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A nurse discovers that the wrong dosage of medication was given to client. When determining what action to take your should recognize that which of the following ethical principles should be applied? a) Utility b) Paternalism c) Veracity d) Fidelity
- ANSWERS-c) Veracity A nurse is review in the prescription for doxazosin with a client. Which of the following should be included in the teaching? a) Decrease caloric intake to reduce weight gain. b) Increased dietary fiber to prevent constipation. c) Rise slowly when sitting up from bed. d) Take this medication each morning . - ANSWERS-c) Rise slowly when sitting up from bed. Addresses planning to provide teaching to young adult client who is insomnia. Which of the following should the nurse include in the teaching? a) Exercising an hour before bedtime b) Take a short nap today
c) Keep bedroom cool at night d) Consume a high carbohydrate snack at bedtime.
- ANSWERS-d) Consume a high carbohydrate snack at bedtime. A nurse is caring for client who has a stool culture that is positive for Clostridium difficile. Which of the following infection control precautions is appropriate? a) Wear a face shield prior into entering the room. b) Place the client private room. c) Place the client in a negative pressure room. d) Use alcohol based hand rub following client care.
- ANSWERS-b) Place the client private room. A nurse is planning care for a child who has increased intracranial pressure with a decreased level of consciousness. Which of the following intervention should the nurse including the plan of care? a) Perform active range of motion exercises. b) Perform neurological checks every 4 hours. c) Suction the airway frequently. d) Maintain the head at a midline position.
- ANSWERS-d) Maintain the head at a midline position. The nurse is assessing a client is receiving radiation therapy. Which of the following findings should the nurse expect? a) White blood cell count at 12,500 mm b) Excessive salivation c) +3 pitting edema d) Platelets 95,000 mm
This is assessing clients as had a long arm cast. Which of the following findings of the dress moderate and when assessing for acute compartment syndrome? a) Shortness of breath b) Petechiae c) Change in mental status d) Edema
- ANSWERS-d) Edema I Just came from client is receiving IV moderate (Conscious) sedation with midazolam. The client has a respiratory rate of 9/min and is not responding to commands. Which of the following is an appropriate action by the nurse? a) Placed the client in a prone proposition. b) Implement Positive pressure ventilation. c) Perform nasopharyngeal suctioning. d) administer flumazenil
- ANSWERS-d) administer flumazenil A nurses in a hospital cafeteria overhears two assistive personnel (AP) discussing a client. They are using the clients name and discussing details of his diagnosis. Which of following actions should the nurse take first? a) Report the AP's behavior to the supervisor. b) Completed instant report regarding the Aps conversation. c) Provide the AP with written documentation regarding client confidentiality d) Tell the AP to discontinue their conversation
- ANSWERS-d) Tell the AP to discontinue their conversation
A community health nurse is teaching a group of adults about the importance of health screenings. The nurse should include African American males almost twice as likely as caucasian males to experience which of the following? a) testicular Cancer b) Obesity c) Stroke d) Melanoma
- ANSWERS-c) Stroke A nurse is caring for a client who sprained his left ankle 12 hrs ago. Which of the following prescription is given by the provider should the nurse clarify? a) Over the fact that extremities and two pillows. b) Apply heat to affect extremity for 45 minutes on the 45 is off. c) wrap the affected extremity with a compression dressing. d) Assess the affected extremity for sensation movement impulse every four hours
- ANSWERS-b) Apply heat to affect extremity for 45 minutes on the 45 is off. A nurse is providing dietary teachings for client who has hepatic encephalopathy. Which the following food selections indicates that client understands teaching? a) A sandwich and milkshake b) Rice with black beans c) Cottage cheese and tuna lettuce d) Three egg omelette with low-sodium ham
- ANSWERS-b) Rice with black beans
b) My stoma will drain liquid fluid continuously c) I will change my pump system every two weeks d) My stoma size will stay the same even after healed
