ATI RN COMPREHENSIVE EXIT EXAM NG QUESTIONS&ANSWERS THIS DOCUMENT CONTAINS NEXT GEN QUESTIONS WITH CASE STUDIES 2023

ATI RN COMPREHENSIVE EXIT EXAM NG QUESTIONS&ANSWERS THIS DOCUMENT CONTAINS NEXT GEN QUESTIONS WITH CASE STUDIES 2023 1. Your patient is a 43-year-old male who is initiating phenytoin maintenance treatment for generalized seizure disorder. He will take phenytoin 100mg PO TID with a goal plasma concentration between 10 – 20 mg/L. Resource As a supplement resource to Dr. Vicini’s lecture, please read the following article on the Principles of Nonlinear Pharmacokinetics. Mehvar R. Principles of Nonlinear Pharmacokinetics. Am J Pharm Edu 2001 (65): 178-184. A. What type of pharmacokinetics are anticipated with phenytoin: linear or nonlinear? ▪ Nonlinear kinetics B. What equation should be used to calculate the elimination rate of phenytoin at steady state? ▪ Phenytoin is eliminated completely by metabolism and the kinetics can be defined by the MichaelisMenten equation. At steady state, the elimination rate equals the metabolism rate. ▪ v = __Vmax ∙ Css___ KM + Css v=metabolism rate (which equals elimination rate in this scenario) Vmax=maximum rate of metabolism KM=Michaelis-Menten constant Css=steady state concentration C. If your patient’s dose of phenytoin is increased from 300mg/day to 450mg/day, would you anticipate the AUC will be increased proportionally? ▪ No, the AUC of phenytoin would not be expected to increase proportionally when the dose is increased because phenytoin exhibits nonlinear kinetics. For example, when the dose of phenytoin is increased by 50% from 300mg/day to 450mg/day, the average steady state concentration may increase by as much as ten-fold. 2 . A client enters the emergency department unconscious via ambulance from the client’s work place. What document should be given priority to guide the direction of care for this client? C) A notarized original of advance directives brought in by the partner 3. The charge nurse has a health care team that consists of 1 PN, 1 unlicensed assistive personnel (UAP) and 1 PN nursing student. Which assignment should be questioned by the nurse manager? A) An admission at the change of shifts with atrial fibrillation and heart failure 4. A mother brings her 3 month-old into the clinic, complaining that the child seems to be spitting up all the time and has a lot of gas. The nurse expects to find which of the following on the initial history and physical assessment? B) Restlessness and increased mucus production 5. A 69-year-old male client is admitted to the ambulatory surgery unit for laparoscopic knee surgery. He reports past medical history of hypertension, hyperlipidemia, osteoarthritis, and atrial fibrillation. He is 6 feet tall and weighs 175 pounds. He denies any allergies to food or medications. Pre-op Orders: NPO IV 1000 mL LR @ 100 mL/hr Ondansetron hydrochloride 4 mg IV stat before anesthesia induction Fentanyl 75 mcg IVP stat Transfer to OR Post-op Orders: NPO, advance to clear liquids as tolerated IV 1000 mL D5NS @ 125 mL/hr Nexium (esomeprazole magnesium) 20 mg IVP stat Morphine sulfate 2 mg IV once prn severe pain VS q 15 min X 4, q 30 min X 2 hr, q 1 hr X 2 hr Cold compresses to right knee 20 min q 1 hr Discharge when stable Discharge Orders: Losartan potassium-hydrochlorothiazide 100/12.5 mg PO daily Lovastatin 20 mg PO daily Warfarin 3.75 mg PO daily Nexium (esomeprazole magnesium) 20 mg PO 1 hr ac daily Hydrocodone 5 mg/Acetaminophen 500 mg PO q 6 hr prn pain Cold compresses to right knee 20 min q 1 hr Follow up appointment with surgeon in 1 week A. The ondansetron hydrochloride is supplied in vials labeled 32 mg/5 mL. a. Calculate how many mL the nurse will draw up for the prescribed dose. - The nurse will draw up 0.6 mL. b. What type of syringe will the nurse use to draw up the prescribed dose? - The nurse will use a 1 mL syringe. B. The fentanyl is supplied in vials labeled 0.05 mg/mL. a. Calculate how many mL the nurse will draw up for the prescribed dose. - The nurse will draw up 1.5 mL. b. What type of syringe will the nurse use to draw up the prescribed dose? - The nurse will use a 3 mL syringe. C. Morphine sulfate is supplied as DURAMORPH (morphine sulfate injection, USP) 5 mg/10 mL in amber DOSETTE ampuls for intravenous, epidural and intrathecal administration. How many mL will the nurse will draw up for the prescribed dose? - The nurse will draw up 4 mL. During discharge teaching, the nurse is reviewing the client’s medications and dosages D. Regarding the losartan potassium-hydrochlorothiazide: a. Select the correct label for the order and write the letter below. - The correct label is label J, which are the losartan potassium-hydrochlorothiazide 100- 12.5 mg tablets which is exactly what the order calls for. b. How many tablets will the nurse instruct the client to take for each dose? - The nurse will instruct the client to take one tablet. E. Regarding the lovastatin: a. Select the correct label for the order and write the letter below. - The correct label is H, which are the lovastatin 20 mg tablets which is exactly what the order calls for. b. How many tablets will the nurse instruct the client to take for each dose? - The nurse will instruct the client to take one tablet. F. Regarding the hydrocodone: a. Select the correct label for the order and write the letter below. - The correct label is I, which are the hydrocodone 5 mg/acetaminophen 500 mg tablets which is exactly what the order calls for. b. How many tablets will the nurse instruct the client that he may take in a 24 hr period? - The client can take up to 4 tablets, each 6 hours apart, in a 24 hour period. G. How many tablets or warfarin will the nurse instruct the client to take each day? - The nurse will instruct the client to take 0.5 tablets a day. H. A 16 year-old enters the emergency department. The triage nurse identifies that this teenager is legally married and signs the consent form for treatment. What would be the appropriate action by the nurse? D) Proceed with the triage process in the same manner as any adult client 7. A newly admitted elderly client is severely dehydrated. When planning care for This client, which task is appropriate to assign to an unlicensed assistive personnel (UAP)? B) Report hourly outputs of less than 30 ml/hr 8. The nurse has admitted a 4 year-old with the diagnosis of possible rheumatic fever. Which statement by the parent would cause the nurse to suspect an association with thisdisease? B) Strep throat went through all the children at the day care last month. 9. A nurse assigned to a manipulative client for 5 days becomes awareof feelings for a reluctance to interact with the client. The next action by the nurse shouldbe to A) Discuss the feeling of reluctance with an objective peer or supervisor 10. A client is being treated for paranoid schizophrenia. When the clientbecame loud and boisterous, the nurse immediately placed him in seclusion as a precautionary measure. The client willingly complied. The nurse’s action A) May result in charges of unlawful seclusion and restraint 11. A client has been admitted to the Coronary Care Unit with a myocardial infarction. Which nursing diagnosis should have priority? A) Pain related to ischemia 12. The provisions of the law for the Americans with Disabilities Act require Nurse managers to B) Provide reasonable accommodations for disabled individuals 13. A 42 year-old male client refuses to take propranolol hydrochloride (Inderal) as prescribed. Which client statement s from the assessment data is likely to explain his noncompliance? C) "I have diminished sexual function." 