Comprehensive Predictor 2019 FormA, B and C

A nurse is admitting a client who has dementia to a long-term care facility. The client tells the nurse that she lived in this facility years ago and took care of all the residents by herself. The nurse should document this as which of the following findings? A. Confabulation B. Agnosia C. Projection D. Perseveration - CORRECT ANSERS-A. Confabulation . A nurse is assessing a client who is 36 weeks of gestation. Which of the following findings should the nurse report to the provider? A. 3+ deep tendon reflexes B. Protruding Hemorrhoids C. Urinary Frequency (expected) D. Supine Hypotension - CORRECT ANSERS-B. Protruding Hemorrhoids rational for option A (common finding in women with preeclampsia and does not require action unless there are symptoms of magnesium toxicity.) . A nurse is caring for a client who has heart failure and is receiving a continuous IV infusion of low dose dopamine. Which of the following findings is the highest priority? a. Erythema 5 cm (2in) above the IV site b. Blood pressure 92/68 mm Hg - c. Urine output 35mL/hr d. Pedal pulse of +1 bilaterally - CORRECT ANSERS-a. Erythema 5 cm (2in) above the IV site . A nurse is caring for a client who is in a seclusion room following violent behavior. The client continues to display aggressive behavior. Which of the following actions should the nurse take? A. Stand within 30cm (1 ft) of the client when speaking with them. B. Express sympathy for the client's situation. C. Confront the client about his behavior. D. Speak assertively to the client. - CORRECT ANSERS-D. Speak assertively to the client. . A nurse is providing dietary teaching to a guardian of a preschooler who has a new diagnosis of celiac disease. Which of the following statements by the guardian indicates an understanding of the teaching? A. "I will put my child on a gluten-free diet". B. "I will administer digestive enzymes with meals and snacks". - CF C. "Provide my child with some high fiber foods." D. "I will give my child whole wheat toast and milk for breakfast" - CORRECT ANSERS-A. "I will put my child on a gluten-free diet". . A nurse is providing teaching about patient-controlled analgesia (PCA) to a client. Which of the following statements should the nurse include in the teaching? A. "The PCA will deliver a double dose of medication when you push the button twice." B. "You can adjust the amount of pain medication you receive by pushing on the keypad." C. "Continuous PCA infusion is designed to allow fluctuating plasma medication levels." D. "You should push the button before physical activity to allow maximum pain control." - CORRECT ANSERS-D. "You should push the button before physical activity to allow maximum pain control." . A nurse is reviewing the laboratory levels of a client who is having elective surgery. Which of the following levels should the nurse report to the provider? a. Potassium 3.2 mEq/L 3.5 - 5.0 is normal b. BUN 16 mg/dL (Normal 10-20) c. PT 12.2 seconds (Normal 11-14) d. Fasting blood glucose 103 mg/dL - CORRECT ANSERS-a. Potassium 3.2 mEq/L 3.5 - 5.0 is normal .A nurse is admitting a client who has acute heart failure. Which of the following prescriptions from the provider should the nurse anticipate? a. Administer enalapril 2.5 mg PO twice daily b. Ambulate the client every 4 hr while awake(bedrest) c. Provide the client with 4 g sodium diet( d. Infuse 0.9% sodium chloride 500 mL IV bolus over 1 hr - CORRECT ANSERS-a. Administer enalapril 2.5 mg PO twice daily .A nurse is admitting an older adult client who is transferring from another facility. The nurse notes pressure ulcers on the client's coccyx and abrasions around the wrists. Which of the following actions should the nurse take to address the suspicions of elder abuse? a. Inform the transferring agency of the client's condition. b. Privately interview the client about her condition. c. Notify risk management d. Contact the family regarding the client's condition. - CORRECT ANSERS-b. Privately interview the client about her condition. .A nurse is planning to administer ampicillin 100 mg/kg/day in divided doses every 12 hours to a newborn who weighs 4.34 kg(9.5 lbs). Available is ampicillin 125mg/ml. How many milliliters should the nurse administer per dose? ( Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero - CORRECT ANSERS-Answer is 1.7 mL per dose Rationale: 100mg X 4.34 kg= 434 mg/day 434mg/125mgX1=3.472/day 3.472/2= 1.736 .A nurse is teaching a client who has tuberculosis. Which of the following statements should the nurse include in the teaching? A. "You will need to continue to take the multi-medication regimen for 4 months." B. You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication C. "You will need to remain hospitalized for treatment." D. "You will need to wear a mask at all times." - CORRECT ANSERS-B. You will need to provide sputum samples every 4 weeks to monitor the effectiveness of the medication 1. A nurse is caring for a client who has bipolar disorder and is experiencing acute mania. The nurse obtained a verbal prescription for restraints. Which of the following should the actions the nurse take? A. Request a renewal of the prescription every 8 hr. B. Check the client's peripheral pulse rate every 30 min C. Obtain a prescription for restraint within 4 hr. D. Document the client's condition every 15 minutes - CORRECT ANSERS-D. Document the client's condition every 15 minutes 2. A nurse is administering digoxin 0.125 mg Po to an adult client. For which of the following findings should the nurse report to the provider? A. Potassium level 4.2 mEq/L. B. Apical pulse 58/min. C. Digoxin level 1 ng/ml. D.Constipation for 2 days. - CORRECT ANSERS-B. Apical pulse 58/min 98. A nurse is admitting a client who had a stroke and exhibits facial drooping, drooling and hoarseness. Which of the following is the nurse's priority? A. Refer the client to a speech language pathologist. B. Monitor the client's prealbumin levels C. Measure the client's weight. D. Place the client on NPO status. - CORRECT ANSERS-D. Place the client on NPO status. 117. A nurse is planning to administer vancomycin IV to a client. Which of the following actions should the nurse take to reduce the risk of an adverse reaction to the vancomycin? a. Give the dose over 60 min b. Administer the medication undiluted c. Obtain trough level 30 min after the medication infusion d. Inject 1% lidocaine prior to each dose - CORRECT ANSERS-a. Give the dose over 60 min A case manager is meeting with a client who asks about using alternative therapies to manage her rheumatoid arthritis. Which of the following statements should the nurse make? A. Im sure you can find alternative remedies through an online suppo