NGN ATI RN MED SURG PROCTORED EXAM 2024 VERSION 100+ QUESTIONS WITH VERIFIED DETAILED ANSWERS (100% CORRECT ANSWERS) A+ GRADE ASSURED

1. A nurse is teaching a client about the use of an incentive spirometer. Which of the following instructions should the nurse include in the teaching? A. Place hands on the upper abdomen during inhalation B. Exhale slowly through pursed lips C. Hold breaths about 3 to 5 seconds before exhaling D. Position the mouthpiece 2.5 cm (1 in) from the mouth - C. Hold breaths about 3 to 5 seconds before exhaling 2. A nurse is assessing a client who is 12 hr postoperative following a colon resection. Which of the following findings should the nurse report to the surgeon? a. Heart rate 90/min b. Hgb 8.2 g/dL c. Gastric pH of 3.0 d. Absent bowel sounds - b. Hgb 8.2 g/dL 3. A nurse is preparing to receive a client from surgery following a transverse colon resection with colostomy placement. The nurse should expect to assess the stoma at which of the following locations? - pic with male chest B on top - a. Upper left abdomen 4. A nurse is caring for a client who has diabetes insipidus. Which of the following medications should the nurse plan to administer? a. Regular insulin b. Furosemide c. Desmopressin d. Lithium carbonate - c. Desmopressin 5. A nurse is caring for a client in diabetic ketoacidosis (DKA). Which of the following is the priority intervention by the nurse? a. Begin bicarbonate continuous IV infusion b. Administer 0.9% sodium chloride c. Check potassium levels d. Initiate a continuous IV insulin infusion - b. Administer 0.9% sodium chloride 6. A nurse is reviewing the medical record of a client who has diabetes insipidus. Which of the following findings should the nurse expect? a. Elevated blood pressure b. Hypothermia c. Urine specific gravity 1.001 d. BUN 15 mg/dL - c. Urine specific gravity 1.001 A nurse is admitting a client who has arthritic pain and reports taking ibuprofen several times daily for 3 years. Which of the following tests should the nurse monitor? a. Stool for occult blood b. Urine for white blood cells c. Fasting blood glucose d. Serum calcium - a. Stool for occult blood 8. A nurse in the emergency department is assessing a client. Which of the following actions should the nurse take first? (Click on the "Exhibit" button) a. Obtain a sputum sample for culture b. Prepare the client for a chest x-ray c. Initiate airborne precautions d. Administer ondansetron - c. Initiate airborne precautions 9. A nurse is reviewing the laboratory results of a female client who asks about acupuncture as treatment for chemotherapy-induced nausea and vomiting. Which of the following laboratory results should the nurse identify as a contraindication to receiving acupuncture? a. Hemoglobin 12 g/dL b. C-reactive protein 0.7 mg/dL c. Platelets 160,000/mm^3 d. Absolute neutrophil count 500/mm^3 - d. Absolute neutrophil count 500/mm^3 10. A nurse is contacting the provider of a client who has cancer and is experiencing breakthrough pain. Which of the following prescriptions should the nurse anticipate? a. Intravenous dexamethasone b. Transmucosal fentanyl c. Oral acetaminophen d. Intramuscular meperidine - b. Transmucosal fentanyl 11. A nurse is teaching a client who has ovarian cancer about skin care following radiation treatment. Which of the following instructions should the nurse include? a. Apply over-the-counter moisturizer to the radiation site b. Cover the radiation site loosely with a gauze wrap before dressing c. Use a soft washcloth to clean the area around the radiation site d. Pat the skin on the radiation site to dry it - d. Pat the skin on the radiation site to dry it 12. A nurse is caring for a client who has cervical cancer and a sealed radiation implant. Which of the following actions should the nurse take? a. Leave unused equipment in the client's room until discharge b. Place long-handled forceps at the client's bedside c. Attach a dosimeter badge to the client's gown d. Move the client's soiled lines to a designated container outside the room - a. Leave unused equipment in the client's room until discharge A nurse is caring for a client who is receiving radiation. The client reports nausea since the therapy was initiated. Which of the following considerations should the nurse include when planning the client's meals? a. Offer a snack prior to radiation therapy b. Offer highly seasoned foods. c. Offer frequent, high carbohydrate meals d. Offer hot beverages with meals - c. Offer frequent, high carbohydrate meals A nurse on an oncology unit is caring for a client who is receiving internal radiation therapy. Which of the following actions should the nurse take? a. Place the