PN Comprehensive Online Practice 2023 A

A nurse in a mental health facility accuses a nurse of stealing money from their room. Which of the following therapeutic responses should the nurse make?

Tell me how you decided who took your money

A nurse is reinforcing teaching with a client who has asthma and a new prescription for an ipratropium inhaler. Which of the following statements by the client indicates an understanding of the teaching?

I should wait 1 minute before taking a second puff of the medication/

A nurse and a provider Office is assisting with the care of a client who has a new diagnosis of type two diabetes mellitus. The client is at risk for developing _____ during to _____.

-delayed wound healing -glucose levels

A nurse is assisting with the care of a client who is postoperative following coronary artery bypass surgery (CABG). The client is at greatest risk for developing _____ as evidenced by _____.

-dysrhythmia -Laboratory reports and muscle cramps

A nurse is collecting data from a client who has iron deficiency anemia. Which of the following findings should the nurse expect?

difficulty concentrating

A nurse is reinforcing teaching with a client who is bottle feeding their full-term newborn with formula. Which of the following instructions should the nurse include in the teaching?

feeding newborn at least every 3 to 4 hr

A nurse is positioning a client who is scheduled for a lumbar puncture. The nurse should assist the client into which of the following positions?

lateral recumbent

A nurse is contributing to the plan of care for a client who has a chest tube connected to a closed drainage system. Which of the following interventions should the nurse include?

maintain the drainage below the level of the clients chest.

A nurse is reinforcing teaching with a client who has tuberculosis (TB). Which of the following statements by the client indicates an understanding of the teaching?

the people I live with should be tested for TB

A client is requesting information from a nurse about creating a health care proxy. Which of the following statements should the nurse make?

the person you appoint will make health care decisions for you if you cannot do so yourself

A nurse is reinforcing teaching about puberty with a group of prepubescent female clients. Which of the following information should the nurse include in the teaching?

you will likely gain weight before you start to get taller

A nurse is caring for a client who has Alzheimer's disease. Which of the following actions should the nurse take?

Encourage the client to reminisce about the past.

A nurse is working with an interpreter to assist the provider with explaining a diagnostic procedure to a client who speaks a different language than the nurse. Which of the following actions should the nurse take?

Ensure the interpreter is culturally compatible with the client.

A nurse is inspecting the skin of a newborn. Which of the following findings should the nurse report to the provider?

Generalized petechiae

A nurse is monitoring a client who is receiving telemetry. Which of the following ECG findings should the nurse report to the provider?

PR interval 0.24 seconds

A nurse is contributing to the plan of care for a client who has viral meningitis. Which of the following interventions should the nurse include?

Place the client in a private room.

A nurse is transferring a client from a bed to a wheelchair. The client has right-sided weakness following a recent stroke. Which of the following actions should the nurse take?

Place the wheelchair on the client's left side

A nurse is reinforcing home safety instructions with the parent of a newborn. Which of the following statements should the nurse include in the instructions?

Place your baby's crib away from heat vents.

A nurse is preparing to administer insulin to a client who has type 1 diabetes mellitus. After drawing up the medication, the nurse accidentally brushed the needle on the counter's surface. Which of the following actions should the nurse take?

Prepare a new dose of insulin for injection

A nurse is caring for a client who has expressive aphasia following a stroke. Which of the following methods should the nurse use when communicating with the client?

Provide a picture board.

A nurse is assisting a client who is scheduled for a non stress test (NST). Which of the following actions should the nurse take?

Provide the client with a hand help event marker to record fetal activity

A charge nurse is observing a newly licensed nurse apply sterile gloves. Which of the following actions by the newly licensed nurse demonstrates sterile technique?

Putting a glove on their dominant hand first

A nurse at a long-term care facility is part of a team preparing a report on the quality of care at the facility. Which of the following information should the nurse recommend including in the report to demonstrate improvement in care quality?

The facility had 12% fewer urinary tract infections over the past 6 months.

A nurse is reinforcing teaching with a client who is scheduled for a barium enema. Which of the following statements should the nurse make?

This procedure uses diagnostic imaging to locate an obstruction.

A nurse is assisting with an educational session for newly licensed nurses about partner violence. Which of the following should the nurse include as increasing a person's risk of being recipient of partner violence?

Threats to leave the relationship

A nurse is collecting a urine specimen for a female client who has diabetes insipidus. Which of the following findings should the nurse expect?

