NR4520 Capstone

Question 5 A client is being induced due to increasing symptoms of preeclampsia. The client also receiving magnesium sulfate, It appears that her labor has not become active despite several hours of oxytocin administration. The client asks the nurse, “Why is it taking so long?” Which response by the nurse is most appropriate? Answers: A-D • • • • The Magnesium makes your uterus have a higher tone, making it compete with the oxytocin.’ magnesium relaxes your uterus and competes with oxytocin. It may increase the duration of your labor. The length of labor varies for different clients. It could be because this is your first baby.” ‘ I don’t know why it is taking so long. Why don’t we check with the health care provider?” 6. A 19-year-old client presents to a primary care clinic reporting a severe headache, nuchal rigidity, temperature of 102(38.9), and scattered petechiae on the torso. What is the nurse’s most appropriate initial action? • • • • Infuse ceftriaxone intravenously as prescribed. Inquire about recent travel outside of the county. Obtain a prescription for intravenous morphine. Place the client in a private room on droplet precautions. 7. A parent asks the nurse whether their infant is susceptible to pertussis and whether they should consent for their infant to receive the pertussis vaccination The nurse’s response should be based on which statement concerning susceptibility to pertussis? • • • • Most children are highly susceptible from birth. Neonates will be immune to pertussis in the first few months of life. Children younger than 1 year seldom contract this disease. If the mother has had the disease, the infant will receive passive immunity. 8. A nurse cares for a client with hypertension. The client’s blood pressure is 186/92 mmHg, heart rate is 90 beats/minute, and respiratory rate is 14 breaths/minute Calculate the client’s pulse pressure. Round to the nearest whole number. 94 9. An infant had a bilateral cleft lip repair two days ago. Which nursing intervention should the nurse include in the client’s plan of care? • • • • Alternate the infant’s position from prone to side-lying to supine. Leave the infant in the crib at all times to prevent future strain. Remove the restraints periodically to cuddle the infant. Keep the infant heavily sedated to prevent stress on the suture line. 10. The following six questions are part of an unfolding case study. A 65-year-old client presents to the emergency department for care. For each client cue, click to specify if the cue is concerning or not concerning to the nurse. Cues Concerning Not concerning. Blood pressure Pulse Bowel assessment Lung sounds 11. 0900 The client presents to the emergency department reports of shortness of breath x3 days and onset of chest pain overnight. On as assessment and is alert and oriented. Labored breathing with fine crackles auscultated bilaterally to lower lung lobes. The client reports chest pain rated 6/10 radiating to the upper abdomen and shoulder. The client reports decreased appetite since the onset of shortness of breath. Bowel sounds active, reported BM 2 days ago Complete the following sentences by choosing from the list of options. The nurse reviews the EKG strip and recognizes the client is most likely experiencing (1 STelevation myocardial infarction. Obtaining a(n) 2) troponin level will verify this hypothesis. The nurse’s priority action is to prepare. client for cardiac catheterization. Answers 1-3 • ST-elevation myocardial infarction • • • troponin level prepare client for cardiac catheterization. Administer epinephrine intravenously. 12. The nurse continues to care for the client in the emergency department following diagnosis. Which orders should the nurse expect from the provider for this client? Select all that apply. • • • • • • • • • • Give nitroglycerin 5 mg SL x 3 doses for chest pain. Continuous heart rhythm monitoring CT with contrast Continuous pulse oximetry Blood culture and sensitivity Amoxicillin 250 mg IVP every 6 hours, first dose now Administer aspirin 324 mg PO x1 dose now. Draw serial troponin levels. Draw CMP and CBC Apply oxygen. 13. The nurse reviews the electronic health record to plan client care for the shift For each action, click to specify if the action should be completed within 5 minutes, within 2 hours, or within 8 hours RN Action hours • • • • • • • 5 minutes 2 hour 8 Transfer client to cardiac catheterization procedure. Reassess client’s vital signs. Ensure troponin collected. Educate on cardiac diet. Administer metoprolol. Administer home antidepressant. Assess client’s pain. 14. The nurse re-assesses the client later in the shift. Complete the following sentences by choosing from the lists of options. Based on the nursing note and client’s vital signs at 1400, the nurse suspects the client is most likely experiencing • • Notify the provider. Prepare for intubation. • • Administer nitroglycerin. Pulmonary embolism 15. The client has remained hospitalized for 7 days and is now stable enough for discharge. For each client statement, click to specify if the statement indicates understanding of discharge education or requires further education. Client Statement Understanding • • • • • • Requires Education “A healthy diet for me includes high-protein red meat and canned vegetables: “I will need to have my cholesterol levels checked regularly.” “Adding light exercise or activity to my daily routine will help me stay healthy: “1 will take a nitroglycerin in the morning to prevent chest pain.” “If I experience chest pain, I will lie down until the discomfort subsides.” “1 should try to cut down on smoking to half as much as I typically smoke.” 