dosimeter firm badge on the client's door b. Wear a lead apron when providing client care c. Leave the door to the client's room open d. Allow visitors to hold the client's hand - b. Wear a lead apron when providing client care A nurse is caring for a client who has cancer. The client tells the nurse, "I would prefer to try vitamins and minerals instead of chemotherapy." Which of the following responses should the nurse make? a. Tell me what you know about chemotherapy b. I have never heard of any holistic treatment that is effective c. The best way to treat your cancer is chemotherapy d. You should ask your provider about your plan - a. Tell me what you know about chemotherapy A nurse is providing dietary teaching to a client who is at risk for developing cancer. Which of the following instruction should the nurse indicate? a. Eat 1 cup of fruits and vegetables each day b. Choose solid fats when cooking c. Select lean meats d. Consume foods low in fiber - c. Select lean meats A nurse is caring for a client who has cervical cancer and is receiving brachytherapy. Which of the following actions should the nurse take? a. Limit time for visitors to 2 hrs. per day b. Discard the radioactive device in the client's trash car c. Keep soiled bed linens in the client's room d. Instruct visitors to remain 3 feet from the client - c. Keep soiled bed linens in the client's room A nurse is reviewing the medical record of a client to identify risk factors for colorectal cancer. The nurse should identify which of the following findings as increasing the client's risks? a. History of Crohn's disease b. Age 46 years c. Diet high in fiber d. BMI of 24 - a. History of Crohn's disease A nurse is assessing a client who has a new diagnosis of colon cancer. Which of the following findings should the nurse expect? a. Weight gain b. Hematochezia c. Steatorrhea d. Elevated Hemoglobin - b. Hematochezia A nurse is providing education to a client who is concerned about developing breast cancer. Which of the following information should the nurse include in the teaching? a. Having a first child before age 30 increases the risk for breast cancer b. Experiencing late menarche and early menopause increases the risk for breast cancer c. Postmenopausal obesity increases the risk for breast cancer d. Dense breast tissue decreases the risk for breast cancer - c. Postmenopausal obesity increases the risk for breast cancer A nurse is monitoring an older adult client who has an exacerbation of chronic lymphocytic leukemia. The nurse notes petechiae on the client's skin. Which of the following actions should the nurse take? a. Institute bleeding precautions b. Determine the client's blood type c. Avoid administering IV pain medication d. Implement airborne precautions - a. Institute bleeding precautions A nurse is caring for a client who is receiving a blood transfusion. The nurse observes that the client has bounding peripheral pulses, hypertension, and distended jugular veins. The nurse should anticipate administering which of the following prescribed medications? a. Acetaminophen b. Furosemide c. Diphenhydramine d. Pantoprazole - b. Furosemide A nurse is assessing a client 15 min after the start of a transfusion of 1 unit of packed RBCs. Which of the following findings is an indication of a hemolytic transfusion reaction? a. Hypotension b. Hypothermia c. Bradypnea d. Bradycardia - a. Hypotension 24. A nurse is preparing to administer a unit of packed RBCs to a client who is anemic. Identify the sequence of steps the nurse should follow. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.) a. (1) Obtain venous access using a 19-gauge needle b. (2) Obtain the unit of packed RBCs from blood bank c. (2) Verify blood compatibility with another nurse d. (3) Initiate transfusion of the unit of packed RBCs e. (5) Remain with the client for the first 15 to 30 min of the infusion - a. (1) Obtain venous access using a 19-gauge needle b. (2) Obtain the unit of packed RBCs from blood bank c. (2) Verify blood compatibility with another nurse d. (3) Initiate transfusion of the unit of packed RBCs e. (5) Remain with the client for the first 15 to 30 min of the infusion A nurse is preparing to administer 1 unit of packed RBCs to an adult client. Which of the following actions should the nurse plan to take? a. Prime the IV tubing with 0.45% sodium chloride b. Complete the transfusion within 2 hrs. c. Slow the transfusion rate if the client reports itching d. Administer through a 22-gauge IV catheter - b. Complete the transfusion within 2 hrs. A nurse is assessing a client who is receiving magnesium sulfate IV for the treatment of hypomagnesemia. Which of the following findings