A male client who is admitted the morning of his scheduled surgery tells the pn that he
drank a glass of water last night. What interventions will the PN implement first?
a Reassure the client that a small amount of water is not harmful
b Determine the amount of water and exact time it was taken
c Auscultate the client for bowel and ability to urinate
d Notify the healthcare provider of the client's fluid intake
b Determine the amount of water and exact time it was taken
The client receives ondansetron prior to chemotherapy therapy. How should the PN
evaluate medication?
a Determine if the client feels calm and relaxed before treatment
b Observe the client for signs of pain and discomfort during the treatment
c Monitor the client for nausea/ vomiting following the treatment
d Assess for changes in vital signs during and after treatment
c Monitor the client for nausea/ vomiting following the treatment
During morning rounds a client who is admitted with obsessive compulsive disorder is in
the same table. What interventions should the PN implement when approaching?
a Encourage the client to be calm and relax for a little while
b Assist the client to identify stimuli that precipitates the activity
c Provide time for the behavior then guide the client to other activities
d Assist the client to a chair after taking away the cleaning materials
c Provide time for the behavior then guide the client to other activities
The PN is caring for an older adult client who is confused and spends factor contributes
to an increased risk for impaired skin integrity for this client?
a Refuses to use a walker when ambulating
b Likes to drink several cola drinks every day
c No recorded bowel movement for several days
,d Has increasing episodes of urinary incontinence
d Has increasing episodes of urinary incontinence
The PN determines that a client with cirrhosis is experiencing peripheral take?
a Apply a heating pad to affected area
b Assess the feet and legs for jaundice
c Keep the clients feet elevated
d Protect the client's feet from injury
d Protect the client's feet from injury
A client is admitted to the postoperative surgical unit after a left lobectomy with two
chest observes that the water sealed chambers set at the prescribed suction of 20 cm
water and bubbling. What action should the PN implement?
a Notify the RN of the malfunction
b Apply a partial occlusive dressing to chest
c Clamp the chest tube to see if activity stops
d Maintain system integrity to promote lung reexpansion
d Maintain system integrity to promote lung reexpansion
At the end of a 12 hour shift the PN observes the urine in a clients drainage action should
PN take next?
a Determine if the clients bladder feels distended
b Offer to administer a prescribed PRN analgesic
c Note the most recent WBC
d Obtain a fingerstick capillary glucose level
c Note the most recent WBC
A client with a compound fracture of the left ankle is being discharged with a below PN
provide to the client prior to discharge?
,a Keep the left leg in a dependent position
b Expect some increase in pain
c Never scratch under the cast
d Apply a cold pack to any hot spots on the cast
c Never scratch under the cast
Thirty minutes after receiving IV morphine, a postoperative male client continues to rate
action should PN implement first?
a Call healthcare provider to request a different analgesic
b Observe dressing to determine presence of bleeding
c Determine when morphine can be given again
d Implement complementary pain relief methods
d Implement complementary pain relief methods
A male client who has been diagnosed with schizophrenia withdrawn, isolates himself in
with one or two word responses. This morning , the PN observes that he. Which
intervention is most important for the PN to implement?
a Observe the client during the shift
b Persuade the client to lie down
c Provide a drink high in electrolytes
d Measure appropriate vital signs
d Measure appropriate vital signs
The PN is assisting an unsteady client to ambulate from the bed to the ba client loses
balance and falls into the beside table. What actions should the PN take first?
a Stay with the client and call for assistance
b Assist the client back to bed
c Take the client vital signs
d Reassure the client that everything will be okay
, a Stay with the client and call for assistance
The PN is assisting a female client to obtain a voided specimen for urine meatus, which
intervention is performed next?
a Separate the labia
b Position the collection cup
c Observe the urine
d Initiate the urine stream
d Initiate the urine stream
An 8 year old is placed in 90-90 traction for a fractured femur that resulted from further
action by the PN?
a Child moves the toes freely when tickled
b Weights are touching the foot of the bed
c Mother helps child change positions
d No bowel movement for two days
d No bowel movement for two days
The PN is reviewing diet instruction with a female client who has hyper she has
increased her intake of protein and calories. What action should the PN take?
a Reinforce with her the need to also increase intake of dietary fiber
b Remind the client to increase physical activity to prevent weight gain
c Emphasize the need to reduce caloric intake, rather that increasing it
d Encourage the client to continue the dietary changes she has made
d Encourage the client to continue the dietary changes she has made
A 3 year old child returns to the pediatricians' office for a postoperative visit after having
a procedure. The PN should expect to observe which behavior?
