Q. Suicide Precautions Are Initiated For a Child Admitted To The Mental Health
Unit Following An Intentional Narcotic Overdose. After a Visitor Leaves, The Nurse
Finds a Package Of Cigarettes In The Client's Room. Which Intervention Is Most
Important For The Nurse To Implement?
CORRECT ANSWER: Remove Cigarettes For The Client's Room
Q. A Family Member Of a Frail Elderly Adult Asks The Nurse About Eligibility
Requirements For Hospice Care. What Information Should The Nurse Provide?
(Select All That Apply.)
A.)A Client Must Be Willing To Accept Palliative Care, Not Curative Care.
B.)The Healthcare Provider Must Project That The Client Has 6 Months Or
Less To Live.
C.)The Client Must Be Diagnosed With Clinical Depression
D.)The Client Must Be Of Sound Mind
,Q. A Client With Atrial Fibrillation Receives a New Prescription For Dabigatran.
What Instruction Should The Nurse Include In This Client's Teaching Plan?
CORRECT ANSWER: Avoid Use Of Nonsteroidal Ant-Inflammatory Drugs
(Nsaid).
Q. An Infant Who Is Admitted For Surgical Repair Of a Ventricular Septal Defect
(Vsd) Is Irritable And Diaphoretic With Jugular Vein Distention. Which Prescription
Should The Nurse Administer First?
CORRECT ANSWER:Digoxin
Q. The Nursing Staff On a Medical Unit Includes a Registered Nurse (Rn), Practical
Nurse (Pn), And An Unlicensed Assistive Personnel (Uap). Which Task Should The
Charge Nurse Assign To The Rn?
CORRECT ANSWER:Supervise a Newly Hired Graduate Nurse During An
Admission Assessment.
Q.While Teaching a Young Male Adult To Use An Inhaler For His Newly Diagnosed
Asthma, The Client Stares Into The Distance And Appears To Be Concentrating On
Something Other Than The Lesson The Nurse Is Presenting. What Action Should The
Nurse Take?
CORRECT ANSWER:Ask The Client What He Is Thinking About At His Time.
Q After Several Hours Of Non-Productive Coughing, a Client Presents To The
Emergency Room Complaining Of Chest Tightness And Shortness Of Breath. History
Includes End Stage Chronic Obstructive Pulmonary Disease (Copd) And Diabetes
Mellitus. While Completing The Pulmonary Assessment, The Nurse Hears Wheezing
And Poor Air Movement Bilaterally. Which Actions Should The Nurse Implement?
(Select All That Apply.)
A.)Administer Prn Nebulizer Treatment.
B.)Obtain 12 Lead Electrocardiogram.
C.)Monitor Continuous Oxygen Saturation.
D.) Lay The Client In The Prone Position
A,B,C
Q The Nurse Caring For a 3-Month-Old Boy One Day After a Pylorotomy Notices
That The Infant Is Restless, Is Exhibiting Facial Grimaces, And Is Drawing His Knees
To His Chest. What Action Should The Nurse Take?
CORRECT ANSWER:Administer a Prescribed Analgesia For Pain.
,Q A 4 Year-Old With Acute Lymphocytic Leukemia (All) Is Receiving a
Chemotherapy (Ct) Protocol That Includes Methotrexate (Mexate, Trexal, Mix), An
Antimetabolite. Which Information Should The Nurse Provide The Parents About
Caring For Their Child?
Use Sunblock Or Protective Clothing When Outdoors.
Two Days After Admission a Male Client Remembers That He Is Allergic To Eggs,
And Informs The Nurse Of The Allergy. Which Actions Should The Nurse
Implement? Sata
A.) Tell The Client That Its a Mild Reaction
B.)Notify The Food Services Department Of The Allergy.
C.)Enter The Allergy Information In The Client's Record.
D.)Add Egg Allergy To The Client's Allergy Arm Band.
B,C,D
Q The Rapid Response Team's Detects Return Of Spontaneous Circulation (Rosc)
After 2 Min Of Continuous Chest Compressions. The Client Has a Weak, Fast Pulse
And No Respiratory Effort, So The Healthcare Provider Performs a Successful Oral,
Intubation. What Action Should The Nurse Implement?
CORRECT ANSWER:Perform Bilateral Chest Auscultation.
Q After Administering An Antipyretic Medication. Which Intervention Should The
Nurse Implement?
CORRECT ANSWER:Encouraging Liberal Fluid Intake
Q A Client With Hyperthyroidism Is Being Treated With Radioactive Iodine (I-131).
Which Explanation Should Be Included In Preparing This Client For This Treatment?
Describe Radioactive Iodine As a Tasteless, Colorless Medication Administered By
CORRECT ANSWER:The Healthcare Provider
Q After a Colon Resection For Colon Cancer, a Male Client Is Moaning While Being
Transferred To The Postanesthesia Care Unit (Pacu). Which Intervention Should The
Nurse Implement First?
