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Nursing Clinical Scenarios Worksheet

Total questions: 86

Worksheet time: 43mins

Name
Class
Date
1.

A client with a 20-year history of schizophrenia is hospitalized. The client appears visibly upset, approaches the nurse, and says in a shaky voice, "I can’t find my headband. I can’t find my headband. The oil is going to leak out of the crack in my head." What is the best response by the nurse?

a)

"How long has the oil been leaking from your head?"

b)

"Let’s go back to your room and look for your headband together."

c)

"There is no oil coming out of your head."

d)

"You are going to miss breakfast if you do not go into the dining room."

2.

A nurse is caring for a 1-month-old client who is being evaluated for congenital hypothyroidism. Which of the following are clinical manifestations of hypothyroidism in infants? Select all that apply.

a)

Difficult to awaken

b)

Dry skin

c)

Frequent, loose stools

d)

Hoarse cry

e)

Tachycardia

3.

The nurse is monitoring a client who is 6 cm dilated with recurrent variable decelerations on the fetal heart rate monitor. The health care provider places an intrauterine pressure catheter and prescribes an amnioinfusion. After the amnioinfusion bolus is complete, which assessment finding should the nurse report immediately?

a)

Cervix is 8 cm dilated and 100% effaced, with fetal presenting part at +1 station

b)

Contractions are every 3 minutes and 60–80 seconds each

c)

Fetal heart rate baseline is 155/min with early decelerations and moderate variability

d)

Uterine resting tone baseline has increased to 45 mm Hg and perineal pads are dry

4.

The nurse is caring for a client with surgical complications who requires continuous total parenteral nutrition (TPN). A subclavian triple-lumen central venous access device is inserted. What is the priority action before initiating the TPN infusion?

a)

Attach a filter to the IV tubing

b)

Check baseline fingerstick glucose levels

c)

Check the results of the portable chest x-ray

d)

Program the electronic infusion pump

5.

The emergency department nurse prepares a male client for surgery. The client was admitted with a traumatic open fracture of the femur, hematocrit of 36%, and hemoglobin of 12 g/dL. Which prescription should the nurse validate with the health care provider before administration?

a)

Cefazolin

b)

Enoxaparin

c)

Morphine

d)

Tetanus toxoid

6.

The nurse is preparing to defibrillate a client who suddenly went into ventricular fibrillation. Which steps are essential prior to delivering a shock? Select all that apply.

a)

Apply defibrillator pads

b)

Call out and visually confirm that everyone is "all clear"

c)

Continue chest compressions until ready to deliver the shock

d)

Ensure adequate IV sedation has been given

e)

Ensure the synchronization button is turned on

7.

The home health nurse assesses a child and suspects child abuse. Which questions are appropriate for the nurse to ask the caregiver? Select all that apply.

a)

"How would you describe your child’s usual behavior at home?"

b)

"These bruises seem excessive and suspicious. How did they happen?"

c)

"What forms of discipline do you use with your child?"

d)

"When you are stressed, what coping mechanisms do you use?"

e)

"Who watches your child when you are at work?"

8.

A client is receiving lithium carbonate 900 mg/day for schizoaffective disorder. The lithium level is 1.0 mEq/L. Which prescription does the nurse anticipate receiving?

a)

Continue at the current dosage

b)

Decrease the dosage

c)

Discontinue the medication

d)

Increase the dosage

9.

A nurse auscultates a loud cardiac murmur in a newborn with suspected trisomy 21. Vital signs are stable and oxygen saturation is 98% on room air. What is the most appropriate next action?

a)

Call the health care provider immediately

b)

Document the assessment finding

c)

Place the neonate in a knee-chest position

d)

Provide oxygen to the neonate

10.

A nurse is participating in an obstetrical emergency simulation when the provider announces shoulder dystocia. Which interventions should the assisting nurse implement? Select all that apply.

a)

Assist maternal pushing efforts by applying fundal pressure

b)

Document the time the fetal head was born

c)

Flex the client’s legs back against the abdomen and apply suprapubic pressure

d)

Prepare for a forceps-assisted birth

e)

Request additional assistance from other nurses immediately

11.

