RN Comprehensive Online Practice 2019 B

RN Comprehensive Online Practice 2019 B A nurse is assessing a client who received 2 units of packed RBCs 48 hr ago. Which of the following findings should indicate to the nurse that the therapy has been effective? - ANSWER ==Hemoglobin 14.9 g/dL A nurse working in an emergency department is triaging four clients. Which of the following clients should the nurse recommend for treatment first? - ANSWER ==A middle adult client who has unstable vital signs A nurse is caring for a client who has fluid volume overload. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? - ANSWER ==Measure the client's daily weight. A nurse is preparing to administer mannitol 0.2g/kg IV bolus over 5 min as a test dose to a client who has severe oliguria. The client weighs 198 lb. What is the amount in grams the nurse should administer? - ANSWER ==18 g 198/2.2=90kg 0.2*90=18g A nurse is conducting a physical examination for an adolescent and is assessing the range of motion of the legs. Which of the following images indicates the adolescent is abducting the hip joint? - ANSWER ==D A nurse is caring for a client who has hyperthyroidism. Which of the following findings should the nurse expect? - ANSWER ==Tremors -Tremors are a manifestation of hyperthyroidism, along with tachycardia, diaphoresis, weight loss, insomnia, and exophthalmia. A nurse is assessing a school-age child who has bacterial meningitis. Which of the following findings should the nurse expect? - ANSWER ==Nuchal rigidity A nurse is assessing a newborn's heart rate. Which of the following actions should the nurse take? - ANSWER ==Auscultate the apical pulse at least 1 min. A nurse is preparing to assist with a thoracentesis for a client who has pleurisy. The nurse should plan to perform which of the following actions? - ANSWER ==Instruct the client to avoid coughing during the procedure. -avoid coughing and to lie still during a thoracentesis to avoid puncturing the pleura. A nurse in the emergency department is assessing a preschooler who has a facial laceration. The nurse should identify which of the following findings as a potential indication of child sexual abuse? - ANSWER ==The child exhibits discomfort while walking. A nurse is preparing to teach about dietary management to a client who has Crohn's disease and an enteroenteric fistula. Which of the following nutrients should the nurse instruct the client to decrease in their diet? - ANSWER ==Fiber -consume a low-fiber diet to reduce diarrhea and inflammation. A nurse is caring for a client who has a prescription for a continuous passive motion (CPM) machine following a total knee arthroplasty. Which of the following actions should the nurse take? - ANSWER ==Turn off the CPM machine during mealtime. A nurse is preparing to initiate IV access for an older adult client. Which of the following sites should the nurse select when initiating the IV for this client? - ANSWER ==Radial vein of the inner arm A nurse is developing an education program about osteoporosis for older adult clients. The nurse should include which of the following variables as a risk factor for osteoporosis? - ANSWER ==Sedentary lifestyle A nurse in the emergency department is caring for a child who has a fever and fluid-filled vesicles on the trunk and extremities. Which of the following interventions should the nurse identify as the priority? - ANSWER ==Initiate transmission-based precautions. A nurse is caring for a client who has a clogged percutaneous gastrostomy feeding tube. Which of the following actions should the nurse take first? - ANSWER ==Change the position of the client. -use the least restrictive intervention first. A home health care nurse is developing a teaching plan for a client who has a new ileostomy. Which of the following instructions should the nurse include? - ANSWER ==Empty the appliance when it is one-third to one-half full. A nurse is reviewing the laboratory report of a client who has end-stage kidney disease and received hemodialysis 24 hr ago. Which of the following laboratory values should the nurse report to the provider? - ANSWER ==Sodium 148 mEq/L -136 to 145 mEq/L, indicating hypernatremia A nurse is caring for four clients. Which of the following tasks should the nurse delegate to an assistive personnel (AP)? - ANSWER ==Arrange the lunch tray for a client who has a hip fracture. A nurse is preparing a client for a paracentesis. Which of the following actions should the nurse take? - ANSWER ==Instruct the client to void -void prior to the procedure, because an empty bladder decreases the risk of a bladder puncture and