1. A nurse is planning care for a group d. Providing postmortem care
of clients. Which of the following tasks to a client
should the nurse delegate to an assistive
personnel?
a. Changing the dressing for a client who
has a stage 3 pressure injury
b. Determining a client's response to a di-
uretic
c. Comparing radial pulses for a client who
is postoperative
d. Providing postmortem care to a client
2. A nurse is conducting a health assess- I use ginger when I get car sick
ment for a client who takes herbal supple-
ments. Which of the following statements
by the client indicates an understanding of
the use of the supplements?
A. I take ginkgo biloba for a headache
B. I take echinacea to control my choles-
terol
C. I use ginger when I get car sick
D. I use garlic for my menopausal symp-
toms
3. A nurse is caring for a client who has in- Wear a mask when working
fluenza and isolation precautions in place. within 3 feet of the client
Which of the following actions should the
nurse take to prevent the spread of infec-
tion?
A. Wear a mask when working within 3 feet
of the client
B. Administer metronidazole
C. Don protective eyewear before entering
the room.
D. Place the client in a negative airflow
room.
4.
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A nurse obtains a prescription for wrist Allow room for two fingers to
restraints for a client who is trying to pull fit between the clients skin and
out his NG tube. Which of the following the restraints
actions should the nurse take?
A. Attach the restraints securely to the
side rails of the client's bed.
B. Apply the restraints to allow as little
movement as possible
C.Allow room for two fingers to fit between
the clients skin and the restraints
d. remove the restraints every 4 hours
5. A nurse is admitting a client who has tu- Airborne
berculosis. Which of the following types
of transmission precautions should the
nurse plan to initiate?
A. Droplet
B. Airborne
c. protective environment
d. contact
6. A nurse in a well-child clinic receives a Have your child drink one
telephone call from a parent who states large glass of water
that their child accidentally swallowed
paint thinner. The child is awake and alert.
Which of the following responses should
the nurse make?
A. Have your child drink one large glass of
water.
B. Hang up and call a poison control center
hotline.
C. Bring your child into the clinic later to-
day.
D. Induce vomiting in your child with syrup
of ipecac.
7. A nurse is documenting a client's med- Administered pain medication
ical record. Which of the following entries
should the nurse record.
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A. Oral temperature slightly elevated at
0800
B. Administered pain medication
C. Incision without redness or drainage
D. Drank adequate amounts of fluid with
meals.
8. A nurse is providing oral care for a client Place the client in a side-lying
who is unconscious. Which of the follow- position
ing actions should the nurse take?
A. Place the client in a side-lying position.
B. Brush the clients teeth daily
C. Apply mineral oil to the client's lips
D. Rinse the client's mouth with an alco-
hol-based mouthwash
9. A nurse is collaborating with a risk man- A nurse begins a blood trans-
agement team about potential legal issues fusion without obtaining con-
involving client care. The nurse should sent
identify which of the following situations
is an example of negligence?
A. A nurse administers a medication with-
out first identifying the client.
B. An assistive personnel discusses client
care in the facility cafeteria with visitors
present.
C. A nurse begins a blood transfusion
without obtaining consent.
D. An assistive personnel prevents a client
from leaving the facility.
10. A nurse is collecting a sputum specimen Offer the client oral hygiene
for culture from a client who has a res- after the collection
piratory infection. Which of the following
actions should the nurse take?
A. Wear sterile gloves when collecting the
specimen.
B. Offer the client oral hygiene after the
collection
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C. Collect the specimen in the evening.
D Collect 1 ml of sputum.
11. A nurse is assessing an older client. Which Decreased sense of balance
of the following findings should the nurse
expect?
a. Decreased sense of balance
b. Increased nighttime sleeping
c. Heightened sense of pain
d. Nighttime urinary incontinence
12. A nurse is completing discharge teaching Cut the opening of the pouch
about ostomy care with a client who has 1D8 of an inch larger than the
a new stoma. Which of the following in- stoma
structions should the nurse include in the
teaching? (select all that apply) Place a piece a gauze over
a. "Cut the opening of the pouch 1D8 of anthe stoma while changing the
inch larger than the stoma " pouch
b. "Place a piece a gauze over the stoma
while changing the pouch" Use povidone-iodine to clean
c. "Use povidone-iodine to clean around around the stoma
the stoma"
d. "Empty the ostomy pouch when it be- Empty the ostomy pouch
comes one-third full of contents" when it becomes one-third full
e. expect the stoma to turn a purple-blue of contents
color as its heals"
13. A nurse is preparing to obtain informed Offer written information in the
consent from a client who speaks a differ- client's language
ent language than the nurse. Which of the
following actions should the nurse take?
a. "Request that an assistive personnel in-
terpret the information for the client"
b. "Use proper medical terms when giving
information to the client"
c. "Offer written information in the client's
language"
d. "Avoid using gestures when speaking to
the client"