540 Questions (1).
Test A:
1. A nurse is caring for a client who is at 33 weeks of gestation following an
amniocentesis. The nurse should monitor the client for which of the
following complications?
D. Contractions
2. A nurse is providing teaching to an older adult client about methods to
promote nighttime sleep. Which of the following instruction should the nurse
include?
D. Eat a light stack before bedtime.
3. A nurse on a telemetry unit is caring for a client who becomes unconscious
and whose monitor displays ventricular tachycardia. Which of the following
actions should the nurse take first after determining the client does not have a
palpable pulse?
B. Defibrillate
4. A nurse is admitting a client who is 1 week postpartum and reports excessive
vaginal bleeding. The nurse does not speak the same language as the client. The
client’s partner and 10-year-old child are accompanying her. Which of the
following actions should the nurse take to gather the client’s admission data?
C. Request a female interpreter through the facility.
5. A nurse is caring for a client who is febrile. To reduce the client’s fever, the
nurse applies a cooling blanket. Which of the following findings indicates the
client is having an adverse reaction to the cooling.
D. Shivering
6. A nurse is caring for a client who has deep-vein thrombosis of the left lower
extremity which of the following actions should the nurse take? (Click on the
“Exhibit” button below for additional client information. There are three tabs
that contain separate categories of data.)
B. Withhold heparin IV infusion
[OR] C. Administer
acetaminophen
7. A nurse is reviewing assessment data from several clients. For which of
the following clients should the nurse recommend referral to a dietitian.
B. A client who has a nonhealing leg ulcer
8. A nurse is providing discharge teaching to a client who has a chronic kidney
disease and is receiving hemodialysis. Which of the following instructions should
the nurse include in the teaching?
A. Eat 1 g/kg of protein per day
9. A nurse is caring for a client who is receiving intermittent enteral tube
feedings. Which of the following places the client at risk for aspiration?
B. A history of gastroesophageal reflux disease
10. A nurse is providing prenatal teaching to a client who is at 12 weeks of
gestation. The nurse should tell the client that she will undergo which of the
following screening tests at 16 weeks of gestation?
D. Maternal serum alpha-fetoprotein
11. A nurse is caring for a client who is on bed rest. The nurse should recognize
that which of the following findings is a complication of immobility?
C. Swollen area on calf
,540 Questions (1).
12. A nurse in an acute care mental health facility is participating in a medical-
education group. The leader of the group uses a laissez-faire leadership style.
Which of the following actions should the nurse expect from the leader during the
session?
C. The leader allows the group to discuss whatever they would like to
regarding their medications.
13. A nurse is providing teaching about digoxin administration to the parents of a
toddler who has heart failure. Which of the following statements should the
nurse include in the teaching?
D. “Have your child drink a small glass of water after swallowing
the medication.”
14. A nurse is providing teaching to a client who has a depressive disorder and
a new prescription for phenelzine. Which of the following foods should the
nurse instruct the client to avoid?
D. Smoked salmon
16. A nurse is planning care for a client who has bipolar disorder and is
experiencing mania. Which of the following interventions should the nurse
include in the plan?
C. Encourage the client to take frequent rest periods.
17. A parish nurse is leading a support group for clients whose family members
have committed suicide. Which of the following strategies should the nurse plan to
use during the group session?
A. Initiate a discussion with clients about ways to cope with changes
in family dynamics.
18. A nurse manager observes two staff nurses reviewing the computer records of
a client who is not under their care. Which of the following actions should the
nurse manager take first?
A. Instruct the nurses to close the client’s computer record.
19. A nurse is reviewing the medical record of a client who has schizophrenia and
is taking clozapine. Which of the following findings should the nurse identify as a
contraindication to the administration of clozapine?
D. WBC count 2,900/mm3
20. A nurse is caring for several clients on a medical-surgical unit. For which of
the following nursing activities is it required that the nurse use sterile gloves?
D. Performing tracheostomy care
21. A nurse is caring for a client who is at 11 weeks of gestation. Which of
the following immunizations should the nurse recommend?
A. Influenza
22. A nurse is inserting an indwelling urinary catheter for a male client. Which of
the following actions should the nurse take?
