A 20-year-old woman comes into the clinic after missing her menstrual period 2 weeks
ago and states that she suspects that she is pregnant. As the nurse is reviewing her
medications, the client says that she is taking isotretinoin. What should the nurse
consider regarding isotretinoin? - Answer -✔✔it is a teratogen
A nurse is teaching skin and basic care to the mother of a 6-month-old infant with
eczema. Which statement indicates that the mother needs further teaching? - Answer -
✔✔I'll have to be careful not to cut my baby's nails short."
The registered nurse (RN) delegated a task to a licensed practical nurse (LPN). The
LPN completed the task effectively. Which statement made by the RN is appropriate
feedback? - Answer -✔✔"You performed that procedure safely and professionally.
A nurse in the pediatric clinic is planning care for a 7-year-old boy with enuresis. What is
an appropriate short-term goal for this child? - Answer -✔✔The interval between
voidings will increase by 1 hour
Which statement of the nurse is true regarding Hersey's Situational Leadership Model? -
Answer -✔✔The situational leadership model provides a solid foundation for delegation
decisions.
The nurse leader performs his or her own honest appraisals on a regular basis and
feels good about the job. Which rule is the nurse leader implementing by this action? -
Answer -✔✔Building self-confidence
A newborn is found to have Down syndrome. The nurse knows that Down syndrome is
usually accompanied by several problems. Which assessment should the nurse perform
during the physical examination? - Answer -✔✔ardiac irregularities for congenital heart
disease
Which model of nursing care would include working "within the walls" as well as
"beyond the walls" of the hospital? - Answer -✔✔nursing case-management model
A registered nurse (RN) delegates the task of oral care of a client with stomatitis, to an
unlicensed assistive personnel (UAP). Which instruction should be given by the RN to
the UAP? - Answer -✔✔"Be certain to use mouthwash containing sodium bicarbonate
with the client."
The nurse is reviewing a plan of care for a client who has experienced a traumatic
amputation of a leg. The nurse recognizes that which intervention listed on the plan is of
lowest priority? - Answer -✔✔Teaching residual limb care
, While working with a delegatee, the registered nurse says to the delegate, "It's easy;
you can do the procedure tomorrow after watching me do it today. Just follow the steps I
have demonstrated." What is the behavior of the registered nurse in this situation? -
Answer -✔✔selling
At which body temperature does the blood pressure of a victim of hypothermia become
obtainable only by Doppler? - Answer -✔✔91.4
The nurse manager finds that there is an increased infection rate in the unit due to an
increased number of client visitors. The nurse believes that a change in the visitor policy
could help reduce the infection rates. The leader is initiating an open dialogue about
external and internal realities among the team members. Which attribute of Kotter's
eight-step model is involved in this action by the nurse manager? - Answer -✔✔creating
urgency
The nurse manager is implementing a change in evening care for clients to include back
rubs to promote sleep. The nurse manager convinces the managers of various nursing
units and also supports nursing staff who are willing to implement the change. Which
component of Kotter's eight step model is involved in this scenario? - Answer -
✔✔forming coalition
The nurse is caring for a client who meets the criteria for the emergency severity index
level 2 (ESI-2). How soon should the client be seen by the physician? - Answer -
✔✔within 10 minutes
A nurse auscultates a client's lungs and hears a fine crackling sound in the left lower
lung during respiration. The nurse charts, "crackles and rhonchi in the left lower lung."
What does this documentation represent? - Answer -✔✔inaccurate interpretation
Which action of the nurse would be most important to convey interest in starting a
conversation with a client who has hearing loss? - Answer -✔✔making eye contact
The nurse is caring for the victims of a natural disaster who are all hypothermic. Which
interventions does the nurse employ when using spontaneous rewarming? Select all
that apply. - Answer -✔✔radiant lights and move to warm dry place
A nurse is conducting a health campaign in a school. During the health campaign, the
nurse finds that the school management has replaced the registered nurse (RN) with a
trained clerk. What should the nurse, as a community opinion leader, do? - Answer -
✔✔Write a letter to a local newspaper editor opposing the decision of the school board
- Answer -✔✔