Title 3. FC FUNDA (Mr. Gasmin) - SC ✅

2 | Page D. Place the thumb over the groove along the thumb side of the patient’s wrist. 15. The nurse is assessing the patient’s respirations. Which action by the nurse is most appropriate? A. Inform the patient that she is counting respirations. B. Do not touch the patient until completed. C. Obtain without the patient knowing. D. Estimate respirations. 16. The patient’s blood pressure is 140/60. Which value will the nurse record for the pulse pressure? A. 60 B. 80 C. 140 D. 200 17.The nurse reviews the laboratory results for a patient and determines the viscosity of the blood is thick. Which laboratory result did the nurse check? A. Arterial blood gas B. Blood culture C. Hematocrit D. Potassium19. 20. 21. 18. The patient is being admitted to the emergency department with reports of shortness of breath. The patient has had chronic lung disease for many years but still smokes. What will the nurse do? A. Allow the patient to breathe into a paper bag. B. Use oxygen cautiously in this patient. C. Administer high levels of oxygen. D. Give CO2 via mask. 19. The patient was found unresponsive in an apartment and is being brought to the emergency department. The patient has arm, hand, and leg edema, temperature is 95.6F, and hands are cold secondary to a history of peripheral vascular disease. It is reported that the patient has a latex allergy. What should the nurse do to quickly measure the patient’s oxygen saturation? A. Attach a finger probe to the patient’s index finger. B. Place a non-adhesive sensor on the patient’s earlobe. C. Attach a disposable adhesive sensor to the bridge of the patient’s nose. D. Place the sensor on the same arm that the electronic blood pressure cuff is on. 20. The patient is admitted with shortness of breath and chest discomfort. Which laboratory value could account for the patient’s symptoms? A. Red blood cell count of 5.0 million/mm3 B. Hemoglobin level of 8.0 g/100 mL C. Hematocrit level of 45% D. Pulse oximetry of 95% 21. A nurse reviews blood pressures of several patients. Which finding will the nurse report as prehypertension? A. 98/50 in a 7-year-old child B. 115/70 in an infant C. 120/80 in a middle-aged adult D. 146/90 in an older adult 22. A nurse is caring for a patient who smokes and drinks caffeine. Which point is important for the nurse to understand before assessing the patient’s blood pressure (BP)? A. Smoking increases BP for up to 3 hours. B. Caffeine increases BP for up to 15 minutes. C. Smoking result in vasoconstriction, falsely elevating BP. D. Caffeine intake should not have occurred 30 to 40 minutes before BP measurement. 23. When taking the pulse of an infant, the nurse notices that the rate is 145 beats/min and the rhythm is regular. How should the nurse interpret this finding? A. This is normal for an infant. B. This is too fast for an infant. C. This is too slow for an infant. D. This is not a rate for an infant but for a toddler. 24. The nurse is caring for an older-adult patient and notes that the temperature is 96.8F (36C). How will the nurse interpret this finding? A. The patient has hyperthermia. B. The patient has a normal temperature. C. The patient is suffering from hypothermia. D. The patient is demonstrating increased metabolism. 25. The nurse is caring for a patient who is being discharged from the hospital after being treated for hypertension. The patient is instructed to take blood pressure 3 times a day and to keep a record of the readings. The nurse recommends that the patient purchase a portable electronic blood pressure device. Which other information will the nurse share with the patient? A. You can apply the cuff in any manner. B. You will need to recalibrate the machine. C. You can move your arm during the reading. D. You will need to use a stethoscope properly. 26. A nurse is preparing to administer an injection to a patient. Which statement made by the patient is an indication for the nurse to use the Z-track method? A. ―I am allergic to many medications. B. ―I’m really afraid that a big needle will hurt. C. ―The last shot really irritated my skin around the site. D. ―My legs are too obese for the needle to go through. 27. A 2-year-old child is ordered to have eardrops daily. Which action will the nurse take? A. Pull the auricle down and back to straighten the ear canal. B. Pull the auricle upward and outward to straighten the ear canal. C. Sit the child up for 2 to 3 minutes after instilling drops in ear canal. D. Sit the child up to insert the cotton ball into the innermost ear canal. 