NURSING CHALLENGERS BY

SUBHASH CHOUDHARY
EXAM PREPARATION LEAGUE ( EPL ) #30
Q. 1 A male client is started on IV anticoagulant therapy with heparin. Which of the following
laboratory studies will be ordered to monitor the therapeutic effects of heparin?
A. Partial thromboplastin time
B. Hemoglobin
C. Red blood cell (RBC) count
D. Prothrombin time

Ans. – A
✓ Partial thromboplastin time is used to monitor the effects of heparin, and dosage is
adjusted depending on test results. It is a screening test used to detect deficiencies in
all plasma clotting factors except factors VII and XIII and platelets.
✓ Hemoglobin is the main component of RBCs. Its main function is to carry O2 from the
lungs to the body tissues and to transport CO2 back to the lungs.
✓ RBC count is the determination of the number of RBCs found in each cubic millimeter
of whole blood.
✓ PT is used to monitor the effects of oral anticoagulants ( warfarin ).

Q. 2 A 74-year-old obese man who has undergone open reduction and internal fixation of
the right hip is 8 days postoperative. He has a history of arthritis and atrial fibrillation. He
admits to right lower leg pain, described as "a cramp in my leg." An appropriate nursing
action is to:
A. Assess for pain with plantiflexion
B. Assess for oedema and heat of the right leg
C. Instruct him to rub the cramp out of his leg
D. Elevate right lower extremity with pillows propped under the knee

Ans. – B
✓ Swelling and warmth along the affected vein are commonly observed clinical
manifestations of a deep venous thrombosis as a result of inflammation of the vessel
wall.

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✓ Calf pain with dorsiflexion of the foot (Homans' sign) can be a sign of a deep venous
thrombosis.
✓ Rubbing or massaging of the affected leg is contraindicated because of the risk of the
clot breaking loose and becoming an embolus.
✓ A pillow behind the knee can be constricting and further impair blood flow.

Q. 3 A pregnant client is at the clinic for a third trimester prenatal visit. During this
examination, it has been determined that her fetus is in a vertex presentation with the
occiput located in her right anterior quadrant. On her chart this would be noted as:
A. Right occipitoposterior
B. Right occipitoanterior
C. Right sacroanterior
D. LOA

Ans. – B

Q. 4 A client is being discharged with albuterol and beclomethasone dipropionate to be

administered via inhalation three times a day and at bedtime. Client teaching regarding the
sequential order in which the drugs should be administered includes: ( AIIMS NORCET 4.0
JUNE 2023 )
A. Glucocorticoid followed by the bronchodilator
B. Bronchodilator followed by the glucocorticoid
C. Alternate successive administrations
D. According to the client's preference

Ans. – B
✓ Bronchodilating the airways first allows for the glucocorticoid to be inhaled through
open airways and increases the penetration of the steroid for maximum effectiveness
of the drug.

Q. 5 To prevent fungal infections of the mouth and throat, the nurse should teach clients on
inhaled steroids to:
A. Rinse the plastic holder that aerosolizes the drug with hydrogen peroxide every other day

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B. Rinse the mouth and gargle with warm water after each use of the inhaler
C. Take antacids immediately before inhalation to neutralize mucous membranes and
prevent infection
D. Rinse the mouth before each use to eliminate colonization of bacteria

Ans. – B
✓ It is important to rinse the mouth after each use to minimize the risk of fungal
infections by reducing the droplets of the glucocorticoid left in the oral cavity.

Q. 6 Which of the following would indicate the need for further teaching for the client with
COPD? The client verbalizes the need to:
A. Eat high-calorie, high-protein foods
B. Take vitamin supplementation
C. Eliminate intake of milk and milk products
D. Eat small, frequent meals

Ans. – C
✓ Milk does not make mucus thicker. It may coat the back of the throat and make it feel
thicker. Rinsing the mouth with water after drinking milk will prevent this problem.

Q. 7 MgSO4 is ordered IV following the established protocol for a client with severe PIH. The
anticipated effects of this therapy are anticonvulsant and:
A. Vasoconstrictive
B. Vasodilative
C. Hypertensive
D. Antiemetic

Ans. – B
✓ An anticonvulsant effect and vasodilation are the desired outcomes when
administering this drug.

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✓ Respiratory depression common side effect of this medication and needs to be
monitored and recorded frequently.
✓ Antidote for MgSO4 is Calcium gluconate.

Q. 8 In addition to changing the mother's position to relieve cord pressure, the nurse may
employ the following measure (s) in the event that she observes the cord out of the vagina:
A. Immediately pour sterile saline on the cord, and repeat this every 15 minutes to prevent
drying.
B. Cover the cord with a wet sponge.
C. Apply a cord clamp to the exposed cord, and cover with a sterile towel.
D. Keep the cord warm and moist by continuous applications of warm, sterile saline
compresses.

Ans. – D
✓ The cord should be kept warm and moist to maintain fetal circulation. This measure
is an accepted nursing action.

Q. 9 Which of the following signs might indicate a complication during the labor process with
vertex presentation?
A. Fetal tachycardia to 170 bpm during a contraction
B. Nausea and vomiting at 810 cm dilation
C. Contraction lasting 60 seconds
D. Appearance of dark-colored amniotic fluid

Ans. – D
✓ Passage of meconium in a vertex presentation is a sign of fetal distress.

Q. 10 A client is admitted to the hospital for an induction of labor owing to a gestation of 42

weeks confirmed by dates and ultrasound. When she is dilated 3 cm, she has a contraction
of 70 seconds. She is receiving oxytocin. The nurse's first intervention should be to: ( AIIMS
NORCET 4.0 JUNE 2023 )
A. Check FHT

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B. Notify the attending physician
C. Turn off the IV oxytocin
D. Prepare for the delivery because the client is probably in transition

Ans. – C
✓ The standard of care for an induction according to the Association of Women's
Health, Obstetric, and Neonatal Nurses and American College of Obstetrics and
Gynecology is that contractions should not exceed 60 seconds in an induction.
Inductions should simulate normal labor; 70-second contractions during the latent
phase (3 cm) are not the normal. The next contractions can be longer and increase
risks to the mother and fetus.

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