ATI - Comp Predictor #1

a nurse is calculating a client's expected date of delivery. the client's last menstrual period began on april 12. using nagele's rule, what date should the nurse determine to be the client's expected date of delivery?

0119

a nurse is preparing to administer eye drops to a school age child. identify the actions the nurse should take. a. ask the child to look upward b. instill the drops of medication c. apply pressure to the lacrimal punctum d. place the child in a sitting position e. pull the lower eyelid downward

1. place the child in a sitting position 2. ask the child to look upward 3. pull the lower eyelid downward 4. instill the drops of medication 5. apply pressure to the lacrimal punctum

(picture) a nurse is administering an intradermal injection for allergy testing to a client. into which of the following sites should the nurse inject the medication

C

a nurse is reviewing the medical record of a client who has schizophrenia and is taking clozapine. which of the following findings should the nurse identify as a contraindication to the administration of clozapine? a. WBC count 2,900/mm3 b. Hgb 14 g/dL c. fasting blood glucose 100 mg/dL d. heart rate 58/min

a. WBC wound 2,900/mm3

a nurse in a mental health facility receives change of shift report for four clients. which of the following clients should the nurse plan to assess first? a. a client placed in restraints due to aggressive behavior b. a client who will be receiving her first ECT treatment today c. a newly admitted client who has a history of 4.5 kg (10 lb) weight loss in the past 2 months d. a client who received a PRN dose of haloperidol 2 hr ago for increased anxiety

a. a client placed in restraints due to aggressive behavior

a nurse is planning care for four clients who are at risk for fluid imbalances. the nurse should identify that which of the following clients is at risk for fluid volume excess? a. a client who has advanced stage liver cirrhosis b. a client who has an exacerbation of peptic ulcer disease c. a client who has diabetes insipidus d. a client who has ulcerative colitis

a. a client who has advanced stage liver cirrhosis

a charge nurse on a medical-surgical unit is assisting with the emergency response plan following an external disaster in the community. in anticipation of multiple client admissions. which of the following current clients should the nurse recommend for early discharge? a. a client who has cancer and a sealed implant for radiation therapy b. a client who is 1 day postoperative following a vertebroplasty c. a client who has COPD and a respiratory rate of 44/min d. a client who is receiving heparin for deep-vein thrombosis

a. a client who has cancer and a sealed implant for radiation therapy

a nurse is reviewing the formulary about NPH insulin before administering the medication to a client. which of the following information should the nurse expect? a. administering NPH insulin 30 min before breakfast b. use NPH insulin to treat ketoacidosis c. give NPH insulin by IV bolus d. discard the NPH insulin vial if the medication is cloudy

a. administering NPH insulin 30 min before breakfast

a nurse is caring for a client who has vision loss. which of the following actions should the nurse take? SATA a. allow extra time for client to perform tasks b. touch the client gently to announce presence c. approach the client from the side d. ensure there is a high-wattage lighting in the client's room e. keep objects in the client's room in the same place

a. allow extra time for client to perform tasks d. ensure there is a high-wattage lighting in the client's room e. keep objects in the client's room in the same place

a nurse is creating a plan of care for a newly admitted client who has obsessive-compulsive disorder. which of the following interventions should the nurse include? a. allow the client enough time to perform rituals b. discourage the client from exploring irrational fears c. give the client autonomy in scheduling activities d. provide negative reinforcements for ritualistic behaviors

a. allow the client enough time to perform rituals

a nurse is caring a client who is postoperative immediately following a cardiac catheterization with a right femoral approach. which of the following actions should the nurse take? a. assess the client's peripheral pulses every 15 min b. instruct the client to flex the right knee every 30 min c. elevate the head of the client's bed to 45 d. change the client's dressing 4 hr following the procedures

a. assess the client's peripheral pulses every 15 min

a nurse is caring for a client who has chronic pancreatitis. which of the following dietary recommendations should the nurse make? a. broiled, skinless chicken breast with brown rice b. lettuce with sliced avocados c. warm toast with margarine d. coffee with creamer

a. broiled, skinless chicken breast with brown rice

a nurse is assessing a client who is immediately postoperative following a subtotal thyroidectomy. the nurse observes tetany. which of the following medication should the nurse expect to administer? a. calcium gluconate b. sodium bicarbonate c. sodium phosphate d. potassium chloride

a. calcium gluconate

a nurse is caring for a client who has gestational hypertension and is experiencing toxic effects due to magnesium sulfate therapy. the nurse should anticipate administering which of the following medications? a. calcium gluconate b. magnesium citrate c. potassium chloride d. sodium bicarbonate

a. calcium gluconate

a nurse in an emergency department is caring for a toddler who has burns following a house fire. which of the following actions should the nurse take first? a. check the mouth for soot and smoky breath b. determine the location and depth of the burns c. administer antibiotics prophylactically to prevent sepsis d. calculate fluid replacement based on vital signs and urinary output

a. check the mouth for soot and smoky breath

a nurse is assessing a client who is 30 min postoperative following an arterial thrombectomy. which of the following findings is the priority for the nurse to report? a. chest pain b. muscle spasms c. incisional pain d. cool, moist skin

a. chest pain

a nurse in the infectious disease division of the local health department is caring for a client. which of the following infections should the nurse identify should be reported to the health department? a. chlamydia trachomatis b. herpes simplex virus c. clostridium difficile d. human papillomavirus

a. chlamydia trachomatis

a nurse is planning teaching for a client who has a new diagnosis of HIV. which of the following information should the nurse include about preventing the spread of infection? a. clean blood contaminated surfaces with bleach b. buy disposable dishes for daily use c. wash soiled clothes in cold water d. use condoms with a petroleum based lubricant

a. clean blood contaminated surfaces with bleach

a nurse is verifying a record of informed consent for a client who is scheduled for surgery. which of the following actions should the nurse take? a. confirm the client's signature is authentic b. provide information on the informed consent form about the benefits of the surgery c. explain the procedure to the client before verifying informed consent d. inform the client about the condition that requires treatment

a. confirm the client's signature is authentic

a nurse is preparing to administer an autologous blood product to a client. which of the following actions should the nurse take to identify the client? a. confirm the provider's prescriptions matches the number on the blood component b. ask the client to state his blood type and the date of the blood donation c. ensure that the client's identification band matches the number on the blood unit d. match the client's blood type with the type and cross match specimen

a. confirm the provider's prescription matches the number on the blood component

a nurse is providing dietary teaching to a client who has a new diagnosis of irritable bowel syndrome. which of the following recommendations should the nurse include? a. consume foods high in bran fiber b. increase intake of foods high in gluten c. increase intake of milk products d. sweeten foods with fructose corn syrup

