2019 NGN ATI RN Adult Medical Surgical Online Practice Updated 2024-2025 with All Qs, Exams of Nursing

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2019 NGN ATI RN Adult Medical Surgical Online Practice

Updated 2024 - 2025 with All Questions and Answers

A nurse is monitoring a client who has a cast and reports intense itching underneath the cast. Which of the following actions should the nurse take? ---------- Correct Answer ----- ---- Blow cool air into the cast using a blow dryer on a cool setting. A nurse in an emergency department is caring for a client who reports vomiting and diarrhea for the past 3 days. Which of the following findings should indicate to the nurse that the client is experiencing fluid volume deficit? Heart rate 110/min Blood pressure 138/90 mm Hg Urine specific gravity 1. BUN 15 mg/dL --------- Correct Answer --------- Heart rate 110/min A nurse in a telemetry unit is collecting data from a client who has a newly-inserted permanent pacemaker. Which of the following findings should the nurse report to the provider? ---------- Correct Answer --------- The client experiences hiccups when sitting. A nurse is assisting with the development of a plan of care to manage pain for a client who has herpes zoster with lesions on the lower extremities. Which of the following interventions should the nurse include in the plan of care? ---------- Correct Answer ------- -- Keep bed linens off of the affected areas A nurse is contributing to the plan of care to promote a restful night's sleep for a client who has Alzheimer's disease. Which of the following interventions should the nurse include in the plan? ---------- Correct Answer --------- Offer a small snack at bedtime. A nurse is caring for a client who is postoperative following a transurethral resection of the prostate (TURP) and is receiving continuous bladder irrigation. The nurse notes decreased output from the urethral catheter. Which of the following provider prescriptions should the nurse expect? ---------- Correct Answer --------- Irrigate the urethral catheter with 0.9% sodium chloride. A nurse is reviewing the plan of care for a client who is 1 day postoperative following a total hip arthroplasty. Which of the following interventions should the nurse contribute to the plan of care? ---------- Correct Answer --------- Keep an abduction pillow between the client's legs. Select the 3 findings that require follow-up by the nurse. ---------- Correct Answer --------- Visual disturbances

headache Nausea For each finding below, click to specify if the finding is consistent with migraine, stroke, or meningitis. Each finding may support more than 1 disease process. ---------- Correct Answer --------- Family history - migraine, stroke Pain - migraine, stroke, meningitis Nausea - migraine, meningitis Visual changes - migraine, stroke, meningitis Complete the following sentence by using the lists of options. The nurse should identify that the client is most likely experiencing _______, and the nurse should address the client's _________. ---------- Correct Answer --------- Migraine Pain A nurse is assisting with the care of a client who has a migraine. Which of the following interventions should the nurse anticipate? Select all that apply. ---------- Correct Answer --------- Administer sumatriptan Dim the lights in the client's room A nurse is reinforcing teaching with a client who has osteoporosis and a new prescription for calcitonin. Which of the following statements should the nurse make to describe the effect of calcitonin in treating osteoporosis? ---------- Correct Answer --------- "Calcitonin will slow the breakdown of bone in your body." A nurse is reviewing the medical record of a client who is postoperative. Which of the following findings should the nurse identify as a complication of surgery? ---------- Correct Answer --------- WBC count of 15,000/mm A nurse is caring for a client following a gastrectomy. Which of the following actions should the nurse take to decrease episodes of dumping syndrome? ---------- Correct Answer --------- Place the client in the supine position after meals. A nurse is caring for a client who is suspected of having a myocardial infarction. Which of the following actions should the nurse take to prepare the client for an ECG? ---------- Correct Answer --------- Cleanse the client's skin prior to electrode placement. A nurse is collecting data from a client who is being treated for hypovolemia due to nausea and vomiting. Which of the following findings should the nurse report to the provider? ---------- Correct Answer --------- Heat rate 120/min A nurse is reinforcing discharge teaching with a client who has Crohn's disease. Which of the following statements should the nurse include in the teaching? ---------- Correct Answer --------- "Maintain a low-residue diet."

