Mid-Term
A nurse prepares to teach a 60-year-old client who is highly anxious about a heart catheterization scheduled for tomorrow. What form of instruction is best when the nurse prepares the anxious client for the procedure? a. Draw elaborate diagrams b. Show a teaching video c. Provide detailed explanations d. Use short, simple sentences
d. Use short, simple sentences
The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing which client is at risk for a potassium deficit? a. The client with intestinal obstruction b. The client with Addison disease c. The client receiving nasogastric suction d. The client with metabolic acidosis
d. The client with metabolic acidosis
When interacting with a client experiencing a panic attack, what nursing technique is most likely to help reduce the client's anxiety level? a. Calmly instructing the client to take shallow breaths b. Explaining in advance all necessary actions and procedures c. Staying less than an arm length away from the client at all times d. Repeatedly assuring the client that everything will be okay
a. Calmly instructing the client to take shallow breaths
The nurse is monitoring a client who abuses alcohol for signs of alcohol withdrawal delirium. The nurse would monitor for which symptoms? a. Hypertension, disorientation, hallucinations b. Hypotension, bradycardia, agitation c. Stupor, agitation, muscular rigidity d. Hypotension, ataxia, vomiting
a. Hypertension, disorientation, hallucinations
Which are appropriate interventions for caring for the client undergoing alcohol withdrawal? Select all that apply. a. Provide a safe environment b. Monitor vital signs c. Provide reality orientation as appropriate d. Maintain an NPO status e. Provide stimulation in the environment f. Address hallucinations therapeutically
a. Provide a safe environment b. Monitor vital signs c. Provide reality orientation as appropriate d. Maintain an NPO status e. Provide stimulation in the environment
The client, diagnosed with human immunodeficiency virus (HIV) seropositive, has been taking stavudine. The nurse would monitor which parameter closely while the client is taking this medication? a. Gait b. Appetite c. Hemoglobin and hematocrit blood levels d. Level of consciousness
a. Gait
The nurse is caring for a client with severe depression. Which activity is appropriate for this client? a.Drawing b. Paint by number c. Puzzle d. Checkers
c. Puzzle
A client is unwilling to leave the house for fear of "doing something crazy in public." Because of this fear, the client remains homebound except when accompanied outside by the spouse. The spouse asks the nurse, "What is the name of my wife's disorder?" Which answer would the nurse give to the spouse? a.Claustrophobia b.Hypochondriasis c.Hematophobia d. Agoraphobia
d. Agoraphobia
The adult child of the client with Alzheimer disease wants take the client home for a day. What nursing assessment is critical for ensuring the client well-being during the home visit? A.The caregiver understanding of when to administer medications B.The caregiver understanding of how to provide hygiene measures C. The caregiver understanding of when the client must return D. The caregiver understanding of the symptoms the client manifests
A.The caregiver understanding of when to administer medications
3. Which nursing explanation is accurate for why older clients with AIDS need more care than heir younger counterparts? A.Older clients do not generally adhere to therapy. B.Older clients have a faster progression of disease. C. Older clients lack knowledge about disorders D. Older clients lack in balanced diet and activity
B.Older clients have a faster progression of disease
When the client begins crying and says, "es, "I feel like I am going to die" what response Is it most therapeutic? A. Everyone feels frightened when they have chest pain as it is an emergency B. You need not worry since a panic attack will not kill you C. I will stay with you until your pain has subsided and you feel in control. D. Do not cry. It will not help matters and may make your symptoms worse
