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    Exam Review

    1. A nurse in an emergency department (ED) is caring for a client. Exhibits Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.
      ✓Measure the abdominal girth
      ✓Teach the client about restricted sodium intake
      ✓Cirrhosis
      ✓Ascites
      ✓Ammonia levels
      Actions to Take Choices
      ✓Measure the abdominal girth
      ✕Assess amylase and lipase levels
      ✕Manage pain control.
      ✓Teach the client about restricted sodium intake
      ✕Teach the client restricted gluten intake
      Potential Condition Choices
      ✕Crohn's disease
      ✕Celiac disease
      ✕Pancreatitis
      ✓Cirrhosis
      Parameters to Monitor Choices
      ✕Unintentional weight loss
      ✓Ascites
      ✕Diet adherence to prevent exacerbations
      ✓Ammonia levels
    2. A nurse is teaching a client about the manifestations of menopause. Which of the following findings should the nurse include?
      A)
      Increased sexual desire
      B)
      Decreased bone density
      C)
      Decreased sweating
      D)
      Increased vaginal secretions
    3. A nurse in a health clinic is caring for a client. Exhibits Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is at risk for developing ▾ infectiondue to▾ WBC count.
      Dropdown 1:
      Option 1: Seizures
      Option 2: bleeding
      Option 3: dysrhythmias
      Option 4: infection
      Option 5: renal failure
      Dropdown 2:
      Option 1: potassium level
      Option 2: sodium level
      Option 3: WBC count
      Option 4: BUN level
      Option 5: platelet count
    4. A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?
      A)
      Partial pressure of CO2 50 mm Hg (35 to 45 mm Hg)
      B)
      Serum bicarbonate 9 mEq/L (21 to 28 mEq/L)
      C)
      Blood glucose 230 mg/dL (74 to 106 mg/dL)
      D)
      pH 7.5 (7.35 to 7.45)
    Page 1 of 22

    Exam Review

    1. A nurse is changing the dressing for a client who is receiving peritoneal dialysis. Which of the following actions should the nurse take?
      A)
      Place a mask on the client during the procedure
      B)
      Cleanse the catheter site using a side-to-side motion.
      C)
      Tape down the corners of the dressing
      D)
      Secure an occlusive dressing over the gauze pads.
    2. A nurse is planning care for an older adult client who has a history of dementia and is admitted following surgical repair of a hip fracture. Which of the following actions should the nurse plan to take?
      A)
      Encourage frequent visits from friends.
      B)
      Keep the over-the-bed light on.
      C)
      Apply restraints to the upper extremities.
      D)
      Play serene, soothing music.
    3. A nurse is obtaining a medication history from a client who is to start therapy with naproxen for rheumatoid arthritis. Which of the following medications places the client at risk for bleeding?
      A)
      Digoxin
      B)
      Ibuprofen
      C)
      Captopril
      D)
      Phenytoin
    4. A nurse is planning care for a client who is experiencing seizures secondary to meningitis. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)
      (SATA)
      A)
      Place a tongue blade at the bedside.
      B)
      Dim the overhead lights.
      C)
      Assist the client to ambulate every 4 hr.
      D)
      Apply a warming blanket.
      E)
      Have suction equipment at the bedside.
    Page 2 of 22

    Exam Review

    1. A nurse is reviewing a client's ECG rhythm strip. Which of the following components should the nurse use to measure impulse conduction from the sinus node through the atrioventricular node?
      A)
      ST segment
      B)
      QRS complex
      C)
      PR interval
      D)
      PP interval
    2. A nurse is caring for a client who is receiving phototherapy for psoriasis. Which of the following findings should the nurse identify as an indication of overexposure?
      A)
      Increased joint pain
      B)
      Increased body temperature
      C)
      Cool, moist extremities
      D)
      Small blisters on the skin
    3. A nurse is planning care for a client who requires insertion of a peripherally inserted central catheter (PICC) line. Which of the following actions should the nurse plan to take?
      A)
      Flush the PICC line with 0.9% sodium chloride after medication administration.
      B)
      Monitor for a pneumothorax following insertion of the PICC line.
      C)
      Use a 3 mL syringe when flushing the PICC line.
      D)
      Expect the PICC line to be inserted into a lower extremity vein.
    4. A nurse manager is evaluating a quality improvement initiative for reducing health care-associated infections. Which of the following findings indicate the initiative is effective?
      A)
      Clients who are intubated are kept in the supine position
      B)
      Central lines are inserted into the femoral vein for clients who are obese.
      C)
      Clients who have an indwelling urinary catheter are assessed daily to determine if it is still needed.
      D)
      Nurses perform hand hygiene for 10 seconds before completing tasks.
    Page 3 of 22

