Predictive exam I

A nurse stops to assist an individual who was involved in a motor vehicle accident and thrown from the car.

When the nurse assists at the scene of an accident, what emergency measure should the nurse perform first?

The nurse evaluates the medication profile because of the increased risk for falls.

On the basis of the client’s fall risk assessment, what interventions should the nurse implement? Select all that apply.

A client who wears a hearing aid is frustrated by the loud and shrill noise (feedback) that is occasionally heard.

If a client who has recently experienced diminished hearing takes medications from each of the following drug categories, which one is most likely to have affected the client’s hearing?

After thyroidectomy surgery, the client is returned to the nursing unit in stable condition.

Postoperatively, for what activity should the nurse provide further instruction if seen when caring for the client with the thyroidectomy?

The results of the diagnostic tests confirm that the client has myxedema.

In addition to amenorrhea, what other signs of myxedema is the nurse likely to observe in this client? Select all that apply.

A client is diagnosed with angina pectoris. Sublingual nitroglycerin tablets are prescribed for whenever the client experiences chest pain.  Following client instruction of the correct medication regimen, which client statement confirms successful teaching?

A client has just completed a cardiac catheterization and coronary arteriogram.

The nurse provides discharge instructions for the client who has now recovered. What instructions should be included?

Select all that apply.

A 67-year-old client has developed venous stasis injuries on the lower leg.

A client returns to the wound clinic for evaluation of a stasis injury. What nursing observation confirms healing progress?

Heparin sodium 7,500 units subcutaneously daily is prescribed.

When the nurse withdraws the heparin sodium from the multidose vial, what technique is correct?

The nursing team develops a care plan for a client who has been diagnosed with cancer of the larynx. The client is scheduled for a total laryngectomy. After surgery, the client is taken to the recovery room until stabilized.

What assessment finding noted by the nurse on the client’s return to the room is an early indication that the client’s oxygenation status is compromised?

The client is given a prescription for codeine-guaifenesin 10-100 for cough.

What nursing instruction regarding the prescribed medication is most important to tell this client?

The client who has been diagnosed with pneumonia has difficulty expectorating respiratory secretions.

What nursing action is most appropriate when planning to obtain the prescribed sputum specimen?

The nurse chooses to use the vastus lateralis muscle as the site for the I.M. vitamin B12 injection.

If the correct technique for administering the injection is followed, the nurse should give the injection in what location?

In anticipation of transferring the client to a nursing home, a gastrostomy tube is inserted to provide nourishment.

Immediately after the gastrostomy tube is inserted, what finding should the nurse consider normal when assessing drainage around the gastrostomy tube?

The client’s discharge prescriptions have been written, and radiation therapy is scheduled the following week.

Before discharge, the nurse prepares the client about the expected side effects of radiation therapy. What topic(s) should the nurse include in the discharge plan? Select all that apply.

The client returns from surgery with an infusing I.V., nasogastric tube, a T-tube for bile drainage, and a Jackson-Pratt tube for wound drainage in place.

Immediately after surgery, the nurse assesses the drainage from the T-tube. What assessment finding best indicates that the drainage color is normal at this time?

The client then asks the nurse to contrast the lithotripsy procedure with the laparoscopic procedure.

What statements made by the nurse provide the key points of laparoscopic cholecystectomy, clarifying the procedure?

Select all that apply.

While being prepared for an annual gynecologic examination, the nurse notes a herpes simplex type 1 mouth lesion that the client refers to as a “cold sore.”

What statement made by the client indicates to the nurse that further instruction regarding herpes simplex is needed?

The client has an advance directive that requests no aggressive treatment. The client is referred for hospice care.

If the client has pain medication prescribed every 3 to 4 hours as necessary, what action by the hospice nurse is most appropriate to promote maximum comfort at this time?

The steroids methylprednisolone and prednisone are both prescribed on alternate days by oral administration to treat the client’s inflammatory process.

When the client questions why both drugs are not taken daily, what response by the nurse is most appropriate?

The client is scheduled for intravenous pyelography (IVP). The nurse prepares to administer a laxative to the client.

If the client makes the following statements, what information is most important to report before the client undergoes an intravenous pyelography (IVP)?

A middle-aged client presents to the clinic with vague symptoms of malaise and headache. Even though these symptoms are rather unremarkable, the client is diagnosed with acute glomerulonephritis.

When the nurse interviews the client, what event most likely precipitated glomerulonephritis?

Because of her persistent symptoms, the client chooses to undergo surgery to correct the cystocele. She is instructed to catheterize herself for approximately 1 week after being discharged.

A postmenopausal woman receives a prescription for alendronate. What health teaching information should the nurse provide?

Select all that apply.

The client’s breast tumor is confirmed as malignant, and she undergoes a left modified radical mastectomy.

