NUR 004 EXAM 2024/2025 WITH 100%
ACCURATE SOLUTIONS
Client call lights come on while the unlicensed assistive personnel
(UAP) sits at a desk and reads a magazine. When the nurse asks the
UAP to answer the lights, the UAP says, "Those aren't my clients." What
is the best response by the nurse?
1. "Would you mind answering the lights anyway?"
2. "I need you to answer the lights because we want to provide good
client care."
3. Say nothing and answer the lights, but write up a disciplinary action
4. Tell the UAP that this is unacceptable and speak to the nurse manager.
- Precise Answer ✔✔2
The risk management nurse is reviewing client records. Which nursing
intervention could have contributed to a sentinel event?
1. Administered flumazenil to a client who overdosed on lorazepam
2. Administered insulin/dextrose to a client with potassium level of 7.2
mEq/L (7.2 mmol/L)
3. Administered warfarin to a client with International Normalized Ratio
of 6
4. Initiated nitroprusside infusion in a client with blood pressure of
210/112 mm Hg - Precise Answer ✔✔3
,The registered nurse is caring for multiple clients on a busy surgical unit
and should delegate which action to the unlicensed assistive personnel?
1. Assist client, post hip fracture repair, to the bathroom
2. Check the appearance of client's wound
3. If client tolerates oral liquids, discontinue nasogastric tube
4. Offer orange juice to client if bedside glucose reading is <70 mg/dL
(3.9 mmol/L) - Precise Answer ✔✔1
Which statements related to ethical nursing practices are correct? Select
all that apply.
1. Accountability is documenting that the nurse administered the wrong
medication
2. Autonomy is informing the client of the decision the family made for
the client
3. Confidentiality is respecting a client's request to keep suicidal ideation
a secret
4. Justice is providing the same cardiac care to a homeless person as a
businessperson 5.Nonmaleficence is reporting abuse for a client with
Alzheimer disease - Precise Answer ✔✔1,4,5
A major earthquake has occurred. Local gas lines and water pipes are
breaking with resulting fires and flooding in collapsed buildings.
Multiple victims come to the triage area. Which client would the nurse
care for first?
1. Charred leathery skin over entire back, chest, and legs
2. Client shivering from sitting in water until rescued
,3. Diabetic client who was unable to take insulin today
4. High-pitched, crowing inspiratory respirations - Precise Answer ✔✔4
The charge nurse on a medical-surgical step-down unit is responsible for
making assignments. Which client is most appropriate to assign to a new
graduate nurse who is still in orientation?
1. 65-year-old client 1 day postoperative left femoral-popliteal bypass
graft surgery with a diminished pedal pulse
2. 66-year-old client admitted for hypertensive crisis 2 days ago; blood
pressure currently 180/102 mm Hg; reports headache and blurred vision
3. 75-year-old client with an ischemic stroke transferred from the
intensive care unit 1 hour ago; unresponsive with right-sided paralysis
4. 78-year-old client with diabetes and cellulitis of the left foot; requires
frequent dressing changes due to excessive drainage - Precise Answer
✔✔4
An unaccompanied 16-year-old female comes to the emergency
department with severe abdominal pain and vomiting. The minor has a
temperature of 102.2 F (39 C) and a pulse of 120 /min and is lethargic.
The parents are out of town, and no guardians could be reached. How
should the care be handled?
1. Administer care until parents or guardians can be reached
2. Keep the minor but without giving care until parents or guardians can
be reached
3. Perform a pregnancy test to see if the minor qualifies as an
emancipated minor
, 4. Provide health care and follow-up advice but do not give any direct
care - Precise Answer ✔✔1
A staff nurse automatically takes a lunch break first every day instead of
asking other staff nurses about their preferences. Another nurse would
like to take the first lunch break time sometimes. Which is the best way
for the staff nurse to handle the situation initially?
1. Ask the nurse manager to talk to the nurse who takes the first break
time
2. Poll the other staff nurses to see what they think about the situation
3. Realize that some matters are not worth bringing up and say nothing
4. Tell the nurse directly of wanting to take the first lunch break
sometimes - Precise Answer ✔✔4
The nurse reviews the laboratory results for 4 assigned clients. Which
result is most important for the nurse to report to the primary health care
provider?
1. Client with atrial fibrillation receiving warfarin for 7 days with an
International Normalized Ratio (INR) of 1.3
2. Client with chronic bronchitis who has a hematocrit of 56% [0.56]
and hemoglobin of 19 g/dL (190 g/L)
3. Client with Clostridium difficile infection who has a white blood cell
count of 15,000/mm3 (15 × 109/L)
4. Client with sepsis receiving gentamycin who has a creatinine of 0.6
mg/dL (53 µmol/L) - Precise Answer ✔✔1
ACCURATE SOLUTIONS
Client call lights come on while the unlicensed assistive personnel
(UAP) sits at a desk and reads a magazine. When the nurse asks the
UAP to answer the lights, the UAP says, "Those aren't my clients." What
is the best response by the nurse?