A client with schizophrenia is hospitalized. After 2 weeks of treatment, the frequency of the client's hallucinations seems to be diminishing. When first hospitalized, the client refused to leave the room. Now the client spends time in the dayroom, sitting in a corner watching television, but does not initiate conversation or social interaction with other clients or staff. What is the most appropriate activity for the client?

a)

A board game with a staff member

b)

Participation in a group songfest

c)

Planning a unit picnic

d)

Playing Bingo with other clients

12.

A client with hypothermia has just arrived in the emergency department via ambulance. The client is being rewarmed with blankets, and IV fluids are being changed over to warmed fluids. What additional intervention is a priority?

a)

Attaching the cardiac monitor

b)

Covering the client’s head

c)

Drawing blood for electrolytes and glucose

d)

Placing an additional large-bore IV catheter

13.

The nurse is documenting assessments of pregnant clients in the antepartum unit. Which client’s assessment findings are most important to report to the health care provider?

a)

Client at 28 weeks gestation with an asymptomatic systolic murmur

b)

Client at 34 weeks gestation with 1+ edema of bilateral lower extremities

c)

Client at 35 weeks gestation with painful genital lesions

d)

Client at 39 weeks gestation with brownish, mucoid vaginal discharge

14.

Which assessment findings should the nurse anticipate in a child with suspected acute otitis media (AOM)? Select all that apply.

a)

Frequent pulling on the affected ear

b)

Refusal to eat

c)

Restlessness and irritability

d)

Retracted tympanic membranes

e)

Severe pain with pressure on the tragus

15.

The nurse reinforces medication teaching to a client prescribed metronidazole. Which client statement indicates a need for further education?

a)

I might have a metallic taste in my mouth when I’m taking this medicine.

b)

I need to decrease the amount of alcohol I drink while taking this medicine.

c)

I should not worry if my urine turns a dark color while taking this medication.

d)

I will immediately call the clinic if I get a new rash or have skin peeling.

16.

A 3‑month‑old infant has irritability, facial edema, a 1‑day history of diarrhea with adequate oral intake, and seizure activity. The parents report that they have recently been diluting formula to save money. What is the most likely cause of the infant’s symptoms?

a)

Hypernatremia due to diarrhea

b)

Hypoglycemia due to dilute formula intake

c)

Hypokalemia due to excess gastrointestinal output

d)

Hyponatremia due to water intoxication

17.

The nurse develops a teaching plan for a client prescribed isoniazid, rifampin, ethambutol, and pyrazinamide to treat active tuberculosis (TB). Which instruction regarding the adverse effects of rifampin is most important to include?

a)

Notify the health care provider if your urine is red

b)

Take acetaminophen every 6 hours for drug‑associated joint pain

c)

Wear eyeglasses instead of soft contact lenses while taking this medication

d)

You can stop taking the medications as soon as one sputum culture comes back normal

18.

A client with schizophrenia says, “The world turns as the world turns on a ball at the beach. But all the world’s a stagecoach and I took the bus home.” The nurse recognizes this statement as an example of:

a)

Concrete thinking

b)

Loose associations

c)

Tangentiality

d)

Word salad

19.

The nurse is reviewing several fetal heart rate (FHR) tracings for laboring clients at term gestation. Based on the FHR tracings, which client requires priority assessment?

a)

Client with minimal variability and early decelerations

b)

Client with a normal frequency of contractions and FHR pattern

c)

Client experiencing uterine tachysystole (>5 contractions in 10 minutes)

d)

Client with a category 1 FHR tracing

20.

The emergency department nurse receives a client with extensive injuries to the head and upper back. The nurse will perform what action to allow the best visualization of the airway?

a)

Head‑tilt chin‑lift in the supine position on a backboard

b)

Head‑tilt chin‑lift in the Trendelenburg position

c)

Jaw‑thrust maneuver in semi‑Fowler’s position

d)

Jaw‑thrust maneuver in the supine position on a backboard

21.

