The nurse is planning teaching for a client that focuses on Healthy People 2020 objectives for cardiovascular health. Which modifiable risk factors should the nurse include in this teaching? 1. Age 2. Gender 3. Obesity 4. Smoking 5. Hypertension ANSWER Correct Answer: 3, 4, 5 Rationale 1: Age is a nonmodifiable risk factor. Rationale […]
Which of the following symptoms should the nurse assess with a client who is deprived of sleep? 1. Elevated blood pressure and confusion 2. Confusion and irritability 3. Inappropriateness and rapid respirations 4. Decreased temperature and talkativeness ANSWER ANS: 2 Psychological symptoms of sleep deprivation include confusion and irritability. Elevated blood pressure is not […]
The nurse is aware that there are medications that are taken that alter the client’s taste and may influence the dietary intake. In reviewing the medications taken by the clients on the unit, the nurse will consult with the nu-tritionist to develop a palatable meal plan for the client taking: 1. Ampicillin 2. Morphine 3. […]
A client has a new order for a medication that does not have a termination date. The nurse would place this medication order under which classification on the client’s medication administration record? 1. Standing 2. PRN 3. STAT 4. Single ANSWER Correct Answer: 1 Rationale 1: A standing order might not have a termination […]
The RN has just been stuck with a syringe while dropping it into a sharps container that was too full in a client’s room. What action should the nurse take first for this puncture wound? 1. Complete an injury report. 2. Encourage bleeding. 3. Initiate first aid. 4. Wash the area with soap and water. […]
An ambulatory client is admitted to the extended care facility with a diagnosis of Alzheimer’s disease. In using a falls assessment tool, the nurse knows that the greatest indicator of risk is: 1. Confusion 2. Impaired judgment 3. Sensory deficits 4. History of falls ANSWER ANS: 4 According to the falls assessment tool, the […]
The nurse is completing a preoperative assessment with a client. What should this assessment include? 1. Current health status 2. Allergies 3. Current medications 4. Mental status 5. Respiratory rate ANSWER Correct Answer: 1, 2, 3, 4 Rationale 1: When documenting the current health status, essential information includes general health status and the presence […]
The nurse is preparing to provide morning care to a client. What should the nurse explain to the client as the reason for a daily bath? 1. Assess skin integrity 2. Develop a nurse–client relationship 3. Moisturize the skin 4. Stimulate circulation ANSWER Correct Answer: 4 Rationale 1: Giving a bath to a client […]
The primary reason for documenting discontinued portions of the care plan when a client goal has been met is to ensure: 1. Effective use of both nursing time and resources 2. Delivery of both timely and relevant nursing care 3. Concrete evidence of successful outcome achievement 4. Minimal ineffective communication among the nursing staff […]
A registered nurse interprets a scribbled medication order by the attending physician as 25 mg. The nurse administers 25 mg of the medication to a client, and then discovers that the dose was incorrectly interpreted and should have been 15 mg. Who would ultimately be responsible for the error? 1. Attending physician 2. Assisting resident […]
