TEST 1
1. The nurse is caring for a client following an appendectomy. The client reports nausea
and complains of surgical site pain at a 6 on a 0 to 10 scale. The client's employer is
present in the room and states he is paying for the insurance and wants to know what
pain medication has been prescribed by the physician. Which of the following is the
appropriate nurse response?
A. Answer any questions the employer may have as he pays for the insurance.
B. Tell the employer his question is inappropriate and that the information is none of his
business.
C. Explain to the employer that you cannot release private information and ask the
employer to step out while you conduct your assessment of the client.
D. Ask the employer to leave and wait until the client returns home to visit. - CORRECT
ANSWER-C. Explain to the employer that you cannot release private information and
ask the employer to step out while you conduct your assessment of the client.
2. The nurse is caring for a client with a history of advanced chronic obstructive
pulmonary disease (COPD). The client had conventional gallbladder surgery 2 days
previously. Which intervention has priority for preventing respiratory complications?
A. Incentive spirometry every 4 hours.
B. Coughing and deep breathing four times daily.
C. Getting the client out of bed 4 times daily as ordered by the physician.
D. Giving oxygen at 4 L/minute according to the physician's order. - CORRECT
ANSWER-C. Getting the client out of bed 4 times daily as ordered by the physician
, 3. A mnurse mis mdeveloping ma mcare mplan mfor ma mclient mwith macute mmania. mPlace mthe
mfollowing mbehaviors min mthe morder min mwhich mthey moccur mas mthe mclient mdevelops macute
mmania. mUse mall mof mthe moptions. m
m
mm
A. mDelusions mof
mgrandeur.
B. mRelevant, mcalm
mspeech mpatterns. m
C. mHighly mproductive mand
mcompetitive min mwork mand mleisure
mactivities. m
mm
D. mEasily
mirritated.
m
E. mPoor mjudgment mand mimpulse
mcontrol. m- mCORRECT
mANSWER-
m
4. When meducating ma mpregnant mclient mabout mhome msafety, mwhich mof mthe mfollowing
minformation mis mappropriate mfor mthe mnurse mto minclude min mthe mteaching mplan? mSelect mall
mthat mapply. m
m
A. When mtaking ma mshower, mplace ma mnon-skid mmat mon mthe mfloor mof mthe mtub mor mshower. m
m
B. Avoid mclimbing mstairs. m m
C. Avoid mwearing mhigh mheels. m m
D. Use mnon-slip mrugs mon mthe mfloors. m- mCORRECT mANSWER-A. mWhen mtaking ma
mshower, mplace ma mnon-skid mmat mon mthe mfloor mof mthe mtub mor mshower. m mB. mAvoid
mclimbing mstairs. m m
C. mAvoid mwearing mhigh mheels. m
m
5. mA mclient mhad ma mC5 mspinal mcord mcontusion mthat mresulted min mquadriplegia. mTwo mdays
mafter mthe minjury moccurred, mthe mnurse msees mhis mmother mcrying min mthe mwaiting mroom.
mThe mmother masks mthe mnurse mwhether mher mson mwill mever mplay mfootball magain. mWhich mof
mthe mfollowing mis mthe mbest minitial mresponse? m
m
A. "Given mtime mand mmotivation, myour mson mcan mreturn mto mnormal mfunction." m m
B. "I'm mnot msure, mbut mI'll mcall mthe mphysician mto mtalk mto myou mright maway." m m
C. "What mdo myou mknow mabout myour mson's minjury?" m m
D. "Getting mupset misn't min myou mson's mbest minterest." m- mCORRECT mANSWER-C. m"What
mdo myou mknow mabout myour mson's minjury?" m
m
6. mThe mnurse mis mcaring mfor ma mclient mwho mwill mundergo msurgical mrepair mof ma mdetached
mretina. mWhich mof mthe mfollowing mis mthe mmost mlikely mpreoperative mnursing mdiagnosis mfor
mthis mclient? m
m
A. Anxiety mrelated mto mloss mof mvision mand mpotential mfailure mto mregain mvision. m m