CORRECT ANSWER:Determine Client's Pulse, Blood Pressure, And
Respirations
Q The Nurse Is Caring For a Group Of Clients With The Help Of a Licensed
Practical Nurse (Lpn) And An Experienced Unlicensed Assistive Personnel (Uap).
, Which Procedures Can The Nurse Delegate To The Uap? (Select All That Apply)
A.)Take Postoperative Vital Signs For a Client Who Has An Epidual Following Knee
Arthroplasty
B.)Collect a Sputum Specimen For a Client With a Fever Of Unknown Origin
C.)Ambulate a Client Who Had a Femoral-Popliteal Bypass Graft Yesterday
CORRECT ANSWER:A,B,C
A Male Client With Cirrhosis Has Ascites And Reports Feeling Short Of Breath. The
Client Is In Semi Fowler Position With His Arms At His Side. What Action Should
The Nurse Implement?
CORRECT ANSWER:Raise The Head Of The Bed To a Fowler's Position And
Support His Arms With a Pillow
A Client With a History Of Chronic Pain Requests a Nonopioid Analgesic. The Client
Is Alert But Has Difficulty Describing The Exact Nature And Location Of The Pain
To The Nurse. Which Action Should The Nurse Implement Next?
CORRECT ANSWER:Administer The Analgesic As Requested
Q The Nurse Uses The Parkland Formula (4ml x Kg x Total Body Surface Area = 24
Hours Fluid Replacement) To Calculate The 24-Hours Iv Fluid Replacement For a
Client With 40% Burns Who Weighs 76kg. How Many Ml Should The Client
Receive? (Enter Numeric Value Only.)
CORRECT ANSWER:12160
A Client With Leukemia Undergoes a Bone Marrow Biopsy. The Client's Laboratory
Values Indicate The Client Has Thrombocytopenia. Based On This Data, Which
Nursing Assessment Is Most Important Following The Procedure?
A.)Observe Aspiration Site.
B.)Assess Body Temperature
C.)Monitor Skin Elasticity
D.)Measure Urinary Output
Q An 18-Year-Old Female Client Is Seen At The Health Department For Treatment
Of Condylomata Acuminate (Perineal Warts) Caused By The Human Papillomavirus
(Hpv). Which Intervention Should The Nurse Implement?
CORRECT ANSWER:Reinforce The Importance Of Annual Papanicolaou (Pap)
Smears.
Unit Following An Intentional Narcotic Overdose. After a Visitor Leaves, The Nurse
Finds a Package Of Cigarettes In The Client's Room. Which Intervention Is Most
Important For The Nurse To Implement?
CORRECT ANSWER: Remove Cigarettes For The Client's Room
Q. A Family Member Of a Frail Elderly Adult Asks The Nurse About Eligibility
Requirements For Hospice Care. What Information Should The Nurse Provide?
(Select All That Apply.)
A.)A Client Must Be Willing To Accept Palliative Care, Not Curative Care.
B.)The Healthcare Provider Must Project That The Client Has 6 Months Or
Less To Live.
C.)The Client Must Be Diagnosed With Clinical Depression
D.)The Client Must Be Of Sound Mind
,Q. A Client With Atrial Fibrillation Receives a New Prescription For Dabigatran.
What Instruction Should The Nurse Include In This Client's Teaching Plan?
CORRECT ANSWER: Avoid Use Of Nonsteroidal Ant-Inflammatory Drugs
(Nsaid).
Q. An Infant Who Is Admitted For Surgical Repair Of a Ventricular Septal Defect
(Vsd) Is Irritable And Diaphoretic With Jugular Vein Distention. Which Prescription
Should The Nurse Administer First?
CORRECT ANSWER:Digoxin
Q. The Nursing Staff On a Medical Unit Includes a Registered Nurse (Rn), Practical
Nurse (Pn), And An Unlicensed Assistive Personnel (Uap). Which Task Should The
Charge Nurse Assign To The Rn?
CORRECT ANSWER:Supervise a Newly Hired Graduate Nurse During An
Admission Assessment.
Q.While Teaching a Young Male Adult To Use An Inhaler For His Newly Diagnosed
Asthma, The Client Stares Into The Distance And Appears To Be Concentrating On
Something Other Than The Lesson The Nurse Is Presenting. What Action Should The
Nurse Take?
CORRECT ANSWER:Ask The Client What He Is Thinking About At His Time.
Q After Several Hours Of Non-Productive Coughing, a Client Presents To The
Emergency Room Complaining Of Chest Tightness And Shortness Of Breath. History
Includes End Stage Chronic Obstructive Pulmonary Disease (Copd) And Diabetes
Mellitus. While Completing The Pulmonary Assessment, The Nurse Hears Wheezing
And Poor Air Movement Bilaterally. Which Actions Should The Nurse Implement?
