PN Med Surge Online Practice end
A nurse is reinforcing teaching with a client who has coronary artery disease. Which of the following instructions should the nurse include in the teaching? "Maintain a fat intake of 40 percent of your total daily calories." "Limit consumption of whole milk products to 8 ounces three times per week." "Exercise for 20 minutes twice per week." "Add oily fish to your diet twice weekly."
"Add oily fish to your diet twice weekly."
A nurse is reinforcing instructions with a client who has a new hearing aid. Which of the following instructions should the nurse include? "Change the batteries if you hear a whistling sound." "Adjust the volume to a level where you can hear others speak at a distance of 3 feet." "Keep the hearing aid in place while showering." "Clean the hearing aid with a bristle brush to remove excess cerumen."
"Adjust the volume to a level where you can hear others speak at a distance of 3 feet."
A nurse is reinforcing teaching with a client who has osteoporosis and a new prescription for calcitonin. Which of the following statements should the nurse make to describe the effect of calcitonin in treating osteoporosis? "Calcitonin will slow the breakdown of bone in your body." "Calcitonin will increase the level of cortisol in your blood." "Calcitonin will decrease the amount of calcium you are losing in your urine." "Calcitonin will increase the blood ow to your skeletal muscles."
"Calcitonin will slow the breakdown of bone in your body."
A nurse is reinforcing teaching about hospice care with a client who has terminal cancer. Which of the following statements should the nurse make? "Hospice care will provide support for you and your loved ones during the dying process." "As part of hospice services, you will need to decide if you want resuscitative measures or not." "Hospice care must be provided in the hospital." "As part of hospice services, nursing care will be available Monday through Friday."
"Hospice care will provide support for you and your loved ones during the dying process."
A nurse in a health clinic is reinforcing teaching with a client about tuberculosis (TB). Which of the following client statements indicates an understanding of the teaching? "I can develop TB by breathing in the infection." "After exposure, I could develop TB within 5 days." "A positive reaction to a TB test means I'm currently infected." "I need to wear a mask in my house if I become infected."
"I can develop TB by breathing in the infection."
A nurse is reinforcing teaching about nutrition choices with a client who has leukemia and is receiving chemotherapy. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? "I drink bottled water." "I eat at a salad bar for lunch." "I like to eat steak cooked medium." "I put plenty of pepper on my soft-boiled eggs."
"I drink bottled water."
A nurse is preparing to administer an influenza vaccine to a client. Which of the following statements by the client should cause the nurse to postpone administration of the vaccine? "I am allergic to shrimp." "I am allergic to latex balloons." "I had a tuberculosis skin test 2 days ago." "I had a low fever this morning."
"I had a low fever this morning."
A nurse in a clinic is collecting data from a client who has hyperthyroidism and has been taking methimazole for 4 weeks. Which of the following statements by the client indicates a therapeutic response to the medication? "I have been sleeping less since I started the medication." "I have gained 3 pounds since my last appointment." "My bowel movements have become more frequent." "I urinate more often than before."
"I have gained 3 pounds since my last appointment."
A nurse is reinforcing teaching with a client prior to the removal of a leg cast. Which of the following statements should indicate to the nurse that the client understands the teaching? "I will scrub the skin to remove the old skin flakes." "I can expect my leg to be swollen after the cast is removed." "I can go back to my usual activities as soon as the cast is off." "I will feel vibrations on my leg from the cast cutter."
"I will feel vibrations on my leg from the cast cutter."
A nurse is reinforcing teaching with a client about preventing osteoporosis. Which of the following client statements indicates an understanding of the teaching? "I will eat a banana every day." "I will walk for 20 minutes 3 days per week." "I will limit my coffee intake." "I will take vitamin E at bedtime."
"I will limit my coffee intake."
A nurse is reinforcing teaching with a client who has chronic kidney disease about disease management. Which of the following statements by the client indicates an understanding of the teaching? "I will add a banana to my morning cereal." "I will decrease my intake of carbohydrates." "I will limit my daily intake of protein." "I will season my foods with a salt substitute.
"I will limit my daily intake of protein."
A nurse is reinforcing discharge teaching with a client who had a mechanical mitral valve replacement. Which of the following statements by the client indicates an understanding of the teaching? "I will notify my dentist about this procedure." "I will take an enteric-coated aspirin daily." "I will use a firm-bristled toothbrush." "I will weigh myself once a week."
