A nurse in a long term care facility notices a client who has alzheimers disease standing at the exit doorsattheendofthe hallway.
A nurse in a long term care facility notices a client who has alzheimers disease standing at the exit doorsattheendofthe hallway.Theclientsappearstobeanxiousandagitated.Whichofthefollowing actions should the nurse take?
Anurseisassistingwiththeplanofcare foraclientwhohasacontinenturinarydivision.Whichofthe following interventions should the nurse plan to implement to facilitate urinaryelimination?
Anurseisassistingwithaeducationalprogramaboutcarrestraintsafetyforagroupofparents.Which of the following statements by a parent indicates an understanding of theinstructions?
AnurseisreinforcingteachingaboutstrategiestopromoteeatingwithaclientwhohasCOPD.Which of the following instructions should the nurse include in theteaching?
A nurse is supervising an assistive personnel who is preparing to remove her personal protective equipment after providing direct care to a client who requires airborne and contact precautions. The nurseshouldrecognizethattheAPunderstandstheprocedurewhensheremoveswhichofthefollowing PPEfirst?
Anurseisinspectingtheskinofanewborn.Whichofthefollowingfindingsshouldthenursereportto theprovider
Anurseiscontributingtoateachingplanforagroupofmaleadolescentsabouttheadverseeffectsof anabolic steroid use. Which of the following manifestations should the nurseinclude
Anurseisreinforcingteachingwithanolderadultclientwhohasasevereleftsidedheartfailure. Which of the following statements should the nursemake
Anurseinalongtermcarefacilityisdocumentingthecareofanolderclient.Whichofthefollowing information should the nurse include in the weekly nursing caresummary
Anurseiscaringforaclientwhohasahead injury.Usingthegasgowcomascalecollectiondata,the nurse should obtain which of the followinginformation
Ahomehealthnurseisreinforcingteachingwithaclientabouttheuseofelasticstockingsto decrease peripheral edema. Which of the following instructions should the nurseinclude?
Anurseinaprovidersofficeisobtainingahealthhistoryfromaclientwhoisscheduledtoundergoa cardiac catheterization in 2 days. Which of the following questions isthe
Anurseisplanningtoadministernystatinoralsuspensiontoaclientwhohasoralcandiasis.Whichof the following instructions should the nurse give to theclient
Anurseispreparingtocarefortheassignedclientsonherupcomingshift.Whichofthefollowing time management strategies should the nurse plan touse?
Anurseispreparingtowitnessaclientwhoisscheduled forsurgerysignainformedconsent.Which of the following actions should the nurse take?
Anurseinaninpatientmentalhealthcliniciscaringfor anewlyadmittedclientwhohasalcoholuse disorder. During a therapy session, the client asks about alcoholics anonymous. Which of the following responses should the nursemake?
Anurseisassistingwiththecareofaclientwhois2dayspostopfollowingatotalkneearthroplasty. Which of the following tasks should the nurse assign to an assistivepersonnel?
Aclientinamentalhealthfacilityunjustlyaccusesanurseofstealingmoneyfromhisroom.Whichof the following therapeutic responses should the nursemake?
A nurse is reinforcing teaching with a client who is receiving radiation therapy for cancer of the larynx.Whichofthefollowingstatementsmadebytheclientindicatesunderstandingoftheteaching?
