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    Exam Review

    1. A nurse is caring for a client who has early-stage Alzheimer's disease. In which of the following actions is the nurse acting as a client advocate?
      A)Requesting a referral for the client to attend reminiscence therapy sessions
      B)Performing an updated cognitive assessment on the client
      C)Providing assistance for the client when ambulating down the hall
      D)Reorienting the client several times throughout the day
    2. A nurse is preparing to transfer a client from the emergency department to a medical-surgical unit using the SBAR communication tool. Which of the following information should the nurse include in the background portion of the report?
      A)The client's vital signs
      B)The client's name
      C)The client's code status
      D)A prescribed consultation
    3. A charge nurse notices that two staff nurses are not taking meal breaks during their shifts. Which of the following actions should the nurse take first?
      A)Provide coverage for the nurses' breaks
      B)Review facility policies for taking scheduled breaks
      C)Determine the reasons the nurses are not taking scheduled breaks
      D)Discuss time management strategies with the nurses
    4. A nurse on a medical-surgical unit is caring for four clients. The nurse should recognize that which of the following clients is the highest priority?
      A)A client who has peripheral vascular disease and has an absent pedal pulse in the right foot
      B)A client who is newly diagnosed with pancreatic cancer and is scheduled to begin IV chemotherapy
      C)A client who has methicillin-resistant Staphylococcus aureus (MRSA) and has an axillary temperature of 38°C (101°F)
      D)A client who is postoperative following a laminectomy 12 hr ago and is unable to void
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    Exam Review

    1. A charge nurse on an obstetrical unit is preparing the shift assignment. Which of the following clients should be assigned to an RN who has floated from a medical-surgical unit?
      A)A multigravida client who has preeclampsia and is receiving misoprostol for induction of labor
      B)A client who has gestational diabetes and is receiving biweekly nonstress tests
      C)A client who is at 32 weeks of gestation and has premature rupture of membranes
      D)A primigravida client who is 1 day postoperative following a Cesarean section and has a PCA pump
    2. A pediatric nurse is caring for multiple clients and reviewing each of their care plans. Which of the following client care interventions requires revising?
      A)Administer a bronchodilator two times a day for a child who has cystic fibrosis.
      B)Check the neurovascular status every 4 hr of a child who had a hip spica cast placed 6 hr ago
      C)Maintain eye shields for a newborn receiving phototherapy for hyperbilirubinemia.
      D)Teach an adolescent who has an exacerbation of ulcerative colitis about a high-protein, low-fiber diet
    3. A nurse on a medical-surgical unit is delegating client care. Which of the following tasks should the nurse delegate to an assistive personnel?
      A)Using a pain rating scale to monitor a client's pain level
      B)Instructing a client on self-administration of a tap water enema
      C)Performing a dressing change on a client's peripherally inserted central catheter
      D)Suctioning a client's long-term tracheostomy
    4. A nurse is assessing a client who had a stroke 2 days ago. Which of the following findings should the nurse identify as a need for a referral to speech-language pathology?
      A)Diminished hand-to-mouth coordination
      B)Altered level of consciousness
      C)Unilateral ptosis
      D)Impaired voluntary cough
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    Exam Review

    1. A newly hired unlicensed assistive personnel (UAP) expresses fear to the charge nurse about collecting a sputum specimen from a client who is HIV positive. Which action should the charge nurse take first?
      A)Provide the UAP with the infection control policy.
      B)Offer to assist the UAP with the collection of the specimen.
      C)Determine the UAP's knowledge about HIV transmission.
      D)Demonstrate the proper use of personal protective equipment.
    2. A nurse is assessing a client who has meningitis. Which of the following findings should the nurse report to the provider immediately?
      A)Report of photophobia
      B)Increased temperature
      C)Decreased level of consciousness
      D)Generalized rash over trunk
    3. A nurse is teaching a newly licensed nurse about the role of nurses during a facility disaster. Which of the following statements by the newly licensed nurse indicates an understanding of the teaching?
      A)A unit nurse has the authority to prescribe emergency medications during a disaster.
      B)A nurse should communicate with the performance improvement committee during a disaster to improve client outcomes.
      C)A nurse can recommend clients who are stable for discharge during a disaster.
      D)A unit nurse can provide information to the media during a disaster.
    4. A nurse is providing discharge teaching to the parent of a toddler who has a new diagnosis of asthma. The parent states she is unable to afford the nebulizer prescribed for the child. Which of the following referrals should the nurse recommend?
      A)Respiratory therapist
      B)Pharmacist
      C)Social worker
      D)Child protective services
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    Exam Review

    1. A nurse is providing an in-service about actions to take during a fire on the unit. Which of the following instructions should the nurse include?
      A)Use the fire extinguisher by aiming at the top of the flames
      B)Move client care equipment into the hallway
      C)Place dry towels at the base of doors
      D)Close the windows in client rooms
    2. A nurse is assessing pressure ulcers on four clients to evaluate the effectiveness of a change in wound care procedure. Which of the following findings indicates wound healing?
      A)Inflammation noted on the tissue edges of a client's wound
      B)Increase in serosanguineous exudate from a client's wound
      C)Erythema on the skin surrounding a client's wound
      D)Deep red color on the center of a client's wound
    3. A nurse is caring for a client who has uterine prolapse. The provider has recommended a total abdominal hysterectomy, but the client tells the nurse that the surgery is not an option. Which of the following is an appropriate action for the nurse to take?
      A)Respect the client's decision and inform the provider
      B)Explain the benefits and risks of the procedure
      C)Suggest alternative treatments for the condition
      D)Assess the client's understanding of the consequences of uterine prolapse and the need for surgery
    4. A nurse is serving on a committee whose task is to plan cost-effective care at the facility. Which of the following client care tasks should the nurse recommend?
      A)Purchasing primary tubing for IV therapy
      B)Implementing a fall prevention program
      C)Providing staff education on infection control
      D)Hiring a wound care specialist
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    Exam Review

    1. A nurse enters a client's room and notices a small fire in the bathroom trash can. The nurse removes the client from the room. Which of the following actions should the nurse take next?
      A)Close the fire doors and the doors to the room
      B)Extinguish the fire
      C)Remove clients from nearby rooms
      D)Activate the fire alarm
    2. A nurse is providing care for a client who is receiving chemotherapy. Which of the following actions should the nurse take?
      A)Wear gloves when handling the client's bed linens
      B)Flush the client's urine down the toilet twice
      C)Dispose of the client's intravenous tubing in a regular trash can
      D)Wash the client's dishes with hot water and soap
    3. A triage nurse in an emergency department is caring for a group of clients. Which of the following clients should the nurse assess first?
      A)Client who has a displaced femur fracture from a fall
      B)Client who is experiencing severe vomiting and diarrhea with tachycardia
      C)Client who is confused and has slurred speech
      D)Client who has chemical burns covering 20% of the total body surface area
    4. A nurse is teaching a group of newly hired nurses about evidence-based practice. The nurse should include which of the following as the first step in the process?
      A)Evaluate the outcomes
      B)Implement the findings
      C)Formulate a question
      D)Search for evidence
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