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Nurs 465 Practice Questions on Setting Priorities Questions and Correct Answers/ Latest Update / Already Graded

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Nurs 465 Practice Questions on Setting Priorities Questions and Correct Answers/ Latest Update / Already Graded

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Page |1


Nurs 465 Practice Questions on Setting
Priorities Questions and Correct Answers/
Latest Update / Already Graded
A nurse is caring for a client who has dementia. The client is agitated
and is having difficulty staying in his chair. Which of the following
actions should the nurse take first?

Ans: place a seat alarm in the client's chair


A nurse is caring for a client who is in the first stage of labor. The nurse
observes the umbilical cord protruding from the vagina. Which of the
following actions should the nurse perform first?

Ans: Insert a gloved hand into the vagina to relieve pressure on
the cord


A nurse is assessing a client for a suspected anaphylactic reaction
following a CT scan with contrast media. For which of the following
client finding should the nurse intervene first?

Ans: stridor


A nurse is caring for a client who has CHF and is taking digoxin daily.
The client refused breakfast and is complaining of nausea and
weakness. Which of the following actions should the nurse take first?


All rights reserved © 2025/ 2026 |

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Ans: check the client's vital signs


A nurse is removing PPE after giving direct care to a client who requires
isolation. Which of the following PPE items should the nurse remove
first?

Ans: Gloves


A nurse in an emergency department is caring for a client who has
anaphylaxis following a bee sting. Which of the following actions
should the nurse take first?

Ans: Auscultate for wheezing


A nurse sees and assistive personnel (AP) entering the room of a client
who requires transmission based precautions without using the
appropriate PPE. Which of the following actions should the nurse take
first?

Ans: Provide the appropriate PPE to the AP


A nurse is working with an assistive personnel (AP) to care for a group
of clients on the pediatric unit. Which of the following tasks should the
nurse have the AP perform first?




All rights reserved © 2025/ 2026 |

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Ans: check to see if the elbow restraint is in place for an infant
who is postoperative from a surgical correction of a cleft palate


A nurse is caring for a client who attacked one of her friends and is
administered to the psychiatric unit. Which of the following actions
should the nurse take first?

Ans: Set behavioral limits for the client


A nurse is caring for a client who has a spinal cord injury and suspects
the client is developing autonomic dysreflexia. Which of the following
actions should the nurse take first?

Ans: Place the client in a sitting position


A nurse is assessing four clients on a medical surgical unit. Which of the
following client should the nurse care for first?

Ans: A client who has a cast on the left leg and reports
numbness and paresthesia


A nurse is caring for a client who develops a pulmonary embolism.
Which of the following interventions should the nurse implement first?

Ans: Administer oxygen therapy



All rights reserved © 2025/ 2026 |

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While caring for a client, the nurse experiences a needle stick injury.
Which of the following actions should the nurse take first?

Ans: Wash the site of the injury with soap and water


A nurse is assessing a client's abdomen who reports stomach pain.
Which of the following actions should the nurse take first?

Ans: Inspect


A nurse in a clinic is collecting a history from a client who reports that a
member of his family just received a diagnosis of pulmonary
tuberculosis. The nurse should expect that the provider will prescribe
which of the following diagnostic tests first?

Ans: Nucleic acid amplification test (NAAT)


A nurse is caring for a client who is in active labor and notes late
deceleration in the FHR. Which of the following actions should the
nurse take first?

Ans: Change the client's position


A nurse has been reassigned from her regular area of work to a unit
that is short staffed. Which of the following actions should the nurse
take first?


All rights reserved © 2025/ 2026 |

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