COMPLETE SOLUTIONS123
A nurse is taking a health history from parents of a child admitted with possible Reye's
syndrome. Which recent illness should the nurse recognize as being associated with an
increased the risk for the development of Reye's syndrome?
1. Varicella
2. Meningitis
3. Hepatitis
4. Rubeola - ANSWERS-1. Varicella -
A Native American chief visits his newborn son and performs a traditional ceremony that
involves feathers and chanting. The nurse comments to a colleague: "I wonder if he has any idea
how ridiculous he looks - he's a grown man!" The nurse's comment is an example of what type
of attitude?
1. Prejudice
2. Ethnocentrism
3. Discrimination
4. Stereotyping - ANSWERS-1. Prejudice-
A nursing student asks the licensed practical nurse (LPN) to explain the forces that drive health
care reform. When responding to the student's question, what information should the nurse
emphasize?
1. Increased competition between health care insurers
2. Increase in health care spending that's growing faster than the economy
3. Increase in the population who have health insurance
4. Increase in spending for end-of-life treatment - ANSWERS-2
,A child is admitted to the unit with the suspected diagnosis of pertussis (whooping cough).
What is the priority nursing intervention for this child?
1. Maintain hydration and encourage fluids
2. Implement droplet precautions
3. Monitor respiratory rate and oxygen saturation
4. Anti- infective therapy - ANSWERS-2
A client has an indwelling catheter with continuous bladder irrigation after undergoing a
transurethral resection of the prostate (TURP) 12 hours ago. Which finding at this time should
be reported to the registered nurse (RN) charge nurse?
1Complaints for the feeling of pulling on the urinary catheter
2Light, pink to clear urine
3Occasional suprapubic cramping
4Minimal drainage into the urinary collection bag - ANSWERS-4Minimal drainage into the
urinary collection bag
A nurse is caring for a woman two hours after a vaginal delivery. Documentation indicates that
the membranes ruptured 36 hours prior to delivery. Which of these nursing diagnoses should
the nurse expect the charge nurse to list as a priority at this time?
1Risk for fluid volume deficit
2Risk for excessive bleeding
3Risk for infection -
4Altered tissue perfusion - ANSWERS-3
A 14 month-old child ingests a half a bottle of baby aspirin (81 mg) tablets. Which finding should
a nurse expect to see in the child?
1Hypothermia
,2Nausea and vomiting
3Hypoventilation
4Bradycardia - ANSWERS-2
A school nurse monitors a child with a history of tonic-clonic seizures. The school nurse should
inform teachers that if the child falls to the floor and experiences a seizure while in the
classroom, which of the following would be the most important action to take during the
seizure?
1Place the hands or a folded blanket under the head of the child
2Provide privacy as much as possible to minimize frightening the other children
3Move any chairs or desks at least three feet away from the child
4Note the sequence of movements with the time lapse of the event - ANSWERS-1Place the
hands or a folded blanket under the head of the child -
A client is admitted with diagnosis of a right upper lobe infiltrate and to rule out active
tuberculosis (TB). Which type of precautions will be needed for this client?
1Droplet
2Contact
3Standard
4Airborne - ANSWERS-4
A LPN complains to the charge nurse that an unlicensed assistive person (UAP) consistently
leaves the work area untidy and does not restock supplies. What is the best initial response by
the charge nurse?
1Write down potential solutions to the problems today by shift's end
2Add this concern to the agenda of the next unit meeting
3Assure the staff nurse that the complaint will be investigated
4Explore for further identification about the nature of the problem - ANSWERS-4 Explore for
further identification about the nature of the problem
, The nurse assists with the reinforcement of information about breast self-examination to a
group of college students. A female student asks when to perform the monthly exam. The
appropriate reply by the nurse should include which statement?
1"Ovulation, or midcycle is the best time to detect changes."
2"Do the exam at the same time every month."
3"Right after the period, when your breasts are less tender."
4"The first of every month, because it will be easiest to remember." - ANSWERS-3
The nurse is caring for a 75 year-old client with type 2 diabetes mellitus. The client should be
instructed to contact the outpatient clinic immediately if which findings are present?
1An open wound on the heel with minimal discomfort
2Occasional hiccups and sneezing
3Sustained insomnia and daytime fatigue
4Persistent dryness and itching of the perineal area - ANSWERS-1An open wound on the heel
with minimal discomfort-
A pregnant woman has been advised to alter her diet during pregnancy by increasing the intake
of protein and vitamin C to meet the needs of the growing fetus. Which diet choice would best
meet the woman's needs?
1. 1 cup of macaroni, three-fourths cup of peas, glass whole milk, medium pear
2. Scrambled egg, hash browned potatoes, one-half glass of buttermilk, large nectarine
3. 3 oz. chicken, one-half cup of corn, lettuce salad, small banana
4. Beef, one-half cup of lima beans, glass of skim milk, three-fourths cup of strawberries -
ANSWERS-4. Beef, one-half cup of lima beans, glass of skim milk, three-fourths cup of
strawberries -
A client has had a positive reaction to purified protein derivative (PPD). Which statement made
by the client suggests the client understands the teaching by the registered nurse (RN)?