1.A nurse is caring for a client

1.A nurse is caring for a client who has schizophrenia . Which of the following behaviors of the client should the nurse identify as a negative symptom of schizophrenia? Mimics the nurse’s movements Initiates speech rarely Has a preoccupation with religious thoughts Smells odors that don’t exist 2 .A nurse is assisting with preparing a client who is to have a central venous catheter inserted for the administration of total parenteral nutrition (TPN). Which of the following actions should the nurse take? Prepare the client for a chest ray to verify catheter placement Place the client in Sims Position for catheter insertion Verify the amount of TPN solution the client is receiving every 4 hr Use clean technique when changing the catheter dressing 3 nurses are reviewing the medication administration record of a client who takes atenolol PO and applies a nitroglycerin transdermal patch daily. For which of the following interactions should the nurse monitor this client? Hypotension Dry cough Hyperglycemia Thrombocytopenia 4. A nurse is assisting in the care of a client who is 48 hr postpartum. The client states, “My baby won’t stop crying even though I’ve changed her diaper and breastfed her.Which of the following statements should the nurse make? Swaddling your baby snugly in a blanket might help soothe her . Your baby needs to suck on a pacifier Breastfed babies are usually fussy from swallowing too much air during feedings Breastfed babies often need to be supplemented with formula 5 .A nurse is making a follow-up call to a client who has a new prescription for an ACE inhibitor to treat hypertension. The client reports lightheadedness upon standing. Which of the following statements should the nurse make? Sit back down for a few minutes when this occurs Take a daily potassium supplement ” Discontinue this medication if this occurs again Restrict your daily fluid intake. 6. A nurse is collecting data from a client who is 8 hr postoperative following an appendectomy . Which of the following manifestations is the best indication that the client needs a PRN analgesic ? The client reports pain as 7 on a scale of to 10 The client’s heart rate has increased to 110/ min. The client grimaces when changing positions The client demonstrates a decreased attention span 7 . A nurse is collecting nutritional data from a group of adult clientsFor which of the following clients should the nurse recommend an interprofessional care conference with a dietitian? . A client who has a body mass index of 32 A client who has a sodium intake of 1, 200mg / day A client who has a total fat intake of 25% of daily calories A client who has a serum albumin level of 4.5g / dL 8 A nurse is discussing risk factors for child abuse with members of a parenting group. The nurse should identify which of the following findings as a characteristic of perpetrators of child abuse? Rigid expectations of behavior Self-blame for financial problems High self esteem Laissez- faire leadership style 9. A client who has type 1 diabetes mellitus asks a nurse about beginning an exercise regimen . Which of the following instructions should the nurse include? Avoid protein before exercising Eat a piece of fruit before exercising Inject additional insulin before exercising Exercise when insulin is at its peak action 10 A nurse is providing preoperative care to a client who reports he has no one at home to help him after his outpatient surgeryWhich of the following actions should the nurse take? Contact the next of kin to assist the client at home Assist with a referral to a home health care agency Call the provider about admitting the client to the facility overnight Give the client a list of home care assistants to contact 11. A nurse is contributing to the plan of care for a client who has bipolar disorder and is experiencing acute mania. Which of the following interventions should the nurse include in the plan of care ? Check the client’s vital signs every 4 hr. Provide the client with high- calorie finger foods. Encourage the client to participate in group activities. Allow the client to establish his own schedule 12. A nurse is collecting data from a client who has anorexia nervosa Which of the following findings should the nurse identify as a positive outcome of treatment? The client’s develops lanugo The client’s potassium level is 2.7 mEqL The client resumes menstruation The pulse rate is 44 13. A nurse is reinforcing teaching with a parent of a child who has asthma about the administration of montelukast. Which of the following statements by the parent indicates an understanding of the teaching ? I can stop giving my child this medication if he is taking a steroid I will give this medication to my child every 2 hours if he is wheezing It takes 2 months of scheduled use before this medication is effective I will give this medication to my child once daily in the evening 14.. A nurse is caring for a client who has a terminal illness. The client states, “I wish I would die now. Which of the following responses should the nurse make ? Why do you wish you you weren’t alive any longer You wish you were no longer alive We should talk about the terminal illness to feel that way it’s common for people Who are the terminal illness to feel that way 15.. A nurse is giving a change -of -shift report on a group of clients . Which of the following statements should the nurse make ? ( Select all that apply The client in room 204 has a new prescription for IV gentamicin . The client in room 204 received some pain medicine earlier today . The client in room 203 will undergo surgery at 0900 tomorrow ” The client in room 205 has had several visitors today ” The client in room 205 is scheduled for a dressing change at 1800 16. A nurse is monitoring a client’s lower extremity following the placement of a cast earlier in the dayWhich of the following findings should the nurse identify as manifestations of compartment syndrome? (Select all that apply.) Sensation of tingling Decreased skin turgor Diminished capillary refill Pale- colored toes Pain relieved by analgesia 93.. A client who is in bed and begins experiencing a clonic seizureWhich of the following actions should the nurse take? 17. A charge nurse in a long-term care facility is discussing ethical theories with a group of newly licensed nurses. Which of the following statements should the charge nurse identify as an indication that a newly licensed nurse understands utilitarianism? will respect the decision of a client who has a chronic illness