2-nurse is caring for an older adult client who has a new di

2-nurse is caring for an older adult client who has a new diagnosis… 2-nurse is caring for an older adult client who has a new diagnosis of cancer. Which of the following client statements include acting as a client advocate?1-I will take chemotherapy since my family wants me to.”2-I do not want to have any surgery for my cancer.”3-I will discuss treatment options next week after thinking about this.”4-I have contacted another surgeon to get a second opinion.” 3- the nurse is prioritizing care for four clients. Which of the following tasks should the nurse perform first?1-Change the dressing for a client who has a decubitus ulcer.2-Initiate a 24-hr urine collection for a client who has end-stage kidney disease.3-Administer an antibiotic for a client who has methicillin-resistant Staphylococcus aureus.4-initiate oxygen therapy via nasal cannula for a client who has COPD. 4-nurse working in a long-term care facility is giving a change-of-shift report on a client who had a stroke. Which of the following info do nurses include in the report?1-The client’s blood pressure was recorded at 0730 and 1130.2-The client’s enteral feeding bag needs to be changed at 2200.3- The client’s pain medication was administered twice during this shift.4-The client received a bath and backrub 5– nurse is reinforcing teaching with a client who wants to create advance directives, Which of the following statements by the client in the understanding of the teaching? (Select all that apply.)1-I can change my health care decisions at any time even if I have2-I do not need advance directives unless I become terminal3-I must select a blood relative as my health care surrogate ” 4-I can state in my inviting will that I do not want to have CPR performed on me,5- the judge is required to determine if 1 am able to make health care decisions for myself  6-nurse is reviewing client information following the evening change-of-shift report. Which of the following client needs should the nurse first? 1-A client awaiting discharge needs to demonstrate colostomy care before leaving.2- A client who has a new tracheostomy is experiencing coughing episodes.3-A client who has a BMI of 17 refuses his dinner tray.4-A client who has type 2 diabetes mellitus needs assistance counting the carbohydrates in her meal. 7-nurse is assisting with the preparation for incoming casualties due to an external disaster, Which of the following clients should the nurse recommend for discharge to provide bed availability?1-À client who is receiving continuous bladder irrigation2-A client who is being evaluated for a transient ischemic attack3-A client who is on a cardiac monitor4-A client who has diabetes mellitus8-nurse is caring for a group of clients on a medical-surgical unit. The nurse should ensure that a client has signed a written inform form prior to which of the following procedures?1-Suctioning a tracheostomy tube2-insertion of a central venous catheter3- irrigation of an indwelling urinary catheter4-Placement of a nasogastric tube 9-A nurse in a long-term care facility is reviewing the facility documentation policies with a newly licensed nurse. Which of the following abbreviations should the nurse remind the newly licensed nurse to use when documenting care?1-ADL2-HS3-AU4-SO 10-nurse is caring for four clients with assistive personnel (AP). Which of the following tasks should the nurse delegate to the ap?1-Collect a midstream urine specimen2-mission vital signs3- Measure the Size of a Pressure Injury4-Determine client risk of fall  11-nurse in a long-term care facility is reinforcing teaching with a newly licensed nurse about chemotherapy-induced nausea. With the following food, selections indicate the newly licensed nurse understands the teaching.1-Hot tea2- Raisin toast3-Soft-serve ice cream4- String cheese 12-A nurse is reinforcing teaching about client falls with a newly licensed nurse. Which of the following should the nurse include as the take following a client fall?1-Obtain the client’s vital signs.2- Notify the client’s provider.3-inform the client’s family members. 4-Place the client back in bed. 13-nurse is asked by the family member of a client to access the client’s medical record. The nurse is not assigned to this client. Which following actions should the nurse take?1-Tell the family member to ask the client’s provider for access to the client’s medical record.2-Explain that nurses are not allowed to open the medical records of clients not in their care.3-Request identification from the family member before providing the information.4-Report the situation to the facility’s security personnel. 14-nurse in a facility elevator overhears two assistive personnel (AP) discussing the diagnosis of a client recently admitted to the medical unit. Which of the following actions should the nurse take first?1-Inform the AP that their conversation violates the client’s privacy.2-Notify the nurse manager of the medical-surgical unit of the incident,3-Review HIPAA guidelines with the AP4-Submit a written statement regarding the incident to the risk manager 16-nurse is reinforcing teaching with a group of older adults about collecting home supplies for disaster situations. Which of the information should the nurse include in the teaching?1-Stock 2 liters of water per person per day.”2-Replace nonperishable food items annually.3-Have a backup supply of nonprescription medications.”4-Gather enough supplies to last for 2 weeks.” 