The nurse is caring for a client with a history of heart failure and atrial fibrillation. The client’s current medications include digoxin and furosemide. Which assessment finding is most important to report to the health care provider?

a)

Apical pulse of 62 beats/min

b)

Digoxin level of 1.2 ng/mL

c)

Potassium level of 3.2 mEq/L

d)

Serum creatinine of 0.9 mg/dL

22.

A nurse is caring for a client being treated for a deep vein thrombosis (DVT) with a continuous heparin infusion. Which laboratory result should the nurse monitor to evaluate the effectiveness of heparin?

a)

Activated partial thromboplastin time (aPTT)

b)

International normalized ratio (INR)

c)

Platelet count

d)

Prothrombin time (PT)

23.

The nurse is assessing a client with a diagnosis of pleural effusion. Which physical assessment findings should the nurse expect? Select all that apply.

a)

Decreased breath sounds

b)

Dullness on percussion

c)

Hyperresonance on percussion

d)

Increased tactile fremitus

e)

Sharp pleuritic chest pain

24.

The nurse is reviewing arterial blood gas results for a client with an exacerbation of chronic obstructive pulmonary disease (COPD): pH 7.30, PaCO2 52 mm Hg, HCO3 28 mEq/L, PaO2 60 mm Hg. How should the nurse interpret these results?

a)

Metabolic acidosis

b)

Metabolic alkalosis

c)

Respiratory acidosis

d)

Respiratory alkalosis

25.

The nurse is teaching a client newly diagnosed with type 1 diabetes mellitus about foot care. Which instruction should the nurse include?

a)

Apply moisturizing lotion between the toes

b)

Cut toenails in a rounded shape to follow the toe’s curve

c)

Soak feet in warm water for 20 minutes daily

d)

Wear well‑fitting, closed‑toe shoes

26.

A client with chronic kidney disease (CKD) has a serum potassium level of 6.8 mEq/L. Which intervention should the nurse prioritize?

a)

Administering a dose of sodium polystyrene sulfonate

b)

Placing the client on a cardiac monitor

c)

Preparing the client for emergency hemodialysis

d)

Restricting dietary potassium intake

27.

The nurse is caring for a client with a permanent pacemaker. Which instruction should be included in discharge teaching?

a)

Avoid using a microwave oven

b)

Do not travel by airplane

c)

Notify airport security of the pacemaker before a search

d)

Refrain from using a cellular phone

28.

The nurse is caring for a client scheduled for a colonoscopy. Which action should the nurse perform as part of pre‑procedure care?

a)

Administer a clear liquid diet the day before the procedure

b)

Maintain the client on NPO status for 24 hours

c)

Provide a high‑fiber meal the evening before

d)

Withhold all medications on the morning of the procedure

29.

The nurse is assessing a client with a history of cirrhosis who is scheduled for a paracentesis. Which action is a priority to perform before the procedure?

a)

Ask the client to empty the bladder

b)

Obtain a baseline weight

c)

Place the client in a Trendelenburg position

d)

Record the client’s abdominal girth

30.

The office nurse instructs a client newly diagnosed with asthma about using a peak flow meter to evaluate airflow. Which statement indicates an understanding of the teaching?

a)

I will exhale as quickly and forcibly as possible through the mouthpiece of the device to obtain a peak flow reading.

b)

I will move the indicator to the desired reading on the numbered scale before using the device.

c)

I will record my personal best reading, which is the average of three consecutive peak flow readings.

d)

I will remember to use the device after taking my fluticasone metered-dose inhaler.

31.

A client has just returned from the cardiac catheterization laboratory for a permanent pacemaker placement. How should the nurse document the rhythm on the client's cardiac monitor?

a)

Atrial paced rhythm

b)

Atrioventricular paced rhythm

c)

Biventricular paced rhythm

d)

Ventricular paced rhythm

32.

A client in the postoperative period after an open reduction and internal fixation of a left wrist fracture reports constant, severe arm pain unrelieved by morphine administered 30 minutes ago. The client's nail beds appear dusky. What are the nurse’s appropriate actions? Select all that apply.

a)

Apply a heating pad and encourage range-of-motion exercises

b)

Assess the temperature and movement of the fingers

c)

Elevate the arm on pillows above the level of the heart

d)

Notify the health care provider

e)

Reassure the client, document findings, and reassess in 1 hour

33.