Urine specific gravity of 1.002

A nurse is reviewing the techniques for transferring a client from a bed to chair with a group of assistive personnel (AP). Which of the following instructions should the nurse include?

Use lower-body strength.

A nurse is assisting in the care of quiet who is in the emergency department. For each body system below, click to specify the potential nursing intervention that would be appropriate for the care of the client. Each body system may support more than 1 potential nursing intervention.

-Administer naloxone -Monitor the client for hypotension -Observe the client for pinpoint pupils

A nurse in the emergency department is assisting in the care of a client. The nurse should suspect the client is experiencing _____ as evidenced by the client's _____.

-serotonin syndrome -altered mental status

Urinalysis results were reported to the primary care provider's office. Click to highlight the findings that indicate that the treatment has been effective. To deselect a finding, click on the finding again.

-urinate without discomfort -urine is clear -client is drinking 1.5 L of water daily

A nurse is reinforcing teaching for a client who has type 1 diabetes mellitus. Which of the following client statements indicates an understanding of the teaching?

"I should check my blood sugar if my appetite is decreased."

A nurse is reinforcing teaching with a client who is scheduled for a colonoscopy. Which of the following client statements indicates an understanding of the teaching?

"I will undergo bowel cleansing prior to the procedure."

A nurse is collecting data from an older adult client. Which of the following client statements should the nurse identify as an indication of possible maltreatment?

"My child took my wallet so they can keep track of what I'm spending."

A nurse is collecting data from a client who has schizophrenia. Which of the following statements by the client should the nurse identify as a delusion?

"My doctor's glasses have lasers that will burn holes in my brain if I look at them."

A nurse is caring for a client who is crying and states their provider informed them that they have tumor and will need a biopsy. Which of the following responses should the nurse make?

"What have you done to help yourself get through stressful situations before?"

A nurse is preparing to administer amoxicillin 875 mg PO every 12 hr. The amount available is amoxicillin oral suspension 400 mg/ 5 mL. How many mL should the nurse administer per dose?

11 mL

A licensed practical nurse (LPN) is reviewing client assignments for the upcoming shift. Which of the following clients should the LPN ask the charge nurse to reassign to a registered nurse (RN)?

A client who has a new colostomy and requires the development of a teaching plan

A nurse is receiving report on gout clients. Which of the following clients should the nurse plan to see first?

A client who has pneumonia and a new onset of confusion

A nurse is working in an acute care facility when a natural disaster occurs. The facility must discharge clients to provide room for new admission. Which of the following clients should the nurse recommend the charge nurse discharge?

A client who has pneumonia and is currently receiving oral antibiotics

A nurse in an urgent care clinic is collecting data from four clients. Which of the following clients should the nurse recommend for treatment first?

A client who is experiencing shortness of breath after taking amoxicillin

A nurse is reviewing the electronic health records of four clients. Which of the following client conditions should the nurse recognize as reportable to regulatory agency?

A client who is newly diagnosed with tuberculosis

A nurse is caring for a group of client. The nurse should fill out an incident report for which of the following situations?

A visitor who develops a bruise on their head following a syncopal episode.

A nurse is assisting with the care of a client. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address the condition, and 2 parameters the nurse should monitor to assess the client's progress.

Action 1:? Action 2:? Potential Condition: Somatic symptom disorder Parameter to Monitor 1: Secondary gains from their illness Parameter to Monitor 2: Physical manifestations Upon recognizing and analyzing the client's assessment findings, such as joint pain and physical inactivity, the nurse's priority hypothesis is that the client is most likely experiencing somatic symptom disorder. It is essential to generate solutions and take actions by monitoring for both the presence of secondary gains from their illness and the client's physical manifestations. Somatic symptom disorders are characterized by the presence of many physical manifestations like dizziness, nausea, back pain, joint pain, etc. The nurse should evaluate and monitor the client's vital signs and pain level.

A nurse on a medical unit is reviewing a client's health record. The nurse should identify which of the following procedures requires the client to sign a separate informed consent form?

Blood transfusion

A nurse is caring for a client who reports an intense headache, nuchal rigidity, nausea and vomiting, along with fever and chills. Which of the following diagnostic tests should the nurse expect the provider to prescribe?

Cerebrospinal fluid analysis

A nurse is assisting with the care of a client who is experiencing alcohol withdrawal. Which of the following medications should the nurse expect to administer?

Chlordiazepoxide

A nurse is collecting data from a school-age child who has sustained a skull fracture. Which of the following is a manifestation of increased intracranial pressure?

