nursing skills exam 2

A client with allergy has been advised to have an allergy test. The nurse needs to administer an injection to the client for allergy testing. Which of the following injection routes is most suitable for allergy testing? A) Subcutaneous B) Intramuscular C) Intradermal D) Intravenous

C

A client with dry skin has been prescribed inunction. Which of the following should the nurse do to promote absorption of the ointment? A) Shaking the contents of the ointment B) Applying inunction with a cotton ball C) Rubbing the ointment into the skin D) Warming the inunction before application

C

A client's PaCO2 is abnormal on an ABG report. Which of is the most likely be the medical diagnosis? A) Rheumatoid arthritis B) Sexually transmitted infection C) Chronic obstructive pulmonary disease D) Infection of the bladder and ureters

C

A nurse is caring for a client with phlebitis. The nurse notices that the client's forearm, which has the tubing, has become red and slightly warm. Which of the following actions should the nurse perform to avoid further complications and provide relief to the client? A) Administer oxygen. B) Call for help. C) Discontinue the IV promptly. D) Elevate the affected arm.

C

A nurse is caring for a frail older adult client with chronic obstructive pulmonary disease. The client always remains in a sitting position to help him breathe more easily. Based on the understanding that prolonged sitting may put pressure on bony prominences, the nurse frequently assesses which area of this client? A) Back of the skull B) Elbows C) Sacrum D) Heels

C

A nurse is reviewing results of preoperative screening tests and notes the client's potassium level is dangerously low. What should the nurse do next? A) Nothing; potassium levels have no influence on surgical outcome. B) Include the information in the postoperative end of shift report. C) Document the data and notify the physician who will do the surgery. D) Ask the client and family members why the potassium is low.

C

A nurse measures a client's 24-hour fluid intake and documents the findings. To be an accurate indicator of fluid status, what must the nurse also do with the information? A) Compare the client's intake with the normal range of adult fluid intake. B) Report the exact milliliter of intake to the physician's office nurse. C) Compare the total intake and output of fluids for the 24 hours. D) Ensure that the information is included in the verbal end-of-shift report.

C

A physician has ordered a nurse to administer conscious sedation to a client. Which of the following is possible after administering conscious sedation to a client? A) Client can respond verbally despite physical immobility. B) Client can tolerate long therapeutic surgical procedures. C) Client is relaxed, emotionally comfortable, and conscious. D) Client's consciousness level can be monitored by equipment.

C

An operating room nurse is preparing for a surgical procedure on an infant. The nurse's perioperative care is based on what physiologic factor that puts infants at greater risk from surgery than adults? A) Increased vascular rigidity B) Diminished chest expansion C) Lower total blood volume D) Decreased peripheral circulation

C

What is the name of the process by which a drug moves through the body and is eventually eliminated? A) Pharmacology B) Pharmacotherapeutics C) Pharmacokinetics D) Pharmacodynamics

C

A client asks a nurse if it is possible to contract a disease by donating blood. How would the nurse respond? A) "There is only a very small chance; I know you will be safe." B) "Although hepatitis is possible, AIDS is not." C) "If I were you, I would request special handling of my blood." D) "There is no way you can contract a disease by giving blood."

D

A client has an order to restrict fluids. What is one comfort measure nurses can implement for this client to alleviate a common problem? A) Back rubs B) Chewing gum C) Hair care D) Oral hygiene

D

A client is having a blood transfusion, but the fluid is dripping very slowly. The blood has been infusing for more than four hours. What should the nurse do next? A) Continue with the transfusion and document the drip rate. B) Report to the next shift the amount of blood left to infuse. C) Take and record vital signs more often. D) Discontinue the blood transfusion.

D

A client taking insulin has his levels adjusted to ensure that the concentration of drug in the blood serum produces the desired effect without causing toxicity. What is the term for this desired effect? A) Peak level B) Trough level C) Half-life D) Therapeutic range

D

A client with abdominal incisions experiences excruciating pain when he tries to cough. What should the nurse do to reduce the client's discomfort when coughing? A) Administer prescribed pain medication just before coughing. B) Ask the client to drink plenty of water before coughing. C) Ask the client to lie in a lateral position when coughing. D) Administer prescribed pain medication 30 minutes before deliberately attempting to cough.

