9. swallowing, the nurse knows this symptom of this kind of reaction to be?
Answer = anaphylactic reaction
10. A nurse is teaching a client’s partner about how to obtain blood pressure. Which of the following
action by the partner indicates a need for further teaching?
Answer = place the client’s arm above the level of client’s heart
11. A nurse is caring for a client with urinary incontinence, which of the following action should the
nurse implement to prevent skin break down?
Answer = apply a moisture barrier ointment on client’s skin
12. A nurse is preparing medication and observes the date of the expiration on the vile occur 2 months
after, which action should the nurse take?
Answer = return the meds to the pharmacy
13. A nurse is caring for a client who has an infection, the nurse should use which of the following
strategies to prevent the transmission of infection?
Answer = perform hand hygiene before and after contact with the client
14. A nurse is calculating the output of a client at the end of the shift and notes that a client voided
400 ml at 1100 and 350 ml at 1430. The close chest drainage system was previously marked at 155 ml
and is now at 175 ml, the NG tube has 575 ml in drainage container and 25 ml is emptied out of the
Jackson pratts drainage tab. How many ml should the nurse record as the client’s output?
Answer = 1370 ml
15. A nurse is discussing catheter catherization with a newly licensed nurse, which of the following needs
should the nurse include? Select all that apply?
Answer = relief of urinary retention
Answer = measurement of residual after urination
Answer = open perineal wound
16. A nurse is caring for a patient with an NG tube and tests the pH of the secretion to determine if tube
is correctly placed. Which of the flow reading, should the nurse expect?
Answer = 4.0
17. A nurse is assisting with transferring a client from bed to a wheel chair, which action should be
taken?
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