PN Comprehensive Online Practice 2017 B

A nurse is assisting with monitoring a client who is in labor and has spontaneous rupture of membranes following a vaginal examination. The provider reports the client's cervix is dilated to 1 cm with an unengaged presenting part. Which of the following a

Apply the external fetal heart rate monitor.

A Nurse is collecting data from a client who has bipolar disorder and is experiencing acute mania. Which of the following findings is the nurse's priority?

lack of sleep

A nurse is reinforcing teaching with a client who has a type 2 diabetes mellitus and reports waking during the night with tremors and anxiety. which of the following information should the nurse provide to help the client manage his symptoms?

Eat a bedtime snack

a Nurse is reinforcing teaching for a client who has a coronary artery disease and is taking low-dose aspirin daily. The nurse should include that this medication has which of the following therapeutic effects for CAD?

Antiplatelet

A nurse is collecting data from a client who has an unprepared femur fracture and rates his pain as 8 on a scale of 0 to 10. The client is talking and caught with a visitor. Which of the following of the prescribed medication should the nurse administer?

Hydromorphone 5 mg orally.

A nurse is reinforcing preoperative teaching with a client scheduled for a bowel retention with ileostomy. which of the following descriptions should the nurse give of the expected output from a mature ileostomy?

liquid with little odor

A nurse is caring for a client who is 16 hr postoperative following a total hip arthroplasty. the client reports numbness, pain, and tingling in the affected leg. Which of the following actions should the nurse take first?

compare capillary refill in toes bilateraly

A nurse is reinforcing teaching with a client who has acute diverticulitis. Which of the following statements by the client indicates an understanding of the teaching about the acute phase of diverticulitis?

I will receive the nutrient I need through my IV Fluid

A nurse in reinforcing teaching with a client about cancer prevention. The nurse should include that frequent consumption of which of the following foods increases the risk of cancer?

Lamb

A nurse is assisting in teaching a group of staff nurses about hepatitis A. Which of the following modes should the nurse include as a method of transmitting hepatitis A?

Consumption of contaminated food.

A nurse is reinforcing teaching with a client who is bottle feeding he full-term newborn with formula. Which of the following instructions should the nurse include in the teaching?

Although is is unnecessary to be rigid about feeding times, six to eight feedings every 24 hrs should support a full-term newborn's nutrition adequately. Fewer feedings in the initial weeks could delay the estabilment of an adequate weight-gain pattern.

A nurse is assisting with the plan of care for a client following a transurethral resection of the prostate. Which of the following interventions should the nurse include in the plan of care?

The nurse should irrigate the bladder using strict sterile technique and maintain closed catheter drainage system to minimize the rick of infection.

A nurse is reviewing a client's electronic medical record and finds that an assistive personnel recorder the client's temperature as 35.3 degrees Celsius (95.5 degrees F) 2 hrs earlier. Which of the following actions should the nurse take firsT?

Check the client's temperature.

A nurse is receiving change-of-shift report for four clients. Which of the following clients should the nurse see first?

A client whose urinary output was 100mL for the past 12 hrs

A nurse in reinforcing teaching about weight loss with a female older adult client who is overweight. Which of the following statements should the nurse include in teaching?

keep fat intake to no more that 30% of daily caloric intake.

A nurse is collecting data from a client who has iron deficiency anemia. Which of the following findings should the nurse expect?

Difficulty concentrating.

A Nurse is collecting data from an older adult client who is 48 hr postoperative following abdominal surgery. The provider writes a prescription to advance the client to a regular Diet. For which of the following findings should the nurse notify the provi

The client has absent bowel sounds.

A nurse is reinforcing discharge teaching with a client who is postoperative following transurethral resection fo the prostate. Which of the following instructions should the nurse include in the teaching?

perform Kegel exercises daily.

A nurse is reinforcing teaching about ways to reduce solid fat consumption with a client who has an elevate cholesterol level. which of the following strategies should the nurse include in the teaching?

purchase beef that is a loin cut.