"I will notify my dentist about this procedure."
A nurse is reinforcing discharge teaching with a client who has Crohn's disease. Which of the following statements should the nurse include in the teaching? "Increase your intake of dietary fat." "Maintain a low-residue diet." "Avoid taking antidiarrheal medications." "Plan to weigh yourself weekly."
"Maintain a low-residue diet."
A nurse is collecting data from an older adult client who has several concerns. Which of the following concerns should the nurse recognize as an expected change associated with aging? "I sweat more than I used to." "Sometimes, I can't remember my kids' names." "I seem to have more loose stools than I used to." "My food tastes bland even after I add seasoning."
"My food tastes bland even after I add seasoning."
A nurse is reinforcing teaching with a client about testicular self-examination. Which of the following instructions should the nurse include in the teaching? "Perform testicular self-examination after taking a warm shower." "Examine both testicles at the same time." "Use the palm of your hand to palpate for abnormalities." "Perform testicular self-examination every 6 months."
"Perform testicular self-examination after taking a warm shower."
A nurse is providing information regarding transmission-based precautions for a client who has Clostridium dicile to an assistive personnel (AP). Which of the following instructions should the nurse include? (Select all that apply.) "Provide the client with disposable utensils and dishes for meals." "Leave blood pressure equipment in the client's room." "Clean contaminated surfaces with a bleach solution." "Use an alcohol-based hand sanitizer after client care." "Wear a face mask when in the client's room."
"Provide the client with disposable utensils and dishes for meals." "Leave blood pressure equipment in the client's room." "Clean contaminated surfaces with a bleach solution."
A nurse is reinforcing teaching about pursed-lip breathing with a client who has a new diagnosis of COPD. The nurse should identify that which of the following client statements indicates an understanding of the teaching? "I should perform pursed-lip breathing exercises before going to bed." "When I'm fatigued, I should inhale slowly through pursed lips." "Pursed-lip breathing works best for activities like walking up stairs." "I will exhale through my nose after breathing in through pursed lips."
"Pursed-lip breathing works best for activities like walking up stairs."
A nurse is reinforcing teaching with a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? "Place throw rugs on wooden floors at home." "Supplement your diet with vitamin E." "Swim laps for 20 minutes twice per week." "Take calcium supplements with meals."
"Take calcium supplements with meals."
A nurse is reinforcing teaching with a client who is taking levothyroxine. Which of the following statements by the client indicates an understanding of the teaching? "I will need to take the medication until my thyroid function returns to normal." "The medication should be taken before I eat breakfast every morning." "The medication might lower my blood sugar." "I will take the medication with an antacid if it gives me heartburn."
"The medication should be taken before I eat breakfast every morning."
A nurse is caring for a client who has prostate cancer. The client asks the nurse why they are having difficulty with urination. Which of the following responses should the nurse make? "The kidneys' ability to filter urine is decreased." "The tumor causes obstruction of urine from the urethra." "The cancer results in hormonal changes, which aect urination." "The protein-specific antigen in your blood is decreased."
"The tumor causes obstruction of urine from the urethra."
A nurse is reinforcing teaching with a client who has a new diagnosis of genital herpes. Which of the following information should the nurse include? "Use barrier methods for sexual contact when lesions are present." "Look for lesions that have a wart-like appearance." "The virus can be transmitted without lesions being present." "The lesions resolve in 2 weeks and usually do not recur."
"The virus can be transmitted without lesions being present."
A home health nurse is caring for a client who has COPD. The client reports shortness of breath while eating, despite the use of home oxygen. Which of the following recommendations should the nurse make? "Limit the intake of protein in your diet." "Use a bronchodilator 30 minutes before your meal." "Drink beverages throughout your meal." "Lie down for 1 hour after finishing a meal."
"Use a bronchodilator 30 minutes before your meal."
A nurse is reinforcing discharge teaching with a client who has leukemia and is receiving chemotherapy. Which of the following statements should the nurse include in the teaching? "You should thaw frozen meat at room temperature." "You should use paprika as a seasoning for your food." "You should place your toothbrush in hydrogen peroxide." "You should use a glycerin-based soap while bathing."