a. consume foods high in bran fiber

a nurse is caring for a client who is at 33 weeks of gestation following an amniocentesis. the nurse should monitor the client for which of the following complications? a. contractions b. epigastric pain c. hypertension d. vomiting

a. contractions

a nurse is caring for a newborn who is experiencing neonatal abstinence syndrome. which of the following actions should the nurse take? a. decrease the lighting levels in the nursery b. encourage frequent eye contact with the newborn during feedings c. wrap the newborn loosely in a blanket d. provide frequent stimulation for the newborn

a. decrease the lighting levels in the nursery

a nurse is providing discharge teaching to a client who has chronic kidney disease and is receiving hemodialysis. which of the following instructions should the nurse include in the teaching? a. eat 1g/kg of protein per day b. take magnesium hydroxide for indigestion c. consume foods high in potassium

a. eat 1 g/kg of protein per day

a nurse is planning care for a client who has bipolar disorder and is experiencing mania. which of the following interventions should the nurse include in the plan? a. encourage the client to take frequent rest periods b. encourage the client to spend time in the dayroom c. withdraw the client's TV privileges if he does not attend group therapy d. place the client in seclusion when he exhibits signs of anxiety

a. encourage the client to take frequent rest periods

a nurse is caring for a client who request the creation of a living will. which of the following actions should the nurse take? a. evaluate the client's understanding of life-sustaining measures b. determine the client's preferences about postmortem care c. schedule a meeting between the hospital ethics committee and the client d. request a conference with the client's family

a. evaluate the client's understanding of life-sustaining measures

a nurse is providing teaching about digoxin administration to the parents of a toddler who has heart failure. which of the following statements should the nurse include in the teaching? a. have your child drink a small glass of water after swallowing the medication b. limit your child's potassium intake while she is taking this medication c. you can add the medication to half-cup your child's favorite juice d. repeat the dose if your child vomits within 1 hour after taking the medication

a. have your child drink a small glass of water after swallowing the medication

a nurse is caring for a client who has end-stage kidney disease. the client's adult child asks the nurse about becoming a living kidney donor for their parent. which of the following conditions in the child's history should the nurse identify as a contraindication to the procedure? a. hypertension b. amputation c. primary glaucoma d. osteoarthritis

a. hypertension

a nurse is administering a scheduled medication to a client. the client reports that the medication appears different than what they take at home. which of the following responses should the nurse make? a. i will call the pharmacists now to check on this medication b. do you know why this medication is being prescribed for you c. did the doctor discuss with that there was a change in this medication d. i recommend that you take this medication as prescr

a. i will call the pharmacist now to check on this medication

a nurse is teaching a client who has systemic lupus erythematous (SLE). which of the following statements by the client indicates an understanding of the teaching? a. i will not be able to go for my daily walk b. i should check my skin once weekly for rashes c. i should apply powder to my skin after showering d. i will cleanse my skin using a mild soap

a. i will not be able to go for my daily walk

a nurse is providing discharge teaching about care safety to a parent of a newborn. which of the following statements by the parent indicates an understanding of the teaching? a. i will position my baby at a 45 degree angle in the car seat b. i will place my baby in a forward facing car seat in my back seat c. i can place my baby in the front seat with the airbag turned off d. i can turn my baby's car seat around when she weighs 15 pounds

a. i will position my baby at a 45 degree angle in the car seat

a community health nurse is reviewing laboratory reports for a group of clients. the nurse should identify that which of the following disorders is on the CDC's nationally notifiable conditions list? a. lyme disease b. pediculosis capitis c. bacterial vaginosis d. respiratory syncytial virus

a. lyme disease

a nurse is caring for a client who is in labor and receiving oxytocin. which of the following findings indicates that the nurse should increase the rate of infusion? a. montevideo units consistently 300 mmHg b. contractions every 5 min that last 30 seconds c. urine output of 20 ml/hr d. FHR pattern with absent variability

a. montevideo units consistently 300 mmHg

a nurse is talking with another nurse on the unit and smells alcohol on her breath. which of the following actions should the nurse take? a. notify the nursing supervisor about the suspected alcohol use b. ask the nurse to finish administering medications and then go home c. inform another nurse on the unit about the suspected alcohol use d. confront the nurse about the suspected alcohol use

a. notify the nursing supervisor about the suspected alcohol use

a charge nurse is assigning client care tasks for the upcoming shift. which of the following tasks should the charge nurse assign to an RN? a. obtaining blood cultures from a central catheter b. inserting an epidural catheter c. performing a thoracentesis d. inserting an endotracheal tube

a. obtaining blood cultures from a central catheter

a nurse is caring for a client who is 12 hr. postoperative following artofemoral bypass surgery. which of the following findings should the nurse expect in the affected extremity? a. pedal pulse 2 + b. throbbing pain c. cool extremities d. capillary refill of 4 seconds

a. pedal pulse 2+

a nurse is caring for several clients on a medical surgical unit. for which of the following nursing activities is it required that the nurse use sterile gloves? a. performing tracheostomy care b. inserting an NG tube c. administering total parenteral nutrition through a central venous access device d. initiating IV access

a. performing tracheostomy care

a nurse is planning care for a client who has unilateral paralysis and dysphagia following a right hemisphere stroke. which of the following interventions should the nurse include in the plan? a. place food on the left side of the client's mouth when he is ready to eat b. maintain the client on bed rest c. place the client's left arm on a pillow while he is sitting d. provide total care in performing the client's ADLs

a. place food on the left side of the client's mouth when he is ready to eat

a nurse is performing an initial assessment of a newborn. which of the following actions should the nurse take to prevent any heat loss through conduction? a. place the newborn's crib away from an air vent to perform the assessment b. evaluate respirations by observing the newborns's uncovered chest for 1 min c. cover the scale with a warmed blanket before weighing the baby d. perform the assessment immediately after birth before removing amniotic fluid

a. place the newborn's crib away from an air vent to perform the assessment

a nurse is initiating bladder retraining for a client who has urge urinary incontinence. which of the following instructions should the nurse give the client? a. plan to urinate every 3 hours while you are awake b. take your diuretic medication with your evening meal c. limit your fluid intake to 500 mL per day d. decrease your intake of cranberry juice

a. plan to urinate every 3 hours while you are awake

a nurse is caring for a client who has generalized petechiae and ecchymoses. the nurse should expect a prescription for which of the following laboratory tests? a. platelet count b. creatinine clearance c. prealbumin d. potassium level

a. platelet count

a nurse is caring for a toddler who has acute lymphocytic leukemia. in which of the following activities should the nurse expect the child to participate? a. playing with a large plastic truck b. using scissors to cut out paper shapes c. looking at alphabet paper shapes d. watching a cartoon in the activity room

