AWITH ACTUAL QUESTIONS AND CORRECT ANSWERS
When caring for a child, a nurse plans to use nonpharmacological interventions
to enhance the effectiveness of pain medication. Which of the following
strategies incorporates visualization techniques to help decrease the child's
discomfort?
Blowing bubbles with liquid soap to "blow the hurt away"
A nurse is providing education to a client who expresses a desire to lose weight.
Which of the following recommendations should the nurse make?
"Follow the MyPlate plan."
A nurse is assigning task roles for a group of clients in a community mental
health clinic. Which of the following tasks should the nurse assign to the
member of the group functioning as the orienter?
Noting the progress of the group toward assigned goals
A nurse is caring for a client who has a leg cast and is returning a demonstration
on the proper use of crutches while climbing stairs. Identify the sequence the
client should follow. (Move the steps into the box on the right, placing them in
the order of performance. Use all the steps.)
Stand in the tripod position.
Place body weight on the crutches
Place the unaffected leg on the stair.
Move the affected leg and the crutches up to the stair.
A nurse is assessing for correct placement of a client's NG feeding tube prior to
administering a bolus feeding. Which of the following actions should the nurse
take?
Aspirate contents from the tube and verify the pH level.
,A nurse is admitting a client to the mental health unit following a suicide
attempt. The client states, "My family does not care whether I live or die."
Which of the following responses should the nurse make?
"How does this make you feel?"
A nurse is caring for a client who is immediately postoperative following a total
vaginal hysterectomy. Which of the following actions should the nurse take first?
Measure the client's vital signs.
A nurse is caring for a 4-year-old preschooler in an emergency department (ED).
After completing the assessment and reviewing the preschooler's medical
record, which of the following actions should the nurse plan to take?
administer supplemental oxygen, place the preschooler on the affected side,
and administer an antipyretic.
A nurse is caring for a client who has fluid volume overload. Which of the
following tasks should the nurse delegate to an assistive personnel (AP)?
Measure the client's daily weight.
A nurse is caring for a group of clients. Which of the following clients should the
nurse attend to first?
A client who is anxious and attempting to pull out an IV line
A nurse is providing discharge teaching about the use of car seats to the
guardian of a newborn. Which of the following statements by one of the
guardians indicates an understanding of the teaching?
"I should ensure that the harness is snug around my baby's body."
A nurse is reviewing the laboratory results of a toddler who has hemophilia A.
Which of the following aPTT (30 to 40 seconds) values should the nurse expect?
45 seconds
A nurse manager is planning to make changes to the current scheduling system
on the unit. To facilitate the staff's acceptance of this change, which of the
following actions should the nurse manager take first?
, Provide information about scheduling issues to the staff.
A nurse is caring for a client admitted with profuse vomiting and abdominal
pain.
The client is at risk for developing "blank" due to "blank"
Peritonitis due to bowel obstruction.
The client is one day postoperative following a thyroidectomy.
Select the 2 findings the nurse should report to the provider.
Heart Rate
Dressing
A nurse is preparing an educational session about infection control measures.
Which of the following statements should the nurse plan to make?
"You should wear eye goggles if splash is likely from a client's body fluids."
A nurse is discussing dietary sources of iron with a client who has anemia. Which
of the following foods should the nurse identify as containing the most iron?
One slice of whole wheat bread
A nurse is providing teaching to a client who has HIV and a new prescription for
combination antiretroviral therapy (cART). Which of the following client
statements should the nurse recognize as an indication of understanding the
teaching?
"I should not skip a dose of my medication, even if it makes me nauseous."
A nurse is caring for a client who is receiving mechanical ventilation, and the
low-pressure alarm sounds from the ventilator machine. Which of the following
actions should the nurse take?
Check the tubing for disconnection.
A nurse is preparing to administer heparin 5,000 units subcutaneously. Available
is heparin injection 10,000 units/mL. How many mL should the nurse administer
per dose? (Round the answer to the nearest tenth. Use a leading zero if it
applies. Do not use a trailing zero.)