14. A school-aged child has had a long leg (hip to ankle)synthetic castapplied 4 hours ago. Which statement from the mother indicates that teaching has been inadequate? D) ”I think I remember that standing cannot be done until after 72 hours." The 15. Which statement best describes time management strategies appliedto the role of a nurse manager? C) Set daily goals with a prioritization of the work 16. The pediatric clinic nurse examines a toddler with a tentative diagnosis of neuroblastoma. Findings observed by the nurse that is associated withthis problem include which of these? D) Abdominal mass and weakness 17. – Mary Jane, a “frequent flier,” is admitted to the emergency department (ED) with a diagnosis of heart failure (HF). She was discharged from the hospital 10 days ago and comes in today stating, “I just had to come to the hospital today because I can't catch my breath and my legs are as big as tree trunks.” After further questioning, you learn she is strictly following the fluid and salt restriction ordered during her last hospital admission. She reports gaining 1 to 2 pounds every day since her discharge. A. What error in teaching most likely occurred when MARY JANE was discharged 10 days ago? The patient education regarding the fluid and sodium restriction was most likely not adequate enough for her to understand exactly what to avoid in her diet. For example, the patient may not have been aware of exactly what foods contain sodium, but rather thought it simply meant to avoid consuming salt. The patient may not have understood that a diet based on sodium and fluid restriction would extend to fast foods, preserved foods, canned foods, and many other commonly chosen items. Additionally, she was most likely was not taught how to read food labels that would have shown her how much sodium was contained in each item. Finally, the patient education likely also failed in that she did not understand the severity of the amount of weight gain she was experiencing. The patient should have been better informed that a weight gain of that amount in that short time period is concerning and she should immediately contact her provider or go to the emergency department. Nursing Assessment: Medications Taken at Home 1.Enalapril (Vasotec) 5 mg PO bid 2. Pioglitazone (Actos) 45 mg PO every morning 3. Furosemide (Lasix) 40 mg/day PO 4. Potassium chloride 20 mEq/day PO B. Which of these medications may have contributed to MARY JANE's heart failure? Explain. Pioglitazone would have contributed to the patient’s heart failure because side effects of the medication include fluid retention and weight gain. Both of these side effects can lead to heart failure and the edema that brought the patient into the emergency department. C. How do angiotensin-converting enzyme (ACE) inhibitors, such as enalapril (Vasotec), work to reduce heart failure? (Select all that apply.) ACE inhibitors: Answer: A, B, C, and D a) prevent the conversion of angiotensin I to angiotensin II b) cause systemic vasodilation c) promote the excretion of sodium and water in the renal tubules d) reduce preload and afterload e) increase cardiac contractility f) block sympathetic nervous system stimulation to the heart Medication Orders Enalapril (Vasotec) 5 mg PO bid Carvedilol (Coreg) 3.125 mg PO twice daily Glipizide (Glucotrol) 10 mg PO every morning Furosemide (Lasix) 80 mg IV push (IVP) now, then 40 mg/day IVP Potassium chloride (K-Dur) 20 mEq/day PO D. What is the rationale for changing the route of the furosemide (Lasix)? The patient is currently in fluid overload, and changing the route of administration for her prescribed diuretic from oral (PO) to intravenous (IV) will allow for a more rapid onset of action, thus giving faster results for the needed fluid loss. E. You administer furosemide (Lasix) 80 mg IVP. Identify three parameters you would use to monitor the effectiveness of this medication. To monitor the effectiveness of the Lasix medication, parameters would include taking daily weights, monitoring I&Os, and renal function labs, including BUN and creatinine. F. What laboratory tests should be ordered for MARY JANE related to the order for furosemide (Lasix)? (Select all that apply.) a) Magnesium level b) Sodium level c) Complete blood count (CBC) d) Serum glucose levels e) Potassium level 18. The nurse manager has been using a decentralized block schedulingplan to staff thenursing unit. However, staff have asked for many changes and exceptionsto the schedule over the past few months. The manager considers self schedulingknowing that this method will D) Improve team morale 19. uphenazine (Prolixin). Which should be a focus of the first assessment? B) Medication compliance 20. The nurse is caring for a client with an unstable spinal cord injury at the T7 level. Which intervention should take priority in planning care? B) Place client on a pressure reducing support surface 21. A nurse is conducting a community wide seminar on childhood safety issues. Which of these children is at the highest risk for poisoning? B) 20 month-old who has just learned to climb stairs 22. During an examination of a 2 year-old child with a tentative diagnosis of Wilm's tumor, the nurse would be most concerned about which statement by the mother? C) All the pants have become tight around the waist. 23. What is the most important aspect to include when developing a home care plan for a client with severe arthritis? A) Maintaining and preserving function 24. A mother asks the nurse if she should be concerned about the tendency of her child to stutter. What assessment data will be most useful in counseling the parent? A) Age of the child 25. A pre-term newborn is to be fed breast milk through nasogastric tube. Why is breast milk preferred over formula for premature infants? C) Provides antibodies 26. Which of the following nursing assessments in an infant is most valuable in identifying serious visual defects? A) Red reflex test 27. A client is admitted with a pressure ulcer in the sacral area. The partial thickness wound is 4cm by 7cm, the wound base is red and moist with no exudate and the surrounding skin is intact. Which of the following coverings is most appropriate for this wound? D) Occlusive moist dressing 28. A 30 month-old child is admitted to the hospital unit. Which of the following toys would be appropriate for the nurse to select from the toy room for this child? B) Large wooden puzzle 29. A nurse is to present information about Chinese folk medicine to a group of student nurses. Based on this cultural belief, the nurse would explain that illness is attributed to the B) Yin, the negative force that represents darkness, cold, and emptiness 30. A 2 year-old child has just been diagnosed with cystic fibrosis. The child's father asks the nurse "What is our major concern now, and what will we have to deal with in the future?" Which of the following is the best response? C) "Thin, tenacious secretions from the lungs are a constant struggle in cystic fibrosis." 