D

A clinic nurse is preparing for a tuberculosis screening. Knowing the injections will be administered intradermally, what size needles and syringes will the nurse prepare? A) 10-mL syringe, 3-inch 18-gauge needle B) 5-mL syringe, 2-inch 20-gauge needle C) Insulin syringe, 1-inch 16-gauge needle D) Tuberculin syringe, 1/2-inch 26-gauge needle

D

A nurse is administering a medication that is formulated as enteric-coated tablets. What is the rationale for not crushing or chewing enteric-coated tablets? A) To prevent absorption in the mouth B) To prevent absorption in the esophagus C) To facilitate absorption in the stomach D) To prevent gastric irritation

D

A nurse is assisting a postoperative client with deep-breathing exercises. Which of the following is an accurate step for this procedure? A) Place the client in prone position, with the neck and shoulders supported. B) Ask the client to place the hands over the stomach, so he or she can feel the chest rise as the lungs expand. C) Ask the client to exhale rapidly and completely, and inhale through the nose rapidly and completely. D) Ask the client to hold his or her breath for three to five seconds and mentally count "one, one thousand, two, one thousand" and so forth.

D

A nurse is conducting an interview for a health history. In addition to asking the client about medications being taken, what else should be asked to assess the risk for drug interactions? A) The effects of prescribed medications B) Type and amount of foods eaten C) Daily amount of intake and output D) Use of herbal supplements

D

What is the average adult fluid intake and loss in each 24 hours? A) 500 to 1,000 mL B) 1,000 to 1,500 mL C) 1,500 to 2,000 mL D) 1,500 to 3500 mL

D

A client diagnosed with anemia is receiving a blood transfusion. The client develops urticaria accompanied by wheezing and dyspnea not long after the transfusion starts. The nurse interprets this as indicative of which of the following? A) Allergic reaction B) Side effect C) Toxicity D) Antagonism

A

A client has a physician's order for NPO (nothing by mouth) following abdominal surgery to repair a bowel obstruction. The client has a nasogastric tube inserted to low intermittent suction. The client requires intravenous therapy for what purpose? A) Replace fluid and electrolytes B) Administer blood products C) Provide protein supplements D) Treat the client's infection

A

A client returning to the floor after orthopedic surgery is complaining of nausea. The nurse is aware that an appropriate intervention is to do which of the following? A) Avoid strong smelling foods. B) Provide clear liquids with a straw. C) Avoid oral hygiene until the nausea subsides. D) Hold all medications.

A

A client scheduled for major surgery will receive general anesthesia. Why is inhalation anesthesia often used to provide the desired actions? A) Rapid excretion and reversal of effects B) Safe administration in the client's own room C) Involves only the respiratory system and skin D) Slow onset of action and maintains reflexes

A

A client, scheduled for open-heart surgery, tells the nurse he does not want to be "saved" if he dies during surgery. What should the nurse do next? A) Discuss with and document the wishes of the client and family B) Administer the ordered oral and intravenous preoperative medications C) Notify the physician after completion of the surgical procedure D) Verbally report the client's wishes to the operating room supervisor

A

A nurse at a health care facility has to instill ear drops in a client. The nurse knows that which of the following techniques varies for an adult and child client? A) Manipulation of the client's ear to straighten the auditory canal B) Dilution of the medication drops before instilling in the client's ear C) Position in which the client remains until medication reaches the eardrum D) Amount of time before instilling medication in the client's opposite ear

A

A nurse is administering a liquid medication to an infant. Where will the nurse place the medication to prevent aspiration? A) Between the gum and the cheek B) In front of the teeth and gums C) On the front of the tongue D) Under the tongue

A

A nurse is administering a potassium supplement to a client. What will the nurse do to disguise the taste and decrease gastric irritation? A) Dilute it B) Give it after meals C) Mix it with food D) Freeze it

A

A nurse is converting the dosage of a medication to a different unit in the metric system. The medication label specifies the drug as being 0.5 g per tablet. The order is for 500 mg. How many tablets will the nurse give? A) 1 B) 2 C) 5 D) 10

A

A nurse is educating a preoperative client on how to cough effectively. What can the nurse tell the client to do to facilitate coughing? A) "Hold a pillow or folded bath blanket over the incision." B) "Get up and walk before you try to cough." C) "It would be best if you do not cough until you feel better." D) "When you cough, cover your nose and mouth with a tissue."