AnurseisusingtheFLACCscaletodeterminethelevelofpain foran11montholdinfantwhois postop.Whichofthefollowingfactorsshouldthenurseconsiderwhenusingthispainscale
Anurseisreviewingthetechniquesfortransferringaclientfrombedtochairwithagroupof assistive personnel. Which of the following instructions should the nurseinclude
Anurseisreinforcingtachingwithaclientwhoistoselfadministerepoetinalfa.Whichofthe following instructions should the nurseinclude
A nurse is collecting data from a 5 year old child at a well child visit. The parents reports that the childishavingfrequentnightmares.Whichofthefollowingstatementsbytheparentindicatestothe nurse that the child is experiencing sleep terrors rather thannightmares
Anurseassistingwiththecareofaschoolagechildimmediatelyfollowingsurgery.Thechildweighs 21.8kgandhasachesttubeappliedtosuction.Whichofthefollowingfindingsshouldthenursereport to theprovider
Anurseisreinforcingteachingaboutadvanceddirectiveswithaclient.Whichofthefollowing statements by the client indicates an understanding of theteaching
Anurseisassistingwiththeadmissionofaclientwhohasrubeola.Whichofthefollowing transmission-based precautions should the nurse plan to initiate for thisclient
A nurse is administering morning medications to clients on the unit. A client questions the nurse regardingamedicationthatshedoesnotrecognize.Whichofthefollowingactionsshouldthenursetake first
Anurseinanurgentcarecliniciscollectingdatafromfourclients.Whichofthefollowingclients should the nurse recommend for treatment
Anurseentersaclientsroomandseessmokecomingfromawastebasketnexttothebed.Whichof the following actions should the nurse take first
Anurseiscaring foraclientwhoisinthefinalstagesofcancer.Whichofthefollowingsituations should the nurse identify as an ethicaldilemma
Anurseisreinforcingteachingwithanolderadultclientwhohasosteoarthritis.Whichofthe following instructions should the nurseincludes
Anurseinaurgentcarecliniciscaring forachildwhohasaminorburnonhispalmaftertouching the burner on a hot stove. Which of the following actions should the nursetake?
Anurseonamedicalunitisreviewingaclientsmedicalrecord.Whichofthefollowingprocedures should the nurse identify requires the client to sign a separate informedconsent
Anurseisreinforcingteachingaboutmanagingmanifestationsofanxietywithaclientwhohas generalized anxiety disorder. Which of the following information should the nurseinclude
Anurseisperformingadressingchangeforaclientwhois3dayspostop.Whichofthefollowing findings should the nurse report to theprovider
Anurseinalongtermcarefacilityiscollectingdatafromaclientwhohasbeenreceivingbetaxololto treat glaucoma. Which of the following findings in an adverse effect of thismedication
A nurse in an outpatient surgery center is reinforcing discharge teaching with a client following a lithotripsyforuricacidstones.Whichofthefollowinginstructionsshouldthenurseplantoincludeinthe teaching?
Anurseiscaring foraclientwhoisscheduled foraperitonealdialysis.Whichofthefollowingactions should the nurse takefirst
A nurse in a providers office is reinforcing teaching with a client who is to follow a 2000mg sodium restricteddiet.Whichofthefollowingclientfoodselectionsindicatesanunderstandingoftheteaching
Anurseenterstheroomofanadolescentclientandfindshimonthefloorexperiencingatonicclonic seizure. Which of the following actions should the nurse take when the seizuresubsides
Anurseispreparingtoperformabladderscanforaclient.Whichofthefollowingactionsshouldthe nursetake?
Anurseisassistingwiththeadmissionofanolderadultclient.Whichofthefollowingactionsshould the nurse takefirst
A nurse is contributing to the plan of care for a client who has a prescription for range of motion exercisesoftheshoulder.Whichofthefollowingexercisesshouldthenurserecommendtopromote shoulderhyper-extension
Anurseisreceivingchangeofshiftreportforfourclients.Thenurseshouldplantocollectdatafrom which of the following clientsfirst
Anurseinaprovidersofficeiscaringforaclientwhoisat34weeksofgeststion.Whichofthe following instructions should the nurse anticipate providing to theclient?
Anurseiscollectingdatafromanolderadultclientwhohasagastriculcer.Whichofthefindings should the nurse identify as a complication to report to theprovider?
A nurse is assisting with planning palliative care for a client who has stage IV cancer and is in the activestageofdying.Whichofthefollowinginterventionsshouldthenurseincludeintheplanofcare
A nurse is discussing the use of epidural analgesia with a newly licensed nurse. Which of the followingstatementsbythenewlylicensednurseindicatesanunderstandingofthismethodofpain control?
Anurseiscontributingtotheplanofcarefor aclientwhoisreceivingcontinuousbladderirrigation immediately following a transurethral resection of the prostate. Which of the following interventions should the nurseinclude
Anurseiscaring foraclientwhoisscheduled foramastectomythefollowingday.Theclientistearful and tells the nurse that she is not ready to have this procedure done at this time. Which of the following responses should the nirsemake?