    Exam Review

    1. A nurse is caring for a client who has experienced a stroke, decreased weight, and a decreased prealbumin. Which of the following interdisciplinary team members should the nurse anticipate collaborating with about the client's condition?
      A)
      Occupational therapist
      B)
      Respiratory therapist
      C)
      Dietitian
      D)
      Physical therapist
    2. A nurse is teaching a client who has HIV about infection prevention. The nurse should instruct the client to avoid contact with which of the following items?
      A)
      Soiled cat litter
      B)
      Pasteurized milk
      C)
      Scrambled eggs
      D)
      Electric razor
    3. A nurse is caring for a client who has a chest tube in the pleural space. The nurse notices continuous bubbling in the water seal chamber of the client's drainage system. Which of the following actions should the nurse take?
      A)
      Clamp the tubing to check for air leaks.
      B)
      Raise the drainage system to the client's chest level.
      C)
      Gently squeeze the tubing to remove excess drainage.
      D)
      Empty the collection chamber.
    4. A nurse is monitoring a client who recently had an esophagogastroduodenoscopy procedure. Which of the following findings should the nurse Identify as an indication that the client is recovering after the procedure as expected?
      A)
      SpO2 92%
      B)
      Heart rate 110/min
      C)
      Temperature 38.7° C (101.7° F)
      D)
      Respiratory rate 14/min
    Page 4 of 22

    Exam Review

    1. A nurse is caring for a client who is terminally ill. Which of the following findings should the nurse identify as an indication that palliative care should be recommended?
      A)
      Constipation
      B)
      Serum albumin 52 g/dL 135105 g/dL) Serum
      C)
      Apnea alternating with hyperventilation
      D)
      Peripheral edema
    2. A nurse is providing teaching to a client who is about to begin using a PCA pump to deliver morphine for postoperative pain management. Which of the following statements by the client indicates an understanding of the teaching?
      A)
      "The lockout interval prevents me from receiving too much medication."
      B)
      "Each time I push the button, I receive the same amount as a morphine injection
      C)
      "My family can push the button for me on a regular basis."
      D)
      "It will take about 30 minutes to feel relief after I push the button
    3. A nurse is teaching a client who has type 1 diabetes mellitus about treating a hypoglycemic episode. Which of the following statements should the nurse include in the teaching?
      A)
      "Drink 4 to 6 ounces of juice."
      B)
      "Consume1 teaspoon of corn syrup-based glucose gel."
      C)
      "Consume two glucose tablets and check your blood glucose 1 hour later."
      D)
      "Eat two crackers with peanut butter."
    4. A nurse is caring for a client who has hypoparathyroidism. Which of the following findings should indicate to the nurse that the treatment is effective?
      A)
      Calcium 9.6 mg/dL (9 to 10.5 mg/dL)
      B)
      Glucose 96 (74 to 106 mg/dL)
      C)
      Potassium 4.3 mEq/L (3.5 to 5 mEq/L)
      D)
      Sodium 142 mEq/L (136 to 145 mEq/L)
    Page 5 of 22

    Exam Review

    1. A nurse is caring for a female client who is receiving intravenous gentamicin. Which of the following laboratory values is the priority to report to the provider?
      A)
      Hgb 11.5 g/dL (12 to 16 g/dL)
      B)
      Creatinine 3.2 mg/dL (0.5 to 1.1 mg/dL)
      C)
      Sodium 146 mEq/L (136 to 145 mEq/L)
      D)
      WBC count 12,000/mm3 (5,000 to 10,000/mm3)
    2. A nurse is caring for a client who is scheduled for heart surgery. Prior to surgery the client states, "I'm not sure I want to go through with this procedure after all." Which of the following actions should the nurse take?
      A)
      Reinforce and clarify the information provided by the surgeon with the client
      B)
      Inform the client that this procedure is the only option they have for treatment
      C)
      Terminate the conversation and state, "It's too late to cancel the procedure
      D)
      Delay the procedure and enlist additional staff to persuade the client to have the procedure.
    3. A nurse is caring for a client who has Meniere's disease. Which of the following instructions should the nurse include?
      A)
      Use large-print books.
      B)
      Avoid standing on chairs or ladders.
      C)
      Stay away from flickering lights.
      D)
      Minimize unnecessary room changes.
    4. A nurse is caring for a client who has a deep vein thrombosis. Which of the following findings should indicate to the nurse that the client could be experiencing a pulmonary embolism?
      A)
      Respiratory rate 12/min
      B)
      Temperature 40° C (104° F)
      C)
      Heartrate 120/min
      D)
      Blood pressure 140/90 mm Hg
    Page 6 of 22