QUESTIONS AND ANSWERS|| GUARANTEED
PASS|| ALREADY GRADED A+|| LATEST
VERSION
The physician orders ranitidine hydrochloride (Zantac) 150 mg PO qd for a
client. The nurse should advise the client the BEST time to take this medication
is
1. before breakfast.
2. with dinner.
3. with food.
4. at hs. - ANSWER-4
If a client develops cor pulmonale (right-sided heart failure), the nurse would
expect to observe
1. increasing respiratory difficulty seen with exertion.
2. cough productive of a large amount of thick, yellow mucus.
3. peripheral edema and anorexia.
4. twitching of extremities. - ANSWER-3
The nurse is performing triage on a group of clients in the emergency
department. Which of the following clients should the nurse see FIRST?
1. A 12-year-old oozing blood from a laceration of the left thumb due to cut on
a rusty metal can.
,2. A 19-year-old with a fever of 103.8°F (39.8°C) who is able to identify her
sister but not the place and time.
3. A 49-year-old with a compound fracture of the right leg who is complaining
of severe pain.
4. A 65-year-old with a flushed face, dry mucous membranes, and a blood sugar
of 470 mg/dL. - ANSWER-2
The nurse in the outpatient clinic teaches a client with a sprained right ankle to
walk with a cane. What behavior, if demonstrated by the client, would indicate
that teaching was effective?
1. The client advances the cane 18 inches in front of her foot with each step.
2. The client holds the cane in her left hand.
3. The client advances her right leg, then her left leg, and then the cane.
4. The client holds the cane with her elbow flexed 60°. - ANSWER-2
The nurse is observing care given to a client experiencing severe to panic levels
of anxiety. The nurse would intervene in which of the following situations?
1. The staff maintains a calm manner when interacting with the client.
2. The staff attends to client's physical needs as necessary.
3. The staff helps the client identify thoughts or feelings that occurred prior to
the onset of the anxiety.
4. The staff assesses the client's need for medication or seclusion if other
interventions have failed to reduce anxiety. - ANSWER-3
A 69-year-old client is undergoing his second exchange of intermittent
peritoneal dialysis (IPD). Which of the following would require an intervention
by the nurse?
1. The client complains of pain during the inflow of the dialysate.
2. The client complains of constipation.
3. The dialysate outflow is cloudy.
,4. There is blood-tinged fluid around the intra-abdominal catheter. - ANSWER-
3
The clinic nurse is performing diet teaching with a 67-year-old client with acute
gout. The nurse should teach the client to limit his intake of
1. red meat and shellfish.
2. cottage cheese and ice cream.
3. fruit juices and milk.
4. fresh fruits and uncooked vegetables. - ANSWER-1
A client is scheduled for a left lower lobectomy. The physician has ordered
diazepam (Valium) 2 mg IM for anxiety. The nurse would determine that the
medication is appropriate if the client displays which of the following
symptoms?
1. Agitation and decreased level of consciousness.
2. Lethargy and decreased respiratory rate.
3. Restlessness and increased heart rate.
4. Hostility and increased blood pressure. - ANSWER-3
A 59-year-old woman with bipolar disorder is receiving haloperidol (Haldol) 2
mg PO tid. She tells the nurse, "Milk is coming out of my breasts." Which of the
following responses by the nurse is BEST?
1. "You are seeing things that aren't real."
2. "Why don't we go make some fudge."
3. "You are experiencing a side effect of Haldol."
4. "I'll contact your physician to change your medication." - ANSWER-3
, . The nursing team includes two RNs, one LPN/LVN, and one nursing assistant.
The nurse should consider the assignments appropriate if the nursing assistant is
assigned to care for
1. a client with Alzheimer's requiring assistance with feeding.
2. a client with osteoporosis complaining of burning on urination.
3. a client with scleroderma receiving a tube feeding.
4. a client with cancer who has Cheyne-Stokes respirations. - ANSWER-1
An elderly client is returned to her room after an open reduction and internal
fixation of the left femoral head after a fracture. It is MOST important for the
nursing care plan to include that the client
1. eat a high-protein, low-residue diet.
2. lie on her unoperated side.
3. exercise her arms and legs.
4. cough and deep breathe. - ANSWER-4
Which of the following is a correctly stated nursing diagnosis for a client with
abruptio placentae?
1. Infection related to obstetrical trauma.
2. Potential for fetal injury related to abruptio placentae.
3. Potential alteration in tissue perfusion related to depletion of fibrinogen.
4. Fluid volume deficit related to bleeding. - ANSWER-4
An 8-year-old client is returned to the recovery room after a bronchoscopy. The
nurse should position the client
1. in semi-Fowler's position.
2. prone, with the head turned to the side.
3. with the head of the bed elevated 45° and the neck extended.
4. supine, with the head in the midline position. - ANSWER-1