Question 1

What is the difference between serum and plasma?
A)There is not a difference.
B)Serum contains proteins and no clotting factors; plasma contains serum and clotting factors.
C)Serum contains clotting factors; plasma contains serum and proteins.
D)Serum and plasma contain clotting factors. Serum also contains proteins; plasma also contains lymph fluid.

Accepted Answer

The difference between serum and plasma is that serum contains proteins and does not contain clotting factors, while plasma is the portion of blood that contains serum and clotting factors. Plasma is the fluid that blood cells reside in and represents about 55% of total blood volume. Plasma contains the clotting factors essential for formation of blood clots. Serum is the fluid left after a clot has formed, it does not contain clotting factors, but it does contain proteins such as serum albumin and serum globulin.

Question 2

A nurse is making the initial rounds for the IV fluids of clients assigned to her care. The nurse notes that the client in Room 312, a 23-year-old student admitted for hemorrhagic fever, is complaining of difficulty breathing with productive cough. The nursing assessment shows swelling of the arms and crackles. How should the nurse have prevented this?
A)Elevate the head of bed.
B)Closely monitor oral fluid intake.
C)Use infusion pumps to reduce the risk of rapid fluid infusion.
D)Monitor daily weights and I&O to appropriately adjust the IV infusion.

Accepted Answer

To prevent fluid volume overload, the nurse should use infusion pumps as much as possible to prevent rapid fluid infusion. Rapid IV infusion results in heart congestion and pulmonary edema. To manage fluid volume overload, the client is placed in an upright position to promote ventilation. Oral fluid intake rarely causes congestion, and if it does, it does so gradually. Daily weights are done to monitor changes in fluid status.

Question 3

In which of the following situations can the nurse release client information without obtaining the client's consent first?
A)A member of the research team is inquiring about a client who is a subject of a clinical trial.
B)A documentary film is doing a story on the client.
C)The client has a communicable and infectious respiratory disease.
D)The client's relative who is a physician in the same hospital asks for information.

Accepted Answer

Highly communicable diseases are reportable to the appropriate agency that handles this sort of data. The nurse, however, could not release information to another individual, group, or agency without a written consent of the client. The nurse and other members of the health care team cannot disclose any information unless required by law or if the said information threatens bodily harm to the client or to another individual.

Question 4

A nurse is administering vasopressin IV to a patient with bleeding esophageal varices. When evaluating the therapeutic effect of this drug on the patient's condition, the nurse should check for:
A)Increased pulse rate
B)Increased hemostasis
C)Increased urine output
D)Increased blood pressure

Accepted Answer

Vasopressin and ADH hormone act by constricting the blood vessels, resulting in increased circulating blood volume that causes an increase in blood pressure. Increase in blood pressure subsequently normalizes the heart rate. Vasopressin allows reabsorption of water by the kidneys leading to increased fluid volume and lesser urine output. This drug is not associated with hemostasis, but since it constricts the blood vessels it may result in controlled bleeding.

Question 5

As the nurse is making her rounds, she notes that a client's intravenous site is cool, slightly edematous, and painful. When the vein proximal to the IV site is occluded by the nurse, the IV fluid continues to flow. The nurse determines that which of the following complications is being experienced by the client?
A)Phlebitis
B)Hematoma
C)Infiltration
D)Infection

Accepted Answer

A cool, slightly edematous, and painful IV site is indicative of infiltration. Continuous flow of the fluid after the occlusion of the vein proximal to the IV site supports the finding.

Question 6

At 9:00 a.m., a nurse finds that a client being infused with 5% dextrose in 0.9% sodium chloride is having difficulty of breathing. On assessment, the nurse notes increased blood pressure, distended jugular veins, and crackles on auscultation. The solution in a 1,000 ml infusion bag was hung at 8:00 a.m. The remaining solution is measured at 600 ml. The nurse's most immediate action is to:
A)Notify the physician
B)Place the client in semi-Fowler's
C)Stop the infusion and contact the physician
D)Stop the infusion and remove the IV catheter

Accepted Answer

The client is experiencing circulatory overload; therefore, stopping the infusion until the physician is notified is the best immediate action. Positioning the client in semi-Fowler's is appropriate, but stopping the infusion should be done first.

Question 7

A nurse is enrolled in an orientation program regarding clients' rights, confidentiality, and ethical practices in nursing. Which of the following situations is an example of a breach of confidentiality?
A)Release of laboratory results to the client via an encrypted electronic email.
B)Disclosing information for reimbursement of hospital payment.
C)Disclosing the client's disease prognosis to the estranged spouse.
D)Using a reference number to replace the client's name in the medical record.

Accepted Answer

A breach of confidentiality is defined as disclosure of information to a third party without the prior consent of the client or by court order. The medium of disclosure is irrelevant, that is why special security measures, such as encryption and password-protected electronic transfer should be used. Under HIPAA (Health Insurance Portability Accountability Act), covered entities are permitted to release information only to facilitate payment and treatment. This act also provides guidelines for safeguarding the client's privacy through the use of reference numbers or codes.

