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A nurse is preparing to perform a dressing change on a
preschooler. Which of the following actions should the nurse
take to prepare the child for the procedure?
A. Explain in simple terms how the procedure will affect the child.
B. Ask the parents to wait outside the room during the procedure.
C. Limit teaching sessions about the procedure to 20 min.
D. Instruct the child in deep-breathing methods prior to the procedure.
A nurse is performing wound care for a client who has an abdominal
incision. Which of the followingtechniques should the nurse implement?
A. Irrigate the wound using a 10-mL syringe.
B. Cleanse the wound starting at the bottom and moving upward.
C. Cleanse the insertion site of the drain using a circular
motion towards the center.D. Irrigate the wound with a low-
pressure flow of solution.
A nurse on an antepartum unit is prioritizing care for multiple clients.
Which of the following clientsshould the nurse see first?
A. A client who is at 36 weeks of gestation and has a
biophysical profile score of 8.B. A client who has
preeclampsia and reports a persistent headache.
, C. A client who has pregestational diabetes mellitus and an HbA1c of 6.2%.
D. A client who is at 28 weeks of gestation and reports leukorrhea.
A nurse is caring for a client who is recovering from an amputation of her
right arm above the elbow.Which of the following information should the
nurse report the occupational therapist?
A. The client’s parent is in a skilled
nursing facility.B. The client has two
small children at home.
C. The client is allergic to penicillin.
D. The client lives in a two-story home.
A nurse is caring for a client who has major depressive disorder. The
client tells the nurse, “No onecares about me. I’m completely alone.”
Which of the following responses should the nurse make?
A. “You should join a community support group.”
B. “What makes you think that?”
C. “Don’t worry. You should be feeling better in a couple weeks.”
D. “Can you give me an example of how others are making you feel this
way?”
A nurse is caring for a client who has sustained a severe head trauma
and has significant bleedingfrom the nose. Which of the following
actions should the nurse take first?
A. Prepare for a CT scan.
B. Insert a peripheral
IV line.C. Establish a
patent airway.
D. Apply direct pressure to the nose.
A nurse is reviewing the rhythm strip of a client who is experiencing sinus
arrhythmia. Which of thefollowing findings should the nurse expect?
A. Inconsistent P wave formation.
B. Ventricular and atrial rates 120/min
C. P-R intervals of 0.30 seconds
D. P to QRS ratio 1:1 page 720 Med surg book
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