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    Exam Review

    1. A nurse is providing change-of-shift report to another nurse for a client using the Introduction, Situation, Background, Assessment and Recommendation (ISBARR) communication tool. Which of the following information should the nurse include as part of the situation component of this communication tool?
      A)
      List of medications
      B)
      Treatment
      C)
      Medical condition
      D)
      Vital signs
    2. A nurse is assisting with the care of a client.Exhibits Exhibits A nurse in a provider's office is assisting with the review of fall risk data collected on a client. Which of the following findings places the client at risk for a fall? Select all that apply.
      (SATA)
      A)
      Macular degeneration
      B)
      Throw rugs in kitchen
      C)
      Grab bar in bathroom
      D)
      Electrical cord on floor over walkway
      E)
      Uses a cane to ambulate
    3. A nurse is assisting with teaching a class about physical manifestations associated with the fight-or-flight response to stress. Which of the following manifestations should the nurse include?
      A)
      Dilated pupils
      B)
      Decreased blood pressure
      C)
      Bronchial airway constriction
      D)
      Hypoglycemia
    4. A nurse is assisting with teaching a client who has visual impairment. Which of the following actions should the nurse take?
      A)
      Turn on the television in the client's room during the educational session.
      B)
      Use a loud tone of voice during the educational session.
      C)
      Use reading material written with a large print.
      D)
      Identify your presence in the client's room by tapping the client's arm.
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    Exam Review

    1. A nurse is planning care for a client who has diverticulitis. The nurse should plan to monitor the client for which of the following complications of diverticulitis?
      A)
      Dysphagia
      B)
      Ulcerative colitis
      C)
      Crohn's disease
      D)
      Peritonitis
    2. A nurse is assisting with teaching a class about physiological changes to hearing in older adult clients. Which of the following should the nurse include?
      A)
      Decreased tinnitus
      B)
      Decreased thickness of tympanic membranes
      C)
      Decreased ability to hear high-frequency sounds
      D)
      Decreased ear wax
    3. A nurse is caring for a client who has a moderate vision impairment. Which of the following actions should the nurse take?
      A)
      Open shades on windows in the client's room to provide direct lighting.
      B)
      Speak loudly when talking to the client.
      C)
      Face the client when speaking to them.
      D)
      Use gestures to communicate with the client.
    4. A nurse is assisting with teaching a class about the general adaptive syndrome. The nurse should include that which of the following manifestations occur during the exhaustion stage?
      A)
      Dilation of pupils
      B)
      Blood pressure increases.
      C)
      Depression
      D)
      Blood glucose levels return to the expected reference range.
    Page 2 of 11

    Exam Review

    1. A nurse is reinforcing teaching with a client who has kidney stones. Which of the following instructions should the nurse include?
      A)
      "Limit your calcium intake."
      B)
      "Drink 1 liter of fluid each day."
      C)
      "Filter your urine each day."
      D)
      "Choose sugar-sweetened beverages."
    2. A nurse is caring for a client who reports experiencing flashbacks of a traumatic event that occurred a year ago. The nurse should identify that the client is experiencing which of the following stress-related disorders?
      A)
      Irritable bowel syndrome (IBS)
      B)
      Acute stress disorder (ASD)
      C)
      Episodic acute stress
      D)
      Posttraumatic stress disorder (PTSD)
    3. A nurse is caring for four clients who are all requesting assistance. Which of the following clients should the nurse assist first?
      A)
      A client who reports they have fallen while ambulating.
      B)
      A client who reports their IV pump is beeping.
      C)
      A client who is requesting a bedpan.
      D)
      A client who is postoperative and is reporting nausea.
    4. A nurse is caring for a client who has urinary leakage due to nerve damage following a spinal cord injury. The nurse should identify that the client is experiencing which of the following types of urinary incontinence?
      A)
      Urge incontinence
      B)
      Stress incontinence
      C)
      Reflex incontinence
      D)
      Overflow incontinence
    Page 3 of 11

    Exam Review

    1. A nurse is assisting with the care of a client who has a new colostomy and states they are not ready to look at the stoma. The nurse encourages the client to share their feelings about the colostomy. Which of the following strategies is the nurse utilizing?
      A)
      Return demonstration
      B)
      Discussion
      C)
      Question-and-answer
      D)
      Role-play
    2. A nurse is reinforcing teaching with a client about foods and beverages that can cause diarrhea. Which of the following should the nurse include in the teaching?
      A)
      Caffeinated beverages
      B)
      White rice
      C)
      Low-fiber cereal
      D)
      Ripe bananas
    3. A nurse is assisting with teaching a client who has constipation. Which of the following statements should the nurse include?
      A)
      "Try to defecate at different times of the day."
      B)
      "Reduce your daily activity."
      C)
      "Increase your daily fluid intake."
      D)
      "Consume a low-fiber diet."
    4. A nurse is assisting with teaching a class about sources of stress. The nurse should include that which of the following is an example of a physiological stressor?
      A)
      Financial difficulties
      B)
      Burn injury
      C)
      Academic pressure
      D)
      Change in marital status
    Page 4 of 11

    Exam Review

    1. A nurse is caring for a client who reports a decrease in central vision. The nurse should identify that this is a manifestation of which of the following visual impairments?
      A)
      Cataracts
      B)
      Macular degeneration
      C)
      Diabetic retinopathy
      D)
      Glaucoma
    2. A nurse is assisting with teaching a client about the benefits of exercise. Which of the following information should the nurse include? Select all that apply.
      A)
      Inhibits release of endorphins
      B)
      Improves sleep
      C)
      Decreases energy
      D)
      Decreases stress
      E)
      Increases mood
    3. A nurse is reinforcing teaching with a client who has diabetic neuropathy about foot care. Which of the following instructions should the nurse include?
      A)
      Wash feet in hot water.
      B)
      Wear open-toed shoes.
      C)
      Avoid walking barefoot.
      D)
      Apply lotion between the toes.
    4. A nurse is caring for a client who states, "I am under a great deal of stress at work, but I am able to forget my work and concentrate on my family when I get home at night." The nurse should identify that the client is demonstrating which of the following defense mechanisms?
      A)
      Regression
      B)
      Compartmentalization
      C)
      Repression
      D)
      Projection
    Page 5 of 11

    Exam Review

    1. A nurse is assisting with teaching a client who is preoperative for an ileostomy. Which of the following statements should the nurse include?
      A)
      "You will have a stoma placed in your right lower abdomen."
      B)
      "You will have solid stool pass through your stoma."
      C)
      "You should expect your stoma to be a purple color."
      D)
      "The end of the stoma will be painful after this procedure."
    2. A nurse is collecting data on a client who has urinary retention. Which of the following findings should the nurse expect?
      A)
      Leakage of urine
      B)
      Cloudy urine
      C)
      Blood in urine
      D)
      Dark-colored urine
    3. A nurse is reinforcing teaching with a client about the Rinne test. Which of the following client statements indicates an understanding of the teaching?
      A)
      "I will wear earphones during this test."
      B)
      "A tuning fork is placed on my head."
      C)
      "A small probe is placed inside my ear."
      D)
      "Small electrodes are placed on my scalp."
    4. A nurse is reinforcing teaching with a client about tactile testing. Which of the following client statements indicates an understanding of the teaching?
      A)
      "I will be asked to identify different sensations, such as sharp or dull."
      B)
      "I will be asleep during this test."
      C)
      "A dye is injected into my vein during this test."
      D)
      "Small needles will be inserted into one of my muscles."
    Page 6 of 11