C. I will stay with you until your pain has subsided and you feel in control.
A young adult who has been diagnosed with schizophrenia is able to function for extended periods of time in the community. During a home visit, what behavior is most suggestive that the client is experiencing auditory hallucinations? A.Singing a song loudly while walking around the room B. Repeating a sentence numerous times C. Turning an ear as if listening to someone D. Quickly changing the topic of conversation
C. Turning an ear as if listening to someone
A 38-year-old client presents to the clinic to receive information and treatment for a fear of flying. If this client is typical of others with phobias, what coping mechanism is the nurse most correct in suspecting the client has been using it to deal with the fear of flying? a. Avoidance b. Suppression c. Compensation d. Undoing
a. Avoidance
A 23-year-old client experiences the following symptoms every fall: swollen nasal passages, endless sneezing, and red, watery, itchy eyes. The client makes an appointment with an allergist. When the health care provider prescribes the first-generation antihistamine diphenhydramine for the client's symptomatic relief, what side effect is most emphasized? a. Drowsiness b. Dry mouth c. Nausea d. Constipation
a. Drowsiness
A nurse is assigned to care for a 35-year-old client who sustained a severe head injury and brain damage in a motor vehicle accident. During feeding, the client deliberately spits at the nurse. What action is most appropriate to take? a. Leave the client room immediately to defuse the situation b. Matter-of-factly state that such behavior is unacceptable c. Stand as far from the bed as possible until the client calms down d. Assume that the behavior was accidental and do not react
b. Matter-of-factly state that such behavior is unacceptable
The nurse is told that the arterial blood gas (ABG) results indicate a pH of 7.50 and a Pco2 of 32 mm Hg. The nurse determines that these results are indicative of which acid-base disturbance? a. Metabolic acidosis b. Respiratory alkalosis c. Respiratory acidosis d. Metabolic alkalosis
b. Respiratory alkalosis
At a nurse-led group meeting for clients with eating disorders, the client with bulimia tells a very emaciated client "You are a real loser if you think you have got a weight problem. What nursing action is most appropriate in responding to this comment? a. Criticize the nature of the client rude behavior b. Support the emaciated client who was targeted by the remark c. Shame the client with bulimia with a similar comment d. Invite others in the group to respond to the situation
b. Support the emaciated client who was targeted by the remark
After having an argument with a spouse on the phone, a client becomes angry and belligerent toward the unlicensed assistive personnel (UAP). The nurse correctly explains to the UAP that the client behavior is an example of what coping mechanism? a. Compensation b. Projection c. Displacement d. Introjection
c. Displacement
The nurse reviews electrolyte values and notes a sodium level of 130 mEq/L. The nurse expects that this sodium level would be noted in a client with which condition? a. The client with diabetes insipidus b. The client with watery diarrhea c. The client with the syndrome of inappropriate secretion of antidiuretic hormone d. The client with an inadequate daily water intake
The client with the syndrome of inappropriate secretion of antidiuretic hormone
An older adult who is admitted to the hospital is dying of a terminal illness. The client has an advance directive indicating that no heroic measures be used to prolong life. What is the most appropriate nursing action when the terminally ill client death is imminent? a. Notifying the hospital chaplain of the potential for death b.Calling the funeral home, alerting them of an imminent death c. Transferring the client to the intensive care unit d. Sitting quietly and hold the dying client hand
b.Calling the funeral home, alerting them of an imminent death
The nurse is collecting data on a client who is actively hallucinating. Which nursing statement would be therapeutic at this time? a. "I can hear the voice, and she wants you to come to dinner." b. "I talked to the voices you're hearing, and they won't hurt you now." c. "Sometimes people hear things or voices others can't hear." d. "I know you feel 'they are out to get you,' but it's not true."
c. "Sometimes people hear things or voices others can't hear."
A client with HIV has been prescribed antiviral medications. What instructions related to administration of medications should the nurse give such a client? a.Avoid all nonprescription medications after taking the medication. b. Take an increased dose of the medications c. Comply with the timing of antiviral medications. d.Take the medications with plenty of fruit juice.
c. Comply with the timing of antiviral medications.
