Board Exam Question (Day 4)

Robert, a 57-year-old client with acute arterial occlusion of the left leg undergoes an emergency embolectomy. Six hours later, the nurse isn’t able to obtain pulses in his left foot using Doppler ultrasound. The nurse immediately notifies the physician, and asks her to prepare the client for surgery. As the nurse enters the client’s room to prepare him, he states that he won’t have any more surgery. Which of the following is the best initial response by the nurse?

• Explain the risks of not having the surgery
• Notifying the physician immediately
• Notifying the nursing supervisor
• Recording the client’s refusal in the nurses’ notes

During the endorsement, which of the following clients should the on-duty nurse assess first?

• The 58-year-old client who was admitted 2 days ago with heart failure, blood pressure of 126/76 mm Hg, and a respiratory rate of 22 breaths/minute.
• The 89-year-old client with end-stage right-sided heart failure, blood pressure of 78/50 mm Hg, and a “do not resuscitate” order
• 6The 62-year-old client who was admitted 1 day ago with thrombophlebitis and is receiving L.V. heparin
• The 75-year-old client who was admitted 1 hour ago with new-onset atrial fibrillation and is receiving L.V. dilitiazem (Cardizem)

Matilda, with hyperthyroidism is to receive Lugol’s iodine solution before a subtotal thyroidectomy is performed. The nurse is aware that this medication is given to:

• Decrease the total basal metabolic rate.
• Maintain the function of the parathyroid glands.
• Block the formation of thyroxine by the thyroid gland.
• Decrease the size and vascularity of the thyroid gland.

Tonny has undergoes a left thoracotomy and a partial pneumonectomy. Chest tubes are inserted, and one-bottle water-seal drainage is instituted in the operating room. In the postanesthesia care unit Tonny is placed in Fowler’s position on either his right side or on his back. The nurse is aware that this position:

• Reduce incisional pain.
• Facilitate ventilation of the left lung.
• Equalize pressure in the pleural space.
• Increase venous return

Ricardo is scheduled for a prostatectomy, and the anesthesiologist plans to use a spinal (subarachnoid) block during surgery. In the operating room, the nurse positions the client according to the anesthesiologist’s instructions. Why does the client require special positioning for this type of anesthesia?

• To prevent confusion
• To prevent seizures
• To prevent cerebrospinal fluid (CSF) leakage
• To prevent cardiac arrhythmias

Mr. Mendoza who has suffered a cerebrovascular accident (CVA) is too weak to move on his own. To help the client avoid pressure ulcers, Nurse Celia should:

• Turn him frequently.
• Perform passive range-of-motion (ROM) exercises.
• Reduce the client’s fluid intake.
• Encourage the client to use a footboard.

The nurse is aware that one of the following classes of medications maximizes cardiac performance in clients with heart failure by increasing ventricular contractility?

• Beta-adrenergic blockers
• Calcium channel blocker
• Diuretics
• Inotropic agents

Francis with leukemia has neutropenia. Which of the following functions must frequently assessed?

• Blood pressure
• Bowel sounds
• Heart sounds
• Breath sounds

Timothy’s arterial blood gas (ABG) results are as follows; pH 7.16; Paco2 80 mm Hg; Pao2 46 mm Hg; HCO3- 24mEq/L; Sao2 81%. This ABG result represents which of the following conditions?

• Metabolic acidosis
• Metabolic alkalosis
• Respiratory acidosis
• Respirator y alkalosis

Nurse Alexandra teaches a client about elastic stockings. Which of the following statements, if made by the client, indicates to the nurse that the teaching was successful?

• “I will wear the stockings until the physician tells me to remove them.”
• “I should wear the stockings even when I am sleep.”
• “Every four hours I should remove the stockings for a half hour.”
• “I should put on the stockings before getting out of bed in the morning.”