8/10/2019 bsn 2 ward quiz

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Name: _____________________________________ Score: __________________Date: ______________________________________

1. The nurse in charge is assessing a patients

abdomen. Which examination technique

should the nurse use first?

a. Auscultation

b. Inspection

c. Percussion

d. Palpation

2. Nurse Baoraki is revising a clients care plan.

During which step of the nursing process

does such revision take place?

a. Assessment

b. Planning

c. Implementation

d. Evaluation

3. The nurse in charge measures a patients

temperature at 102 degrees F. what is itsequivalent Centigrade?

a. 39 degrees C

b. 47 degrees C

c. 38.9 degrees C

d. 40.1 degrees C

4. The doctor orders dextrose 5% in water

(D5W) 1L to be infused over 8 hours. The IV

tubing delivers 15 drops per milliliters. The

nurse in charge should run the IV infusion at

a rate of:

a. 15 drops per minuteb. 21 drops per minute

c. 32 drops per minute

d. 125 drops per minute

5. Which pulse should the nurse palpate during

rapid assessment of an unconscious male

adult?

a. Radial

b. Brachial

c. Femoral

d. Carotid

6. Blood pressure measurement is an important

part of the patients data base. It is

considered to be:

a. The basis of the nursing diagnosis

b. Objective data

c. An indicator of the patients well-being

d. Subjective data

7. Jake is complaining of shortness of breath.

The nurse assesses his respiratory rate to be

30 breaths per minute and documents that

Jake is tachypneic. The nurse understands

that tachypnea means:

a. Pulse rate greater than 100 beats pe

minute

b. Blood pressure of 140/90

c. Respiratory rate greater than 20 breaths

per minute

d. Frequent bowel sounds

8. A client is receiving 115 mL/hr o

continuous IVF. The nurse notices that the

venipuncture site is red and swollen. Which

of the following interventions would the

nurse perform first?

a. Stop the infusion

b. Call the attending physician

c. Slow the infusion to 20 mL/hr

d. Place a cold towel on the site

9. Nurse Trina, a school nurse, alwaysperforms physical exam to students who

would want to take up nursing. Her

assessment would always start from head

down to the shoulder and waist. This

approach is called as:

a. System framework

b. Proximo-distal method

c. Cephalocaudal type

d. Mass to specific

10. Student Nurse Basmala is about to examine

the abrasions in the posterior portion of an

abuse 5 year old childs body. She would

begin her assessment by which of the

following sequence:

1. Inspection

2. Percussion

3. Palpation

4. Auscultation

a. 1, 2, 4, 3

b. 1, 2, 3, 4

c. 1, 4, 2, 3

d. 1, 3, 2, 411. Postural drainage to relieve respiratory

congestion should take place:

a. Before meals

b. Early morning

c. At bedtime

d. All of the above

12. Which of the following is most correc

concerning suctioning?

a. Apply suction for 5-10 seconds while

withdrawing the suction catheter

8/10/2019 bsn 2 ward quiz

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b. Hyper-oxygenate for several deep

breaths with the ambubag after each

procedure

c. Maintain a clean technique at all times

while suctioning

d. All of the above

13. To assess correct placement of a

nasogastric tube, the nurse should:

a. Instill 30 mL of saline to assess client

tolerance

b. Instill 10 mL of air into the tube and

listen for gurgling sounds with a

stethoscope over the gastric area

c. Aspirate the stomach content with a

syringe

d. Place the end of the tube in water to

assess for bubbling

14. A 43-year-old client is to have foley urinary

catheter care daily. Which of the following is

the best action to provide for the clients

privacy during the treatment?a. Pull the curtain

b. Cover the penis with a towel while

performing catheter care

c. Close the windows of the clients room

d. Ask the clients roommate to leave until

the treatment is finished

15. A patient has IVF infusing in the right arm.

When taking a blood pressure on this

patient, the nurse would:

a. Take the BP in the right arm

b. Take the BP in the left arm

c. Use the smallest possible cuffd. Report inability to take BP

Calculate the following:

16. D5W 1L to infuse for 8 hours, drop factor: 20

gtts/mL

17. D5LR 500 mL to infuse for 12 hours, drop factor:

15 gtts/mL

Identify the following:

18. pH 7.41

PaCO2 32

HCO3 18

19. pH 7.27

PaCO2 25

HCO3 20

20. pH 7.46

PaCO2 48

HCO3 37

Identify the following data as subjective orobjective:

21. Headache -22. Blood pressure (BP) 170/110 -23. Nausea -24. Diaphoresis -25. Equal pupillary reaction -26. Tingling sensation -27. Dizziness -28. Decreased muscle strength -29. Slurred speech -30. Numbness, left arm -

Elaine Ploransky is a pregnant 29-year-old marriedwoman, gravida 1, para 0. She is having contractions 5minutes apart, which she describes as severe cramps.Her husband states, I think her water broke on the wayto the hospital. Physical examination reveals that MrsPloransky is 6 cm dilated. Fetal monitor reveals a fetaheart rate of 120 beats per minute (BPM). The patientsvital signs include BP 140/80, pulse 90 BPMrespirations 22/min. Prenatal records reveal hemoglobin12.0, hematocrit 45, and blood type AB_.Identify:

Primary data source Secondary data source Subjective data Objective data

Prioritize the problems below, assigning primarysecondary, and tertiary levels of priority. Bleeding Fatigue, pallor, hemoglobin 7.0 Nausea and vomiting Grieving Sleep disturbance, fever, night sweats Knowledge deficit on self-administration of insulin Impaired mobility, fractured hip Irregular heart rate >140 BPM BP 70/40 New parent roleMetabolic Acidosis

Metabolic Alkalosis

Respiratory Acidosis

Respiratory Alkalosis