A nurse is reinforcing teaching with a client who has a new prescription for prednisone for the treatment of Addison's disease. which of the following instructions should the nurse include in the teaching?

You will need to schedule a bone density test.

A nurse is collecting data from a client who has type 2 diabetes mellitus and is concerned about weight gain during pregnancy. Which of the following responses should the nurse make?

You weight gain should be the same as for someone without diabetes.

A nurse is reinforcing teaching with the parent of a preschooler who has lactose intolerance. Which of the following statements by the parent indicates an understanding of the teaching?

I should offer my child yogurt that has a probiotic as a snack.

A parent brings her adolescent son to an urgent care center and states. "He is high on something and needs help" The client is exhibiting agitation and paranoia and reports visual hallucinations. The nurse should suspect intoxication with which of the fol

Methamphetamines

A nurse notices an assistive personnel taking a nap in the break room during he meal time. The AP appears drowsy while performing routine tasks. Which of the following actions should the nurse take?

Report the observations about the ap to the unit's nurse manager.

A nurse is reinforcing teaching with a client who has a fluid volume deficit about selecting foods that have a high water content. The nurse should include that which of the following raw foods contains the highest amount of water per 1 cup serving?

Cherry tomatoes

The nurse is position a client who is scheduled for a lumbar puncture. The nurse should assist the client into which of the following positions?

Lateral Recumbent.

A nurse is talking with a client whose son died in a motor-vehicle crash 2 weeks ago. The client states "I really thought I;d be back to my usual routines by now, but I can't think of anything else except my son is gone" Which of the following responses s

Grieving for your son is hard work. It will take as much time as you need to come to terms with your loss.

A nurse is instructing an assistive personnel on the use of proper body mechanics when moving a client. which of the following statements by the assistive personnel should the nurse identify as an understanding of the teaching?

I will use a pull sheet to help slide the client toward me.

a Nurse in maintaining droplet precautions for a client who has meningitis. Which of the following actions should the nurse take?

Wear a surgical mask within 3 feet of the client.

A nurse is collecting data from a female client who has a new diagnosis of genital herpes. Which of the following findings should the nurse expect?

Painful erythematous vesicles.

a school nurse is having a conversation with the parents of an adolescent. The nurse should identify which of the following situations as an ethical dilemma for the parents?

We can't decide whether to try to homeschool our child or move her to a private school.

A nurse is preparing to administer prednisone 1mg/kg PO to a preschooler who weights 20kg (44lb). Available is prednisone oral solution 5mg/1mL. How many mL should the nurse administer? Round

4 mL

A nurse is preparing to administer a rectal suppository to a school-age child. Which of the following action should the nurse plan to take?

Use one finger to insert the suppository past the anal sphincters.

A nurse is assisting with monitoring a client who is at 40 weeks of gestation and is in active labor. The nurse recognizes late deceleration on the fetal monitor tracing. Which of the following actions should the nurse take?

Place the client in the lateral position.

A nurse manager is providing an in-service on hand hygiene to assistive personnel. which of the following information should the nurse manager include in the in-service?

Remove reigns when washing hand with soap and water.

A nurse is reinforcing home safety instructions with the parent of a newborn. Which of the following statements should the nurse include in the instructions?

Place your baby's crib away from heat vents.

A nurse is preparing to administer a client's morning medications. Which of the following actions should the nurse take to verify the client's identity?

Scan the facility identification board.

A nurse is caring for a client following a bronchoscopy procedure. Which of the following actions should the nurse perform first?

Check for a gag reflex.

While administering a medication to a client, a nurse notices a frayed electrical cord connecting the client's continuous passive motion machine to the electrical outlet. Which of the following actions should the nurse take?

Remove the device from the client's room.

A nurse is caring for a client who requests information bout advance directives. Which of the following responses should the nurse make?

Advance directives are written instructions regarding end-of-life care.

A nurse is contributing to the plan of care for a client who is at risk of developing pressure ulcers. Which of the following actions should the nurse include in the plan of care?