indicates effectiveness of the medication? a. Lungs clear b. Hyperactive bowel sounds c. Blood pressure 90/50 mm Hg d. Apical pulse 82/min - d. Apical pulse 82/min A nurse is preparing a client for a lumbar puncture. Which of the following images indicates the position the nurse should assist the client into for this procedure? - Answer is exhibit "C" - picture shows pt lying in side-lying left position Fetal position (cannonball position A nurse is reviewing a client's ABG results: pH 7.42, PaCO2 30 mm Hg, and HCO3- 21 mEq/L. The nurse should recognize these findings as an indication of which of the following conditions? a. Compensated respiratory alkalosis b. Uncompensated respiratory acidosis c. Metabolic acidosis d. Metabolic alkalosis - a. Compensated respiratory alkalosis A nurse is reviewing ABG results for a client who has COPD. Which of the following findings should the nurse expect? Paco2 should be acidic in COPD patients a. pH 7.38 b. HCO3 25 mEq/L c. PaCO2 48 mm Hg d. PaO2 85 mmHg - c. PaCO2 48 mm Hg A nurse is preparing to administer daily medications to a client who is undergoing a procedure at 1000 that requires IV contrast dye. Which of the following routine medications to give at 0800 should the nurse withhold? a. Metoprolol b. Metformin c. Fluticasone d. Valproic acid - b. Metformin A nurse is caring for a client following a cardiac catheterization who has hives and urticaria following administration of IV contrast dye. Which of the following Medication should the nurse plan to administer? a. Diphenhydramine (Benadryl) b. Spironolactone c. Desmopressin d. Metoclopramide - a. Diphenhydramine (Benadryl) A nurse is providing preoperative teaching for a client who is having a left sided cardiac catheterization. Which of the following information should the nurse include in the teaching? a. You will receive a general anesthetic during the procedure b. You should expect warm sensation after injection of the contrast dye during the procedure c. You will have blood pressure measurements every 5 minutes for the first 2 hours after the procedure d. You should plan to remain in bed for 18 hours after the procedure. - b. You should expect warm sensation after injection of the contrast dye during the procedure A nurse is planning care for a client following a cardiac catheterization. which of the following actions should the nurse take? a. Maintain the client's affected extremity in extension b. Keep the client on bed rest for 24 hours c. Limit the client's fluid intake to 1 l per day d. Change the client's dressing every 8 hour - a. Maintain the client's affected extremity in extension A nurse is assessing a client who has pericarditis. In which of the following areas of the client's chest should the nurse place the stethoscope best hear a pericardial friction? - a. left lower sternal border nurse is assessing a client admitted with peripheral vascular disease. Which of the following findings indicate a venous vascular disorder? a. Edema of the ankle b. An ulcer on the tip of the toe c. Hair loss distal to the client's calves d. Leg pain at rest - a. Edema of the ankle A community health nurse is reviewing home care instructions with an older adult who has a new diagnosis of heart failure. Which of the following is the priority topic for the nurse to review with the client? a. Changes in weight b. Daily sodium restrictions c. Fluid intake record d. Daily exercise routine - a. Changes in weight A nurse finds a client in bed, unresponsive and breathing. Which of the following actions should the nurse take first? a. Establish an IV access b. Apply a blood pressure cuff c. Palpate for the client's carotid pulse d. Initiate cardiac monitoring for the client - c. Palpate for the client's carotid pulse A nurse is caring for a client who is experiencing a hypertensive crisis. Which of the following actions should the nurse take? a. Initiate an IV dopamine infusion b. Place the client supine c. Begin an IV bolus of lactated Ringer's d. Perform neurological assessments - d. Perform neurological assessments A nurse is planning care for a client who is experiencing seizures secondary to meningitis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.) a. Assist the client to ambulate every 4 hr b. Place a tongue blade at the bedside c. Have suction equipment at the bedside d. Dim the overhead lights e. Apply a warming blanket - c. Have suction equipment at the bedside d. Dim the overhead lights A nurse is caring for a client who has a pressure ulcer with necrotic tissue and requires wet- to-damp dressing changes daily. Which of the following types of debridement should the nurse include in the plan of care? a. Enzymatic b. Surgical c. Autolytic d. Mechanical - b. Surgical A nurse is caring for a client who has a duodenal ulcer. Which of the following actions should the nurse take? