2024 – 2025. RATED A+
A nurse has delegated care to an assistive personnel. At the end of the shift, the Ap
asks the nurse to enter data for her because the AP has forgotten her password and
needs to leave. Which of the following actions should the nurse take?
(ANS- Tell the AP to contact the IT department for charting assistance.
A nurse is reinforcing teaching about car seat safety to the parents of a newborn.
The nurse should instruct the parents to place the car seat in a....
(ANS- Rear-facing position in the back seat.
A nurse is preparing a client for surgery. The client tells the nurse that he is
concerned about the safety of a large sum of money in his wallet. Which of the
following actions is appropriate for the nurse to take?
(ANS- contact security personnel to place the money in the facility safe.
A nurse is caring for a toddler who is admitted to the pediatric unit and is 2 hr
postoperative following a tonsillectomy. Which of the following findings is a sign
on hemorrhage?
(ANS- Frequent Swallowing
A nurse is reinforcing discharge teaching with an older adult client's family about
safety precautions when administering a tap water enema to the client. Which of
the following should the nurse include?
(ANS- Instruct the client to bear down during rectal tube insertion.
,A nurse is caring for a client. Which of the following client statements should the
nurse attend first?
(ANS- "My heartburn pain is going into my jaw now"
A nurse is caring for a client who is 3 days postoperative following abdominal
surgery and has a Penrose drain. Which of the following actions should the nurse
take?
(ANS- Leave the drain insertion site open to air
A nurse is reinforcing with a client who is about to undergo an upper
gastrointestinal series with fluoroscopy. Which of the following information
should the nurse provide?
(ANS- "You will have to drink a contrast medium before the test."
A nurse is reviewing the medical record of a client who has sustained a
fullthickness burn and is in the emergent phase of burn. Which of the following
findings should the nurse expect?
(ANS- Hypernatremia
A nurse is planing to administer an ophthalmic medication to a client. Which of the
following actions would minimize systemic absorption of the medication? (ANS-
Wait 5 mins after instillation before instilling the drops in the other eye
A nurse is preparing morning medication for a client who has potassium level of
3.2 mEq/L. For which of the following medications should the nurse withhold
administration and notify the provider?
(ANS- Furosemide
, A nurse is collecting data from a client who has preeclampsia and is receiving
magnesium sulfate via a continuous IV infusion. Which of the following findings
should the nurse report to the provider?
(ANS- Facial flushing
A nurse in a provider'a office is collecting data from a client who was discharged
from the hospital 7 days ago following treatment from deep-vein thrombosis.
Which of the following findings is the nurse's priority?
(ANS- The client takes ibuprofen to treat musculosketal pain.
A nurse in an urgent care clinic is collecting data from a client who reports having
diarrhea for the past 3 days. Which of the following findings indicates
hypokalemia?
(ANS- Muscle weakness
A nurse is participating in a performance improvement process to decrease the rate
of health care-associated infections within the facility. The nurse should recognize
that which of the following is an appropriate performance improvement outcome
indicator?
(ANS- Client data indicates a decreased rate of infection
A nurse is establishing a baseline postoperative assessment for a client who is
recovering from a right femoropopliteal bypass graft. Which of the following
findings in the assessment of the clients's right leg should be of the most concern to
the nurse?
(ANS- The client's foot feels cooler than the previous assessment