Comprehensive Practice Exam 1 questions
and answers with solutions
During her first prenatal visit, a client expresses concern about gaining weight. What is the
nurse's first action?
Ask the client how she feels about gaining weight and provide instructions about expected
weight gain and diet.
A client with major depression is taking tranylcypromine sulfate, a monoamine oxidase (MAO)
inhibitor. The nurse understands that additional teaching is needed when the client reports
eating which food?
aged cheese
The use of a patient-controlled analgesia (PCA) pump is effective in which situation?
The client achieves a therapeutic level of analgesia.
The client has various sensory impairments associated with type 1 diabetes. The nurse
determines that the client needs further instruction when the client makes which statement?
"I will avoid kitchen activities."
The nurse covers the myelomeningocele of a neonate with a sterile dressing. Which statements
direct the nurse's action?
preventing infection
When making ethical decisions about caring for preschoolers, a nurse should remember to
provide beneficial care and avoid harming the child.
A client has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting
longer than 1 week. The nurse should assess the client for which complication?
hypokalemia
We have an expert-written solution to this problem!
,A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. The client
reports that the episodes occur most often after feeling cold drafts and drinking cold beverages.
Based on these findings, the nurse determines that the client is most likely suffering from which
neurologic disorder?
trigeminal neuralgia
The home health nurse attends to a terminally ill client whose older adult spouse is the primary
caregiver. The spouse states, "I am so ashamed to admit that sometimes I wish it would all just
end. I am so tired." How should the nurse respond?
"It sounds like you are overwhelmed. How can we better support you through this process?"
Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically
address testicular cancer risk, a nurse should modify client teaching for male clients to include
testicular self-examination.
At the completion of a shift, the nurse is participating in the nursing handoff during the
transition from the day shift to the evening shift. At the time of shift change, there are not
enough evening nurses to meet mandated nurse-client ratios. What is the nurse's best action?
Document the situation, and remain on the unit until sufficient staffing levels are achieved.
A client with lymphoma tells the nurse that a holistic practitioner has offered to treat the client
with coffee enemas. How does the nurse respond?
"You should speak with your oncologist about this treatment."
We have an expert-written solution to this problem!
An older adult alert and oriented client is admitted to the hospital for treatment of cellulitis of
the left shoulder. Which fall prevention strategy is most appropriate for this client?
Use a night-light in the bathroom.
Which foods are contraindicated for a client taking tranylcypromine?
chicken livers, Chianti wine, and beer
An older adult who lives alone is admitted to the hospital for debility and weakness. What is
the most important intervention to ensuring cost-effective care is provided for this client?
,Ensure case management is actively involved in the client's care to facilitate care coordination.
We have an expert-written solution to this problem!
The nurse cares for a client of a different cultural background. What is the best way for the
nurse to provide culturally competent care to the client?
Plan and implement care in a way that is sensitive to the needs of the client.
A community nurse arrives at the home of a client. The client is in soiled clothes due to the
inability to make it to the bathroom in time. The nurse overhears the unregulated care provider
(UCP) scolding the client for the soiled clothes. What is the most appropriate response by the
nurse to the UCP?
"Your behavior in this situation is considered verbal abuse."
The nurse notes serous discharge when an abdominal dressing is changed. How would the
nurse would document this drainage?
clear, watery, yellow-tinged drainage
We have an expert-written solution to this problem!
A client with suspected inhalation anthrax is admitted to the emergency department. Which
action by the nurse takes the highest priority?
Monitor vital signs and oxygen saturation every 15 to 30 minutes.
Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and
symptoms of dehydration. Which additional assessment finding will the nurse assess for?
severe abdominal pain with direct palpation or rebound tenderness
A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The
nurse should assess the client for:
abruptio placentae
A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform
mole. Which expected outcome takes highest priority for this client?
, Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and
her hCG level is negative.
We have an expert-written solution to this problem!
A client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that their spouse sleeps in
another room because the client's snoring keeps the spouse awake. The nurse notices that the
client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible
cause of the client's hyperglycemia?
acromegaly
We have an expert-written solution to this problem!
A woman delivers a 3,250-g neonate at 42-weeks' gestation. Which physical finding is expected
during an examination of this neonate's plantar creases?
The father of a neonate diagnosed with gastroschisis tells the nurse that his wife had planned
on breastfeeding the neonate. Which information should the nurse include in the preoperative
teaching plan about feeding the neonate?
The neonate will remain on nothing-by-mouth (NPO) status until after surgery.
We have an expert-written solution to this problem!
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolbutamide.
Which laboratory test is the most important for confirming this disorder?
and answers with solutions
During her first prenatal visit, a client expresses concern about gaining weight. What is the
nurse's first action?
Ask the client how she feels about gaining weight and provide instructions about expected
weight gain and diet.
