ESSENTIAL NURSING 2025 GRADED A+
SUMMARY WITH GUARANTEED PASS
The nurse facilitating the medication management group consistently notices that a particular client
positions himself on the perimeter of the group. In order to be culturally mindful about the origin of this
behavior, what question would the nurse ask the client? - Answer-"Where will you be comfortable sitting
and still remain a part of the group?"
The nurse is caring for a group of clients in an acute medicine setting. What statement by a client would
most warrant a referral to spiritual care, with the client's permission? - Answer-"It feels like one round of
bad news after another for me, like I am being punished."
The wife of a client with alcohol dependency tells the nurse, "I am tired of making excuses for him to his
boss and coworkers when he cannot make it into work. I believe him every time he says he is going to
quit." The nurse recognizes the wife's statement as indicating which behavior? - Answer-enabling
A client has been diagnosed with dementia related to chronic and heavy alcohol consumption. In a family
meeting with the client, discharge plans are being discussed. Which points should the nurse share with
the family and client? Select all that apply. - Answer-Safety alarms on the doors will keep the client from
wandering off.
As the need for supervision increases, it may be necessary for the client to be placed in an extendedcare
facility.
A client with a history of cocaine abuse is receiving intravenous therapy and exits the hospital "to visit a
friend." The client returns to the nursing unit 1 hour later, agitated, aggressive, combative, and reporting
"chest pain." Place the nurse's actions in priority order from first to last. All options must be used. -
Answer-Contact the security department.
Obtain an ECG.
Obtain a urine sample.
Initiate a referral to obtain drug rehabilitation counseling.
A client on the adolescent psychiatric unit was admitted with a diagnosis of body dysmorphic disorder.
The client has not been able to attend school or his/her part-time work over the past year as a result of
certain body obsessions. Recently, the client shaved the hair all over his/her body, claiming, "It is all
,growing weird." What component of therapy would be most important for the nurse to apply to this
client? - Answer-The client's body image is real to the client.
The nurse is caring for a client admitted to the emergency department after being found lying on the
bathroom floor with several empty pill bottles around her. While waiting for a psychiatric consult, the
nurse discovers that the client's boyfriend has recently broken up with her. Which response is most likely
is to build and maintain a therapeutic relationship within the emergency department? - Answer-"What
can I do to help while you are here?"
A client is being admitted to the substance abuse unit for alcohol detoxification. As part of his intake
interview, a nurse asks when he had his last alcoholic drink. He says that he had his last drink 6 hours
before admission. Based on this response, the nurse should expect early withdrawal symptoms to peak: -
Answer-in 1 to 2 days.
A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day.
Several months later he reports having insomnia, shakiness, sweating, and one seizure. The nurse should
first ask the client if he: - Answer-has stopped taking the clonazepam suddenly.
While admitting a client to the alcohol treatment program, the nurse asks the client how long she has
been drinking, how much she has been drinking, and when she had her last drink. The client replies that
she has been drinking about a liter of vodka a day for the past week and her last drink was about an hour
ago. This information helps the nurse to determine which factor? - Answer-the severity of withdrawal
symptoms
The nurse is performing an admission assessment of a new client. When assessing potential cultural
influences on the client's care, the nurse should address what domains? Select all that apply. -
Answerdecision-making processes
nutrition
communication
expressions of pain
The nurse is admitting a hospital client who does not speak English and who is accompanied by the
client's school-aged child. The client appears to be in pain, but the nurse is unable to assess the
, character or history of the client's pain. How should the nurse best communicate with the client? -
Answer-Enlist the help of a hospital interpreter; ask the son to translate if none is readily available.
A nurse is making a home visit to a pregnant client at 20 weeks' gestation who is a member of the local
Hmong community. The nurse is assisting the client with meal planning to promote optimal nutrition
during her pregnancy. Based on the nurse's understanding of the client's culture and food preferences,
which foods would the nurse suggest? Select all that apply. - Answer-fish cheese eggs
A client with chronic pain comes to the clinic for an evaluation. During the visit, the client asks the nurse
about possibly using acupuncture for pain relief. Which response by the nurse would be most
appropriate? - Answer-"Restoring the energy balance in your body could help with pain relief."
A Japanese couple are experiencing labor. During the admission process, the husband tells the nurse that
the wife will not receive any pain medication during the process. The husband then waits in the waiting
room. As the birthing process continues, the nurse asks the wife if she needs pain medication. She
declines the offer and reminds the nurse by saying, "My husband told you I cannot have any pain
medicine." What is the nurse's best response to the client? - Answer-"I want to advocate for you and
assist with the pain during this process."
The client who experiences residual arm pain after a fall has been referred to an acupuncture treatment
center. What is the nurse's best response to the client's question, "How is acupuncture supposed to help
me?" - Answer-"Pain is relieved by releasing endorphins, which balance the flow of energy."
A client admitted with acute pyelonephritis now reports having a severe migraine, but declines PRN
analgesics. What should the nurse discuss with this client? (Select all that apply.) - Answer-Ask the client
which migraine treatments are helpful when at home.
Alternative therapies such as relaxation or music can help.
A young woman is admitted for surgical treatment of genital lesions. What should the nurse identify as
an important part of care for this client? - Answer-Provide a chaperone or assistant in her care whenever
possible.
A hospital client has told the nurse that his religion involves the burning of incense and has asked
permission to do so on the unit. The nurse is aware that this practice would violate the hospital's fire
regulations. What is the nurse's best action? - Answer-Dialogue with the client about alternative rituals
or the possibility of performing the ritual outdoors.