a. playing with a large plastic truck

a nurse is caring for a client who has fibromyalgia and requests pain medications. which of the following medications should the nurse plan to administer? a. pregabalin b. colchicine c. lorazepam d. codeine

a. pregabalin

a nurse is preparing to administer a blood transfusion to a client. which of the following actions should the nurse take? a. prime the tubing with 0.9% sodium chloride b. use an IV catheter that is at least 24 gauge c. use tubing that does not have a filter in the drip chamber d. attach a single line administration set

a. prime the tubing with 0.9% sodium chloride

a nurse is helping to prepare a client in the operating room prior to a surgical procedure. which of the following actions should the nurse take? a. provide padding to the pressure areas when positioning the client b. minimize conversations with the client to reduce anxiety c. leave the client's arm and legs uncovered until after the induction of anesthesia d. remove the client's eyeglasses upon arrival to the operating room

a. provide padding to the pressure areas when positioning the client

a nurse is completing an incident report after a client fall. which of the following competencies of quality and safety education for nurses is the nurse demonstrating? a. quality improvement b. patient-centered care c. informatics d. evidence-based practice

a. quality improvement

a client's partner tells a staff that he overheard laboratory staff discussing the results of the client's biopsy report while on the elevator. which of the following actions should the nurse take? a. report the information to the charge nurse b. review confidentiality c. notify the facility's legal department d. contact the laboratory manager regarding the situation

a. report the information to the charge nurse

a nurse is providing teaching to a client who has heart failure and a new prescription for furosemide. which of the following statements should the nurse make? a. rise slowly when getting out of bed b. eat foods that are high in sodium c. taking furosemide can cause you to be overhydrated d. taking furosemide can cause your potassium levels to be high

a. rise slowly when getting out of bed

a nurse manage is reviewing the steps of the progressive discipline process prior to counseling staff member who exhibits unprofessional behavior. identify the sequence of steps the nurse manager should plan to take in response to the staff member's conduct. (move steps into correct order)

a. set up a meeting to speak with the staff member about the behavior b. verbally remind the staff member of the expected behavior changes c. give the staff member a written warning about the behavior d. dismiss the staff member from employment at the facility

a nurse is caring for a client who is in labor and requires augmentation of labor. which of the following conditions should the nurse recognize as a contraindication to the use of oxytocin? a. shoulder presentation b. diabetes mellitus c. post-term with oligohydraminos d. chorioamniotitis

a. shoulder presentation

a nurse is caring for a client who is in the advanced stage of amyotrophic lateral sclerosis (ALS). which of the following referrals is the nurse's priority? a. speech language pathologist b. social worker c. psychologist d. occupational therapist

a. speech language pathologist

a nurse is caring for a client who a pressure injury on the coccyx. which of the following findings should indicate to the nurse that the wound is a stage III pressure injury? a. subcutaneous fat is visible b. bone is exposed within the wound c. slough and eschar is present d. the skin is redenned and intact

a. subcutaneous fat is visible

a nurse is caring for an adolescent who has sickle cell anemia. which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider? a. substernal retractions b. hematuria c. temperature 37.9 C (100.2 F) d. sneezing

a. substernal retractions

a nurse is providing teaching to a client who is at 14 weeks of gestation about findings to report to the provider. which of the following findings should the nurse include in the teaching? a. swelling of the face b. urinary frequency c. faintness upon rising d. bleeding gums

a. swelling of the face

a nurse is caring for a client who is near the end of life and is on complete bed rest. the client states that he needs to have a bowel movement and the nurse offers a bed pan. the client states, i've always used the bathroom. which of the following responses should the nurse make? a. tell me what your concerns you have about using a bed pan b. you have to use the bed pan for your own safety c. i will have the physical therapist ambulate you to the bathroom d. make sure to use nearby furniture to support yourself when walking to the bathroom

a. tell me what your concerns you have about using a bed pan

a nurse is developing an in service about personality disorders. which of the following information should the nurse include when discussing borderline personality disorder? a. the client exhibits impulsive behavior b. the client is overly concerned about minor details c. the client might act seductively d. the client is exceptionally clingy to others

a. the client exhibits impulsive behavior

a nurse is providing teaching to the parents of a newborn about newborn genetic screening. which of the following statements should the nurse include in the teaching? a. this test should be performed after your baby is 24 hrs old b. your baby will be given 2 ounces of water to drink prior to the test c. a nurse will draw blood from your baby's inner elbow d. this test will be repeated when your baby is 2 months old

a. this test should be performed after your baby is 24 hrs old

a nurse is teaching at a community health fair about electrical fire preventions. which of the following information should the nurse include in the teaching? a. use three pronged grounded plugs b. check for tingling sensation around the cord to ensure the electricity is working c. cover extension cords with a rug d. remove the plug from the socket by pulling the cord

a. use three pronged grounded plugs

a nurse is teaching a group of newly licensed nurses about measures to take when caring for a client who is on contract precautions. which of the following should the nurse include in the teaching? a. wear gloves when providing care for the client b. place the client in a room with negative air pressure c. wear a mask when changing the linens in the client's room d. remove the protective gown after the client's room

a. wear gloves when providing care for the client

a nurse is caring for a 1 month old infant who has manifestations of severe dehydration and a prescription for parenteral fluid therapy. the guardian asks. "what are the indications that my baby needs an IV?" which of the following responses should the nurse make? a. your baby needs an IV because she is not producing tears b. your baby needs an IV because her heart rate is decreased c. your baby needs an IV because she is breathing slower than normal d. your baby needs an IV because her fontanels are bulging

a. your baby needs an IV because she is not producing tears

a nurse is providing discharge teaching to a female client who has tuberculosis and a new prescription for rifampin. which of the following information should the nurse include? a. your urine will be orange while taking this medication b. weight gain is an expected adverse effect of this medication c. you should avoid getting pregnant for 6 months after stopping this medication d. you should avoid sun exposure while taking this medication

a. your urine will be orange while taking this medication

a nurse is counseling a group of clients from a town that was affected by a hurricane 6 months ago. for which of the following clients should the nurse initiate a referral to assess for the presence of posttraumatic stress disorder. (SATA) a. a client who expresses a realization that life will not return to the way it was before the hurricane b. a client who describes having persistent feelings of anger about the hurricane c. a client who describes feeling disconnected from those around him following the hurricane d. a client who moved to an apartment located on higher ground than her previous home e. a client who has frequent nightmares about the hurricane

b. a client who describes having persistent feelings of anger about the hurricane c. a client who describes feeling disconnected from those around him following the hurricane e. a client who has frequent nightmares about the hurricane