"You should place your toothbrush in hydrogen peroxide."
A nurse is reinforcing teaching regarding the use of a continuous passive motion (CPM) machine with a client who is scheduled for a total knee arthroplasty. Which of the following information should the nurse include in the teaching? (Select all that apply.) "Your knee is flexed and extended as prescribed by your provider." "The machine is padded with sheep skin." "You might have the head of the bed elevated to 45 degrees while using this machine." "To use the machine, you must pedal as if you are riding a bike." "We will store the CPM machine on the oor under the bed when not in use."
"Your knee is flexed and extended as prescribed by your provider." "The machine is padded with sheep skin."
A nurse is preparing to assist with the insertion of a double-lumen gastric sump tube for a client who has peptic ulcer disease and has developed gastrointestinal bleeding. Which of the following images depicts the tube that the nurse should select?
(first picture, clear tube ending with blue tube) When using a double-lumen gastric sump tube, the clear portion of the tube allows for aspiration of stomach contents. The blue portion of the tube, or the "pigtail", vents the tube to the atmosphere, which prevents the tube from becoming lodged against the wall of the stomach and protects the stomach from damage.
A nurse is reinforcing dietary teaching with a client about increasing the intake of foods containing vitamin C to enhance absorption of oral iron supplements. Which of the following food choices should the nurse include in the teaching? 1 cup of cooked brown rice 1 cup of boiled broccoli 1 cup of cottage cheese 1 cup of scrambled eggs
1 cup of boiled broccoli
A nurse is reinforcing teaching with a client about increasing dietary fiber. The nurse should recommend which of the following foods as the best source of fiber? 1/2 cup cooked kidney beans 1/2 cup raw cauliflower 1 cup cucumber with peel 1 cup parboiled brown rice
1/2 cup cooked kidney beans
A nurse is caring for a client who is receiving a continuous tube feeding of 60 mL/hr at 1.2 cal/mL. How many calories will the client receive in 12 hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
864
A nurse is planning care for a group of clients after receiving change-of-shift report. Which of the following clients should the nurse plan to see first? A client who had a colectomy 2 days ago and has a nasogastric tube attached to low suction A client who is dehydrated, has mental confusion, and has tried to get out of bed several times during the night A client who had a right lower lobectomy 4 days ago and has 50 mL/hr of serous drainage from a chest tube A client who has pneumonia, has an elevated oral temperature, and is requesting medication for a cough
A client who is dehydrated, has mental confusion, and has tried to get out of bed several times during the night
A nurse is assisting with the care of a client who had a stroke and is unable to speak. The nurse should identify that the client's injury occurred in which of the following lobes of the brain? (You will nd hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
A is correct. Injury to the frontal lobe can result in alterations to motor function or voluntary movement. This involves the ability to speak and the ability to move purposefully.
A nurse is reviewing the medication administration record of a client who has osteoarthritis. Which of the following analgesic prescriptions should the nurse expect to administer when the client reports pain? Methotrexate Acetaminophen Gabapentin Etanercept
Acetaminophen
A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. Which of the following actions should the nurse take? Prepare for intubation of the client. Administer opioid medication. Administer oxygen via nasal cannula. Place the client in low-Fowler's position.
Administer oxygen via nasal cannula.
A nurse is delegating the task of repositioning a client who is in skeletal traction to an assistive personnel (AP). Which of the following instructions should the nurse give the AP? Allow the weights to hang freely. Release the tension of the ropes. Remove the weights when rewrapping bandages. Manually lift the weights when moving the client up in bed
Allow the weights to hang freely.
A nurse is contributing to the plan of care for a client who has just transferred to the medical-surgical unit from the PACU following a right total knee arthroplasty. Which of the following interventions should the nurse include in the plan? Massage both lower extremities to promote comfort. Begin the client on a regular diet when the gag reflex returns. Encourage the client to use the incentive spirometer every 4 hr while awake. Assist the client to change positions at least every 2 hr.
Assist the client to change positions at least every 2 hr.
A nurse is monitoring a client who has a cast and reports intense itching underneath the cast. Which of the following actions should the nurse take? Blow cool air into the cast using a blow dryer on a cool setting. Obtain a prescription for pregabalin. Ask the provider to bivalve the cast. Provide the client with a tongue blade to rub the skin under the cast
Blow cool air into the cast using a blow dryer on a cool setting.