Question 8

Ana, a 22-year-old student, was admitted for a needle biopsy of a breast mass. A day after the procedure, Ana developed a high fever accompanied by localized redness of the IV site. The physician suspects bacteremia. Which of the following actions could prevent this infection from spreading?
A)Strict hand-washing practice
B)Antibiotic therapy
C)Place the client on isolation
D)Wear full PPE during client contact

Accepted Answer

The hands of the health care team are the most common means of transport of microorganisms. Strict hand-washing should be observed at all times. Administering antibiotics or isolation doesn't decrease the chance of spreading the infection. Full PPE include gloves, gown, mask, goggles, and a face shield. The nurse can wear gloves and a mask when doing activities that don't generate spraying or splashing of body fluids.

Question 9

The following are accurate statements about informed consent except:
A)A nurse can be involved in the informed consent process.
B)A client cannot refuse information, waive the informed consent, and undergo treatment.
C)If a client is mentally incompetent, the next of kin can give consent.
D)A client can withdraw consent any time.

Accepted Answer

A client can refuse information, waive the informed consent, and undergo treatment, but it must be documented in the client's record. A nurse can be involved in the process, but only as a witness. The other options are accurate.

Question 10

A woman in labor is administered with methylergonovine (Methergine) IV. The occurrence of which adverse side effect necessitates immediate intervention?
A)Headache
B)Hypotension
C)Hypertension
D)Tachycardia

Accepted Answer

Methylergonovine, a uterotonic, is administered during labor to prevent or control postpartum hemorrhage. Severe hypertensive episodes, nausea, vomiting, and bradycardia are potential adverse reactions.

Question 11

A nurse has prepared a client for an elective surgical procedure. After administering a pre-op sedative, the nurse notices the consent form was not signed. She asks the client to sign it before going to surgery. Is this the appropriate action? If not, why?
A)No, this is not appropriate or necessary because the client willingly came to the facility for an elective procedure, which implies consent.
B)No, this is not appropriate because the client has received a mind-altering medication (sedative) and is unable to give informed consent.
C)Yes, the consent must be signed before the procedure can begin.

Accepted Answer

A client who has received a sedative is not alert and not able to give informed consent. Invasive procedures require informed consent. Since this was an elective procedure and not a life-threatening circumstance, the best action would be to notify the physician and reschedule the procedure. Implied consent is not legally defensible for invasive procedures.

Question 12

Which of the following statements is true regarding sharps counts during the operating procedure?
A)Packages of suture should all be opened onto the sterile field for counting.
B)The scrub nurse should document how many needles are contained within a package at the time of counting.
C)Needles should be counted once at the beginning of the procedure and once at the end.
D)A broken needle should be counted as two sharps because of having two sharp ends.

Accepted Answer

The nurse should document how many needles are contained within a package at the time of counting. Suture packages do not necessarily need to be opened completely in the beginning; the nurse can count the needles within the package and mark it down. Counts should be performed regularly throughout the procedure and a broken needle should have both ends kept together, but should be counted as one.

Question 13

What is the difference between fainting and hypovolemic shock?
A)Hypovolemic shock is a medical emergency.
B)Fainting is a medical emergency.
C)Fainting may be caused by an emotional reaction or pain.
D)A and C

Accepted Answer

Hypovolemic shock is a medical emergency that requires immediate care. Fainting, while frightening, is generally not a medical emergency. Shock is caused by excessive loss of body fluids, while fainting can be caused by several conditions, including emotional reactions. Fainting is the temporary loss of consciousness, with rapid return of consciousness. Symptoms of shock include pale, cool, and clammy skin; shallow and rapid breathing; rapid pulse rate; and low blood pressure. Symptoms of fainting may include pale skin, low blood pressure, and complaints of feeling light headed.

Question 14

What is the most important action a nurse can do to protect themself if they become the target of legal action from a patient?
A)Document all patient assessments, nursing diagnoses and interventions for the patient.
B)Keep a separate notebook for the nurse's own reference of any situations that were questionable.
C)Have adequate professional insurance and access to a good attorney.
D)Both A and B

Accepted Answer

The most important action a nurse can do to protect themself is to document all patient assessments, nursing diagnoses and interventions for the patient. The nurse should clearly state what was done as well as what was not done, and any outcomes that resulted. Documentation protects the healthcare institution as well as the nurse, and if practices were not documented, it is assumed that they were never done.

Question 15

A physician orders regular insulin at 10 units per hour to be administered by IV infusion pump. An IV infusion bag is labeled 100 units of regular insulin in 500 ml of 5% dextrose in water. The nurse prepares to set the infusion pump at how many millimeters per hour?
A)10 ml
B)20 ml
C)50 ml
D)100 ml

Accepted Answer

Initially, determine the number of insulin in 1 ml and then calculate for the infusion rate.
Step 1:
Known amount of insulin in solution = Amount of insulin per ml
Total volume of diluent
100 units = 0.2 unit/ml
500 ml
Step 2:
Dose per hour desired = milliliters per hour
Concentration per ml
10 units per hour = 50 milliliters per hour
0.2 unit/ml

Question 16

Which of the following is considered to be a disadvantage of using intravenous anesthesia?
A)Increased risk of nausea and vomiting
B)Laryngospasm may occur with use
C)Dizziness typically occurs during onset
D)Both A and C

Accepted Answer

A disadvantage of using intravenous anesthesia is that laryngospasm may occur with its use. Intravenous anesthesia may be less likely to cause nausea and vomiting and is often used for shorter surgical procedures. The patient also experiences fewer feelings of potentially uncomfortable dizziness during onset.

