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    Exam Review

    1. A nurse is reinforcing teaching with a client about reducing dietary caffeine intake. The nurse should remind the client that 240 mL (8 oz. of which of the following beverages contains the least amount of caffeine?
      A)Hot cocoa
      B)Cola soft drink
      C)Instant coffee
      D)Brewed green tea
    2. A nurse is collecting data from a client who is 1 day postoperative following a transurethral resection of the prostate. Which of the following findings should the nurse report to the provider?
      A)Urine output of 300 ml over 8 hr.
      B)Occasional small clots in the urine
      C)Dark red urine
      D)Frequent urge to urinate
    3. A nurse is verifying informed consent for a client who is preoperative for a vaginal hysterectomy. Which of the following statements should the nurse identify as an indication that the client has given informed consent?
      A)"I should expect my periods to resume in 1 month."
      B)"I will no longer need a regular gynecological examination."
      C)"I am thankful I am done having children."
      D)"I will have a large scar on my stomach after this procedure."
    4. A nurse in an assisted living facility is reinforcing teaching with staff members about preparing for an external chemical disaster. Which of the following instructions should the nurse include?
      A)"Open the fireplace dampers in the day room."
      B)"Cover the electrical outlets with wet towels."
      C)"Move clients to a room above ground with few windows."
      D)"Turn on fans in the facility to circulate air."
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    Exam Review

    1. A nurse in a provider's office is caring for a group of clients who have communicable diseases. Which of the following infections should the nurse report to the state health department?
      A)Human papillomavirus
      B)Neisseria gonorrhoeae
      C)Impetigo contagious
      D)Sarcoptes scabiei
    2. A nurse in a mental health facility is caring for a client who expresses anxiety about exercising in the outdoor courtyard. The nurse promises to walk with the client in the courtyard each day. Which of the following ethical principles is the nurse demonstrating?
      A)Justice
      B)Fidelity
      C)Autonomy
      D)Nonmaleficence
    3. A nurse is caring for a client who is receiving a continuous IV infusion. The nurse notes that the skin around the catheter's insertion site is edematous and cool. Which of the following actions should the nurse take first?
      A)Elevate the arm.
      B)Document the infiltration.
      C)Stop the infusion.
      D)Apply a warm compress.
    4. A nurse is reviewing client confidentiality with other staff members. The nurse should identify which of the following actions is an example of protecting client confidentiality.
      A)Discarding worksheets containing client information in a wastebasket
      B)Writing a client's diagnosis on the message board in the client's room
      C)Giving change of shift report to a nurse outside the client's room
      D)Discussing a client's prognosis with an assistive personnel who is caring for the client
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    Exam Review

    1. A nurse is contributing to the plan of care for a client who has a chest tube set to continuous suction to relieve a pneumothorax. Which of the following interventions should the nurse include?
      A)Place the client in a supine position.
      B)Ensure the device is kept below the level of the client's chest.
      C)Empty the collection chamber every 8 hr.
      D)Clamp the chest tube every 4 hr.
    2. A nurse is reinforcing teaching with new parents about car seat safety. Which of the following instructions should the nurse include?
      A)Keep the airbag on if the car seat is in the front seat.
      B)Position the car seat at a 90° angle.
      C)Put a small cushion under the newborn's head for support.
      D)Place the shoulder harnesses at the level of the infant's shoulders.
    3. A nurse is reinforcing teaching with a female client who is taking phenytoin. Which of the following statements should the nurse include in the teaching?
      A)"You can safely take this medication if you become pregnant."
      B)"You can skip a dose of this medication if you are nauseated."
      C)"You should expect to have blood work every 6 months while taking this medication."
      D)"You might experience swollen gums while taking this medication."
    4. A nurse is reinforcing dietary teaching with a client whose pre-pregnancy BMI was 30.5. The nurse should include which of the following is an acceptable weight gain for this client?
      A)16 lb
      B)32 lb
      C)24 lb
      D)8 lb
    Page 3 of 45