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data) a. Infuse packed RBCs b. Offer a snack before bedtime c. Administer the client's naproxen prescription d. Restrict the client's fluid intake to 1,000 mL/day - of data) a. Infuse packed RBCs A nurse is assessing a client who has a pressure ulcer. Which of the following findings should the nurse expect as an indication the wound is healing? - a. Dark red granulation tissue A nurse in a provider's office is teaching a client about the self-management of GERD. Which of the following instructions should the nurse include? a. "Sleep with the head of the bed elevated 6 inches" b. "Increase your caloric intake by 250 calories per day" c. "Lie down for 30 min after each meal" d. "Eat a light meal 1 hour before bedtime" - a. "Sleep with the head of the bed elevated 6 inches" A nurse is caring for a female client who has toxic shock syndrome. Which of the following findings should the nurse expect? a. Elevated platelet count b. Decreased total bilirubin c. Generalized rash d. Hypertension - c. Generalized rash A nurse in the emergency department is caring for a client who is in hypovolemic shock. Which of the following actions should the nurse take first? a. Monitor urine output b. Administer IV therapy c. Insert a large-bore IV catheter d. Obtain a blood specimen for type and crossmatch - c. Insert a large-bore IV catheter A nurse is caring for an older adult client who is suspected of having septicemia. Which of the following actions is the nurse's priority? a. Obtain a history to determine recent injuries b. Obtain a WBC count with differential c. Obtain a broad-spectrum antibiotic for rapid administration d. Obtain a blood specimen for culture and sensitivity testing - d. Obtain a blood specimen for culture and sensitivity testing A nurse is caring for a client who has hypervolemia. Which of the following is an expected assessment finding? a. Weight gain b. Bradycardia c. Hypotension d. Loss of skin turgor - a. Weight gain A nurse is preparing to administer a medication for a client through a non-tunneled percutaneous central catheter. Which of the following actions should the nurse take? a. Close the inline clamp b. Apply a local anesthetic to the skin c. Don sterile gloves d. Flush the catheter with 10 mL of 0.9% sodium chloride - d. Flush the catheter with 10 mL of 0.9% sodium chloride A nurse is planning care for a client who has a central venous access device for intermittent infusion. Which of the following actions should the nurse include in the plan of care? a. Use clean technique when changing the dressing b. Cleanse the site with povidone-iodine c. Change the dressing every 24 hrs. d. Flush the catheter using a 10-mL syringe - d. Flush the catheter using a 10-mL syringe A nurse is caring for a client who has a central venous access device and notes the tubing has become disconnected. The client develops dyspnea and tachycardia. Which of the following actions should the nurse take first? a. Obtain ABG values b. Perform an ECG c. Turn the client to his left side d. Clamp the catheter - d. Clamp the catheter A nurse is caring for a client who was admitted with nausea, vomiting, and a possible bowel obstruction. An NG tube is placed and set to low intermittent suction. Which of the following findings should the nurse report to the provider? a. The client reports being extremely thirsty with a sore throat b. The drainage is bright green in color with brown fecal material c. The amount of drainage is gradually decreasing d. The client's abdomen becomes distended and firm - d. The client's abdomen becomes distended and firm A nurse is preparing to perform gastric lavage for a client who has a bleeding gastric ulcer. Which of the following equipment should the nurse use for the procedure? - a. NG tube A nurse in an emergency department is preparing a client for emergency surgery. The client's blood alcohol level is 180 mg/dL. Which of the following actions is the nurse's priority a. Apply antiembolic stockings b. Insert an NG tube; a patient will have an NG tube after any major surgery, to help prevent vomiting and to keep the patient's stomach empty c. Obtain consent for surgery d. Insert an indwelling urinary catheter - b. Insert an NG tube; a patient will have an NG tube after any major surgery, to help prevent vomiting and to keep the patient's stomach empty A nurse is planning care for a client who has upper gastrointestinal bleeding due to a peptic ulcer. Which of the following actions should the nurse