When teaching a female client to perform intermittent self-catheterization, the nurse
should ensure the client's ability to perform which action?
A. Locate the perineum.
B. Transfer to a commode.
C. Attach the catheter to a drainage bag.
D. Manipulate a syringe to inflate the balloon.
Give this one a try later!
A. Locate the perineum.
A client with chronic renal disease is admitted to the hospital for evaluation prior to a
surgical procedure. Which laboratory test indicates the client's protein status for the
longest length of time?
A. Transferrin.
B. Prealbumin.
,C. Serum albumin.
D. Urine urea nitrogen.
Give this one a try later!
C. Serum albumin.
The home health nurse visits an elderly client who lives at home with her husband. The
client is experiencing frequent episodes of diarrhea and bowel incontinence. Which
problem, for which the client is at risk, has the greatest priority when planning the
client's care?
A. Disturbed sleep pattern.
B. Caregiver role strain.
C. Impaired skin integrity.
D. Fluid volume imbalance.
Give this one a try later!
D. Fluid volume imbalance.
Which nursing intervention is most beneficial in reducing the risk of urosepsis in a
hospitalized client with an indwelling urinary catheter?
A. Ensure that the client's perineal area is cleansed twice a day.
B. Maintain accurate documentation of the fluid intake and output.
C. Encourage frequent ambulation if allowed or regular turning if on bedrest.
D. Obtain a prescription for removal of the catheter as soon as possible.
Give this one a try later!
D. Obtain a prescription for removal of the catheter as soon as possible.
,A female client who has breast cancer with metastasis to the liver and spine is
admitted with constant, severe pain despite around-the-clock use of oxycodone
(Percodan) and amitriptyline (Elavil) for pain control at home. During the admission
assessment, which information is most important for the nurse to obtain?
A. Sensory pattern, area, intensity, and nature of the pain.
B. Trigger points identified by palpation and manual pressure of painful areas.
C. Schedule and total dosages of drugs currently used for breakthrough pain.
D. Sympathetic responses consistent with onset of acute pain.
Give this one a try later!
A. Sensory pattern, area, intensity, and nature of the pain.
What activity should the nurse use in the evaluation phase of the nursing process?
A. Ask a client to evaluate the nursing care provided.
B. Document the nursing care plan in the progress notes.
C. Determine whether a client's health problems have been alleviated.
D. Examine the effectiveness of nursing interventions toward meeting client
outcomes.
Give this one a try later!
D. Examine the effectiveness of nursing interventions toward meeting client
outcomes.
A 4-year-old boy who is scheduled for a tonsillectomy and adenoidectomy asks the
nurse, "Will it hurt to have my tonsils and adenoids taken out?" Which response is best
for the nurse to provide?
A. "It may hurt a little because of the incision made in your throat."
B. "It won't hurt because you're such a big boy."
, C. "It won't hurt because we put you to sleep."
D. "It may hurt but we'll give you medicine to help you feel better."
Give this one a try later!
D. "It may hurt but we'll give you medicine to help you feel better."
The nurse removes the dressing on a client's heel that is covering a pressure sore one-
inch in diameter and finds that there is straw-colored drainage seeping from the
wound. What description of this finding should the nurse include in the client's
record?
A. Stage 1 pressure sore draining sero-sanguineous drainage.
B. Pressure sore at bony prominence with exudate noted.
C. One-inch pressure sore draining serous fluid.
D. Pressure sore on heel with a small amount of purulent drainage.
Give this one a try later!
C. One-inch pressure sore draining serous fluid.
Which client assessment data is most important for the nurse to consider before
ambulating a postoperative client?
A. Respiratory rate.
B. Wound location.
C. Pedal pulses.
D. Pain rating.
Give this one a try later!
A. Respiratory rate.
should ensure the client's ability to perform which action?
A. Locate the perineum.
B. Transfer to a commode.
C. Attach the catheter to a drainage bag.
D. Manipulate a syringe to inflate the balloon.
Give this one a try later!
A. Locate the perineum.
A client with chronic renal disease is admitted to the hospital for evaluation prior to a
surgical procedure. Which laboratory test indicates the client's protein status for the
longest length of time?
A. Transferrin.
B. Prealbumin.
,C. Serum albumin.
D. Urine urea nitrogen.
Give this one a try later!
C. Serum albumin.
The home health nurse visits an elderly client who lives at home with her husband. The
client is experiencing frequent episodes of diarrhea and bowel incontinence. Which
problem, for which the client is at risk, has the greatest priority when planning the
client's care?
A. Disturbed sleep pattern.
B. Caregiver role strain.
C. Impaired skin integrity.
D. Fluid volume imbalance.
Give this one a try later!
D. Fluid volume imbalance.
Which nursing intervention is most beneficial in reducing the risk of urosepsis in a
hospitalized client with an indwelling urinary catheter?
A. Ensure that the client's perineal area is cleansed twice a day.
B. Maintain accurate documentation of the fluid intake and output.
C. Encourage frequent ambulation if allowed or regular turning if on bedrest.
D. Obtain a prescription for removal of the catheter as soon as possible.
Give this one a try later!
D. Obtain a prescription for removal of the catheter as soon as possible.
,A female client who has breast cancer with metastasis to the liver and spine is
admitted with constant, severe pain despite around-the-clock use of oxycodone
(Percodan) and amitriptyline (Elavil) for pain control at home. During the admission
assessment, which information is most important for the nurse to obtain?
A. Sensory pattern, area, intensity, and nature of the pain.
B. Trigger points identified by palpation and manual pressure of painful areas.
C. Schedule and total dosages of drugs currently used for breakthrough pain.
D. Sympathetic responses consistent with onset of acute pain.
Give this one a try later!
A. Sensory pattern, area, intensity, and nature of the pain.
What activity should the nurse use in the evaluation phase of the nursing process?
A. Ask a client to evaluate the nursing care provided.
B. Document the nursing care plan in the progress notes.
C. Determine whether a client's health problems have been alleviated.
D. Examine the effectiveness of nursing interventions toward meeting client
outcomes.
Give this one a try later!
D. Examine the effectiveness of nursing interventions toward meeting client
outcomes.
A 4-year-old boy who is scheduled for a tonsillectomy and adenoidectomy asks the
nurse, "Will it hurt to have my tonsils and adenoids taken out?" Which response is best
for the nurse to provide?
A. "It may hurt a little because of the incision made in your throat."
B. "It won't hurt because you're such a big boy."
, C. "It won't hurt because we put you to sleep."
D. "It may hurt but we'll give you medicine to help you feel better."
Give this one a try later!
D. "It may hurt but we'll give you medicine to help you feel better."
The nurse removes the dressing on a client's heel that is covering a pressure sore one-
inch in diameter and finds that there is straw-colored drainage seeping from the
wound. What description of this finding should the nurse include in the client's
record?
A. Stage 1 pressure sore draining sero-sanguineous drainage.
B. Pressure sore at bony prominence with exudate noted.
C. One-inch pressure sore draining serous fluid.
D. Pressure sore on heel with a small amount of purulent drainage.
Give this one a try later!
C. One-inch pressure sore draining serous fluid.
Which client assessment data is most important for the nurse to consider before
ambulating a postoperative client?
A. Respiratory rate.
B. Wound location.
C. Pedal pulses.
D. Pain rating.
Give this one a try later!
A. Respiratory rate.