to stop treatment will consider what is going to benefit the most people when making decisions. will withhold a terminal diagnosis from a client who has cancer will place a higher emphasis on human dignity than on the needs of a group 18..A nurse in a mental health facility is caring for a client who reports palpitations and a sense of impending doom. Which of the following actions should the nurse take first? Explain to the client that anxiety causes physical manifestations Explore behaviors that have helped to reduce the client’s anxiety in the past. Administer an anti-anxiety medication Minimize environmental stimuli in the client’s surroundings 19. A nurse is assisting with the care of a client who is in the latent stage of labor and has pelvic pain with contractions . Which of the following actions should the nurse take ? Apply fundal pressure during contractions Encourage the client to soak in a hot bath Tell the client to push during contractions Instruct the client to change positions frequently 20.. A nurse is reinforcing teaching with a client who has an ankle injury and requires crutches . Which of the following instructions should the nurse provide? Keep your elbows flexed at a 35 angle when using the crutches Support your body weight by leaning on the crutches Wash the tips of your crutches daily. Maintain your head and neck erect when walking with crutches. 21.. A home health nurse is caring for an older adult client who lives with a family caregiver and has urinary incontinence . The client states, “Guess I will be locked in my room again for wetting the bed.” Which of the following actions should the nurse take? Report the suspected abuse to the nurse manager Review the medical record to see if the client has reported abuse in the past Contact the caregiver to discuss the comment Restrict family members from visiting with the client 22. A nurse in a long -term care facility is caring for a client who has methicillin – resistant Staphylococcus aureus ( MRSA ). Which of the following actions should the nurse take ? Restrict the client’s visitors . Wear a gown when assisting the client with personal hygiene Remove personal protective equipment after leaving the client’s room Ensure that the negative air pressure is active for the client’s room 23.,A nurse is reinforcing teaching about hand hygiene with a newly licensed nurse . Which of the following information should the nurse include in the teaching? Apply friction to hands for 10 seconds Interlace the fingers while rubbing hands together Use hot water to wash hands. Dry hands starting from forearm to fingers 24. A nurse is reviewing the medical record of a client who is at 37 weeks of gestation and has HELLP syndrome. Which of the following laboratory findings should the nurse expect ? Hemoglobin 12 g / d L Platelet count 77000 / m * m ^ 3 WBC count 18 / m m ^ 3; 20mg / d * L 25. A nurse is caring for a client who is 2 days postoperative following a total bilateral mastectomy . The client is tearful and looks away when her surgical dressings are removed. The nurse should place the priority on which of the following actions ? Providing the client with information on community resources that will strengthen her coping skills Encouraging the client to write about her feelings in a journal each day Demonstrating a nonjudgmental attitude toward the client when providing care for her surgical wounds identifying the client’s perception of the changes in her physical appearance 26. A nurse is reinforcing teaching with a client’s family about home oxygen use via nasal cannula. Which of the following statements by a family member indicates an understanding of the teaching ? We can use petroleum jelly to keep his nares moist We will frequently check the top of his ears for sores ” We can turn the oxygen up to when he has trouble breathing We will need to remove the nasal cannula when he is eating 27. A nurse is contributing to the plan of care for a client who is pregnant and reports having trouble sleepingWhich of the following instructions should the nurse include in the plan of care? Lie on your left side with your top leg forward Use a transcutaneous electrical nerve stimulator Obtain a prescription for pramipexole Soak in a bathtub of hot water each night 28. A nurse has assigned an assistive personnel (AP) to perform a gastrostomy feeding for a client who has been receiving feedings at home. Which of the following actions should the nurse take to monitor the AP’s performance of the task? Tell the AP to list the steps of the task Request the AP to provide a return demonstration of the task Ask the family if the AP performed the task correctly. Instruct the AP to report back once the task is complete 29. A nurse is caring for a client who is day postoperative following a total hip arthroplasty and is receiving heparin subcutaneously. Which of the following adverse effects of the medication should the nurse report to the provider ? Anorexia weight gain Epistaxis Bradycardia 30. A nurse is caring for a client who is 12 hr postpartum and has deep -vein thrombosis of the left leg. The client is receiving anticoagulant therapy . Which of the following actions should the nurse take? Initiate bed rest Apply an ice pack to the affected extremity for 20 min every 2 hr Administer aspirin for pain. Massage the affected extremity every 4 hr. 31. A nurse is reinforcing teaching with a client about advance directives and a health care proxy. Which of the following client statements indicates an understanding of the teaching? I do not need to name a relative as my designee in my health care proxy If I have a health care proxy, then I do not need to have a living will. My health care proxy designee is not able to sign a consent form on my behalf. ” Once my health care proxy is in place relinquish my right to make my own decisions 32 A nurse is collecting data from a client who has left sided heart failure. For which of the following findings should the nurse notify the provider? Weight loss of 1 kg ( 2.2ib) in the past 24 hr Pale ,clammy skin Fatigue when ambulating 152 m (500 ft) Productive cough with pink, frothy sputum 33, A nurse is caring for a 2-year-old child who has Clostridium difficile. Which of the following actions should the nurse take? Place the child in a room that has a HEPA filtration system Initiate contact precautions Use an N95 respirator Instruct the parents to avoid bringing fresh flowers into the room SCIENCE HEALTH SCIENCE NURSING NSG MISC

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