301-400

Question 1

301. In monitoring tissue perfusion in a client following an above the knee amputation (aka), which action should the nurse include in the plan of care?

Answer 1

Evaluate closet proximal pulse.

Question 2

302. The leg of a client who is receiving hospice care have become mottled in appearance. When the nurse observes the unlicensed assistive personal (UAP) place a heating pad on the mottled areas, what action should the nurse take?

Answer 2

Remove the heating pads and place a soft blanket over the client’s leg and feet.

Question 3

303. A client who underwent an uncomplicated gastric bypass surgery is having difficult with diet management. What dietary instruction is most important for the nurse to explain to the client?

Answer 3

Plan volume-controlled evenly-space meal thorough the day

Question 4

304. If the nurse is initiating IV fluid replacement for a child who has dry, sticky mucous membranes, flushed skin, and fever of 103.6 F. Laboratory finding indicate that the child has a sodium concentration of 156 mEq/L. What physiologic mechanism contributes to this finding?

Answer 4

Insensible loss of body fluids contributes to the hemoconcentration of serum solutes

Question 5

305. During a Woman’s Health fair, which assignment is the best for the Practical Nurse (PN) who is working with a register nurse (RN)

Answer 5

Prepare a woman for a bone density screening

Question 6

306. An adult client present to the clinic with large draining ulcers on both lower legs that are characteristics of Kaposi’s sarcoma lesions. The client is accompanied by two family member. Which action should the nurse take

Answer 6

Send family to the waiting area while the client’s history is taking

Question 7

307. An adult client is exhibit the maniac stage of bipolar disorder is admitted to the psychiatric unit. The client has lost 10 pounds in the last two weeks and has no bathed in a week “I’m trying to start a new business and “I’m too busy to eat”. The client is oriented to time, place, person but not situation. Which nursing problem has the greatest priority?

Answer 7

Imbalance Nutrition

Question 8

308. The nurse is preparing a discharge teaching plan for a client who had a liver transplant. Which instruction is most important to include in this plan?

Answer 8

Avoid crowds for first two months after surgery.

Question 9

309. The nurse is assessing a client’s nailbeds. Which appearance indicates further follow-up is needed for problems associated with chronic hypoxia?

Answer 9

Please see image for Q 309

Question 10

310. A client who had a percutaneous transluminal coronary angioplasty (PTCA) two weeks ago returns to the clinic for a follow up visit. The client has a postoperative ejection fraction ejection fraction of 30%. Today the client has lungs which are clear, +1 pedal edema, and a 5pound weight gain. Which intervention the nurse implement

Answer 10

Assess compliance with routine prescriptions.

Question 11

311. The RN is assigned to care for four surgical clients. After receiving report, which client should the nurse see first? The client who is

Answer 11

Three days postoperative colon resection receiving transfusion of packed RBCs.

Question 12

312. The nurse is preparing an older client for discharge following cataract extraction. Which instruction should be include in the discharge teaching?

Answer 12

Avoid straining at stool, bending, or lifting heavy objects

Question 13

313. The healthcare provider prescribes potassium chloride 25 mEq in 500 ml D_5W to infuse over 6 hours. The available 20 ml vial of potassium chloride is labeled, “10 mEq/5ml.” how many ml of potassium chloride should the nurse add the IV fluid? (Enter numeric value only. If is rounding is required, round to the nearest tenth.)

Answer 13

12.5

Question 14

314. At 40 week gestation, a laboring client who is lying is a supine position tells the nurse that she has finally found a comfortable position. What action should the nurse take?

Answer 14

Place a wedge under the client’s right hip.

Question 15

315. A client with a history of diabetes and coronary artery disease is admitted with shortness of breath, anxiety, and confusion. The client’s blood pressure is 80/60 mmHg, heart rate 120 beats/minute with audible third and fourth heart sounds, and bibasilar crackles. The client’s average urinary output is 5 ml/hour. Normal saline is infusing at 124 ml/hour with a secondary infusion of dopamine at mcg/kg/minute per infusion pump. With intervention should the nurse implement?