Place the client in a 30� lateral position.

A nurse is assisting with performing a non stress test for a client who is at 39 weeks of gestation which of the following instructions should the nurse reinforce with the client?

You should depress the button on the handheld marker when you feel your baby move.

A nurse is reinforcing discharge teaching with a client following cataract surgery. Which of the following instructions should the nurse include in the teaching?

Sleep on the nonoperative side for 2 weeks.

A nurse manager is preparing to complete a performance analysis for a group of assistive personnel. The manager asks a staff nurse for feedback on each assistants abilities. Which of the following actions should the staff nurse take?

Discuss how each AP's actions measure against the job description.

A nurse is preparing to administer a medication to a client when the client states " I'm sick of all there medication. I'm not taking any more today!" Which of the following actions should the nurse take?

Inform the client of the possible consequences of the medication refusal.

a nurse is contributing to the plan of care for a client who is on suicide precautions. Which of the following interventions should the recommend?

Encourage the client to sign a no-harm contract.

A nurse is reinforcing reaching for a preoperative client on how to use an incentive spirometer. Which of the following actions by the client indicates an understanding of the teaching?

The client attempts to elevate the cylinder by inhaling deeply.

A nurse at a long term care facility is part of a team preparing a report on the quality of care at the facility. Which of the following information should the nurse recommend including in the report to demonstrate improvement in care quality?

The facility had 12% fewer urinary tract infections over the past 6 months.

A nurse is reviewing laboratory reports for a client who has an Escherichia Coli infection and is receiving gentamicin. Which of the following results should the nurse report to the provider before administering the next dose?

Creatinine 2.5 mg/dL

A nurse working in a community clinic is caring for an adolescent who has infectious mononucleosis. The client asks the nurse to explain how the disease was acquired. The nurse should explain that an individual acquires this disease by which of the follow

Sharing eating utensils with an infected person

A nurse is reinforcing teaching with a client who has hypothyroidism and a prescription for levothyroxine. Which of the following instructions should the nurse include in the teaching?

You will need to take the medication for the rest of your life.

A nurse is collecting data from a postpartum client who had a vaginal birth 2 days ago. Which of the following findings is the nurse's priority to report to the provider?

Client reports during with urination.

A nurse is reinforcing reaching with a client about a planned thoracentesis. Which of the following information should the nurse include in the teaching?

You will need to be monitored for 1 hour after the procedure.

A nurse is contributing to the plan of care for an older adult client who has difficulty sleeping. Which of the following interventions should the nurse include in the plan?

Establish a regular exercise routine 2 hr or more before bedtime.

A nurse in a provider's office is reinforcing teaching with a client who has a new prescription for ferrous sulfate elixir. Which of the following statements by the client should indicate to the nurse an understanding of the teaching?

I will rinse my mouth after taking this medication.

A licensed practical nurse on a medical surgical unit is working with an RN and an Assistive personnel. Which of the following assignments should the LPN expect to receive?

Administering an NG tube feeding to a client who had a stroke

A nurse is caring for a client who has schizophrenia and is experiencing auditory hallucinations. Which of the following actions should the nurse take?

Offer the client headphones to listen to music.

A nurse is reinforcing teaching with a client about taking warfarin to treat atrial fibrillation. Which of the following statements by the client indicates an understanding of the teaching?

If I forget to take a dose, I can take it later on the same day.

A nurse is working with an interpreter to explain a diagnostic procedure to a client who doesn't speak the same language as the nurse. Which of the following actions should the nurse take?

Ensure the interpreter is culturally compatible with the client.

A nurse is reinforcing discharge teaching with a client who has dependent personality disorder. Which of the following instructions should the nurse include in the discharge teaching?

Demonstrate assertiveness.

A nurse is contributing to the discharge plan for a client who had a knee arthroplasty. Which of the following actions should the nurse identify as the priority?

Check the client's mobility

A nurse in a long-term care facility is assisting with the admission of a client who requires oropharyngeal suctioning. Which of the following supplies does the nurse need to perform this task?

