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    Exam Review

    1. A nurse is caring for a client who has a tumor. The provider recommends surgery. The client refuses, but the client's partner wants the surgery performed. Which of the following is the deciding factor in determining if the surgery will be done?
      A)
      Whether the client understands the risk of refusing the procedure
      B)
      Whether the partner is the client's durable power of attorney for health care
      C)
      Whether the client's refusal is based on a religious belief
      D)
      Whether the facility ethics committee reaches a consensus on the case
    2. A nurse is assessing an older adult client who was brought to the emergency department by his adult son, who reports that the client fell at home. The nurse suspect's elder abuse. Which of the following actions should the nurse take?
      A)
      Ask the client's son to go to the waiting area
      B)
      File an incident report
      C)
      Treat and discharge the client
      D)
      Ask the client about his injuries with the son present
    3. A nurse is conducting a disaster preparedness drill with a group of nurses who are orienting to the facility. Which of the following triage tag colors should the nurse instruct the group to apply to a client who has full thickness burns on 72% of his body?
      A)
      Green
      B)
      Yellow
      C)
      Black
      D)
      Red
    4. 6) A nurse on a medica-surgical unit is caring for a client who asks about advance directives and states that he wants to appoint a health care proxy. Which of the following responses should the nurse make?
      A)
      “You must choose a member of your family to serve as your health care proxy”
      B)
      “A health care proxy can make decisions for you when you are unable to do so”
      C)
      “You should appoint a health care proxy before undergoing an invasive procedure”
      D)
      “It is necessary for an attorney to approve your health care proxy”
    Page 1 of 17

    Exam Review

    1. A hospice nurse is caring for a client who has terminal illness and reports severe pain. After the nurse administers the prescribed opioid and benzodiazepine, the client becomes somnolent and difficult to arouse. Which of the following actions should the nurse take?
      A)
      Continue the medication dosages that relieve the client’s pain
      B)
      Contact the provider about replacing the opioid with an NSAID
      C)
      Administer the benzodiazepine but withhold the opioid
      D)
      Withhold the benzodiazepine but continue the opioid
    2. A nurse is orienting a newly licensed nurse about client confidentiality. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
      A)
      “I should encrypt personal health information when sending emails”
      B)
      “I can use another nurse’s password as long as I log off after using the computer”
      C)
      “I should discard personal health information documents in the trash before leaving the unit”
      D)
      “I can post the client’s vital signs in the client’s room”
    3. A nurse is delegating care for a group of clients. Which of the following clients should the nurse assign to the LPN?
      A)
      A client who is scheduled for an endoscopy later today and requires an enema
      B)
      A newly admitted client who has sickle cell anemia and requires the development of an initial plan of care
      C)
      A client who had a myocardial infarction and will be transferring to the unit from the CCU
      D)
      A newly admitted client who has diabetes mellitus and requires initial teaching on self-administration of insulin
    4. A nurse on a med-surge unit is caring for four clients. The nurse should recognize that which of the following clients is the priority?
      A)
      A client who is postoperative following a laminectomy 12 hour and is unable to void
      B)
      A client who is scheduled for a tubal ligation in 2 hours and is crying
      C)
      A client who has peripheral vascular disease and has an absent pulse in the right foot
      D)
      A client who has type 1 diabetes and needs the first dressing change for an ulcer
    Page 2 of 17

    Exam Review

    1. A nurse manager observes assistive personnel (AP) incorrectly transferring a client to the bedside commode. Which of the following actions should the nurse take first?
      A)
      Help the AP assist the client with the transfer
      B)
      Demonstrate the proper client transfer technique to the AP
      C)
      Instruct the AP to request assistance when unsure about a task
      D)
      Refer the AP to the facility procedure manual
    2. A nurse in the emergency department admits a client who has been exposed to cutaneous anthrax. Which of the following actions should the nurse take?
      A)
      Prepare to administer antibiotics to the client
      B)
      Wear an N95 respirator mask while caring for the client
      C)
      Plan to administer an antiviral medication to the client.
      D)
      Place a surgical mask on the client during transfer to the unit.
    3. 13) A nurse is caring for a client who is unconscious and whose partner is their health care surrogate. The partner wishes to discontinue the client’s feeding tube, but another family member tells the nurse that they want the client to continue receiving treatment. Which of the following responses should the nurse make?
      A)
      “You should contact the provider about your wishes for your family member”
      B)
      “You should speak with the facility’s ethics committee about your concerns
      C)
      “We’ll need to have the nursing supervisor review the client’s advance directives”
      D)
      “As the health care surrogate, the client’s partner can make this decision
    4. 14) A nurse is preparing to discharge a client who has end- stage heart failure. the client's partner tells the nurse she can no longer handle caring for the client. which of the following actions should the nurse take?
      A)
      Ask the provider to delay the client's discharge home for a few more days.
      B)
      Recommend the partner place the client in a long- term care facility.
      C)
      Contact the case manager to discuss discharge options.
      D)
      Request another family member assist the client's partner with care.
    Page 3 of 17

