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    Exam Review

    1. A nurse is caring for a client who has a urinary tract infection. Exhibits The nurse is reviewing the client's medical record. Which of the following actions should the nurse take? Select all that apply.(SATA)
      A)Ensure the client wears a surgical mask when they are outside of their room.
      B)Place the client on contact precautions.
      C)Clarify the prescription for amoxicillin with the provider.
      D)Hold the dose of levothyroxine.
      E)Recommend increasing the dose of metoprolol.
      F)Request a prescription for an antiemetic medication.
    2. A nurse is caring for a client on a medical-surgical unit. Exhibits Which of the following actions are part of the isolation precautions for this client? Select all that apply.(SATA)
      A)Perform hand hygiene with at least 4 to 5 mL of hand sanitizer when leaving the client's room.
      B)Provide a mask for the client when they are outside their room.
      C)Place the client in a room with positive air flow.
      D)Don a gown when entering the client's room.
      E)When removing personal protective equipment, remove gloves first.
    3. A nurse is caring for a client who has a clogged NG tube. Which of the following actions should the nurse take?
      A)Flush the NG tube using a push and pull technique.
      B)Irrigate the NG tube witha carbonated beverage
      C)Use a 1 mL syringe to flush the NG tube.
      D)Place the patient in prone position.
    4. A nurse is preparing to transfer a client who is immobile and weighs 104.3 kg (230 lb) from the bed to a stretcher. Which of the following actions should the nurse plan to take?
      A)Apply a transfer belt to the client prior to transferring to the stretcher.
      B)Move the client onto the stretcher using a slide board with the assistance of two health care workers.
      C)Have the client roll onto a transfer board and pull the board onto the stretcher.
      D)Move the client's upper body onto the stretcher first.
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    Exam Review

    1. A nurse is performing skin assessments for a group of clients. Which of the following images indicates a wound that is healing by secondary intention?
      A)A: Circular Red Area
      B)B: Bruise on Leg
      C)C: Sutured Incision (Primary intention)
      D)D: Open Ulcer/Pressure Injury (Secondary Intention)
    2. A nurse is caring for an adult client who requires nasopharyngeal suctioning. Which of the following actions should the nurse take?
      A)Set the suction device to 120 mm Hg.
      B)Apply suction to the catheter during insertion.
      C)Have the client tuck his chin to his chest during suctioning.
      D)Apply a petroleum-based lubricant to the catheter.
    3. A nurse is caring for a client who has a new prescription for warfarin. The client states, "I don't want to take that medication because I don't want to have to undergo any kind of monitoring." Which of the following responses should the nurse make?
      A)"Your provider wants you to take this medication."
      B)"Would you like to discuss other treatment options with your provider?"
      C)"Why don't you want to undergo monitoring?"
      D)"Regular monitoring is not difficult and will ensure that you remain healthy."
    4. A nurse is assessing a client who is experiencing fluid volume excess. Which of the following findings should the nurse expect?
      A)Poor skin turgor
      B)Thready pulse
      C)Crackles in lung bases
      D)Flat neck veins
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    Exam Review

    1. A charge nurse is providing an in-service to a group of nurses about the components of informed consent. Which of the following information should the nurse include?
      A)The provider obtains verbal consent for the procedure without witnessing the client's signature.
      B)The provider performing the procedure is responsible for obtaining informed consent.
      C)The nurse's role is to provide the client with initial information about the procedure prior to obtaining informed consent.
      D)Clients are unable to change their mind once a consent form is signed.
    2. A nurse is caring for a client following bilateral knee replacement surgery and they require assistance with dressing. The nurse should report this information to which of the following interdisciplinary team members?
      A)Respiratory therapist
      B)Physical therapist
      C)Social worker
      D)Occupational therapist
    3. A nurse is caring for a client who has fluid volume excess. Which of the following manifestations should the nurse expect?
      A)Bounding pulse
      B)Polyuria
      C)Weight loss
      D)Dry mucous membranes
    4. A nurse is teaching a client about meditation and progressive relaxation to reduce stress. Which of the following instructions should the nurse include?
      A)Plan to meditate immediately after meals.
      B)Tighten and relax muscles during relaxation therapy.
      C)Keep eyes open during relaxation therapy.
      D)Take short and shallow breaths when meditating.
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    Exam Review

    1. A nurse is caring for a client who has just died following unsuccessful CPR. The family wishes to view the body. Which of the following actions should the nurse take before inviting the family into the room?
      A)Keep the head of the bed flat.
      B)Hold the client's eyelids closed until they remain shut.
      C)Apply identification tags to the client's extremities.
      D)Leave resuscitation equipment and supplies at the bedside.
    2. A nurse is evaluating a newly licensed nurse's understanding of advance directives. The newly licensed nurse should identify that which of the following individuals is responsible for deciding whether a client is capable of making their own decisions regarding medical treatment?
      A)Primary provider
      B)Health care surrogate
      C)Social worker
      D)Charge nurse
    3. A nurse is using the domains of learning to provide teaching to a client who has diabetes mellitus. Which of the following actions should the nurse take to utilize psychomotor learning?
      A)Assist the client in discussing their feelings about having diabetes mellitus.
      B)Ask the client to attend a class about following a diabetic diet.
      C)Show the client a video about self-administration of insulin.
      D)Observe the client practice self-monitoring of blood glucose levels.
    4. A nurse is assessing the impact of stressors on a family. Which of the following should indicate to the nurse there has been a change in family system?
      A)A middle adult experiences physical changes.
      B)A young adult develops a close, personal relationship.
      C)A middle adult assumes their parent's responsibilities.
      D)A young adult focuses on their career.
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    Exam Review

    1. A nurse is caring for a client who is immobile. Which of the following interventions should the nurse plan to take to prevent plantar flexion contractures?
      A)Apply an abduction pillow to the legs.
      B)Use a trochanter roll.
      C)Use foot splints.
      D)Prop the feet up.
    2. A nurse is caring for a client who has hypocalcemia. Which of the following findings should the nurse expect?
      A)Lethargy
      B)Constipation
      C)Positive Chvostek's sign
      D)Muscle flaccidity
    3. A nurse overhears two staff members in the facility elevator discussing a client's care. Which of the following federal statutes does this violate?
      A)Patient Self-Determination Act
      B)Patient Protection and Affordable Care Act
      C)Health Insurance Portability and Accountability Act
      D)American With Disabilities Act
    4. A nurse enters a client's room to perform a focused assessment. Which of the following client information should the nurse use to properly identify the client?
      A)Telephone number
      B)Diagnosis
      C)Provider's name
      D)Room number
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    Exam Review

    1. A nurse is planning care for a toddler who has measles. Which of the following isolation precautions should the nurse initiate?
      A)Contact
      B)Airborne
      C)Protective
      D)Droplet
    2. A nurse is caring for a client who has type 2 diabetes mellitus. Which of the following findings should the nurse identify as manifestations of hypoglycemia?
      A)Dry mucous membranes
      B)Thirst
      C)Polyuria
      D)Shakiness
    3. A nurse is caring for a client who has dehydration and reports muscle cramps and constipation. Which of the following laboratory values should the nurse expect?
      A)Decreased serum potassium
      B)Decreased BUN
      C)Decreased hematocrit (Hct)
      D)Decreased specific gravity
    4. A nurse is caring for a client who is immobile and developing skin breakdown. Which of the following actions should the nurse take?
      A)Keep the head of the client's bed at 30° or less.
      B)Bathe the client with soap and hot water.
      C)Slide the client up in bed every 2 hr.
      D)Massage bony prominences four times daily.
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