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Exam (elaborations)

NLN NACE Prep Exam with Verified Answers 100% Pass

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  • NLN NACE

NLN NACE Prep Exam with Verified Answers 100% Pass 1. A nurse is caring for a client that has not voided for sever- al hours. When percussing the client's bladder to assess for distention, the nurse should expect to hear...... 2. A client is receiving intermit- tent nasogastric tube feed- ...

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  • September 12, 2024
  • 19
  • 2024/2025
  • Exam (elaborations)
  • Questions & answers
  • NLN NACE
  • NLN NACE
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MERCYTRISHIA
NLN NACE Prep Exam with Verified Answers 100% Pass
1. A nurse is caring for a client Dullness
that has not voided for sever- This indicates a full bladder
al hours. When percussing the -Tympany means empty
client's bladder to assess for -Hyperrenosance is an abnormal pul-
distention, the nurse should monary sound
expect to hear...... -Renosance is a vibration

2. A client is receiving intermit- Determine absorption of feedings
tent nasogastric tube feed-
ings. A nurse should aspi-
rate the residual stomach con-
tents prior to administering a
scheduled feeding to.....

3. Which medication should be Iron dextran(Imferon) to prevent tissue
delivered using the z-track damage
method?

4. A nurse is to administer med- Check name bands on the clients' arms
ication to 2 clients sitting in
the lounge with several oth-
er clients. What action by the
nurse is appropriate?

5. A client is to be checked for Immediately after the client voids
residual urine. At which time
should the procedure be per-
formed?

6. A nurse is to obtain a residual To assess for urinary retention
urine specimen from an elder-
ly client whose indwelling fo-
ley catheter was just removed.
What is the purpose of a resid-
ual urine specimen?

7. A nurse is caring for a client Cutaneous tissue at the intravenous site is
receiving intravenous thera- swollen
py. What would indicate to the



, nurse that the intravenous in- -the IV catheter should be removed and a
fusion has infiltrated? new site should be restarted

8. Which of the following mea- Keeping the client's environment cool
sures should a nurse include -A client with hyperthyroidism is heat intol-
in the plan of care of a patient erant
with hyperthyroidism? -The client should be encouraged to eat
foods high in calories because they are of-
ten below their ideal weight and have diffi-
culty maintaining a healthy weight

9. A nurse should reinforce the Keep the floor of the client's surroundings
instructions to the family of free of obstacles
a client who has propulsive -Propulsive gait is a stooping, rigid posture
gait related to Parkinsons Dis- with the head and neck bent forward. Steps
ease? tend to become faster and shorter.
-Encourage the client to ambulate as much
as they want in order to maintain activity
level

10. Which of these measures Placing the food on the unaffected side of
should a nurse emphasize the client's mouth
when feeding a client with left -prevents aspiration
side facial paralysis who has
difficulty swallowing?

11. Before assisting a patient who Assess pulse and blood pressure in order
is on day postop OOB for the to assess the client for orthostatic hypoten-
first time, a nurse should take sion
which action?

12. Which of these objectives is Prevent contractures
most important to include in -it will decrease the client's functional abili-
the care of a client with multi- ties
ple sclerosis?

13. A client who is terminally Standard Precautions
ill with AIDS is admitted to
the hospital. What precaution



, should be included in the
client's plan of care?

14. A nurse is caring for a client Keep the system below the level of the
who had a right lower lobec- client's waist
tomy and has a closed wa- -prevents backflow of fluids
ter-sealed chest drainage sys-
tem in place. Which action
should the nurse include as
part of the plan of care?

15. A client who is suspected of "Do you experience heartburn after a large
having a hiatal hernia is ad- meal?"
mitted to the hospital. Which -They need to eat small, frequent meals
question is important for the
nurse to ask?

16. A nurse discovers flames in Rescue the client
a wastebasket in the room of
a client who is a paraplegic.
What action should the nurse
take first?

17. A nurse is caring for a Every 2hours to check circulation
client whose arms are in re- -Manual restraints can decrease circulation
straints. When is it essential
for the nurse to remove the re-
straints?

18. A nurse is instructing an adult The client pulls the ear lobe down and back
client on the correct technique when administering the ear drops
for ear drop instillation. What -Ages 3 and up should be pulled up and
action by the client indicates outward
the need for further teaching?

19. A nurse obtains lab results for Prothrombin time of 32 seconds
a client prior to surgery. What -May be indicative of bleeding/clotting prob-
should the nurse report to the lems
physician? -Normal is 11-15 seconds

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