,A 35 year-old client with sickle cell crisis is talking on the C) Administer the prescribed analgesia
telephone but stops as the nurse enters the room to
request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control
While caring for a toddler with croup, which initial sign of A) Respiratory rate of 42
croup requires the nurse's immediate attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions
A client is admitted with low T3 and T4 levels and an A) Lethargy
elevated TSH level. On initial assessment, the nurse would
anticipate which of the following assessment findings?
A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions
The emergency room nurse admits a child who B) "The seizure may or may not mean your child has epilepsy."
experienced a seizure at school. The father comments
that this is the first occurrence, and denies any family
history of epilepsy. What is the best response by the
nurse?
A) "Do not worry. Epilepsy can be treated with
medications."
B) "The seizure may or may not mean your child has
epilepsy."
C) "Since this was the first convulsion, it may not happen
again."
D) "Long term treatment will prevent future seizures."
Alcohol and drug abuse impairs judgment and increases A) Risk for injury
risk taking behavior. What nursing diagnosis best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem
Which these findings would the nurse more closely B) Pale mucosa of the eyelids and lips
associate with anemia in a 10 month-old infant?
A) Hemoglobin level of 12 g/dI
B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160
, The nurse is caring for a client in hypertensive crisis in an D) Pupil responses
intensive care unit. The priority assessment in the first
hour of care is
A) Heart rate
B) Pedal pulses
C) Lung sounds
D) Pupil responses
Which of these clients who are all in the terminal stage of D) A preschooler with intermittent episodes of alertness
cancer is least appropriate to suggest the use of patient
controlled analgesia (PCA) with a pump?
A) A young adult with a history of Down's syndrome
B) A teenager who reads at a 4th grade level
C) An elderly client with numerous arthritic nodules on
the hands
D) A preschooler with intermittent episodes of alertness
The nurse is about to assess a 6 month-old child with D) Pale, thin arms and legs, uninterested in surroundings
nonorganic failure-to thrive (NOFTT). Upon entering the
room, the nurse would expect the baby to be
A) Irritable and "colicky" with no attempts to pull to
standing
B) Alert, laughing and playing with a rattle, sitting with
support
C) Skin color dusky with poor skin turgor over abdomen
D) Pale, thin arms and legs, uninterested in surroundings
As the nurse is speaking with a group of teens which of D) Hair loss
these side effects of chemotherapy for cancer would the
nurse expect this group to be more interested in during
the discussion?
A) Mouth sores
B) Fatigue
C) Diarrhea
D) Hair loss
While caring for a client who was admitted with B) Administer acetaminophen as ordered as this is normal at this time
myocardial infarction (MI) 2 days ago, the nurse notes
today's temperature is 101.1 degrees Fahrenheit (38.5
degreesCelsius). The appropriate nursing intervention is
to
A) Call the health care provider immediately
B) Administer acetaminophen as ordered as this is normal
at this time
C) Send blood, urine and sputum for culture
D) Increase the client's fluid intake
telephone but stops as the nurse enters the room to
request something for pain. The nurse should
A) Administer a placebo
B) Encourage increased fluid intake
C) Administer the prescribed analgesia
D) Recommend relaxation exercises for pain control
While caring for a toddler with croup, which initial sign of A) Respiratory rate of 42
croup requires the nurse's immediate attention?
A) Respiratory rate of 42
B) Lethargy for the past hour
C) Apical pulse of 54
D) Coughing up copious secretions
A client is admitted with low T3 and T4 levels and an A) Lethargy
elevated TSH level. On initial assessment, the nurse would
anticipate which of the following assessment findings?
A) Lethargy
B) Heat intolerance
C) Diarrhea
D) Skin eruptions
The emergency room nurse admits a child who B) "The seizure may or may not mean your child has epilepsy."
experienced a seizure at school. The father comments
that this is the first occurrence, and denies any family
history of epilepsy. What is the best response by the
nurse?
A) "Do not worry. Epilepsy can be treated with
medications."
B) "The seizure may or may not mean your child has
epilepsy."
C) "Since this was the first convulsion, it may not happen
again."
D) "Long term treatment will prevent future seizures."
Alcohol and drug abuse impairs judgment and increases A) Risk for injury
risk taking behavior. What nursing diagnosis best applies?
A) Risk for injury
B) Risk for knowledge deficit
C) Altered thought process
D) Disturbance in self-esteem
Which these findings would the nurse more closely B) Pale mucosa of the eyelids and lips
associate with anemia in a 10 month-old infant?
A) Hemoglobin level of 12 g/dI
B) Pale mucosa of the eyelids and lips
C) Hypoactivity
D) A heart rate between 140 to 160
, The nurse is caring for a client in hypertensive crisis in an D) Pupil responses
intensive care unit. The priority assessment in the first
hour of care is
A) Heart rate
B) Pedal pulses
C) Lung sounds
D) Pupil responses
Which of these clients who are all in the terminal stage of D) A preschooler with intermittent episodes of alertness
cancer is least appropriate to suggest the use of patient
controlled analgesia (PCA) with a pump?
A) A young adult with a history of Down's syndrome
B) A teenager who reads at a 4th grade level
C) An elderly client with numerous arthritic nodules on
the hands
D) A preschooler with intermittent episodes of alertness
The nurse is about to assess a 6 month-old child with D) Pale, thin arms and legs, uninterested in surroundings
nonorganic failure-to thrive (NOFTT). Upon entering the
room, the nurse would expect the baby to be
A) Irritable and "colicky" with no attempts to pull to
standing
B) Alert, laughing and playing with a rattle, sitting with
support
C) Skin color dusky with poor skin turgor over abdomen
D) Pale, thin arms and legs, uninterested in surroundings
As the nurse is speaking with a group of teens which of D) Hair loss
these side effects of chemotherapy for cancer would the
nurse expect this group to be more interested in during
the discussion?
A) Mouth sores
B) Fatigue
C) Diarrhea
D) Hair loss
While caring for a client who was admitted with B) Administer acetaminophen as ordered as this is normal at this time
myocardial infarction (MI) 2 days ago, the nurse notes
today's temperature is 101.1 degrees Fahrenheit (38.5
degreesCelsius). The appropriate nursing intervention is
to
A) Call the health care provider immediately
B) Administer acetaminophen as ordered as this is normal
at this time
C) Send blood, urine and sputum for culture
D) Increase the client's fluid intake
