A 2 year-old child has just been diagnosed with cystic fibrosis. The child's father asks the
nurse "What is our major concern now, and what will we have to deal with in the future?"
Which of the following is the best response?
A) "There is a probability of life-long complications."
B) "Cystic fibrosis results in nutritional concerns that can be dealt with."
C) "Thin, tenacious secretions from the lungs are a constant struggle in cystic fibrosis."
D) "You will work with a team of experts and also have access to a support group that the
family can attend." - ANSWER>>C) "Thin, tenacious secretions from the lungs are a
constant struggle in cystic fibrosis."
A 20 year-old client has an infected leg wound from a motorcycle accident, and the client has
returned home from the hospital. The client is to keep the affected leg elevated and is on
contact precautions. The client wants to know if visitors can come. The appropriate response
from the home health nurse is that:
A) Visitors must wear a mask and a gown
B) There are no special requirements for visitors of clients on contact precautions
C) Visitors should wash their hands before and after touching the client
D) Visitors - ANSWER>>C) Visitors should wash their hands before and after touching the
client
A 26-year-old female client is admitted to the hospital for treatment of a simple goiter, and
levothyroxine sodium (Synthroid) is prescribed. Which symptoms indicate to the nurse that
the prescribed dosage is too high for this client? The client experiences:
,A. Bradycardia and constipation
B. Lethargy and lack of appetite
C. Muscle cramping and dry, flushed skin
D. Palpitations and shortness of breath - ANSWER>>D. Palpitations and shortness of breath
A 30 month-old child is admitted to the hospital unit. Which of the following toys would be
appropriate for the nurse to select from the toy room for this child?
A) Cartoon stickers
B) Large wooden puzzle
C) Blunt scissors and paper
D) Beach ball - ANSWER>>B) Large wooden puzzle
A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse
enters the room to request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control - ANSWER>>C) Administer the
prescribed analgesia
A 38 year-old female client is admitted to the hospital with an acute exacerbation of asthma.
This is her third admission for asthma in 7 months. She describes how she doesn't really like
having to use her medications all the time. Which explanation by the nurse best describes the
long-term consequence of uncontrolled airway inflammation?
,A) Degeneration of the alveoli
B) Chronic broncho constriction of the large airways
C) Lung remodeling and permanent changes in lung function
D) Frequent pneumonia - ANSWER>>C) Lung remodeling and permanent changes in lung
function
A 60 year-old male client had a hernia repair in an outpatient surgery clinic. He is awake and
alert, but has not been able to void since he returned from surgery 6 hours ago.He received
1000 mL of IV fluid. Which action would be most likely to help him void?
A) Have him drink several glasses of water
B) Crede' the bladder from the bottom to the top
C) Assist him to stand by the side of the bed to void
D) Wait 2 hours and have him try to void again - ANSWER>>C) Assist him to stand by the
side of the bed to void
A 65-year-old Hispanic-Latino client with prostate cancer rates his pain as a 6 on a 0- to-10
scale. The client refuses all pain medication other than Motrin, which does not relieve his
pain. The next action for the nurse to take is to
A) Ask the client about the refusal of certain pain medications
B) Talk with the client's family about the situation
C) Report the situation to the health care provider
D) Document the situation in the notes - ANSWER>>A) Ask the client about the refusal of
certain pain medications
, A child is admitted to the pediatric unit with a diagnosis of suspected meningococcal
meningitis. Which admission orders should the nurse do first?
A) Institute seizure precautions
B) Monitor neurologic status every hour
C) Place in respiratory/secretion precautions
D) Cefotaxime IV 50 mg/kg/day divided q6h - ANSWER>>C) Place in respiratory/secretion
precautions
A client asks the nurse to call the police and states: "I need to report that I am being abused
by a nurse." The nurse should first
A) Focus on reality orientation to place and person
B) Assist with the report of the client's complaint to the police
C) Obtain more details of the client's claim of abuse
D) Document the statement on the client's chart with a report to the manager -
ANSWER>>C) Obtain more details of the client's claim of abuse
A client develops volume overload from an IV that has infused too rapidly. What assessment
would the nurse expect to find?
A) S3 heart sound
B) Thready pulse
C) Flattened neck veins
D) Hypoventilation - ANSWER>>A) S3 heart sound