a Plays doctor and nurse with dolls
drank a glass of water last night. What interventions will the PN implement first?
a Reassure the client that a small amount of water is not harmful
b Determine the amount of water and exact time it was taken
c Auscultate the client for bowel and ability to urinate
d Notify the healthcare provider of the client's fluid intake
b Determine the amount of water and exact time it was taken
The client receives ondansetron prior to chemotherapy therapy. How should the PN
evaluate medication?
a Determine if the client feels calm and relaxed before treatment
b Observe the client for signs of pain and discomfort during the treatment
c Monitor the client for nausea/ vomiting following the treatment
d Assess for changes in vital signs during and after treatment
c Monitor the client for nausea/ vomiting following the treatment
During morning rounds a client who is admitted with obsessive compulsive disorder is in
the same table. What interventions should the PN implement when approaching?
a Encourage the client to be calm and relax for a little while
b Assist the client to identify stimuli that precipitates the activity
c Provide time for the behavior then guide the client to other activities
d Assist the client to a chair after taking away the cleaning materials
c Provide time for the behavior then guide the client to other activities
The PN is caring for an older adult client who is confused and spends factor contributes
to an increased risk for impaired skin integrity for this client?
a Refuses to use a walker when ambulating
b Likes to drink several cola drinks every day
c No recorded bowel movement for several days
,d Has increasing episodes of urinary incontinence
d Has increasing episodes of urinary incontinence
The PN determines that a client with cirrhosis is experiencing peripheral take?
a Apply a heating pad to affected area
b Assess the feet and legs for jaundice
c Keep the clients feet elevated
d Protect the client's feet from injury
d Protect the client's feet from injury
A client is admitted to the postoperative surgical unit after a left lobectomy with two
chest observes that the water sealed chambers set at the prescribed suction of 20 cm
water and bubbling. What action should the PN implement?
a Notify the RN of the malfunction
b Apply a partial occlusive dressing to chest
c Clamp the chest tube to see if activity stops
d Maintain system integrity to promote lung reexpansion
d Maintain system integrity to promote lung reexpansion
At the end of a 12 hour shift the PN observes the urine in a clients drainage action should
PN take next?
a Determine if the clients bladder feels distended
b Offer to administer a prescribed PRN analgesic
c Note the most recent WBC
d Obtain a fingerstick capillary glucose level
c Note the most recent WBC
A client with a compound fracture of the left ankle is being discharged with a below PN
provide to the client prior to discharge?
,a Keep the left leg in a dependent position
b Expect some increase in pain
c Never scratch under the cast
d Apply a cold pack to any hot spots on the cast
c Never scratch under the cast
Thirty minutes after receiving IV morphine, a postoperative male client continues to rate
action should PN implement first?
a Call healthcare provider to request a different analgesic
b Observe dressing to determine presence of bleeding
c Determine when morphine can be given again
d Implement complementary pain relief methods
d Implement complementary pain relief methods
A male client who has been diagnosed with schizophrenia withdrawn, isolates himself in
with one or two word responses. This morning , the PN observes that he. Which
intervention is most important for the PN to implement?
a Observe the client during the shift
b Persuade the client to lie down
c Provide a drink high in electrolytes
d Measure appropriate vital signs
d Measure appropriate vital signs
The PN is assisting an unsteady client to ambulate from the bed to the ba client loses
balance and falls into the beside table. What actions should the PN take first?
a Stay with the client and call for assistance
b Assist the client back to bed
c Take the client vital signs
d Reassure the client that everything will be okay
, a Stay with the client and call for assistance
The PN is assisting a female client to obtain a voided specimen for urine meatus, which
intervention is performed next?
a Separate the labia
b Position the collection cup
c Observe the urine
d Initiate the urine stream
d Initiate the urine stream
An 8 year old is placed in 90-90 traction for a fractured femur that resulted from further
action by the PN?
a Child moves the toes freely when tickled
b Weights are touching the foot of the bed
c Mother helps child change positions
d No bowel movement for two days
d No bowel movement for two days
The PN is reviewing diet instruction with a female client who has hyper she has
increased her intake of protein and calories. What action should the PN take?
a Reinforce with her the need to also increase intake of dietary fiber
b Remind the client to increase physical activity to prevent weight gain
c Emphasize the need to reduce caloric intake, rather that increasing it
d Encourage the client to continue the dietary changes she has made
d Encourage the client to continue the dietary changes she has made
A 3 year old child returns to the pediatricians' office for a postoperative visit after having
a procedure. The PN should expect to observe which behavior?
a Plays doctor and nurse with dolls
