A community health nurse is teaching a group of older adult clients about interventions to
prevent pneumonia. Which of the following instructions should the nurse include in the
teaching? - ANSWER Wash your hands when you return home from running errands
A nurse is reviewing the medical record of a client who has a family history of gallstones.
Which of the following findings should the nurse identify as a risk factor for developing chol-
ecystitis? - ANSWER Client is taking atorvastatin
A nurse is assessing a client who is receiving morphine via a PCA pump to manage postoper-
ative pain. The client has a heart rate of 66/min and a respiratory rate of 9/min. Which of
the following medications should the nurse anticipate the provider will prescribe for the cli-
ent? - ANSWER Naloxone
A nurse is teaching a client who has gastroesophageal reflux disease about ways to prevent
reflux. Which of the following information should the nurse include in the teaching? - AN-
SWER Plan to finish eating at least 3 hr before bedtime
A nurse is assessing a client who has a calcium level of 6.3 mg/dL. Which of the following
findings should the nurse expect? - ANSWER Circumoral tingling
A nurse is leading a small group discussion in an acute care mental health facility when one
client suddenly begins to experience a panic attack. Which of the following actions should
the nurse take? - ANSWER Remain with the client until manifestations subside
A nurse in an emergency department is assessing a client who reports severe constipation.
The nurse should identify which of the following findings as an indication that the client
might have a small-bowel obstruction? - ANSWER Visible peristaltic waves in the upper
abdomen
1
, A nurse is reviewing the urinalysis results of a client who has completed a 14-day course of
ciprofloxacin to treat pyelonephritis. Which of the following values should indicate to the
nurse that the client has a continuing infection? - ANSWER Positive leukocyte esterase
A nurse is providing discharge teaching for a client who had lithotripsy to break up calculi in
the right kidney. Which of the following findings should the nurse instruct the client to re-
port to the provider? - ANSWER Painful urination
A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the fol-
lowing findings is a priority to report to the provider? - ANSWER Hemoglobin 7.6 mg/dL
A nurse in an emergency department is caring for a client whose ABG results are pH 7.31,
PaCO2 50mm Hg, and HCO3- 25 mEq/L after experiencing an airway obstruction. Which of
the following interventions is the nurse's priority for this client? - ANSWER Apply oxygen
therapy to the client
A nurse is assessing a client who has Graves' disease. Which of the following findings should
the nurse expect? - ANSWER Exophthalmos
A nurse is providing teaching to a client who has a hearing impairment and has a new pre-
scription for a hearing aid. Which of the following client statements indicates an understand-
ing of the teaching? - ANSWER "I will make sure the hearing aid is off before inserting it
in my ear"
A nurse is assessing a client who has an ulcer due to peripheral vascular disease. Which of
the following findings should the nurse identify as an indication that the client has a venous
ulcer rather than an arterial ulcer? - ANSWER Discoloration and edema of the right ankle
A nurse is providing home care instructions to a client who had a short-arm plaster cast ap-
plied for a wrist fracture. Which of the following instructions should the nurse include? - AN-
SWER Elevate the wrist above heart level
2
prevent pneumonia. Which of the following instructions should the nurse include in the
teaching? - ANSWER Wash your hands when you return home from running errands
A nurse is reviewing the medical record of a client who has a family history of gallstones.
Which of the following findings should the nurse identify as a risk factor for developing chol-
ecystitis? - ANSWER Client is taking atorvastatin
A nurse is assessing a client who is receiving morphine via a PCA pump to manage postoper-
ative pain. The client has a heart rate of 66/min and a respiratory rate of 9/min. Which of
the following medications should the nurse anticipate the provider will prescribe for the cli-
ent? - ANSWER Naloxone
A nurse is teaching a client who has gastroesophageal reflux disease about ways to prevent
reflux. Which of the following information should the nurse include in the teaching? - AN-
SWER Plan to finish eating at least 3 hr before bedtime
A nurse is assessing a client who has a calcium level of 6.3 mg/dL. Which of the following
findings should the nurse expect? - ANSWER Circumoral tingling
A nurse is leading a small group discussion in an acute care mental health facility when one
client suddenly begins to experience a panic attack. Which of the following actions should
the nurse take? - ANSWER Remain with the client until manifestations subside
A nurse in an emergency department is assessing a client who reports severe constipation.
The nurse should identify which of the following findings as an indication that the client
might have a small-bowel obstruction? - ANSWER Visible peristaltic waves in the upper
abdomen
1
, A nurse is reviewing the urinalysis results of a client who has completed a 14-day course of
ciprofloxacin to treat pyelonephritis. Which of the following values should indicate to the
nurse that the client has a continuing infection? - ANSWER Positive leukocyte esterase
A nurse is providing discharge teaching for a client who had lithotripsy to break up calculi in
the right kidney. Which of the following findings should the nurse instruct the client to re-
port to the provider? - ANSWER Painful urination
A nurse is reviewing the medical record of a client who has a peptic ulcer. Which of the fol-
lowing findings is a priority to report to the provider? - ANSWER Hemoglobin 7.6 mg/dL
A nurse in an emergency department is caring for a client whose ABG results are pH 7.31,
PaCO2 50mm Hg, and HCO3- 25 mEq/L after experiencing an airway obstruction. Which of
the following interventions is the nurse's priority for this client? - ANSWER Apply oxygen
therapy to the client
A nurse is assessing a client who has Graves' disease. Which of the following findings should
the nurse expect? - ANSWER Exophthalmos
A nurse is providing teaching to a client who has a hearing impairment and has a new pre-
scription for a hearing aid. Which of the following client statements indicates an understand-
ing of the teaching? - ANSWER "I will make sure the hearing aid is off before inserting it
in my ear"
A nurse is assessing a client who has an ulcer due to peripheral vascular disease. Which of
the following findings should the nurse identify as an indication that the client has a venous
ulcer rather than an arterial ulcer? - ANSWER Discoloration and edema of the right ankle
A nurse is providing home care instructions to a client who had a short-arm plaster cast ap-
plied for a wrist fracture. Which of the following instructions should the nurse include? - AN-
SWER Elevate the wrist above heart level
2
