CJE PRACTICE ACTUAL EXAM 1. QUESTIONS AND

CJE PRACTICE (ACTUAL / ) EXAM 1. QUESTIONS AND

VERIFIED 100% ANSWERS (LATEST UPDATE

Prepare for intubation. - --Answers---The nurse is assessing

a client who has the following arterial blood gas results: pH

7.30; PaCO2 56 mmHg; HCO3 28 mEq/L; PAO2 75 mmHg.Assessment findings include decreased level of consciousness, blood pressure of 90/58mmHg, weak, thready pulse, respirations 10 breaths/minute and shallow. What is a priority action by the nurse?

1 Prepare for intubation.2 Initiate fluid resuscitation.3 Place the client on a cardiac monitor.4 Initiate fall precautions.

Absent pedal and popliteal pulses.Black eschar on toes.

Pain in lower extremity caused by walking and relieved with rest. This is an early sign of PAD 1 / 4

Absent pedal and popliteal pulses. Correct - Indicates ischemia Numbness and tingling in toes. This is an early symptom Black eschar on toes. Correct - Indicates ischemia Loss of hair on lower leg. This is an early symptom - -- Answers---The nurse is assessing a client with a history of peripheral artery disease (PAD) in right lower extremity for evidence of progression of the disease. Which new findings are of greatest concern? Select all that apply

1 Pain in lower extremity caused by walking and relieved with rest.2 Absent pedal and popliteal pulses.3 Numbness and tingling in toes.4 Black eschar on toes.5 Loss of hair on lower leg.

Client is difficult to arouse

Mild swelling around incision - This is expected 2 / 4

Client is difficult to arouse - Correct - Change is mental status is a sign of infection Serous-sanguineous drainage - This is expected Client report hip pain 8 out of 10 - This is expected. Pain medication should be administered - --Answers---The nurse is caring for a client who had a right hip replacement 2 days ago. Which change in assessment requires further action?

1 Mild swelling around incision 2 Client is difficult to arouse 3 Serous-sanguineous drainage 4 Client report hip pain 8 out of 10

Collect the fluid from peritoneal catheter and send for culture.

Collect the fluid from peritoneal catheter and send for culture.Correct - The client is exhibiting signs of peritonitis. A culture will confirm diagnosis. - --Answers---The nurse is caring for a client receiving peritoneal dialysis who reports nausea and diarrhea. Assessment findings include an enlarged abdomen 3 / 4

with hyperactive bowel sounds. What is an appropriate action by the nurse?

1 Collect the fluid from peritoneal catheter and send for culture.2 Initiate cefazolin (Rocephin) intravenously.3 Administer an enema after vomiting resolves.4 Ensure the drainage bag is lower than the client's abdomen.

Assess a client who reports severe pain before administering routine medications. - --Answers---The charge nurse is observing a newly hired nurse on the medical-surgical unit.Which client situation should the nurse address first to demonstrate the ability to safely prioritize care?

1 Attempt to calm a patient with anxiety before inserting a Foley catheter.2 Administer medication for nausea before assessing a client who is complaining of chest pain.

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