Concepts for Nursing Practice Test Bank

Questions 14

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Concepts for Nursing Practice Test Bank Questions

Question 1 of 5

A nurse working in the emergency department is participating in the resuscitation of a client experiencing sudden cardiac death. After five cycles of CPR, the nurse evaluates the client's cardiac rhythm as asystole. What is the next action by the nurse?

Correct Answer: B

Rationale: Asystole is the absence of any cardiac electrical activity, and it is a non-shockable rhythm. In the case of asystole, defibrillation would not be effective. The next appropriate action would be to continue high-quality CPR and administer epinephrine according to the advanced cardiac life support (ACLS) protocol. Additionally, assessing the client's pulse is crucial to determine if there is any return of spontaneous circulation (ROSC) following CPR and medication administration. Checking the cardiac monitor electrodes ensures proper attachment and accurate monitoring of the client's cardiac rhythm but may not directly impact the management of asystole.

Question 2 of 5

The mother of a baby born with a congenital heart defect is upset, as no one else in the family has been born with this condition. To determine the cause of the defect, which question is appropriate for the nurse to ask the mother?

Correct Answer: A

Rationale: The appropriate question for the nurse to ask the mother in this scenario is "Did you consume any alcohol before you knew you were pregnant?" This is because maternal alcohol consumption during pregnancy is a known risk factor for congenital heart defects. By asking this question, the nurse can gather crucial information to determine a potential cause for the baby's condition. It is important to address this potential risk factor to provide appropriate care and support to the mother and baby.

Question 3 of 5

A nurse working in the emergency department is participating in the resuscitation of a client experiencing sudden cardiac death. After five cycles of CPR, the nurse evaluates the client's cardiac rhythm as asystole. What is the next action by the nurse?

Correct Answer: B

Rationale: Asystole is the absence of any cardiac electrical activity, and it is a non-shockable rhythm. In the case of asystole, defibrillation would not be effective. The next appropriate action would be to continue high-quality CPR and administer epinephrine according to the advanced cardiac life support (ACLS) protocol. Additionally, assessing the client's pulse is crucial to determine if there is any return of spontaneous circulation (ROSC) following CPR and medication administration. Checking the cardiac monitor electrodes ensures proper attachment and accurate monitoring of the client's cardiac rhythm but may not directly impact the management of asystole.

Question 4 of 5

During the health history of an older male patient, the nurse focuses on the gland that encircles the male urethra at the base of the bladder. On which organ is the nurse focusing?

Correct Answer: B

Rationale: The gland that encircles the male urethra at the base of the bladder is the prostate gland. The prostate is an important organ in the male reproductive system that produces fluid to nourish and protect sperm. It also plays a role in ejaculation. A nurse focusing on the prostate gland during the health history of an older male patient is particularly important because issues related to the prostate, such as benign prostatic hyperplasia (BPH) or prostate cancer, commonly affect older men. Regular assessment and screening of the prostate gland are crucial for early detection and management of any potential prostate problems.

Question 5 of 5

The client's vital signs include P 119, R 24, BP 98/63, T 1�F, and SpO2 89%. Which actions would the nurse implement at this time? Select all that apply.

Correct Answer: B

Rationale: B. Coach in nonpharmacologic pain management techniques: The client's vital signs indicate they may be experiencing pain as evidenced by an elevated heart rate (P 119), which can be addressed initially with nonpharmacologic pain management techniques. This approach can help reduce pain and anxiety without the immediate need for medication.

Similar Questions

The client's vital signs include P 119, R 24, BP 98/63, T 1�F, and SpO2 89%. Which actions would the nurse implement at this time? Select all that apply.
A client diagnosed with a pulmonary embolism has a reduction in arterial oxygen saturation level and dyspnea. Which is the priority nursing diagnosis for this client?
The nurse is performing an assessment of a client. Which should the nurse recognize as a noncardiac risk factor for heart failure?
A home health nurse is working with a client who has chronic obstructive pulmonary disease. Which nursing diagnosis will take the highest priority for implementing client education?
A client is admitted to the intensive care unit with disseminated intravascular coagulation (DIC). Which clinical manifestations does the nurse anticipate? Select all that apply.

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