The nurse reviews the client serum calcium level and notes that the level is 8.0 mg/dL. The nurse understands that which condition would cause this serum calcium level? a. Excessive ingestion of vitamin D b. Ans: Adrenal insufficiency c. Prolonged bed rest d. Hyperparathyroidism
c. Prolonged bed rest
When teaching the client about nasal decongestant sprays, what adverse effect is most important to stress? a.Bleeding from the nasal mucous membranes b.Nasal irritation with rhinorrhea c.Decreased ability to fight microorganisms d.Rebound congestion with nasal stuffiness
d.Rebound congestion with nasal stuffiness
the spouse of a client on the dementia unit visits daily. A nurse who regularly cares for the client notices that the spouse is beginning to show signs of exhaustion and self-neglect. What nursing intervention is most beneficial for the client spouse? a. Discussing modifying the amount of time the spouse devotes to caregiving b. Reminding the spouse of the scheduled times for visiting clients on the unit c. Suggesting that the spouse make an appointment for a physical examination d. Explaining that many staff members are available to client
a. Discussing modifying the amount of time the spouse devotes to caregiving
The client brought to the emergency department is experiencing an anaphylactic reaction from eating shellfish. The nurse needs to implement which immediate action? a. Administering a corticosteroid b. Maintaining a patent airway c. Administering epinephrine d. Instructing the client on the importance of obtaining a MedicAlert bracelet
b. Maintaining a patent airway
A client is scheduled for blood to be drawn from the radial artery for an arterial blood gas (ABG) determination. The nurse assists with performing an Allen test before drawing the blood to determine the adequacy of which? a. Ulnar circulation b. Carotid circulation c. Brachial circulation d. Femoral circulation
a. Ulnar circulation
A client arrives at the health care clinic and tells the nurse that they have been doubling their daily dosage of bupropion hydrochloride to get better faster. The nurse understands that the client is now at risk for which problem? a.Seizure activity b.Weight gain c.Orthostatic hypotension d.insomnia
a.Seizure activity
The nurse is collecting data from a client, and the client spouse reports that the client is taking donepezil hydrochloride. Which disorder would the nurse suspect that this client may have based on the use of this medication? a. Obsessive-compulsive disorder b. Seizure disorder c. Schizophrenia d. Dementia
d. Dementia
The nurse is caring for a client with leukemia and notes that the client has poor skin turgor and flat neck and hand veins. The nurse suspects hyponatremia. Which sign/symptom would the nurse expect to note in this client if hyponatremia is present? a. Dry mucous membranes b. Slow bounding pulse c. Intense thirst d. Postural blood pressure changes
d. Postural blood pressure changes
The nursing team develops a care plan for a client who has been diagnosed with cancer of the larynx. The client is scheduled for a total laryngectomy. After surgery, the client is taken to the recovery room until stabilized. What assessment finding noted by the nurse on the client's return to the room is an early indication that the client's oxygenation status is compromised? A.The client indicates feeling cold B.The client becomes restless C.The client's dressing is bloody D. The client's heart rate is irregular D. The client's heart rate is irregular
B.The client becomes restless
The nurse on a mental health unit conducts a group meeting for clients diagnosed with obsessive-compulsive disorder (OCD). Which client(s) can the nurse most likely expect as members of an obsessive-compulsive disorder (OCD) support group? Select all that apply. a. A 50-year-old client who cannot throw anything away b. A 30-year-old client who performs thorough hand washing five times per hour c. A 35-year-old client who wears gloves when touching a public faucet d. A 45-year-old client who drinks a fifth of whiskey daily e. A 60-year-old client who is always late for work due to a checking ritual f.
a. A 50-year-old client who cannot throw anything away (indicative of hoarding behavior, a common symptom of OCD). b. A 30-year-old client who performs thorough hand washing five times per hour (excessive hand washing is a common compulsive behavior in OCD). c. A 35-year-old client who wears gloves when touching a public faucet (this behavior could indicate contamination fears, which are common in OCD). e. A 60-year-old client who is always late for work due to a checking ritual (repeated checking is a common compulsion in OCD).
