Nursing.Com Simclex
A 36-year-old client is being seen in the primary care clinic with symptoms of pain,
numbness, and tingling in both wrists. The nurse is providing information to the client about
the best ways to prevent repetitive strain injuries when working at a computer. Which
information would the nurse include as part of this teaching? Select all that apply. - correct
answer-Light touch when typing
frequent breaks
keep hands warm
A 70-year-old client with a terminal illness wants to remain at home with her family. The
client has signed a Do Not Resuscitate order in the event of cardiac arrest. Which of the
following factors must be considered for use of a DNR order outside of a healthcare facility?
Select all that apply. - correct answer-Client must be deemed competent at the time
The action is to prevent unwanted resuscitation of a terminally ill client
The client must be deemed competent at the time the DNR order is signed
Rationale:
Some clients with significant illnesses who live at home have signed DNR orders so that if
they suffer cardiac arrest, they will not be resuscitated. If the client has not made his wishes
known, rescue personnel could potentially start CPR without knowing what the client wants.
The client should have the DNR order available and ready at hand in case something
happens. A family member or someone with the client could assist by presenting the DNR to
prevent unwanted resuscitation.
A client has a "lazy eye". The medical term for this condition is which of the following? -
correct answer-Amblyopia
Myopia- Near sightedness
Hyperopia- Far sightedness
Strabismus- Ocular muscles weak on one side
A client has insomnia. The client asked the nurse how to improve their sleep. The nurse tells
the client to first establish a sleep schedule. The nurse would best evaluate the effectiveness
of the client's sleep schedule by which of the following actions? - correct answer-Checking to
see if the client gets up and goes to bed the same time each day
A client in the healthcare clinic complains of feeling dizzy when standing after sitting for a
period. The client's blood pressure is 136/78 mmHg while sitting and 102/58 mmHg after
standing. Which types of treatment goals are most appropriate in this situation? Select all
that apply. - correct answer-Evaluate meds the client is taking
Instruct client about getting adequate hydration
A client in the ICU has hemodynamic monitoring in place and has been showing ventricular
irritability on the monitor as evidenced by changes in waveform configuration. What
, describes a potential cause of this condition? - correct answer-Presence of excess catheter
in the right ventricle
Ventricular irritability occurs when there is irritation to the ventricular endocardium, typically
because of catheter placement within the heart. There may be excess catheter looping in the
ventricle that causes irritation, or the catheter is excessively long, which will show up on the
monitor as changes in waveform. The nurse should notify the provider when this occurs.
A client is admitted to the hospital after falling at home. The nurse case manager reviews the
client's information and meets with the client to discuss healthcare needs. Which of the
following describes what the nurse case manager would perform during the planning stage
of the case management process? - correct answer-Finding the least restrictive level of care
for the client
The planning stage of the case management process is somewhat similar to the planning
stage of the nursing process, in that the nurse has intentions for the client's care. When
planning for client care services, the nurse case manager should find the least restrictive
level of care for the client that would still allow the most independence possible for the health
condition.
A client who receives peritoneal dialysis has called the nurse to explain that he is unable to
infuse the dialysate into the catheter. When the nurse arrives at the client's home, which
method would the nurse use to assess for an occlusion? - correct answer-Gently rotate the
catheter to improve flow or check for kinks
A client who was injured in a fall at a construction site has been brought into the emergency
room for care of a crush injury. The client's lower leg at the site of the injury is swollen and
the client is screaming in pain. The nurse notes that the client has decreased sensation
below the level of the injury and pale toes. Which intervention by the nurse is most
appropriate? - correct answer-Prepare to assist with surgical intervention
Prepare to assist with surgical intervention
The client with a crush injury is at risk of developing compartment syndrome, in which there
is swelling and increased pressure within the compartment of a limb underneath the fascia
membrane. The swelling may build to a point where it cuts off nerve sensation and occludes
circulation. Emergency treatment involves a fasciotomy, which cuts into the affected tissue to
relieve the pressure.
A client with hyperlipidemia is in for a follow-up appointment. The client has lost some
weight, but lab work reveals that the client still has hyperlipidemia. Which of the following
changes would help to lower this client's lipid levels? Select all that apply. - correct
answer-Plant based diet, stop smoking, take atorvastatin
A client with lymphedema is admitted to the hospital. Which best describes the difference
between edema and lymphedema? - correct answer-Edema involves dependent areas of the
body, while lymphedema can occur in any body area
The conditions of edema and lymphedema can seem similar but they have different
physiological processes. Edema may develop when areas of the body develop excess fluid,
which collects outside of the intravascular system. Lymphedema often occurs as a result of
damage to the lymph system, in which lymph fluid collects in the subcutaneous tissues.
