A nurse in an emergency department is preparing to
perform an ocular irrigation for a client. Which of the
following actions should the nurse plan to take?
a. Assess the client's visual acuity prior to irrigation
b. Have the client turn their head toward the
unaffected eye
c. Hold the irrigator syringe 3.81 cm (1.5 in) above
the eye
d. Perform the irrigation with sterile water for
irrigation - answerd. Perform the irrigation with sterile
water for irrigation
A nurse is preparing to administer lactated ringer's
via continuous IV infusion at 200 ml/hr. The IV
tubing has a drop factor of 10 drops/ml. How many
gtt/min should the nurse set the IV pump to
administer? Round to near whole number -
answer33 gtt/min
,A nurse is providing discharge teaching to a client
who has a new prescription for sublingual
nitroglycerin. Which of the following client
statements indicates an understanding of the
teaching?
a. I can keep my medications for 1 year before
replacing it
b. I should lie down when I take this medication
c. I should discontinue this medication if I develop a
headache
d. I can take up to five tablets in 15 minutes before
seeking medical attention - answerb. I should lie
down when I take this medication
A nurse is providing discharge teaching to an older
adult client following a left total hip arthroplasty.
Which of the following instructions should the nurse
include in the teaching?
a. Clean the incision daily with hydrogen peroxide
b. You can cross your legs the ankles when sitting
down
c. You should use an incentive spirometer every 8
hours
d. Install a raised toilet seat in your bathroom -
answerd. Install a raised toilet seat in your bathroom
A nurse is planning care for a client following a
cardiac catheterization. Which of the following
actions should the nurse take?
a. Keep the client on bed rest for 24 hours
,b. Limit the client's fluid intake to 1 l per day
c. Maintain the client's affected extremity in
extension
d. Change the client's dressing every 8 hour -
answerc. Maintain the client's affected extremity in
extension
A nurse is caring for a client who has a lower
extremity fracture and a prescription for crutches.
Which of the following client statements indicates
that the client is adapting to their role change?
a. I will need to have my partner take over shopping
for groceries and cooking the meals for us
b. These crutches will make it impossible to care for
my child
c. I feel bad that I have to ask my partner to keep the
house clean
d. Its going to be difficult to tell my parents I cant
take them to their appointments anymore - answera.
I will need to have my partner take over shopping for
groceries and cooking the meals for us
A nurse is caring for a client who has gastroenteritis.
Which of the following assessment findings should
the nurse recognize as an indication that the client is
experiencing dehydration?
a. Pitting, dependent edema
b. Distended jugular veins
c. Increased BP
d. Decreased BP - answerd. Decreased BP
, A nurse is caring for a client who has a contusion of
the brainstem and reports thirst. The client's urinary
output was 4,000 ml over the past 24 hour. The
nurse should anticipate a prescription for which of
the following IV medication?
a. Desmopressin
b. Epinephrine
c. Furosemide
d. Nitroprusside - answera. Desmopressin
A nurse in a clinic receives a phone call from a client
who recently started therapy with an ACE inhibitor
and reports a nagging dry cough. Which of the
following responses by the nurse is appropriate?
a. "your cough may require that you stop or change
your medication"
b. "Increasing your daily fluid intake may eliminate
your cough"
c. "sucking on lozenge may reduce the frequency of
your cough"
d. You cough should go away in time" - answera.
"your cough may require that you stop or change
your medication"
A nurse is taking an admission history from a client
who reports Raynaud's disease. Which of the
following assessment findings should the nurse
identify as a potential trigger for exacerbations
of Raynaud's?
a. Eating a strict vegetarian diet
perform an ocular irrigation for a client. Which of the
following actions should the nurse plan to take?
a. Assess the client's visual acuity prior to irrigation
b. Have the client turn their head toward the
unaffected eye
c. Hold the irrigator syringe 3.81 cm (1.5 in) above
the eye
d. Perform the irrigation with sterile water for
irrigation - answerd. Perform the irrigation with sterile
water for irrigation
A nurse is preparing to administer lactated ringer's
via continuous IV infusion at 200 ml/hr. The IV
tubing has a drop factor of 10 drops/ml. How many
gtt/min should the nurse set the IV pump to
administer? Round to near whole number -
answer33 gtt/min
,A nurse is providing discharge teaching to a client
who has a new prescription for sublingual
nitroglycerin. Which of the following client
statements indicates an understanding of the
teaching?
a. I can keep my medications for 1 year before
replacing it
b. I should lie down when I take this medication
c. I should discontinue this medication if I develop a
headache
d. I can take up to five tablets in 15 minutes before
seeking medical attention - answerb. I should lie
down when I take this medication
A nurse is providing discharge teaching to an older
adult client following a left total hip arthroplasty.
Which of the following instructions should the nurse
include in the teaching?
a. Clean the incision daily with hydrogen peroxide
b. You can cross your legs the ankles when sitting
down
c. You should use an incentive spirometer every 8
hours
d. Install a raised toilet seat in your bathroom -
answerd. Install a raised toilet seat in your bathroom
A nurse is planning care for a client following a
cardiac catheterization. Which of the following
actions should the nurse take?
a. Keep the client on bed rest for 24 hours
,b. Limit the client's fluid intake to 1 l per day
c. Maintain the client's affected extremity in
extension
d. Change the client's dressing every 8 hour -
answerc. Maintain the client's affected extremity in
extension
A nurse is caring for a client who has a lower
extremity fracture and a prescription for crutches.
Which of the following client statements indicates
that the client is adapting to their role change?
a. I will need to have my partner take over shopping
for groceries and cooking the meals for us
b. These crutches will make it impossible to care for
my child
c. I feel bad that I have to ask my partner to keep the
house clean
d. Its going to be difficult to tell my parents I cant
take them to their appointments anymore - answera.
I will need to have my partner take over shopping for
groceries and cooking the meals for us
A nurse is caring for a client who has gastroenteritis.
Which of the following assessment findings should
the nurse recognize as an indication that the client is
experiencing dehydration?
a. Pitting, dependent edema
b. Distended jugular veins
c. Increased BP
d. Decreased BP - answerd. Decreased BP
, A nurse is caring for a client who has a contusion of
the brainstem and reports thirst. The client's urinary
output was 4,000 ml over the past 24 hour. The
nurse should anticipate a prescription for which of
the following IV medication?
a. Desmopressin
b. Epinephrine
c. Furosemide
d. Nitroprusside - answera. Desmopressin
A nurse in a clinic receives a phone call from a client
who recently started therapy with an ACE inhibitor
and reports a nagging dry cough. Which of the
following responses by the nurse is appropriate?
a. "your cough may require that you stop or change
your medication"
b. "Increasing your daily fluid intake may eliminate
your cough"
c. "sucking on lozenge may reduce the frequency of
your cough"
d. You cough should go away in time" - answera.
"your cough may require that you stop or change
your medication"
A nurse is taking an admission history from a client
who reports Raynaud's disease. Which of the
following assessment findings should the nurse
identify as a potential trigger for exacerbations
of Raynaud's?
a. Eating a strict vegetarian diet
