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    Exam Review

    1. A nurse is reviewing the medical records of 5 clients at a local clinic. The charge nurse reviews the medical records for the 5 clients and notifies the provider of the laboratory reports. Which of the following clients who have communicable diseases should the nurse report as required by law? Select the 3 clients that the nurse should report.
      (SATA)
      A)
      Client 5
      B)
      Client 1
      C)
      Client 4
      D)
      Client 2
      E)
      Client 3
    2. A nurse in the emergency department is preparing a married 17-year-old client for an appendectomy. The client's parents are en route to the facility but have not spoken with the surgeon. Which of the following actions should the nurse take?
      A)
      Have the client sign the consent form after the surgeon explains the procedure.
      B)
      Delay the surgery until the parents arrive to sign the consent form.
      C)
      Proceed with the preparation because the client signed a general consent form.
      D)
      Obtain consent from the client's parents by telephone with another nurse listening as a witness.
    3. 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.)
      (SATA)
      A)
      Make a copy of the incident report for personal record keeping.
      B)
      Place a copy of the completed report in the client's medical record.
      C)
      identify the medication name and dosage administered to the client in the report.
      D)
      Obtain an order from the client's provider to complete the report.
      E)
      Include the time the medication error occurred in the report.
    4. A nurse working on a medical-surgical unit is managing the care of four clients. The nurse should schedule an interdisciplinary conference for which of the following clients?
      A)
      A client who is receiving heparin and has an aPTT of 34 seconds (30 to 40 seconds).
      B)
      A client who is at risk for pressure injuries and has an albumin level of 4.2 g/dL (3.5 to 5 g/dL).
      C)
      A client who has orthostatic hypotension and is receiving IV fluids.
      D)
      A client who has type 1 diabetes mellitus and uses an insulin pump.
    Page 1 of 18

    Exam Review

    1. A nurse is caring for a client who does not share a language with the nurse. Which of the following actions should the nurse take?
      A)
      Speak facing the interpreter when using language services.
      B)
      Speak in the third person when using an interpreter.
      C)
      Notify the client in writing of their rights to receive an interpreter.
      D)
      Tell the client an interpreter telephone service is only available during daytime hours.
    2. A nurse is caring for a client who had a total knee arthroplasty. The client asks if they can miss their physical therapy session. Which of the following responses made by the nurse demonstrates the ethical principle of beneficence?
      A)
      "If you don't attend physical therapy, your knee won't heal."
      B)
      "I can provide you with medication if you are experiencing discomfort."
      C)
      "You are required to attend your physical therapy session each day."
      D)
      "Physical therapy will charge you for the cancellation."
    3. A nurse manager is teaching a newly licensed nurse about leadership styles. Which of the following information should the nurse include?
      A)
      A transactional leader is results-oriented.
      B)
      A transformational leader lacks long-term vision.
      C)
      An authoritarian leader allows decisions to be made by the group.
      D)
      A laissez-faire leader motivates group members through criticism.
    4. A nurse is caring for a client who is confused and attempting to remove the IV access. Which of the following actions should the nurse take first?
      A)
      Request a prescription for mitten restraints.
      B)
      Provide a stimulating environment for the client.
      C)
      Administer an anti-anxiety medication.
      D)
      Arrange for someone to sit with the client.
    Page 2 of 18

    Exam Review

    1. A nurse manager is attending a meeting about the cost of health care. Which of the following measures should the nurse implement to reduce the cost of treatment in the acute care setting?
      A)
      Encourage staff to participate in quality improvement projects.
      B)
      Staff an additional assistive personnel each shift.
      C)
      Plan budget needs based on average client stay over 6 months.
      D)
      Reserve budgetary planning for senior management.
    2. A nurse is providing discharge teaching to the parent of a toddler who has a new diagnosis of asthma. The parent states that they are unable to afford the nebulizer prescribed for the child. Which of the following referrals should the nurse recommend?
      A)
      Respiratory therapist
      B)
      Child protective services
      C)
      Pharmacist
      D)
      Social worker
    3. 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 client's preferred time for bathing
      B)
      The steps to follow when providing wound care
      C)
      The time the client received their last dose of pain medication
      D)
      The belief that the client has a difficult relationship with their child
    4. A nurse enters the room of a client who is unconscious and finds that the client's son is reading her electronic medical records from a monitor located at the bedside. Which of the following actions should the nurse take first?
      A)
      Recommend the son meet with the provider to get information about his mother's condition.
      B)
      Complete an incident report regarding the breach of the client's confidentiality.
      C)
      Log out the computer so that the client's son is unable to view his mother's information.
      D)
      Report the possible violation of client confidentiality to the nurse manager
    Page 3 of 18

