A nurse is planning on care for a client who is recovering from an acute myocardial
infarction that occurred 3 days ago. Which of the following
... [Show More] instructions should the nurse
include?
A. Perform an ECG every 12 hr.
B. Place the client in a supine position while resting.
C. Draw a troponin level every 4hr.
D. Obtain a cardiac rehabilitation consultation. - answers-D. Obtain a cardiac
rehabilitation consultation.
The nurse is reviewing the medical record of a client who is requesting combination oral
contraceptives. Which of the following conditions in the client's history is a contradiction
to the use of oral contraceptives?
A. Hyperthyroidism.
B. Thrombophlebitis.
C. Diverticulosis.
D. Hypocalcemia - answers-B. Thrombophlebitis.
A nurse is caring for a client who request the creation of a living will. Which of the
following actions should the nurse take?
A. Schedule a meeting between the hospital ethics committee and the client.
B. Evaluate the client's understanding of life-sustaining measures.
C. Determine the client's preferences about post mortem care.
D. Request a conference with the client's family. - answers-B. Evaluate the client's
understanding of life-sustaining measures.
A nurse is caring for an adolescent who has sickle-cell anemia. Which of the following
manifestations indicates acute chest syndrome and should be immediately reported to
the provider?
A. Substernal retractions.
B. Hematuria.
C. Temperature 37.9 C (100.2 F).
D. Sneezing. - answers-A. Substernal retractions.
A nurse is preforming a gastric lavage for a client who has upper gastrointestinal
bleeding. Which of the .following action should the nurse take?
A. Instill 500 ml of solution through the NG tube.
B. Insert a large-bore NG tube.
C. Use a cold irrigation solution.
D. Instruct the client to lie on his right side. - answers-B. Insert a large-bore NG tube.
A nurse is providing care for a client who is in the advance stage of amyotrophic lateral
sclerosis. (ALS). Which of the following referrals is the nurse's priority?
A. Psychologist.
B. Social worker.
C. Occupational therapist.
D. Speech-language pathologist. - answers-D. Speech-language pathologist.
A nurse is reviewing the laboratory results of a client who has rheumatoid arthritis.
Which of the following findings should the nurse report to the provider?
A. WBC count 8,000/mm3.
B. Platelets 150,000/mm3.
C. Aspartate aminotransferase 10 units/L.
D. Erythrocyte sedimentation rate 75 mm/hr - answers-D. Erythrocyte sedimentation rate
75 mm/hr
A nurse is caring for a client who has generalized petechiae and ecchymoses. The
nurse should expect a prescription for which of the following laboratory tests?
A. Platelet count.
B. Potassium level.
C. Creatine clearance.
D. Pre-albumin. - answers-A. Platelet count.
A nurse is caring for a client following application of a cast. Which of the following
actions should the nurse take first?
A. Place an ice pack over the cast.
B. Palpate the pulse distal to the cast.
C. Teach the client to keep the cast clean and dry.
D. Position the casted extremity on a pillow. - answers-B. Palpate the pulse distal to the
cast.
A nurse is caring for a client who has vision loss. Which of the following actions should
the nurse take? (Select all that apply)
A. Keep objects in the client's room in the same place.
B. Ensure there is high-wattage lighting in the client's room.
C. Approach the client from the side.
D. Allow extra time for the client to perform tasks.
E. Touch the client gently to announce presence. - answers-A. Keep objects in the
client's room in the same place.
B. Ensure there is high-wattage lighting in the client's room.
D. Allow extra time for the client to perform tasks.
A nurse is caring for a client who is newly diagnosed with pancreatic cancer and has
questions about the disease. To research the nurse should identify that which of the
following electronic database has the most comprehensive collection of nursing (Unable
to read) articles?
A. MEDLINE
B. CINAHL.
C. ProQuest.
D. Health Source. - answers-B. CINAHL.
A nurse in an emergency department is assessing newly admitted client who is
experiencing drooling and hoarseness following a burn injury. Which of the following
should actions should the nurse take first?
A. Obtain a baseline ECG.
B. Obtain a blood specimen for ABG analysis.
C. Insert an 18-gauge IV catheter.
D. Administer 100% humidified oxygen. - answers-D. Administer 100% humidified
oxygen.
A nurse is planning care for a client who has unilateral paralysis and dysphagia following
a right hemispheric stroke. Which of the following interventions should the nurse include
in the plan?
A. Place food on the left side of the client's mouth when he is ready to eat.
B. Provide total care in performing the client's ADLs.
C. Maintain the client on bed rest.
D. Place the client's left arm on a pillow while he is sitting. - answers-D. Place the client's
left arm on a pillow while he is sitting.
A nurse is caring for a client who is in a seclusion room following violent behavior. The
client continues to display aggressive behavior. Which of the following actions should
the nurse take?
A. Confront the client about this behavior.
B. Express sympathy for the client's situation.
C. Speak assertively to the client.
D. Stand within 30 cm (1 ft) of the client when speaking with them. - answers-A.
Confront the client about this behavior.
A nurse is caring for a client who is receiving brachytherapy for treatment of prostate
cancer. Which of the following actions should the nurse take?
A. Cleanse equipment before removal from the client's room.
B. Limit the client's visitors to 30 min per day.
C. Discard the client's linens in a double bag. D. Discard the radioactive source in a
biohazard bag - answers-B. Limit the client's visitors to 30 min per day.
A nurse is assessing a client who has left-sided heart failure. Which of the following
should the nurse identify as a manifestation of pulmonary congestion?
A. Frothy, pink sputum.
B. Jugular vein distention.
C. Weight gain.
D..Bradypnea - answers-A
A nurse is caring for a client who is in labor and requires augmentation of labor. Which
of the following conditions should the nurse recognize as a contraindication to the use of
oxytocin.
A. Diabetes mellitus.
B. Shoulder presentation.
C. Post term with oligohydramnios.
D. Chorioamnionitis - answers-C. Post term with oligohydramnios [Show Less]