• A nurse is assessing a client who has received an antibiotic. The nurse should id
findings as an indication of a possible allergic reaction to the medication? A. Brady
B. Headache
C. Joint pain
D. Hypotension
• A nurse on a mental health unit is caring for a client who has schizophrenia a
hallucinations telling them to hurt others. The client is refusing to take anti-psycho
following responses should the nurse make?
A. “You should plan to take this medication for a few weeks.”
B. “You will regret it if you do not take this medication.”
C. “This medication will help you respond to the voices.
D. “This medication will help you stop the voices you are hearing.”
• A nurse is providing care for a patient who has depression and is to have electroc
the following conditions should the nurse identify as increasing the client’s risk for
A. Hyperthyroidism
B. Renal calculi
C. Diabetes mellitus
D. Cardiac dysrhythmias
,• A nurse is caring for a client who has a tension pneumothorax. Which of the followi
nurse expect?
A. Paradoxical chest movement
B. Bilateral crackles
C. Asymmetry of the chest
D. Blood-tinged sputum
• A nurse is caring for a client who is at 11 weeks of gestation. Which of the follow
nurse recommend?
A. Human papillomavirus
B. Influenza
C. Measles, mumps and rubella
D. Varicella
• A nurse in a pediatric clinic is reviewing the laboratory test results of a school-age
findings should the nurse report to the provider?
A. Hct 40%
B. Hgb 12.5 g/dL
C. Platelets 250,000/mm
D. WBC 14,000/mm
, A. Hyperglycemia
B. Uterine contractions
C. Proteinuria
D. Hypotension
• A nurse is preparing to obtain a blood sample from a client who has a central ve
following actions should the nurse take? (SATA)
A. Apply a tourniquet above the catheter insertion site.
B. Access the catheter using a large bore needle.
C. Aspirate for blood return to access catheter patency.
D. Flush the catheter with 0.9% sodium chloride.
E. Apply force when resistance is met while flushing the catheter.
• A nurse is preparing to perform a dressing change on a preschooler. Which of the
nurse take to prepare the child for the procedure?
A. Explain in simple terms how the procedure will affect the child.
B. Ask the parents to wait outside the room during the procedure.
C. Limit teaching sessions about the procedure to 20 min.
D. Instruct the child in deep-breathing methods prior to the procedure.
• A nurse is performing wound care for a client who has an abdominal incision. Whic
should the nurse implement?
A. Irrigate the wound using a 10-mL syringe.
, B. A client who has preeclampsia and reports a persistent headache.
C. A client who has pregestational diabetes mellitus and an HbA1c of 6.2%.
D. A client who is at 28 weeks of gestation and reports leukorrhea.
• A nurse is caring for a client who is recovering from an amputation of her right arm
Which of the following information should the nurse report the occupational therap
A. The client’s parent is in a skilled nursing facility.
B. The client has two small children at home.
C. The client is allergic to penicillin.
D. The client lives in a two-story home.
• A nurse is caring for a client who has major depressive disorder. The client tells the
me. I’m completely alone.” Which of the following responses should the nurse make
A. “You should join a community support group.”
B. “What makes you think that?”
C. “Don’t worry. You should be feeling better in a couple weeks.”
D. “Can you give me an example of how others are making you feel this way?”
• A nurse is caring for a client who has sustained a severe head trauma and has signif
Which of the following actions should the nurse take first?
A. Prepare for a CT scan.