A client is admitted to a psychiatric unit for treatment of a psychotic disorder. The client is at the locked exit door and is shouting, "Let me out! There is nothing wrong with me! I don't belong here!" The nurse identifies this behavior as which defense mechanism? a. Projection b. Denial c. Regression d. Rationalization
b. Denial
A nurse is a volunteer answering telephone calls on a hotline at a crisis center. When the nurse responds to a call from a 22-year- old victim of sexual assault, what instruction is most important before referring the client to the emergency department of the local hospital? a. Write down what happened b. Do not bathe or shower c. Call a 911 operator d. Make a sketch of the rapist
b. Do not bathe or shower
The client is suspected of having systemic lupus erythematosus (SLE). The nurse monitors the client, knowing that which is one of the initial characteristic signs of SLE? a. Weight gain b. Rash on the face across the nose and on the cheeks c. Elevated red blood cell count d. Subnormal temperature
b. Rash on the face across the nose and on the cheeks
The nurse is evaluating a family member's suction technique of the client tracheostomy. After the catheter is appropriately introduced, suction is applied for no longer than which amount of time? a. 5 to 7 seconds b. ANS: 15 to 20 seconds c. 25 to 30 seconds d. 10 to 12 seconds
b. ANS: 15 to 20 seconds
The spouse of a client with dementia is concerned about safety in the home and asks the nurse for some actions that are appropriate to implement. The nurse is informed that the client awakens at night and wanders about the house. What suggestion is most appropriate for this behavior? a. Administering a nighttime sedative in the evening b. Ensuring there is enough lighting throughout the house c. Installing deadbolts at the top of doors leading outside d. Fastening bed rails on the bed where the client sleeps
b. Ensuring there is enough lighting throughout the house
Metabolic alkalosisThe nurse is caring for a female client who was recently admitted to the hospital for anorexia nervosa. The nurse enters the client room and notes that the client is doing vigorous push-ups. Which nursing action is appropriate? a. ANS: Interrupt the client and weigh her immediately b. Interrupt the client and offer to take her for a walk. c. Allow the client to complete her exercise program. d. Tell the client that she is not allowed to exercise
b. interrupt the client and offer to take her for a walk.
A client diagnosed with Alzheimer's disease lives in a long-term care center. The client's adult child visits regularly. One day, the client's child states to the nurse, "I am not sure my parents recognize me." What nursing response is most therapeutic? a. "This is probably the beginning of the end for your parent." b. "You are distressed that there is not an appropriate response to you." c. "Do not worry. The standard of care is being delivered." d. "There will be good days and bad days. Today is a bad day."
b. "You are distressed that there is not an appropriate response to you."
After the death of the terminally ill client, the unlicensed assistive personnel is extremely distraught. What nursing approach is most beneficial for helping the unlicensed assistive personnel (UAP) at this time? a. Sending the UAP home for the rest of the shift b. Allowing the UAP to express feelings c. Terminating the UAP from this type of work d. Asking the UAP to help with post mortem care
b. Allowing the UAP to express feelings
When a 24-year-old client with a record of multiple convictions for driving under the influence (DUI) claims not to suffer from alcohol use disorder, what is the most pertinent assessment question the nurse can ask? a. When you drink, do you drink beer or hard liquor? b. Are you unable to recall events that occurred while drinking? c. Did you begin drinking before or after you were of legal age? d. Do you prefer to drink alcohol rather than soft drinks?
b. Are you unable to recall events that occurred while drinking?