28. A patient has an order to receive 12.5 mg of hydrochlorothiazide. The nurse has on hand a 25 mg tablet of hydrochlorothiazide. How many tablet(s) will the nurse administer? A. 1/2 tablet B. 1 tablet C. 1 1/2 tablets D. 2 tablets 29. A health care provider orders lorazepam 1 mg orally 2 times a day. The dose available is 0.5 mg per tablet. How many tablet(s) will the nurse administer for each dose? A. 1 B. 2 C. 3 D. 4 30. The nurse is preparing to administer an injection into the deltoid muscle of an adult patient weighing approximately 160 lb. Which needle size and length will the nurse choose? A. 18 gauge 1 1/2 inch B. 23 gauge 1/2 inch C. 25 gauge 1 inch D. 27 gauge 5/8 inch 31. A registered nurse interprets that a scribbled medication prescription reads 25 mg. The nurse administers 25 mg of the medication to a patient and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who is ultimately responsible for the error? A. Health care provider B. Pharmacist C. Hospital D. Nurse 32.A prescription is written for phenytoin 500 mg IM q3-4h prn for pain. The nurse recognizes that treatment of pain is not a standard therapeutic indication for this drug. The nurse believes that the health care provider meant to write hydromorphone. What action should the nurse take? A. Call the health care provider to clarify the order. B. Give the patient hydromorphone, as it was meant to be written. C. Administer the medication and monitor the patient frequently. D. Refuse to give the medication and notify the nurse supervisor. 33. A nurse teaches the patient about the prescribed buccal medication. Which statement by the patient indicates teaching by the nurse is successful? A. ―I should let the medication dissolve completely. B. ―I will place the medication in the same location. C. ―I can only drink water, not juice, with this medication.
3 | Page D. ―I better chew my medication first for faster distribution. 34. What is the nurse’s priority action to protect a patient from medication error? A. Reading medication labels at least 3 times before administering B. Administering as many of the medications as possible at one time C. Asking anxious family members to leave the room before giving a medication D. Checking the patient’s room number against the medication administration record 35. A patient refuses medication. Which is the nurse’s first action? A. Educate the patient about the importance of the medication. B. Discreetly hide the medication in the patient’s favorite gelatin. C. Agree with the patient’s decision and document it in the chart. D. Explore with the patient reasons for not wanting to take the medication. 36. A nurse is performing the three accuracy checks before administering an oral liquid medication to a patient. When will the nurse perform the second accuracy check? A. At the patient’s bedside B. Before going to the patient’s room C. When checking the medication order D. When selecting medication from the unit-dose drawer 37. The nurse is caring for two patients with the same last name. In this situation which right of medication administration is the priority to reduce the chance of an error? A. Right medication B. Right patient C. Right dose D. Right route 38. A patient prefers not to take the daily allergy pill this morning because it causes drowsiness throughout the day. Which response by the nurse is best? A. ―The physician ordered it; therefore, you must take your medication every morning at the same time whether you’re drowsy or not. B. ―Let’s see if we can change the time you take your pill to 9 PM, so the drowsiness occurs when you would normally be sleeping. C. ―You can skip this medication on days when you need to be awake and alert. D. ―Try to get as much done as you can before you take your pill, so you can sleep in the afternoon. 39. A nurse is preparing to administer a medication from a vial. In which order will the nurse perform the steps, starting with the first step? 1. Invert the vial. 2. Fill the syringe with medication. 