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    Exam Review

    1. A nurse is assessing an adolescent who began taking atomoxetine 1 month ago. Which of the following findings is an indication the medication is effective?
      A)
      Decrease in impulsivity
      B)
      Decrease in fasting blood glucose level
      C)
      Decrease in weight
      D)
      Decrease in blood pressure
    2. (Highlight — findings requiring follow-up are marked)

      Click to highlight the findings that indicate the client requires immediate follow-up. To deselect a finding, click on the finding again.

      Body System

      Findings

      integumentary

      Skin feels cool to the touch

      Capillary refill 3 seconds in left foot.

      Dressing on left hand shows small amount of moisture through gauze

      Vital Signs

      Blood pressure 102/50 mm Hg

      Temperature 35.8°  C (96.4° F)

      Respiratory rate 20/min

      Genitourinary

      Output of 25 mL dark amber urine through catheter.
    3. A nurse is assessing a school-age child who is taking atomoxetine. Which of the following findings should the nurse identify as an adverse effect of the medication?
      A)
      Decreased heart rate
      B)
      Weight gain
      C)
      Loose stools
      D)
      Difficulty sleeping
    4. A nurse manager assigns a nurse to a client who is to undergo a procedural abortion. The nurse refuses the assignment based on their own spiritual beliefs. Which of the following actions should the nurse manager take?
      A)
      Instruct the nurse to discuss their beliefs with the client.
      B)
      Reassign the nurse to a different client.
      C)
      Report the nurse to the ethics committee.
      D)
      Inform the nurse that this action is a violation of the nursing code of ethics.
    Page 1 of 22

    Exam Review

    1. A nurse is assessing a client who is postpartum and has developed endometritis. Which of the following findings should the nurse expect?
      A)
      Back pain
      B)
      Bradycardia
      C)
      Agitation
      D)
      Chills
    2. A nurse is caring for a client who had a stroke and is having difficulty swallowing. Which of the following referrals should the nurse make for the client?
      A)
      Speech therapy
      B)
      Occupational therapy
      C)
      Physical therapy
      D)
      Respiratory therapy
    3. A nurse is teaching a newly licensed nurse about staff safety issues related to compassion fatigue. Which of the following information should the nurse include in the discussion?
      A)
      Ignore disruptive behaviors.
      B)
      Publicly confront coworkers when conflict arises.
      C)
      Encourage a passive communication style.
      D)
      Focus on self-care.
    4. A nurse is providing teaching to a client who has schizophrenia and is to begin taking clozapine. Which of the following adverse effects should the nurse include in the teaching?
      A)
      Hypertension
      B)
      Agranulocytosis
      C)
      Urinary retention
      D)
      Weight loss
    Page 2 of 22

    Exam Review

    1. A nurse on a mental health unit is reviewing a client's medical record prior to administering risperidone. For which of the following findings should the nurse withhold this medication?
      A)
      Xerostomia
      B)
      Diarrhea
      C)
      Increased HbA1c
      D)
      Neutropenia
    2. A nurse is planning care for a client who is to begin using a hearing aid. Which of the following instructions should the nurse include in the plan?
      A)
      "Clean the earmold using an alcohol swab."
      B)
      "Store the hearing aid in a moist environment."
      C)
      "Turn the hearing aid volume up slowly once inserted."
      D)
      "Increase volume on the hearing aid if whistling occurs."
    3. A nurse providing care to a client who was administered a subcutaneous medication intramuscularly. To which of the following types of medication errors should the nurse categorize this as in their report?
      A)
      Drug preparation error
      B)
      Knowledge deficit
      C)
      Performance deficit
      D)
      Transcription error
    4. A nurse is receiving a report on a group of clients. For which of the following clients should the nurse implement airborne precautions?
      A)
      A client who has measles
      B)
      A client who has vancomycin-resistant enterococcus
      C)
      A client who has pertussis
      D)
      A client who has respiratory syncytial virus
    Page 3 of 22