A nurse is caring for a client who has an intestinal obstruction and reports a new onset of nausea. The client has an NG tube set at low intermittent suction and is receiving continuous IV infusion of 0.9% sodium chloride. Which of the following actions should the nurse take first? ---------- Correct Answer --------- Check for kinks in the NG tube. A nurse is caring for a client who is 2 hr postoperative following the amputation of a foot. Which of the following actions should the nurse take first? ---------- Correct Answer ------- -- Check the incisional dressing A nurse is assisting in the care of a client who has AIDS-related pneumonia. The client is receiving antibiotic therapy and albuterol nebulizer treatments daily. Which of the following findings should indicate to the nurse that the client's therapeutic regimen is effective? ---------- Correct Answer --------- Decrease in exertional dyspnea A nurse is caring for a client who has neutropenia. Which of the following nursing interventions should the nurse implement? ---------- Correct Answer --------- Limit visitors to healthy adults. A nurse is reinforcing teaching with a client who has type 1 diabetes mellitus about glycosylated hemoglobin (HbA1c) testing. Which of the following information should the nurse include in the teaching? ---------- Correct Answer --------- HbA1c results measure glucose control for the prior 3 months. A nurse is caring for a client who is receiving a continuous tube feeding of 60 mL/hr at 1.2 cal/mL. How many calories will the client receive in 12 hr? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.) ------- --- Correct Answer --------- 864 cal A nurse is repositioning a client who has low back pain. Which of the following positions is should the nurse place the client in? ---------- Correct Answer --------- Semi-Fowler's with knees flexed A nurse is preparing to administer an influenza vaccine to a client. Which of the following statements by the client should cause the nurse to postpone administration of the vaccine? ---------- Correct Answer --------- "I had a low fever this morning." A nurse is reinforcing teaching with a client about testicular self-examination. Which of the following instructions should the nurse include in the teaching? ---------- Correct Answer --------- "Perform testicular self-examination after taking a warm shower." A nurse is preparing to assist a client out of bed 4 hr following a laparoscopic cholecystectomy. Which of the following actions should the nurse take first? ---------- Correct Answer --------- Obtain the client's blood pressure.

A nurse is collecting data from a client who has 30% body surface area deep partial- thickness and full-thickness burns. Which of the following findings indicates that fluid resuscitation is adequate? ---------- Correct Answer --------- Urine output is 50 mL/hr. A nurse is reinforcing teaching with a client who has a new diagnosis of tuberculosis (TB) and a prescription for isoniazid and rifampin. Which of the following information should the nurse include in the teaching? ---------- Correct Answer --------- Household family members should be tested for TB. A nurse is contributing to the plan of care for a client who had a stroke. For which of the following interprofessional team members should the nurse recommend a referral prior to initiating oral intake for the client? ---------- Correct Answer --------- Speech-language pathologist A nurse is reinforcing teaching with a client who has a new diagnosis of genital herpes. Which of the following information should the nurse include? ---------- Correct Answer --- ------ "The virus can be transmitted without lesions being present." A nurse is assisting with an educational program for clients who have been newly diagnosed with diabetes mellitus. Which of the following instructions should the nurse include in the program regarding insulin? ---------- Correct Answer --------- Opened insulin can be stored on a cool countertop away from light A nurse is caring for a client who is postoperative following an above-the-knee amputation of the right leg and reports pain in the absent portion of the limb. The client received an opioid analgesic 1 hr prior. Which of the following actions should the nurse take? ---------- Correct Answer --------- Collaborate with the physical therapist to initiate alternative pain therapies Click to highlight the findings the nurse should report to the charge nurse immediately. To deselect a finding, clink on the finding again. ---------- Correct Answer --------- Perineal pad is saturated with blood, and large clots are present Blood pressure 98/56 mm Hg Heart rate 102/min A nurse is reinforcing teaching with a client who has osteoporosis. Which of the following instructions should the nurse include in the teaching? ---------- Correct Answer --------- "Take calcium supplements with meals." A nurse is contributing to the plan of care for a client who has tuberculosis (TB). Which of the following interventions should the nurse include? ---------- Correct Answer --------- Place the client in a negative-pressure airflow room. A nurse is reviewing the chart of a client who is experiencing an adrenal crisis, which was precipitated by the client not taking their medication for several days. The nurse

should identify that withdrawal from which of the following medications potentiated the adrenal crisis? ---------- Correct Answer --------- Prednisone A nurse is reinforcing teaching with a client who is taking levothyroxine. Which of the following statements by the client indicates an understanding of the teaching? ---------- Correct Answer --------- "The medication should be taken before I eat breakfast every morning." A nurse is caring for a client who has a prescription for digoxin 0.25 mg PO daily. While taking the client's apical pulse, the nurse notes a rate of 58/min. Which of the following actions should the nurse take? ---------- Correct Answer --------- Withhold the dose. A nurse is reinforcing teaching with a client who has asthma and a new prescription for a corticosteroid. Which of the following findings should the nurse include as an adverse effect of the medication? ---------- Correct Answer --------- Frequent colds A nurse is contributing to the plan of care for a client who has a head injury and is at risk for increased intracranial pressure (ICP). Which of the following actions should the nurse include in the plan? ---------- Correct Answer --------- Use a turn sheet to reposition the client. A nurse is collecting data from an older adult client who has several concerns. Which of the following concerns should the nurse recognize as an expected change associated with aging? ---------- Correct Answer --------- "My food tastes bland even after I add seasoning." A nurse is reinforcing discharge teaching with a client who has leukemia and is receiving chemotherapy. Which of the following statements should the nurse include in the teaching? ---------- Correct Answer --------- "You should place your toothbrush in hydrogen peroxide." A nurse is reinforcing teaching with a client prior to the removal of a leg cast. Which of the following statements should indicate to the nurse that the client understands the teaching? ---------- Correct Answer --------- "I will feel vibrations on my leg from the cast cutter." For each finding, click to specify if the finding is consistent with emphysema, asthma, or pneumonia. Each finding may support more than 1 disease process. ---------- Correct Answer --------- Temperature - pneumonia Breath sounds - emphysema, asthma, & pneumonia Respiratory rate - emphysema, asthma, & pneumonia Cough - emphysema, asthma, & pneumonia A nurse is delegating the task of repositioning a client who is in skeletal traction to an assistive personnel (AP). Which of the following instructions should the nurse give the AP? ---------- Correct Answer --------- Allow the weights to hang freely.