a nurse is receiving change-of-shift report for a group of clients. which of the following clients should the nurse plan to assess first? a. a client who has epidural analgesia and weakness in the lower extremities b. a client who has a hip fracture and a new onset of tachypnea c. a client who has diabetes mellitus and a HbA1c of 6.8% d. a client who has sinus arrhythmia and is receiving cardiac monitoring

b. a client who has a hip fracture and a new onset of tachypnea

a nurse is providing teaching about the administration of gastronomy tube feedings to the parents of a school-age child. which of the following instructions should the nurse include? a. warm the formula in the microwave prior to administration b. administer the feeding over 30 min c. place the child in a supine position after the feeding d. change the feeding bag and tubing every 3 days

b. administer the feeding over 30 min

a nurse is reviewing the laboratory report of a client who has been receiving lithium carbonate for the past 12 months. the nurse notes a lithium level of 0.8 mEq/L. which of the following orders from the provider should the nurse expect? a. increase the dosage b. administer the medication c. discontinue the medication d. withhold the next dose

b. administer the medication

a nurse manager is reviewing documentation with a newly licensed nurse. which of the following notations by the newly licensed nurse indicates an understanding of the teaching? a. dressing changed qd b. administered 8 u regular insulin sq c. given 2 mg MSO4 IM for report of pain d. OOB with assistance for breakfast

b. administered 8 u regular insulin sq

a nurse administers digoxin 0.125 mg PO to an adult client. for which of the following findings should the nurse notify the provider? a. potassium level 4.2 mEq/L b. apical pulse 58/ min c. digoxin level 1 ng/mL d. constipation for 2 days

b. apical pulse 58/min

a nurse is developing a plan of care for a client who has schizophrenia and is experiencing auditory hallucinations. which of the following actions should the nurse include in the plan? a. refer to the hallucinations as if they are real b. ask the client directly what he is hearing c. encourage the client to lie down in a quiet room d. avoid eye contact with the client

b. ask the client directly what he is hearing

a nurse is preparing to perform a sterile wound irrigation and dressing change for a client. which of the following actions by the nurse indicates a break in surgical aseptic technique? a. apply a sterile gown after applying a sterile mask b. balancing the bottle on the sterile basin while pouring the liquid c. putting on sterile gloves after preparing the sterile field d. placing the supplies on the sterile field and leaving a 1 inch perimeter

b. balancing the bottle on the sterile basin while pouring the liquid

a nurse in a community clinic is caring for a client who requests assistance with smoking cessation. the nurse should expect a prescription for which of the following medications? a. chlordiazepoxide b. bupropion c. chonidine d. naltrexone

b. bupropion

a nurse is interviewing the partner of a client who was admitted in the manic phase of bipolar disorder. the partner states "i dont know what to do. everything has been happening so quickly." which of the following responses by the nurse is therapeutic? a. you should make sure your partner takes the prescribed medication b. can you talk about what was happening with your partner at home? c. you did the right thing by bringing your partner in for treatment d. why do you think your partner's symptoms are progressing so quickly?

b. can you talk about what was happening with your partner at home?

a community health nurse is developing a plan to improve the community's environment health. which of the following actions should the nurse take first? a. establish a timeframe for environmental improvements b. collect information about the community's environmental status c. request funding from community's organization d. encourage community involvement in environmental improvement

b. collect information about the community's environmental status

a nurse is admitting a client who has dementia to a long-term facility. the client tells the nurse that she lived in this facility years ago and took care of all the residents by herself. the nurse should document this as which of the following findings? a. perseveration b. confabulation c. projection d. agnosia

b. confabulation

a nurse his assessing a client who is receiving daily aspirin therapy. the nurse should identify that which of the following findings might indicate an allergic reaction to this medication? a. blurred vision b. difficulty swallowing c. weight gain d. high blood pressure

b. difficulty swallowing

a nurse is planning care for a client who is post-operative following a total hip arthroplasty. which of the following actions should the nurse plan to take when positioning the client? a. flex the clients hip up to 120 degrees when sitting in a chair b. ensure that the client's hip remains in an abducted position c. maintain the client in a supine position for the first 24 hours after surgery d. place the client's heels directly against the bed mattress

b. ensure that the client's hip remains in an abducted position

a nurse is reviewing the laboratory results of a client who has rheumatoid arthritis. which of the following findings should the nurse report to the provider? a. aspartate aminotransferase 10 units/L b. erythrocyte sedimentation rate 75 mm/hr c. platelets 150,000/mm3 d. WBC count 8,000/mm3

b. erythrocyte sedimentation rate 75 mm/hr

a nurse is providing teaching to an adolescent who has peptic ulcer disease. which of the following statements by the client indicates an understanding of the teaching? a. i will use ibuprofen as needed to control abdominal pain b. i will avoid food and beverages that contain caffeine c. i will decrease my daily protein intake to 15 grams per day d. i will take sucralfate with meals three times per day

b. i will avoid food and beverages that contain caffeine

a nurse is caring for a client who tells the nurse that he feels he is being discharged form the facility too soon. which of the following statements by the nurse demonstrates client advocacy? a. i will contact your insurance company to see if they will pay for you to be here longer b. i will tell the provider about your concerns c. your provider understands your illness and is acting according to your best interests d. i know you will be able to recover faster at home

b. i will tell the provider about your concerns

a nurse is performing gastric lavage for a client who has upper gastrointestinal bleeding. which of the following actions should the nurse take? a. use cold irrigation solution b. insert a larg bore NG tube c. instruct the client to lie on his right side d. instill 500 mL of solution through the NG tube

b. insert a large bore NG tube

a nurse is preparing to measure the temperature of an infant. which of the following actions should the nurse take? a. place the tip of the thermometer under the center of the infant's axilla b. insert the probe 3.8 cm (1.5 in) into the infant's rectum c. pull the pinna of the infant's ear forward before inserting the probe d. insert the oral thermometer in front of the infant's tongue

b. insert the probe 3.8 cm (1.5 in) into the infant's rectum

a nurse is performing a safety assessment for a client who has parkinson's disease. which of the following statements by the client indicates the need for a referral to physical therapy? a. i have been experiencing more tremors in my left arm than before b. lately, i feel like my feet are freezing up, as if they are stuck to the ground c. i noticed that i am having a harder time holding on to my toothbrush d. sometimes, i feel like i am making a chewing motion when im not eating

b. lately, i feel like my feet are freezing up, as if they are stuck to the ground

a nurse realizes that the wrong medication has been administered to a client. which of the following actions should the nurse take first? a. report the incident to the nurse manager b. measure the client's vital signs c. fill out an incident report d. notify the provider

