A home health nurse is assigned to a client who was recently discharged from a
rehabilitation center after experiencing a right-hemispheric stroke. Which of the
following neurologic deficits should the nurse expect to find when assessing the client?
(Select all that apply.) -- Visual spatial deficits
- Left hemianopsia
- One-sided neglect
/.A nurse is reviewing the health record of a client who is scheduled for allergy skin
testing. The nurse should postpone the testing and report to the provider which of the
following findings -Current medications
/.A nurse is caring for a group of clients. The nurse should plan to make a referral to
physical therapy for which of the following clients? -A client who is receiving
preoperative teaching for a right knee arthroplasty
/.A nurse is caring for a client who is having a seizure. Which of the following
interventions is the nurse's priority? -Turn the client to the side
/.A nurse is caring for a client who is 12 hr postoperative following a total hip
arthroplasty. Which of the following actions should the nurse take? -Place a pillow
between the clients legs
/.A nurse is preparing to admit a client who has dysphagia. The nurse should plan to
place which of the following items at the client's bedside? -Suction machine
/.A nurse is planning teaching for a client who has bladder cancer and is to undergo a
cutaneous diversion procedure to establish a ureterostomy. Which of the following
statements should the nurse include in the teaching? -"You should cut the opening of
the skin barrier one-eighth inch wider than the stoma."
/.A nurse in an emergency department is caring for a client who reports vomiting and
diarrhea for the past 3 days. Which of the following findings should indicate to the nurse
that the client is experiencing fluid volume deficit? - r-Heart rate 110/min
/.A nurse is planning care for a client who is undergoing brachytherapy via a sealed
vaginal implant to treat endometrial cancer. Which of the following actions should the
nurse include in the client's plan of care? -Wear a lead apron while providing care to
the client.
, /.A nurse is planning to provide discharge teaching for the family of an older adult client
who has hemianopsia and is at risk for falls. Which of the following instructions should
the nurse include? -Remind the client to scan their complete range of vision during
ambulation.
/.A nurse is planning care to decrease psychosocial health issues for a client who is
starting dialysis treatments for chronic kidney disease. Which of the following
interventions should the nurse include in the plan? Tell the client that it is possible to
return to similar previous levels of activity.
/.A nurse is caring for a client who has a closed head injury and has an intraventricular
catheter placed. Which of the following findings indicates that the client is experiencing
increased intracranial pressure (ICP)? (Select all that apply -- Sleepiness exhibited by
the client
- Widening pulse pressure
- Decerebrate posturing
/.An older adult client is brought to an emergency department by a family member.
Which of the following assessment findings should cause the nurse to suspect that the
client has hypertonic dehydration? -Urine specific gravity 1.045
/.A nurse is caring for a client who has a prescription for enalapril. The nurse should
identify which of the following findings as an adverse effect of the medication?
Orthostatic hypotension
/.A nurse in a provider's office is caring for a client who requests sildenafil to treat
erectile dysfunction. Which of the following statements should the nurse make? - You
will not be able to use sildenafil if you are taking nitroglycerin."
/.A nurse is planning care for a client who has extensive burn injuries and is
immunocompromised. Which of the following precautions should the nurse include in
the plan of care to prevent a Pseudomonas aeruginosa infection? -Avoid placing plants
or flowers in the client's room.
/.A nurse is teaching a class about client rights. Which of the following instructions
should the nurse include? -A client should sign an informed consent before receiving a
placebo during a research trial.
/.A nurse is caring for a client who is receiving morphine for daily dressing changes. The
client tells the nurse, "I don't want any more morphine because I don't want to get
addicted." Which of the following actions should the nurse take? -Instruct the client on
alternative therapies for pain reduction.
/.A nurse is preparing a client who has supraventricular tachycardia for elective
cardioversion. Which of the following prescribed medications should the nurse instruct
the client to withhold for 48 hr prior to cardioversion? -Digoxin