Anurseiscollectingdatafromaschoolagechildwhohashypoglycemia.Whichofthefollowing clinical manifestations should the nurseexpect?
A nurse is assisting with a community education program for parents of preschoolers about recommendactivitiestopromotephysicaldevelopment.Whichofthefollowingstatementsshouldthe nursemake?
AnursemonitoringaschoolagechildwhohasanemiaandisreceivingatransfusionofpackedRBCs. Which of the following statements by the child indicates a possible hemolytic transfusion reaction that the nurse should report to the charge nurse and theprovider?
Anurseiscollectingdatafromaclientwhoisat30weeksofgestationandhasgestationaldiabetes. Thenurseshouldreportwhichofthefollowingfindingsasanindicationofhyperglycemia
Anurseiscollectingdatafromaclientwhohaschronicpancreatitisandisreceivingpancrelipase. Whichofthefollowingindicatestheclientisexperiencingatherapeuticresponsetothemedication
Anurseiscaringforaclientwhois12hrpostopfollowingatotalhiparthroplasty.Whichofthe following actions should the nurse take?
Anurseinaprovidersofficeiscaringforfourclients.Whichofthefollowingclientsshouldthenurse seefirst?
Anurseisreinforcingteachingwithaclientabouthowtoreplaceher2pieceostomy pouching system. The client tells the nurse that removing the skin barrier is painful. Which of the following strategies should the nursesuggest
A nurse is instructing an assistive personnel about caring fora client who has hepatitis A and is incontinentofstool.Whichofthefollowinginfectioncontrolprecautionsshouldthenurseinstructthe aptouse
Anurseisassistingintheplanofcareforaclientwhohasaviralmeningitis.Whichofthefollowing interventions should the nurse include in the plan ofcare?
Anurseisreinforcingteachingregardingpubertywithagroupofprepubescentfemaleclients.Which of the following information should the nurse include in theteaching
A nurse in a providers office is reviewing the medical record of a client who requests a prescription foranoralcontraceptive.Whichofthefollowingfindingsshouldthenurseidentifyasacontraindication for oralcontraceptiveuse?
Anurseiscaring foraclientwhohasjustbeendiagnosedwithaterminalillness.Theclientstates,I havenothingtolivefor.Ijustcannotgoon.Whichofthefollowingresponsesshouldthenursemake?
A nurse is contributing to the plan of care for a client who has a nasogastric tube and is receiving continuousenteralfeedings.Whichofthefollowinginterventionsshouldthenurseincludeintheplan
Anurseiscaring foraclientwhoisat34weeksofgestationandhasmildpreeclampsia.Whichofthe following findings indicates a progression from mild to severepreeclampsia‘
Anurseiscollectingdatafromaclientwhohaschronichepatitis.Inwhichofthefollowinglocations should the nurse expect the client to point to indicate hepatictenderness?
Anurseiscaring foraclientwhoisscheduledtoundergoathoracentesisforaleftpleuraleffusion.In which of the following positions should the nurse place the client for theprovider?