Answer 15

Titrate the dopamine infusion to raise the BP.

Question 16

316. The nurse ends the assessment of a client by performing a mental status exam. Which statement correctly describes the purpose of the mental status exam?

Answer 16

Evaluate the client’s mood, cognition and orientation.

Question 17

317. An older adult resident of a long-term care facility has a 5-year history of hypertension. The client has a headache and rate the pain 5 on a pain scale 0 to 10. The client’s blood pressure is currently 142/89. Which interventions should the nurse implement? (Select all that apply)

Answer 17

• Administer a daily dose of lisinopril as scheduled.

* Provide a PRN dose of acetaminophen for headache

Question 18

318. When conducting diet teaching for a client who is on a postoperative soft diet, which foods should eat? (Select all that apply)

Answer 18

• Pasta, noodles, rice.
• Egg, tofu, ground meat.
• Mashed, potatoes, pudding, milk.

Question 19

319. The nurse is preparing a 4-day-old infant with a serum bilirubin level of 19 mg/dl (325 micromol/L) for discharge from the hospital. When teaching the parents about home phototherapy, which instruction should the nurse include in the discharge teaching plan?

Answer 19

Reposition the infant every 2 hours.

Question 20

320. When planning care for a client with acute pancreatitis, which nursing intervention has the highest priority?

Answer 20

Withhold food and fluid intake.

Question 21

321. Assessment by the home health nurse of an older client who lives alone indicates that client has chronic constipations. Daily medications include furosemide for hypertension and heart failure and laxatives. To manage the client’s constipation, which suggestions should the nurse provide? (Select all that apply)

Answer 21

• Include oatmeal with stewed pruned for breakfast as often as possible.
• Increase fluid intake by keeping water glass next to recliner.
• Recommend seeking help with regular shopping and meal preparation.

Question 22

322. A young boy who is in a chronic vegetative state and living at home is readmitted to the hospital with pneumonia and pressure ulcers. The mother insists that she is capable of caring for her son and which action should the nurse implement next?

Answer 22

Determine the mother’s basic skill level in providing care.

Question 23

323. After the risk and benefits of having a cardiac catheterization are reviewed by the healthcare provider, an older adult with unstable angina is scheduled for the procedure. When the nurse presents the consent form for signature, the client asks how the wires will keep a heart heating during the procedure. What action should the nurse take?

Answer 23

Notify the healthcare provider of the client’s lack of understanding.

Question 24

324. In assessing a client at 34-weeks’ gestation, the nurse notes that she has a slightly elevated total T4 with a slightly enlarged thyroid, a hematocrit of 28%, a heart rate of 92 beats per minute, and a systolic murmur. Which finding requires follow-up?

Answer 24

Hematocrit of 28%.

Question 25

325. A client with osteoporosis related to long-term corticosteroid therapy receives a prescription for calcium carbonate. Which client’s serum laboratory values requires intervention by the nurse?

Answer 25

Creatinine 4 mg/dl (354 micromol/L SI)

Question 26

326. A clinical trial is recommended for a client with metastatic breast cancer, but she refuses to participate and tells her family that she does not wish to have further treatments. The client’s son and daughter ask the nurse to try and convince their mother to reconsider this decision. How should the nurse respond?

Answer 26

Explore the client’s decision to refuse treatment and offer support

Question 27

327. An adult client with severe depression was admitted to the psychiatric unit yesterday evening. Although the client ran one year ago, his spouse states that the client no longer runs, bur sits and watches television most of the day. Which is most important for the nurse to include in this client’s plan of care for today?

Answer 27

Assist client in identifying goals for the day.

Question 28

328. An adult who is 5 feet 5 inches (165.1 cm) tall and weighs 90 lb. (40.8 Kg) is admitted with a diagnosis of chronic anorexia. The client receives a regular diet for 2 days, and the client’s medical records indicates that 100% of the diet provided has been consumed. However the client’s weight on the third day morning after admission is 89 lb. (40.4 Kg). What action should the nurse implement?

