please help me answer the following s A client informs a…
please help me answer the following s A client informs a… please help me answer the following s A client informs a nurse at a clinic visit that he has been taking megadoses of vitamin A on the advice of a friend. Which of the following does the nurse understand is true concerning vitamin A? A. The body has a large vitamin A requirement but can synthesize it as needed. B. Vitamin A is toxic in small amounts. C. The liver stores vitamin A easily in large amounts. D. Vitamin A is a fat soluble vitamin The nurse observes a coworker leaving her medication administration computer logged on and in the hall unattended. Which initial action by the nurse is most appropriate? A. Go immediately and log off the computer B. Speak with the coworker about the problem C. Move away from this unsafe nurse D. Alert the charge nurse of the colleague’s unsafe practices A tornado strikes a small town, resulting in multiple casualties. A nurse on a medical surgical unit has been ordered to discharge clients who can be safely discharged to make room for casualties from the tornado. Which of the following clients should NOT be discharged? A. A 44-year-old female 2 days post-op from a total hysterectomy with stable vitals who is voiding independently B. A 56-year-old male with diabetes scheduled for amputation of the right lower leg due to infection that has been unresponsive to all therapies C. A female infant born 8 hours earlier with initial APGARs of 9 and 10 D. A 16-year-old female admitted with dehydration and weakness (resolved with intravenous fluids) who is suffering from anorexia nervosa E. An 85-year-old male 8 days post-op from a knee repair who is receiving daily physiotherapy A nurse is reviewing positioning for a client who is to receive enteral feedings at home with a family member. Which of the following statements by the family member indicates an understanding of the teaching? A. “I will allow him to choose the position where he is most comfortable during the feeding.” B. “I will place his head on a pillow during the feeding.” C. “I will turn him on his left side during the feeding.” D. “I will have him sit in his chair during the feeding.” A nurse is caring for a client who is receiving total parenteral nutrition (TPN). The nurse is informed there will be a delay in receiving the new container of solution from the pharmacy. Which of the following solutions should the nurse infuse until the next container of TPN solution becomes available? A. Lactated Ringer’s B. Dextrose 5% in 0.45% sodium chloride C. Dextrose 10% in water D. 0.9% sodium chloride A nurse is caring for an older adult client who requires maximum support to ambulate using a standard walker. Which of the following actions should the nurse take? A. Check that the client lifts the walker and then places it down in front of them. B. Ensure that the client’s elbows are straight when gripping the walker. C. Have the client move one leg forward with the walker. D. Make sure that the upper bar of the walker is level with the client’s waist. A nurse is teaching a client who is about to start using transcutaneous electrical nerve stimulation (TENS) to manage chronic knee pain. Which of the following statements by the client indicates an understanding of the teaching? A. “I will place the stimulation unit on my unaffected knee.” B. “It’s unfortunate that I have to be in the hospital for this treatment.” C. “I’ll need to shave the hair off the skin where I place the electrodes.” D. “I wish I did not need to have needles inserted for this therapy.” A nurse is assigned to care for a client with dementia who is admitted with a stroke. Which of the following nursing diagnoses is the highest priority when caring for this client? A. Bathing/hygiene self-care deficit B. Risk of injury C. Impaired physical mobility D. Disturbed thought processes What should the nurse do with clients who arrive at the hospital on their own following a mass casualty disaster in the community? A. Triage just like the clients coming by ambulance B. Ask these clients to wait in the waiting room C. Put these clients into a treatment room D. Have the clients document their symptoms in writing A nurse who volunteers to serve on a committee that addresses community disaster preparedness and response understands that secondary prevention in disaster response includes which of the following? A. Participation in community disaster exercises B. Conducting community outreach C. Assessment of disaster survivors D. Providing community service linkages to families for recovery assistance A client has just returned from surgery after below-the-knee amputation. The client has an immediate postoperative prosthesis (IPOP) in place. What is the purpose of an IPOP? A. It prevents development of a blood clot in the leg after surgery B. It increases the adjustment period so the client is not rushed. C. It prevents infection in the stump incision D. It promotes body image after surgery A client at 12 weeks’ gestation tells the nurse that she is a vegan and she eats “lots of rice.” To help meet the client’s need for protein during pregnancy, the nurse suggests that the client combine rice with which of the following? A. Beans B. Steamed broccoli C. Sour Cream D. Corn A nurse is assessing a client to gain information about the client’s personal hygiene habits. Which of the following s should the nurse ask the client? A. “Do you have grab bars in your bathtub at home?” B. “Do you have sores on the bottoms of your feet?” C. “Can I provide you with a bed bath today?” D. “When was the last time you saw your dentist?” A nurse is assessing a client’s level of strength prior to ambulation. Which of the following