A nurse is caring for a client who has global aphasia following a cerebrovascular accident
(CVA). Which of the following actions should the nurse incorporate into the client's care?
A. Provide the client with two-step tasks
B. Request a consult with the speech-language pathologist.
C. Ask questions the client can answer with a simple "yes" or "no."
D. Use a raised voice when speaking to the client. - ANSWER B. Request a consult with
the speech-language pathologist.
The speech-language pathologist can recommend specific communication strategies for a
client who has global aphasia. By identifying this need, the nurse is advocating for the client.
A client who is newly diagnosed with cancer has been prescribed oral chemotherapy. The
client tells the nurse, "I'm not sure if I want to take this medicine." Which of the following
responses should the nurse make?
A. "I think you should seriously consider the consequences of not going through with
treatment."
B. "You do not have to take any medications that you don't want to."
C. "Tell me more about what is making you feel unsure about taking this medication."
D. "Are you nervous about the side effects of chemotherapy?" - ANSWER C. "Tell me
more about what is making you feel unsure about taking this medication."
1
,This is an open-ended statement that allows the client to express their concerns about the
treatment plan.
A nurse is caring for a client who has multiple sclerosis and is unable to maintain a grip on
eating utensils. Which of the following referrals should the nurse make?
A. Speech-language pathologist
B. Physical therapist
C. Registered dietitian
D. Occupational therapist - ANSWER D. Occupational therapist
Occupational therapists assist with developing a client's fine motor skills used for activities
of daily living, such as eating, grooming, and hygiene.
A nurse is reviewing the medical record of a client who has a prescription for liraglutide.
Which of the following findings should the nurse identify as a contraindication to this
medication?
A. History of thyroid cancer
B. Concurrent use of metformin
C. Blood glucose 200 mg/dL
D. Albumin 3.8 g/dL - ANSWER A. History of thyroid cancer
The nurse should identify a personal or family history of thyroid cancer as a contraindication
to taking liraglutide and notify the provider. Other contraindications to receiving this
medication can include type 1 diabetes mellitus, diabetic ketoacidosis, and a history of
suicidal thoughts or attempts.
2
, A nurse is monitoring a client who has a prescription for ciprofloxacin 400 mg IV every 12 hr.
Which of the following manifestations should the nurse identify as an adverse effect of this
medication?
A. Constipation
B. Anorexia
C. Fever
D. Myalgia - ANSWER D. Myalgia
The nurse should identify that myalgia is an adverse effect of ciprofloxacin and can be an
indication that the client might be experiencing tendonitis, which could lead to tendon
rupture. Other adverse effects can include dizziness, agitation, and confusion.
A nurse is preparing to administer a unit of fresh frozen plasma (FFP) to a client. Which of
the following actions should the nurse plan to take prior to the transfusion?
A. Initiate an IV infusion of dextrose 5% in water.
B. Ensure the FFP is compatible with the client's Rh status.
C. Confirm the plasma compatibility with another nurse.
D. Review liver function tests. - ANSWER C. Confirm the plasma compatibility with
another nurse.
The nurse should confirm the plasma ABO compatibility with another nurse by verifying the
client's identity and comparing the bag of FFP to the medical record to prevent an adverse
reaction. The nurse should also check the expiration time on the FFP.
A nurse is preparing to administer an IV bolus medication for a client who has an implanted
port. Which of the following actions should the nurse take?
A. Check the blood return
3
(CVA). Which of the following actions should the nurse incorporate into the client's care?
A. Provide the client with two-step tasks
B. Request a consult with the speech-language pathologist.
C. Ask questions the client can answer with a simple "yes" or "no."
D. Use a raised voice when speaking to the client. - ANSWER B. Request a consult with
the speech-language pathologist.
The speech-language pathologist can recommend specific communication strategies for a
client who has global aphasia. By identifying this need, the nurse is advocating for the client.
A client who is newly diagnosed with cancer has been prescribed oral chemotherapy. The
client tells the nurse, "I'm not sure if I want to take this medicine." Which of the following
responses should the nurse make?
A. "I think you should seriously consider the consequences of not going through with
treatment."
B. "You do not have to take any medications that you don't want to."
C. "Tell me more about what is making you feel unsure about taking this medication."
D. "Are you nervous about the side effects of chemotherapy?" - ANSWER C. "Tell me
more about what is making you feel unsure about taking this medication."
1
,This is an open-ended statement that allows the client to express their concerns about the
treatment plan.
A nurse is caring for a client who has multiple sclerosis and is unable to maintain a grip on
eating utensils. Which of the following referrals should the nurse make?
A. Speech-language pathologist
B. Physical therapist
C. Registered dietitian
D. Occupational therapist - ANSWER D. Occupational therapist
Occupational therapists assist with developing a client's fine motor skills used for activities
of daily living, such as eating, grooming, and hygiene.
A nurse is reviewing the medical record of a client who has a prescription for liraglutide.
Which of the following findings should the nurse identify as a contraindication to this
medication?
A. History of thyroid cancer
B. Concurrent use of metformin
C. Blood glucose 200 mg/dL
D. Albumin 3.8 g/dL - ANSWER A. History of thyroid cancer
The nurse should identify a personal or family history of thyroid cancer as a contraindication
to taking liraglutide and notify the provider. Other contraindications to receiving this
medication can include type 1 diabetes mellitus, diabetic ketoacidosis, and a history of
suicidal thoughts or attempts.
2
, A nurse is monitoring a client who has a prescription for ciprofloxacin 400 mg IV every 12 hr.
Which of the following manifestations should the nurse identify as an adverse effect of this
medication?
A. Constipation
B. Anorexia
C. Fever
D. Myalgia - ANSWER D. Myalgia
The nurse should identify that myalgia is an adverse effect of ciprofloxacin and can be an
indication that the client might be experiencing tendonitis, which could lead to tendon
rupture. Other adverse effects can include dizziness, agitation, and confusion.
A nurse is preparing to administer a unit of fresh frozen plasma (FFP) to a client. Which of
the following actions should the nurse plan to take prior to the transfusion?
A. Initiate an IV infusion of dextrose 5% in water.
B. Ensure the FFP is compatible with the client's Rh status.
C. Confirm the plasma compatibility with another nurse.
D. Review liver function tests. - ANSWER C. Confirm the plasma compatibility with
another nurse.
The nurse should confirm the plasma ABO compatibility with another nurse by verifying the
client's identity and comparing the bag of FFP to the medical record to prevent an adverse
reaction. The nurse should also check the expiration time on the FFP.
A nurse is preparing to administer an IV bolus medication for a client who has an implanted
port. Which of the following actions should the nurse take?
A. Check the blood return
3