Answer 28

Assign staff to monitor what the client eats.

Question 29

329. A client exposed to tuberculosis is scheduled to begin prophylactic treatment with isoniazid. Which information is most important for the nurse to note before administering the initial dose?

Answer 29

Current diagnosis of hepatitis B.

Question 30

330. The nurse walks into a client’s room and notices bright red blood on the sheets and on the floor by the IV pole. Which action should the nurse take first?

Answer 30

Identify the source and amount of bleeding.

Question 31

331. During a routine clinic visit, an older female adult tells the nurse that she is concerned that the flu season is coming soon, but is reluctant to obtain the vaccination. What action should the nurse take first?

Answer 31

Discuss the concerns expressed by the client about the vaccination.

Question 32

332. A client is admitted with acute pancreatitis. The client admits to drinking a pint of bourbon daily. The nurse medicates the client for pain and monitors vital signs q2 hours. Which finding should the nurse report immediately to the healthcare provider?

Answer 32

Confusion and tremors.

Question 33

333. The nurse is teaching a mother of a newborn with a cleft lip how to bottle feed her baby using medela haberman feeder, which has a valve to control the release of milk and a slit nipple opening. The nurse discusses placing the nipple’s elongated tip in the back of the oral cavity. What instructions should the nurse provide the mother about feedings?

Answer 33

Hold the newborn in an upright position

Question 34

334. Following and gunshot wound, an adult client a hemoglobin level of 4 grams/dl (40 mmol/L SI). The nurse prepares to administer a unit of blood for an emergency transfusion. The client has AB negative blood type and the blood bank sends a unit of type A Rh negative, reporting that there is not type AB negative blood currently available. Which intervention should the nurse implement?

Answer 34

Transfuse Type A negative blood until type AB negative is available.

Question 35

335. A young adult female college student visits the health clinic in early winter to obtain birth control pills. The clinic nurse asks if the student has received an influenza vaccination. The student stated she did not receive vaccination because she has asthma. How should the nurse respond?

Answer 35

Offer to provide the influenza vaccination to the student while she is at the clinic

Question 36

336.A client with eczema is experiencing severe pruritus. Which PRN prescriptions should the nurse administer? (Select all that apply)

Answer 36

* Topical corticosteroid. | * Oral antihistamine

Question 37

337. The nurse is using a straight urinary catheter kit to collect a sterile urine specimen from a female client. After positioning am prepping this client, rank the actions in the sequence they should be implemented. (Place to first action on the top on the last action on the bottom.)

Answer 37

* 1. Open the sterile catheter kit close to the client’s perineum. * 2. Don sterile gloves and prepare to sterile field * 3. Cleanse the urinary meatus using the solution, swabs, and forceps provided * 4. Place distal end of the catheter in sterile specimen cup and insert catheter into meatus

Question 38

338. An adult male was diagnosed with stage IV lung cancer three weeks ago. His wife approaches the nurse and asks how she will know that her husband's death is imminent because their two adult children want to be there when he dies. What is the best response by the nurse?

Answer 38

Explain that the client will start to lose consciousness and his body system will slow down

Question 39

339. When should intimate partner violence (IPV) screening occur?

Answer 39

As a routine part of each healthcare encounter

Question 40

340. A child newly diagnosed with sickle cell anemia (SCA) is being discharged from the hospital. Which information is most important for the nurse to provide the parents prior to discharge?

Answer 40

Instructions about how much fluid the child should drink daily

Question 41

341. What action should the school nurse implement to provide secondary prevention to a school-age children?

Answer 41

Initiate a hearing and vision screening program for first-graders

Question 42

342. While assisting a client who recently had a hip replacement into a bed pan, the nurse notices that there is a small amount of bloody drainage on the surgical dressing, the client’s skin is warm to the touch, and there is a strong odor from the urine. Which action should the nurse take?