31. You are the registered nurse case manager in an outpatient mental health clinic. S.T. is here today for her outpatient mental health appointment. She has a diagnosis of bipolar disorder and has been stable for the past year. Her last episode was one of mania that required hospitalization. She is 29 years old, married, with two children aged 2 and 4. She reports that her mood is better than it has been in a long time and she has lots of energy. When asked whether she thinks this is a recurrence of mania, she says no, she thinks that things are just finally getting better. a.It is common for patient with bipolar illness to deny the onset of mania because it feels good. What other information would be important to ask S.T.? How many hours of sleeping are you getting at night? Do your thoughts race inside your head? Are you involved in any kinds of activities? Do other people make comments about your actions or behavior. b.What other information would help determine whether S.T. is experiencing the onset of a manic or hypomanic episode? Assess body language, eye movements, nonverbal communication, as well as obtain information from the patient’s husband if he is present during the interview or meet with him separately with the patient’s permission to avoid violating HIPAA. c.Bipolar disorder is a disorder of mood, characterized by episodes of depression, mania or hypomania. What symptoms might you see if S.T. is experiencing mania or hypomania? Some symptoms could include inflated self-esteem, decreased need for sleep, more talkative, distracted, agitated, racing thoughts, or impulsive/reckless behavior. d.How is hypomania different from mania? Hypomania is an episode that lasts for about four days and the person can still function well, therefore does not need to be hospitalized. The symptoms could still be observed by others but harder to see from that specific person. While mania is a severe episode that may last for a week and the person could feel uncontrollably and have high energy level in which could interfere with their daily life. Due to this, a person experiencing a mania episode is more likely required to be hospitalized in order to protect harm from self and others. Case Study Progress: Lithium (Eskalith) is commonly used to treat bipolar disorder. S.T. has been taking lithium for several years. e.When S.T. first started taking lithium, she would have been cautioned to report side effects. Which are common side effects of lithium? Select all that apply. a.Thirst b.Nausea d.Tremor f.Lithium toxicity can occur in patients taking lithium. What are the symptoms of early lithium toxicity? Select all that apply. a. Vomiting d. Diarrhea e. Lethargy g.S.T.’s maintenance lithium level results are reported as 1.0 mEq/L. Interpret these results. Her lithium blood level is within normal range since the approximate normal range being in between 0.6 and 1.2 mEq/L. There is a difference in ranges due to different hospital policies. h.What other laboratory examinations should be routinely performed while S.T. is taking lithium? In addition to baseline testing like CBC and EKG, other laboratory exams that should be routinely performed while the patient is taking lithium are thyroid function test, liver function test, sodium level, creatinine and blood urea nitrogen. i.What instructions should have been given to S.T. when she began lithium therapy? Maintain adequate hydration especially when losing a lot of fluids, be aware of symptoms of toxicity and if they occur don’t take next dose and notify physician. j.Aside from lithium, what other medications are used to treat bipolar disorder? Other medications that treat bipolar disorder include anticonvulsant, antianxiety (diazepam), SSRIs, antidepressants, antipsychotics, and antiseizure (Depakote). k.Even though she has been taking lithium for a year, you review some teaching about drug therapy with S.T. Which statement by S.T. reveal a need for further education? b. “I need to be careful because lithium is addictive.” l.Given her history of bipolar disorder, what should you teach S.T. to minimize mood swings? Avoid stressful situations, eat a healthy balanced diet, avoid caffeine/alcohol/drugs, maintain a schedule for sleeping/exercising/taking medications and keep attending group or individual therapy sessions. Case Study Outcome: S.T. is told that her lithium levels is within normal limits, and states, “I feel better than I’ve felt in ages!” She expresses hope that this will last a long time. 32. A client was admitted to the psychiatric unit with a diagnosis of bipolar disorder. He constantly bothers other clients, tries to help the housekeeping staff, demonstrates pressured speech and demands constant attention from the staff. Which activity would be best for the client? D) Ping-pong 33. The nurse is caring for a client who has developed cardiac tamponade. Which finding would the nurse anticipate? C) Distended neck veins 34. Which nursing action is a priority as the plan of care is developed for a 7 year-old child hospitalized for acute glomerulonephritis? D) Note patterns of increased blood pressure 35. The nurse is caring for a child receiving chest physiotherapy (CPT). Which of the following actions by the nurse would be appropriate? C) Confine the percussion to the rib cage area 36. A polydrug user has been in recovery for 8 months. The client has began skipping breakfast and not eating regular dinners. The client has also started frequenting bars to "see old buddies." The nurse understands that the client’s behavior is a warning sign to indicate that the client may be A) headed for relapse 37. A client was admitted to the psychiatric unit with major depression after a suicide attempt. In addition to feeling sad and hopeless, the nurse would assess for C) Psychomotor retardation or agitation 38. A client is experiencing hallucinations that are markedly increased at night. The client is very frightened by the hallucinations. The client’s partner asked to stay a few hours beyond the visiting time, in the client’s private room. What would be the best response by the nurse demonstrating emotional support for the client? C) "Yes, staying with the client and orienting her to her surroundings may decrease her anxiety." 39. At a well baby clinic the nurse is assigned to assess an 8 month-old child. Which of these developmental achievements would the nurse anticipate that the child would be able to perform? C) Sit without support 40. The nurse is talking to parents about nutrition in school aged children. Which of the following is the most common nutritional disorder in this age group? C) Obesity 41. A 15 year-old client has been placed in a Milwaukee Brace. Which statement from the adolescent indicates the need for additional teaching? A) "I will only have to wear this for 6 months." 42. Which type of accidental poisoning would the nurse expect to occur in children under age 6? A) Oral ingestion 43. An 8-year-old boy is admitted to the hospital with a diagnosis of sickle cell crisis and pneumonia. He complains of pain in his legs and abdomen, wheezing, and pain in his chest. He has a history of asthma, epilepsy, and is allergic to peanuts, tomatoes, and aspirin. He is 40 inches tall and weighs 55 pounds. Vital signs are: T 102 degrees F, BP 90/66, P 112, R 30. Chest X-ray confirms right upper lobe pneumonia, and a throat culture is positive for Group A streptococcus. His orders include the following: Bed rest Diet as tolerated, encourage PO fluids Fluid bolus D5 ½NS at 20 mL/kg over 1 hr followed by IV D5½NS at 110 mL/hr Morphine sulfate 0.075 mg/kg/h IV Penicillin G 100,000 units/kg/day divided doses q6h. Add to in 100 mL D5W and infuse over 1 hr Methylprednisolone 1 mg/kg IM now, then 1 mg/kg PO in the morning Flovent HFA (fluticasone propionate) inhalation aerosol 2 puffs bid Folic acid 1 mg po daily Depakene (valproic acid) 30 mg/kg PO bid Tylenol (acetaminophen) 12 mg/kg PO q4h prn for temp over 101 Montelukast 5 mg PO qhs