GREEN LIGHT TEST A WITH 100%
CORRECT ANSWERS
A nurse is caring for a client who has an order for a 12-lead ECG. Which of the following
actions should the nurse take? - Answer- b. Instruct the client to take slow, deep
breaths.
A newly admitted client tells the nurse that he does not have an advance directive.
Which of the following is the appropriate action for the nurse to take? - Answer- b.
Provide the client with written information about advance directives.
A nurse is observing a client who is in the manic phase of bipolar disorder. The client
states, "Don't need to eat today. Where's the money? Time to write that speech." The
nurse should document this as which of the following? - Answer- c. Flight of ideas.
A nurse is reinforcing dietary teaching to a client who has end-stage renal failure. Which
of the following instructions should the nurse include in the teaching? - Answer- a.
Decrease calcium intake. c. Decease sodium intake.
A nurse is assisting with the admission of a client who attempted suicide. When the
nurse processes the client's belongings, which of the following items should the nurse
remove from the client's suitcase? - Answer- b. Perfume d. Emery Boards.
A nurse is collecting data from a client at an urgent care clinic. The client tells the nurse
that she hasn't been able to sleep since the death of her father 2 days ago. Which of the
following is the nurse's priority action? - Answer- c. Discuss coping skills that have
worked for the client previously.
A nurse is planning care for a client who is 6 hours postoperative following a right knee
arthroplasty. Which of the following interventions should the nurse include in the client's
care plan? - Answer- b. Place a pillow under the client's surgical knee.
A nurse in pediatric clinic is reviewing the history of a 11-year-old child. Which of the
following immunizations should the nurse anticipate administering? - Answer- a.
rotavirus c. meningococcal conjugate
A nurse is caring for a client who was recently diagnosed with paranoid schizophrenia
and is taking risperidone (risperdal). Which of the following statements by the family
,indicates a need for further teaching? - Answer- a. "Our son's symptoms will stop as
soon as he begins his medications."
A nurse is caring for a newly postoperative client who has unilateral breath sounds and
asymmetrical chest expansion. The nurse should recognize these findings are indicative
of which of the following and should be reported to the provider? - Answer- a.
atelectasis.
A nurse is planning care for a client with delirium. Which of the following should the
nurse recognize as interfering with the client's recovery? - Answer- c. providing the
client with activities that vary daily.
A nurse is caring for a client who has paranoid schizophrenia and believes that she is
being followed by FBI agents who are pretending to be psychiatric staff. Which of the
following responses should the nurse make? - Answer- b. "The psychiatric staff are not
FBI. They are here to help you."
A nurse is monitoring a client who is in labor. Which of the following findings needs
further evaluation? - Answer- b. Uterine contractions lasting 100 to 120 seconds.
A nurse is taking the vital signs of an adult client who has just been transferred from the
PACU to the clinical unit. Which of the following findings should the nurse recognize as
the most significant? - Answer- c. Temperature 36 C (96.8 F)
A nurse observes a client who has Alzheimer's disease and is experiencing aphasia.
Which of the following behaviors should the nurse expect? - Answer- c. Difficulty
understanding spoken words.
A nurse in a long-term care facility is caring for an older adult client who has a history of
hypertension. Which of the following is indicative of transient ischemic attacks? -
Answer- a. pain radiating down the left arm c. sudden loss of vision in one eye.
A nurse is caring for a client experiencing alcohol withdrawal. Which of the following
medications should the nurse anticipate administering? - Answer- d. Lorazepam
(Ativan)
A nurse is caring for a client who has borderline personality disorder. The client states,
"I look forward to seeing you in the morning because the night nurse treats me badly."
Which of the following behaviors is the client likely demonstrating? - Answer- a. Splitting
A nurse is planning a health-promotion program for high school students. Which of the
following facts about cigarette smoking is likely to be most effective in changing the
adolescents' attitudes towards smoking? - Answer- c. Smoking causes unattractive
stains on the teeth and hands.
, A nurse is caring for a group of clients, which of the following can be assigned to an
assistive personnel? - Answer- a. Collecting a stool specimen to test for occult blood.
