Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
1. A client in late active first stage labor has just reported a gush of
vaginal fluid. The nurse observes a feta monitor pattern of variable
decelerations during contractions followed by a brief acceleration.
Then, there is a return to baseline until the next contraction, when the
pattern is repeated. Based on this data, the nurse prepares to
initially.
Options:
A) Take the clients vital signs
B) Perform a manual sterile vaginal exam
C) Perform a Leopold’s maneuver
D) Test the vaginal fluid with a nitrazine strip
Correct Answer is: B
Explanation : Variable deceleration with brief acceleration after a
gush of amniotic fluid is a common clinical manifestation of cord
compression caused by occult or frank prolapse of the umbilical
cord. A manual vaginal exam can detect the presence of the cord in
the vagina, confirming the problem. Based on the data in the
question, options 1, 3, and 4 are not initial actions.
2. A nurse is preparing to administer a feeding to a client
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
,Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
receiving enteral nutrition through a nasogastric tube. The
nurse takes which most important action before administering
the feeding?
Options:
A) Measuring intake and output
B) Weighing the client
C) Adding blue food coloring formula
D) Determining tube placement
Correct Answer is: D
Explanation : Initiating a tube feeding before determining tube place.
Options can lead to serious complications such as aspiration.
Options 1 and 2 are part of the total plan of care for a client on
enteral feedings. Option 3 is instituted for a client who has been
identified as a high risk for aspiration. Option 4 is the priority
nursing action.
3. A nurse teaches a client with a rib fracture to cough and deep
breathe. The client resists directions by the nurse because of the
pain. The nurse most appropriately:
Options:
A) Continues to give the client gentle encouragement to do so
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
,Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
B) Requests that the physician perform a nerve block deaden the
pain
C) Explains in detail the potential complications from lack of
coughing and deep breathing
D) Premedicates the client and assists the client to splint the area
during these exercises.
Correct Answer is: D
Explanation : Shallow respirations that occur with rib fracture
predispose the client to developing atelectasis and pneumonia. It is
essential that the client perform coughing and deep breathing
exercises to prevent these complications. The nurse accomplishes
this most effectively by premedicating the client with pain
medication and assisting the client with splinting during the
exercises. Options 2 and 3 are inappropriate. Option 2 is an extreme
measure, and the nurse would not explain in detail potential
complications as identified in option 3. Because the client is
resisting directions, “gentle encouragement” may not be adequate.
4. A nurse is caring for a 14-year-old child who is hospitalized and
placed in Crutch field traction. The child is having difficulty adjusting
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
, Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
to the length or the hospital confinement. Which nursing action
would be most appropriate to meet the child’s needs?
Options:
A) Allow the child to have his or her hair dyed if the parent agrees
B) Allow the child to play loud music in the hospital room
C) Let the child wear his or her own clothing when friends visit
D) Allow the child to keep the shades closed and the room darkened
at all times
Correct Answer is: C
Explanation : An adolescent needs to identify with peers and has a
strong need to belong to a group. The child should be allowed to
wear his or her own clothes to feel a sense of belonging to the group.
The adolescent likes to dress like the group and wear similar
hairstyles. Because Crutch field traction uses skeletal pins, hair dye
is not appropriate.
Loud music may disturb others in the hospital. The child’s request for
a darkened room is indicative of a possible problem with depression
that may need further evaluation and intervention.
5. A nurse receives a telephone call from the emergency room and is
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
Answers With Explanations Latest Update 2022
1. A client in late active first stage labor has just reported a gush of
vaginal fluid. The nurse observes a feta monitor pattern of variable
decelerations during contractions followed by a brief acceleration.
Then, there is a return to baseline until the next contraction, when the
pattern is repeated. Based on this data, the nurse prepares to
initially.
Options:
A) Take the clients vital signs
B) Perform a manual sterile vaginal exam
C) Perform a Leopold’s maneuver
D) Test the vaginal fluid with a nitrazine strip
Correct Answer is: B
Explanation : Variable deceleration with brief acceleration after a
gush of amniotic fluid is a common clinical manifestation of cord
compression caused by occult or frank prolapse of the umbilical
cord. A manual vaginal exam can detect the presence of the cord in
the vagina, confirming the problem. Based on the data in the
question, options 1, 3, and 4 are not initial actions.
2. A nurse is preparing to administer a feeding to a client
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
,Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
receiving enteral nutrition through a nasogastric tube. The
nurse takes which most important action before administering
the feeding?
Options:
A) Measuring intake and output
B) Weighing the client
C) Adding blue food coloring formula
D) Determining tube placement
Correct Answer is: D
Explanation : Initiating a tube feeding before determining tube place.
Options can lead to serious complications such as aspiration.
Options 1 and 2 are part of the total plan of care for a client on
enteral feedings. Option 3 is instituted for a client who has been
identified as a high risk for aspiration. Option 4 is the priority
nursing action.
3. A nurse teaches a client with a rib fracture to cough and deep
breathe. The client resists directions by the nurse because of the
pain. The nurse most appropriately:
Options:
A) Continues to give the client gentle encouragement to do so
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
,Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
B) Requests that the physician perform a nerve block deaden the
pain
C) Explains in detail the potential complications from lack of
coughing and deep breathing
D) Premedicates the client and assists the client to splint the area
during these exercises.
Correct Answer is: D
Explanation : Shallow respirations that occur with rib fracture
predispose the client to developing atelectasis and pneumonia. It is
essential that the client perform coughing and deep breathing
exercises to prevent these complications. The nurse accomplishes
this most effectively by premedicating the client with pain
medication and assisting the client with splinting during the
exercises. Options 2 and 3 are inappropriate. Option 2 is an extreme
measure, and the nurse would not explain in detail potential
complications as identified in option 3. Because the client is
resisting directions, “gentle encouragement” may not be adequate.
4. A nurse is caring for a 14-year-old child who is hospitalized and
placed in Crutch field traction. The child is having difficulty adjusting
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
, Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
to the length or the hospital confinement. Which nursing action
would be most appropriate to meet the child’s needs?
Options:
A) Allow the child to have his or her hair dyed if the parent agrees
B) Allow the child to play loud music in the hospital room
C) Let the child wear his or her own clothing when friends visit
D) Allow the child to keep the shades closed and the room darkened
at all times
Correct Answer is: C
Explanation : An adolescent needs to identify with peers and has a
strong need to belong to a group. The child should be allowed to
wear his or her own clothes to feel a sense of belonging to the group.
The adolescent likes to dress like the group and wear similar
hairstyles. Because Crutch field traction uses skeletal pins, hair dye
is not appropriate.
Loud music may disturb others in the hospital. The child’s request for
a darkened room is indicative of a possible problem with depression
that may need further evaluation and intervention.
5. A nurse receives a telephone call from the emergency room and is
Ryerson University IEPN 150 Exam Questions And
Answers With Explanations Latest Update 2022
