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    Exam Review

    1. A nurse is prioritizing care for four patients. Which patient should the nurse see first?
      A)
      A patient with an acute decrease in oxygen saturation
      B)
      A patient with a healed abdominal incision
      C)
      A patient who needs education regarding a medication
      D)
      A patient with a slight temperature
    2. A nurse is performing a home safety assessment for a client who has experienced a stroke. Which of the following findings are a safety hazards for the client? Select all that apply
      (SATA)
      A)
      Raised toilet in the bathroom
      B)
      Uneven steps into the home
      C)
      Grip bars in the shower
      D)
      Loose throw rugs in the kitchen
      E)
      Commonly used items stored within easy reach
    3. A nurse is performing passive range of motion on a client who had a stroke. The nurse should identify that passive range of motion is performed to increase which of the following?
      A)
      Joint flexibility
      B)
      Bone density
      C)
      Muscle strength
      D)
      Muscle mass
    4. A nurse is caring for a client with a draining foot wound. Which of the following PPE equipment should the nurse don before entering the client's room?
      A)
      Mask and face shield
      B)
      Gown and face shield
      C)
      Non-sterile gloves and gown
      D)
      Sterile gloves and mask
    Page 1 of 22

    Exam Review

    1. A charge nurse is discussing culturally competent care with a newly licensed nurse. Which of the following statements should the charge nurse make?
      A)
      "Evaluating your own preconceived ideas about other cultures is important."
      B)
      "Cultural desire is the ability to accurately assess a client's cultural beliefs."
      C)
      "Your personal cultural background does not affect how you interpret your client's behaviors."
      D)
      "Clients within the same cultural group will all follow the same health practices."
    2. A nurse is teaching a class about the roles and responsibilities of a case manager. Which of the following responsibilities should the nurse include?
      A)
      Provides direct client care
      B)
      Organizes client services following discharge
      C)
      Teaches nursing students
      D)
      Collects and utilizes data to change current practice
    3. A nurse is assisting an older adult client who sometimes loses her balance while walking. Which of the following devices should the nurse use when helping the client ambulate?
      A)
      Jacket harness
      B)
      Gait belt
      C)
      Four-wheel walker
      D)
      Cane
    4. Which action(s) indicates a caring behavior? Select all that apply
      (SATA)
      A)
      Holding a client's hand during a procedure
      B)
      Taking action to alleviate the patients pain.
      C)
      Not acting on the patient's concerns.
      D)
      Completing the patient's charting
      E)
      Listening to the patient.
      F)
      Spending time with the patient
    Page 2 of 22

    Exam Review

    1. A nurse is discussing factors that influence communication with a group of newly licensed nurses. Which of the following information should the nurse include?
      A)
      Nurses caring for clients experiencing a highly emotional situation report that communication is rarely affected.
      B)
      Clients who have developmental deficits are less distracted by environmental noises than client who do not have these deficits.
      C)
      Hearing loss is considered a development factor that has minimal effect on nurse-client communication.
      D)
      Nurses might focus on a client's physiological needs over psychosocial needs when communicating during care.
    2. A nurse is admitting a new client. Which of the followings steps of the nursing process is the nurse performing when formulating goals for a positive outcome?
      A)
      Evaluation
      B)
      Planning
      C)
      Assessment
      D)
      Implementation
    3. A nurse in a community health clinic is interviewing a couple who just lost their house in a fire. Using the priority framework of Maslow’s hierarchy of needs, which category should the nurse identify for the clients' situation?
      A)
      Physiological
      B)
      Psychosocial
      C)
      Self-actualization
      D)
      Esteem
    4. Which patient scenario involving a surgical client in pain most clearly demonstrates critical thinking?
      A)
      Offering pain-relief medication based on the health care provider's orders
      B)
      Explaining to the client that self-reporting of severe pain is not consistent with the minor procedure that was performed
      C)
      Administering pain-relief medication according to what was given last shift
      D)
      Considering the client what pain-relief methods, pharmacological and nonpharmacological, have worked in the past
    Page 3 of 22

