NSG 245 Exam 2

Question: 1 of 43

NSG 245 Exam 2. A client with a history of angina reports chest pain while walking in the hallway. The nurse assists the client to sit down and administers a nitroglycerin tablet as prescribed. After 5 minutes, the client reports, “The pain hasn’t gone away and it’s actually getting worse.” Which action should the nurse take next?

• Administer a second nitroglycerin tablet and continue to monitor closely
• Document the pain characteristics and reassess in 10 minutes
• Notify the healthcare provider of the client’s response to the first dose
• Activate the rapid response system and prepare to administer oxygen

Question: 3 of 43

A nurse is teaching a group of clients about risk factors for developing peripheral artery disease. Which of the following risk factors should the nurse include in the teaching?

• Body mass index of 35
• Chronic pulmonary disease
• History of venous thrombosis
• Rheumatic fever

Question: 3 of 43

A nurse is caring for a client diagnosed with hepatitis A. Based on the mode of transmission, which nursing intervention should be prioritized to prevent the spread of the infection?

• Isolating the client in a negative pressure room to prevent droplet spread
• Using airborne precautions such as N95 masks when providing care
• Ensuring strict hand hygiene after assisting the client with toileting and before handling food
• Avoiding direct contact with blood or bodily fluids during care

Question: 4 of 43

A nurse is reinforcing medication teaching with a client who has been prescribed pantoprazole for gastroesophageal reflux disease (GERD). Considering the pharmacokinetics and optimal therapeutic effects, which instruction should the nurse include about when to take the medication?

• Take the medication once daily before breakfast.
• Take the medication after meals to prevent irritation.
• Take the medication with your morning meal.
• Take the medication only when you feel heartburn.

Question: 5 of 43

A nurse is reinforcing discharge teaching for a client with heart failure. Which client statement indicates a need for further teaching regarding management of their condition?

• “I’ll weigh myself every morning before breakfast and report if I gain more than 2 pounds in a day.”
• “If I start feeling short of breath, I’ll just rest for a while and see if it goes away.”
• “I’ll try to rest after activities and spread tasks throughout the day.”
• “I’ll limit my sodium intake and avoid adding salt to foods.”

Question: 6 of 43

A nurse is preparing a client with Crohn’s disease for a barium enema. Which nursing action is the highest priority to ensure client safety and accurate diagnostic results?

• Encourage the client to eat a high-residue diet the day before the test to improve bowel visualization.
• Schedule the barium enema based on the patient’s preference.
• Advise the client to chew gum prior to the procedure to stimulate peristalsis and aid bowel cleansing.
• Assess the client for signs of bowel perforation or obstruction before the procedure.

Question: 7 of 43

A nurse is caring for a client admitted with suspected acute cholecystitis. Which clinical cue should the nurse recognize as most indicative of this condition?

• Generalized abdominal discomfort without any relation to meals
• Left lower quadrant abdominal pain with bloating
• Epigastric pain relieved by defecation
• Right upper quadrant pain radiating to the right shoulder after eating a fatty meal

Question: 8 of 43

A patient with heart failure expresses feelings of frustration and states, “I’m tired of all these limits. I can’t do anything I used to enjoy. I feel like my life is shrinking.” Which is the most appropriate response from the nurse?

• “Many people with heart failure feel frustrated at first, but you’ll adjust.”
• “You should focus on what you can still do instead of what you can’t.”
• “Let’s talk about what activities are most meaningful to you and how we can adapt them safely.”
• “You need to rest more often so you don’t make your symptoms worse.”

Question: 9 of 43

A nurse is providing teaching to a client who has long-term symptoms of GERD (gastroesophageal reflux disease). Which of the following statements should the nurse include in the educational materials? NSG 245 Exam 2

• “Follow-up with an endocrinologist as your risks for diabetes increases.”
• “It is important to watch for manifestations of pancreatic cancer.”
• “You will need to monitor for manifestations of liver issues.”
• “It is important to follow up with a GI specialist for recommended surveillance for Barrett’s esophagus”.

Question: 10 of 43

A nurse is reinforcing discharge teaching for a client newly diagnosed with Crohn’s disease. Which statement by the client indicates a need for further teaching to prevent disease flare-ups and complications?

• “It’s okay if I skip my corticosteroid when I feel well.”
• “I’ll keep a food diary to help identify foods that make my symptoms worse.”
• “I’ll eat small, frequent meals to help with digestion.”
• “I’ll try to manage my stress because it can trigger flare-ups.”

