Exam Review

A nurse is caring for a client who is pregnant. 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.
✓Prepare the client for suction curettage
✓Discuss weekly pregnancy hormone level monitoring
✓Hydatidiform mole
✓Vaginal bleeding
✓Blood pressure
Actions to Take Choices
✕Administer methotrexate
✓Prepare the client for suction curettage
✓Discuss weekly pregnancy hormone level monitoring
✕Prepare the client for an emergency cesarean birth.
✕Administer terbutaline
Potential Condition Choices
✕Ectopic pregnancy
✕Abruptio placentae
✓Hydatidiform mole
✕Placenta previa
Parameters to Monitor Choices
✓Vaginal bleeding
✓Blood pressure
✕Cervical dilation
✕Uterus for Hypertonicity
✕Unilateral pelvic pain
A nurse is assessing the fontanels of an 8-month-old infant. Which of the following findings should the nurse recognize as an expected finding?
A)
The anterior fontanel is open.
B)
The posterior fontanel is open.
C)
Both fontanels are the same size.
D)
Both fontanels show molding.
A nurse is assessing a client who is 6 hr postoperative following a total abdominal hysterectomy. Which of the following findings should the nurse report to the provider?
A)
The client reports a pain level of 4 on a scale of 0 to 10.
B)
The client's dressing has a scant amount of dark red drainage.
C)
The client has decreased bowel sounds in all four quadrants.
D)
The client's total urinary output is 75 mL in the last 3 hr.

A nurse is caring for a client in a clinic. For each intervention, click to specify if the intervention is anticipated or unanticipated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

	Anticipated	Unanticipated
Apply warm compresses to eyes.		✓
Implement seizure precautions.	✓
Administer furosemide.	✓
Administer 0.9% sodium chloride 1000mL IV at 150 mL/hr.		✓
Administer dexamethasone.	✓

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Exam Review

A nurse is reviewing the medication administration record of a client who has rheumatoid arthritis and is 1 day postoperative following a left total hip arthroplasty. Which of the following medications places the client at risk for delayed wound healing?
A)
Omeprazole
B)
Digoxin
C)
Morphine
D)
Prednisone
A nurse is transcribing new medication prescriptions for a group of clients. For which of the following prescriptions should the nurse contact the provider for clarification?
A)
Hydrochlorothiazide 12.5 mg PO BID
B)
Zolpidem 10 mg PO one tablet at bedtime
C)
Triamcinolone acetonide 55 mcg two sprays in each nostril once daily
D)
Lorazepam .5 mg PO one tablet daily
A nurse is caring for a group of children. Which of the following children should the nurse recognize as at risk for developing acute poststreptococcal glomerulonephritis?
A)
A 7-year-old child who is recovering from impetigo
B)
A 16-year-old adolescent who has appendicitis
C)
A 2-month-old infant who has pyloric stenosis
D)
An 18-year-old adolescent who is in the second trimester of pregnancy
A nurse is caring for a client who is receiving continuous enteral feedings. Which of the following actions should the nurse take? (Select all that apply.)
(SATA)
A)
Maintain the head of the client's bed at a 30° angle or higher.
B)
Change the feeding container and tubing every 24 hr.
C)
Ensure the formula is cold before administration.
D)
Check placement of the feeding tube by x-ray once daily.
E)
Check gastric residuals every 4 hr.

