Fundamentals proctored exam review
A nurse is conducting a health promotion class for a group of college students. Which of the following statements by a student should the nurse identify as a potential problem with achieving Eriksons developmental task for this age group?
"I go home on the weekends to be with my family because I do not have any good friends here on campus."
A nurse is providing discharge teaching to an older adult client about personal safety. Which of the following statements by the client indicates an understanding of the teaching?
"I will put a night-light in the hallway."
An adolescent client in an outpatient mental health facility tells the nurse that he struggles to follow his treatment plans because his friends discourage him. Which of the following statements should the nurse make?
"Tell me more about how your friends discourage you."
A nurse in a providers office is reviewing the laboratory findings of a client who reports child and aching joints. The nurse should identify which of the following as an indication of infection?
A WBC 15,000 mm3
A nurse is cleaning a clients wound by swabbing from the area of least contamination to the area of greater contamination. Which of the following rationales should the nurse identify for using this technique
Keeping microorganisms from entering the wound
A nurse is teaching a client how to self-administer insulin. Which of the following actions should the nurse take to evaluate the clients understanding of the process within the psychomotor domain of learning
Have the client demonstrates the procedure.
A nurse is changing the bed linens for a client who is on bed rest. Which of the following actions should the nurse perform?
Hold the linens away from the body and clothing
A nurse on a medical unit is caring for a client who has difficulty sleeping. Which of the following actions should the nurse take to promote the clients ability to fall asleep?
Allow the client to maintain the same bedtime routine as at home
A nurse is caring for a client who has emphysema. The client has not stopped smoking cigarettes and states "its too late for me to quit". Which of the following actions should the nurse take
Assist the client in finding local smoking cessation assistance programs
A nurse is caring for a client who just recieved a diagnosis of cancer. The client states, "I just dont know what I'm going to do now" which of the following responses should the nurse make
Can you explain the concerns you're having right now?
A nurse is inserting an IV catheter for a client that results in a blood spill on her gloved hand. The client has no documented bloodstream infection. Which of the following actions should the nurse take?
Carefully remove the gloves and follow with hand hygiene
A nurse is caring for a postoperative client who has an indwelling urinary catheter for gravity drainage. The nurse notes no urine output in the past 2 hours. Which of the following actions should the nurse take first?
Check to determine if the catheter tubing is kinked
A nurse is assisting a client who is eating at mealtime. Suddenly, the client grabs her neck with both hands and appears frightened. Which of the following actions should the nurse take first?
Determine whether the client is able to breathe
A nurse is caring for a client who has cancer and is experiencing pain. The nurse should implement which of the following interventions to assist the client with pain relief
Encourage the client to listen to soft music
A nurse on a medical-surgical unit observes smoke billowing from a clients room. Which of the following actions should the nurse take first?
Evacuate the client from the room
A client who reports shortness of breath requests the nurses help in changing positions. After repositioning the client, which of the following actions should the nurse take?
Observe the rate, depth, and character of the clients respirations
A nurse is performing a physical assessment of a client. Which of the following actions should the nurse take to asses the clients tissue perfusion
Perform a blanch test
A nurse is performing a neurological assessment for a client. Which of the following examinations should the nurse use to check the clients balance?
Romberg test
An assistive peronnel (AP) is helping a nurse care for a female client who has an indwelling urinary catheter. Which of the following actions by the AP indicates a need for further teaching
The AP hangs the collection bag at the level of the bladder
A nurse is caring for a client who was admitted to a long-term care facility for rehabilitation after a total hip arthoplasty. At which of the following times should the nurse begin discharge planning?
Upon the clients admission to the care facilit
A nurse in a providers clinic is taking a clients age, height, weight, and vital signs. The nurse should identify this action as part of which of the following components of the nursing process
assessment
A nurse documents the presence of clubbing of the fingernails for a client who has emphysema. Which of the following is the underlying cause of this finding?
chronic hypoxemia
A nurse is assessing a client who is postoperative. Which of the following findings should the nurse identify as an indication that the client is experiencing pain
Grimacing
A nurse is a providers office is collecting information from an older client who reports taking 500 mg of acetaminophen a day for severe joint pain. The nurse should instruct the client that large doses of acetaminophen could cause which of the following adverse effects
Liver damage
A nurse is reviewing a client from the PACU who is postoperative following abdominal surgery. Which of the following actions should the nurse perform to transfer the client from the stretcher to the bed?
Lock the wheels on the bed and stretcher