ANSWERS Updated 2026
Postpartum Care - ANSWER Monitor for complications like endometritis.
Client Autonomy - ANSWER Respecting client decisions in healthcare settings.
Pain Management - ANSWER Address pain prior to medical procedures.
Child Assessment Techniques - ANSWER Use comforting methods for anxious
children.
Medication Protocols - ANSWER Follow specific guidelines for drug administration.
Quality Improvement and Risk Management Department - ANSWER Group focused on
tracking medication errors and improving outcomes.
Apical Pulse - ANSWER Pulse measured at the apex of the heart.
Coercion - ANSWER Manipulative behavior exploiting a trusting relationship.
Hepatitis C Virus Test - ANSWER Test for hepatitis C in former IV drug users.
Pregnancy Loss - ANSWER Risk factor for clients with prior miscarriages.
Intimate Partner Violence Screening - ANSWER Assessing safety in the home
environment.
Conduct Disorder - ANSWER Behavioral disorder characterized by aggression and
defiance.
Transfer Board - ANSWER Assistive device for transferring patients safely.
IV Antibiotic Administration - ANSWER Process of delivering antibiotics intravenously.
Medication Errors - ANSWER Mistakes in prescribing, dispensing, or administering
drugs.
Spotting in Pregnancy - ANSWER Light bleeding that can indicate complications.
Laryngectomy - ANSWER Surgical removal of the larynx.
Cuffed Tracheostomy Tube - ANSWER Tube with inflatable cuff for airway
management.
Bolus Tube Feeding - ANSWER Intermittent feeding through a tube.
Synchronized Cardioversion - ANSWER Controlled electrical shock to restore normal
heart rhythm.
,Atrial Fibrillation - ANSWER Irregular heart rhythm with rapid heart rate.
Pedal Pulses - ANSWER Blood flow assessment in the feet.
Cirrhosis - ANSWER Liver disease causing scarring and dysfunction.
Ascites - ANSWER Fluid accumulation in the abdominal cavity.
TPN (Total Parenteral Nutrition) - ANSWER Nutritional support via intravenous
infusion.
NPH Insulin - ANSWER Intermediate-acting insulin for blood sugar control.
Hepatitis B - ANSWER Viral infection affecting the liver.
Tumor Lysis Syndrome - ANSWER Metabolic complications after cancer treatment.
IV Infusion - ANSWER Delivery of fluids directly into the bloodstream.
Fluid Restriction - ANSWER Limiting fluid intake to manage conditions.
Weak Pedal Pulses - ANSWER Indicates poor circulation in the extremities.
Dietary Modification - ANSWER Changes in diet to improve health outcomes.
Blood Glucose Monitoring - ANSWER Regular checks of blood sugar levels.
Capillary Refill - ANSWER Test for peripheral circulation efficiency.
Chest Tube Insertion - ANSWER Procedure to drain air or fluid from the chest.
Hemothorax - ANSWER Blood accumulation in the pleural cavity.
Kinks in Tubing - ANSWER Obstructions that can affect fluid flow.
Fluid Intake Restriction - ANSWER Limiting fluid consumption to prevent overload.
Diabetes Mellitus - ANSWER Chronic condition affecting blood sugar regulation.
Kinks in tubing - ANSWER Obstructions in medical tubing affecting flow.
Elevated BUN level - ANSWER Indicates possible kidney dysfunction or dehydration.
Anorexia and vomiting - ANSWER Can lead to elevated BUN levels.
, Anticholinergic medication - ANSWER Causes pupillary dilation, contraindicated in
glaucoma.
In planning care for a 6 month-old infant, what must the nurse provide to assist in the
development of trust?
A) Food
B) Warmth
C) Security
D) Comfort - ANSWER C) Security
A nurse has just received a medication order which is not legible. Which statement best
reflects assertive communication?
A) "I cannot give this medication as it is written. I have no idea of what you mean."
B) "Would you please clarify what you have written so I am sure I am reading it
correctly?"
C) "I am having difficulty reading your handwriting. It would save me time if you would
be more careful."
D) "Please print in the future so I do not have to spend extra time attempting to read
your writing." - ANSWER B) "Would you please clarify what you have written so I am
sure I am reading it
correctly?"
What is the most important consideration when teaching parents how to reduce risks in
the home?
A) Age and knowledge level of the parents
B) Proximity to emergency services
C) Number of children in the home
D) Age of children in the home - ANSWER D) Age of children in the home
A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the
nurse enters the room to request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control - ANSWER C) Administer the
prescribed analgesia
While caring for a toddler with croup, which initial sign of croup requires the nurse's
immediate attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions - ANSWER A) Respiratory rate of 42
A client is admitted with low T3 and T4 levels and an elevated TSH level. On initial
assessment, the nurse would anticipate which of the following assessment findings?
, A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions - ANSWER A) Lethargy
The emergency room nurse admits a child who experienced a seizure at school. The
father comments that this is the first occurrence, and denies any family history of
epilepsy. What is the best response by the nurse?
A) "Do not worry. Epilepsy can be treated with medications."
B) "The seizure may or may not mean your child has epilepsy."
C) "Since this was the first convulsion, it may not happen again."
D) "Long term treatment will prevent future seizures." - ANSWER B) "The seizure may
or may not mean your child has epilepsy."
Alcohol and drug abuse impairs judgment and increases risk taking behavior. What
nursing diagnosis best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem - ANSWER A) Risk for injury
Which these findings would the nurse more closely associate with anemia in a 10
month-old infant?
A) Hemoglobin level of 12 g/dI
B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160 - ANSWER B) Pale mucosa of the eyelids and lips
The nurse is caring for a client in hypertensive crisis in an intensive care unit. The
priority assessment in the first hour of care is
A) Heart rate
B) Pedal pulses
C) Lung sounds
D) Pupil responses - ANSWER D) Pupil responses
Which of these clients who are all in the terminal stage of cancer is least appropriate to
suggest the use of patient controlled analgesia (PCA) with a pump?
A) A young adult with a history of Down's syndrome
B) A teenager who reads at a 4th grade level
C) An elderly client with numerous arthritic nodules on the hands
D) A preschooler with intermittent episodes of alertness - ANSWER D) A preschooler
with intermittent episodes of alertness
The nurse is about to assess a 6 month-old child with nonorganic failure-to thrive
(NOFTT). Upon entering the room, the nurse would expect the baby to be
A) Irritable and "colicky" with no attempts to pull to standing