Yankauer catheter

A nurse is collecting data from a client who is 24 hr post op from an open colon resection, has a clamped NG tube, and is resuming a clean liquid diet. Which of the following findings should the nurse report to the provider?

Client reports vomiting green-tinged fluid.

A nurse is caring for a client who took an overdose of acetaminophen. Which of the following medications should the nurse plan to administer to the client?

Acetylcysteine

A nurse delegates the collection of a sputum specimen from a client who has tuberculosis to an assistive personnel. At which of the following times should the nurse instruct the ap to collect the specimen?

As soon as the client wakes up.

A nurse in a long term care facility is using validation therapy with a client who has dementia. The client becomes agitated and asks why his wife who died several years ago has not visited him. Which of the following responses should the nurse make?

You must miss your wife. Let's take a walk and you can tell me about her.

A nurse is reinforcing teaching with a client who has a prescription for nitroglycerin sublingual tablets Which of the following instructions should the nurse include in the teaching?

Take up to three tablets during a single angina episode.

a Nurse is caring for a client who is post op following an open reduction with internal fixation of the ankle. The client report pain and the nurse notes that the affected extremity is cool, pale, and has a weak pulse. The nurse calls the surgical assista

Notify the nursing supervisor.

a nurse is collecting data from a client who has Tourette syndrome. The client reports taking haloperidol 0.5 mL orally 3 times a day at home. Which of the following components of the prescription should the nurse question?

Dosage

A nurse is caring for a female client who has an indwelling urinary catheter. which of the following actions should the nurse take?

Wipe the drainage port with an antiseptic wipe after emptying urine from bag.

A nurse is reinforcing teaching with a newborn's parents about umbilical cord card. Which of the following statements by a parent indicates an understanding of the instruction?

I will give our baby sponge baths until the cord falls off.

A nurse who is facilitating a support group notices that one client in the group is extremely talkative, to the point where others in the group have difficulty sharing their own ideas. Which of the following strategies should the nurse use to facilitate t

Speak privately to the client about this behavior.

A nurse at a clinic is performing vision testing for a client following a head injury. Which of the following findings should the nurse identify as a problem with pupil accommodation?

Lack of change in pupil size when the client looks from a far to a near object.

A nurse is reinforcing teaching with a client who has cancer and a new prescription for fentanyl transdermal patches. Which of the following statements by the client indicates an understanding of the teaching?

I will fold the patch with the adhesive sides inward before discarding it.

A nurse is contributing to the plan of care for a client who had a vaginal delivery 4 hours ago and has a 4th degree perineal laceration. Which of the following actions should the nurse recommend?

Instruct the client to use a sitz bath at least twice a day.

A nurse is collecting data from a client who sustained spinal cord injuries from fractures to the t1 and t2 vertebrae. Which of the following client outcomes should the nurse expect?

Flexes and extends the shoulders

A nurse is preparing to administer an influenza virus immunization to a client by the intradermal route. Which of the following actions should the nurse take?

Avoid massaging the site after injecting the vaccine

A nurse assisting with a childbirth class is discussing non pharmacological strategies used during labor. Which of the following statements by a client indicates an understanding of cutaneous stimulation?

I should use counterpressure for back pain during labor.

A nurse is assisting with the admission of a client who has major depressive disorder. Which of the ff communication technique should the nurse use to establish a trusting relationship with the client?

Offering general leads

A nurse is preparing to administer medications to a client who is NPO and is receiving enteral feedings through an NG tube. Which of the ff prescription should the nurse clarify with the provider?

Metoprolol ER 50mg per NG tube BID

A nurse is contributing to the plan of care for a client who is newly diagnosed with iron deficiency anemia. Which of the ff foods should the nurse include in the plan as having the highest amount of iron?

Boiled spinach

A nurse is administering lorazepam to a client who is scheduled for surgery within 1 yr. Which of the ff actions should the nurse take after administering the medication ?

Instruct the client not to get out of bed.

