NR 304 Exam 3

Name

Chamberlain University

NR-304: Health Assessment II

Prof. Name

Date

1. Which of the following are risk factors for deep vein thrombosis (DVT)? (Select all that apply)

A. Oral contraceptive use ✅
B. Immobility ✅
C. Venous insufficiency ✅
D. Physical activity
E. Calcium intake

2. Facial asymmetry and sagging during a cranial nerve assessment indicates dysfunction of which nerve?

A. Motor component of CN VII (7) ✅
B. Motor and sensory components of CN XI (11)
C. Motor component of CN X (10)
D. Motor component of CN IV (4)

3. Which client statement about genital herpes indicates a need for further teaching?

A. “Abstaining from sexual activity reduces the risk of transmission of the disease”
B. “The use of condoms will reduce the risk of transmission”
C. “Antiviral medications will not cure the infection”
D. “Transmission of the disease will not occur when my lesions are gone” ✅

4. What is the primary function of the thymus, spleen, and lymph nodes?

A. These organs assist vitamin absorption
B. These organs are used in digestion
C. These organs regulate electrolyte balance
D. These organs support immunity ✅

5. Which findings are associated with urinary retention due to prostatic hypertrophy? (Select all that apply)

A. Voiding small amounts of urine frequently ✅
B. Report of feeling pressure ✅
C. Distended bladder ✅
D. Dysuria ✅
E. Tenderness over the symphysis pubis ✅

6. Which is a manifestation of deep-vein thrombosis (DVT)?

A. Decreased pedal pulses
B. Pain in the ankle and foot
C. Coolness of the leg or legs
D. Unilateral leg edema ✅

7. Which finding indicates that peristalsis is returning post abdominal surgery?

A. Abdominal distention
B. Hypoactive bowel sounds in two quadrants
C. Passage of flatus ✅
D. Request for a cup of tea and some toast

8. Which is a risk factor for the development of osteoporosis?

A. Long-term use of diuretics
B. Obesity
C. Sedentary lifestyle ✅
D. Prolonged stress

9. What action should a nurse take to prevent infection in a client with a urinary catheter?

A. Replace the catheter every 3 days
B. Check the catheter tubing for kinks or twisting ✅
C. Irrigate the catheter once each shift
D. Clean the perineal area with an antiseptic solution daily

10. Which client has a contraindication for oral contraceptives?

A. A 38-year-old client that reports smoking one pack of cigarettes every day ✅
B. A 28-year-old client with a history of pelvic inflammatory disease
C. A 32-year-old client with benign breast disease
D. A 26-year-old client with migraine headaches at the start of each menstrual cycle

11. Which of the following is a sign of hypoglycemia?

A. Flushed skin
B. Bradycardia
C. Diaphoresis ✅
D. Decreased respirations

12. What is the most accurate method for verifying placement of a nasogastric (NG) tube?

A. Aspirating stomach contents
B. Injecting air and listening with a stethoscope
C. Checking pH of aspirate
D. Chest x-ray ✅

