NSG 4800 Exam Test Questions with Answers Graded A+
The nurse is monitoring a client in the immediate postpar- B, During the fourth stage of labor, the maternal blood
tum period for signs of hemorrhage. Which sign, if noted, pressure, pulse, and respiration should be checked every
would be an early sign of excessive blood loss? 15 minutes during the first hour. An increasing pulse is
A .temperature of 100.4°F (38°C) an early sign of excessive blood loss because the heart
B. An increase in the pulse rate from 88 to 102 pumps faster to compensate for reduced blood volume.
beats/minute A slight increase in temperature is normal. The blood
C. A blood pressure change from 130/88 to 124/80 mm pressure decreases as the blood volume diminishes, but a
Hg decreased blood pressure would not be the earliest sign
D. An increase in the respiratory rate from 18 to 22 of hemorrhage. The respiratory rate is slightly increased
breaths/minute from normal.
3, Cryotherapy involves the local application of liquid ni-
The nurse in the ambulatory care unit is providing home
trogen to the lesion; this causes cell death and tissue de-
care instructions to a client after cryotherapy for the treat-
struction. Tissue freezing is followed in 1 to 2 days by he-
ment of malignant skin lesions. Which statement would
morrhagic blister formation; therefore, ice is not applied
be most appropriate for the nurse to include in the home
to the site. The application of a warm, damp washcloth
care instructions for this client?
intermittently to the site will provide relief of any discom-
"Apply ice to the site to prevent swelling."
fort. The nurse instructs the client to clean the site with
"Clean the site with alcohol 3 times daily."
the prescribed solution to prevent secondary infection. A
"Apply a warm, damp washcloth if discomfort occurs."
topical antibiotic also may be prescribed. Alcohol would
"Avoid showering or taking baths until seen by the health
cause irritation to the skin. There is no reason for the client
care provider in 1 week."
to avoid showering or bathing.
The registered nurse is caring for the following clients. It
would be a priority for the nurse to initiate a multidiscipli-
nary conference for the client who is B
A.12 years old with Autism who is starting a new school A client with uncontrolled Diabetes Mellitus would require
and recently had a URI (upper respiratory tract infection) the greatest number of disciplines (multidisciplinary) to
B.39 years old, has type 2 Diabetes Mellitus, is homeless manage their care i.e. Medicine, Nursing, Social Work,
and had a recent Hemoglobin A1c of 13% Nutritionist; the other choices do not require as many
C.52 years old, with Myasthenia Gravis, recently pre- providers of care to meet their needs.
scribed Mestinon (pyridostigmine) and is employed as a
mail carrier
, NSG 4800 Exam Test Questions with Answers Graded A+
D.79 years old, has bipolar and schizophrenia, lives alone
and reports hearing non threatening voices.
D. Carbamazepine may be used to treat a seizure disor-
der. It can cause leukopenia, anemia, thrombocytopenia,
A client is scheduled to begin therapy with carba-
and, very rarely, fatal aplastic anemia. To reduce the risk
mazepine. The nurse should assess the results of which
of serious hematological ettects, a complete blood cell
test(s) before administering the first dose of this medica-
count should be done before treatment and periodically
tion to the client?
thereafter. This medication should be avoided in clients
Liver function tests
with preexisting hematological abnormalities. The client
Renal function tests
also is told to report the occurrence of fever, sore throat,
Pancreatic enzyme studies
pallor, weakness, infection, easy bruising, and petechiae.
Complete blood cell count
The results of the remaining tests listed in the options are
not associated with the use of this medication.
C. Emergency management of DKA focuses on correct-
A client is admitted to a hospital with a diagnosis of dia-
ing fluid and electrolyte imbalances and normalizing the
betic ketoacidosis (DKA). The initial blood glucose level is
serum glucose level. If the corrections occur too quickly,
950 mg/dL (54.2 mmol/L). A continuous intravenous (IV)
serious consequences, including hypoglycemia and cere-
infusion of short-acting insulin is initiated, along with IV
bral edema, can occur. During management of DKA, when
rehydration with normal saline. The serum glucose level is
the blood glucose level falls to 250 to 300 mg/dL (14.2
now decreased to 240 mg/dL (13.7 mmol/L). The nurse
to 17.1 mmol/L), the IV infusion rate is reduced and a
would next prepare to administer which medication?
dextrose solution is added to maintain a blood glucose
An ampule of 50% dextrose
level of about 250 mg/dL (14.2 mmol/L), or until the client
NPH insulin subcutaneously
recovers from ketosis. Fifty percent dextrose is used to
IV fluids containing dextrose
treat hypoglycemia. NPH insulin is not used to treat DKA.
Phenytoin for the prevention of seizures
Phenytoin is not a usual treatment measure for DKA.
A client is being discharged from the emergency de-
partment after an evaluation for a concussion. The nurse
reinforces teaching regarding follow-up should the client 2; all others responses would indicate IICP and needs to
develop complications. Which of the following complica- go to the ER
tions, if listed by the client, would require further instruc-
tion?
