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A nurse is reinforcing teaching with the parents of a toddler who has
a new diagnosis of asthma and a prescription for montelukast. Which
of the following instructions should the nurse include in the teaching?
- ANSWER -Administer the medication to the toddler each evening
A nurse in an acute mental health facility is caring for a newly
admitted client. Which of the following should occur during the
orientation phase of the nurse-client relationship? - ANSWER -
Defining responsibilities
A nurse is caring for a client who reports having a decrease in fetal
movement following an external cephalic version 6 hr ago. The nurse
identifies the fetus is in the right occiput anterior position. The nurse
should place the fetal heart monitor on which of the following sites to
auscultate the fetal heart rate? - ANSWER -Lower left
A charge nurse is observing a newly licensed nurse perform
suctioning for a client who has a tracheostomy. For which of the
following actions by the newly licensed nurse should the charge
nurse intervene? - ANSWER -Suction for 30 seconds
A nurse is reviewing the medication administration record of a client
who takes atenolol PO and supplies a nitroglycerin transdermal patch
daily. Which of the following interactions should the nurse monitor
with this client? - ANSWER -Hypotension
A nurse in an acute care setting is preparing to administer
medications to a client. Which of the following actions should the
,nurse verify the client's identity? - ANSWER -Verify the client's
identity using a photograph
A nurse in a provider's office is collecting data from a client who has
psoriasis. Which of the following statements made by the client
should she report to the provider? - ANSWER -"I try not to look at the
scales on my body"
A nurse is completing chart reviews in a long-term care facility in
response to an increase in falls. Which of the following responses in
the chart should the nurse use to determine the potential causes of
falls? - ANSWER -Medication record
A nurse is making client care assignments for an assistive personnel
(AP). Which of the following tasks should the nurse assign to the AP?
- ANSWER -Complete post mortem care for a client who has died
A nurse is reinforcing teaching with a client who is taking allopurinol
about the risk for developing Stevens-Johnsons syndrome. For which
of the following manifestations should the nurse instruct the client to
monitor and report? - ANSWER -Skin rash with fever
A charge nurse in a long-term care facility is reinforcing teaching with
a group of nurses about fall precautions. Which of the following
statements made by the nurse indicates an understanding of the
teaching? - ANSWER -"I will instruct the client to sit when putting on a
pair of pants"
A nurse is recommending clients for discharge to allow for admission
of clients following a tornado disaster. Which of the following clients
, should the nurse recommend for discharge? - ANSWER -A client who
has a sodium level of 140 mEq/L after one episode of diarrhea
A nurse is assisting with the plan of care for a newly admitted client
who has anorexia nervosa. Which of the following interventions
should the nurse include in the plan? - ANSWER -Administer liquid
supplements
A charge nurse is reinforcing teaching with a newly licensed nurse
about floating to a different unit. Which of the following statements by
the newly licensed nurse indicates an understanding of the teaching?
- ANSWER -"I will document in the medical record the support nurse
who assists with planning care for my clients"
A nurse is caring for a client who has dehydration due to diarrhea.
Which of the following findings should the nurse report to the
provider? - ANSWER -Urine output 12 mL/hr
A nurse is preparing the administer NPH (Novolin N) insulin to a client
who has diabetes mellitus before breakfast at 0700. At which of the ff.
times should the nurse plan to check the client for hypoglycemia? -
ANSWER -1100
A nurse in a clinic is obtaining a health history from a client
scheduled to un- dergo a cardiac catheterization in 2 days. Which of
the ff. questions is the most im- portant for the nurse to ask? -
ANSWER -"Do you know if you're allergic to iodine?"
A nurse in an urgent-care facility is collecting data from a client who
is scheduled for a procedure. Which of the ff. clinical manifestations
indicates a possi- ble latex allergy? - ANSWER -Rhinorrhea