1. KAPLAN PREDICTOR Q & A
Which of these instructions should a nurse include in the teaching plan for a client who had removal of a cataract in the left eye?
"Take the prescribed stool softener to avoid increasing intraocular pressure."
2. A client vomits during a continuous nasogastric tube feeding. A nurse should stop the feeding and take which of these actions?
Check the residual volume.
3. Which of these actions best demonstrates cultural sensitivity by a nurse?.
The nurse asks clients about their beliefs and practices toward pregnancy.
4. Which of these manifestations should a nurse expect to observe in a 3-month-old infant who is diagnosed with dehydration? Tachycardia.
5. When assessing a client's risk of developing nosocomial infection, a nurse plans to determine potential entry portals, which include:
the urinary meatus.
6. A client who is on the inpatient psychiatric unit has a history of violence. Which of these actions should a nurse take if the client is agitated?
Encourage the client to verbalize feelings.
7. Which of these measures should a nurse include when planning care for a school-aged child during a sickle cell crisis episode? Providing pain relief.
8. Which of these instructions should a nurse include in the plan of care for a 32-week gestation client who had an amniocentesis today?
"Call the clinic if you experience any abdominal cramps."
9. An adolescent has a nursing diagnosis of fatigue related to inadequate intake of iron-rich foods. Selection of which of these lunches by the client
indicates a correct understanding of foods high in iron content? Beefburger with cheese.
10. A client has been admitted with acute pancreatitis. Which of these laboratory test results supports this diagnosis? Elevated serum amylase level.
11. Which of these manifestations, if assessed in a client who is two-hours postoperative after abdominal surgery, should a nurse report immediately?
Vomiting and a pulse rate of 106/minute.
12. Which of these observations of a student nurse's behavior while interacting with a client who is crying indicates a correct understanding of
therapeutic communication? The student sits quietly next to the client.
13. Which of these actions should a nurse take initially if a client who is diagnosed with diabetes mellitus develops tremors and ataxia?
Measure the client's blood sugar level.
14. An elderly client is at increased risk of developing drug toxicity to prescribed medications due to declining hepatic and renal functioning. Which of
these strategies should a nurse plan to decrease this risk? Increasing the time interval between medication doses.
15. A client has persistent paranoid delusions that the food on the unit is poisoned. Which of these measures should a nurse include in the client's care
plan? Allowing the client to eat food from sealed containers.
16. Thrombophlebitis is a complication that may result due to surgery. Which of these actions should a nurse take in the operating room to prevent this
complication from occurring?Apply sequential compression devices.
17. When discussing weigh gain during pregnancy, a nurse should recommend that the total weight gain for a pregnant client who is at ideal body
weight for her height is: 25 to 35 pounds.
18. Which of these manifestations, if reported by a client who is 10-weeks-pregnant, supports the diagnosis of ruptured tubal pregnancy?
Sharp unilateral abdominal pain.
19. Which of these assignments, if made by a nurse to a nursing assistant, indicates that the nurse needs additional instructions regarding the principles
of delegation?
"Please bathe the client in room 10, administer a back rub, and then evaluate if the back rub eased the client's discomfort."
20. A client has the following order for regular insulin (Humulin R) on a sliding scale:
Blood sugar 150-180 mg: Give 2 units regular insulin
Blood sugar 181-200 mg: Give 4 units regular insulin
Blood sugar 201-220 mg: Give 6 units of regular insulin
Blood sugar above 220 mg: Call MD
1
, KAPLAN PREDICTOR Q & A
At 11 A.M., a nurse obtains a finger stick glucose of 198 mg. The only syringe is a three milliliter one. Regular insulin is available as 100 units per
milliliter. How many milliliters should the nurse administer? 0.04
21. Which of these nursing diagnosis is the priority for a client who is one-hour postoperative after extensive abdominal surgery?
Risk for ineffective airway clearance.
22. A nurse should recognize that which of these occupations increases a person's risk of developing hepatitis B? Hemodialysis nurse.
23. Which of these assessments is the priority for a client who sustained second-degree burns of the face and neck? Respiratory status.
24. A nurse should place a child who is two hours post-tonsillectomy and adenoidectomy in which of these positions? Side-lying.
25. Which of these instructions should a nurse include in the discharge teaching for a client who has diabetes mellitus?
"Apply lotion to your feet each day."
26. A nurse inadvertently administers an incorrect medication to a client. Which of these actions should the nurse take first? Assess the client.
27. An elderly client who is receiving a blood transfusion develops a rapid bounding pulse and an elevated blood pressure. Which of these actions
should a nurse take? Stop the transfusion.
