WITH ACTUAL CORRECT DETAILED ANSWERS ALREADY
GRADED A+
A nurse in an emergency department is preparing to perform ocular irrigation for a client.
Which of the following actions should the nurse plan to take?
a. Assess the client's visual acuity prior to irrigation
b. Have the client turn their head toward the unaffected eye
c. Hold the irrigator syringe 3.81 cm (1.5in) above the eye
d. Perform the irrigation with sterile water for irrigation - ANSWER-d. perform the irrigation with
sterile water for irrigation
A nurse is preparing to administer lactated ringer's via continuous IV infusion at 200 ml/hr. The
IV tubing has a drop factor of 10 drops / mL. How many gtt/min should the nurse set the IV
pump to administer? Round to the nearest whole number - ANSWER-33 gtt/min
A nurse is providing discharge teaching to a client who has a new prescription for sublingual
nitroglycerin. Which of the following client statements indicates an understanding of the
teaching?
a. I can keep my medications for 1 year before replacing it.
b. I should lie down when I take this medication
c. I should discontinue this medication if I develop a headache.
,d. I can take up to 5 tablets in 15 minutes before seeking medical attention - ANSWER-b. I
should lie down when I take this medication
M/S c. 31/p. 201 "Stop activity and rest. Heachace is a common AE of this medication, change
positions slowly"
A nurse is providing discharge teaching to an older adult following a left total hip arthroplasty.
Which of the follwoing instructions should the nurse include in the teaching?
a. clean the incision daily with hydrogen peroxid
b. you can cross your legs and the ankles when sitting down
c. you should use an incentive spirometer every 8 hours
d. install a raised toilet in your bathroom - ANSWER-d. install a raised toilet in your bathroom
M/S c. 68/ p. 455 "Follow position restrictions to avoid dislocation, use elevated seating and a
raised toilet seat"
A nurse is planning care for a client following a cardiac catheterization. Which of the following
actions should the nurse take?
a. keep the client on bed rest for 24 hours
b. limit the client's fluid intake to 1L per day.
c. maintain the client's affected extremity in extension
d. change the client's dressing every 8 hours. - ANSWER-c. maintain the client's affected
extremity in extension
M/S c. 27/p. 173 "Maintain bed rest in supine position with extremity straight for prescribed
time"
A nurse is caring for a client who has a lower extremity fracture and a prescription for crutches.
Which of the following client statements indicates the client is adapting to their role change?
a. I will need to have my partner take over shopping for groceries and cooking the meal for us
b. These crutches make it impossible to care for my child
, c. I feel bad that I have to ask my partner to keep the house clean
d. it's going to be difficult to tell my parents I can't take them to their appointment. - ANSWER-
a. I will need to have my partner take over shopping for groceries and cooking the meal for us
A nurse is caring for a client who has gastroenteritis. Which of the following assessment findings
should the nurse recognize as an indication that the client is experiencing dehydration?
a. pitting, dependent edema
b. distended jugular veins
c. increased BP
d. decreased BP - ANSWER-d. decreased BP
M/S C. 43/ p. 277 "signs of dehydration or hypovolemia include, hypothermia, tachycardia,
thready pulse, HYPOTENSION, orthostatic hypotension, decreased central venous pressure,
tachypnea, hypoxia
A nurse is caring for a client who has a contusion of the brainstem and reports thirst. The
client's urinary output was 4,000 ml over the past 24 hours. The nurse should anticipate a
prescription for which of the following IV medications?
a. Desmopressin
b. Epinephrine
c. Furosemide
d. Nitroprusside - ANSWER-a. Desmopressin
M/S c. 14/p. 85 "Diabetes insipidous is a possible complication"
Pharm c. 40/ p.323 "desmopressin is an agent of choice for DI"
A nurse in a clinic receives a phone call from a client who recently started therapy with an ACE
inhibitor and reports a nagging dry coug. Which of the following response by the nurse is
appropriate?
a. "your cough may require that you stop or change your medicaiton"