    Exam Review

    1. A nurse is providing change-of-shift report for an oncoming nurse. Which of the following information should the nurse include in the report?
      A)
      “The client is in radiology department for a chest x-ray”
      B)
      “The client’s partner came to visit him 2 hrs. ago”
      C)
      “The client has routine vital signs prescribed”
      D)
      “The client is the president of a local bank”
    2. A nurse in the emergency department is preparing to care for a client who arrived via ambulance. The client is disoriented and has a cardiac arrhythmia. Which of the following actions should the nurse take?
      A)
      Proceed with treatment without obtaining written consent
      B)
      Notify risk management before initiating treatment
      C)
      Have the client sign a consent for treatment
      D)
      Contact the client's next of kin to obtain consent for treatment
    3. A nurse is preparing to discharge a client who requires home oxygen. The equipment company has not yet delivered the oxygen tank. Which of the following actions should the nurse take?
      A)
      Instruct the client’s family to contact the insurance provider about the oxygen equipment
      B)
      Send an oxygen tank from the facility home with the client
      C)
      Contact social services about the delivery of the oxygen equipment
      D)
      Notify the provider about the delayed oxygen tank delivery
    4. A nurse on a medical-surgical unit is caring for a group of clients with the assistance of a licensed practicing nurse and assistive personnel. Which of the following tasks should the nurse assign to the LPN?
      A)
      Accompanying a client who just had a wound debridement to physical therapy
      B)
      Obtaining a sterile urine specimen from an older adult client
      C)
      Providing postmortem care for a client that just died
      D)
      Reinforcing dietary teaching with a client who has heart disease
    Page 4 of 17

    Exam Review

    1. A nurse manager is leading a discussion about ethical dilemmas. Which of the following situations should the nurse manager include as an example of an ethical dilemma?
      A)
      A visitor experiences a minor burn after spilling coffee
      B)
      A parent wants her 14-year-old adolescent to receive radiation treatment against his will
      C)
      A nurse witnesses another nurse administer an incorrect medication
      D)
      A client receives an operation on the wrong side of her body
    2. 20) A nurse is developing a discharge plan for a client who is postoperative and will require a wheelchair in the home. The nurse should place a referral to which of the following resources to assist the client with this need?
      A)
      Occupational therapy
      B)
      Social services
      C)
      Home health
      D)
      Physical therapy
    3. A nurse is caring for a client who requests information about the prevalence of Tay-Sachs disease. Which of the following resources should the nurse use to obtain this information?
      A)
      An evidence-based nursing journal
      B)
      The client's health care provider
      C)
      The facility's case manager
      D)
      A collaborative, user-edited website
    4. A nurse has just completed assessment charting on the electronic record for an assigned client. As assistive personnel (AP) who just measured the client’s vital signs asks to chart them while the nurse is still logged into the record. Which of the following actions should the nurse take?
      A)
      Recommend the AP come back later when the record is available
      B)
      Log out so the AP can log in to document the vital signs
      C)
      Offer to chart the vital signs for the AP
      D)
      Allow the AP to document the vital signs prior to logging out
    Page 5 of 17

    Exam Review

    1. A nurse is preparing a teaching session with a client who speaks a different language than the nurse. Which of the following interventions should the nurse plan to include?
      A)
      Involve the client’s partner to assist with the teaching session
      B)
      Incorporate gestures and hand signals when presenting information
      C)
      Validate understanding by interpreting the client’s body language
      D)
      Provide an interpreter when obtaining consent for the client
    2. A nurse on a surgical unit is preparing to transfer a client to a rehabilitation facility. Which of the following information should the nurse include in the change-of-shift report?
      A)
      The time the client received his last dose of pain medication
      B)
      The belief that the client has a difficult relationship with his son
      C)
      The steps to follow when providing wound care
      D)
      The client's preferred time for bathing
    3. A nurse on an inpatient care unit is working to help reduce unit costs. Which of the following actions is appropriate to include in the cost-containment plan?
      A)
      Store opened bottles of normal saline in a refrigerator for up to 48 hours
      B)
      Wait to dispose of sharps containers until they are completely full
      C)
      Use clean gloves rather than sterile gloves for colostomy care
      D)
      Return unused supplies from the bedside to the unit’s supply stock
    4. 26) a nurse is preparing to complete an incident report regarding a medication error which of the following actions should the nurse plan to take? select all that apply
      A)
      Include the time the medication error occurs in the report
      B)
      Make a copy of the incident report for personal record-keeping
      C)
      Identify the medication name and dosage administered to the client in the report
      D)
      Place a copy of the completed report in the client's medical record
      E)
      Obtain an order from the client's provider to complete the report
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