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A nurse is caring for a family experiencing a crisis. What approach should the nurse use when working with a family using an open structure for coping with crisis? A. Refer them to individual therapy B. Convene a family meeting C. Offer written coping strategies D. Provide spiritual guidance Correct answer: B. Convene a family meeting Rationale: An open family structure encourages open communication and shared problemsolving; a family meeting promotes unity and collaborative coping. What should you do before administering any medications? A. Ask the provider for confirmation B. Check the expiration date C. Obtain a complete medication and allergy history D. Have another nurse double-check the dose Correct answer: C. Obtain a complete medication and allergy history Rationale: This ensures safety and helps prevent adverse reactions. What does diphenhydramine treat in relation to allergic reactions? A. Anaphylaxis B. Mild rashes and hives C. Bronchospasm D. Angioedema Correct answer: B. Mild rashes and hives Rationale: Diphenhydramine is an antihistamine that treats mild allergic reactions like skin rashes and hives. What should you do after hand-washing with ostomy skin care? A. Reassess vital signs B. Apply gloves and inspect the stoma C. Use iodine to cleanse the skin D. Administer pain medication Correct answer: B. Apply gloves and inspect the stoma Rationale: After hand hygiene, gloves should be used to inspect and clean the stoma safely. What are the steps to take when administering a large-volume enema? A. Place the client prone and insert the tube quickly B. Use cold water and insert tube deeply C. Left side, lubricate, insert 3–4 inches, elevate bag, assist to defecate D. Insert enema before placing gloves Correct answer: C. Left side, lubricate, insert 3–4 inches, elevate bag, assist to defecate Rationale: Standard procedure ensures safe and effective enema administration. What should the nurse do to help prevent plantar flexion? A. Use footboards only B. Provide daily massages C. Encourage or perform passive/active ROM D. Apply compression stockings Correct answer: C. Encourage or perform passive/active ROM Rationale: Range-of-motion exercises prevent contractures like plantar flexion. What should be done for a client to promote a proper sleep-wake cycle? A. Dim lights all day B. Cluster care C. Offer frequent visitors D. Keep TV on for comfort Correct answer: B. Cluster care Rationale: Clustering care minimizes sleep disruptions and supports rest. Who is a fracture pan used for? A. Clients who are ambulatory B. Clients needing bowel training C. Supine clients or clients in body/leg casts D. Postpartum clients Correct answer: C. Supine clients or clients in body/leg casts Rationale: A fracture pan is designed for immobile clients. What should the nurse do for clients using a fracture pan? A. Lay the client flat B. Elevate legs before placement C. Raise head of bed to 30°, roll client if needed D. Insert the pan without moving the client Correct answer: C. Raise head of bed to 30°, roll client if needed Rationale: This technique allows proper positioning for use of the bedpan. Signs/symptoms of extracellular fluid volume deficit: A. Fever, bradycardia, crackles B. Hypothermia, tachycardia, dizziness C. Edema, bounding pulse, weight gain D. Hypotension, cyanosis, dyspnea Correct answer: B. Hypothermia, tachycardia, dizziness Rationale: These are classic signs of fluid volume depletion. GI findings related to extracellular fluid volume deficit: A. Diarrhea and melena B. Hematemesis and bloating C. Dry mucous membranes, nausea, weight loss D. Constipation and polyphagia Correct answer: C. Dry mucous membranes, nausea, weight loss Rationale: These findings indicate decreased fluid volume in the GI system. The nurse should recognize which labs as a sign of dehydration? A. Hct 35%, sodium 130 mEq/L, urine gravity 1.010 B. Hct 55%, sodium 150 mEq/L, urine gravity 1.035 C. Hct 25%, sodium 110 mEq/L, urine gravity 1.002 D. Hct 42%, sodium 136 mEq/L, urine gravity 1.025 Correct answer: B. Hct 55%, sodium 150 mEq/L, urine gravity 1.035 Rationale: Elevated hematocrit, sodium, and specific gravity are signs of dehydration. What is a heart murmur? A. A skipped heartbeat B. Audible crackling sound C. A blowing or swishing sound heard with a bell D. Sign of heart failure only Correct answer: C. A blowing or swishing sound heard with a bell Rationale: Murmurs result from turbulent blood flow and are heard with the bell. What are risk factors for pressure ulcers? A. Only immobility and age B. Sedation, immobility, incontinence C. Exercise and fever D. Low BMI and cold weather Correct answer: B. Sedation, immobility, incontinence