BETH SAUNDERS PRACTICE 2
10. A primary health care provider has written a prescription for wrist restraints to be applied on a client from 10:00 p.m. to 7:00 a.m. because the client becomes disoriented during the night and is at risk for pulling out the nasogastric tube and the intravenous catheter. At 11:00 p.m. The charge nurse makes rounds on all of the clients in the unit. When assessing the client with the restraints, which observation by the charge nurse indicates that the nurse who applied the restraints performed an unsafe action? The restraints were applied tightly. A safety knot was used to secure the restraints. The call light was placed within reach of the client. The client's record indicates that the restraints will be released every 2 hours.
1
11. A nurse is assessing the status of a client who returned to the surgical nursing unit after a parathyroidectomy procedure. The nurse would place highest priority on which assessment finding? 1 Laryngeal stridor 2 Difficulty voiding 3 Mild incisional pain 4 Absence of bowel sounds
1
18. A client is unwilling to go to church because the ex-spouse goes there and the client feels that the ex-spouse will laugh at the client. Because of this hypersensitivity to a reaction from the spouse, the client remains homebound. The home care nurse develops a plan of care that addresses which personality disorder? Avoidant Borderline 3 Schizotypal Obsessive-compulsive
1
22. The nurse is providing discharge instructions to a non-American client regarding prescribed dietary modifications. During the teaching session, the client continuously turns away from the nurse. Which nursing action is most appropriate? 1.Continue with the instructions, verifying client understanding. 2. Walk around the client so that the nurse is continuously facing the client. 3. Identify the importance of the instructions for the maintenance of health care. 4. Give the client a dietary booklet and return later to continue with the instructions
1
31. The nurse determines that a history of which mental health disorder would support the prescription of taking donepezil hydrochloride? Dementia Schizophrenia Seizure disorder Obsessive-compulsive disorder
1
41. The nurse is assessing the colostomy of a client who has had an abdominal perineal resection for a bowel tumor. Which assessment finding indicates that the colostomy is beginning to function? The passage of fatus Absent bowel sounds The client's ability to tolerate food Bloody drainage from the colostomy
1
45. Capecitabine has been prescribed for a client with breast cancer, and the client asks the nurse about the side effects of the medication. The nurse responds that a frequent side effect of this medication is which finding? Diarrhea Weakness Irritability Increased appetile
1
57 A client has begun to use a methylxanthine bronchodilator. What beverage would the nurse plan to teach the client to avoid while taking this medication? 1. Coffee 2. Orange juice 3. Mineral water 4. Cranberry juice
1
59. The nurse reviews the primary health care provider's (PHCP's) prescriptions for a client with Guillain-Barré syndrome. Which prescription written by the PHCP would the nurse question? 1 Clear liquid diet 2 Bilateral calf measure 3 Monitor vital signs frequently 4 Passive range-of-motion (ROM) exercises
1
8. The registered nurse (RN) is educating a new nurse on mitral stenosis. Which statement by the new nurse indicates that the teaching has been effective? 1. "Left ventricle to aorta narrowing will impede flow of blood." 2. "Left atrium to left ventricle narrowing will impede flow of blood." 3 "Right atrium to right ventricle narrowing will impede flow of blood." 4. "Right ventricle to pulmonary artery narrowing will impede flow of blood."
1
A client is determined by blood gas analysis to be in respiratory alkalosis. Which electrolyte disorder would the nurse monitor for that could accompany the acid-base imbalance? 1. Hypokalemia 2. Hypercalcemia 3. Hypochloremin 4. Hypernatremia
1
The nurse, making rounds at 1545, finds that the client is apprehensive, complaining of a pounding headache, is dyspneic with chills, and has an increased pulse rate. The intravenous (IV) bag has 400 mL remaining, The nurse would take which action first? 1. Shut off the infusion. 2 Sit the client up in bed. 3 Remove the angiocatheter and IV quickly. 4. Place the client in the Trendelenburg's position.