b. measure the client's vital signs

a nurse is preparing to assess a 2-week old newborn. which of the following actions should the nurse plan to take? a. auscultate the newborn's apical pulse for 60 seconds b. measure the newborn's head circumference over the eyebrows and below the occipital prominence d. obtain the newborn's body temperature using a tympanic thermometer

b. measure the newborn's head circumference over the eyebrows and below the occipital prominence

a nurse is planning care for a client who is recovering form an acute myocardial infarction that occurred 3 days ago. which of the following interventions should the nurse include? a. draw troponin level every 4 hrs b. obtain a cardiac rehabilitation consultation c. place the client in a supine position while resting d. perform and ECG every 12 hr

b. obtain a cardiac rehabilitation consultation

a nurse is caring for a client who is experiencing acute mania. which of the following foods should the nurse provider for this client? a. oatmeal with butter b. peanut butter sandwhich c. celery sticks d. chicken noodle soup

b. peanut butter sandwhich

a nurse is caring for a client who speaks a language different from the nurse. which of the following actions should the nurse take? a. request an interpreter of a different sex from the client b. review the facility policy about the use of an interpreter c. direct attention toward the interpreter when speaking to the client d. request a family member or friend to interpret for the client

b. review the facility policy about the use of an interpreter

a nurse is discussing group treatment and therapy with a client. the nurse should include which of the following as being a characteristic of a therapeutic group? a. the group is organized in an autocratic structure b. the group encourages members to focus on a particular issue c. the group encourages clients to form dependent relationships d. the group must be led by a licensed psychiatrist

b. the group encourages members to focus on a particular issue

a school nurse is teaching a parent about absence seizures. which of the following information should the nurse include? a. this type of seizure lasts 30 to 60 seconds b. this type of seizure can be mistaken for daydreaming c. this type of seizure has a gradual onset d. the child usually has an aura prior to onset

b. this type of seizure can be mistaken for daydreaming

a nurse is providing discharge instructions about newborn safety to a client who is 2 days postpartum. which of the following instructions should the nurse include? a. change smoke detector batteries every other year b. use a car seat when traveling by airplane c. place a plastic waterproof sheet over the crib bedding d. lay the baby on his stomach to nap during the day time

b. use a car seat when traveling by airplane

a nurse in a mental health clinic receives a request from a client who is undergoing psychotherapy to obtain a copy of the therapists notes. which of the following responses should the nurse make? a. are you not happy with your treatment b. we can provide a copy of your record, but the therapists notes are not included c. i dont think you will benefit from reviewing your therapists notes right now d. why are you interested in seeing you therapists notes?

b. we can provide a copy of your record, but the therapists notes are not included

a nurse is caring for an infant who has coarctation of the aorta. which of the following should the nurse identify as an expected finding? a. increased intracranial pressure b. weak femoral pulses c. frequent nosebleeds d. upper extremity hypotension

b. weak femoral pulses

a nurse is providing discharge teaching to a client who has a new prescription of phenelzine. the nurse should instruct the client to eat which of the following while taking this medication? a. smoked salmon b. whole grain bread c. avocados d. pepperonia pizza

b. whole grain bread

a nurse is providing preoperative teaching about patient-controlled analgesia (PCA) to a client. which of the following statements should the nurse include in the teaching? a. continuous PCA infusion is designed to allow fluctuating plasma medication levels b. you should push the button before physical activity to allow maximum pain control c. the PCA will deliver a double dose of medication when you push the button twice d. you can adjust the amount of pain medication you receive by pushing on the keypad

b. you should push the button before physical activity to allow maximum pain control

a nurse is assessing a client who is active labor. which of the following findings should the nurse report to the provider? a. temperature 37.4 (99.3 F) b. contractions lasting 80 seconds c. FHR baseline 170/min d. early deceleration in the FHR

c. FHR baseline 170/min

a nurse is reviewing the medical records of four clients. the nurse should identify that which of the following client findings requires follow-up care? a. a client who is taking buemtanide and has a potassium level of 3.6 mEq/L b. a client who received a mantoux test 48 hr and has an induration c. a client who is taking warfarin and has an INR of 1.8 d. a client who is scheduled for a colonoscopy and is taking sodium phosphate

c. a client who is taking warfarin and has an INR of 1.8

a nurse is teaching participants at a community center about advance directives. which of the following information should the nurse include in the teaching? a. advance directives cannot be changed once implemented b. assigning a health care surrogate requires legal consultation c. a health care surrogate makes health care decisions when the client is no longer able d. a client must create a resuscitate order when completing advance directives

c. a health care surrogate makes health care decisions when the client is no longer able

a nurse is caring for a client who is receiving intermittent enteral tube feedings. which of the following factors places the client at risk for aspiration? a. sitting in a high-fowler's position during the feeding b. receiving a high-osmolarity formula c. a history of gastroesophageal reflux disease d. a residual of 65 mL 1 hr postprandial

c. a history of gastroesophageal reflux disease

a nurse is preparing to administer PRN pain medication to a client who has cholelithiasis and is experiencing moderate abdominal pain. which of the following findings should the nurse plan to administer? a. omeprazole b. ketolorac c. acetaminophen d. metoclopramide

c. acetaminophen

a nurse is caring for a client who has cancer of the throat and is receiving radiation therapy. the nurse should monitor for which of the following findings as an adverse effect of the radiation? a. elevated platelet count b. insomnia c. altered taste sensation d. excessive salivation

c. altered taste sensation

a nurse in the emergency department is assessing a newly admitted client who is experiencing drooling and hoarseness following a burn injury. which of the following actions should the nurse take first? a. obtain a blood specimen for ABG analysis b. obtain a baseline ECG c. apply 100% humidified oxygen d. insert an 18-gauge IV catheter

c. apply 100% humidified oxygen

a nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. the client's family wants the client to have life-sustaining measures. which of the following actions should the nurse take? a. complete an incident report b. encourage the family to contact an attorney c. arrange for an ethics committee meeting to address the family's concerns d. support the family's decision and initiate life-sustaining measures

c. arrange for an ethics committee meeting to address the family's concerns

a nurse is preparing to obtain a client's signature on an informed consent form. which of the following actions should the nurse take first? a. inform the client of his right to change his mind b. witness the client signing the informed consent form c. ask the client to explain his understanding of the procedure d. notify the provider if the client has questions about the procedure

c. ask the client to explain his understanding of the procedure

a nurse in a clinic is assessing a 6 month old infant. which of the following findings should the nurse report to the provider? a. abdominal breathing b. respiratory rate 26/min c. closed anterior fontanel d. pulse 140/min