Answer 42

Measure the client’s oral temperature

Question 43

343. While making rounds, the charge nurse notices that a young adult client with asthma who was admitted yesterday is sitting on the side of the bed and leaning over the bed-side-table. The client is currently receiving at 2 litters/minute via nasal cannula. The client is wheezing and is using pursed-lip breathing. Which intervention should the nurse implement?

Answer 43

Administer a nebulizer Treatment

Question 44

344. A client with emphysema is being discharged from the hospital. The nurse enters the client’s room to complete discharge teaching. The client reports feeling a little short of breath and is anxious about going home. What is the best course of action?

Answer 44

Provide only necessary information in short, simple explanations with written instructions to take home

Question 45

345. An older adult male who had an abdominal cholecystectomy has become increasingly confused and disoriented over the past 24 hours. He is found wandering into another client’s room and is return to his room by the unlicensed assistive personnel (UAP). What actions should the nurse take? (Select all that apply).

Answer 45

* Report mental status change to the healthcare provider * Assess the client’s breath sounds and oxygen saturation * Review the client’s most recent serum electrolyte values

Question 46

346. A client is admitted to a medical unit with the diagnosis of gastritis and chronic heavy alcohol abuse. What should the nurse administered to prevent the development of Wernicke's syndrome?

Answer 46

Thiamine (Vitamin B1)

Question 47

347. When conducting diet teaching for a client who was diagnosed with nutritional anemia in pregnancy, which foods should the nurse encourage the client to eat? (Select all that apply)

Answer 47

* Fortified whole wheat cereals, whole-grain pasta, brown rice * Spinach, kale, dried raisins and apricots

Question 48

348. A client with type 2 diabetes mellitus is admitted for antibiotic treatment for a leg ulcer. To monitor the client for the onset of hyperosmolar hyperglycemic nonketotic syndrome (HHNS), what actions should the nurse take? (Select all that apply)

Answer 48

* Measure blood glucose * Monitor vital signs * Assessed level of consciousness

Question 49

349. An infant is receiving penicillin G procaine 220,000 units IM. The drug is supplied as 600,000 units/ml. How many ml should the nurse administer? (Enter numeric value only. If rounding is required, round to the nearest tenth)

Answer 49

0.4

Question 50

350. After receiving report, the nurse can most safely plan to assess which client last? The client with…

Answer 50

No postoperative drainage in the Jackson-Pratt drain with the bulb compressed

Question 51

351. The nurse instructs an unlicensed assistive personnel (UAP) to turn an immobilized elderly client with an indwelling urinary catheter every two hours. What additional action should the nurse instruct the UAP to take each time the client is turned?

Answer 51

Offer the client oral fluids

Question 52

352. The nurse is preparing a client who had a below-the-knee (BKA) amputation for discharge to home. Which recommendations should the nurse provide this client? (Select all that apply)

Answer 52

* Inspect skin for redness * Use a residual limb shrinker * Wash the stump with soap and water

Question 53

353. When assessing the surgical dressing of a client who had abdominal surgery the previous day, the nurse observes that a small amount of drainage is present on the dressing and the wound’s Hemovac suction device is empty with the plug open. How should the nurse respond?

Answer 53

• Recompress the wound suction device and secure to plug

Question 54

354. A mother brings her 4-month-old son to the clinic with a quarter taped over his umbilicus, and tells the nurse the quarter is supposed to fix her child’s hernia. Which explanations should the nurse provide?

Answer 54

This hernia is a normal variation that resolves without treatment.

Question 55

355. A client who is admitted to the intensive care unit with syndrome of inappropriate antidiuretic hormone (SIADH) has developed osmotic demyelination. Which intervention should the nurse implement first?

Answer 55

Evaluate swallow

Question 56

356. A client with possible acute kidney injury (AKI) is admitted to the hospital and mannitol is prescribed as a fluid challenge. Prior to carrying out this prescription, what intervention should the nurse implement?