A client with major depression is taking tranylcypromine sulfate, a monoamine oxidase (MAO)
inhibitor. The nurse understands that additional teaching is needed when the client reports
eating which food?
aged cheese
The use of a patient-controlled analgesia (PCA) pump is effective in which situation?
The client achieves a therapeutic level of analgesia.
The client has various sensory impairments associated with type 1 diabetes. The nurse
determines that the client needs further instruction when the client makes which statement?
"I will avoid kitchen activities."
The nurse covers the myelomeningocele of a neonate with a sterile dressing. Which statements
direct the nurse's action?
preventing infection
When making ethical decisions about caring for preschoolers, a nurse should remember to
provide beneficial care and avoid harming the child.
A client has had an exacerbation of ulcerative colitis with cramping and diarrhea persisting
longer than 1 week. The nurse should assess the client for which complication?
hypokalemia
We have an expert-written solution to this problem!
,A 45-year-old client is admitted to the facility with excruciating paroxysmal facial pain. The client
reports that the episodes occur most often after feeling cold drafts and drinking cold beverages.
Based on these findings, the nurse determines that the client is most likely suffering from which
neurologic disorder?
trigeminal neuralgia
The home health nurse attends to a terminally ill client whose older adult spouse is the primary
caregiver. The spouse states, "I am so ashamed to admit that sometimes I wish it would all just
end. I am so tired." How should the nurse respond?
"It sounds like you are overwhelmed. How can we better support you through this process?"
Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically
address testicular cancer risk, a nurse should modify client teaching for male clients to include
testicular self-examination.
At the completion of a shift, the nurse is participating in the nursing handoff during the
transition from the day shift to the evening shift. At the time of shift change, there are not
enough evening nurses to meet mandated nurse-client ratios. What is the nurse's best action?
Document the situation, and remain on the unit until sufficient staffing levels are achieved.
A client with lymphoma tells the nurse that a holistic practitioner has offered to treat the client
with coffee enemas. How does the nurse respond?
"You should speak with your oncologist about this treatment."
We have an expert-written solution to this problem!
An older adult alert and oriented client is admitted to the hospital for treatment of cellulitis of
the left shoulder. Which fall prevention strategy is most appropriate for this client?
Use a night-light in the bathroom.
Which foods are contraindicated for a client taking tranylcypromine?
chicken livers, Chianti wine, and beer
An older adult who lives alone is admitted to the hospital for debility and weakness. What is
the most important intervention to ensuring cost-effective care is provided for this client?
,Ensure case management is actively involved in the client's care to facilitate care coordination.
We have an expert-written solution to this problem!
The nurse cares for a client of a different cultural background. What is the best way for the
nurse to provide culturally competent care to the client?
Plan and implement care in a way that is sensitive to the needs of the client.
A community nurse arrives at the home of a client. The client is in soiled clothes due to the
inability to make it to the bathroom in time. The nurse overhears the unregulated care provider
(UCP) scolding the client for the soiled clothes. What is the most appropriate response by the
nurse to the UCP?
"Your behavior in this situation is considered verbal abuse."
The nurse notes serous discharge when an abdominal dressing is changed. How would the
nurse would document this drainage?
clear, watery, yellow-tinged drainage
We have an expert-written solution to this problem!
A client with suspected inhalation anthrax is admitted to the emergency department. Which
action by the nurse takes the highest priority?
Monitor vital signs and oxygen saturation every 15 to 30 minutes.
Nursing assessment of a client with peritonitis reveals hypotension, tachycardia, and signs and
symptoms of dehydration. Which additional assessment finding will the nurse assess for?
severe abdominal pain with direct palpation or rebound tenderness
A client at 36 weeks' gestation, begins to exhibit signs of labor after an eclamptic seizure. The
nurse should assess the client for:
abruptio placentae
A nurse is providing teaching to a client who's being discharged after delivering a hydatidiform
mole. Which expected outcome takes highest priority for this client?
, Client will use a reliable contraceptive method until her follow-up care is complete in 1 year and
her hCG level is negative.
We have an expert-written solution to this problem!
A client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that their spouse sleeps in
another room because the client's snoring keeps the spouse awake. The nurse notices that the
client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible
cause of the client's hyperglycemia?
acromegaly
We have an expert-written solution to this problem!
A woman delivers a 3,250-g neonate at 42-weeks' gestation. Which physical finding is expected
during an examination of this neonate's plantar creases?
The father of a neonate diagnosed with gastroschisis tells the nurse that his wife had planned
on breastfeeding the neonate. Which information should the nurse include in the preoperative
teaching plan about feeding the neonate?
The neonate will remain on nothing-by-mouth (NPO) status until after surgery.
We have an expert-written solution to this problem!
A client with a tentative diagnosis of hyperosmolar hyperglycemic nonketotic syndrome (HHNS)
has a history of type 2 diabetes that is being controlled with an oral diabetic agent, tolbutamide.
Which laboratory test is the most important for confirming this disorder?