    Exam Review

    1. A nurse is caring for a client who is scheduled for coronary artery bypass surgery and does not wish to have any blood transfusions. The nurse should recognize that administering blood to this client is a violation of which of the following ethical principles?
      A)
      Fidelity.
      B)
      Veracity.
      C)
      Autonomy.
    2. A nurse on a medical-surgical unit is caring for a group of clients with the assistance of a licensed practical nurse (LPN) and an 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)
      Reinforcing dietary teaching with a client who has heart disease.
      C)
      Obtaining a urine specimen from an older adult client.
      D)
      Providing postmortem care for a client who has just died.
    3. A charge nurse notices that two staff nurses are not taking meal breaks during their shifts. Which of the following actions should the nurse take first?
      A)
      Determine the reasons the nurses are not taking scheduled breaks
      B)
      Provide coverage for the nurses’ breaks
      C)
      Discuss time management strategies with the nurses
      D)
      Review facility policies for taking scheduled breaks
    4. A nurse is planning an in-service program about nationally notifiable infectious diseases. Which of the following diseases should the nurse include as reportable to community health officials?
      A)
      Respiratory syncytial virus
      B)
      Lyme disease
      C)
      Endocarditis
      D)
      Coxsackievirus
    Page 4 of 18

    Exam Review

    1. A nurse is teaching a group of assistive personnel about airborne precautions. Which of the following statements should the nurse make?
      A)
      Masks are not required when more than 3 ft from a client who requires airborne precautions.
      B)
      An N95 respirator mask is required when caring for a client who has the measles.
      C)
      A client who has influenza requires airborne precautions.
      D)
      Clients who have varicella should be placed in a positive pressure room.
    2. A nurse assumes the leading role on the hazardous materials team immediately following a chemical mass casualty incident in the community. As clients arrive at the designated triage area outside the hospital, which of the following actions should the nurse take?
      A)
      Admit the injured clients to positive-pressure rooms.
      B)
      Remove contaminated clothing.
      C)
      Scrub the clients' skin with betadine solution.
      D)
      Place shower caps over the clients' hair.
    3. A charge nurse is admitting a client who speaks a different language than the nurse. The charge nurse asks a staff nurse who speaks the client's language to witness the client's informed consent form for surgery. Which of the following actions should the staff nurse take?
      A)
      Review the facility's policy regarding the use of staff members as interpreters.
      B)
      Explain the risks and benefits of the procedure to the client before signing the form.
      C)
      Inform the client that they will need a family member or friend to interpret for them.
      D)
      Sign the informed consent form after confirming the procedure with the provider.
    4. A nurse on a medical-surgical unit is preparing to assign vital sign measurements for a group of clients. Which of the following clients should the nurse delegate to an assistive personnel?
      A)
      A client who has sickle-cell anemia and has completed an infusion of packed RBCs
      B)
      A client who reports acute chest pain
      C)
      A client who has a closed head injury and increased intracranial pressure
      D)
      A client who has just returned to the unit from the PACU
    Page 5 of 18

    Exam Review

    1. A nurse is assessing a client who had a recent stroke. Which of the following findings should indicate to the nurse the need for referral to an occupational therapist?
      A)
      Receptive aphasia.
      B)
      Unilateral neglect.
      C)
      Memory loss.
      D)
      Facial drooping.
    2. A charge nurse is assessing the room of a newly admitted client who has dysphagia. Which of the following pieces of equipment should the nurse ensure is available in the client's room?
      A)
      Large-handled utensils
      B)
      Bite block
      C)
      Yankauer suction device
      D)
      Nasal cannula and oxygen
    3. A charge nurse is teaching a group of nurses about the purpose of a living will. Which of the following information about living wills should the charge nurse include in the teaching?
      A)
      Addresses resuscitation measures
      B)
      Provides protection against malpractice
      C)
      Documents that the client gave informed consent
      D)
      Designates a health care surrogate to make health care decisions
    4. A nurse enters a client's room to witness an informed consent for a gastroscopy. The client states he does not understand the procedure. Which of the following actions should the nurse take?
      A)
      Inform the provider that the client requires clarification about the procedure.
      B)
      Educate the client about the risks of refusing the procedure.
      C)
      Complete an incident report.
      D)
      Answer the client's questions concerning the procedure.
    Page 6 of 18