The nurse is teaching about the importance of dietary fiber at a community health fair. Which health benefits of consuming a fiber-rich diet should the nurse include? Select all that apply.

a)

Helps prevent colorectal cancer

b)

Improves glycemic control

c)

Promotes weight loss

d)

Reduces risk of vascular disease

e)

Regulates bowel movements

34.

A home health nurse is assessing a client who has been using crutches for 2 weeks. Assessing for which finding is most important?

a)

Biceps muscle spasm

b)

Forearm swelling

c)

Hand and wrist weakness

d)

Shoulder range of motion

35.

A client with myocardial infarction (MI) underwent successful revascularization with stent placement and is now chest pain free. The client is embarrassed to talk about resuming sexual activity. What teaching should the nurse initiate?

a)

If the client is able to climb two flights of stairs without symptoms, the client may be ready for sexual activity if approved by the health care provider.

b)

Inform the client that medications such as sildenafil or tadalafil are available as prescriptions from the health care provider.

c)

It will be six months before the heart is healthy enough for sexual activity.

d)

The client will be ready for sexual activity after completion of cardiac rehabilitation.

36.

The camp nurse conducts a class for incoming summer counselors on prevention of tick bites and Lyme disease. Which instructions should the nurse include? Select all that apply.

a)

Apply a tick repellent spray before outdoor activities

b)

Avoid hiking through areas of tall grass and thick underbrush

c)

Cover ticks found on skin with petroleum jelly

d)

Report bull's-eye rash or flulike symptoms to a health care provider

e)

Wear a long-sleeved shirt tucked into pants and closed-toe shoes while hiking

37.

A cardiac catheterization was performed on a client 2 hours ago. The catheter was inserted into the left femoral artery. What signs of potential complications should the nurse report immediately? Select all that apply.

a)

Bleeding at the catheterization site

b)

Client lying down and quietly watching television

c)

Client taking only sips of fluids

d)

Left foot remarkably cooler than right foot

e)

Urine output of 100 mL since the procedure

38.

The nurse has provided education for a client with newly diagnosed ankylosing spondylitis. Which statements indicate a correct understanding of teaching? Select all that apply.

a)

I should continue strenuous exercise during flare-ups.

b)

I should include spine-stretching activities such as swimming.

c)

I should quit smoking and perform breathing exercises.

d)

I will sleep on a soft mattress to decrease my morning stiffness.

e)

I will take the prescribed ibuprofen on an empty stomach.

39.

During assessment of a client who had major abdominal surgery a week ago, the nurse notes dehiscence and evisceration of the incision. How should the nurse position the client while waiting to cover the wound?

a)

Low Fowler's position with knees bent

b)

Prone to prevent further evisceration

c)

Side-lying lateral position

d)

Supine with head of the bed flat

40.

If a client reports muscle weakness or sensory symptoms in the forearm, wrist, and hand after using crutches, what is the most likely cause?

a)

Biceps muscle spasm

b)

Damage to the radial nerve

c)

Restricted shoulder range of motion

d)

Triceps muscle fatigue

41.

The nurse plans teaching for an adolescent client being discharged home with a Boston brace for treatment of scoliosis. Which instruction should the nurse include in the discharge teaching plan?

a)

Apply body lotion or powder under the brace to prevent skin irritation

b)

Avoid any exercises that require the use of spinal muscles

c)

Keep the brace on for all activities, including showering

d)

Wear a cotton T-shirt under the brace at all times

42.

A client with type 1 diabetes mellitus is prescribed an insulin pump. Which statement indicates that the teaching has been effective?

a)

I will check my blood glucose levels at least four times a day.

b)

I will still need to give myself a shot of long-acting insulin every night.

c)

I won't have to worry about what I eat anymore because the pump does all the work.

d)

The pump will automatically adjust my insulin based on my glucose levels.

43.

