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A depressed client in an assisted living facility tells the nurse that "life isn’t worth living anymore." What is the best response to this statement?
A client, recovering from alcoholism, asks the nurse, "What can I do when I start recognizing relapse triggers within myself?" How might the nurse best respond?
A client with paranoid delusions stares at the nurse over a period of several days. The client suddenly walks up to the nurse and shouts "You think you? ‘re so perfect and pure and good." An appropriate response for the nurse is
A client with moderate persistent asthma is admitted for a minor surgical procedure. On admission the peak flow meter is measured at 480 liters/minute. Post-operatively the client is complaining of chest tightness. The peak flow has dropped to 200 liters/minute. What should the nurse do first?
A client with Guillain Barre is in a nonresponsive state, yet vital signs are stable and breathing is independent. What should the nurse document to most accurately describe the client’s condition?
A client with anorexia is hospitalized on a medical unit due to electrolyte imbalance and cardiac dysrhythmias. Additional assessment findings that the nurse would expect to observe are
A client with a documented pulmonary embolism has the following arterial blood gases: PO2 – 70 mm hg, PCO2 – 32 mm hg, pH – 7.45, SaO2 – 87%, HCO3 – 22. Based on these data, what is the first nursing action?
A client with a diagnosis of Methicillin resistant Staphylococcus aureus (MRSA) has died. Which type of precautions is appropriate to use when performing postmortem care?
A client who is a former actress enters the day room wearing a sheer nightgown, high heels, numerous bracelets, bright red lipstick and heavily rouged cheeks. Which nursing action is the best in response to the client? ‘s attire?
A client was admitted to the eating disorder unit with bulimia nervosa. The nurse assessing for a history of complications of this disorder expects
A client tells the nurse, "I have something very important to tell you if you promise not to tell." The best response by the nurse is
A client receiving chlorpromazine HCL (Thorazine) is in psychiatric home care. During a home visit the nurse observes the client smacking her lips alternately with grinding her teeth. The nurse recognizes this assessment finding as what?
A client is scheduled for an intravenous pyelogram (IVP). Which of the following data from the client? ‘s history indicate a potential hazard for this test?
A client is recovering from a thyroidectomy. While monitoring the client’s initial post-operative condition, which of the following should the nurse report immediately?
A client is being treated for paranoid schizophrenia. When the client became loud and boisterous, the nurse immediately placed him in seclusion as a precautionary measure. The client willingly complied. The nurse? ‘s action
A client is admitted with infective endocarditis (IE). Which finding would alert the nurse to a complication of this condition?
A client is admitted to the rehabilitation unit following a cerebral vascular accident (CVA) and mild dysphagia. The most appropriate intervention for this client is to
A client is admitted to the emergency room following an acute asthma attack. Which of the following assessments would be expected by the nurse?
A client is admitted to a voluntary hospital mental health unit due to suicidal ideation. The client has been on the unit for 2 days and now states ? “I demand to be released now!? ” The appropriate from the nurse is
A client is admitted to a psychiatric unit with delusions. What findings could the nurse observe that would be consistent with delusional thought patterns?
A client is admitted for treatment of a right upper lobe infiltrate and to rule out tuberculosis. Which of these would be the most appropriate self-protective action by the nurse ?
A client has returned to the unit following a renal biopsy. Which of the following nursing interventions is appropriate?
A client has been tentatively diagnosed with Graves’ disease (hyperthyroidism). Which of these findings noted on the initial nursing assessment requires quick intervention by the nurse?
A client has been hospitalized after an automobile accident. A full leg cast was applied in the emergency room. The most important reason for the nurse to elevate the casted leg is to
A client has been admitted with a fractured femur and has been placed in skeletal traction. Which of the following nursing interventions should receive priority?
A client has been admitted to the coronary care unit with a myocardial infarction. Which nursing diagnosis should have priority?
A client has an order for 1000 ml of D5W over an 8 hour period. The nurse discovers that 800 ml has been infused after 4 hours. What is the priority nursing action?
A client has a nasogastric tube after colon surgery. Which one of these tasks can be safely delegated to an unlicensed assistive personnel (UAP)?
A client had 20 mg of Lasix (furosemide) PO at 10 AM. Which would be essential for the nurse to include at the change of shift report?
A client enters the emergency department unconscious via ambulance. What document should be given priority to guide the direction of care for this client?
A client diagnosed with hepatitis C discusses his health history with the admitting nurse. The nurse should recognize which statement by the client as the most important?
A 72 year-old client with osteomyelitis requires a 6 week course of intravenous antibiotics. In planning for home care, what is the most important action by the nurse?
