NURS 215 EXANM 2 LATEST VERSION
UPDATED QUESTIONS AND ANSWERS
GRADED A+ VERIFIED 2024-2025
The nurse is assessing the confused client. In trying to determine the
client’s level of pain, the nurse should
A. Be aware that confused clients do not feel as much pain due to
their confusion.
B. Observe the client carefully for changes in behavior or vital signs.
C. Ask the client’s family how much pain the client normally has.
D. Use only pain scales that feature numbers or “faces” the client can
point to.
B. Observe the client carefully for changes in behavior or vital signs.
The nurse should observe the confused client for nonverbal cues to
pain.
In meeting the safety needs of the adolescent client, it would be most
important for the nurse to focus his or her teaching on
A. Smoking cessation
B. Sports injuries
C. Alcohol abuse
D. Driver’s education
D. Driver's Education
The leading cause of death for adolescents is motor vehicle accidents.
,A child has had hiccups for 2 hr. Is this a sign of suspected ingestion of
poison?
A. Yes
B. No
B. No
Hiccups are not a sign of suspected ingestion of poison.
When implementing the use of restraints on a hospitalized client, the
nurse should
A. Restrain all confused clients so that they do not sustain a fall injury.
B. Tie the restraint to the bottom of the siderail so the client cannot
reach it.
C. Ensure that the primary care provider renews the order for
restraints once every 24 hr.
D. Release the restraints and provide skin care at least once every
shift.
C. Ensure that the primary care provider renews the order for restraints
once every 24 hr.
This statement meets the most current guidelines for the provider's
orders related to the use of restraints.
Mr. Zenobia’s chronic cancer pain has recently increased, and he asks
the home health nurse what can be done. In relation to his long-acting
opioid, which is an appropriate response by the nurse?
A. “If you take more opioid, it will not change your pain relief.“
,B. “I’ll call the primary care provider and ask for an increased dose.”
C. “The amount you are taking now is all I can give you.”
D. “I’m worried if we increase your dose that you will stop breathing.”
B. "I'll call the primary care provider and ask for an increased dose."
There is no ceiling on the analgesic effect of opioid narcotics. Patients
develop a tolerance to the effects, which often necessitates an increase
in the dose.
At is most important for the nurse to understand the various ways in
which pain is classified so that he or she can
A. Document the client’s pain using accurate terms.
B. Be clear in communication with the physician.
C. Develop an effective pain management plan.
D. Educate the client thoroughly.
C: Develop an effective pain management plan
Different modalities are used in the treatment/ management of pain
and are often based on how the pain is classified (e.g., acute versus
chronic).
To maintain proper posture, it is important to
A. Sleep on the softest mattress possible.
B. Avoid arching shoulders forward when sitting.
C. Keep your knees locked when standing upright.
D. Keep your stomach muscles relaxed to prevent back spasms.
, B. Avoid arching shoulders forward when sitting.
Arching shoulders forward when sitting alters the curvature of the spine
and contributes to poor body alignment.
Of the following interventions for the client who is immobile, the
nurse will give priority to
A. Encouraging a diet high in fiber and extra fluids
B. Administering the medication for sleep as needed
C. Having the client use the incentive spirometer q 2 hrs
D. Massaging the client’s legs every hour
C. Having the client use the incentive spirometer q 2 hrs
Use of the incentive spirometer helps to prevent atelectasis, which
improves oxygenation—a priority need.
Identify the true statement about devices used when assisting clients
to ambulate.
A. The client should stand a foot back from the back legs of a walker.
B. A cane should be used by the client to support the weakest side of
the body.
C. A transfer belt should be placed around the client’s chest for
maximum lift.
D. Each crutch-walking gait begins with the client in the tripod
position.
D. Each crutch-walking gait begins with the client in the tripod position.
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