A

A nurse monitoring the intake and output of fluids for a client with severe diarrhea knows that normally how much body fluid is lost via the gastrointestinal tract? A) 300 mL B) 1,000 mL C) 1,300 mL D) 2,600 mL

A

A nurse needs to administer a prescribed dose of a narcotic medication to a client with acute neck pain. Which of the following precautions should the nurse take when storing narcotic medications? A) In a double-locked drawer B) In a single container C) In a self-contained packet D) In disguised containers

A

A physician writes an order to "force fluids." What will be the first action the nurse will take in implementing this order? A) Explain to the client why this is needed. B) Tell the client and family to increase oral intake. C) Decide how much fluid to increase each eight hours. D) Divide the intake so the largest amount is at night.

A

A postoperative home care client has developed thrombophlebitis in her right leg. What category of medications will probably be prescribed for this cardiovascular complication? A) Anticoagulants B) Antibiotics C) Antihistamines D) Antigens

A

Cross-matching of blood is ordered for a client before major surgery. What does this process do? A) Determines compatibility between blood specimens B) Determines a person's blood type C) Predicts the amount of needed blood replacement D) Specifies the donor and the recipient of the blood

A

In order to prevent the possibility of venous stasis, a nurse is teaching a surgical client how to perform leg exercises. Which of the client's following statements indicates a sound understanding of leg exercises? A) "I'll practice these now and try to start them as soon as I can after my surgery." B) "I'll try to do these lying on my stomach so that I can bend my knees more fully." C) "I'll make sure to do these, as long as my doctor doesn't tell me to stay on bed rest after my operation." D) "I'm pretty sure my stomach muscles are strong enough to lift both of my legs off the bed at the same time."

A

The medical chart of a newly admitted client notes a penicillin allergy, yet the physician has just written an order for an antibiotic in the same drug family after reviewing the client's wound culture and sensitivity. How should the nurse respond to this situation? A) Withhold the medication until the potential drug allergy has been addressed by the care team. B) Administer the medication and increase the frequency of assessments in the hours that follow. C) Substitute an antibiotic with similar action, but which is from a different drug family. D) Discuss the severity, signs and symptoms of the drug allergy with the client in order to ascertain the risks of administration.

A

The nurse is preparing to administer a medication via a nasogastric tube. What guideline is appropriate for the nurse to follow when administering a drug via this route? A) Flush the tube with water between each drug administered. B) Position the client supine prior to administering the drug. C) Administer the medication at a cold temperature. D) If connected to suction, do not reconnect to suction for five minutes after drug administration.

A

The nurse is preparing to send a client to the operating room for an exploratory laparoscopy. The nurse recognizes that there is no informed consent for the procedure on the client's chart. The nurse informs the physician who is performing the procedure. The physician asks the nurse to obtain the informed consent signature from the client. What is the nurse's best action to the physician's request? A) Inform the physician that it is his or her responsibility to obtain the signature. B) Obtain the signature and ask another nurse to cosign the signature. C) Inform the physician that the nurse manager will need to obtain the signature. D) Call the house officer to obtain the signature.

A

The nurse is providing education to a client regarding pain control after surgery. What time does the nurse inform the client is the best time to request pain medication? A) Before the pain becomes severe B) When the client experiences a pain rating of "10" on a 1-to-10 pain scale C) When there is no pain, but it is time for the medication to be administered D) After the pain becomes severe and relaxation techniques have failed

A

The telemetry unit nurse is reviewing laboratory results for a client who is scheduled for an operative procedure later in the day. The nurse notes on the laboratory report that the client has a serum potassium level of 6.5 mEq/L, indicative of hyperkalemia. The nurse informs the physician of this laboratory result because the nurse recognizes hyperkalemia increases the client's operative risk for which of the following? A) Cardiac problems B) Infection C) Bleeding and anemia D) Fluid imbalances

