1. A nurse is caring for a client who had a par- The infusion pump for administering
tial laryngectomy and is receiving continuous contimuous feeding is turned off.
enteral feedings at 65 mL/hr through a gas-
trostomy tube. Which of the following findings
requires immediate intervention by the nurse?
2. A nurse is assessing a client who has a magne- Hypotension
sium level of 4.4 mEq/L. Which of the following
findings should the nurse expect?
3. A nurse is providing dietary teaching to a client Egg whites
who has an increased cholesterol level. Which
of the following foods should the nurse recom-
mend?
4. A nurse is caring for a toddler who has respi- Use a designated stethoscope when
ratory syncytial virus. Which of the following caring for the toddler.
actions should the nurse plan to take?
5. A nurse is assessing a client who has a chest 1 cm of water present in the water
tube following a thoracotomy. Which of the seal
following findings requires intervention by the
nurse?
6. A nurse is reviewing the medical history of The client takes aspirin daily.
a client who is taking garlic supplement. The
nurse should identify that which of the follow-
ing findings is a contraindication for taking this
supplement?
7. A nurse is planning to provide community ed- series of four hepatitis vaccines is rec-
ucation about viral hepatitis. Which of the fol- ommended to prevent viral hepatitis.
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lowing should the nurse plan to include in the
teaching?
8. A nurse is reviewing the history and physical of Elevated pulmonary artery pressure
a client who has right ventricular heart failure.
Which of the following is an expected finding?
9. A home health nurse is conducting an initial Inform the client of available commu-
home visit for a client who has terminal breast nity resources.
cancer. The client has two school-age children
and a limited support system. Which of the
following is the priority nursing action?
10. A nurse is providing postoperative teaching to "I will use my cell phone on the ear
a client who has a newly-inserted pacemaker. opposite of my pacemaker."
Which of the following statements by the client
indicates that the teaching has been effective?
11. A nurse is caring for a client who has heart Decreased reflexes
failure and has started taking a loop diuretic.
Which of the following findings indicates the
client is experiencing an adverse effect of the
medication?
12. A nurse is caring for a client who has neu- Wear an N95 respirator.
tropenia due to HIV. Which of the following
precautions should the nurse take while caring
for this client?
13. A nurse manager is presenting information The nurse should pad the bony
to the nursing staff regarding the appropriate prominences. The nurse should re-
use of client restraints. Which of the following move the restraints every 2 hr. The
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should the nurse include? (Select all that ap- provider's prescription should in-
ply.) clude the
14. A nurse is providing discharge teaching about Educating the client how to cover
disease prevention to a client who has active nose and mouth with tissues when
tuberculosis. Which of the following should the coughing
nurse include?
15. A nurse is caring for a client who reports dif- Schedule routine care tasks during
ficulty falling asleep at night. Which of the hours when the client is awake.
following actions should the nurse take?
16. A nurse is preparing a client for surgery and Review deep breathing and coughing
has just administered the preoperative injec- exercises.
tion. Which of the following actions should the
nurse take?
17. A nurse suspects another nurse is chemically Report to the nurse manager.
impaired during their shift. Which of the fol-
lowing is an appropriate action for the nurse
to take?
18. A nurse in the recovery room is assessing a The tubing may be kinked.
client who has a new chest tube. The nurse
finds that the water seal is no longer tidaling.
The nurse should identify the finding as result-
ing from which of the following?
19. A nurse delegates tasks to a licensed practical Measure the amount of gastric
nurse (LPN) and an assistive personnel (AP). drainage every 2 hr.
When admitting a client who is experiencing
acute liver failure and who has ascites and an
NG tube, which of the following tasks is most
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appropriate for the nurse to delegate to the
LPN?
20. A nurse is assessing an adult male client who Healthy weight
has a BMI of 20. The nurse should identify
that the client's BMI falls within which of the
following categories?
21. A nurse is assessing a client who has a long Change in mental status
arm cast. For which of the following findings
should the nurse monitor when assessing for
acute compartment syndrome?
22. A nurse is planning care for a newly admit- Administer pain medication to the
ted client. Which of the following interventions client.
should the nurse plan to take first? (Click on
the "Exhibit" button for additional information
about the client. There are three tabs that con-
tain separate categories of data.)
23. A community health nurse is performing a vi- The infant closes their eyes.
sion screening on a 4-month-old infant. When
shining a light source into the infant's visual
field, which of the following is an expected
finding?
24. A nurse is planning discharge teaching for a Place the infusion pump cord against
client who is scheduled to receive intravenous the baseboards.
infusions at home. Which of the following in-
structions should the nurse plan to include?
25. A nurse is caring for a client who has just re- Offers oral fluids to the client
turned to the unit following a bronchoscopy.