A nurse is assis ng with the care of a client who has a femur fracture and is in skeletal trac on.
Which of the following ac ons should the nurse take -correct answers Ensure the client's
weights are hanging freely from the bed.
A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been
taking ferrous gluconate for several weeks. Which of the following instruc ons should the nurse
include? -correct answers Take this medica on between meals
A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been
taking ferrous gluconate for several weeks. Which of the following instruc ons should the nurse
include? -correct answers Take this medica on between meals.
A nurse is reviewing the plan of care for a client who has celluli s of the leg. Which of the
following interven ons should the nurse recommend? -correct answers Wash daily with an
an bacterial soap.
A nurse is reinforcing teaching with a client who is postopera ve a er having an ileostomy
established. Which of the following instruc ons should the nurse include in the teaching? -
correct answers Avoid medica ons in capsule or enteric form.
A nurse is caring for a client with severe burns to both lower extremi es. The client is scheduled
for an escharotomy and wants to know what the procedure involves. Which of the following
statements is appropriate for the nurse to make? -correct answers "Large incisions will be made
in the burned ssue to improve circula on."
,A nurse is collec ng data from a client who has a possible cataract. Which of the following
manifesta ons should the nurse expect the client to report? -correct answers Decreased color
percep on
A nurse is contribu ng to the plan of care for a client who has an intes nal obstruc on and is
receiving con nuous gastrointes nal decompression using a nasogastric tube. Which of the
following interven ons should the nurse include in the plan of care? -correct answers Maintain
the client in Fowler's posi on.
A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical
manifesta ons should the nurse expect to observe? (Select all that apply.) -correct answers 1)
Buffalo hump 2) Purple stria ons 3) Moon face
A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the
following ac ons should the nurse take? -correct answers Monitor intake and output hourly
A nurse is reinforcing teaching about an esophagogastroduodenoscopy with a client who has
upper gastric pain. Which of the following statements should the nurse include in the teaching?
-correct answers "You will remain NPO for 8 hours before the procedure."
A nurse is caring for a client who is difficult to arouse and very sleepy for several hours following
a generalized tonic-clonic seizure. Which of the following descrip ons should the nurse use
when documen ng this finding in the medical record? -correct answers Pos ctal phase
A nurse is reinforcing teaching with a client who reports right shoulder pain following a
laparoscopic cholecystectomy. Which of the following statements should the nurse make? -
correct answers "The pain will dissipate if you ambulate frequently."
A nurse is checking the suc on control chamber of a client's chest tube and notes that there is
no bubbling in the suc on control chamber. Which of the following ac ons should the nurse
take? -correct answers Verify that the suc on regulator is on.
, A nurse is assis ng with the care of a client immediately following a lumbar puncture. Which of
the following ac ons should the nurse take? (Select all that apply.) -correct answers Encourage
fluid intake. 2) Monitor the puncture site for hematoma.
A nurse is assis ng with the care of a client who is postopera ve following surgical repair of a
fractured mandible. The client's jaw is wired shut to repair and stabilize the fracture. The nurse
should recognize which of the following is the priority ac on? -correct answers Prevent
aspira on.
A nurse is collec ng data from a client who has scleroderma. Which of the following findings
should the nurse expect? -correct answers Hardened skin
A nurse is caring for an older adult client who has dysphagia and le -sided weakness following a
stroke. Which of the following ac ons should the nurse take? -correct answers Add thickener to
fluids.
A nurse is caring for a client who has par al-thickness and full-thickness burns of his head, neck,
and chest. The nurse should recognize which of the following is the priority risk to the client? -
correct answers Airway obstruc on
A nurse is reinforcing teaching with a client who is newly diagnosed with myasthenia gravis and
is to start taking neos gmine. Which of the following instruc ons should the nurse include in
the teaching? -correct answers 1) Take the medica on 45 minutes before ea ng.
A nurse is caring for a client who is 12 hours postopera ve following a transurethral resec on of
the prostate (TURP) and has a 3-way urinary catheter with con nuous irriga on. The nurse
notes there has not been any urinary output in the last hour. Which of the following ac ons
should the nurse perform first? -correct answers No fy the provider.. Determine the patency of
the tubing.