The nurse is caring for a 4-year-old child in the emergency department who has a high fever, is drooling, and is making a high-pitched noise when breathing. What action should the nurse take first?

a)

Assess the child's throat with a tongue blade

b)

Obtain a STAT throat culture

c)

Place the child in a high Fowler's position

d)

Prepare for immediate endotracheal intubation

44.

The nurse is preparing to administer an intramuscular injection to a 6-month-old infant. Which is the most appropriate site?

a)

Deltoid muscle

b)

Dorsogluteal muscle

c)

Ventrogluteal muscle

d)

Vastus lateralis muscle

45.

A client is admitted with a diagnosis of acute pancreatitis. Which nursing intervention should the nurse prioritize?

a)

Administering oral pain medications

b)

Maintaining the client on NPO status

c)

Measuring abdominal girth every 4 hours

d)

Starting a high-protein, low-fat diet

46.

The nurse is assessing a client 24 hours postoperative following a total hip replacement. Which finding requires immediate intervention?

a)

Client reports pain as 7 on a scale of 0-10

b)

New onset of confusion and restlessness

c)

Redness and warmth around the incision site

d)

Total drainage of 50 mL in the suction drain

47.

The nurse is reviewing laboratory results for a client with suspected Addisonian crisis. Which result should the nurse expect?

a)

Blood glucose 140 mg/dL and Sodium 150 mEq/L

b)

Blood glucose 60 mg/dL and Potassium 5.8 mEq/L

c)

Calcium 12 mg/dL and Magnesium 3.0 mEq/L

d)

Sodium 145 mEq/L and Potassium 3.5 mEq/L

48.

A client with a history of asthma is brought to the emergency department in respiratory distress. The nurse notes a "silent chest" upon auscultation. What is the immediate priority?

a)

Administer a sedative to reduce anxiety

b)

Administer a stat dose of an inhaled corticosteroid

c)

Prepare for emergency intubation

d)

Start an IV infusion of normal saline

49.

A nurse is triaging victims of a mass casualty event. Which client should be assigned a red tag (emergent)?

a)

Client with full-thickness burns to the chest, back, and legs (expectant)

b)

Client with wet clothing who was immersed in cold water

c)

Client with diabetes who is unable to receive their daily insulin

d)

Client with high-pitched, crowing inspiratory respirations (stridor)

50.

A critical care nurse is caring for a newly admitted client with acute aortic dissection. Which prescription should the nurse prioritize while awaiting surgical revision?

a)

Administer IV labetalol to maintain blood pressure within prescribed parameters

b)

Initiate and maintain strict bed rest and a low-stimulation environment

c)

Monitor bilateral lower extremity peripheral pulse strength

d)

Prepare the client's consent form for surgical repair of the aorta

51.

The health care provider has prescribed amitriptyline 25 mg orally every morning for an elderly client with recent shingles and severe postherpetic neuralgia. What is the priority nursing action?

a)

Encourage increased fluid intake

b)

Provide frequent rest periods

c)

Teach the client to get up slowly from the bed or a sitting position

d)

Tell the client to wear sunglasses when outdoors

52.

The nurse is assessing a client with rheumatoid arthritis who is being considered for adalimumab therapy. Which statement made by the client needs further investigation?

a)

"I am taking an antibiotic for a urinary tract infection."

b)

"I had a negative tuberculosis skin test 2 weeks ago."

c)

"I just received my yearly flu shot a week ago."

d)

"I will continue taking naproxen at night to help with pain."

53.

A client comes to the community mental health clinic seeking treatment for severe anxiety associated with a recent job promotion that requires a 30-minute commute via train. The nurse recognizes that this client most likely suffers from which psychological disorder?

a)

Agoraphobia

b)

Generalized anxiety disorder

c)

Social anxiety disorder

d)

Zoophobia

54.

A nurse cares for a client with impairment of cranial nerve VIII. What instructions should the nurse provide the unlicensed assistive personnel prior to delegating interventions related to the client's activities of daily living?

a)

"Be aware of the client's shoulder weakness and provide support as needed."

b)

"Ensure that the client sits upright and tucks the chin when swallowing food."

c)

"Explain all procedures in step-by-step detail before performing them."

d)

"Make sure the items needed by the client are within reach."

