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NUR 2392 EXAM 1 LATEST 2023-2024 /NUR2392
MULTIDIMENSIONAL CARE 2 EXAM 1/MDC2 EXAM 1
ACTUAL EXAM 75 QUESTIONS AND CORRECT DETAILED
ANSWERS|AGRADE (RASMUSSEN COLLEGE)
The nurse is educating a group of older adults about screening for colorectal cancer. Which
statement by a group member indicates the need for further clarification about these
guidelines?
Correct
- “I will need to have a routine colonoscopy every 5 years.”
The 2015 guidelines indicate that routine screening with colonoscopy is performed every
10 years, not every 5 years.Other options are performed at 5-year intervals. A barium
enema every 5 years is a screening option. A flexible sigmoidoscopy and a “virtual”
colonoscopy every 5 years are also acceptable for screening. A “virtual” colonoscopy or
CT colonography is a noninvasive imaging procedure that takes multidimensional views
of the entire colon.
The nurse is assessing an alert client who had abdominal surgery yesterday. What method
provides the most accurate data about resumption of peristalsis in the client?
Correct - Asking the client whether he or she has passed flatus (gas) within the previous 12 to 24
hours. (p. 17)
The best and most reliable method for assessing the return of peristalsis following
abdominal surgery is the client’s report of passing flatus within the past 8 hours or stool
within the past 12 hours.Although auscultation and counting the number of sounds was
once a method of assessing for bowel activity, it is no longer considered the most
effective method. Observing the abdomen is one method of examining a client’s
abdomen, but it is not a reliable way to assess for resumption of activity after surgery.
The nurse is assessing a client who comes to the emergency department with acute
abdominal pain. The nurse notes a bulging, pulsating mass when inspecting the abdomen.
Which action by the nurse is correct?
Correct - Notify the provider about this finding immediately.
The nurse needs to immediately notify the health care provider because a bulging,
pulsating mass may indicate an abdominal aortic aneurysm requiring emergency
actions.Palpating the abdomen or even touching the abdomen with a stethoscope may
cause this to rupture, which would be a life-threatening emergency. Because this is a
potential life-threatening situation, questioning the client about stool habits is not
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appropriate.
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The nurse is assessing a client who has come to the emergency department with acute
abdominal pain. The client is very thin and the nurse observes visible peristaltic
movements when inspecting the abdomen. What does the nurse suspect?
Correct
- Intestinal obstruction
The nurse would suspect an intestinal obstruction related to peristaltic movements.
Peristaltic movements are rarely seen except in thin clients. This needs to be reported to
the HCP.Acute diarrhea does not cause visible peristaltic movements. Aortic aneurysm
may cause a bulging, pulsatile mass. Pancreatitis is characterized by severe pain.
.
A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal
pain. Which assessment technique does the nurse use for this client?
Correct - Examines the RUQ of the abdomen last following all other assessment techniques.
If the client reports pain in the RUQ, the nurse would examine this area last in the
examination sequence. This sequence prevents the client from tensing abdominal muscles
because of the pain, which would make the examination difficult.The sequence for
examining the abdomen is inspection, auscultation, percussion, and then palpation. This
sequence prevents the increase in intestinal activity and bowel sounds caused by
palpation and percussion. The client would be positioned supine with the knees bent,
while keeping the arms at the sides to prevent tensing of the abdominal muscles. If a
bulging, pulsating mass is present during assessment of the abdomen, do not touch the
area because the client may have an abdominal aortic aneurysm, a life-threatening
problem. Notify the health care provider of this finding immediately!
Which substance, produced in the stomach, facilitates the absorption of vitamin B12?
Correct - Intrinsic factor
Intrinsic cells are produced by the parietal cells in the stomach. This substance facilitates
the absorption of vitamin B12. Absence of intrinsic factor causes pernicious
anemia.Glucagon, which is produced by the alpha cells in the pancreas, is essential for
the regulation of metabolism. Parietal cells secrete hydrochloric acid, but this does not
facilitate the absorption of vitamin B12. Pepsinogen is secreted by the chief cells;
pepsinogen is a precursor to pepsin, a digestive enzyme.
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Which client does the charge nurse assign to an experienced LPN/LVN working on the
adult medical unit?
Correct
- A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis
Nasogastric tube insertion is included in LPN/LVN education and is an appropriate task
for an experienced LPN/LVN.Assessment and client teaching would be done by an RN.
