NUR3219C
CARE MANAGEMENT II
EXAM Q & A
2024
1. A nurse is assigned to care for a patient with chronic obstructive
pulmonary disease (COPD) who is admitted to the hospital with an
acute exacerbation. The nurse reviews the patient's care plan and
notes that the patient has a goal of maintaining oxygen saturation
above 90%. Which of the following interventions should the nurse
prioritize to achieve this goal?
a) Administer bronchodilators as prescribed
b) Encourage pursed-lip breathing and diaphragmatic breathing
c) Monitor oxygen saturation continuously and adjust oxygen therapy
accordingly
d) Teach the patient about the benefits of smoking cessation
*Answer: c) Monitor oxygen saturation continuously and adjust oxygen
therapy accordingly*
Rationale: Monitoring oxygen saturation continuously and adjusting
oxygen therapy accordingly is the most important intervention to
maintain adequate oxygenation in a patient with COPD.
Bronchodilators, pursed-lip breathing, diaphragmatic breathing, and
smoking cessation are also beneficial, but they are not as urgent as
oxygen therapy.
, 2. A nurse is caring for a patient with heart failure who is receiving
intravenous furosemide, a loop diuretic. The nurse notes that the
patient's urine output has decreased from 100 mL/hour to 30
mL/hour in the past two hours. Which of the following actions should
the nurse take first?
a) Notify the physician
b) Check the patient's blood pressure and pulse
c) Assess the patient for signs of fluid overload
d) Review the patient's electrolyte levels
*Answer: b) Check the patient's blood pressure and pulse*
Rationale: Checking the patient's blood pressure and pulse is the first
action that the nurse should take, as a decrease in urine output could
indicate hypotension or hypovolemia, which are serious
complications of loop diuretics. Notifying the physician, assessing for
fluid overload, and reviewing electrolyte levels are also important, but
they are not as immediate as checking vital signs.
3. A nurse is managing the care of a patient with diabetes mellitus who is
scheduled for a colonoscopy. The nurse instructs the patient to stop
taking metformin, an oral antidiabetic agent, 48 hours before and after
the procedure. What is the rationale for this instruction?
a) To prevent hypoglycemia during fasting
b) To reduce the risk of lactic acidosis
c) To enhance bowel preparation
d) To avoid drug interactions with sedatives
*Answer: b) To reduce the risk of lactic acidosis*
Rationale: Metformin can cause lactic acidosis, a rare but potentially fatal
condition characterized by elevated lactate levels and metabolic acidosis. The risk
of lactic acidosis is increased by factors that impair renal function, such as
dehydration, hypotension, or contrast media. Therefore, metformin should be
discontinued 48 hours before and after any procedure that involves these factors,
such as a colonoscopy.
CARE MANAGEMENT II
EXAM Q & A
2024
1. A nurse is assigned to care for a patient with chronic obstructive
pulmonary disease (COPD) who is admitted to the hospital with an
acute exacerbation. The nurse reviews the patient's care plan and
notes that the patient has a goal of maintaining oxygen saturation
above 90%. Which of the following interventions should the nurse
prioritize to achieve this goal?
a) Administer bronchodilators as prescribed
b) Encourage pursed-lip breathing and diaphragmatic breathing
c) Monitor oxygen saturation continuously and adjust oxygen therapy
accordingly
d) Teach the patient about the benefits of smoking cessation
*Answer: c) Monitor oxygen saturation continuously and adjust oxygen
therapy accordingly*
Rationale: Monitoring oxygen saturation continuously and adjusting
oxygen therapy accordingly is the most important intervention to
maintain adequate oxygenation in a patient with COPD.
Bronchodilators, pursed-lip breathing, diaphragmatic breathing, and
smoking cessation are also beneficial, but they are not as urgent as
oxygen therapy.
, 2. A nurse is caring for a patient with heart failure who is receiving
intravenous furosemide, a loop diuretic. The nurse notes that the
patient's urine output has decreased from 100 mL/hour to 30
mL/hour in the past two hours. Which of the following actions should
the nurse take first?
a) Notify the physician
b) Check the patient's blood pressure and pulse
c) Assess the patient for signs of fluid overload
d) Review the patient's electrolyte levels
*Answer: b) Check the patient's blood pressure and pulse*
Rationale: Checking the patient's blood pressure and pulse is the first
action that the nurse should take, as a decrease in urine output could
indicate hypotension or hypovolemia, which are serious
complications of loop diuretics. Notifying the physician, assessing for
fluid overload, and reviewing electrolyte levels are also important, but
they are not as immediate as checking vital signs.
3. A nurse is managing the care of a patient with diabetes mellitus who is
scheduled for a colonoscopy. The nurse instructs the patient to stop
taking metformin, an oral antidiabetic agent, 48 hours before and after
the procedure. What is the rationale for this instruction?
a) To prevent hypoglycemia during fasting
b) To reduce the risk of lactic acidosis
c) To enhance bowel preparation
d) To avoid drug interactions with sedatives
*Answer: b) To reduce the risk of lactic acidosis*
Rationale: Metformin can cause lactic acidosis, a rare but potentially fatal
condition characterized by elevated lactate levels and metabolic acidosis. The risk
of lactic acidosis is increased by factors that impair renal function, such as
dehydration, hypotension, or contrast media. Therefore, metformin should be
discontinued 48 hours before and after any procedure that involves these factors,
such as a colonoscopy.