A nurse is reinforcing teaching with a client about preventing osteoporosis. Which of the following client statements indicates an understanding of the teaching? ---------- Correct Answer --------- "I will limit my coffee intake." A nurse is reviewing the laboratory reports of a client who reports chest pain. Which of the following laboratory results indicates the client is experiencing a myocardial infarction? ---------- Correct Answer --------- Elevated troponin A nurse is preparing a client for a cardiac catheterization. Which of the following actions should the nurse take first? ---------- Correct Answer --------- Verify the client has given informed consent. For each potential nursing intervention, click to specify if the intervention is indicated or not indicated. ---------- Correct Answer --------- Request a chest x-ray - not indicated Place the client in reverse Trendelenburg position - indicated Assist with administering a 0.9% sodium chloride 200 mL IV bolus - indicated Apply oxygen at 2 L/min via nasal cannula - indicated Notify the charge nurse immediately - indicated Obtain the client's blood glucose level - not indicated A nurse is reinforcing instructions with a client who has a new hearing aid. Which of the following instructions should the nurse include? ---------- Correct Answer --------- "Adjust the volume to a level where you can hear others speak at a distance of 3 feet." Complete the following sentence by using the list of options. Following the administration of sumatriptan, the nurse should monitor for ________ due to the risk for ________. ---------- Correct Answer --------- Chest pain Myocardial ischemia The nurse is evaluating the client's understanding of the discharge instructions. click to highlight the client statements that indicate an understanding of the teaching. to deselect a statement, click on the statement again. ---------- Correct Answer --------- "Foods that contain tyramine might trigger my headaches" "I will keep a food headache diary" " I will place a cool cloth on my forehead when I experience a migraine" A nurse in a clinic is collecting data from a client who has hyperthyroidism and has been taking methimazole for 4 weeks. Which of the following statements by the client indicates a therapeutic response to the medication? ---------- Correct Answer --------- "I have gained 3 pounds since my last appointment." A nurse is reinforcing teaching regarding the use of a continuous passive motion (CPM) machine with a client who is scheduled for a total knee arthroplasty. Which of the following information should the nurse include in the teaching? (Select all that apply.) ---

------- Correct Answer --------- "Your knee is flexed and extended as prescribed by your provider" "The machine is padded with sheep skin" A nurse is providing information regarding transmission-based precautions for a client who has Clostridium difficile to an assistive personnel (AP). Which of the following instructions should the nurse include? (Select all that apply.) ---------- Correct Answer --- ------ "Provide the client with disposable utensils and dishes for meals." "Leave blood pressure equipment in the client's room." "Clean contaminated surfaces with a bleach solution." A nurse is reviewing the medication administration record of a client who has osteoarthritis. Which of the following analgesic prescriptions should the nurse expect to administer when the client reports pain? ---------- Correct Answer --------- Acetaminophen A nurse is reinforcing discharge teaching with a client who has hearing loss. Which of the following actions should the nurse take when communicating with the client? ---------

• Correct Answer --------- Rephrase client instructions when not understood. A nurse is caring for a client who has been taking enalapril. The nurse should monitor the client for which of the following adverse effects? ---------- Correct Answer --------- Cough A nurse in an orthopedic clinic is reinforcing teaching with a client who has osteoarthritis. Which of the following instructions should the nurse include to promote comfort? ---------- Correct Answer --------- Sleep on a firm mattress. Drag 1 condition and 1 client finding to fill in each blank in the following sentence. The client is experiencing manifestations of (Condition) due to the client's (Client Finding). ---------- Correct Answer --------- Peritonitis Abdominal x-ray results A nurse is caring for a client who is in Buck's traction for a fractured hip. The client reports increased pain at the site of the fracture. Which of the following actions should the nurse take? ---------- Correct Answer --------- Reposition the client. A nurse is planning care for a group of clients after receiving change-of-shift report. Which of the following clients should the nurse plan to see first? ---------- Correct Answer --------- A client who is dehydrated, has mental confusion, and has tried to get out of bed several times during the night A nurse is reinforcing teaching about nutrition choices with a client who has leukemia and is receiving chemotherapy. The nurse should identify that which of the following statements by the client indicates an understanding of the teaching? ---------- Correct Answer --------- "I drink bottled water."