A nurse is caring for a client who has an intestinal obstruction and reports a new onset of nausea. The client has an NG tube set at low intermittent suction and is receiving continuous IV infusion of 0.9% sodium chloride. Which of the following actions should the nurse take first? Check for kinks in the NG tube. Increase the IV uid rate. Provide ice chips. Administer an antiemetic
Check for kinks in the NG tube.
A nurse is caring for a client who is 2 hr postoperative following the amputation of a foot. Which of the following actions should the nurse take first? Obtain the client's temperature. Observe for phantom pain. Measure urinary output. Check the incisional dressing
Check the incisional dressing
A nurse is caring for a client who is suspected of having a myocardial infarction. Which of the following actions should the nurse take to prepare the client for an ECG? Position the client in Sims' position before electrode placement. Ensure that each electrode is dry before application. Cleanse the client's skin prior to electrode placement. Place the electrodes on the client's abdomen and back.
Cleanse the client's skin prior to electrode placement.
A nurse is changing the dressing for a client who has an abdominal incision and a closed-suction drain. Which of the following actions should the nurse take? Secure the drainage tube to the client's bedding. Wear sterile gloves to empty the drainage system. Cut an absorbent gauze dressing to t around the drainage tube. Cleanse the drainage plug with alcohol swabs.
Cleanse the drainage plug with alcohol swabs.
A nurse is caring for a client who is postoperative following an above-the-knee amputation of the right leg and reports pain in the absent portion of the limb. The client received an opioid analgesic 1 hr prior. Which of the following actions should the nurse take? Recommend a referral for a mental health provider to begin lithium therapy. Remind the client that the portion of the limb where they feel pain is gone. Ask the provider to increase the frequency of the client's opioid medication. Collaborate with the physical therapist to initiate alternative pain therapies
Collaborate with the physical therapist to initiate alternative pain therapies
A nurse is caring for a client who is postoperative and has a portable wound bulb suction device. Which of the following actions should the nurse take? Fill the bulb reservoir with 0.9% sodium chloride. Prepare for the drain to be removed after 24 hr. Cut a slit in a gauze sponge and apply it around the tubing insertion site. Compress the bulb reservoir and then close the drainage valve
Compress the bulb reservoir and then close the drainage valve
A nurse is caring for a client who has been taking enalapril. The nurse should monitor the client for which of the following adverse effects? Bradycardia Tremors Cough Hyperglycemia
Cough
A nurse is assisting in the care of a client who has AIDS-related pneumonia. The client is receiving antibiotic therapy and albuterol nebulizer treatments daily. Which of the following findings should indicate to the nurse that the client's therapeutic regimen is effective? Adventitious lung sounds Decrease in exertional dyspnea Respiratory rate of 26/min while sitting in a chair Elevation of the head of the bed is required to sleep
Decrease in exertional dyspnea
A nurse is caring for a client who has end-stage liver disease and just underwent an abdominal paracentesis. For which of the following manifestations should the nurse monitor as an adverse effect of the procedure? Changes in the client's sputum Decreased blood pressure Changes in neurological status Increased urinary output
Decreased blood pressure
A nurse in a dermatology clinic is reviewing the medical records of a group of clients. Which of the following prescriptions for a client who has psoriasis should the nurse clarify with the provider? Topical corticosteroids Coal tar ointment Moderate UV radiation Dermabrasion
Dermabrasion
A nurse is caring for four clients. Which of the following conditions should the nurse identify as a risk for developing vascular disease? Rheumatoid arthritis Diabetes mellitus Myasthenia gravis Crohn's disease
Diabetes mellitus
A nurse is caring for a client who has just returned to the unit following a bronchoscopy. Which of the following findings should the nurse report to the provider? Absent gag reflex Blood-tinged mucus Diminished breath sounds Oxygen saturation 95%
Diminished breath sounds
A nurse is collecting data from a client who is receiving sumatriptan. Which of the following is an expected outcome? Reduced cough Diminished headache Relaxed muscles Decreased peripheral edema
Diminished headache
A nurse is caring for a client who has age-related macular degeneration. Which of the following findings should the nurse expect? Seeing halos around artificial lights Distorted central vision of the eyes Colored spots before the visual fields Spontaneous tearing of the eyes
Distorted central vision of the eyes
A nurse is reviewing the medical record of a client who has acute pancreatitis. Which of the following findings should the nurse anticipate? Elevated serum amylase level Hypertension Bradycardia Decreased leukocyte count
Elevated serum amylase level
A nurse is reviewing the laboratory reports of a client who reports chest pain. Which of the following laboratory results indicates the client is experiencing a myocardial infarction? Decreased lipase Decreased erythrocyte sedimentation rate (ESR) Elevated creatinine Elevated troponin
Elevated troponin
A nurse is caring for a client who has dementia due to Alzheimer's disease. Which of the following actions should the nurse take to reduce the client's confusion? Restrict visitors to three at a time. Avoid touching the client during care. Encourage reminiscence of past experiences. Give the client multiple options for daily events.