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Exam Review

A nurse is caring for a client in a clinic. For each body system below, click to specify the adverse effect that the nurse should include in the teaching. Choose the most likely response for the dropdown(s) in the table below by choosing from the lists of options. Body System Common Adverse Effects Head, eyes, ears, nose, and throat (HEENT) ▾ Dry mouth Cardiovascular ▾ Tachycardia Genitourinary ▾ Urinary retention Gastrointestinal ▾ Constipation
Dropdown 1:
Option 1: Double vision
Option 2: Dry mouth
Option 3: Sore throat
Dropdown 2:
Option 1: Tachycardia
Option 2: Chest pain
Option 3: Hypertension
Dropdown 3:
Option 1: Hematuria
Option 2: Urinary incontinence
Option 3: Urinary retention
Dropdown 4:
Option 1: Weight loss
Option 2: Diarrhea
Option 3: Constipation
A nurse is preparing to administer an intramuscular injection to a client. Which of the following injection sites should the nurse choose to utilize?
A)
Ventrogluteal
B)
Forearm
C)
Abdomen
D)
Upper back
A nurse is caring for a client who has a new diagnosis of terminal advanced lung cancer. Which of the following is an expected stage of grief based on the stages of dying?
A)
Denial
B)
Reorganization
C)
Reinvesting
D)
Numbing
A charge nurse delegates to an assistive personnel (AP) the task of ambulating a client. At the end of the shift, the nurse discovers the client has not been ambulated. Which of the following actions should the nurse take first?
A)
Ambulate the client on behalf of the AP.
B)
Supervise the AP performing the task.
C)
Remind the AP of their assigned tasks.
D)
Evaluate why the client was not ambulated.

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Exam Review

A nurse on a mental health unit is caring for a client who has suicidal ideation. Which of the following actions should the nurse take?
A)
Encourage visitors to bring the client's favorite items to the unit.
B)
Establish a no-suicide contract with the client.
C)
Suggest the client relax in their room alone.
D)
Avoid discussing suicidal thoughts with the client.
A triage nurse is assessing a client in an emergency department. 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.
A nurse is caring for a school-age child. Complete the following sentence by using the lists of options. The nurse should first dropdownbecause ofdropdown
A nurse in an outpatient clinic is caring for an older adult female client. 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.

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Exam Review

A nurse is caring for a client who has a new diagnosis of schizophrenia and a prescription for an antipsychotic medication. Which of the following should the nurse recognize as an adverse effect that must be immediately reported to the provider?
A)
The client is observed displaying a shuffling gait while walking in the hall.
B)
The client is observed mumbling quietly while alone in the day room.
C)
The client states, "Being in the sun seems to really hurt my eyes."
D)
The client states, "I feel light-headed when I stand up quickly."
A nurse is planning care for a client who has bipolar disorder and is experiencing mania. Which of the following interventions should the nurse include in the plan?
A)
Place the client in seclusion when they exhibit signs of anxiety.
B)
Withdraw the client's TV privileges if they do not attend group therapy.
C)
Encourage the client to take frequent rest periods.
D)
Encourage the client to spend time in the dayroom.
A nurse is discharging two clients from the hospital to their homes. The provider states that the client with insurance will receive supplies to take home and the one without insurance will need to pick up supplies at the local clinic. The nurse should recognize that this is a breach of which of the following ethical principles?
A)
Autonomy
B)
Nonmaleficence
C)
Justice
D)
Beneficence
A nurse is caring for a client who is pregnant. 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.

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Exam Review

A nurse is caring for a client in an emergency department. The nurse reviews the medical record. Complete the following sentence by using the lists of options. The client likely experienced dropdownas evidenced by dropdown
A nurse is preparing to initiate IV therapy for an older adult client. Which of the following actions should the nurse plan to take?
A)
Select a vein on the back of the hand.
B)
Use a 22-gauge catheter for insertion.
C)
Apply a tourniquet firmly above the insertion site.
D)
Clean the site using vigorous friction.
A nurse in an emergency department is caring for a client. Select the 4 actions the nurse should take.
A)
Administer oxygen at 2 L/min via nasal cannula.
B)
Obtain arterial blood gases.
C)
Prepare to administer antiplatelet therapy.
D)
Perform a 12-lead ECG.
E)
Prepare the client for a cardiac catheterization.
F)
Request a prescription for a sputum culture.
A nurse is caring for a client in an outpatient health clinic. For each potential nursing intervention, click to specify if the intervention is indicated or not indicated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.
A)
Encourage a regular sleep-wake schedule.
B)
Instruct client to avoid foods that have been fermented or aged.
C)
Encourage high-calorie finger foods.
D)
Encourage client to sleep until later in the morning.
E)
Encourage naps during the day when client is tired.
F)
Advise client to rise slowly from sitting position
G)
Advise client to notify provider if pregnant.

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