ACTUAL EXAM |MOST TESTED QUESTIONS|COMPLETE QUESTIONS AND
CORRECT DETAILED ANSWERS (VERIFIED ANSWERS) |ALREADY GRADED A+
A client is brought to the emergency department following a motor-vehicle crash. Drug use is
suspected in the crash, and a voided urine specimen is ordered. The client repeatedly refuses to
provide the specimen. Which of the following is the appropriate action by the nurse? -
CORRECT ANSWER ; B* Document the client‟s refusal in the chart.
A nurse is making shift assignments in a hospital. Which of the following tasks is appropriate to
assign to a licensed practical nurse? - CORRECT ANSWER ; Administer a nasogastric tube
feeding.
A nurse preceptor is evaluating a newly licensed nurse‟s competency in assisting with a sterile
procedure. Which of the following actions indicates the newly licensed nurse is maintaining
sterile technique? (SATA) - CORRECT ANSWER ; b. Opens the sterile pack by first unfolding
the top flap away from her body
d. Removes the outside packaging of a sterile instrument before dropping it onto the sterile field
A nurse enters a client‟s room and identifies that the client is receiving too much IV fluid
because the IV pump is not working properly. Which of the following actions should the nurse
take first? - CORRECT ANSWER ; Auscultate the client‟s lungs.
A nurse is planning care for a group of clients and can delegate care to a licensed practical nurse
(LPN) and an assistive personnel. Which of the following tasks should the nurse assign to the
LPN? - CORRECT ANSWER ; Reinforcing teaching with a client who is learning to self-
administer insulin
A nurse is supervising a newly licensed nurse who is performing surgical asepsis. After donning
a sterile gown and gloves, which of the following actions by the newly licensed nurse
demonstrates correct aseptic technique? - CORRECT ANSWER ; The nurse holds her hands
above her waist.
,A nurse who is caring for a group of clients delegates collection of vital signs to an assistive
personnel (AP). Which of the following actions should the nurse take to evaluate the delegated
task? - CORRECT ANSWER ; Recheck vital signs that are outside the expected reference
range.
A nurse is caring for four clients. Which of the following tasks can be delegated to an assistive
personnel? - CORRECT ANSWER ; Obtaining a stool sample from a client who has renal
failure
A nurse is triaging a group of clients following a disaster. Which of the following clients should
the nurse recommend for treatment first? - CORRECT ANSWER ; A client who has two open
chest wounds with a left tracheal deviation
A nurse manager is reviewing guidelines for informed consent with the nursing staff. Which of
the following statements by a staff nurse indicates that the teaching was effective? - CORRECT
ANSWER ; "Consent can be given by a durable power of attorney."
A nurse is caring for four clients. For which of the following clients should the nurse collaborate
with the facility ethics committee? - CORRECT ANSWER ; An adolescent client whose
parents refuse a blood transfusion for religious reasons
A nurse in an ambulatory care setting is orient a newly licensed nurse who is preparing to return
a call to a client. The nurse should explain that which of the following is an objective of
telehealth? - CORRECT ANSWER ; Establishing communication between providers
A nurse is providing discharge teaching to a client who has a new diagnosis of diabetes. The
client expresses concern about the cost of blood-glucose monitoring supplies. Which of the
following actions should the nurse take? - CORRECT ANSWER ; Refer the client to the social
services department
A charge nurse is receiving change-of-shift report. Which of the following situations should the
charge nurse address first? - CORRECT ANSWER ; The emergency department nurse is
waiting to give report on a new admission.
, A nurse who is precepting a newly licensed nurse is discussing the client assignment for the shift.
Which of the following actions should the nurse preceptor take first to demonstrate appropriate
time management? - CORRECT ANSWER ; Determine client care goals (set/plan goals)
A charge nurse is reviewing information about HIPAA with a group of staff nurses. Which of the
following statements by a staff nurse indicates understanding? - CORRECT ANSWER ;
"HIPAA allows clients to request a review of their own medical records."
A nurse is caring for a client who has a tumor. The provider recommends surgery. The client
refuses, but the client‟s partner wants the surgery performed. Which of the following is the
deciding factor in determining if the surgery will be done? - CORRECT ANSWER ; Whether
the client understands the risk of refusing the procedure
A charge nurse is planning the care of four newborns. An assistive personnel and licensed
practical nurse are available for staffing. Which of the following tasks should the nurse assign to
a licensed practical nurse? - CORRECT ANSWER ; Administer a hepatitis B vaccine.
During a staff meeting a unit manager reviews the results for documenting client education and
finds that they are below the benchmark. Which of the following strategies should the nurse
manager implement first? - CORRECT ANSWER ; Determine factors that interfere with the
documentation of client education.
A nurse is explaining ethics and values to a newly licensed nurse. The nurse should explain that
preventing client injury by removing a fall hazard demonstrates which of the following ethical
principles? - CORRECT ANSWER ; Nonmaleficence
A nurse is caring for a group of clients. Which of the following clients should the nurse plan to
assess first? - CORRECT ANSWER ; A client who has a nasogastric tube and has crackles in
the lungs (ABC-- airway)
A charge nurse is planning to evacuate clients on the unit because there is a fire on another floor.
Which of the following clients should the nurse evacuate first? - CORRECT ANSWER ; A
client who is receiving IV chemotherapy and is ambulatory