Answer 56

Obtain vital signs and breath sounds.

Question 57

357. A male client with COPD smokes two packs of cigarettes per day and is admitted to the hospital for a respiratory infection. He complains that he has trouble controlling respiratory distress at home when using his rescue inhaler. Which comment from the client indicates to the nurse that he is not using his inhaler properly?

Answer 57

“After I squeeze the inhaler and swallow, I always feel a slight wave of nausea, bit it goes away”

Question 58

358. A nurse is planning to teach infant care and preventive measures for sudden infant death syndrome (SIDS) to a group of new parents. What information is most important for the nurse to include?

Answer 58

Ensure that the infant’s crib mattress is firm

Question 59

359. A 6 -years-old who has asthma is demonstrating a prolonged expiratory phase and wheezing, and has 35% personal best peak expiratory flow rate (PEFR). Based on these finding, which action should the nurse implement first?

Answer 59

Administer a prescribed bronchodilator.

Question 60

360. A client is receiving lactulose (Portalac) for signs of hepatic encephalopathy. To evaluate the client’s therapeutic response to this medication, which assessment should the nurse obtain?

Answer 60

Level of Consciousness

Question 61

361. When administering an immunization in an adult client, the nurse palpates and administer the injection one inch below the acromion process into the center of the muscle mass. The nurse should document that the vaccine was administered at what site?

Answer 61

Deltoid

Question 62

362. A primigravida a 40-weeks gestation with preeclampsia is admitted after having a seizure in the hot tub at a midwife’s birthing center. Based on documentation in the medical record, which action should the nurse implement? (Click on each chart tab for additional information. Please be sure to scroll to the bottom right corner of each tab to view all information contained in the client’s medical record.)

Answer 62

Continue to monitor the client’s blood pressure hourly

Question 63

363. A female nurse who took drugs from the unit for personal use was temporarily released from duty. After completion of mandatory counseling, the nurse has asked administration to allow her to return to work. When the nurse administrator approaches the charge nurse with the impaired nurse request, which action is best for the charge nurse to take?

Answer 63

Allow the impaired nurse to return to work and monitor medication administration

Question 64

364. In making client care assignment, which client is best to assign to the practical nurse (PN) working on the unit with the nurse?

Answer 64

An immobile client receiving low molecular weight heparin q12 h

Question 65

365. A client who is admitted to the intensive care unit with a right chest tube attached to a THORA-SEAL chest drainage unit becomes increasingly anxious and complain of difficulty breathing. The nurse determine the client is tachypneic with absent breath sounds in the client’s right lungs fields. Which additional finding indicates that the client has developed a tension pneumothorax?

Answer 65

Tracheal deviation toward the left lung.

Question 66

366. A low-risk primigravida at 28-weeks gestation arrives for her regular antepartal clinic visit. Which assessment finding should the nurse consider within normal limits for this client?

Answer 66

Pulse increase of 10 beats/minute

Question 67

367. The nurse discovers that an elderly client with no history of cardiac or renal disease has an elevated serum magnesium level. To further investigate the cause of this electrolyte imbalance, what information is most important for the nurse to obtain from the client’s medical history?

Answer 67

Frequency of laxative use for chronic constipation

Question 68

368. Which action should the nurse implement with auscultating anterior breath sounds? (Place the first action on top and last action on the bottom)

Answer 68

1. Place stethoscope in suprasternal area to auscultate for bronchial sounds 2. Auscultate bronchovesicular sounds from side to side the first and second intercostal spaces 3. Displace female breast tissue and apply stethoscope directly on chest wall to hear vesicular sounds 4. Document normal breath sounds and location of adventitious breath sounds

Question 69

369. A client with chronic alcoholism is admitted with a decreased serum magnesium level. Which snack option should the nurse recommend to this client?

Answer 69

Dry roasted almonds

Question 70

370. The nurse is preparing a teaching plan for an older female client diagnosed with osteoporosis. What expected outcome has the highest priority for this client?