Encourage reminiscence of past experiences.
A nurse is caring for a client who has restricted movement of the chest due to a burn injury. The nurse should anticipate preparing the client for which of the following procedures? Fasciotomy Escharotomy Skin grafting Hyperbaric oxygen therapy
Escharotomy
A nurse in a clinic is assisting with the development of a pamphlet about STIs. Which of the following information should the nurse recommend including in the pamphlet? The number of sexual partners does not affect the risk for STIs. Oral contraceptive use decreases the risk for STIs. Males seek treatment for STIs later than females. Females have a higher risk for contracting STIs than males.
Females have a higher risk for contracting STIs than males.
A nurse is reinforcing teaching with a client who has asthma and a new prescription for a corticosteroid. Which of the following findings should the nurse include as an adverse effect of the medication? Frequent colds Vitamin deficiency Increased urination Orthostatic hypotension
Frequent colds
A nurse is reviewing the medication record of a client who is taking digoxin. Which of the following medications should the nurse identify as increasing the risk for the client to develop digoxin toxicity? Potassium chloride Famotidine Levothyroxine Furosemide
Furosemide
A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about glycosylated hemoglobin (HbA1c) testing. Which of the following information should the nurse include in the teaching? The expected therapeutic reference range for HbA1c for a client who has diabetes mellitus is 9.5% to 10%. An HbA1c level below the expected reference range indicates ineffective glucose control HbA1c results measure glucose control for the prior 3 months. HbA1c testing is used to provide a diagnosis of diabetes mellitus
HbA1c results measure glucose control for the prior 3 months.
A nurse is collecting data from a client who is being treated for hypovolemia due to nausea and vomiting. Which of the following findings should the nurse report to the provider? Hemoglobin 15 g/dL Blood pressure 110/55 mm Hg Heart rate 120/min Potassium 3.6 mEq/L
Heart rate 120/min
A nurse is reinforcing teaching with a client who has a new diagnosis of tuberculosis (TB) and a prescription for isoniazid and rifampin. Which of the following information should the nurse include in the teaching? Weekly sputum cultures will be needed. Household family members should be tested for TB. TB is no longer contagious after 2 to 3 days of medication therapy. Family members should wear N95 masks when in contact with the client
Household family members should be tested for TB.
A nurse is caring for a client who is postoperative following a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigation. The nurse notes decreased output from the urethral catheter. Which of the following provider prescriptions should the nurse expect? Clamp the urethral catheter for 30 min. Place the urethral catheter drainage bag at the client's heart level. Slow the bladder irrigation ow rate. Irrigate the urethral catheter with 0.9% sodium chloride.
Irrigate the urethral catheter with 0.9% sodium chloride.
A nurse is reviewing the plan of care for a client who is 1 day postoperative following a total hip arthroplasty. Which of the following interventions should the nurse contribute to the plan of care? Check neurovascular status on the extremity every 8 hr. Have the client perform incentive spirometry every 4 hr. Keep an abduction pillow between the client's legs. Maintain the client on bed rest until the third postoperative day
Keep an abduction pillow between the client's legs.
A nurse is assisting with the development of a plan of care to manage pain for a client who has herpes zoster with lesions on the lower extremities. Which of the following interventions should the nurse include in the plan of care? Keep bed linens o of the affected areas. Position a heat lamp over the lower extremities. Apply warm, moist compresses to the affected areas. Initiate droplet isolation precautions.
Keep bed linens o of the affected areas.
