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WITH QUESTIONS AND CORRECT ANSWERS
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CURRENTLY TESTED AND APPROVED NEW
v v v v v
MODIFIED 2026/2027 LATEST WITH RATIONALES
v v v v
• v Avnursevisvcontributingvtovthevplanvofvcarevforvavclientvwhovisvreceivingvcontinuousvb
laddervirrigationvfollowingvavtransurethralvresectionvofvthevprostatev(TURP).vWhichvofvthev
followingvinterventionsvshouldvthevnursevinclude?
ANS:vMaintainvavdrainagevflowvratevtovkeepvthevurinevdilutedvtovavreddish-
pinkvcolorvRATIONALE:vThevnursevshouldvmaintainvthevflowvratevofvthevbladdervirrigationvtovke
epvthevurinevdilutedvtovavreddish-pinkvcolorvandvthevtubingvfreevofvclotsvandvbleeding
• Avnursevisvassistingvwithvthevcarevofvavclientvwhovisvpostpartumvandvhasvavdeep-
veinvthrombosis.vThevclientvhasvbeenvreceivingvheparinvIVvinfusion.vWhichvofvthevfollowingv
medicationsvshouldvthevnursevensurevisvreadilyvavailable?
ANS:vProtaminevsulfate
RATIONALE:vThevnursevshouldvensurevthatvprotaminevsulfatevisvreadilyvavailable.vProtaminevs
ulfatevisvthevantidotevusedvtovreversevthevanticoagulantveffectsvofvheparin
• Avnursevisvreinforcingvteachingvwithvavclientvaboutvhowvtovreplacevtheirvtwovpiecevosto
myvpouchingvsystem.vThevclientvtellsvthevnursevthatvremovingvthevskinvbarriervisvpainful.vWhic
hvofvthevfollowingvstrategiesvshouldvthevnursevsuggest?
ANS:vHoldvthevskinvtautvwhilevremovingvthevbarrier
RATIONALE:vGentlyvandvgraduallyvpeelingvthevskinvbarriervawayvwhilevholdingvthevskinvtautv
minimizesvdiscomfortvandvtraumavtovthevperistomalvskin
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,• Avnursevinvanvinpatientvmentalvhealthvfacilityvisvcaringvforvavnewlyvadmittedvclientvwho
hasvalcoholvusevdisorder.vDuringvavtherapyvsession,vthevclientvasksvaboutvAlcoholicsv
v
Anonymousv(AA).vWhichvofvthevfollowingvresponsesvshouldvthevnursevmake?
ANS:v"WhatvisvyourvcurrentvunderstandingvaboutvthevpurposevofvAA?"vRATIONALE:vThevnurs
evshouldvidentifyvthevclient'svunderstandingvaboutvthevpurposevofAAvtovprovidevfurthervinformati
onvaboutvthevprogramvandvmeetingsvandvtovfacilitatevavreferralvifvneeded.vForvtreatmentvtovbevsuc
cessful,vthevnursevshouldvinvolvevthevclientvinvthevcarevdecision-
makingvprocess.vThisvensuresvthevtreatmentvprogramvmeetsvthevclient'svindividualvneedsvandv
demonstratesvcaringvbyvthevnurse
• Avnursevisvperformingvavdressingvchangevforvavclientvwhovisv3vdaysvpostoperative.v
WhichvOfvthevfollowingvfindingsvshouldvthevnursevreportvtovthevprovider?
ANS:vYellow-greenvdrainagevatvthevincisionvline
RATIONALE:vYellow-
green,vpurulent,vorvodorousvdrainagevindicatesvthevwoundvisvinfected.vThevnursevshouldvreportvth
isvfindingvtovthevProvider
• Avnursevisvprovidingvcomfortvtovthevpartnervofvavclientvwhovhasvdied.vWhichvofvthevf
ollowingvstatementsvshouldvthevnursevmake?
ANS:v"Journalingvaboutvyourvrelationshipvmightvhelpvwithvthevgrievingvprocess."
