A patient who has terminal cancer has an order for morphine sulfate (MS)tablets
every 8 to 12 hrs p.r.n for moderate pain or morphine sulfateinjections of 10 to
12 mg every 4 hrs p.r.n. intramuscularly for severe pain.The patient has been r
eceiving MS Contain p.o. every 12 hrs but isexperiencing breakthrough pain after
about 10 hrs. Which of the ff nursingaction is most appropriate?A. Administer i
njectable morphine sulfate, 12 mg, IM, p.r.n.B. Administer the MS Contain, po, e
very 12 hrsC. Administer the MS Contain, po every 10 hrsD. Withhold the pain med
ications and notify the physician
2.
Which of the following outcomes observed by the nurse during the draincycle of p
eritoneal dialysis should be reported immediately to the physician?A. Clear yell
ow outputB. Cloudy outputC. Patient Complaint of slight crampingD. A drain outpu
t of 50 cc less than instilled
3.
Which of the ff conditions would a nurse recognized as contributing to thedevelo
pment of respiratory alkalosis?A. Chronic Obstructive Pulmonary Disease (COPD)B.
Episodes of hyperventilationC. Frequent loose stoolD. Hiatal hernia
4.
When planning preoperative care for a child suspected of having WILMStumor, the
nurse should recognized that which of the ff interventions placesthe child at ri
sk for complications?A. Palpating the child s abdomen every 8 hrsB. Measuring the
child s temperature rectallyC. Monitoring the child s blood pressure every 4 hrsD. M
onitoring the child s intake and output
5.
Which of the ff comments by a patient should indicate to a nurse that thepatient
has ideas of reference?A. Those other nurses are talking about me B. The nurse expl
ained how my medication works C. Do all the nurse here have a college degree? D. Will
a nurse lead group therapy today?
6.
Which of the ff conditions would a nurse recognize as contributing todevelopment
of respiratory acidosis?A. EmphysemaB. HyperventilationC. DiarrheaD. Achalasia
7.
A woman who is 24 hrs postpartum and who has an episiotomy would beinstructed to
report which of the ff findings immediately?A. Decrtease in urine outputB. Abse
nce of a daily bowel movementC. Presence of lochia rubraD. Increase in perineal
pain sensation
8.
A nurse is counseling a parent of a 6 mos old infant about beginning solidfoods
in the infant s diet. Which of the ff should the nurse recommend beintroduced init
ially?A. Poached eggB. Strained peachesC. Pureed peasD. Rice cereal
9.
A nurse observes a nurse s aide taking all of the ff measures when caringfor a pat
ient in the postoperative period ff a pneumonectomy. Whichmeasures would require
immediate intervention by the nurse?A. Assisting the patient to ambulate in the
hallB. Positioning the patient on the unoperated sideC. Placing elastic stockin
gs on the patient s legsD. Splinting the patient s chest during coughing
10.
Which of the ff pulmonary findings would a nurse expect to assess ina patient wh