1. Which of the following clients is at a higher risk of developing oral health problems?
a. A pregnant client
b. A client with diabetes
c. A client rec... [Show More] eiving chemotherapy
d. Both b and c
2. Which nursing intervention is most appropriate to reduce environmental stimuli that may
cause discomfort for a client?
a. Loosen pressure dressings on wounds
b. Use assistance to pull a client up in bed
c. Check temperature of water used in a sponge bath
d. Position the client prone
3. A client has developed a vitamin C deficiency. Which of the following symptoms might the
nurse most likely see with this condition?
a. Cracks at the corners of the mouth
b. Altered mental status
c. Bleeding gums and loose teeth
d. Anorexia and diarrhea
4. Which of the following interventions should a nurse perform for a female client who is
incontinent with impaired skin integrity?
a. Turn the client at least every 8 hours
b. Apply lotion to the skin before a bath
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c. Provide perineal care after the client uses the bathroom
d. Bathe the client every 3 days
5. A nurse is caring for a client who died approximately one hour ago. The nurse notes that the
client's temperature has decreased in the last hour since his death. Which of the following
processes explains this phenomenon?
a. Rigor mortis
b. Postmortem decomposition
c. Algor mortis
d. Livor mortis
6. A nurse is calculating a client's intake and output. During the last shift, the client has had ½
cup of gelatin, a skinless chicken breast, 1 cup of green beans, and 300 cc of water. The client
has urinated 250 cc and has had 2 bowel movements. What is this client's intake and output for
this shift?
a. 420 cc intake, 250 cc output
b. 300 cc intake, 250 cc output
c. 550 cc intake, 550 cc output
d. 300 cc intake, 550 cc output
7. A nurse is caring for a client with ariboflavinosis. Which of the following foods should the
nurse serve this client?
a. Citrus fruits
b. Milk
c. Fish
d. Potatoes
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8. A client is taking a walk down the hallway when she suddenly realizes that she needs to use
the restroom. Although she tries to make it to the bathroom on time, she is incontinent of urine
before reaching the toilet. What type of incontinence does this situation represent?
a. Reflex incontinence
b. Urge incontinence
c. Total incontinence
d. Functional incontinence
9. Which of the following is an example of a positive effect of exercise on a client?
a. Decreased basal metabolic rate
b. Decreased venous return
c. Decreased work of breathing
d. Decreased gastric motility
10. You have taken the vital signs for your patient. They are normal for the patient. What should
you do next?
a. Report the vital signs to the doctor
b. Write the vital signs on a scrap paper
c. Call the family members
d. Document them on the graphic VS form
11. Penny Thornton has had a stroke, or CVA. She is having difficulty eating on her own. Soon,
she will be getting some assistive devices for eating meals.
Which healthcare worker will be getting Penny these assistive devices?
a. A physical therapist
b. A speech therapist
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c. A social worker
d. An occupational therapist
12. Which of the following is an example of emotional abuse?
a. A slap to the person's hand
b. Threatening the person
c. Ignoring and isolating a person
d. Leaving a patient soiled for hours
13. Which of the following is an example of emotional neglect?
a. A slap to the person's hand
b. Threatening the person
c. Ignoring and isolating a person
d. Leaving a patient soiled for hours
14. The duodenum:
a. is the third section of the small intestine, which leads immediately to the colon.
b. is the section of the stomach where the gall bladder delivers bile.
c. is the section of the small intestine where the pancreas delivers insulin.
d. None of the above.
15. The nurse is performing discharge teaching for Mrs. S after cardiac angioplasty. Her husband
is present for the teaching. While explaining the prescription for antiplatelet medication to use at
home, Mrs. S's husband states, "I don't think I can afford to refill that medication." What is the
most appropriate response of the nurse?
a. Don't worry, your insurance will cover it."
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b. I'll ask the physician if he can prescribe a medication that is more affordable."
c. You should apply for Medicare to see if they can help you."
d. This medication is essential for her care and should be given priority over all others that
she is taking."
16. The discharge planning team is discussing plans for the dismissal of a 16- year old admitted
for complications associated with asthma. The client's mother has not participated in any of the
discharge planning process, but has stated that she wants to be involved. Which of the following
reasons might prohibit this mother from participating in discharge planning?
a. The client is an emancipated minor
b. The mother has to work and is unavailable
c. The client has a job and a driver's license
d. The mother does not speak English
17. A nurse enters a client's room and finds her lying on the floor near the bathroom door. As the
nurse provides assistance, the client states, "I thought I could get up on my own." What
information must the nurse document in this situation?
a. A statement explaining the condition the client was found in, quoting the client's words
about the situation
b. An explanation of how the fall happened and when the physician was notified
c. An account of the conditions of the room that contributed to the client's fall
d. A description of the client's condition and the reasons why she should have had assistance
to the bathroom
18. Which of the following may be a cultural barrier that impacts a nurse's ability to provide care
or education to the client?
a. A nurse offers educational materials to a client that are written at an 8th grade reading
level
b. A Vietnamese woman wants to use steaming in addition to her prescription antibiotics
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c. A nurse uses pantomime to explain a procedure to a deaf client
d. A Native American client requests a healing ritual before he will consider surgery
19. Which of the following is an example of low health literacy skills?
a. A nurse's aide cannot calculate the correct IV rate for Ringer's lactate
b. A client cannot read an admission form to sign it
c. A nurse is unable to explain the dose, indications, side effects, and structural formula of
carbamazepine
d. A client does not understand the treatment for his cholecystectomy
20. A 39-year old woman presents for treatment of excessive vaginal bleeding after giving birth
to twins one week ago. Which nursing diagnosis is most appropriate in this situation?
a. Knowledge Deficit related to post-partum blood loss
b. Self-Care Deficit related to post-partum neglect
c. Fluid Volume Deficit related to post-partum hemorrhage
d. Body Image Disturbance related to body changes after delivery
21. Mr. K is admitted to the orthopedic unit one morning in preparation for a total knee
replacement to start in two hours. Which of the following is a priority topic to instruct this client
on admission?
a. The approximate length of the surgery
b. The type of anticoagulants that will be prescribed
c. The time of the next meal of solid food
d. The length of time until the client can return to work
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22. Which of the following is an example of the intervention phase of the individualized nursing
care plan for a client who receives a colostomy after a bowel resection?
a. Taking a health history and performing a physical exam prior to the procedure
b. Instructing the client about how to care for his colostomy stoma
c. Developing goals that state the client will ambulate three times a day
d. Determining that the client may need more support at home after dismissal [Show Less]
