Chapter 1
1. The nurse is caring for four clients on a medical–surgical unit. Which client should the nurse see initially?
2. The nurse is preparing
... [Show More] to administer influenza vaccines to a mass drive-through clinic. Which statement by a client would indicate further questioning prior to giving the client the influenza vaccine?
3. The nurse is caring for four clients on a medical–surgical unit. The secretary gives the nurse the morning labs. Which of the following labs would require that the nurse call the physician and inform the healthcare provider about the client’s abnormalities?
4. The nurse is orienting a new graduate. The nurse is reinforcing the importance of standard precautions. Which of the following observations by the nurse would require further education regarding standard precautions?
5. The admitting department alerts the nurse on a medical–surgical unit that a client with active tuberculosis (TB) is being admitted to the unit. Which type of isolation is appropriate based on the client’s diagnosis?
6. A client is receiving IV vancomycin for the treatment of Clostridium difficile. The nurse understands that the client who develops flushing, tachycardia, and hypotension during the infusion of vancomycin indicates:
7. The physician has ordered for the client to receive a trough blood level to evaluate the therapeutic effect of an antibiotic. The nurse understands that the trough should be ordered:
8. The nurse needs to change a dressing on the client’s abdomen. Which of the following techniques should be implemented?
9. The physician has ordered for the nurse to obtain a sputum specimen. The nurse understands that the sputum specimen should be collected:
10. Which of the following manifestations indicates a systemic reaction associated with an inflammatory response?
CHAPTER 4
1. When preparing a client for surgery, the nurse observes that the client has been crying. When the nurse asks the client to sign the surgery consent form, the client states “I guess I should just go ahead and sign it, even though I’m not really sure about doing this.” The best response by the nurse would be:
2. Upon review of the medical history prior to surgery, the nurse notes that a client has a history of alcoholism. The nurse makes a point to bring this to the surgeon’s attention when informed consent is being provided. The rationale for this action would be:
3. The nurse is providing preoperative teaching to a client with diabetes. The client states “I know I won’t need as much insulin after surgery, since I haven’t had anything to eat or drink since midnight.” Which response by the nurse would be most appropriate?
4. A client has a history of malignant hyperthermia. A bowel resection with colostomy placement surgery is scheduled. The nurse anticipates which type of anesthesia will be used with this client?
5. A client reports a pain level of 6 on a 0–10 pain scale. The nurse offers to review the orders for additional pain medication. The client states “I really don’t want to take any more pain medication, because I am afraid I will become addicted.” The nurse’s response should focus on which concept?
6. The nurse has many teaching responsibilities preoperatively. From the following list, select all topics that would be within the nurse’s scope to provide instructions about preoperatively:
7. Assessment findings that would alert the nurse that a client might be at greater risk for deep vein thrombosis include: [Show Less]