A 42 year-old male client refuses to take propranolol hydrochloride (Inderal) as prescribed. Which client statement from the assessment data is likely to explain his noncompliance?
A 16 year-old enters the emergency department. The triage nurse identifies that this teenager is legally married and signs the consent form for treatment. What would be the appropriate action by the nurse?
You are the charge nurse on the 3 P.M. to 11 P.M. shift. The nurses on this shift range from novice to competent. What response would be expected in the beginner stage of clinical competence development when the nurse is assigned a patient on beta-blockers and scheduled for a stress test?
Workplace violence can be initiated by an employee in the workplace as well as by patients or family members. Which of the following would be cause for concern when observed in an employee?
Which statement regarding informed consent is correct? Informed consent:
Which patient should be considered the highest priority by the charge nurse?
Which of the following would constitute negligence if performed by a nurse?
Which of the following represents a short-term goal for an organization?
Which of the following are some of the qualities found in a team player? Select all that apply.
Which of the following are included in the guidelines for valuable, effective acknowledgement of each member’s contribution to the team?
Which must be reported to legal authorities in some states in North America?
Which measure can be used to avoid ethical dilemmas in the health care setting?
Which is most appropriate for the new graduate when preparing for the first interview?
Which factors have influenced the U.S. health care delivery system? Select all that apply.
Which ethical principle should help guide the nurse who suspects another nurse is incorrectly charting pain medications and then taking them?
Which are examples of violations of the Health Insurance Portability and Accountability Act (HIPAA)? Select all that apply.
Which ANA Principles for Nurse Staffing standards are applied to patient care?
Which ANA Principles for Nurse Staffing standard is applied to the organization?
Which ANA Principles for Nurse Staffing standard is applied to staffing?
Which advice to the new graduate regarding their first nursing position is best?
Which activity should be considered the highest priority by the RN?
Which actions are a violation of the Health Insur- ance Portability and Accountability Act of 1996 (HIPAA)? Select all that apply.
When leading a team, a middle performing leader is seen as having which abilities?
When nurses are confronted with ethical dilemmas that challenge their values and beliefs, what is the best source to rely on to make the right decision?
When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Quality best describes which characteristic?
When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Financial best describes which characteristic?
When referring to the critical success factors (CSFs) that organizations use for developing their strategic plans, the term Growth best describes which characteristic?
When studying for the NCLEX-RN exam, the new graduate should be able to determine which tasks to delegate to which employee. Which tasks are appropriately delegated to the UAP?
When studying for the NCLEX-RN exam, the new graduate should be able to determine which tasks to delegate to which employee. Which tasks are appropriately delegated to the LPN?
When studying for the NCLEX-RN exam, the new graduate should be able to determine which tasks to delegate to which employee. Which task would require an intervention if performed by the UAP?
When studying for the NCLEX-RN exam, the new graduate should be able to determine which tasks to delegate to which employee. Which tasks would require an intervention if performed by the LPN?
When taking the NCLEX-RN exam, the new graduate realizes that most of the questions will address nursing in which unit?
When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the M (measure) refers to:
When using the DMAIC acronym of the Six Sigma quality process improvement model, the nurse understands that the I (improve) refers to:
When leading a team, a low performing leader is seen as having which abilities?
When leading a team, a high performing leader is seen as which type of leader?
When interviewing with the nurse manager, the new nurse should be prepared to ask about:
When interviewing for a position at a new facility, the nurse managers ask to review the mission, vision, and values statements because they understand that these statements provide information about the organization’s:
When identifying the objectives in an organization’s action plan, what would be an essential tool to use to improve performance?
When healthy, a patient had requested that all life-sustaining measures be implemented. Now the patient has Alzheimer’s and had a deterioration in health that severely limits quality of life. The patient’s only child is petitioning that the parent not be placed on life support again and be given only palliative care. The nurse assessing this ethical situation following the procedure would place the steps in what order?
a. Discuss with the ethics committee possible alternatives that would be acceptable to the family while considering the patient’s wishes.
b. After the family presents two alternatives, work with the committee and family to agree on one alternative.
c. Provide rationale for the selection made.
d. Carefully assess the situation to identify the ethical issue and concerns.
When following up with a thank-you letter to the nurse manager after an interview, the new nurse should include:
When establishing a unit action plan, the nurse manager identifies steps to be taken to accomplish the goal. What is most important for achieving the goal?
When eligible, the new nurse is encouraged to sit for a certification exam in their specialty area. What is the best reason for “going this extra mile”?