plan to take? a. Provide ketorolac for abdominal pain b. Administer nitroprusside IV based on the client's weight c.Insert a large bore nasogastric tube d. Ensure that the client has 22-gauge IV line in place - c.Insert a large bore nasogastric tube A nurse is caring for a client who is receiving epidural analgesic. Which of the following assessment findings is the nurse's priority? a. Hypotension b. Weakness to lower extremities c. Bladder distention d. Hypoactive bowel sounds - a. Hypotension A nurse is caring for a female client who is receiving total parenteral nutrition without fat emulsion. Which of the following findings should the nurse report? a. Triglyceride 110 mg/dl b. Bowel sounds absent in lower quadrants c. Crackles in the bilateral lung bases d. Weight gain of 1.3 kg (3 lb.) over the past days - c. Crackles in the bilateral lung bases A nurse is caring for a client who has hyperthyroidism and develops thyroid storm. Which of the following instructions should the nurse give to the client regarding management of thyroid storm? a. You will need to begin taking an ACE inhibitor medication b. You will need a pacemaker to increase your heart rate c. You will need a cooling blanket to lower your body temperature d. You will need additional thyroid supplementation - c. You will need a cooling blanket to lower your body temperature nurse is teaching a client who has Grave's disease about recognizing the manifestations of thyroid storm. Which of the following findings should the nurse include in the teaching? a. Increased temperature b. Decreased HR c. Hypotension d. Lethargy - a. Increased temperature A nurse is caring for a client who is 6 hours postoperative following a thyroidectomy. The client reports tingling and numbness in the hands. The nurse should identify this as a sign of which of the following electrolyte imbalances? a. Hypernatremia b. Hypocalcemia c. Hypomagnesemia d. Hypokalemia - b. Hypocalcemia A nurse is caring for a client who is postoperative following a complete thyroidectomy. Which of the following findings is the priority for the nurse to report to the provider? a. Client report of incisional pain b. Serosanguineous drainage c. Client report of nausea d. Muscle twitching - d. Muscle twitching A nurse is assessing a client for a positive Chvostek's sign following a thyroidectomy. Which of the following areas on the client's head should the nurse tap to assess the client for tetany? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.) - a. Facial nerve in front of ear for Chvostek's sign; look for square sign in front of man's ear A nurse is planning health promotion education for a population that is primarily African American men. The nurse should plan to include teaching on prevention of which of the following disorders? a. Hypothyroidism b. Hypertension c. Sickle cell anemia d. Cystic fibrosis - b. Hypertension A nurse is caring for a client who is postoperative following a partial thyroidectomy. Which of the following findings is the priority for the nurse to report to the provider? a. High-pitched sound on inspiration (stridor) b. Hypoactive bowel sounds c. Loose tracheal secretions d. Client report of pain at the incision site - a. High-pitched sound on inspiration (stridor) A nurse is reviewing the medical record of a client who has acute gout. The nurse should expect an increase in which of the following laboratory results? a. Uric acid b. Intrinsic factor c. Creatinine kinase d. Chloride level - a. Uric acid A nurse in the emergency department is caring for a client who has a gunshot wound in the abdomen. Which of the following actions should the nurse take first? a. Prepare the client for peritoneal lavage b. Remove all of the client's clothing c. Check the color of the client's skin d. Administer an opioid analgesic - b. Remove all of the client's clothing A nurse is admitting a client to the emergency department after a gunshot wound to the abdomen. Which of the following actions should the nurse take to help prevent the onset of acute kidney failure? a. Initiate beta blocker therapy b. Administer IV fluids to the client c. Insert a urinary catheter d. Prepare the client for an intravenous pyelogram - b. Administer IV fluids to the client A nurse is caring for an adolescent client who has an acute kidney injury. Which of the following laboratory findings should the nurse anticipate? a. BUN 8mg/dLf b. Creatinine 0.4mg/dL c. Hgb 20g/dL d. Potassium 6.8 - d. Potassium 6.8 nurse is assessing a client who has pyelonephritis and reports flank pain. Which of the following actions should the nurse take? a. Auscultate for a bruit over the costovertebral area b. Assist the client to a