(Select All That Apply.)
A.)Administer Prn Nebulizer Treatment.
B.)Obtain 12 Lead Electrocardiogram.
C.)Monitor Continuous Oxygen Saturation.
D.) Lay The Client In The Prone Position
A,B,C
Q The Nurse Caring For a 3-Month-Old Boy One Day After a Pylorotomy Notices
That The Infant Is Restless, Is Exhibiting Facial Grimaces, And Is Drawing His Knees
To His Chest. What Action Should The Nurse Take?
CORRECT ANSWER:Administer a Prescribed Analgesia For Pain.
,Q A 4 Year-Old With Acute Lymphocytic Leukemia (All) Is Receiving a
Chemotherapy (Ct) Protocol That Includes Methotrexate (Mexate, Trexal, Mix), An
Antimetabolite. Which Information Should The Nurse Provide The Parents About
Caring For Their Child?
Use Sunblock Or Protective Clothing When Outdoors.
Two Days After Admission a Male Client Remembers That He Is Allergic To Eggs,
And Informs The Nurse Of The Allergy. Which Actions Should The Nurse
Implement? Sata
A.) Tell The Client That Its a Mild Reaction
B.)Notify The Food Services Department Of The Allergy.
C.)Enter The Allergy Information In The Client's Record.
D.)Add Egg Allergy To The Client's Allergy Arm Band.
B,C,D
Q The Rapid Response Team's Detects Return Of Spontaneous Circulation (Rosc)
After 2 Min Of Continuous Chest Compressions. The Client Has a Weak, Fast Pulse
And No Respiratory Effort, So The Healthcare Provider Performs a Successful Oral,
Intubation. What Action Should The Nurse Implement?
CORRECT ANSWER:Perform Bilateral Chest Auscultation.
Q After Administering An Antipyretic Medication. Which Intervention Should The
Nurse Implement?
CORRECT ANSWER:Encouraging Liberal Fluid Intake
Q A Client With Hyperthyroidism Is Being Treated With Radioactive Iodine (I-131).
Which Explanation Should Be Included In Preparing This Client For This Treatment?
Describe Radioactive Iodine As a Tasteless, Colorless Medication Administered By
CORRECT ANSWER:The Healthcare Provider
Q After a Colon Resection For Colon Cancer, a Male Client Is Moaning While Being
Transferred To The Postanesthesia Care Unit (Pacu). Which Intervention Should The
Nurse Implement First?
CORRECT ANSWER:Determine Client's Pulse, Blood Pressure, And
Respirations
Q The Nurse Is Caring For a Group Of Clients With The Help Of a Licensed
Practical Nurse (Lpn) And An Experienced Unlicensed Assistive Personnel (Uap).
, Which Procedures Can The Nurse Delegate To The Uap? (Select All That Apply)
A.)Take Postoperative Vital Signs For a Client Who Has An Epidual Following Knee
Arthroplasty
B.)Collect a Sputum Specimen For a Client With a Fever Of Unknown Origin
C.)Ambulate a Client Who Had a Femoral-Popliteal Bypass Graft Yesterday
CORRECT ANSWER:A,B,C
A Male Client With Cirrhosis Has Ascites And Reports Feeling Short Of Breath. The
Client Is In Semi Fowler Position With His Arms At His Side. What Action Should
The Nurse Implement?
CORRECT ANSWER:Raise The Head Of The Bed To a Fowler's Position And
Support His Arms With a Pillow
A Client With a History Of Chronic Pain Requests a Nonopioid Analgesic. The Client
Is Alert But Has Difficulty Describing The Exact Nature And Location Of The Pain
To The Nurse. Which Action Should The Nurse Implement Next?
CORRECT ANSWER:Administer The Analgesic As Requested
Q The Nurse Uses The Parkland Formula (4ml x Kg x Total Body Surface Area = 24
Hours Fluid Replacement) To Calculate The 24-Hours Iv Fluid Replacement For a
Client With 40% Burns Who Weighs 76kg. How Many Ml Should The Client
Receive? (Enter Numeric Value Only.)
CORRECT ANSWER:12160
A Client With Leukemia Undergoes a Bone Marrow Biopsy. The Client's Laboratory
Values Indicate The Client Has Thrombocytopenia. Based On This Data, Which
Nursing Assessment Is Most Important Following The Procedure?
A.)Observe Aspiration Site.
B.)Assess Body Temperature
C.)Monitor Skin Elasticity
D.)Measure Urinary Output
Q An 18-Year-Old Female Client Is Seen At The Health Department For Treatment
Of Condylomata Acuminate (Perineal Warts) Caused By The Human Papillomavirus
(Hpv). Which Intervention Should The Nurse Implement?
CORRECT ANSWER:Reinforce The Importance Of Annual Papanicolaou (Pap)
Smears.
