A nurse is assessing an infant who has water intoxication. Which of the following findings should the nurse expect?
bounding pulse
A nurse is discussing
... [Show More] the z-track administration of hydroxyzine with a newly licensed nurse. Which of the following statements indicates the newly licensed nurse understands the purpose of the technique
a. This technique decreases the risk of subcutaneous infiltration
1. A nurse is creating a plan of care for a client who has anorexia nervosa. Which of the following interventions should the nurse include in the plan?
a. Monitor the client for 1 hr after meals
A nurse notices smoke coming from a client's room and discovers a fire in the wastebasket. After moving the client to safety, which of the followings is the priority action?
a. Close the fire door on the unit
A nurse is assessing a client who has delirium due to a febrile illness. Which of the following findings should the nurse expect?
a. Hallucinations
A nurse is caring for a client following an open colectomy. Which of the following findings places the client at risk for delayed wound healing?
hyperemesis
A home health nurse is reviewing treatment goals with a client who has diabetes mellitus. The nurse should evaluate which of the following laboratory tests to determine effective long-term management of blood glucose levels?
A1C
A nurse is caring for a client who has neutropenia due to HIV. Which of the following precautions should the nurse take while caring for this client?
a. Use a dedicated stethoscope
1. A nurse is caring for a client who reports difficulty falling asleep at night. Which of the following actions should the nurse take?
Tell the client to avoid drinking fluids 1 hr before bedtime
1. A nurse is planning care for a newborn who has hyperbilirubinemia and is to receive phototherapy. Which of the following interventions should the nurse include?
a. Place the newborn 45 cm from the light source
1. A nurse is planning care for a client who has schizophrenia and is having difficulty expressing their feelings. Which of the following referrals should the nurse make?
social worker
1. A nurse is caring for a client who has heart failure and has started taking a loop diuretic. Which of the following findings indicates the client is experiencing an adverse effect of the medication
decreased reflexes
1. At the start of an evening shift on a cardiac unit, a licensed practical nurse brings the nurse a list of client reports. Which of the following client reports should the nurse assess first?
indigestion
1. A nurse is caring for a client who has just returned to the unit following a bronchoscopy. Which of the following actions by the assistive personnel requires the nurse to intervene?
offer oral fluids to the client
1. A nurse on a medical unit has just received change-of-shift report. Which of the following clients should the nurse assess first?
a. A 68 year old client who had a myocardial infarction 2 days ago and reports chest pain as a 4 on a scale of 0 to 10
1. A nurse is assessing a client prior to performing a blood draw. The nurse should identify that an allergy to which of the following food can indicate that the client has an allergy to latex?
avocados
1. A nurse is preparing to witness a client's signature on an informed consent for a total knee arthroplasty. Which of the following client statements indicates the nurse should contact the surgeon?
a. I am thankful there are no serious complications from this type of surgery
1. A nurse is admitting a client who has antisocial personality disorder. Which of the following client behaviors should the nurse identify as consistent with this disorder?
a. Uses others for personal gain
1. A nurse is teaching the parent of a school-age child who has scabies about the application of permethrin 5% cream. The nurse should include which of the following as a potential adverse effect of the medication?
burning
1. A nurse is teaching a client who has a new prescription for digoxin. Which of the following statements should the nurse include in the teaching?
muscle weakness
1. A nurse is planning teaching for a client who is at 10 weeks of gestation and has a history of urinary tract infections. Which of the following information should the nurse plan to include in the teaching about UTI prevention?
a. Empty the bladder before and after intercourse
1. A nurse is providing discharge teaching to a client who is postpartum and plans to breastfeed. Which of the following should the nurse recommend the client increase in their diet during lactation?
a. Calcium
1. A nurse is providing teaching about preventing mastitis to a client who is postpartum and breastfeeding her newborn. Which of the following instructions should the nurse include?
a. Try to have your baby empty your breasts with each feeding."
