RN Fundamentals Quiz 2019 A
A charge nurse is delegating tasks for 4 pts. Which of the following tasks should the nurse delegate to the AP? Prepare the room for a client who requires seizure precautions.* Check a client's deep tendon reflexes. Develop a plan of care for a client who is at risk for falling. Obtain a wound culture on a client who has a small pressure injury.
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A charge nurse is teaching a newly hired nurse about the facility's computerized documentation system. Which of the following actions should the nurse take? Direct the newly hired nurse to wait until the end of the shift to document client care. Instruct the newly hired nurse to use direct quotes when recording client statements.* Perform documentation for the newly hired nurse until the orientation period is complete. Print records from previously discharged clients as examples for the newly hired nurse to review.
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A nurse in a provider's office is reviewing the lab reports for a pt who is at risk for heart disease. Which of the following results should the nurse report to the provider? LDL 170 mg/dL* HDL 60 mg/dL Triglycerides 60 mg/dL Total cholesterol 197 mg/dL
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A nurse is admitting a pt to an acute care facility. Which of the following actions by the nurse promotes pt self-determination? Reviewing the policy on safeguarding personal valuables with the client Informing the client's family about the regulations for visiting hours Providing the client with information about end-of-life decision-making* Comparing the client's home medications to the admission prescriptions
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A nurse is caring for a pt who is recovering from a stroke & tells the nurse he is concerned about paying his medical bills. The nurse should refer the pt to which of the following members of the interprofessional health care team? Physical therapist Occupational therapist Social worker* Speech pathologist
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A nurse is completing an informed consent document for a 16 y/o adolescent who is married & is schedules for an emergency appendectomy. Which of the following action should the nurse take? Locate the adolescent's partner to sign the form prior to the appendectomy. Document that consent is implied due to the urgency of the procedure. Tell the client that a general consent to treatment covers the surgical procedure. Ask the client if they understand the provider's plan for the appendectomy.*
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A nurse is performing guaiac testing for a pt to screen for colon cancer. The nurse should ID that ingestion of which of the following foods can cause a false negative result? Dairy products Citrus fruits* Soy products Fish with omega-3 fats
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A nurse is performing medication reconciliation with a pt. Which of the following actions should the nurse take first? Contact the provider about discrepancies in medication dosages. Provide the client with a new list of prescribed medications. Compare the provider's admission prescriptions to the client's list of home medications. Ask the client if she takes any over-the-counter medications.*
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A nurse is planning care for 4 pts. Which of the following pts should the nurse see first? A client who has diabetes mellitus and a fasting blood glucose of 68 mg/dL A client who has moderate serosanguineous drainage on a surgical dressing A client who has pneumonia and expiratory wheezing* A client who has a PCA pump and reports pain as 7 on a scale of 0 to 10
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A nurse is preparing the room for a pt who is transferring from the ED & is on seizure precautions. Which of the following items should the nurse place in the pt's room? Oral-nasal suction* Tongue blade Sterile gloves Wire cutters
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A nurse is preparing to admin 15 units of regular insulin along wtih 25 units of NPH insulin. Which of the following actions should the nurse take first when mixing the insulin? Withdraw the regular insulin from the vial. Inject 15 units of air into the regular vial of insulin. Withdraw the NPH insulin from the vial. Inject 25 units of air into the NPH vial of insulin.*
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A nurse is preparing to admin an intermittent tube feeeding to a pt who has a g-tube. which of the following actions should the nurse take first? Flush the client's tubing with 30 mL of water. Draw up 30 mL of air and instill into the tubing. Check the pH of the client's stomach contents.* Check the gastric residual volume.
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A nurse is preparing to insert a new IV catheter for a pt. Which of the following actions should the nurse plan to take? Choose a vein that is palpable.* Use the client's dominant arm to start the IV. Select an insertion site at an area of flexion. Elevate the extremity prior to insertion.
