1. A nurse is caring for a client who has a recent diagnosis of a terminal illness. The nurse
should identify which of the following as an indication of hopelessness?
a. The client wants to talk about the diagnosis with nursing staff
b. The client has a decreased energy level
c. The client makes funeral arrangements
d. The client requests a second opinion
2. A nurse is preparing to collect data on a preschooler. Which of the following behaviors by the
child indicates that he is ready to cooperate? (Select all that apply)
a. Allows the nurse to touch him on the arm
b. Plays with toys in the examining room c.
Answers questions asked by the nurse
d. Makes eye contact with the nurse
e. Sits on his parent’s lap when the nurse enters the room
3. A nurse on a mental health unit is planning care for a group of clients. Which of the
following clients should the nurse see first?
a. A client who has bipolar disorder and is displaying flights of ideas
b. A client who has ADHD and has an inability to concentrate
c. A client who has schizophrenia and is having command hallucinations
d. A client who has depressive disorder and is withdrawn
4. A nurse is caring for a client who recently gave birth to her first child. The newborn is crying
and the client states, “ I can’t seem to do anything right. What should I do?” Which of the
following responses should the nurse make?
a. “I’ll take him back to the nursery, so you can get some rest.”
b. “Babies need to cry soon after they are born to develop their lungs.”
c. “Let me show you how to swaddle and cuddle him, then you try.”
d. “If I turn him on his side, maybe he’ll go back to sleep.”
5. A nurse is using a glucometer to measure a client’s capillary blood glucose level, Which of
the following actions should the nurse take?
a. Test the first drop of blood that forms after the puncture
b. Wear sterile gloves
c. Keep the finger in a dependent position
d. Select the central tip of the finger
6. A nurse is reviewing the home medications of a client who recently had transient ischemic
attacks and is to begin taking clopidogrel. The nurse should instruct the client that which of the
following over-the-counter medications interacts adversely with clopidogrel?
a. Docusate sodium
c. Bradycardia
d. Decreased blood pressure
9. A nurse is contributing to the development of an in-service program for mental health
nursing staff. The nurse should include that the st
aff can medicate a client against his will, without a court hearing, in which of the following
situations?
a. A client who has a serious mental illness
b. A client who is having difficulty making decisions about his treatment
c. A client for whom the benefits of the medication outweigh the risks
d. A client who is attempting to hurt himself or others
10. A nurse is reinforcing teaching with a client who has a new prescription for digoxin. Which of
the following instructions should the nurse include in the teaching?
a. “Monitor for muscle weakness while taking the medication.”
b. “Rotate injection sites when administering the medication.”
c. “Withhold the medication if your pulse rate is above 100 beats per minute.”
d. “Increase your intake of dietary fiber to increase absorption.”
b. Ranitidine
c. Vitamin D3
d. Naproxen
7.A nurse is collecting data from a client who has a long leg cast that was applied 2 days ago.
The client’s foot is pale with a weak pedal pulse, and the client reports foot numbness. Which of
the following actions should the nurse plan to take first?
a. Administer opioid pain medication
b. Apply an ice pack to the affected extremity
c. Check for pain with passive movement of the affected extremity
d. Elevate the affected extremity with several pillows
8. A nurse in a provider’s office is reinforcing teaching about cigarette smoking with a client.
Which of the following adverse effects should the nurse include in the teaching?
a. Decreased hemoglobin
b. Somnolence
11. A charge nurse is discussing confidentiality requirements with a newly licensed nurse when
sharing a client’s medical information. Which of the following individuals should the charge nurse
identify as appropriate with whom to share client information?
a. A nurse from another unit after a client commits suicide
b. A social worker who is assigned to an involuntary committed school-age client
c. A client’s partner after the client reports intimate partner abuse
d. A client’s employer who is concerned about safety due to substance use
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