The nurse is planning care for a client who is being hospitalized because the client has been displaying violent behavior and is at risk for potential harm to others. The nurse would avoid which intervention in the plan of care? a. Facing the client when providing care b. Assigning the client to a room at the end of the hall to prevent disturbing the other clients c. Ensuring that a security officer is within the immediate area d. Keeping the door to the client room open when with the client
b. Assigning the client to a room at the end of the hall to prevent disturbing the other clients
calcium level is 13 mg/dL. Which prescribed medication would the nurse plan to assist in administering to the client? a. Calcium chloride b. Calcitonin c. Calcium gluconate d.Large doses of vitamin D
b. Calcitonin
A 27-year-old foreign-born client is admitted to the mental health unit with abdominal pain thought to be psychophysiological in origin. The client is apprehensive and speaks very little of the dominant language. What translation method is best when the nurse is attempting to obtain the client history? a. Requesting that the client family member translate the process b. ANS: Requesting a certified translator who speaks the language c. Utilizing a hospital housekeeper who speaks the client language d. Using translation cards that include key words, phrases, and pictures
b. Requesting a certified translator who speaks the language
A 70-year-old client with dementia removes clothing and walks naked through the halls of a long-term care facility. What action is most appropriate for the nurse to take first? a.Explaining to the residents that the client is not of sound mind b. Instructing the client to put clothes on again c. Taking the client to a vacant room nearby d.Reminding the client that clothes are required in public
c. Taking the client to a vacant room nearby
The client returns to the health care provider's office, and the nurse updates the medical record. Notes Documented At: 8/7 1415 Additional Notes: Temperature: 101°F (38.3°C) Heart rate: 88 beats/min Respiratory rate: 20 breaths/min Lethargic. States having difficulty sleeping at night. Clear nasal drainage with nasal stuffiness. Verbalizes a hacky cough and scratchy throat. What symptom reported by the client to the nurse is the best indicator that complications are developing from this cold? Additional Notes: a. Nasal stuffiness b. Scratchy throat c.High fever d. Dry cough
c.High fever
Which assessment finding provides the best indication that the nurse needs to suction the Client tracheostomy? a. Scattered rales is noted over the bronchi b. The pulse oximeter has fallen to 94% on room air c. Wheezes are noted in the right middle lobe d. The respiratory rate is under 16 breaths/minute
d. The respiratory rate is under 16 breaths/minute
The nurse, a Cub Scout leader, is preparing a group of Cub Scouts for an overnight camping trip and instructs them about the methods to prevent Lyme disease. Which statement by one of the Cub Scouts indicates a need for further teaching
"I should not use insect repellent because it will attract the ticks."
6. During a visit to the healthcare provider office, a client angrily states to the nurse that the health care provider would not prescribe an antibiotic for a head cold. The client states I have felt awful for 3 days. When de-escalating the situation, what explanation to the client by the nurse regarding the use of antibiotics is best? Use of antibiotics is best?
"The health care provider is protecting you from inappropriate use of antibiotics. Antibiotics are ineffective in treating viral infections."
The nurse in the mental health unit reviews the therapeutic and nontherapeutic communication techniques with a nursing student. Which are therapeutic communication techniques? Select all that apply.
1. Restating 2. Listening 4. Maintaining neutral responses 6. Providing acknowledgment and feedback
The nurse observes that a client with diabetic ketoacidosis is experiencing abnormally deep, regular, rapid respirations. How would the nurse correctly document this observation in the Medical record? A. Bradypnea B. respirations C. Cheyne-Stokes D. Apnea
C. Cheyne-Stoke
The medication prescribed is digoxin 0.25 mg orally, daily. The medication label reads digoxin 0.125 mg/ tablet. The nurse would prepare how many tablet(s) to administer the dose? Fill in the blank.
2 tablets
The intravenous prescription is 3000 mL of 5% dextrose in water (D5W) to run over a 24-hour period. The drop factor is 10 gtts/1 mL. The nurse plans to adjust the flow rate to how many gtts/minute? Fill in the blank and record the answer to the nearest whole number. 21______gtts/minute
21______gtts/minute
The nurse is preparing to care for a dying client, and several family members are at the client's bedside. Which therapeutic techniques should the nurse use when communicating with the family? Select all that apply.
3.Encourage expression of feelings, concerns, and fears.5.Touch and hold the client's or family member's hand if appropriate.6.Be honest and let the client and family know that they will not be abandoned by the nurse.