sitting position c. Thump the area of tenderness directly with a closed fist d. Percuss the side of tenderness first - b. Assist the client to a sitting position A nurse is assessing a client who has acute kidney failure. Which of the following findings should the nurse report to the provider? a. Peripheral pulses 2+ bilaterally b. Creatinine 0.8 mL/dL c. Urine specific gravity 1.045 d. Weight gain 1.1 kg (2.4 lb) in 24 hr - d. Weight gain 1.1 kg (2.4 lb) in 24 hr A nurse is teaching about food choices to a client who has kidney disease and must limit potassium intake. Which of the following choices should the nurse recommend as containing the least potassium? a. 1 medium baked potato with skin b. 1 cup white rice c. 1⁄2 cup nonfat yogurt d. 2 tbsp peanut butter - b. 1 cup white rice A nurse is preparing to administer peritoneal dialysis to a client. Which of the following actions should the nurse take? a. Use clean technique to access the catheter b. Chill the dialysate before administration c. Hang the drainage bag below the client's abdomen d. Place the client in high-Fowler's position - c. Hang the drainage bag below the client's abdomen A nurse is providing teaching to a client and his partner about performing peritoneal dialysis at home. When discussing peritonitis, which of the following manifestations should the nurse identify as the earliest indication of this complication? a. Fever b. Increased heart rate c. Generalized abdominal pain d. Cloudy effluent - d. Cloudy effluent A nurse is teaching about manifestation to prevent recuring urinary tract infections with a female client. Which of the following interventions should the nurse include in the teaching? (Select all that apply) a. Wipe the peritoneal area from front to back after urinating b. Void every 6 hours during the day c. Drink 3 L of fluids daily d. Take a warm bubble bath daily e. Drink low-fructose cranberry juice - a. Wipe the peritoneal area from front to back after urinating c. Drink 3 L of fluids daily e. Drink low-fructose cranberry juice A nurse is caring for a client who is receiving total parenteral nutrition (TPN). Which of the following nursing actions are appropriate? (Select all that apply.) a. Increase the rate of infusion if administration is delayed b. Monitor serum blood glucose during infusion c. Infuse 0.9% sodium chloride if the solution is not available d. Verify the solution with another RN prior to infusion e. Obtain the client's weight daily - b. Monitor serum blood glucose during infusion d. Verify the solution with another RN prior to infusion e. Obtain the client's weight daily A nurse is caring for a client who has completed 10 daily cycles of total parenteral nutrition (TPN). Which of the following findings indicates that the client is receiving adequate TPN supplementation? a. Weight gain of 9.1 kg (20 lb) b. BUN level of 15 mg/dL c. Improved mobility d. Potassium level of 2.5 mEq/L - a. Weight gain of 9.1 kg (20 lb) A nurse is caring for a client who is receiving total parenteral nutrition (TPN) through a central line. The current bag is nearly empty, and a new bag is unavailable from the pharmacy. Which of the following actions should the nurse take? a. Switch the infusion to a 10% dextrose solution b. Discontinue the infusion and flush the line c. Decrease the rate of infusion to last until the new bag is available d. Start an infusion of 0.45% sodium chloride solution - a. Switch the infusion to a 10% dextrose solution A nurse is teaching a client who is receiving total parenteral nutrition (TPN) at home through a central venous access device about transparent dressing changes. Which of the following instructions should the nurse include in the teaching? a. Use clean technique when changing the dressing b. Wear a mask during the dressing change c. Replace the extension tubing with each dressing change d. Change the dressing every 48 hr - b. Wear a mask during the dressing change A nurse in an emergency department is assessing a client who has cirrhosis of the liver. Which of the following is a priority finding? a. yellow sclera b. Mental confusion c. Palmar erythema d. Spider angiomas - b. Mental confusion A nurse is assessing a client who has cirrhosis. Which of the following findings is the priority for the nurse to report? a. Alkaline phosphate 125 units/L b. Platelets 70,000 mm c. Clay colored stools d. Distended abdomen - b. Platelets 70,000 mm A nurse is caring for a client who has advanced liver disease. Which of the following laboratory results should the nurse monitor when assessing this client? a. Phosphate level b. Serum troponin c. Serum ammonia d. Glucose level - c. Serum ammonia A nurse is planning a staff