RN Comprehensive Online Practice

RN Comprehensive Online Practice A nurse is providing dietary teaching to the parents of a 6 month old. What instructions should the nurse give? - ANS introduce new foods over 5-7 days A nurse is caring for a client that is in labor at 39 weeks gestation. During the second stage of labor, the nurse observes early decelerations on the monitor. What action should the nurse take? - ANS continue observing the fetal heart rate A nurse is caring for an older adult client in the PACU following general anesthesia. What finding should the nurse report to the provider - ANS audible stridor A nurse is providing discharge instructions to a client following a total hip arthroplasty. Which instruction should the nurse include? - ANS install a raised toilet seat at home A nurse is assessing a client who is receiving a blood transfusion. Which of the following findings should indicate to the nurse that the client is having a hemolytic transfusion reaction? - ANS low back pain A nurse is assessing a client who has macular degeneration. Which of the following findings should the nurse expect? - ANS decreased central vision A nurse in a clinic receives a call from a guardian whose child has varicella. The guardian asks when the child returns to school. Which of the following responses should the nurse make? - ANS when crusts have formed on every lesion A nurse is caring for a client who has generalized anxiety disorder and is going to start alprazolam. Which action should the nurse take? - ANS initiate fall precautions A nurse in a mental health facility is planning care for a client who has anorexia nervosa. Which intervention should the nurse include in the plan of care? - ANS Supervise the client during and after eating A nurse is talking with the partner of a client who attempted suicide. Which of the following statements by the client's partner is priority? - ANS "My husband doesn't know I;ve already moved out and filed for divorce" A nurse is assessing a client who has MS. Which manifestation should the nurse expect? - ANS nystagmus A nurse is assessing a client who has been taking lithium carbonate for the past month to treat bipolar disorder. Assessment finding priority? - ANS confusion A nurse is caring for a client with a potassium level of 3. What manifestation should the nurse monitor for? - ANS decreased DTR A nurse in an ER is planning discharge for a client who has experienced intimate partner violence. Which action should the nurse take first? - ANS develop a safety plan A nurse is caring for a client at 37 weeks gestation and is experiencing abruptio placentae. Which finding should the nurse expect? - ANS persistent uterine contractions A nurse manager is preparing a newly licensed nurse's performance appraisal. Which method should the manager use to evaluate time management skills? - ANS maintain regular notes about the nurses time management skills A nurse is assessing a client who has a stage II pressure injury. Expected would characteristics? - ANS partial thickness skin loss A nurse is providing discharge instructions to a client who has a new prescription for amitriptyline to treat depression. Which client statements shows understanding of teaching? - ANS "I should watch for dry mouth and constipation" A nurse is assessing a 2hr old newborn. Report to MD? - ANS axillary temp 36.2C (97.2F) A nurse is planning care for a client who has thrombocytopenia. Which of the following instructions should the nurse include in the client's plan of care? - ANS avoid venipunctures when possible A nurse is reviewing the urinalysis report of a client who has acute glomerulonephritis. Expected finding? - ANS protein A nurse is caring for a client who has dehydration secondary to nausea and vomiting. The nurse should identify which of the following findings as fluid volume deficit? - ANS orthostatic hypotension A nurse is providing discharge teaching to a new parent about car seat safety. Which statement should the nurse include in the teaching? - ANS "secure the retainer clip at the level of baby's armpits" A nurse is caring for a toddler who has infectious gastroenteritis. Which of the following actions should the nurse take? - ANS initiate oral rehydration therapy for the toddler A nurse working in a long term care facility is assessing an adult client. Which of the following findings places the client at risk for developing a pressure injury? - ANS recent weight loss A nurse is performing trach care for a client post op following a laryngectomy. Which of the following actions should the nurse take when suctioning the client's airway? - ANS apply suction for 10 seconds A nurse is conducting visual acuity testing using the Snellen letter chart for a school-age child who has eye glasses. Which of the following instructions should the nurse give to the child? - ANS "you should keep both eyes open during the test" A nurse is caring for a client who has hypertension and is taking captopril. Delegatetask to AP? - ANS obtain vital signs A nurse is performing an admission assessment on a preschooler who is in the acute phase of Kawasaki disease. Which finding should the nurse expect? - ANS fever unresponsive to antipyretics A nurse is assessing a preschooler who has CF and has been receiving oxygen therapy for the past 36 hours. Which finding shows oxygen toxicity? - ANS substernal pain A nurse is teaching home wound care to the family of a child who has a large wound. Which intervention should the nurse recommend? - ANS double bag soiled dressings in plastic bags for disposal A nurse is preparing to administer 2U FFP to a client. Which action should the nurse plan to take? - ANS enter the plasma product number into the client's medical record A nurse is reviewing the ABG results of a client with COPD. The results include pH 7.3, PaO2 56 mm Hg, PaCO2 54 mm Hg, HCOs 26 mEq/L, SaO2 87%. Correct interpretation? - ANS uncompensated respiratory acidosis A nurse is assessing a client who has Raynaud's disease. Which finding should the nurse expect? - ANS blanching of the fingers and toes