A nurse in a clinic is assisting with the development of a pamphlet about STIs. Which of the following information should the nurse recommend including in the pamphlet? -------- -- Correct Answer --------- Females have a higher risk for contracting STIs than males. A nurse is reinforcing teaching with a client about increasing dietary fiber. The nurse should recommend which of the following foods as the best source of fiber? ---------- Correct Answer --------- 1/2 cup cooked kidney beans A nurse in a dermatology clinic is reviewing the medical records of a group of clients. Which of the following prescriptions for a client who has psoriasis should the nurse clarify with the provider? ---------- Correct Answer --------- Dermabrasion A nurse is reinforcing preoperative teaching with a client. Which of the following statements by the client indicates an understanding of the teaching? Select all that apply. ---------- Correct Answer --------- " I will need to do the breathing exercises every 1 to 2 hrs after surgery." "I will use my PCA medication before my knee starts to hurt too bad." "I will probably be going home with a walker." A nurse is contributing to the plan of care for a client who has just transferred to the medical-surgical unit from the PACU following a right total knee arthroplasty. Which of the following interventions should the nurse include in the plan? ---------- Correct Answer --------- Assist the client to change positions at least every 2 hrs. A nurse is caring for a client who reports shortness of breath and has an oxygen saturation of 90%. Which of the following actions should the nurse take? ---------- Correct Answer --------- Administer oxygen via nasal cannula. A nurse is reviewing the medication record of a client who is taking digoxin. Which of the following medications should the nurse identify as increasing the risk for the client to develop digoxin toxicity? ---------- Correct Answer --------- Furosemide A nurse is contributing to the plan of care for a client who has pericarditis. In which of the following positions should the nurse plan to place the client to decrease pain? -------- -- Correct Answer --------- Upright, leaning forward A nurse is caring for a client who has dementia due to Alzheimer's disease. Which of the following actions should the nurse take to reduce the client's confusion? ---------- Correct Answer --------- Encourage reminiscence of past experiences. Select the 3 findings that require follow-up by the nurse. ---------- Correct Answer --------- oxygen saturation pain level wound dressing Complete the following sentence by using the lists of options.

The client is most likely experiencing a _______ as evidenced by the client's ________. ---------- Correct Answer --------- Hemothorax Respiratory findings Drag words from the choices below to fill in each blank in the following sentence. The nurse should first address the client's ______, followed by the client's ________. --- ------- Correct Answer --------- Oxygenation Blood pressure For each potential provider prescription, click to specify if the potential prescription is anticipated or contraindicated for the client. ---------- Correct Answer --------- Transfuse packed RBCs - anticipated Place the client in Trendelenburg position - contraindicated Prepare the client for chest tube insertion - anticipated Cover the client with a cooling blanket - contraindicated Initiate NPO status - anticipated The nurse is assisting with the care of the client following the placement of a chest tube for a hemothorax. Which of the following actions should the nurse take? Select all that apply. ---------- Correct Answer --------- Place the client in high-fowler's position Place two rubber-tipped hemostats in client's room Palpate the chest tube insertion site for subcutaneous Ensure that all chest tube connections are securely attached The nurse is assisting with the care of the client 1 hr following chest tube insertion. Click to highlight the findings that indicate the client's condition is improving. To deselect a finding, click on the finding again. ---------- Correct Answer --------- Client reports pain as a 3 on a scale of 0 to 10 Client reports shortness of breath has decreased Wound dressing is dry and intact Respiratory rate 24/min Blood pressure 108/74 mm Hg Oxygen saturation 95% on oxygen 2L/min via nasal cannula A nurse is caring for four clients. Which of the following conditions should the nurse identify as a risk for developing vascular disease? ---------- Correct Answer --------- Diabetes Mellitus A nurse is reinforcing teaching with a client who has diabetes mellitus and a new prescription for regular and NPH insulin. Which of the following instructions on preparing the insulins should the nurse include? ---------- Correct Answer --------- Withdraw the regular insulin before withdrawing the NPH insulin.

A nurse is changing the dressing for a client who has an abdominal incision and a closed-suction drain. Which of the following actions should the nurse take? ---------- Correct Answer --------- Cleanse the drainage plug with alcohol swabs. A nurse is reinforcing dietary teaching with a client about increasing the intake of foods containing vitamin C to enhance absorption of oral iron supplements. Which of the following food choices should the nurse include in the teaching? ---------- Correct Answer --------- 1 cup of boiled broccoli A nurse is reinforcing discharge teaching with a client who had a mechanical mitral valve replacement. Which of the following statements by the client indicates an understanding of the teaching? ---------- Correct Answer --------- "I will notify my dentist about this procedure." A nurse is caring for a client who has just returned to the unit following a bronchoscopy. Which of the following findings should the nurse report to the provider? ---------- Correct Answer --------- Diminished breath sounds A nurse is reinforcing teaching with a client who has coronary artery disease. Which of the following instructions should the nurse include in the teaching? ---------- Correct Answer --------- "Add oily fish to your diet twice weekly." Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress. --- ------- Correct Answer --------- Administer Morphine IV Ensure the client is NPO Cholecystitis Jaundice Increasing temperature A nurse is caring for a client who has Cushing's syndrome and expresses concern regarding physical changes associated with the syndrome. Which of the following should the nurse recognize as a physical change caused by this disorder? ---------- Correct Answer --------- Truncal Obesity A nurse is reinforcing teaching about hospice care with a client who has terminal cancer. Which of the following statements should the nurse make? ---------- Correct Answer --------- "Hospice care will provide support for you and your loved ones during the dying process." A home health nurse is caring for a client who has COPD. The client reports shortness of breath while eating, despite the use of home oxygen. Which of the following recommendations should the nurse make? ---------- Correct Answer --------- "Use a bronchodilator 30 minutes before your meal."

