Exam Questions and Answers
A nurse at a long-term care facility is caring for a client who requires oral suctioning. Which
of the following supplies should the nurse plan to use for this task? correct answers yankeurs
catheter
rationale: A Yankauer catheter is a clean suction catheter used when performing oral and
oropharyngeal suctioning to remove secretions from the client's mouth to facilitate breathing
or obtain a sample for diagnostic evaluation.
A nurse in a long-term care facility is serving on the ethics committee, which is addressing a
client care dilemma. Which of the following strategies will facilitate resolving the dilemma?
(Select all that apply.) correct answers [1] determine the facts related to the dilemma.
[2] identify possible solution
[3]consider the client wishes
A nurse is talking with a client whose son died in a motor-vehicle crash 2 weeks ago. The
client states, "l really thought I'd be back to my usual routines by now, but I can't think of
anything else except that my son is gone." Which Of the following responses should the
nurse make? correct answers Grieving for your son is hard work. it will take as much time as
you need to come to terms with your loss.
A nurse is reinforcing teaching with a client about cancer prevention. The nurse should
include that frequent consumption of which of the following foods increases the risk for
developing cancer? correct answers Lamb
rationale: including tuna fish reduces risk of developing cancer.
including poultry reduces risk,
A nurse notices an assistive personnel (AP) taking a nap in the break room during meal time.
The nurse also notes that the AP is drowsy while performing routine tasks. Which of the
following actions should the nurse take? correct answers Report the observation about the AP
to the Unit nurse manager
A nurse on a pediatric unit is collecting data from four newly admitted clients. Which of the
following clients should the nurse identify as being at risk for urinary retention? correct
answers A school age child who has allergic rhinitis and is taking diphenhydramine.
A nurse is caring for a client following a bronchoscopy. Which of the following actions
should the nurse take first? correct answers check for gag reflex
A nurse is assisting with the admission of a client who has a latex allergy. The nurse should
identify that which of the following supplies has the potential to contain latex? correct
answers Indwelling urinary catheter
, A nurse is performing postmortem care for a client prior to the arrival Of the client's family
for viewing Of the body. Which Of the following actions should the nurse take? correct
answers Gently close the client's eyelids
A nurse is reinforcing teaching with a client who has dumping syndrome about measures to
reduce manifestations. Which of the following instructions should the nurse include in the
teaching? correct answers avoid foods high in sugar content.
rationale: The nurse should instruct the client to avoid sweet foods, which often increase the
manifestations of dumping syndrome. These manifestations include nausea, sweating,
abdominal pain, diarrhea, and weakness.
A nurse is collecting data from a client who is experiencing a situational crisis following the
loss of a job. The client states, "l don't think I can go through this again." Which of the
following actions is the nurse's priority? correct answers Determine if the client is
experiencing psychotic thinking.
A nurse is contributing to the plan of care for a client following a transurethral resection of
the prostate (TURP). Which of the following interventions should the nurse include? correct
answers Irrigate the bladder using sterile technique
A nurse is caring for an infant who is receiving IV fluids for dehydration. Which of the
following should the nurse recognize as a positive response to the therapy? correct answers
Moist mucus membranes.
A nurse is assisting with the admission of a client who is experiencing alcohol withdrawal.
Which of the following medications should the nurse expect the provider to prescribe for the
client? correct answers Chlordiazepoxide
rationale: The nurse should expect to administer chlordiazepoxide to decrease anxiety and the
risk for seizures associated with alcohol withdrawal.
A nurse is caring for a client who is scheduled for surgery in the morning. The nurse learns
that the client has decided not to have surgery even though they have already signed the
informed consent form. Which of the following actions should the nurse take? correct
answers report the situation to the provider who obtained informed consent.
A nurse is collecting data from a client who is in severe pain. Which of the following
questions should the nurse ask first? correct answers where is your pain located
A nurse in a provider's office is reinforcing teaching with a client who has a new prescription
for ferrous sulfate elixir. Which of the following statements by the client should indicate to
the nurse an understanding of the teaching? correct answers i will rinse my mouth after taking
this medication
A nurse is contributing to the plan of care for a client who is postoperative following a
rhinoplasty. Which of the following interventions should the nurse recommend? correct
answers instruct the client to avoid the Valsalva maneuver.