2019 Form B RETAKE GUIDE- BEST
GRADES GUARANTEED
1. A nurse is assessing an infant who has water intoxication. Which of the
following findings should the nurse expect?
Answer : bounding pulse/generalized edema
2. A nurse is discussing the z-track administration of hydroxyzine with a newly
licensed nurse. Which of the following statements indicates the newly licensed
nurse understands the purpose of the technique
Answer: a. This technique decreases the risk of subcutaneous infiltration
3. 1. A nurse is creating a plan of care for a client who has anorexia nervosa.
Which of the following interventions should the nurse include in the plan?
Answer: a. Monitor the client for 1 hr after meals
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, 4. A nurse notices smoke coming from a client's room and discovers a fire in
the wastebasket. After moving the client to safety, which of the followings is
the priority action?
Answer: a. Close the fire door on the unit
5. A nurse is assessing a client who has delirium due to a febrile illness. Which
of the following findings should the nurse expect?
Answer: a. Hallucinations
6. 1. A nurse is caring for a client following an open colectomy. Which of the
following findings places the client at risk for delayed wound healing?
Answer: hyper- emesis
7. 1. A home health nurse is reviewing treatment goals with a client who has
diabetes mellitus. The nurse should evaluate which of the following laboratory
tests to determine effective long-term management of blood glucose levels?-
Answer: A1C
8. 1. A nurse is caring for a client who has neutropenia due to HIV. Which of
the following precautions should the nurse take while caring for this client?
Answer: a. Use a dedicated stethoscope
9. 1. A nurse is caring for a client who reports difficulty falling asleep at night.
Which of the following actions should the nurse take?
Answer: Tell the client to avoid drinking fluids 1 hr before bedtime
10. 1. A nurse is planning care for a newborn who has hyperbilirubinemia and
is to receive phototherapy. Which of the following interventions should the
nurse include?
Answer: a. Place the newborn 45 cm from the light source
11. 1. A nurse is planning care for a client who has schizophrenia and is having
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, difficulty expressing their feelings. Which of the following referrals should the
nurse make?
Answer: social worker
12. 1. A nurse is caring for a client who has heart failure and has started
taking a loop diuretic. Which of the following findings indicates the client is
experiencing an adverse effect of the medication
Answer: decreased reflexes
13. 1. At the start of an evening shift on a cardiac unit, a licensed practical
nurse brings the nurse a list of client reports. Which of the following client
reports should the nurse assess first?
Answer: indigestion
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, 14. 1. A nurse is caring for a client who has just returned to the unit following
a bronchoscopy. Which of the following actions by the assistive personnel
requires the nurse to intervene?
Answer: offer oral fluids to the client
15. 1. A nurse on a medical unit has just received change-of-shift report. Which
of the following clients should the nurse assess first?
Answer: a. A 68 year old client who had a myocardial infarction 2 days ago and
reports chest pain as a 4 on a scale of 0 to 10
16. 1. A nurse is assessing a client prior to performing a blood draw. The nurse
should identify that an allergy to which of the following food can indicate that
the client has an allergy to latex?
Answer: avocados
17. 1. A nurse is preparing to witness a client's signature on an informed
consent for a total knee arthroplasty. Which of the following client statements
indicates the nurse should contact the surgeon?
Answer: a. I am thankful there are no serious complications from this type of
surgery
18. 1. A nurse is admitting a client who has antisocial personality disorder.
Which of the following client behaviors should the nurse identify as consistent
with this disorder?
Answer: a. Uses others for personal gain
19. 1. A nurse is teaching the parent of a school-age child who has scabies
about the application of permethrin 5% cream. The nurse should include which
of the following as a potential adverse effect of the medication?
Answer: burning
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