A

Upon assessment, a client reports that he drinks five to six bottles of beer every evening after work. Based upon this information, the nurse is aware that the client may require which of the following? A) Larger doses of anesthetic agents and larger doses of postoperative analgesics B) Larger doses of anesthetic agents and lower doses of postoperative analgesics C) Lower doses of anesthetic agents and lower doses of postoperative analgesics D) Lower doses of anesthetic agents and larger doses of postoperative analgesics

A

What does the nurse do to verify an order for a medication listed on a medication administration record (MAR)? A) Compare it with the original physician's order. B) Ask another nurse what the drug is. C) Look up the drug in a textbook. D) Call the pharmacist for verification.

A

Which client will have more adipose tissue and less fluid? A) A woman B) A man C) An infant D) A child

A

Which client would be the most likely candidate for the administration of total parenteral nutrition? A) A client with severe pancreatitis B) A client with a myocardial infarction C) A client with hepatitis B D) A client with mild malnutrition

A

Which of the following clients receives a drug that requires parenteral route? A) A woman who has been ordered intravenous antibiotics B) A woman who takes a diuretic pill each morning C) A man with emphysema who uses nebulized bronchodilators D) A man who has an antifungal ointment applied to his skin rash daily

A

Which of the following individuals with diarrhea for three days is more likely to suffer from fluid and electrolyte imbalance? A) Infant B) School-age child C) Adolescent D) Young adult

A

Which of the following nursing interventions occurs in the postoperative phase of the surgical experience? A) Airway/oxygen therapy/pulse oximetry B) Teaching deep breathing exercises C) Reviewing the meaning of p.r.n. orders for pain medications D) Putting in IV lines and administering fluids

A

Which of the following statements is an appropriate nursing diagnosis for an client 80 years of age diagnosed with congestive heart failure, with symptoms of edema, orthopnea, and confusion? A) Extracellular volume excess related to heart failure, as evidenced by edema and orthopnea B) Congestive heart failure related to edema C) Fluid volume excess related to loss of sodium and potassium D) Fluid volume deficit related to congestive heart failure, as evidenced by shortness of breath

A

Which question about fluid balance would be appropriate when conducting a health history for a client? A) "Describe your usual urination habits." B) "Describe your problems with constipation." C) "How did you feel when your calcium was low?" D) "Do you eat fruits and vegetables each day?"

A

35. The "Rights of Medication Administration" help to ensure accuracy when administering medications. Which of the following represent these five rights? Select all that apply. A) Medication B) Client C) Prescribing physician D) Pharmacy E) Dosage F) Route

A, B, E, F

A client is taking a diuretic that increases her urinary output. What would be an appropriate nursing diagnosis on which to base an educational plan? A) Impaired Skin Integrity B) Risk for Deficient Fluid Volume C) Impaired Urinary Elimination D) Urinary Retention

B

A client scheduled for surgery has arranged for an autologous transfusion. What type of blood transfusion is this? A) The client's family members have been donors. B) The client donates his or her own blood. C) The client's blood has been rendered sterile. D) The client will only need fluids, not blood.

B

A client who is taking an oral narcotic for pain relief tells the nurse he is constipated. What is this common response to narcotics called? A) Therapeutic effect B) Adverse effect C) Toxic effect D) Idiosyncratic effect

B

A nurse has administered an intramuscular injection. What will the nurse do with the syringe and needle? A) Recap the needle; place it in a puncture-resistant container. B) Do not recap the needle; place it in a puncture-resistant container. C) Break off the needle, place it in the barrel, and throw it in the trash. D) Take off the needle and throw the syringe in the client's trash can.

B

A nurse has been asked to ensure informed consent for a surgical procedure. What might be a role of the nurse? A) Securing informed consent from the client B) Signing the consent form as a witness C) Ensuring the client does not refuse treatment D) Refusing to participate based on legal guidelines

B

A nurse is assisting a physician during a cesarean section for a client. The client is administered epidural anesthesia. Which of the following is an advantage of epidural anesthesia? A) It counteracts the effects of conscious sedation. B) It decreases the risk of gastrointestinal complications. C) It prevents clients from remembering the initial recovery period. D) It acts on the central nervous system to produce loss of sensation.