A 36-year-old client is being seen in the primary care clinic with symptoms of pain,
numbness, and tingling in both wrists. The nurse is providing information to the client about
the best ways to prevent repetitive strain injuries when working at a computer. Which
information would the nurse include as part of this teaching? Select all that apply. - correct
answer-Light touch when typing
frequent breaks
keep hands warm
A 70-year-old client with a terminal illness wants to remain at home with her family. The
client has signed a Do Not Resuscitate order in the event of cardiac arrest. Which of the
following factors must be considered for use of a DNR order outside of a healthcare facility?
Select all that apply. - correct answer-Client must be deemed competent at the time
The action is to prevent unwanted resuscitation of a terminally ill client
The client must be deemed competent at the time the DNR order is signed
Rationale:
Some clients with significant illnesses who live at home have signed DNR orders so that if
they suffer cardiac arrest, they will not be resuscitated. If the client has not made his wishes
known, rescue personnel could potentially start CPR without knowing what the client wants.
The client should have the DNR order available and ready at hand in case something
happens. A family member or someone with the client could assist by presenting the DNR to
prevent unwanted resuscitation.
A client has a "lazy eye". The medical term for this condition is which of the following? -
correct answer-Amblyopia
Myopia- Near sightedness
Hyperopia- Far sightedness
Strabismus- Ocular muscles weak on one side
A client has insomnia. The client asked the nurse how to improve their sleep. The nurse tells
the client to first establish a sleep schedule. The nurse would best evaluate the effectiveness
of the client's sleep schedule by which of the following actions? - correct answer-Checking to
see if the client gets up and goes to bed the same time each day
A client in the healthcare clinic complains of feeling dizzy when standing after sitting for a
period. The client's blood pressure is 136/78 mmHg while sitting and 102/58 mmHg after
standing. Which types of treatment goals are most appropriate in this situation? Select all
that apply. - correct answer-Evaluate meds the client is taking
Instruct client about getting adequate hydration
A client in the ICU has hemodynamic monitoring in place and has been showing ventricular
irritability on the monitor as evidenced by changes in waveform configuration. What
, describes a potential cause of this condition? - correct answer-Presence of excess catheter
in the right ventricle
Ventricular irritability occurs when there is irritation to the ventricular endocardium, typically
because of catheter placement within the heart. There may be excess catheter looping in the
ventricle that causes irritation, or the catheter is excessively long, which will show up on the
monitor as changes in waveform. The nurse should notify the provider when this occurs.
A client is admitted to the hospital after falling at home. The nurse case manager reviews the
client's information and meets with the client to discuss healthcare needs. Which of the
following describes what the nurse case manager would perform during the planning stage
of the case management process? - correct answer-Finding the least restrictive level of care
for the client
The planning stage of the case management process is somewhat similar to the planning
stage of the nursing process, in that the nurse has intentions for the client's care. When
planning for client care services, the nurse case manager should find the least restrictive
level of care for the client that would still allow the most independence possible for the health
condition.
A client who receives peritoneal dialysis has called the nurse to explain that he is unable to
infuse the dialysate into the catheter. When the nurse arrives at the client's home, which
method would the nurse use to assess for an occlusion? - correct answer-Gently rotate the
catheter to improve flow or check for kinks
A client who was injured in a fall at a construction site has been brought into the emergency
room for care of a crush injury. The client's lower leg at the site of the injury is swollen and
the client is screaming in pain. The nurse notes that the client has decreased sensation
below the level of the injury and pale toes. Which intervention by the nurse is most
appropriate? - correct answer-Prepare to assist with surgical intervention
Prepare to assist with surgical intervention
The client with a crush injury is at risk of developing compartment syndrome, in which there
is swelling and increased pressure within the compartment of a limb underneath the fascia
membrane. The swelling may build to a point where it cuts off nerve sensation and occludes
circulation. Emergency treatment involves a fasciotomy, which cuts into the affected tissue to
relieve the pressure.
A client with hyperlipidemia is in for a follow-up appointment. The client has lost some
weight, but lab work reveals that the client still has hyperlipidemia. Which of the following
changes would help to lower this client's lipid levels? Select all that apply. - correct
answer-Plant based diet, stop smoking, take atorvastatin
A client with lymphedema is admitted to the hospital. Which best describes the difference
between edema and lymphedema? - correct answer-Edema involves dependent areas of the
body, while lymphedema can occur in any body area
The conditions of edema and lymphedema can seem similar but they have different
physiological processes. Edema may develop when areas of the body develop excess fluid,
which collects outside of the intravascular system. Lymphedema often occurs as a result of
damage to the lymph system, in which lymph fluid collects in the subcutaneous tissues.