Question: 11 of 43

A nurse is reviewing a client’s laboratory results and sees that their hemoglobin A1C is 9%. Which of the following statements from the nurse is appropriate?

• “You have many dangerously low blood sugar levels.”
• “Your blood sugar is very unstable.”
• “Your blood sugar is too high after meals.”
• “Your average blood sugar is high.”

Question: 12 of 43

A nurse is educating a client about the risk factors for GERD (gastroesophageal reflux disease). Which of the following statements should the nurse include?

• “There is no causal link between lying down after eating and increased onset of GERD.”
• “You should avoid possible mercury-containing foods such as some seafood because of their risk to GERD.”
• “You should avoid or cut down on alcohol and caffeine which can aggravate GERD.”
• “It is okay to take aspirin with GERD.”

Question: 13 of 43

A nurse is reviewing the laboratory and clinical data of a client recently diagnosed with Type 1 diabetes mellitus. Which pathophysiological finding best explains the underlying cause of this condition?

• Impaired glucose uptake caused by hyperlipidemia
• Decreased tissue sensitivity to insulin
• Autoimmune destruction of pancreatic beta cells
• Gradual decline in insulin production due to obesity

Question: 14 of 43

A client arrives at the clinic reporting mild shortness of breath after climbing two flights of stairs because the elevator was broken. On assessment, the nurse notes a heart rate of 118 beats/min. Which action should the nurse take next?

• Notify the healthcare provider immediately
• Have the client sit and rest, then reassess the heart rate in a few minutes
• Administer oxygen at 2 L/min by nasal cannula
• Document the finding as a normal resting heart rate

Question: 15 of 43

A nurse is creating a stress management teaching plan for a client with Crohn’s disease who experiences frequent flare-ups triggered by stress. Considering the importance of culturally sensitive care, which nurse statement best demonstrates an appropriate approach to incorporating the client’s cultural background into stress reduction strategies?

• “Deep breathing exercises work for everyone, so you can start doing those every day.”
• “You should try yoga or meditation because those are the best ways to relieve stress.”
• “Let’s talk about what practices you already use to relax or connect spiritually, and see how we can include them in your plan.”
• “It’s important that you stop relying on family rituals and focus on medical stress-relief techniques instead.”

Question: 16 of 43

A nurse delegates the task of applying compression stockings to an unlicensed assistive personnel (UAP) for a client with chronic peripheral vascular disease who wears the stockings to control leg swelling. Which instruction should the nurse provide to ensure the stockings are applied correctly?

• Apply the stockings in the morning before the client gets out of bed.
• Put the stockings on after the client has been walking for about an hour.
• Apply the stockings any time during the day as long as they are smooth and not twisted.
• Have the client dangle the legs for a few minutes before putting the stockings on.

Question: 17 of 43

A nurse is reviewing the laboratory results for a client admitted with ulcerative colitis. Which of the following findings should the nurse expect? (Select all that apply.)NSG 245 Exam 2

(Select All That Apply.)

• [ ] Hemoglobin: 9.6 g/dL (Normal: 12–16 g/dL)
• [ ] Serum albumin: 2.8 g/dL (Normal: 3.5–5.0 g/dL)
• [ ] White blood cell count (WBC): 7,200/mm³ (Normal: 4,000–11,000/mm³)
• [ ] Potassium: 5.0 mEq/L (Normal: 3.5–5.0 mEq/L)
• [ ] Erythrocyte sedimentation rate (ESR): 52 mm/hr (Normal: 0–20 mm/hr)
• [ ] C-reactive protein (CRP): 2 mg/L (Normal: <3 mg/L)

Answer

The expected findings are:

• Hemoglobin: 9.6 g/dL (Normal: 12–16 g/dL)
• Serum albumin: 2.8 g/dL (Normal: 3.5–5.0 g/dL)
• Erythrocyte sedimentation rate (ESR): 52 mm/hr (Normal: 0–20 mm/hr

Question: 18 of 43

A nurse is analyzing the cardiac monitor strip of a client who reports feeling anxious and experiencing mild shortness of breath. The monitor displays a rate of 122 beats per minute, a regular rhythm, P waves present before each QRS complex, a PR interval of 0.16 seconds, and a QRS complex duration of 0.08 seconds. Based on this data, which rhythm interpretation should the nurse document?

