Which one of the following factors has the greatest influence on the recovery and sobriety of a client with a chemical addiction?

The nurse is caring for a 22-year-old G 2, P 2 client who has disseminated intravascular coagulation after delivering a dead fetus. Which findings are the highest priority to report to the health care provider?

A 24-year-old female client is diagnosed with acute lymphoblastic leukemia and requires an allogeneic bone marrow transplant. The nurse determines the client understands the treatment when the client states:

The nurse is performing discharge teaching on a client with diverticulitis who has been placed on a low-roughage diet. Which food would have to be eliminated from this client’s diet?

A client is admitted to the hospital due to complications of cardiomyopathy. The client states, “I am always being admitted to the hospital for the same problem.” The nurse knows that which recurring condition develops in clients with cardiomyopathy?

The primary cause of anemia in a client with chronic renal failure is:

A primigravida, age 42, is 6 weeks pregnant. Based on the client’s age, her infant is at risk for:

An intubated client admitted to the intensive care unit appears anxious and fearful of the equipment in the room. The nurse observes this and takes the time to explain each piece of equipment and its role in providing care to the client. This is an example of the nurse acting as a client advocate by:

During a Preparation for Parenting class, one of the participants asks the nurse, “How will I know if I am really in labor?” The nurse should tell the participant which of the following about true labor contractions?

A student nurse is having difficulty determining the liver span of a client. The experienced nurse educates the student:

A hospitalized patient needs a central I.V. catheter inserted. The physician places the catheter in the subclavian vein. Shortly afterward, the patient develops shortness of breath and appears restless. Which action should the nurse perform first?

Which of the following findings is associated with right-sided heart failure?

A client tells the nurse,“There’s no point in quitting cigarette smoking at my age. I have smoked for 40 years.” The nurse:

A client in the intensive care unit is alert and oriented, but loud and verbally abusive to all health care personnel who enter the client’s room. Multiple staff members including the charge nurse have spoken to the client about the inappropriate behavior, but all attempts have been ineffective. The client has lorazepam (Ativan) IV ordered as needed for disorientation and agitation. Which client right would be violated if the nurse were to administer the medication to the client under these circumstances?

The nurse witnesses the nursing assistant hitting the client in the long-term care facility. The nursing assistant can be charged with:

A client is admitted for suspected bladder cancer. Which one of the following factors is most significant in the client’s diagnosis?

A client with pancreatic cancer has an infusion of TPN (Total Parenteral Nutrition). The doctor has ordered a sliding scale insulin. The most likely explanation for this order is:

As winter approaches, the nurse counsels an elderly client:

The nurse cares for a client post-thyroidectomy. The nurse notices the client experiences muscle twitches.Upon questioning, the client complains of numbness and tingling of the mouth and fingertips. The nurse suspects which electrolyte disturbance?

Several pregnant clients are waiting to be seen in the triage area of the obstetrical unit. Which client should the nurse see first?

A client complains of being stung by a yellow jacket which caused “whelps” on the skin and light-headedness. The nurse knows first-line treatment consists of:

The nurse is assessing a client immediately following delivery. The nurse notes that the client’s fundus is boggy. The nurse’s next action should be to:

The LPN is assigned to care for a client with a fractured femur. Which of the following should be reported to the charge nurse immediately?

Young children living in housing that was built before the 1970s are at risk for:

It is essential that the nurse have which piece of equipment at the bedside of a client on a ventilator?

The nurse auscultates breath sounds in a client. The nurse knows an incorrect method for auscultation is:

The most effective method to decrease morbidity and mortality of stroke is prevention.What is the most effective method of stroke prevention?

A patient is diagnosed with hyperthyroidism. The nurse should expect clinical signs and symptoms similar to:

The doctor has prescribed aspirin 325mg daily for a client with transient ischemic attacks. The nurse knows that aspirin was prescribed to:

A client has eye ointment instilled in both eyes. Which action should the nurse take immediately after medication administration?

A removal of the left lower lobe of the lung is performed on a client with lung cancer. Which post-operative measure would usually be included in the plan?

A patient, age 16, has type 1 diabetes mellitus and is in the hospital for regulation of his disease. He tells the nurse he feels hungry, thirsty, tired, and weak, and he frequently asks to use the bathroom. What should the nurse do first?

Which nursing action is most appropriate immediately following the removal of a nasogastric tube?