A nurse is reinforcing teaching about pursed-lip breathing with a client who has a new diagnosis of COPD. The nurse should identify that which of the following client statements indicates an understanding of the teaching? ---------- Correct Answer --------- "Pursed-lip breathing works best for activities like walking up stairs." A nurse is assessing a client who has acute cholecystitis. Which of the following findings is the nurse's priority? Anorexia Abdominal pain radiating to the right shoulder Tachycardia Rebound abdominal tenderness --------- Correct Answer --------- Tachycardia A nurse is caring for a client who is undergoing hemodialysis to treat end-stage kidney disease (ESKD). The client reports muscle cramps and tingling sensation in their hands. Which of the following medications should the nurse plan to administer? Epoetin alfa Furosemide Captopril Calcium carbonate --------- Correct Answer --------- Calcium carbonate A nurse is providing teaching to a client who is receiving chemotherapy and has a new prescription for epoetin alfa. Which of the following client statements indicates an understanding of the teaching? "I will monitor my blood pressure while taking this medication" "I should take a vitamin D supplement to increase the effectiveness of the medication." "I should inform the provider if I experience an increased appetite while taking this medication" "I will decrease the amount of protein in --------- Correct Answer --------- "I will monitor my blood pressure while taking this medication" The nurse is caring for a group of clients. The nurse should plan to make a referral to physical therapy for which of the following clients? A client who is receiving preoperative teaching for a right knee arthroplasty.

A client who states they will have difficulty obtaining a walker for home use. A client who reports an increase in pain following a left hip arthroplasty. A client who is having emotional difficulty accepting that they have a prosthetic leg. ------ --- Correct Answer --------- A client who is receiving preoperative teaching for a right knee arthroplasty. A nurse is providing teaching to a female client who has a history of urinary tract infections (UTIs). Which of the following information should the nurse include in the teaching? Avoid foods that are high in ascorbic acid. Add oatmeal to the water when taking a tub bath. Urinate every 6 hr. Take daily cranberry supplements. --------- Correct Answer --------- Take daily cranberry supplements. A nurse is providing instructions to a client who has type 2 diabetes mellitus and a new prescription for metformin. Which of the following statements by the client indicates an understanding of the teaching? "I will monitor my blood sugar carefully because the medication increases the secretion of insulin." "I should take this medication with a meal." "I can expect to gain weight while taking this medication." "While taking this medication, I will experience flushing of my skin." --------- Correct Answer --------- "I should take this medication with a meal." A nurse is caring for a client who is receiving total parenteral nutrition (TPN). A new bag is not available when the current infusion is nearly completed. Which of the following actions should the nurse take? Keep the line open with 0.9% sodium chloride until the new bag arrives. Administer dextrose 10% in water until the new bag arrives. Flush the line and cap the port until the new bag arrives.

Decrease the infusion rate until the new bag arrives. --------- Correct Answer --------- Administer dextrose 10% in water until the new bag arrives. A nurse in a community clinic is caring for a client who reports an increase in the frequency of migraine headaches. To help reduce the risk for migraine headaches, which of the following foods should the nurse recommend the client avoid? Shellfish Aged cheese Peppermint candy Enriched pasta --------- Correct Answer --------- Aged cheese A nurse is preparing a client who has supraventricular tachycardia for elective cardioversion. Which of the following prescribed medications should the nurse instruct the client to withhold for 48 hr prior to cardioversion? Enoxaparin Metformin Diazepam Digoxin --------- Correct Answer --------- Digoxin A nurse is caring for a client who has anorexia, low-grade fever, night sweats, and a productive cough. Which of the following actions should the nurse take first? Obtain a sputum sample. Administer antipyretics. Provide hand hygiene education. Initiate airborne precautions. --------- Correct Answer --------- Initiate airborne precautions. A nurse is caring for a client who has a stage 111 pressure injury. Which of the following findings contributes to delayed wound healing? WBC count 6,000/mm BMI 24

Urine output 25 mL/hr Albumin 4 g/dL --------- Correct Answer --------- Urine output 25 mL/hr A nurse is caring for a client who has emphysema and is receiving mechanical ventilation. The client appears anxious and restless, and the high-pressure alarm is sounding. Which of the following actions should the nurse take first? Obtain ABGs Administer Propofol to the client. Instruct the client to allow the machine to breathe for them. Disconnect the machine and manually ventilate the client. --------- Correct Answer --------

• Instruct the client to allow the machine to breathe for them. A nurse is caring for a client who has hepatic encephalopathy that is being treated withy lactulose. The client is experiencing excessive stools. Which of the following findings is an adverse effect of this medication? Hypokalemia Hypercalcemia Gastrointestinal bleeding Confusion --------- Correct Answer --------- Hypokalemia A nurse is caring for a client who has pancreatitis. The nurse should expect which of the following laboratory results to be below the expected reference range? Amylase Alkaline phosphatase Bilirubin Calcium --------- Correct Answer --------- Calcium A nurse is assessing a client who has Graces' disease. Which of the following images should indicate to the nurse that the client has exophthalmos? --------- Correct Answer -- ------- Eyes bulging out of head. A nurse is caring for a client who was just admitted from the emergency department (ED).

