and answer 2022~2023
1. Older female client can't sleep at night. Nurse recommends SATA
A. Take afternoon nap
B. Ask HCP for prescription of mild sedative at bedtime
C. Establish regular time for getting up and going to bed
D. Drink whiskey, water and honey before bed
E. Avoid drinking caffeine before bedtime - correct answer Ans: C, E
2. The nurse has been alerted by the EMR when scanning the dispensed medication
that the dosage is two times higher than the prescribed dose. The nurse should:
A. Report mismatch of prescription and available dosages
B. Withhold medication until exact dose is available
C. Ask pharmacy if another dose can be dispensed
D. Calculate dose on hand to match the prescribed dose - correct answer Ans: D
3. A patient diagnosed with small bowel obstruction refuses surgery. The nurse should:
A. Assess client needs for antiemetics and pain medications
B. Prepare nasogastric tube compress
C. Sent patient to CT abdominal scan
D. Notify HCP that patient refuses surgery - correct answer Ans: D
4. What is the most important factor for obesity referral?
A. BMI >35
B. Client expressed desire to lose 50 pounds
C. Body weight is 10% over ideal weight
D. Daily calorie intake is 3,500 - correct answer Ans: A
5. An elderly patient returns to the clinic for chronic pain management. He is prescribed
MS Contin PO Q12H. He states that he only takes it when the pain is so severe that he
can't sleep.
A. Long time use of opioids may cause drug addiction
B. Take medication Q12H as prescribed
C. Teach alternative methods for pain management
D. Continue taking MS Contin for severe pain. - correct answer Ans: B
6. IM ventrogluteal landmark
A. Upper outer quadrant of buttock
B. Deltoid
C. Knee and greater trochanter
D. Greater trochanter and anterior superior iliac spine - correct answer Ans: D
, 7. A client with a nasogastric tube is receiving low intermittent suction and is
complaining of dry mouth. What should the nurse implement?
A. Tell the client that the mucosa must stay dry to prevent aspiration
B. Turn off suction so that the client can rinse his mouth with cold water
C. Provide oral sponge toothettes so the client can clean and moisten his mouth
D. Instill 50 mL of normal saline and clamp - correct answer Ans: C
8. A client who is 12 days post op complains of thoracic incisional pain 2 hours after he
received his pain medication. The HCP has been called. What should the nurse do
next?
A. Guided imagery and deep breathing
B. Turn on a T.V. show and music for distraction
C. Put a hot device on the area
D. Provide a 20 minute back massage - correct answer Ans: A
9. A post-op patient is grimacing when moving from bed to chair but denies pain. What
should the nurse do next?
A. Administer pain medication PRN
B. Review his pain medications that are prescribed
C. Monitor patient's nonverbal actions
D. Ask what is making him grimace - correct answer Ans: D
10. A client is on a mechanical soft diet and is constipated. He requests for prune juice.
The nurse should:
A. Restrict fluid
B. Initiate bowel training protocol
C. Advance to regular diet
D. Offer to warm up the prune juice - correct answer Ans: D
11. The nurse is assessing a client's ability to perform activities of daily living (ADL)
safely. The client has steady gait and is able to ambulate from the door to the bed with
full ROM. The nurse should:
A. Teach the client to take shorter strides for better balance
B. Record client's ability to perform ADL safely
C. Initiate fall risk protocol
D. Determine client's activity tolerance - correct answer Ans: D
12. A patient is demonstrating diaphragmatic breathing by holding her abdomen while
inhaling and removing her hands during exhalation.
A. The demonstration was successful
B. The hands do not need be on the abdomen, but the demonstration was still correct
C. Keep light pressure on abdomen and cough after inspiration
D. Expand abdomen during inspiration and let the abdomen sink during exhalation -
correct answer Ans: D
13. Highest priority?