    Exam Review

    1. A nurse is reinforcing discharge teaching with a client who has a prescription for antibiotic therapy. The client reports experiencing diarrhea when taking antibiotics. Which of the following foods should the nurse recommend to lessen the occurrence of diarrhea?
      A)Coffee
      B)Ice cream
      C)Apple juice
      D)Yogurt
    2. A nurse is implementing a bladder training program for a client who had a stroke. Which of the following interventions should the nurse take first?
      A)Assist the client with relaxation techniques.
      B)Discourage intake of carbonated beverages.
      C)Offer toileting opportunities every 1 to 2 hr.
      D)Determine the client's pattern for voiding.
    3. A nurse begins to bathe a newly admitted client who reports that they have not had anything to eat that day. The nurse interrupts the bath and obtains a healthy meal for the client. This action by the nurse is an example of which of the following?
      A)Countertransference
      B)Boundary crossing
      C)Promoting trust
      D)Veracity
    4. A nurse is reinforcing discharge teaching with the caregiver of a client who has a dependent personality disorder. Which of the following instructions should the nurse include in the teaching?
      A)Limit the client's social interactions.
      B)Encourage the client to be assertive.
      C)Assume responsibility for making the client's decisions.
      D)Maintain a verbal no-harm contract with the client.
    Page 4 of 45

    Exam Review

    1. A nurse is reinforcing teaching with a client who is about to undergo electroconvulsive therapy. The nurse should explain to the client which of the following adverse reactions can occur following the procedure.
      A)Tingling of the scalp
      B)Voice alteration
      C)Neck pain
      D)Temporary memory loss
    2. A nurse is caring for a client who has bulimia nervosa. Which of the following actions should the nurse take first?
      A)Observe the client during and after meals.
      B)Suggest that the client assist with meal planning.
      C)Instruct the client about effective coping strategies.
      D)Refer the client to a support group for clients who have eating disorders.
    3. A nurse is caring for a client who has end-stage kidney disease. The client has decided to stop dialysis treatment. Which of the following actions should the nurse take?
      A)Tell the client she should discuss this decision with her family.
      B)Support the client's decision to stop the treatment.
      C)Discuss alternative treatment methods with the client.
      D)Ask the facility chaplain to visit the client.
    4. A nurse is caring for a client who has been admitted to the mental health unit. While reinforcing teaching about the client's prescribed medications, the nurse communicates truthfully about the adverse effects of the medications. Which of the following ethical concepts is the nurse exhibiting?
      A)Justice
      B)Autonomy
      C)Veracity
      D)Beneficence
    Page 5 of 45

    Exam Review

    1. A nurse is caring for a client who is 12 hr postpartum and has deep vein thrombosis of the left leg. The client is receiving anticoagulant therapy. Which of the following actions should the nurse take?
      A)Apply an ice pack to the affected extremity for 20 min every 2 hr.
      B)Administer aspirin for pain.
      C)Massage the affected extremity every 4 hr.
      D)Initiate bed rest.
    2. A nurse is reinforcing teaching with a client about advanced directives. Which of the following information should the nurse include?
      A)"Your health care surrogate will make decisions on your behalf if you are unable."
      B)"Once you have completed a living will, it cannot be changed."
      C)"You will need an attorney to appoint a health care surrogate."
      D)"You should appoint a family member as your health care surrogate."
    3. A nurse on a medical surgical unit is caring for a group of clients. Which of the following clients should the nurse see first?
      A)A client who is scheduled for surgery in 2 hr
      B)A client whose blood pressure is 160/90 mm Hg and reports a headache
      C)A client who is postoperative and reports intermittent nausea
      D)A client who is postoperative and has a Jackson Pratt drain
    4. A nurse is contributing to the plan of care for a client who is experiencing delirium. Which of the following interventions should the nurse recommend?
      A)Remind the client of the day and time often.
      B)Offer the client several choices at mealtimes.
      C)Avoid discussing the client's fears.
      D)Alternate daily caregivers.
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