A nurse is working on a unit for clients with dementia. Which of the following client
situations requires the nurse to write an incident report? - Answer- c. A client is found
lying on the floor next to a chair.
A nurse is discharging a client who was admitted for newly diagnosed type 2 diabetes
mellitus. The client is independent and lives alone. Which of the following should be
included in the discharge plan? - Answer- c. Refer the client to a diabetic support group.
A nurse is caring for a client who has type 2 diabetes mellitus and a blood glucose level
of 60 mg/dL. For which of the following findings should the nurse monitor? - Answer- a.
Clammy Skin
A female client who is an abusive marriage has discusses with the nurse strategies to
prevent this abuse. which of the following client statements indicate an understanding of
an appropriate strategy? - Answer- a. "I need to recognize the signs that my husband is
becoming abusive." c. "I need to identify what triggers my husband's anger to prevent
his abuse."
A charge nurse in a long-term care facility is preparing to administer noon insulin to a
client. The nurse observes that the assistive personnel (AP) has no documented the
client's blood glucose level. Which of the following actions should the charge nurse take
first? - Answer- d. Determine if the AP has completed the assignment.
A client is scheduled for an outpatient colonoscopy. which of the following actions is a
nursing responsibility in the informed consent process? - Answer- a. Verify that there is
a signed and witnesses consent form in the client's chart.
A nurse smells alcohol on the breath of an assistive personnel (AP) during report.
Which of the following actions should the nurse take? - Answer- c. Report the situation
to the nurse manager.
A nurse from a medical-surgical unit is floating to a postpartum unit. Which of the
following clients is an appropriate assignment for the nurse to accept? - Answer- b. A
client who had a cesarean delivery 24hr ago.
A nurse in a provider's office is collecting data from a parent of an infant who is being
screened for cystic fibrosis. Which of the following supports a diagnosis of cystic
fibrosis? - Answer- a. Frothy stools.
When caring for an assigned group of clients, the nurse should wear gloves when -
Answer- a. performing oral hygiene.
CORRECT ANSWERS
A nurse is caring for a client who has an order for a 12-lead ECG. Which of the following
actions should the nurse take? - Answer- b. Instruct the client to take slow, deep
breaths.
A newly admitted client tells the nurse that he does not have an advance directive.
Which of the following is the appropriate action for the nurse to take? - Answer- b.
Provide the client with written information about advance directives.
A nurse is observing a client who is in the manic phase of bipolar disorder. The client
states, "Don't need to eat today. Where's the money? Time to write that speech." The
nurse should document this as which of the following? - Answer- c. Flight of ideas.
A nurse is reinforcing dietary teaching to a client who has end-stage renal failure. Which
of the following instructions should the nurse include in the teaching? - Answer- a.
Decrease calcium intake. c. Decease sodium intake.
A nurse is assisting with the admission of a client who attempted suicide. When the
nurse processes the client's belongings, which of the following items should the nurse
remove from the client's suitcase? - Answer- b. Perfume d. Emery Boards.
A nurse is collecting data from a client at an urgent care clinic. The client tells the nurse
that she hasn't been able to sleep since the death of her father 2 days ago. Which of the
following is the nurse's priority action? - Answer- c. Discuss coping skills that have
worked for the client previously.
A nurse is planning care for a client who is 6 hours postoperative following a right knee
arthroplasty. Which of the following interventions should the nurse include in the client's
care plan? - Answer- b. Place a pillow under the client's surgical knee.
A nurse in pediatric clinic is reviewing the history of a 11-year-old child. Which of the
following immunizations should the nurse anticipate administering? - Answer- a.
rotavirus c. meningococcal conjugate
A nurse is caring for a client who was recently diagnosed with paranoid schizophrenia
and is taking risperidone (risperdal). Which of the following statements by the family
,indicates a need for further teaching? - Answer- a. "Our son's symptoms will stop as
soon as he begins his medications."