IV hypnotic medications would be administered by an RN.
The outpatient clinic nurse is caring for a recovering client who had a colonoscopy. The
client asks for a drink. How does the nurse respond to this request?
Correct - “When you are able to pass flatus (gas), you can have a drink.”
Fluids are permitted after the client’s peristalsis has returned, which is validated by the
client’s passing flatus (p. 34).Ability to pass flatus (gas) is more reliable than auscultation
of bowel sounds when assessing a client’s status to drink after a colonoscopy. There is no
set time period after the procedure that is considered safe for the client to have something
to drink. The client will not be discharged home without the nurse determining that
peristalsis has returned. The client must report that he or she is passing flatus to go home;
therefore, the client should be given a drink before being sent home.
Which factors place a client at risk for gastrointestinal (GI) problems?
Correct - Smoking a half-pack of cigarettes per day
Smoking or any tobacco use places a client in a higher-risk category for GI problems.
Socioeconomic status can also influence the risk for GI problems; clients may not be able
to afford to seek care or treatment and may put off seeking help. Some herbal
preparations contribute to GI problems, such as Ayurvedic herbs, which can affect
appetite, absorption, and elimination. NSAIDs can predispose clients to peptic ulcer
disease or GI bleeding.High-fiber diets are generally believed to be healthy for most
clients.
Correct - Socioeconomic status
Smoking or any tobacco use places a client in a higher-risk category for GI problems.
Socioeconomic status can also influence the risk for GI problems; clients may not be able
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1
NUR 2392 EXAM 2 LATEST 2023-2024 /NUR2392 MULTIDIMENSIONAL CARE 2 EXAM
2/MDC2 EXAM 2 ACTUAL EXAM 75 QUESTIONS AND CORRECT DETAILED
ANSWERS|AGRADE (RASMUSSEN COLLEGE)
- Which pH value indicates the highest concentration of free hydrogen ions in the blood and other
extracellular fluids?
A. 7.57
B. 7.47
C. 7.37
D. 7.27
The blood level of free hydrogen ions is calculated in negative logarithm units. This calculation makes the value of
pH inversely related (negatively related) to the concentration of free hydrogen ions. Thus, the lower the pH value
of a fluid, the higher the level of free hydrogen ions in that fluid. - Which client arterial blood gas results would the nurse interpret as within normal limits?
A. pH 7.28, PaCO2 24, bicarbonate 15, PaO2 95
B. pH 7.45, PaCO2 41, bicarbonate 25, PaO2 97
C. pH 7.35, PaCO2 24, bicarbonate 15, PaO2 95
D. pH 7.30, PaCO2 66, bicarbonate 38, PaO2 70 The normal arterial pH range is 7.35-7.45. The normal
PaCO2 range is 35-45 mm Hg.
The normal PaO2 range is 80-100 mm Hg.
The normal arterial bicarbonate range is 21-28 mEq/L (mmol/L). - Which arterial blood pH level can be fatal?
A. 7.22 B. 7.11
C. 7.05
D. 6.85
An arterial pH below 6.85 is considered incompatible with life because all vital organ functions would be
inhibited. - By which mechanism do buffers help maintain arterial blood pH within the normal range?
A. Binding excess free hydrogen ions
B. Increasing kidney excretion of free hydrogen ions
C. Triggering increased bicarbonate production in the pancreas
D. Stimulating respiratory neurons to increase the rate and depth of ventilation
Buffers in body fluids act like hydrogen ion “sponges,” soaking up hydrogen ions when too many are present and
squeezing out hydrogen ions when very few are present. Buffers have no mechanism to change kidney, pancreas,
or neuronal function. - What changes in body functions does the nurse anticipate in a client who has lower than normal blood
pH levels? Select all that apply.
A. Decreased serum potassium levels
B. Increased effectiveness of drugs
C. Reduced function of hormones
D. Increased function of enzymes
E. Decreased electrical conduction in the heart
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2
F. Decreased skeletal muscle strength
Higher concentration of hydrogen ions (reflected by a lower pH) increases (not decreases) serum potassium
levels, decreases effectiveness of drugs, reduces function of hormones, reduces function of enzymes, slows
electrical conduction through the heart (because of the elevated potassium levels) and decreases muscle strength.
- The continuous normal function of which organs is most critical for acid-base balance? Select all that
apply.
