Exam Prep | High-Yield Review Guide
1. Describe how the ABC framework can guide nursing practice in emergency
situations.
The ABC framework helps nurses prioritize patient care by focusing
on the most critical needs: ensuring the airway is clear, assessing
breathing, and maintaining circulation.
The ABC framework is a method for documenting patient history.
The ABC framework outlines the steps for medication administration.
The ABC framework is used to evaluate patient satisfaction and
comfort levels.
2. A nurse has a client who decides they no longer want to have a surgery
despite significant blockages of arteries. The nurse knows that this is the
client's choice of which of the following principles
justice
fidelity
autonomy
nonmaleficence
3. An extremely agitated client receives haloperidol IM every 30 min while in
the psych ED. It is most important for the RN to take which action?
Tell the client the name of the med and its effects
Remain at the pts. Bedside to provide reassurance
Assess for anticholinergic effects of the med
Monitor BP every 30 minutes
,4. What is a common symptom of cor pulmonale that a nurse would expect to
observe?
Peripheral edema
Hyperactivity
Increased appetite
Chest pain
5. Why is it critical for the nurse to address the expired warfarin prescription for
the client with a CVA?
The expired warfarin prescription poses a risk of thromboembolic
events due to inadequate anticoagulation.
Routine check-ups are always prioritized over other conditions.
The client with stable vital signs does not require immediate care.
The client may experience increased pain without morphine.
6. Why is it appropriate for a nurse to delegate the task of reapplying a condom
catheter to an assistive personnel?
The task is within the scope of practice for assistive personnel and
does not require nursing judgment.
The task is too critical and must be performed by a registered nurse.
The task requires patient education that the AP is not qualified to
provide.
The task involves complex decision-making that only a nurse can
perform.
7. A nurse is preparing to educate a patient about the timing of ranitidine
hydrochloride (Zantac) administration. If the patient has a history of morning
, acid reflux, what advice should the nurse provide?
The patient should take ranitidine at bedtime to ensure it works
overnight.
The patient should take ranitidine after dinner to avoid nighttime
symptoms.
The patient should take ranitidine before breakfast to prevent acid
reflux symptoms.
The patient should take ranitidine with lunch for better results.
8. Which instruction should the nurse include in the discharge teaching for a
patient receiving tetracycline?
"Use sunscreen and protective clothing when outdoors."
"Take the medication with food or milk to minimize gastrointestinal
upset."
"Keep the remainder of the medication in case of recurrence."
"Take the medication until you feel better."
9. Describe how the principle of beneficence applies to nursing practice in
patient care.
Beneficence is only relevant in end-of-life care situations.
Beneficence requires nurses to act in ways that promote the well-
being of patients.
Beneficence focuses solely on the distribution of resources.
Beneficence allows nurses to prioritize their own needs over patients.
, 10. Which ethical principle emphasizes fairness in the distribution of healthcare
resources?
Fidelity
Beneficence
Autonomy
Justice
11. A nurse is developing a care plan for a patient with oliguria and elevated
blood pressure. If the patient's lab results indicate high levels of urea, what
dietary change should the nurse recommend?
Restrict fluid intake
Increase carbohydrate intake
Restrict protein intake
Increase fat intake
12. A nurse on a med-surg unit has received change-of-shift and will care for 4
clients. Which need of the client may the nurse assign to an AP?
Feeding a client who has aspiration pneumonia
Reapplying a condom catheter for a client who has urinary
incontinence
Applying a sterile dressing to a pressure ulcer
Reinforcing teaching w/ client who's learning to walk using a quad
cane
13. A nurse is caring for a patient in the hospital. When should the nurse begin
discharge planning?