NURS 355 EXAM 3 QUESTIONS AND
VERIFIED ANSWERS; GET IT 100%
ACCURATE
. A patient who has cirrhosis and esophageal varices is being
treated with propranolol (Inderal). Which finding is the best
indicator to the nurse that the medication has been effective?
a. The patient reports no chest pain.
b. Blood pressure is 130/80 mm Hg.
c. Stools test negative for occult blood.
d. The apical pulse rate is 68 beats/min. - correct
answer- Answer: Stool tests negative for occult blood
Rationale: Because the purpose of β-blocker therapy for patients
with esophageal varices is to decrease
the risk for bleeding from esophageal varices, the best indicator
of the effectiveness for propranolol is the lack of blood in the
stools. Although propranolol is used to treat hypertension,
angina, and tachycardia, the purpose for use in this patient is to
decrease the risk for bleeding from esophageal varices.
,. The nurse is titrating the IV fluid infusion rate immediately after
a patient has had kidney transplantation. Which parameter will
be most important for the nurse to consider?
a. Heart rate
b. Urine output
c. Creatinine clearance
d. Blood urea nitrogen (BUN) level - correct answer-
Answer: Urine output
Rationale: Fluid volume is replaced based on urine output after
transplant because the urine output can be as high as a liter an
hour. The other data will be monitored but are not the most
important determinants of fluid infusion rate.
2. An older patient reports chronic constipation. To promote
bowel evacuation, when should the nurse suggest that the
patient attempt defecation?
a. In the mid-afternoon
b. After eating breakfast
,c. Right after awakening in the morning
d. Immediately before the first daily meal - correct
answer- Answer: After eating breakfast
Rationale: The gastrocolic reflex is most active after the first
daily meal. Awakening, the anticipation of eating, and mid-
afternoon timing do not stimulate these reflexes.
A 19-yr-old woman admitted with anorexia nervosa is 5 ft, 6 in
(163 cm) tall and weighs 88 lb (41 kg). Laboratory tests reveal
hypokalemia and iron-deficiency anemia. Which patient problem
has the highest priority?
a. Difficulty coping
b. Disturbed body image
c. Impaired nutritional status
d. Risk for electrolyte imbalance - correct answer-
Answer: Risk for electrolyte imbalance
Rationale: The patient's hypokalemia may lead to life-
threatening cardiac dysrhythmias. The other diagnoses are also
appropriate for this patient but are not associated with
immediate risk for fatal complications
, A 19-yr-old woman is brought to the emergency department
with a knife handle protruding from her abdomen. What should
the nurse do during the initial assessment of the patient?
a. Remove the knife and assess the wound.
b. Determine the presence of Rovsing sign.
c. Check for circulation and tissue perfusion.
d. Insert a urinary catheter and assess for hematuria. -
correct answer- Answer: Check the circulation and
tissue perfusion
Rationale: The initial assessment is focused on determining
whether the patient has hypovolemic shock. The knife should
not be removed until the patient is in surgery, where bleeding
can be controlled. Rovsing sign is assessed in the patient with
suspected appendicitis. Assessment for bladder trauma is not
part of the initial assessment.
VERIFIED ANSWERS; GET IT 100%
ACCURATE
. A patient who has cirrhosis and esophageal varices is being
treated with propranolol (Inderal). Which finding is the best
indicator to the nurse that the medication has been effective?
a. The patient reports no chest pain.
b. Blood pressure is 130/80 mm Hg.
c. Stools test negative for occult blood.
d. The apical pulse rate is 68 beats/min. - correct
answer- Answer: Stool tests negative for occult blood
Rationale: Because the purpose of β-blocker therapy for patients
with esophageal varices is to decrease
the risk for bleeding from esophageal varices, the best indicator
of the effectiveness for propranolol is the lack of blood in the
stools. Although propranolol is used to treat hypertension,
angina, and tachycardia, the purpose for use in this patient is to
decrease the risk for bleeding from esophageal varices.
,. The nurse is titrating the IV fluid infusion rate immediately after
a patient has had kidney transplantation. Which parameter will
be most important for the nurse to consider?
a. Heart rate
b. Urine output
c. Creatinine clearance
d. Blood urea nitrogen (BUN) level - correct answer-
Answer: Urine output
Rationale: Fluid volume is replaced based on urine output after
transplant because the urine output can be as high as a liter an
hour. The other data will be monitored but are not the most
important determinants of fluid infusion rate.
2. An older patient reports chronic constipation. To promote
bowel evacuation, when should the nurse suggest that the
patient attempt defecation?
a. In the mid-afternoon
b. After eating breakfast
,c. Right after awakening in the morning
d. Immediately before the first daily meal - correct
answer- Answer: After eating breakfast
Rationale: The gastrocolic reflex is most active after the first
daily meal. Awakening, the anticipation of eating, and mid-
afternoon timing do not stimulate these reflexes.
A 19-yr-old woman admitted with anorexia nervosa is 5 ft, 6 in
(163 cm) tall and weighs 88 lb (41 kg). Laboratory tests reveal
hypokalemia and iron-deficiency anemia. Which patient problem
has the highest priority?
a. Difficulty coping
b. Disturbed body image
c. Impaired nutritional status
d. Risk for electrolyte imbalance - correct answer-
Answer: Risk for electrolyte imbalance
Rationale: The patient's hypokalemia may lead to life-
threatening cardiac dysrhythmias. The other diagnoses are also
appropriate for this patient but are not associated with
immediate risk for fatal complications
, A 19-yr-old woman is brought to the emergency department
with a knife handle protruding from her abdomen. What should
the nurse do during the initial assessment of the patient?
a. Remove the knife and assess the wound.
b. Determine the presence of Rovsing sign.
c. Check for circulation and tissue perfusion.
d. Insert a urinary catheter and assess for hematuria. -
correct answer- Answer: Check the circulation and
tissue perfusion
Rationale: The initial assessment is focused on determining
whether the patient has hypovolemic shock. The knife should
not be removed until the patient is in surgery, where bleeding
can be controlled. Rovsing sign is assessed in the patient with
suspected appendicitis. Assessment for bladder trauma is not
part of the initial assessment.