17-A nurse is accessing computerized data about a client recently transferred to a step-down unit. Which of the following forms should nurse with the most comprehensive client information?1-Standardized care plan2-Client care lyrdex3-Medication administration record4- I&0 record18-nurse is assisting with the planning of an in-service for a group of newly licensed nurses about transcribing prescriptions from a proof of the following examples should the nurse include as an approved abbreviation?1-PO2-OD3-SQ4-HS19-nurse is reinforcing teaching with a client about fire safety in the home. Which of the following instructions should the nurse include teaching?1-Open windows to allow smoke to escape if a fire occurs.2-Change batteries in home smoke alarms every 2 years.3-Aim the extinguisher nozzle at the top of the flames if a fire occurs.4-Store a fire extinguisher away from the stove in the home.20-nurse is discussing common models of nursing care with other nurses. Which of the following information should the nurse include discussing team nursing?1-An RN coordinates the care provided by other team members.2-An RN links community resources with clients to ensure quality care.3-An RN provides every aspect of care for a group of clients during a shift.4-An RN cares for the same clients throughout their hospitalization. 21-A nurse is discussing reporting statutes for child maltreatment with a newly licensed nurse. Which of the following statements by the licensed nurse indicates an understanding of reporting statutes?1-I need to confirm the presence of child maltreatment before reporting my findings.”2-Removing a child from their home is mandatory following a report of child maltreatment.”3-I can be criminally charged with negligence if I fail to report a suspicion of child maltreatment.”4-The child’s guardian can sue me if I make a report of child maltreatment and they are proven innocent.” 22-nurse is caring for a client who reports being nervous about receiving a prescribed medication via injection. Which of the following should the nurse make?1-Why are you nervous about receiving this medication?’2-I can ask your provider to prescribe a different route for the medication.3-You, need this medication to feel better.”4-I will administer the medication when you are feeling less anxious.” 23-nurse is caring for a 16-year-old client who was in a motor vehicle crash and needs surgical intervention immediately. Either of the client’s parents. The nurse should identify that which of the following is true about obtaining consent?1-The surgeon can obtain informed consent from the client’s adult cousin,2-The surgeon should delay surgery until he can obtain informed consent from a parent.3-The client’s pediatrician can obtain implied consent.4-The surgeon can proceed with the surgery by invoking implied consent. 24-nurse is caring for a group of clients who are postoperative. Which of the following actions demonstrates appropriate, cost in providing nursing care?1-Have clients ask their families to assist with ambulation.2-Provide pain medication intravenously.3- Encourage the use of an incentive spirometer.4-Turn a client who is immobile every 4 hr. .35 nurses on a neonatal unit is reinforcing teaching with assistive personnel about infant abduction. Which of the following situations do nurses include as a potential breach of facility security?1-A parent has not signed the facility’s infant safety pledge.2-A parent reports that his identification bracelet is loose and requests a replacement.3-A person wearing a picture identification badge asks to take an infant for testing.4-A person wearing scrubs is seen carrying an infant out of the unit doors. 26 nurse identifies that a client has received a double dose of a medication in error, which of the following actions should the nurse take first 1-notify the charge nurse of the error.2-Document the facts of the incident in the nurse’s notes.3-Compt an incident report about the occurrence.4-Check the client’s vital signs. 27-nurse is caring for a client who has type 1 diabetes mellitus. Which of the following actions should the nurse take first when providing morning?1-Check the calibration of the glucometer.2-Obtain the client’s capillary blood glucose level.3-Administer prescribed insulin.4-Provide the client’s breakfast. 28-nurse has sustained a needlestick injury from a needle he used to give an injection to a client who has hepatitis C. Which of the following should the nurse take?1-Start prophylactic antibiotic therapy.2-Notify the health department.3-Comple an incident report.4-Receive a hepatitis C immunization. 