PN COMPREHENSIVE ONLINE ACTUAL
STUDY QUESTIONS WITH ELABORATE
RATIONALE ANSWERS | GUANRATEE
PASS
1. A nurse is assisting in the care of a client who is pregnant. For each
discharge instruction, click to specify of each action is recommended or
contraindicated for the client. - ANSWER Recommended:
- eat every 2 to 3 hr
- alternate eating solid foods and liquids
- increase intake of high-protein foods
- drink warm ginger ale when nauseated
2. A nurse is assisting with the care of a client who is 24 hr postoperative
following a cesarean birth. Complete the following sentence by using the
lists of options. - ANSWER The client is at risk for developing SEIZURES
as evidenced by SEVERE FEATURES OF PREECLAMPSIA
3. A nurse is caring for a client on a medical-surgical unit. Complete the
following sentence by using a list of the options. - ANSWER The nurse
recognizes that the client is having a possible febrile nonhemolytic
transfusion reaction. The nurse should first STOP THE TRANSFUSION
and then plan to administer AN ANTIPYRETIC
4. A nurse is assisting in the care of a client who is in the emergency
department (ED). For each body system below, click to specify the potential
nursing intervention that would be appropriate for the care of the client.
Each body system may support more than 1 potential nursing intervention. -
ANSWER Respiratory:
, - administer naloxone
Cardiovascular:
- monitor the client for hypotension
- observe the client for pinpoint pupils
5. A nurse is preparing a client on the medical-surgical unit for hemodialysis.
Which of the following actions should the nurse take? - ANSWER
Auscultate the arteriovenous (AV) access site
6. A nurse is monitoring a client who is 12 hr postoperative following a
cholecystectomy and received morphine 30 min ago for pain. The nurse
should identify which of the following findings as an adverse effect of the
medication? - ANSWER Respiratory rate 10/min
7. A nurse in a provider's office is caring for four clients. Which of the
following clients should the nurse see first? - ANSWER A client who is at
36 weeks of gestation and reports painless vaginal bleeding
8. A nurse is working with an interpreter to assist the provider with explaining
a diagnostic procedure to a client who speaks a different language than the
nurse. Which of the following actions should the nurse? - ANSWER Ensure
the interpreter is culturally compatible with the client
9. A nurse is collecting data from a client who is at 34 weeks of gestation and
has gestational diabetes. Which of the following findings should the nurse
report to the provider as an indication of hyperglycemia? - ANSWER
Polyuria
,10.A nurse is assisting with the care of a client in an inpatient psychiatric unit.
Which of the following actions should the nurse take? Select all that apply. -
ANSWER - ask about the client's method of lethality
- ensure that all windows and exit doors are locked
- ensure that the client does not have access to sharp objects, including
silverware
- observe the client swallow all prescribed medications
- Provide one-on-one observation
11.A nurse in the emergency department (ED) is assisting in the care of a client
- ANSWER The nurse should suspect the client is experiencing
SEROTONIN SYNDROME as evidenced by the client's ALTERED
MENTAL STATUS
12.A nurse is caring for a client in an outpatient setting. Complete the following
sentence by using the lists of options. - ANSWER The client is exhibiting
manifestations of HEART FAILURE as evidenced by the client's drop BNP
LEVEL
13.A nurse is collecting data from a school-age child who has sustained a skull
fracture. Which of the following is a manifestation of increased intracranial
pressure? - ANSWER Confusion about knowing their own name
14.A nurse is assisting with the care of an adolescent client in the emergency
department. For each finding, click to specify of the finding is consistent
with bacterial meningitis or encephalitis. Each finding may support more
than 1 disease process. - ANSWER Bacterial Meningitis:
- rash
- mental status
- pain
- photophobia
- temperature
Encephalitis:
, - mental status
- pain
- temperature
15.A nurse is collecting data from a client who is scheduled for surgery. 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. - ANSWER - hemoglobin level
- allergy
- family history
16.A nurse is in an outpatient setting is assisting with the care of a client.