55.

The pediatric clinic nurse reinforces culturally competent care at an in-service. Which finding would be inappropriate to include as a common dermatologic effect of alternative medicine therapies?

a)

Blisters with a garlic scent near the wrists

b)

Circular bruised blemishes on the back

c)

Markings appearing to be human bites on the arms

d)

Welt-like linear lesions on the back

56.

Which of the following tasks should the registered nurse avoid delegating to the unlicensed assistive personnel?

a)

Obtaining a blood glucose level from a client

b)

Assessing a client who reports a new symptom

c)

Assisting a stable client with ambulation

d)

Documenting intake and output for a client

57.

The nurse is caring for a client who is nauseated and dry heaving following extensive abdominal surgery. What is the priority nursing action?

a)

Administer a prescribed antiemetic medication

b)

Assess the surgical incision for signs of dehiscence

c)

Encourage the client to take deep breaths

d)

Notify the health care provider immediately

58.

The nurse is preparing to administer medications through a client's feeding tube. Which action is most important to ensure tube patency and avoid drug interactions?

a)

Combine all crushed medications into one cup

b)

Administer each medication separately and flush the tube with water before, between, and after medications

c)

Mix crushed medications with enteral formula to ease administration

d)

Crush extended-release tablets to ensure they pass through the tube

59.

A client with hepatic encephalopathy is receiving lactulose. Which finding indicates the medication is achieving its desired therapeutic effect?

a)

Improved mental status and orientation

b)

Increased serum ammonia levels

c)

Production of five or more watery stools per day

d)

Reversal of the client's cirrhosis

60.

The nurse is preparing to give a heparin injection to a client who is malnourished and cachectic. Which method of injection would be appropriate for this client?

a)

27 gauge, 1/4 in (0.6 cm) long needle at 90 degrees

b)

25 gauge, 1/2 in (1.3 cm) long needle at 45 degrees

c)

25 gauge, 1/2 in (1.3 cm) long needle at 90 degrees

d)

21 gauge, 1 in (2.5 cm) long needle at 90 degrees

61.

The nurse is caring for a client with a history of heart failure who is being discharged with a prescription for a low-sodium diet. Which of the following food choices should the nurse instruct the client to avoid? Select all that apply.

a)

Canned soups and vegetables

b)

Fresh fruits and berries

c)

Frozen dinners

d)

Grilled chicken breast

e)

Processed meats (e.g., deli turkey, ham)

62.

A client is admitted to the hospital with a diagnosis of acute cholecystitis. Which of the following clinical manifestations should the nurse expect to find during assessment?

a)

Left-sided abdominal pain that radiates to the back

b)

Pain in the right upper quadrant that radiates to the right shoulder

c)

Pain in the umbilical region that moves to the right lower quadrant

d)

Severe epigastric pain relieved by leaning forward

63.

The nurse is providing teaching to a client with a new prescription for warfarin. Which of the following statements by the client indicates a need for further instruction?

a)

"I will need to have my blood checked regularly to monitor the medicine's effect."

b)

"I should avoid eating large amounts of leafy green vegetables like spinach."

c)

"I will use a soft-bristled toothbrush to prevent my gums from bleeding."

d)

"I'll start taking a daily aspirin to help the warfarin work better."

64.

The nurse is assessing a 2-day-old infant and notes a yellow tint to the skin and sclera. Which action should the nurse take first?

a)

Encourage the mother to breastfeed the infant more frequently

b)

Notify the health care provider to obtain a serum bilirubin level

c)

Place the infant under phototherapy lights immediately

d)

Reassure the parents that this is a normal finding in newborns

65.

A client with chronic obstructive pulmonary disease (COPD) is receiving oxygen via a nasal cannula at 2 L/min. The nurse notes that the client's SpO2 is 89%. What is the most appropriate nursing action?

a)

Increase the oxygen flow rate to 4 L/min immediately

b)

Instruct the client to perform pursed-lip breathing

c)

Notify the health care provider that the oxygen is ineffective

d)

Prepare the client for arterial blood gas (ABG) analysis

66.