The nurse is monitoring a client in the immediate postpar- B, During the fourth stage of labor, the maternal blood
tum period for signs of hemorrhage. Which sign, if noted, pressure, pulse, and respiration should be checked every
would be an early sign of excessive blood loss? 15 minutes during the first hour. An increasing pulse is
A .temperature of 100.4°F (38°C) an early sign of excessive blood loss because the heart
B. An increase in the pulse rate from 88 to 102 pumps faster to compensate for reduced blood volume.
beats/minute A slight increase in temperature is normal. The blood
C. A blood pressure change from 130/88 to 124/80 mm pressure decreases as the blood volume diminishes, but a
Hg decreased blood pressure would not be the earliest sign
D. An increase in the respiratory rate from 18 to 22 of hemorrhage. The respiratory rate is slightly increased
breaths/minute from normal.
3, Cryotherapy involves the local application of liquid ni-
The nurse in the ambulatory care unit is providing home
trogen to the lesion; this causes cell death and tissue de-
care instructions to a client after cryotherapy for the treat-
struction. Tissue freezing is followed in 1 to 2 days by he-
ment of malignant skin lesions. Which statement would
morrhagic blister formation; therefore, ice is not applied
be most appropriate for the nurse to include in the home
to the site. The application of a warm, damp washcloth
care instructions for this client?
intermittently to the site will provide relief of any discom-
"Apply ice to the site to prevent swelling."
fort. The nurse instructs the client to clean the site with
"Clean the site with alcohol 3 times daily."
the prescribed solution to prevent secondary infection. A
"Apply a warm, damp washcloth if discomfort occurs."
topical antibiotic also may be prescribed. Alcohol would
"Avoid showering or taking baths until seen by the health
cause irritation to the skin. There is no reason for the client
care provider in 1 week."
to avoid showering or bathing.
The registered nurse is caring for the following clients. It
would be a priority for the nurse to initiate a multidiscipli-
nary conference for the client who is B
A.12 years old with Autism who is starting a new school A client with uncontrolled Diabetes Mellitus would require
and recently had a URI (upper respiratory tract infection) the greatest number of disciplines (multidisciplinary) to
B.39 years old, has type 2 Diabetes Mellitus, is homeless manage their care i.e. Medicine, Nursing, Social Work,
and had a recent Hemoglobin A1c of 13% Nutritionist; the other choices do not require as many
C.52 years old, with Myasthenia Gravis, recently pre- providers of care to meet their needs.
scribed Mestinon (pyridostigmine) and is employed as a
mail carrier
, NSG 4800 Exam Test Questions with Answers Graded A+
D.79 years old, has bipolar and schizophrenia, lives alone
and reports hearing non threatening voices.
D. Carbamazepine may be used to treat a seizure disor-
der. It can cause leukopenia, anemia, thrombocytopenia,
A client is scheduled to begin therapy with carba-
and, very rarely, fatal aplastic anemia. To reduce the risk
mazepine. The nurse should assess the results of which
of serious hematological ettects, a complete blood cell
test(s) before administering the first dose of this medica-
count should be done before treatment and periodically
tion to the client?
thereafter. This medication should be avoided in clients
Liver function tests
with preexisting hematological abnormalities. The client
Renal function tests
also is told to report the occurrence of fever, sore throat,
Pancreatic enzyme studies
pallor, weakness, infection, easy bruising, and petechiae.
Complete blood cell count
The results of the remaining tests listed in the options are
not associated with the use of this medication.
C. Emergency management of DKA focuses on correct-
A client is admitted to a hospital with a diagnosis of dia-
ing fluid and electrolyte imbalances and normalizing the
betic ketoacidosis (DKA). The initial blood glucose level is
serum glucose level. If the corrections occur too quickly,
950 mg/dL (54.2 mmol/L). A continuous intravenous (IV)
serious consequences, including hypoglycemia and cere-
infusion of short-acting insulin is initiated, along with IV
bral edema, can occur. During management of DKA, when
rehydration with normal saline. The serum glucose level is
the blood glucose level falls to 250 to 300 mg/dL (14.2
now decreased to 240 mg/dL (13.7 mmol/L). The nurse
to 17.1 mmol/L), the IV infusion rate is reduced and a
would next prepare to administer which medication?
dextrose solution is added to maintain a blood glucose
An ampule of 50% dextrose
level of about 250 mg/dL (14.2 mmol/L), or until the client
NPH insulin subcutaneously
recovers from ketosis. Fifty percent dextrose is used to
IV fluids containing dextrose
treat hypoglycemia. NPH insulin is not used to treat DKA.
Phenytoin for the prevention of seizures
Phenytoin is not a usual treatment measure for DKA.
A client is being discharged from the emergency de-
partment after an evaluation for a concussion. The nurse
reinforces teaching regarding follow-up should the client 2; all others responses would indicate IICP and needs to
develop complications. Which of the following complica- go to the ER
tions, if listed by the client, would require further instruc-
tion?
