A client arrives in the emergency department

A client arrives in the emergency department after being burned in a house fire. The client’s burns cover the anterior head and neck, left anterior and posterior arm, and anterior trunk. What extent of burns does the client most likely have, measured as a percentage? 2 The intensive care nurse is reviewing a patient’s chart to find the most accurate indicator of fluid volume status, which is: 3 CPR is started on a patient who has developed ventricular fibrillation. The patient is defibrillated once with the resulting rhythm. Which intervention should the nurse implement next? 4 A patient being treated with warfarin (Coumadin) experiences an intracerebral hemorrhage. What should be considered to aid in the care of this patient? 5 The client has been diagnosed with aphasia after suffering a stroke. What can the nurse do to best make the client’s atmosphere more conducive to communication? 6 The nurse is planning care for a patient with an acute kidney injury. Which interventions would prevent further injury to the patient’s kidneys? (Select all that apply.) 7 Using evidence-based practice interventions for a patient with acute kidney injury, the nurse is aware that the best approach for fluid volume excess management is: 8 A patient with heart failure has a decreasing cardiac output. The nurse will expect compensatory mechanisms to be activated in order to: 9 An 82-year-old patient is readmitted for heart failure (HF) 1 week after being discharged for the same diagnosis. Which findings most likely contributed to the patient’s readmission? (Select all that apply.) 10 A client presents to the clinic reporting vomiting and burning in her mid-epigastria. The nurse knows that in the process of confirming peptic ulcer disease, the health care provider is likely to order a diagnostic test to detect the presence of what? 11 A client is brought to the ED by paramedics, who report that the client has partial-thickness burns on the chest and legs. The client has also suffered smoke inhalation. What is the priority in the care of a client who has been burned and suffered smoke inhalation? 12 A home care nurse is performing a visit to a client’s home to perform wound care following the client’s hospital treatment for severe burns. While interacting with the client, the nurse should assess for evidence of what complication? 13 The nurse is teaching a patient, recovering from a mild brain injury, about manifestations to expect during the recovery process. What will the nurse instruct this patient to expect while recuperating from this injury? (Select all that apply.) 14 Of the following patients in an intensive care unit, the nurse identifies which patient as being at the highest risk for the development of acute kidney injury with a prerenal cause? A patient who is: 15 The client with bipolar disorder is started on lamotrigine (Lamictal) and develops a rash. What is the correct nursing response? 16 The parents of a young adult male who has schizophrenia ask how they can recognize when their son is beginning to relapse. The nurse teaches the family to look for which of the following? (Select all that apply.) 17 Which of the following is a priority nursing intervention for a child or adolescent newly started on an SSRI antidepressant? 18 What will the nurse do when caring for a patient with an atrioventricular fistula in the forearm for hemodialysis? 19 Order: Dobutamine 500 mg in 500 mL D5W to infuse at 30 mL/hr. Calculate the following: mg/min _________________________________________________ 20 A patient being treated for a cardiac dysrhythmia is demonstrating signs of an ischemic stroke. What assessment findings alerted the nurse to the development of this complication? (Select all that apply). 21 The nurse monitors the patient undergoing intermittent hemodialysis (IHD) for the most common complication of the procedure, which is: 22 To test for a positive Trousseau’s sign indicating hypocalcemia, the nurse would need which piece of equipment? 23 A patient with a brain tumor is prescribed an antiseizure medication. The nurse realizes that the purpose of this medication will be to: 24 A patient with a penetrating head injury has a Glasgow Coma Scale of 9. The nurse realizes that what will most likely be implemented for patients with this condition? 25 A client has been admitted to a burn intensive care unit with extensive full-thickness burns over 25% of the body. After ensuring cardiopulmonary stability, what would be the nurse’s immediate, priority concern when planning this client’s care? 26 A client’s burns are estimated at 36% of total body surface area; fluid resuscitation has been ordered in the emergency department. After establishing intravenous access, the nurse should anticipate the administration of what fluid? 27 The ICU nurse is caring for a client with sepsis whose tissue perfusion is declining. What sign would indicate to the nurse that end-organ damage may be occurring? 28 The nurse reviews the chart of a child and notes that the child is prescribed methylphenidate (Ritalin). The nurse expects to see which of the following if the Ritalin is effective? 29 The nurse is caring for a client who had a hemorrhagic stroke. What assessment finding constitutes an early sign of deterioration? 30 A client with mania is demonstrating hypersexual behavior by blowing kisses to other clients, making suggestive remarks, and removing some articles of clothing. Which nursing intervention would be most appropriate at this time? 31 A client is brought to the emergency department with a burn injury. The nurse knows that the first systemic event after a major burn injury is what? 32 A client who weighs 90 kg and had a 50% burn injury arrives at the hospital. a. Using the Parkland formula calculate the total volume of fluid the client should be given over the first 24 hours. ___________________mL. b. How many ml/hr would be given for the first 8 hours? _______________mL/hr 33 A nurse on a burn unit is caring for a client who experienced burn injuries 2 days ago. The client is now showing signs and symptoms of airway obstruction, despite appearing stable since admitted. How should the client’s change in status be best understood? 