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    Exam Review

    1. When providing nursing care to a client, the nurse provides family-centered nursing care. What is the best rationale for this nursing action?
      A)
      The nurse does not want the client to feel lonely.
      B)
      The client will be more compliant with medical instructions.
      C)
      The family will be more willing to listen to instructions.
      D)
      Illness in one family member can affect the other family members.
    2. A client on digitalis has a lab report of potassium 3.0 mEq/L. The nurse would instruct the client to eat which of these foods?
      A)
      Asparagus.
      B)
      Cantaloupe.
      C)
      Blackberries.
      D)
      Cucumbers.
      E)
      Cucumbers.
    3. The unlicensed assistive personnel (UAP) is feeding a client with dysphagia. What action would cause the nurse to intervene?
      A)
      Offering thickened liquids.
      B)
      Placing client in upright position.
      C)
      Providing large, frequent bites.
      D)
      Allowing ample time between choices.
    4. Warfarin sodium (Coumadin) is ordered for a client. The client asks the nurse about dietary restrictions while taking this medication. Which of the following foods should be limited?
      A)
      Wheat bread and butter.
      B)
      Mangoes and tomatoes.
      C)
      Spinach and salads.
      D)
      Aged cheeses and wine.
    Page 1 of 49

    Exam Review

    1. A client is diagnosed with hearing loss. Which nursing intervention will best facilitate communication with the client?
      A)
      Use exaggerated mouth and hand movements when speaking.
      B)
      Face the client while speaking and ask them to verify understanding.
      C)
      Stand in front of a light when speaking to the client and touch them to be sure they know where you are.
      D)
      Obtain an interpreter for sign language.
    2. A client has undergone a surgical procedure and develops a weak, rapid pulse. Which intervention should the nurse recommend to provider during their SBAR communication?
      A)
      Anticholinergic.
      B)
      Urinary catheter placement.
      C)
      Beta blocker.
      D)
      Intravenous fluid bolus.
    3. Which is the most appropriate order to remove (doff) personal protective equipment (PPE)?
      A)
      Remove gown, gloves, wash hands, remove mask, and goggles.
      B)
      Discard gloves, gown, face shield, mask, and wash hands.
      C)
      Remove gloves, wash hands, remove face shield, gown, mask, and wash hands again.
      D)
      Discard gloves, wash hands, remove gown, face shield, and mask.
    4. A nurse is developing a plan of care for a client diagnosed with constipation. Which nursing interventions should be included in planning? (Select all that apply).
      (SATA)
      A)
      Encourage high-fiber food choices.
      B)
      Increase fluid intake to 2,000 mL per day.
      C)
      Encourage ambulation several times per day.
      D)
      Administer antacids as necessary per bowel management program.
    Page 2 of 49

    Exam Review

    1. A client states “I don’t want to have surgery.” Which of the following is a therapeutic response to the client?
      A)
      “Surgery is your only choice. You need this operation.”.
      B)
      “Whether or not you have the surgery is your choice. What is your understanding of the situation?”.
      C)
      “I hear you.
      D)
      I wouldn’t want surgery either.
    2. A nurse is out in public when an individual suddenly falls to the ground with a generalized tonic- clonic (grand mal) seizure. Which action should the nurse take first?
      A)
      Place a stick in the person’s mouth to prevent biting of the tongue and call for assistance.
      B)
      Completely record time of the person’s seizure and save for paramedics.
      C)
      Restrain the limbs to prevent injury while providing as much privacy for the person as possible.
      D)
      Loosen the individual’s necktie after placing the person in the recovery position.
    3. A health care provider prescribes guaifenesin with dextromethorphan 1 tablespoon every 6 hours for a client who has a nonproductive cough. How many milliliters should a nurse administer for each dose?
      A)
      10 mL.
      B)
      5 mL.
      C)
      15 ml.
      D)
      30 ml.
    4. Which technique is the proper method to administer otic drops to an adult client?
      A)
      Straighten the auditory canal by pulling it down and toward the front.
      B)
      Gently pull the auricle up and back before instilling the drops.
      C)
      Ask the client to lower the head and take a deep breath during the instillation.
      D)
      Don sterile glove and gently insert one finger in the canal to promote the flow of the drops.
    Page 3 of 49

