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    Exam Review

    1. Some antibodies against foreign antigens can react to similar self-antigens, causing an autoimmune disease.
      A)True
      B)False
      C)None
      D)None
      E)None
      F)None
    2. Monocytes differentiate into large phagocytic cells. True or False
      True/False
    3. A nurse is measuring vital signs for a client and notices an irregularity in the pulse. Which of the following actions should the nurse take?
      A)Take the pulse at each peripheral site and count the rate for 30 seconds.
      B)Count the apical pulse rate for 1 full minute, and describe the rhythm in the chart.
      C)Measure the pulse using a Doppler ultrasound stethoscope.
      D)Check the client's pedal pulses.
    4. A nurse is caring for a client who has end-stage lung cancer. The client has a decreased level of consciousness, extreme shortness of breath, and a respiratory rate of 40/min. The client's family member states to the nurse, "My sibling doesn't have any advance directives. Can they still receive palliative sedation?" Which of the following statements should the nurse include when speaking with the client's family?
      A)"The client's wish is not followed for palliative sedation.”.
      B)"Yes, consent can be obtained from a legal proxy.”.
      C)"No, consent should have been obtained before a change in the level of consciousness.”.
      D)"Consent is not required for palliative sedation to be administered.”.
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    Exam Review

    1. A nurse is preparing a teaching plan for a client who has chronic constipation secondary to irregular bowel habits. Which of the following should the nurse plan to include in the teaching?
      A)The client should try to take in all of the required dietary fiber with the morning meal.
      B)The client should drink two to three 8 oz glasses of water each day.
      C)The client should follow a high-fiber diet to establish bowel regularity.
      D)The client should be taught that the goal of therapy is to have a bowel movement daily.
    2. A nurse is instructing the caregiver of a toddler who has bacterial conjunctivitis and a new prescription for an ophthalmic ointment. Which of the following instructions should the nurse provide?
      A)"Ask the child to look down before applying the ointment.”.
      B)"Apply the ointment in a thin line into the conjunctival sac.”.
      C)"Always wipe from the outer to the inner canthus when wiping away secretions.”.
      D)"Use a sterile glove and applicator to apply the antibiotic ointment.”.
    3. A nurse is caring for a client who has congestive heart failure and is taking digoxin daily. The client refused breakfast and is complaining of nausea and weakness. Which of the following actions should the nurse take first?
      A)Check the client's vital signs.
      B)Request an order for an antiemetic.
      C)Request a dietitian consult.
      D)Suggest that the client rests before eating the meal.
    4. A nurse is caring for a client who reports abdominal pain. The nurse asks the client to describe what the pain feels like. The nurse is using which of the following components of the PQRST mnemonic?
      A)Quality.
      B)Precipitating cause.
      C)Severity.
      D)Region.
    Page 2 of 20

    Exam Review

    1. A nurse is assessing a parent who lost their 3-year-old in a drowning accident 2 years prior. The nurse notes that the client is showing signs of complicated grieving when the parent states:
      A)She volunteers at the local childcare center.
      B)She visits the child's grave at least once a month.
      C)She has left the child's room exactly as it was before the loss.
      D)She talks about the child in the past tense.
    2. A client is scheduled to have heart surgery and informs the nurse that she does not want any life saving measures done should there be any complications. Which of the following responses by the nurse is appropriate?
      A)You and your provider will need to discuss your desire for DNR/DNI designation, I will put a call out to him.
      B)Have you discussed this with your family? I think that would be best.
      C)You do not need to worry about anything because everyone does well after this type of heart surgery.
      D)I think you should discuss your choices with the hospital chaplain considering you are contemplating life and death.
    3. A nurse is obtaining a health history from a client. Which of the following findings should the nurse identify as a modifiable risk factor for developing a disease?
      A)Family history.
      B)Age.
      C)Genetics.
      D)Sunbathing.
    4. During a pulse deficit assessment, the nurse compares the apical pulse rate to which peripheral pulse rate?
      A)Brachial pulse rate.
      B)Dorsalis pedis pulse rate.
      C)Radial pulse rate.
      D)Carotid pulse rate.
    Page 3 of 20