Complete the diagram by dragging from the choices below to specify what
condition the client is most likely experiencing, 2 actions the nurse should
take to address that condition and 2 parameters the nurse should monitor to
assess the client's progress. - ANSWER Actions to take:
- prepare to administer antibiotics
- encourage increased fluid intake
Condition Most likely Experiencing:
- pyelonephritis
Parameters to monitor:
- fever
- BUN
17.A nurse is assisting with the care of a client who is postoperative. Click to
highlight the findings that require immediate follow-up. To deselect a
finding, click on the finding again. - ANSWER - Respiratory rate 26/min
- blood-tinged sputum
- bp 98/60 mmHg
- client reports shortness of breath and chest pain
- D-dimer 700ng/mL
- Client reports feeling anxious and appears restless
STUDY QUESTIONS WITH ELABORATE
RATIONALE ANSWERS | GUANRATEE
PASS
1. A nurse is assisting in the care of a client who is pregnant. For each
discharge instruction, click to specify of each action is recommended or
contraindicated for the client. - ANSWER Recommended:
- eat every 2 to 3 hr
- alternate eating solid foods and liquids
- increase intake of high-protein foods
- drink warm ginger ale when nauseated
2. A nurse is assisting with the care of a client who is 24 hr postoperative
following a cesarean birth. Complete the following sentence by using the
lists of options. - ANSWER The client is at risk for developing SEIZURES
as evidenced by SEVERE FEATURES OF PREECLAMPSIA
3. A nurse is caring for a client on a medical-surgical unit. Complete the
following sentence by using a list of the options. - ANSWER The nurse
recognizes that the client is having a possible febrile nonhemolytic
transfusion reaction. The nurse should first STOP THE TRANSFUSION
and then plan to administer AN ANTIPYRETIC
4. A nurse is assisting in the care of a client who is in the emergency
department (ED). For each body system below, click to specify the potential
nursing intervention that would be appropriate for the care of the client.
Each body system may support more than 1 potential nursing intervention. -
ANSWER Respiratory:
, - administer naloxone
Cardiovascular:
- monitor the client for hypotension
- observe the client for pinpoint pupils
5. A nurse is preparing a client on the medical-surgical unit for hemodialysis.
Which of the following actions should the nurse take? - ANSWER
Auscultate the arteriovenous (AV) access site
6. A nurse is monitoring a client who is 12 hr postoperative following a
cholecystectomy and received morphine 30 min ago for pain. The nurse
should identify which of the following findings as an adverse effect of the
medication? - ANSWER Respiratory rate 10/min
7. A nurse in a provider's office is caring for four clients. Which of the
following clients should the nurse see first? - ANSWER A client who is at
36 weeks of gestation and reports painless vaginal bleeding
8. A nurse is working with an interpreter to assist the provider with explaining
a diagnostic procedure to a client who speaks a different language than the
nurse. Which of the following actions should the nurse? - ANSWER Ensure
the interpreter is culturally compatible with the client
9. A nurse is collecting data from a client who is at 34 weeks of gestation and
has gestational diabetes. Which of the following findings should the nurse
report to the provider as an indication of hyperglycemia? - ANSWER
Polyuria
,10.A nurse is assisting with the care of a client in an inpatient psychiatric unit.
Which of the following actions should the nurse take? Select all that apply. -
ANSWER - ask about the client's method of lethality
- ensure that all windows and exit doors are locked
- ensure that the client does not have access to sharp objects, including
silverware
- observe the client swallow all prescribed medications
- Provide one-on-one observation
11.A nurse in the emergency department (ED) is assisting in the care of a client
- ANSWER The nurse should suspect the client is experiencing
SEROTONIN SYNDROME as evidenced by the client's ALTERED
MENTAL STATUS
12.A nurse is caring for a client in an outpatient setting. Complete the following
sentence by using the lists of options. - ANSWER The client is exhibiting
manifestations of HEART FAILURE as evidenced by the client's drop BNP
LEVEL
13.A nurse is collecting data from a school-age child who has sustained a skull
fracture. Which of the following is a manifestation of increased intracranial
pressure? - ANSWER Confusion about knowing their own name
14.A nurse is assisting with the care of an adolescent client in the emergency
department. For each finding, click to specify of the finding is consistent
with bacterial meningitis or encephalitis. Each finding may support more
than 1 disease process. - ANSWER Bacterial Meningitis:
- rash
- mental status
- pain
- photophobia
- temperature
Encephalitis:
, - mental status
- pain
- temperature
15.A nurse is collecting data from a client who is scheduled for surgery. 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. - ANSWER - hemoglobin level
- allergy
- family history
16.A nurse is in an outpatient setting is assisting with the care of a client.
Complete the diagram by dragging from the choices below to specify what
condition the client is most likely experiencing, 2 actions the nurse should
take to address that condition and 2 parameters the nurse should monitor to
assess the client's progress. - ANSWER Actions to take:
- prepare to administer antibiotics
- encourage increased fluid intake
Condition Most likely Experiencing:
- pyelonephritis
Parameters to monitor:
- fever
- BUN
17.A nurse is assisting with the care of a client who is postoperative. Click to
highlight the findings that require immediate follow-up. To deselect a
finding, click on the finding again. - ANSWER - Respiratory rate 26/min
- blood-tinged sputum
- bp 98/60 mmHg
- client reports shortness of breath and chest pain
- D-dimer 700ng/mL
- Client reports feeling anxious and appears restless