1
The nurse is caring for a postoperative client weighing 68 kilograms (kg) who began to show signs of altered mental status, decreased mean arterial pressure (MAP), hypotension, fever, and tachycardia. The nurse suspects sepsis and notifies the primary health care provider (PHCP). The nurse would anticipate which of the following interventions? Select all that apply. (4) 1 Obtain blood cultures 2 Draw serum lactate levels 3 Administer broad-spectrum antibiotics 4 Administer intravenous (IV) normal serum human albumin 5 Administer 2 liters (L) of IV 0.9% normal saline solution over I hour
1 2 3 5
32. The nurse is assessing a client for signs and symptoms of peritonitis. Which of the following signs or symptoms would alert the nurse to the possibility of this condition? Select all that apply. (3) Nausea Polyuria Vomiting Temperature of 98.7 F (37 °C) Temperature of 102 °F (38.9 °C) Heart rate of 58 beats per minute
1 3 5
39 The primary health care provider (PHCP) writes a prescription for atenolol for a client who was admitted to the hospital. The nurse contacts the PHCP to verify the prescription if which finding is noted in the assessment data? Temperature is 100.1° F (37.8° C). Apical heart rate is 48 beats/min. Blood pressure is 138/82 mm Hg. Pedal pulses are bounding and strong.
2
43. The nurse has been working with a laboring client and notes that the client has been pushing effectively for I hour. What is the client's primary physiological need at this time? Ambulation Rest between contractions Change positions frequently Consume oral food and fluids
2
5. A client comes into the emergency department with suspected appendicitis. The nurse places the client in which position that would be best for the client? Supine Semi-Fowler's High Fowler's Trendelenburg
2
7. The postpartum client asks the nurse about the occurrence of afterpains. The nurse informs the client that afterpains will be especially noticeable during which activity? Ambulating Breast/chest-feeding Taking sitz baths Increasing activity after arriving home
2
The nurse determines that a history of which mental health disorder would support the prescription of taking donepezil hydrochloride ? 1. Dementia 2. Schizophrenia 3. Obsessive compulsive disorder 4. Seizure disorder
1. Dementia
Capecitabine has been prescribed for a client with breast cancer , and the client asks the nurse about the side effects of the medication . The nurse responds that a frequent side effect of this medication is which finding ? 1. Diarrhea 2. Weakness 3. Irritability 4. Increased appetite
1. Diarrhea
The nurse is caring for a client with cardiac disease who has been placed on a cardiac monitor. The nurse notes that the client has developed atrial fibrillation and has a rapid ventricular rate of 150 beats/minute. The nurse would next assess the client for which finding? 1. Hypotension 2. Flat neck veins 3. Complaints of nausea 4. Complaints of headache
1. Hypotension
The registered nurse ( RN ) is educating a new nurse on mitral stenosis . Which statement by the new nurse indicates that the teaching has been effective ? 1. Left ventricle to aorta narrowing will impede flow of blood 2. Left atrium to left ventricle narrowing will impede flow of blood 3. Right atrium to right ventricle narrowing will impede flow of blood 4. Right ventricle to pulmonary artery narrowing will impede flow of blood
1. Left ventricle to aorta narrowing will impede flow of blood
54. The nurse creates a plan of care for a birthing parent with human immunodeficiency virus (HIV) infection and the newborn. The nurse would include which intervention in the plan of care? 1. Monitoring the newborn's vital signs routinely 2. Maintaining standard precautions at all times while caring for the newborn 3. Initiating referral to evaluate for blindness, deafness, learning problems, or behavioral problems 4. Instructing the breast-feeding/chest-feeding parent regarding the treatment of the nipples with nystatin ointment
2
6. Which oral medication, if present in the client's history, indicates a need for teaching related to the client's potential risk for carrying a fetus with a congenital cleft lip or cleft palate? Folic acid Phenytoin Bupropion Methyldopa
2
4. The nurse is teaching a client with right-sided weakness related to a stroke about how to properly ambulate with a cane. Which action would indicate a need for further teaching? 1. The client holds the cane on the right side of the body 2. The client move the weaker leg towards the cane first 3. The client hold the cane 6 inches laterally from the foot 4. The client keeps two points of support on the floor at all times
1. The client holds the cane on the right side of the body
An assistive personnel ( AP ) is caring for a client who has an indwelling urinary catheter . Which action by the AP would indicate a need for further instruction in the care of the client? 1. Used soap and water to cleanse the perineal area 2. Allowed the drainage tubing to rest under the leg 3. Kept the drainage bag below the level of the bladder 4. Used the drainage tubing port to obtain urine samples
1. Used soap and water to cleanse the perineal area
12. The nurse in a health care clinic is preparing to test a client for accommodation, Initially, the nurse would ask the client to take which action? 1 Focus on a close object. 2 Focus on a distant object. 3 Close 1 eye and read letters on a chart. 4 Raise 1 finger when the sound is heard.