1. "Would you mind answering the lights anyway?"
2. "I need you to answer the lights because we want to provide good
client care."
3. Say nothing and answer the lights, but write up a disciplinary action
4. Tell the UAP that this is unacceptable and speak to the nurse manager.
- Precise Answer ✔✔2
The risk management nurse is reviewing client records. Which nursing
intervention could have contributed to a sentinel event?
1. Administered flumazenil to a client who overdosed on lorazepam
2. Administered insulin/dextrose to a client with potassium level of 7.2
mEq/L (7.2 mmol/L)
3. Administered warfarin to a client with International Normalized Ratio
of 6
4. Initiated nitroprusside infusion in a client with blood pressure of
210/112 mm Hg - Precise Answer ✔✔3
,The registered nurse is caring for multiple clients on a busy surgical unit
and should delegate which action to the unlicensed assistive personnel?
1. Assist client, post hip fracture repair, to the bathroom
2. Check the appearance of client's wound
3. If client tolerates oral liquids, discontinue nasogastric tube
4. Offer orange juice to client if bedside glucose reading is <70 mg/dL
(3.9 mmol/L) - Precise Answer ✔✔1
Which statements related to ethical nursing practices are correct? Select
all that apply.
1. Accountability is documenting that the nurse administered the wrong
medication
2. Autonomy is informing the client of the decision the family made for
the client
3. Confidentiality is respecting a client's request to keep suicidal ideation
a secret
4. Justice is providing the same cardiac care to a homeless person as a
businessperson 5.Nonmaleficence is reporting abuse for a client with
Alzheimer disease - Precise Answer ✔✔1,4,5
A major earthquake has occurred. Local gas lines and water pipes are
breaking with resulting fires and flooding in collapsed buildings.
Multiple victims come to the triage area. Which client would the nurse
care for first?
1. Charred leathery skin over entire back, chest, and legs
2. Client shivering from sitting in water until rescued
,3. Diabetic client who was unable to take insulin today
4. High-pitched, crowing inspiratory respirations - Precise Answer ✔✔4
The charge nurse on a medical-surgical step-down unit is responsible for
making assignments. Which client is most appropriate to assign to a new
graduate nurse who is still in orientation?
1. 65-year-old client 1 day postoperative left femoral-popliteal bypass
graft surgery with a diminished pedal pulse
2. 66-year-old client admitted for hypertensive crisis 2 days ago; blood
pressure currently 180/102 mm Hg; reports headache and blurred vision
3. 75-year-old client with an ischemic stroke transferred from the
intensive care unit 1 hour ago; unresponsive with right-sided paralysis
4. 78-year-old client with diabetes and cellulitis of the left foot; requires
frequent dressing changes due to excessive drainage - Precise Answer
✔✔4
An unaccompanied 16-year-old female comes to the emergency
department with severe abdominal pain and vomiting. The minor has a
temperature of 102.2 F (39 C) and a pulse of 120 /min and is lethargic.
The parents are out of town, and no guardians could be reached. How
should the care be handled?
1. Administer care until parents or guardians can be reached
2. Keep the minor but without giving care until parents or guardians can
be reached
3. Perform a pregnancy test to see if the minor qualifies as an
emancipated minor
, 4. Provide health care and follow-up advice but do not give any direct
care - Precise Answer ✔✔1
A staff nurse automatically takes a lunch break first every day instead of
asking other staff nurses about their preferences. Another nurse would
like to take the first lunch break time sometimes. Which is the best way
for the staff nurse to handle the situation initially?
1. Ask the nurse manager to talk to the nurse who takes the first break
time
2. Poll the other staff nurses to see what they think about the situation
3. Realize that some matters are not worth bringing up and say nothing
4. Tell the nurse directly of wanting to take the first lunch break
sometimes - Precise Answer ✔✔4
The nurse reviews the laboratory results for 4 assigned clients. Which
result is most important for the nurse to report to the primary health care
provider?
1. Client with atrial fibrillation receiving warfarin for 7 days with an
International Normalized Ratio (INR) of 1.3
2. Client with chronic bronchitis who has a hematocrit of 56% [0.56]
and hemoglobin of 19 g/dL (190 g/L)
3. Client with Clostridium difficile infection who has a white blood cell
count of 15,000/mm3 (15 × 109/L)
4. Client with sepsis receiving gentamycin who has a creatinine of 0.6
mg/dL (53 µmol/L) - Precise Answer ✔✔1