0945:

Client is experiencing a sickle cell crisis. 1200: Client is sitting up in high-Fowler's position and appears anxious. Client reports shortness of breath and severe chest pain as 9 on a scale of 0 to 10. Client states that they have started coughing and are expectorating pink-tinged mucus. Lung sounds with increased wheezing in left lung and clear on the right side. Equal chest expansion noted. --------- Correct Answer --------- The client is most likely experiencing Acute chest syndrome and pneumonia. A nurse in an acute care facility is caring for a client who is at risk for seizures. Which of the following precautions should the nurse implement? Place a padded tongue blade at the client's bedside. Keep the side rails lowered on the client's bed. Maintain the client's bed at hip level and above. Ensure the client has a patent IV. --------- Correct Answer --------- Ensure the client has a patent IV. A nurse is ass4ess9ing a client who has had a plaster cast applied to their left leg 2 hr ago. Which of the following actions should the nurse take? Inspect the cast for drainage once every 24 hr Check that one finger fits between the cast and the leg. Perform neurovascular checks every 2 to 3 hr. Make sure the client has a warm blanket covering the cast. --------- Correct Answer ------ --- Check that one finger fits between the cast and the leg. A nurse is caring for a client 1 hr following a cardiac catheterization. The nurse notes the formation of a hematoma at the insertion site and a decreased pulse rate in the affected extremity. Which of the following interventions is the nurse's priority? Initiate oxygen at 2 L/min via nasal cannula Apply firm pressure to the insertion site Take the client's vital signs.

Obtain a stat order for an aPTT --------- Correct Answer --------- Apply firm pressure to the insertion site A nurse is assessing a male client for an inguinal hernia. Which of the following areas should the nurse palpate to verify that the client has an inguinal hernia? Belly button Upper groin Lower groin --------- Correct Answer --------- Upper groin A nurse is teaching a class about client rights. Which of the following instructions should the nurse include? A client should sign an informed consent before receiving a placebo during a research trial. A client cannot refuse to sign a consent form for a life-saving treatment. A client who has a mental illness is unable to give informed consent. An unemancipated minor needs guardian consent for substance use disorder treatment. --------- Correct Answer --------- A client should sign an informed consent before receiving a placebo during a research trial. A nurse in a provider's office is caring for a client who requests sildenafil to treat erectile dysfunction. Which of the following statements should the nurse make? "You might need to take a stool softener while taking this medication." "You will not be abled to use sildenafil if you have diabetes." "You will need to limit your caffeine intake if you start taking sildenafil." "You will not be able to use sildenafil if you are taking nitroglycerin." --------- Correct Answer --------- "You will not be able to use sildenafil if you are taking nitroglycerin." A nurse is caring for a client has who has chronic glomerulonephritis with oliguria. Which of the following findings should the nurse identify as a manifestation of chronic glomerulonephritis? Metabolic alkalosis Hyperkalemia

Increased hemoglobin Hypophosphatemia --------- Correct Answer --------- Hyperkalemia A nurse is assessing a patient for suspected stroke. The nurse should place the priority on which of the following findings? Dysphagia Aphasia Ataxia Hemianopsia --------- Correct Answer --------- Dysphagia A nurse is caring for a client who has a prescription for enalapril. The nurse should identify which of the following findings as an adverse effect of the medication? Bradycardia Tremors Orthostatic hypotension Drowsiness --------- Correct Answer --------- Orthostatic hypotension A nurse is assessing a client who had extracorporeal shock wave lithotripsy (ESWL) 6 hr ago. Which of the following findings should the nurse expect? Stone fragments in the urine Fever Deceased urine output Bruising on the lower abdomen --------- Correct Answer --------- Stone fragments in the urine A nurse is caring for a client who is postoperative following abdominal surgery. 1100: Client received from PACU 1200:

Client reports nausea and pain as 8 on a scale of 0 to 10. Abdominal dressing intact, no further drainage noted. Urine output 15 mL since arrival from PACU. Analgesic and antiemetic administered as prescribed. 1230: Client reports relief from nausea and pain as 4 on a scale of 0 to 10. SaO2 96%. Repositioned for comfort. Encouraged to turn, cough, and deep breathe. 130 --------- Correct Answer --------- Plan to ambulate the client as soon as possible Instruct the client to splint the abdomen with a pillow for coughing Report urinary output to the provider Ask the client to rate their pain on a 0 to 10 scale. A nurse is providing teaching to a client who has chronic kidney disease and a new prescription for erythropoietin. Which of the following statements buy the client indicates and understanding of the teaching? " I should take calcium supplements so the medication will work better in my system" "I am taking this medication to increase my energy level" "This medication can cause my blood pressure to drop" "I will not need to restrict protein in my diet while taking this medication" --------- Correct Answer --------- "I am taking this medication to increase my energy level" A nurse is creating a plan of care for a client who has neutropenia as a result of chemotherapy. Which of the following interventions should the nurse include in the plan? Monitor the client's temperature every 4 hr Insert an indwelling urinary catheter for the client. Request the client's bathroom to be cleaned three times each week. Place a box of latex gloves just outside the client's room. --------- Correct Answer --------- Monitor the client's temperature every 4 hr A nurse is evaluating a client who has a new diagnosis of type 1 diabetes mellitus. Which of the following client statements indicates the client is successfully coping with the change?