When ambulating a client recovering after a modified radical mastectomy, what action is best for reducing the client’s potential for postural instability and falling?

A child is brought to the emergency room with burns over 50% of the body. Using a modified “Rule of Nines” to estimate the percentage of the body surface area burned, the practical nurse (PN) considers which part of the child’s body is proportionally larger than an adult’s?

A client’s statement should indicate to the practical nurse (PN) that the client understands how HIV is transmitted?

Cushing syndrome results from hypersecretion of glucocorticoids in the adrenal cortex. Based on the clinical manifestations of Cushing syndrome, which intervention should the practical nurse (PN) implement that is most appropriate for a client who is newly diagnosed with Cushing syndrome?

Following heparin treatment for a pulmonary embolism, a client is being discharged with a prescription for warfarin. During discharge teaching, the practical nurse (PN) reinforces the importance of regularly having diagnostic tests after discharge?

The nurse is caring for a client who practices Islam and is expected to die during the shift. Which of the following questions should the nurse ask the client’s family members?

A client who develops oral candidiasis receives a prescription for nystatin 500,000 units swish and swallow 4 times daily. The medication contains 100,000 units/1 mL. How many teaspoons should the practical nurse (PN) administer daily? (Enter numeric value only.)

A 62-year-old female who lives alone tripped on a rug in her home and fractured her hip at the femur’s proximal end. Which predisposing factor should the practical nurse (PN) identify that most likely contributed to the fracture?

An adolescent female client diagnosed with anorexia nervosa wants to serve dinner trays to other clients on a psychiatric unit. What action should the practical nurse (PN) take?

An obese client discusses with the practical nurse (PN) that the client plans to begin a long-term weight loss regimen. In addition to dietary changes, the plans include an intensive aerobic exercise program 3 to 4 times a week and stress management, classes. After praising the client for these decisions, which information is most important for the PN to provide?

A client in a long-term care facility reports to the practical nurse (PN) that he has not had a bowel movement in 2 days. Which intervention should the PN implement first?

The practical nurse (PN) reinforces instructions in using a gait belt to a caregiver whose spouse has right-sided weakness and needs assistance with ambulation. The caregiver-spouse performs a return demonstration of the skill. Which observation by the PN indicates that the caregiver-spouse has learned to perform this procedure correctly?

An adult client is admitted with a possible kidney tumor and is scheduled for an intravenous pyelogram (IVP) in the morning. The practical nurse (PN) should prepare the client before the IVP by implementing which protocol?

A client with type 2 diabetes mellitus is admitted to treating an ulcer on the left foot’s heel that has not healed with conventional wound care. The practical nurse (PN) observes that the entire left foot is paler in color than the right foot. Which additional symptom should the PN expect to find?

During a well-child clinic visit, the practical nurse (PN) teaches the parents of a toddler about the prevention of accidental poisonings. What information should the PN reinforce?

The practical nurse (PN) is obtaining a lie-sit-stand blood pressure reading on a client. Which action is most important for the PN to implement?

The nurse observes the unlicensed assistive personnel assigned to a client who just returned from having a bronchoscopy. What action by the nursing assistant would prompt the nurse to intervene?

When changing a sterile abdominal dressing, what nursing action(s) supports the principles of asepsis? Select all that apply.

The nurse is caring for a client who has experienced a cerebral aneurysm and is in grave condition. In determining the client’s health care wishes, what documentation is most helpful?

What assessment finding(s) provides the nurse with the best indication that a client’s tracheostomy needs suctioning?

Select all that apply.

Before suctioning a client with a tracheostomy, what nursing action should the nurse perform first?

A nurse is a volunteer answering telephone calls on a hotline at a crisis center.

When the nurse responds to a call from a 22-year-old victim of sexual assault, what instruction is most important before referring the client to the local hospital’s emergency department?

The nurse is updating the care plan of a client with diabetes who has maintained hemoglobin A1C levels between 5% (5.6 mmol/L) and 5.5% (6.6 mmol/L) for the past 12 months. What documentation on the plan of care is most appropriate?

A couple who has been childless for 10 years becomes the parents of a newborn with Down syndrome. To help the parents cope with their disappointment and loss of their “perfect” newborn, what nursing action is most appropriate initially?

When the nurse brings the newborn with Down syndrome to the mother’s room, the spouse says, “These health care providers do not know anything. We are going to consult specialists.” What is the response by the nurse to the parents most appropriate at this time?

During a routine prenatal visit, the health care provider determines that a client in the 4th month of pregnancy is not eating an appropriate diet and asks whether she has been taking the prenatal vitamins, folic acid, and iron supplements previously prescribed. The health care provider asks the nurse to instruct the client about nutritional needs during pregnancy. Before teaching the client about the nutritional needs during pregnancy, what nursing intervention is most appropriate?

