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1. A post-operative client has three different PRN anal- Assess for side effects of
gesics prescribed for different levels of pain. The nurse the medication.
inadvertently administers a dose that is not within the
prescribed parameters. What action should the nurse
take first?
A: Determine if the pain was relieved.
B: Complete a medication error report.
C: Assess for side effects of the medication.
D: Document the client's responses.
2. The UAP describes the appearance of the bowel move- Multiple hard pellets
ments of several clients. Which descriptions warrant
additional follow-up by the nurse?(SATA) Brown liquid
A: Multiple hard pellets Solid with red streaks
B: Brown liquid
Tarry appearance
C: Formed but soft
D: Solid with red streaks
E: Tarry appearance
3. An elderly woman comes to the clinic because of vagi- The importance of using
nal bleeding. The healthcare provider finds a vaginal vaginal lubricants.
tear, which the client reports is likely to have occurred
during unprotected sexual intercourse. Which content
is most important for the nurse to include in the client's
teaching plan?
A: The importance of using vaginal lubricants.
B: Methods used to practice safe sex.
C: Information about alternative ways to express sex-
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uality.
D: Intercourse positions that help prevent tears.
4. While suctioning a client's nasopharynx, the nurse ob- Complete the intermittent
serves that the client's oxygen saturation remains at suction of the nasophar-
94%, which is the same reading obtained prior to start- ynx.
ing the procedure. What action would the nurse take
in response to this finding?
A: Reposition the pulse oximeter clip to obtain a new
reading.
B: Stop suctioning until the pulse oximeter reading is
above 95%.
C: Complete the intermittent suction of the nasophar-
ynx.
D: Apply an oxygen mask over the client's nose and
mouth.
5. An older woman with end-stage heart disease is hos- Discuss with the client her
pitalized for severe heart failure. She is alert, oriented, meaning of heroic mea-
and requests that no heroic measures are implement- sures.
ed if her breathing stops. What actions should the
nurse take first?
A: Discuss with the client her meaning of heroic mea-
sures.
B: Obtain a DNR.
C: Set up a family conference to discuss the client.
D: Consult the palliative care team about the client's
care.
6. A client diagnosed with primary open-angle glaucoma "Do not allow the dropper
received a prescription for biotic eye drops, pilocarpine bottle to touch the eye."
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HCl. What instruction should the nurse plan to include
in this client's teaching?
A: "Do not allow the dropper bottle to touch the eye."
B: "Administer the medication directly on the cornea."
C: Squeeze the eye closed after administering the
drops."
D: Wash your hands after administration of eye drops."
7. The home health nurse is reviewing the personal care Syncope when bending.
of an elderly client who lives alone. Which client as-
sessment findings indicate the need to assign the UAP Hand tremors.
to provide routine foot care and file the client's toe-
Diminished visual acuity.
nails?(SATA)
A: Syncope when bending.
B: Hand tremors.
C: Diminished visual acuity.
D: Urinary incontinence.
E: Shuffling gait.
8. The client is discharged to a long-term care facility with Encourage increase intake
an indwelling urinary catheter. Which nursing action of oral fluids.
should be included in the plan to reduce the client's
risk for infection related to the catheter?
A: Flush the catheter daily with sterile saline.
B: Encourage increase intake of oral fluids.
C: Administer a PRN antipyretic if a fever develops.
D: Secure the drainage bag at bladder level during
transport.
9.