Albuterol 2 mg PO tid A. Calculate the child’s 24-hour fluid requirement. - (100 x 10) + (50 x 10) + (20 x 35) = 1000 + 500 + 700 = 2200 - The child’s 24-hour fluid requirement is 2200 mL. B. The first thing the nurse will do is set up the IV fluids. a) Calculate the amount of IV fluids the child will receive in the bolus - 25 kg x 20 mL/kg = 500 mL b) What rate will the nurse set the pump at in mL/hr to infuse the bolus? - The nurse will set the pump to 500 mL per hour. C. What rate will the nurse set the pump to infuse the penicillin G? - 100,000 units x 25 kg = 2,500,000 units/kg/day - 2,500,000 units/kg/day divided by 4 = 625,000 units/kg per dose - The nurse will set the pump to infuse 100 mL an hour. D. The recommended dose for morphine is 0.05-0.1 mg/kg IV q4h. Is the prescribed dose safe? - Yes, the prescribed dose is safe because it is 0.075 mg/kg/h IV, which is between 0.05 and 0.1 mg/kg. E. Methylprednisolone comes in a single dose vial in the concentration 40 mg/mL. How many mL of methylprednisolone will the nurse administer for the IM dose? - 1 mg/kg x 25 kg = 25 mg/kg/day - 25 mg / 40 mg = 0.625 mL – 0.6 mL - The nurse will administer 0.6 mL F. Regarding the valproic acid: a) Select the correct label for valproic acid and write it below. - 250 mg b) How many capsules of this medication will the nurse administer? - 30 mg/kg x 25 mg = 750 mg - 750 mg / 250 mg = 3 - The nurse will administer 3 capsules G. The folic acid is available in 1 mg tablets. How many micrograms is the child receiving per day? - The child is receiving 1,000 mcg in the 1 mg tablet H. Regarding the montelukast: a) Select the correct label for montelukast and write it below. - Montelukast 5 mg tablets b) How many tablets of this medication will the nurse administer? - The nurse will administer 1 tablet H. The Tylenol available is labeled 160 mg/5 mL. How many mL will the nurse administer? - Tylenol (acetaminophen) 12 mg/kg PO q4h prn for temp over 101 = 12 mg/kg x 25 kg = 300 mg - 300 mg x 5 mL / 160 mg = 9.375 mL – 9.4 mL - The nurse will administer 9.4 mL I. Albuterol sulfate comes in 2 mg/5 mL syrup. How many mL will the nurse administer daily? - The nurse will administer 15 mL daily. J. The strength of the Flovent is 44 mcg/inhalation. How many mcg is the child receiving per day? - The child is receiving 2 pumps per day - 44 mcg x 2 pumps = 88 mcg per dose - 88 mcg x 2 = 176 mcg per day 44. The nurse is developing the plan of care for a hospitalized child with von Willebrand disease. What priority nursing intervention should be included in this child’s plan of care? Guard against bleeding injuries 45. How should then nurse instruct the parents of a 4-month-old with seborrheic dermatitis (cradle cap) to shampoo the child’s hair? use a soft brush and gently scrub the area 46. The mother of a one-month-old calls the clinic to report that the back of her infant’s head is flat. How should the nurse respond? Position the infant on the stomach occasionally when awake and active 47. A 7-year-old child is admitted to the hospital with acute glomerulonephritis (AGN). When obtaining the nursing history which finding should the nurse expect to obtain? A recent strep throat infection 48. In assessing a 10-year-old newly diagnosed with osteomyelitis, which information is most for the nurse to obtain? recent recurrence of infection 49. A mother brings her 8-month-old baby boy to the clinic because he has been vomiting and had diarrhea for the last 3 days. Which assessment is more important for the nurse to make? Measure the infant's pulse. 50. A nurse is preparing to perform peritoneal dialysis for a child who has an elevated serum creatinine level. After explaining the procedure, which of the following actions should the nurse plan to take? Obtain the child's weight 51. A female client on a psychiatric unit is sweating profusely while she vigorously does pushups and then runs the length of the corridor several times before crashing in to the furniture in the sitting room. Picking herself up, she begins to toss chairs aside, looking for a red one to sit in. When another client objects to the disturbances, the client shouts," I am the boss here. I do what I want." Which nursing problem best supports these observations – Risk for other related violence related to disruptive behavior 52. A nurse is providing discharge teaching to the parents of a toddler who has iron deficiency anemia and a new prescription for ferrous sulfate elixir. Which of the following instructions should the nurse include? Administer this medication to your child with a dropper. 53. A nurse is administering albuterol by metered dose inhaler for a preschool-age child who is experiencing an asthma exacerbation. Which of the following findings should the nurse report to the provider? Intercostal retractions 54. A nurse is caring for a 4-year-old child who has meningitis and is receiving gentamicin. Which of the following laboratory values should the nurse report to the provider? Creatinine 1.4 mg/dL 55. A nurse is preparing to administer cephalexin 25 mg/kg PO to a child who has otitis media and weighs 22 kg (48.5lb). Available is cephalexin solution 250 mg/5mL. How many mL should the nurse administer? (Round to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) 11 mL 56. A nurse is providing dietary teaching to a parent of a 10-month-old infant who has phenylketonuria. Which of the following responses by the parent indicates an understanding of the teaching? I will steam carrots and cut them into small pieces for her. 57. A nurse is providing discharge teaching to the parents of a school-age child who has cystic fibrosis. Which of the following responses by the parents indicates an understanding of the teaching? "I will give my child pancreatic enzymes with snacks and meals." 58. A nurse is caring for a preschooler who has a brain tumor. Which of the following findings is the priority for the nurse to report to the provider? Diplopia 59. A nurse is providing education about dietary modifications to the parents of a school-age child who has glomerulonephritis. Which of the following information should the nurse include in the teaching? Decrease the child's sodium intake. 60. A nurse is assessing an adolescent who has type 1 diabetes mellitus. Which of the following findings is the nurse's priority? HbA1c 11.5% 61. A nurse is providing teaching to the parents of a school-age child newly diagnosed with a seizure disorder. The nurse should teach the parents to take which of the following actions during a seizure? Clear the area of hard objects 62. A nurse in an emergency department is caring for a child following an overdose of acetylsalicylic acid. Which of the following mediations should the nurse plan to administer? Phytonadione 63. A nurse is providing teaching to the parents of a preschool-age child who has celiac disease. Which of the following instructions should the nurse include? Your child will be on a gluten-free diet for the rest of her life. 64. A nurse is teaching a parent of a 10-month-old infant about home safety. Which of the following instructions should the nurse include in the teaching? (Select all that apply) Place gates at the top and bottom of the stairs and Ensure the crib mattress is in the lowest position 65. A nurse is prioritizing care for four clients. Which of the following clients should the nurse assess first? An adolescent who has a sickle cell anemia and slurred speech . 