A nurse is observing an AP caring for a client. For which of the ff actions should the nurse intervene?

An AP reports client information to the oncoming AP in the hallway

A nurse is observing a stable preterm newborn who develops apnea for longer than 20 sec, with a decrease heart rate of 20/min. Which of the ff actions should the nurse take first?

Flick the sole of the newborn's foot

A nurse is assisting in the plan of care for a female client who is to undergo a 12-lead ECG. Which of th off actions should the nurse include in the plan of care?

Instruct the client to remain still while the test is performed.

A nurse is caring for a client who is 4 hr postoperative ff a total thyroidectomy. Which of the ff manifestations should the nurse report to the provider as indicating possible hypocalcemia?

Tingling of fingers

A nurse in a long-term care facility is assisting with an in-service for newly hired assistive personnel about legal issues within the facility. Which of the ff should the nurse include as an example of assault?

Informing a client the nurse is going to administer an injection even though the client refuses.

A nurse is collecting data from who is severe pain. Which of the ff questions should the nurse ask first?

Where is your pain located?

A nurse is reviewing the laboratory results for a client who is at 29 weeks gestation. For which of the ff results should the nurse notify the provider?

Platelet count 95,000 mm3

A nurse is performing a dressing change for a client who had abdominal surgery 5 days ago. The nurse notes organs protruding from the incision. Which of the ff actions should the nurse take?

Cover the exposed area with sterile, saline-soaked dressings.

A nurse is speaking with the adult daughter of a client who has Alzheimer's disease. The daughter states, "I love my dad, but caring for him is wearing me out." Which of the ff response should the nurse make?

Let's discuss how caring for your father is affecting your health.

A nurse is contributing to the plan of care for a care for a client who has chest tube connected to a closed drainage system. Which of the ff actions should the nurse include in the plan of care?

Maintain the drainage system below the level of the client's chest.

A nurse in an acute mental health facility is caring for a client who has borderline personality disorder and reports. "I am going to kill my girlfriend when I get out of here." Which of the ff actions should the nurse take?

Notify the client's care team of the threats against the partner

A nurse is admitting a client who is at high risk for suicide. Which of the ff actions is the nurse's priority?

Search the client's personal belongings

A nurse is caring for a client who is 1 day postoperative and is unable to ambulate. Which of the ff actions should the nurse take to promote the client's venous return?

Maintain the sequential compression device.

A urse in a pediatric clinic is collecting the data from a school-age child whose injuries are inconsistent with the parent's stated cause. Which of the ff actions should the nurse take?

Report the suspected abuse to a appropriate agency.

A nurse is collecting data from a middle adult female client who is taking melatonin. Which of the ff responses to the med should the nurse expect?

Improved sleep

A nurse on a pediatric unit is collecting data from four newly admitted clients. Which of the ff clients should the nurse identify as being at risk for urinary retention?

A school-age child who has allergic rhinitis and is taking diphenhydramine.

A nurse is preparing to administer purified protein derivative (PPD) to a client who has suspected TB. Which of the ff actions should the nurse plan to take?

Ensure the injection produces a wheal on the skin

A client who is diagnosed with Parkinson's disease verbalizes frustration due to increase difficulty with ambulation. Which of the ff responses should the nurse take?

Perform active ROM with your arms and legs two times a day.

a Nurse is collecting data from a client who has multiple fractures following a motor-vehicle crash. For which of the following client statements

I am so frustrated. I cannot even open my milk carton for breakfast.

A nurse on an acute care unity is collecting data from a school-age Child who has cystic fibrosis. Which of the following findings is the priority for the nurse?

Reports lack of appetite

a nurse working in a provider's office receives a phone call from the parent of a school-age child who has varicella. The parent asked the nurse when the child can return to school. Which of the following responses should the nurse make?

When the lesions have scabbed over.

A nurse is caring for a client who has a Penrose drain. To ensure proper placement and functioning of the drain, which of the following should the nurse expect to observe?

The safety pin is present at the distal end of the drain.

