1. Which of these instructions should a nurse include
in the teaching plan for a client who had removal of a
cataract in the left eye?
2. A client
... [Show More] vomits during a continuous nasogastric tube
feeding. A nurse should stop the feeding and take
which of these actions?
3. Which of these actions best demonstrates cultural
sensitivity by a nurse?.
4. Which of these manifestations should a nurse expect
to observe in a 3-month-old infant who is diagnosed
with dehydration?
5. When assessing a client's risk of developing nosocomial infection, a nurse plans to determine potential
entry portals, which include:
6. A client who is on the inpatient psychiatric unit has a
history of violence. Which of these actions should a
nurse take if the client is agitated?
7. Which of these measures should a nurse include
when planning care for a school-aged child during a
sickle cell crisis episode?
8. Which of these instructions should a nurse include
in the plan of care for a 32-week gestation client who
had an amniocentesis today?
9. An adolescent has a nursing diagnosis of fatigue
related to inadequate intake of iron-rich foods. Selec-
"Take the prescribed stool softener to avoid increasing intraocular pressure."
Check the residual
volume.
The nurse asks
clients about their
beliefs and practices toward pregnancy.
Tachycardia.
the urinary meatus.
Encourage the
client to verbalize
feelings.
Providing pain relief.
"Call the clinic if you experience any abdominal cramps."
Beefburger with
cheese.
3 / 19
tion of which of these lunches by the client indicates a
correct understanding of foods high in iron content?
10. A client has been admitted with acute pancreatitis.
Which of these laboratory test results supports this
diagnosis?
11. Which of these manifestations, if assessed in a
client who is two-hours postoperative after abdominal surgery, should a nurse report immediately?
12. Which of these observations of a student nurse's
behavior while interacting with a client who is crying indicates a correct understanding of therapeutic
communication?
13. Which of these actions should a nurse take initially
if a client who is diagnosed with diabetes mellitus
develops tremors and ataxia?
14. An elderly client is at increased risk of developing
drug toxicity to prescribed medications due to declining hepatic and renal functioning.Which of these
strategies should a nurse plan to decrease this risk?
15. A client has persistent paranoid delusions that the
food on the unit is poisoned. Which of these measures should a nurse include in the client's care plan?
16. Thrombophlebitis is a complication that may result
due to surgery.Which of these actions should a nurse
take in the operating room to prevent this complication from occurring?
17. When discussing weigh gain during pregnancy, a
nurse should recommend that the total weight gain
for a pregnant client who is at ideal body weight for
her height is:
Elevated serum
amylase level.
Vomiting and a
pulse rate of
106/minute.
The student sits
quietly next to the
client.
Measure the
client's blood sugar level.
Increasing the
time interval between medication
doses.
Allowing the client
to eat food from
sealed containers.
Apply sequential
compression devices.
25 to 35 pounds.
18.18.
4 / 19
Which of these manifestations, if reported by a client
who is 10-weeks-pregnant, supports the diagnosis of
ruptured tubal pregnancy.
19. Which of these assignments, if made by a nurse to
a nursing assistant, indicates that the nurse needs
additional instructions regarding the principles of
delegation?
20. A client has the following order for regular insulin
(Humulin R) on a sliding scale:
Blood sugar 150-180 mg: Give 2 units regular insulin
Blood sugar 181-200 mg: Give 4 units regular insulin
Blood sugar 201-220 mg: Give 6 units of regular insulin
Blood sugar above 220 mg: Call MD
At 11 A.M., a nurse obtains a finger stick glucose
of 198 mg.The only syringe is a three milliliter one.
Regular insulin is available as 100 units per milliliter.
How many milliliters should the nurse administer?
21. Which of these nursing diagnosis is the priority for a
client who is one-hour postoperative after extensive
abdominal surgery?
22. A nurse should recognize that which of these occupations increases a person's risk of developing
hepatitis B?
23. Which of these assessments is the priority for a client
who sustained second-degree burns of the face and
neck?
24. A nurse should place a child who is two hours
post-tonsillectomy and adenoidectomy in which of
these positions?
Sharp unilateral
abdominal pain.
"Please bathe the
client in room
10, administer a
back rub, and then
evaluate if the
back rub eased
the client's discomfort."
0.04
Risk for ineffective
airway clearance.
Hemodialysis
nurse.
Respiratory status.
Side-lying.
5 / 19
25. Which of these instructions should a nurse include in
the discharge teaching for a client who has diabetes
mellitus?
26. A nurse inadvertently administers an incorrect medication to a client. Which of these actions should the
nurse take first?
27. An elderly client who is receiving a blood transfusion develops a rapid bounding pulse and an elevated blood pressure. Which of these actions should a
nurse take?
28. When caring for a client who has hepatitis B, a nurse
should wear:
29. Which of these outcome criteria is appropriate for
a client who has a nursing diagnosis of ineffective
airway clearance?
30. A doctor prescribes liquid oral iron medication for
a 4-year-old child.Which of these questions should
a nurse ask the child's mother to determine if the
medication is being administered correctly?
31. Which of these assessment findings, if present in a
4-month-old infant who has severe diarrhea, should
a nurse recognize as suggestive that the infant is
dehydrated?
32. Which of these instructions should be included in the
teaching plan for the parents of a 10-month-old infant
who is admitted to the hospital for failure to thrive?
33. When a newborn is 48 hours old, a nurse notes that
the child is jaundiced.The nurse should recognize
"Apply lotion to
your feet each
day."
Assess the client.
Stop the transfusion.
gloves when removing the intravenous cannula.
Clear lung sounds
on auscultation.
