Leadership Quizzes/Final
A nurse is caring for four clients who are postoperative from surgery 24 hr ago. At 1200 the nurse assesses the clients. Which of the following clients is the nurse's priority?
A client whose BP at 0800 was 138/86 and at 1200 is 106/60
A nurse is triaging clients following a mass casualty event. Which of the following clients should the nurse assess first?
A client who has severe respiratory stridor and a deviated trachea.
A nurse is assessing a group of clients for hospice services. The nurse should recommend hospice care for which of he following clients?
A client who has terminal cancer and needs assistance with pain management
A charge nurse is planning to admit several clients to the medical unit. Which of the following clients should the nurse assign to a private room?
A client who is neutropenic.
A nurse is assessing a client to ID risk factors for disease. Which of the following findings is a risk factor for metabolic syndrome?
Large waist size.
A nurse is caring for a client who is postop and is at risk for developing VTE. The nurse should instruct the client to avoid which of the following unsafe actions?
Massaging her legs
A home health nurse is developing a plan of care for a child who has hemiplegic cerebral palsy. Which of the following goals is the priority for the nurse to include in the plan of care?
Modify the environment
A client smoking in his bathroom has dropped a cigarette butt into a wastepaper basket, which begins to smolder. Which of the following actions is the nurse's priority?
Move any clients in the immediate vicinity.
A nurse is discussing ageism with a newly licensed nurse. Which of the following statements by the new nurse indicates an understanding of the concept?
"Ageism refers to the stereotype that older adults are not able to understand new information."
A nurse is assessing a client who has insomnia. Which of the following questions is the highest priority for the nurse to ask the client?
"Do you have difficult staying awake when you are driving?"
A nurse in the nursery is caring for a newborn. The grandmother of the newborn ask if she can take the newborn to the mother's room. Which of the following is an appropriate response by the nurse?
"Have the mother call and I will take the baby to the room."
A nurse in a provider's office is collecting a health history from a client who has a new prescription for glyburide to treat type 2 DM. Which of the following statements by the client indicates a contraindication for taking this medication?
"I plan to continue nursing my baby until he is at least a year old."
A nurse is providing DC teaching to a client who was recently dx with a latex allergy. Which of the following statements indicates an understanding of the teaching?
"I will use ink pens for writing."
The nurse is caring for a client who is 9 days post op following a total laryngectomy. The nurse removes the client's NG tube and initiates oral feedings. Which of the following statements should the nurse make?
"It is no longer possible for you to choke on or aspirate food."
A nurse is filling out an accident report after findings a client lying on the floor. Which of the following information should the nurse include?
"The client was lying on the floor next to his bed."
A nurse is teaching an AP to measure a newborn's respiratory rate. Which of the following statements indicates an understanding of why the respiratory rate should be counted for a complete minute?
"The rate and rhythm of breath are irregular in newborns."
A nurse is caring for a client who has severe head injuries and is declared brain dead. The transplant coordinator has spoken with the clients family about organ donation. The client's spouse state she is confused and does not know what she should do. Which of the following responses by the nurse is appropriate?
"What do you think your spouse would have wanted?"
A nurse is reviewing information about HIPPA with a newly licensed nurse. Which of the following statements by the newly licensed nurse indicated a need for further teaching?
"information about a client can be disclosed to a family member at any time."
A nurse is reviewing data for four children. Which of the following children should the nurse assess first?
A 10-year-old who has SCA who reports severe chest pain
A nurse is admitting a child who has leukemia. Which of the following clients should the nurse place in the same room with the client?
A child who has nephrotic syndrome.
A nurse is assigned a group of clients at the start of the shift. Which of the following clients should the nurse plan to care for first?
A client asking about his PCA pump that contains morphine
A nurse is caring for four clients on a med surg unit. Which of the following clients should the nurse assess first?
A client who had an indwelling urinary cath removed 5 hr ago and has not voided.
A nurse at a health fair is assessing the weight status of four clients. Which of the following clients are classified as overweight?
A male client who has a BMI of 29
A nurse is triaging clients in an urgent care clinic. Which of the following clients should the nursed have the provider care for immediately?
A middle adult male who is diaphoretic and reports epigastric pain.
A charge nurse is providing an inservice for staff nurses on the use of new IV pumps. Which of he following actions should the nurse take to best evaluate staff competency with the new equipment?
Allow time during the workday when each nursed can demonstrate proficiency.
A nurse on a peds unit is reviewing her client assignment following the shift report. Which of the following clients should the nurse plan to assess first?
An infant who has pertussis and is receiving O2 via NC
A nurse has been reassigned from her regular area of work to a unit that is short staffed. Which of the following actions should the nurse take first?
Ask what she will assigned to do.