2
16. A 4-year-old child is admitted to the hospital for abdominal pain. The parents report that the child has been pale and excessively tired and is bruising easily. On physical examination, lymphadenopathy and hepatosplenomegaly are noted. Diagnostic studies are being performed because acute lymphocytic leukemia is suspected. The nurse determines that which laboratory result confirms the diagnosis? Lumbar puncture showing no blast cells Bone marrow biopsy showing blast cells Platelet count of 350,000 mm (350 × 10%L) White blood cell count of 4500 mm (4.5 x 10%/L)
2
26. The nurse is caring for an infant with bronchiolitis, and diagnostic tests have confirmed respiratory syncytial virus (RSV). On the basis of this finding, which is the most appropriate nursing action? Initiate strict enteric precautions. Move the infant to a private room. Leave the infant in the present room, because RV is not contagious. 4 Inform the staff that using standard precautions is all that is necessary when caring for the child.
2
29. An assistive personnel (AP) is caring for a client who has an indwelling urinary catheter. Which action by the AP would indicate the need for further instruction in the care of the client? Used soap and water to cleanse the perineal area Allowed the drainage tubing to rest under the leg Kept the drainage bag below the level of the bladder Used the drainage tubing port to obtain urine samples
2
9. A child with developmental dysplasia of the hip is placed in a Pavlik harness. The nurse would demonstrate to the parents how to place the child in this harness by placing the child's legs in which position? Prone Abduction Extension Adduction
2
55. A client with a diagnosis of rheumatoid arthritis (RA) is admitted to the unit. What blood tests would the nurse expect to be prescribed to confirm the diagnosis? Select all that apply. (4) 1. Cardiac enzymes 2. Rheumatoid factor 3. Fasting blood glucose 4. Antinuclear antibody (ANA) 5. Erythrocyte sedimentation rate (ESR) 6. Anticyclic citrullinated peptide antibody (anti-CCP)
2 4 5 6
A nurse is caring for a pediatric client diagnosed with intussusception who has undergone surgery. Which task(s) can the nurse delegate to the assistive personnel (AP) in the care of the child? Select all that apply. (2) Dressing changes Vital signs every shift Auscultating bowel sounds Assessing whether sutures are intact Providing assistance with bathing Administering IV fluids per provider's order
2 5
42. When performing a surgical dressing change on a client's abdominal dressing, the nurse notes an increased amount of drainage and separation of the incision line. The underlying tissue is visible to the nurse. The nurse would take which action in the initial care of this wound? 1.Leave the incision open to the air to dry the area. 2.Irrigate the wound and apply a sterile dry dressing. 3.Apply a sterile dressing soaked with normal saline. 4.Apply a sterile dressing soaked in povidone-iodine.
3
A 4 - year - old child is admitted to the hospital for abdominal pain . The parents report that the child has been pale and excessively tired and is bruising easily . On physical examination , lymphadenopathy and hepatosplenomegaly are noted . Diagnostic studies are being performed because acute lymphocytic leukemia is suspected . The nurse determines that which laboratory result confirms the diagnosis ? 1. Lumbar puncture showing no blast cells 2. Bone marrow biopsy showing blast cells 3. Platelet count of 350,000 mm³ ( 350 × 10 % / L ) 4. White blood cell count of 4500 mm³ ( 4.5 × 10 % / L )
2. Bone marrow biopsy showing blast cells
The nurse is caring for a child with a fracture who is placed in skeletal traction. The nurse would monitor for which sign of a serious complication associated with this type of traction? 1. Lack of appetite 2. Elevated temperature 3. Increase in the blood pressure 4. Decrease in the urinary output
2. Elevated temperature
The nurse is performing an assessment on a client with the diagnosis of Brown-Séquard syndrome. The nurse would expect to note which assessment finding? 1. Bilateral loss of pain and temperature sensation 2. Ipsilateral paralysis and loss of touch and vibration 3. Contralateral paralysis and loss of touch, pressure, and vibration 4. Complete paraplegia or quadriplegia, depending on the level of injury
2. Ipsilateral paralysis and loss of touch and vibration
The nurse creates a plan of care for a birthing parent with human immunodeficiency virus (HIV) infection and the newborn . The nurse would include which intervention in the plan of care? 1. Monitoring the newborn's vital signs routinely 2. Maintaining standard precautions at all times while caring for the newborn 3. Initiating referral to evaluate for blindness , deafness , learning problems , or behavioral problems 4. Instructing the breast-feeding /chest-feeding parent regarding the treatment of the nipples with nystatin ointment
2. Maintaining standard precautions at all times while caring for the newborn
