Questions With Correct Verified Answers ) , 2025
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The nurse returns to the nurse's station after making client rounds and finds four phone
messages. Which of the following messages should the nurse return FIRST?
1. A client with hepatitis A who states, "My arms and legs are itching."
2. A client with a cast on the right leg who states, "I have a funny feeling in my right leg."
3. A client with osteomyelitis of the spine who states, "I am so nauseated that I can't eat."
4. A client with arthritis who states, "I am having trouble sleeping at night." - ANSWER 2
Following total hip arthroplasty, an elderly client is ordered to begin ambulation with a walker.
Which of the following statements by the nurse is BEST?
1. "Sit in a low chair for ease in getting up to use the walker."
2. "Make sure rubber caps are in place on all four legs of the walker."
3. "You will begin weight bearing on the affected hip soon."
4. "Practice tying your own shoes before you begin ambulating." - ANSWER 2
A client comes to the hospital at term in the early stages of labor. A diagnosis of complete
placenta previa is made. It is MOST important for the nurse to take which of the following
actions?
1. Start an IV of terbutaline (Brethine) and monitor the patient's vital signs closely.
2. Prepare the patient for an immediate cesarean section.
3. Maintain the patient on bedrest until spontaneous vaginal delivery is achieved.
,4. Monitor the patient's length and duration of contractions. - ANSWER 2
Which of the following nursing observations indicates to the nurse that a child diagnosed with
epiglottitis is having an early complication of hypoxemia?
1. Heart rate of 148 beats per minute (bpm).
2. Bluish discoloration of the skin.
3. Bluish discoloration around the mouth.
4. Difficulty swallowing. - ANSWER 1
After stabilizing a client with severe multiple trauma injuries from a motor vehicle accident,
which of the following actions by the nurse is BEST?
1. Limit visiting hours to promote optimal rest.
2. Arrange for clergy to visit with the client and family as requested.
3. Arrange for a psychologist to visit with the family.
4. Arrange for the family to meet with a social worker to discuss financial aid. - ANSWER 2
The nurse's aide comes to take a client by wheelchair for a magnetic resonance imaging (MRI)
scan of the head and neck. Which of the following observations, if made by the nurse, requires
an intervention?
1. The client removes her dentures and gives them to her spouse.
2. The client's vital signs are BP 120/70, pulse 80, respirations 12, temperature 99°F (37.3°C).
3. The client has a nitroglycerine patch on the right chest area.
4. The client has red nail polish on both fingers and toes. - ANSWER 3
,The neonatal nurse instructs the family of a newborn about an apnea monitor. The nurse is
MOST concerned if a family member makes which of the following statements?
1. "We will be able to leave our baby for brief periods of time."
2. "We plan to sleep by our baby's crib."
3. "We can remove the monitor during our baby's bath."
4. "A family member will closely watch the monitor all the time." - ANSWER 4
A client has a cast applied for a fracture of the right femur. Three hours later, the client
complains that it is hot and painful under the cast. Which of the following is the MOST
appropriate action for the nurse to take?
1. Assess the cast for wet spots, and increase air circulation in the room.
2. Check the circulation in the casted extremity, and change the client's position.
3. Take the client's temperature, and observe for other signs of infection.
4. Medicate the client for pain, and notify the physician of his complaint. - ANSWER 2
A client is admitted to the hospital with dry mucous membranes and decreased skin turgor. The
client's vital signs are BP 120/70, temperature 101°F (38.3°C), pulse 88, respirations 14.
Laboratory tests indicate the serum sodium is 150 mEq/L and the Hct is 48%. The nurse expects
the physician to order which of the following IV fluids?
1. D5NS.
2. 0.45% NaCl.
3. 0.9% NaCl.
4. Lactated Ringer's. - ANSWER 2
, Which of the following plans is MOST appropriate for the nurse to use to prepare a 10-year-old
for a cardiac catheterization?
1. Show a videotape specifically prepared for children about cardiac catheterization.
2. Provide the child with a pamphlet about the procedure, and encourage him to read it.
3. Draw a picture of a heart, and explain where the tube will go and what the doctor will see.
4. Present a puppet show explaining the anatomy and physiology of the heart. - ANSWER 3
The nurse cares for a client complaining of moderate pain. Which of the following nursing
actions is MOST important to provide the patient with effective pain relief?
1. Teach the patient about the pain.
2. Establish a trusting relationship with the patient.
3. Determine how various relaxation techniques affect the pain.
4. Provide alternative measures to relieve pain - ANSWER 2
A client diagnosed with a necrotizing spider bite is to perform dressing changes at home. The
nurse determines which of the following statements, if made by the client, indicates a correct
understanding of aseptic technique?
1. "I need to buy sterile gloves to redress this wound."
2. "I should wash my hands before redressing my wound."
3. "I should keep the wound covered at all times."
4. "I should use an over-the-counter antimicrobial ointment." - ANSWER 2
An adult client is admitted to an acute locked psychiatric unit one month prior to an election.
The client requests the opportunity to vote in the upcoming election. Which of the following
responses by the nurse is BEST?