Anurseisreinforcingteachingwithaclientwhohasasthmaandhasaprescriptionforthophylline which of the following statements should the nursemake
Anurseisreinforcingteachingwithaclientwhohasanewprescription formetrondiazole.Thenurse shouldinstructtheclienttoexpertwhichofthefollowingadverseeffectswhiletakingthismedication
AnurseisreinforcingpreopteachingwithaclientwhowillreceivemorphinethroughaPCApump after surgery. Which of the following information should the nurseinclude
A home health nurse is collecting data from an older adult client who has generalized anxiety disorder.Theclientlivesathomewithherpartnerandasibling.Whichofthefollowingresponsesbythe clients partner is the priority for the nurse toaddress
Anurseiscaring foragroupofclients.Thenurseshouldfilloutanincidentreport forwhichofthe followingsituations
Anurseiscaringforaclientwhoisrecoveringfroma stroke andisexperiencingdifficultyusingeating utensils. The nurse should identify the need for a referral to which of the following interprofessional teammembers
A nurse is caring for a client who is being discharged home after experiencing a cerebrovascular accident.Whichofthefollowingdocumentsshouldthenurseplantoincludewithdischargeinstructions
Anurseinapediatricclinicreceivesaphonecallfromaparentwhosechildhasjustingestedthe contentsofafullbottleofacetaminophen.Whichofthefollowingresponsesshouldthenursemake
Aclientisrequestinginformationfromanurseaboutcreatingahealthcareproxy.Whichofthe following statements should the nurse make
Anurseispreparingtoperformvenipuncturetoobtainabloodsamplefromaclient.Whichofthe following actions should the nursetake
Anurseisreviewingthelaboratoryreportsforaclientwhois2dayspostopfollowingthoracic surgery. Which of the following results should the nurse report to theprovider
Anurseisassistingwiththetransferofaclienttoalongtermcare facility.Thenurseshouldreview whichofthefollowingsectionsoftheelectronicmedicalrecordtolocateinformationabouttheclients personal healthinsurance
Anurseiscaring foraclientwhoisinaninpatientmentalhealthunitandhasdependentpersonality disorder. Which of the following client behaviors should the nurseexpect
A nurse is monitoring a client who is receiving IV fluids. For which of the following findings should the nurse stop theinfusion
Anurseisusinganinterpretertoreinforcedischargeteachingwithaclientwhodoesnotspeakthe same language as the nurse. Which of the following actions should the nursetake
Anurseisassistingwiththedevelopmentofaninservice fornewlylicensednursesaboutseclusion. The nurse should identify the need to request a prescription for seclusion for which of the following situations
Anurseiscaring foraclientwhohasaphobiaofelevators.Whichofthefollowingshouldthenurse recognize as indicative of a positive client response to a systemicdesensitization
Anurseisassistingwiththecareofaclientwhoispostpartumandhasdeepveinthrombosis.The clienthasbeenreceivingheparinviaIVinfusion.Whichofthefollowingmedicationsshouldthenurse ensure is readily available
Anurseiscontributingtotheplanofcare foraclientwhohaspneumonia.Whichofthefollowing entries should the nurse include in theplan
Anurseinaprovidersofficeisreviewingpediculosiscapitismanagementandpreventionstrategies with the parent of a school aged child. Which of the following should the nurseinclude
Anurseiscaringfor aclientwhohasagastrostomy tube.Whichofthefollowingactionsshouldthe nurse plan to take
Anurseispreparingtoinsertanindwellingcatheter forafemaleadultclient. Cleanse the clients labia and meatus using a front to backmotion
Anurseiscaringforaclientwhois4hrpostopfollowinggastrointestinalsurgeryandhasanNGtube for gastric decompression. Which of the following actions should the nursetake
Anurseismonitoringaclientwhoisreceivinglactatedringers500mlivover4hr.Thedropfactorof the manual iv tubing is 10gtt/ml. The nurse should check that the manual iv infusion is delivering how manygtt/min?
Anurseisassistingaclientwhoispostoptositonthesideofthebed.Whichofthefollowingactions should the nursetake
Anurseisreinforcingteachingaboutatherapeuticdietwithaclientwhohasirondeficiencyanemia. Which of the following food items should the nurse recommend that the clientconsume
Anurseiscaring fora3yearoldtoddleratawellchildvisit.Theparentstatesthatthechildwillnot eat a full meal. Which of the following responses should the nursemake?
Anurseisreinforcingteachingwithaclientwhoisscheduled foran exerciseECGstresstest.Whichof the following actions should the nurse make?
Anurseisassistingwiththecareofaclientwhohasaterminalillness.Theclientpracticesorthodox Judaism. Which of the following actions should the nursetake.