A client with a fractured tibia has a plaster-of-Paris cast applied to immobilize the fracture. Which action by the nurse indicates understanding of a plaster-of-Paris cast? The nurse: ❍ D.

The nurse who works in the emergency department cares for a client who was bitten by a stray cat. Which gram-negative causative organism is found in 75% of cat bite wound infections?

The client returns to the recovery room following repair of an intrathoracic aneurysm. Which finding would require further investigation?

A multigravid client at 34 weeks’ gestation visits the hospital because she suspects that her water has broken. After testing the leaking fluid with nitrazine paper, the nurse confirms that the client’s membranes have ruptured when the paper turns which of the following colors?

A patient has just returned from the postanesthesia care unit after undergoing internal fixation of a left femoral neck fracture. The nurse should place the patient in which position?

The nurse educator knows that a client will understand and recall material better if the learning environment includes problem-based as well as knowledge-based activities. Which is an example of a problem-based activity?

Which of the following laboratory results would cause the most concern in the immunosuppressed client?

A patient, age 58, is admitted with complaints of anorexia, weight loss, and general body wasting. After a diagnostic workup, he is diagnosed with Addison’s disease. Which statement best describes the pathophysiology of Addison’s disease?

Infants born to diabetic mothers are often described as large for gestational age. The primary reason for the infant’s large size is:

A client with an abdominal aortic aneurysm is admitted in preparation for surgery. Which of the following should be reported to the doctor?

The physician has ordered a daily dose of Tagamet (cimetidine) for a client with gastric ulcers. The nurse should administer the medication:

When drawing blood from a central venous access device, how many milliliters of blood should the nurse discard before drawing the laboratory specimen?

Clients unlikely to abstain from alcohol are not appropriate candidates for treatment with disulfiram (Antabuse), nor are clients with:

The two types of surgery primarily used to promote weight loss are restrictive and malabsorptive-restrictive. Which of the following is an example of restrictive weight-loss surgery?

When performing Leopold’s maneuvers on a primigravid client at 22 weeks’ gestation, the nurse performs the first maneuver to do which of the following?

The nurse is performing an assessment on a client with possible pernicious anemia. Which data would support this diagnosis?

A client is admitted to the emergency room with symptoms of delirium tremens. After admitting the client to a private room, the priority nursing intervention is to:

A client is to undergo a bone marrow aspiration. The nurse plans to include which statement in the client preparation?

The patient’s intake and output record contains the following information: milk, 180 mL; orange juice, 60 mL; one serving scrambled eggs; one slice toast; one can Ensure oral nutritional supplement, 240 mL; I.V. dextrose 5% in water at 100 mL/hour; 50 mL water after twice daily medications. Medications are given at 9:00 a.m. and 9:00 p.m. What is the patient’s total intake for the 7 a.m. to 3 p.m. shift?

The nurse studies an electrocardiogram (EKG) and notices a U-wave. The nurse suspects that this is caused by:

When performing an assessment, the nurse identifies the following signs and symptoms: impaired coordination, decreased muscle strength, limited range of motion, and reluctance to move. These signs and symptoms indicate which nursing diagnosis?

The physician has ordered a minimal bacteria diet for a client with neutropenia. The client should be taught to avoid eating:

Assessment reveals that the fetus of a multigravid client is at + 1 station and 8 cm dilated. Based on these data, the nurse should first:

The nurse is providing care for a 10-month-old infant diagnosed with a Wilms tumor. Most parents report feeling a mass when:

The nurse employed in the emergency room is responsible for triage of four clients injured in a motor vehicle accident. Which of the following clients should receive priority in care?

An infant is in need of intravenous access. The nurse makes an observation about scalp veins. Which statement indicates the nurse is knowledgeable about this type of venous access?

A client presents in the emergency department with acute onset of fever, headache, stiff neck, nausea/vomiting, and mental status changes. From which condition is the client most likely suffering?

A 6-year-old with cystic fibrosis has an order for pancreatic replacement. The nurse knows that the medication will be given:

A 2-month-old infant has just received her first Tetramune injection. The nurse should tell the mother that the immunization:

When assessing a patient with glaucoma, the nurse would expect which of the following findings?

During a yearly physical examination, a client tells the nurse that the client “is stressed to the max” by work and family obligations. First, the nurse:

The nurse is caring for a client admitted to the emergency room after a fall. X-rays reveal that the client has several fractured bones in the foot. Which treatment should the nurse anticipate for the fractured foot?

Which electrolyte imbalances should be of concern for the client taking digoxin (Lanoxin)?