- ANSWERS-b) My stoma will drain liquid fluid continuously A nurse in a provider's office is interviewing a client who is requesting an oral contraceptive. Which of the following findings in the client's history is a contraindication to use in combination oral contraceptives? a) thyroid disease b) Allergy to penicillin c) impaired liver function d) abnormal blood glucose
- ANSWERS-c) impaired liver function The nurses providing teaching to a client who has mild persistent asthma has been prescribed montelukast. Which of the following statements to the nursing put in teaching? a) This medication can be used to help you when have an acute asthma attack b) This medication should be taken before exercise and physical activity c) This medication can be taken for 10 days and then gradually discontinued d) This medication helps decrease swelling and mucus production - ANSWERS-d) This medication helps decrease swelling and mucus production A nurse on the medical surgical unit is receiving reports on four clients. Which of the following client should the nurse assess first? a) A client who is receiving warfarin and has and INR of 3. b) A client who has an acute kidney injury, a creatinine of 4 mg/dL, and a BUN 52 mg/dL c) A client who had a NG tube inserted 6 hr ago and has abdominal distention
18 of 28 d) A client who is 4 hr postoperative following a thyroidectomy and reports fullness in the back of the throat - ANSWERS-b) A client who has an acute kidney injury, a creatinine of 4 mg/dL, and a BUN 52 mg/dL A nurse is assessing a client who has pericarditis. Which of the following findings is priority a) Paradoxical pulse b) dependent edema c) Pericardial friction rub d) Substernal chest pain - ANSWERS-a) Paradoxical pulse A charge nurse is providing teaching to a new licensed nurse on how to cleanup surfaces contaminated with blood. Which of the following agents said the nurse include in the teaching? a) Hydrogen peroxide b) Chlorhexidine c) Isopropyl alcohol d) Chlorine bleach - ANSWERS-d) Chlorine bleach A nurse is preparing to feed a newly admitted patient with dysphagia. Which of the following actions in response take? a) instruct the client to lift her chin when swallowing b) discourage the client from coughing during feedings c) Sit at or below the clients eye level during feedings. d) Talk with the client during her feeding - ANSWERS-c) Sit at or below the clients eye level during feedings. A nurses caring for a client who repeatedly refuses meals. The nurse overhears an assistive
d) Constricted pupils - ANSWERS-b) Oliguria A nurse is a receiving report on four clients. Which of the following clients should the nurse assess first? a) A client who has illeal conduit and mucus in the pouch b) Client pleasant arteriovenous additional vibration palpated c) A client whose chronic kidney disease with cloudy diasylate outflow d) A client was transurethral resection of the prostate with a red tinged urine in the bag - ANSWERS-c) A client whose chronic kidney disease with cloudy diasylate outflow A nurse is caring for a client just received the first dose of lisinopril. The following is an appropriate nursing intervention? a) Place's cardiac monitoring b) Monitor the clients oxygen saturation level c) Provide standby assist with the client from bed d) Encourage foods high in potassium - ANSWERS-c) Provide standby assist with the client from bed A nurse is caring for a client who is in labor and his seat is receiving electronic fetal monitoring. The nurse is reviewing the monitor tracing and notes early decelerations. Which the following should the nurse expect? a) Feta hypoxia b) Abrupto placentae c) Post maturity d) Head Compression - ANSWERS-d) Head Compression A nurse is caring for a client who has chronic kidney disease. The nurse should identify which of the following laboratory values as in an indication for hemodialysis? a) glomerular filtration rate of 14 mL/ minute
