Name: Section: Direction: Encircle the correct answer. No erasure. Computation: 5 points each 1.

After intentionally taking an overdose of hydrocodone (Vicodin), a client is admitted to the emergency department. Activated charcoal is prescribed. Before administering the drug, the nurse should ensure that the client: a. Is able to follow commands b. Has nasogastric tube in place c. Has advance directive on file d. Has audible bowel sounds 2. The nurse is preparing to give an average sized 9 year old client a preoperative I.M. injection. Which size needle should the nurse use? a. 22G, 1 b. 22G, 1 c. 20G, 1 d. 20G, 1 3. The nurse is preparing a continuous insulin infusion for a child with diabetic ketoacidosis and a blood glucose level of 800 mg/dl. Which solution is the most appropriate at the beginning of therapy? a. 100 U of regular insulin in normal saline solution b. 100 U of neutral protamine Hagedorn (NPH) insulin in normal saline solution c. 100 U of regular insulin in dextrose 5 % in water d. 100 U of NPH insulin in dextrose 5% in water 4. The physician prescribes heparin 25,000 U in 250 ml of normal saline solution to infuse at 600 U/hour for a client who suffered an acute myocardial infarction. After 6 hours of heparin therapy, the client's partial thromboplastin time is subtherapeutic. The physician orders an increase in the infusion to 800 U/hour. The nurse should set the infusion pump to deliver how many milliliters per hour?

5. The nurse has an order to administer an I.M injection using Z track technique. When carrying out this order, what should the nurse do? a. Insert the needle at a 45 degree angle b. Wipe the needle immediately after injection c. Pull the skin laterally toward the injection site d. Simultaneously withdraw the needle and release the skin 6. Following a fall from the horse, an 25 year old client is seen in the emergency department. He has a large dirty laceration on his leg. The wound is vigorously cleaned, closed, and dressed. In

the past, the client has received the full immunization regimen for tetanus toxoid. The nurse asks the client about the tetanus immunization history and he says, I had my last shot when I was 18 years old . The nurse should: a. Advise the client to get a tetanus vaccine within 3 years b. Request the physician to order a serum tetanus titer c. Plan on administering a dose of tetanus vaccine d. Each the client that he has life-long immunity to tetanus 7. A 75-year-old client is admitted to the hospital with lower GI bleeding. His hemoglobin on admission to the emergency department is 7.3 g/dl. The physician prescribes 2 U of packed red blood cells to infuse over 1 hour each. The blood administration set has a drip factor of 10 gtt/ml. What is the flow rate in drops per minute?

8. Which type of solution, when administered I.V would cause a shift of fluid from the body tissues to the bloodstream/ a. Hypotonic b. Isotonic c. Sodium chloride d. Hypertonic 9. The nurse regularly inspects a client s I.V site to ensure patency and prevent extravasation during dopamine (Intropin) therapy. What is the treatment for dopamine extravasation? a. Elevating the affected limb, applying warm compresses, and administering phentolamine (regitine) as prescribed b. Elevating the affected limb applying cold compresses and administering hyalurinidase as prescribed c. Maintaining the limb in a dependent position and massaging it every 15 minutes d. Asking the physician to make an incision and allowing the affected area to drain 10. Nurse is administering sublingual nitroglycerin to the patient. Immediatelyy afterward, the client may experience: a. Nervousness or parethesia b. Throbbing headache or dizziness c. Drowsiness or blurred vision d. Tinnitus or diplopia 11. A client with no known history of peripheral vascular disease comes to the emergency department complaining of sudden onset of lower leg pain. Inspection and palpation reveal absent pulses, paresthesia and a mottled, cyanotic, cold and cadaverous left calf. While the physician determines the appropriate therapy, the nurse should: a. Place the heating pad around the affected calf b. Elevate the affected leg as high as possible c. Keep the affected leg level or slightly dependent

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d. Shave the affected leg in anticipation of surgery A black client with asthma seeks emergency care for acute respiratory distress. Because of this client s dark skin, the nurse should assess for cyanosis by inspecting the: a. Lips b. Mucous membranes c. Nail beds d. Earlobes A client with a serum glucose level of 618 mg/dl is admitted to the facility. He is awake and oriented, has hot dry skin and has the following vital signs: temperature of 100.6 F (38.1 C), heart rate of 116 beats per minute and blood pressure of 108/70 mmHg. Based on these assessment findings, which nursing diagnosis takes highest priority? a. Deficient fluid volume related to osmotic diuresis b. Decreased cardiac output related to elevated heart arte c. Imbalanced nutrition: Less than body requirements related to insulin deficiency d. Ineffective thermoregulation related to dehydration A client with advanced cirrhosis comes to emergency department. Patient has prothrombin time (PT) of 15 seconds, compared with a control time of 11 seconds. The nurse expects to administer: a. Spironolactone (Aldactone) b. Phytonadione (Mephyton) c. Furosemide (Lasix) d. Warfarin (Coumadin) Patient with pancreatitis arrived at the emergency department; the doctor order for laboratory. Which laboratory finding is the primary indicator of pancreatitis? a. Elevated blood urea nitrogen (BUN) b. Elevated serum lipase c. Elevated aspartate aminotransferase (AST) d. Increased lactate dehydrogenase (LD)

If anyone lacks wisdom let him ask of God who gives to all liberally and without reproach and it will be given to him. James 1: 5

God bless you!!!!