"It is just easier to let my partner administer my insulin" "I used to never worry about my feet. now, I inspect my feet every day with a mirror" "I'm concerned I won't be able to read my blood sugar level because the screen is so small" "I know a lot of people who have diabetes and do not take insulin. I --------- Correct Answer --------- "I used to never worry about my feet. now, I inspect my feet every day with a mirror" A nurse is planning care to decrease psychosocial health issues for a client who is starting dialysis treatments for chronic kidney disease. Which of the following interventions should the nurse include in the plan. Remind the client that dialysis treatments are not difficult to incorporate into daily life. Inform the client that dialysis will result in a cure. Tell the client that it is possible to return to similar precious levels of activity. Begin health promotion teaching during the --------- Correct Answer --------- Tell the client that it is possible to return to similar precious levels of activity. A nurse is providing teaching to an older adult client who has cancer and a new prescription for an opioid analgesic for pain management. Which of the following information should the nurse include in the teaching? "It is an expected effect to sleep through the day when taking this medication" "Your constipation will be lessened as you develop a tolerance to the medication" "You should void every 4 hours to decrease the risk of urinary retention." "If you experience ringing in your ears, y --------- Correct Answer --------- "You should void every 4 hours to decrease the risk of urinary retention." A nurse is providing preoperative teaching for a client who is scheduled for an open cholecystectomy. Which of the following actions should the nurse take? Teach the importance of a clear liquid diet after discharge Tell the client to remove the incisional adhesive strips 3 days after discharge. Demonstrate ways to deep breathe and cough

Instruct the client to maintain bed rest for 48 hr --------- Correct Answer --------- Demonstrate ways to deep breathe and cough A nurse is caring for a client. 1000: Client is on continuous ambulatory peritoneal dialysis (CAPD) and reports dialysate appeared cloudy this morning. 1300: Client is lying in bed with the knees flexed, guarding the abdomen. Abdomen is slightly distended, hypoactive bowel sounds. Client reports nausea. Reports pain as 6 non a scale of 0 to 10. Provider notified and updated with client condition and diagnostic results. Diagnostic Results WBC count 17,000/mm Abdominal x-ray result: Fluid n --------- Correct Answer --------- The client is experiencing manifestations of peritonitis due to X-ray results. A nurse is caring for a client who presents to the clinic for a 1-week follow-up visit after hospitalization for heart failure. Exhibit question Prescriptions Digoxin 0.25 mg PO daily Furosemide 40 mg PO daily Potassium chloride 20 mEq/L PO daily History and physical Discharge: Weight 66.7 kg (147 lb) SaO2 94% 2+ pedal edema Heart rate 74/min Current: Weight 67.1 kg (148 lb) SaO2 92% 1+ pedal edema Heart rate 55/min Based on the information in the client's chart, which of the following --------- Correct Answer --------- Heart rate 55/min

A nurse is preparing to admit a client who has dysphagia. The nurse should plan to place which of the following items at the client's bedside? Suction machine Wire cutters Padded clamps Communication board --------- Correct Answer --------- Suction machine A nurse is caring for a client who has amyotrophic lateral sclerosis (ALS) an is being admitted to the hospital with pneumonia. Which of the following assessment findings is the nurse's priority? Temperature 38.4C (101.1F) Increased respiratory secretions Fluid intake of 200 mL in the prior 8 hr Limited range of motion --------- Correct Answer --------- Increased respiratory secretions A nurse is teaching a client who has a family history of colorectal cancer. To help mitigate this risk, which of the following dietary alterations should the nurse recommend? Add full-fat yogurt to the diet Add cabbage to the diet Replace butter with coconut oil Replace shellfish with red meat --------- Correct Answer --------- Add cabbage to the diet A nurse is providing teahing to a client who has esophageal cancer and is to undergo radiation therapy. Which of the following statements should the nurse identify as an indication that the client understands the teaching? "I will wash the ink markings off the radiation area after each treatment" "I will use my hands rather than a washcloth to clean the radiation area" "I will be able to be out in the sun 1 month after my radiation treatments are over"