    Exam Review

    1. A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the following actions should the nurse take?
      A)
      Encourage client to use incentive spirometer every 4 hr.
      B)
      Elevate the head of the client's bed to a 45-degree position when awake.
      C)
      Place an abduction pillow between the client's legs.
      D)
      Use a sequential compression device on the client's unaffected leg.
    2. A nurse is assessing several clients who have asthma. Which of the following clients should the nurse identify as requiring immediate intervention?
      A)
      A client who is using accessory muscles to breathe
      B)
      A client who has intermittent inspiratory and expiratory wheezes
      C)
      A client who has an oxygen saturation of 94%
      D)
      A client who has a daytime cough
    3. A nurse is assessing a client who is receiving intermittent tube feedings. Which of the following actions should the nurse take to reduce the risk of aspiration when administering the tube feeding?
      A)
      Verify the tube placement with x-ray prior to initial use.
      B)
      Check the gastric residual every 2 hr.
      C)
      Stop feeding if gastric residual is greater than 100 mL.
      D)
      Place client in the Trendelenburg position.
    4. A nurse is assessing a toddler following the casting of the right arm due to a fractured humerus. Which of the following findings should the nurse identify as a manifestation of compartment syndrome?
      A)
      Heart rate 120/min
      B)
      Bounding radial pulse
      C)
      Respiratory rate 28/min
      D)
      Weak hand grip
    Page 4 of 22

    Exam Review

    1. A nurse is assessing a client who is at 37 weeks of gestation and reports sudden, severe abdominal pain with moderate vaginal bleeding and persistent uterine contractions. The client's blood pressure is 88/50 mm Hg and their abdomen is rigid. The nurse should identify these findings as indicating which of the following complications?
      A)
      Placenta previa
      B)
      Placental abruption
      C)
      Amniotic fluid embolus
      D)
      Uterine rupture
    2. A nurse is caring for a client who has hypoglycemia. Which of the following findings should the nurse expect?
      A)
      Blurred vision
      B)
      Diaphoresis
      C)
      Polyphagia
      D)
      Dehydration
    3. A nurse is teaching the parent of a newborn who underwent a circumcision using the Gomco method. Which of the following statements by the parent indicates an understanding of teaching?
      A)
      "I will wipe off the yellow drainage each time I change my baby's diaper."
      B)
      "I will clean my baby's penis with alcohol after each diaper change."
      C)
      "I will apply petroleum to my baby's penis with each diaper change."
      D)
      "I will use the diaper to apply gentle pressure to the area."
    4. A nurse is preparing to administer heparin at 1,000 units/hr via continuous IV infusion to a client who had a coronary artery bypass graft. Available is heparin 25,000 units in dextrose 5% in water in 250 mL. The nurse should set the IV pump to deliver how many mL/hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)
    Page 5 of 22

    Exam Review

    1. A nurse is assessing a client who is 2 days postoperative following a transurethral resection of the prostate and has an indwelling urinary catheter in place. Which of the following findings should the nurse expect?
      A)
      Urinary output 25 mL/hr
      B)
      Pain of 8 on a scale of 0 to 10
      C)
      Dark red urine
      D)
      Small clots with tissue in the urine
    2. A nurse is preparing to administer continuous total parenteral nutrition (TPN) to a client. Which of the following components should the nurse identify as a fat emulsion?
      A)
      Amino acid
      B)
      Egg phospholipid
      C)
      Folic acid
      D)
      Calcium gluconate
    3. A nurse is planning care for a client who is scheduled for a thoracentesis. Which of the following actions should the nurse include in the plan?
      A)
      Ensure the client has been NPO for 6 hr.
      B)
      Place the client leaning forward over the overbed table.
      C)
      Schedule the client for an MRI after the procedure.
      D)
      Encourage the client to take deep breaths during the procedure.
    4. A nurse is assessing a newborn who is 1 hr old. Which of the following findings should the nurse report to the provider?
      A)
      Bulging anterior fontanel
      B)
      Flexed posture
      C)
      Moro reflex present
      D)
      Acrocyanosis
    Page 6 of 22