NUR 4120 Kaplan Diag A MS3. Questions And Answers. Latest 2021/22.The nurse cares for the client diagnosed as being in the manic phase of bipolar
... [Show More] disorder. Which behavior indicates to
the nurse the client condition is improving?
a. The client offers suggestions to other clients on the unit
b. The client begins to write a book about life
c. The client sits and eats with other clients on unit
d. The client talks with other clients a group meeting
2. The health care provider orders a continuous intravenous aminophylline infusion for a two year old client. It is most
important for the nurse to intervene for which situation?
a. The client heart rate is 100 bpm
b. The clients blood pressure is 100/60 mmHg
c. The clients serum theophylline level is 25 mcg/mL
d. The client is sleepy
3. The nurse teaches the client about the schedule cardiac catheterization. Which statement, if made by the client to the
nurse, indicates that the teaching was effective?
a. "I understand that there is little or no risk associated with this procedure."
b. "I may experience a little pounding sensation in my chest during the procedure."
c. "I will be in and out of the procedure room in about 30 minutes."
d. "I will be able to walk in the hall soon after the procedure is completed."
4. During the second stage of labor, the client's partner asks the nurse, "Can I go get a cup of coffee from the
cafeteria?" Which response by the nurse is best?
a. "I will get you a cup of coffee."
b. "It would be best if you stayed here at this time."
c. "Ask your partner if it is acceptable to leave."
d. "Why do you want to leave the room?"
5. The nurse discovers that client lying face down on the floor. Which action does the nurse take first?
a. Assess the patency of the client's airway
b. Determine whether the client is responsive
c. Check the client's carotid pulse
d. Reposition the client onto the back
6. A nurse works 3 weeks at a 100-bed suburban hospital after working several months at a 40-bed rural hospital. The
nurse prefers the total client care delivery system that was used at the rural hospital, rather then the team leading
system of client care that is used at the suburban hospital. Which action does the nurse take?
a. Works with in the system at the hospital to change the type of client care delivery
b. Discuss his thoughts about the type of client care delivery system with the nurses supervisor
c. Asks the nurses peers why this type of client care delivery system is used
d. Suggests a change in the type of client care delivery system to the director of nursing
7. The nurse cares for the client diagnosed with a left traumatic below knee amputation (BKA) with a tourniquet in
place. The client also has a tear from the perineum to the rectum. Which action is the nurse take first?
a. Apply anti-shock trousers
b. Assesses the clients level of consciousness
c. Remove the tourniquet
d. Check the client's blood pressure and pulse
8. During morning rounds, the client diagnosed with schizophrenia tells the nurse, "I know you are conspiring with my
spouse to keep me locked away." Which statement by the nurse is the most appropriate?
a. "What makes you think your spouse is trying to hide your existence?"
b. "Are you saying that you think your spouse doesn't love you?"
c. "I can see that you are frightened about being here but I am a nurse in a hospital."
d. "I'm not conspiring with your spouse. I first met your spouse when you are admitted to the hospital."
9. During a routine prenatal visit, the nurse auscultates the fetal heart rate (FHR). If the fetal position is left sacrum
posterior (LSP), at which site does the nurse expect to find the fetal heart (FHT)?
a. Below umbilicus, on the mothers right
b. Below umbilicus, on the mothers left
c. Above umbilicus, on the mothers left
d. Above umbilicus, on the mothers right
10. The nurse makes environmental rounds on the client care unit. Which problem does the nurse addressed first?
a. A wheel of the medication cart is broken
b. The needle disposal unit in unoccupied room is full
c. The call light and occupied isolation room is broken
d. The ice machine and the visitors lounge is leaking water on the floor
11. The nurse observes a nursing assistive personnel (NAP) enter the room of the client diagnosed with tuberculosis (TB)
to provide morning care. Which observation, if you made by the nurse, does not require an intervention?
a. The NAP enters the room while wearing goggles and a hair covering
b. That NAP enters the room while wearing a mask and sterile gloves
c. The NAP enters the room while wearing a gown and clean gloves
d. The NAP enters the room while wearing a particulate respirator and a gown
12. The nurse teaches the client about ferrous sulfate. Which statement by the client indicates to the nurse that the
client understands the education?
a. "I should take this medication when I take my antacid."
b. "I should take this medication with orange juice."
c. "I should increase my intake of foods that contain calcium."
d. "I should take this medication at bedtime."
13. The nurse gives discharge instructions about home care for orchitis to the client. Which statement indicates to the
nurse that teaching has been successful?
a. "I should make an appointment to have a circumcision."
b. "It will help if I use a scrotal support."
c. "I should restrict my athletic activities for about 6 weeks."
d. "I need to stay in bed for at least 10 days."
14. The nurse cares for the client having a left total hip arthroplasty period in which position does the nurse placed the
client after surgery?
a. Legs abducted with the toes pointing upward
b. Legs adducted with a bed cradle in place
c. Flat on the bed with a foot board in place
d. Legs elevated on two pillows with the knees flexed
15. The adolescent receives 10 units of intermediate-acting insulin every morning at 0700. If the client requires the
insulin dosage reduced, the nurse expects the client to present with which symptom?
a. Declines lunch at 1200
b. Reports hunger at 0900
c. Experiences confusion at 1600
d. Becomes sleepy at 2100
16. The nurse discovers the client in the bathroom attempting self-harm. Which action does the nurse take first?
a. Removes the client from the bathroom and escorts the client to the bedroom
b. Stays with the client and continually monitors for self-destructive behaviors
c. Initiates a discussion with the client concerning reasons for self-harm
d. Distracts the client from trying to hurt self by talking about the family.
17. The nurse admits a 2-month-old infant for surgical correction of hypospadias. Which assessment does the nurse
complete?
a. Check this scrotal sac and palpate the testes
b. Inspect the position of the urinary meatus
c. Obtained a urine sample for analysis
d. Measure intake and output hourly
18. The patient of an 18 month old toddler ask the nurse, (Which toy is most appropriate for my child?) The nurse from
recommend which toy?
a. A story book
b. A stuffed animal
c. A colorful mobile
d. A large yo-yo
19. The nurse cares for the client prior to cataract surgery. The nurse administers the preoperative medication. Ten
minutes later, the nurse finds the client on the floor at the foot of the bed. Which action does the nurse takes
initially?
a. a. Notifies the healthcare provider, and receive new orders
b. b. Complete accident report documenting the fall
c. c. Stays with the client and calls for assistance
d. d. Moves the client back onto the bed providing support to the cervical area
20. The nurse teaches the client what to expect during a cardiac catheterization. Which statement if made by the client,
indicates further teaching is necessary?
a. "I may feel a fluttering sensation in my chest during the test."
b. "I may kill chest pain during the test."
c. "I may have chest pain for several days following the test."
d. "I may have some pain at the catheter insertion site." [Show Less]