The nurse is planning care for a client. Which intervention would be appropriate to
reduce the risk of infection?
1. Assess vital signs only once daily.
2. Raise the temperature in the clients room.
3. Wash hands.
4. Wear a mask for all client care.
Give this one a try later!
3. Wash hands.
The newly admitted client has contractures of both lower extremities. What nursing
intervention should be included in this clients plan of care?
1. Frequent position changes to reverse the contractures
2. Exercises to strengthen flexor muscles
,3. Range-of-motion exercises to prevent worsening of contractures
4. Weight-bearing activities to stimulate joint relaxation
Give this one a try later!
3. Range-of-motion exercises to prevent worsening of contractures
Unlicensed assistive personnel are caring for a clients ears. What information should
be reported to the nurse?
1. Excessive earwax
2. Loud talking
3. Presence of a hearing aid
4. Presence of any drainage
Give this one a try later!
4. Presence of any drainage
The nurse needs to measure the temperature of a client who has a history of heart
disease and has eaten a bowl of vegetable soup 45 minutes ago. Which site should
the nurse use?
1. Axilla
2. Oral
3. Popliteal
4. Rectal
Give this one a try later!
, 2. Oral
A client receives several tube feedings each day. After documenting the clients
tolerance of the feedings and assessments in the medical record, the nurse should
also document the amount of feeding provided on the
1. graphic sheet.
2. dietary consultation notes.
3. vital signs record.
4. intake and output record.
Give this one a try later!
4. intake and output record.
The nurse assesses phase 1 Korotkoff's sound occurring at 136 and phase 5 Korotkoff's
sound occurring at 72. How should the nurse document this client's blood pressure
reading?
1. 136/72
2. 72/136
3. 136 - 72
4. 72 - 136
Give this one a try later!
1. 136/72
, During review of admission data, the nurse learns that the new client has impairment
of kinesthetic sensation. Which nursing intervention should be planned for this client?
1. Use the clock face as a format for describing the position of food on meal trays.
2. Provide all teaching materials in very large font.
3. Ensure that the client has assistance when ambulating.
4. Use only nonirritating soaps for bathing.
Give this one a try later!
3. Ensure that the client has assistance when ambulating.
The nurse is identifying diagnoses appropriate for a client recovering from cataract
surgery who lives alone. Which diagnosis would be the priority for this client?
1. Social Isolation
2. Risk for Impaired Skin Integrity
3. Disturbed Sensory Perception
4. Risk for Injury
Give this one a try later!
4. Risk for Injury
A 65-year-old female is about 20 lb over her desired weight. She states she has been
on a "low-calorie" diet with no improvement. Which statement reflects a healthy
approach to the desired weight loss? "I need to:
a. Increase my exercise to at least 30 minutes every day."
b. Switch to a low-carbohydrate diet."
reduce the risk of infection?
1. Assess vital signs only once daily.
2. Raise the temperature in the clients room.
3. Wash hands.
4. Wear a mask for all client care.
Give this one a try later!
3. Wash hands.
The newly admitted client has contractures of both lower extremities. What nursing
intervention should be included in this clients plan of care?
1. Frequent position changes to reverse the contractures
2. Exercises to strengthen flexor muscles
,3. Range-of-motion exercises to prevent worsening of contractures
4. Weight-bearing activities to stimulate joint relaxation
Give this one a try later!
3. Range-of-motion exercises to prevent worsening of contractures
Unlicensed assistive personnel are caring for a clients ears. What information should
be reported to the nurse?
1. Excessive earwax
2. Loud talking
3. Presence of a hearing aid
4. Presence of any drainage
Give this one a try later!
4. Presence of any drainage
The nurse needs to measure the temperature of a client who has a history of heart
disease and has eaten a bowl of vegetable soup 45 minutes ago. Which site should
the nurse use?
1. Axilla
2. Oral
3. Popliteal
4. Rectal
Give this one a try later!
, 2. Oral
A client receives several tube feedings each day. After documenting the clients
tolerance of the feedings and assessments in the medical record, the nurse should
also document the amount of feeding provided on the
1. graphic sheet.
2. dietary consultation notes.
3. vital signs record.
4. intake and output record.
Give this one a try later!
4. intake and output record.
The nurse assesses phase 1 Korotkoff's sound occurring at 136 and phase 5 Korotkoff's
sound occurring at 72. How should the nurse document this client's blood pressure
reading?
1. 136/72
2. 72/136
3. 136 - 72
4. 72 - 136
Give this one a try later!
1. 136/72
, During review of admission data, the nurse learns that the new client has impairment
of kinesthetic sensation. Which nursing intervention should be planned for this client?
1. Use the clock face as a format for describing the position of food on meal trays.
2. Provide all teaching materials in very large font.
3. Ensure that the client has assistance when ambulating.
4. Use only nonirritating soaps for bathing.
Give this one a try later!
3. Ensure that the client has assistance when ambulating.
The nurse is identifying diagnoses appropriate for a client recovering from cataract
surgery who lives alone. Which diagnosis would be the priority for this client?
1. Social Isolation
2. Risk for Impaired Skin Integrity
3. Disturbed Sensory Perception
4. Risk for Injury
Give this one a try later!
4. Risk for Injury
A 65-year-old female is about 20 lb over her desired weight. She states she has been
on a "low-calorie" diet with no improvement. Which statement reflects a healthy
approach to the desired weight loss? "I need to:
a. Increase my exercise to at least 30 minutes every day."
b. Switch to a low-carbohydrate diet."
