PN comprehensive predictor practice B
A nurse at a long-term care facility is caring for a client who requires oral suctioning.
Which of the following supplies should the nurse plan to use for this task? -
ANS-yankeurs catheter
rationale: A Yankauer catheter is a clean suction catheter used when performing oral
and oropharyngeal suctioning to remove secretions from the client's mouth to facilitate
breathing or obtain a sample for diagnostic evaluation.
A nurse in a long-term care facility is serving on the ethics committee, which is
addressing a client care dilemma. Which of the following strategies will facilitate
resolving the dilemma? (Select all that apply.) - ANS-[1] determine the facts related to
the dilemma.
[2] identify possible solution
[3]consider the client wishes
A nurse is talking with a client whose son died in a motor-vehicle crash 2 weeks ago.
The client states, "l really thought I'd be back to my usual routines by now, but I can't
think of anything else except that my son is gone." Which Of the following responses
should the nurse make? - ANS-Grieving for your son is hard work. it will take as much
time as you need to come to terms with your loss.
A nurse is reinforcing teaching with a client about cancer prevention. The nurse should
include that frequent consumption of which of the following foods increases the risk for
developing cancer? - ANS-Lamb
rationale: including tuna fish reduces risk of developing cancer.
including poultry reduces risk,
A nurse notices an assistive personnel (AP) taking a nap in the break room during meal
time. The nurse also notes that the AP is drowsy while performing routine tasks. Which
of the following actions should the nurse take? - ANS-Report the observation about the
AP to the Unit nurse manager
A nurse on a pediatric unit is collecting data from four newly admitted clients. Which of
the following clients should the nurse identify as being at risk for urinary retention? -
,ANS-A school age child who has allergic rhinitis and is taking diphenhydramine.
A nurse is caring for a client following a bronchoscopy. Which of the following actions
should the nurse take first? - ANS-check for gag reflex
A nurse is assisting with the admission of a client who has a latex allergy. The nurse
should identify that which of the following supplies has the potential to contain latex? -
ANS-Indwelling urinary catheter
A nurse is performing postmortem care for a client prior to the arrival Of the client's
family for viewing Of the body. Which Of the following actions should the nurse take? -
ANS-Gently close the client's eyelids
A nurse is reinforcing teaching with a client who has dumping syndrome about
measures to reduce manifestations. Which of the following instructions should the nurse
include in the teaching? - ANS-avoid foods high in sugar content.
rationale: The nurse should instruct the client to avoid sweet foods, which often increase
the manifestations of dumping syndrome. These manifestations include nausea,
sweating, abdominal pain, diarrhea, and weakness.
A nurse is collecting data from a client who is experiencing a situational crisis following
the loss of a job. The client states, "l don't think I can go through this again." Which of
the following actions is the nurse's priority? - ANS-Determine if the client is experiencing
psychotic thinking.
A nurse is contributing to the plan of care for a client following a transurethral resection
of the prostate (TURP). Which of the following interventions should the nurse include? -
ANS-Irrigate the bladder using sterile technique
A nurse is caring for an infant who is receiving IV fluids for dehydration. Which of the
following should the nurse recognize as a positive response to the therapy? -
ANS-Moist mucus membranes.
A nurse is assisting with the admission of a client who is experiencing alcohol
withdrawal. Which of the following medications should the nurse expect the provider to
prescribe for the client? - ANS-Chlordiazepoxide
rationale: The nurse should expect to administer chlordiazepoxide to decrease anxiety
and the risk for seizures associated with alcohol withdrawal.
, A nurse is caring for a client who is scheduled for surgery in the morning. The nurse
learns that the client has decided not to have surgery even though they have already
signed the informed consent form. Which of the following actions should the nurse take?
- ANS-report the situation to the provider who obtained informed consent.
A nurse is collecting data from a client who is in severe pain. Which of the following
questions should the nurse ask first? - ANS-where is your pain located
A nurse in a provider's office is reinforcing teaching with a client who has a new
prescription for ferrous sulfate elixir. Which of the following statements by the client
should indicate to the nurse an understanding of the teaching? - ANS-i will rinse my
mouth after taking this medication
A nurse is contributing to the plan of care for a client who is postoperative following a
rhinoplasty. Which of the following interventions should the nurse recommend? -
ANS-instruct the client to avoid the Valsalva maneuver.
rationale. Valsalva ts such as straining during defecation or playing the saxophone
entail performance of Valsalva maneuver
A nurse is collecting data from a postpartum client who had a vaginal birth 2 days ago.
Which Of the following findings is the nurse's priority to report to the provider? -
ANS-client reports burning with urination.
rationale: When using the urgent vs. nonurgent approach to client care, the nurse
should determine that dysuria is a manifestation of a urinary tract infection. Therefore,
the nurse should identify this as the priority finding to report to the provider.
A nurse is preparing to administer digoxin to a client who has heart failure. Which Of the
following findings should indicate to the nurse that the medication has been effective? -
ANS-cardiac workload decreases
A nurse is reinforcing teaching about stress management techniques with a client who
has moderate anxiety disorder. Which of the following responses by the client indicates
an understanding of the teaching? - ANS-i will imagine myself in a calm place when i
cant concentrate
A nurse is reinforcing teaching with a client about taking warfarin to treat atrial
fibrillation. Which of the following statements by the client indicates an understanding of
A nurse at a long-term care facility is caring for a client who requires oral suctioning.
