AND ANSWERS 100% CORRECT!!
,A nurse is assessing a client who has an abdominal aortic aneurysm. Which of the
following manifestations should the nurse expect?
A) Midsternal chest pain
B) Thrill
C) Pitting edema in lower extremities
D) Lower back discomfort - ANSWER D) Lower back discomfort
A nurse is preparing a plan of care for a client who is postoperative following a modified
radical mastectomy. Which of the following invoice decides should the nurse expect the
client to have?
A) Chest tube
B) Indwelling urinary catheter
C) Nasogastric tube
D) Jackson-Pratt drain - ANSWER D) Jackson-Pratt drain
A nurse is planning care for a client who has anorexia and nausea due to cancer
treatment. Which of the following interventions should the nurse include.
A) Serve foods at warm or hot temperatures
B) Offer the client low-density foods
C) Make sure the client lies supine after meals
D) Limit drinking liquids with food - ANSWER D) Limit drinking liquids with food
A newly licensed nurse is preparing to administer medications to a client. The nurse
notes that the provider has prescribed a medication that is unfamiliar to him. Which of
the following actions should the nurse take?
A) Consult the medication reference book available on the unit
B) Ask a more experienced nurse for information about the medication
C) Call the clients provider and verify the prescription
D) Ask the client if she takes this medication at home - ANSWER A) Consult the
medication reference book available on the unit
A nurse in a providers office is assessing a client who has heart failure. The client has
gained weight since her last, and her an,les are edematous. Which of the following
findings is another clinical manifestation of fluid volume excess
A) Sunken eyeball
B) Hypotension
C) Poor skin turgor
D) Bounding pulse - ANSWER D) Bounding pulse
A nurse is caring for a client who has acute renal failure. Which of the following
assessments provides the most accurate measure of the clients fluid status?
, A) Daily weight
B) Blood pressure
C) specific gravity
D) Intake and output - ANSWER A) Daily weight
A nurse is caring for a client who is unstable and has vital sign measured every 15
minutes by an electronic blood pressure machine. The nurse notices the machine
begins to measure the blood pressure at varied intervals, and the readings are
inconsistent. Which of the following actions should the nurse take?
A) Turn on the machine every 15 min to measure the clients blood pressure
B) Record only the blood pressure reading needed for 15 min intervals
C) Obtain manual and automatic readings and compare them
D) Disconnect the machine and measure the blood pressure manually every 15 min -
ANSWER D) Disconnect the machine and measure the blood pressure manually every
15 min
A nurse is caring for a client who has a temperature of 38.7 C (101.7 F). Which of the
following actions should the nurse take?
A) Apply an alcohol-water solution to the clients skin
B) Keel the clients bed linens dry
C) Apply ice packs to the groin
D) Limit the clients fluid intake to 1183 mL (40 oz) of fluid per day - ANSWER B) Keep
the clients bed linens dry
A nurse is supervising a newly licensed nurse who is administering a controlled
substance. Which of the following actions by the newly licensed nurse indicates an
understanding of the procedure?
A) Placing an unused portion of the medication in a sharps box
B) Asking another nurse to observe the disposal of an unused portion of the medication
C) Counting the inventory of the available narcotic after administering the medication
D) Ensuring that another nurse signs the control inventory form after disposal of an
unused portion of medication - ANSWER B) Asking another nurse to observe the
disposal of an unused portion of the medication
A nurse is teaching a client with lower extremity weakness how to use a 4-point crutch
gait. Which of the following instructions should the nurse included in the teaching?
A) "Support the majority of your weight on the axillae"
B) "Keep your elbows extended"
C) "Bear weight on both of your legs"
D) "Move both crutches forward at the same time" - ANSWER C) "Bear weight on both
of your legs"