Answers | Latest Update 2026 | Exam Prep | Graded
A+
1. A client is scheduled for a left lower lobectomy. The physician orders
diazepam (valium) 2 mg IM for anxiety. The nurse determines the medication is
appropriate if the client displays which of the following symptoms?
agitation and decreased LOC
hostility and increased BP
restlessness and increased HR
lethargy and decreased RR
2. Which food group is specifically recommended for limitation in a diet for a
client with acute gout?
Cottage cheese and ice cream.
Fruit juices and milk.
Red meat and shellfish.
Fresh fruits and uncooked vegetables.
3. A client has sustained a head injury and is unconscious in the emergency
room. A family member of the client arrives and is providing details of the
client's medical history. Which information is of most concern to the nurse?
The client has a history of concussions from playing hockey.
The client's medications include warfarin (Coumadin).
The client is a heart transplant recipient.
The client is HIV positive.
,4. If a patient with rheumatoid arthritis reports increased pain during range of
motion exercises, what should the nurse do next?
Continue with the exercises as planned without changes.
Suggest the patient stop all exercises until further notice.
Increase the intensity of the exercises immediately.
Reassess the patient's pain level and adjust the exercise plan
accordingly.
5. Describe why a high-pitched cry might indicate increased intracranial
pressure in an infant.
A high-pitched cry can indicate increased intracranial pressure due
to irritation of the central nervous system.
A high-pitched cry suggests the infant is hungry or tired.
A high-pitched cry is unrelated to neurological conditions.
A high-pitched cry is a normal developmental milestone for infants.
6. Nurses in practice are guided by their values and beliefs, as well as by
knowledge. These values, beliefs, and knowledge often are reflected in the
literature about nursing's , philosophies, and theories.
theory-based thinking
decision-making
problem-solving
metaparadigm
7. What is the primary nursing intervention for a client receiving haloperidol IM
every 30 minutes?
, Monitor vital signs, especially blood pressure, every 30 minutes.
Tell the client the name of the medication and its effects.
Monitor the anticholinergic effects of the medication.
Remain at the client's side to provide reassurance.
8. What are the key ethical principles that guide nursing practice?
Empathy, loyalty, and diligence
Compassion, integrity, and respect
Accountability, transparency, and efficiency
Autonomy, beneficence, and justice
9. Why is the tracheostomy set-up considered nonessential in the context of
hyperthyroidism management?
The tracheostomy set-up is necessary for monitoring thyroid hormone
levels.
The tracheostomy set-up is used to administer medications for
hyperthyroidism.
The tracheostomy set-up is not typically required for
hyperthyroidism, which primarily affects metabolic functions rather
than airway management.
The tracheostomy set-up is essential for managing severe respiratory
distress in hyperthyroid patients.
10. A nurse is discussing dietary modifications with a patient who has been
diagnosed with diabetic nephropathy. The nurse should indicate to the
patient that there should be a reduction in the intake of which nutrient in the
diet?
, Calcium
Carbohydrates
Iron
Protein
11. The nurse is implementing a plan of care for a client with myxedema. Based
on the client's diagnosis, the nurse should:
Provide high-calorie snacks for the client
Tell the client to elevate her feet when sitting
Provide an additional blanket
Perform urine checks for ketones
12. The nurse is admitting a new client who is facing a serious health problem.
The nurse can best apply the skills of advocacy when working with this client
by:
engaging closely and genuinely with the client and family.
making decisions for the client and family in order to lessen their
responsibilities.
providing evidence-based care.
seeking opportunities to demonstrate professionalism.
13. What observation during intermittent peritoneal dialysis indicates a potential
complication that requires nursing intervention?
The dialysate outflow is cloudy.
The client complains of pain during inflow.
There is blood-tinged fluid around the catheter.