CMS NR341 QUESTIONS AND ANSWERS ALL CORRECT

CMS NR341 A nurse is caring for a client who had a total hip arthroplasty. Which of the following actions should the nurse take to prevent hip dislocation? Correct Answer: Place two bed pillows between the legs when in bed. A nurse is providing teaching to a client who has diabetes mellitus. Which of the following instructions should the nurse provide to the client to help prevent the development of nephropathy? Correct Answer: a. Controlling hypertension A nurse in a long-term care facility is caring for a bedridden client. Which of the following findings should alert the nurse to a potential complication of the client's immobility? Correct Answer: Confusion A nurse is instructing a client who has a new diagnosis of type 1 diabetes mellitus about the sick-day rules. Which of the following statements by the client indicates an understanding of the teaching? Correct Answer: "I will check my urine for ketones if my blood glucose is greater than 240 mg/dL." 1. A nurse is reviewing medications taken at home with a client who has angina. Which of the following statements by the client indicates an understanding of the teaching? I should withhold my metoprolol if my heart rate is above 100 bpm Correct Answer: I should lie down before taking dose of isosorbide dinitrate 1. A nurse is teaching a client who has Graves' disease about recognizing the manifestation of thyroid storm. Which of the following findings should the nurse include in the teaching? Correct Answer: Increased temperature 1. A nurse is caring for a client who is receiving total parenteral nutrition through 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? Correct Answer: Switch the infusion to a 10% dextrose solution. A nurse is providing instructions about foot care for a client who has peripheral disease. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? Correct Answer: I rest in my recliner with my feet elevated for about an hour every afternoon 1. A nurse is providing discharge teaching to a client who has an ileostomy. Which of the following client statements indicates an understanding of the teaching? Correct Answer: a. I will expect my stools to be loose 11. A nurse is caring for a client who is receiving chemotherapy and requests information about acupuncture to relieve some of the side effects. Which of the following findings should the nurse identify as a contraindication to receiving this alternative therapy? Correct Answer: a. Lymphedema 1. A nurse is caring for a client who is 2 days postoperative following below the knee amputation and asks about the purpose of maintaining an elastic bandage around the residual limb of the extremity. Which of the following is an appropriate response by the nurse? Correct Answer: The elastic bandage will prevent a postoperative wound infection 1. 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? Correct Answer: Insert a large bore IV catheter 1. A nurse is providing discharge teaching to a client who has an impaired immune system due to chemotherapy. Which of the following information should the nurse include in the teaching? Correct Answer: Wash your perineal area two times each day with antimicrobial soap A nurse is caring for a client who is receiving epidural analgesia. Which of the following findings is the nurse's priority? Correct Answer: Hypotension 1. A nurse is reviewing the laboratory results of a client who has COPD and severe dyspnea. Which of the following ABG values should the nurse expect? Correct Answer: PaCO2 48 mmHg 1. A nurse is planning care for a client following a cardiac catheterization. Which of the following actions should the nurse take? Correct Answer: Maintain the client's affected extremity in extension 1. nurse is reviewing the medical record of a client who has nephrotic syndrome. Which of the following findings should the nurse expect? Correct Answer: Proteinuria 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? Correct Answer: Hold breaths 3 to 5 seconds before exhaling 1. A nurse is preparing a client who is to undergo a thoracentesis. The nurse should place the client in which of the following positions? Correct Answer: Upright on the edge of the bed leaning over the bedside table 1. 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? Correct Answer: Metformin 1. A nurse is caring for a client who has contusion of the brainstem and reports thirst. The client's urinary output was 4,000 mL over the past 24 hr. The nurse should anticipate a prescription for which of the following IV medications? Correct Answer: Desmopressin 1. A nurse is caring for a client who is receiving continuous bladder irrigation following a transurethral resection of the prostate. The client reports spasms and the nurse observes decreased urinary output. Which of the following actions should the nurse take? Correct Answer: Flush the catheter manually with 0.9% sodium chloride Patient with lumbar puncture order, what position should nurse have him in Correct Answer: laying in bed in cannonball position (diagram 4) 1. A nurse is assessing a client who has an arteriovenous (AV) fistula in the left forearm. Which of the following findings should the nurse identify as an indication of a complication at the vascular access site? Correct Answer: Absence of bruit 1. A nurse in the emergency department is caring for a client who has a gunshot wound to the abdomen. which of the following should the nurse take first? Correct Answer: Check the color of the client's skin 1. A nurse in the emergency department is caring for a client who has a gunshot wound to the abdomen. which of the following should the nurse take first? Correct Answer: Check the color of the client's skin 1. A nurse is planning care for a client who has a newly implanted arteriovenous graft in the right arm. Which of the following actions should the nurse include in the plan of care? Correct Answer: Palpate the site for thrill 1. A nurse is caring for a client who has a sealed radiation implant which of the following actions should the nurse take? Correct Answer: Attach the dosimeter badge to patient's gown 1. A nurse is providing discharge teaching for a client who has new tracheostomy. Which of the following statements by the client indicates an understanding of the teaching Correct Answer: I'll cleanse the cannula with half strength hydrogen peroxide A critical care nurse is assessing a client who has a severe head injury. In response to painful stimuli the client does not open her eyes, displays decerebrate posturing, and makes incomprehensible sounds. Which of the following Glasgow coma scale scores should the nurse assign the client? Correct Answer: 5 A nurse is caring for a client with severe burn injury. The nurse should recognize which of the following client findings as an indication of hypovolemic shock? Correct Answer: Potassium 6.8 mEq/L Patient with transverse colon colostomy placement should be where Correct Answer: 1. Diagram will show, chose LL Abdomen 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? Correct Answer: Muscle twitching A nurse is taking an admission history from a client who reports Raynaud's disease. Which of the following assessment findings should the nurse identify as a potential trigger for exacerbations of Raynaud's? Correct Answer: Taking amlodipine for hypertension A nurse is planning care for a client who is 8 hrs postoperative following a coronary artery bypass grafting. which of the following assessments should the nurse plan to perform first? Correct Answer: Auscultate breath sounds 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? Correct Answer: insert a urinary catheter A nurse is providing discharge teaching to a client who has heart failure and instruct hi to limit sodium intake to 2g per day. which of the following statements by the client indicates an understanding of the teaching? Correct Answer: " I can have a frozen fruit juice with a meal" A nurse is assessing a client following exudation from a ventilator. For which of the following findings should the nurse intervene immediately? Correct Answer: Stridor A nurse is caring for an older adult client who has dementia. which of the following questions should the nurse ask to assess the clients abstract thinking? Correct Answer: "What is meant by the saying "Don't beat around the bush?