Multi-drug Resistant Organisms

2

You are teaching a client with CORONARY ARTERY DISEASE about dietary measures that should be followed & the client expresses frustration in learning the dietary regimen. You would initially:

• Identify the cause of frustration

• Continue w/ the dietary teaching

• Tell the client that the diet need to be followed

• Notify the physician

3

A postoperative client asks you for pain medication. You would take w/c most appropriate action first?

• Ask for client how long it has been since the last dose of pain medication was administered.

• Gather data from the client about pain.

• Ask the client if the last dose of the medication was effective.

• Prepare the prescribed dose of pain medication.

4

A nurse is caring for a client after crainiotomy (supratentorial surgery) involving the pituitary gland.W/c finding indicates a complication of the surgical procedure & the need to notify the doctor?

• Periorbital edema

• Urine specific gravity of 1.001

• Client reports of mouth dryness

• 30mL fluid in the Jackson-Pratt drain

5

Celebrex has been prescribed for a client. On a follow-up doctor's visit, you determine that the medication is effective if the client states relief of:

• Constipation

• Abdominal pain

• Joint stiffness

• Heartburn

6

You taught a client's spouse how to change the client's colostomy bag. You would best determine that the spouse understands the procedure by:

• Asking the spouse if she has any questions about the procedure

• Asking the spouse if she understands what items are needed to perform the procedure

• Asking the spouse to perform the procedure and observe her performing it

• Asking the spuse if she feels comfortable performing the procedure

7

A client w/ suspected active tuberculosis is being scheduled for diagnostic test. You anticipate that w/c of the ff. diagnostic test will most likely be prescribed to confirm the diagnosis?

• Skin testing

• RBC count

• Chest x-ray

• Sputum smear

8

You are reviewing the nursing care plan of a client hospitalized w/ sickle cell crisis. W/c nursing diagnosis written in the plan is the least priority?

• Acute pain

• Deficient fluid volume

• Ineffective/Impaired tissue perfusion

• Ineffective coping

9

You enter a client's room and find the client slumped over in bed. You quickly assess the client and discover that the client is not breathing. You would immediately:

• Place oxygen via nassal cannula on the client

• Sit the client upright in bed

• Call the physician/doctor

• Begin with CPR

10

A client w/ a diagnosis of cancer is receiving morphine sulfate 10mg subcu q 3-4 hours for pain. When preparing the plan of care for the client, you include w/c priority action?

• Monitor stool

• Monitor the urine output

• Encourage the client to cough and deep breath

• Encourage fluid intake

11

You are assessing the client's conditions afteter cardio version. W/c of the ff. observation would be of highest priority to you?

• Status of airway

• Oxygen flow rate

• Level of consciousness

• Blood pressure

12

You are providing preoperative teaching to a client scheduled for a chocystectomy. W/c intervention would be of highest priority in the preoperative teaching plan?

• Teaching coughing and deep breathing exercise

• Teaching leg exercises

• Instruction regarding fluid restriction

• Assessing the client's understanding of the surgical procedure

13

You are admitting a client w/ a diagnosis of posttraumatic stress disorder to mental health unit. The client is confused and disoriented. Duriing the assessment, your primary goal for this client is:

• Stabilize the client's psychiatric needs

• Orient the client to the unit

• Explain unit rules

• Accept the client and make the client feel safe

14

You have developed a plan of care for a client w/ anorexia nervosa. W/c of the ff. ns. diagnoses would you select as the priority in the plan of care?

• Disturbed body image

• Defensive coping

• Deficient knowledge

• Imbalanced Nutrition

15

You are providing dietary instructions to a client about a low fat diet. You tell the client to:

• Never use butter for cooking

• Read the labels on the food items to determine the fat content

• Eat only foods that have less than 1% fat content

• Drink fluids only if they are fat-free

16

A client is scheduled for computerized tomography (CT) scan for the abdomen and asks you when the result of the test will be available. You make w/c of the most appropriate response to the client?

• "The results won't be available for at least one week"

• "You must ask the CT technician for that information"

• "Your physician may have the results in about 3 days"

• "Every scan is read by radiologist and this process always takes one week"

17

You are caring for a client w/ congestive heart failure who suddenly experience severe dyspnea; you suspect that pulmonary edema has developed. You would immediately:

• Obtain a vial of furosemide (lasix) and a syringe

• Place the client in high-fowlers position

• Obtain a dose of morphine sulfate

• Insert Foley Catheter

18

A client is admitted to the hospital w/ pericarditis. You assess the client for w/c manifestation that differentiate pericarditis from othe cardiopulmonary disease/problems?

• Chest pain that worsens on inspiration

• Pericardial Friction Rub

• Anterior Chest pain

• Weakness and severe irritability

19

Erythromycin has been prescribed for a client w/ a respiratory infection. You tell the client that w/c frequent side effect can occur from this medication?

• Yellow discoloration to the white part of the eye

• Abdominal cramping

• Yellow-colored skin

• Severe diarrhea