    Exam Review

    1. A nurse is caring for a client who is expressing anger about their diagnosis of colorectal cancer. Which of the following actions should the nurse take?
      A)Focus teaching on what the client will need to do in the future to manage their illness.
      B)Initiate pastoral services.
      C)Discuss the risk factors for colon cancer.
      D)Reassure the client that this is an expected response to grief.
    2. A nurse is preparing to transfer a client who can bear weight on one leg from the bed to a chair. After securing a safe environment, which of the following actions should the nurse take next?
      A)Rock the client up to a standing position.
      B)Apply a gait belt to the client.
      C)Pivot on the foot that is the farthest from the chair.
      D)Assess the client for orthostatic hypotension.
    3. A nurse at an ophthalmology clinic is providing teaching to a client who has open angle glaucoma and a new prescription for timolol eye drops. Which of the following instructions should the nurse provide?
      A)The medication is to be applied when the client is experiencing eye pain.
      B)The medication should be applied on a regular schedule for the rest of the client's life.
      C)The medication is to be used for approximately 10 days, followed by a gradual tapering off.
      D)The medication will be used until the client's intraocular pressure returns to normal.
    4. Which of the following is an early sign that an infection is developing in an older adult client?
      A)Wheezes in the bronchioles.
      B)Urinary retention.
      C)Low back pain.
      D)Confusion.
    Page 4 of 20

    Exam Review

    1. A nurse is teaching about delegation with a newly licensed nurse. Which of the following statements if made by the newly licensed nurse indicates understanding?
      A)There are 4 rights of delegation.
      B)The nurse manager is responsible for delegating nursing tasks during each shift.
      C)It is the duty of the delegatee to perform a task without asking Questions when it is delegated.
      D)I am responsible for ensuring that a delegated task is completed.
    2. The nurse's role in regard to informed consent is to:
      A)Verify and witness that the client or a legal representative signs the consent form in their presence.
      B)Obtain the client's consent.
      C)Describe in depth what will happen if the client chooses not to have the surgical procedure.
      D)Initiate the conversation in regard to the risks and benefits of the surgical procedure.
    3. A nurse is preparing to administer morphine sulfate 2 mg IV bolus. Available is morphine sulfate 10 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.) . . .
    4. A nurse is assessing a client who has a long history of rheumatoid arthritis. The nurse should expect to find which of the following?
      A)Heberden's nodes.
      B)Ulnar deviation.
      C)Tophi.
      D)Bouchard's nodes.
    Page 5 of 20

    Exam Review

    1. A nurse notes that her client's dressing has a scant amount of pale drainage and marks the area. The nurse knows this drainage is:
      A)Sanguineous drainage.
      B)Serous drainage.
      C)Serosanguineous drainage.
      D)Purulent drainage.
    2. A nurse is delegating care for a group of four clients. Which of the following tasks should the nurse delegate to an assistive personnel (AP)?
      A)Obtain a daily weight on a client who has heart failure.
      B)Irrigate and perform a dressing change for a client who has a pressure injury wound.
      C)Administer oral PRN pain medication to a client who has arthritis.
      D)Teach the use of an incentive spirometer to a postoperative client.
    3. A nurse is using the introduction, situation, background, assessment, recommendation, and readback (I-SBAR-R) communication tool when contacting a provider about a client who has COPD. Which of the following statements by the nurse should be included in the assessment component?
      A)"The client has a respiratory rate of 38/min.”.
      B)"The client has a history of COPD.”.
      C)"Should I increase the client's supplemental oxygen?"
      D)"I will obtain a sputum culture.”.
    4. A nurse is caring for a client with a wound. Which of the following cultural considerations should the nurse consider when making the plan of care?
      A)Food preferences when making a nutrition plan.
      B)The time it will take to complete the dressing change.
      C)The cost of the wound dressings.
      D)The size of the home that the client lives in.
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