Exam Review
- A 14-year-old female student is brought to the clinic by her mother, who says the client has been using laxatives to lose weight. The client complains of feeling tired and weak and is probably experiencing what electrolyte imbalance?A)HypocalcemiaB)HyperkalemiaC)HypokalemiaD)Hypernatremia
- A nurse is working with an older adult and educating the client on how to ambulate with the aid of a walker. The nurse notes that the client appears disengaged and states, “I’m just too old to learn.” What would be most appropriate for the nurse to do to motivate this client?A)Tell the client how to move the walker as the client ambulatesB)Describe how the walker can improve the client’s quality of lifeC)Explain how the walker supports the client’s lower extremitiesD)Fully discuss the rationale for using the walker
- The nurse is prepping a client for a trip to the operating room. The nurse anticipates that the physician will order which IV fluid?A)10% DextroseB)3% NaClC)Lactated Ringer’sD)0.45% NaCl
- A nurse in a long-term care facility is caring for a client with dementia who is upset over not being able to find their spouse, who passed away years ago. Which of the following actions should the nurse take first?A)Take the client for a walk and ask them to talk about their familyB)Administer alprazolam to decrease their anxietyC)Administer olanzapine to decrease their agitationD)Take the client to their room so they will not upset others
Exam Review
- A nurse in a community health clinic is assessing a client brought by their parents. Which of the following would be the highest priority nursing diagnosis?A)Risk for caregiver role strainB)Risk for delayed developmentC)Sleep deprivationD)Altered urinary elimination
- As the nurse assesses a client’s laboratory values, the following are noted: Sodium 140 mEq/L, Magnesium 0.8 mEq/L, Chloride 107 mEq/L, Potassium 3.6 mEq/L. What electrolyte imbalance is indicated?A)HypomagnesemiaB)HyponatremiaC)HyperchloremiaD)Hypokalemia
- As the nurse assesses a client’s blood pressure, the patient’s wrist severely flexes inward. The nurse questions the client’s response because this finding may indicate what condition?A)HyperchloremiaB)HypercalcemiaC)HypocalcemiaD)Hypomagnesemia
- As the nurse assesses a client’s blood pressure, the patient’s wrist severely flexes inward. The nurse questions the client’s response because this finding may indicate what condition?A)HyperchloremiaB)HypercalcemiaC)HypocalcemiaD)Hypomagnesemia
Exam Review
- As the nurse assesses a client’s laboratory values, the following are noted: Sodium 140 mEq/L, Magnesium 0.8 mEq/L, Chloride 107 mEq/L, Potassium 3.6 mEq/L. What electrolyte imbalance is indicated?A)HypomagnesemiaB)HyponatremiaC)HyperchloremiaD)Hypokalemia
- A client states to the nurse, “I understand that I need a mastectomy, but I am worried about the pain and appearance afterwards.” When responding to the client, the nurse will need to address which domain?A)CognitiveB)PsychomotorC)AffectiveD)Behavioral
- The client is admitted to the nurse’s unit with a diagnosis of heart failure. His heart is not pumping effectively, resulting in edema and coarse crackles in his lungs. The term for this condition is?A)Fluid volume deficitB)Fluid volume excessC)Myocardial infarctionD)Atelectasis
- A client reads the nutritional chart and follows it accurately. The nurse also notes that the client understands the need for a balanced diet and its relationship with quick recovery. In which domain is the client demonstrating successful learning?A)AffectiveB)PsychomotorC)InterpersonalD)Cognitive
Exam Review
- A nurse is caring for a client who has a fluid and electrolyte imbalance. The nurse knows that the priority goal of taking care of this client is?A)To obtain homeostasisB)To prevent infectionC)To promote mobilityD)To enhance nutrition
- indicate the nurse is addressing the affective domain of learning?A)The nurse shows the best positions to hold the newborn while feedingB)The nurse explains the steps of warming a bottleC)The nurse has both parents demonstrate changing a diaperD)The nurse asks the clients their views on breastfeeding
- Which nursing interventions are appropriate to include in a plan of care to promote sleep for patients who are hospitalized? (Select all that apply)A)Instruct them to take a long walk an hour before bedtimeB)Arrange with laboratory to draw blood outside of sleep hoursC)Encourage patients to fall asleep while watching televisionD)Close the door to patients’ rooms at bedtimeE)Provide a warm green tea or coffee with evening meal
- A 73-year-old hospitalized client demonstrates the following symptoms: dry mucous membranes, decreased urine output, confusion, a serum sodium of 153 mEq/L, and a serum condition difficult to measure. This is indicative of?A)Sensible water lossB)Major magnesium lossesC)Insensible water lossD)Low potassium levels
Exam Review
- A 73-year-old hospitalized client demonstrates the following symptoms: dry mucous membranes, decreased urine output, confusion, a serum sodium of 158 mEq/L, a potassium of 4.8 mEq/L. The nurse recognizes that these symptoms are indicative of?A)HypernatremiaB)HyperkalemiaC)HyponatremiaD)Hypokalemia
- During an indwelling Foley catheterization of a male patient, it is important that the nurse?A)Advance the catheter to the bifurcation or “Y” level of the portsB)Instruct the patient to contract or squeeze his pelvic musclesC)Bathe the catheter after urine appears in the tube prior to inflating the balloonD)Advance the catheter 2–3 inches after urine appears in the tube prior to inflating the balloon
- A client continues to report nausea following surgery from the anesthesia. She has received an antiemetic, and the next dose is not due for another hour. What should the nurse do first?A)Explore non-pharmacological options for nauseaB)Offer to notify the healthcare provider after morning rounds are completedC)Discuss how anesthesia can cause nausea after surgeryD)Explain to the patient that nothing else has been ordered
- A client is taking a diuretic that increases urinary output. What nursing concern is appropriate to base an educational plan?A)Urinary retentionB)Decreased fluid volume riskC)Altered skin integrityD)Altered urinary elimination
Exam Review
- A nurse is receiving report on a group of clients. Using the ABCD-E priority framework, which of the following clients should the nurse see first?A)A client who is scheduled for discharge and has become febrile this morningB)A client who has early dementia and awoke confused to their location this morningC)A client who has pneumonia and has developed wheezingD)A client who is postoperative and has a urine output of 50 mL for the past 4 hours
- The oncoming nurse is assigned to the following clients. Which client should the nurse assess first?A)A 47-year-old who had a colon resection yesterday and is reporting painB)A 20-year-old 2 days postoperative who refuses to ambulateC)A newly admitted 88-year-old with a 2-day history of vomiting and loose stoolsD)A 60-year-old who is 3 days post-myocardial infarction and has been stable
- The nurse is assessing a client and asks which of the following questions to evaluate potential heart failure symptoms?A)Have you been having swelling in your legs?B)Have you been experiencing difficulty breathing?C)Have you been experiencing chest pain?D)Have you been experiencing heart palpitations?
- A nurse is monitoring a client receiving a blood transfusion. Which symptom indicates a potential transfusion reaction that requires immediate action?A)Mild itching at the infusion siteB)Slight increase in heart rateC)Sudden chills and feverD)Minor redness around the IV site