NUR 262 EXAM 1 QUESTIONS AND ANSWERS WITH
COMPLETE SOLUTIONS GRADED A++
The nurse teaches a client diagnosed with atherosclerosis about the disease
process. Which client statement allows the nurse to evaluate the instruction as
effective?
1. "Fatty deposits on the heart muscle it denser and pumping becomes
ineffective"
2. "Fat generates fewer calories than other energy sources in the diet. So you
have to eat more, which causes obesity"
3. "Fatty deposits in the artery makes its diameter smaller"
4. "Fat is not the primary source of energy that the body uses for all metabolic
functions"
3. "Fatty deposits in the artery make its diameter smaller."
Fat in the form of LDL cholesterol deposits on the artery wall, shrinking its diameter and
providing greater resistance to flow. When the diameter becomes too small and flow
cannot keep up with the requirements of the tissue, ischemia can result.
in a normal adult, fat does not deposit on the heart muscle. Fat will deposit itself
in the walls of the arteries
,Which objective data is most important when determining if a client is hypoxic?
1. Cool, bluish skin
2. Abnormal blood gases
3. Elevated temperature
4. Increased sputum production
2. Abnormal blood gases
Arterial blood gases test measures tissue oxygenation, carbon dioxide removal, and
acid-base balance. If the client has inadequate exchange of oxygen and carbon dioxide,
respiratory acidosis occurs.
A client diagnosed with iron deficiency anemia receives heparin after a venous
thromboembolism (VTE) is diagnosed in the left leg. Which observation most
concerns the nurse?
1. The client passes a black stool.
2. The client is pale.
3. The client has a nosebleed.
4. The client is confused
3. The client has a nosebleed
Active bleeding from any site can indicate hemorrhage, the primary concern with
anticoagulant medications such as heparin. Immediate management of the epistaxis
,(nosebleed) and notification of the healthcare provider should occur. If needed, protein
sulfate, the specific heparin antagonist, may be given.
To assess the pedal pulse, the nurse palpates which location?
1. the region in the back of the knee
2. The top of the foot
3. The groin area
4. The inner side of the ankle below the medial malleolus
2. The top of the foot
Passes laterally over the foot
A client is diagnosed with a tension pneumothorax resulting from the chest
hitting the steering wheel during an automobile accident. The emergency
department nurse knows the highest priority is given to which intervention?
1. Oxygenation
2. Chest Tube insertion
3. Arterial blood gas (ABG) determination
4. Attaching a cardiac monitor
2. Chest tube insertion
A tension pneumothorax is an accumulation of air in the pleural space that is under
pressure. The pressure compresses the lungs and decreases venous return to the
, heart. It is considered a medical emergency. immediate treatment for a tension
pneumothorax is a needle decompression to allow the release of air. The needle
decompression will cause a simple pneumothorax and a chest tube will need to be
inserted. Motor vehicle accidents and blunt chest trauma are 2 potential causes.
Blood gas results from a client with emphysema indicate serve hypoxia. Oxygen
therapy is prescribed at 50% GiO2. Which method of oxygen administration will
most likely be used?
1. Face mask with reservoir
2. simple face mask
3. Nasal cannula
4. venturi mask
4. Venturi mask
Venturi masks provide oxygen at specified percentages, which is how oxygen should be
administered to clients with COPD or emphysema. The nurse will ensure that the
correct adapter is on the Venturi mask and that the oxygen flow corresponds to the
needed FiO2 prescribed. The nurse should keep the tubing free of kinks.
The nurse provides care for a client in Buck traction awaiting repair of a fractured
left femoral neck. The client reports pain in the left calf. The nurse notes the calf
area is warm and red. The nurse identifies these symptoms as being caused by
which pathology?
COMPLETE SOLUTIONS GRADED A++
The nurse teaches a client diagnosed with atherosclerosis about the disease
process. Which client statement allows the nurse to evaluate the instruction as
effective?
1. "Fatty deposits on the heart muscle it denser and pumping becomes
ineffective"
2. "Fat generates fewer calories than other energy sources in the diet. So you
have to eat more, which causes obesity"
3. "Fatty deposits in the artery makes its diameter smaller"
4. "Fat is not the primary source of energy that the body uses for all metabolic
functions"
3. "Fatty deposits in the artery make its diameter smaller."
Fat in the form of LDL cholesterol deposits on the artery wall, shrinking its diameter and
providing greater resistance to flow. When the diameter becomes too small and flow
cannot keep up with the requirements of the tissue, ischemia can result.
in a normal adult, fat does not deposit on the heart muscle. Fat will deposit itself
in the walls of the arteries
,Which objective data is most important when determining if a client is hypoxic?
1. Cool, bluish skin
2. Abnormal blood gases
3. Elevated temperature
4. Increased sputum production
2. Abnormal blood gases
Arterial blood gases test measures tissue oxygenation, carbon dioxide removal, and
acid-base balance. If the client has inadequate exchange of oxygen and carbon dioxide,
respiratory acidosis occurs.
A client diagnosed with iron deficiency anemia receives heparin after a venous
thromboembolism (VTE) is diagnosed in the left leg. Which observation most
concerns the nurse?
1. The client passes a black stool.
2. The client is pale.
3. The client has a nosebleed.
4. The client is confused
3. The client has a nosebleed
Active bleeding from any site can indicate hemorrhage, the primary concern with
anticoagulant medications such as heparin. Immediate management of the epistaxis
,(nosebleed) and notification of the healthcare provider should occur. If needed, protein
sulfate, the specific heparin antagonist, may be given.
To assess the pedal pulse, the nurse palpates which location?
1. the region in the back of the knee
2. The top of the foot
3. The groin area
4. The inner side of the ankle below the medial malleolus
2. The top of the foot
Passes laterally over the foot
A client is diagnosed with a tension pneumothorax resulting from the chest
hitting the steering wheel during an automobile accident. The emergency
department nurse knows the highest priority is given to which intervention?
1. Oxygenation
2. Chest Tube insertion
3. Arterial blood gas (ABG) determination
4. Attaching a cardiac monitor
2. Chest tube insertion
A tension pneumothorax is an accumulation of air in the pleural space that is under
pressure. The pressure compresses the lungs and decreases venous return to the
, heart. It is considered a medical emergency. immediate treatment for a tension
pneumothorax is a needle decompression to allow the release of air. The needle
decompression will cause a simple pneumothorax and a chest tube will need to be
inserted. Motor vehicle accidents and blunt chest trauma are 2 potential causes.
Blood gas results from a client with emphysema indicate serve hypoxia. Oxygen
therapy is prescribed at 50% GiO2. Which method of oxygen administration will
most likely be used?
1. Face mask with reservoir
2. simple face mask
3. Nasal cannula
4. venturi mask
4. Venturi mask
Venturi masks provide oxygen at specified percentages, which is how oxygen should be
administered to clients with COPD or emphysema. The nurse will ensure that the
correct adapter is on the Venturi mask and that the oxygen flow corresponds to the
needed FiO2 prescribed. The nurse should keep the tubing free of kinks.
The nurse provides care for a client in Buck traction awaiting repair of a fractured
left femoral neck. The client reports pain in the left calf. The nurse notes the calf
area is warm and red. The nurse identifies these symptoms as being caused by
which pathology?