The nurse is caring for a postrenal transplantation client with a prescription for cyclosporine. If the nurse notes an increase in one of the clients, vital. signs and the client is complaining of a headache, which vital sign is most likely increased? A. Pulse B. Pulse oximetry C. Blood pressure D. Respirations
C. Blood pressure
The nurse is performing a follow-up teaching session with a client discharged 1 month ago who is taking fluoxetine. Which information would be important for the nurse to gather regarding the adverse effects related to the medication? a. Gastrointestinal dysfunctions b. Problems with excessive sweating c. Problems with mouth dryness d. Cardiovascular symptoms
A. Gastrointestinal dysfunctions
A female client with anorexia nervosa is a member of a support group. The client has verbalized that she would like to buy some new clothes, but her finances are limited. Group members have brought some used clothes for the client to replace her old clothes. The client believes that the new clothes were much too tight, so she has reduced her calorie intake to 800 calories daily. The nurse identifies this behavior as which finding? A. Regressive B. Indicative of the client ambivalence C. Evidence of the client altered and distorted body image D. Normal
C. Evidence of the client altered and distorted body image
The client diagnosed with acquired immunodeficiency syndrome (AIDS) is taking nevirapine. The nurse should monitor for which side/adverse effects of the medication? Select all that apply
Rash Hepatotoxicity
A client is admitted to the psychiatric nursing unit. When collecting data from the client, the nurse notes that the client was admitted on an involuntary status. Based on this type of admission, which would the nurse expect to note? a. The client consented to the admission. b. The client presents a harm to self c. The client provided written application to the facility for admission d. The client requested the admission.
The client presents a harm to self
The nurse is reviewing the health records of assigned clients. The nurse would plan care knowing that which client is at the least likely risk for the development of third-spacing? a. The client with diabetes mellitus b. The client with cirrhosis c. The client with kidney failure d. The client with sepsis
The client with diabetes mellitus
A public health nurse must inform a 26-year-old client that the client has tested positive for human immunodeficiency virus (HIV). What initial reaction would the nurse expect if the client is typical of others who just received news of this diagnosis? a. Anger b. Depression c. Resentment d. Shock
c. Resentment
A 68-year-old client who is currently being treated for major depression is transferred to a medical unit after an episode of acute abdominal pain. What nursing assessment data places the client at highest risk for suicide? a. Acknowledging plans for a possible suicide b. Expressing that the distress is intolerable c. Stating that death would end the misery d. Feeling hopeless about the future
a. Acknowledging plans for a possible suicide
Which interventions should be implemented in the care of a client at high risk for an allergic response to a latex allergy? Select all that apply.
Use nonlatex gloves. Use medications from glass ampules. Do not puncture rubber stoppers with needles. Keep a latex-safe supply cart available in the client's area.
A 40-year-old client who is sexually promiscuous A hospitalized client is taking clozapine for the treatment of a schizophrenic disorder. Which laboratory study prescribed for the client would the nurse specifically review to monitor for an adverse effect associated with the use of this medication? a. White blood cell count b. Cholesterol level c. Blood urea nitrogen level d. Platelet count
White blood cell count
The medication is an intramuscular dose of 400,000 units of penicillin G benzathine. The the medication label reads penicillin G benzathine 300,000 units/ mL. The nurse prepares how much medication to administer the correct dose? Fill in the blank and record the answer using one decimal place.
_1.333_____mL
The intravenous prescription is 1000 mL of 0.9% NaCl (normal saline) to run over 12 hours. The drop factor is 15 gtts/1 mL. The nurse plans to adjust the flow rate to how many gtts/minute? Fill in the blank and record the answer to the nearest whole number.
__21___gtts/minute
The intravenous prescription is 3000 mL of 5% dextrose in water (D5W) to run over a 24-hour period.The drop factor is 10 gtts/1 mL. The nurse plans to adjust the flow rate to how many gtts/minute? Fill in the blank and record the answer to the nearest whole number.
__21__gtts/minute
The medication prescribed is metoclopramide hy- drochloride 10 mg intramuscularly times one dose. The medication label reads metoclopramide hydro-chloride 5 mg/ml. The nurse prepares how many mL to administer one does? Fill in the blank. __2____mL Answer text 10mg divided by 5mg equal to 2ml
__2____mL
Until the client can be examined later that morning, what nursing advice would be most helpful? a. Drink plenty of hot liquids b. Rest your voice by using gestures c. Rub a camphor and menthol balm on your throat d. Sucking on ice chips should help.