A nurse is caring for a client who has neutropenia. Which of the following nursing interventions should the nurse implement? Offer the client fresh fruits and vegetables. Monitor the client's platelet count daily. Limit visitors to healthy adults. Apply firm pressure to injection sites.
Limit visitors to healthy adults.
A nurse is caring for a client who begins to have a seizure while ambulating in the hall. Identify the sequence of actions the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) Lower the client to the floor. Loosen the clothing around the client's neck. Place a pad beneath the client's head. Time the length of the client's seizure. Reorient and reassure the client.
Lower the client to the floor. Place a pad beneath the client's head. Loosen the clothing around the client's neck. Time the length of the client's seizure. Reorient and reassure the client.
A nurse is reinforcing teaching with a client who is postoperative following a cemented total hip arthroplasty. Which of the following instructions should the nurse include in the teaching? Avoid weight-bearing until healing of the hip incision is complete. Cross legs intermittently several times a day. Lean forward to change positions when sitting in a chair. Maintain hip exion at 90° or less when sitting.
Maintain hip exion at 90° or less when sitting.
A nurse is caring for a client who is undergoing testing for multiple sclerosis. Which of the following findings should the nurse expect? Muscle spasticity Tremors at rest Ptosis Ascending paralysis
Muscle spasticity
A nurse is caring for a client following a thyroidectomy. Which of the following findings should alert the nurse to the possibility of parathyroid gland injury? Anorexia Hoarseness Muscle twitching Blurred vision
Muscle twitching
A nurse is reviewing the medical record for a client who is experiencing nausea and vomiting. Based on the client data, which of the following actions should the nurse take? Encourage the client to ambulate. Administer an antipyretic medication. Notify the charge nurse of the client's BUN level. Keep the temperature in the client's room warm
Notify the charge nurse of the client's BUN level.
A nurse is preparing to assist a client out of bed 4 hr following a laparoscopic cholecystectomy. Which of the following actions should the nurse take first? Place the client in Fowler's position. Obtain the client's blood pressure. Dangle the client's legs at the bedside. Apply nonskid slippers
Obtain the client's blood pressure.
A nurse is contributing to the plan of care to promote a restful night's sleep for a client who has Alzheimer's disease. Which of the following interventions should the nurse include in the plan? Encourage stimulating activities after dinner. Encourage a late afternoon nap. Offer a small snack at bedtime. Offer hot chocolate at bedtime
Offer a small snack at bedtime.
A nurse is assisting with an educational program for clients who have been newly diagnosed with diabetes mellitus. Which of the following instructions should the nurse include in the program regarding insulin? Store unopened insulin vials in the freezer for up to 1 month. Opened insulin can be stored on a cool countertop away from light. Roll discolored insulin gently to mix it before use. Use refrigerated insulin immediately after removing it from the refrigerator.
Opened insulin can be stored on a cool countertop away from light
A nurse is caring for a client who is 24 hr postoperative following an abdominal surgery. Which of the following findings requires immediate attention from the nurse? Reported pain level of 6 on a scale of 0 to 10 Urinary output of 110 mL in the past 4 hr Temperature of 38º C (100.4º F) Oxygen saturation of 88%
Oxygen saturation of 88%
A nurse is contributing to the plan of care for a client who has tuberculosis (TB). Which of the following interventions should the nurse include? Place a "no visitors" sign on the client's door. Have the client wear an N95 respiratory mask during transport. Initiate droplet precautions for the client. Place the client in a negative-pressure airflow room.
Place the client in a negative-pressure airflow room.
A nurse is caring for a client following a gastrectomy. Which of the following actions should the nurse take to decrease episodes of dumping syndrome? Place the client in the supine position after meals. Administer pancreatic enzymes before meals. Encourage the client to drink 240 mL (8 oz) of uids with meals. Offer the client three meals daily
Place the client in the supine position after meals.
A nurse is reviewing the chart of a client who is experiencing an adrenal crisis, which was precipitated by the client not taking their medication for several days. The nurse should identify that withdrawal from which of the following medications potentiated the adrenal crisis? Metoprolol Methimazole Furosemide Prednisone
Prednisone
A nurse is reinforcing discharge teaching with a client who has hearing loss. Which of the following actions should the nurse take when communicating with the client? Rephrase client instructions when not understood. Cup hands around the mouth and direct speech toward the client. Accentuate vowel sounds by using a higher pitch when speaking. Sit to the side of the client and speak instructions into their best ear.