b) BUN 16 mg/DL c) serum magnesium 1.8 mg mg/dl d) Serum phosphorus 4.0 mg/dL - ANSWERS-a) glomerular filtration rate of 14 mL/ minute A nurse is caring for an infant who has a prescription for continuous pulse oximetry. The following is an appropriate action for the nurse to take? a) Placed infant under radiant warmer b) Move the probe site every 3 hours c) Heat the skin one minute prior to placing the program d) Placed a sensor on the index finger - ANSWERS-c) Heat the skin one minute prior to placing the program A nurse in a mental health facility receives a change of shift report on for clients. Which of the following clients should the nurse plan to assess first? a) Client placed in restraints to the aggressive behavior b) A new limited client pleasures history of 4.5 kg weight loss in the past two months c) Client is receiving a PRN dose of health heard all two hours ago for increased anxiety d) Applied he'll be receiving his first ECT treatment today - ANSWERS-a) Client placed in restraints to the aggressive behavior A nurse in an emergency department completes an assessment on an adolescent client that has conduct disorder. The client threatened suicide to teacher at school. Which of the following statements should the nurse include in the assessment? a) Tell me about your siblings b) Tell me what kind of music you like c) Tell me how often do you drink alcohol d) Tell me about your school schedule - ANSWERS-c) Tell me how often do you drink alcohol
c) Plant oxygen tent fell over minutes via rebreather mask d) Obtain a cardiac rehabilitation consult - ANSWERS-d) Obtain a cardiac rehabilitation consult A Nurses caring for client who has breast cancer and has been covering receiving chemotherapy. Which of the following laboratory values should nurse report to provider? a) WBC 3,000/mm b) Hemoglobin 14 g/dl c) Platelet 250,000/mm d) aPTT 30 seconds - ANSWERS-a) WBC 3,000/mm Home health nurse is carefully planned for Alzheimer's disease. To the following action should the nurse include in the plan of care a) Place a daily calendar in the kitchen b) Replace button clothing with zippered items c) Replace the carpet with hardwood floors d) Create variation in daily routine - ANSWERS-a) Place a daily calendar in the kitchen Nurse is performing change of shift assessments on 4 clients. Which of the following findings should the nurse report to provider first? a) The client was cystic fibrosis and has a thick productive clock and reports thirst b) Client who has gastroenteritis and is lethargic and confused c) The Client has diabetes mellitus has morning fasting Legal cost of 185 mg over deal d) The client was sick of signing it reports pain 15 minutes after receiving oral analgesic - ANSWERS-b) Client who has gastroenteritis and is lethargic and confused
A nurse is caring for a client was in the second trimester of pregnancy and asks how to treat constipation. Which of the following statements by the nurse is appropriate? a) Decrease taking vitamins and supplements to every other day b) Eat 15 g of fiber per day c) Consume 48 ounces of water each day d) Drink hot water with lemon juice each morning when you wake up - ANSWERS-d) Drink hot water with lemon juice each morning when you wake up A nurse is caring for a client who is preparing his advance directives. Which is the following statements by the client indicates an understanding of advanced directives? select all that apply a) I can't change my instructions once a minute b) My doctor will need to approve my advance directives c) I need an attorney to witness my signature on the advance directives d) I have the right to refuse treatment e) My health care proxy can make medical decisions for me - ANSWERS-d) I have the right to refuse treatment e) My health care proxy can make medical decisions for me A nurse is caring for client who is taking levothyroxin. Which of the following findings should indicate that the medication is effective? a) Weight loss b) Decreased blood pressure c) Absence of seizures d) Decrease inflammation - ANSWERS-a) Weight loss A nurse is caring for a client who is at 32 weeks gestation and has a history of cardiac disease. Which of
c) Fever d) Dry Mouth - ANSWERS-c) Fever A nurse observes an AP providing care to a child who is in skeletal traction. Which of the following action requires intervention? a) Providing a high protein snack b) Assisting the child to reposition c) Placing weights as a child's bed d) Massaging pressure points-causes skin breakdown - ANSWERS-c) Placing weights as a child's bed A nurse is planning to delegate to an AP the fasting blood glucose testing for a client who has diabetes mellitus. Which of the following action should the nurse take? a) Determine if the AP is qualified to perform the test. b) Help the AP performed the blood glucose test c) Assign the AP to ask the client is taking his diabetic medication today d) Have AP check the medical record for prior blood glucose test results - ANSWERS-a) Determine if the AP is qualified to perform the test. A nurse is assessing client brought to the hospital psychiatric emergency services by a law enforcement officer. The client has disorganized, incoherent speech with loose associations and religious content. You should recognize the signs and symptoms as being consistent with which of the following? a) Alzheimer's disease b) Schizophrenia c) Substance intoxication