A community health nurse is helping to reinforce teaching about hepatitis A with a group of employees at a childcare facility. Which of the following characteristics should the nurse identify as an external factor that can impede learning for the particip

Poor lighting in the learning setting

A nurse is observing newly licensed nurse who is providing tracheostomy care for a client. The nurse identifies proper performance of the procedure when the newly licensed nurse selects which of the following solutions to clean the inner cannula?

Hydrogen peroxide

A nurse is caring for a client who has right sided heart failure. The client's partner expresses concern the the client will die. Which of the following responses should the nurse make?

It is difficult to see someone so sick. What have you been told about your partner's prognosis?

A nurse is reinforcing discharge instructions with the parent of an infant who has rotavirus. which of the following statements by the parent indicates an understanding of the teaching?

I will apply diaper cream to my baby's skin during each diaper change.

A nurse is caring for a client who is scheduled for surgery in the morning. The nurse learns that the client has decided not to have surgery even though he has already signed the informed consent form. Which of the following actions should the nurse take?

Report the situation to the provider who obtained the informed consent.

A nurse has administer medications to a group of clients. For which of the following client situations should the nurse complete and incident report?

The nurse administered insulin lispro to a client who has diabetes mellitus and is NPO.

a nurse is collecting data from a client who is experiencing a situational crisis following the loss of a job. The client states, I don't think I can go through this again. Which of the following actions is the nurse's priority?

Determine if the client is experiencing psychotic thinking.

A nurse is reinforcing discharge teaching with a client who is 48 hr post op from a mastectomy. Which of the following statements by the client indicates an understanding of the teaching?

I will wear rubber gloves whenever I wash dishes or do yard work.

a Nurse is reinforcing teaching about home care for conjunctivitis with the parent of a school age child. which of the following information should the nurse include?

Separate the child's used washcloth from those of others.

a Nurse prescribes levothyroxine 0.3 PO daily for a client. Available is levothyroxine 150mcg/tablet. How many tablets should the nurse administer?

2

a nurse is collecting data from an older adult client during a routine physical exam. Which of the following client statements should the nurse identify as a possible indication of abuse?

My son took my wallet so he can keep track of what I'm spending.

A nurse is assisting with a presentation at a community center about personal disaster preparedness. which of the following strategies should the nurse recommend for preparing a home disaster supply kit?

Have a supply of prescribed medications.

A nurse is reinforcing teaching on food selection with a client who has a moderate burn injury. Which of the following foods should the nurse recommend as being high in Vitamin C.

Tomatoes

A nurse on a medical surgical unit is delegating tasks to an assistant. Which of the following tasks should the nurse delegate to the Assistant?

Obtaining a client's vital signs prior to discharge

A Nurse is caring for a client in Buck's Traction. Which of the following actions should the nurse take?

Allow the weights to hang freely.

A nurse in a long term care facility is contributing to the plan of care for a client who has a new ostomy. Which of the following actions should the nurse plan include?

Change the appliance two times each week.

A nurse is receiving report on 4 clients Which of the following clients should the nurse plan to see first.

A client who has pneumonia and a new onset of confusion

A nurse is reinforcing discharge teaching with a client who has a t Tube in place following a cholecystectomy. Which of the following instructions should the nurse include in the teaching?

Empty the drainage bag each day at the same time.

A nurse is preparing to insert an indwelling urinary catheter for a female client who has a urinary retention. Which of the following actions should the nurse take?

Open the outer package flap of the catheterization kit away from her body.

A nurse I caring for a client who has expressive aphasia following a stroke. Which of the following communication methods should the nurse use?

Provide a picture board.

A nurse is caring for a client who is NPO and has an NG tube attached to suction for gastric decompression. Which of the following actions should the nurse take if the client experiences abdominal distention?

Irrigate the tube with normal saline.

A nurse is assisting with admitting a client who has colorectal cancer. When Collecting data from the client, which of the following manifestations should the nurse expect?

Abdominal cramps

A nurse is preparing to administer digoxin to a client who has heart failure. Which of the following findings should indicate to the nurse that the medication is effective?