b. Rest your voice by using gestures
the change in body image, and the loss of speech following a laryngectomy. What is the best indication to the nurse that the client is beginning to accept the condition? a. ANS: The client examines the tracheostomy tube in a mirror. b. The client begins bathing independently each day c. The client wants the spouse and children to visit d. The client asks about other treatment measures
c. The client wants the spouse and children to visit
The nurse is caring for a client with a suspected diagnosis of hypercalcemia. Which sign/symptom would be an indication of this electrolyte imbalance? a. Hyperactive bowel sounds b. Twitching c. Generalized muscle weakness d. Positive Trousseau's sign
c. Generalized muscle weakness
The nurse is teaching the client how to self-administer nose drops. When evaluating the client technique, what method would the nurse identify as correct? a. : Tilting the head backward, then instilling the drops b. Pushing the nose laterally, then instilling the drops c. Turning the head to the side, then instilling the drop d. Bending the head forward, then instilling the drops
a. : Tilting the head backward, then instilling the drops
Which nursing interventions are appropriate for a hospitalized client with mania who is exhibiting manipulative behavior? Select all that apply
- Communicate expected behaviors to the client - Assist the client in developing means of setting limits on personal behavior. - Follow through about the consequences of behavior in a nonpunitive manner. - Be clear with the client regarding the consequences of exceeding limits set regarding behavior.
The medication prescribed is hydromorphone hy-drochloride 3 mg intramuscularly, every 4hours as needed. The medication label reads hydromorphone hydrochloride 4 mg/1 mL. The nurse would prepare to administer how many mL to the client? Fill in the blank.
0.75ML
A client experiencing disturbed thought processes believes that his food is being poisoned. Which communication technique should the nurse use to encourage the client to eat? A. Using open-ended questions and silence B. Sharing personal preference regarding food choices C. Documenting reasons why the client does not want to eat D. Offering opinions about the necessity of adequate nutrition
A. Using open-ended questions and silence
2. Fluoxetine is prescribed, and the nurse reinforces instructions to the client regarding the administration of the medication. Which statement by the client indicates an understanding about the administration of this medication? A.I should take the medication in the morning when I first arise B.I should take the medication right before bed-time with a snack C.I should take the medication with my evening meal D.I should take the medication at noon with an antacid
A.I should take the medication in the morning when I first arise
A client is admitted to the psychiatric unit after a serious suicidal attempt by hanging. What Is the nurse the most important intervention to maintain client safety? a. Request that a peer remain with the client at all times. b. Assign a staff member to the client who will remain with him or her at all times. c. Remove the client's clothing and place the client in a hospital gown. d. Admit the client to a seclusion room where all potentially dangerous articles are removed
ANS: Assign a staff member to the client who will remain with him or her at all times.
. The medication is an intramuscular dose of 400,000 units of penicillin G benzathine. The medication. label reads penicillin G benzathine 300,000 units/ mL. The nurse prepares how much medication to administer the correct dose Fill in the blank and record the answer using one decimal place.
Ans: 1.333ML
What client statement(s) regarding the effects of chronic marijuana use requires clarification and additional education? Select all that apply. A. I know for a fact smoking it suppresses personal motivation. B. My roommate's memory was really affected. C. I am convinced it was what caused my brother lung cancer. D. It dangerously slows down your respirations. E. Its effects are not worth getting physically Addicted
Ans: A, B, C, D
The nurse is assisting with the data collection on a client admitted to the psychiatric unit. After review of the obtained data, the nurse would identify which as a priority concern? a. The client report of not eating or sleeping b. The client report of self-destructive thoughts c. The presence of bruises on the client body d. The family member is disapproving of the treatment.
B. The client report of self-destructive thoughts
During a conversation with a depressed client on a psychiatric unit, the client says to the nurse, My family would be better off without me The nurse would make which therapeutic response to the client? A. You will feel better once your medication begins to work. B. You sound very upset. Are you thinking of hurting yourself? C. Everyone feels this way when they are depressed. D. Have you talked to your family about this?