Anurseisworkinginanacutecarefacilitywhenanaturaldisasteroccurs.Thefacilitymustdischarge clientstoprovideroomfornewadmissions.Whichofthefollowingclientsshouldthenurserecommend to the charge nurse for discharge
A nurse is caring for a newborn who is 1hr old. The mother received fentanyl 30 min before delivery. For which of the following adverse effects should the nurse monitor thenewborn
Anurseisreinforcingdischargeteachingwithaclientwhohasaprescriptionfor home oxygen therapy via nasal cannula. Which of the following instructions should the nurseinclude
A nurse is reinforcing teaching with a client who has hypertension and is beginning medication therapywithcaptopril.Whichofthefollowingoverthecountermedicationsshouldthenurseinstruct the client toavoid
A nurse is assisting with the care of a client who has a terminal cancer. Which of the following statementsbytheclientsfamilyshouldindicatetothenursethattheyarecopingwiththeirsituation
Anurseobservesaclientinlabor.Whichofthefollowinginterventionsshouldthenurse recommend for thisclient
A nurse in a providers office is collecting growth and development data from a 7 month old infant duringawellchildvisit.Whichofthefollowingimagesshouldthenurseidentifyindicatesexpectedgross motor skills for the infant
Anurseisdiscussinghome safety withagroupofclientswhohavetype1diabetesmellitus.Which of the following client statements indicates an understanding of teaching theclient
Anurseispreparingtoadminamoxicillin875mgpoevery12hr.Theamountavailableisamoxicillin oral suspension 400mg/5ml. How many ml should the nurse administer perdose
Anurseispreparingtoperformbloodglucosemonitoring foraclientwhohastype2diabetes mellitus. Which of the following actions should the nurse takefirst
Anurseisreinforcingdischargeteachingwiththeparentsofaschoolagechildwhohassevere hemophilia A. Which of the following statements by the parents indicates an understanding of the teaching
Anurseiscaring foranolderadultclientwhoisexperiencingdifficultysleeping.Whichofthe following actions should the nursetake
Anurseisreinforcingteachingonselfadminofenoxaparin.Whichofthefollowinginstructions should the nurse give theclient
AnurseistalkingwithaclientwhosaystheprovideragreedtoinitiateaDNRprescription.After leaving the clients room, which of the following actions should the nurse takefirst
A nurse caring for a client who has hiv and lost 15% of his body weight in the last 3 months. The nurseshouldofferaservingofwhichofthefollowingfoodstoaddthemostproteintotheclientsdiet
Anurseiscollectingdatafromanolderadultclientwhohasahipfracture.Whichofthefollowing findings should the nurseexpect
Anurseisobservinganassistivepersonnelapplyantiembolicstockingsforaclientwhoisatriskfor deepveinthrombosis.WhichofthefollowingactionsindicatestheAPisapplyingthestockingscorrectly
AnurseispreparingtoadminanIMimmunizationtoapreschooler. Whichofthefollowing statements should the nurse plan to make prior to performing theinjection
Anurseiscaringforaclientwhoisrecoveringfromamotorvehiclecrash.Theclientsemployercalls to ask if the clients injuries will prevent him from returning to work. Which of the following responses should the nursemake
Anurseiscaring foranewbornwhois12hrold.Whichofthefollowingstoolsshouldthenurse instruct the parents to expect during the first 24hr afterbirth
Anurseisreinforcingteachingwithaclientwhohashypercholesterolemiaandanewprescription for atorvastatin. The nurse should instruct the client that which of the following findings is an adverse effect of this medication and should be reported to theprovider
Anurseisassistingwiththeplanofcareforaclientwhohasbipolardisorderandisinthemanic phase. Which of the following activities should the nurse recommend for theclient
AnurseisassistingwithadiscussionaboutSTI’s withagroupofadolescentsatahealthfair.Which of the following statements should the nursemake?