6. Which oral medication , if present in the client's history , indicates with a congenital cleft lip or cleft palate ? 1.Folic acid 2.Phenytoin 3.Bupropion 4.Methyldopa
2.Phenytoin
20. A nurse is caring for a client who had a thyroidectomy 1 day ago. Which client laboratory data would the nurse identify as a possible complication of thyroid surgery? Increased serum sodium level Increased serum glucose level Decreased serum calcium level Decreased serum atbumin level
3
24. The nurse is caring for a client with human immunodeficiency virus (HIV) infection and notes a diagnosis of cryptococcosis in the client's medical record. The nurse understands that this opportunistic infection most likely was diagnosed by which test? Skin biopsy Viral culture Sputum culture Bone marrow biopsy
3
27 The nurse is developing a plan of care for a client with depression who is scheduled to have electroconvulsive therapy. Which problem is a priority for this client? Fear Anxiety Risk for aspiration Distorted body image
3
30. The nurse is caring for a client admitted for fever and urinary tract infection (UTD) who is at risk for sepsis. What initial intervention would the nurse anticipate? 1. Rechecking the temperature to ensure accuracy 2. Obtaining a history and physical to find out the source of the fever 3. Obtaining a urine culture and sensitivity prior to beginning antibiotics 4. Administering prophylactic antibiotics until the client becomes afebrile
3
35. The nurse is conducting an initial assessment of a client in crisis. When assessing the client's perception of the precipitating event that led to the crisis, which is the most appropriate question? "With whom do you live?* "Who is available to help you?" *What leads you to seek help now?° "What do you usually do to feel better?*
3
38. The nurse is monitoring a client with diabetes mellitus for signs of hypoglycemia. Which manifestations are associated with this complication? 1. Slow pulse; lethargy; warm, dry skin 2. Elevated pulse; lethargy; warm, dry skin 3. Elevated pulse; shakiness; cool, clammy skin 4. Slow pulse, confusion, increased urine output
3
40. The nurse is providing instructions to the assistive personnel (AP) regarding care of an older client with hearing loss. What would the nurse tell the AP about older clients with hearing loss? 1. They are often distracted. 2. They have middle ear changes. 3. They respond to low-pitched tones. 4. They develop moist cerumen production.
3
49 The nurse is caring for a client with cancer of the prostate who has undergone a prostatectomy. Which action would the nurse plan to include in discharge instructions? 1 Avoid driving the car for a few days. 2 Restrict fluid intake to prevent incontinence 3 Avoid lifting objects heavier than 20 lb (9 kg) for at least weeks. 4 Notify the primary health care provider if small blood clots are noticed during urination.
3
50. A client is in extreme pain from scrotal swelling that is caused by epididymitis. The nurse providing care for the client administers an opioid analgesic to relieve the pain, as prescribed. What is the next nursing action for this client? 1. Dim the lights in the room. 2. Check the name bracelet of the client. 3. Ensure that the call bell is within the client's reach. 4. Tell the client to perform range of motion at the site of the injection.
3
52 A client is admitted to the mental health unit after an attempted suicide by hanging. The nurse can best ensure client safety by which action? 1. Requesting that a peer remain with the client at all times 2. Removing the client's clothing and placing the client in a hospital gown 3. Assigning to the client a staff member who will remain with the client at all times 4 Admitting the client to a seclusion room where all potentially dangerous articles are removed
3
53. The nurse is conducting a teaching session with a client on their diagnosis of pemphigus. Which statement by the client indicates that the client understands the diagnosis? 1. "My skin will have tiny red vesicles." 2. "The presence of the skin vesicles is caused by a virus." 3. "I have an autoimmune disease that causes blistering in the skin." 4. "Red, raised papules and large plaques covered by silvery scales will be present on my skin."
3
56. Ciproflovacin is prescribed for a client with a Pseudomonas aerueinosa infection of the urinary tract. The primary health care provider (PHCP) would be questioned by the nurse about the prescription if which underlying condition is noted in the client's record? 1 Osteoarthritis 2 Diabetes mellitus 3 Myasthenia gravis 4. Chronic obstructive pulmonary disease (COPD)
3
60. The parents of a child with juvenile idiopathic arthritis call the clinic nurse because the child is experiencing a painful exacerbation of the disease. The parents ask the nurse if the child can perform range-of-motion exercises at this time. The nurse would make which response? 1 "Avoid all exercise during painful periods." 2 "Range-of-motion exercises must be performed every day." 3 "Have the child perform simple isometric exercises during this time." 4 "Administer additional pain medication before performing range-of-motion exercises."
