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A client has had a positive reaction to purified protein
derivative (PPD). Which statement made by the client
suggests the client understands the teaching by the
registered nurse (RN)?
1"I have active tuberculosis."
2"I have been exposed to mycobacterium tuberculosis."
3"I have never been infected with mycobacterium
tuberculosis."
4"I have never had tuberculosis." - Answer-2
A nurse is caring for a client with pneumococcal
pneumonia. Which breath sounds would the nurse expect
to disappear as the client responds to the antibiotic
treatment?
1Wheezes
2Friction rubs
3Rhonchi
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4Diminished sounds - Answer-3
A young adult seeks treatment in an outpatient mental
health center. The client tells a nurse, "I am a government
official and spies are following me." Upon further
questioning, the client reveals that warnings must be
heeded to prevent nuclear war. What is the initial
therapeutic approach that the nurse should use?
1Listen quietly without comment
2Ask for further information on the spies
3Confront the client about the delusions
4Contact security for potential safety concerns - Answer-
1Listen quietly without comment -
Lactulose has been prescribed for a client with advanced
liver disease. Which finding should the nurse use to
evaluate the effectiveness of this treatment?
1Less jaundice
2Increased appetite
3Decreased lethargy
4Less edema - Answer-3
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The LPN is unsure about an assignment by the charge
nurse to hang an intravenous (IV) infusion that contains
potassium. What resource should the LPN check first to
determine if LPNs can administer IV medications?
1Employer policy and procedures manuals
2Nursing faculty from a local nursing program
3The nurse practice act of the state in which the practice
takes place
4American Nurses Association (ANA) professional
standards - Answer-3
The nurse is assisting with the delivery of a newborn
infant. What is the priority nursing intervention for a normal
newborn immediately after delivery?
1Dry off infant with a warm blanket or towel
2Apply identification bracelets
3Assign the one-minute APGAR score
4Obtain vital signs - Answer-1Dry off infant with a warm
blanket or towel -
The registered nurse is teaching a childbirth education
class about postpartum depression. Which statement,
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made by a class member, indicates that more teaching is
needed?
1"I will make an effort to talk with someone about my
feelings if I start to feel overwhelmed."
2"It's common for women with postpartum depression to
have delusions about the infant."
3"Women with postpartum depression have feelings of
guilt and worthlessness."
4"I may experience postpartum depression up to a year
after delivery." - Answer-2
The nurse is reinforcing information about the side effects
of fluoxetine to a client. Which group of findings should be
included?
1Diarrhea, dry mouth, weight loss, reduced libido
2Tachycardia, blurred vision, hypotension, anorexia
3Orthostatic hypotension, vertigo, reactions to tyramine,
nausea
4Photosensitivity, seizures, edema, hyperglycemia -
Answer-1Diarrhea, dry mouth, weight loss, reduced libido