16. A client with seizures is to have phenytoin oral suspension 125 mg three times daily. The medication dispensing system delivers a phenytoin solution with concentration of phenytoin 50 mg/mL. How many milliliters (mL) should the nurse administer? Do not round. 17.The nurse admits a client with rash on the torso and upper arms When collecting data to develop a plan of care for the client, which questions should the nurse ask to further assess the rash? Select all that apply. Currently Selected: A,B,E, F • • • • • ” Do you have any allergies?” “When did you first notice the rash?” “Do you smoke cigarettes or drink alcohol?” “How old are you?” “Have you taken any medications recently?” • “Have you recently traveled outside, the country?” 18. The nurse cares for a 27-year-old client in the postoperative care unit. Click to identify the information the nurse identifies that requires corrective action. Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. to Client with history of cerebral palsy and hydrocephalus, postop day 2 after VP shunt revision. Client with allergy to penicillin Alert and oriented, PERRLA, moving al| extremities, lower extremities weaker bilaterally Moderate pain |well-controlled. Client intermittently incontinence at baseline but now reports. pain with urination. Intermittent catheterization performed for urination cultures and sensitivity. Parent is at bedside as client has always required assistance with ADLs. Client alert and oriented, PERRLA, bilateral leg weakness continues. Client reports mild headache and intermittent nausea. Client and parent educated on new droplet precautions. 19. The new nurse manager is getting ready to counsel a staff member for the first time since taking the role of the unit manager. The manager has an idea of the progressive disciplinary process that the hospital uses but wants to ensure that it is done correctly. Which actions by the manager are most appropriate before the meeting? Select all that apply. Answers:A-E • • • • • A Plan on giving the nurse a verbal warning since it is the first time counseling this nurse. Ask another nurse manager to explain the progressive disciplinary policy. Ask a more experienced nurse on the unit how progressive discipline works. Review the hospital’s electronic version of the policy on progressive disciplinary action. Ask colleagues if there is a hard copy of the progressive disciplinary action policy. 20. The nurse cares for a client undergoing conscious sedation for a colonoscopy. During the procedure, which client data is the most important parameter for the nurse to monitor? Answers: A-D • • • • Temperature Blood pressure Heartrate Oxygen saturation 21. The following six questions are part of an unfolding case study. The nurse cares for a 28year-old client in the urgent care clinic • • • • • • • • Appetite Temperature Intermittent dyspnea Cough Respiratory rate Medical history Blood pressure Fatigue Lung sounds 22. The nurse evaluates the diagnostic tests completed on the client as noted in the new nursing note. For each client cue, click to specify if the cue is consistent with respiratory infection, asthma, or both. Client cues • • • • • • Asthma Respiratory infection Fatigue Dyspnea Respiratory Rate Temperature Chest x-ray impression Cough 23. Client presents to urgent care clinic reporting worsening shortness of breath over past 3 months especially with activity, occasional tightness in chest, and frequent coughing spells during the night, client states, this cough keeps me awake at night, and then I am tired during the day.” On assessment client skirts pale, expiratory wheezes bilaterally on auscultation. The client is alert and oriented but denies fever or sick contacts| Client reports decreased appetite over the past few months due to decreased energy, but no weight loss. Adequate fluid intake. Client with a history of hypothyroidism and acid reflux. Takes levothyroxine and esomeprazole dally Chest x-ray and blood work pending. 1430 Blood work as expected with no values out of range. Chest x-ray impression indicates bilateral lungs clear and expanded with no infiltrates or foreign objects. A lung function test was prescribed. Lung function test performed. Results consistent with asthma. Client states, How dan I have asthma? Isn’t that something you get as a child? 