66. A nurse is providing teaching to the parent of a school-age child who has diabetes mellitus about managing diabetes during illness. Which of the following statement by the parent indicates an understanding of the teaching? I will increase the amount of fluids I offer my children 67. A nurse is reviewing the medical record of a 24-month-old child who has acute lymphocytic leukemia. Which of the following actions should the nurse take? (Click the exhibit button for additional information about the client. There are three tabs that contain separate categories of data.) Initiate bleeding precaution 68. A nurse is caring for an infant who has tetralogy of fallot and is having a hypercyanotic episode after crying. Which of the following intervention should the nurse implement? Place the infant in the knee-chest position. 69. A nurse is assessing a toddler who has a history of lead poisoning. Which of the following actions should the nurse take? Perform development testing for delays. 70. A nurse is assessing a 6-month-old infant who has respiratory syncytial virus. The nurse should immediately report which of the following findings to the provider? Pharyngiti 71. . A home health nurse is preparing to make an initial visit to a family following a referral from a local provider. Identify the sequence of steps the nurse should take when conducting a home visit. Clarify the reason for the referral with the providers office Contact the family to determine availability and readiness to make an appointment Identify family needs and interventions using the nursing process Discuss plans for future visits with the family Record information about the home visit according to agency policy 72. A nurse is planning care for a child immediately following the insertion of a chest tube for continuous suction with a closed drainage system. Which of the following interventions should the nurse include in the plan of care? Ensure continuous bubbling is present in the suction control chamber 73. A nurse is teaching a guardian of an adolescent who has mild persistent asthma and a new prescription for maintenance prednisone. Which of the following statements by the guardian indicates an understanding of the teaching? This medication can increase my son’s risk for infection. 74. A nurse is using an IV pump for a newly admitted client. Which of the following actions should the nurse take? Check the cords of the IV pump for fraying 75. A nurse is assessing a client who is receiving daily aspirin therapy. The nurse should identify that which of the following findings might indicate an allergic reaction to this medication? Blurred vision 76. A nurse manager is developing a protocol for staff discipline. Which of the following actions should the nurse manager take when implementing this new protocol? Inform staff about the purpose of the unit’s new processes 77. A nurse is caring for a 1 month old infant who has manifestation of severe dehydration and a prescription for parenteral fluid therapy the guardian asks: what are the indications that my baby needs an iv?” which of the following responses should the nurse make? Your baby needs an iv because she is not producing tears 78. A nurse on a mental health unit is planning room assignments for four clients. Which of the following clients should the nurse assign to a room near the nurses station? A client who has a depressive disorder and reports feeling hopeless. 79. A nurse is performing an abdominal assessment as part of a clients comprehensive physical examination. Which of the following is the final step the nurse should perform? Palpation 80. A nurse is teaching a client who is pregnant and has a new prescription for an iron supplement. Which of the following statements should the nurse include? You might become constipated while taking this medication 81. A nurse is teaching a client who is receiving radiation therapy about skin protection. Which of the following client statements understanding of the teaching? I will use my hand instead of a washcloth to was the irradiated area of skin 82. A nurse is caring for a client who is 4 hr postpartum. The client reports an urge to void but is unable to void. Which of the following actions should the nurse take? Massage the clients fundus 83. A nurse is preparing educational material for a client. Which of the following techniques should the nurse use in creating the material? Write information at a seventh grade reading level 84 A nurse is reviewing laboratory findings for a client who is receiving tpn. For which of the following findings should the nurse notify the provider? Sodium 125 mew/L 85. A nurse is providing discharge teaching to a client who is postoperative following surgery for carpal tunnel syndrome. Which of the following statements by the client indicates an understanding of the teaching? I will needs to keep my hand elevated above my heart for several days 86. A nurse is planning care for a client who has an L4 spinal cord injury. Which of the following interventions to prevent skin breakdown should the nurse include in the plan of care? Ask the client to shift his weight every 20 mins while sitting in a chair 87. A nurse is caring for a client who repeatedly refuses meals. The nurse overhears an AP telling the client” if you don’t eat ill put restraints on your wrists and feed you. The nurse should intervene and explain to the AP that this statement constitutes which of the following torts? Assult 88. A nurse is caring for a client who reports insomnia. Which of the following is the priority for the nurse to report to the provider? Snores loudly at night with morning headaches 89. A nurse is teaching a client who has heart failure about engaging in an exercise program. Which of the following statements by the client indicates an understandings of the teaching? I will make sure I can still talk while exercising 80. A nurse is assessing a client who has anorexia nervosa. Which of the following findings indicates effectiveness of the treatment plan? The client gains a total of 0.9 kh (2 lbs) during the first month 81. A nurse is assessing a client to determine the needs for physical restraints. The nurse should identify which of the following as an acceptable reason to apply physical restraints. To maintain the patency of an IV line 82. A nurse is reviewing the laboratory results of a client who is taking cyclosporine following a kidney transplant. Which of the following findings should the nurse report to the provider? Serum creatinine 1.6 83. A nurse is planning a community health program about Parkinson’s disease, which of the following interventions should the nurse include as a tertiary prevention strategy? Provide daily exercise classes to improve ambulation for clients who have Parkinson’s disease 87. A nurse is creating a plan of care for a newly admitted client who has obsessive compulsive disorder. Which of the following interventions should the nurse include? Allow the client enough time to perform rituals 88. A nurse is teaching a client who has alcohol use disorder about disulfiram. Which of the following client statements indicates an understanding of the teaching? I should avoid products containing alcohol, like mouthwash, while taking the medication 89. A nurse is assessing a client who has type 1 diabetes mellulitis and was administered insulin lispro 1 hr ago. Which of the following manifestations indicates that the client might be experiencing hypoglycemia? Confusion 90. A nurse is preparing to initiate intravenous fluids via infusion pump for a client. Which of the following actions should the nurse take? Check the