1. A nurse is assisting in the care of a client who has a urinary tract infection. The nurse is
reviewing the client's medical record. Which of the following actions should the nurse
take? Select all that apply. - >>>>> ANSWER Clarify the prescription for amoxicillin with
the provider. Place the client on contact precautions.
2. A nurse is providing end-of-life care to a client who is experiencing dyspnea. Which of
the following actions should the nurse take? - >>>>> ANSWER Reposition the client once
every 4 hr.
3. A nurse is caring for an adult client who has acute lymphocytic leukemia. The client is
refusing blood products. Which of the following responses should the nurse make? -
>>>>> ANSWER "I understand that you decided not to receive blood products."
4. A nurse is collecting data from an older adult client who lives alone. Which of the
following findings should the nurse identify as the priority? - >>>>> ANSWER The client is
sedentary throughout most of the day.
5. A nurse is planning to obtain a client's oxygen saturation. Which of the following might
influence the result of this test? - >>>>> ANSWER The client is wearing nail polish.
6. A nurse is caring for an adult client who has a developmental disability. The client
requires an emergency appendectomy, and the staff cannot reach the appointed
guardian. Which of the following is an appropriate action for the nurse to take? - >>>>>
ANSWER Prepare the client for surgery with implied consent
7. A nurse is collecting data from a client who is 2 days postoperative following the
placement of a colostomy. Which of the following findings should the nurse report to the
provider? - >>>>> ANSWER The stoma appears dark in color.
, 8. A nurse is preparing to obtain a capillary blood specimen from a client. Which of the
following actions should the nurse take? (Select all that apply) - >>>>> ANSWER Prick the
side of the client's finger.
9. Using clean gloves
10. A nurse is collecting data from a client who is immobile and has a potential deep-vein
thrombosis. Which of the following findings should the nurse report to the provider? -
>>>>> ANSWER calf swelling
11. A nurse is caring for a client who has a new prescription for a belt restraint. Which of the
following actions should the nurse take? - >>>>> ANSWER Apply the belt restraint over
the client's gown.
12. A nurse is caring for a client who is postpartum. Which of the following documentations
should the nurse include in the client's health record? - >>>>> ANSWER Episiotomy
approximated, 3 cm (1.18 in) in length.
13. A nurse is contributing to a community center's in-service program about early detection
of breast cancer. Which of the following recommendations should the nurse make for
female clients who do not have a family history of breast cancer? - >>>>> ANSWER "You
should receive a breast examination from your provider each year after age 30.
14. A nurse is preparing to perform a fecal occult blood test of stool specimens for a client.
Which of the following actions should the nurse plan to take? - >>>>> ANSWER Ensure
that the stool specimen does not contain urine.
15. A nurse is assisting in the care of a client who is receiving newly prescribed IV antibiotics.
Which of the following findings should the nurse report immediately? - >>>>> ANSWER
Severe wheezing