A nurse is preparing to reposition a client who has a
stroke. Which action should the nurse take?
a. Evaluate the client's ability to help with repositioning
b. Reposition client without the use of assistive device
c. Raise the side rails on both sides of the client's bed
during reposition
d. Discuss the client's preferences for determining a
reposition schedule - ...ANSWER...a. Evaluate the
client's ability to help with repositioning
A nurse is providing discharge teaching to a client who
is post-op following the repair of a detached retina.
Which statements by the client indicate understanding
of the teaching?
a. I can go jogging after 2 weeks
b. I should bend at the waist when putting on my shoes
c. I can lift objects that are less than 10 lbs
d. I can resume activities, such as sewing -
...ANSWER...c. I can lift objects that are less than 10 lbs
A nurse is giving discharge teaching about home care
of a surgical incision to a client who speaks a different
language. The nurse communicating using an
interpreter. Which action should the nurse take?
a. Speak slowly when talking to the interpreter
b. Pause in the middle of sentence
c. Speak directly to the client
d. Use gestures to convey meaning - ...ANSWER...c.
Speak directly to the client
A nurse is teaching a client who has new prescription
for enoxaparin. Which pain med should the nurse
include that can be taken concurrently with enoxaparin?
a. Ibuprofen
b. Naproxen sodium
c. Acetaminophen
d. Aspirin - ...ANSWER...c. Acetaminophen
A nurse is receiving report for a group of clients. Which
clients should the nurse assess first?
a. A client who has epidural analgesia and weakness in
the lower extremities
b. A client who has a hip fracture and a new onset of
tachypnea
c. A client who has sinus arrhythmia and is receiving
cardiac monitoring
d. A client who has DM and an HbA1c of 6.8% -
...ANSWER...b. A client who has a hip fracture and a new
onset of tachypnea
A nurse is assessing skin of a client who has dark skin.
Which locations should the nurse observe to assess for
cyanosis?
a. Sacrum
b. Palms of the hands
c. Shoulders
d. Area of trauma - ...ANSWER...b. Palms of the hands
A charge nurse is teaching new staff about factors that
increase a client's risk to become violent. Which factors
should the nurse include as the best predictor future
violence?
a. A history of being in prison
b. Male gender
c. Experiencing delusions
d. Previous violent behavior - ...ANSWER...d. Previous
violent behavior
A nurse is assessing a client who is in active labor.
which findings should the nurse report to provider?
a. Temp 37.4 (99.3)
b. Early decelerations in FHR
c. FHR baseline 170/min
d. Contractions last 80 secs - ...ANSWER...c. FHR
baseline 170/min
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