B. Lift the penis so that it is perpendicular to the client’s body.
23. A nurse is providing teaching to a client who is at 14 weeks of gestation about
findings to report to the provider. Which of the following findings should the
nurse include in the teaching?
C. Swelling of the face
,540 Questions (1).
24. A nurse has received change-of-shift report for a group of clients. Which of
the following actions should the nurse take to manage time effectively?
A. Document client care at the end of shift.
B. Make a client to-do list for the day.
C. Skip breaks until client tasks are completed.
D. Focus on several client tasks at a time.
25. A nurse is developing a plan of care for a newborn whose mother tested
positive for heroin during pregnancy. The newborn is experiencing neonatal
abstinence syndrome. Which of the following actions should the nurse include in
the plan?
A. Minimize the noise in the newborn’s environment.
B. Administer naloxone to the newborn.
C. Swaddle the newborn with his legs extended.
D. Maintain eye contact with the newborn during feedings.
26. A nurse is assessing the fontanels of an 8-month-old infant. Which of
the following findings should the nurse recognize as an expected finding?
A. The anterior fontanel is open
B. The posterior fontanel is open.
C. Both fontanels are the same size.
D. Both fontanels show molding.
27. A nurse is caring for a client who has acute diverticulitis. Which of the
following diets should the nurse recommend to the client?
A. High residue
B. Lactose-free
C. Gluten-free
D. Low-fiber
28. A nurse is caring for a client who is 48 hr postoperative following a total hip
arthroplasty. Which of the following actions should the nurse include in the plan
of care?
A. Administer low-dose heparin
B. Place the client on a full liquid diet.
C. Use an incentive spirometer ever 3 hr.
D. Maintain the client on bed rest.
29. A nurse is providing teaching to the parent of an infant who has a cleft lip
palate. Which of the following feeding techniques should the nurse include in the
teaching?
A. Burp the infant frequently during feedings.
B. Position the nipple at the front of the infant’s mouth.
C. Hold the infant in a supine position.
D. Use feeding devices without nipples.
30. A nurse in an acute mental health care facility is prioritizing care for
, 540 Questions (1).
multiple clients. Which of the following clients should the nurse see first?
Test A:
1. A nurse is caring for a client who is at 33 weeks of gestation following an
amniocentesis. The nurse should monitor the client for which of the
following complications?
D. Contractions
2. A nurse is providing teaching to an older adult client about methods to
promote nighttime sleep. Which of the following instruction should the nurse
include?
D. Eat a light stack before bedtime.
3. A nurse on a telemetry unit is caring for a client who becomes unconscious
and whose monitor displays ventricular tachycardia. Which of the following
actions should the nurse take first after determining the client does not have a
palpable pulse?
B. Defibrillate
4. A nurse is admitting a client who is 1 week postpartum and reports excessive
vaginal bleeding. The nurse does not speak the same language as the client. The
client’s partner and 10-year-old child are accompanying her. Which of the
following actions should the nurse take to gather the client’s admission data?
C. Request a female interpreter through the facility.
5. A nurse is caring for a client who is febrile. To reduce the client’s fever, the
nurse applies a cooling blanket. Which of the following findings indicates the
client is having an adverse reaction to the cooling.
D. Shivering
6. A nurse is caring for a client who has deep-vein thrombosis of the left lower
extremity which of the following actions should the nurse take? (Click on the
“Exhibit” button below for additional client information. There are three tabs
that contain separate categories of data.)
B. Withhold heparin IV infusion
[OR] C. Administer
acetaminophen
7. A nurse is reviewing assessment data from several clients. For which of
the following clients should the nurse recommend referral to a dietitian.
B. A client who has a nonhealing leg ulcer
8. A nurse is providing discharge teaching to a client who has a chronic kidney
disease and is receiving hemodialysis. Which of the following instructions should
the nurse include in the teaching?
A. Eat 1 g/kg of protein per day
9. A nurse is caring for a client who is receiving intermittent enteral tube
feedings. Which of the following places the client at risk for aspiration?
B. A history of gastroesophageal reflux disease
10. A nurse is providing prenatal teaching to a client who is at 12 weeks of
gestation. The nurse should tell the client that she will undergo which of the
following screening tests at 16 weeks of gestation?