minimizes the client's discomfort during the procedure. A nurse has received change-of-shift report on four assigned clients. For which of the following clients should the nurse intervene to prevent a potential food and medication interaction? - ANSWER ==A client who is receiving an MAOI and is requesting a cheeseburger for dinner. A nurse is planning care for a client who has rheumatoid arthritis and has moderate to severe pain in multiple joints. Which of the following actions should the nurse plan to take? - ANSWER ==Allow for frequent rest periods throughout the day. A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. The client reports bladder spasms, and the nurse observes a decreased urinary output. Which of the following actions should the nurse take? - ANSWER ==Irrigate the catheter with 0.9% sodium chloride irrigation. -Decreased urine output and bladder spasms indicate internal obstructions of the catheter. A nurse is assessing a client who has COPD. Which of the following findings should the nurse expect? - ANSWER ==pH 7.31 -Respiratory acidosis is an expected finding for a client who has COPD. The expected reference range of pH is 7.35 to 7.45. A pH level less than 7.35 indicates acidosis. For a client who has COPD, a decrease in pH will be accompanied by an increase in the level of carbon dioxide over the expected reference range of 35 to 45 mm Hg, indicating respiratory acidosis. A nurse in a community center is providing an educational session to a group of clients about ovarian cancer. Which of the following manifestations of ovarian cancer should the nurse include in the teaching? - ANSWER ==Abdominal bloating -Other manifestations include an increase in abdominal girth, pelvic or abdominal pain, early satiety, and urinary frequency or urgency. A nurse is caring for a client who has active tuberculosis (TB). Which of the following actions should the nurse plan to take to prevent the transmission of the disease? - ANSWER ==Have the client wear a surgical mask while being transported outside the room. A nurse is caring for a group of clients. Which of the following clients should the nurse attend to first? - ANSWER ==An older adult client who is anxious and attempting to pull out an IV line An RN is observing a licensed practical nurse (LPN) and an assistive personnel (AP) move a client up in bed. For which of the following situations should the nurse intervene? - ANSWER ==The LPN and the AP grasp the client under his arms to lift him up in bed. A nurse is preparing to administer insulin to a client via a pen device. Which of the following actions should the nurse take? - ANSWER ==Hold the insulin pen device perpendicular to the client's skin to inject the medication. -hold pen in place 6-10 seconds after injecting insulin A nurse is caring for a client who has immunosuppression and a continuous IV infusion. Which of the following actions should the nurse take? - ANSWER ==Monitor the client's mouth every 8 hr. - IV tubing q24h -WBC every 24 hours - Assess infection q4h A nurse is providing teaching about advanced directives to a middle adult client. Which of the following client responses indicates an understanding of the teaching? - ANSWER =="I can designate my partner as my health care surrogate." A nurse is assessing a client following a vaginal delivery and notes heavy lochia and a boggy fundus. Which of the following medications should the nurse expect to administer? - ANSWER ==Oxytocin -a hormone that stimulates uterine contractions, to decrease vaginal bleeding. A nurse manager is planning to use a democratic leadership style with the nurses on the unit. Which of the following actions by the nurse manager demonstrates a democratic leadership style? - ANSWER ==Seeks input from the other nurses A nurse is assigning task roles for a group of clients in a community mental health clinic. Which of the following tasks should the nurse assign to the member of the group functioning as the orienteer? - ANSWER ==Noting the progress of the group toward assigned goals A nurse is creating a plan of care for a newly admitted child. Which of the following actions should the nurse include in the plan? - ANSWER ==Administer high-dose antibiotic therapy. A nurse is caring for a newborn immediately after delivery. Which of the following interventions should the nurse implement to prevent heat loss by conduction. - ANSWER ==Use a protective cover on the scale when weighing the infant. A nurse is caring for a client who had abdominal surgery 24 hr ago. Which of the following actions is the nurse's priority? - ANSWER ==Assist with deep breathing and coughing.