Cardiac workload decreases

A nurse is discussing alopecia with a client who is scheduled to begin chemotherapy. Which of the following statements should the nurse make?

Your oncologist may prescribe a cold cap to wear during treatment to reduce hair loss.

A nurse is reinforcing teaching about stress management techniques with a client who has moderate anxiety disorder. Which of the following responses by the client indicates an understanding of the teaching?

I will imagine myself in a calm place when I can't concentrate.

a nurse is caring for a female client during an outpatient clinic visit. Which of the following findings places the client at risk for coronary artery disease?

The client's LDL level

A nurse is reinforcing teaching with a client who is at 20 weeks of gestation and will undergo routine abdominal ultrasonography the following day. Which of the following statements should the nurse include in the teaching?

You will need to have a full bladder for the procedure.

a nurse is reviewing the plan of care for a client who is 3 hr postoperative following a thyroidectomy. Which of the following is the priority intervention?

Listen to the client for evidence of stridor.

A nurse in a long term care facility is reviewing information about health care associated infection with a newly licensed nurse. Which of the following information should the nurse include?

Prolonged use of corticosteroids is a risk factor for infection.

A nurse is collecting data on a client who has post traumatic stress disorder Which of the following manifestations should the nurse expect?

Hypervigilance

A nurse is caring for a client who has multiple sclerosis. Which of the following manifestations should the nurse expect?

Ataxia

A nurse is checking a newborn's vital signs. Which of the following methods of temperature measurement should the nurse use?

Axillary

A nurse in a provider's office is collecting data from a preschooler. Which of the following findings should the nurse report to the provider?

Heart rate 146/min

A nurse is preparing to discharge a middle adult client who is immunocompromised. Which of the following immunizations should the nurse plan to administer?

Pneumococcal polysaccharide (PPSV) vaccine

A nurse is caring for a client who had a bone marrow transplant 3 days ago for treatment for leukemia. Which of the following findings should the nurse identify as a safety hazard?

A visitor brought the client a bouquet of flowers.

A nurse is caring for an infant who is receiving IV fluids for dehydration. Which of the following should the nurse recognize as a positive response to therapy?

Moist mucous membranes

A nurse is preparing a client for surgery. The client states, "I'm sure this surgery will not help me get better" Which of the following responses should the nurse make?

You're saying that you are doubtful that this procedure will benefit you.

A nurse at a long term care facility is transcribing new prescriptions for 4 clients. Which of the following prescriptions is accurately transcribed by the nurse?

?Potassium chloride 20 mEq PO every morning

A charge nurse in a long term care facility notices an assistants repeated failure to provide oral care for clients. Which of the following actions should the nurse take?

Discuss the unacceptable behavior with the AP while reinforcing expectations.

A Nurse is reinforcing teaching with a male client who is uncircumcised about obtaining a clean-catch midstream urine specimen. Identify the sequence of actions the client should take after washing his hands.

Retract the foreskin to expose the glans
cleanse the penis using an antiseptic swab
Begin to urinate
pass the urine container into the stream
collect the specimen
move the container out of the stream
Replace the foreskin

A nurse is reinforcing teaching with a client who has a new diagnosis of type 2 diabetes mellitus and inquires about information concerning oral anti diabetic agents. In addition to the provider, where should the nurse refer the client for information?

A pharmacist
Package inserts
American Diabetes Association

A nurse is caring for four clients who are all scheduled for surgery on the same day. Which of the following nursing actions demonstrates that the nurse possesses effective time management skills?

Gathers all needed supplies and equipment before entering client rooms
Completes one task before beginning a new task
Documents the clients' preoperative vital signs when they are taken
Delegates tasks to an assistive personnel (AP) that are within his ra

A nurse in a long term care facility is serving on the ethics committee, which is addressing a client care dilemma. Which of the following strategies will facilitate resolving the dilemma?

Determine the facts related to the dilemma.
Identify possible solutions.
Consider the client's wishes.