Which of the following ac ons should the nurse take -correct answers Ensure the client's
weights are hanging freely from the bed.
A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been
taking ferrous gluconate for several weeks. Which of the following instruc ons should the nurse
include? -correct answers Take this medica on between meals
A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been
taking ferrous gluconate for several weeks. Which of the following instruc ons should the nurse
include? -correct answers Take this medica on between meals.
A nurse is reviewing the plan of care for a client who has celluli s of the leg. Which of the
following interven ons should the nurse recommend? -correct answers Wash daily with an
an bacterial soap.
A nurse is reinforcing teaching with a client who is postopera ve a er having an ileostomy
established. Which of the following instruc ons should the nurse include in the teaching? -
correct answers Avoid medica ons in capsule or enteric form.
A nurse is caring for a client with severe burns to both lower extremi es. The client is scheduled
for an escharotomy and wants to know what the procedure involves. Which of the following
statements is appropriate for the nurse to make? -correct answers "Large incisions will be made
in the burned ssue to improve circula on."
,A nurse is collec ng data from a client who has a possible cataract. Which of the following
manifesta ons should the nurse expect the client to report? -correct answers Decreased color
percep on
A nurse is contribu ng to the plan of care for a client who has an intes nal obstruc on and is
receiving con nuous gastrointes nal decompression using a nasogastric tube. Which of the
following interven ons should the nurse include in the plan of care? -correct answers Maintain
the client in Fowler's posi on.
A nurse is caring for a client who has Cushing's syndrome. Which of the following clinical
manifesta ons should the nurse expect to observe? (Select all that apply.) -correct answers 1)
Buffalo hump 2) Purple stria ons 3) Moon face
A nurse is caring for a client who is in the oliguric phase of acute kidney injury. Which of the
following ac ons should the nurse take? -correct answers Monitor intake and output hourly
A nurse is reinforcing teaching about an esophagogastroduodenoscopy with a client who has
upper gastric pain. Which of the following statements should the nurse include in the teaching?
-correct answers "You will remain NPO for 8 hours before the procedure."
A nurse is caring for a client who is difficult to arouse and very sleepy for several hours following
a generalized tonic-clonic seizure. Which of the following descrip ons should the nurse use
when documen ng this finding in the medical record? -correct answers Pos ctal phase
A nurse is reinforcing teaching with a client who reports right shoulder pain following a
laparoscopic cholecystectomy. Which of the following statements should the nurse make? -
correct answers "The pain will dissipate if you ambulate frequently."
A nurse is checking the suc on control chamber of a client's chest tube and notes that there is
no bubbling in the suc on control chamber. Which of the following ac ons should the nurse
take? -correct answers Verify that the suc on regulator is on.
, A nurse is assis ng with the care of a client immediately following a lumbar puncture. Which of
the following ac ons should the nurse take? (Select all that apply.) -correct answers Encourage
fluid intake. 2) Monitor the puncture site for hematoma.
A nurse is assis ng with the care of a client who is postopera ve following surgical repair of a
fractured mandible. The client's jaw is wired shut to repair and stabilize the fracture. The nurse
should recognize which of the following is the priority ac on? -correct answers Prevent
aspira on.
A nurse is collec ng data from a client who has scleroderma. Which of the following findings
should the nurse expect? -correct answers Hardened skin
A nurse is caring for an older adult client who has dysphagia and le -sided weakness following a
stroke. Which of the following ac ons should the nurse take? -correct answers Add thickener to
fluids.
A nurse is caring for a client who has par al-thickness and full-thickness burns of his head, neck,
and chest. The nurse should recognize which of the following is the priority risk to the client? -
correct answers Airway obstruc on
A nurse is reinforcing teaching with a client who is newly diagnosed with myasthenia gravis and
is to start taking neos gmine. Which of the following instruc ons should the nurse include in
the teaching? -correct answers 1) Take the medica on 45 minutes before ea ng.
A nurse is caring for a client who is 12 hours postopera ve following a transurethral resec on of
the prostate (TURP) and has a 3-way urinary catheter with con nuous irriga on. The nurse
notes there has not been any urinary output in the last hour. Which of the following ac ons
should the nurse perform first? -correct answers No fy the provider.. Determine the patency of
the tubing.