34 A patient a history of type 2 diabetes mellitus and heart failure is prescribed carvedilol (Coreg). What will the nurse assess prior to administering this medication to the patient? (Select all that apply.) 35 While performing a client’s ordered wound care for the treatment of a burn, the client has made a series of sarcastic remarks to the nurse and criticized her technique. How should the nurse best interpret this client’s behavior? 36 An acutely violent client diagnosed with schizophrenia receives several doses of haloperidol (Haldol). Two hours later the nurse notices the client’s head rotated to one side in a stiffly fixed position; the lower jaw is thrust forward, and the client is drooling. Which intervention by the nurse is indicated? 37 Order is to infuse Dopamine 5 mcg / Kg / min. Infusion is prepared with Dopamine 800 mg in D5W 500 mL. Client weighs 85 Kg. What rate will you set the IV pump at? Include all measures. (Round to the nearest tenth.) ________________________mL/hr 38 When a patient says, “The chest pain occurs each time I play basketball; it does not occur when I am sleeping; and it improves when I take those pills under my tongue,” the pain will most likely be classified as: 39 While reviewing a patient’s medication record, the critical care nurse would be concerned about which drugs that have been implicated in the development of renal failure? (Select all that apply.) Note: Credit will be given only if all correct choices and no incorrect choices are selected. 40 A patient is being admitted after sustaining a head injury from an acceleration/deceleration motor vehicle accident. The type of injury that this patient most likely sustained would be: 41 Lab values: pH 7.23, paCo2 34, HCO3 18, pO2 91 Acid- Base Imbalance _______________________________________________ 42 The relative of a chronically mentally ill woman requests that the mentally ill woman be committed because of her history of 12 previous hospitalizations and because she sits around the house all day refusing to get dressed. The nurse tells the relative that the woman cannot be committed because: 43 Lab values: pH 7.56, paCo2 20, HCO3 20, pO2 78 Acid- Base Imbalance ______________________________________________ 44 A nurse is developing a care plan for a client with a partial-thickness burn, and determines that an appropriate goal is to maintain position of joints in alignment. What is the best rationale for this intervention? 45 A nurse is caring for a client who has sustained a deep partial-thickness burn injury. In prioritizing the nursing diagnoses for the plan of care, the nurse will give the highest priority to what nursing diagnosis? 46 A client with a cerebral aneurysm exhibits signs and symptoms of an increase in intracranial pressure (ICP). What nursing intervention would be most appropriate for this client? 47 For which of the following medications would the nurse plan to teach clients to wear protective clothing or sunscreen when outdoors to protect the skin from rashes or sunburns? 48 While transferring a patient with heart failure from the bed to a chair the nurse stops and decides to keep the patient in bed. What patient manifestations indicated to the nurse this patient’s status was deteriorating? (Select all that apply.) 49 A patient’s mean arterial pressure (MAP) decreases to 50 while his ICP is 20. The nurse realizes that this drop in MAP is likely to lead to: 50 A medical nurse is providing palliative care to a client with a diagnosis of end-stage chronic obstructive pulmonary disease (COPD). What is the primary goal of this nurse’s care? 51 The nurse caring for a client who is recovering from full-thickness burns is aware of the client’s risk for contracture and hypertrophic scarring. How can the nurse best reduce this risk? 52 A 67-year-old male patient complaining of “feeling tired” has the following cardiac rhythm. The patient states that he has a history of an irregular heartbeat. His vital signs are BP 134/78; RR 17; SaO2 97% on room air. He denies other complaints at present. The priority action for this patient would be to: 53 The nurse is comparing diabetic ketoacidosis (DKA) to hyperglycemic hyperosmolar nonketotic syndrome (HHNS). What does the nurse identify as the main difference between the two disorders? 54 A client’s burns have required a homograft. During the nurse’s most recent assessment, the nurse observes that the graft is newly covered with purulent exudate. What is the nurse’s most appropriate response? 55 A client has sustained a severe burn injury and is thought to have an impaired intestinal mucosal barrier. What intervention will best assist in avoiding increased intestinal permeability and prevent early endotoxin translocation? 56 A student nurse is working with a client on the inpatient unit who exhibits manipulative behavior. What action should the student incorporate in interactions with this client? 57 A client with severe burns is admitted to the intensive care unit to stabilize and begin fluid resuscitation before transport to the burn center. The nurse should monitor the client closely for what signs of the onset of shock related to burns? 58 A client is brought to the emergency department from the site of a chemical fire, where he suffered a burn that involves the epidermis, dermis, and the muscle and bone of the right arm. On inspection, the skin appears charred. Based on these assessment findings, what is the depth of the burn on the client’s arm? 59 A patient diagnosed with major depressive disorder tells the nurse, “Bad things that happen are always my fault.” To assist the patient in reframing this overgeneralization, how should the nurse should respond? SCIENCE HEALTH SCIENCE NURSING EEX 4931

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