NURSING NIGHTINGALE COLLEGE
1. The nurse is monitoring neurological vital signs for a male client who
lost consciousness after falling and hitting his head. Which assessment
finding is the earliest and most sensitive indication of altered cerebral
function?
a. Unequal pupils.
b. Loss of central reflexes.
c. Inability to open the eyes.
d. Change in level of consciousness.:
D
2. A nurse is planning to teach self-care measures to a female client about
prevention of yeast infections. Which instructions should the nurse
provide?
a. Use a douche preparation no more than once a month.
b. Increase daily intake of fiber and leafy green vegetables.
c. Select nylon underwear that is loose-fitting, white, and comfortable.
d. Avoid tight-fitting clothing and do not use bubble-bath or bath salts.:
D
,3. A client who has active tuberculosis (TB) is admitted to the medical
unit. What action is most important for the nurse to implement?
a. Place an isolation cart in the hallway.
b. Fit the client with a respirator mask.
c. Don a clean gown for client care.
d. Assign the client to a negative air-flow room.:
D
4. The nurse is planning to conduct nutritional assessments and diet
teaching to clients at a family health clinic. Which individual has the greatest
nutritional and energy demands?
a. A pregnant woman.
b. A teenager beginning puberty.
c. A 3-month-old infant.
d. A school-aged child.:
A
5. What nursing delivery of care provides the nurse to plan and direct care
of a group of clients over a 24-hour period?
a. Team nursing.
b. Primary nursing.
c. Case management.
d. Functional nursing.:
, B
6. Which approach should the nurse use when preparing a toddler
for a procedure?
a. Demonstrate the procedure using a doll.
b. Avoid asking the child to make choices.
, c. Plan a teaching session to last about 20 minutes.
d. Show equipment but prevent child from handling it.:
A
7. The nurse is caring for a client who is the daughter of a local politician.
When the nurse approaches a man who is reading the names on the hall
doors, he identifies himself as a reporter for the local newspaper and
requests information about the client's status. Which standard of nursing
practice should the nurse use to respond?
a. Caring.
b. Veracity.
c. Advocacy.
d. Confidentiality.:
D
8. A male client diagnosed with antisocial personality disorder is morbidly
obese and is placed on a low fat, low calorie diet. At dinner the nurse notes
that he is trying to get other clients on the unit to give him part of their
meals. What intervention should the nurse implement?
a. Remove the client from the table and have him sit alone.
b. Send the client back to his room and do not allow him to eat.
c. Report the behavior to the on-call psychologist immediately.