1 haven’t had breathing issues before this. 1 just thought I had a cold that wouldn’t go away and the client in the urgent care clinic. The nurse continues the assessment of the 28-year-old client in the urgent care clinic. Which questions should the nurse ask to gather further relevant data from the client. Select all that apply. • • • • • • • • • At what time of day do your symptoms seem to be worse?” “What type of environment do you work in?” “Do you use a humidifier in your room when you are sleeping?” “Is there anything that triggers your breathing difficulties?” “At what age were you diagnosed with hypothyroidism?” F “Do you smoke or are you exposed to cigarette smoke regularly?” G “Do you have pets that live in your home with you?” H “Do you take acetaminophen when you experience pin?” “Is there a history of adult-onset asthma in your family?” 24. The client returns to the emergency department about 2 weeks after the urgent care visit. For each nursing action, click to specify if the action is indicated or not indicated in the client’s care RN Actions Indicated Not indicated. Apply oxygen via nasal cannula. Monitor intake and output Administer intravenous fluid bolus Obtain chest x-ray Administer bronchodilator via nebulizer Monitor pulse oximetry. 25. The nurse cares for the client in the emergency department on 2/21 Click to identify the client statement that is most concerning to the nurse Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To pin. 26.The nurse cares for the client in the emergency department on 2/21 Click to identify the client statement that is most concerning to the nurse Select your answer by clicking the desired location on the image below. To move a pin, click another location on the image. To remove a pin, click it once. 2/21 0145 Client Wheezes breathing administered. on oxygen ability. resolved. Client via Lung RN with nasal sounds discusses mild cannula mildly the shortness at 2L. asthma of diminished Albuterol breath treatment but bilaterally. nebulizer haven’t plan improved the really client was prescribed diagnosis. Client states, gotten any better since my last visit. We gave our cats to our neighbors and had the apartment deep cleaned. My partner also quit smoking in the car or around me at all. I finished my 30-day prednisone prescription just like I was told. I have been taking my budesonide and salmeterol inhalers twice a day. every day. 1 have also been taking my albuterol inhaler every night at bedtime. I don’t understand why I am having attacks with all this medicine. improved breathing ability. Lung sounds mildly diminished bilaterally. Wheezes reso Ned. RN discusses the asthma treatment plan the client was prescribed on diagnosis. Client states, “1 haven’t gotten any better since my last visit. We gave our cats to our neighbors and had the apartment deep cleaned My partner also quit smoking in the car or around me at all. I finished my 30-day prednisone prescription just like was told. I have been taking my budesonide and salmeterol inhalers twice a day, every day. I have also been taking my albuterol inhaler every night at bedtime. I don’t understand why 1 am having attacks with all thjs medicine!” 0500 Client stable since albuterol nebulizer and has been weaned off oxygen. No evidence of infection. Client to be discharged home. RN to provide discharge education. The nurse prepares to discharge the client from the emergency department. For each statement by the nurse completing discharge education, click to specify if the statement should be included or not included in the education. Discharge Education Use a peak flow monitor daily and record your readings Include Do not include Wear a mask whenever outdoors “Lie down when an asthma attack begins. “Follow up with your provider for home oxygen equipment “Keep the albuterol inhaler with you at all times. 27. Four clients in the dining room of a skilled nursing facility have been served lunch, but only three ate the meal. The other client, who practices the Islam faith, did not eat any item from the meal tray of ham, mashed potatoes, and green beans What nursing action is the priority • Practicing Muslims do not eat vegetables, so remove the meal and bring the client something else. • Ask the client what other food is desired since practicing Muslims do not eat pork • Remove the tray and document that the client refused the meal. • Remove the ham from the client’s plate and leave the remaining food items 28.A client with chronic obstructive pulmonary disease is admitted to the unit and is receiving inhaled corticosteroids. What is an appropriate goal that should be included in the client’s plan of care? Currently Selected: B • A Will remain free of fungal oral infection throughout the hospital stay • B Will gargle with water after every usage of inhaled corticosteroid • C Will not experience any symptoms of respiratory distress • D Draw labs for arterial blood gases in am and call provider with results. 