expiration date on the safety inspection sticker of the pump 91. A nurse is caring for a client who will undergo a procedure. The client states he does not want to provider to discuss the results with his partner . which of the following is an appropriate response for the nurse to make? You have the right to decide who receives information 92. A nurse is caring for a client who is obese. The client is crying and states “everyone is staring at me because o my weight.” Which of the following responses should the nurse make? Is sounds like you’re saying that you feel uncomfortable around others 93. A nurse is teaching a group of clients at a community health fair about genetic risks for diseases. Which of the following statements by a client indicates an understanding of the teaching? My family has a genetic risk for breast cancer, so I am considering a total mastectomy 94. A nurse manager is planning a performance evaluation for a staff nurse. Which of following actions should the nurse manager take? Establish goals for improvement with the staff nurse 95. A nurse is caring for a client who has acute glomerulonephritis. The nurse should identify that which of the following findings is the priority? BUN 24 96. A nurse is teaching participants at a community center about advance directives. Which of the following information should the nurse include in the teaching? A heath care surrogate makes health care decisions when the client is no longer able 97. A nurse is instructing a school age child who has asthma about the use of a peak expiratory flow meter. Which of the following instructions should the nurse include in the teaching? Blow into the meter as hard and quickly as possible 98. A nurse is caring for a client who is postoperative and has a chest tube drainage system. For which of the following findings should the nurse notify the provider? Continuous bubbling in the water seal chamber 99. A nurse is planning care for a client who is receiving hemodialysis. Which of the following actions should the nurse include in the plan of care? Check the vascular access site for bleeding after dialysis 100. A nurse is preparing to administer vancomycin IV to an adult client. The client asks the nurse if the medications can be given 2 hr earlier. Which of the the following statements should the nurse make? I can start the medication 30 minutes earlier 101. A nurse is preparing to administer a medication that is available in a glass ampule. Which of the following actions should the nurse plan to take? The nurse should use a filter needles to withdraw the medication 102. A nurse is caring for a client who had heart failure. For which of the following lab values should the nurse withhold the client’s morning dose of digoxin and contact the provider Potassium 3.2 103. A nurse is assessing a client who had an uncomplicated vaginal birth 3 days ago. In which of the following locations should the nurse expect to palpate the clients fundus? C (lowest one) 104. A nurse is planning care for a client who is Chinese American and reports adhering to Chinese culture postpartum practices. Which of the following should the nurse anticipate? Prefers foods that maintain a balance of hot and cold within the body 105. A nurse is caring for a client who speaks a language different from the nurse. Which of the following actions should the nurse take? use a facility based interpreter of the same sex as the client 106. a charge nurse on a medical surgical unit is planning assignments for a LPN who has been sent from the postpartum unit due to a staffing shortage for the shift. Which of the following client assignments should the nruse delegate to the LPN? A client who is postoperatice following a bowel resection with a NG tube set to continuous suction 107. A nurse is caring for a 1 day old newborn who has jaundice and is receiving phototherapy. Which of the following actions shoul the nurse take? Ensure that the newborn wears a diaper 108. A nurse is providing discharge teaching to a client who has a new prescription for phenelzine. The nurse should instruct the client that is safe to eat which of the following foods while taking this medication? Whole grain bread 109. A nurse in a PACU is caring for a client who is postoperative following a knee arthroplasty using general anesthesia. Which of the following findings should the nurse report to the provider immediately? Nasal flaring is present with inspiratory stridor 110. A nurse is planning care for a group of clients. Which of the following methods should the nurse use to manage time effectively? Gather supplies prior to completeing a dressing change 111. a nurse is assessing a client who is receiving peritoneal dialysis for manifestation for peritonitis. Which of the following findings should the nurse identify as the first indication of peritonitis? Abdominal pain 113. A charge nurse is supervision the care of four clients. For which of the following occurrences should the nurse complete an incident report? A nurse forgets to document the administration of a medication 114. A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life sustaining measures. The client’s family wants the client to have life sustainging measures. Which of the following actions should the nurse take? Arrange for an ethics committee meeting to address the family’s concerns 115. A nurse is preparing to administer a NG tube feeding to a school age child. Which of the following actions should the nurse plan to take? Measure the tubing form the nose to the distal port 116. A nurse is reviewing the lab report of a client who has been receiving lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8. which of the following orders from the provider should the nurse expect? Administer the medication 117. A nurse is a mental health facility is airing for a child who is experiencing a panic level of anxiety. Which of the following actions should the nurse take? Encourage the client to take about his feelings 118. A nurse is teaching a group of newly licensed nurses about client advocacy. Which of the following statements by a newly licensed nurse indicates an Understandings of the teaching? I will interfere if there is a conflict between a client and his provider 119. A nurse in a surgical clinical is teaching to a client who is scheduled for a modified radical mastectomy. Which of the following statements by the client indicates an understanding of the teaching? I will complete my arm exercises four times daily 120. A nurse is preparing to perform a dressing change on a preschooler. Which of the following actions should the nurse to prepare the child for the procedure? Explain in simple terms how the procedure will affect the child 121. A nurse is teaching a client who has a new prescription for oxycodone extended release. Which of the following instructions should the nurse include? Increase daily fiber intake 122. A Charge nurse is teaching a group of newly licensed nurses about the correct use of restraints. Which of the following examples should the charge nurse include in the teaching? Keeping the side rails of a toddlers crib elevated 123. A charge nurse is teaching a newly licensed nurse about the facilities computerized documentation system. Which of the following information should the nurse include? Information technology will install a firewall to secure client information 124. A nurse overhears two assistive personals discussing care for a client while in the elevator.. Which of the following actions should the nurse take? Report the