106. The nurse counsels a client diagnosed with iron deficiency anemia.
The nurse determines that teaching is effective if the client selects
which of the following menus?
1. Roast beef, brown rice, green beans, carrot and raisin
salad, and milk.
107. The nurse supervises care of a client who is receiving enteral
feeding via a nasogastric tube. The nurse determines that care is
appropriate if which of the following is observed? Select all that
apply:
2. The nursing assistant elevates the head of the client’s bed 30
degrees.
3. The nursing assistant warms the formula to room temperature.
6. The nursing assistant clamps the proximal end of the feeding
tube at the end of the feeding.
108. The nurse performs a physical assessment of a newborn. It is
MOST important for the nurse to report which of the following
findings?
1. Head circumference of 40 cm.
109. The nurse in the pediatric clinic performs a physical assessment of
a 13-year-old boy. Which of the following findings by the nurse
requires an immediate intervention?
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, 4.The child’s scrotum appears enlarged and red. The nurse palpates
a thickened and swollen spermatic cord.
110. The nurse on the medical/surgical unit admits a client with a
diagnosis of cerebrovascular accident (CVA.. The nursing
assessment of the client’s neurological status should include which
of the following?
2. Ask the client to grasp and squeeze two fingers on each of the
nurse’s hands.
3. Determine client’s orientation to person, place, and time.
6. Assess the client’s pupillary response.
111. A nurse is caring for a client with a diagnosis of catatonic
schizophrenia. What clinical finding does the nurse expect the
client to exhibit?
C.Immobile posturing
112. A client with type 1 diabetes is diagnosed with diabetic
ketoacidosis and initially treated with intravenous fluids followed
by an IV bolus of regular insulin. The nurse anticipates that the
practitioner will prescribe a continuous infusion of:
B.Novolin R insulin
113. A client is admitted to the hospital with the diagnosis of a right-
sided brain attack (CVA.. The client is right handed. Which task
will be most difficult for this client?
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