29.A Client is on vacation in the United States from another country and is returning home in 5 days. Presents to the emergency department with reports of fatigue, night sweats, and persistent cough for about 10 days. The client states, “When I coughed yesterday, I noticed my sputum was blood tinged.” The client is worried about getting sick while here because the client has no family members in the country Lungs clear to auscultation. The client has a non-productive cough but exhibits no shortness of breath. Blood pressure 108/62, heart rate 68, respiratory rate 16 temperature 100.8 °F (38.2 °C), and Sp02 97% on room air. 1430 The client awaiting health care provider (HCP) examination. No distress 1510 Client came to the nurse’s station to ask how much longer the wait to see the HCP will be as the client has 1630 appointment somewhere. Notified client that HCP should be there shortly. • • • • • • A client presents to the emergency department and shares a health history with the nurse that includes malaria and ulcerative colitis. Based on the information in the chart, what lapse in nursing care occurred? No medication was given for increased temperature. Supplemental oxygen was not administered Nurse did not administer medication for the cough Respiratory isolation was not instituted. 30. The nurse assesses multiple pregnant clients in the clinic. Which client is at greatest risk for preeclampsia? • • • • A 25-year-old Asian American whose pregnancy is the result of donor insemination. A 30-year-old Caucasian with her third pregnancy who is obese. A 19-year-old African American client who is pregnant with twins. A 41-year-old Caucasian primigravida 31.The nurse performs medication reconciliation for a newly admitted client and notes a prescription for daily antacids. What other prescription in the client’s electronic health record causes the nurse to call the health care provider? • A Levofloxacin • B Sublingual nitroglycerin • C Acetaminophen • D Saline enema 32. The nurse teaches the parents of a preschool child with sickle cell disease about the condition. Which information should the nurse include about the care of their child? Select all that apply. • Notify the provider if the child’s temperature is 101.3 °F (38.5 PC) or greater. • Limit fluids at bedtime to avoid trips to the bathroom during the night. • Notify the provider if the child develops symptoms of a cold. • • • Administer oral penicillin as prescribed. Make bedrest tolerable by using age-appropriate toys and diversions Use ice packs to minimize Vaso-occlusive pain in the legs 33. Nursing Notes MAR 26 27 Medication 6/19 28 Metoprolol 50 mg Po bid 0636 Given 29 Midazolam1 mg IVPX1 1125 Given For each situation, click to specify if the situation is a problem to address prior to surgery or if the situation is not a problem. The nurse preceptor oversees a new nurse preparing a client for surgery. 34.A client with diabetes Meletus received the prescribed doses of regular and NPh insulin at0800.At1200, the client reports feeling shaky, lightheaded, and faint. Which action should the nurse take next? • Prepare the next dose of regular insulin. • Obtain capillary blood glucose. • Call the rapid response team. • Prepare to administer 50% dextrose IV. 35. 36 37 39 40 6.something you get as a child? 1 haven’t had breathing issues before this. 1 just thought had a cold that wouldn’t go away.” 2/21 19 0100 Client presents to emergency department with reports of being woken up with a severe coughing spell and significant shortness of breath following the coughing spell. Client was recently diagnosed with asthma. On assessment client’s lung sounds diminished with expiratory wheeze bilaterally. The client is pale and diaphoretic Client. reports feeling dizzy. 0145 Client on oxygen via nasal cannula at 2L. Albuterol nebulizer was administered. The client with mild shortness of breath but improved breathing ability. Lung sounds mildly diminished bilaterally. Wheezes resoNed. RN discusses the asthma treatment plan the client was prescribed on diagnosis. The client states, “1 haven’t really gotten any better since my last visit. We gave our cats to our neighbors and had the apartment deep cleaned, My partner also quit smoking in the Ihave been taking my car or around me at all. finished my 30-day prednisone prescription just like was budesonide and salmeterol inhalers twice a day, every day. I have also been taking my albuterol inhaler every night at bedtime. I don’t understand why I am having attacks with all th|s medicine!” Client stable since albuterol nebulizer and has been weaned off oxygen. No evidence of infection. Client to be 0500 discharged home. RN to provide discharge education. The nurse prepares to discharge the client from the emergency department. Discharge Education “Use a peak flow monitor daily and record your readings. “Wear a mask whenever outdoors. “Lie down when an asthma attack begins. “Follow up with your provider for home oxygen equipment.” “Keep the albuterol inhaler with you at all times. 