2025/ Solutions A+
Nurse is a rehabilitation facility is observing an assistive personal (AP) help a client
transfer from a bed to a wheelchair. Which of the following actions indicates to the nurse
that the AP understands how to perform this task
A) Locking the brakes on the bed and the wheelchair before moving the client
B) Lowering the footplates of the wheelchair before the transfer
C) Placing the wheelchair perpendicular to the bed
D) Placing the wheelchair on the clients weaker side prior to the transfer - CORRECT
ANSWER-A) Locking the brakes on the bed and the wheelchair before moving the client
A nurse is caring for a client who has cancer and refuses visitors because of his
debilitated physical appearance. Which of the following comments should the nurse
make?
A) "You look just fine to me."
B) "Nobody expects you to look beautiful in the hospital."
C) "I understand how you feel. I would feel the same way."
D) Would you like to talk about how you feel?" - CORRECT ANSWER-D) "Would you
like to talk about how you feel?"
A nurse is assessing the pH of a clients gastric fluid to confirm the placement of an NG
tube in the stomach. Which of the following pH values should the nurse expect?
A) 6
B) 2
C) 10
D) 8 - CORRECT ANSWER-B) 2
A nurse is caring for a client who is scheduled to receive transcutaneous electrical
nerve (TENS) for pain management. The client asks the nurse how a TENS unit helps
to relieve pain. Which of the following responses should the nurse make?
A) "It provides a distraction from the pain"
B) "It modulates the transmission of the pain impulse"
C) "It promotes increased circulation to the painful area"
D) "It elicits a relaxation response" - CORRECT ANSWER-B) "It modulates the
transmission of the pain impulse"
A school nurse is assessing a child who has been stung by a bee. The child's hand is
swelling and the nurse notes that the child is allergic to insect stings. Which of the
following findings should the nurse expect if the child develops anaphylaxis? (SATA)
A) Bradycardia
B) Nausea
C) Hypertension
, D) Urticaria
E) Stridor - CORRECT ANSWER-B) Nausea
D) Urticaria
E) Stridor
A nurse is caring for a client who is unconscious. Which of the following actions should
the nurse take when providing oral care for the client?
A) Test for the presence of the clients gag reflex
B) Place the client in the supine position
C) Use a firm toothbrush for tooth and gum care
D) Use 2 gauze-wrapped fingers to hold the mouth open - CORRECT ANSWER-A) Test
for the presence of the clients gag reflex
A nurse is planning care for a client who has acute myelogenous leukemia and a
platelet count of 48,000/mm^3. Which of the follow interventions should the nurse
include?
A) Avoid IM injections
B) Assess the client for ecchymosis once per shift
C) Do not allow the client to have visitors
D) Encourage daily flossing between teeth - CORRECT ANSWER-A) Avoid IM injection
A nurse is preparing to assess the function of the clients trigeminal nerve (cranial nerve
V). Which of the following items should the nurse gather for the test?
A) Sugar
B) Coffee
C) Cotton wisps
D) Snellen chart - CORRECT ANSWER-C) Cotton wisps
A nurse is caring for a client with alcohol use disorder who has undergone
detoxification. Which of the following medications should the nurse expect the provider
to prescribe to assist the client with maintaining sobriety
A) Varenicline
B) Clonidine
C) Buprenorphine
D) Disulfiram - CORRECT ANSWER-D) Disulfiram
A newly admitted client who has major depressive disorder states to the nurse, "I'm a
failure, I can't even cope with the little things anymore." Which of the following
responses should the nurse provide?
A) "What happened in your life to make you feel like such a failure?"
B) "It sounds as if you are feeling pretty overwhelmed right now"