Rationale: These factors contribute to skin breakdown and ulcer formation. What should the nurse do if she finds a surgical wound separated with viscera protruding? A. Apply pressure B. Irrigate with saline C. Cover with saline-soaked dressing, position supine with knees bent D. Push the organs back in Correct answer: C. Cover with saline-soaked dressing, position supine with knees bent Rationale: This prevents further evisceration and reduces strain on the wound. What is the expected reference range for ALT? A. 0 to 12 units/L B. 4 to 36 units/L C. 36 to 90 units/L D. 10 to 75 units/L Correct answer: B. 4 to 36 units/L Rationale: Elevated ALT indicates liver damage such as hepatitis or cirrhosis. What are indications for ALT? A. Kidney failure symptoms B. Suspected liver, pancreatic, or biliary disorder C. Bone fractures D. Autoimmune disease Correct answer: B. Suspected liver, pancreatic, or biliary disorder Rationale: ALT is a liver enzyme; elevated levels suggest hepatobiliary issues. When do you use surgical asepsis for suctioning? A. Only for oral suctioning B. For all types of suctioning C. For nasotracheal suctioning D. For rectal tube insertion Correct answer: C. For nasotracheal suctioning Rationale: Surgical asepsis prevents infection in sterile body areas like the trachea. How long should the nurse suction for? A. 30 seconds continuously B. Up to 20 seconds C. No longer than 10 to 15 seconds D. Until client coughs Correct answer: C. No longer than 10 to 15 seconds Rationale: Prolonged suctioning can cause hypoxia and vagal stimulation. What position will promote draining of both lobes of the lungs in general? A. Supine B. High Fowler’s C. Prone D. Trendelenburg Correct answer: B. High Fowler’s Rationale: Upright positioning enhances lung expansion and drainage. What position will promote draining of apical segments of both lobes? A. Trendelenburg B. Supine with pillow C. Sitting on the side of the bed D. Prone with legs raised Correct answer: C. Sitting on the side of the bed Rationale: Upright sitting promotes apical drainage. What position will promote draining of both lower lobes of the lungs, anterior segments? A. High Fowler’s B. Supine in Trendelenburg C. Sims’ position D. Sitting up Correct answer: B. Supine in Trendelenburg Rationale: This facilitates gravitational drainage of lower anterior lung lobes. What position will promote draining of both lower lobes, posterior segments? A. Prone in Trendelenburg B. Supine with knees raised C. Sitting upright D. Lateral with head down Correct answer: A. Prone in Trendelenburg Rationale: Prone and downward head position aid in posterior drainage. What should the nurse do when caring for a client who has a C. Diff infection? A. Use standard precautions only B. Encourage use of hand sanitizer C. Implement contact precautions, private room, and hand washing D. Assign a shared bathroom Correct answer: C. Implement contact precautions, private room, and hand washing Rationale: C. diff is highly contagious and requires strict infection control. A nurse is teaching an assistive personnel about upper body mechanics to prevent injury. Which action shows understanding? A. Lifting with back muscles B. Bending at the waist C. Keeping object close to body D. Twisting the torso Correct answer: C. Keeping object close to body Rationale: This minimizes strain and supports safer lifting. A nurse notices a red area over a client’s coccyx. What should the nurse do? A. Massage the area B. Cover with dressing C. Assess the red area for blanching D. Apply ice Correct answer: C. Assess the red area for blanching Rationale: Blanching assessment helps determine stage and severity of pressure injury. A nurse is preparing to insert an IV after a right mastectomy. Which vein should be used? A. Right antecubital B. Cephalic vein in left distal forearm C. Femoral vein D. Subclavian vein Correct answer: B. Cephalic vein in left distal forearm Rationale: Avoid using the affected side; choose the contralateral extremity. A nurse is providing teaching about colorectal cancer prevention. What recommendation is correct? A. Increase intake of red meat B. Avoid all dairy C. Reduce intake of red meats D. Skip routine screenings Correct answer: C. Reduce intake of red meats Rationale: Reducing red meat intake lowers the risk of colorectal cancer. A nurse is planning care to prevent skin breakdown in a client who is immobile and incontinent. What should the nurse include? A. Limit fluid intake B. Apply barrier cream only C. Request indwelling urinary catheter D. Avoid repositioning to minimize movement Correct answer: C. Request indwelling urinary catheter Rationale: Managing incontinence reduces moisture and risk of skin breakdown.