education session about hepatitis A. Which of the following information should the nurse include? a.Clients who have hepatitis A require a broad-spectrum antibiotic b. Hepatitis A is transmitted is through blood-to-blood exposure c. The incubation period of hepatitis A is 5 to 10 days d. Immunizations for hepatitis A is recommended prior to travel to high-risk areas - d. Immunizations for hepatitis A is recommended prior to travel to high-risk areas A nurse in the post anesthesia care unit is assessing a client following an appendectomy and finds a 2 cm (3/4 in) area of blood on the postoperative dressing. Which of the following actions should the nurse take? a. Loosen the dressing b. Circle the drainage c. Apply a new dressing d. Apply pressure - b. Circle the drainage A nurse is reviewing the laboratory reports of a client who has acute pancreatitis. Which of the following findings should the nurse expect? a. Decreased erythrocyte sedimentation rate b. Decreased serum amylase c. Elevated blood glucose d. Elevates serum calcium - c. Elevated blood glucose A nurse is planning care for a client who is 1 day postoperative following an open cholecystectomy. Which of the following interventions should the nurse include in the plan of care? a. Discourage leg exercises while in bed b. Place pillows under the client's knees c. Avoid use of anticoagulants d. Apply compressing stockings to the lower extremities - d. Apply compressing stockings to the lower extremities A nurse in the emergency department is caring for a client who has deep partial thickness burns over 30% of his body, including his upper chest and abdomen. Which of the following actions is the nurse's priority? a. Insert an 18-gauge IV catheter b. Administer tetanus toxoid c. Check the client's mouth for black particles d. Remove the client's burned clothing - d. Remove the client's burned clothing A nurse is caring for a client who experienced extensive burns to the arms and torso. Which of the following actions should the nurse take regarding the client's oral nutritional intake? a. Adhere to scheduled mealtimes three times daily b. Limit the client's fluid intake to 1,500 ml/day c. Encourage the client to eat as many calories as possible d. Avoid the use of supplemental feedings throughout the day - c. Encourage the client to eat as many calories as possible A nurse is caring for a client who has a full thickness burn injury covering 15% of their body. Which of the following actions should the nurse take? a. Weigh the client once per week b. Provide the client with a protein intake of 1g/kg/day c. Maintain a daily count of the client's calorie intake d. Place the client on a low-carb diet - c. Maintain a daily count of the client's calorie intake A nurse is caring for a client in the emergency department who experienced a full thickness burn injury to the lower torso 1 hr ago. Which of the following findings should the nurse expect? a. Decreased respiratory rate b. Urinary diuresis c. Hypotension d. Bradycardia - c. Hypotension . A nurse working in the emergency department is caring for a client who has a burn injury. After securing the client's airway, which of the following interventions should the nurse take first? a. Cleanse the client's wounds b. Administer analgesic medication c. Start an IV with a large-bore needle d. Increase the room temperature - c. Start an IV with a large-bore needle A nurse is planning care for a client who has full-thickness burns on the lower extremities. Which of the following interventions should the nurse include? a. Apply new gloves when alternating between wound care sites b. Provide a diet of fresh fruits and vegetables for the client c. Limit visitation time for the client's children to 40 min per day d. Clean the equipment in the client's room once per week - a. Apply new gloves when alternating between wound care sites A nurse is caring for a client who has an arteriovenous graft. Which of the following findings indicates adequate circulation of the graft? a. Absence of a bruit b. Palpable thrill c. Normotensive blood pressure d. Dilated appearance of the graft - b. Palpable thrill A nurse is presenting an in-service program about Parkinson's disease (PD). Which of the following statements should the nurse include in the teaching? a. PD results from a decreased amount of dopamine in the client's brain b. PD causes clients to have an increased sympathetic nervous system response c. PD results in the development of neurofibrillary tangles within the client's brain d. PD manifestations worsen due to the client's decreased production of acetylcholine - a. PD results from a decreased amount of dopamine in the client's brain