B

A nurse is initiating a peripheral venous access IV infusion ordered for a client presurgically. In what position would the nurse place the client to perform this skill? A) High-Fowler's B) Low-Fowler's C) Sims' D) Dorsal recumbent

B

A nurse is providing ongoing postoperative care to a client who has had knee surgery. The nurse assesses the dressing and finds it saturated with blood. The client is restless and has a rapid pulse. What should the nurse do next? A) Document the data and apply a new dressing. B) Apply a pressure dressing and report findings. C) Reassure the family that this is a common problem. D) Make assessments every 15 minutes for four hours.

B

What would a nurse instruct a client to do after administration of a sublingual medication? A) "Take a big drink of water and swallow the pill." B) "Try not to swallow while the pill dissolves." C) "Swallow frequently to get the best benefit." D) "Chew the pill so it will dissolve faster."

B

Which body fluid is the fluid within the cells, constituting about 70% of the total body water? A) Extracellular fluid (ECF) B) Intracellular fluid (ICF) C) Intravascular fluid D) Interstitial fluid

B

Which medication system allows for client independence? A) Unit dose system B) Self-administered medication system C) Automated medication-dispensing system D) Bar Code Medication Administration

B

Which of the following interventions are recommended guidelines for meeting client postoperative elimination needs? A) Assess abdominal distention, especially if bowel sounds are audible or are low pitched. B) Assess for the return of peristalsis by auscultating bowel sounds every four hours when the client is awake. C) Encourage food and fluid intake when ordered, especially dairy products and low-fiber foods. D) Assess for bladder distention by Palpating below the symphysis pubis if the client has not voided within eight hours after surgery.

B

Which of the following interventions is of major importance during preoperative education? A) Performing skills necessary for gastrointestinal preparation B) Encouraging the client to identify and verbalize fears C) Discussing the site and extent of the surgical incision D) Telling the client not to worry or be afraid of surgery

B

A nurse at a health care facility administers a prescribed drug to a client and does not record doing so in the medical administration record. The nurse who comes during the next shift, assuming that the medication has not been administered, administers the same drug to the client again. The nurse on the previous shift calls to inform the health care facility that the administration of the drug to this client in the earlier shift was not recorded. What should the nurse on duty do immediately upon detection of the medication error? A) Report the incident to the physician. B) Report the incident to the supervising nurse. C) Check the client's condition. D) Fill in the accident report sheet.

C

A nurse is caring for a client who is scheduled to undergo a breast biopsy. Which of the following major tasks does the nurse perform immediately during the pre-operative period? A) Obtain a signature on the consent form. B) Review the surgical checklist. C) Conduct a nursing assessment. D) Reduce the dosage of toxic drugs.

C

A physician has ordered peak and trough levels of a medication. When would the nurse schedule the trough level specimen? A) Before administering the first dose B) Immediately after the first dose C) 30 minutes before the next dose D) 24 hours after the last dose

C

A physician writes an order for ampicillin 1 gram every 6 hours for a client. What is missing in this order? A) Time B) Amount C) Route D) Frequency

C

A preoperative assessment finds a client to be 75 pounds overweight. The client is to have abdominal surgery. What nursing diagnosis would be appropriate based on the client's weight? A) Risk for Aspiration B) Risk for Imbalanced Body Temperature C) Risk for Infection D) Risk for Falls

C

A student nurse is administering medications through a nasogastric tube connected to continuous suction. How will the student do this accurately? A) Briefly disconnect tubing from the suction to administer medications, then reconnect. B) Realize this can't be done, and document information. C) Disconnect tubing from the suction before giving drugs, and clamp tubing for 20 to 30 minutes. D) Leave the suction alone and give medications orally or rectally.

