NUR 243 FINAL EXAM QUESTIONS AND VERIFIED
ANSWERS
The nurse is caring for a male patient diagnosed with alcohol cirrhosis and needs a liver
transplant. The patient has been out of work for several months and does not have
insurance or enough cash. The patient is concerned that he may not be considered for
the transplant. What statement made the nurse would be lacking in cultural competence
- Answers - It is definitely a negative that your liver disease is caused by alcohol abuse
The nurse is caring for a patient who was taking ibuprofen three times d ay for pain due
to her osteoarthritis. The patient present with dizzies, HA, nausea and vomiting coffee
ground emesis. Which s/s will the nurse monitor for? - Answers - Tachycardia,
Tachypnea
The nurse is assessing the function of a chest tube drainage system in a patient who
has
just returned from the recovery room following a thoracotomy. Which are the expected
assessment finding related to chest tube drainage system? - Answers - Drainage
system maintained below the patient's chest, Occlusive dressing over the insertion site,
Tidaling in the water seal chamber during inhalation and exhalation
A nurse is caring for four patients on the floor. Which patient should the nurse see first?
- Answers - A patient with end stage liver disease with platelet count of 25,000
The nurse is assessing a patient status post hemicolectomy and notes the patient's calf
is red and slightly edematous. The nurse precedes to do a pain assessment. The
patient
states the pain is an 8 out of 10. The patient's vitals are as follows HR 92, BP 140/89,
RR
224, T 98.7. The health care provider has ordered Morphine 4-6 mg IBP q 4 hours.
Which stage Tanners is this? - Answers - Interpreting
The nurse is providing care to a patient with a large surgical wound that requires and
extensive amount of dressing and supplies. What cost-effective action would the nurse
take when performing dressing changes? (SATA) - Answers - Review previous
documentation to identify specific supplies needed, Survey the room for supplies before
starting the dressing change
A patient with bleeding esophageal varices from alcoholic cirrhosis is admitted to the
emergency department. Which comment overhead by the charge nurse from a staff
nurse requires immediate intervention? - Answers - "Charlie is here, my tax dollars
going to good use once again"
, The nurse is caring for a patient admitted to the emergency room with complaints of
chest pain. Which step in tanners does the nurse need to do first when caring for this
patient? - Answers - Noticing
A patient with AKI has been admitted to the hospital for 24-hour observation. The
patient c/o 8/10 flank pain and N/V and has a urine output of 81 mL over the past three
hours. The pt. T is 99, HR 100, R 22, BP 90/50. What is the nursing priority - Answers -
Administer IV fluids
A patient is admitted to the ED after an MVA. The patient was conscious at the scene
but is now confused and lethargic with a T 98.4, HR 105, RR 25, BP 110/58. What is the
nurses first action? - Answers - Assess for loose teeth
The nurse is caring for a patient with alcoholic cirrhosis. The patient is about to have a
paracentesis in one hour. The patient has undergone this procedure several times in the
past 2 years. The nurse says to the patient "Your dr will be here for the procedure in 1
hour, I know you don't have any questions since you've been here so many times?"
What is this an example of - Answers - Possible bias related to the client's diagnosis
The nurse is providing discharge instructions to patient diagnosed with cirrhosis and
experiencing severe ascites. What info would be the most important for the nurse to
include (SATA) - Answers - Restrict sodium intake
Abstain from alcohol consumption
Report weight gain and SOB
Avoid acetaminophen in high doses
Report extreme swelling in the legs and feet
The nurse is caring for a patient in labor on oxytocin at 8 mu/min. The nurse is notices
late decelerations on the fetal heart monitor. What actions will the nurse take (SATA) -
Answers - Position on left side
Turn off oxytocin
Apply 02
notify HCP
The nurse manager is planning to discuss hospital consumer assessment of healthcare
providers and systems surveys at the next nursing staff meeting. Which HCAHPS would
the nurse manager include at the meeting? - Answers - The HCAHPS survey creates
incentives for hospital to improve quality of care based on public reporting of the results
The nurse receives report on a new admission. The male patient has a new diagnosis of
cirrhosis and is being admitted for dyspnea, edema and extreme fatigue. The nurse
receiving the report says "How long has he been an alcoholic?" What does the
comment demonstrate? - Answers - Stereotyping based on personal bias
ANSWERS
The nurse is caring for a male patient diagnosed with alcohol cirrhosis and needs a liver
transplant. The patient has been out of work for several months and does not have
insurance or enough cash. The patient is concerned that he may not be considered for
the transplant. What statement made the nurse would be lacking in cultural competence
- Answers - It is definitely a negative that your liver disease is caused by alcohol abuse
The nurse is caring for a patient who was taking ibuprofen three times d ay for pain due
to her osteoarthritis. The patient present with dizzies, HA, nausea and vomiting coffee
ground emesis. Which s/s will the nurse monitor for? - Answers - Tachycardia,
Tachypnea
The nurse is assessing the function of a chest tube drainage system in a patient who
has
just returned from the recovery room following a thoracotomy. Which are the expected
assessment finding related to chest tube drainage system? - Answers - Drainage
system maintained below the patient's chest, Occlusive dressing over the insertion site,
Tidaling in the water seal chamber during inhalation and exhalation
A nurse is caring for four patients on the floor. Which patient should the nurse see first?
