Unitek Term 2 Finals A Practice Set
A nurse is caring for a pt who is receiving continuous NGT feedings. Nurse listens to
bowel sounds. Which of the following actions should the nurse take? (Has clip for you to
listen to) - ANS-Decrease the rate of feeding
A nurse is preparing to administer oxygen to a pt who has heart failure and is having
severe difficulty breathing. Which of the following oxygen delivery equipment should the
nurse select to provide highest concentration oxygen to the client? -
ANS-Non-rebreather mask
A charge nurse who sells smoke, enters the visitor restroom, and sees flames in the
trash can. What is the sequence of actions that the nurse should take? - ANS-1.
Evacuate Clients from area
2. Pull lever on alarm box
3. Close the fire doors
4. Use fire extinguisher
A nurse is caring for a pt who has metastatic cancer and practices Catholicism. The
client nurse asks the nurse to discuss the afterlife with them. Which of the following
statements by the nurse assists in meeting the clients spiritual needs? - ANS-"Tell me
what the afterlife means to you"
A nurse is reinforcing teaching with a client about the prevention of stress injuries.
Which of the following instruction should the nurse include? - ANS-"When lifting a heavy
object, keep it close to your body"
A nurse is reinforcing teaching with a client about the use of crutches. Which of the
following actions but the client indicated an understanding of teaching? - ANS-The client
advances the unaffected leg first while climbing stairs.
A client who has advanced cancer tells the nurse they have a difficult time talking to
anyone about the illness. Which of the following actions should the nurse take to
encourage therapeutic communication? - ANS-Let the client know, as their nurse, you
are available to listen
A nurse is preparing to to remove client peripheral IV catheter. After hand hygiene and
applying don clean gloves, which of the following actions should the nurse take first? -
ANS-clamp the infusion tubing
, a nurse is contributing to the plan of care for a client who has a positive throat culture
for streptococci. Which of the following interventions should the nurse recommend to be
included in the plan of care? - ANS-Ensure client wears a surgical mask during
transportation throughout facility.
A nurse is caring for a pt who has just died and practiced his Islamic faith. Which of the
following cultural practices should the nurse expect? - ANS-The clients face should be
turned towards Mecca.
A nurse is preparing to transport a client to an acute care facility to a long term care
facility. Which of the following information should the nurse plan to include in the
transfer report? - ANS-Resolved health conditions
A nurse is contributing to the plan of care for a client who has a prescription for elastic
bandages to the lower extremities. Which of the following actions should the nurse
recommend for the plan of care? - ANS-Compare the clients pedal pulses bilaterally
every 4 hours
A nurse is taking notes of client information on a piece of paper while receiving the
report. Which of the following actions should the nurse take while disposing the paper? -
ANS-Shred the paper in a secured container
A nurse is assisting with care of a recently deceased pt. Which of the following actions
should the nurse take prior to the family views the body? - ANS-Clean soiled areas of
the body
A nurse is preparing to administer an enteral feeding tube to a client who has a NGT in
place. Which of the following should the nurse do to verify correct placement of the NG
Tube? - ANS-Check the pH of the gastric aspirate A nurse i
A nurse is caring for a pt who has a terminal illness and the pt family member asks why
the pt mouth is continually open. Which of the following should the nurse respond? -
ANS-The reduced muscle tone has relaxed the jaw muscles.
A nurse is caring for a postoperative client who is at risk for thrombus formation. Which
of the following interventions should the nurse delegate to an assistive personal (AP)? -
ANS-Apply thromboembolic stockings
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