A nurse has assigned four tasks to an assistive personnel. Which of the following should
the nurse instruct the AP to perform first?
A. take an ABG specimen to the lab.
B. Transport a client to the radiology department for an xray.
C obtain a clean catch urine sample for a newly admitted client
D pass fresh water to clients
Take an ABG specimen to the lab
rationale: ABG samples are kept on ice and should be transported
immediately to the lab or the specimen will deteriorate.
,A nurse is caring for an older adult client who has dysphagia following a cerebrovascular
accident. Which of the following actions should the nurse take when assisting the client
at mealtime?
A. Encourage the client to drink fluids before swallowing food.
B. Offer the client tart or sour foods first.
C. Tilt the client's head backward when swallowing.
D. Turn on the television
Offer the client tart or sour foods first
rationale: this stimulates saliva production, which helps with chewing and
swallowing.
A nurse is caring for a client who has type 1 diabetes and is to receive hemodialysis. The
client says " I dont even know why i am doing this. there is no cure. Which of the
following statements should the nurse make?
A it sounds as though you have given up
B dialysis will help you live longer
C you shouldnt complain. you are fortunate to have this option available to you
d lets talk about what you are going to do after dialysis today
It sounds as though you have given up
rationale: Restatement to encourage expression of feelings
,A nurse is reinforcing teaching to a client who is newly diagnosed with hypertension and
has been prescribed captopril (Capoten). The nurse should reinforce that of which of the
following medications has the potential to reduce the antihypertensive effect of
captopril?
A. Aspirin (Bayer)
B. Acetaminophen (Tylenol)
C. Guaifenesin (Robitussin)
D. Diphenhydramine hydrochloride (Benadryl)
Aspirin
Rationale: Aspirin and other NSAIDS can reduce the antihypertensive effects
of captopril, which is an ACE Inhibitor.
A nurse is changing the dressings for a client who is 3 days postoperative following a
cholecystectomy. The nurse observes yellow, thick drainage on the dressing. The nurse
should document this finding as which of the following types of drainage?
purulent exudate
A nurse is caring for a 13 year old female client who is admitted for an emergency
appendectomy. While the nurse is reinforcing preoperative teaching, the client asks, Will
I have a large scar from the surgery? Which of the following responses should the nurse
make?
A. It will be small enough that it won't show when youre wearing a bathing suit.
, B that isnt our biggest concern right now. you will be fine
C you should be happy. You won't be in pain for much longer
D What is your favorite class in school
A. It will be small enough that it won't show when youre wearing a bathing suit.
rationale: nurse is providing info specific to clients concern
A nurse is caring for a client who is newly diagnosed with bipolar disorder and is
currently experiencing an acute manic episode. Which of the following is the priority
concern of the nurse?
A. Enhancing self-esteem
B. Preventing injury
C. encouraging problem solving
D. Promoting usefulness
Give this one a try later!
Preventing injury
A nurse is caring for an older adult client who is to undergo surgery for a hip fracture.
The client says " I guess Ive lived long enough, and its my time" which of the following
responses should the nurse make?
A. The doctors and nurses will take good care of you. There's nothing to worry about"
B. This is just a minor setback. You will be on your feet in no time
C You are in really good shape for your age
D you feel that your life is ending?
Give this one a try later!
the nurse instruct the AP to perform first?
A. take an ABG specimen to the lab.
B. Transport a client to the radiology department for an xray.
C obtain a clean catch urine sample for a newly admitted client
D pass fresh water to clients
Take an ABG specimen to the lab
rationale: ABG samples are kept on ice and should be transported
immediately to the lab or the specimen will deteriorate.
,A nurse is caring for an older adult client who has dysphagia following a cerebrovascular
accident. Which of the following actions should the nurse take when assisting the client
at mealtime?
A. Encourage the client to drink fluids before swallowing food.
B. Offer the client tart or sour foods first.
C. Tilt the client's head backward when swallowing.
D. Turn on the television
Offer the client tart or sour foods first
rationale: this stimulates saliva production, which helps with chewing and
swallowing.
A nurse is caring for a client who has type 1 diabetes and is to receive hemodialysis. The
client says " I dont even know why i am doing this. there is no cure. Which of the
following statements should the nurse make?
A it sounds as though you have given up
B dialysis will help you live longer
C you shouldnt complain. you are fortunate to have this option available to you
d lets talk about what you are going to do after dialysis today
It sounds as though you have given up
rationale: Restatement to encourage expression of feelings
,A nurse is reinforcing teaching to a client who is newly diagnosed with hypertension and
has been prescribed captopril (Capoten). The nurse should reinforce that of which of the
following medications has the potential to reduce the antihypertensive effect of
captopril?
A. Aspirin (Bayer)
B. Acetaminophen (Tylenol)
C. Guaifenesin (Robitussin)
D. Diphenhydramine hydrochloride (Benadryl)
Aspirin
Rationale: Aspirin and other NSAIDS can reduce the antihypertensive effects
of captopril, which is an ACE Inhibitor.
A nurse is changing the dressings for a client who is 3 days postoperative following a
cholecystectomy. The nurse observes yellow, thick drainage on the dressing. The nurse
should document this finding as which of the following types of drainage?
purulent exudate
A nurse is caring for a 13 year old female client who is admitted for an emergency
appendectomy. While the nurse is reinforcing preoperative teaching, the client asks, Will
I have a large scar from the surgery? Which of the following responses should the nurse
make?
A. It will be small enough that it won't show when youre wearing a bathing suit.
, B that isnt our biggest concern right now. you will be fine
C you should be happy. You won't be in pain for much longer
D What is your favorite class in school
A. It will be small enough that it won't show when youre wearing a bathing suit.
rationale: nurse is providing info specific to clients concern
A nurse is caring for a client who is newly diagnosed with bipolar disorder and is
currently experiencing an acute manic episode. Which of the following is the priority
concern of the nurse?
A. Enhancing self-esteem
B. Preventing injury
C. encouraging problem solving
D. Promoting usefulness
Give this one a try later!
Preventing injury
A nurse is caring for an older adult client who is to undergo surgery for a hip fracture.
The client says " I guess Ive lived long enough, and its my time" which of the following
responses should the nurse make?
A. The doctors and nurses will take good care of you. There's nothing to worry about"
B. This is just a minor setback. You will be on your feet in no time
C You are in really good shape for your age
D you feel that your life is ending?
Give this one a try later!