• Atrial flutter
• Sinus tachycardia
• Supraventricular tachycardia (SVT)
• Atrial fibrillation

Question: 19 of 43

A client with irritable bowel syndrome (IBS) confides to the nurse, “I’ve stopped going out with friends because I never know when my symptoms will start. I just stay home now.” What is the nurse’s most appropriate response to support the client’s psychosocial well-being and promote coping?

• “You should try to push yourself to go out more so you don’t become isolated.”
• “Staying home for now might be best until your symptoms improve.”
• “It sounds like IBS is really affecting your quality of life. Let’s talk about strategies to help you feel comfortable going out again.”
• “Maybe once you get your symptoms under control, you can start socializing again.”

Question: 19 of 43

A client with irritable bowel syndrome (IBS) confides to the nurse, “I’ve stopped going out with friends because I never know when my symptoms will start. I just stay home now.” What is the nurse’s most appropriate response to support the client’s psychosocial well-being and promote coping?

• “You should try to push yourself to go out more so you don’t become isolated.”
• “Staying home for now might be best until your symptoms improve.”
• “It sounds like IBS is really affecting your quality of life. Let’s talk about strategies to help you feel comfortable going out again.”
• “Maybe once you get your symptoms under control, you can start socializing again.”

Question: 20 of 43

A nurse is caring for a patient with Crohn’s disease who reports new severe abdominal pain and restlessness. Which additional finding should prompt the nurse to notify the provider immediately?

• Low-grade fever of 100.2°F (37.9°C) without other symptoms
• Mild abdominal distension with soft bowel sounds
• Rigid, board-like abdomen on palpation
• Complaints of intermittent nausea with no vomiting

Question: 21 of 43

A nurse is reviewing the chart of a client scheduled for laparoscopic gallbladder removal. Which underlying condition most likely led to this surgical procedure?

• Cholelithiasis causing recurrent biliary colic and inflammation
• Hepatitis C infection leading to liver cirrhosis
• Chronic pancreatitis due to alcohol abuse
• Peptic ulcer disease with gastric outlet obstruction

Question: 22 of 43

A nurse is planning care for a client who has peripheral venous disease. Which of the following interventions should the nurse include in the plan of care?

(Select All That Apply.)

• [ ] Intermittent pneumatic compression pumps
• [ ] Elevation of legs
• [ ] Ankle-brachial index test
• [ ] Layered wraps
• [ ] Exercise

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Answer

The correct interventions to include are:

• Intermittent pneumatic compression pumps
• Elevation of legs
• Layered wraps
• Exercise

Question: 23 of 43

A nurse is assessing a client admitted with abdominal distention, vomiting, and colicky abdominal pain who has had no bowel movement or flatus for two days. Which additional finding should the nurse recognize as an indication of worsening bowel obstruction requiring urgent intervention? NSG 245 Exam 2

• Hypoactive bowel sounds and increasing abdominal girth
• Active bowel sounds in all quadrants with intermittent cramping
• Passage of loose, watery stools after several days of constipation
• Decrease in abdominal pain and return of appetite

Question: 24 of 43

A nurse is planning care for a client who has type 1 diabetes mellitus and is scheduled for joint replacement surgery. Which of the following considerations should the nurse include in the plan of care?

• The client’s blood glucose levels may fluctuate more severely.
• The client will be less able to handle temperature changes.
• The client may need more time to feel the effects of pain medication.
• The client is at higher risk for developing loss of bone density.

Question: 25 of 43

A nurse is caring for a client hospitalized with acute diverticulitis who reports severe left lower quadrant pain and nausea. The client is experiencing high fever and absent bowel sounds. Which nursing action should the nurse take first?

• Offer a heating pad to the abdomen for comfort.
• Encourage the client to eat small, frequent meals with added fiber.
• Place the client NPO and administer IV fluids as prescribed.
• Insert a nasogastric tube for decompression as prescribed.

Question: 26 of 43

A 52-year-old patient with newly diagnosed type 2 diabetes mellitus has a fasting blood glucose of 160 mg/dL and a BMI of 32. The nurse understands that the pathophysiology of type 2 diabetes in this patient primarily involves which of the following mechanisms?