3
63. Lactulose is prescribed for a client with a diagnosis of hepatic encephalopathy. The nurse would determine that this medication is effeetive if serum diagnostics reveal which finding? 1.Increased protein level 2. Increased red blood cell count 3. Decreased serum ammonia level 4. Decreased white blood cell count
3
A postpartum parent with mastitis in the right breast complains that the breast is too sore to feed. The nurse would tell the client to implement which measure? Pump both breasts and discard the milk. Bottle-feed the infant on a temporary basis. Feed from the left breast and gently pump the right breast. Feeding from both breasts until this condition resolves.
3
The nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit. The nurse prepares for the child's arrival and plans to implement which type of precautions? Enteric Contact Droplet Neutropenic
3
3. The nurse creates a plan of care for a client with a cervical-uterine radiation implant. Which intervention would be appropriate for the nurse to include in the plan? Restrict all visitors. Keep the client's room door open. Place the client in a semi-private room. Place a lead shield at the client's room.
4
36. The client in chronic kidney disease is receiving epoetin alfa. The nurse would monitor this client for which side/adverse effect of this medication? Fever Depression Bradycardia Hypertension
4
37. A client who has been chronically taking acetylsalicylic acid (aspirin) for arthritis has been given a prescription for misoprostol. The nurse determines that the new medication is effective if the client states relief from which problem? 1. Diarrhea 3. Bleeding 2. Joint aches 4. Epigastric pain
4
44. The nurse determines that the client understands the basis of the diagnosis of obsessive-compulsive disorder after making which statement? 1. "Inner voices tell me to perform my rituals." 2. "My behavior is a conscious attempt to punish myself." 3. "I'm demonstrating control when I engage in my rituals." 4. "My rituals are ways for me to control unpleasant thoughts or feelings."
4
The nurse is conducting a teaching session with a client on their diagnosis of pemphigus. Which statement by the client indicates that the client understands the diagnosis ? 1. "My skin will have tiny red vesicles ." 2. "The presence of the skin vesicles is caused by a virus." 3. " I have an autoimmune disease that causes blistering in the skin." 4 "Red raised papules and large plaques covered by silvery scales will be present on my skin ."
3. " I have an autoimmune disease that causes blistering in the skin."
The nurse provides an educational session on client rights. Which statement by a member of the session demonstrates the best understanding of the nurse's role regarding ensuring that each client's rights are respected? 1. "Autonomy is the fundamental right of each and every client." 2. "A client's rights are guaranteed by both state and federal laws." 3. "Being respectful and concerned will ensure that I'm attentive to my client's rights." 4. "Regardless of the client's condition, all nurses have the duty to value client rights."
3. "Being respectful and concerned will ensure that I'm attentive to my client's rights."
The nurse receives a telephone call from the admissions office and is told that a child with acute bacterial meningitis will be admitted to the pediatric unit . The nurse prepares for the child's arrival and plans to implement which type of precautions ? 1. Enteric 2. Contact 3. Droplet 4. Neutropenic
3. Droplet
25. A 12-month-old child with human immunodeficiency virus infection is currently immunocompromised. The nurse determines that the immunization needs of this child include which action? Withholding the inactivated polio vaccine Recommending against any influenza vaccinations Administering the measles, mumps, and rubella (MM) vaccine Delaying the administration of the varicella virus vaccine until the child is not immunocompromised
4
The nurse is performing an assessment on a client who has been receiving total parenteral nutrition (TPN) at 125 mL/hour. On assessment, the nurse notes the presence of bilateral crackles in the lungs and 2+ pedal edema. The nurse also notes that the client has gained 3 lb (1.5 kg) in S days. Which nursing action would be most appropriate for this client? 1. Slow the infusion rate to 100 mL/hour. 2. Encourage the client to cough and deep-breathe. 3. Notify the primary health care provider (PHCP) of the assessment findings. 4. Administer the prescribed daily diuretic and reassess the client in 2 hours.
