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Practice Questions and Correct
Answers the Latest Update
A nurse is assisting in the care of a client who is 1 hr postpartum.
Exhibit 1
Nurses' Notes
1200:
Large amount of lochia rubra noted on perineal pad. Fundus boggy at two
fingerbreadths above the umbilicus.Oxytocin 20 units being administered via
continuous IV infusion
1215:
Large amount of lochia rubra with several large clots noted. Client reports
feeling anxious. Skin cool and clammy. Provider notified.
Exhibit 2
Vital Signs
1200:
Temperature 37.5° C (99.5° F)Heart rate 92/minRespiratory
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✓ Select the 6 actions the nurse should take.
✓
✓ Weigh the perineal pads.
✓ Insert an indwelling urinary catheter.
✓ Administer methylergonovine.
✓ Provide emotional support.
✓ Administer oxygen at 12 L/min via nonrebreather face mask.
✓ Firmly massage the uterine fundus.
✓
✓
✓ When taking action for the client, the nurse should firmly massage the uterine
fundus, administer methylergonovine, weigh the perineal pads, provide emotional
support, insert an indwelling urinary catheter, and administer oxygen at 12 L/min via
nonrebreather face mask. The nurse should identify that the client is experiencing a
postpartum hemorrhage, which requires immediate intervention to prevent
hemorrhagic shock.
A nurse is collecting data from a client who is scheduled for surgery.
Exhibit 1
Vital Signs
0630:
Temperature 36.9° C (98.5° F)Heart rate 74/minRespiratory rate 20/minBlood
pressure 122/76 mmHgOxygen saturation 96% on room air
0730:
Temperature 36.9° C (98.5° F)Heart rate 76/minRespiratory rate 20/minBlood
pressure 128/78 mmHgOxygen saturation 95% on room air
Exhibit 2
Nurses' Notes
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0630:
Client reports restlessness and inability to sleep more than 3 to 4 hr per night
for the last week. Cli
✓ Click to highlight the data collection findings that the nurse should report to the
provider prior to the procedure. To deselect a finding, click on the finding again.
✓ Hemoglobin level
✓ Allergy
✓ Family history
✓
✓
✓
✓ When collecting data from the client and analyzing cues, the nurse should determine
the client's hemoglobin level, latex allergy, and family history of malignant
hyperthermia should be reported to the provider. When the client's hemoglobin
level is below the expected range, the client might require blood products during the
intraoperative phase. The client's allergy to avocados and bananas can indicate an
allergy to latex products and should be reported to the provider. The surgical team
will need to remove all latex products from the operating room. During the
intraoperative phase, the nurses must be diligent in monitoring the client's vital signs
and laboratory values, especially in a client who has a family history of malignant
hyperthermia.
A nurse is caring for a client who is recovering from a stroke and is experiencing
difficulty using eating utensils. The nurse should identify the need for a referral
to which of the following interprofessional team members?
✓ Occupational therapist
✓
✓ The nurse should identify the need for a referral to an occupational therapist to
teach the client how to use special eating utensils.
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A nurse is reviewing the electronic health records of four clients. Which of the
following client conditions should the nurse recognize as reportable to a
regulatory agency?
✓ A client who is newly diagnosed with tuberculosis
✓
✓
✓ The nurse should identify that certain communicable diseases, such as tuberculosis,
require notification of the local and state health departments.
A nurse is caring for a client who is being discharged home following a
cerebrovascular accident. Which of the following documents should the nurse
plan to include with the discharge report?
✓ List of potential complications to report
✓
✓ Discharge instructions are defined as any form of documentation provided to the
client, upon discharge to home, which facilitates safe and appropriate continuity of
care. The nurse should plan to include a list of potential complications that should be
reported to the provider in the client's discharge instructions.
A nurse is reinforcing teaching with the parent of a preschooler who has lactose
intolerance. Which of the following statements by the parent indicates an
understanding of the teaching?
✓ "I should offer my child yogurt that has a probiotic as a snack."
✓
✓ Children who have lactose intolerance should be offered dairy products that have a
probiotic, such as lactobacillus. The probiotic promotes tolerance of lactose in the
colon.
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PN Comprehensive Online
Practice Questions and Correct
Answers the Latest Update
A nurse is assisting in the care of a client who is 1 hr postpartum.
