NursGuru

    Exam Review

    1. When inspecting a client's abdominal contour, the nurse observes the abdomen to be sunken with the lower edges of the ribs visible. The nurse documents this as which of the following?
      A)
      Flat
      B)
      Protuberant
      C)
      Rounded
      D)
      Scaphoid
    2. The nurse receives the primary provider's order of phenytoin 0.2 g orally twice daily. The medication label states that each capsule is 100 mg. The nurse prepares how many capsule(s) to administer. (Round to the nearest whole number)
      A)
      20
      B)
      0.2
      C)
      2
      D)
      200
    3. A client comes to the emergency department complaining of pain in the right lower quadrant. Rebound tenderness is present, and the nurse assesses the client for referred rebound experiences. The client experiences pain the right lower quadrant. How would the nurse document this finding?
      A)
      Positive skin hypersensitivity test.
      B)
      Positive Rovsing sign.
      C)
      Psoas sign.
      D)
      Positive Obturator sign.
    4. The nurse in the dialysis unit is initiating the morning scheduled dialysis clients. Which client would the nurse prioritize to assess first?
      A)
      The client on peritoneal dialysis who is reporting a hard and rigid abdomen.
      B)
      The client who does not have a palpable thrill or auscultated bruit.
      C)
      The client who is reporting a 3.6 kg weight gain and it refusing dialysis.
      D)
      The client who has a hemoglobin of 9.0 mg/dL (12.0-15.5 mg/dL) and hematocrit of 26% (36.1% -44.3%).

    Exam Review

    1. A client's bladder is found to be distended. At which location would the nurse begin palpating?
      A)
      At the symphysis pubis.
      B)
      In the left lower quadrant.
      C)
      At the umbilicus.
      D)
      In the right lower quadrant.
    2. The nurse is caring for a 33-year-old male client who has visited the primary healthcare provider for several months stating that he is experiencing "heartburn" after lunch and dinner. He reports that these episodes last about an hour after eating, and are much worse if he lays down to sleep after a meal. Most of the time, he also experiences belching and bloating with "heartburn" that feels like chest pain. He has been taking over-the-counter antacids with minimal relief. He says that his wife sent him today because she was getting concerned about the number of antacids he has been using. Reading the electronic health record, the nurse notes: id="exhibits">Exhibits What subjective assessment information in this client situation is the most important and immediate concern for the nurse?
      A)
      Belching
      B)
      chest pain
      C)
      Flatulence
      D)
      Pain with position
    3. Assessment of a client reveals a distended abdomen with some bulging of the flanks. Which test would be most accurate in confirming nurse's suspicions?
      A)
      Abdominal x-ray
      B)
      Shifting dullness
      C)
      Fluid wave
      D)
      Ultrasound
    4. A nurse is assessing a client who has a medical history of chronic kidney disease for fluid volume excess. Which assessment data provides the most reliable measure of fluid retention?
      A)
      Intake and output
      B)
      Daily weight
      C)
      Sodium level
      D)
      Skin tenting

    Exam Review

    1. The client is brought into the emergency room (ER) by paramedics with blunt trauma to the left upper side of the abdomen due to a motor vehicle accident. The ER nurse knows what organ is most likely impacted.
      A)
      appendix
      B)
      left ureter
      C)
      left lobe of liver
      D)
      sigmoid colon
    2. A nurse is caring for a client who has an extracellular fluid volume deficit. Which of the following findings should the nurse expect?
      A)
      Postural hypotension
      B)
      Dependent edema
      C)
      Bradycardia
      D)
      Distended neck veins
    3. A staff nurse is teaching a newly hired nurse how to complete an informed consent document for a client. The staff nurse should include that the nurse's signature on the form confirms which of the following requirements? (Select all that apply.)
      A)
      The client has legal authority to do so.
      B)
      The client does not have a mental health condition.
      C)
      The client was not coerced.
      D)
      The client signed in the nurse's presence.
      E)
      The client speaks the same language as the nurse.
    4. A charge nurse has four new clients arriving on the unit for admission. Which of the following clients should the nurse place in airborne precautions?
      A)
      A client who has pneumonia
      B)
      A client who has shigella
      C)
      A client who has strep throat
      D)
      A client who has tuberculosis

    Exam Review

    1. A nurse is providing information to a client about durable power of attorney. The nurse should include that durable power of attorney is enforceable under which of the following conditions?
      A)
      The client is terminally ill.
      B)
      The client is incapable of providing self-care.
      C)
      The client is unable to express their wishes.
      D)
      The client has refused treatment.
    2. A nurse is caring for a client who was recently diagnosed with breast cancer. The client states, "I feel so alone. I don't know how I will be able to deal with this." Which of the following responses should the nurse make?
      A)
      "Most people in your situation are able to get through this."
      B)
      "Why do you think you're feeling so alone?"
      C)
      "Do you have anyone you can talk to about your diagnosis?"
      D)
      "I am so sorry about your diagnosis. You must be devastated."
    3. During change-of-shift report, a nurse discovers they overlooked a prescription for a type and cross-match of a client who is to have surgery the next day. Which of the following actions should the nurse take first?
      A)
      Prepare an incident report for risk management.
      B)
      Inform the provider of the delay in obtaining the type and cross-match.
      C)
      Obtain the client's type and cross-match.
      D)
      Document the incident in the client's medical record.
    4. A nurse says to their nurse manager that, "I'm the only one on my team who is working hard." Which of the following responses should the nurse manager make?
      A)
      "You must feel frustrated."
      B)
      "Why do you feel upset about this?"
      C)
      "You should be working harder."
      D)
      "I will reprimand your team members."

    Exam Review

    1. A nurse at a long-term care facility is assessing a client who just received hearing aids. Which of the following actions should indicate to the nurse that the client understands how to use the hearing aids? (Select all that apply.)
      A)
      Cleanses the ear molds with isopropyl alcohol to remove cerumen
      B)
      Turns off the hearing aids when not in use
      C)
      Inspects the ear molds to determine the ear canal portion
      D)
      Turns the volume all the way down before inserting the hearing aids
      E)
      Ensures that the ears are not blocked with cerumen
    2. The nurse is conducting a focused assessment of a client who is experiencing pain. Which question should the nurse ask the client?
      A)
      When did your pain symptoms begin?"
      B)
      "Do you think you know what caused the swelling?
      C)
      "What brings you to the clinic today?"
      D)
      "Can you go over what you said about nothing relieving the pain?
    3. The absence of bowel sounds is established after listening for:
      A)
      2 full minutes.
      B)
      1 full minute.
      C)
      5 full mutes.
      D)
      1 1/2 minutes.
    4. Select the sequence of techniques used during an examination of the abdomen.
      A)
      Percussion, inspection, palpation, auscultation.
      B)
      Inspection, palpation, percussion, auscultation.
      C)
      Inspection, auscultation, percussion, palpation.
      D)
      Auscultation, inspection, palpation, percussion.