Confusion about knowing their own name

A nurse is assisting with the care of a client who has terminal cancer. Which of the following statements by the client's family should indicate to the nurse that they are coping effectively with their situation?

Dad, I remember the time we all went fishing at the lake

A nurse is assisting with the admission of an older adult client. Which of the following actions should the nurse take first?

complete a fall risk assessment on the client

A nurse is assisting with teaching a group of local residents at a community health fair about the Dietary Approach to Stop Hypertension (DASH) diet. Which of the following statements by the resident indicates an understanding of the teaching?

I will keep my intake of sodium less than 2,300 milligrams per day

A nurse in a provider's office is reinforcing teaching with a client who has a new prescription for ferrous sulfate elixir. Which of the following statements by the client should indicate to the nurse an understanding of the teaching?

I will rinse my mouth after taking this medication

A nurse is reinforcing teaching with a client who has hypertension and is beginning medication therapy with captopril. Which of the following over-the-counter medications should the nurse instruct the client to avoid?

Ibuprofen

A nurse is assisting in the care of a client who experienced a spinal cord injury (SCI). Complete the diagram by dragging from the choices below, to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

-Autonomic dysreflexia -blood pressure -noxious stimuli -administer nifedipine or a nitrate Upon collecting data, the nurse should recognize the client cues of high blood pressure, headache, face and neck warm to the touch, and constipation. The nurse should recognize that the client is likely experiencing autonomic dysreflexia, and that it is important to generate solutions and take actions that will decrease the client's blood pressure and noxious stimuli. Therefore, the nurse should prepare to administer nifedipine or a nitrate to decrease the client's blood pressure and check for bladder distention, which may be contributing to visceral stimuli. The nurse should monitor the client's blood pressure every 10 to 15 min and monitor vision for changes caused by autonomic dysreflexia, such as blurred vision.

The nurse is preparing to reinforce teaching to the client on how to prevent further urinary tract infections from occurring. Which of the following information should the nurse include? (Select all that apply.)

-Avoid coffee, teas, colas, and alcoholic drinks -Shower rather than bathe in a tub -Clean the perineum from front to back when wiping -Void every 2 to 3 hr during the day

A nurse is assisting with the care of an adolescent client in the emergency department. For each finding click to specify if the finding is consistent with bacterial meningitis or encephalitis. Each finding may support more than one disease process.

-Bacterial Meningitis: fever, photophobia, pain, mental status, and rash -Encephalitis: fever, pain, and mental status

A nurse in a provider's office is reviewing ppediculosis cavities management and prevention strategies with the parent of a school-age child. Which of the following strategies should the nurse include? (Select all that apply)

-Boil brushes and combs in water for 10 min -Dry bed linens and clothes in a hot dryer for at least 20 min -Store the child's clothing in a separate cubicle when at school

A nurse is contributing to the plan of care for a client who had a vaginal delivery 4 hr ago and has a fourth-degree perineal laceration. Which of the following interventions should the nurse recommend?

Instruct the client to use a sitz bath at least twice a day.

A nurse is reinforcing teaching with a client who requires information about how to lose weight. Which of the following statements should the nurse make?

Keep fat intake to no more than 30 percent of your daily caloric intake

A nurse is using the FLACC scale to determine the pain level of an 11-month-old infant who is postoperative. Which of the following factors should the nurse consider when using this pain scale?

Level of activity

A nurse is caring for a client who is being discharged home following a cerebrovascular accident. Which of the following documents should the nurse plan to include with her discharge report?

List of potential complications to report

A nurse is caring for a client who is immunocompromised. Which of the following immunizations is contraindicated?

Measles, mumps, and rubella (MMR)

A nurse is reinforcing teaching with a client who had hypercholesterolemia and a new prescription for atorvastatin. The nurse should instruct the client that which of the following findings is an adverse effect of this medication and should be reported to the provider?

Muscle pain

A nurse is caring for a client who is recovering from a a stroke and is experiencing difficulty using eating utensils. The nurse should identify the need for a referral to which of the following interprofessional team member?

Occupational therapist

A nurse is reinforcing teaching with an older adult client who has severe left-sides heart failure. Which of the following statements should the nurse make?

Rest for 15 minutes between activities

A nurse in an urgent care clinic is caring for a child who has a minor burn on their palm after touching the burner on a hot stove. Which of the following actions should the nurse take?