The mother of a 3-month-old with esophageal reflux asks the nurse what she can do to lessen the baby’s reflux. The nurse should tell the mother to:

When auscultating the chest of a patient with pneumonia, the nurse should expect to hear which type of sounds over areas of consolidation?

A patient, age 72, has otosclerosis and is scheduled for a stapedectomy. During preoperative teaching, the nurse should give him which instruction?

When measuring the fundal height of a primigravid client at 20 weeks’ gestation, the nurse will locate the fundal height at which of the following points?

Diuretics are ordered for a patient. What would be the best time of day for the nurse to schedule this medication?

The physician has ordered Basalgel (aluminum carbonate gel) for a client with recurrent indigestion. The nurse should teach the client common side effects of the medication, which include:

A multigravid client at 34 weeks’ gestation is being treated with indomethacin (Indocin) to halt preterm labor. If the client delivers a preterm infant, the nurse should notify the nursery personnel about this therapy because of the possibility for which of the following?

A 19-year-old nulligravid client visiting the clinic for a routine examination asks the nurse about cervical mucus changes that occur during the menstrual cycle. Which of the following statements would the nurse expect to include in the client’s teaching plan?

Health care facilities store a large portion of their clients’ health information on the facility’s health information system. Each health care team member with a need to access health information is given a password or log in code. How closely is access to a facility’s health information system monitored?

The nurse is teaching a group of new graduates about the safety needs of the client receiving chemotherapy. Before administering chemotherapy, the nurse should:

A male client and his partner have decided not to have more children. The client requests information about permanent, male birth control options. The nurse explains:

Which of the following laboratory results would cause the most concern in the immunosuppressed client?

A client is receiving external radiation for cancer of the larynx. As a result of the treatment, the client will most likely complain of:

A client with a fractured hip is being taught correct use of the walker. The nurse is aware that the correct use of the walker is achieved if the:

A client with a history of clots is receiving Lovenox (enoxaparin). Which drug is given to counteract the effects of enoxaparin?

Studies show that collaboration between the members of a multidisciplinary health care team improves quality of client care, decreases length of stay in health care facilities, and decreases the cost of health care to the client.Which members of the multidisciplinary team are responsible for collaboration in client care?

A newborn of 32 weeks gestation is diagnosed with respiratory distress syndrome 3 hours after birth. An assessment finding in the newborn with respiratory distress syndrome is:

When performing Leopold’s maneuvers on a primigravid client at 22 weeks’ gestation, the nurse performs the first maneuver to do which of the following?

Which of the following would be included in the teaching plan about pregnancy-related breast changes for a primigravid client?

A key nursing task is to administer injections to clients. This requires the nurse’s knowledge of needle sizes and lengths.Which needle size is the largest?

A client is scheduled to have in vitro fertilization (IVF) as an infertility treatment. Which of the following client statements about IVF indicates that the client understands this procedure?

An 82-year-old female client is prescribed meperidine (Demerol) to be given every 4 hours as needed for pain. Why should the nurse question this order?

A primagravid client at 16 weeks’ gestation has had an amniocentesis and has received teaching concerning signs and symptoms to report. Which statement indicates that the client needs further teaching?

Which of the following findings is associated with fluid overload in the child with renal disease?

38. Which client can best be assigned to the newly licensed practical nurse?

The nurse cares for a client diagnosed with atelectasis. Which intervention should be included in the client’s plan of care?

A client with a spinal cord injury complains of severe headache. The nurse finds the client to be diaphoretic, hypertensive, and bradycardiac. The nurse suspects the client is experiencing autonomic dysreflexia.Which is the nurse’s first action?

The nurse knows that risk factors for glaucoma include:

The physician has prescribed Xanax (alprazolam) for a client with acute anxiety. The nurse should teach the client to avoid:

A client has just returned home and the hospice nurse is visiting for the first time. The client complains of a lot of pain. In addition to the physician and the nurse, what member of the care team will assist in providing comfort therapies for this client?

A client with a total hip replacement requires special equipment. Which equipment would assist the client with a total hip replacement with prevention of dislocation of the prosthesis?

The client has a prescription for a calcium carbonate compound to neutralize stomach acid. The nurse should assess the client for:

Which skin condition is characterized by erythematous plaques with an adherent silvery scale usually appearing over the extensor surfaces of the extremities, including lesions on the palms, soles, scalp, umbilicus, and genital areas?