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exit examA nurse is caring for a client who has a recent diagnosis of a terminal illness. The nurse should
identify which of the following as an indication of hopelessness? - ANSThe client has a
decreased energy level
A nurse is preparing to collect data on a preschooler. Which of the following behaviors by the
child indicates that he is ready to cooperate? (Select all that - ANSAllows the nurse to touch him
on the arm. Answers questions asked by the nurse. Makes eye contact with the nurse
A nurse on a mental health unit is planning care for a group of clients. Which of the following
clients should the nurse see first? - ANSA client who has schizophrenia and is having command
hallucinations
A nurse is caring for a client who recently gave birth to her first child. The newborn is crying and
the client states, " I can't seem to do anything right. What should I do?" Which of the following
responses should the nurse make? - ANS"Let me show you how to swaddle and cuddle him,
then you try
A nurse is using a glucometer to measure a client's capillary blood glucose level, Which of the
following actions should the nurse take? - ANSKeep the finger in a dependent position
A nurse is reviewing the home medications of a client who recently had transient ischemic
attacks and is to begin taking clopidogrel. The nurse should instruct the client that which of the
following over-the-counter medications interacts adversely with clopidogrel? - ANSNaproxen
A nurse is collecting data from a client who has a long leg cast that was applied 2 days ago. The
client's foot is pale with a weak pedal pulse, and the client reports foot numbness. Which of the
following actions should the nurse plan to take first - ANSCheck for pain with passive movement
of the affected extremity
A nurse in a provider's office is reinforcing teaching about cigarette smoking with a client. Which
of the following adverse effects should the nurse include in the teaching? - ANSSomnolence
A nurse is contributing to the development of an in-service program for mental health nursing
staff. The nurse should include that the staff can medicate a client against his will, without a
court hearing, in which of the following situations? - ANSA client who is attempting to hurt
himself or others
,A nurse is reinforcing teaching with a client who has a new prescription for digoxin. Which of the
following instructions should the nurse include in the teaching - ANS"Monitor for muscle
weakness while taking the medication."
A charge nurse is discussing confidentiality requirements with a newly licensed nurse when
sharing a client's medical information. Which of the following individuals should the charge
nurse identify as appropriate with whom to share client information. - ANSA social worker who is
assigned to an involuntary committed school-age client
A nurse is reviewing laboratory values for a client who is at 34 weeks of gestation. Which of the
following findings should the nurse report to the provider? - ANSUrine protein 3 plus
A nurse is collecting data from a client who is 4 hr postoperative following a hemicolectomy.
Which of the following findings is the nurse's priority, requiring immediate intervention? -
ANSOxygen saturation 89%
A nurse in a provider's office is collecting data from a client who has a history of hypertension
during his annual physical examination. Which of the following findings should the nurse report
to the provider immediately? - ANSBlurred vision
A nurse is caring for a client who suddenly develops chest pain and dyspnea. Which of the
following actions should the nurse take first? - ANSElevate the head of the client's bed
A nurse is reinforcing teaching on a client who has diabetes mellitus. Which of the following
laboratory tests is the most accurate of blood glucose effective management? -
ANSGlycosylated hemoglobin
A charge nurse on a mental health unit is supervising a newly licensed nurse. For which of the
following actions by the newly licensed nurse should the supervising nurse intervene? -
ANSTells a client he will lose his phone privileges if he does not take his medication
A nurse is supervising an assistive personnel (AP) obtain supplies for a client who is on seizure
precautions. Which of the following materials should the AP place in the client's room? -
ANSOral suction equipment
A nurse is reinforcing discharge teaching with the faculty of a client who has dependent
personality disorder. Which of the following instructions should the nurse indicate in the
teaching? - ANSEncourage the client to be assertive
A nurse is reinforcing discharge teaching with a client who had a right total hip arthroplasty.
Which of the following instructions should the nurse indicate? - ANS"You should avoid crossing
your legs for 3 months."
, A nurse is reinforcing dietary teaching with a client who has hyperemesis gravidarum. Which of
the following instructions should the nurse include in the teaching - ANSEat a small meal every
2 to 3 hr
A nurse is reinforcing teaching with a client who has GERD and a prescription for ranitidine.
Which of the following statements by the client indicates an understanding of the teaching? -
ANS"I should take this medication in the morning and at night.
A nurse is assisting with the admission of a client who has pulmonary tuberculosis. Which of the
following types of isolation precautions should the nurse include? - ANSAirborne
A nurse is reinforcing discharge teaching with a client who has COPD and reports problems with
maintaining adequate nutrition. Which of the following instructions should the nurse include? -
ANS"Perform pulmonary hygiene 1 hour before meals.
A nurse is administering pancreatic enzymes to a client who has cystic fibrosis. Which of the
following outcomes should the nurse expect as a therapeutic effect of the treatment? -
ANSReduced fat in the stools
A nurse is caring for a client who has paranoid schizophrenia and believes that she is being
followed by FBI agents who are pretending to be psychiatric staff. Which of the following
responses should the nurse make? - ANSThe psychiatric staff is not FBI. They are here to help
you.
A nurse is assisting in the care of a client who has a fractured femur and is in Buck's traction,
which of the following actions should the nurse take? - ANSEnsure that the weights are hanging
freely
A nurse is reviewing the medication record of a client who requires continuous oxygen
saturation monitoring. Which of the following should the nurse identify as a factor that can affect
the validity of the readings? - ANSPeripheral vascular disease
A nurse is collecting data from a group of clients. Which of the following clients should the nurse
identify as having xanthelasma? - ANSLady with eyes closed with nodules on eye lid
A nurse is assisting with the admission of a client who has Vancomycin resistant enterococcus
of the urine. Which of the following types of precautions should the nurse implement for this
client? - ANSContact precautions
A community health nurse is assisting in the development of a brochure about hypertension.
Which of the following actions should the nurse take? - ANSExplain medical terminology using
basic, one-syllable words
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