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A nurse is preparing to perform a sterile procedure for a pt. Which of the following actions should the nurse include in the plan? Consider objects contaminated if they are 5 cm (2 in) from the border of the sterile field. Hold a clean bottle over the sterile field when pouring the solution. Don sterile gloves prior to opening sterile packages. Position a bedside table so the sterile field can be seen continuously throughout the procedure.*
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A nurse is reviewing the medical record for a pt who is receiving continuous enteral feedings. Which of the following findings should the nurse report to the provider? Gastric residual of 50 mL Weight gain of 0.23 kg (0.5) lb in 24 hr Blood glucose of 105 mg/dL Gastric aspirate pH of 7*
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A nurse is teaching a pt about health promotion & secondary prevention strategies. Which of the following recommendations should the nurse include? Influenza immunization Rehabilitation therapy Genetic screening Hypertension screening*
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A nurse is completing dietary teaching with a pt who has HF & has a Rx for a 2g sodium diet. Which of the following statements made by the pts indicates an understanding of the teaching? "I can have nonfat yogurt as a dessert." "I can eat processed foods as long as it has less than 500 mg of sodium per serving." "I can use baking soda when I bake." "I should season my foods with salt sparingly." *
* "I can have nonfat yogurt as a dessert." (?)
A nurse is teaching a pt who has a new hearing aid. Which of the following statements by the pt indicates to the nurse an understanding of the teaching? "I will turn the volume up on my hearing aid to full volume after insertion." "I will reinsert the hearing aid if I hear a whistling sound." "Initially, I will wear my hearing aid for 2 hours each day."* "I will soak my hearing aid in warm water to clean it."
* "I will reinsert the hearing aid if I hear a whistling sound." (?)
A nurse in a community health center is teaching a group of pts about the use of aromatherapy. The nurse should include in the teaching that which of the following essential oils is used to alleviate swollen joints? Lavender* Jasmine Sage Chamomile
* Chamomile (anti-inflammatory, calming) Ch. 42
A nurse is planning care for a pt who is postop. Which of the following interventions should the nurse include in the plan to decrease the pt's risk for venous stasis?. Instruct the client to elevate her legs when sitting in a chair. Assist the client to ambulate after IV infusions are discontinued. Place a pillow under the client's knees while she is in bed. * Encourage the client to exercise the legs every 4 hr while awake.
* Instruct the client to elevate her legs when sitting in a chair. (?) Ch. 40 Moblility & Immobility
A nurse is reviewing a pt's ABG lab results. Which of the following ABG results should the nurse report to the provider? pH 7.42 PaCO2 32 mm Hg PaO284 mm Hg* HCO3- 25 mEq/L
* PaCO2 32 mm Hg Respiratory alkalosis: Decreased CO2 <35mmHg, increased pH >7.45 Ch. 57 Fluid Imbalances
A nurse is evaluating the developmental motor skills of a 4 month old infant. Which of the following findings should the nurse expect? Uses a spoon to feed herself Sits up with support Uses a pincher grasp* Creeps on hands and knees
* ??? (4 mo infant- rolls from back to side & grasps objects with both hands) Uses a spoon to feed herself Sits up with support (7mo) Uses a pincher grasp (8mo) Creeps on hands and knees (9mo)
A nurse is performing a preop assessment on 4 pts. The nurse should ID that which of the following pts is at risk for a latex allergy? A client who has an allergy to walnuts* A client who has spina bifida A client who has a family history of malignant hyperthermia A client who has a history of smoking
*** A client who has spina bifida Ch. 29 Chronic Neuromusculoskeletal Disorders
A nurse is teaching a pt how to perform active ROM exercises of the lower extremities to improve mobility. Which of the following instructions should the nurse include in the teaching? Move each joint just beyond the point of resistance. Perform each exercise six times each session. Complete each session two times per day. Start with a different set of joints each session.*
*** Complete each session two times per day. (Encourage active or passive ROM 2 or 3x/day Ch. 40 Mobility & Immobility
A nurse is caring for a pt who has C diff. Which of the following actions should the nurse take? Place the client in a room with negative-pressure airflow. Place a mask on the client when he leaves the room. Wear a cover gown when caring for the client. Wash hands with an alcohol-based antiseptic solution after caring for the client.*
*** Wear a cover gown when caring for the client. (?) Private room/room with other pts who have the same infection; gloves & gowns worn by caregivers & visitors; disposal of infectious dressing material into a single, nonporous bag without touching the outside of the bag. (Contact precautions- C.diff, HSV, impetigo, MRSA, VRSA) Ch. 11 Infection Control Ch. 56 Bacterial, Viral, Fungal & Parasitic Infections