A nurse is caring for a newly postoperative client who has unilateral breath sounds and
asymmetrical chest expansion. The nurse should recognize these findings are indicative
of which of the following and should be reported to the provider? - Answer- a.
atelectasis.
A nurse is planning care for a client with delirium. Which of the following should the
nurse recognize as interfering with the client's recovery? - Answer- c. providing the
client with activities that vary daily.
A nurse is caring for a client who has paranoid schizophrenia and believes that she is
being followed by FBI agents who are pretending to be psychiatric staff. Which of the
following responses should the nurse make? - Answer- b. "The psychiatric staff are not
FBI. They are here to help you."
A nurse is monitoring a client who is in labor. Which of the following findings needs
further evaluation? - Answer- b. Uterine contractions lasting 100 to 120 seconds.
A nurse is taking the vital signs of an adult client who has just been transferred from the
PACU to the clinical unit. Which of the following findings should the nurse recognize as
the most significant? - Answer- c. Temperature 36 C (96.8 F)
A nurse observes a client who has Alzheimer's disease and is experiencing aphasia.
Which of the following behaviors should the nurse expect? - Answer- c. Difficulty
understanding spoken words.
A nurse in a long-term care facility is caring for an older adult client who has a history of
hypertension. Which of the following is indicative of transient ischemic attacks? -
Answer- a. pain radiating down the left arm c. sudden loss of vision in one eye.
A nurse is caring for a client experiencing alcohol withdrawal. Which of the following
medications should the nurse anticipate administering? - Answer- d. Lorazepam
(Ativan)
A nurse is caring for a client who has borderline personality disorder. The client states,
"I look forward to seeing you in the morning because the night nurse treats me badly."
Which of the following behaviors is the client likely demonstrating? - Answer- a. Splitting
A nurse is planning a health-promotion program for high school students. Which of the
following facts about cigarette smoking is likely to be most effective in changing the
adolescents' attitudes towards smoking? - Answer- c. Smoking causes unattractive
stains on the teeth and hands.
, A nurse is caring for a group of clients, which of the following can be assigned to an
assistive personnel? - Answer- a. Collecting a stool specimen to test for occult blood.
A nurse is working on a unit for clients with dementia. Which of the following client
situations requires the nurse to write an incident report? - Answer- c. A client is found
lying on the floor next to a chair.
A nurse is discharging a client who was admitted for newly diagnosed type 2 diabetes
mellitus. The client is independent and lives alone. Which of the following should be
included in the discharge plan? - Answer- c. Refer the client to a diabetic support group.
A nurse is caring for a client who has type 2 diabetes mellitus and a blood glucose level
of 60 mg/dL. For which of the following findings should the nurse monitor? - Answer- a.
Clammy Skin
A female client who is an abusive marriage has discusses with the nurse strategies to
prevent this abuse. which of the following client statements indicate an understanding of
an appropriate strategy? - Answer- a. "I need to recognize the signs that my husband is
becoming abusive." c. "I need to identify what triggers my husband's anger to prevent
his abuse."
A charge nurse in a long-term care facility is preparing to administer noon insulin to a
client. The nurse observes that the assistive personnel (AP) has no documented the
client's blood glucose level. Which of the following actions should the charge nurse take
first? - Answer- d. Determine if the AP has completed the assignment.
A client is scheduled for an outpatient colonoscopy. which of the following actions is a
nursing responsibility in the informed consent process? - Answer- a. Verify that there is
a signed and witnesses consent form in the client's chart.
A nurse smells alcohol on the breath of an assistive personnel (AP) during report.
Which of the following actions should the nurse take? - Answer- c. Report the situation
to the nurse manager.
A nurse from a medical-surgical unit is floating to a postpartum unit. Which of the
following clients is an appropriate assignment for the nurse to accept? - Answer- b. A
client who had a cesarean delivery 24hr ago.
A nurse in a provider's office is collecting data from a parent of an infant who is being
screened for cystic fibrosis. Which of the following supports a diagnosis of cystic
fibrosis? - Answer- a. Frothy stools.
When caring for an assigned group of clients, the nurse should wear gloves when -
Answer- a. performing oral hygiene.
