NursingPlex
    Sign In
    Review ModeExam ModePractice Mode

    Exam Review

    1. A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?
      A)Decrease in the urinary output from 50 mL to 30 mL per hour.
      B)Increase in the temperature from 37.5 C (99.5 F) to 38.6 C (101.5 F).
      C)Increase in the heart rate from 88 to 110/min.
      D)Decrease in the respiratory rate from 20 to 16/min.
    2. A nurse is caring for a client who has a fractured tibia as a result of a fall. The client x-ray shows that the bone is splintered into several pieces around the shaft. The nurse should identify that the client has which of the following types of fractures?
      A)Comminuted.
      B)Impacted.
      C)Oblique.
      D)Transverse.
    3. A nurse in an emergency department is caring for a client who has a sucking chest wound resulting from a gunshot. The client has a blood pressure of 100/60 mm Hg, a weak pulse rate of 118/min, and a respiratory rate of 40/min. Which of the following actions should the nurse take?
      A)Prepare to insert a central line.
      B)Administer oxygen via nasal cannula.
      C)Remove the dressing to inspect the wound.
      D)Apply a non-adherent dressing taped on three sides.
    4. A nurse is preparing to start an IV infusion of lactated Ringer's for a client who sustained a burn injury. The client is prescribed 5,200 mL of fluid over the first 24 hr. How many mL/hr should the nurse set the pump to infuse for the first 8 hr?
    Page 1 of 15

    Exam Review

    1. A nurse is caring for a client who has a spinal cord injury and suspects the client is developing autonomic dysreflexia. Which of the following actions should the nurse take first?
      A)Check the client for a fecal impaction.
      B)Examine the client for areas of skin breakdown.
      C)Place the client in a sitting position.
      D)Check the client's bladder for distention.
    2. A nurse is teaching a client who has fibromyalgia about self-care strategies for managing the disorder. Which of the following information should the nurse include in the teaching?
      A)Try jogging or running between flare-ups.
      B)Avoid exercise during flare-ups.
      C)Establish a regular sleep pattern.
      D)Increase calcium intake.
    3. A nurse is caring for a client immediately following a procedure that required spinal anesthesia. Which of the following findings indicates the client is experiencing a complication of the anesthesia?
      A)Absence of urge to void.
      B)Hiccoughs.
      C)Numbness in the legs.
      D)Headache.
    4. A nurse is monitoring a client who is receiving a blood transfusion. Which of the following findings should the nurse identify as a manifestation of a hemolytic transfusion reaction?
      A)Low back pain.
      B)Tachycardia.
      C)Hypotension.
      D)Apprehension.
    Page 2 of 15

    Exam Review

    1. A nurse is caring for an older adult client who has a urinary tract infection (UTI). Which of the following manifestations should the nurse identify as a finding specifically associated with this client?
      A)Low back pain.
      B)Confusion.
      C)Urinary retention.
      D)Incontinence.
    2. A nurse is caring for a client who is being admitted for an acute exacerbation of ulcerative colitis. Which of the following actions should the nurse take first?
      A)Obtain a dietary history from the client.
      B)Check the client's perianal skin integrity.
      C)Investigate the client's emotional concerns.
      D)Review the client's electrolyte values.
    3. A nurse is caring for a client who had an anaphylactic reaction after a blood transfusion. The nurse reviews the literature to further understand antibody-mediated immunity (AMI). Which of the following information should the nurse confirm about AMI?
      A)AMI is mediated by antibodies produced by B-lymphocytes.
      B)AMI involves phagocytic natural killer cells.
      C)Humoral immune response is mediated by T-lymphocytes.
      D)AMI defends only against viral infections.
    4. A nurse is planning care for a female client who has a T4 spinal cord injury and is at risk for acquiring urinary tract infections. Which of the following actions should the nurse include in the client's plan of care?
      A)Encourage fluid intake at and between meals.
      B)Cleanse the perineum from back to front.
      C)Obtain a prescription for an indwelling urinary catheter.
      D)Offer the client the bedpan every 2 hr.
    Page 3 of 15