c. closed anterior fontanel

a nurse is caring for a client who has heart failure. the nurse notes the client's 24-hr intake is 1,750 mL and output is 425 mL. which of the following actions should the nurse take first? a. encourage the client to change positions frequently b. reduce the client's sodium intake c. compare the client's weight to the previous day d. administer furosemide to the client

c. compare the client's weight to the previous day

a nurse is caring for a client who has a history of depression and is experiencing a situational crisis. which of the following actions should the nurse take first? a. teach the client relaxation techniques b. notify the client's support person c. confirm the client's perception of the event d. help the client identify personal strengths

c. confirm the client's perception of the event

a nurse is reviewing the laboratory result of a client and notes increased values for hemoglobin, hematocrit, and urine osmolarity. the nurse should identify that these results are manifestations of which of the following conditions? a. acute renal failure b. hepatic failure c. dehydration d. anemia

c. dehydration

a nurse is planning care for a group of clients and is working with one licensed practical nurse (LPN) and one assisstive personnel (AP). which of the following actions should the nurse take first to manage her time effectively? a. schedule daily activities b. develop an hourly time frame for tasks c. determine goals of the day d. delegate tasks to the AP

c. determine goals of the day

a nurse is preparing to administer an IV medication to a client and accidentally punctures the IV bag, causing the medication to leak on the counter. which of the following medications requires the nurse to follow facility procedures in the safe handling of biohazardous material spill? a. metronidazole b. phenytoin c. doxorubicin-hydrochloride d. ampicillin sodium

c. doxorubicin-hydrochloride

a nurse is providing dietary teaching to a client who had an exacerbation of COPD. which of the following information should the nurse include in the teaching? a. while eating, you should drink liquids frequently b. you should eat hot foods to reduce your sense of fullness during a meal c. during meals, you shoud eat foods with a high-calorie content first d. lunch should be your largest meal of the day

c. during meals, you should eat foods with a high-calorie content first

a nurse is assessing a client who is receiving packed RBCs. which of the following findings indicates fluid overload? a. low-back pain b. hypotension c. dyspnea d. thready pulse

c. dyspnea

a nurse is providing teaching about home safety to the adult child of an older adult client who is post-operative following knee replacement surgery. which of the following instructions should the nurse include? a. encourage the client to avoid wearing shoes at home b. place a throw rug over electrical cords c. ensure that area rugs have rubber backs d. mark the edges of the doorway to the house with tape

c. ensure that area rugs have rubber backs

a nurse is providing teaching to a client about the adverse effects of sertraline. which of the following adverse effects should the nurse include? a. dry cough b. metallic taste in mout c. excessive sweating d. increased urinary frequency

c. excessive sweating

a nurse is assessing a client who is in skeletal traction for a fractured left tibia. the nurse should identify that which of the following findings indicates altered tissue perfusion of the affected extremity? a. purulent drainage at the pin site b. pain with movement of the left great toe c. faint pedal pulse of left leg d. warm skin temperature distal to pin site

c. fain pedal pulse of left leg

a nurse is caring for a client who has hypertension and a new prescription for chlorthalidone. the nurse should monitor for which of the following adverse effects? a. hypoglycemia b. euphoria c. hypokalemia d. increased intraocular pressure

c. hypokalemia

a nurse is assessing the grief response of a client whose child died 6 months ago. which of the following client statements should the nurse report to the provider as an indication of major depressive disorder? a. i know that i will be reunited with my child someday b. i feel guilty because my child died c. i am unable to feel any joy since my child died d. i am angry that my child died

c. i am unable to feel any joy since my child died

a nurse in a surgical clinic is providing teaching to a client who is scheduled for a modified radical mastectomy. which of the following statements by the client indicates an understanding of the teaching? a. i can shower within 48 hours of my surgery b. i can begin to drive 24 hours after surgery c. i will complete my arm exercises four times a day d. i will have my drains removed 1 hour prior to going home

c. i will complete arm exercises four times a day

a nurse is teaching a client who has chronic low back pain about the use of alternative therapy to manage pain. which of the following statements by the client indicates an understanding of the use of distraction? a. i should apply my heating blanket to my back to reduce tension b. i should jog every morning to improve my circulation c. i will watch my favorite old movies when i want to reduce stress d. i will have electrodes inserted in my skin to treat the pain

c. i will watch my favorite old movies when i want to reduce stress

a nurse is caring for a school age child who has sickle cell anemia and is in vaso-occlusive crisis. which of the following actions should the nurse take? a. promote active range of motion exercises b. prepare for a transfusion of platelets c. increase oral fluid intake d. apply cold compresses to the affected areas

c. increase oral fluid intake

a nurse is caring for a client who has an acute exacerbation of multiple sclerosis. which of the following prescriptions should the nurse expect the provider to prescribe? a. enoxaparin b. atorvostatin c. interferon beta-1a d. amoxicillin

c. interferon beta-1a

a nurse is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. which of the following entries should the nurse make in the medical record? a. morphine 3 mg SC q 4 PRN pain b. morphine 3 mg SQ every 4 hr PRN for pain c. morphine 3 mg subcutaneous every 4 hr PRN pain d. morphine 3.0 mg sub q every 4 hr PRN for pain

c. morphine 3 mg subcutaneous every 4 hr PRN pain

a nurse is caring for a client following an application of a cast. which of the following actions should the nurse take first? a. place an ice pack over the cast b. position the casted extremity on a pillow c. palpate the pulse distal do the cast d. teach the client to keep the cast clean and dry

c. palpate the pulse distal do the cast

a newly licensed nurse is reviewing the role of a nurse in disaster planning. which of the following is an activity a nurse should engage in to assist in disaster preparedness? a. vaccinate susceptible children and adults against smallpox b. assess types, levels, and scopes of disasters c. participate in community drills and mock events d. make quarantine preparations for those exposed to anthrax

c. participate in community drills and mock events

a nurse is caring for a child who has cystic fibrosis and requires postural drainage. which of the following actions should the nurse take? a. hold hand flat to perform percussions on the child b. administer a bronchodilator after the procedure c. perform the procedure prior to meals d. perform the procedure twice each day

c. perform the procedure prior to meals

a nurse is planning care for a child who has neutropenia due to leukemia. which of the following interventions should the nurse include in the plan of care? a. screen the child's vision for active infections b. monitor the child for indications of active bleeding c. prepare the child for a platelet transfusion d. initiate a low-protein diet for the child

c. prepare the child for a platelet transfusion

a charge nurse is teaching new staff members about factors that increase a client's risk to become violent. which of the following risk factors should the nurse include as the best predictor of future violence? a. male gender b. a history of being in prison c. previous violent behavior d. experiencing delusions