C

A young adult woman has had orthopedic surgery on her right knee. The first time she gets out of bed, she describes weakness, dizziness, and feeling faint. The nurse correctly recognizes that which of the following conditions is likely affecting the client? A) Thrombophlebitis B) Anemia C) Orthostatic hypotension D) Bradycardia

C

Which location might the nurse use to assess the condition of an insertion site for a central venous access device? A) Below the sternum B) Over the fourth intercostal space C) Over the jugular vein D) The back of the hand

C

16. A nurse is administering an intramuscular injection of a viscous medication using the appropriate-gauge needle. What does the nurse need to know about needle gauges? A) All needles for parenteral injection are the same gauge. B) The gauge will depend on the length of the needle. C) Ask the client what size needle is preferred. D) Gauges range from 18 to 30, with 18 being the largest.

D

A cleansing enema is ordered for a client who is scheduled to have colon surgery. What is the rationale for this procedure? A) Surgical clients routinely are given a cleansing enema. B) Cleansing enemas are given before surgery at the client's request. C) There will be less flatus and discomfort postoperatively. D) Peristalsis does not return for 24 to 48 hours after surgery.

D

A nurse is bunching the tissue of a client when administering a subcutaneous injection to that client. The nurse knows that which of the following is the reason for bunching when injecting subcutaneously? A) To prevent needle-stick injuries B) To ensure the accuracy of landmarking C) To facilitate blood circulation at injection site D) To avoid instilling medication within the muscle

D

A nurse is caring for a client in the nursing unit when the physician, during the rounds, prescribes a medication for the client. What appropriate action should the nurse take to ensure the accuracy of the verbal medication order? A) Ask the physician to repeat the dosage. B) Ask the physician to spell out the medication name. C) Ask a second nurse to listen for accuracy. D) Ask the physician to write out the order.

D

A nurse is educating a client about regional anesthesia. Which of the following statements is accurate about this type of anesthesia? A) "You will be asleep and won't be aware of the procedure." B) "You will be asleep but may feel some pain during the procedure." C) "You will be awake but will not be aware of the procedure." D) "You will be awake and will not have sensation of the procedure."

D

A nurse is educating a surgical client on postoperative p.r.n. pain control. Which of the following should be included? A) "We will bring you pain medications; you don't need to ask." B) "Even if you have pain, you may get addicted to the drugs." C) "You won't have much pain so just tough it out." D) "You need to ask for the medication before the pain becomes severe."

D

A nurse needs to administer an intradermal tuberculin skin test injection to a client. Which of the following is the most suitable angle when administering an intradermal injection? A) 180-degree angle B) 90-degree angle C) 45-degree angle D) 10-degree angle

D

A nurse reads the laboratory report and notes that the client has hyponatremia. What physical assessment should be made? A) Observe skin color and texture. B) Auscultate bowel sounds. C) Percuss lung density. D) Monitor for GI symptoms.

D

A nurse should read the instructions stated on a vial container before reconstituting it and administering it to a client. Which of the following instructions are stated on the label of a vial container? A) Type of needle to be used for withdrawal B) Directions for administering the drug C) Best site for administering the drug D) Amount of diluent to be added

D

A nurse working in a PACU is responsible for conducting assessments on immediate postoperative clients. What is the purpose of these assessments? A) To determine the length of time to recover from anesthesia B) To use intraoperative data as a basis for comparison C) To focus on cardiovascular data and findings D) To prevent complications from anesthesia and surgery

D

A specially trained nurse has inserted a PICC line. What would be done next? A) Start administration of prescribed fluids. B) Explain the procedure to the client and family. C) Place the client on restricted oral fluids. D) Send the client to the radiology department.

D

A student is assessing a postoperative client who has developed pneumonia. The plan of care includes positioning the client in the Fowler's or semi-Fowler's position. What is the rationale for this position? A) It increases blood flow to the heart. B) The client will be more comfortable and have less pain. C) It facilitates nursing assessments of skin color and temperature. D) It promotes full aeration of the lungs.

D

A student is learning how to administer intravenous fluids, including accessing a vein. Although all of the following may occur, which is the most potentially harmful risk posed for the client when accessing the vein? A) Discomfort B) Pain C) Minor bleeding D) Infection

D

After conducting a preoperative health assessment, the nurse documents that the client has physical assessments supporting the medical diagnosis of emphysema. Based on this finding, what postoperative interventions would be included on the plan of care? A) Perform sterile dressing changes each morning. B) Administer pain medications as needed. C) Conduct a head-to-toe assessment each shift. D) Monitor respirations and breath sounds.