3. Inject air into the airspace of the vial. 4. Clean with alcohol swab and allow to dry. 5. Pull back on the plunger the amount to be drawn up. 6. Tap the side of the syringe barrel to remove air bubbles. A. 4, 1, 5, 3, 6, 2 B. 1, 4, 5, 3, 2, 6 C. 4, 5, 3, 1, 2, 6 D. 1, 4, 5, 3, 6, 2 40. A nurse is preparing to administer an antibiotic medication at 1000 to a patient but gets busy in another room. When should the nurse give the antibiotic medication? A. By 1030 B. By 1100 C. By 1130 D. By 1200 41. The nurse is teaching about the process of exchanging gases through the alveolar capillary membrane. Which term will the nurse use to describe this process? A. Ventilation B. Surfactant C. Perfusion D. Diffusion 42. A nurse is caring for a patient who was in a motor vehicle accident that resulted in cervical trauma to C4. Which assessment is the priority? A. Pulse B. Respirations C. Temperature D. Blood pressure 43. The nurse suspects the patient has increased cardiac afterload. Which piece of equipment should the nurse obtain to determine the presence of this condition? A. Pulse oximeter B. Oxygen cannula C. Blood pressure cuff D. Yankauer suction tip catheter 44. A nurse is preparing to suction a patient. The pulse is 65 and pulse oximetry is 94%. Which finding will cause the nurse to stop suctioning? A. Pulse 75 B. Pulse 80 C. Oxygen saturation 91% D. Oxygen saturation 88% 45. A nurse is caring for a patient diagnosed with chronic obstructive pulmonary disease (COPD) who is receiving 2 L/min of oxygen. Which oxygen delivery device is most appropriate for the nurse to administer the oxygen? A. Nasal cannula B. Simple face mask C. Non-rebreather mask D. Partial non-rebreather mask 46.A patient is experiencing dehydration. While planning care, the nurse considers that the majority of the patient’s total water volume exists in with compartment? A. Intracellular B. Extracellular C. Intravascular D. Transcellular 47. The nurse is teaching about the process of passively moving water from an area of lower particle concentration to an area of higher particle concentration. Which process is the nurse describing? A. Osmosis B. Filtration C. Diffusion D. Active transport 48. The nurse administers an intravenous (IV) hypertonic solution to a patient expects the fluid shift to occur in what direction? A. From intracellular to extracellular B. From extracellular to intracellular C. From intravascular to intracellular D. From intravascular to interstitial 49. A nurse is preparing to start peripheral intravenous (IV) therapy. In which order will the nurse perform the steps starting with the first one? 1. Clean site. 2. Select vein. 3. Apply tourniquet. 4. Release tourniquet. 5. Reapply tourniquet. 6. Advance and secure. 7. Insert vascular access device. A. 1, 3, 2, 7, 5, 4, 6 B. 1, 3, 2, 5, 7, 6, 4 C. 3, 2, 1, 5, 7, 6, 4 D. 3, 2, 4, 1, 5, 7, 6 50. The nurse is laboratory blood results will expect to observe which cation in the most abundance? A. Sodium B. Chloride C. Potassium D. Magnesium 51. The nurse receives the patient’s most recent blood work results. Which laboratory value is of greatest concern? A. Sodium of 145 mEq/L B. Calcium of 15.5 mg/dL C. Potassium of 3.5 mEq/L D. Chloride of 100 mEq/L 52. Four patients arrive at the emergency department at the same time. Which patient will the nurse see first? A. An infant with temperature of 102.2F and diarrhea for 3 days
4 | Page B. A teenager with a sprained ankle and excessive edema C. A middle-aged adult with abdominal pain who is moaning and holding her stomach D. An older adult with nausea and vomiting for 3 days with blood pressure 112/60 53. The patient has an intravenous (IV) line and the nurse needs to remove the gown. In which order will the nurse perform the steps, starting with the first one? 1. Remove the sleeve of the gown from the arm without the IV. 2. Remove the sleeve of the gown from the arm with the IV. 3. Remove the IV solution container from its stand. 4. Pass the IV bag and tubing through the sleeve. A. 1, 2, 3, 4 B. 2, 3, 4, 1 C. 3, 4, 1, 2 D. 4, 1, 2, 3 54. The health care provider has ordered a hypotonic intravenous (IV) solution to be administered. Which IV bag will the nurse prepare? A. 0.45% sodium chloride (1/2 NS) B. 0.9% sodium chloride (NS) C. Lactated Ringer’s (LR) D. Dextrose 5% in Lactated Ringer’s (D5LR) 55. A patient presents to the emergency department with reports of vomiting and diarrhea for the past 48 hours. The health care provider orders isotonic intravenous (IV) therapy. Which IV will the nurse prepare? A. 0.225% sodium chloride (1/4 NS) B. 0.45% sodium chloride (1/2 NS) C. 0.9% sodium chloride (NS) D. 3% sodium chloride (3% NaCl) 56. A nurse administering a diuretic to a patient is teaching about foods to increase in the diet. Which food choices by the patient will best indicate successful teaching? A. Milk and cheese B. Potatoes and fresh fruit C. Canned soups and vegetables D. Whole grains and dark green leafy vegetables 57.The nurse is evaluating the effectiveness of the intravenous fluid therapy in a patient with hypernatremia. Which finding indicates goal achievement? A. Urine output increases to 150 mL/hr. B. Systolic and diastolic blood pressure decreases. C. Serum sodium concentration returns to normal. D. Large amounts of emesis and diarrhea decrease. 