Answer 70

Names 3 home safety hazards to be resolve immediately.

Question 71

371. The nurse is teaching a male adolescent recently diagnosed with type 1diabetes mellitus (DM) about self-injecting insulin. Which approach is best for the nurse to use to evaluate do you effectiveness of the teaching?

Answer 71

Observe him as he demonstrates self-injection technique in another diabetic adolescent

Question 72

372. A young adult woman visits the clinic and learns that she is positive for BRCA1 gene mutation and asks the nurse what to expect next. How should the nurse respond?

Answer 72

Explain that counseling will be provided to give her information about her cancer risk

Question 73

373. A mother runs into the emergency department with s toddler in her arms and tells the nurse that her child got into some cleaning products. The child smells of chemicals on hands, face, and on the front of the child's clothes. After ensuring the airway is patent, what action should the nurse implement first?

Answer 73

Determine type of chemical exposure

Question 74

374. The nurse assigned unlicensed assistive personnel (UAP) to apply antiembolism stockings to a client. The nurse and UAP enters the room, the nurse observes the stockings that were applying by the UAP. The UAP states that the client requested application of the stockings as seen on the picture, for increased comfort. What action should the nurse take?

Answer 74

Discussed effective use of the stockings with the client on UAP

Question 75

375. Nurses working on a surgical unit are concerned about the physicians treatment of clients during invasive procedures, such as dressing changes and insertion of IV lines. Clients are often crying during the procedures, and the physician is usually unconcerned or annoyed by the client’s response. To resolve this problem, what actions should the nurses take? (Arrange from the first action on the top of the list on the bottom)

Answer 75

1. Talk to the physician as a group in a non-confrontational manner. 2. Document concerns and report them to the charge nurse. 3. Submit a written report to the director of nursing. 4. Contact the hospital’s chief of medical services. 5. File a formal complaint with the state medical board.

Question 76

376. While changing a client’s chest tube dressing, the nurse notes a crackling sensation when gentle pressure is applied to the skin at the insertion site. What is the best action for the nurse to take?

Answer 76

Measure the area of swelling and crackling.

Question 77

377. To prevent infection by auto contamination during the acute phase of recovery from multiple burns, which intervention is most important for the nurse to implement?

Answer 77

Dress each wound separately

Question 78

378. The nurse is preparing an intravenous (IV) fluid infusion using an IV pump. Within 30 seconds of turning on the machine, the pump’s alarm beeps “occlusion”. What action should the nurse implement first?

Answer 78

Determine if the clamp on the IV tubing is released

Question 79

379. A client with arthritis has been receiving treatment with naproxen and now reports ongoing stomach pain, increasing weakness, and fatigue. Which laboratory test should the nurse monitor?

Answer 79

Hemoglobin

Question 80

380. The nurse assesses a child in 90-90 traction. Where should did nurse assess for signs of compartment syndrome?

Answer 80

Look at the picture. | Answer, its at the toes

Question 81

381. After receiving the Braden scale findings of residents at a long-term facility, the charge nurse should to tell the unlicensed assistive personnel (UAP) to prioritize the skin care for which client

Answer 81

An older man whose sheets are damped each time he is turned.

Question 82

382. A client with acute renal failure (ARF) is admitted for uncontrolled type 1 diabetes Mellitus and hyperkalemia. The nurse administers an IV dose of regular insulin per sliding scale. Which intervention is the most important for the nurse to include in this client’s plan of care?

Answer 82

Monitor the client’s cardiac activity via telemetry.

Question 83

383. A client with C-6 spinal cord injury rehabilitation. In the middle of the night the client reports a severe, pounding headache, and has observable piloerection or “goosebumps”. The nurse should asses for which trigger?

Answer 83

Full bladder

Question 84

384. A nurse working on an endocrine unit should see which client first?

Answer 84

A client taking corticosteroids who has become disoriented in the last two hours.

