NR667 Chamberlain CEA Week 8 Exit
Exam Study Guide: Nursing Practice
Questions & Answers
EXAM
1. A nurse performing a change-of-shift assessment. Which of the
following clients has the priority finding?
a) Type 2 DM and a blood glucose of 250 mg/dL
b) Pneumonia with a productive cough and a fever of 38.8° C (101.8° F)
c) 2 hr. post cast placement and has 2+ pitting edema and pallor
d) First-degree heart block and a heart rate of 62/min
Answer: c) 2 hr. post cast placement and has 2+ pitting edema and
pallor
Rationale: 2+ pitting edema and pallor in a limb with a new cast are signs
of compartment syndrome, a limb-threatening emergency caused by
increased pressure within the muscle compartment. This requires immediate
intervention to prevent permanent neurovascular damage. The other
findings are abnormal but not immediately life- or limb-threatening .
2. A nurse is caring for a client who has pneumonia and tells the
nurse, "I feel like an elephant is sitting on my chest." The client is
weak and unable to walk. After the nurse initiates chest pain
protocol, which of the following is the priority diagnostic test?
, a) PT and INR
b) 12-lead ECG
c) Chest X-ray
d) Serum potassium
Answer: b) 12-lead ECG
Rationale: The description of "elephant sitting on my chest" is classic
for angina or myocardial infarction. The priority diagnostic test is a 12-
lead ECG to evaluate for ST-segment changes indicating ischemia or
infarction. This must be obtained within 10 minutes of presentation per ACS
protocols .
3. A nurse is receiving change of shift report for four clients. Which
of the following clients should the nurse assess first?
a) DM and HbA1c of 5.2%
b) Leukemia and platelet level of 95,000/mm³
c) Received IV Lasix and K of 3.6 mEq/L
d) Hepatitis B and total bilirubin of 1.2 mg/dL
Answer: b) Leukemia and platelet level of 95,000/mm³
Rationale: A platelet count of 95,000/mm³ indicates thrombocytopenia,
placing the client at significant risk for bleeding. This requires priority
assessment for signs of bleeding such as petechiae, ecchymosis, or altered
mental status from potential intracranial hemorrhage. The other findings are
within acceptable ranges or expected post-treatment .
,4. A 65-year-old woman presents for a follow-up examination. She is
a smoker, and her hypertension is now adequately controlled. Her
mother died at age 40 from a heart attack. Fasting lipid profile
shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In
addition to starting therapeutic lifestyle changes, the nurse
practitioner should start the patient on:
a) A bile acid sequestrant
b) A statin drug
c) A cholesterol absorption inhibitor
d) Lifestyle modifications only
Answer: b) A statin drug
Rationale: This patient has multiple risk factors: active smoker, premature
coronary disease history (mother <65 for women), hypertension, and LDL far
above goal (>190 mg/dL). Statin therapy represents the most aggressive
and guideline-directed therapy for this high-risk patient. Bile acid
sequestrants and cholesterol absorption inhibitors may be useful adjuncts
but are not the primary first-line therapy in this scenario .
5. Which of the following end-organ sequelae is not directly caused
by uncontrolled hypertension?
a) Proteinuria
b) AV nicking
c) Peripheral neuropathy
d) Hemorrhagic stroke
Answer: c) Peripheral neuropathy
, Rationale: Peripheral neuropathy is not directly caused by hypertension
alone. While patients with hypertension frequently have peripheral
neuropathy, it is directly attributed to diabetes or other metabolic causes.
Proteinuria (renal damage), AV nicking (retinopathy), and hemorrhagic stroke
(vascular rupture) are all direct sequelae of uncontrolled hypertension .
💊 Pharmacology & Medication Safety
6. A nurse is caring for a client who is postoperative and has a new
prescription for hydromorphone. Which of the following actions
should the nurse take?
a) Document administration upon removal from the medication
dispensing system
b) Withhold the medication if the client does not appear to be in pain
c) Count the current number of unit doses available in the medication
dispensing system
d) Withhold the medication if the client has a fever
Answer: c) Count the current number of unit doses available in the
medication dispensing system
Rationale: For controlled substances like hydromorphone (Schedule II), a
count of the available unit doses must be performed with another nurse
before removing the medication to ensure accuracy and prevent diversion.
Documentation occurs after administration, and pain should be assessed
systematically rather than by appearance .