Exhibit 1
Nurses' Notes
1200:
Large amount of lochia rubra noted on perineal pad. Fundus boggy at two
fingerbreadths above the umbilicus.Oxytocin 20 units being administered via
continuous IV infusion
1215:
Large amount of lochia rubra with several large clots noted. Client reports
feeling anxious. Skin cool and clammy. Provider notified.
Exhibit 2
Vital Signs
1200:
Temperature 37.5° C (99.5° F)Heart rate 92/minRespiratory
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✓ Select the 6 actions the nurse should take.
✓
✓ Weigh the perineal pads.
✓ Insert an indwelling urinary catheter.
✓ Administer methylergonovine.
✓ Provide emotional support.
✓ Administer oxygen at 12 L/min via nonrebreather face mask.
✓ Firmly massage the uterine fundus.
✓
✓
✓ When taking action for the client, the nurse should firmly massage the uterine
fundus, administer methylergonovine, weigh the perineal pads, provide emotional
support, insert an indwelling urinary catheter, and administer oxygen at 12 L/min via
nonrebreather face mask. The nurse should identify that the client is experiencing a
postpartum hemorrhage, which requires immediate intervention to prevent
hemorrhagic shock.
A nurse is collecting data from a client who is scheduled for surgery.
Exhibit 1
Vital Signs
0630:
Temperature 36.9° C (98.5° F)Heart rate 74/minRespiratory rate 20/minBlood
pressure 122/76 mmHgOxygen saturation 96% on room air
0730:
Temperature 36.9° C (98.5° F)Heart rate 76/minRespiratory rate 20/minBlood
pressure 128/78 mmHgOxygen saturation 95% on room air
Exhibit 2
Nurses' Notes
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0630:
Client reports restlessness and inability to sleep more than 3 to 4 hr per night
for the last week. Cli
✓ Click to highlight the data collection findings that the nurse should report to the
provider prior to the procedure. To deselect a finding, click on the finding again.
✓ Hemoglobin level
✓ Allergy
✓ Family history
✓
✓
✓
✓ When collecting data from the client and analyzing cues, the nurse should determine
the client's hemoglobin level, latex allergy, and family history of malignant
hyperthermia should be reported to the provider. When the client's hemoglobin
level is below the expected range, the client might require blood products during the
intraoperative phase. The client's allergy to avocados and bananas can indicate an
allergy to latex products and should be reported to the provider. The surgical team
will need to remove all latex products from the operating room. During the
intraoperative phase, the nurses must be diligent in monitoring the client's vital signs
and laboratory values, especially in a client who has a family history of malignant
hyperthermia.
A nurse is caring for a client who is recovering from a stroke and is experiencing
difficulty using eating utensils. The nurse should identify the need for a referral
to which of the following interprofessional team members?
✓ Occupational therapist
✓
✓ The nurse should identify the need for a referral to an occupational therapist to
teach the client how to use special eating utensils.
Examify | Smart Grades | Latest update
, #Examify | #OnlineExams | #TestPrep | #StudyResources | #AcademicSuccess |
#ExamPreparation | #QuizTime | #LearningTools | #Education | #StudentSupport
A nurse is reviewing the electronic health records of four clients. Which of the
following client conditions should the nurse recognize as reportable to a
regulatory agency?
✓ A client who is newly diagnosed with tuberculosis
✓
✓
✓ The nurse should identify that certain communicable diseases, such as tuberculosis,
require notification of the local and state health departments.
A nurse is caring for a client who is being discharged home following a
cerebrovascular accident. Which of the following documents should the nurse
plan to include with the discharge report?
✓ List of potential complications to report
✓
✓ Discharge instructions are defined as any form of documentation provided to the
client, upon discharge to home, which facilitates safe and appropriate continuity of
care. The nurse should plan to include a list of potential complications that should be
reported to the provider in the client's discharge instructions.
A nurse is reinforcing teaching with the parent of a preschooler who has lactose
intolerance. Which of the following statements by the parent indicates an
understanding of the teaching?
✓ "I should offer my child yogurt that has a probiotic as a snack."
✓
✓ Children who have lactose intolerance should be offered dairy products that have a
probiotic, such as lactobacillus. The probiotic promotes tolerance of lactose in the
colon.
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