Rephrase client instructions when not understood.
A nurse is caring for a client who is in Buck's traction for a fractured hip. The client reports increased pain at the site of the fracture. Which of the following actions should the nurse take? Massage the area. Remove the weights. Loosen the ropes. Reposition the client
Reposition the client
A nurse is repositioning a client who has low back pain. Which of the following positions is should the nurse place the client in? Semi-Fowler's with knees flexed Orthopneic Dorsal recumbent Prone with legs straight
Semi-Fowler's with knees flexed
A nurse in an orthopedic clinic is reinforcing teaching with a client who has osteoarthritis. Which of the following instructions should the nurse include to promote comfort? Sleep on a firm mattress. Try jogging in place when joints feel stiff. Use a soft chair or recliner for sitting. Apply ice packs to painful joints
Sleep on a firm mattress.
A nurse is contributing to the plan of care for a client who had a stroke. For which of the following interprofessional team members should the nurse recommend a referral prior to initiating oral intake for the client? Occupational therapist Speech-language pathologist Physical therapist Case manager
Speech-language pathologist
A nurse in a telemetry unit is collecting data from a client who has a newly-inserted permanent pacemaker. Which of the following findings should the nurse report to the provider? The client experiences hiccups when sitting. The client's pulse rate is 5/min faster than the preset pacemaker rate. There is the presence of a pacing spike before the P-wave on the ECG rhythm strip. The dressing over the insertion site is dry and intact.
The client experiences hiccups when sitting.
A nurse is caring for a client who has Cushing's syndrome and expresses concern regarding physical changes associated with the syndrome. Which of the following should the nurse recognize as a physical change caused by this disorder? Bronze skin Truncal obesity Lordosis Exophthalmos
Truncal obesity
A nurse is contributing to the plan of care for a client who has pericarditis. In which of the following positions should the nurse plan to place the client to decrease pain? Semi-Fowler's Supine with lower extremities elevated Upright, leaning forward Side-lying with knees bent
Upright, leaning forward
A nurse is collecting data from a client who has 30% body surface area deep partial-thickness and full-thickness burns. Which of the following findings indicates that fluid resuscitation is adequate? Granulation tissue is present. Urine output is 50 mL/hr. Lung sounds are clear. Oxygen saturation level is 95%.
Urine output is 50 mL/hr.
A nurse is contributing to the plan of care for a client who has a head injury and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse include in the plan? Measure rectal temperature every 4 hr. Remind the client to cough as needed. Use a turn sheet to reposition the client. Apply wrist restraints.
Use a turn sheet to reposition the client.
A nurse is preparing a client for a cardiac catheterization. Which of the following actions should the nurse take rst? Verify the client has given informed consent. Administer preoperative medication. Mark the location of the pedal pulses. Have the client void.
Verify the client has given informed consent.
A nurse is reviewing the medical record of a client who is postoperative. Which of the following findings should the nurse identify as a complication of surgery? Serous drainage from the incision WBC count of 15,000/mm3 Temperature of 37.2° C (99° F) Urine output of 400 mL over the past 8 hr
WBC count of 15,000/mm3
A nurse is collecting data from a client who has an obstructive pulmonary disorder. The nurse should document the sound as which of the following? (Click on the audio button to listen to the clip.) Pleural friction rub Wheezes Vesicular Crackles
Wheezes
A nurse is reinforcing teaching with a client who has diabetes mellitus and a new prescription for regular and NPH insulin. Which of the following instructions on preparing the insulins should the nurse include? Withdraw both types of insulin and then add 0.2 mL of air to the syringe Gently shake the NPH insulin prior to withdrawing the dose. Withdraw the regular insulin before withdrawing the NPH insulin. Inject air into the NPH vial after withdrawing regular insulin.
Withdraw the regular insulin before withdrawing the NPH insulin.
A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. While taking the client's apical pulse, the nurse notes a rate of 58/min. Which of the following actions should the nurse take? Give the dose as prescribed. Use a different route to administer the medication. Administer half of the prescribed dose. Withhold the dose.
Withhold the dose.