The nurse is caring for a client with a chest tube that was inserted 12 hours ago for a pneumothorax. The nurse notes continuous bubbling in the water-seal chamber. Which of the following is the most likely cause?

a)

The client is experiencing an active air leak from the lung

b)

The suction pressure is set too high on the drainage system

c)

There is an air leak in the chest tube drainage system

d)

This is a normal finding as the lung begins to re-expand

67.

The nurse is preparing to administer an intravenous bolus of furosemide to a client with pulmonary edema. Which of the following should the nurse monitor most closely after administration?

a)

Blood pressure and heart rate

b)

Oxygen saturation and respiratory rate

c)

Serum potassium and sodium levels

d)

Urinary output and daily weight

68.

A client is admitted with a diagnosis of deep vein thrombosis (DVT) in the right leg. Which of the following nursing interventions should be included in the plan of care?

a)

Apply a heating pad to the right calf to reduce pain

b)

Encourage the client to ambulate in the hallway twice a day

c)

Maintain the client on strict bed rest with the right leg elevated

d)

Perform vigorous massage of the right calf to improve circulation

69.

The nurse is caring for a client whose spouse is dying. The spouse's heart rate is slowing, and breathing is becoming irregular with long pauses. The spouse asks, "Do you think he'll be here for our anniversary tomorrow?" Which response by the nurse is most therapeutic?

a)

"Happy anniversary! I'll go get the anniversary memory that you shared."

b)

"That would be very special, but please understand that it may not happen."

c)

"We never know, so try not to worry about it."

d)

"I think he will make it through the night."

70.

Which would be the appropriate client criteria for activating a rapid response team at the hospital? Select all that apply.

a)

Glasgow coma scale (GCS) score of 9 throughout shift

b)

Heart rate remaining at 58 beats/min for more than 1 hour

c)

Postoperative pain rated at 10

d)

Respiratory rate maintaining an increase to 30 breaths/min

e)

Sustained change in level of consciousness for 10 minutes

71.

The nurse is preparing to suction a client with a tracheostomy. Which of the following actions should the nurse perform? Select all that apply

a)

Apply suction while inserting the catheter into the airway

b)

Hyperoxygenate the client with 100% oxygen before suctioning

c)

Limit suctioning to no more than 10 seconds per pass

d)

Select a suction catheter that is half the size of the tracheostomy tube

e)

Use a clean technique when performing the procedure

72.

A client with chronic obstructive pulmonary disease (COPD) is being discharged with a new prescription for a long-acting beta-agonist (LABA) inhaler. Which of the following instructions should the nurse include in the teaching?

a)

"Take this medication as soon as you feel short of breath."

b)

"Use this inhaler every day, even if you are not feeling sick."

c)

"Rinse your mouth with water immediately after each use."

d)

"This medication replaces your quick-relief albuterol inhaler."

73.

The nurse is caring for a client with a history of seizures who is currently having a generalized tonic-clonic seizure. Which of the following actions is a priority?

a)

Insert a padded tongue blade into the client's mouth

b)

Place the client in a side-lying position

c)

Restrain the client's arms and legs to prevent injury

d)

Start an IV line to administer anti-seizure medication

74.

The nurse is assessing a client with suspected appendicitis. Which of the following findings should the nurse report to the health care provider immediately?

a)

Client reports pain in the right lower quadrant

b)

Client's white blood cell count is 12,000/mm³

c)

Client has a temperature of 100.2 F (37.9 C)

d)

Sudden relief of pain followed by increased fever

75.

A client is admitted to the hospital with a diagnosis of bacterial meningitis. Which of the following precautions should the nurse implement?

a)

Airborne precautions

b)

Contact precautions

c)

Droplet precautions

d)

Standard precautions only

76.

The nurse is teaching a client about a clear liquid diet. Which of the following items should the nurse inform the client are allowed? Select all that apply

a)

Apple juice

b)

Chicken broth

c)

Frozen yogurt

d)

Orange juice with pulp

e)

Tea with sugar

77.