A. Adrenal glands
B. Bladder
C. Heart
D. Kidneys
E. Liver
F. Lungs
The kidneys are critical in retaining and eliminating hydrogen ions and bicarbonate to maintain acid-base
balance. The lungs are the organs that control carbon dioxide elimination. Normal functioning of both these
organs are necessary for acid-base balance. A problem interfering with the function of either of them can lead to
life-threatening acid-base imbalances. The heart, liver, and bladder have no role in acid-base balance. Although
specific adrenal gland problems are indirectly associated with acid-base imbalances, they do not directly affect
acid-base balance. - Which statement most accurately describes the relationship between the hydrogen ion concentration and
carbon dioxide concentration in extracellular fluids?
A. Because carbon dioxide is a gas and hydrogen ions are electrolytes, these two substances have no
relationship in extracellular fluids.
The concentrations of hydrogen ions and carbon dioxide are directly related, with an increase or
decrease in one always resulting in a corresponding increase or decrease in the other.
C. Carbon dioxide buffers hydrogen ions, thus these two concentrations are inversely related to each other.
The greater the carbon dioxide concentration, the fewer hydrogen ions present in that fluid.
D. Hydrogen ions and carbon dioxide ions exist in a balanced relationship as a result of their charges. The
positively charged hydrogen ions are attracted to the negatively charged carbon dioxide ions, forming an
electrically neutral substance.
Through the action of the carbonic anhydrase reaction, the concentration of hydrogen ions is directly related to
the concentration of carbon dioxide in the blood. Any condition that increases the concentration of one also
increases the concentration of the other. Carbon dioxide is not a buffer. - Which statement about compensation for acid-base imbalance is accurate? A. The respiratory system is
less sensitive to acid-base changes.
B. The respiratory system can begin compensation within seconds to minutes.
C. The renal system is less powerful than the respiratory system.
D. The renal system is more sensitive to acid-base changes.
The healthy respiratory system can compensate for acid-base imbalances from other causes. It represents the
second line of defense to prevent an imbalance and can begin to compensate within seconds to minutes after a
change in hydrogen ion concentration (reflected as a corresponding change in carbon dioxide). The central
chemoreceptors controlling rate and depth of ventilation are extremely sensitive to changes in carbon dioxide
levels. - Which condition or response is an example of physiologic compensation to maintain acid-base balance?
A. Increasing rate and depth of respiration when running 2000 feet
B.
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B. Increasing urine output when blood pressure increases during heavy exercise
C. Drinking more fluids when spending an extended period of time in a dry environment
D. Shifting body weight when pain occurs as a result of remaining in one position for too long
The respiratory system increases its activity by “blowing off” excess carbon dioxide that developed as a result of
lactic acidosis occurring in skeletal muscle when blood flow and oxygenation were insufficient to meet the
increased demand for oxygen (oxygen debt) created during increased skeletal muscle metabolism.
- Which statements correctly apply to acid-base balance in the body? Select all that apply.
B. The immediate binding of excess hydrogen ions occurs primarily in the red blood cells.
C. Combined acidosis is less severe than either metabolic acidosis or respiratory acidosis alone.
D. Respiratory acidosis is caused by a patent airway.
E. Acid-base balance occurs through control of hydrogen ion production and elimination.
F. Buffers are the third-line defense against acid-base imbalances in the body.
Acid-base balance is maintained by controlling the body’s hydrogen ion production with mechanisms to eliminate
hydrogen ions at the same rate they are produced. Renal mechanisms for control of acid-base balance are the
most powerful but are slow to start, usually requiring that an acid-base disturbance be present for at least 24
hours before becoming active. The first line of defense against acid-base changes are the buffers in the blood,
other extracellular fluids, and inside cells. Red blood cells in particular can reduce excess hydrogen ions by having
them enter the cells and then binding them to buffers and hemoglobin. Respiratory acidosis is caused by
problems that interfere with effective ventilation. A patent airway never causes respiratory acidosis. When
conditions that cause respiratory acidosis are present at the same time as conditions that cause metabolic
acidosis, the severity of the imbalance increases, not decreases. - Which alteration in acid-base balance does the nurse expect to see as a compensatory response in a client
who has a long-term severe respiratory impairment?