D

Which statement accurately represents a recommended guideline when providing postoperative care for the following clients? A) Force fluids for an adult client who has a urine output of less that 30 mL per hour. B) If client is febrile within 12 hours of surgery, notify the physician immediately. C) If the dressing was clean but now has a large amount of fresh blood, remove the dressing and reapply it. D) If vital signs are progressively increasing or decreasing from baseline, notify the physician of possible internal bleeding.

D

A client with dehydration is being administered IV fluids. During her rounds, the nurse noticed that the skin immediately surrounding the IV site was reddish in color and showing signs of inflammation. The nurse recognizes that what phenomenon is likely responsible? A) Phlebitis B) Thrombus formation C) Pulmonary embolus D) Air embolism

A

A nurse at the health care facility is preparing the medication dosage for a client. Why should the nurse read and compare the label on the medication with the MAR at least three times (before, during, and after) while preparing the medication for administration? A) Ensures that the right medication is given at the right time by the right route B) Complies with the medical order and ensures that the right dose is given C) Ensures that the medication has been administered to the right client D) Demonstrates timely administration and compliance with the medical order

A

A nurse in an outpatient surgical center is teaching a client about what will be necessary for discharge to home. What information should the nurse include about transportation? A) The client is not allowed to drive a car home. B) If the client is not dizzy, driving a car is allowed. C) Only adults over the age of 25 may drive home. D) None; this is not necessary information.

A

A diabetic client is undergoing surgery to amputate a gangrenous foot. This procedure would be considered which of the following categories of surgery based on purpose? A) Diagnostic B) Ablative C) Palliative D) Reconstructive

B

A female client is scheduled for liposuction surgery to reduce her weight. Based on urgency, how is this surgery classified? A) Urgent B) Elective C) Emergency D) Emergent

B

A home care client reports weakness and leg cramps. Per order, the nurse draws blood and requests a potassium level. What is the rationale for this request? A) The nurse is concerned that the client's diet has caused sodium loss. B) The nurse recognizes these symptoms of hypokalemia. C) The client is actively seeking increased attention. D) The client had bananas and orange juice for breakfast.

B

A nurse is showing an older adult client the correct method of self-administering an insulin injection at home. Which of the following points should the nurse tell the client in order to avoid lipoatrophy and lipohypertrophy? A) Change the needle daily with each injection. B) Rotate the site with each injection. C) Apply local anesthetic to the injection site. D) Massage the injection site for 10 minutes.

B

A nurse is taking care of a client during the immediate post-operative period. Which of the following duties performed during the immediate post-operative period is most important? A) Ensure the safe recovery of surgical clients. B) Monitor the client for complications. C) Prepare a room for the client's return. D) Assess the client's health constantly.

B

A nurse is teaching an older adult at home about taking newly prescribed medications. Which information would be included? A) "You can identify your medications by their color." B) "I have written the names of your drugs with times to take them." C) "You won't forget a medication if you count them every day." D) "Don't worry if the label comes off; just look at the shapes."

B

A physician has ordered that a medication be given "stat" for a client who is having an anaphylactic drug reaction. At what time would the nurse administer the medication? A) At the next scheduled medication time B) Immediately after the order is noted C) Not until verifying it with the client D) Whenever the client asks for it

B

A young woman has been in an automobile crash that resulted in an amputation of her left lower leg. She verbalizes grief and loss. What knowledge by the nurse is used to provide interventions to help the client cope? A) The client should be grateful to be alive. B) This is a normal, appropriate response. C) This is an abnormal, inappropriate response. D) Tissue healing will help the client adapt.

B

Based on knowledge of total body fluids, a nurse is especially watchful for a fluid volume deficit in an infant. Why would the nurse do this? A) Infants have less total body fluid and ECF than adults. B) Infants have more total body fluid and ECF than adults. C) Infants drink less fluid than adults. D) Infants lose more fluids through output than adults.

B

Medications administered that are renal toxic should have frequent assessments of which blood values? A) AST and ALT B) BUN and creatinine C) WBC and platelets D) RBC and differential

B