SWIFT RIVER: JOYCE WORKMAN,
SWIFT RIVER EXAM SET Q&A
Calvin Umbyuma, a 42-year-old male, has been admitted for shortness of breath and
pleuritic chest pain. He was diagnosed with HIV over a year ago. He recently traveled
Kenya, to visit his mother, who is ill. While visiting his mother, he received herbal
therapies to help with the manifestations he was experiencing. Vital signs are
temperature 100.9°F (38.3° C), respirations 22/min, heart rate 92/min, blood pressure
152/89 mmHg, oxygen saturation 91% on room air. Inflammatory markers including
erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) are elevated at 78.9
mmh and 67.2 mg/L. The client has been placed in a negative pressure room at the end
of the hallway. - ANSWER -Maslow's Hierarchy of Needs - High Priority
ABCs - High Priority
Safety and Risk Reduction - High Priority
Urgent vs Nonurgent - High Priority
Chronic vs Acute/Stable vs Unstable - High Priority
Calvin Umbyuma
The nurse reviews the information received in the report and enters the client's room to
perform a physical assessment. Upon assessment, the client is alert and oriented to
person, place, time, and event. Pupils are equal, round, reactive to light, and
accommodation. Lung sounds reveal crackles in right upper lobe. Client is expectorating
blood-tinged mucopurulent sputum and reports pain during coughing episodes rated as
a 5 on a 0 to 10 pain scale. S1S2 heart tones noted, All pulses palpable. Abdomen is
soft and non-tender. Bowel sounds active in all 4 quadrants. Client is lying in semi-
Fowler's position. Call light is within reach. - ANSWER -Which of the following concerns
should the nurse address while providing client care? (Select all that apply.)
Correct Options:
Physiological: Comfort
Health Promotion: Education
Physiological: Immunity
Physiological: Infection
Incorrect Options:
Physiological: Nutrition
Physiological: Mobility
Physiological: Clotting
Physiological: Grief
Calvin Umbyuma
The nurse is planning client care and reviewing information in the electronic medical
record (EMR). During episodes of coughing, the client expectorates sputum that is
blood-tinged and greenish yellow in color. The client reports that the pain increases
during episodes of coughing. When examining the client's previous chest x-ray, the
,nurse identifies an area of patchy shadowing in the right upper lobe. The client reports
having night sweats and waking up through the night for the past 4 weeks being
drenched in sweat. The client stated that they have traveled to Kenya twice this year to
care for their ill parent. The client reports that their parent has not received treatment for
their illness at a medical facility but does practice naturopathic medicine. The client
reports using provider prescribed medications, darunavir 800 mg with ritonavir 100
mg, ...etc - ANSWER -When planning client care, which of the following actions should
the nurse take?
Correct:
Prepare to obtain a sputum specimen culture
Place the client on airborne isolation precautions
Review client's immunization record for bacillus Calmette-Guerin vaccine
Incorrect:
Prepare to administer client's herbal therapies
Preform venipuncture on client's right hand to obtain blood for culture
Joyce Workman priority framework - ANSWER -Maslow- high
ABC- high
Safety and Risk reduction- high
Urgent vs Nonurgent- high
chronic vs acute- high
concerns the nurse address while providing client care - ANSWER -fluid and
electrolytes
cognition
acid base balance
infection
perfusion
Laboratory values that support the clients Dx of diabetic ketoacidosis - ANSWER -low
pH, low bicarbonate
Insulin units received from admission to one hour after initiation of continuous drip -
ANSWER -25.8
indication that the client is not tolerating prescribed fluid replacement therapy -
ANSWER -peripheral pulses that are 3+, blood pressure of 159/92, pulse oximetry 85%,
auscultatory crackles in all lung fields
lab values that indicate the client condition is improving - ANSWER -blood glucose 180
mg/dl, pH 7.35, potassium 3.6 mEq/L, HCo3 21 mEq/L, BUN 28 mg/dl
Sick day rules the nurse should provide - ANSWER -check glucose q4, check urine
ketones when glucose is above 300, if nauseous dink liquids with both glucose and
,electrolytes, continue to take anti-diabetic medication when ill, contact provider if illness
last more than 24-48 hr
Calvin Umbyuma
The client calls the nurse to report severe pain when coughing and a worsening of
shortness of breath. When entering the client's room to administer a PRN pain
medication, the nurse notices the client has a visitor in the room who has delivered the
client's herbal therapy, echinacea and St. John's wort, from home. - ANSWER -Which of
the following actions should the nurse take?
