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1. A nurse is caring for a client who is
at 33 weeks of gestation following an
amniocentesis. The nurse should moni-
tor the client for which of the following
complications? D. Contractions
A. Vomiting
B. Hypertension
C. Epigastric pain
D. Contractions
2. A nurse is providing teaching to an
older client about methods to promote
nighttime sleep. Which of the following
instructions should the nurse include?
A. Stay in bed at least 1hr if unable to fall D. Eat a light snack before bedtime
asleep
B. Take 1 hr nap during the day
C. Perform exercise prior to bed
D. Eat a light snack before bedtime
3. A nurse on a telemetry unit is caring
for a client who becomes unconscious
and whose monitor displays ventricular
tachycardia. Which of the following ac-
tions should the nurse take first after
determining the client does not have a B. Defibrillate
palpable pulse?
A. Assess heart sounds
B. Defibrillate
C. Establish IV access
D. Administer epinephrine
4. A nurse is admitting a client who is 1
week postpartum and reports excessive
vaginal bleeding. The nurse does not
speak the same language as the client. C. Request a female interpreter through
The client's partner and 10-year old child the facility
are accompanying her. Which of the fol-
lowing actions should the nurse take to
gather the client's admission data?
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A. Have the client's child translate
B. Allow the partner to translate
C. Request a female interpreter through
the facility
D. Ask a nursing student who speaks the
same language as the client to translate
5. A nurse is caring for a client who is
febrile. To reduce the clients fever, the
nurse applies a cooling blanket. Which of
the following findings indicates the client
is having an adverse reaction to the cool-
D. Shivering (hypothermic)
ing?
A. Flushing
B. Tachycardia
C. Restlessness
D. Shivering
6. A nurse is caring for a client who has
deep vein thrombosis of the left lower
extremity. Which of the following actions
should the nurse take? (Exhibit)
a. Position the client with the affected
b. Withhold heparin IV infusion PTT-
extremity lower than the heart
30-40 seconds; x2 if on heparin
b. Withhold heparin IV infusion PTT-
30-40 seconds; x2 if on heparin
c. Administer acetaminophen
d. Massage the affected extremity every
4 hr
A nurse is reviewing assessment data
from several clients. For which of the fol-
lowing
clients should the nurse recommend re-
ferral to a dietitian?
b. A client who has a nonhealing leg ulcer
a. An older adult client who has a BMI of
24
b. A client who has a nonhealing leg ulcer
c. An older adult client who has presby-
opia
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d. A client who has an albumin level of
3.7 g/dL
9. A nurse is providing discharge teach-
ing to a client who has a chronic kidney
disease and is
receiving hemodialysis. Which of the fol-
lowing instructions should the nurse in-
clude in the
a. Eat 1 g/kg of protein per day
teaching?
a. Eat 1 g/kg of protein per day
b. Take magnesium hydroxide for indi-
gestion
c. Drink at least 3 L of fluid daily.
d. Consume foods high in potassium
12. A nurse is caring for a client who is
on bed rest. The nurse should recognize
that which of
the following findings is a complication of
immobility? c. Swollen area on calf
a. Decreased serum calcium levels
b. Increased blood pressure
c. Swollen area on calf
d. Urinary frequency
10. A nurse is caring for a client who is
receiving intermittent enteral tube feed-
ings. Which of
the following places the client at risk for
aspiration?
b. A history of gastroesophageal reflux
a. Sitting in a high-Fowler's position dur-
disease
ing the feeding
b. A history of gastroesophageal reflux
disease
c. Receiving a high osmolarity formula
d. A residual of 65 mL 1 hr postprandial
11. A nurse is providing prenatal teach-
ing to a client who is at 12 weeks of
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gestation. The
nurse should tell the client that she will
undergo which of the following screening
tests at
16 weeks of gestation? d. Maternal serum alpha-fetoprotein
a. Chorionic villus sampling
b. Cervical cultures for chlamydia
c. Nonstress test
d. Maternal serum alpha-fetoprotein
13. A nurse in acute care mental health
facility is participating in a medica-
tion-education group.
The leader of the group uses a lais-
sez-faire leadership style. Which of the
following actions
should the nurse expect from the leader
during the session?
a. The leader encourages group mem-
c. The leader allows the group to discuss
bers to remain silent until questions are
whatever they would like to regarding
called for
their
b. The leader lecture about medication
medications
adverse effects to the group members
c. The leader allows the group to discuss
whatever they would like to regarding
their
medications
d. The leader has group members vote
on what they would like to learn about
during
the session
14. A nurse is providing teaching about
digoxin administration to the parents of a
toddler who
has heart failure. Which of the following
statements should the nurse include in
the
teaching?