A nurse is reinforcing teaching with a group of expectant parents regarding the proper
use of car seat. Which of the following statements by a parent indicates an understanding
of the teaching?
a. "I can place a rolled towel on each side of my newborn's head until he can
hold his head up."
The parent of a 3-year-old child tells the nurse that he is concerned because his
daughter has begun playing with an imaginary friend. Which of the following is an
appropriate response by the nurse?
, a. This is a common behavior for children of this age.
A nurse is reinforcing discharge teaching to a client who is prescribed propylthiuracil. for
which of the following should the nurse instruct the client to monitor and report to the
provider immediately?
d. Sore throat.
A nurse is preparing to apply a pulse oximeter to a client's finger. Which of the following
actions should the nurse take before applying the sensor?
a. Check the client's capillary refill.
A nurse is reinforcing teaching with a new mother of a full-term newborn about
breastfeeding. The newborn is 5 days old. Which of the following statements by the
mother indicates an understanding of the teaching?
c. "I should have my baby latch on to my nipple and areola during feeding."
,A nurse is taking the vital signs of an adult client who has just been transferred from the
PACU to the clinical unit. Which of the following findings should the nurse recognize as
the most significant?
c. Temperature 36 C (96.8 F)
A nurse is reviewing the immunization records of a 9-year-old child during a routine
physical exam. Which of the following should indicate to the nurse the child is not current
with the minimum required immunization?
a. One MMR vaccine.
A nurse has administered cephalexin (Keflex) to a client. Which of the following is the
earliest indicator of an anaphylactic reaction?
a. Wheezes b. Hypotension
A nurse is reinforcing teaching with a new mother regarding the use of breast milk. Which
of the following statements by the mother indicates an understanding of the teaching?
, d. "I can store my breast milk in the freezer for up to 6 months."
A nurse is supervising an assistive personnel (AP). During the morning meal, the nurse
observes the AP accidentally spill a cup of coffee on a client. Which of the following
actions should the nurse take?
c. Reinforce safe meal setup techniques.
A nurse is collecting data from a client at an urgent care clinic. The client tells the nurse
that she hasn't been able to sleep since the death of her father 2 days ago. Which of the
following is the nurse's priority action?
c. Discuss coping skills that have worked for the client previously.
A nurse is monitoring a client who is receiving a unit of packed red blood cells (PRBCs).
The nurse recognizes an allergic reaction when the client reports
use of car seat. Which of the following statements by a parent indicates an understanding
of the teaching?
a. "I can place a rolled towel on each side of my newborn's head until he can
hold his head up."
The parent of a 3-year-old child tells the nurse that he is concerned because his
daughter has begun playing with an imaginary friend. Which of the following is an
appropriate response by the nurse?
, a. This is a common behavior for children of this age.
A nurse is reinforcing discharge teaching to a client who is prescribed propylthiuracil. for
which of the following should the nurse instruct the client to monitor and report to the
provider immediately?
d. Sore throat.
A nurse is preparing to apply a pulse oximeter to a client's finger. Which of the following
actions should the nurse take before applying the sensor?
a. Check the client's capillary refill.
A nurse is reinforcing teaching with a new mother of a full-term newborn about
breastfeeding. The newborn is 5 days old. Which of the following statements by the
mother indicates an understanding of the teaching?
c. "I should have my baby latch on to my nipple and areola during feeding."
,A nurse is taking the vital signs of an adult client who has just been transferred from the
PACU to the clinical unit. Which of the following findings should the nurse recognize as
the most significant?
c. Temperature 36 C (96.8 F)
A nurse is reviewing the immunization records of a 9-year-old child during a routine
physical exam. Which of the following should indicate to the nurse the child is not current
with the minimum required immunization?
a. One MMR vaccine.
A nurse has administered cephalexin (Keflex) to a client. Which of the following is the
earliest indicator of an anaphylactic reaction?
a. Wheezes b. Hypotension
A nurse is reinforcing teaching with a new mother regarding the use of breast milk. Which
of the following statements by the mother indicates an understanding of the teaching?
, d. "I can store my breast milk in the freezer for up to 6 months."
A nurse is supervising an assistive personnel (AP). During the morning meal, the nurse
observes the AP accidentally spill a cup of coffee on a client. Which of the following
actions should the nurse take?
c. Reinforce safe meal setup techniques.
A nurse is collecting data from a client at an urgent care clinic. The client tells the nurse
that she hasn't been able to sleep since the death of her father 2 days ago. Which of the
following is the nurse's priority action?
c. Discuss coping skills that have worked for the client previously.
A nurse is monitoring a client who is receiving a unit of packed red blood cells (PRBCs).
The nurse recognizes an allergic reaction when the client reports