• Increased renal glucose excretion causing depletion of blood glucose levels
• Impaired insulin secretion by pancreatic beta cells combined with insulin resistance in peripheral tissues
• Complete autoimmune destruction of pancreatic beta cells leading to absolute insulin deficiency
• Excessive insulin production causing persistent hypoglycemia and pancreatic burnout

Question: 27 of 43

A nurse is educating a client with atrial fibrillation who is prescribed warfarin about managing their diet. Which client statement indicates a misunderstanding that requires further teaching?

• “If I eat more spinach and kale one day, I can just skip my warfarin dose to balance it out.”
• “I’ll let my provider know if I start a new vitamin or change my diet.”
• “I’ll try to eat about the same amount of green vegetables each week.”
• “I’ll avoid taking herbal supplements without talking to my doctor.”

Question: 28 of 43

A nurse is reviewing laboratory results for a client who has atrial fibrillation. Which of the following blood test results should the nurse identify as a possible cause of atrial fibrillation?

• Elevated brain natriuretic peptide (BNP)
• Elevated triiodothyronine (T3)
• Elevated C-reactive protein (CRP)
• Elevated erythrocyte sedimentation rate (ESR)

Question: 29 of 43

A nurse is caring for a client admitted with a small bowel obstruction who presents with abdominal distention, nausea, and vomiting. Which of the following provider orders should the nurse prioritize to implement?

• Insert a nasogastric (NG) tube for gastric decompression
• Encourage oral fluids to promote peristalsis
• Provide a high-fiber diet to stimulate bowel movement
• Administer prescribed opioid medication every 2 hours

Question: 30 of 43

A nurse is preparing a client for an esophagogastroduodenoscopy (EGD). Before witnessing the client’s signature on the consent form, what is the nurse’s priority action to ensure legal and ethical compliance?

• Witness the consent signing and immediately place it in the medical record without confirming client understanding.
• Explain the risks and benefits of the EGD procedure to the client to ensure understanding.
• Verify that the provider has explained the procedure and obtained the client’s signature voluntarily and competently.
• Have the client sign the consent form immediately before sedation to ensure timing accuracy.

Question: 31 of 43

A nurse is providing teaching to a client who has coronary artery disease. Which of the following statements should the nurse include to explain the correlation between changes in the coronary arteries and manifestations that occur?

• “Coronary arteries become more elastic, causing the arteries to stretch as individuals age and the heart not to receive enough oxygen.”
• “The heart and the coronary arteries weaken, leading to poor perfusion and resulting in angina.”
• “Coronary arteries decrease in diameter, leading to insufficient blood, oxygen, and nutrients reaching the heart muscle.” NSG 245 Exam 2
• “Manifestations occur due to dilation of coronary arteries with increased blood flow, causing increased pressure.”

Question: 32 of 43

A nurse is teaching a client who has peripheral arterial disease. Which of the following statements should the nurse include in the teaching to explain peripheral arterial disease?

• “Blood flow is altered and causes blood to pool in the legs.”
• “Blood flow is altered due to atherosclerosis affecting the tissues’ ability to receive oxygen-rich blood.”
• “Blood flow is altered due to incompetent valves causing increased venous pressure.”
• “Blood flow is altered due to excessive stretching of the ventricles impairing the heart to contract.”

Question: 33 of 43

A nurse is reinforcing teaching with a client recently diagnosed with essential hypertension who states, “I don’t really feel any different, so I’m not sure how serious this is.” Which client statement indicates the need for further teaching?

• “I’m limiting alcohol and taking short walks during my lunch breaks.”
• “I’ve started checking my blood pressure twice a week and writing the numbers down.”
• “If my blood pressure is normal for a few weeks, I can stop my medication and focus on lifestyle changes instead.”
• “I’m trying to plan meals with less sodium and more vegetables.”

Question: 34 of 43

A nurse is evaluating a client who has just undergone revascularization surgery for peripheral vascular disease (PVD). Which assessment finding best indicates that the procedure was successful?

• Capillary refill in the toes greater than 5 seconds
• Foot appears pale and cool compared with the unaffected leg
• Dorsalis pedis pulse palpable at 2+ strength in the affected leg
• Client reports new onset of numbness and tingling in the toes

Question: 35 of 43

A nurse is assessing a client who has peripheral artery disease for potential safety concerns. Which of the following client statements should the nurse report to the provider?

• “I have a small-healed area on my spine that is painful.”
• “I don’t go out much because of the pain in my legs.”
• “I need to walk slowly as I lose my balance often.”
• “It makes me sad that I can’t keep up with my grandchildren.”

