LEADERSHIP PN FINAL Exam Test Bank
A nurse enters the room of a client and finds the client lying on the floor. Which of the following actions should
... [Show More] the nurse take first?
A. Inspect the client for injuries
An RN on a medical-surgical unit is making assignments at the beginning of the shift. Which of the following tasks should the nurse delegate to the PN?
A. Obtain vital signs for a client who is 2 hr post procedure following a cardiac catheterization
A PN ending their shift reports to the RN that a newly hired AP has not calculated the intake and output for several clients. Which of the following actions should the RN take?
A. Ask the AP if they need assistance
A nurse manager is developing an orientation plan for newly licensed nurses. Which of the following information should the manager include in the plan? Select all that apply.
A. Skill proficiency
B. Assignment to a preceptor C. Computerized charting
D. Socialization into unit culture E. Facility policies and procedures
A nurse manager is providing information about the audit process to members of the nursing team. Which of the following information should the nurse manager include? Select all that apply.
A. A structure audit evaluates the setting and resources available to provide care B. An outcome audit evaluates the results of the nursing care provided
C. A root cause analysis is indicated when a sentinel event occurs D. After data collection is completed, it is compared to a benchmark
A nurse is participating in a quality improvement study of a procedure frequently performed on the unit. Which of the following information will provide data regarding the efficacy of the procedure?
A. Incidence of complications related to procedure
A nurse is hired to replace a staff member who has resigned. After working on the unit for several weeks, the nurse notices that the unit manager does not intervene when there is conflict between team members, even when it escalates. Which of the following conflict resolution strategies is the unit manager demonstrating?
A. Avoidance
A nurse is preparing a transfer a client who is 72 hr postoperative to a long-term facility. Which of the following information should the nurse include in the transfer report? Select all that apply.
A. Advanced directives status
B. Medical diagnosis
C. Need for specific equipment
A nurse is assisting with the discharge planning for a client. Which of the following actions should the nurse take?
A. Determine the client’s need for home medical equipment
B. Obtain printed instructions for medication self-administration
C. Provide the family with a list of community agencies that can provide assistance D. Discuss the importance of attending follow-up appointments.
A case manager is discussing critical pathways with a group of newly hired nurses. Which of the following statements indicates understanding?
A. “The pathway shows an estimate of the number of days the client will be hospitalized.”
A nurse who has just assumed the role of unit manager is examining the skills necessary for interprofessional collaboration. Which of the following actions support the nurse’s interprofessional collaboration? Select all that apply.
A. Recognize the knowledge and skills of each member of the team
B. Encourage the client and the family to participate in the team meeting C. Support team member requests for referral
A nurse is caring for a client who has chest pain. The client says, “I am going home immediately.” Which of the following actions should the nurse take? Select all that apply.
A. Document the client’s intent to leave the facility against medical advice B. Explain to the client the risks involved if they choose to leave
C. Ask the client to sign a form relinquishing responsibility of the facility
A nurse is discussing the disaster planning with the board members of a hospital. Which of the following individuals should the nurse expect to request extra supplies and staffing for the facility.
A. Medical command physician
DISASTER PREPAREDNESS#1 EMERGENCY NURSING #4
1. An emergency room nurse assesses a client who has been raped. With which health care team member should the nurse collaborate when planning this clients care?
c. Forensic nurse
2. The emergency department team is performing cardiopulmonary resuscitation on a client when the clients spouse arrives at the emergency department. Which action should the nurse take first?
b. Ask the spouse if he wishes to be present during the resuscitation.
3. An emergency room nurse is triaging victims of a multi-casualty event. Which client should receive care first?
c. A 26-year-old male who has pale, cool, clammy skin
4. While triaging clients in a crowded emergency department, a nurse assesses a client who presents with symptoms of tuberculosis. Which action should the nurse take first?
c. Transfer the client to a negative-pressure room.
5. A nurse is triaging clients in the emergency department (ED). Which client should the nurse prioritize to receive care first?
b. A 45-year-old reporting chest pain and diaphoresis
6. A nurse is evaluating levels and functions of trauma centers. Which function is appropriately paired with the level of the trauma center?
b. Level II Located within community hospitals and provides care to most injured clients
7. Emergency medical technicians arrive at the emergency department with an unresponsive client who has an oxygen mask in place. Which action should the nurse take first?
a. Assess that the client is breathing adequately.
8. A trauma client with multiple open wounds is brought to the emergency department in cardiac arrest. Which action should the nurse take prior to providing advanced cardiac life support?
b. Don personal protective equipment.
9. A nurse is triaging clients in the emergency department. Which client should be considered urgent? a.
c. A 75-year-old female with a cough and a temperature of 102 F
10. An emergency department nurse is caring for a client who has died from a suspected homicide. Which action should the nurse take?
d. Communicate the clients death to the family in a simple and concrete manner.
11. An emergency department (ED) case manager is consulted for a client who is homeless. Which intervention should the case manager provide?
c. Provide referrals to subsidized community-based health clinics.
