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,1.) A nurse is assessing a client who is receiving intravenous therapy. The nurse should identify which
of the following ;ndings as a manifestation of =uid volume excess?
a. Decreased bowel sounds
b. Distended neck veins
c. Bilateral muscle weakness
d. Thread pulse
2.) A nurse is caring for a client who has hyponatremia and is receiving an infusion of a prescribed
hypertonic solution. Which of the following ;ndings should indicate to the nurse that the treatment is
eFective?
a. Absent sign
b. Improved cognition
c. Decreased vomiting
d. Cardiac arrhythmias absent
3.) A nurse is teaching a client who has a new prescription for a nitroglycerin transdermal patch.
Which of the following instructions should the nurse include?
a. the patch if you experience a
b. a new patch if you have chest
c. the patch with dry gauze when taking a
d. the patch prior to going to
4.) A nurse is reviewing he laboratory results of a client who has a prescription for sodium polystyrene
sulfonate (Kayexalate) every 6 hr. which of the following should the nurse report to the provider?
a. Creatinine 0.72 mg/dL
b. Sodium 138 mEq/L
c. Magnesium 2 mEq/L
d. Potassium 5.2 mEq/L - Hyperkalemia (serum potassium level greater than 5.0 mEq/L)
increases the client risk for fatal cardiac dysrhythmias. Kayexalate is used to decrease the serum
potassium level, so the PN should monitor the client's serum potassium level
5.) A nurse is caring for a client who has tuberculosis and is taking isoniazid and rifampin. Which of
, the following outcomes indicates that the client is adhering to the medication regimen?
a. The client has a negative sputum culture
b. The client tests negative for HIV
c. The client has a positive puri;ed protein derivative test
d. The liver function test results are within the expected reference range
6.) A client is caring for a client who develops an anaphylactic reaction to IV administration. A]er assessing
should the nurse take next?
a. Replace the infusion with 0.9% sodium chloride
b. Give diphenhydramine IM
c. Elevate the legs and feet
d. Administer epinephrine IM
, 7.) A nurse is caring for a client who is taking sertraline and reports a desire to begin taking supplements.
Which of the following supplements should the nurse advise the client to avoid?
a.
b. Ginger root
c. Black cohosh
d. Coenzyme Q10
8.) A nurse is caring for a client who has heart failure and a new prescription for lisinopril. For which of the
following adverse eFects should the nurse monitor when administering lisinopril?
a. Bradycardia
b. Hypokalemia
c. Tinnitus
d. Hypotension
9.) A nurse is assessing a client who is receiving heparin IV continuous IV. The client has an PPT of 90
seconds. They should monitor the client for which of the following changes in their vital signs?
a. Decreased temperature
b. Increased pulse rate
c. Decreased respiratory rate
d. Increased blood pressure
10.) A nurse is preparing to administer medication to a client and discovers a medication error. The nurse
should recognize that which of the following staF members is responsible for completing an incident
report?
a. The quality improvement committee
b. The nurse who identifies the error
c. The nurse who caused the error
d. The charge nurse
11.) A nurse is planning care for a client who is receiving morphine via continuous epidural infusion.
The nurse should monitor the client for which of the following?
a. Pruritus Sign of allergic reaction to morphine
b. Cough
c. Tachypnea
d. Gastric bleeding
12.) A nurse is preparing to administer digoxin orally to a client. Identify the sequence of steps the nurse
should take. (Move the steps into the box on the right, placing them in the order of performance. Use
all the steps.)
a. Obtain the apical heart rate
b. Remove the medication from the dispensing system
c. Open the medication package
d. Compare the wristband to the medication administration record
e. Document administration of the medication
,1.) A nurse is assessing a client who is receiving intravenous therapy. The nurse should identify which
of the following ;ndings as a manifestation of =uid volume excess?
a. Decreased bowel sounds
b. Distended neck veins
c. Bilateral muscle weakness
d. Thread pulse
2.) A nurse is caring for a client who has hyponatremia and is receiving an infusion of a prescribed
hypertonic solution. Which of the following ;ndings should indicate to the nurse that the treatment is
eFective?
a. Absent sign
b. Improved cognition
c. Decreased vomiting
d. Cardiac arrhythmias absent
3.) A nurse is teaching a client who has a new prescription for a nitroglycerin transdermal patch.
Which of the following instructions should the nurse include?
a. the patch if you experience a
b. a new patch if you have chest
c. the patch with dry gauze when taking a
d. the patch prior to going to
4.) A nurse is reviewing he laboratory results of a client who has a prescription for sodium polystyrene
sulfonate (Kayexalate) every 6 hr. which of the following should the nurse report to the provider?
a. Creatinine 0.72 mg/dL
b. Sodium 138 mEq/L
c. Magnesium 2 mEq/L
d. Potassium 5.2 mEq/L - Hyperkalemia (serum potassium level greater than 5.0 mEq/L)
increases the client risk for fatal cardiac dysrhythmias. Kayexalate is used to decrease the serum
potassium level, so the PN should monitor the client's serum potassium level
5.) A nurse is caring for a client who has tuberculosis and is taking isoniazid and rifampin. Which of
, the following outcomes indicates that the client is adhering to the medication regimen?
a. The client has a negative sputum culture
b. The client tests negative for HIV
c. The client has a positive puri;ed protein derivative test
d. The liver function test results are within the expected reference range
6.) A client is caring for a client who develops an anaphylactic reaction to IV administration. A]er assessing
should the nurse take next?
a. Replace the infusion with 0.9% sodium chloride
b. Give diphenhydramine IM
c. Elevate the legs and feet
d. Administer epinephrine IM
, 7.) A nurse is caring for a client who is taking sertraline and reports a desire to begin taking supplements.
Which of the following supplements should the nurse advise the client to avoid?
a.
b. Ginger root
c. Black cohosh
d. Coenzyme Q10
8.) A nurse is caring for a client who has heart failure and a new prescription for lisinopril. For which of the
following adverse eFects should the nurse monitor when administering lisinopril?
a. Bradycardia
b. Hypokalemia
c. Tinnitus
d. Hypotension
9.) A nurse is assessing a client who is receiving heparin IV continuous IV. The client has an PPT of 90
seconds. They should monitor the client for which of the following changes in their vital signs?
a. Decreased temperature
b. Increased pulse rate
c. Decreased respiratory rate
d. Increased blood pressure
10.) A nurse is preparing to administer medication to a client and discovers a medication error. The nurse
should recognize that which of the following staF members is responsible for completing an incident
report?
a. The quality improvement committee
b. The nurse who identifies the error
c. The nurse who caused the error
d. The charge nurse
11.) A nurse is planning care for a client who is receiving morphine via continuous epidural infusion.
The nurse should monitor the client for which of the following?
a. Pruritus Sign of allergic reaction to morphine
b. Cough
c. Tachypnea
d. Gastric bleeding
12.) A nurse is preparing to administer digoxin orally to a client. Identify the sequence of steps the nurse
should take. (Move the steps into the box on the right, placing them in the order of performance. Use
all the steps.)
a. Obtain the apical heart rate
b. Remove the medication from the dispensing system
c. Open the medication package
d. Compare the wristband to the medication administration record
e. Document administration of the medication