3. Notify the primary health care provider (PHCP) of the assessment findings.
The nurse is caring for a client the day after a left total knee arthroplasty surgery. In reviewing the client's past medical history, the nurse notes that the client has a history of urinary incontinence and heart failure, which is managed with a potassium-sparing diuretic and a beta-adrenergic blocker. Which prescription, if not already prescribed, would the nurse contact the primary health care provider to obtain? 1.Daily electrolytes 2 A 12-lead electrocardiogram 3. Resume the client's dose of metoprolol 4 Insertion of an indwelling urinary catheter
3. Resume the client's dose of metoprolol
The nurse is caring for a client with human immunodeficiency virus ( HIV ) infection and notes a diagnosis of cryptococcosis in the client's medical record . The nurse understands that this opportunistic infection most likely was diagnosed by which test ? 1. Skin biopsy 2. Viral culture 3. Sputum culture 4. Bone marrow biopsy
3. Sputum culture
1. The school nurse has conducted a class on testicular self-examination (TE) at the local high school. The nurse determines that the information was correctly interpreted if one of the students states that which action would be performed? 1. Perform the exam after a cold shower. 2. Expect the exam to be slightly painful. 3. Perform the self-examination every other month. 4. Roll the testicle between the thumb and forefinger.
4
13. The nurse is caring for an infant after repair of an(inguinal hernia. Which of these assessment findings indicates that the surgical repair was effective? A clean, dry incision Abdominal distention An adequate flow of urine Absence of inguinal swelling with crying
4
14. The staff nurse reviews the nursing documentation in a client's chart and notes that the wound care nurse has documented that the client has a stage Il pressure injury in the sacral area. Which finding would the nurse expect to note on assessment of the client's sacral area? Intact skin Full-thickness skin loss Exposed bone, tendon, or muscle Partial-thickness skin loss of the dermis
4
15. The nurse is providing instructions to a client regarding ambulation after the application of a fiberglass cast to the lower leg. The nurse determines that the client understands the instructions if the client states that weight bearing on the casted leg can begin at which time period? In 48 hours In 24 hours In approximately 8 hours Within 20 to 30 minutes of application
4
17. The nurse provides discharge instructions to a client with pulmonary sarcoidosis. The nurse concludes that the client understands the information if the client indicates to report which early sign of exacerbation? Fever Fatigue Weight loss Shortness of breath
4
19. A 52-year-old male client is seen in the primary health care provider's (PCP's) office for a physical examination after experiencing unusual fatigue over the last several weeks. The client's height is 5 ft, 8 in (173 cm) and his weight is 220 lb (99.8 kg). Vital signs are as follows: temperature, 98.6° F (37° C) orally; pulse, 86 beats/min; and respirations, 18 breaths/min. The blood pressure reading is 184/100 mm Hg. A random blood glucose level is 122 mg/dL (6.8 mmol/L). Which question would the nurse ask the client first? "Do you exercise regularly?" "Are you considering trying to lose weight?" "Is there a history of diabetes mellitus in your family?" "When was the last time you had your blood pressure checked?"
4
2. Daily administration of dipyridamole has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates an understanding of the instructions? "This medication will prevent a stroke." "This medication will prevent a heart attack." "This medication will help keep my blood pressure down. "If I take this medicine with my warfarin, it will protect my artificial heart valve."
4
58. Itraconazole is prescribed for a client with a fungal infection of the hands. The nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? 1. "I would take the medication on an empty stomach." 2."I would decrease my fluid intake while taking the medication." 3."I may become unusually fatigued while taking this medication." 4."If my urine becomes very dark in color, I would contact my primary health care provider (PHCP)."
4
A client is receiving oxybutynin. The nurse would suspect that this medication is prescribed to relieve which condition? Gastritis Renal calculi Ulcerative colitis Overactive bladder
4
Carbidopa-levodopa is prescribed for a client with Parkinson's disease. The nurse monitors the chient for side and adverse effects of the medication. Which finding indicates that the client is experiencing an adverse effect? Pruritus Tachycardia Hypertension Impaired voluntary movements
4
Itraconazole is prescribed for a client with a fungal infection of the hands. The nurse provides instructions to the client about the medication. Which statement by the client indicates an understanding of the instructions? (O'I would take the medication on an empty stomach." 2"I would decrease my fluid intake while taking the medication." 3 "I may become unusually fatigued while taking this medication." "If my urine becomes very dark in color, I would contact my primary health care provider (PHCP)."
