ASSESSMENT/7 QUESTIONS
AND CORRECT VERIFIED
ANSWERS (GUARANTEED PASS)
NEW!!
A nurse is preparing to mix short-acting and intermediate-acting insulin
in one syringe to administer to a client who has type 1 diabetes
mellitus.
Identify the sequence the nurse should follow. - Correct Answer -1:
Draw up the volume of insulin from the intermediate-acting insulin vial.
2: Inject the volume of air equal to the amount of insulin to withdraw
from the intermediate-acting insulin vial.
3: Inject the volume of air equal to the insulin dose form the short-acting
insulin vial
4: Withdraw the prescribed amount of insulin form the short-acting
insulin vial.
5: Withdraw the prescribed amount of insulin form the intermediate-
acting insulin vial.
A nurse is assessing a client who wears partial dentures and reports
mouth pain. Which of the following actions should the nurse take? -
Correct Answer
-Advise the client to rinse their mouth and dentures after each meal.
A nurse is planning care for a client who has dysphagia and is at risk
for aspiration. Which of the following referrals should the nurse make? -
Correct Answer -Speech-language pathologist
thoracentesis post procedure? - Correct Answer -Position the client on the
unaffected side.The nurse should position the client on the unaffected side
to help facilitate expansion of the affected lung.
Maintain the head of the bed at 45°.MY ANSWERSome facility
protocols recommend that the nurse should raise the head of the bed to
30° for at least 30 min to facilitate expansion of the affected lung and
ease of breathing.
Measure the client's abdominal girth at the level of the umbilicus.The
nurse should measure the client's abdominal girth following an
,abdominal paracentesis, rather than a thoracentesis.
Leave the puncture site open to air.The nurse should apply a small,
sterile dressing over the puncture site.
A nurse is preparing to notify the provider about a change in a client's
status. Which of the following information should the nurse plan to
include in the "background" portion of the SBAR communication tool?
- Correct Answer
-Previous treatments
A nurse is providing discharge teaching to a client who has a new
prescription for home oxygen therapy utilizing a compressed oxygen
system. Which of the following statements by the client indicates an
understanding of the teaching? - Correct Answer -"I will store oxygen
tanks in an upright position"
A nurse is caring for a client who has terminal cancer. The client begins
to cry and says, "I am afraid of dying." Which of the following responses
should the nurse make? - Correct Answer -"It must me a very difficult
time for you."
A nurse is assessing a client's coping skills. Which of the following
should the nurse identify as an internal stressor? - Correct Answer -Fear of
medical test results
A nurse is performing postmortem care for an older client who had just
died. Which of the following actions should the nurse take? - Correct
Answer
-Identify the client using two identifiers
A nurse has administered 5 mL of medication to a client via NG tube.
Then used 30 mL of water to flush the tue both before and after the
instillation. the nurse should document which of the following amounts
as liquid intake for the client? - Correct Answer -65 mL
A nurse is performing a family assessment for a client who has recently
developed paraplegia following a stroke. Which of the following actions
should the nurse take first? - Correct Answer -Determine how the client
views the concept of family
A nurse is caring for a client who reports having insomnia due to
increased stress. Which of the following actions should the nurse take
first? - Correct Answer -Determine the source of the client's stress
, A nurse is caring for a client who had a stroke and is immobile. Which of
the following actions should the nurse take to maintain the client's skin
integrity?
- Correct Answer -Use an alcohol-free barrier product
A nurse receives a telephone prescription form the provider, who states,
"four milligrams of morphine diluted with 5 milliliters of sterile water
intravenous each morning at nine o'clock before client dressing
changes." Which of the following entries by the nurse indicates correct
transcription of the prescription? - Correct Answer -Morphine 4 mg IV
bolus daily at 0900 before dressing change, dilute medication with 5 mL
of sterile water
how to assess for clonus? - Correct Answer -Use a reflex hammer.MY
ANSWER
The nurse should use a reflex hammer to assess the client for clonus. The
reflex hammer causes the muscle to immediately contract due to a two-
neuron reflex arc involving the spinal or brainstem segment that
innervates the muscle.
Administer magnesium sulfate.Administering magnesium sulfate is not a
test for clonus. Magnesium sulfate is administered for convulsions,
hypomagnesemia, and hypertension.
Perform a Romberg test.A Romberg test assesses balance, gross-motor
function, and equilibrium.
Test the gait for symmetry.Testing the client's gait gives the nurse
information about symmetry, walking ability, posture, and balance.
A nurse in a long-term care facility is planning to use therapeutic tough for
a group of selected clients who have chronic pain. The nurse should
identify that the use of therapeutic touch is contraindicated for which of the
following patients? - Correct Answer -A client who has chronic back
pain and a history of physical maltreatment
A nurse is preparing to delegate task for multiple clients at the beginning
of the shift. Which of the following tasks should the nurse delegate to an
assistive personnel (AP)? - Correct Answer -Assist a client with
ambulation
A home health nurse is making an initial assessment visit to an older
client who has type 1 diabetes mellitus. Which of the following
statements should the nurse make to evaluate the clients ability ot
measure blood glucose accurately? - Correct Answer -"Please use your