    Exam Review

    1. A nurse is caring for a client who has had a stroke involving the right hemisphere. Which of the following alterations in function should the nurse expect?
      A)Inability to recognize his family members.
      B)Difficulty reading.
      C)Right hemiparesis.
      D)Aphasia.
    2. A nurse is admitting a client who was prescribed antibiotic therapy and now has a Clostridium difficile infection. Which of the following actions should the nurse take?
      A)Use alcohol hand sanitizer after completing tasks for the client.
      B)Have the client wear a mask when out of the room.
      C)Disinfect equipment in the client's room daily.
      D)Place the client in a protective environment.
    3. A nurse is caring for a client who has paraplegia following an automobile accident. The client is on an intermittent urinary catheterization program. Which of the following findings indicates the need for catheterization?
      A)Dribbling of urine.
      B)Rectal distention.
      C)Weight gain.
      D)Urge incontinence.
    4. A nurse is teaching a female client who has a new diagnosis of systemic lupus erythematosus (SLE). The nurse should recognize the need for further teaching when the client identifies which of the following as a factor that can exacerbate SLE?
      A)Infection.
      B)Exercise.
      C)Pregnancy.
      D)Sunlight.
    Page 4 of 15

    Exam Review

    1. A nurse is performing postoperative care for a client who is scheduled for an ileal conduit procedure. The nurse should include which of the following in the client's plan of care? (Select All that Apply.)(SATA)
      A)Maintain the client on fluid restriction.
      B)Monitor hourly urine output.
      C)Apply skin barrier to the stoma site.
      D)Educate the client that hematuria is expected following the procedure.
      E)Notify the provider immediately if mucus is present in the urine.
    2. A nurse is assessing the depth and extent of injury on a client who has severe burns to the face, neck, and upper extremities. Which of the following factors is the nurse's priority when assessing the severity of the client's burns?
      A)Age of the client.
      B)Cause of the burn.
      C)Location of the burn.
      D)Associated medical history.
    3. A nurse in the emergency department is assessing a client who has internal injuries from a car crash. The client is disoriented to time and place, diaphoretic, and his lips are cyanotic. The nurse should anticipate which of the following findings as an indication of hypovolemic shock?
      A)Widening pulse pressure.
      B)Increased deep tendon reflexes.
      C)Increased heart rate.
      D)Pulse oximetry 96 percent.
    4. A nurse is caring for a client who has a femur fracture. The nurse suspects that the client has fat embolism syndrome. Which of the following findings should the nurse identify as an early manifestation of fat embolism syndrome?
      A)Headache.
      B)Petechiae.
      C)Precordial chest pain.
      D)Hypoxemia.
    Page 5 of 15

    Exam Review

    1. A nurse is preparing a presentation at a community center about osteoarthritis. The nurse should plan to include which of the following information? Select All that Apply.(SATA)
      A)Affects bilateral symmetrical joints.
      B)Causes joint pain.
      C)Crepitus can occur in affected joints.
      D)Affects weight-bearing joints.
      E)Causes joint stiffness.
    2. A nurse is teaching the family of a client who has Alzheimer's disease about donepezil. Which of the following information should the nurse include in the teaching?
      A)You will need to monitor for constipation.
      B)This medication may cause tachycardia.
      C)You should administer the medication each morning.
      D)Syncope episodes may occur when taking this medication.
    3. A nurse is teaching the family of a client who has a new diagnosis of epilepsy about actions to take if the client experiences a seizure. Which of the following instructions should the nurse include in the teaching?
      A)Place the client on his back.
      B)Move objects away from the client.
      C)Restrain the client.
      D)Insert a padded tongue blade into the client's mouth.
    4. A nurse is completing discharge instructions with a client following an acute onset of gout. Which of the following client statements indicates an understanding of the treatment regimen?
      A)I will closely follow a high-purine diet.
      B)I will take one aspirin every day.
      C)I will limit my fluid intake to 1 liter per day.
      D)I will limit my alcohol intake.
    Page 6 of 15