NurseLogic 2.0: Knowledge and Clinical Judgement - Advanced Test
A nurse is caring for a client who has terminal pancreatic cancer. The client is
competent and has requested no resuscitative measures be taken in the event of
respiratory or cardiac arrest. Which of the following is necessary to legally change the
client's code status to do-not-resuscitate (DNR)? - A written prescription from the
provider
A DNR is typically instituted at the request of a client or family member and should be a
written order instead of a verbal prescription. Until a DNR prescription exists. every
attempts to revive the client should be made in the event of respiratory or cardiac arrest.
A written prescription from the provider is necessary to legally change the client's code
status to a DNR
A nurse is caring for a toddler who has acute otitis media and is prescribed benzocaine
(Americaine) ear drops for pain relief. Which of the following actions by the nurse is
appropriate when administering the ear drops? - Warm refrigerated drops to room
temperature prior to instillation.
Because of the anatomy of internal ear structures, it is important to remember that the
ear is sensitive to extremes in temp. Ear drops should be warmed to room temp prior to
instillation to reduce the risk of painful stimuli
A nurse is caring for a client who has a new colostomy. The client is being discharged
and plans to live with her daughter. Which of the following responses by the nurse is
appropriate when the daughter states that she doesn't know how she is going to care for
her mother's colostomy? - "What part of your mother's care concerns you?"
A nurse is caring for a client who is diagnosed with bipolar disorder and is taking lithium
(Lithane). Which of the following serum lithium levels indicates the client's dosage is
appropriate for maintenance therapy? - 0.75 mEq/L
Lithium is a mood-stabilizing medication used in the treatment of bipolar I acute and
recurrent manic and depressive episodes. To achieve a therapeutic range, give 300 mg
to 600 mg of lithium during the active phase. The therapeutic serum lithium level is
between 0.8 mEq/L and 1.4 mEq/L. Maintenance levels of 0.4 to 1.3 mEq/L are then
achieved for clients who are prescribed lithium for long-term therapy. Because small
increments of dosage separate therapeutic, maintenance, and toxic levels of lithium,
knowledge of these levels is essential to ensure safe, quality care. This serum lithium
level indicates the client's dosage is appropriate for maintenance therapy.
A nurse is caring for a client who is scheduled for a lumbar puncture. The nurse should
teach the client that which of the following is a post-procedure complication? -
Headache
A headache is a manifestation experienced by 15 to 30% of clients following a lumbar
puncture that results from cerebrospinal fluid leakage at the puncture site. These
headaches are managed primarily with analgesics, hydration, and bed rest
A nurse is caring for a client who has terminal pancreatic cancer. The client is
competent and has requested no resuscitative measures be taken in the event of
respiratory or cardiac arrest. Which of the following is necessary to legally change the
client's code status to do-not-resuscitate (DNR)? - A written prescription from the
provider
A DNR is typically instituted at the request of a client or family member and should be a
written order instead of a verbal prescription. Until a DNR prescription exists. every
attempts to revive the client should be made in the event of respiratory or cardiac arrest.
A written prescription from the provider is necessary to legally change the client's code
status to a DNR
A nurse is caring for a toddler who has acute otitis media and is prescribed benzocaine
(Americaine) ear drops for pain relief. Which of the following actions by the nurse is
appropriate when administering the ear drops? - Warm refrigerated drops to room
temperature prior to instillation.
Because of the anatomy of internal ear structures, it is important to remember that the
ear is sensitive to extremes in temp. Ear drops should be warmed to room temp prior to
instillation to reduce the risk of painful stimuli
A nurse is caring for a client who has a new colostomy. The client is being discharged
and plans to live with her daughter. Which of the following responses by the nurse is
appropriate when the daughter states that she doesn't know how she is going to care for
her mother's colostomy? - "What part of your mother's care concerns you?"
A nurse is caring for a client who is diagnosed with bipolar disorder and is taking lithium
(Lithane). Which of the following serum lithium levels indicates the client's dosage is
appropriate for maintenance therapy? - 0.75 mEq/L
Lithium is a mood-stabilizing medication used in the treatment of bipolar I acute and
recurrent manic and depressive episodes. To achieve a therapeutic range, give 300 mg
to 600 mg of lithium during the active phase. The therapeutic serum lithium level is
between 0.8 mEq/L and 1.4 mEq/L. Maintenance levels of 0.4 to 1.3 mEq/L are then
achieved for clients who are prescribed lithium for long-term therapy. Because small
increments of dosage separate therapeutic, maintenance, and toxic levels of lithium,
knowledge of these levels is essential to ensure safe, quality care. This serum lithium
level indicates the client's dosage is appropriate for maintenance therapy.
A nurse is caring for a client who is scheduled for a lumbar puncture. The nurse should
teach the client that which of the following is a post-procedure complication? -
Headache
A headache is a manifestation experienced by 15 to 30% of clients following a lumbar
puncture that results from cerebrospinal fluid leakage at the puncture site. These
headaches are managed primarily with analgesics, hydration, and bed rest
