PRACTICE NCSBN LATES CTUAL EXAM

PRACTICE NCSBN LATES CTUAL EXAM

QUESTIONS AND ANSWERS ALREADY GRADED A+.

• An ICU nurse and intensivist remotely monitor ICU clients around the clock
• An ICU nurse is on-call to answer questions when needed
• Clients can ask the intensivist for a second opinion
• Less staff is needed on site when a remote eICU is available Answer - A

Using cameras, microphones, and high-speed computer data lines, the eICU involves having an experienced ICU nurse and practicing intensivist monitoring ICU clients in remote locations around the clock. The eICU does not change the ratio of nurses to clients at the bedside, but it does make the nurse's bedside time more productive and assistance from their remote colleagues is only a push button away.

⫸ The client is diagnosed with tuberculosis (TB). The nurse understands that the treatment plan for this client will involve what type of drug therapy?

• Administering two antituberculosis drugs
• Aminoglycoside antibiotics
• An anti-inflammatory agent
• High doses of B complex vitamins Answer - A

In order to prevent drug-resistant strains of TB, clients are always prescribed at least two different antitubercule medications. Rifampin and isoniazid are the most effective drugs used to treat TB and are always used together, for at least six months. Additional medications, such as pyrazinamide and either streptomycin or ethambutol, may also be prescribed. Vitamin B6 is usually prescribed to help prevent expected side effect of isoniazid.

⫸ While working a 12-hour night shift, the nurse has a "near miss" and catches an error before administering a new medication to the client. Which factors could have contributed to the near miss? (Select all that apply.)

• The nurse works in the intensive care unit (ICU)
• The nurse has worked on the same unit for five years
• The nurse is assigned more clients than usual due to staffing issues
• The nurse was interrupted when preparing the medication 1 / 4

• The nurse has worked four 12-hour night shifts in a row Answer - A,C,D,E

There are a number of reasons for near misses and making medication errors, including heavy workload and inadequate staffing, distractions, interruptions and inexperience. Fatigue and sleep loss are also factors, especially for nurses working in units with high acuity clients such as the ICU.

⫸ A 4 month-old infant is being given digoxin. The client's blood pressure is 92/78 mm Hg; resting pulse is 78 BPM; respirations are 28 BPM; and the serum potassium level is 4.8 mEq/L (4.8 mmol/L). The client is irritable and has vomited twice since the morning dose of digoxin.Which finding is most indicative of digoxin toxicity?

• Irritability
• Vomiting
• Bradycardia
• Dyspnea Answer - C

The most common sign of digoxin toxicity in children is bradycardia which is a heart rate below 100 BPM in an infant. Normal resting heart rate for infants 1-11 months-old is 100-160 BPM.

⫸ A client is receiving total parenteral nutrition (TPN) via a tunneled catheter. The catheter accidentally becomes dislodged from the site. Which action by the nurse should take priority?

• Monitor respiratory status
• Apply a pressure dressing to the site
• Assess for mental status changes
• Check that the catheter tip is intact Answer - B

The client is at risk of bleeding or developing an air embolus if the catheter exit site is not covered with a pressure and occlusive dressing. An occlusive dressing is one that is totally covered by adhesive tape around the edges, as well as over the entire dressing.

⫸ The oncology client reports pain, and the provider orders hydromorphone IM 0.015 mg/kg right away. How many milligrams does the nurse administer? The nurse checks the chart and determines the client weighs 119 pounds.How many milligrams of hydromorphone (Dilaudid, Exalgo) will the nurse administer? (Report your answer to one decimal point and write only the number.) Answer - 0.8 Using dimensional analysis, the final units will be milligrams, so begin the equation with milligrams on top, then multiply to cancel unwanted units until only the milligrams remain.(0.015 mg/kg) X (1 kg/2.2 lbs) X (119 lb/1) = 1.79/2.2 = 0.82 = 0.8 2 / 4

⫸ The nurse is caring for a client admitted with a diagnosis of Meniere's disease. When teaching the client about the disease, the nurse should explain that the client should avoid foods high in which substance?

• Fiber
• Carbohydrates
• Calcium
• Sodium Answer - D

The client with Meniere's disease has an alteration in the balance of the fluid in the inner ear (endolymph). A low-sodium diet will aid in reduction of the fluid. Sodium restriction is commonly ordered as adjunct to diuretic therapy in the acute and chronic treatment.

⫸ The nurse is assessing a 4 year-old child who is in skeletal traction 24 hours after surgical repair of a fractured femur. The child is crying and reports having severe pain. The right foot is pale and there is no palpable pulse. What action should the nurse take first?

• Notify the health care provider
• Administer the ordered PRN medication
• Reassess the extremity in 15 minutes
• Readjust the traction for comfort Answer - A

Pain and absence of a pulse within 48-72 hours after a severe injury to an extremity suggests acute compartment syndrome. This condition occurs when there's a build up of pressure within the muscles; this pressure decreases blood flow and can cause muscle and nerve damage. Acute compartment syndrome is a medical emergency. Surgery is needed immediately; delaying surgery can lead to permanent damage to the extremity.

⫸ An 80 year-old client diagnosed with pneumonia is exhibiting new onset confusion. The client is pulling at tubes and items near the bed and trying to get out of bed. Which intervention would be most appropriate?

• Request an order for restraints
• Frequently remind the client to stay in bed
• Request an order for antianxiety medication
• Arrange for a sitter to stay with the client Answer - D 3 / 4

Clients treated for pneumonia often develop new cognitive impairments; confusion or delirium is common. Although no one wants someone to fall out of bed or pull out tubes, restraints should always be used as a last resort. A less restrictive approach would be to arrange for a sitter to stay with the client. Use of antianxiety medications, such as benzodiazepines, should be avoided in the elderly because they increase the risk of cognitive impairment, delirium and falls.

⫸ A woman in early labor puts her call light on and tells the nurse "I think my water bag just broke and I feel like something came out with the water." A visual exam by the nurse reveals a prolapsed umbilical cord. List in order of priority the actions the nurse should perform in this obstetrical emergency.

• Glove and place two fingers into the cervical opening, beside the umbilical cord, to relieve

pressure

• Administer oxygen to the mother via mask at 10 L/min
• Call for assistance, asking that the health care provider is notified
• Place the client in a knee-chest position on the bed Answer - A,C,D,B

A prolapsed cord is a medical emergency; the blood flow from the placenta to the fetus will be occluded with each contraction if the umbilical cord is compressed against the presenting part of the fetus and the dilated cervix which is why the priority intervention is to apply gloves and place two fingers to one side of the cord (or entire hand) to relieve pressure. The nurse is also calling for assistance so that someone can notify the health care provider and staff can prepare for emergent cesarean. Placing the client in a modified Sims or knee-chest position will allow gravity to help decrease pressure on the cord from the presenting part, but the primary relief from pressure on the umbilical cord is the gloved fingers. Oxygen administration will help once the circulation of blood to the fetus is re-established.

⫸ A client tells a nurse: "I have decided to stop taking sertraline (Zoloft) because I don't like the nightmares, sex dreams and obsessions I have had since starting on the medication." What is an appropriate response by the nurse?

• "Side effects and benefits should be discussed with your health care provider."
• "Many medications have potential side effects."
• "This medication should be continued despite unpleasant symptoms."
• "It is unsafe to abruptly stop taking any prescribed medication." Answer - D

Abrupt withdrawal the short-acting SSRI sertraline (Zoloft) causes SSRI Discontinuation Syndrome. A slow tapering of the medication will be prescribed to avoid the symptoms associated with this syndrome, which may include insomnia, headache, dry mouth, nausea and diarrhea.

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