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A nurse is caring caring for a client who has a recently admitted to an inpatient mental health
unit. the client tells the nurse he is not coming out of his room anymore because other client on
the unit makes fun of him. which of the following response by the nurse is appropriate? -
(answers)B) " you feel upset by the response of other."
A nursing admitting a client who has active tuberculosis. which of the following intervention is
appropriate? - (answers)A. Place the client in a room that is ventilated outside.
A nurse is reinforcing teaching with the parent of a toddler who has difficulty falling asleep.
which of the following instruction should the nurse include? - (answers)A. establish a bedtime
routine.
A nurse is collecting data from an 18 month- old toddler at a well-child visit. which of the
following finding should the nurse report to the provider? - (answers)C. Toddler can say four
words.
A nurse is planning to administer morphine IM to a client using Z track method. Identify the
order of steps the nurse should take to administer the medication using this method. place the
steps in order. - (answers)A. Insert the needle at a 90-degree angle.
B. Use the ulna side of the nondominant hand to pull the skin.
C. Inject the medication approximately 2.5cm (1in) into the skin.
D. Clean the skin
E.Aspirate for blood return
A nurse discovers a fire in a trash can in a patient's room. which of the following action should
the nurse take first? - (answers)A. Extinguish the fire.
B. Shut the door to the client room.
C. Pull the fire alarm.
D. Walk the client to the waiting room.
,A nurse is teaching a client who is about to undergo an upper gastrointestinal series with
fluoroscopy. which of the following information should the nurse provide? - (answers)D. " you
will have to drink a contrast medium before the test."
A nurse is reinforcing teaching with a client who has a new diagnosis of myasthenia gravis (MG)
and a prescription for neostigmine. which of the following information should the nurse include
in the about action of the medication? - (answers)A. Improve muscle strength.
A nurse is caring for a school-age child whose family adheres to vegan diet in the home. the
nurse should recognize the child is at risk for deficiency of which of the following? - (answers)C.
Vitamin D
A nurse is assisting with the admission of a client who attempted suicide. when the nurse
processes the client's belongings, which of the following items should the nurse remove from the
client's suitcase? - (answers)D. Perfume
A nurse is collecting data from a client who is one day postoperative following a total hip
arthroplasty and has deep- vein thrombosis. which of the following findings should the nurse
expect in the affected extremity? - (answers)D. Dull, aching pain.
A nurse is a prenatal clinic is reinforcing teaching with a client about a nonstress test . which of
the following statements should the nurse include? - (answers)D. " you will be asked to press a
button when you feel the baby move."
A nurse is planning to administer an ophthalmic medication to a client. which of the following
actions will minimize systemic absorption of the medication? - (answers)A. apply light pressure
to the inner canthus just after instilling the eye drops.
A nurse is caring for a client who has a new colostomy. he voices a reluctance about resuming
sexual relations.which of the following is an appropriate response by the nurse? - (answers)D.
"I'm available if you'd like to talk about your concerns."
A nurse is caring for a client who is receiving warfarin 5mg po daily. Which of the following
laboratory values should the nurse check prior to administering the medication? - (answers)A.PT
B. Serum potassium
C. INR
D. serum sodium
E. BUN
A.PT
C.INR
E.BUN
, A nurse is contributing to the plan of care for a school-age child who has sickle-cell disease and
is experiencing a vaso-occlusive crisis. which of the following should the nurse recommend
including in the plan of care? - (answers)C. perform passive range of motion exercises
A nurse is discussing including report with a group of newly licensed nurses. The nurse should
include that which of the following situations requires completion of an incident report? -
(answers)C. A nurse collects data from a client who reports severe pain and finds a dose of
hydro-morphine in the client's bed.
A nurse in a long-term care facility has received change of shift report about four clients. which
of the following clients should the nurse attend to first? - (answers)B. A client who has COPD
and dementia and was agitated during the night shift.
A nurse is reinforcing teaching with a client who is about to undergo a thoracentesis. which of
the following statements by the client indicates an understanding of the information? -
(answers)C. " I will have a chest X-ray following procedure."
A nurse is reviewing the medical record of a client who is requesting an oral contraceptive.
which of the following findings should the nurse identify as contraindication to the use of oral
contraceptive? - (answers)B. Migraine with aura
A nurse is reinforcing teaching about transmission precautions with a client who has hepatitis C.
which of the following information should the nurse include? - (answers)B. Clean toilet surface
with bleach after each use.
A nurse is preparing to administer an IM injection to a client. to reduce the risk of a needlestick
injury, the nurse should take which of the following actions? - (answers)C. Dispose of the used
needle immediately in a puncture-proof sharps container.
A nurse is reinforcing teaching about colostomy care with a client. Which of the following client
statements indicates an understanding of how to care for the colostomy? - (answers)C. " I will
cut the wafer 1 inch bigger than my stoma."
A nurse is teaching a client who has a permanent pacemaker in place. Which of the following
statement by the client indicates an understanding of the teaching? - (answers)B. " I need to
record my pulse rate daily."
A nurse is collecting data from a parent of a preschooler at a well-child visit. Which of the
following findings is a contraindication to a measles, mumps, and rubella (MMR) immunization?
- (answers)C. Long-term use of immunosuppresants.