12. An emergency department nurse is caring for a client who is homeless. Which action should the nurse take to gain the clients trust?
c. Listen to the clients concerns and needs.
13. A nurse is triaging clients in the emergency department. Which client should the nurse classify as nonurgent?
c. A 62-year-old with a simple fracture of the left arm
1. A nurse is caring for clients in a busy emergency department. Which actions should the nurse take to ensure client and staff safety? (Select all that apply.)
b. Use two identifiers before each intervention and before mediation administration.
c. Attempt de-escalation strategies for clients who demonstrate aggressive behaviors.
d. Search the belongings of clients with altered mental status to gain essential medical information.
2. An emergency department (ED) nurse is preparing to transfer a client to the trauma intensive care unit. Which information should the nurse include in the nurse- to-nurse hand-off report? (Select all that apply.) a. Mechanism of injury
b. Diagnostic test results
e. Isolation precautions
3. An emergency room nurse is caring for a trauma client. Which interventions should the nurse perform during the primary survey? (Select all that apply.)
b. Needle decompression
c. Initiating IV fluids
e. Endotracheal intubation
f. Removing wet clothing
4. The complex care provided during an emergency requires interdisciplinary collaboration. Which interdisciplinary team members are paired with the correct
responsibilities? (Select all that apply.)
a. Psychiatric crisis nurse Interacts with clients and families when sudden illness, serious injury, or death of a loved one may cause a crisis
e. Paramedic Provides prehospital advanced life support, including cardiac monitoring, advanced airway management, and medication administration
5. A nurse prepares to discharge an older adult client home from the emergency department (ED). Which actions should the nurse take to prevent future ED visits? (Select all that apply.)
d. Screen for depression and suicide. e. Complete a functional assessment.
AKI #4 CKD#1 NUTRITION FOR RENAL DISORDERS #1
1. The nurse is assessing a client with a diagnosis of pre-renal acute kidney injury (AKI). Which condition would the nurse expect to find in the clients recent history?
b. Myocardial infarction
2. A marathon runner comes into the clinic and states I have not urinated very much in the last few days. The nurse notes a heart rate of 110 beats/min and a blood pressure of 86/58 mm Hg. Which action by the nurse is the priority?
a. Give the client a bottle of water immediately.
3. A male client comes into the emergency department with a serum creatinine of 2.2 mg/dL and a blood urea nitrogen (BUN) of 24 mL/dL. What question should the nurse ask first when taking this clients history?
a. Have you been taking any aspirin, ibuprofen, or naproxen recently?
NOT: Client Needs Category: Physiological Integrity: Reduction of Risk Potential
4. A client is admitted with acute kidney injury (AKI) and a urine output of 2000 mL/day. What is the major concern of the nurse regarding this clients care?
b. Electrolyte and fluid imbalance
5. A client with acute kidney injury has a blood pressure of 76/55 mm Hg. The health care provider ordered 1000 mL of normal saline to be infused
over 1 hour to maintain perfusion. The client is starting to develop shortness of breath. What is the nurses priority action?
d. Slow down the normal saline infusion.
6. A client has a serum potassium level of 6.5 mmol/L, a serum creatinine level of 2 mg/dL, and a urine output of 350 mL/day. What is the best action by the nurse?
a. Place the client on a cardiac monitor immediately.
7. A client has just had a central line catheter placed that is specific for hemodialysis. What is the most appropriate action by the nurse?
d. Place a heparin or heparin/saline dwell after hemodialysis.
8. A client in the intensive care unit is started on continuous venovenous hemofiltration (CVVH). Which finding is the cause of immediate action by the nurse?
a. Blood pressure of 76/58 mm Hg
9. The nurse is caring for four clients with chronic kidney disease. Which client should the nurse assess first upon initial rounding?
b. Client with Kussmaul respirations
10. The charge nurse of the medical-surgical unit is making staff assignments. Which staff member should be assigned to a client with chronic kidney disease who is exhibiting a low-grade fever and a pericardial friction rub?
c. Registered nurse who was assigned the same client yesterday
11. A male client with chronic kidney disease (CKD) is refusing to take his medication and has missed two hemodialysis appointments. What is the best initial action for the nurse?
a. Discuss what the treatment regimen means to him.
12. A client is taking furosemide (Lasix) 40 mg/day for management of chronic kidney disease (CKD). To detect the positive effect of the medication, what action of the nurse is best?
a. Obtain daily weights of the client.
13. A client is diagnosed with chronic kidney disease (CKD). What is an ideal goal of treatment set by the nurse in the care plan to reduce the risk of pulmonary edema?
c. Maintaining a balanced intake and output
14. A client has a long history of hypertension. Which category of medications would the nurse expect to be ordered to avoid chronic kidney disease (CKD)?
d. Angiotensin-converting enzyme (ACE) inhibitor
15. A 70-kg adult with chronic renal failure is on a 40-g protein diet. The client has a reduced glomerular filtration rate and is not undergoing dialysis. Which result would give the nurse the most concern?
a. Albumin level of 2.5 g/dL
16. The nurse is teaching a client with chronic kidney disease (CKD) about the sodium restriction needed in the diet to prevent edema and hypertension. Which statement by the client indicates more teaching is needed?
a. I am thrilled that I can continue to eat fast food.