Correct:
Listen to the client's lung sounds
Preform a medication reconciliation with the client's medications and therapies.
Monitor the client's lymphocyte count
Incorrect:
Wear a surgical face mask when entering the client's room
Place an N-95 on the client when visitors enter the client's room
Calvin Umbyuma - ANSWER -Correct:
Once you have 3 consecutive negative sputum cultures you are no longer considered
contagious.
It will not be necessary to maintain airborne precautions once you are discharged home.
You'll have to have sputum cultures done every 4 weeks
Incorrect:
It is important to take your medications first thing in the morning.
You'll need to take your prescribed medications for at least 3 months
You will need to go to your provider's office to take your daily medication after you are
discharged.
Calvin Umbyuma
The nurse is reviewing the client's current prescriptions, lab work, and vital signs in the
EMR. The client is prescribed isoniazid 300 mg daily and rifampin 600 mg daily. The
client's CD4 count is 300 X 1 0s/L. A consult has been placed for an infectious disease
provider to manage the client's co-infection of TB and HIV. The nurse &ccur is
concerned about the possibility of this being a resistant strain of TB, which can occur in
clients who have HIV. The client's current vital signs are temperature 100.6°F (38.1°C),
respirations 22/min, heart rate 101/min, and oxygen saturation 91 %. - ANSWER -
Correct
Chest X-ray
ABGs
Incorrect:
Mantoux test
Western Blot test
ELISA test
, Calvin Umbyuma
Pulse ox 89% on room air
SOB & coughing
Dusky mucous membranes
Crackles & Rhonchi right upper lobe - ANSWER -Correct:
Elevate the HOB to 45 degrees
Apply oxygen on the client at 2L/min nasal cannula
Monitor the client's vital signs
Teach the client diaphragmatic breathing
Increase the client's oral fluids
Instruct the client to use incentive spirometry
Incorrect:
Chanthavy Chhet is a 46-year-old who identifies as female and uses she/her pronouns
who is being admitted from the ED for dehydration and epigastric pain. Chanthavy
introduced her support person as her nephew. Chanthavy speaks Vietnamese. Her
nephew speaks English and Vietnamese. Chanthavy requests for the nephew to
interpret for her while she is hospitalized. We have contacted the facility's interpreter to
assist, and they explained their role to Chanthavy and her nephew.
Chanthavy reported not wanting to eat much due to epigastric pain and nausea that has
gotten worse over the past month. Over the past week, her nephew reports being
concerned because she is not even drinking fluids. They came to the ED today after
Chanthavy vomited a small amount of coffee-ground enesis, was weak, and felt dizzy
when standing. - ANSWER -Maslow's Hierarchy of Needs - High Priority
ABCs - Low Priority
Safety and Risk Reduction - High Priority
Urgent vs Nonurgent - Low Priority
Chronic vs Acute/Stable vs Unstable - Low Priority
Chanthavy Chhet
A facility approved interpreter was introduced to the nephew and client. The nurse
collaborated with the interpreter, client, and client's nephew to gather subjective data
and history. The nurse's admission assessment reveals the following findings. Client
reports with the assistance of the interpreter, nausea, and a burning pain of 6/10 on a 0
to 10 numeric pain scale in the epigastric region. Abdomen is flat and soft with some
guarding in the upper quadrants upon palpation. Bowels sounds are active in all 4
quadrants. Skin turgor is poor and shows tenting. Skin color is consistent with client's
genetic background. Mucus membranes are pale pink and dry. Capillary refill is 2
seconds. Peripheral pulses are strong and regular. Breath sounds are clear and equal
bilaterally. Chanthavy is not currently taking any prescribed medications. ...etc -
ANSWER -Which of the following concerns should the nurse address while providing
client care? (Select all that apply.)