actions should the nurse take to determine the client’s level of strength to ambulate? A. Check the client’s ankles for the presence of edema. B. Ask the client to shrug their shoulders against resistance from the nurse’s hands. C. Check the client’s pedal pulses. D. Ask the client to push their feet against the nurse’s palms. A nurse is caring for a client who has a nasogastric (NG) tube connected to wall suction. Which of the following should the nurse do when administering a medication through the NG tube? A. Clamp the nasogastric tube for 30 minutes after the medication is administered. B. After giving the medication, set the NG tube on low intermittent suction for 30 minutes. C. Position the client in the supine position so the medication will be better absorbed. D. Aspirate the NG tube after giving the medication. A nurse is preparing to assist in a surgical procedure. Place the following steps in the correct order for performing a surgical scrub: Rinse the soap from hands and arms. Open the scrub brush package. Scrub the nails, fingers, hands, wrists, and forearms. Turn off the water and discard the brush. Wet the hands and arms thoroughly. Moisten the surgical brush. Hold the hands away from the body with the hands above the level of the elbows. Which of the following is the most effective intervention for reducing the spread of methicillin-resistant Staphylococcus aureus when bathing a client who has a new surgical incision? A. A bath basin should be used, and the wash cloth should be changed with each new body area. B. Pre-moistened commercially packaged chlorhexidine cloths should be used to bathe the client. C. The client should not bathe until 24 hours after antibiotic therapy has been initiated. D. The client should be instructed to use antibacterial soap in the shower. A nurse is providing teaching to a client who has a prescription for a mechanical soft diet. Which of the following food selections indicates to the nurse the client understands the teaching? (Select all that apply.) A. Raw broccoli B. Ground turkey C. Mashed carrots D. Fresh strawberries E. Cottage cheese A nurse is going through annual fire safety training. She reads a nearby fire extinguisher and sees that it is marked as class B. Which of the following materials would this fire extinguisher be designed to put out? (Select all that apply.) A. Wood B. Alcohols C. Oil D. Electrical equipment E. Plastic A nurse is planning care for a child who is in skeletal traction. Which of the following interventions should the nurse include in the plan? (Select all that apply.) A. Remove the weights to reposition the client. B. Provide a high-fiber diet. C. Assess the pin sites every 4 hr. D. Limit oral fluid intake. E. Ensure the rope’s knot is in contact with the pulley. A nurse is caring for a client with acute renal failure who is undergoing hemodialysis. What should the nurse consider when educating the client on healthy food choices? A. Increase dairy products to maintain phosphorus balance. B. Decrease total fat intake to 45% of daily calories. C. Decrease potassium intake to 40 mg/kg per day. D. Limit sodium intake to 4.5 g/day. An RN and an LPN are caring for a client admitted for control of pain due to metastatic cancer. The RN administers the prescribed dose of hydromorphone 2 mg IVP STAT. The client calls for the nurse in 2 hours and states his pain is 8 on a scale of 0-10 and requests pain medication. Which of the following is the priority action by the RN? A. Reposition the client B. Assess the client and notify the healthcare provider C. Give a second dose of hydromorphone D. Ask the LPN to take vital signs and administer the medication if vitals are within normal limits A nurse is caring for a client who uses a fragrant spray in her room to help her feel more calm and relaxed. This practice would most likely be described as: A. Guided imagery B. Aromatherapy C. Meditation D. Self-hypnosis A nurse is providing discharge teaching about diet and fluid restrictions to a client who has a calcium oxalate kidney stone. Which instruction should the nurse include in the teaching? A. Increase intake of spinach. B. Limit sodium to no more than 2,300 mg/day. C. Increase intake of vitamin C supplements. D. Limit consumption of high-purine foods. A nurse is caring for a 26-year-old female client with a recent history of international travel, fever, and suspected H1N1 infection. The nurse understands that which of the following symptoms are consistent with H1N1 infection? (Select all that apply.) A. Dizziness B. Temperature of 103°F and above C. Shortness of breath D. Diarrhea E. Persistent cough A nurse is caring for a 15-year-old client with sickle cell anemia who was admitted for the treatment of a vaso-occlusive crisis and is complaining of severe pain “all over.” What is the priority nursing intervention for this client? A. Maintain bed rest B. Alert the blood bank to obtain blood for transfusion C. Apply supplemental oxygen through nasal cannula D. Start an intravenous bolus of normal saline Which of the following clients should not be considered to use anti-embolism stockings? (Select all that apply.) A. A client with pulmonary edema due to heart failure B. A client with necrotic limb tissue in the lower leg C. A client with a deformity of the lower leg D. A post operative hip replacement client E. A client with diabetes The nurse is caring for a client with a new plaster cast on his left arm. Which of the following will the nurse NOT include in teaching this client about cast care? A. Keep the arm below the level of your heart B. Keep the cast dry C. Do not insert anything into the cast D. Exercise your joints above and below the cast every day A nurse is assisting a client with personal