"I will use a heating pad on my nec --------- Correct Answer --------- "I will use my hands rather than a washcloth to clean the radiation area" A nurse is caring for a client who is postoperative following a total hip arthroplasty. Which of the following laboratory values should the nurse report to the provider? Potassium 4 mEq/L WBC count 10,000/mm3 Hct 45% Hgb 8 g/dL --------- Correct Answer --------- Hgb 8 g/dL A nurse is caring for a client. The nurse is reviewing the client's diagnostic results. Skip Nurse's' Notes Diagnostic Results: 1000: Sodium 150 mEq/L (136-145) Potassium 4.8 mEq/L (3.5-5) Calcium 9.5 mg/dL (7.6-10.4) BUN 24 mg/dL (10-20) WBC count 12,000/mm3 (5,000-10,000) ABG's pH 7.35 (7.35-7.45) PCO2 50 mm Hg (35-45) HCO3 24 mEq/L (22-26) Chest x-ray reveals increased opacity in the bilateral posterior lobes Vital signs: Temperature 38.6C (101.5F) Heart Rate 98/min Respiratory rat --------- Correct Answer --------- BUN level WBC count Oxygen saturation level PCO2 level Chest X-ray A nurse is caring for a client. A nurse is reviewing the client's medical record. Review exhibit 1-3 and answer question: Click to highlight the findings below that indicate that the client has a potential problem.

Client is short of breath and has a productive cough with yellow mucus "I could barely breathe when I got up this morning and I had a throbbing headache" Capillary refill less than 2 seconds Client is diaphoretic Crackles heard in posterior lungs Pedal pulses +2 bilaterally --------- Correct Answer --------- Client is short of breath and has a productive cough with yellow mucus "I could barely breathe when I got up this morning and I had a throbbing headache" Client is diaphoretic Crackles heard in posterior lungs A nurse is caring for a client. A nurse is prioritizing client care. Same patient as previous question. BUN 24 mg/dL (10-20) Oxygen saturation 88% on room air Loss of appetite. Client reports throbbing headache this morning Temperature 38.6C (101.5F) Heart rate 98/min Complete the following sentence by using the lists of options: The nurse should first address the client's _______, followed by the client's _____ loss of appetite BUN level oxygen saturation Heart rate Temperature Headac --------- Correct Answer --------- The nurse should first address the client's oxygen saturation following by the client's temperature. A nurse is caring for a client. The nurse is planning care for a client. Same patient as 42 and 43.

1000:

Client has productive cough with yellow mucous. Could barely breathe when he got up this morning and had a throbbing headache. Client is diaphoretic, crackles heard in posterior lungs. Diagnostic Results: Sodium 150 mEq/L (136-145) BUN 24 mg/dL (10-20) WBC count 12,000/mm3 (5,000-10,000) Chest X-ray reveals increased opacity in the bilateral posterior lobes. VS: Temperature 38.6C ( --------- Correct Answer --------- 1) Cough and deep breathe every 2 hr. (A)

2. Perform neurological checks every 2 hr (N)
3. Famotidine 40 mg PO daily (N)
4. Acetaminophen 500 mg PO every 6 hr as needed (A)
5. Administer oxygen at 3 L/min via nasal cannula (A)
6. Limit the client's fluid intake to 1,500 mL per day (C)
7. Obtain a sputum culture and sensitivity. (A) A nurse is caring for a client. Same client. The nurse is reviewing the client's medical record. Day 3: 0800 Supplemental oxygen is use at 2 L/min via nasal cannula. Client reports difficulty coughing up mucus. Encouraged the client to cough and deep breathe. Sodium 146 mEq/L (136-145) - previously 150 Potassium 5.4 mEq/L (3.5-5) - previously 4.8 BUN 22 mg/dL (10-20) - previously 24 WBC count 15,000/mm3 (5,000-10,000) - previously 12,000 Sputum culture and sensitivity results indicate strept --------- Correct Answer --------- Temperature Potassium level WBC count The nurse is caring for a client. Same client. The nurse is reviewing the client's medical record from Day 5. Click to highlight the findings below that indicate the client is improving. Heart rate 72/min Respiratory rate 20/min Blood pressure 128/56

Oxygen saturation 95% on room air Lung sounds are diminished in the bilateral posterior bases with occasional crackles heard upon auscultation Cough is productive with yellow mucus --------- Correct Answer --------- Heart rate 72/min Respiratory rate 20/min Blood pressure 128/56 Oxygen saturation 95% on room air A nurse in the ICU is assessing a client who has traumatic brain injury. Which of the following findings should the nurse identify as a component of Cushing's triad? Hypotension Tachypnea Nuchal rigidity Bradycardia --------- Correct Answer --------- Bradycardia A nurse is providing teach8ing to an older adult female client who has stress incontinence and a BMI of 32. Which of the following statements by the client indicates an understanding of the teaching. "I am taking my progesterone daily" "I am dieting to lose weight" "I am limiting my daily fluid intake" "I have switched my morning cups of coffee to hot tea" --------- Correct Answer --------- "I am dieting to lose weight" A nurse is planning to provide discharge teaching for the family of an older adult client who has hemianopsia and is at risk for falls. Which of the following instructions should the nurse include? Keep the client's personal care items in the bathroom Keep the overhead lights on in the client's bedroom while the client is sleep8ing Remind the client to scan their complete range of vision during ambulation Secure the client's extension cords under carpeting. --------- Correct Answer --------- Remind the client to scan their complete range of vision during ambulation