Exam Review

The nurse is caring for a client admitted to the unit for possible hyperthyroidism. The client describes weakness, nervousness, a racing heartbeat, and recent weight loss of 15 pounds (6.8 kg). Which action should the nurse implement first?
A)Pace the client's care to provide periods of rest.
B)Make arrangements for radioactive iodine therapy.
C)Administer beta-adrenergic blocking agent.
D)Monitor the client's vital signs frequently.
The nurse administers galantamine hydrobromide to a client with early onset Alzheimer's disease. Which nursing problem addresses its therapeutic use?
A)Fluid volume excess.
B)Disturbed thought processes.
C)Altered breathing pattern.
A client in the operating room received succinylcholine. The client is experiencing muscle rigidity and has an extremely high temperature. Which action should the nurse implement?
A)Call the postanesthetic care unit (PACU) nurse to prepare for prolonged ventilatory support.
B)Determine if prescribed antibiotics were administered preoperatively.
C)Hold a prescription for dantrolene until fever is reduced.
D)Prepare ice packs for placement in the client's axillary area.
A client with cholelithiasis is admitted with jaundice due to obstruction of the common bile duct. Which finding is most important for the nurse to report to the healthcare provider?
A)Clay coloured stool.
B)Distended, hard, and rigid abdomen.
C)Bile-stained emesis.
D)Radiating, sharp pain in right shoulder.

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Exam Review

When assessing a client on the first postoperative day following abdominal surgery, the nurse does not hear any bowel sounds. In response to this finding, which action should the nurse implement?
A)Withhold further opioid analgesics.
B)Obtain a prescription for a laxative.
C)Document the assessment finding.
D)Prepare to insert a nasogastric tube.
A male client comes to the clinic with concerns of erectile dysfunction (ED). Which information is most important for the nurse to obtain?
A)Frequency of sexual activity.
B)Environmental toxin exposure.
C)Familial history of diabetes.
D)Current medication regimen.
The home health nurse visits a client who has a serum sodium level of 123 me/L (123 mmol/L). To explore possible etiologist for this value, what question should the nurse ask the client?
A)"Do you drink milk or eat dairy products at each meal?"
B)"How much water and ice chips do you have each day?"
C)"What amount of your daily meals contains fresh vegetables?"
D)"How frequently do you eat processed or canned foods?"
A client with acute abdominal pain, persistent nausea, and projectile vomiting is admitted to the hospital for observation. Acetaminophen is administered as prescribed for an oral temperature of 103°F (39.4°C) and an IV infusion of normal saline is initiated at 250 ml/hour. Which assessment finding should the nurse report to the healthcare provider immediately?
A)Petechial haemorrhage under client's eyes.
B)Right lower abdomen rebound tenderness.
C)Severe headache with photosensitivity.
D)Dark green coloured emesis.

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Exam Review

The nurse is planning discharge teaching for a client who has cystitis. Which information should the nurse include in the teaching plan?
A)Use a feminine hygiene spray.
B)Limit cranberry juice intake.
C)Wear cotton underwear.
D)Take daily tub baths.
The nurse is caring for an older adult client with Alzheimer's disease who becomes increasingly agitated and is speaking to someone who is not visible to the nurse. Which action should the nurse implement?
A)Reduce the client's interaction with others during the day.
B)Awaken the client for reality checks every 4 hours at night.
C)Clarify reality with the client about delusional thoughts.
D)Use distraction and therapeutic communication skills.
The nurse is assessing a client who is newly diagnosed with hypothyroidism. Which assessment finding requires immediate intervention?
A)Cold intolerance.
B)Weight gain.
C)Hypoventilation.
D)Lethargy.
The nurse is providing education to a client who is returning home with an indwelling urinary catheter after having a transurethral resection of the prostate (TURP). Which statement made by the client demonstrates a need for the nurse to clarify the instructions?
A)Start pelvic floor exercises.
B)Report fever or chills.
C)Increase fluid intake to help with hydration.
D)Tape urinary catheter securely to the thigh.

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Exam Review

A client who is postmenopausal, obese, and is a smoker, has developed an intolerance to fatty foods and believes she is at risk for developing gallbladder problems. Which instruction should the nurse provide to help reduce the client's risk for gallbladder disease?
A)Join a group weight loss program.
B)Begin a smoking cessation class.
C)Consider hormone replacement therapy.
D)Schedule rest periods after eating.
The nurse plans to provide diet instructions to a client who was recently diagnosed with diverticulosis. Which dietary modification should the nurse include in the teaching plan?
A)Decrease foods high in fat or trans fats.
B)Eliminate caffeine and chocolate.
C)Augment intake of dairy products.
D)Increase intake of insoluble fibber.
While assisting a client to the toilet, the client begins to have a seizure and the nurse eases the client to the floor. The nurse calls for help and monitors the client until the seizing stops. Which intervention should the nurse implement first?
A)Evaluate for evidence of incontinence.
B)Observe for lacerations to the tongue.
C)Document details of the seizure activity.
D)Observe for prolonged periods of apnoea.
A client with Crohn's disease is admitted to the medical unit with a three-day history of abdominal cramping, nausea, and vomiting. Which prescription should the nurse implement first?
A)Send the client to x-ray for a flat plate of the abdomen.
B)Give a prescribed analgesic for temperature above 101°F (38.3°C).
C)Place an indwelling urinary catheter and attach to a bedside drainage unit.
D)Insert a nasogastric tube (NGT) and attach to low intermittent suction.

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Exam Review

The nurse is preparing to obtain a rapid coronavirus (COVID-19) test for a client who was exposed to the virus eight days ago. The client is experiencing fever, cough, and shortness of breath. Which action is most important for the nurse to take?
A)Notify the charge nurse that the client will need assignment to the COVID-19 specified area of the facility.
B)Place the nasal swab specimen for COVID-19 directly into a biohazard bag.
C)Maintain a 6 feet (1.8 meters) distance from the client unless wearing an N95 respirator and personal protective equipment (PPE) for droplet precautions.
D)Start an intravenous infusion for an antiviral drug to be administered for positive COVID-19 test results.
The nurse completes the admission assessment of a client with systemic lupus erythematosus. Which finding requires immediate follow-up by the nurse?
A)Alopecia.
B)Haematuria.
C)Fatigue.
D)Joint pain.
A client with type 1 diabetes mellitus (DM) is admitted to the hospital for an emergency cholecystectomy. The client explains to the nurse about experiencing difficulty at home in keeping blood glucose levels under 200 mg/dl (11.1 mmol/L). To prevent the client from developing diabetic ketoacidosis (DKA), which intervention is most important for the nurse to include in the plan of care?
A)Obtain a fingerstick glucose every 6 hours.
B)Ensure IV fluids are infusing continuously.
C)Test urine for the presence of ketones.
D)Teach the client how to manage sick days.
E)None
F)None
The nurse is performing a physical assessment of a client. Which finding should the nurse recognize is a result of a compromised peripheral arterial circulation of the lower extremity?
A)Bounding peripheral pulse.
B)uneven hair distribution.
C)Lower leg enema.
D)bronze pigmentation.

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