Nursing Concepts - Beginning test
A nurse discovers that a client who is diagnosed with dementia received the wrong medication. Which of the following should be the nurse's first action? - notify the provider - complete an incident report - determine client's condition - inform the nurse manager
Determine the client's condition
A nurse is reviewing the documentation of a newly licensed nurse. Which of the following actions by the newly licensed nurse while documenting requires the nurse preceptor to intervene?
Including in a client's nurses' notes that an incident an incident report was completed after a medication error
A nurse is reinforcing teaching by demonstrating deep breathing and coughing exercise to a client who is scheduled for abdominal surgery. For which of the following responses by the client should the nurse postpone teaching teach+
States that pain is an 8 on a scale of 0 to 10
A nurse on the coronary care unit is caring for a client who has transferred from the medical floor after experiencing a myocardial infarction. After the client is stabilized, she asks the nurse why she had to be transferred to a unit where her family will be unable to stay with her all the time. Which of the following responses is appropriate?
"Let's talk for a minute about your concerns."
A nurse is reinforcing teaching about transdermal nitroglycerin to a client who has stable angina. Which of the following statements by the client indicates teaching has been effective?
"The patch should be effective within an hour of being applied."
A nurse is working with the information technology department of his facility to establish a protocol regarding security mechanisms that will protect the electronic health records of clients. Which of the following could result in a violation of client confidentiality? - occurrence of an automatic log off after a period of inactivity - installation of firewall software on each computer - placement of computer systems in restricted ares -Ability of staff to access electronic health records throughout the facility
Ability of staff to access electronic health records throughout the facility
A nurse is caring for a client who has osteoarthritis and is considering treatment with acupuncture. Which of the following i acceptable for the nurse to include in discussion with the client? - its loose regulated by the federal government - has been discredited by scientific research - is thought to be effective only as a placebo - it has been proven to reduce pain and increase function
Acupuncture has been proven to reduce pain and increase.
A nurse is caring for a client who has cancer. The client has decided to stop treatment and requests a referral to hospice. By making the referral as requested, the nurse is illustrating which of the following ethical principles?
Autonomy
A nurse is caring for an older adult client who has an allergy to sulfa, is taking valproic acid (Depakote) for a seizure disorder, and has been newly diagnosed with osteoarthrisits. The client states, "I keep seeing commercials on TV for Celebrex and I want to try it and see if it will help my pain." Upon review of scientific evidence, the nurse should inform the client of which of the following? - celecoxib is contraindicated in clients taking valproic acid - celecoxib is contraindicated in older adults - celecoxib is contraindicated in clients with a seizure disorder - celecoxib is contraindicated in clients with an allergy to sulfonamide
Celecoxib is contraindicated in clients with an allergy to sulfonamide
A nurse is reinforcing teaching about performing suctioning to a client who is being discharged following a tracheotomy. Which of the following behaviors by the client best indicate to the nurse that teaching has been effective? - self reporting the ability to perform the procedure - answering appropriately when questioned orally - responding accurately on a written examination - demonstrating independent performance of the procedure
Demonstrating independent performance of the procedure
A nurse in a local clinic is caring for a female client who is 35 years old. Which of the following screenings should the nurse recommend to the client?
Dermatologist evaluation every 3 years to detect skin cancer.
A nurse is caring for a client following a bronchoscopy. Which of the following findings requires immediate intervention?
Difficulty breathing
A nurse is reinforcing teaching to a client who has aphasia. Which of the following actions by the nurse is appropriate when communicating with the client?
Having the client use eye blinks to indicate yes or no
A nurse is reinforcing teaching about HIV with a group of high school students. Which of the following information is appropriate for the nurse to include?
Initial HIV symptoms are often similar to the flu
A nurse in a providers office is orientating a newly licensed nurse on how to position a client for a vaginal exam. The nurse should include in the teaching to place the client in which of the following positions? - lithotomy - dorsal recumbent - prone - lateral recumbent
Lithotomy
A nurse is caring for a client who is diagnosed with active pulmonary tuberculosis and is taking isoniazid (INH) and ethambutol (Myambutol). Which of the following manifestations reported by the client necessitate the discontinuation of ethambutol? - loss of color discrimination - nausea and vomiting - red orange discoloration to body fluids - edema of feet and hands
Loss of color discrimination
A nurse is caring for a client who has been admitted to the medical unit with vomiting and possible dehydration. Which of the following findings immediate intervention?
Potassium 2.5 mEq/L
A nurse is caring for an older adult client who was admitted 3 days ago with fractured ribs bilaterally and is suspected of being abused by his caregivers. Which of the following should be the nurse's priority goal? - support the clients relationship with his caregivers - encourage the client to express his feelings - determine who is responsible for the abuse - protect the client from further abuse
Protect the client from further abuse.
A nurse is caring for a client who has nausea and a prescription for promethazine (Phenergan) 25 mg IM. Which of the following is appropriate when preparing a medication for administration from an ampule?
Set the ampule on a flat surface to withdraw the promethazine
A nurse is caring for a client who has a cerebrovascular accident and is having difficulty swallowing. Which of the following health care professionals should attend the clients next interdisciplinary team meeting to address this complication? - speech pathologist - occupational therapist - social worker - respiratory therapist
Speech pathologist