28. When caring for a client who has hepatitis B, a nurse should wear: gloves when removing the intravenous cannula.
29. Which of these outcome criteria is appropriate for a client who has a nursing diagnosis of ineffective airway clearance?
Clear lung sounds on auscultation.
30. A doctor prescribes liquid oral iron medication for a 4-year-old child. Which of these questions should a nurse ask the child's mother to determine if
the medication is being administered correctly? "Are you using a straw to administer the medicine?"
31. Which of these assessment findings, if present in a 4-month-old infant who has severe diarrhea, should a nurse recognize as suggestive that the
infant is dehydrated? Decreased urine output.
32. Which of these instructions should be included in the teaching plan for the parents of a 10-month-old infant who is admitted to the hospital for
failure to thrive? Encourage the mother to feed the infant slowly in a quiet environment.
33. When a newborn is 48 hours old, a nurse notes that the child is jaundiced. The nurse should recognize which of these conditions as a probable
cause of the newborn's jaundice? Liver immaturity.
34. Which of these items should a nurse removed from the food tray of a client who is on a sodium-restricted diet? Ketchup.
35. Which of these statements, if made by a client who had a total hip replacement, would indicate a correct understanding of the postoperative
instructions? "I will use a raised toilet seat in the bathroom."
36. Which of these measures should a nurse include when planning care for an 88-year-old client who is admitted to the hospital with pneumonia?
Allowing the client to perform self-care as tolerated.
37. A client, who is newly diagnosed with cancer says to a nurse, "I suppose I need to complete all unfinished business as soon as possible." Which of
these responses is appropriate? "It sounds like you are concerned with your diagnosis."
38. Which of these interventions should plan for a child who is receiving chelation therapy for lead poisoning?
Keeping an accurate record of intake and output.
39. A nurse obtains these vital signs on an adult client. Which finding should the nurse follow-up first? Respiration, 30/minute and deep.
40. When determining the duration of a uterine contraction, a nurse should measure the contraction from the:
beginning of one contraction to the end of that contraction.
41. A nurse should recognize which of these signs is a probable sign of pregnancy? Positive pregnancy test.
42. All of these clients are on bed rest. Which one is the most at risk to develop skin breakdown?
An 84-year-old client who has been NPO for four days.
2
Which of these instructions should a nurse include in the teaching plan for a client who had removal of a cataract in the left eye?
"Take the prescribed stool softener to avoid increasing intraocular pressure."
2. A client vomits during a continuous nasogastric tube feeding. A nurse should stop the feeding and take which of these actions?
Check the residual volume.
3. Which of these actions best demonstrates cultural sensitivity by a nurse?.
The nurse asks clients about their beliefs and practices toward pregnancy.
4. Which of these manifestations should a nurse expect to observe in a 3-month-old infant who is diagnosed with dehydration? Tachycardia.
5. When assessing a client's risk of developing nosocomial infection, a nurse plans to determine potential entry portals, which include:
the urinary meatus.
6. A client who is on the inpatient psychiatric unit has a history of violence. Which of these actions should a nurse take if the client is agitated?
Encourage the client to verbalize feelings.
7. Which of these measures should a nurse include when planning care for a school-aged child during a sickle cell crisis episode? Providing pain relief.
8. Which of these instructions should a nurse include in the plan of care for a 32-week gestation client who had an amniocentesis today?
"Call the clinic if you experience any abdominal cramps."
9. An adolescent has a nursing diagnosis of fatigue related to inadequate intake of iron-rich foods. Selection of which of these lunches by the client
indicates a correct understanding of foods high in iron content? Beefburger with cheese.
10. A client has been admitted with acute pancreatitis. Which of these laboratory test results supports this diagnosis? Elevated serum amylase level.
11. Which of these manifestations, if assessed in a client who is two-hours postoperative after abdominal surgery, should a nurse report immediately?
Vomiting and a pulse rate of 106/minute.
12. Which of these observations of a student nurse's behavior while interacting with a client who is crying indicates a correct understanding of
therapeutic communication? The student sits quietly next to the client.
13. Which of these actions should a nurse take initially if a client who is diagnosed with diabetes mellitus develops tremors and ataxia?
Measure the client's blood sugar level.
14. An elderly client is at increased risk of developing drug toxicity to prescribed medications due to declining hepatic and renal functioning. Which of
these strategies should a nurse plan to decrease this risk? Increasing the time interval between medication doses.
15. A client has persistent paranoid delusions that the food on the unit is poisoned. Which of these measures should a nurse include in the client's care
plan? Allowing the client to eat food from sealed containers.
