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    Exam Review

    1. A nurse is reviewing the laboratory report of a client who has been experiencing a fever for the last 3 days. Which of the following laboratory results indicates the client is experiencing fluid volume deficit?
      A)
      Decreased blood urea nitrogen (BUN)
      B)
      Increased hematocrit
      C)
      Decreased urine specific gravity
      D)
      Increased calcium level
    2. A nurse is caring for a client in the emergency department. Exhibits Complete the following sentence by using the lists of options. To implement the provider's prescriptions the nurse should ▾ Insert the NG tube because this will ▾ Decompress the stomach and reduce vomiting
      Dropdown 1:
      Option 1: Insert the NG tube
      Option 2: Administer prescribed antibiotics
      Option 3: Perform abdominal assessment
      Dropdown 2:
      Option 1: Reduce the risk of aspiration
      Option 2: Decompress the stomach and reduce vomiting
      Option 3: Evaluate the extent of abdominal distention
    3. A community health nurse is teaching a group of clients about first aid for different types of wounds. Which of the following client statements Indicates an understanding of the teaching?
      A)
      "I should apply clean dressings over the top of blood saturated dressings and hold pressure."
      B)
      "I can clean wounds with hydrogen peroxide."
      C)
      "I can carefully remove the object from a penetrating wound."
      D)
      "I should place the affected area in a dependent position."
    4. A nurse is caring for a client on a medical-surgical unit. Exhibits Complete the following sentence by using the list of options. The nurse should ▾ Apply firm, direct pressure to the catheter insertion site and then ▾ Assess vital signs and assess for signs of hypovolemia
      Dropdown 1:
      Option 1: Apply firm, direct pressure to the catheter insertion site
      Option 2: Lower the head of the bed and assess circulation to the extremity
      Option 3: Increase IV fluid rate per provider orders
      Dropdown 2:
      Option 1: Assess vital signs and assess for signs of hypovolemia
      Option 2: Prepare for possible fluid resuscitation or blood transfusion
      Option 3: Notify the provider of continued bleeding or hemodynamic instability
    Page 1 of 12

    Exam Review

    1. A nurse is assisting with meal planning for a client who has been prescribed a mechanical soft diet. The nurse should instruct the client to avoid which of the following foods?
      A)
      Orange slices
      B)
      Ground hamburger
      C)
      Cooked green beans
      D)
      Canned peaches
    2. A nurse is caring for a client who has been recently hospitalized. The nurse should identify that which of the following findings indicates that the client is experiencing stress?
      A)
      Dry skin
      B)
      Increased urinary output
      C)
      Dilated pupils
      D)
      Hyperactive bowel sounds
    3. A nurse is caring for a client in the emergency department. Exhibits
      (Highlight — findings requiring follow-up are marked)

      A nurse is caring for a client in the emergency department.

      Exhibits

      Click to highlight the findings that indicate client's condition is worsening. To deselect a finding, click on the finding again.

      Physical Exam:

      1200:

      Client re-evaluated following nebulizer treatment. Client appears anxious, hand tremor present. Mucous membranes cyanotic, clear rhinorrhea visible. Diffuse wheezing auscultated throughout lung fields. S1, S2 auscultated, no murmur. Skin warm and dry.

      Temperature 37° C (98.6° F)

      Heart rate 98/min

      Respiratory rate 27/min

      Blood pressure 168/90 mm Hg

      Oxygen saturation 84% on 3L nasal cannula

    4. A nurse is caring for a client on a medical-surgical unit. Exhibits
      (Highlight — findings requiring follow-up are marked)

      A nurse is caring for a client on a medical-surgical unit.

      Exhibits

      Click to highlight the findings below of the prescriptions that the nurse should clarify with the provider prior to administering the medications. To deselect a finding, click on the finding again.

      1300:

      Potassium Chloride 20 mEq PO daily

      HCTZ 25mg QD

      Amlodipine 10 mg QOD

      Clonidine .1 mg PO TID PRN blood pressure > 180 systolic

    Page 2 of 12

    Exam Review

    1. A nurse is planning to administer several medications to a client through a nasogastric (NG) tube. Which of the following actions should the nurse take?
      A)
      Mix the medications together and administer through the NG tube.
      B)
      Crush the sublingual medication into powder form.
      C)
      Dissolve crushed tablet medications in sterile water.
      D)
      Flush the tube with 5 mL saline between each medication.
    2. A nurse is preparing to transfer a client from a chair to the client's bed. The client can bear partial weight and has upper body strength. Which of the following devices should the nurse use to transfer the client?
      A)
      A stand assist lift
      B)
      A footboard
      C)
      A slide board
      D)
      A mechanical lift with a full body sling
    3. A nurse is monitoring a client who has been receiving intermittent enteral feedings which of the following findings should the nurse identify as an indication of intolerance to the feeding?
      A)
      Nausea
      B)
      Urine output 40 m/hr
      C)
      Soft stools
      D)
      Headache
    4. A nurse is completing an admission assessment for a client who has hearing loss. Which of the following actions should the nurse take?
      A)
      Limit the use of hand gestures when communicating with the client.
      B)
      Speak to the client with an increased pitch.
      C)
      Use written materials to assist with communication.
      D)
      Limit visitors to avoid communication misunderstandings.
    Page 3 of 12