4
The nurse is preparing to care for a client with coronary artery disease who has returned to the nursing unit following cardiac catheterization performed through the femoral vessel. The nurse checks the primary health care provider's (PHCP's) prescription and plans to allow which client position or activity following the procedure? Bed rest in high-Fowler's position Bed rest with bathroom privileges only Bed rest with head elevation at 60 degrees Bed rest with head elevation no greater than 30 degrees
4
62 The nurse is counseling a pregnant elient diagnosed with gestational diabetes at 29 weeks gestation. Which information would the nurse diseuss with the client? Select all that apply. (2) Plan induction at 35 weeks. Plan amniocentesis at this time. Schedule a biophysical profile immediately. Plan for weekly nonstress tests at 32 weeks, Obtain nutritional counseling with a dietitian.
4 5
Tretinoin is prescribed for a client with acne, and the nurse provides instructions to the client regarding the medication. Which statement by the client indicates a need for further instruction? 1. "I need to avoid exposure to the sun." 2 "I would start to see results in 2 to 3 weeks." 3. "I will cleanse the skin thoroughly before applying the medication." 4. "If my skin begins to peel, I will notify the primary health care provider (PHCP)."
4. "If my skin begins to peel, I will notify the primary health care provider (PHCP)."
A client who has shared with the group at a previous session now suddenly gets up and announces, "I'm leaving." How can the nurse initially meet the needs of both the client and the group? 1. Offer to go with the client to the client's room to talk. 2. Ask the client to refocus the group's discussion. 3. End the therapy session for everyone immediately. 4. Ask the client to stay and share own feelings.
4. Ask the client to stay and share own feelings
The nurse is giving the client directions for proper use of aluminum hydroxide tablets. What would the nurse tell the client? 1. Swallow the tablets whole with a full glass of water. 2. Take the tablets at the same time as other medications. 3. Take each dose with a laxative to prevent constipation. 4. Chew the tablets thoroughly and follow with 8 oz of water.
4. Chew the tablets thoroughly and follow with 8 oz of water.
A 12 month old child with human immunodeficiency virus infection is currently immunocompromised . The nurse determines that the immunization needs of this child include which action? 1. Withholding the inactivated polio vaccine 2. Recommending against any influenza vaccinations 3. Administering the measles , mumps , and rubella ( MMR ) vaccine 4. Delaying the administration of the varicella virus vaccine until the child is not immunocompromised
4. Delaying the administration of the varicella virus vaccine until the child is not immunocompromised
A client who has been chronically taking acetylsalicylic acid (aspirin) for arthritis has been given a prescription for misoprostol. The nurse determines that the new medication is effective if the client states relief from which problem? 1.Diarrhea 2. Bleeding 3. Joint aches 4. Epigastric pain
4. Epigastric pain
Daily administration of dipyridamole has been prescribed for the client, and the nurse teaches the client about the medication. Which client statement indicates an understanding of the instructions? 1. This medication will prevent a stroke 2. This medication will prevent a heart attack 3. This medication will help keep my blood pressure down 4. If I take this medication with my warfarin, it will protect my artificial heart valve
4. If I take this medication with my warfarin, it will protect my artificial heart valve
Carbidopa levodopa is prescribed for a client with Parkinson's disease . The nurse monitors the client for side and adverse effects of the medication . Which finding indicates that the client is experiencing an adverse effect? 1. Pruritus 2. Tachycardia 3. Hypertension 4. Impaired voluntary movements
4. Impaired voluntary movements
The nurse is counseling a pregnant client diagnosed with gestational diabetes at 29 weeks' gestation . Which information would the nurse discuss with the client ? Select all that apply . (2 ) 1. Plan induction at 35 weeks . 2. Plan amniocentesis at this time . 3. Schedule a biophysical profile immediately . 4. Plan for weekly nonstress tests at 32 weeks . 5. Obtain nutritional counseling with a dietitian .
4. Plan for weekly nonstress tests at 32 weeks . 5. Obtain nutritional counseling with a dietitian .
The spouse of a client with acute kidney injury secondary to heart failure asks the nurse how a heart problem can affect the kidneys. The nurse would formulate a response using what fact about the kidneys? 1. The kidneys get fatigued from having to filter too much fluid. 2. The kidneys can react adversely to moderate doses of furosemide. 3. The kidneys will shut down easily if serum levels of digoxin are high. 4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.
4. The kidneys generally require and receive about 20% to 25% of the resting cardiac output.