Test Yourself Quiz 1
Question 1
0.33 / 1 pts
A client is being discharged home after a routine hip replacement surgery. The nurse is
instructing the
... [Show More] client on how to prevent postoperative complications. What statements by the
client would indicate the need for further teaching? Select all that apply.
“I should empty my bladder when I feel the urge.”
You Answered
“I should continue with my physical therapy and walking.”
Correct Answer
“I should drink plenty of liquids like iced tea or coffee.”
Correct!
“Limiting fiber is necessary to avoid diarrhea.”
Correct!
“Avoiding pain medication will prevent constipation.”
Question 2
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The nurse is caring for a Vietnamese client diagnosed with tuberculosis. The client speaks
limited English. What should the nurse do to ensure the client and family receives the most
accurate information? Select all that apply.
Correct Answer
Urge all family and close contact community members to seek and complete treatment to
enhance compliance.
Encourage the client and family to wash all dishes by hand to prevent the spread of infection.
You Answered
Provide written instructions in English for the client to reference.
Correct!
Encourage family members to obtain a tuberculosis skin test.
Correct!
Provide culturally sensitive education.
Question 3
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The nurse is observing the cardiac monitor of a client and notes this cardiac rhythm (refer to
figure). What is the initial nursing action?
Obtain a 12 lead electrocardiogram (ECG)
Notify the health care provider
Correct!
Check for a pulse
Begin cardiopulmonary resuscitation (CPR)
Rationale: Ventricular tachycardia can be stable or unstable depending on whether the client has
a pulse or not. In this case, assessing the client’s pulse is the initial action. Obtaining a 12 lead
ECG and notifying the health care provider may be necessary but are not initial actions. Initiating
CPR may be necessary of the ventricular tachycardia becomes unstable and cardiac arrest occurs.
Test-Taking Strategy: Note eh strategic word, initial. Use the steps of the nursing process and
recall that assessment is the first step and the first action to take. Review: Ventricular
Tachycardia
Level of Cognitive Ability: Analyzing
Client Need: Physiological Integrity
Integrated Process: Nursing Process/Implementation
Content Area: Adult Health: Cardiovascular
Priority Concepts: Clinical Judgment, Perfusion
HESI Concepts: Clinical Decision-Making/Clinical Judgment, Perfusion
Reference: Lewis, S., Dirksen, S., Heitkemper, M., & Bucher, L. (2014). Medical-surgical
nursing: Assessment and management of clinical problems (9th
ed., pp. 799-800). St. Louis: Mosby.
Question 4
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A mother brings her 9-month-old child to see the pediatrician and has concerns that the child
may have a developmental delay because the child cannot roll over yet. for the nurse should ask
the mother about which risk factors associated with a developmental delay? Select all that
apply.
Correct!
Environmental exposure to toxins
Age
Correct Answer
Income
Correct!
Chronic illness
Race
Correct!
Low birth weight
Question 5
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The nurse in a pediatric unit is planning the staff assignments for children with developmental
delays. When planning the assignment, the nurse decides to assign those children who have
social or emotional delays amongst different nurses. Which children should be assigned to
different nurses? Select all that apply.
A child with expressive language disorder
Correct!
A child with generalized anxiety disorder
You Answered
An infant with fetal alcohol syndrome
Correct!
A child with autism
You Answered
A child with attention deficit disorder
Rationale: A developmental delay is defined as not meeting the expected developmental level.
Social and emotional developmental delays include those affecting personality, emotion, or
behaviors. Two examples are autism, and generalized anxiety disorder. Attention deficit disorder
and fetal alcohol syndrome are classified as cognitive developmental delays, and expressive
language disorder is a communication developmental delay.
Test Taking Strategy: Focus on the subject, planning assignments and children with social and
emotional developmental delays. Use knowledge of the different types of developmental delays
to eliminate those options. Review: developmental delays
Level of Cognitive Ability: Creating
Client Need: Safe and Effective Care Environment
Integrated Process: Nursing Process/Planning
Content Area: Developmental Stages: Infancy to Adolescence
Priority Concepts: Care Coordination, Development
HESI Concepts: Care Coordination, Development
References: Giddens, J. (2013). Concepts for nursing practice. (p. 4, 8-9). St. Louis, MO:
Mosby.
Hockenberry, M, & Wilson, D. (2015). Wong’s nursing care of infants and children (10th ed. pp.
147-148). St Louis: Mosby.
McKinney, E., James, S., Murray, S., Nelson, K. & Ashwill, J. (2013). Maternal-child nursing
(4th
ed., pp. 1492-1493). St. Louis: Elsevier.
Question 6 [Show Less]