A nurse is assessing a client's radial pulse and determines that the pulse is irregular. Which of he following actions should the nurse take?
Assess the apical pulse for a full minute.
A nurse on a surgical unit is caring for a group of clients. Which of the following is the priority action of the nurse?
Assessing a client who is experiences unitlateral calf pain when ambulating
A nurse is planning care for a client who has anorexia nervosa. The nurse should make which of the following client goals the priority?
Attain a wt that is greater than the 75th percentile for age and height.
A nurse is among the first responders to a mass-casualty incident and does not know what type of PPE is needed. Which of the following should the nurse take?
Chose the highest level of protection equipment available.
A nurse enters a client's room and finds the client pulseless. The family has requested a DNR order from the provider, but he has not written the order yet. Which of the following actions should the nurse take?
Call the emergency response team.
A nurse is caring for a client who is a primigravida, at term, and having contractions but is stating that she is "not really sure if she is in labor or not". Which of the following should the nurse recognize as signs of true labor?
Changes in the cervix.
A nurse is working with an AP to care for a group of clients on the peds unit. Which of the following task should the nurse have the AP preform first?
Check to see if the elbow restraint is in place for an infant who is post op from a surgical correction of cleft palate.
A nurse is assisting with the admission of a client to an inpatient unit. Which of the following sources of info should then nurse rely on for accurate info about the client?
Client concerns
A nurse is preparing to administer oral medication to a client. Which of the following should the nurse recognize as an acceptable client identifier?
Client's full name Facility assigned ID number
A nurse is caring for a client who is 12 hr post op and has a chest tube to a disposable water-seal drainage system with suction. The nurse should intervene for which of the following observations?
Cont bubbling in the water seal chamber
When reviewing the admitting prescription for a client, the nurse notes that the dose of one medication is three times the usual dose of this medication. Which of the following actions should the nurse take?
Contact the provider to question the dosage.
A nurse is caring for a client in the ED who, 2 hr earlier, severed the tip of a finger in an accident. During the assessment, the nurse detects a strong smell of alcohol from the client's breath. For which of the following findings should the nurse assess first?
Date of clients last tetanus immunization.
A nurse is developing a teaching plan for a client who has a new dx of type 2 DM. Which of the following actions should the nurse plan to take first?
Determine what the client knows about managing diabetes.
A nurse is observing a newly licensed nurse who is preforming a focused skin assessment on a client who reports a skin condition. Which of the following questions by the newly licensed nurse requires intervention?
How do you handle stress?
A nurse working in an ED is caring for a client who has been exposed to sarin gas following a bioterrorism attack. Which of the following interventions should the nurse plan to take?
Initiate seizure precautions.
A nurse is teaching about safety for car seats with the parents of a 24 month old toddler who is in the 50th percentile for height and weight. Which of the following instructions should the nurse include in the teaching?
Position the toddler rear-facing in the middle of the back seat.
A nurse is serving on a continuous quality improvement (CQI) committee that has been assigned to develop a program to reduce the number of medication administration errors following a sentinel event at the facility. Which of the following strategies should the committee plan to initiate first?
Review the events leading up to each medication administration error.
A nurse teaching the parents for a 10-month-infant about home safety. Which of the following information should the nurse include in the teaching?
Serve food in small, non-circular pieces. Tie plastic bags in knots before discarding them. Fit the mattress so that is i snug against the sides of the crib.
A nurse is teaching staff which factors to include in an abuse assessment of a client. Which of the following factors should the nurse include in the teaching? SATA
Suicide risk coping patterns support system alcohol use
A nurse is caring for a client who is at risk for falls. Which of the following should he nurse take?
Teach the client to use the call light. Keep the client's bed in the lowest position. Place a fall-risk identification band on the client's wrist.
A nurse is preparing to transfer a client who has left-sided weakness from the bed to a chair. Which of the following actions should the nurse plan to take?
Use a gait belt yo stand and pivot the client.
A charge nurse is teaching a group of health care workers about hand hygiene to prevent infection. Which of the following information should the charge nurse include in the teaching?
Use chlorehexidine to wash hands if the client is immunosuppressed.
A nurse is obtaining informed consent from a client who is preoperative. Which of the following actions should the nursed take?
Validate the signature is authentic. Verify that the client understands the surgical procedure. Confirm that the consent is voluntary.
A charge nurse is teaching a new nurse how to initiate IV access on a client. Which of the following action by the new nurse indicates an understanding of the teaching?
Washes hands with soap and water before the procedure
A nurse is having difficulty reading the provider's writing when transcribing a prescription for a client's medication. Which of the following actions should the nurse take?
contact the provider to clarify
A charge nurse is observing a nurse auscultating a client's bowel sounds. Which of the following actions requires interventions by the charge nurse?
palpates before auscultating