hygiene. Which of the following actions should the nurse take when performing nail care for the client? A. Clean under the nails with an orange stick. B. File the nails in a rounded shape. C. Apply an alcohol rub to the cuticles after pushing them back. D. Trim the nails at the lateral corners. A client calls the nurse and reports that another person dressed in differently colored scrubs was in her room sleeping in a chair when she returned from an X-ray. The unidentified person left quickly without an incident. What is the nurse’s priority action? A. Go to the room to reassure the client B. Alert the nursing supervisor C. Page a security officer to the nursing unit D. Ask around to see if anyone saw something A nurse is teaching a group of clients about stomatitis related to chemotherapy. Which of the following statements by a client indicates an understanding of the teaching? A. “I will try chewing larger pieces of food.” B. “I will eat scrambled eggs and bananas for breakfast.” C. “I will consume foods that are hot.” D. “I will add more citrus foods to my diet.” A nurse is providing information on diet to a client with type 2 diabetes. Which of the following statements by the client indicates understanding of the dietary recommendations for diabetes? A. The total daily intake should consist of more than 400 mg of cholesterol B. The total daily intake should consist of at least 65% carbohydrates C. The total daily intake should consist of at least 10g of fiber for each 1,000 calories in the diet D. The total daily intake should consist of at least 15-20% protein A nurse is applying antiembolic stockings for a client who is postoperative. Which of the following actions should the nurse take? A. Apply the stockings while the client is sitting in a chair. B. Apply the foot portion while the client flexes their foot. C. Check the stockings for wrinkles. D. Measure the size of the client’s foot. A nurse smells smoke when entering a client’s room and finds a fire is burning in the bathroom. What is the most appropriate response? A. Find other staff members to assist. B. Take the client out of the room C. Check the bathroom to find out if anything is broken D. Find the closet fire extinguisher Which of the statements by a client with a new-onset seizure disorder will require additional teaching by the nurse at discharge? A. “I will drive myself to the doctor next week.” B. “I will avoid cooking at home for the next few days.” C. “I will take a shower each day.” D. “I will take my medication before bedtime.” A nurse is caring for a client who is postoperative Roux-en-Y gastric bypass surgery for management of morbid obesity. The client will most likely require a multivitamin with additional supplementation of which of the following to avoid a frequent complication of the procedure? A. Vitamin B6 B. Vitamin E C. Vitamin B12 D. Intrinsic factor Which of the following clients has the greatest risk of a healthcare-associated infection due to methicillin-resistant staphylococcus aureus? A. A 45-year-old client postoperative abdominal surgery with two peripheral intravenous catheters in place B. A 78-year-old client on a ventilator with pneumonia and a history of Chronic Obstructive Pulmonary Disease (COPD) C. A 20-year-old client recovering from a motor vehicle accident (MVA) with a fractured femur and pelvis in the emergency department (ED) D. A 62-year-old client who had an implanted cardioverter defibrillator (ICD) placed yesterday When using the mnemonic PASS to utilize a fire extinguisher, the A stands for: A. Advance B. All C. Aggressive D. Aim The nurse is donning a sterile gown in preparation for surgery. Which of the following procedures was performed correctly? (Select all that apply) A. Sterile gown was opened over a clean, dry surface B. Gown was picked up by grasping the outside surface at the collar C. Folded gown was shaken out D. Gown was allowed to unfold at an arm’s length away while avoiding the outside of the gown touching the body E. Both arms were slipped into the armholes simultaneously while hands are at shoulder level A nurse is performing a full bed bath for a client who is immobile. Which of the following actions should the nurse take? (Select all that apply.) A. Offer the client a bedpan before the bath. B. Wash the client’s face last. C. Keep the bath water temperature between 43° C (109.4° F) and 46° C (114.8° F). D. Shave the client’s facial hair in the direction of the hair growth. E. Wash the client’s extremities by moving from the proximal end to the distal end. Which of the following prescribed medications does the hospice nurse understand is indicated for treatment of a “death rattle” that is distressing family members of a client who is actively dying? A. Morphine B. Fentanyl patch C. Lorazepam D. Scopolamine patch A nurse is caring for a 58-year-old client with an indwelling catheter that was placed on admission 3 days ago. The client has developed a urinary tract infection (UTI). The nurse classifies this as which of the following types of infection? A. Nosocomial infection B. Opportunistic infection C. Systemic infection D. Sepsis Which of the following measures should be used to prevent the transmission of respiratory infections? A. Individuals should not be admitted as visitors or staff without proof of immunization for seasonal influenza and pneumonia. B. Individuals with signs of respiratory infection should wear a surgical mask. C. A distance of separation of at least 10 feet should be maintained from an individual with signs of respiratory infection. D. Infected individuals should be encouraged to sneeze or cough into their hand.Health Science Science Nursing NUR 1142
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