Question 85

385. A client is receiving and oral antibiotic suspension labeled 250 mg/2ml. The healthcare provider prescribes 200mg every 6 hours. How many ml should the nurse administer at each dose? (Enter numerical value only. If rounding is required, round to the nearest tenth)

Answer 85

1.6

Question 86

386. Four hours after surgery, a client reports nausea and begins to vomit. The nurse notes that the client has a scopolamine transdermal patch applied behind the ear. What action should the nurse take?

Answer 86

Notify the healthcare provider of the vomiting.

Question 87

387. The nurse identifies an electrolyte imbalance, an elevated pulse rate, and elevated BP for a client with chronic kidney disease. Which is the most important action for the nurse to take?

Answer 87

Auscultate for irregular heart rate.

Question 88

388. A client with persistent low back pain has received a prescription for electronic stimulator (TENS) unit. After the nurse applies the electrodes and turns on the power, the client reports feeling a tingling sensation. How should the nurse respond?

Answer 88

Determine if the sensation feels uncomfortable.

Question 89

389. A female client is extremely anxious after being informed that her mammogram was abnormal and needs to be repeated. Client is tearful and tells the nurse her mother died of breast cancer. What action should the nurse take?

Answer 89

Encourage the client to continue expressing her fears and concerns.

Question 90

390. The psychiatric nurse is talking to a newly admitted client when a male client diagnosed with antisocial behavior intrudes on the conversation and tells the nurse, “I have to talk to you right now! It is very important!” how should the nurse respond to this client?

Answer 90

Inform him that the nurse is busy admitting a new client and will talk to him later.

Question 91

391. The charge nurse is planning for the shift and has a registered nurse (RN) and a practical nurse (PN) on the team. Which client should the charge nurse assign to the RN?

Answer 91

A 30 year old depressed client who admits to suicide ideation.

Question 92

392. A female client presents in the Emergency Department and tells the nurse that she was raped last night. Which question is most important for the nurse to ask?

Answer 92

Has she taken a bath since the raped occurred?

Question 93

393. While caring for a client’s postoperative dressing, the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should review which of the client’s laboratory values?

Answer 93

Culture for sensitive organisms.

Question 94

394. The nurse is demonstrating correct transfer procedures to the unlicensed assisted personnel (UAP) working on a rehabilitation unit. The UAPs ask the nurse how to safely move a physically disabled client from the wheelchair to a bed. What action should the nurse recommended?

Answer 94

Place a client’s locked wheelchair on the client’s strong side next to the bed.

Question 95

395. A client who is experiencing musculoskeletal pain receives a prescription for ketorolac 15mg IM q6 hours. The medication is depended in a 39mg/ml pre-filled syringe. Which action should the nurse implement when giving the medication?

Answer 95

Waste 0.5 ml from the pre-filled syringe and inject the medication in the ventrogluteal site.

Question 96

396. A client with a lower respiratory tract infection receives a prescription for ciprofloxacin 500mg PO q 12hours. When the client request an afternoon snack, which dietary choice should the nurse provide?

Answer 96

Cinnamon applesauce

Question 97

397. The healthcare provider prescribes a low-fiber diet for a client with ulcerative colitis. Which food selection would indicate to the nurse the client understands they prescribed diet?

Answer 97

Roasted turkey canned vegetables

Question 98

398. An adult client with schizophrenia begin treatment three days ago with the Antipsychotic risperidone. The client also received prescription for trazodone as needed for sleep and clonazepam as needed for severe anxiety. When the client reports difficulty with swallowing, what action should the nurse take?

Answer 98

Obtain a prescription for an anticholinergic medication

Question 99

399. One year after being discharged from the burn trauma unit, a client with a history of 40% full-thickness burns is admitted with bone pain and muscle weakness. Which intervention should the nurse include in the clients plan of care?

Answer 99

Teach need for dietary and supplementary vitamin D3

Question 100

400. When teaching a group of school-age children how to reduce the risk of Lyme disease which instruction should the camp nurse include?

Answer 100

Wear long sleeves and pants