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A 3-year-old boy was successfully D. Children usually resume their toileting
toilet trained prior to his admission behaviors when they leave the hospital
to the hospital for injuries sustained
from a fall. His parents are very
concerned that the child has
regressed in his toileting behaviors.
Which information should the nurse
provide to the parents?
A. A retraining program will need to
be initiated when the child returns
home.
B. Diapering will be provided since
hospitalization is stressful to
preschoolers
C. A potty chair should be brought
from home so he can maintain his
toileting skills
D. Children usually resume their
toileting behaviors when they leave
the hospital
,A 7-year old is admitted to the D. Serum potassium of 3.0 mg/dL
hospital with persistent vomiting,
and a nasogastric tube attached to
low intermittent suction is applied.
Which finding is most important for
the nurse to report to the
healthcare provider?
A. Shift intake of 640mL IV fluids
plus 30mL PO ice chips
B. Serum pH of 7.45
C. Gastric output of 100 mL in the
last 8 hours
D. Serum potassium of 3.0 mg/dL
An adolescent who was diagnosed C. Had a cold and ear infection for the past two
with diabetes mellitus Type 1 at the days
age of 9, is admitted to the hospital
in diabetic ketoacidosis. Which
occurrence is the most likely cause
of the ketoacidosis?
A. Ate an extra peanut butter
sandwich before gym class
B. incorrectly administered too
much insulin
C. Had a cold and ear infection for
the past two days
D. Skipped eating lunch
,An adult client is admitted to the B. Explain the reason for using only non-narcotics
emergency department after falling
from the ladder. While waiting to
have a computed tomography (CT)
scan, the client requests something
for a severe headache. When the
nurse offers a prescribed dose of
acetaminophen, the client asks for
something stronger. Which
intervention should the nurse
implement?
A. Review client's history for use of
illicit drugs
B. Explain the reason for using only
non-narcotics
C. Assess client's pupils for their
reaction to light
D. Request that the CT scan be
done immediately
An adult female client tells the A. Explore client's readiness to discuss the
nurse that though she is afraid her situation
abusive boyfriend might one day
kill her, she keeps hoping that he
will change. Which action should
the nurse take first?
A. Explore client's readiness to
discuss the situation
B. Determine the frequency and
type of client's abuse
C. Report the finding to the police
department
D. Discuss treatment options for
abusive partners
, After administering a 12 ounce can 495
of nutritional supplement, 3
teaspoons of medication, and 120
mL of water, the nurse should
document the client's fluid intake as
how many mL?
After administering a proton pump B. Ask the client about gastrointestinal pain
inhibitor (PPI), which action should
the nurse take to evaluate the
effectiveness of the medication?
A. Auscultate for bowel sounds in
all quadrants
B. Ask the client about
gastrointestinal pain
C. Monitor the client's serum
electrolyte levels
D. Measure the client's fluid intake
and output
After an older client receives C. Notify the healthcare provider of the results
treatment for drug toxicity, the
healthcare provider prescribes a
24-hour creatinine clearance test.
Prior to starting the urine
collection, the nurse notes that the
client's serum creatinine is 0.3
mg/dL. Which action should the
nurse implement?
A. Evaluate the client's serum BUN
level
B. Initiate the urine collection as
prescribed
C. Notify the healthcare provider of
the results
D. Assess the client for signs of
hypokalemia