incident to the ap’s charge nurse 125. A nurse is assessing a client who is 1 day postoperative following the placement of an ileostomy. Which of the following findings should the nurse report to the provider? The stoma has a purplish hue 126. A nurse is providing teaching to a client who has heart failure and a new prescription for furosemide. Which of the following statements should the nurse make? Rise slowly when getting out of bed 127. A home health nurse is performing a home safety evaluation for an older adult client who uses a walker. The nurse should identify that which of the following findings indicates proper home safety? The client utilizes a night light in the hallway and bathroom 128. A nurse is assessing a school age child who has a urinary tract infection. Which of the following should the nurse expect? Enuresis 129. A nurse is teaching a newly licensed nurse about incident reports. Which of the following statements by the newly licensed nurse indicates an understandings of the teaching? They assist with unit quality improvements 130. The nurse is evaluating the discharge teaching for a client who has an ileal conduit. Which of the following statements indicates that the client has correctly understood the teaching? Select all that apply. “I can usually keepmy ostomy pouch on for 3 to 7 days before changing it.” “I must use a skin barrier to protect my skin from urine.” 131. A nurse is assisting in performing an assessment on a client who suspects that she is pregnant and ischecking the client for probable signs of pregnancy. Select all probable signs of pregnancy. Uterine enlargement Chadwick’ssign Braxton Hicks contractions Ballottement 132. A nurse is monitoring a pregnant client with pregnancy induced hypertension who is at risk for Preeclampsia. The nurse checks the client for which specific signs of Preeclampsia (select all that apply)? Elevated blood pressure Facial edema 133. A 45-year-old client diagnosed with major depression is scheduled for electroconvulsive therapy (ECT) in the morning. Which of the following medications are routinely administered either before or during ECT? B. Atropine, sodium brevitol, and succinylcholine chloride (Anectine) 134. A 35-year-old client is receiving psychopharmacological treatment of his major depression with tranylcypromine sulfate (Parnate), a monoamine oxidase (MAO) inhibitor. The nurse teaches the client that while he is taking this type of antidepressant, he needs to restrict his dietary intake of: C. Tyramine 135. A 23-year-old female client is brought to the emergency room by her roommate for repeatedly making superficial cuts on her wrists and experiencing wide mood swings. She is very angry and hostile. Her medical diagnosis is adjustment disorder versus borderline personality disorder. The client comments to the nurse, "Nobody in here seems to really care about the clients. I thought nurses cared about people!" The client is exhibiting the ego defense mechanism: C. Splitting 136.A client hospitalized with a medical diagnosis of adjustment disorder versus personality disorder states, "Nobody cares about the clients." The nurse’s most effective response would be: D. "You seem angry. Tell me more about how you feel." 137.A measurable outcome criterion in the nursing care of an adolescent with anorexia nervosa would be: B. Verbalizing realistic feelings about her body 138. A 14-year-old teenager is hospitalized for anorexia nervosa. She is admitted to the adolescent mental health unit and placed on a behavior modification program. Nursing interventions for the teenager will most likely include: A. Establishing routine tasks and activities around mealtimes 139. One afternoon 3 weeks into his alcohol treatment program, a client says to the nurse, "It’s really not all my fault that I have a drinking problem. Alcoholism runs in my family. Both my grandfather and father were heavy drinkers." The nurse’s best response would be: B. "Risk factors can often be controlled by self-responsibility." 140. When preparing insulin for IV administration, the nurse identifies which kind of insulin to use? C. Regular 141. A 33-year-old client is diagnosed with bipolar disorder, acute phase. This is her first psychiatric hospitalization, and she is being evaluated for treatment with lithium. Which of the following diagnostic tests are essential prior to the initiation of lithium therapy with this client? B. Blood urea nitrogen, electrolytes, and creatinine 142. A client has been taking lithium 300 mg po bid for the past two weeks. This morning her lithium level was 1 mEq/L. The nurse should: C. Administer the morning lithium dose as scheduled 143. A 23-year-old male client is admitted to the chemical dependency unit with a medical diagnosis of alcoholism. He reports that the last time he drank was 3 days ago, and that now he is starting to "feel kind of shaky." Based on the information given above, nursing care goals for this client will initially focus on: D. Physiological stabilization 144. A 14-year-old boy has had diabetes for 7 years. He takes 30 U of NPH insulin and 10 U of regular insulin every morning at 7 AM. He eats breakfast at 7:30 AM and lunch at noon. What time should he expect the greatest risk for hypoglycemia? C. 11 AM 145. A 16-year-old diabetic girl has been selected as a cheerleader at her school. She asks the nurse whether she should increase her insulin when she is planning to attend cheerleading practice sessions lasting from 8 to 11 AM. The most appropriate answer would be: D. "No, do not increase your insulin, but eating a snack prior to practice exercise will make insulin more effective and move more glucose into the cells." 146. The physician decides to prescribe both a short-acting insulin and an intermediate-acting insulin for a newly diagnosed 8-year-old diabetic client. An example of a short-acting insulin is: A. Novolin Regular 147. Diabetes mellitus is a disorder that affects 3.1 out of every 1000 children younger than 20 years old. It is characterized by an absence of, or marked decrease in, circulating insulin. When teaching a newly diagnosed diabetes client, the nurse includes information on the functions of insulin: A. Transport of glucose into body cells and storage of glycogen in the liver 148. Cystic fibrosis is transmitted as an autosomal recessive trait. This means that: D. Both parents must be carriers for a child to have the disease 149. A 9-year-old child was in the garage with his father, who was repairing a lawnmower. Some gasoline ignited and caused an explosion. His father was killed, and the child has split-thickness and fullthickness burns over 40% of his upper body, face, neck, and arms. All of the following nursing diagnoses are included on his care plan. Which of these nursing diagnoses should have top priority during the first 2448 hours postburn? D. Potential for impaired gas exchange related to edema of respiratory tract 150. A female baby was born with talipes equinovarus. Her mother has requested that the nurse assigned to the baby come to her room to discuss the baby’s condition. The nurse knows that the pediatrician has discussed the baby’s condition with her mother and that an orthopedist has been consulted but has not yet seen the baby. What should the nurse do first? B. Question the mother and find out what the pediatrician has told her about the baby’s condition. 151. A child has a nursing diagnosis of fluid volume excess related to compromised regulatory mechanisms. Which of the following nursing interventions is the most accurate measure to include in his care? A. Weigh the child twice daily on the same scale. 