A nurse is reinforcing teaching with a postpartum client. Which of the following
should the nurse explain as the most important reason for staff to wear
identification? Correct Ans - Reducing the risk of newborn abduction
A nurse is reinforcing teaching with a client who plans to bottle feed her newborn.
Which of the following statements indicates an understanding of the instructions?
Correct Ans - I will feed my baby six to eight times a day
A nurse is reinforcing teaching with a client diagnosed with osteoarthritis who
reports joint pain,swelling, and stiffness. Which of the following client statements
indicates understanding of the teaching? Correct Ans - I will exercise my joints
as much as i can when they are inflamed
A nurse is reinforcing teaching with a client who is scheduled for a mammogram.
Which of the following instructions should the nurse include in the teaching?
Correct Ans - Refrain from using deodorant on the morning of the test
A nurse is preparing a clients insulin regimen. Which of the following insulin's can be
mixed? Correct Ans - Insulin aspart, regular insulin, insulin lispro
A nurse is reinforcing discharge teaching with a client who is postoperative following
laser surgery for open-angle glaucoma. Which of the following statements by the
client indicates an understanding of the instructions? Correct Ans - I will take a
stool softener to prevent constipation
A nurse is caring for a client who had a stroke and is having difficulty swallowing.
The nurse should recommend a referral to which of the following members of the
interprofessional team? Correct Ans - Speech therapist
A nurse is reinforcing teaching with a client who is 12 hr postpartum and has an
episiotomy. Which of the following instructions should the nurse include? Correct
Ans - Change the perineal pad with each void
A nurse is collecting data from a child who has acute Glomerulonephritis. Which of
the following findings should the nurse expect? Correct Ans - Periorbital edema
A nurse is preparing to administer a liquid medication to a 6-month-old infant who is
crying. Which of the following actions should the nurse take to reduce the risk of
aspiration? Correct Ans - Administer using a needless syringe in the buccal
cavity
A nurse is reinforcing teaching with a client who has peptic ulcer disease. Which of
the following statements by the client indicates an understanding of the teaching?
Correct Ans - I will plan to have my meals at regular intervals
,A nurse in long-term care facility has received change-of-shift report about four
clients. Which of the following clients should the nurse attend to first? Correct Ans
- A client who has COPD and dementia and was agitated during the night shift
A nurse is collecting data from a client who has substance use disorder and reports
recently taking opioids. Which of the following findings should the nurse identify as
a manifestation of opioid intoxication? Correct Ans - Pinpoint pupils
A nurse in a urgent care clinic is collecting data from a client who reports having
diarrhea for the past 3 days. Which of the following findings indicates hypokalemia?
Correct Ans - Muscle weakness
A nurse is contributing to the discharge plans for four clients. The nurse should
identify that which of the following clients requires an interdisciplinary care
conference? Correct Ans - A client who has hemiparesis and lives alone
A nurse is reinforcing teaching with an adolescent who has a new prescription for
cefazolin. For which of the following findings should the nurse instruct the
adolescent to monitor and report to the provider? Correct Ans - Depression
A nurse is reinforcing teaching with a group of expectant parents regarding the
proper use of a car seat. Which of the following statements by a parent indicates an
understanding of the teaching? Correct Ans - I can place a rolled towel on each
side of my newborns head until he can hold his head up
A nurse is caring for a school-age child who has epistaxis. Which of them following
actions should the nurse take? Correct Ans - Apply pressure at the bridge of
the child's nose
A nurse is caring for four clients. Which of the following clients statements should
the nurse attend to first? Correct Ans - My heartburn pain is going into my jaw
now
A nurse in a providers office is talking on the phone with the parent of a school-age
child who has varicella. Correct Ans - All vesicles have crusted over
A nurse is collecting data from a client who hgb is 8.8 mg/dL. Which of the following
statements should the nurse expect? Correct Ans - I feel tired all the time
A nurse is administering a cleansing enema to a client who reports mild cramping
during instillation of the solution. Which of the following actions should the nurse
take? Correct Ans - Slow the rate of instillation
A nurse receives report on four clients. The nurse should first collect data about the
client who has which of the following? Correct Ans - A decreased level of
consciousness and vomiting
A nurse is setting up a sterile field prior to performing a dressing change. Which of
the following actions should the nurse take? Correct Ans - Open the outermost
flap of the wrapper toward the body
, A nurse is caring for a client who has bipolar disorder and is experiencing mania.
Which of the following actions should the nurse take? Correct Ans - Frequently
remind the client of the expectations for her behavior
A nurse is caring for a client who has viral pneumonia. Which of the following
actions should the nurse take? Correct Ans - Administer Azithromycin
A nurse who orienting to a medical-surgical unit is having difficulty finishing client
care tasks during his shift. Which of the following suggestions should the nurse's
preceptor make to help the nurse with time management? Correct Ans - Try to
complete a task before moving on to the next.
A nurse is caring for an older adult client who is postoperative following a total hip
arthroplasty. The nurse is preparing to change the client's dressing. Which of the
following actions should the nurse take to demonstrate sensitivity to age-related
changes? Correct Ans - Use paper tape for securing the new dressing.
A nurse working in an inpatient mental health facility is assisting with the plan of
care for a client who has anorexia nervosa. Which of the following should the nurse
recommend to include in the plan of care? Correct Ans - Maintain continuity of
staff members.
A nurse is assisting with an admission interview for a client who has schizophrenia.
He tells the nurse that he is receiving special audible messages from the Central
Intelligence Agency that no one else is able to hear. The nurse should identify that
the client is having which of the following alterations in perception? Correct Ans -
Hallucination
A nurse is reinforcing teaching with a postpartum client about bathing her newborn.
Which of the following statements should the nurse include? Correct Ans -
"Wash your newborn's head under a stream of running water."
A nurse is caring for a client who has heart failure and reports difficulty limiting
sodium in his diet. Which of the following recommendations should the nurse
provide? Correct Ans - Replace bottled salad dressing with homemade vinegar
and oil dressing.
A nurse is reinforcing teaching about nonpharmacological pain relief with a client
who is 6 hr postpartum following a vaginal delivery. The client has an episiotomy
and swelling of the labia. Which of the following instructions should the nurse
include? Correct Ans - Sit on soft pillows throughout the day.
A nurse is caring for a client who has a new colostomy. He voices a reluctance
about resuming sexual relations. Which of the following is an appropriate response
by the nurse? Correct Ans - "I'm available if you'd like to talk about your
concerns."
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