Which of the following supplies should the nurse plan to use for this task? -
ANS-yankeurs catheter
rationale: A Yankauer catheter is a clean suction catheter used when performing oral
and oropharyngeal suctioning to remove secretions from the client's mouth to facilitate
breathing or obtain a sample for diagnostic evaluation.
A nurse in a long-term care facility is serving on the ethics committee, which is
addressing a client care dilemma. Which of the following strategies will facilitate
resolving the dilemma? (Select all that apply.) - ANS-[1] determine the facts related to
the dilemma.
[2] identify possible solution
[3]consider the client wishes
A nurse is talking with a client whose son died in a motor-vehicle crash 2 weeks ago.
The client states, "l really thought I'd be back to my usual routines by now, but I can't
think of anything else except that my son is gone." Which Of the following responses
should the nurse make? - ANS-Grieving for your son is hard work. it will take as much
time as you need to come to terms with your loss.
A nurse is reinforcing teaching with a client about cancer prevention. The nurse should
include that frequent consumption of which of the following foods increases the risk for
developing cancer? - ANS-Lamb
rationale: including tuna fish reduces risk of developing cancer.
including poultry reduces risk,
A nurse notices an assistive personnel (AP) taking a nap in the break room during meal
time. The nurse also notes that the AP is drowsy while performing routine tasks. Which
of the following actions should the nurse take? - ANS-Report the observation about the
AP to the Unit nurse manager
A nurse on a pediatric unit is collecting data from four newly admitted clients. Which of
the following clients should the nurse identify as being at risk for urinary retention? -
,ANS-A school age child who has allergic rhinitis and is taking diphenhydramine.
A nurse is caring for a client following a bronchoscopy. Which of the following actions
should the nurse take first? - ANS-check for gag reflex
A nurse is assisting with the admission of a client who has a latex allergy. The nurse
should identify that which of the following supplies has the potential to contain latex? -
ANS-Indwelling urinary catheter
A nurse is performing postmortem care for a client prior to the arrival Of the client's
family for viewing Of the body. Which Of the following actions should the nurse take? -
ANS-Gently close the client's eyelids
A nurse is reinforcing teaching with a client who has dumping syndrome about
measures to reduce manifestations. Which of the following instructions should the nurse
include in the teaching? - ANS-avoid foods high in sugar content.
rationale: The nurse should instruct the client to avoid sweet foods, which often increase
the manifestations of dumping syndrome. These manifestations include nausea,
sweating, abdominal pain, diarrhea, and weakness.
A nurse is collecting data from a client who is experiencing a situational crisis following
the loss of a job. The client states, "l don't think I can go through this again." Which of
the following actions is the nurse's priority? - ANS-Determine if the client is experiencing
psychotic thinking.
A nurse is contributing to the plan of care for a client following a transurethral resection
of the prostate (TURP). Which of the following interventions should the nurse include? -
ANS-Irrigate the bladder using sterile technique
A nurse is caring for an infant who is receiving IV fluids for dehydration. Which of the
following should the nurse recognize as a positive response to the therapy? -
ANS-Moist mucus membranes.
A nurse is assisting with the admission of a client who is experiencing alcohol
withdrawal. Which of the following medications should the nurse expect the provider to
prescribe for the client? - ANS-Chlordiazepoxide
rationale: The nurse should expect to administer chlordiazepoxide to decrease anxiety
and the risk for seizures associated with alcohol withdrawal.
, A nurse is caring for a client who is scheduled for surgery in the morning. The nurse
learns that the client has decided not to have surgery even though they have already
signed the informed consent form. Which of the following actions should the nurse take?
- ANS-report the situation to the provider who obtained informed consent.
A nurse is collecting data from a client who is in severe pain. Which of the following
questions should the nurse ask first? - ANS-where is your pain located
A nurse in a provider's office is reinforcing teaching with a client who has a new
prescription for ferrous sulfate elixir. Which of the following statements by the client
should indicate to the nurse an understanding of the teaching? - ANS-i will rinse my
mouth after taking this medication
A nurse is contributing to the plan of care for a client who is postoperative following a
rhinoplasty. Which of the following interventions should the nurse recommend? -
ANS-instruct the client to avoid the Valsalva maneuver.
rationale. Valsalva ts such as straining during defecation or playing the saxophone
entail performance of Valsalva maneuver
A nurse is collecting data from a postpartum client who had a vaginal birth 2 days ago.
Which Of the following findings is the nurse's priority to report to the provider? -
ANS-client reports burning with urination.
rationale: When using the urgent vs. nonurgent approach to client care, the nurse
should determine that dysuria is a manifestation of a urinary tract infection. Therefore,
the nurse should identify this as the priority finding to report to the provider.
A nurse is preparing to administer digoxin to a client who has heart failure. Which Of the
following findings should indicate to the nurse that the medication has been effective? -
ANS-cardiac workload decreases
A nurse is reinforcing teaching about stress management techniques with a client who
has moderate anxiety disorder. Which of the following responses by the client indicates
an understanding of the teaching? - ANS-i will imagine myself in a calm place when i
cant concentrate
A nurse is reinforcing teaching with a client about taking warfarin to treat atrial
fibrillation. Which of the following statements by the client indicates an understanding of
