nursin
1. The nurse is preparing the discontinue long term TPN therapy for a client. The nurse should plan to
discontinue the TPN gradually to reduce the risk of which of the following adverse effects?
a. Hyperglycemia
b. Diarrhea
c. Constipation
d. Hypoglycemia- You taper it off to avoid this!!!
Rationale PDF p.298: Never abruptly stop TPN. Speeding up/slowing down the rate is contraindicated.
An abrupt rate change can alter blood glucose levels significantly.
Rationale PDF nutrition p.58: don’t discontinue abruptly, must taper to prevent rebound hypoglycemia
2. A nurse is preparing a client for an ECG. The client is anxious and says that he is afraid the equipment
will give him an electric shock. Which of the following is an appropriate response by the nurse?
a. The machine only senses and records electrical currents coming from your heart – pg.170
Electrocardiography uses an electrocardiograph to record the electrical activity of the
heart over time.
b. The lead wires and cables are insulated for your safety
c. The electrode pads will prevent the conduction of electricity to your skin
d. The machine voltage delivery is low enough that you won’t feel any discomfort
3. A nurse is caring for client who has hypertension and has a new prescription for lisinopril. The nurse
should consult with the provider about which of the following medications in the client’s medication
administration record?
a. Potassium chloride
b. Levothyroxine
c. Acetaminophen
d. Metformin
4. A nurse is administering furosemide 80 mg PO twice daily to a client who has pulmonary edema. Which
of the following assessment findings indicates to the nurse that the medication is effective?
a. Elevation in blood pressure
b. Adventitious breath sounds
c. Weight loss of 1.8 kg (4 lb) in the past 24 hr
d. Respiratory rate of 24/min
5. Couldn't paste the picture on here. But it asked where u can hear pericardial friction rub the best at…
Erb’s Point (3rd Intercostal, Central)
6. A nurse is completing discharge teaching with a client who has a new diagnosis of AIDS. Which of the
following statements by the nurse indicates an understanding of the teaching?
, a. I will increase the amount of fresh veggies
b. I will wipe up areas soiled with body fluids with alcohol and immediately dispose of the trash
c. I will need to take my clothes to the dry cleaners to sterilize them
d. I will be sure to wear gloves and wash my hands when I change my cat’s litter box
7. A nurse is performing a venipuncture on an older adult client whose veins are difficult. Which of the
following actions should the nurse take?
a. Apply cool compresses
b. Elevate the client’s extremity using a pillow
c. Tap the skin around the insertion site
d. Raise the angle of the catheter to 30 degrees above the insertion site
8. A nurse is caring for a client in the ER following a myocardial infarction. which of the following actions
should the nurse anticipate if the client develops asystole?
a. Administer atropine
b. Defibrillate with 200 joules
c. Starts a continuous lidocaine infusion
d. Begin CPR – first line of medical management is CPR and ACLS.
9. A nurse is caring for a client with severe burn injury. The nurse should recognize which of the following
client findings as an indication of hypovolemic shock?
a. Potassium 5.2 mEq/L
b. Capillary refill 1.5 seconds
c. Urine output 45 mL/hr
d. PaCO3 37 mmHg
10. A critical care nurse is assessing a client who has a severe head injury. In response to painful stimuli the
client does not open her eyes, displays decerebrate posturing, and makes incomprehensible sounds.
Which of the following Glasgow coma scale scores should the nurse assign the client?
a. 2
b. 5
c. 10
d. 13
11. A nurse is teaching a client who has heart failure about self-management techniques. Which of the
following statements by the client indicates an understanding of the teaching?
a. I will keep an exercise diary
b. I will take ibuprofen for mild pain
1. The nurse is preparing the discontinue long term TPN therapy for a client. The nurse should plan to
discontinue the TPN gradually to reduce the risk of which of the following adverse effects?
a. Hyperglycemia
b. Diarrhea
c. Constipation
d. Hypoglycemia- You taper it off to avoid this!!!
Rationale PDF p.298: Never abruptly stop TPN. Speeding up/slowing down the rate is contraindicated.
An abrupt rate change can alter blood glucose levels significantly.
Rationale PDF nutrition p.58: don’t discontinue abruptly, must taper to prevent rebound hypoglycemia
2. A nurse is preparing a client for an ECG. The client is anxious and says that he is afraid the equipment
will give him an electric shock. Which of the following is an appropriate response by the nurse?
a. The machine only senses and records electrical currents coming from your heart – pg.170
Electrocardiography uses an electrocardiograph to record the electrical activity of the
heart over time.
b. The lead wires and cables are insulated for your safety
c. The electrode pads will prevent the conduction of electricity to your skin
d. The machine voltage delivery is low enough that you won’t feel any discomfort
3. A nurse is caring for client who has hypertension and has a new prescription for lisinopril. The nurse
should consult with the provider about which of the following medications in the client’s medication
administration record?
a. Potassium chloride
b. Levothyroxine
c. Acetaminophen
d. Metformin
4. A nurse is administering furosemide 80 mg PO twice daily to a client who has pulmonary edema. Which
of the following assessment findings indicates to the nurse that the medication is effective?
a. Elevation in blood pressure
b. Adventitious breath sounds
c. Weight loss of 1.8 kg (4 lb) in the past 24 hr
d. Respiratory rate of 24/min
5. Couldn't paste the picture on here. But it asked where u can hear pericardial friction rub the best at…
Erb’s Point (3rd Intercostal, Central)
6. A nurse is completing discharge teaching with a client who has a new diagnosis of AIDS. Which of the
following statements by the nurse indicates an understanding of the teaching?
, a. I will increase the amount of fresh veggies
b. I will wipe up areas soiled with body fluids with alcohol and immediately dispose of the trash
c. I will need to take my clothes to the dry cleaners to sterilize them
d. I will be sure to wear gloves and wash my hands when I change my cat’s litter box
7. A nurse is performing a venipuncture on an older adult client whose veins are difficult. Which of the
following actions should the nurse take?
a. Apply cool compresses
b. Elevate the client’s extremity using a pillow
c. Tap the skin around the insertion site
d. Raise the angle of the catheter to 30 degrees above the insertion site
8. A nurse is caring for a client in the ER following a myocardial infarction. which of the following actions
should the nurse anticipate if the client develops asystole?
a. Administer atropine
b. Defibrillate with 200 joules
c. Starts a continuous lidocaine infusion
d. Begin CPR – first line of medical management is CPR and ACLS.
9. A nurse is caring for a client with severe burn injury. The nurse should recognize which of the following
client findings as an indication of hypovolemic shock?
a. Potassium 5.2 mEq/L
b. Capillary refill 1.5 seconds
c. Urine output 45 mL/hr
d. PaCO3 37 mmHg
10. A critical care nurse is assessing a client who has a severe head injury. In response to painful stimuli the
client does not open her eyes, displays decerebrate posturing, and makes incomprehensible sounds.
Which of the following Glasgow coma scale scores should the nurse assign the client?
a. 2
b. 5
c. 10
d. 13
11. A nurse is teaching a client who has heart failure about self-management techniques. Which of the
following statements by the client indicates an understanding of the teaching?
a. I will keep an exercise diary
b. I will take ibuprofen for mild pain