Question: 36 of 43

A patient scheduled for a treadmill cardiac stress test asks the nurse why fasting and avoiding caffeine and tobacco are necessary before the procedure. What is the best explanation the nurse should provide to ensure the patient’s understanding and cooperation?

• These restrictions are to ensure the patient has enough energy to complete the test without feeling weak or dizzy.
• Fasting and substance avoidance help to prevent nausea and vomiting during the treadmill exercise.
• Avoiding these substances reduces the risk of allergic reactions to the electrodes used during the ECG monitoring.
• Fasting and avoiding caffeine and tobacco help to prevent interference with heart rate and blood pressure readings during the test.

Question: 37 of 43

A nurse is caring for a postpartum client who underwent a cesarean birth and has a history of deep vein thrombosis (DVT). During the assessment, which clinical cue should the nurse prioritize as an indication of a possible new DVT?

• Swelling and tenderness in one leg, especially calf pain upon dorsiflexion
• Increased urinary frequency and urgency
• Bilateral lower leg muscle cramps without swelling
• Mild bilateral lower leg edema without pain

Question: 38 of 43

The nurse is reviewing laboratory results for a client admitted with an acute exacerbation of Crohn’s disease. Which findings should the nurse expect? (Select all that apply.)

(Select All That Apply.)

• [ ] Increased white blood cell (WBC) count
• [ ] Decreased hemoglobin and hematocrit
• [ ] Elevated C-reactive protein (CRP)
• [ ] Elevated erythrocyte sedimentation rate (ESR)
• [ ] Elevated serum albumin

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Answer

The expected findings during an acute exacerbation of Crohn’s disease are:

• Increased white blood cell (WBC) count
• Decreased hemoglobin and hematocrit
• Elevated C-reactive protein (CRP)
• Elevated erythrocyte sedimentation rate (ESR)

Question: 39 of 43

A nurse is caring for a client who has a new diagnosis of hepatitis C. Which of the following responses from the nurse best explains how a person can become infected with the virus?

• “Eating contaminated food or water from an infected source can cause you to become infected with hepatitis C.”
• “Consuming a large amount of alcohol at one time can cause you to become infected with hepatitis C.”
• “Coming into contact with an infected person’s bodily fluids, such as saliva, can cause you to become infected with hepatitis C.”
• “Coming into contact with infected blood, such as from that of a dirty needle, can cause you to become infected with hepatitis C.”

Question: 40 of 43

A nurse is caring for a client diagnosed with pericarditis who asks, “Why do I need to have an echocardiogram? Isn’t that a heart failure test?” Which response by the nurse best explains the purpose of the echocardiogram in this context?

• “It helps measure how well your heart is pumping blood through the chambers.”
• “It’s used to evaluate whether you might need a pacemaker for your heart rhythm.”
• “It allows the healthcare provider to see if fluid is building up around your heart.”
• “It helps identify blockages in the arteries that may be causing your chest pain.”

Question: 41 of 43

A nurse is reinforcing teaching with a client scheduled for a colonoscopy the next morning. The client asks why they cannot eat any food before the procedure. Which response by the nurse best explains the rationale for maintaining NPO status?

• Food in your stomach could cause severe nausea during the test.
• Eating before the procedure increases the risk of bleeding during the test.
• The bowel needs to be completely empty so the provider can see the colon lining clearly.
• If you eat before the procedure, the anesthesia won’t work as well.

Question: 42 of 43

A 70-year-old client reports abdominal discomfort after eating and nausea. Which additional assessment finding would best help the nurse confirm a diagnosis of acute cholecystitis?

• Lower left quadrant abdominal pain with rebound tenderness
• Diffuse abdominal tenderness without localization
• Tenderness and guarding in the right upper quadrant with positive Murphy’s sign
• Presence of jaundice and pale stools

Question: 43 of 43

A nurse is reinforcing discharge teaching for a client recovering from treatment of an upper GI lesion. Which instruction should the nurse include to help the client recognize early signs of a serious complication requiring immediate medical attention?

• Avoid reporting changes in appetite or mild nausea unless they worsen after one week.
• Report any mild abdominal discomfort that improves with rest within a day.
• Contact your provider only if you experience a persistent mild headache or dry mouth.
• Notify your healthcare provider if you notice black, tarry stools or vomit that looks like coffee grounds.