36) A nurse on acute med-surgical unit is performing assessments on a group of clients. Which is
highestpriority?
a) The client has surgical
... [Show More] hypoparathyroidism and positive Trousseau’s sign
b) A client who was Clostridium difficile with acute diarrhea
c) A client who is acute kidney injury and urine with a low specific gravity
d) The client who has oral cancer and reports a sore on his gums
37) Nurses caring for a client was congestive heart failure. Which of the following prescriptions for
theprovider should the nurse anticipate?
a) Call the provider to clients respiratory rate is less 18/min
b) Give the client 500 mL IV bolus of 0.9 sodium chloride over 1 hr
c) Give the client enalapril 2.5 mg PO twice daily
d) Call the provider if the clients pulse rate is less than 80/min
38) A nurse is caring for a client who has a prescription for sertraline to treat depression. Which of
thefollowing statements by the client indicates an understanding of the medication treatment plan?
a) I will be able starting this medication with feel better
b) I can expect to urinate frequently while on this medication
c) I understand I may experience difficulty sleeping on this medication
d) Ishould decrease my sodium intake while on this medication
39) A nurse has been caring for a female client who has bruises on her arms that she explains are a result of
physical abuse by her husband. The client states, “I don’t know how much longer I can take this, but
I’m afraid he’ll really hurt me if I leave. “Which of the following is an appropriate nursing
intervention?”
a) Offer to speak to the client’s husband regarding his abuse behavior.
b) Help the client to recognize the signs of escalation of abuse behavior
c) Assist the client to identify personal behaviors that trigger abusive behavior
d) Assist the client to Reports abusive behavior to the proper authority
40) A client was having suicidal thoughts tells the nurse “It just does not seem worth it anymore. Why not
endmy misery?” Which of the following responses for the nurses appropriate?
a) Why do you think your life is not worth it anymore?
b) Do you have a plan to end your life?
c) I need to know what you mean my misery
d) You can trust me and tell me what you’re thinking
41) A nurse is caring for a client who has schizophrenia. Which of the following assessment findings
shouldthe nurse expect?
a) Decreased level consciousness
b) Unable to identify common objects
c) Poor problem solving ability
d) Preoccupation was somatic disturbances
10 of 28
ent?
42) A nurse is caring for a client who has deep vein thrombosis of the left lower extremity. Which of the
following action should nurse take? There are 3 tabs that contain separate categories of data.
a) Position the client with the affected extremity lower than the heart
b) Administration of acetaminophen
c) Massage the affected extremity every 4 hrs.
d) Withhold heparin IV infusion
43) Is caring for clients was a new prescription for enoxaparin for the prevention of DVT. Which of
thefollowing is an appropriate action by the nurse?
a) Expel air bubble at the top of the prefilled syringe
b) Massage the injection site to evenly distribute the medication
c) Inject the medication the lateral abdominal wall
d) Administer an NSAID for injection site discomfor [Show Less]