, preface the report by stating the clients name and
admitting diagnosis
communicate the pre-transfusion temperatures
optain prn prescription for acetaminophen for fever 101f
An adult male client is admitted for pneumocystis carinil pneumonia (PCP)
secondary to aids. While hospitalize he receives IV pentamidine isethionate
therapy. In preparing this client for discharge what important aspect
regarding his medication therapy should the nurse explain?
AZT therapy must be stopped when IV aerosol pentamine is
being used.
IV pentamine will be given until oral pentamine can be tolerated
It will be necessary to continue prophylactic doses of IV
or aerosol pentamine every month
Iv pentamine may offer protection to others aids related
conditions such as kaposis sarcoma
A client subjective data includes dysuria, urgency, and urinary
frequency. What action should the nurse implement next?
collect a clean catch specimen
palpate the suprapubic region
instruct to wipe from front to back
inquire about recent sexual activity
A client tells the nurse that her biopsy results indicate that the
cancer cells are well differentiated How should the nurse respond?
offer the client reassurance that this information indicates that
the clients cancer cells are benign
explain that these tissue cells often respond more effectively
to radiation than to chemotherapy
ask the client in the healthcare provider has giving her
any information about the classification of her cancer
help the client make plans to begin inmediate treatment since
her cancer is likely to spread quickly
A client with a chronic kidney disease is treated on hemodialysis.
During the 1 treatment clients blood pressure drops from 150/90 to
80/30 Which action should the nurse take first?
monitor bp q45 minutes
lower the head of the chair and elevate feet
stop dialysis treatment
administer 5%albumin IV
,10. A client with deep vain thrombosis (DVT) is receiving a continues
infusion of heparin sodium 25,000 unit in 5% dextrose injection
250ml. The prescription indicates the dosage should be increase 900
units/hr. The nurse should program the infusion pump to deliver how
many ml/hr?
=9
11. The nurse is obtaining the admission history for a client with
suspected peptic ulcer disease (PUD). Which subjective data reported
by the client supports this diagnosis?
upper mid abdominal gnawing and burning pain
severe abdominal cramps and diarrhea after eating spicy foods
marked loss of weight and appetite over the last few months
use of chewable and liquid antacids for indigestion
12. The nurse is providing preoperative education for a jewish client
schedule to receive a xenograft graft to promote burn healing.
Which information should the nurse provide this client?
the xenograft is taken from nonhuman sources
grafting increases the risk for bacterial infection
as the burn heals the graft permanently attaches
grafts are later removed by debriding procedure
13. A client who took a camping vacation two weeks ago in a country with a
tropical climate comes to the clinic describing vague symptoms and
diarrhea for the past week. Which finding is most important for the
nurse to report?
jaundice sclera
intestinal cramping
weakness and fatigue
weight loss
14. During a home visit the nurse assesses the skin of a client with
eczema who reports than an exacerbation of symptoms has occurred
during the last week. Which information is most useful in determining
the possible cause of the symptoms?
an old friend with eczema came for visit
recently received an influenza immunization
corticosteroid cream was applied to eczema
a grandson and his new dog recently visited
, 15. When explaining dietary guidelines to a client with acute
glomerulonephritis (AGN) which instruction should the nurse include
in the dietary teaching?
select a protein rich food daily
restrict sodium intake
eat high potassium foods
Avoid foods high in carbohydrate
16. A male client who is 24hr post operative for an exploratory
laparoctomy complains that he is starving because he has had no real
food since before surgery. Prior to advancing his diet which intervention
should the nurse implememt?
discontinue intravenous therapy
Assess for abdominal distension and tenderness
Obtain a prescription for a diet change
Auscultate bowel sound in all four quadrants
17. A client diagnose with stable angina secondary to ischemic heart
disease has a prescription for sublingual (SL) nitroglycerin (NTG). The
nurse should tell the client to follow which instructions if chest pain is
not relieved after taking 3 NTG tables 5 min apart?
drive to the nearest emergency department
take another NTG SL tablet and lie down until angina subsides
call primary healthcare provider
call 911 pain is unrelieved and chew a tablet of aspirin 325mg
18. After taking orlistat (Xenical) for one week a femela client tells the home
health nurse that she is experiencing increasingly frequent oily stools
and flatus. What action should the nurse take?
obtain stool specimen to evaluate for occult blood and fat content
instruct the client to increase her intake of saturated fats over
the next week
ask the client to describe her dietary intake history for the
last several days
advice the client to stop taking the drug and contact the
healthcare provider
19. Two days after an abscess of the chin was drained the client returns
to the clinic with fever chills and a maculopapular rash with pruritis.