41. 42.The nurse performs an assessment on a client with chronic obstructive pulmonary disease who reports sleeping less than six hours a day. Which recommendations should the nurse encourage to promote sleep? Select all that apply. Currently Selected: B,C,F • • • • • • Drink a cup of coffee at bedtime. B Take a warm bath before bedtime. Do not eat a large meal before bed. Increase the temperature in the bedroom. E Engage in active stretching exercises before bed F Establish a regular bedtime routine 43. The nurse develops a plan of care for a client on the psychiatric unit admitted with paranoid personality disorder with auditory hallucinations What is the most important intervention for the nurse to include? • • • • Place the client on a suicide watch when out of bed. Apply restraints to the client while in bed to prevent self-harm. Determine from the client what the voices are saying. Ask the client to describe the people the client is seeing. 44. The nurse cares for a client suspected of having Clostridioides difficile (C. diff). Which actions are most appropriate for the nurse to implement? Select all that apply. • • • • • • Place on Contact Precautions Use alcohol-based hand gel. Encourage the client to wear a mask when out of the room. Don a gown and gloves during client care. Wear a mask when entering the room. Wash your hands with soap and water. 45. The nurse prepares to administer morphine sulfate 8 mg via intravenous injection. The pharmacy provides morphine sulfate 15 mg/mL How many milliliters should the nurse administer? Round to the nearest tenth 0.5mL 46. The chief nursing officer (CNO) has had complaints about some nursing units, which are reflected in the client satisfaction scores. It is determined that the laissez-faire leadership style employed by nurse managers on those units is to be blamed. What actions by the nurse managers cause the CNO to label them as laissez-faire leaders? Provide empowerment and inspiration to staff to reach their short-term goals. Give minimal guidance to staff on the unit, using a handsoff approach. Provide rewards in staff meetings for staff who worked the most extra shifts for the month. Encourage and motivate unlicensed assistive personnel (UAP) to return to school. 470830 A 74-year-old client presents to the clinic requesting the influenza vaccine. The client says, “1 always get the flu shot but was on vacation, so I’m late this year. I hear the flu is going to be bad this year. My eyes are itchy from my usual allergies, but apart from that, I feel just fine.” Blood pressure 1 40/86, heart rate 92, respiratory rate 18. Temperature 98.9 °F (37.2 ‘C), and Sp02 96% on room air. 2094 Prescription received from health care provider to administer a dose of live attenuated influenza vaccine (nasal spray) to the client. 47. A client with a history of Guillain-Barré Syndrome and hypertension comes to the primary care clinic Based on the information in the client’s electronic health record, what nursing action |s most appropriate? • • Hold the influenza vaccine and verify the prescription with the health care provider. Tell the client that administering the influenza vaccine is too dangerous. • • Administer the prescribed influenza vaccine and document the client’s tolerance. administer the vaccine but change it to the injection route instead. 48. A seven-year-old child with autism is hospitalized with asthma exacerbation. The nurse works with the healthcare team to establish a plan of care for the child. Which factor associated with the preferences held by many children with autism should be included in the plan of care? • • • • Parents need not be at the hospital or room-in with the client. During the hospitalization, parents’ expectations are met. The child is supported throughout the autistic crisis. The child’s routine habits and preferences are maintained. 49 A client presents to the emergency department with suspected placental abruption. Which assessment finding is most concerning to the nurse? • • • • An Increase in maternal blood pressure Decrease in reports of abdominal pain. Decrease in fundal height. Hard, board-like abdomen. 50. The nurse cares for a client in the emergency department with a painful ankle following a fall while running. The client is depicted in the image above. Which is the next nursing action? • • • Apply sequential compression device. Alternate applying ice packs and heat. Perform passive range of motion. 51. The nurse cares for a preschool child with an arm cast applied recently for a fractured humerus. Which assessment findings would warrant an immediate call to the health care provider due to a potential serious complication? Select all that apply. Currently Selected: • A Capillary refill to extremity of

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