1. A nurse is caring for a client who reports chest pain. Which of the following findings indicates myocardial damage?
a. Troponin I 1.8 ng/mL
1. A nurse is providing teaching about car seat safety to the parent of a term newborn. Which of the following statements by the parent indicates an understanding of the teaching?
a. "I should place my baby's car seat rear-facing until 6 months of age."
1. A nurse is performing high-frequency chest compressions using a mechanical chest compression device for a child who has cystic fibrosis. Which of the following findings indicates the treatment has been effective?
a. The child has increased sputum production
1. A nurse is caring for a client following a possible exposure to anthrax. Which of the following actions should the nurse take?
antitoxin
1. A nurse is caring for a client who has a newly implanted sealed internal radiation device to treat cervical cancer. Which of the following is an appropriate action for the nurse to take?
a. Keep a 3 foot distance from the radiation implant
A nurse is admitting a client to the medical-surgical unit. Which of the following actions should the nurse take first?
a. Observe the client's level of mobility
1. A nurse at a public health clinic is caring for a group of clients. Which of the following should the nurse identify as a reportable diagnosis to the CDC?
hep A
1. A charge nurse is evaluating the time management skills of a newly licensed nurse. Which of the following actions should the charge nurse identify as an effective time management skill?
a. Completes activities for one client before moving to the next client
1. A nurse is caring for a client who has opioid use disorder and is experiencing withdrawal. Which of the following findings should the nurse expect?
a. Hyperreflexia
1. A nurse is planning to perform wound irrigation for a client who has an open secondary wound. When creating a sterile field, which of the following actions should the nurse take?
a. Hold the bottle of sterile solution with the palm over the label while pouring
1. A nurse is planning care for a client who has a sealed radiation implant and is to remain in the hospital for 1 week. Which of the following should the nurse include in the plan of care?
a. Wear a dosimeter film badge while in the client's room
1. A nurse is assessing a client who was brought to the emergency department by his adult child. The client has visible contusions on all four extremities. Which of the following actions should the nurse take?
a. Report the incident to Adult Protective Services
1. A nurse is assessing a client who is postoperative following abdominal surgery. The client states, "I feel like my incision ripped open." The nurse notes dehiscence of the incision. Which of the following actions should the nurse take?
a. Extend the client's legs above heart level
1. A nurse is providing teaching to the parent of a 6 month old infant who is teething and having difficulty sleeping. Which of the following instructions should the nurse include?
a. Administer acetaminophen drops to your child before bedtime
1. A nurse is providing dietary teaching to a client who has an increased cholesterol level. Which of the following foods should the nurse recommend?
egg whites
1. A home health nurse is teaching a guardian about administering tube feedings to their 3 month old infant. Which of the following information should the nurse include in the teaching?
a. Allow the infant to suck on a pacifier during feedings
1. A charge nurse is creating assignments for the next shift for several nurses and one of the nurses is pregnant. Which of the following clients should the charge nurse assign to a nurse who is not pregnant?
a. A 60 year old client who is recovering from shingles
1. A nurse is assessing a client who has a magnesium level of 4.4 mEq/L. Which of the following findings should the nurse expect?
a. Hypotension
1. A nurse is reviewing the medical record of a client who has a new prescription for gentamicin. The nurse should identify that concurrent use with which of the following current medications can increase the client's risk for ototoxicity?
a. Furosemide
1. A nurse is performing triage following a natural disaster. Which of the following clients should the nurse identify as the highest priority to receive care?
a. A client who has a traumatic arm amputation
1. A nurse is assessing a client who is gravida 2, para 1. The client is at 41 weeks of gestation and is receiving oxytocin for the augmentation of labor. The nurse should decrease the infusion rate for which of the following findings?
a. Contractions occur every 90 seocnds
1. A nurse is caring for a client who has constricted pupils, delayed reflexes, and decreased blood pressure. The nurse should identify that these findings are potential manifestations of which of the following?
a. Opioid intoxication [Show Less]