• A nurse is caring for a client who has a tension pneumothorax. Which of the followingmanifestations should the nurse expect?
A. Paradoxical chest
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B. Bilateral crackles
C. Asymmetry of the chest
D. Blood-tinged sputum
• A nurse is caring for a client who is at 11 weeks of gestation. Which of the followingimmunizations should the nurse recommend?
A. Human papillomavirus B. Influenza
C. Measles, mumps and rubella
D. Varicella
• A nurse in a pediatric clinic is reviewing the laboratory test results of a school-age child.Which of the following findings should the nurse report to the provider?
A. Hct 40%
B. Hgb 12.5 g/dL
C. Platelets 250,000/mm D. WBC 14,000/mm
• A nurse is assessing a client who is receiving packed RBCs. Which of the followingindicates fluid overload?
A. Low-back pain
B. Thready pulse
C. Hypotension D. Dyspnea
• A nurse is preparing to administer betamethasone to a client who is 25 weeks of gestation and has preterm labor. Which of the following findings should the nurse identify as an adverse effect of this medication?
A. Hyperglycemia
B. Uterine contractions
C. Proteinuria
D. Hypotension
• A nurse is assessing a client who has received an antibiotic. The nurse should identify which of the following findings as an indication of a possible allergic reaction to the medication?
A. Bradycardia
B. Headache
C. Joint pain
D. Hypotension
• A nurse on a mental health unit is caring for a client who has schizophrenia and is experiencing auditory hallucinations telling them to hurt others. The client is refusing to take anti-psychotic medication. Which of the following responses should the nurse make?
A. “You should plan to take this medication for a few weeks.”
B. “You will regret it if you do not take this medication.”
C. “This medication will help you respond to the voices.
D. “This medication will help you stop the voices you are hearing.”
• A nurse is providing care for a patient who has depression and is to have electroconvulsive therapy. Which of the following conditions should the nurse identify as increasing the client’s risk for complications?
A. Hyperthyroidism
B. Renal calculi
C. Diabetes mellitus
D. Cardiac dysrhythmias
• 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/mm
B. Platelets 150,000/mm
C. Aspartate aminotransferase 10 units/L
D. Erythrocytesedimentation 75 mm/hr
• A nurse is preparing to obtain a blood sample from a client who has a central venous catheter. Whichof the following actions should the nurse take? (SATA)
B. Access the catheter using a large bore needle.
E. Apply force when resistance is met while flushing the catheter.
• A nurse is preparing to perform a dressing change on a preschooler. Which of the following actions should the nurse take to prepare the child for the procedure?
A. Explain in simple terms how the procedure will affect the child.
B. Ask the parents to wait outside the room during the procedure.
C. Limit teaching sessions about the procedure to 20 min.
D. Instruct the child in deep-breathing methods prior to the procedure. [Show Less]