"Are you using a
straw to administer the medicine?"
Decreased urine
output.
Encourage the
mother to feed the
infant slowly in
a quiet environment.
Liver imma1. Which of these instructions should a nurse include
in the teaching plan for a client who had removal of a
cataract in the left eye?
2. A client vomits during a continuous nasogastric tube
feeding. A nurse should stop the feeding and take
which of these actions?
3. Which of these actions best demonstrates cultural
sensitivity by a nurse?.
4. Which of these manifestations should a nurse expect
to observe in a 3-month-old infant who is diagnosed
with dehydration?
5. When assessing a client's risk of developing nosocomial infection, a nurse plans to determine potential
entry portals, which include:
6. A client who is on the inpatient psychiatric unit has a
history of violence. Which of these actions should a
nurse take if the client is agitated?
7. Which of these measures should a nurse include
when planning care for a school-aged child during a
sickle cell crisis episode?
8. Which of these instructions should a nurse include
in the plan of care for a 32-week gestation client who
had an amniocentesis today?
9. An adolescent has a nursing diagnosis of fatigue
related to inadequate intake of iron-rich foods. Selec-
"Take the prescribed stool softener to avoid increasing intraocular pressure."
Check the residual
volume.
The nurse asks
clients about their
beliefs and practices toward pregnancy.
Tachycardia.
the urinary meatus.
Encourage the
client to verbalize
feelings.
Providing pain relief.
"Call the clinic if you experience any abdominal cramps."
Beefburger with
cheese.
3 / 19
tion of which of these lunches by the client indicates a
correct understanding of foods high in iron content?
10. A client has been admitted with acute pancreatitis.
Which of these laboratory test results supports this
diagnosis?
11. Which of these manifestations, if assessed in a
client who is two-hours postoperative after abdominal surgery, should a nurse report immediately?
12. Which of these observations of a student nurse's
behavior while interacting with a client who is crying indicates a correct understanding of therapeutic
communication?
13. Which of these actions should a nurse take initially
if a client who is diagnosed with diabetes mellitus
develops tremors and ataxia?
14. An elderly client is at increased risk of developing
drug toxicity to prescribed medications due to declining hepatic and renal functioning.Which of these
strategies should a nurse plan to decrease this risk?
15. A client has persistent paranoid delusions that the
food on the unit is poisoned. Which of these measures should a nurse include in the client's care plan?
16. Thrombophlebitis is a complication that may result
due to surgery.Which of these actions should a nurse
take in the operating room to prevent this complication from occurring?
17. When discussing weigh gain during pregnancy, a
nurse should recommend that the total weight gain
for a pregnant client who is at ideal body weight for
her height is:
Elevated serum
amylase level.
Vomiting and a
pulse rate of
106/minute.
The student sits
quietly next to the
client.
Measure the
client's blood sugar level.
Increasing the
time interval between medication
doses.
Allowing the client
to eat food from
sealed containers.
Apply sequential
compression devices.
25 to 35 pounds.
18.18.
4 / 19
Which of these manifestations, if reported by a client
who is 10-weeks-pregnant, supports the diagnosis of
ruptured tubal pregnancy.
19. Which of these assignments, if made by a nurse to
a nursing assistant, indicates that the nurse needs
additional instructions regarding the principles of
delegation?
20. A client has the following order for regular insulin
(Humulin R) on a sliding scale:
Blood sugar 150-180 mg: Give 2 units regular insulin
Blood sugar 181-200 mg: Give 4 units regular insulin
Blood sugar 201-220 mg: Give 6 units of regular insulin
Blood sugar above 220 mg: Call MD
At 11 A.M., a nurse obtains a finger stick glucose
of 198 mg.The only syringe is a three milliliter one.
Regular insulin is available as 100 units per milliliter.
How many milliliters should the nurse administer?
21. Which of these nursing diagnosis is the priority for a
client who is one-hour postoperative after extensive
abdominal surgery?
22. A nurse should recognize that which of these occupations increases a person's risk of developing
hepatitis B?
23. Which of these assessments is the priority for a client
who sustained second-degree burns of the face and
neck?
24. A nurse should place a child who is two hours
post-tonsillectomy and adenoidectomy in which of
these positions?
Sharp unilateral
abdominal pain.
"Please bathe the
client in room
10, administer a
back rub, and then
evaluate if the
back rub eased
the client's discomfort."
0.04
Risk for ineffective
airway clearance.
Hemodialysis
nurse.
Respiratory status.
Side-lying.
5 / 19
25. Which of these instructions should a nurse include in
the discharge teaching for a client who has diabetes
mellitus?
26. A nurse inadvertently administers an incorrect medication to a client. Which of these actions should the
nurse take first?
27. An elderly client who is receiving a blood transfusion develops a rapid bounding pulse and an elevated blood pressure. Which of these actions should a
nurse take?
28. When caring for a client who has hepatitis B, a nurse
should wear:
29. Which of these outcome criteria is appropriate for
a client who has a nursing diagnosis of ineffective
airway clearance?
30. A doctor prescribes liquid oral iron medication for
a 4-year-old child.Which of these questions should
a nurse ask the child's mother to determine if the
medication is being administered correctly?
31. Which of these assessment findings, if present in a
4-month-old infant who has severe diarrhea, should
a nurse recognize as suggestive that the infant is
dehydrated?
32. Which of these instructions should be included in the
teaching plan for the parents of a 10-month-old infant
who is admitted to the hospital for failure to thrive?
33. When a newborn is 48 hours old, a nurse notes that
the child is jaundiced.The nurse should recognize
"Apply lot [Show Less]