Sexual experimentation is common among adolescents and should primarily be: 1. Discouraged 2. Encouraged 3. Accepted as normal adolescent behavior 4. Viewed as a means of determining sexual orientation ANSWER ANS: 4 Adolescence is often a time when individuals explore their primary sexual orientation. Although the behavior should not be discouraged or encouraged, in […]
Which of the following statements regarding utilization of personnel made by a new graduate nurse requires immediate follow-up by the nurse’s mentor? 1. “My LPN is really good with dressings, so I usually delegate them to her.” 2. “I always take the time to ambulate a post op client the first time out of bed.” […]
Which of the following interventions is the best example of an indirect intervention directed to-wards client safety? 1. Checking on a restrained client every 15 minutes 2. Performing hand hygiene between client contacts 3. Including the diagnosis at risk for injury related to falls to a client’s care plan 4. Turning on a night light […]
The presence of arterial insufficiency is suspected during an inspection of the lower extremities when the nurse observes: 1. Increased hair growth 2. Cooler skin temperatures 3. Marked edema 4. Brown pigmentation ANSWER ANS: 2 In the presence of arterial insufficiency, the client has signs resulting from an absence of blood flow, such as […]
An older client with mild musculoskeletal pain is being seen by the primary care provider. The nurse anticipates that treatment of this client’s level of discomfort will include: 1. Fentanyl 2. Diazepam 3. Acetaminophen 4. Meperidine hydrochloride ANSWER ANS: 3 A nonopioid analgesic, such as acetaminophen, is used to effectively treat mild musculoskeletal pain. […]
A client is scheduled to have abdominal ascites fluid removed. What should the nurse instruct the client about this procedure? 1. A catheter will be inserted into the bladder. 2. A liver biopsy will be done. 3. An abdominal paracentesis will be done. 4. A thoracentesis will be done. ANSWER Correct Answer: 3 Rationale […]
The nurse encourages the client to “relax and take a deep, slow breath” in order to prepare for a palpating assessment of the abdomen. The primary reason for this is to: 1. Encourage the client to be emotionally comfortable and relaxed 2. Distract the client from the actual possible discomfort the pressure may cause 3. […]
A client has actively picketed for gun control. During a robbery of his business, he was shot in the leg. As the nurse assists him with morning care, which statement would the nurse expect him to make that coincides with his values? 1. “Firearms may have a place in our society.” 2. “Individuals should arm […]
Which of the following would be the most appropriate outcome criterion for the goal, “Client’s pain will be managed to within an acceptable level within 30 minutes of receiving pain medica-tion.” 1. Client will deny presence of any pain or discomfort. 2. Client will rate pain at a level of 3 or less out of […]
When clustering data according to functional health patterns, the nurse determines that the client is only able to ambulate short distances without becoming fatigued and requires rest periods dur-ing morning care. The health pattern that requires intervention is identified by the nurse as: 1. Respiratory 2. Activity and exercise 3. Sleep and rest pattern 4. […]