16. Thrombophlebitis is a complication that may result due to surgery. Which of these actions should a nurse take in the operating room to prevent this
complication from occurring?Apply sequential compression devices.
17. When discussing weigh gain during pregnancy, a nurse should recommend that the total weight gain for a pregnant client who is at ideal body
weight for her height is: 25 to 35 pounds.
18. Which of these manifestations, if reported by a client who is 10-weeks-pregnant, supports the diagnosis of ruptured tubal pregnancy?
Sharp unilateral abdominal pain.
19. Which of these assignments, if made by a nurse to a nursing assistant, indicates that the nurse needs additional instructions regarding the principles
of delegation?
"Please bathe the client in room 10, administer a back rub, and then evaluate if the back rub eased the client's discomfort."
20. A client has the following order for regular insulin (Humulin R) on a sliding scale:
Blood sugar 150-180 mg: Give 2 units regular insulin
Blood sugar 181-200 mg: Give 4 units regular insulin
Blood sugar 201-220 mg: Give 6 units of regular insulin
Blood sugar above 220 mg: Call MD
1
, KAPLAN PREDICTOR Q & A
At 11 A.M., a nurse obtains a finger stick glucose of 198 mg. The only syringe is a three milliliter one. Regular insulin is available as 100 units per
milliliter. How many milliliters should the nurse administer? 0.04
21. Which of these nursing diagnosis is the priority for a client who is one-hour postoperative after extensive abdominal surgery?
Risk for ineffective airway clearance.
22. A nurse should recognize that which of these occupations increases a person's risk of developing hepatitis B? Hemodialysis nurse.
23. Which of these assessments is the priority for a client who sustained second-degree burns of the face and neck? Respiratory status.
24. A nurse should place a child who is two hours post-tonsillectomy and adenoidectomy in which of these positions? Side-lying.
25. Which of these instructions should a nurse include in the discharge teaching for a client who has diabetes mellitus?
"Apply lotion to your feet each day."
26. A nurse inadvertently administers an incorrect medication to a client. Which of these actions should the nurse take first? Assess the client.
27. An elderly client who is receiving a blood transfusion develops a rapid bounding pulse and an elevated blood pressure. Which of these actions
should a nurse take? Stop the transfusion.
28. When caring for a client who has hepatitis B, a nurse should wear: gloves when removing the intravenous cannula.
29. Which of these outcome criteria is appropriate for a client who has a nursing diagnosis of ineffective airway clearance?
Clear lung sounds on auscultation.
30. A doctor prescribes liquid oral iron medication for a 4-year-old child. Which of these questions should a nurse ask the child's mother to determine if
the medication is being administered correctly? "Are you using a straw to administer the medicine?"
31. Which of these assessment findings, if present in a 4-month-old infant who has severe diarrhea, should a nurse recognize as suggestive that the
infant is dehydrated? Decreased urine output.
32. Which of these instructions should be included in the teaching plan for the parents of a 10-month-old infant who is admitted to the hospital for
failure to thrive? Encourage the mother to feed the infant slowly in a quiet environment.
33. When a newborn is 48 hours old, a nurse notes that the child is jaundiced. The nurse should recognize which of these conditions as a probable
cause of the newborn's jaundice? Liver immaturity.
34. Which of these items should a nurse removed from the food tray of a client who is on a sodium-restricted diet? Ketchup.
35. Which of these statements, if made by a client who had a total hip replacement, would indicate a correct understanding of the postoperative
instructions? "I will use a raised toilet seat in the bathroom."
36. Which of these measures should a nurse include when planning care for an 88-year-old client who is admitted to the hospital with pneumonia?
Allowing the client to perform self-care as tolerated.
37. A client, who is newly diagnosed with cancer says to a nurse, "I suppose I need to complete all unfinished business as soon as possible." Which of
these responses is appropriate? "It sounds like you are concerned with your diagnosis."
38. Which of these interventions should plan for a child who is receiving chelation therapy for lead poisoning?
Keeping an accurate record of intake and output.
39. A nurse obtains these vital signs on an adult client. Which finding should the nurse follow-up first? Respiration, 30/minute and deep.
40. When determining the duration of a uterine contraction, a nurse should measure the contraction from the:
beginning of one contraction to the end of that contraction.
41. A nurse should recognize which of these signs is a probable sign of pregnancy? Positive pregnancy test.
42. All of these clients are on bed rest. Which one is the most at risk to develop skin breakdown?
An 84-year-old client who has been NPO for four days.
2