The nurse is caring for a client who is receiving a blood transfusion. Ten minutes into the transfusion, the client reports chills, low back pain, and nausea. What is the nurse's first action?

a)

Check the client's vital signs

b)

Notify the health care provider

c)

Slow the rate of the transfusion

d)

Stop the transfusion immediately

78.

A client with type 2 diabetes mellitus is scheduled for an elective surgery in the morning. The client is NPO after midnight. The nurse notes that the client's 7:00 AM blood glucose is 180 mg/dL. What should the nurse do next?

a)

Administer the client's regular dose of oral metformin

b)

Administer the client's regular dose of insulin glargine

c)

Call the health care provider for instructions

d)

Give the client 4 oz of orange juice to prevent hypoglycemia

79.

A client's spouse is brought to the family waiting room after the client was unexpectedly admitted to the intensive care unit following a "near-drowning accident." The spouse is crying hysterically and says, "I can't believe this is happening. It's all my fault!" Which response by the nurse is most therapeutic?

a)

"I'll call the hospital chaplain to come and talk with you."

b)

"It sounds like you are feeling overwhelmed. Tell me more about what happened."

c)

"This is a very difficult situation. Please try to stay calm for your spouse."

d)

"You shouldn't blame yourself; accidents can happen to anyone."

80.

The nurse is caring for a client at 39 weeks gestation in active labor who is receiving an oxytocin infusion. The nurse notes persistent late decelerations on the fetal monitor. Which of the following actions should the nurse take? Select all that apply

a)

Administer oxygen via a nonrebreather face mask

b)

Change maternal position to the left side

c)

Discontinue the oxytocin infusion

d)

Notify the health care provider

e)

Perform a nitrazine test

81.

The nurse is reviewing teaching with the parents of a child who has tinea capitis and is newly prescribed griseofulvin oral suspension and selenium sulfide shampoo. Which statement by the parent indicates a need for further teaching?

a)

"I will apply the selenium sulfide shampoo to my child's scalp twice a week."

b)

"I will give the griseofulvin with a high-fat food like ice cream."

c)

"I will stop the griseofulvin as soon as the bald spots start to grow hair."

d)

"My child should avoid sharing hats or hairbrushes with other children."

82.

The nurse is assessing a client with acute cholecystitis. Which of the following findings should the nurse expect? Select all that apply

a)

Low-grade fever with chills

b)

Pain in the left upper quadrant

c)

Pain radiating to the right shoulder

d)

Right upper quadrant tenderness

e)

Steatorrhea

83.

A client with chronic obstructive pulmonary disease (COPD) is admitted with an exacerbation. The client is receiving oxygen via a Venturi mask. Which of the following is the most important benefit of using a Venturi mask for this client?

a)

It allows for the delivery of high concentrations of oxygen.

b)

It can deliver a precise, guaranteed concentration of oxygen.

c)

It is more comfortable for the client than a nasal cannula.

d)

It prevents the client from rebreathing exhaled carbon dioxide.

84.

The nurse is caring for a client with a history of heart failure who is receiving a dose of IV furosemide. Which of the following laboratory values should the nurse monitor most closely?

a)

Blood urea nitrogen (BUN)

b)

Hemoglobin and hematocrit

c)

Serum potassium

d)

Serum sodium

85.

The nurse is providing discharge instructions to a client who had a permanent pacemaker inserted. Which of the following statements by the client indicates a correct understanding of the teaching?

a)

"I should avoid using a microwave oven for cooking."

b)

"I will need to carry my pacemaker identification card with me."

c)

"I will notify the airport security before walking through the metal detector."

d)

"I will refrain from using a cell phone indefinitely."

86.

A client is admitted to the psychiatric unit with a diagnosis of major depressive disorder. The client stays in their room all day and refuses to participate in activities. Which of the following actions by the nurse is most appropriate?

a)

Encourage the client to attend a group therapy session.

b)

Leave the client alone until they feel ready to interact.

c)

Sit with the client for 15 minutes in silence.

d)

Tell the client that they must participate in at least one activity.