Archer Nclex questions part 1

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A client is scheduled for gastroscopy at 8:00 AM and has

been placed on NPO since midnight. At 6:30 AM, the

nurse checks the client's capillary blood glucose level and gets a result of 40 mg/dl on the glucometer. The client is alert, coherent, and reports, "I feel fine. I don't feel anything." The most appropriate action for the nurse

is:

• Record the finding in the notes and withhold the

client's morning insulin.

• Take a repeat sample of the capillary blood glucose.
• Give the client simple sugar by mouth.
• Administer intravenous dextrose 50 grams STAT.

Choice B is correct. The nurse should repeat the test because the client does not display any symptoms of hypoglycemia. The glucometer readings are not always accurate. Many variables such as quality of blood sample, dirt on the meter, humidity, aged test strip, high hematocrit etc. may affect glucometer readings. In view of so many variables affecting the blood glucose reading in glucometer, the nurse must be alert while interpreting these values especially, in the absence of any symptoms.Definition of hypoglycemia differs in diabetic patients differs from that of non- diabetic patients. In diabetic patients, Hypoglycemia is defined as a blood glucose of less than 70mg/dl. Many diabetics may also have a condition called "Hypoglycemia unawareness" where there may not be sufficient autonomic warning symptoms before the onset of neuroglycopenia (impaired cognition, coma). In a diabetic patient, therefore, hypoglycemia needs to be treated as soon as possible based on the lab values even in the absence of overt symptoms.In non-diabetic adults with low glucose level, one should assess for symptoms.Symptoms may include cold, clammy skin, tachycardia, palpitations, impaired cognition, slurred speech, seizures, and confusion. A low blood glucose at the time of symptoms and improvement as soon as the blood glucose returns to normal confirm the diagnosis. In a non-diabetic client who has been fasting, a blood glucose less than 50 mg/dL can also be used to define hypoglycemia. In the absence of symptoms, however, the first step is to recheck the blood glucose and confirm the result.Choice A is incorrect. Because the first reading was too low, it is appropriate for the nurse to recheck before documenting the findings to confirm accuracy.Choice C is incorrect. The nurse should recheck and validate the results before deciding

The nurse is obtaining consent for surgery from a client.What should be the initial action of the nurse while obtaining consent?

• Determine if the client has sufficient knowledge about

the procedure.

• Witness the signature of the client.
• Tell the client that obtaining a signature is routine prior

to surgery.

• Explain the risks involved in the surgery.

Choice A is correct. "Informed" consent means that the client must understand the procedure, the alternative options, and the risks and consequences involved. The nurse should make sure that the client has sufficient knowledge about the procedure before asking him to sign a consent.While it is crucial for the client to know the risks of the procedure before signing the consent, those risks should be explained to the client by the doctor, not the nurse.Choice B is incorrect. The nurse should first assess the client's understanding of the surgery/procedure before signing as a witness.Choice C is incorrect. Procuring the client's signature for consent is routine before the surgery. However, just telling this to the client does not satisfy the client's right to informed consent.Choice D is incorrect. Explaining the procedural risks involved is not the nurse's responsibility and should be done by the doctor.Which ergonomically designed work tool can prevent repetitive stress syndrome?

• A back support belt
• A special computer mouse
• A special chair for sitting
• Weighted pens and pencils

Correct Answer is B. A special ergonomically designed work tool that can prevent repetitive stress syndrome, which is also referred to as carpal tunnel syndrome, is a special computer mouse.Choice A is incorrect. A back support belt is a protective device that may help to avoid a back injury and not repetitive stress syndrome.Choice C is incorrect. A special chair for sitting in correct posture prevents muscle fatigue and maintains the body in the correct alignment with lumbar support, but it does not prevent repetitive stress syndrome.Choice D is incorrect. Weighted pens and pencils may be used by clients with poor fine motor coordination, but they do not prevent repetitive stress syndrome.Case management, as a form of patient care delivery and

documentation, is most closely aligned with:

• The SOAP method of documentation
• The SOAPIE method of documentation
• Variances
• Case mix

Correct Answer is C. Variances, including patient variances, system variances and practitioner variances are deviations from the expected plan of care and treatment that is documented on the critical pathway of the case management method of patient care delivery and documentation.Choice A is incorrect. The SOAP method of documentation is part of the problem- oriented medical record documentation system and not the case management method of patient care delivery and documentation.Choice B is incorrect. The SOAPIE method of documentation is part of the problem-oriented medical record documentation system and not the case management method of patient care delivery and documentation.Choice D is incorrect. Case-mix reflects the collective conditions of the clients and it is not part of the case management method of patient care delivery and documentation.

