Correct Answers | Updated & Verified
1). There has been a community disaster and stable clients must be discharged from a facility
to prepare for the influx of new casualties. a nurse should identify that which of the
following clients is safe to discharge?
Ans: a client who has multiple sclerosis and reports ataxia
2). A nurse on a medical-surgical unit is caring for four clients. the nurse should recognize that
which of the following clients is the priority?
Ans: A client who has peripheral vascular disease and has an absent pulse in the right
foot
3). A nurse finds that a new iv pump has infused 400 ml of solution over 2 hr when the rate was
set at 100 ml/hr. after notifying the provider and verifying that the pump was properly
programmed, which of the following is the nurse's priority?
Ans: Tag the pump for maintenance and acquire a new pump for the client
4). A charge nurse is planning care for a group of clients. which of the following tasks should
be delegated to an assistive personnel (ap)? select all that apply
Ans: ambulating a client who uses a walker, adding thickener to thin liquids on a client's
food tray
5). A nurse is caring for a client. which of the following tasks should the nurse delegate to an
assistive personnel (ap)? select all that apply
Ans: Place an absorbent pad on the client's bed, report the client's blood pressure to
the nurse, apply barrier cream to the client's buttocks, document the client's vital signs
6). A charge nurse on a maternal newborn unit is receiving change of shift charge nurse report
for a group of newborns. which of the following 3 newborns should the charge nurse
identify as requiring priority care? select 3 newborns the charge nurse should identify as
priority.
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, Ans: Newborn 5, Newborn 3, Newborn 1
7). A nurse manager is assessing incident reports for the unit. which of the following client's
medical records indicate professional negligence? select 2 clients that the nurse manager
should recognize have charts that indicate professional negligence.
Ans: Client 4, Client 5
8). A charge nurse is assisting with the care of a client. which of the following findings should
the charge nurse identify that the client is experiencing an adverse reaction and requires
notification of provider and updating the client's plan of care? select 6 findings that indicate
that client is having an adverse reaction.
Ans: blood pressure, temperature, heart rate, respiratory rate, pain level, report by the
client
9). A nurse is caring for a client who has acute diverticulitis and is scheduled for surgery within
the next 2 hr. the client tells the nurse that they are leaving the hospital. after notifying the
surgeon, which of the following actions should the nurse take next?
Ans: Inform the client about the risks they may encounter by leaving the facility
10). A nurse is reviewing the plan of care for a client following a total hip arthroplasty. which of
the following actions should the nurse plan to take?
Ans: Inform the assistive personnel (AP) of the client's weight-bearing status
11). A nurse case manager is planning a teaching session on the use of critical pathways with a
group of newly licensed nurses. which of the following information should the nurse include
in the teaching?
Ans: Critical pathways prevent unnecessary expense
12). A nurse is caring for a client who is scheduled for outpatient surgery. which of the following
actions should the nurse take to verify the client gave informed consent?
Ans: Ask the client to explain the procedure that is being performed
13). A nurse is caring for a client who has a terminal illness and voices concern about
performing self-care after discharge. which of the following statements should the nurse
make?
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