B. You sound very upset. Are you thinking of hurting yourself?
11. The nurse is assisting with the administration of immunizations at a health care clinic. The nurse would understand that immunization provides which protection? A. Innate immunity from disease B. Protection from all diseases C. Acquired immunity from disease D. Natural immunity from disease
C. Acquired immunity from disease
What is the most accurate nursing explanation of the first step in recovering from alcohol use disorder? A. Forming a close support network B. Relying on some form of religious belief C. Admitting an inability to control drinking D. Checking into an inpatient rehabilitation uni
C. Admitting an inability to control drinking
Which individual is least at risk for the development of Kaposi's sarcoma? A kidney transplant client A. A kidney transplant client B. A client receiving antineoplastic medications C. An individual working in an environment where exposure to asbestos exists D. A male with a history of same-sex partners
C. An individual working in an environment where exposure to asbestos exists
Which clients would the nurse determine to be at risk for development of metabolic alkalosis? Select all that apply. A. Client receiving oral furosemide 40 mg daily B. Client who has been vomiting for 2 days C. Client who is hyperventilating D. Client with chronic kidney disease E. Client admitted with aspirin overdose F. Client with emphysema.
Client who has been vomiting for 2 days Client receiving oral furosemide 40 mg daily
The client with depression undergoes electroconvulsive therapy (ECT). What outcome can the nurse expect during the client immediate recovery period? a. Brief episodes of absence seizures b. Periods of unexplained fear and anxiety c. Sensitivity to light and double vision d. Short-term memory loss and headaches
a. Brief episodes of absence seizures
Alprazolam is prescribed to treat the client panic 13 disorder. What information is most appropriate for the nurse to share with the client who has been prescribed alprazolam? A. Long-term use will not cause drug dependency B. A blood test will be required periodically C. This drug can cause insomnia in some people D. Avoid consuming any alcohol while taking this drug
D. Avoid consuming any alcohol while taking this drug
1. The nurse is assigned to care for a client at risk for alcohol withdrawal. The client spouse asks the nurse, When will the first signs of withdrawal appear? The nurse would give which reply? A.7 days B.14 days C.21 days D. Within a few hours
D. Within a few hours
What assessment measure is most important for the nurse to monitor when determining whether the client current dose of lithium carbonate is appropriate? a. ANS: Urine volume b. Brain wave scans c. Vital signs d. Drug blood levels
Drug blood levels
What dietary advice is best for the nurse to reinforce when caring for clients with HIV/ AIDS? a. Encourage multivitamin and mineral supplements. b. Increase food sources rich in iron and zinc c. Suggest limiting food intake to control diarrhea. d. Avoid food items with gravies, sauces, and broth.
Increase food sources rich in iron and zinc
Ketoconazole is prescribed for a client with a diagnosis of candidiasis. Which interventions Would the nurse include it when administering this medication? Select all that apply. a. Monitor liver function studies b. Restrict fluid intake c. Instruct the client to avoid alcohol. d. Administer the medication with an antacid e. Administer the medication on an empty stomach. f. Instruct the client to avoid exposure to the sun
Instruct the client to avoid alcohol. Monitor liver function studies
The nurse is assisting with planning the care of a client with a diagnosis of immunodeficiency. The nurse would incorporate which intervention as a priority in the plan of care? a. ANS:Providing emotional support to decrease fear b. Protecting the client from infection c. Identifying factors that decreased the immune function d. Encouraging discussion about lifestyle changes
Protecting the client from infection
The nurse observes that a client is psychotic, pacing, and agitated and is making aggressive gestures. The client speech pattern is rapid, and the client effect is belligerent. Based on these observations, which is the nurse's immediate priority of care? a. Provide the clients on the unit with a sense of comfort and safety. b. ANS: Provide safety for the client and other clients on the unit. c. Assist the staff with caring for the client in a controlled environment. d. Offer the client a less-stimulating area to calm down and gain control. A client has reported that crying spells have been a major problem over the past several weeks
Provide safety for the client and other clients on the unit.
The nurse reviews a client's electrolyte results and notes that the potassium level is 5.4 mEq/L. What would the nurse look for on the cardiac monitor as a result of this laboratory value? a. Prominent U waves b. ST elevation c. Peaked P waves d. Narrow, peaked T waves
d. Narrow, peaked T waves