A male client is expressing frustration with urination at his health care provider’s appointment. The client states, “I am coming to that age where I am having difficulty with urination. I suppose that it has to do with my enlarged prostate gland.” What assessment finding strongly suggests that a client with an enlarged prostate gland is experiencing urinary retention?

The unlicensed assistive personnel (UAP) is assigned to care for a client who has returned from having a transurethral resection of the prostate (TURP) with a three-way catheter in place. The UAP reports extremely bloody drainage from the client’s catheter. What nursing action is most appropriate at this time?

The client who had an open cholecystectomy develops postoperative nausea and vomiting. Metoclopramide 10 mg is prescribed. What adverse effect associated with metoclopramide should the nurse report immediately?

The nurse provides crushed ice chips in an 8-ounce glass to the client who mouth breathes. Which nursing action provides the most accurate intake amount?

A client who develops a benign parathyroid tumor manifests signs of hyperparathyroidism. The unlicensed assistive personnel assigned to this client asks why the care plan indicates that the client is at risk for falls and injury. What is the best nursing explanation?

Postoperatively, the client reports having a great deal of discomfort in the bladder area. There are several analgesic drug prescriptions for the client in anticipation of the pain associated with the prostate’s transurethral resection (TURP). What medication is most appropriate to administer to the client who is having bladder spasms?

Because a client has daily repeated angina episodes, the nitroglycerin tablets are discontinued and replaced with a prescription for a daily nitroglycerin transdermal patch. What nursing action is most appropriate when applying a new transdermal patch?

A client diagnosed with angina has been advised to reduce consumption of saturated fat to control coronary artery disease progression (CAD). When the nurse assesses the client’s dietary compliance, what is the most appropriate fat for cooking?

The client will take warfarin daily. What client statement offers the best evidence to the nurse that the client understands the information that should be reported following discharge?

A 75-year-old client in a skilled nursing facility has the peripheral arterial disease (PAD). The client with PAD says to the nurse, “No matter what I do, my legs get painful and then numb.” What nursing response is best?

Leuprolide is prescribed for the client after the prostatectomy. What statement(s) by the client provides the best evidence that he understands the benefits of this type of hormonal therapy? Select all that apply.

The college student is diagnosed with hepatitis A. When the client asks the nurse how hepatitis A was acquired, what is the best answer?

While a client is waiting to undergo percutaneous transluminal coronary angioplasty (PTCA), the nurse administered the prescribed propranolol. What information validates that the nurse will be giving the medication to the right client? Select all that apply.

The nurse is reviewing laboratory data before administering the morning dose of digoxin. Which nursing action is best?

The nurse chooses to inject the prescribed dose of penicillin into the ventrogluteal injection site. If a client is allergic to penicillin, which medication would the nurse question?

The health care provider prescribes a combination of rifampin and isoniazid to treat the client’s tuberculosis. When the client asks the nurse why the health care provider has prescribed two drugs, what response is most accurate?

The client’s I.V. line has infiltrated and needs to be removed and restarted in a new site. The licensed practical/vocational nurse (LPN/LVN) collaborates with the registered nurse (RN) as part of the health care team. Once the new I.V. site is infusing, what nursing action is most appropriately delegated to the LPN?

The client with poor vision and type 1 diabetes mellitus must learn to combine two insulins—regular and intermediate-acting—and self-administer the injection before being discharged. If the nurse would suggest an insulin administration option, what item would most ensure the client’s success?

A spinal tap will be performed to confirm a diagnosis of meningitis. While awaiting the diagnostic test results for a client with possible meningitis, what transmission-based precautions are best to implement?

The nurse is admitting an older adult client to the acute care medical unit. Which assessment factor alerts the nurse that this client has a risk for acid-base imbalances?

A 6-year-old child who received chemotherapy and had anorexia is now cheerfully eating peanut butter, yogurt, and applesauce. When the mother arrives, the child refuses to eat and throws the dish on the floor. What is the nurse’s best response to this behavior?

After emergency endotracheal intubation, the health care team and the nurse must verify tube placement before securing the tube. What is the most accurate bedside assessment that can be performed immediately after the tube is placed?

Which information will the nurse include when teaching a group of 20-year-old women about emergency contraception with levonorgestrel (the morning-after pill)? Select all that apply.

The health care provider (HCP) prescribes a permethrin application for all family members of a client who has scabies. Which client information will be most important for the nurse to discuss with the HCP before the client teaching about the medication?

The charge nurse would assign the nursing care of which patient to an LPN/LVN, working under an RN’s supervision?

A 13-year-old student takes a gun to school and murders a teacher. Considering the principles of crisis intervention, when is the nurse’s best time to advocate assistance to those affected by this incident?