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A nurse on a telemetry unit is caring for a client who becomes unconscious and
whose monitor displays ventricular tachycardia. Which of the following actions
should the nurse take first after determining the client does not have a
palpable pulse?
A. Assess heart sounds
B. Defibrillate
C. Establish IV access
D. Administer epinephrine
B. Defibrillate
A nurse is admitting a client who 1 week postpartum and reports excessive
vaginal
bleeding. The nurse does not speak the same language as the client. The client's
partner and 10-year-old child are accompanying her. Which of the following
actions should the nurse take to gather the client's admission data?
A. Have the client's child translate
B. Allow the client's partner to translate
C. Request a female interpreter through the facility
D. Ask a nursing student who speaks the same language as the client to translate
C. Request a female interpreter through the facility
,A nurse is caring for a client who is febrile. To reduce the client's fever, the
nurse applies a cooling blanket. Which of the following findings indicates the
client is having an
adverse reaction to the cooling?
a. Flushing
b. Tachycardia
c. Restlessness
d. Shivering
d. Shivering
A nurse is performing an admission assessment for a client who is in the manic
phase of bipolar disorder. Which of the following behaviors should the nurse
expect?
A. Performance of ritualistic behaviors- ocd
B. Suspiciousness and distrust- schizo
C. Distractibility and poor judgment
D. Reports of physical discomfort -anxiety
C. Distractibility and poor judgment
A nurse is caring for an infant who has coarctation of the aorta. Which of the
following should the nurse identify as an expected finding?
A Weak femoral pulses?- they get upper extremity yper, lower extremity hypo
B Frequent nosebleeds- yes
C Upper extremity hypotension
D Increased intracranial pressure
A Weak femoral pulses?- they get upper extremity yper, lower extremity hypo
,A nurse is developing an in-service about personality disorders. Which of the
following information should the nurse include when discussing borderline
personality disorder?
A. "The client might act seductively"- histrionic
B. "The client is overly concerned about minor details"- ocd
C. "The client exhibits impulsive behavior"
D. "The client is exceptionally clingy to others"- dependent
C. "The client exhibits impulsive behavior
A nurse is assessing a client who has a chest tube with a water seal drainage
system. Upon assessment, the nurse notes tidaling in the water seal. Which of
the following is an explanation for the tidaling? TIDLING IN WATER SEAL AND
CONTINUOUS IN SUCTION CHAMBER OKAY! WATER SEAL BUBBLING IS AIR
LEAK.
A. There is a loop of tubing below the drainage system
B. The system is working properly
C. The lung has re-expanded
D. The tubing is partially obstructed by clots
B. The system is working properly
, A nurse in an emergency department is caring for a client who is experiencing
stimulant withdrawal. Which of the following findings should the nurse
expect?
A. Runny nose
B. Decreased appetite -Increased appetite
C. Muscle spasms
D. Fatigue, agitated anxiety, increased appetite
D. Fatigue, agitated anxiety, increased appetite
A charge nurse is teaching new staff members about factors that increase a
client's risk to become violent. Which of the following risk factors should the
nurse include as the best predictor of future violence?
A. A history of being in prison
B. Experiencing delusions
C. Male gender
D. Previous violent behavior
D. Previous violent behavior
A nurse is preparing to feed a newly admitted client who has dysphagia. Which of
the following actions should the nurse plan to take?
A. Instruct the client to lift her chin when swallowing X
B. Talk to the client during feeding X
C. Discourage the client from coughing during feedings
D. Sit at or below the client's eye level during feedings
D. Sit at or below the client's eye level during feedings
Complete Real Exam Questions And Correct Answers (Verified
Answers) Already Graded A+ | Guaranteed Success!! Newest
Exam | Just Released!!
A nurse on a telemetry unit is caring for a client who becomes unconscious and
whose monitor displays ventricular tachycardia. Which of the following actions
should the nurse take first after determining the client does not have a
palpable pulse?
A. Assess heart sounds
B. Defibrillate
C. Establish IV access
D. Administer epinephrine
B. Defibrillate
A nurse is admitting a client who 1 week postpartum and reports excessive
vaginal
bleeding. The nurse does not speak the same language as the client. The client's
partner and 10-year-old child are accompanying her. Which of the following
actions should the nurse take to gather the client's admission data?
A. Have the client's child translate
B. Allow the client's partner to translate
C. Request a female interpreter through the facility
D. Ask a nursing student who speaks the same language as the client to translate
C. Request a female interpreter through the facility
,A nurse is caring for a client who is febrile. To reduce the client's fever, the
nurse applies a cooling blanket. Which of the following findings indicates the
client is having an
adverse reaction to the cooling?
a. Flushing
b. Tachycardia
c. Restlessness
d. Shivering
d. Shivering
A nurse is performing an admission assessment for a client who is in the manic
phase of bipolar disorder. Which of the following behaviors should the nurse
expect?
A. Performance of ritualistic behaviors- ocd
B. Suspiciousness and distrust- schizo
C. Distractibility and poor judgment
D. Reports of physical discomfort -anxiety
C. Distractibility and poor judgment
A nurse is caring for an infant who has coarctation of the aorta. Which of the
following should the nurse identify as an expected finding?
A Weak femoral pulses?- they get upper extremity yper, lower extremity hypo
B Frequent nosebleeds- yes
C Upper extremity hypotension
D Increased intracranial pressure
A Weak femoral pulses?- they get upper extremity yper, lower extremity hypo
,A nurse is developing an in-service about personality disorders. Which of the
following information should the nurse include when discussing borderline
personality disorder?
A. "The client might act seductively"- histrionic
B. "The client is overly concerned about minor details"- ocd
C. "The client exhibits impulsive behavior"
D. "The client is exceptionally clingy to others"- dependent
C. "The client exhibits impulsive behavior
A nurse is assessing a client who has a chest tube with a water seal drainage
system. Upon assessment, the nurse notes tidaling in the water seal. Which of
the following is an explanation for the tidaling? TIDLING IN WATER SEAL AND
CONTINUOUS IN SUCTION CHAMBER OKAY! WATER SEAL BUBBLING IS AIR
LEAK.
A. There is a loop of tubing below the drainage system
B. The system is working properly
C. The lung has re-expanded
D. The tubing is partially obstructed by clots
B. The system is working properly
, A nurse in an emergency department is caring for a client who is experiencing
stimulant withdrawal. Which of the following findings should the nurse
expect?
A. Runny nose
B. Decreased appetite -Increased appetite
C. Muscle spasms
D. Fatigue, agitated anxiety, increased appetite
D. Fatigue, agitated anxiety, increased appetite
A charge nurse is teaching new staff members about factors that increase a
client's risk to become violent. Which of the following risk factors should the
nurse include as the best predictor of future violence?
A. A history of being in prison
B. Experiencing delusions
C. Male gender
D. Previous violent behavior
D. Previous violent behavior
A nurse is preparing to feed a newly admitted client who has dysphagia. Which of
the following actions should the nurse plan to take?
A. Instruct the client to lift her chin when swallowing X
B. Talk to the client during feeding X
C. Discourage the client from coughing during feedings
D. Sit at or below the client's eye level during feedings
D. Sit at or below the client's eye level during feedings