58. The nurse is calculating intake and output on a patient. The patient drinks 150 mL of orange juice at breakfast, voids 125 mL after breakfast, vomits 250 mL of greenish fluid, sucks on 60 mL of ice chips, and for lunch consumes 75 mL of chicken broth. Which totals for intake and output will the nurse document in the patient’s medical record? A. Intake 255; output 375 B. Intake 285; output 375 C. Intake 505; output 125 D. Intake 535; output 125 59.A patient is to receive 1000 mL of 0.9% sodium chloride intravenously at a rate of 125 mL/hr. The nurse is using microdrip gravity drip tubing. Which rate will the nurse calculate for the minute flow rate (drops/min)? A. 12 drops/min B. 24 drops/min C. 125 drops/min D. 150 drops/min 60. A nurse begins infusing a 250-mL bag of IV fluid at 1845 on Monday and programs the pump to infuse at 50 mL/hr. At what time should the infusion be completed? A. 2300 Monday B. 2345 Monday C. 0015 Tuesday D. 0045 Tuesday 61.A patient describes practicing a complementary and alternative therapy involving breathwork and yoga. The nurse also recommends using energy field therapies. Which techniques did the nurse suggest? A. Prayer and tai chi B. The ―zone and acupressure C. Massage therapy and ayurveda D. Reiki therapy and therapeutic touch 62. A teen diagnosed with an anxiety disorder is referred for biofeedback training because the parents do not want their child to take anxiolytics. Which statement from the teen indicates successful learning? A. ―Biofeedback will help me with my thoughts and physiological responses to stress. B. ―Biofeedback will direct my energies in an intentional way when stressed. C. ―Biofeedback will allow me to manipulate my stressed-out joints. D. ―Biofeedback will let me assess and redirect my energy fields 63. An older-adult patient is newly admitted to a skilled nursing facility. Medications brought on admission included lisinopril, hydrochlorothiazide, warfarin, low-dose aspirin, Ginkgo biloba, and echinacea. Which potential interaction will cause the nurse to notify the patient’s health care provider? A. Echinacea and warfarin B. Lisinopril and echinacea C. Warfarin and G. biloba D. Lisinopril and hydrochlorothiazide 64.A patient asks the nurse for a nonmedical approach for excessive worry and work stress. Which therapy should the nurse recommend? A. Meditation B. Acupuncture C. Ayurvedic herbs D. Chiropractic care 65. A patient asks about the new clinic in town that is staffed by allopathic and complementary practitioners. Which term would best describe this type of clinic? A. Ayurvedic B. Homeopathic C. Integrative medical D. Naturopathic medical 66. A patient is proficient at meditation from long-time use of the technique. Which finding in the medication history will cause the nurse to follow up? A. Thyroid-regulating medication B. Corticosteroid medication C. Loop diuretic medication D. Anticoagulant medication 67.A patient is taking an antidepressant medication. The nurse discovers that the patient uses herbs. Which herb will cause the nurse to intervene? A. Aloe B. Garlic C. Chamomile 68.A nurse is teaching a patient about the use of biofeedback. Which goal should the nurse add to the care plan? A. Opens emotional channels. B. Uses music to calm the mind. C. Holds various postures with breathing. D. Controls autonomic physiological functions. 69. Which medical diagnosis will cause the nurse to question an order for acupuncture? A. Acquired immunodeficiency syndrome (AIDS) B. Osteoarthritis C. Low back pain D. Migraine headaches 70.When caring for an older-adult patient, which technique will the nurse use to enhance an older-adult patient’s self-concept? A. Discussing current weather B. Encouraging patients to sing C. Reviewing old photos with patients D. Allowing patients extra computer time 71. A nurse encounters a family who experienced the death of their adult child last year. The parents are talking about the upcoming anniversary of their child’s death. The nurse spends time with them discussing their child’s life and death. Which nursing principle does the nurse’s action best demonstrate? A. Facilitation of normal mourning B. Pain-management technique C. Grief evaluation D. Palliative care 72.A patient diagnosed with terminal cancer asks the nurse what the criteria are for hospice care. Which information should the nurse share with the patient?