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A nurse is planning to administer an ophthalmic medication to
a client. Which of
the following actions will minimize systemic absorption of
the medication? -
ANSWER-Wait 5 min after instillation before instilling the drops
in the other eye.
A nurse is caring for a client who has a methicillin-resistant
Staphylococcus aureus (MRSA) infection. Which of the
following actions should the nurse plan to take? - ANSWER-
Don a gown and gloves when providing perineal care.
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 a contraindication to the
use of oral contraceptives? - ANSWER-History of renal calculi
A nurse is reinforcing teaching with a client who has a new
prescription for lithium carbonate. Which of the following client
statements indicates an understanding of the teaching? -
ANSWER-"I will notify my provider if I develop a tremor."
,A nurse is caring for a client who is undergoing evaluation for a
thoracic aortic aneurysm. Which of the following findings
should make the nurse suspect an impending rupture of the
aneurysm? - ANSWER-Cough with hemoptysis
A nurse collecting data from a client who is receiving a
continuous IV infusion of 0.9% sodium chloride. The nurse
discovers the IV infusion pump was set incorrectly and the
client received 200 mL more than prescribed. Data collection
reveals that the client is stable. The nurse recognizes that this
incident is not considered malpractice for which of the
following reasons? - ANSWER-The client was not harmed as a
result of the incident.
A nurse is escorting a client to his car following discharge from
an acute mental health facility. The client states intentions to
harm a friend when he leaves the facility. Which of the following
actions should the nurse take? – ANSWER-Prevent the client
from leaving the facility.
A nurse is caring for a client who is 5 days postoperative
following abdominal surgery. The client tells the nurse that he
was coughing and "felt a pop" at the incision site. The nurse
examines the incision and finds wound dehiscence and
evisceration. Which of the following actions should the nurse
take? – ANSWER-Place the client in a side-lying position.
A nurse is planning to reinforce teaching with a preschooler
who is about to undergo an incision and drainage for cellulitis
,on the left arm. Which of the following techniques should the
nurse use? - ANSWER-Take the child on a tour of the surgery
and recovery areas.
A nurse receives a verbal order for a client to receive a stat dose
of meperidine
100 mg PO. She administers the medication, charts the
administration, and
then realizes she has administered phenytoin 100 mg PO.
Which of the
following actions should the nurse take first? - ANSWER-Check
the client's vital
signs.
A nurse is caring for a postoperative client and obtains a pulse
oximeter reading
of 89%. Which of the following interventions should the
nurse take first? -
ANSWER-Repeat the test on
another finger.
A nurse is preparing to administer 5 units of regular insulin and
20 units of NPH insulin to a client who has type 1 diabetes
mellitus. Which of the following actions should the nurse take
first? - ANSWER-withdraw 5 units of regular insulin from the
vial.
A nurse is caring for a client who has urolithiasis. Which of the
following actions
, should the nurse take? - ANSWER-Strain the
client's urine.
A nurse is observing the mother of a 12-hr-old newborn. Which
of the following
actions by the mother requires intervention by the nurse? -
ANSWER-The
mother places the newborn in prone
position.
A nurse in a mental health facility is reviewing the laboratory
reports for four
clients. Which of the following results should the nurse
report to the provider
immediately? - ANSWER-Sodium level of 130 mEg/L for a
client who has
bipolar disorder and takes
lithium
After receiving change-of-shift report, which of the following
clients should the
nurse collect data from first? - ANSWER-A client who has
heart failure and
reports severe
dyspnea
A nurse is assisting with the admission of a client who has
Hodgkin's disease and is receiving chemotherapy. Because a
private room is not available, the nurse should recommend that