29 nurses in a long-term care facility are collecting data for an interdisciplinary care conference for a client who has Parkinson’s disease. Which of the following findings is the priority for the nurse to report at the conference?1-The client requires additional help to stand2-The client has increased difficulty dressing.3-The client has difficulty swallowing.4-The client reports insomnia. 30 A nurse is observing a newly licensed nurse remove an indwelling urinary catheter for a client who is postoperative following a hysterecte Which of the following actions by the newly licensed nurse requires intervention by the nurse?1-Applies clean gloves prior to removal of the catheter2-Pulls slowly while removing the catheter3-Removes the catheter with the balloon partially deflated4-Explains to the client a burning sensation might be felt upon removal 31a nurse at a long-term care facility is reinforcing information with newly hired staff about legal issues. Which of the following example to nurse include as a situation where the nurse could face liability?1-A nurse asks assistive personnel to perform postmortem care for a client who does not require an autopsy.2-A nurse does not have another nurse verify an insulin dose prior to administration.3-A nurse leaves out personal opinions while documenting the care of a client who has not adhered to the treatment plan.4-A nurse allows a client’s family to be present at the client’s request while obtaining a medical history.32-nurse is reviewing documentation on a group of clients as part of a quality improvement initiative. Which of the following actions nurse document as decreasing the risk for skin breakdown?1-Daily weighing of clients who have heart failure2-Use of the Braden scale for clients who are immobile3-Implementation of incentive spirometry for clients who are postoperative4-Documentation of PAINAD Scale for clients who have dementia 33-nurse is reviewing his client care assignments after receiving the change-of-shift report. The nurse should notify the charge nurse that which of the following tasks should be reassigned to an RN?1-Classifying a pressure ulcer2-Administering heparin subcutaneously3-inserting an indwelling urinary catheter4-Suctioning a client’s new tracheostomy 34-nurse is assisting with the discharge of a client from an acute care unit to a long-term care facility. Which of the following should the nurse include in the transfer report?1-Name of facility social worker2-Medication administration record3-Need for special equipment4-Health insurance information 35-nurse is reinforcing teaching about the concept of confidentiality with a group of assistive personnel (AP). Which of the following a nurse use as an example of a violation of client confidentiality?1-Discussing a blood pressure value with a member of a client’s family2-Notifying another nurse of a client’s history of alcohol use disorder3-Informing an AP during a report about a client’s request for no visitors4-Faxing a client’s medical records to a consulting provider 36-nurse is completing a peer evaluation. Which of the following actions will ensure the peer evaluation is impartial?1-Asking a staff member from another unit to complete the evaluation2-Linking the evaluation to predetermined standards3-Focusing primarily on areas that need improvement4-discussing the evaluation with the nurse manager 37-nurse is visiting a home care client at home to assess safety. The nurse notices that there are no fire alarms in the client’s home. The client responds for them. Which of the following is the appropriate response by the nurse?1- A Without telling the client, call the client’s family and request that they install fire alarms in the home immediately2- Educate the client regarding the importance of having working fire alarms and encourage him to think about having a fire alarm installed on each3- Advise the client that he will be sent to a nursing home if a report is filed that states he does not live in a safe environment4- Call the client’s primary care provider and report the absence of working fire alarms in his home38-nurse in a long-term care facility is monitoring clients in the day room. A client who has dementia becomes angry and starts screaming nurse. Which of the following interventions should the nurse take first?1-Engage the client in a repetitive activity as a distraction.2-Place the client in a seclusion room.3-Administer PRN haloperidol IM to the client.4-Apply wrist restraints to the client. 39-A nurse is implementing time-management skills when caring for a group of clients, Which of the following activities should the first?1-Group client care activities that are in the same area of the unit.2-Read the client care summary for each assigned client.3-Meet with the assistive personnel to delegate tasks.4-Call for equipment needed to complete treatment. 40-A nurse is caring for four newborns. Which of the following newborns should the nurse see first?1-A newborn who is 2 hr old and has a subconjunctival hemorrhage2-A newborn who is 4 hr old and has grunting3-A newborn who is 24 hr old and has slight tremors in both extremities4-A newborn who is 48 hr old and has jaundiced sclera       Health ScienceScienceNursingNUR 233Share

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