Exam Study Guide: Nursing Practice
Questions & Answers
EXAM
1. A nurse performing a change-of-shift assessment. Which of the
following clients has the priority finding?
a) Type 2 DM and a blood glucose of 250 mg/dL
b) Pneumonia with a productive cough and a fever of 38.8° C (101.8° F)
c) 2 hr. post cast placement and has 2+ pitting edema and pallor
d) First-degree heart block and a heart rate of 62/min
Answer: c) 2 hr. post cast placement and has 2+ pitting edema and
pallor
Rationale: 2+ pitting edema and pallor in a limb with a new cast are signs
of compartment syndrome, a limb-threatening emergency caused by
increased pressure within the muscle compartment. This requires immediate
intervention to prevent permanent neurovascular damage. The other
findings are abnormal but not immediately life- or limb-threatening .
2. A nurse is caring for a client who has pneumonia and tells the
nurse, "I feel like an elephant is sitting on my chest." The client is
weak and unable to walk. After the nurse initiates chest pain
protocol, which of the following is the priority diagnostic test?
, a) PT and INR
b) 12-lead ECG
c) Chest X-ray
d) Serum potassium
Answer: b) 12-lead ECG
Rationale: The description of "elephant sitting on my chest" is classic
for angina or myocardial infarction. The priority diagnostic test is a 12-
lead ECG to evaluate for ST-segment changes indicating ischemia or
infarction. This must be obtained within 10 minutes of presentation per ACS
protocols .
3. A nurse is receiving change of shift report for four clients. Which
of the following clients should the nurse assess first?
a) DM and HbA1c of 5.2%
b) Leukemia and platelet level of 95,000/mm³
c) Received IV Lasix and K of 3.6 mEq/L
d) Hepatitis B and total bilirubin of 1.2 mg/dL
Answer: b) Leukemia and platelet level of 95,000/mm³
Rationale: A platelet count of 95,000/mm³ indicates thrombocytopenia,
placing the client at significant risk for bleeding. This requires priority
assessment for signs of bleeding such as petechiae, ecchymosis, or altered
mental status from potential intracranial hemorrhage. The other findings are
within acceptable ranges or expected post-treatment .
,4. A 65-year-old woman presents for a follow-up examination. She is
a smoker, and her hypertension is now adequately controlled. Her
mother died at age 40 from a heart attack. Fasting lipid profile
shows cholesterol = 240 mg/dL, HDL = 30, and LDL = 200. In
addition to starting therapeutic lifestyle changes, the nurse
practitioner should start the patient on:
a) A bile acid sequestrant
b) A statin drug
c) A cholesterol absorption inhibitor
d) Lifestyle modifications only
Answer: b) A statin drug
Rationale: This patient has multiple risk factors: active smoker, premature
coronary disease history (mother <65 for women), hypertension, and LDL far
above goal (>190 mg/dL). Statin therapy represents the most aggressive
and guideline-directed therapy for this high-risk patient. Bile acid
sequestrants and cholesterol absorption inhibitors may be useful adjuncts
but are not the primary first-line therapy in this scenario .
5. Which of the following end-organ sequelae is not directly caused
by uncontrolled hypertension?
a) Proteinuria
b) AV nicking
c) Peripheral neuropathy
d) Hemorrhagic stroke
Answer: c) Peripheral neuropathy
, Rationale: Peripheral neuropathy is not directly caused by hypertension
alone. While patients with hypertension frequently have peripheral
neuropathy, it is directly attributed to diabetes or other metabolic causes.
Proteinuria (renal damage), AV nicking (retinopathy), and hemorrhagic stroke
(vascular rupture) are all direct sequelae of uncontrolled hypertension .
💊 Pharmacology & Medication Safety
6. A nurse is caring for a client who is postoperative and has a new
prescription for hydromorphone. Which of the following actions
should the nurse take?
a) Document administration upon removal from the medication
dispensing system
b) Withhold the medication if the client does not appear to be in pain
c) Count the current number of unit doses available in the medication
dispensing system
d) Withhold the medication if the client has a fever
Answer: c) Count the current number of unit doses available in the
medication dispensing system
Rationale: For controlled substances like hydromorphone (Schedule II), a
count of the available unit doses must be performed with another nurse
before removing the medication to ensure accuracy and prevent diversion.
Documentation occurs after administration, and pain should be assessed
systematically rather than by appearance .