c. previous violent behavior

a charge nurse is planning a staff education and competence session about operating newly acquired cardiac monitoring equipment. which of the following actions should the nurse plan to take? SATA a. wait to offer feedback on staff use of the equipment until the end of the session b. caution staff that the equipment is complicated to use c. provide reinforcement of teaching until the skill is learned d. identify the current level of staff knowledge about the equipment e. require a return demonstration using the equipment

c. provide reinforcement of teaching until the skill is learned d. identify the current level of staff knowledge about the equipment e. require a return demonstration using the equipment

a nurse is providing teaching to a client who is scheduled for radiation therapy to treat esophageal cancer. which of the following statements should the nurse make? a. use commercial mouthwash to rinse your mouth b. warm up foods before eating c. soften foods with gravy and sauces d. drink mostly clear liquids

c. soften foods with gravy and sauces

a newly licensed nurse is unsure if an assigned task is within their scope of practice. which of the following resources should the nurse consult? a. written prescription from the provider b. verbal direction from the nurse manager c. state nurse practice act d. institutional policies and procedures

c. state nurse practice act

a nurse is caring for a client who wears glasses. which of the following actions should the nurse take? a. clean the glasses with a paper towel b. clean the glasses with hot water c. store the glasses in a labeled case d. store the glasses on the bedside table

c. store the glasses in a labeled case

a nurse in an emergency department is caring for a client following a motor-vehicle crash. the client's glasgow comas scale rating is 15. which of the following findings should the nurse expect? a. the client opens eyes to sound b. the client withdraws from pain c. the client is oriented times three d. the client is unable to obey commands

c. the client is oriented times three

a nurse is caring for a client who is recovering from an amputation of her right arm below the elbow. which of the following information should the nurse report to the occupational therapist? a. the client is allergic to penicillin b. the client has two small children at home c. the client lives in a two-story home d. the client's parent is in a skilled nursing facility

c. the client lives in a two-story home

a nurse is reviewing the medical record of a client who has delayed healing of a leg ulcer. which of the following findings should the nurse identify as a contributing factor? a. the client has an albumin level of 3.8 g/dl b. the client is receiving IV dextrose 5% in water at 100 ml/hr c. the client take prednisone for arthritis d. the client has a total cholesterol level of 190 mg/dl

c. the client take prednisone for arthritis

a nurse is reviewing the medical record of a client who is requesting combination oral contraceptives. which of the following conditions in the client's history is a contraindication to the use of combination oral contraceptives? a. diverticulosis b. hypocalcemia c. thrombophlebitis d. hyperthyroidism

c. thrombophlebitis

a nurse is preparing to initiate IV therapy for an older adult client. which of the following actions should the nurse plan to take? a. clean the site using vigorous friction b. select a vein on the back of the hand c. use a 22-gauge catheter for insertion d. apply a tourniquet firmly above the insertion site

c. use a 22-gauge catheter for insertion

exhibit: a nurse in a provider's office is reviewing a female client's medical record during a routine visit. the nurse should recommend increased dietary intake of which of the following vitamins? a. vitamin K b. vitamin A c. vitamin B12 d. vitamin D

c. vitamin B12

a nurse is working with a client who has an anxiety disorder and is in the orientation phase of the therapeutic relationship. which of the following statements should the nurse make during this phase? a. we should discuss resources to implement in your daily life b. let me show you simple relaxation exercises to manage stress c. we should establish our roles in the initial session d. lets talk about how you can change your response to stress

c. we should establish our roles in the initial session

a nurse is creating a plan of care for a female client who has recurrent urinary tract infections. which of the following interventions should the nurse include in the plan? a. take a bubble bath after intercourse b. void every 5-6 hr. during the day c. wear loose fitting underwear d. drink four 240 mL (8oz) glasses of water each day

c. wear loose fitting underwear

a nurse is teaching a childbirth education class and is discussing sexual intercourse during pregnancy. which of the following statements should the nurse make? a. the female superior position can be used during the third trimester of pregnancy b. frequent intercourse increases the risk for miscarriage in early pregnancy c. your sexual desire might increase during the first trimester of pregnancy d. you should limit the frequency of intercourse after 34 weeks of pregnancy

c. your sexual desire might increase during the first trimester of pregnancy

a nurse is caring for a client who is newly diagnosed with pancreatic cancer and has questions about the disease. to research the disease, the nurse should identify that which of the following electronic databases has the most comprehensive collection of nursing journal articles? a. health source b. proquest c. MEDLINE d. CINAHL

d. CINAHL

a nurse is reviewing assessment data from several clients. for which of the following clients should the nurse recommend a referral to a dietician? a. an older client who has presbyopia b. a client who has an albumin level of 3.7 g/dl c. an older client who has a BMI of 24 d. a client who has a non healing leg ulcer

d. a client who has a non healing leg ulcer

a nurse is providing discharge teaching to a group of clients. the nurse should recommend a referral to a dietitian for which of the following clients? a. a client who has a prescription for warfarin and states " i will need to limit how much spinach i eat" b. a client who has osteoporosis and states "i plan to take my calcium carbonate with a full glass of water" c. a client who has prescription for spironolactone and states " i will reduce my intake of foods that contain potassium" d. a client who has gout and states "i can continue to eat anchovies on my pizza"

d. a client who has gout and states "i can continue to eat anchovies on my pizza"

a nurse is caring for a client who received a large amount of heparin IV in error. which of the following laboratory values should the nurse obtain? a. ferritin level b. INR c. albumin level d. aPTT

d. aPTT

a nurse is caring for an infant who has respiratory syncytial virus. which of the following interventions should the nurse take? a. initiate neutropenic precautions b. request a prescription for guaifenesin c. suction nares prior to feeding d. administer palivizumab intravenously

d. administer palivizumab intravenously

a nurse is providing teaching to a client who is breastfeeding and experiencing engorgement. which of the following recommendations should the nurse include? a. allow the infant to nurse on one breast per feeding b. wear a tight-fitting underwire bra c. take aspirin to reduce pain and swelling d. apply a warm compress on the breasts before feedings

d. apply a warm compress on the breasts before feedings

a nurse is providing teaching a client who has a new prescription for warfarin. the nurse should include that which of the following medications can increase the effects of warfarin? a. oral contraceptives b. vitamin K c. nafcillin d. aspirin

d. aspirin

a nurse is screening food brought in by a family member for a client who takes phenelzine. the nurse should instruct the family member that which of the following foods can cause an interaction with this medication? a. iceberg lettuce salad b. orange gelatin c. cottage cheese d. bologna sandwhich