17. A client is placed on fluid restrictions because of chronic kidney disease (CKD). Which assessment finding would alert the nurse that the clients fluid balance is stable at this time?
c. No adventitious sounds in the lungs
18. A client with chronic kidney disease (CKD) is experiencing nausea, vomiting, visual changes, and anorexia. Which action by the nurse is best? a. Check the clients digoxin (Lanoxin) level.
19. The nurse is taking the vital signs of a client after hemodialysis. Blood pressure is 110/58 mm Hg, pulse 66 beats/min, and temperature is 99.8 F (37.6 C). What is the most appropriate action by the nurse?
c. Monitor the clients temperature.
20. The nurse is teaching the main principles of hemodialysis to a client with chronic kidney disease. Which statement by the client indicates a need for further teaching by the nurse?
b. Dialysis works by movement of wastes from lower to higher concentration.
21. The charge nurse is orienting a float nurse to an assigned client with an arteriovenous (AV) fistula for hemodialysis in her left arm. Which action by the float nurse would be considered unsafe?
c. Administering intravenous fluids through the AV fistula
22. A client is assessed by the nurse after a hemodialysis session. The nurse notes bleeding from the clients nose and around the intravenous catheter. What action by the nurse is the priority?
d. Prepare protamine sulfate for administration.
23. A nurse is caring for a client who is scheduled for a dose of cefazolin and vitamins at this time. Hemodialysis for this client is also scheduled in 60 minutes. Which action by the nurse is best?
d. Hold all medications since both cefazolin and vitamins are dialyzable.
24. A client is having a peritoneal dialysis treatment. The nurse notes an opaque color to the effluent. What is the priority action by the nurse?
b. Take a sample of the effluent and send to the laboratory.
25. The nurse is teaching a client how to increase the flow of dialysate into the peritoneal cavity during dialysis. Which statement by the client demonstrates a correct understanding of the teaching?
c. I should take a stool softener every morning to avoid constipation.
26. A client with chronic kidney disease states, I feel chained to the hemodialysis machine. What is the nurses best response to the clients statement?
d. Tell me more about your feelings regarding hemodialysis treatment.
27. A client is recovering from a kidney transplant. The clients urine output was 1500 mL over the last 12-hour period since transplantation. What is the priority assessment by the nurse?
b. Taking blood pressure
28. A nurse reviews these laboratory values of a client who returned from kidney transplantation 12 hours ago: Sodium 136 mEq/L
Potassium 5 mEq/L
Blood urea nitrogen (BUN) 44 mg/dL
Serum creatinine 2.5 mg/dL
What initial intervention would the nurse anticipate?
c. Increase the dose of immunosuppression.
MULTIPLE RESPONSE
1. The nurse is caring for five clients on the medical-surgical unit. Which clients would the nurse consider to be at risk for post-renal acute kidney injury (AKI)? (Select all that apply.)
a. Man with prostate cancer
b. Woman with blood clots in the urinary tract
c. Client with ureterolithiasis
2. A nurse is caring for a postoperative 70-kg client who had major blood loss during surgery. Which findings by the nurse should prompt immediate action to prevent acute kidney injury? (Select all that apply.)
a. Urine output of 100 mL in 4 hours
c. Large amount of sediment in the urine d. Amber, odorless urine e. Blood pressure of 90/60 mm Hg
3. A client is hospitalized in the oliguric phase of acute kidney injury (AKI) and is receiving tube feedings. The nurse is teaching the clients spouse about the kidney-specific formulation for the enteral solution compared to standard formulas. What components should be discussed in the teaching plan? (Select all that apply.)
a. Lower sodium c. Lower potassium
e. Higher calories
4. The nurse is teaching a client with diabetes mellitus how to prevent or delay chronic kidney disease (CKD). Which client statements indicate a lack of understanding of the teaching? (Select all that apply.)
b. My weight should be maintained at a body mass index of 30. d. I can continue to take an aspirin every 4 to 8 hours for my pain.
e. I really only need to drink a couple of glasses of water each day.
5. A nurse is giving discharge instructions to a client recently diagnosed with chronic kidney disease (CKD). Which statements made by the client indicate a correct understanding of the teaching? (Select all that apply.)
b. I need to ask for an antibiotic when scheduling a dental appointment. c. Ill need to check my blood sugar often to prevent hypoglycemia.
d. The dose of my pain medication may have to be adjusted. e. I should watch for bleeding when taking my anticoagulants.
6. A client is undergoing hemodialysis. The clients blood pressure at the beginning of the procedure was 136/88 mm Hg, and now it is 110/54 mm Hg. [Show Less]