The client has taken an oral antibiotic and cleansed the wound today
with provide iodine (Betadine) solution. Which intervention should the
nurse implement first?
determine if the client has a history of diabetes
assess airway patency and oxygen saturation
admitting diagnosis
communicate the pre-transfusion temperatures
optain prn prescription for acetaminophen for fever 101f
An adult male client is admitted for pneumocystis carinil pneumonia (PCP)
secondary to aids. While hospitalize he receives IV pentamidine isethionate
therapy. In preparing this client for discharge what important aspect
regarding his medication therapy should the nurse explain?
AZT therapy must be stopped when IV aerosol pentamine is
being used.
IV pentamine will be given until oral pentamine can be tolerated
It will be necessary to continue prophylactic doses of IV
or aerosol pentamine every month
Iv pentamine may offer protection to others aids related
conditions such as kaposis sarcoma
A client subjective data includes dysuria, urgency, and urinary
frequency. What action should the nurse implement next?
collect a clean catch specimen
palpate the suprapubic region
instruct to wipe from front to back
inquire about recent sexual activity
A client tells the nurse that her biopsy results indicate that the
cancer cells are well differentiated How should the nurse respond?
offer the client reassurance that this information indicates that
the clients cancer cells are benign
explain that these tissue cells often respond more effectively
to radiation than to chemotherapy
ask the client in the healthcare provider has giving her
any information about the classification of her cancer
help the client make plans to begin inmediate treatment since
her cancer is likely to spread quickly
A client with a chronic kidney disease is treated on hemodialysis.
During the 1 treatment clients blood pressure drops from 150/90 to
80/30 Which action should the nurse take first?
monitor bp q45 minutes
lower the head of the chair and elevate feet
stop dialysis treatment
administer 5%albumin IV
,10. A client with deep vain thrombosis (DVT) is receiving a continues
infusion of heparin sodium 25,000 unit in 5% dextrose injection
250ml. The prescription indicates the dosage should be increase 900
units/hr. The nurse should program the infusion pump to deliver how
many ml/hr?
=9
11. The nurse is obtaining the admission history for a client with
suspected peptic ulcer disease (PUD). Which subjective data reported
by the client supports this diagnosis?
upper mid abdominal gnawing and burning pain
severe abdominal cramps and diarrhea after eating spicy foods
marked loss of weight and appetite over the last few months
use of chewable and liquid antacids for indigestion
12. The nurse is providing preoperative education for a jewish client
schedule to receive a xenograft graft to promote burn healing.
Which information should the nurse provide this client?
the xenograft is taken from nonhuman sources
grafting increases the risk for bacterial infection
as the burn heals the graft permanently attaches
grafts are later removed by debriding procedure
13. A client who took a camping vacation two weeks ago in a country with a
tropical climate comes to the clinic describing vague symptoms and
diarrhea for the past week. Which finding is most important for the
nurse to report?
jaundice sclera
intestinal cramping
weakness and fatigue
weight loss
14. During a home visit the nurse assesses the skin of a client with
eczema who reports than an exacerbation of symptoms has occurred
during the last week. Which information is most useful in determining
the possible cause of the symptoms?
an old friend with eczema came for visit
recently received an influenza immunization
corticosteroid cream was applied to eczema
a grandson and his new dog recently visited
, 15. When explaining dietary guidelines to a client with acute
glomerulonephritis (AGN) which instruction should the nurse include
in the dietary teaching?
select a protein rich food daily
restrict sodium intake
eat high potassium foods
Avoid foods high in carbohydrate
16. A male client who is 24hr post operative for an exploratory
laparoctomy complains that he is starving because he has had no real
food since before surgery. Prior to advancing his diet which intervention
should the nurse implememt?
discontinue intravenous therapy
Assess for abdominal distension and tenderness
Obtain a prescription for a diet change
Auscultate bowel sound in all four quadrants
17. A client diagnose with stable angina secondary to ischemic heart
disease has a prescription for sublingual (SL) nitroglycerin (NTG). The
nurse should tell the client to follow which instructions if chest pain is
not relieved after taking 3 NTG tables 5 min apart?
drive to the nearest emergency department
take another NTG SL tablet and lie down until angina subsides
call primary healthcare provider
call 911 pain is unrelieved and chew a tablet of aspirin 325mg
18. After taking orlistat (Xenical) for one week a femela client tells the home
health nurse that she is experiencing increasingly frequent oily stools
and flatus. What action should the nurse take?
obtain stool specimen to evaluate for occult blood and fat content
instruct the client to increase her intake of saturated fats over
the next week
ask the client to describe her dietary intake history for the
last several days
advice the client to stop taking the drug and contact the
healthcare provider
19. Two days after an abscess of the chin was drained the client returns
to the clinic with fever chills and a maculopapular rash with pruritis.
The client has taken an oral antibiotic and cleansed the wound today
with provide iodine (Betadine) solution. Which intervention should the
nurse implement first?
determine if the client has a history of diabetes
assess airway patency and oxygen saturation
