NCLEX 8

A nurse is using EBP to decrease the incidence of a CAUTIs on a unit. Which of the following actions should the nurse take first?

Ask a clinical question regarding CAUTIs

A nurse is teaching a client who has a new diagnosis of urge incontinence. Which of the following information should the nurse include in the teaching

Your provider might prescribe anticholinergic medications, you should limit your fluids in the evening, you should restrict your intake of caffeine

A nurse is preparing to administer an ophthalmic medication to a client. Which of the following actions should the nurse plan take

apply pressure to the client's nasolacrimal duct after instillation

A nurse is planning post op care for a client who is scheduled for an ileal conduit procedure. The nurse should include which of the following in the client's plan of care

apply skin barrier around the stoma site, educate the client that hematuria, monitor hourly urine output

A nurse is caring for a client with DM who is prescribed regular insulin via a sliding scale. After administering the correct dose at 0715 the nurse should ensure the client receives breakfast at which of the following times

0745

A nurse is preparing to administer cefotaxime 1,000 mg IM to a client. How many grams should the nurse plan to administer

1 g

a nurse working for a home healthy agency is teaching a client who has DM about disease management. Which of the following HbA1c values should the nurse include in the teaching as an indicator that the client is appropriately controlling his glucose levels

6.3%

A nurse is teaching a client about the Rinne test. which of the following client statements indicates an understanding of the teaching?

A tuning fork is placed on my head

A home health nurse is assessing an older adult client in the home who has decreased vision due to a history of glaucoma. Which of the following findings should the nurse identify as a safety risk

scatter rugs are present in the kitchen

a nurse is teaching a client who has DM about diabetic retinopathy. Which of the following statements should the nurse make to the client

seeing spots is a manifestation of diabetic retinopathy.

A nurse is caring for a client in the emergency department

the nurse should first address the client's fall precautions followed by the client's urine collection

a nurse is teaching a class about pharmacodynamics. the nurse should include that which of the following medication levels occurs when a medication is at the lowest serum concentration

trough

A nurse is providing teaching to a client who has a new diagnosis of type 2 DM. The nurse should recognize that the client understands the teaching when he identifies which of the following as manifestations of hypoglycemia

blurred vision, tachycardia, moist clammy skin

A nurse is assessing a client who has peripheral neuropathy. Which of the following findings should the nurse expect

burning sensation in feet.

A nurse is caring for a client who has a cloudy, opaque area over the lens of one eye. The nurse should identify that this is a manifestation of which of the following visual impairments

cataracts

A nurse is providing dietary teaching to a client who has nephropathy secondary to DM and plans to make dietary adjustments. Which of the following instructions should the nurse include

consume less than 0.8g/kg of body weight of protein per day

A nurse is assessing an older adult client who reports a sudden onset of urinary incontinence. the nurse should recognize which of the following conditions can cause incontinence in the older adult client

cystitis

A nurse is providing teaching for a client who is newly diagnosed with type 2 DM and has a prescription for glipizide. Which of the following statements by the nurse best describes the action of glipizide

glipizide stimulates your pancreas to release insulin

A nurse is assessing a client who has type 1 DM and finds the client lying in bed, sweating, and reporting feeling anxious. Which of the following complications should the nurse suspect

hypoglycemia

A nurse is caring for a client following cataract surgery. which of the following comments from the client should the nurse report to the client's provider

i need something for the pain in my eye. I can't stand it

A nurse is preparing to administer lispro insulin to a client who has type 1 DM. which of the following actions should the nurse take

inject the insulin 15 min before a meal

A nurse is preparing to administer 10 units if regular insulin and 20 units of NPH insulin to a client. what is the sequence of events the nurse should follow

inspect vials, roll NPH, inject air into NPH, inject air into regular, withdraw short acting insulin, add intermediate insulin

A nurse is caring for a client who reports a decrease in central vision. The nurse should identify that this is a manifestation of which of the following visual impairments

macular degeneration

A nurse is caring for a client who is postop following a left corneal transplant. the nurse observes purulent drainage from the affected eye. which of the following actions is the nurses priority

notify the surgeon

A nurse is providing teaching to an adolescdent who has type 1 DM. which of the following should the nurse include in the teaching

obtain an influenza vaccine annually

A nurse is reviewing a client's medical record. Select the 3 findings that place the client at risk for hearing impairment

occupation, furosemide, and naproxen

A nurse assessing a client notes that the client has a constant leakage of small amounts of urine and a bladder that is distended and palpable. The nurse should associate these findings with which of the following types of urinary incontinence

overflow incontinence

A nurse is planning care for a client who has a detached retina and is preop for a surgical repair. the nurse should prepare to administer which of the following medications

phenylephrine

A nurse opens a unit dose of a prescribed medication prior to administering it to a client. The client refuses to take the medication. Which of the following actions should the nurse take?

report the incident to the provider

A nurse is reviewing the medical record of a client who has a urinary tract infection (UTI). Which of the following findings should the nurse recognize as a risk factor

Diabetes mellitus

A nurse is administering timolol eye drops to a client who has glaucoma. Which of the following actions should the nurse take

Drop prescribed amount of medication into the conjunctival sac.

A nurse is providing teaching for a client who has diabetes and a new prescription for insulin glargine. Which of the following instructions should the nurse provide regarding this type of insulin

Insulin glargine has a duration of 18 to 24 hrs.

A nurse is teaching a client newly diagnosed with type 1 DM. A referral for a dietician has been initiated. Which of the following statements by the client indicates the purpose for the referral

The dietician will help me with my diet due to diabetes

A nurse at an ophthalmology clinic is providing teaching to a client who has an open angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide

The medication should be applied on a regular schedule for the rest of the clients life

A nurse is caring for a 58 year old client in an outpatient clinic.

Type 2 DM: check clients sense of touch, obtain a glucose level. Lifestyle modifications and glycosylated hemoglobin.

A nurse is caring for a client and observes that the clients urine is dark amber, cloudy, and has an unpleasant odor. The nurse should recognize that these findings are associated with which of the following

UTI

A nurse in the emergency department is caring for an older adult client

UTI; obtain a prescription for an antibiotic and a urine sample; temperature and urine color

A nurse is reviewing discharge instructions with a client following a right cataract extraction. Which of the following instructions should the nurse include

avoid lifting anything heavier than 4.5 kg for 1 week

A nurse is planning care for a client 1 day postop following a detached retinal repair. Which of the following instructions should the nurse include in the plan

avoid reading and writing

A nurse is teaching a class about physiological changes to hearing in older adult clients, which of the following should the nurse include

decreased ability to hear high-frequency sounds

A nurse is caring for a 7 yr old child who has an upper resp infection and type 1 DM. which of the following statements by the mother indicates a need for further instruction

i will continue to check his bs BID

A nurse is teaching a client who has DM about the manifestations of hypoglycemia. which of the following statements by the client indicates an understanding of the teaching

i will feel shaky

A nurse is caring for the client who has menieres disease and asks if he is allowed to ambulate independently. Which of the following responses should the nurse make

please ring for assistance when you wish to get out of bed

A nurse is caring for a client. select the 3 findings that require immediate follow-up

urticaria, blood pressure at 1630, report of dysphagia

A nurse is assessing a client who has an acoustic neuroma. Which of the following client manifestations should the nurse expect

vertigo