-Clean the burn with mild soap and tepid water -Remove any embedded debris -Apply an antimicrobial ointment -Wrap the hand with a gauze dressing -Inform the parent of dressing change schedule

A nurse is assisting in the care of a client who is one hour postpartum. Select the 6 actions the nurse should take.

-Firmly massage the uterine fundus -Administer methylergonovine -Weigh the perineal pads -Provide emotional support -Insert indwelling urinary catheter -administer oxygen at 12 L/min via non rebreather face mask

A nurse is caring for a client in an outpatient setting. The client is exhibiting manifestations of _____ as evidenced by the client's drop _____.

-Heart failure -BNP level

Urinalysis results were reported to the primary care provider's office. Select the 3 prescriptions the nurse should anticipate from the provider.

-Phenazopyridine 200 mg PO three times daily -Sulfamethoxazole 160 mg PO every 12 hr -Obtain a culture and sensitive test

A nurse is reinforcing teaching about managing manifestations of anxiety with a client who has generalized anxiety disorder. Which of the following information should the nurse include?

Say the word "stop" when upsetting thoughts occur.

A nurse in an outpatient setting is assisting with the care of a client. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

-Pyelonephritis -administer antibiotics -encourage fluid intake -Monitor fever -Monitor BUN levels Upon collecting data, the nurse should recognize the client cues of elevated temperature, recent history of UTI, flank pain, nocturia, and urinary frequency and urgency as indicators that the client is most likely experiencing pyelonephritis and that it is important to generate solutions and take actions to support treatment of the infection. Therefore, the nurse should prepare to administer antibiotics and encourage the client to increase their fluid intake to 2 L/day to dilute urine. The nurse should assist the RN with monitoring fever as an indicator of kidney infection and assist with monitoring the client's BUN level as an indicator of kidney function recovery or deterioration.

A nurse in an urgent care setting is assisting with the care of a client. For each finding click to specify if the finding requires follow-up or does not require follow up.

-Requires follow-up: BP, Heart rate, HbA1c, and BMI -Does not require follow-up: Sodium and BUN

A nurse is assisting with the care of a client who is pregnant in the acute care setting. The nurse should first address the client's _____, followed by the _____.

-Respirations -LOC

A nurse is assisiting with the care of a 3-year-old child who has a gastrostomy tube. The nurse should identify that the child may be developing _____ and _____.

-Skin breakdown -An infection

Urinalysis results were reported to the primary care provider's office. The client is at greatest risk of developing _____ as evidenced by the client's _____.

-Urosepsis -Prior catheterization

Urinalysis results were reported to the primary care provider's office. Select the 4 results of the client's urinalysis that require follow-up for a urinary tract infection.

-WBC -RBC -Nitrites -Leukocyte esterase

A nurse is a provider's office is assisting with the care of a client. A nurse is collecting data from a client who has a suspected urinary tract infection. The nurse should identify that which of the following findings indicates a urinary tract infection? (Select all that apply.)

-frequency -dysuria -urgency

A nurse is assisting in the care of a client who is one day postoperative following a total thyroidectomy. The client is the greatest risk for developing _____ as evidenced by _____.

-hypocalcemia -muscle spasms

A nurse is assisting in the care of a client who is postoperative following an appendectomy. Which of the following client findings should the nurse report to the charge nurse?

-pain -nausea -heart rate -oxygen saturation

A nurse is assisting with the care of a client who is 24 hours postoperative following a cesarean birth. The client is a risk for developing _____ as evidenced by _____.

-seizures -severe features of preeclampsia

A nurse is performing postmortem care for a client prior to the arrival of the client's family for viewing of the body. Which of the following actions should the nurse take?

Gently close the client's eyelids

A nurse is reinforcing teaching with the parent of a preschooler who has lactose intolerance. Which of the following statements by the parent indicates an understanding of the teaching?

I should offer my child yogurt that has a probiotic as a snack.

A nurse is assisting with planning care for a 5-year-old child who is 8 hr postoperative following a tonsillectomy. Which of the following interventions should the nurse include in the plan of care?

Administer PRN analgesics regularly for the first 24 hr.

A charge nurse on a long-term care unit is preparing to delegate tasks to a licensed practical nurse (LPN) and an assistive personnel (AP). Which of the following tasks should the nurse delegate to the LPN?

Administer an initial NG tub feeding to a client who had a stroke

A nurse is reinforcing teaching with a client who is to self-administer epoetin Alfa. Which of the following instructions should the nurse include?