The obstetric nurse is reading the prenatal client's chart.The nurse notes that the patient is suffering from preeclampsia and knows to observe for which complications in the newborn?

• Shaking and agitation
• Low birth-weight
• Abnormal kidney function
• Blurred vision

The correct answer is B. The nurse with this patient should expect an infant born with low birth weight. Preeclampsia often results in blood being shunted away from the fetus; growth restriction is commonly found in infants born to these women.Choice A is incorrect. Shaking and agitation aren't commonly connected with preeclampsia. These symptoms may be related to drug abuse or gestational diabetes.Choice C and D are incorrect. Blurred vision and abnormal kidney function affect mothers who are suffering from preeclampsia, not their infants.The nurse is caring for a patient receiving a blood transfusion. On assessment, the nurse notes that the patient's respirations are rapid, the face is flushed, and the patient is complaining of itching. The nurse suspects the patient is having a transfusion reaction. The nurse

should accomplish the following actions:

The nurse should complete the tasks in the following

order:

• Take vital signs
• Stop the transfusion
• Administer oxygen
• Obtain a urine specimen.

The nurse should complete the tasks in the following

order:

B, C,A,D

Correct Answer is:

• Stop the transfusion
• Administer oxygen
• Take vital signs
• Obtain a urine specimen

The most crucial step in the process is to stop the transfusion and begin to treat the symptoms. In this case, the patient is short of breath, so the nurse should start oxygen and raise the head of the patient's bed. Vital signs will help the nurse to determine what other processes might be going on and will give the nurse information to provide to the physician. A urine specimen will help to determine if there is hemoglobin in the urine. Also, the nurse should keep an IV open with normal saline and keep the blood bag to return to the blood bank.The physician orders to administer gentamicin I.V. to a client with acute diverticulitis. It is important for the nurse to know that gentamicin is administered

• over 1 minute as I.V. push
• over 2 minutes as I.V. push
• as an I.V. side drip over 15-20 minutes
• as an I.V. side drip over 30-60 minutes
• as an I.V. side drip over 30-60 minutes

Rationale: Gentamicin is an aminoglycoside that is nephrotoxic. Because of this, it should be administered slowly by intermittent infusion. The recommended duration of infusion for administration is 30-60 minutes. It is not encouraged to be operated by bolus or I.V. push. The correct answer is option D. Options A, B, and C are incorrect.

Which of the following clients is at the highest risk for complications related to folate deficiency?

• An 80-year-old man living in a nursing home
• A 4-year-old boy who is developmentally delayed
• A 16-year-old girl who just started her menstrual cycle
• A 25-year-old woman who is attempting to get

pregnant The correct answer is D. Evidence shows that adequate intake of folate before conception and in the first trimester of pregnancy reduces the incidence of neural tube defects. The U.S. Public Health Service recommends that all women of childbearing age and capable of pregnancy consume 400 ugs of synthetic folic acid daily from either foods or supplements.A, B, and C are incorrect. At the same time, all individuals can have deficiencies in folate, the client at the highest risk of complications among those listed is the 25- year-old woman who is attempting to conceive.Folic acid (vitamin B9) works with vitamin B12 and vitamin C to help the body break down, use, and make new proteins. The vitamin helps form red and white blood cells. It also helps produce DNA, the building block of the human body, which carries genetic information.Folic acid is a water-soluble type of vitamin B. This means it is not stored in the fat tissues of the body. The remaining amounts of the vitamin leave the body through the urine.Because folate is not stored in the body in large amounts, your blood levels will get low after only a few weeks of eating a diet low in folate. Folate is found in green leafy vegetables and liver.

Contributors to folate deficiency include:

Diseases in which folic acid is not well absorbed in the digestive system (such as Celiac disease or Crohn disease) Drinking too much alcohol I am eating overcooked fruits and vegetables. Folate can be easily destroyed by heat.Hemolytic anemia Certain medicines (such as phenytoin, sulfasalazine, or trimethoprim- sulfamethoxazole) Eating an unhealthy diet that does not include enough fruits and vegetables Kidney dialysis Groups of people considered at-risk for folate deficiency include women who are pregnant, women who wish to become pregnant, alcoholics, liver disease and dialys Which of the following is the correct interpretation for the following arterial blood gas?

pH: 7.47

PCO2: 55

HCO3: 36

• Metabolic acidosis
• Respiratory acidosis
• Metabolic alkalosis
• Respiratory alkalosis

Answer: C

This ABG shows metabolic alkalosis. The pH is higher than 7.45, which is alkalotic.The PCO2 is more elevated than 45, which is acidotic (this is compensating for the metabolic alkalosis). Lastly, HCO3 is greater than 26, which is alkalotic. The HCO3 shows alkalosis like the pH, so we know this is metabolic alkalosis.