    Exam Review

    1. Which statement best documents the situation when a client becomes extremely agitated after receiving a sedative?
      A)
      An idiosyncratic drug effect.
      B)
      A toxic drug effect.
      C)
      An allergic drug response.
      D)
      An unexpected drug interaction.
    2. Which intervention should the nurse include while caring for a client who has been diaphoretic for the past six hours?
      A)
      Offering the client a bedpan every three hours.
      B)
      Keeping an emesis basin near the bedside.
      C)
      Providing oral care every four hours.
      D)
      Changing the bed linens frequently.
    3. Which intervention should the nurse include while caring for a client who has been diaphoretic for the past six hours?
      A)
      Offering the client a bedpan every three hours.
      B)
      Keeping an emesis basin near the bedside.
      C)
      Providing oral care every four hours.
      D)
      Changing the bed linens frequently.
    4. Which nursing intervention should be performed before applying client restraints?
      A)
      Visual inspection of skin for placement.
      B)
      Positioning for proper body alignment.
      C)
      Assess the need for restraints placement.
      D)
      Review facility policy before usage.
    Page 4 of 49

    Exam Review

    1. Which instructions should a nurse give to a client prior to obtaining a throat culture?
      A)
      “While depressing your tongue, I will swab the back of your throat.”.
      B)
      “You won’t be able to eat or drink for one hour after the procedure.”.
      C)
      “Take a deep breath and then cough while I swab your throat.”.
      D)
      “I just need to swab your anterior tongue. It will be very quick.”.
    2. Which statement provides the best documentation of the amount of wound drainage?
      A)
      Two 4x4 gauze cloths saturated with purulent drainage.
      B)
      Large amounts of exudate removed with dressing.
      C)
      Dressing dry on top, wet adjacent to the wound.
      D)
      Outer dressing dry and intact, moderate drainage noted underneath.
    3. Following a uterine biopsy, a client asks a nurse, “Do you think I have cancer?” Which response by the nurse would most likely prompt the client to elaborate on their concerns?
      A)
      “I don’t know.Biopsies are often negative.”.
      B)
      “I can’t say. Did your health care provider tell you?”.
      C)
      “No one knows yet. I’d like to hear what you are thinking.”.
      D)
      “Everyone thinks about that. Don’t worry until the final report is back.”.
    4. A nurse is reluctant to pray when a client requests to pray together. Which statement by the nurse would best meet the client’s spiritual needs?
      A)
      “I don’t know how to pray, but I will bring you a Bible.”.
      B)
      “Wouldn’t you prefer to pray with one of your visitors?”.
      C)
      “I don’t share your religious beliefs, so I cannot pray with you.”.
      D)
      “I feel uncomfortable praying with you, but I will find someone who won’t feel that way.”.
    Page 5 of 49

    Exam Review

    1. A client asks a nurse, “Why do I have to remove my nail polish in order for my pulse oximetry to be monitored?” Which is the best response by the nurse?
      A)
      “I need to be able to assess the color of your nailbed.”.
      B)
      “Nail polish can interfere with the transmission of light waves.”.
      C)
      “The sensor may react with the nail polish causing an allergic reaction.”.
      D)
      “The chemicals in the nail polish can cause falsely decreased readings of your oxygen level.”.
    2. Which strategy should a nurse include when communicating with a client who is blind?
      A)
      Speak loudly since the client is unable to observe nonverbal cues.
      B)
      Touch the client prior to speaking to gain the client’s attention.
      C)
      Orient the client to the arrangement of the room to promote independence.
      D)
      Keep the bed in the highest position to prevent the client from getting out of bed alone.
    3. A client is to have a two-hour post-prandial blood glucose drawn. Which statement should the nurse make to inform the client when the two-hour test will be performed?
      A)
      After fasting.
      B)
      Before breakfast.
      C)
      After a normal meal.
      D)
      Before glucose is consumed.
    4. A client with difficult venous access has an intravenous insertion site located at the bend of the wrist. Which action would be most appropriate for a nurse to take?
      A)
      Place the arm across the client’s chest to support the wrist.
      B)
      Use a wrist restraint to decrease mobility in the arm.
      C)
      Apply an arm board to immobilize the wrist.
      D)
      Instruct client to limit use of that arm.
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