A. Decreased arterial blood pH
B. Increased arterial blood oxygen
C. Increased arterial blood bicarbonate
D. Decreased arterial blood carbon dioxide
Because kidneys regulate pH by controlling bicarbonate concentration and the lungs regulate pH by controlling
carbon dioxide loss, a loss of one function can be at least partially compensated by the other function. When
pulmonary function is decreased so that adequate amounts of carbon dioxide are not excreted, the pH drops,
stimulating the kidneys to reabsorb more bicarbonate to balance the increased acid production. - Which specific type of medication reported as taken daily by an older client will cause a nurse to assess
for indications of an acid-base imbalance?
A. Antilipidemics
B. Hormonal therapy
C. Diuretics
D. Antidysrhythmics
Of all the drug categories listed, only the diuretics induce the excretion of specific electrolytes and hydrogen ions,
leading to the development of acid-base imbalances.
Renal mechanisms are stronger in regulating acid-base balance but slower to respond than respiratory
mechanisms.
A.
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NUR 2392 FINAL EXAM 2023-2024 /NUR2392 MULTIDIMENSIONAL
CARE 2 FINAL EXAM/MDC2 FINAL ACTUAL EXAM 75 QUESTIONS
AND CORRECT DETAILED ANSWERS|AGRADE (RASMUSSEN
COLLEGE)
- A nurse is teaching a patient with diabetes mellitus who asks, <why is it
necessary to maintain my blood glucose levels no lower than about 60
mg/dL (3.3 mmol/L)?= How would the nurse respond?
a. <Glucose is the only fuel used by the body to produce the energy that it
needs.=
b. <Your brain needs a constant supply of glucose because it cannot store it.=
c. <Without a minimum level of glucose, your body does not make red blood
cells.=
d. <Glucose in the blood prevents the formation of lactic acid and prevents
acidosis.= - Which of the following surgical procedures is appropriate for a patient
with chronic pancreatitis?
a. Radical pancreatectomy
b. Sphincterotomy
c. Fistulotomy
d. Proctocolectomy - The nurse identifies which lab result is consistent with a client9s
diagnosis of hyperthyroidism?
a. Decreased T3 and T4 levels
b. Elevated serum thyrotropin-releasing hormone (TRH) level
c. Decreased radioactive iodine uptake
d. Increased serum T3 and T4 levels - A nurse is caring for a patient recently diagnosed with diabetes insipidus.
Which of the following medications would be appropriate for this
disorder?
a. Furosemide
b. Diltiazem
c. Vasopressin
d. Growth Hormone antagonist - A nurse is caring for a patient recently diagnosed with thyroid cancer.
Which of the following lab results will validate this diagnosis?
a. Increased Calcium
b. Increase phosphorus
c. Increased serum thyroglobulin level
d. Decreased thyroglobulin level - Which food does the nurse teach the client with hypoparathyroidism to
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avoid in their diet?
a. Canned vegetables
b. Fresh fruit
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c. Red meat
d. Milk
- Which nursing intervention helps to prevent adrenocortical insufficiency
a. Administering diuretic therapy
b. Teaching the patient about a low-sodium diet
c. Discontinuing high-dose steroid therapy quickly
d. Reducing high-dose steroid therapy gradually - Which of the following is a common diagnostic study for patients
with upper gastrointestinal disorder?
a. Arterial blood gas
b. Liver function test
c. Barium enema
d. Esophagogastroduodenoscopy - A nurse is caring for a 57-year-old Hispanic male who was recently
diagnosed with Cushing9s disease. Which of the following laboratory
tests validate the diagnosis?
a. Elevated lymphocyte count
b. Decreased late-night salivary cortisol test
c. Decreased urine specific gravity
d. Elevated urine cortisol level - A nurse is caring for a patient diagnosed with severe gastroesophageal
reflux disease (GERD). Which of the following medications would the
nurse expect the provider to order?
a. Pantoprazole
b. Metoclopramide
c. Diphenoxylate/atropine
d. Sucralfate - A nursing is caring for a patient recently diagnosed with pancreatitis.
Which of the following are treatment options for pancreatitis? (select
all that apply)
a. Nothing by mouth
b. Pain management
c. Antacids
d. IV fluids - James is a 56-year-old male who was recently diagnosed with Type 2
diabetes. Which of the following diagnostic tests would correlate with this
diagnosis? (select all that apply).
a. Increased Hemoglobin A1C level
b. Increased random blood glucose