Correct Options:
Physiological: Pain
SWIFT RIVER EXAM SET Q&A
Calvin Umbyuma, a 42-year-old male, has been admitted for shortness of breath and
pleuritic chest pain. He was diagnosed with HIV over a year ago. He recently traveled
Kenya, to visit his mother, who is ill. While visiting his mother, he received herbal
therapies to help with the manifestations he was experiencing. Vital signs are
temperature 100.9°F (38.3° C), respirations 22/min, heart rate 92/min, blood pressure
152/89 mmHg, oxygen saturation 91% on room air. Inflammatory markers including
erythrocyte sedimentation rate (ESR) and c-reactive protein (CRP) are elevated at 78.9
mmh and 67.2 mg/L. The client has been placed in a negative pressure room at the end
of the hallway. - ANSWER -Maslow's Hierarchy of Needs - High Priority
ABCs - High Priority
Safety and Risk Reduction - High Priority
Urgent vs Nonurgent - High Priority
Chronic vs Acute/Stable vs Unstable - High Priority
Calvin Umbyuma
The nurse reviews the information received in the report and enters the client's room to
perform a physical assessment. Upon assessment, the client is alert and oriented to
person, place, time, and event. Pupils are equal, round, reactive to light, and
accommodation. Lung sounds reveal crackles in right upper lobe. Client is expectorating
blood-tinged mucopurulent sputum and reports pain during coughing episodes rated as
a 5 on a 0 to 10 pain scale. S1S2 heart tones noted, All pulses palpable. Abdomen is
soft and non-tender. Bowel sounds active in all 4 quadrants. Client is lying in semi-
Fowler's position. Call light is within reach. - ANSWER -Which of the following concerns
should the nurse address while providing client care? (Select all that apply.)
Correct Options:
Physiological: Comfort
Health Promotion: Education
Physiological: Immunity
Physiological: Infection
Incorrect Options:
Physiological: Nutrition
Physiological: Mobility
Physiological: Clotting
Physiological: Grief
Calvin Umbyuma
The nurse is planning client care and reviewing information in the electronic medical
record (EMR). During episodes of coughing, the client expectorates sputum that is
blood-tinged and greenish yellow in color. The client reports that the pain increases
during episodes of coughing. When examining the client's previous chest x-ray, the
,nurse identifies an area of patchy shadowing in the right upper lobe. The client reports
having night sweats and waking up through the night for the past 4 weeks being
drenched in sweat. The client stated that they have traveled to Kenya twice this year to
care for their ill parent. The client reports that their parent has not received treatment for
their illness at a medical facility but does practice naturopathic medicine. The client
reports using provider prescribed medications, darunavir 800 mg with ritonavir 100
mg, ...etc - ANSWER -When planning client care, which of the following actions should
the nurse take?
Correct:
Prepare to obtain a sputum specimen culture
Place the client on airborne isolation precautions
Review client's immunization record for bacillus Calmette-Guerin vaccine
Incorrect:
Prepare to administer client's herbal therapies
Preform venipuncture on client's right hand to obtain blood for culture
Joyce Workman priority framework - ANSWER -Maslow- high
ABC- high
Safety and Risk reduction- high
Urgent vs Nonurgent- high
chronic vs acute- high
concerns the nurse address while providing client care - ANSWER -fluid and
electrolytes
cognition
acid base balance
infection
perfusion
Laboratory values that support the clients Dx of diabetic ketoacidosis - ANSWER -low
pH, low bicarbonate
Insulin units received from admission to one hour after initiation of continuous drip -
ANSWER -25.8
indication that the client is not tolerating prescribed fluid replacement therapy -
ANSWER -peripheral pulses that are 3+, blood pressure of 159/92, pulse oximetry 85%,
auscultatory crackles in all lung fields
lab values that indicate the client condition is improving - ANSWER -blood glucose 180
mg/dl, pH 7.35, potassium 3.6 mEq/L, HCo3 21 mEq/L, BUN 28 mg/dl
Sick day rules the nurse should provide - ANSWER -check glucose q4, check urine
ketones when glucose is above 300, if nauseous dink liquids with both glucose and
,electrolytes, continue to take anti-diabetic medication when ill, contact provider if illness
last more than 24-48 hr
Calvin Umbyuma
The client calls the nurse to report severe pain when coughing and a worsening of
shortness of breath. When entering the client's room to administer a PRN pain
medication, the nurse notices the client has a visitor in the room who has delivered the
client's herbal therapy, echinacea and St. John's wort, from home. - ANSWER -Which of
the following actions should the nurse take?