13. Which type of isolation precaution is required for a client with tuberculosis?

A. Droplet precautions
B. Contact precautions
C. Protective environment
D. Airborne precautions ✅

14. A nurse should monitor a client receiving furosemide for which of the following?

A. Hyperkalemia
B. Hypokalemia ✅
C. Hypercalcemia
D. Hypernatremia

15. Which finding is most important to report to the provider for a client taking warfarin?

A. Occasional headaches
B. Bleeding gums ✅
C. Urinary frequency
D. Nausea

16. Which electrolyte imbalance is associated with muscle weakness and dysrhythmias?

A. Hypernatremia
B. Hypokalemia ✅
C. Hypocalcemia
D. Hypermagnesemia

17. A client reports abdominal pain and vomiting. Which finding requires immediate intervention?

A. Bowel sounds present in all quadrants
B. Soft, non-tender abdomen
C. Hematemesis ✅
D. Nausea after meals

NR 304 Exam 3

18. Which is an expected finding in a client with right-sided heart failure?

A. Pulmonary congestion
B. Pink frothy sputum
C. Peripheral edema ✅
D. Orthopnea

19. Which position promotes drainage from a lobectomy site in the right lung?

A. Left side-lying ✅
B. Supine
C. Right side-lying
D. High Fowler’s

20. What is an adverse effect of levothyroxine?

A. Constipation
B. Bradycardia
C. Insomnia ✅
D. Weight gain

21. Which of the following foods should a client taking MAOIs avoid?

A. Yogurt
B. Cottage cheese
C. Aged cheddar ✅
D. Milk

22. A client with COPD is receiving oxygen therapy. Which oxygen delivery device is most appropriate for long-term use?

A. Non-rebreather mask
B. Simple face mask
C. Nasal cannula ✅
D. Venturi mask

23. Which lab value should a nurse monitor for a client receiving heparin therapy?

A. INR
B. Platelet count
C. aPTT ✅
D. Hemoglobin

24. Which is a common side effect of opioid analgesics?

A. Diarrhea
B. Insomnia
C. Constipation ✅
D. Hypertension

25. What is the priority action when a client experiences an anaphylactic reaction to a medication?

A. Start IV fluids
B. Give diphenhydramine
C. Administer epinephrine ✅
D. Provide emotional support

26. A client is prescribed lithium. Which of the following should be reported to the provider?

A. Weight gain
B. Fine hand tremor
C. Polyuria
D. Vomiting and diarrhea ✅

27. Which assessment finding is expected in a client with left-sided heart failure?

A. Jugular vein distension
B. Crackles in the lungs ✅
C. Hepatomegaly
D. Peripheral edema

28. Which of the following indicates digoxin toxicity?

A. Hypertension
B. Yellow-tinged vision ✅
C. Increased appetite
D. Tachycardia

29. What is the purpose of incentive spirometry?

A. Increase oxygen saturation
B. Promote alveolar expansion ✅
C. Reduce mucus production
D. Treat bronchospasms

NR 304 Exam 3

30. What dietary recommendation is appropriate for a client with celiac disease?

A. Low fat
B. High fiber
C. Gluten-free ✅
D. High protein

31. Which of the following is a manifestation of hyperthyroidism?

A. Cold intolerance
B. Weight gain
C. Tachycardia ✅
D. Constipation

32. A client with a spinal cord injury at T6 is at risk for which complication?

A. Autonomic dysreflexia ✅
B. Pulmonary embolism
C. Cardiac tamponade
D. Diabetic ketoacidosis

33. Which of the following lab values is consistent with renal failure?

A. Decreased creatinine
B. Decreased BUN
C. Increased potassium ✅
D. Increased calcium

34. Which is a priority intervention for a client with a suspected stroke?

A. Monitor blood glucose
B. Assess swallowing
C. Maintain airway patency ✅
D. Apply oxygen

35. Which condition is treated with levodopa-carbidopa?

A. Seizures
B. Parkinson’s disease ✅
C. Schizophrenia
D. Multiple sclerosis

36. Which finding is expected in a client with diabetes insipidus?

A. Oliguria
B. Low serum sodium
C. High urine output ✅
D. Edema

37. What teaching is important for a client taking alendronate?

A. Take with food
B. Lie down after taking
C. Take with full glass of water and remain upright ✅
D. Take at bedtime

38. Which of the following vaccines is safe during pregnancy?

A. MMR
B. Varicella
C. Influenza (inactivated) ✅
D. HPV

39. What is a common symptom of meningitis in adults?

A. Tachycardia
B. Photophobia ✅
C. Nausea
D. Vomiting

40. Which of the following is a contraindication to thrombolytic therapy?

A. History of hypertension
B. Recent surgery ✅
C. Diabetes
D. Atrial fibrillation

41. Which lab value is most important to monitor in a client receiving enoxaparin?

A. aPTT
B. INR
C. Platelet count ✅
D. Sodium

42. Which is an appropriate nursing action for a client with neutropenia?

A. Encourage fresh fruits and vegetables
B. Place in negative pressure room
C. Restrict visitors with infections ✅
D. Provide humidified oxygen

43. What is a manifestation of hypocalcemia?

A. Constipation
B. Muscle twitching ✅
C. Lethargy
D. Bradycardia

NR 304 Exam 3

44. A client with a new tracheostomy has thick secretions. What is the nurse’s priority action?

A. Encourage oral fluids
B. Increase humidification ✅
C. Suction frequently
D. Give antibiotics

45. Which is a priority intervention for a client with major depressive disorder?

A. Encourage group therapy
B. Monitor for suicidal ideation ✅
C. Provide high-calorie snacks
D. Promote independence

46. What is a risk factor for cataracts?

A. Obesity
B. Smoking ✅
C. High cholesterol
D. Hyperthyroidism

47. Which insulin has the fastest onset?

A. NPH
B. Regular
C. Glargine
D. Lispro ✅

48. A client has a potassium level of 6.0 mEq/L. What is the priority action?

A. Restrict fluids
B. Administer potassium chloride
C. Place on cardiac monitor ✅
D. Provide high-potassium diet

49. Which is a manifestation of increased intracranial pressure?

A. Bradycardia ✅
B. Tachycardia
C. Hypotension
D. Pupil constriction

50. What teaching should be given to a client using an inhaled corticosteroid?

A. Use before bronchodilator
B. Rinse mouth after use ✅
C. Take with food
D. Avoid shaking the inhaler