    Exam Review

    1. A nurse receives a report from an assistive personnel that a client's blood pressure is 160/95 mm Hg. Which of the following actions should the nurse take first?
      A)
      Report the finding to the provider.
      B)
      Compare the finding to the client's blood pressure baseline.
      C)
      Administer antihypertensive medications as prescribed.
      D)
      Recheck the client's blood pressure.
    2. A nurse is assessing a client who is receiving oxygen therapy. Which of the following findings should the nurse identify as a late manifestation of hypoxia?
      A)
      Bradypnea
      B)
      Restlessness
      C)
      Hypertension
      D)
      Tachycardia
    3. A nurse is reviewing information about advance directives with a newly admitted client. Which of the following statements by the client indicates an understanding of the teaching?
      A)
      "I need to have an attorney sign my advance directives."
      B)
      "I have a living will that outlines my wishes if I am unable to make decisions."
      C)
      "I must have a family member appointed to make my health care decisions."
      D)
      "I will need to sign a document stating that I want to be resuscitated if I require CPR."
    4. A nurse is teaching a client about the correct use of a cane. Which of the following instructions should the nurse include in the teaching? (Select all that apply.)
      A)
      Ensure the cane has a rubber cap.
      B)
      Hold the cane on the weaker side.
      C)
      Flex the elbow slightly when using the cane.
      D)
      Move the cane and stronger leg forward simultaneously.
      E)
      Use a quad cane for increased support.
    Page 4 of 12

    Exam Review

    1. A nurse is planning teaching about meditation for a client who reports feeling anxious. Which of the following statements should the nurse Include in the teaching?
      A)
      "Picture yourself in one of your favorite places."
      B)
      "Choose a word to help focus your attention.
      C)
      "Quickly inhale deeply and hold your breath for 30 seconds.
      D)
      "Plan for 1 hour of meditation for each session."
    2. A nurse is caring for a client who expresses anxiety about an upcoming surgery. Which of the following actions should the nurse take?
      A)
      Ask the client to describe their feelings.
      B)
      Discuss the competency of the surgeon with the client.
      C)
      Inform the client that others have had the procedure without problems.
      D)
      Ask the client why they are experiencing anxiety.
    3. A nurse is caring for a client who has an Indwelling urinary catheter. Which of the following findings should the nurse Identify as an indication of a possible catheter occlusion?
      A)
      Presence of WBCs in urine
      B)
      Cloudy urine
      C)
      Urinary urgency
      D)
      Bladder distention
    4. A nurse is preparing to obtain the oxygen saturation of a client who has peripheral edema and thickened toenails. Which of the following actions should the nurse take?
      A)
      Attach a probe carefully to the client's finger to prevent discomfort.
      B)
      Apply a sensor pad to the client's forehead.
      C)
      Secure a probe to one of the client's toes.
      D)
      Obtain a pulse oximetry reading when peripheral edema has decreased.
    Page 5 of 12

    Exam Review

    1. A nurse is planning a community education program about colorectal cancer. Which of the following risk factors should the nurse identify as modifiable? (Select all that apply.)
      A)
      Smoking
      B)
      Alcohol consumption
      C)
      Inflammatory bowel disease
      D)
      High-fat diet
      E)
      Colorectal polyps
    2. A nurse is caring for a client who reports burning around the peripheral IV site. Which of the following findings should the nurse identify as a manifestation of infiltration?
      A)
      Dryness
      B)
      Edema
      C)
      Erythema
      D)
      A distended vein
    3. A nurse is caring for a client who has a nonpalpable skin lesion that is less than 0.5 cm (0.2 In) in diameter. Which of the following terms should the nurse use to document this finding?
      A)
      Papule
      B)
      Vesicle
      C)
      Nodule
      D)
      Macule
    4. A nurse is teaching a client who has asthma about the use of a metered-dose inhaler. Which of the following instructions should the nurse Include In the teaching?
      A)
      "Hold your breath for 6 seconds after inhaling the medication."
      B)
      "Inhale the medication deeply for 5 seconds."
      C)
      "Do not shake the medication in the inhaler."
      D)
      "Hold the inhaler 3 inches away from your mouth."
    Page 6 of 12