Nurs 465 Practice Questions on Setting
Priorities Questions and Correct Answers/
Latest Update / Already Graded
A nurse is caring for a client who has dementia. The client is agitated
and is having difficulty staying in his chair. Which of the following
actions should the nurse take first?
Ans: place a seat alarm in the client's chair
A nurse is caring for a client who is in the first stage of labor. The nurse
observes the umbilical cord protruding from the vagina. Which of the
following actions should the nurse perform first?
Ans: Insert a gloved hand into the vagina to relieve pressure on
the cord
A nurse is assessing a client for a suspected anaphylactic reaction
following a CT scan with contrast media. For which of the following
client finding should the nurse intervene first?
Ans: stridor
A nurse is caring for a client who has CHF 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?
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Ans: check the client's vital signs
A nurse is removing PPE after giving direct care to a client who requires
isolation. Which of the following PPE items should the nurse remove
first?
Ans: Gloves
A nurse in an emergency department is caring for a client who has
anaphylaxis following a bee sting. Which of the following actions
should the nurse take first?
Ans: Auscultate for wheezing
A nurse sees and assistive personnel (AP) entering the room of a client
who requires transmission based precautions without using the
appropriate PPE. Which of the following actions should the nurse take
first?
Ans: Provide the appropriate PPE to the AP
A nurse is working with an assistive personnel (AP) to care for a group
of clients on the pediatric unit. Which of the following tasks should the
nurse have the AP perform first?
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Ans: check to see if the elbow restraint is in place for an infant
who is postoperative from a surgical correction of a cleft palate
A nurse is caring for a client who attacked one of her friends and is
administered to the psychiatric unit. Which of the following actions
should the nurse take first?
Ans: Set behavioral limits for the client
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?
Ans: Place the client in a sitting position
A nurse is assessing four clients on a medical surgical unit. Which of the
following client should the nurse care for first?
Ans: A client who has a cast on the left leg and reports
numbness and paresthesia
A nurse is caring for a client who develops a pulmonary embolism.
Which of the following interventions should the nurse implement first?
Ans: Administer oxygen therapy
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While caring for a client, the nurse experiences a needle stick injury.
Which of the following actions should the nurse take first?
Ans: Wash the site of the injury with soap and water
A nurse is assessing a client's abdomen who reports stomach pain.
Which of the following actions should the nurse take first?
Ans: Inspect
A nurse in a clinic is collecting a history from a client who reports that a
member of his family just received a diagnosis of pulmonary
tuberculosis. The nurse should expect that the provider will prescribe
which of the following diagnostic tests first?
Ans: Nucleic acid amplification test (NAAT)
A nurse is caring for a client who is in active labor and notes late
deceleration in the FHR. Which of the following actions should the
nurse take first?
Ans: Change the client's position
A nurse has been reassigned from her regular area of work to a unit
that is short staffed. Which of the following actions should the nurse
take first?
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