d) Depression - ANSWERS-b) Schizophrenia A nurse is caring for a child who has infectious mononucleosis.. Which of the following findings are associated with this diagnosis? Select all that apply a) splenomegaly b) Koplik spots c) Malaise d) Vertigo e) Sore throat - ANSWERS-a) splenomegaly c) Malaise e) Sore throat Nurse is performing dressing change for client was a sacral wound using negative pressure wound therapy. Which The following actions should the nurse take first? a) Apply skin preparation to wound edges. b) Normal saline c) Don sterile gloves d) Determine pain level - ANSWERS-d) Determine pain level A nurses caring for client recovery from the bowel surgery who has nasogastric tube connected to low intermittent suction. Which the following assessment findings should indicate to the nurse that the NG tube may not be functioning properly? a) Drainage fluid is greenish-yellow b) aspirate pH of 3
A nurse on acute med-surgical unit is performing assessments on a group of clients. Which is highest priority? a) The client has surgical hypoparathyroidism and positive Trousseau's sign b) A client who was Clostridium difficile with acute diarrhea c) A client who is acute kidney injury and urine with a low specific gravity d) The client who has oral cancer and reports a sore on his gums - ANSWERS-a) The client has surgical hypoparathyroidism and positive Trousseau's sign Nurses caring for a client was congestive heart failure. Which of the following prescriptions for the provider should the nurse anticipate? a) Call the provider to clients respiratory rate is less 18/min b) Give the client 500 mL IV bolus of 0.9 sodium chloride over 1 hr c) Give the client enalapril 2.5 mg PO twice daily d) Call the provider if the clients pulse rate is less than 80/min - ANSWERS-c) Give the client enalapril 2.5 mg PO twice daily A nurse is caring for a client who has a prescription for sertraline to treat depression. Which of the following statements by the client indicates an understanding of the medication treatment plan? a) I will be able starting this medication with feel better b) I can expect to urinate frequently while on this medication c) I understand I may experience difficulty sleeping on this medication d) I should decrease my sodium intake while on this medication - ANSWERS-c) I understand I may experience difficulty sleeping on this medication A nurse has been caring for a female client who has bruises on her arms that she explains are a result of
physical abuse by her husband. The client states, "I don't know how much longer I can take this, but I'm afraid he'll really hurt me if I leave. "Which of the following is an appropriate nursing intervention?" a) Offer to speak to the client's husband regarding his abuse behavior. b) Help the client to recognize the signs of escalation of abuse behavior c) Assist the client to identify personal behaviors that trigger abusive behavior d) Assist the client to Reports abusive behavior to the proper authority - ANSWERS-b) Help the client to recognize the signs of escalation of abuse behavior A client was having suicidal thoughts tells the nurse "It just does not seem worth it anymore. Why not end my misery?" Which of the following responses for the nurses appropriate? a) Why do you think your life is not worth it anymore? b) Do you have a plan to end your life? c) I need to know what you mean my misery d) You can trust me and tell me what you're thinking - ANSWERS-b) Do you have a plan to end your life? A nurse is caring for a client who has schizophrenia. Which of the following assessment findings should the nurse expect? a) Decreased level consciousness b) Unable to identify common objects c) Poor problem solving ability d) Preoccupation was somatic disturbances - ANSWERS-c) Poor problem solving ability A nurse is caring for a client who has deep vein thrombosis of the left lower extremity. Which of the