Question 17

What is the normal range of central venous pressure when measured with a transducer?
A)2 to 6 mmHg
B)7 to 10 mmHg
C)12 to 20 mmHg
D)25 to 50 mmHg

Accepted Answer

The normal range of central venous pressure is 2 to 6 mmHg when measured with a transducer. This reading reflects the pressure in the right atrium of the heart. The catheter is advanced to lie in the superior vena cava or the right atrium and is a reflection of the patient's fluid volume levels.

Question 18

Which of the following is the most important aspect of assessing a patient's readiness for education?
A)The amount of time before the procedure
B)What procedure the patient is going to have
C)The patient's health status
D)The time of day in which the surgery is scheduled

Accepted Answer

The patient's health status is the most important aspect of assessing their readiness to learn. While the timing of education may be right, if the patient is in poor health, they will not be able to absorb the information. Health status can affect a patient's ability to concentrate, they may have pain or anxiety, or they may be unable to retain important information. As part of the mandate of teaching, the nurse needs to assess a patient's ability to take in new information, or the time spent teaching will go to waste.

Question 19

The nurse is in a patients' room, about to collect a blood specimen. During her examination of the patient's arm for a potential site, she observes areas of pinpoint, red dots scattered over both of the patient's arms. What is the clinical name for this phenomenon, and what does the presence of pinpoint red dots indicate?
A)It is known as petechiae, indicating possible excessive bleeding after blood collection.
B)It is known as measles, indicating possible infectious disease exposure.
C)It is known as psoriasis, indicating a possible skin disorder and should be avoided as a potential venipuncture site.

Accepted Answer

The appearance of pinpoint red dots on the body is known as petechiae, and is significant because it may indicate possible excessive bleeding after blood withdrawal. Petechiae are caused by the leaking of blood from tiny blood vessels into surrounding tissues. This phenomenon is seen in patients with coagulation disorders or diseases causing problems with coagulation, or possibly, but not always, in a patient receiving anticoagulant therapy.

Question 20

A patient is receiving thrombolytic therapy to treat a large clot that has formed as a pulmonary embolism while on the post-surgical unit. The patient begins to bleed profusely from the nose and the intravenous line. What is the nurse's response?
A)Apply direct pressure to major sites of bleeding to induce clotting.
B)Increase the rate of fluid and electrolytes while decreasing the thrombolytic therapy.
C)Apply cold compresses to bleeding sites and assess respiratory function.
D)Stop the thrombolytic therapy completely and notify the physician.

Accepted Answer

In this situation, the nurse should stop the thrombolytic therapy completely and notify the physician. Thrombolytic therapy works to break up a large clot that is causing breathing problems. However, persistent bleeding with this therapy can lead to life-threatening hemorrhage.

Quiz 2: Vascular Access

What is the difference between serum and plasma?

In which of the following situations can the nurse release client information without obtaining the client's consent first?

A nurse is administering vasopressin IV to a patient with bleeding esophageal varices. When evaluating the therapeutic effect of this drug on the patient's condition, the nurse should check for:

A nurse is enrolled in an orientation program regarding clients' rights, confidentiality, and ethical practices in nursing. Which of the following situations is an example of a breach of confidentiality?

Ana, a 22-year-old student, was admitted for a needle biopsy of a breast mass. A day after the procedure, Ana developed a high fever accompanied by localized redness of the IV site. The physician suspects bacteremia. Which of the following actions could prevent this infection from spreading?

The following are accurate statements about informed consent except:

A woman in labor is administered with methylergonovine (Methergine) IV. The occurrence of which adverse side effect necessitates immediate intervention?

A nurse has prepared a client for an elective surgical procedure. After administering a pre-op sedative, the nurse notices the consent form was not signed. She asks the client to sign it before going to surgery. Is this the appropriate action? If not, why?

Which of the following statements is true regarding sharps counts during the operating procedure?

What is the difference between fainting and hypovolemic shock?

What is the most important action a nurse can do to protect themself if they become the target of legal action from a patient?

A physician orders regular insulin at 10 units per hour to be administered by IV infusion pump. An IV infusion bag is labeled 100 units of regular insulin in 500 ml of 5% dextrose in water. The nurse prepares to set the infusion pump at how many millimeters per hour?

Which of the following is considered to be a disadvantage of using intravenous anesthesia?

What is the normal range of central venous pressure when measured with a transducer?

Which of the following is the most important aspect of assessing a patient's readiness for education?

A patient is receiving thrombolytic therapy to treat a large clot that has formed as a pulmonary embolism while on the post-surgical unit. The patient begins to bleed profusely from the nose and the intravenous line. What is the nurse's response?