RATIONALE:vJournalingvprovidesvavmeansvforvthevclientvtovidentifyvthoughtsvandvfeelingsvan
dvtovrecognizevandvcomevtovtermsvwithvthevpositivevandvnegativevaspectsvthevclient'svrelationshi
pvwithvtheirvpartner
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,• Avnursevisvassistingvwithvanveducationalvsessionvforvnewlyvlicensedvnursesvaboutvpartne
rvviolence.vWhichvofvthevfollowingvcharacteristicsvshouldvthevNursevincludedvasvplacingvavvulne
rablevpersonvatvriskvforvpartnervviolence?vANS:vRecentvconfirmationvofvpregnancy
RATIONALE:vThevnursevshouldvincludevpregnancyvasvavcharacteristicvplacingvavvulnerablev
personvatvriskvforvpartnervviolence.vThevperpetratorvmightvviewvthevpregnancyvasvavthreatvtovt
hevrelationshipvduevtovthevattentionvthevchildvreceives
• Avnursevisvreviewingvthevtechniquesvforvtransferringvavclientvfromvavbedvtoavchairvwithva
v groupvofvassistivevpersonnelv(AP).vWhichvofvthevfollowingvinstructionsvshouldvthevnursevinclu
de?
ANS:vUsevlower-bodyvstrength
RATIONALE:vThevnursevshouldvinstructvthevAPvtovusevlower-
bodyvstrengthvwhenvliftingvavclientvtovreducevstressvonvthevback
• Avnursevisvparticipatingvinvavqualityvimprovementvstudyvaboutvtheveffectivenessvofvclie
ntvpainvmanagementvinvthevunit.vWhichvofvthevfollowingvstrategiesvshouldvthevnursevusevtovcolle
ctvdata?
ANS:vReviewvclients'vchartsvforvtheirvratingvofvpainvbeforevpainvmedicationvwasvadministeredvan
dv1vhrvaftervadministration
RATIONALE:vThevnursevshouldvcollectvdatavfromvclients'vchartsvaboutvpainvratingsvbeforevand
aftervpainvmanagementvinterventions
v
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, • Avnursevisvreinforcingvteachingvaboutvconfidentialityvwithvavclientvwhovhasvavnewvd
iagnosisvofvHIV.vWhichvofvthevfollowingvinformationvshouldvthevnursevincludevinvthevteac
hing?
ANS:v"YourvHIVvstatusvwillvbevsharedvwithvmembersvofvyourvhealthvcarevteam."
RATIONALE:vThevdiagnosisvofvHIVvorvAIDSvisvsharedvwithveveryvmembervofvthevhealthcarevte
amvwhovprovidesvdirectvcarevforvthevclient,vjustvlikevanyvothervdiagnoses
• Avnursevisvplanningvcarevforvavclientvwhovhasvavhistoryvofvseizures.vWhichvofvthevf
ollowingvpiecesvofvequipmentvshouldvthevnursevplacevinvthevclient'svroom?
ANS:vSuctionvcatheter
RATIONALE:vThevnursevshouldvplacevsuctionvequipmentvinvthevroomvofvavclientvwhovhasvavhist
oryvofvseizures.vDuringvavseizure,vthevclientvmightvhavevexcessivevoralvsecretionsvorvmightvvomit
.vIfvthevclient'svairwayvbecomesvoccluded,vthenvthevnursevwillvneedvtovsuctionvthevoralvcavityvtov
maintainvavpatentvairway
• Avnursevinvavprovider'svofficevisvreviewingvthevmedicalvrecordvofvavclientvwhovrequestsva
prescriptionvforvanvoralvcontraceptive.vWhichvofvthevfollowingvfindingsvshouldvthevnursevidenti
v
fyvasvavcontraindicationvforvoralvcontraceptivevuse?
ANS:vCoronaryvarteryvdisease
RATIONALE:vCoronaryvarteryvdiseasevisvavcontraindicationvtovoralvcontraceptivevusevbecausevit
increasesvthevclient'svriskvforvmyocardialvinfarction.vOthervcontraindicationsvforvreceivingvoralv
v
contraceptivesvincludevgallbladdervdisease,vbreastvcancer,vandvhypertension\
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