Title RECALLS 7 - NP3 - SC ✅

30. When caring for a client with a chest tube and water-seal drainage system, the nurse should implement which of the following interventions? A. Verify that the air vent on the water-seal drainage system is capped when the suction is off. B. Milk the chest drainage tube at least every four hours if excessive bleeding occurs. C. Ensure that chest tube is clamped when moving the client out of bed. D. Make sure that the drainage apparatus is always below the client's chest level. 31. The nurse reviews the most recent blood gas results of a client diagnosed with asthma. The nurse notes a pH of 7.43, Pco2 of 31 mm Hg, and HCO3 of 21 mEq/L. Based on these results, the nurse determines that which acid-base imbalance is present? A. Compensated metabolic acidosis B. Compensated respiratory alkalosis C. Uncompensated respiratory acidosis D. Uncompensated metabolic alkalosis 32. The nurse is performing a respiratory assessment on a client being treated for an asthma attack. The nurse determines that the client's respiratory status is worsening based upon which finding? A. Loud wheezing B. Wheezing on expiration C. Noticeably diminished breath sounds D. Increased displays of emotional apprehension Situation: Nurse Leah is a compassionate and skilled nurse working in a busy medical ward specializing in gastrointestinal (GI) diseases. Today, she is caring for a 28-year-old patient admitted with severe abdominal pain, chronic diarrhea, and weight loss. After diagnostic tests, the patient is diagnosed with Crohn’s disease. 33. Nurse Leah is assessing a patient with suspected Crohn’s disease. Which finding is most characteristic of Crohn’s disease? A. Continuous inflammation limited to the mucosal layer of the colon. B. Bloody diarrhea with tenesmus. C. Cobblestone appearance of the bowel with skip lesions. D. Pseudopolyps observed during colonoscopy. 34. A patient asks Leah how Crohn’s disease differs from ulcerative colitis. Which response by the nurse is most accurate? A. “Crohn’s disease only affects the colon, while ulcerative colitis affects the entire GI tract.” B. “Crohn’s disease causes continuous inflammation, while ulcerative colitis causes skip lesions.” C. “Crohn’s disease can affect any part of the GI tract, while ulcerative colitis is limited to the colon.” D. “Crohn’s disease is caused by stress, while ulcerative colitis is caused by diet.” 35. Leah is caring for a patient with Crohn’s disease who is refusing to take prescribed oral medications due to severe nausea. The patient states, “I can’t keep anything down, and I don’t want to take those pills.” Despite the patient’s refusal, Leah administers the medication by crushing it and mixing it into the patient’s applesauce without their knowledge. Which legal or ethical principle has Leah most likely violated? A. Negligence B. Malpractice C. Battery D. Breach of confidentiality Situation: Clients suffering from Peptic Ulcer Disease (PUD). 36. Nurse Stephen is assessing a client diagnosed with Peptic Ulcer Disease (PUD). Which physical examination should the nurse implement first? A. Palpate the abdominal area for tenderness B. Auscultate the client's bowel sounds in all four quadrants C. Assess the tender area progressing to nontender D. Percuss the abdominal borders to identify organs 37. Nurse Pamela is assessing a client suspected of having a gastric ulcer. Which of the following assessment findings supports the diagnosis of a gastric ulcer? A. Sharp pain in the upper abdomen after eating a heavy meal B. Complaints of epigastric pain 30 to 60 minutes after ingesting food C. Presence of blood in the client's stool for the past month D. Reports of a burning sensation moving like a wave 38. The nurse is caring for a client who admits to a 15-year history of gastric ulcers. The nurse instructs this client to take which of the following drugs for minor aches and pains? A. Acetaminophen (Tylenol) B. Buffered aspirin C. Plain aspirin D. Ibuprofen (Motrin) 39. One of your patients was diagnosed with PUD, however, she was also found to be pregnant. Which of the following will alarm you if prescribed to the patient? A. Cimetidine B. Misoprostol C. Omeprazole D. None of the above 40. The nurse is caring for a client with a diagnosis of peptic ulcer disease. When monitoring the client for possible gastrointestinal perforation, the nurse identifies the importance of what assessment data? A. Slow, strong pulses B. Increase in bowel sounds C. Positive guaiac stool tests D. Sudden, severe abdominal pain Situation: Incident reports serve as official records of unexpected events. They can be used as legal evidence in case of disputes, complaints, or investigations. 41. The nurse administers digoxin 0.25 mg by mouth rather than the prescribed dose of 0.125 mg to the client. After assessing the client and notifying the primary health care provider (PHCP), which action would the nurse implement first? A. Write an incident report. B. Administer digoxin immune fab. C. Tell the client about the medication error. D. Tell the client about the adverse effects of digoxin. 42. The nurse finds a client lying on the floor. The nurse performs an assessment, assists the client back to bed, and completes an incident report. Which would the nurse document on the incident report? A. The client fell onto the floor. B. The client climbed over the side rails. C. The client was found lying on the floor. D. The nurse was the only responder to the event. 43. After finding a client lying on the floor, the nurse ensures the client's safety, completes an incident report, and notifies the primary health care provider of the incident. Which action would the nurse implement next? A. Staple the incident report in the client's medical record. B. Document the client events and follow-up nursing actions. C. Provide a copy of the incident report to the provider and family. D. Document that a copy of the report was sent to risk management. Situation: Effective teamwork and collaboration in nursing is achieved when individuals work together in harmony, processes and goals are aligned towards achieving safe quality patient care. 44. Which of the following actions is INAPPROPRIATE for a nurse leader to apply in a work Setting? A. Ask staff members for their opinion on the matter. B. Modifies his own behavior favoring the needs of individual staff. C. Gives equal consideration to each staff members. D. Plans and organizes group activities of staff members. 3 | Page