SUMMARY WITH GUARANTEED PASS
The nurse facilitating the medication management group consistently notices that a particular client
positions himself on the perimeter of the group. In order to be culturally mindful about the origin of this
behavior, what question would the nurse ask the client? - Answer-"Where will you be comfortable sitting
and still remain a part of the group?"
The nurse is caring for a group of clients in an acute medicine setting. What statement by a client would
most warrant a referral to spiritual care, with the client's permission? - Answer-"It feels like one round of
bad news after another for me, like I am being punished."
The wife of a client with alcohol dependency tells the nurse, "I am tired of making excuses for him to his
boss and coworkers when he cannot make it into work. I believe him every time he says he is going to
quit." The nurse recognizes the wife's statement as indicating which behavior? - Answer-enabling
A client has been diagnosed with dementia related to chronic and heavy alcohol consumption. In a family
meeting with the client, discharge plans are being discussed. Which points should the nurse share with
the family and client? Select all that apply. - Answer-Safety alarms on the doors will keep the client from
wandering off.
As the need for supervision increases, it may be necessary for the client to be placed in an extendedcare
facility.
A client with a history of cocaine abuse is receiving intravenous therapy and exits the hospital "to visit a
friend." The client returns to the nursing unit 1 hour later, agitated, aggressive, combative, and reporting
"chest pain." Place the nurse's actions in priority order from first to last. All options must be used. -
Answer-Contact the security department.
Obtain an ECG.
Obtain a urine sample.
Initiate a referral to obtain drug rehabilitation counseling.
A client on the adolescent psychiatric unit was admitted with a diagnosis of body dysmorphic disorder.
The client has not been able to attend school or his/her part-time work over the past year as a result of
certain body obsessions. Recently, the client shaved the hair all over his/her body, claiming, "It is all
,growing weird." What component of therapy would be most important for the nurse to apply to this
client? - Answer-The client's body image is real to the client.
The nurse is caring for a client admitted to the emergency department after being found lying on the
bathroom floor with several empty pill bottles around her. While waiting for a psychiatric consult, the
nurse discovers that the client's boyfriend has recently broken up with her. Which response is most likely
is to build and maintain a therapeutic relationship within the emergency department? - Answer-"What
can I do to help while you are here?"
A client is being admitted to the substance abuse unit for alcohol detoxification. As part of his intake
interview, a nurse asks when he had his last alcoholic drink. He says that he had his last drink 6 hours
before admission. Based on this response, the nurse should expect early withdrawal symptoms to peak: -
Answer-in 1 to 2 days.
A client was discharged from an alcohol rehabilitation program on clonazepam 0.5 mg three times a day.
Several months later he reports having insomnia, shakiness, sweating, and one seizure. The nurse should
first ask the client if he: - Answer-has stopped taking the clonazepam suddenly.
While admitting a client to the alcohol treatment program, the nurse asks the client how long she has
been drinking, how much she has been drinking, and when she had her last drink. The client replies that
she has been drinking about a liter of vodka a day for the past week and her last drink was about an hour
ago. This information helps the nurse to determine which factor? - Answer-the severity of withdrawal
symptoms
The nurse is performing an admission assessment of a new client. When assessing potential cultural
influences on the client's care, the nurse should address what domains? Select all that apply. -
Answerdecision-making processes
nutrition
communication
expressions of pain
The nurse is admitting a hospital client who does not speak English and who is accompanied by the
client's school-aged child. The client appears to be in pain, but the nurse is unable to assess the
, character or history of the client's pain. How should the nurse best communicate with the client? -
Answer-Enlist the help of a hospital interpreter; ask the son to translate if none is readily available.
A nurse is making a home visit to a pregnant client at 20 weeks' gestation who is a member of the local
Hmong community. The nurse is assisting the client with meal planning to promote optimal nutrition
during her pregnancy. Based on the nurse's understanding of the client's culture and food preferences,
which foods would the nurse suggest? Select all that apply. - Answer-fish cheese eggs
A client with chronic pain comes to the clinic for an evaluation. During the visit, the client asks the nurse
about possibly using acupuncture for pain relief. Which response by the nurse would be most
appropriate? - Answer-"Restoring the energy balance in your body could help with pain relief."
A Japanese couple are experiencing labor. During the admission process, the husband tells the nurse that
the wife will not receive any pain medication during the process. The husband then waits in the waiting
room. As the birthing process continues, the nurse asks the wife if she needs pain medication. She
declines the offer and reminds the nurse by saying, "My husband told you I cannot have any pain
medicine." What is the nurse's best response to the client? - Answer-"I want to advocate for you and
assist with the pain during this process."
The client who experiences residual arm pain after a fall has been referred to an acupuncture treatment
center. What is the nurse's best response to the client's question, "How is acupuncture supposed to help
me?" - Answer-"Pain is relieved by releasing endorphins, which balance the flow of energy."
A client admitted with acute pyelonephritis now reports having a severe migraine, but declines PRN
analgesics. What should the nurse discuss with this client? (Select all that apply.) - Answer-Ask the client
which migraine treatments are helpful when at home.
Alternative therapies such as relaxation or music can help.
A young woman is admitted for surgical treatment of genital lesions. What should the nurse identify as
an important part of care for this client? - Answer-Provide a chaperone or assistant in her care whenever
possible.
A hospital client has told the nurse that his religion involves the burning of incense and has asked
permission to do so on the unit. The nurse is aware that this practice would violate the hospital's fire
regulations. What is the nurse's best action? - Answer-Dialogue with the client about alternative rituals
or the possibility of performing the ritual outdoors.