    Exam Review

    1. A nurse does not take a client's apical heart rate, but documents that it was taken in the client's electronic health record (EHR). Which of the following terms describes the nurse's actions?
      A)
      Battery
      B)
      Libel
      C)
      Falsification
      D)
      Slander
    2. A nurse is preparing an in-service to review the Code of Ethics (COE) with a group of nursing colleagues. Which of the following statements should the nurse make during the in-service about the COE?
      A)
      "Criteria for obtaining licensure is included in the COE."
      B)
      "Student nurses are not held accountable to COE."
      C)
      "The use of social media is not included in the COE."
      D)
      "Professional expectations are included in the COE."
    3. A nurse is preparing to delegate tasks to an assistive personnel (AP). The nurse should identify which of the following as one of the five rights of delegation?
      A)
      Right communication
      B)
      Right time
      C)
      Right documentation
      D)
      Right room
    4. What is the best way to determine if the patient has gastrointestinal complications from immobility?
      A)
      Checking the patient's blood glucose levels
      B)
      Assessing the patient's heart rate and blood pressure
      C)
      Assessing the patient's bowel sounds
      D)
      Measuring the patient's oxygen saturation levels
    Page 4 of 22

    Exam Review

    1. A nurse on the unit is conducting a fall risk assessment for four clients. The nurse should identify which of the following clients is the greatest risk for a fall.
      A)
      An adolescent client who has a leg fracture and has been using crutches for the past 2 days
      B)
      A client with wound on their leg
      C)
      A client who has a nursing assistant helping him out of bed
      D)
      An older adult client who is confused and has urinary frequency
    2. The nurse is gathering data on a client. Which data will the nurse report as objective data? Select all that apply
      A)
      The patient feels nauseous
      B)
      The patient reports a headache
      C)
      The patient is pacing the floor
      D)
      The patient's BP is 130/60
      E)
      Scant drainage noted during dressing change
      F)
      The patient states they have lost their appetite
    3. When the nurse finds a patient on the floor, the patient says, "I fell out of bed." After assessing the patient, the nurse helps the patient back in bed. What should the nurse do next?
      A)
      Re-assess the patient.
      B)
      Do nothing; no harm has occurred.
      C)
      Complete an incident report
      D)
      Notify the health care provider.
    4. Which of the following is a good time management strategy for nurses?
      A)
      Creating a plan and prioritizing client care activities
      B)
      Multitasking and attempting to complete multiple tasks simultaneously
      C)
      Ignoring interruptions and changes in client status
      D)
      Leaving all documentation until the end of the shift
    Page 5 of 22

    Exam Review

    1. Which of the following actions can help nurses decrease the risk for contractures in clients?
      A)
      Encouraging range of motion exercises
      B)
      Complete all basic care for the client
      C)
      Encouraging prolonged sitting in one position
      D)
      Elevate the head of the bed
    2. A nurse uses evidence-based practice to provide nursing care. What is the best rationale for the nurse's behavior?
      A)
      EBP is always right for all situations.
      B)
      EBP is a guide for nurses in making clinical decisions.
      C)
      EBP is easily attained at the bedside
      D)
      EBP is based on the latest textbook information
    3. After assessing a patient, a nurse develops a standard formal nursing diagnosis. What is the rationale for the nurse's actions?
      A)
      To develop clinical judgment based on other's intuition
      B)
      To determine the direction of nursing care
      C)
      To form a language that can be encoded only by nurses
      D)
      To help nurses focus on the scope of medical practice
    4. As a patient is ambulating to the bathroom, they fall. Which initial action will the nurse take next to ensure the care plan is accurately revised?
      A)
      Assess the client
      B)
      Establish a new plan of care.
      C)
      Consult physical therapy.
      D)
      Set new priorities for the patient.
    Page 6 of 22