Administer the medication subcutaneously

A nurse is assisting with the transfer of a client to a long-term care facility. The nurse should review which of the following sections of the electronic health record to locate information about the client's personal health insurance?

Admission sheet

A nurse is caring for a client who requests information about advance directive. Which of the following responses should the nurse make?

Advance directives are written instructions regarding end-of-life care

A home health nurses is reinforcing teaching with a client about the use of elastic stockings to decrease peripheral edema. Which of the following instructions should the nurse include?

Apply the stockings in the morning.

A nurse is reviewing laboratory report for a client who has an Escherichia coli infection and is receiving gentamicin. Which of the following results should the nurse report to the provider before administering the next dose?

Creatinine 2.3 mg/dL (0.5 to 1.1 mg/dL)

A nurse in an urgent care clinic is completing a client examination. Upon listening to the client's lungs, the nurse hears high-pitched, crowing sound. Which of the following adventitious sounds should the nurse document?

Stridor

A nurse is checking the reflexes of a newborn. Which of the following techniques should the nurse use to elicit the Babinski reflex?

Stroke the sole of the newborn's foot upward and toward the great toe

A nurse is assisting with planning care for a client who has a history of seizures. Which of the following pieces of equipment should the nurse place in the client's room?

Suction catheter

A nurse is reinforcing teaching with a client about how to use an incentive spirometer. Which of the following actions by the client indicates an understanding of the teaching?

The client attempts to elevate the cylinder by inhaling deeply.

A school nurse is having a conversation with the guardian of an adolescent. The nurse should identify which of the following situations as an ethical dilemma for the parents?

We cant decide whether to try to homeschool our child or move them to a private school

A nurse is caring for a school-age child. For each data collection finding, click to specify if the finding is consistent with attention deficit hyperactivity disorder (ADHD) or intellectual disability (ID). Each finding may support more than 1 disease process.

When analyzing cues, the nurse should identify that manifestations of ADHD include losing necessary things, interrupting others, social functioning deficit, and hyperreactivity to sensory input. In ADHD, the client often loses necessary things in daily life like pencils, erasers, and books. The client often interrupts others and has difficulty waiting for their turn in conversation. The client might have a social functioning deficit, which can lead to difficulties with socialization. The client might exhibit hyperreactivity or hyporeactivity to stimuli. When analyzing cues, the nurse should identify that manifestations of ID include impaired language skills and social functioning deficit. The client can exhibit difficulty with communication, as well as deficits with problem-solving, judgment, and academic ability.

A nurse is collecting data from a client who is scheduled for surgery. Click to highlight the data collection findings that the nurse should report to the provider prior to the procedure. To deselect a finding, click on the finding again.

When collecting data from the client and analyzing cues, the nurse should determine the client's hemoglobin level, latex allergy, and family history of malignant hyperthermia should be reported to the provider. When the client's hemoglobin level is below the expected range, the client might require blood products during the intraoperative phase. The client's allergy to avocados and bananas can indicate an allergy to latex products and should be reported to the provider. The surgical team will need to remove all latex products from the operating room. During the intraoperative phase, the nurses must be diligent in monitoring the client's vital signs and laboratory values, especially in a client who has a family history of malignant hyperthermia.

A nurse is assisting in the care of a client who is pregnant. For each discharge instruction, click to specify if each action is recommended or contraindicated for the client.

When taking action and reinforcing discharge teaching for a client who has hyperemesis gravidarum, the nurse should recommend the client eat every 2 to 3 hr to avoid having an empty stomach, which can increase nausea. The client should separate liquids from solids every 2 to 3 hr to help minimize nausea. The client should eat foods high in protein and low in fat. Warm ginger ale or ginger tea can also decrease nausea.

A nurse is collecting data from a client who has type 2 diabetes mellitus and is concerned about weight gain during pregnancy. Which of the following responses should the nurse make?

You weight gain should be the same as for someone without diabetes.

A nurse is preparing a client for surgery. The client states, "I'm sure this surgery will not help me get better." Which of the following responses should the nurse make?

You're saying that you are doubtful that this procedure will benefit you.

A nurse is assisting with planning palliative care for a client who has stage IV cancer and is in the active stage of dying. Which of the following interventions should the nurse include in the plan of care?

administer atropine to reduce the clients respiratory secretions

A nurse is assisting with the care of a client who has a terminal illness. The client practices Orthodox Judaism. Which of the following actions should the nurse take?

assure the client that a family member will stay with his body after death