You are caring for a child who is going to have a tonsillectomy. Which of the following laboratory results would you want to check preoperatively?

A. Prothrombin time

B. Sedimentation rate

C. Blood urea nitrogen

D. Creatinine

Your patient is scheduled to go for cataract surgery. What nursing diagnosis should you include in the patients plan of care?

A. Self care deficit

B. Imbalanced nutrition

C. Disturbed sensory perception

D. Anxiety

You are conducting a teaching session for mothers at a local school on rubeola (measles). Which of the following would you not want to include in this education?

A. Profuse runny nose, coughing and fever occur before the rash develops.

B. The child may develop small, blue-white spots with a red base in the mouth

C. Ears usually develop a rash first, which then spreads toward the feet.

D. The communicable period usually ranges from 10 to 15 days after the rash appears.

Your patient has been admitted to the hospital following a suicide attempt by hanging. What would be important to include in this patient plan of care to maintain patient safety?

A. Assign a staff member to the patient at all times.

B. Place the patient in a seclusion room.

C. Place the patient in a hospital gown.

D. Have another patient stay with the patient.

You have assisted the physician with insertion of a chest tube. As you monitor the fluid level in the water seal chamber you notice fluctuations in the fluid. What is the appropriate action?

A. Notify the physician.

B. Encourage the patient to deep breathe.

C. This is a normal finding.

D. Reinforce the dressing.

You are changing the tape on a tracheostomy tube when the patient coughs, and the tube becomes

dislodged.

The initial action of the nurse should be:

A. Cover the site with a sterile dressing.

B. Notify the physician.

C. Grasp the retention sutures and spread the opening.

D. Notify the respiratory therapist.

You began administering blood to a patient 45 minutes ago. You enter the room to assess the patient and find the patient flushed and dyspneic. On auscultation the patient has crackles in the bases of both lungs. What complication of blood transfusion therapy is the patient most likely experiencing?

A. Hypovolemia

B. Transfusion reaction

C. Fluid overload

D. Bacteremia

You are caring for a patient with a gunshot wound. As a result of the patient's Coumadin therapy, the prothrombin time is twice the normal amount. Which blood product do you expect the physician to order?

A. Fresh frozen plasma

B. Random donor platelets

C. Red blood cells

D. Crystalloids

You are caring for a patient with second- and third-degree burns who is getting fluid intravenously. What would you assess to determine if the patient is getting adequate fluid?

A. Vital signs

B. Urine output

C. Peripheral pulses

D. Mental status

Your patient stopped drinking abruptly and now complains of feeling wired and being on pins and needles. What should your next intervention be?

A. Monitor the patient for other symptoms.

B. Determine the time of last drink, and assess the patient for other signs and symptoms of withdrawal.

C. Assess the patient for all current substance use patterns, including time of last usage and withdrawal.

D. Notify the physician to get an order for stimulate medication.