GRADED A+
Question 1
Which of these actions should a nurse take prior to initiating prescribed antibiotic therapy for a
client who has a urinary tract infection?
Correct Answer
Obtain a urine culture specimen.
Question 2
Which of these interventions should plan for a child who is receiving chelation therapy for lead
poisoning?
Correct Answer
Keeping an accurate record of intake and output.
Question 3
Which of these instructions should a nurse give to a client when collecting a sputum specimen?
Correct Answer
"Take a deep breath, then cough and spit into this container."
Question 4
A patient experiences skin eruptions due to an allergic reaction to a medication. The nurse
demonstrates the BEST documentation with which of the following?
Correct Answer
"Multiple red welts noted over trunk and both arms. Patient states that welts itch"
Question 5
,The nurse cares for the client after a near-drowning experience in the Atlantic Ocean. It is MOST
important for the nurse to monitor for which complication?
1. Hypernatremia.
2. Hypomagnesemia.
3. Hypocalcemia.
4. Hyperkalemia.
Correct Answer
1. Hypernatremia.
Question 6
Which of these assessment findings, if present in a primigravida, indicates that the client is
experiencing true labor?
Correct Answer
There is a progressive increase in effacement and cervical dilatation.
Question 7
. The nurse cares for the client after a fall from a ladder. While the client is waiting to be seen by
the physician, the nurse observes the client's spouse using a cloth to wipe clear fluid draining
from the left ear. Which statement, if made by the nurse to the spouse, is BEST?
Correct Answer
"It is not a good idea to wipe the ear, but let me know if you see it draining again.
Question 8
The nurse cares for a patient on the psychiatric unit with a history of drug use and poor impulse
control. After the patient's mother visits, the patient begins pacing rapidly, with arms swinging,
and kicking at chair legs. The nurse should approach the patient and take which of the following
actions?
Correct Answer
Stand facing the patient with legs apart, knees locked, and weight on back leg
,Question 9
An elderly client returns to the room after a colostomy. Because the client has become confused
and repeatedly climbs over the side rails, the physician orders a Posey vest restraint. The nurse
should take which of the following actions?
Correct Answer
Check the patient every 30 to 60 minutes and release the restraint every 2 hours.
Question 10
The nurse teaches the mother of a 3-month-old infant. When planning accident prevention, the
nurse emphasizes which goal?
1. Electric outlets will be covered with plugs.
2. All small objects will be removed from the floor.
3. Crib rails will be kept in the highest position.
4. Toxic substances will be moved from lower storage.
Correct Answer
3. Crib rails will be kept in the highest position.
Question 11
Which of these actions should a nurse take initially if a client who is diagnosed with diabetes
mellitus develops tremors and ataxia?
Correct Answer
Measure the client's blood sugar level.
Question 12
Which of these techniques should a nurse use to assess for correct placement of a nasogastric
tube prior to administering a feeding?
Correct Answer
Aspirate 10 mL contents and measure the pH.
, Question 13
The nurse cares for a client after an involuntary admission to a mental health facility due to
threatening to harm self. The family asks the nurse if they can take the client home. Which
response by the nurse is MOST appropriate?
a. I will speak to the health care provider about your request.
b. The client is lucky to have a loving family like you.
c. The courts determine how long the client is hospitalized.
d. Why do you want to take the client home?
Correct Answer
c. The courts determine how long the client is hospitalized.
Question 14
Question 93 is #1
Correct Answer
Question 15
A client has shortness of breath when lying down and usually assumes an upright or sitting
position in order to breathe more comfortably. A nurse should document this observation as:
Correct Answer
orthopnea.
Question 16
The client receives enteral nutrition at 50 ml/hour due to dysphagia. Which nursing action
diagnosis would be the priority?
a. Risk for fluid volume excess.
b. Risk for electrolyte imbalance.
c. Risk for imbalanced nutrition. Less than body requirements.
d. Risk for aspiration.
Correct Answer