Anurseisinstructinganassistivepersonnelaboutcaring foranolderadultclientwhohasherpes zoster. Which of the following information should the nurseinclude
Anurseispreparingtoperformtracheostomycareforaclient.Whichofthefollowingactions should the nurse takefirst
A nurse in a long term care facility is reviewing standard precaution guidelines with an assistive personnel.ThenurseshouldinstructtheAPthatwhichofthefollowingshouldbeusedtocleanupa bloodspill
Anurseinapediatriccliniciscollectingdatafromatoddler.Whichofthefollowingfindingsshould the nurse identify as possible physicalneglect
Anurseisreviewingaclientsmedicationrecord.Herecognizesthatadoubledoseoforaldigoxin was given 1hr ago. Which of the following actions should the nurse takefirst
Whenpreparingaclientforanenteralfeedinganursenoticesthatthepumpattheclientsbedside is warm to touch. Which of the following actions should the nursetake
A nurse is working at a inpatient mental health facility is contributing to plan of care for a newly admittedpatientwhohasanorexianervosa.Whichofthefollowingactionsshouldthenurseincludein the plan ofcare
A nurse is documenting client care in the medical record. Which of the following entries should the nursemake
Anurseischecking reflexesofanewborn.Whichofthefollowingtechniquesshouldthenurseuse to elicit babinskireflex
Anurseiscaringfor aclientwhoisreceivingtelemetry. WhichofthefollowingECGfindingsshould the nurse report to the chargenurse
Anurseisreviewingvariousdefensemechanismswithnewlylicensednurse.Whichofthefollowing client statements should the nurse use as an example ofrationalization
I didn’t get a good grade because my teacher does not like me
A nurse is caring for a client who reports an excruciating headache, nuchal rigidity, nausea and vomitingalongwithfeverandchills.Whichofthefollowingdiagnostictestshouldthenurseexpectthe provider toprescribe
Anurseisreinforcingteachingwithaclientwhoisscheduledforalumbarpuncture.Whichofthe following statements should the nurse make
Anurseiscaring for aclientwhohasasthmaandhasbeentakingmontelukast for1monthwhichof the following findings should indicate to the nurse the client is complying with thisregimen?
A nurse is reinforcing teaching with a client who has a prescription for phenytoin. Which of the followinginstructionsshouldthenurseincludeasameasuretoassistwiththepossibleadverseeffectsof thismedication
Anurseinanurgentcarecliniciscompletingaclientexamination.Afterlisteningtotheclients lungs, which of the following adventitious sounds should the nursedocument
A nurse is monitoring a client who is 12hr postop following a cholecystectomy and received morphine30minagofor pain.Thenurseshouldidentifywhichofthefollowingfindingsasanadverse effect of themedication
A nurse is reviewing the critical pathway of a client who is 4 days postop following a total knee arthroplasty.Theclientsvitalsignsareoraltemp102.4heartrate116/minrespiratoryrate24andblood pressure 152/92. Which of the following actions should the nursetake?
Anurseisreviewinglaboratoryresultsforaclientwhoisreceivingmechanicalventilation.Whichof thefollowingfindingsshouldthenurserecognizeasapotentialcomplicationofmechanicalventilation
Anurseisassistingwithaneducationalsessionforanewlylicensednursesaboutintimatepartner violence.Whichofthefollowingcharacteristicsshouldthenurseincludeasplacingavulnerableperson at risk for intimate partnerviolence
Anurseiscollectingdatafromaclientwhohasschizophreniawhichofthefollowingstatementsby the client should the nurse identify asdelusional
ALPNisreviewingherclientassignmentsfortheupcomingshift.Whichofthefollowingclients should the LNP ask the charge nurse reassign to a registerednurse
Anurseiscaring foraclientwhoisexpressingsadnessaboutamputationofherleg72hragodueto trauma. The nurse must leave the room but promises to return as soon as possible. Which of the following ethical principles is the nurse demonstrating when he returns aspromised
Anurseiscaring foraclientwhopracticesorthodoxjudaismandadherestoakosherdiet.Whichof the following food selections should the nurse expect to see on the clients mealtray
Anurseispreparingtoadministeradoseofdigoxintoaclientwhoisreceivingcontinuoustube feedings. Which of the following actions should the nursetake
Anurseiscollectingaurinespecimenfromafemaleclientwhohasiabetesinsipidus.Thenurse should expect which of the followingfindings
Anurseisworkingonaunitwithanassistivepersonnel.WhichofthefollowingactionsbytheAP should the nurse recognize and report asassault
Anurseisreinforcingteachingwithafemaleclientwhohastuberculosisandanewprescriptionfor rifampin.Whichofthefollowingstatementsbytheclientindicatesunderstandingoftheteaching
Anurseisreinforcingteachingwithaclientwhohasalcoholusedisorderandistobegindisulfiram therapy. Which of the following statements should the nursemake
Anurseiscaring foraclientwhoreportstwelveliquidstoolsinthepast8hr.Whichofthefollowing findings should indicate to the nurse that the client is experiencingdehydration
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