D. Maternal serum alpha-fetoprotein
11. A nurse is caring for a client who is on bed rest. The nurse should recognize
that which of the following findings is a complication of immobility?
C. Swollen area on calf
,540 Questions (1).
12. A nurse in an acute care mental health facility is participating in a medical-
education group. The leader of the group uses a laissez-faire leadership style.
Which of the following actions should the nurse expect from the leader during the
session?
C. The leader allows the group to discuss whatever they would like to
regarding their medications.
13. A nurse is providing teaching about digoxin administration to the parents of a
toddler who has heart failure. Which of the following statements should the
nurse include in the teaching?
D. “Have your child drink a small glass of water after swallowing
the medication.”
14. A nurse is providing teaching to a client who has a depressive disorder and
a new prescription for phenelzine. Which of the following foods should the
nurse instruct the client to avoid?
D. Smoked salmon
16. A nurse is planning care for a client who has bipolar disorder and is
experiencing mania. Which of the following interventions should the nurse
include in the plan?
C. Encourage the client to take frequent rest periods.
17. A parish nurse is leading a support group for clients whose family members
have committed suicide. Which of the following strategies should the nurse plan to
use during the group session?
A. Initiate a discussion with clients about ways to cope with changes
in family dynamics.
18. A nurse manager observes two staff nurses reviewing the computer records of
a client who is not under their care. Which of the following actions should the
nurse manager take first?
A. Instruct the nurses to close the client’s computer record.
19. A nurse is reviewing the medical record of a client who has schizophrenia and
is taking clozapine. Which of the following findings should the nurse identify as a
contraindication to the administration of clozapine?
D. WBC count 2,900/mm3
20. A nurse is caring for several clients on a medical-surgical unit. For which of
the following nursing activities is it required that the nurse use sterile gloves?
D. Performing tracheostomy care
21. A nurse is caring for a client who is at 11 weeks of gestation. Which of
the following immunizations should the nurse recommend?
A. Influenza
22. A nurse is inserting an indwelling urinary catheter for a male client. Which of
the following actions should the nurse take?
B. Lift the penis so that it is perpendicular to the client’s body.
23. A nurse is providing teaching to a client who is at 14 weeks of gestation about
findings to report to the provider. Which of the following findings should the
nurse include in the teaching?
C. Swelling of the face
,540 Questions (1).
24. A nurse has received change-of-shift report for a group of clients. Which of
the following actions should the nurse take to manage time effectively?
A. Document client care at the end of shift.
B. Make a client to-do list for the day.
C. Skip breaks until client tasks are completed.
D. Focus on several client tasks at a time.
25. A nurse is developing a plan of care for a newborn whose mother tested
positive for heroin during pregnancy. The newborn is experiencing neonatal
abstinence syndrome. Which of the following actions should the nurse include in
the plan?
A. Minimize the noise in the newborn’s environment.
B. Administer naloxone to the newborn.
C. Swaddle the newborn with his legs extended.
D. Maintain eye contact with the newborn during feedings.
26. A nurse is assessing the fontanels of an 8-month-old infant. Which of
the following findings should the nurse recognize as an expected finding?
A. The anterior fontanel is open
B. The posterior fontanel is open.
C. Both fontanels are the same size.
D. Both fontanels show molding.
27. A nurse is caring for a client who has acute diverticulitis. Which of the
following diets should the nurse recommend to the client?
A. High residue
B. Lactose-free
C. Gluten-free
D. Low-fiber
28. A nurse is caring for a client who is 48 hr postoperative following a total hip
arthroplasty. Which of the following actions should the nurse include in the plan
of care?
A. Administer low-dose heparin
B. Place the client on a full liquid diet.
C. Use an incentive spirometer ever 3 hr.
D. Maintain the client on bed rest.
29. A nurse is providing teaching to the parent of an infant who has a cleft lip
palate. Which of the following feeding techniques should the nurse include in the
teaching?
A. Burp the infant frequently during feedings.
B. Position the nipple at the front of the infant’s mouth.
C. Hold the infant in a supine position.
D. Use feeding devices without nipples.
30. A nurse in an acute mental health care facility is prioritizing care for
, 540 Questions (1).
multiple clients. Which of the following clients should the nurse see first?