Correct:
Listen to the client's lung sounds
Preform a medication reconciliation with the client's medications and therapies.
Monitor the client's lymphocyte count
Incorrect:
Wear a surgical face mask when entering the client's room
Place an N-95 on the client when visitors enter the client's room
Calvin Umbyuma - ANSWER -Correct:
Once you have 3 consecutive negative sputum cultures you are no longer considered
contagious.
It will not be necessary to maintain airborne precautions once you are discharged home.
You'll have to have sputum cultures done every 4 weeks
Incorrect:
It is important to take your medications first thing in the morning.
You'll need to take your prescribed medications for at least 3 months
You will need to go to your provider's office to take your daily medication after you are
discharged.
Calvin Umbyuma
The nurse is reviewing the client's current prescriptions, lab work, and vital signs in the
EMR. The client is prescribed isoniazid 300 mg daily and rifampin 600 mg daily. The
client's CD4 count is 300 X 1 0s/L. A consult has been placed for an infectious disease
provider to manage the client's co-infection of TB and HIV. The nurse &ccur is
concerned about the possibility of this being a resistant strain of TB, which can occur in
clients who have HIV. The client's current vital signs are temperature 100.6°F (38.1°C),
respirations 22/min, heart rate 101/min, and oxygen saturation 91 %. - ANSWER -
Correct
Chest X-ray
ABGs
Incorrect:
Mantoux test
Western Blot test
ELISA test
, Calvin Umbyuma
Pulse ox 89% on room air
SOB & coughing
Dusky mucous membranes
Crackles & Rhonchi right upper lobe - ANSWER -Correct:
Elevate the HOB to 45 degrees
Apply oxygen on the client at 2L/min nasal cannula
Monitor the client's vital signs
Teach the client diaphragmatic breathing
Increase the client's oral fluids
Instruct the client to use incentive spirometry
Incorrect:
Chanthavy Chhet is a 46-year-old who identifies as female and uses she/her pronouns
who is being admitted from the ED for dehydration and epigastric pain. Chanthavy
introduced her support person as her nephew. Chanthavy speaks Vietnamese. Her
nephew speaks English and Vietnamese. Chanthavy requests for the nephew to
interpret for her while she is hospitalized. We have contacted the facility's interpreter to
assist, and they explained their role to Chanthavy and her nephew.
Chanthavy reported not wanting to eat much due to epigastric pain and nausea that has
gotten worse over the past month. Over the past week, her nephew reports being
concerned because she is not even drinking fluids. They came to the ED today after
Chanthavy vomited a small amount of coffee-ground enesis, was weak, and felt dizzy
when standing. - ANSWER -Maslow's Hierarchy of Needs - High Priority
ABCs - Low Priority
Safety and Risk Reduction - High Priority
Urgent vs Nonurgent - Low Priority
Chronic vs Acute/Stable vs Unstable - Low Priority
Chanthavy Chhet
A facility approved interpreter was introduced to the nephew and client. The nurse
collaborated with the interpreter, client, and client's nephew to gather subjective data
and history. The nurse's admission assessment reveals the following findings. Client
reports with the assistance of the interpreter, nausea, and a burning pain of 6/10 on a 0
to 10 numeric pain scale in the epigastric region. Abdomen is flat and soft with some
guarding in the upper quadrants upon palpation. Bowels sounds are active in all 4
quadrants. Skin turgor is poor and shows tenting. Skin color is consistent with client's
genetic background. Mucus membranes are pale pink and dry. Capillary refill is 2
seconds. Peripheral pulses are strong and regular. Breath sounds are clear and equal
bilaterally. Chanthavy is not currently taking any prescribed medications. ...etc -
ANSWER -Which of the following concerns should the nurse address while providing
client care? (Select all that apply.)
Correct Options:
Physiological: Pain