- Answers - A patient with end stage liver disease with platelet count of 25,000
The nurse is assessing a patient status post hemicolectomy and notes the patient's calf
is red and slightly edematous. The nurse precedes to do a pain assessment. The
patient
states the pain is an 8 out of 10. The patient's vitals are as follows HR 92, BP 140/89,
RR
224, T 98.7. The health care provider has ordered Morphine 4-6 mg IBP q 4 hours.
Which stage Tanners is this? - Answers - Interpreting
The nurse is providing care to a patient with a large surgical wound that requires and
extensive amount of dressing and supplies. What cost-effective action would the nurse
take when performing dressing changes? (SATA) - Answers - Review previous
documentation to identify specific supplies needed, Survey the room for supplies before
starting the dressing change
A patient with bleeding esophageal varices from alcoholic cirrhosis is admitted to the
emergency department. Which comment overhead by the charge nurse from a staff
nurse requires immediate intervention? - Answers - "Charlie is here, my tax dollars
going to good use once again"
, The nurse is caring for a patient admitted to the emergency room with complaints of
chest pain. Which step in tanners does the nurse need to do first when caring for this
patient? - Answers - Noticing
A patient with AKI has been admitted to the hospital for 24-hour observation. The
patient c/o 8/10 flank pain and N/V and has a urine output of 81 mL over the past three
hours. The pt. T is 99, HR 100, R 22, BP 90/50. What is the nursing priority - Answers -
Administer IV fluids
A patient is admitted to the ED after an MVA. The patient was conscious at the scene
but is now confused and lethargic with a T 98.4, HR 105, RR 25, BP 110/58. What is the
nurses first action? - Answers - Assess for loose teeth
The nurse is caring for a patient with alcoholic cirrhosis. The patient is about to have a
paracentesis in one hour. The patient has undergone this procedure several times in the
past 2 years. The nurse says to the patient "Your dr will be here for the procedure in 1
hour, I know you don't have any questions since you've been here so many times?"
What is this an example of - Answers - Possible bias related to the client's diagnosis
The nurse is providing discharge instructions to patient diagnosed with cirrhosis and
experiencing severe ascites. What info would be the most important for the nurse to
include (SATA) - Answers - Restrict sodium intake
Abstain from alcohol consumption
Report weight gain and SOB
Avoid acetaminophen in high doses
Report extreme swelling in the legs and feet
The nurse is caring for a patient in labor on oxytocin at 8 mu/min. The nurse is notices
late decelerations on the fetal heart monitor. What actions will the nurse take (SATA) -
Answers - Position on left side
Turn off oxytocin
Apply 02
notify HCP
The nurse manager is planning to discuss hospital consumer assessment of healthcare
providers and systems surveys at the next nursing staff meeting. Which HCAHPS would
the nurse manager include at the meeting? - Answers - The HCAHPS survey creates
incentives for hospital to improve quality of care based on public reporting of the results
The nurse receives report on a new admission. The male patient has a new diagnosis of
cirrhosis and is being admitted for dyspnea, edema and extreme fatigue. The nurse
receiving the report says "How long has he been an alcoholic?" What does the
comment demonstrate? - Answers - Stereotyping based on personal bias