152. The pediatric nurse charts that the parents of a 4-yearold child are very anxious. Which observation would indicate to the nurse unhealthy coping by these parents: D. Refusing to participate in the child’s care 153. A 9-week-old female infant has a diagnosis of bilateral cleft lip and cleft palate. She has been admitted to the pediatric unit after surgical repair of the cleft lip. Which of the following nursing interventions would be appropriate during the first 24 hours? B. Maintain elbow restraints in place unless she is being directly supervised. 154. A 6-month-old infant who was diagnosed at 4 weeks of age with a ventricular septal defect, was admitted today with a diagnosis of failure to thrive. His mother stated that he had not been eating well for the past month. A cardiac catheterization reveals congestive heart failure. All of the following nursing diagnoses are appropriate. Which nursing diagnosis should have priority? D. Decreased cardiac output related to ineffective pumping action of the heart 155. To assist an adult client to sleep better the nurse recommends which of the following? (Select all thatapply.) Consuming a small glass of warm milk at bedtime 156. A female client at 36 weeks' gestation has been treated successfully for premature labor for 4 weeks. She has begun having uterine contractions today and has been admitted to the labor and delivery suite. Her amniocentesis results reveal a lecithin/sphingomyelin (L/S) ratio of 2 and positive phosphatidylglycerol (PG). These lab values indicate: Fetal lung maturity 157. A primigravida with a blood type a negative is at 28 weeks' gestation. Today her physician has ordered a RhoGAM injection. Which statement by the client demonstrates that more teaching is needed related to this therapy? "I'm getting this shot so that my baby won't develop antibodies against my blood, right?" 158. at her monthly prenatal visit, a client reports experiencing heartburn. Which nursing measure should be included in her plan of care to help alleviate it? Eat small, frequent bland meals. 159. A client is dilated 8 cm and entering the transition phase of labor. Common behaviors of the laboring woman during transition are: Frustration, vague in communication 160. The FHR pattern in a laboring client beginsto show early decelerations. The nurse would best respond by: Continuing to monitor the FHR closely 161. A female client is admitted to the emergency department complaining of severe right-sided abdominal pain and vaginal spotting. She states that her last menstrual period was about 2 months ago. A positive pregnancy test result and ultrasonography confirm an ectopic pregnancy. The nurse could best explain to the client that her condition is caused by: A distended or ruptured fallopian tube 162. A female client at 10 weeks' gestation complains to her physician ofslight vaginal bleeding and mild cramps. On examination, her physician determines that A threatened abortion An incomplete abortion 163. A female client at 36 weeks' gestation is experiencing preterm labor. Her physician has prescribed two doses of betamethasone 12 mg IM q24h. The nurse explains that she is receiving this drug to: Promote fetal lung maturation 164. A client has returned to the unit following a left femoral popliteal bypass graft. Six hourslater, his dorsalis pedis pulse cannot be palpated, and his foot is cool and dusky. The nurse should: Notify the physician immediately 165. A client isto have a coronary artery bypass graft performed in the morning using a saphenous vein. He wants to know why the physician does not use the internal mammary artery for his bypass graft because his friend's physician uses this artery. The nurse tells the client that the internal mammary artery: Takes more time to remove 166. A client returnsto the cardiovascular intensive care unit following his coronary artery bypass graft. In planning his care, the most important electrolyte the nurse needs to monitor will be: Potassium 167. A client is being discharged from the hospital today. The discharge teaching for care of her colostomy included which of the following basic principles for protecting the skin around her stoma: Using a skin sealant under pouch adhesives 168. A client is being discharged from the hospital tomorrow following a colon resection with a left colostomy. The nurse knows that the client understands the discharge teaching about care of her colostomy when she says: 169. A client had a right below-the-knee amputation 4 days ago. He is complaining of pain in his right lower leg. The nurse should: Give the client his order of Demerol 50 mg IM prn 170. A client hasreturned to the unit from the recovery room after having a thyroidectomy. The nurse knowsthat a major complication after a thyroidectomy is: Respiratory obstruction 171. A client had a transurethralresection of the prostate yesterday. He is concerned about the small amount of blood that is still in his urine. The nurse explains that the blood in his urine: Is normal and he need not be concerned about it 172. A 72-year-old male client had the Foley catheter that was inserted during the transurethral resection of his prostate removed today. He is concerned about the urinary incontinence he is having since removal of the Foley catheter. The nurse explains that: Thisis usually temporary 173. A 48-year-old female client is going to have a cholecystectomy in the morning. In planning for her postoperative care, the nurse is aware that a priority nursing diagnosis for her will be high risk for: Ineffective breathing pattern 174. A client is having a pneumonectomy done today, and the nurse is planning her postoperative care. Nursing interventions for a postoperative left pneumonectomy would include: Monitoring the right lung for an increase in rales 175. A client returned to the unit following a pneumonectomy. As the nurse is assessing her incision, she notices fresh blood on the dressing. The nurse should first: Notify the physician. 176. A nurse is reviewing the laboratory report of a school-age child who has bacterial pneumonia. Which of the following laboratory values should the nurse expect? • WBC 18,000/mm 177. The nurse is caring for a 73-year-old patient who underwent a left total knee arthroplasty. On the third postoperative day, the patient complains of shortness of breath, slight chest pain, and that "something is wrong." Temperature is 98.4o F, blood pressure 130/88, respirations 36, and oxygen saturation 91% on room air. Which of the following should the nurse first suspect as the etiology of this episode? B. Pulmonary embolus from deep vein thrombosis 178. A nurse is preparing a client who has supraventricular tachycardia for elective cardioversion. Which of the following prescribed medications should the nurse instruct the client to withhold for 48 hr prior to cardioversion? Digoxin 179. A nurse is developing a plan of care for a client who has preeclampsia and is to receive magnesium sulfate via continuous IV infusion. Which of the following actions should the nurse include in the plan? a. Measure the client’s urine output every hour. - monitor for toxicity. 180. A nurse is caring for a client who has end stage kidney disease. The client’s adult child asks the nurse about becoming a living kidney donor for her father. Which of the following conditions in the child’s medical history should the nurse identify as a contraindication to the procedure? a. Hypertension