1. A nurse is assessing a client who has a diagnosis on colon cancer which of the following should the nurse expect?
b. Elevated hemoglobi... [Show More] n
d. Weight gain
2. A nurse is assessing a client admitted with peripheral vascular disease. Which of the following findings indicates a
venous vascular disorder?
a. An ulcer at the tip of a toe
b. Hair loss distal to the client’s calves
c. Leg pain at rest
d. Edema of the ankle
3. A nurse is assessing a client who has pericarditis. In which of the following areas of the client’s chest should the
nurse place the stethoscope to best hear a pericardial friction rub? (select HOT spot)
4. A nurse is caring for a client who has a chest tube. The client asks why the fluid in the water-seal chamber rises and
falls. Which of the following statements should the nurse make?
a. “This means your lung is fully expanded “
b. “This indicates a possible leak”
c. “Suction pressure that is too high causes this”
d. “Your breathing pattern causes this” – page 111
5. A community health nurse is reviewing home care instructions with an older adult client who has a new diagnosis of
heart failure. Which of the following is the priority topic for the nurse to review with the client?
a. Daily sodium restriction
b. Daily exercise routine
c. Changes in weight
d. Fluid intake record
6. A nurse is teaching a client about the use of transcutaneous electrical nerve stimulation (TENS) unit.
Which of the following statements should the nurse include?
a. “Apply lotion to the site prior to attaching the electrodes”
b. “This device requires access to a 220-volt outlet”
c. “This device delivers heat via electrodes that are attached to the affected area”
d. “Adjust the dial until you feel a ‘pins and needles’ sensation” – page 648
7. A nurse is providing teaching to a client who is postoperative following a total hip arthroplasty. Which of the
following statements should the nurse make?
a. “Use raised toilet seat to maintain your hips above the knees” – page 455
b. “Twist at the waist when standing from a seated position”
c. “Move your stronger leg first when using a walker”
d. “Apply a heating pad to the operative hip to decrease pain”
8. A nurse finds a client in bed, unresponsive and breathing. Which of the following action should the nurse take first?
a. Establish IV access
b. Apply blood pressure cuff
c. Palpate for the client’s carotid pulse
d. Initiate cardiac monitoring for the client
9. A nurse is caring who is experiencing a hypertensive crisis. Which of the following actions should the nurse take?
a. Initiate IV dopamine infusion
b. Perform neurological assessments
c. Place the client supine
d. Begin an IV bolus of lactated ringer’s
10. A nurse is providing discharge teaching about blood sugar monitoring for a client who has a new diagnosis of type 2
diabetes mellitus. The nurse should instruct the client to obtain which of the following supplies?
a. Sterile lancets
b. Compression stockings
c. Hand mirror
d. Toenail clippers
11. A nurse is completing discharge teaching who has a peripherally inserted central catheter (PICC) line in the left arm.
Which of the following instructions should the nurse include in the teaching?
a. Do not elevate the arm above the level of the heart
b. Change the catheter dressing daily
c. Use 10-mL syringe to flush line – page 176
d. Clean the insertion site using 20- mL of hydrogen peroxide
12. A nurse is preparing naloxone 10 mcg/kg via IV bolus to a client who weights 220 lbs. The amount available is 0.4
mg/mL. How many mL should the nurse administer? (round to the nearest tenth) 2.5 mL
13. A nurse is caring for a client who has a sealed radiation implant. Which action should the nurse take?
a. Remove soiled linens from the room after each change
b. Give the dosimeter badge to the oncoming nurse at the end of the shift
c. Apply a second pair of gloves before touching the client’s implant if it dislodges
d. Limit family member visits to 30 min per day Page 605
14. A nurse is providing teaching to a client and his partner about performing peritoneal dialysis at home. When
discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of
a. Generalized abdominal pain
b. Cloudy effluent – page 381
c. Increased heart rate
15. A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client has bounding
peripheral pulses, hyperte [Show Less]