The nurse working in a free clinic often utilized by Hispanic immigrants is assessing a client who reports a cough and malaise. The client is hearing impaired, speaks very little English and is cur-rently living in a homeless shelter. The nurse’s primary concerns should be the client’s: 1. Language barrier 2. Risk for tuberculosis 3. […]
The nurse is preparing the information that will be provided to the staff on the next shift. Which of the following should the nurse include in the inter-shift report to nursing colleagues? 1. Audit of client care procedures 2. The client’s diagnostic-related group 3. All routine care procedures required by the client 4. Instructions given […]
During the admission interview the client reports to the nurse that she is “a little allergic to peni-cillin.” Which of the following questions asked by the nurse is most likely to provide the most relevant information regarding the client’s possible allergy to penicillin? 1. “Who told you that you are allergic to penicillin?” 2. “What […]
The nurse is caring for a 6-kg 4-month-old infant who is hospitalized with a respiratory infection. The nurse knows that an infant this age needs approximately 108 kcal/kg of body weight. The nurse also understands that human breast milk provides approximately 20 kcal/oz. About how much breast milk does the nurse need to feed the […]
The nurse is preparing to leave a client’s isolation room. Which action should the nurse take first when removing a grossly soiled gown? 1. Grasp the sleeve of the dominant arm, and remove it with a gloved hand. 2. Release the neck ties of the gown and allow the gown to fall forward. 3. Untie […]
The client has experienced a myocardial infarction resulting in damage to the left ventricle. A possible complication the client may experience that the nurse is alert to is: 1. Jugular neck vein distention 2. Pulmonary congestion 3. Peripheral edema 4. Liver enlargement ANSWER ANS: 2 Pulmonary congestion may be experienced in left-sided heart failure. […]
To determine proper drug dosages for children, calculations are most precisely made on the basis of the child’s: 1. Weight 2. Height 3. Age 4. Body surface area ANSWER ANS: 4 The most accurate method of calculating pediatric doses is based on a child’s body surface area. Drug calculations are not most precise when […]
A client is complaining of having the same type of pain that he experienced prior to being diagnosed with cancer. The nurse realizes that which process will influence this client’s perception of pain? 1. Transmission 2. Modulation 3. Perception 4. Transduction ANSWER Correct Answer: 3 Rationale 1: Transmission is a process by which the […]
The nurse, while working with a client to support and assess spirituality should first: 1. Refer the client to the agency chaplain 2. Assist the client to use faith to get well 3. Provide a variety of religious literature 4. Determine the client’s personal belief system ANSWER ANS: 4 While working with a client […]
The nurse is preparing a client for an upper GI endoscopy. For which type of anesthesia should the nurse prepare the client to receive? 1. Local anesthesia 2. Spinal anesthesia 3. Epidural anesthesia 4. Conscious sedation ANSWER Correct Answer: 4 Rationale 1: Local anesthesia is used for minor surgical procedures such as suturing a […]
