QUESTIONS AND ANSWERS
A nurse is caring for a client who is taking lithium
and reports persistent nausea and vomiting for 2
days. Which of the following laboratory values should
the nurse report to the provider?
a) Potassium 4.0 mEq/L
b) Lithium 0.9 mEq/L
c) BUN 12 mg/dL
d) Sodium 132 mEq/L - ✔✔ANS D. Sodium 132 mEq/L
A nurse is caring for a client who has cancer and has
a WBC count of 4,000/mm3. Which of the following
actions should the nurse take?
a) Cleanse the client's toothbrush with hydrogen
peroxide.
b) Instruct the client to use a disposable razor to
shave.
c) Decrease the client's protein intake.
d) Encourage the client to eat unpasteurized
dairy products. - ✔✔ANS A. Cleanse the client's toothbrush with hydrogen
peroxide.
A nurse enters a client's room and sees smoke coming from the bathroom. Which of the following
actions should the nurse take first?
a) Activate the fire alarm system.
b) Use a fire extinguisher at the source of the
smoke.
c) Assist the client to a nearby common area.
d) Close the doors to the room and to the
,bathroom. - ✔✔ANS C. Assist the client to a nearby common area.
A nurse is contributing to the plan of care for a client who reports difficulty eating due to chronic arthritis
Which of the following interventions should the nurse include in the plan?
a) Apply foam handles to the client's eating
utensils.
b) Obtain a referral for physical therapy.
c) Have an assistive personnel feed the client.
d) Ask the provider for a prescription for a
pureed diet. - ✔✔ANS A. Apply foam handles to the client's eating utensils.
A nurse is obtaining a medication history from a client who is to start taking nitroglycerin for ches
discomfort with activity. Which of the following medications should the nurse instruct the client to avoi
taking within 24 hr of using nitroglycerin?
a) Atorvastatin
b) Metformin
c) Sildenafil
d) Omeprazole - ✔✔ANS C. Sildenafil
A nurse is preparing to obtain a postprandial blood glucose level from a client who has diabetes mellitus
Which of the following actions should the nurse take?
a) Apply the first drop of blood to the test strip.
b) Clean the client's finger with
hexachlorophene.
c) Prick the central tip of the client's finger.
d) Hold the client's finger in a dependent
position. - ✔✔ANS D. Hold the client's finger in a dependent
position.
A nurse is reinforcing teaching with a client about breast self-examinations. Which of the followin
statements by the client indicates an understanding of the teaching?
a) "It is common for one breast to be larger than
the other."
b) "It is common for the skin on my breasts to
dimple."
c) "I will perform breast exams the day my
period begins."
, d) "I will perform breast exams every other
month." - ✔✔ANS A. "It is common for one breast to be larger than
the other."
A nurse is reinforcing teaching with a client who has a new ileostomy. Which of the following statement
by the client indicates an understanding of the teaching?
a) "I will need to empty the bag every 4 to 6
hours."
b) "I will use moisturizing soap to clean around
the stoma before applying the bag."
c) "I will use a skin sealant before I apply the
bag."
d) "I will cut the wafer opening one-fourth of an
inch larger than the stoma." - ✔✔ANS C. "I will use a skin sealant before I apply the
bag."
A nurse is assisting in the plan of care for a client who is dehydrated and is receiving IV fluid replacemen
Which of the following interventions should the nurse contribute to the plan of care?
a) Offer oral fluids every 4 hr.
b) Check for neck vein distention.
c) Limit oral fluids prior to bedtime.
d) Monitor pulse pressure every 6 hr. - ✔✔ANS B. Check for neck vein distention.
A nurse is caring for a young adult client who has testicular cancer and expresses concern about the
sexual function following an orchiectomy of the involved testicle. Which of the following response
should the nurse make?
a) "I'm sure any partner will understand that you
have no control over this."
b) "There are other ways to express intimacy
besides intercourse."
c) "You should focus on recovering from your
cancer right now."
d) "The removal of a single testicle will not
prevent you from having an erection." - ✔✔ANS D. "The removal of a single testicle will not
prevent you from having an erection."
A nurse is collecting data from a client who has hyperthyroidism and is taking propylthiouracil. Which o
the following statements by the client indicates the medication is effective?