client’s oral fluid intake
  • monitoring of temperature q4
A

Observe for increasing confusion

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13
Q

Caring a client with Sengstaken Blakemore Tube, what should the nurse anticipate to have at the client’s bedside?

A

Scissor

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14
Q

A nurse suspects acute pancreatitis when a client reports?

A

A sudden onset of pain in the upper left abdominal quadrant that radiates to the back

Anatomy

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15
Q

A client was recovering from acute pancreatitis ask when he can able to eat again?

A

When the pain is controlled and serum lipase level has decreased

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16
Q

Pancreatitis pain control includes the…

A

Pancreatic enzymes and H2 Blocker medications

17
Q

A nurse is assessing a client diagnosed with acute diverticulitis. Which finding should make the nurse suspect that the client has an intestinal perforation

A

Absent bowel sounds