d. bologna sandwhich

a nurse is providing teaching to a client who is experiencing preterm contractions and dehydration. which of the following statements should the nurse make? a. dehydration is caused by a decreased hemoglobin and hematocrit b. dehydration is associated with gastroesophageal reflux c. dehydration is treated with calcium supplements d. dehydration can increase the risk for preterm labor

d. dehydration can increase the risk for preterm labor

a nurse manager is updating protocols for the use of belt restraints. which of the following guidelines should the nurse manager include? a. attach the restraint to the bed's side rails b. request a PRN restraint prescription for clients who are aggressive c. remove the client's restraint every 4 hr d. document the client's condition every 15 min

d. document the client's condition every 15 min

a nurse is caring for a client who has a prescription for 1 unit of packed RBCs. five minutes after beginning the transfusion, the client becomes febrille with chills. after stopping the transfusion, which of the following actions should the nurse take? a. place the blood bag in a biohazard bag before discarding b. administering epinephrine subcutaneously c. infuse 500 mL lactated ringer's IV d. document the reaction in the medical record

d. document the reaction in the medical record

a nurse is providing teaching to an older adult client about methods to promote nighttime sleep. which of the following instructions should the nurse include? a. perform exercises prior to bedtime b. take a 1 hr nap during the day c. stay in bed at least 1 hr if unable to fall asleep d. eat a light snack before bedtime

d. eat a light snack before bedtime

a nurse is completing an admission assessment for a client who has narcissistic personality disorder. which of the following findings should the nurse expect? a. preoccupied with aging b. suspicious of others c. ritualistic behavior d. exhibits separation anxiety

d. exhibits separation anxiety

a nurse is admitting a client who does not speak the same the same language as the nurse and is scheduled for outpatient surgery. which of the following actions should the nurse take? a. help the client look up information about the procedure b. request a family member to interpret the information c. provide a consent form that is written in the client's own language d. explain the procedure to the client through an interpreter

d. explain the procedure to the client through an interpreter

a nurse is teaching a client who is trying to conceive. which of the following should the nurse instruct the client to increase her diet to prevent a neural tube defect? a. calcium b. iron c. zinc d. folate

d. folate

a nurse is assessing a client who has left-sided failure. which of the following findings should the nurse identify as a manifestation of pulmonary congestion? a. jugular vein distention b. bradypnea c. weight gain d. frothy, pink sputum

d. frothy, pink sputum

a nurse is teaching a prenatal class about infection prevention at a community center. which of the following statements by a client indicates understanding of the teaching? a. i should take antibiotics when i have a virus b. i should wash my hands for 10 seconds with hot water after working in the garden c. i can clean my cat's litter box during my pregnancy d. i can visit my nephew who has chicken pox 5 days after the sores have crusted

d. i can visit my nephew who has chicken pox 5 days after the sores have crusted

a home health nurse is teaching a new parent about caring for his 1-week old infant. which of the following statements by the client indicates an understanding of the teaching? a. i can use a firm pillow to prop up the bottle when feeding my baby b. i will avoid picking up my baby too often to keep from spoiling him c. i will place a ticking clock nearby to soothe my baby throughout the day d. i will hang pastel-colored mobile 24 inches above my baby's crib

d. i will hang pastel-colored mobile 24 inches above my baby's crib

a nurse is reviewing the facility's safety protocols concerning newborn abduction with the parent of a newborn. which of the following client statements indicates an understanding of the teaching? a. staff will apply identification bands to my baby after her first bath b. i can remove my baby's identification band as long as she is in my room c. i can leave my baby while i walk in the hallway d. i will not publish a public announcement about my baby's birth

d. i will not publish a public announcement about my baby's birth

a nurse is reviewing laboratory data from a client who has chronic kidney disease. which of the following findings should the nurse expect? a. increased bicarbonate b. increased hemoglobin c. increased calcium d. increased creatinine

d. increased creatinine

a nurse is assessing a newborn who has a blood glucose level of 30 mg/dL. which of the following manifestations should the nurse expect? a. abdominal distention b. hypertonia c. loose stools d. jitteriness

d. jitteriness

a nurse is caring for a client who is receiving brachytherapy for treatment of prostate cancer. which of the following actions should the nurse take? a. cleanse equipment before removal from the client's room b. discard the client's linens in a double bag c. discard the radioactive source in a biohazard bag d. limit the client's visitors to 30 min per day

d. limit the client's visitors to 30 min per day

a nurse is caring for a client who is in active labor and notes the FHR baseline has been 100/min for the past 15 mins. the nurse should identify which of the following conditions as a possible cause of fetal bradycardia? a. fetal anemia b. chorioamnionitis c. maternal fever d. maternal hypoglycemia

d. maternal hypoglycemia

a nurse is developing a plan of care for a client who has preeclampsia and is to receive magnesium sulfate via continuous IV infusion. which of the following actions should the nurse include in the plan? a. restrict the client's total fluid intake to 250 mL/hr b. monitor the FHR via doppler every 30 min c. give the client protamine if signs of magnesium sulfate toxicity occur d. measure the clients urine output every hour

d. measure the client's urine output every hour

a nurse is preparing a change of shift report for an adult female client who is postoperative. which of the following client information should the nurse include in the report? a. potassium 4.2 mEq/L b. Hgb 12.8 g/dL c. RBC 4.4 million/mm3 d. platelets 100,000/mm3

d. platelets 100,000/mm3

a nurse is caring for an older client who has prescriptions for multiple medications. which of the following factors should the nurse identify as an age-related change that increases the risk for adverse effects from this medication? a. rapid gastric emptying b. increased medication elimination c. decreased medication sensitivity d. prolonged medication half-life

d. prolonged medication half-life

a nurse is caring for a client who has depression and reports taking st. john's wort along with citalopram. the nurse should monitor the client for which of the following conditions as a result of an interaction between these substances? a. tardive dyskinesia b. pseudoparkinsonism c. acute dystonia d. serotonin syndrome

d. serotonin syndrome

a public health nurse is managing several projects for the community. which of the following interventions should the nurse identify as a primary prevention strategy? a. conducting mental health screenings at the local community center b. referring clients who have obesity to community exercise programs c. providing crisis intervention through a mobile counseling unit d. teaching parenting skills to expectant mothers and their partners

d. teaching parenting skills to expectant mothers and their partners

a nurse is caring for a cleint who asks for information regarding organ donation. which of the following responses should the nurse make? a. your name cannot be removed once you are listed on the organ donor list b. you must be at least 21 years of age to become an organ donor c. i cannot be a witness for your consent to donate d. your desire to be an organ donor must be documented in writing

d. your desire to be an organ donor must be documented in writing