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High uric acid levels can develop in clients who are receiving chemotherapy. This can be caused by:
The nurse is teaching a client about erythema infectiosum. Which of the following factors are not correct?
Central venous access devices (CVADs) are frequently utilized to administer chemotherapy. What is an advantage of using CVADs for chemotherapeutic agent administration?
Which is the best way to position a client’s neck for palpation of the thyroid?
Signs of impaired breathing in infants and children include all of the following except:
What is the primary theory that explains a family’s concept of health and illness?
A nurse observes a client sitting alone and talking. When asked, the client reports that he is “talking to the voices.” The nurse’s next action should be:
Which of the following is an inappropriate item to include in planning care for a severely neutropenic client?
A client states, “I eat a well-balanced diet. I do not smoke. I exercise regularly, and I have a yearly checkup with my physician. What else can I do to help prevent cancer?” The nurse should respond with which of the following statements?
Several passengers aboard an airliner suddenly become weak and suffer breathing difficulty. The diagnosis is likely to be:
A 17-year-old female was raped by a young man in her neighborhood. She is in the Emergency Department for evaluation and tests. After the procedure is completed, a rape crisis counselor (nurse specialist) talks to the client in a conference room regarding the rape. Implementing counseling by the nurse specialist for the raped victim represents:
Which of the following observations is most important when assessing a client’s breathing?
A client recently lost a child due to poisoning. The client tells the nurse, “I don’t want to make any new friends right now.” This is an example of which of the following indicators of stress?
A corporate executive works 60–80 hours a week. The client is experiencing some physical signs of stress. The nurse teaches the client biofeedback techniques. This is an example of which of the following health-promotion interventions?
A client is diagnosed with HIV. Which of the following are antiviral drug classes used in the treatment of HIV/AIDS?
In conducting a health screening for 12-month-old children, the nurse expects them to have been immunized against which of the following diseases?
Which of the following ethnic groups is at highest risk in the United States for pesticide-related injuries?
A 35-year-old Latin-American client wishes to lose weight to reduce her chances of developing heart disease and diabetes. The client states, “I do not know how to make my diet work with the kind of foods that my family eats.” What should the nurse do first to help the client determine a suitable diet for disease prevention?
A nurse observes a client sitting alone and talking. When asked, the client reports that he is “talking to the voices.” The nurse’s next action should be:
All of the following should be performed when fetal heart monitoring indicates fetal distress except:
A pregnant Asian client who is experiencing morning sickness wants to take ginger to relieve the nausea. Which of the following responses by the nurse is appropriate?
Which of the following physical findings indicates that an 11–12-month-old child is at risk for developmental dysplasia of the hip?
Assessment of the client with an arteriovenous fistula for hemodialysis should include:
When a client needs oxygen therapy, what is the highest flow rate that oxygen can be delivered via nasal cannula?
Erythropoietin used to treat anemia in clients with renal failure should be given in conjunction with:
An appropriate intervention for the client with suspected genitourinary trauma and visible blood at the urethral meatus is:
Which of the following terms refers to soft-tissue injury caused by blunt force?
When administering intravenous electrolyte solution, the nurse should take which of the following precautions?
The nurse is assessing the dental status of an 18-month-old child. How many teeth should the nurse expect to examine?
Which of the following neurological disorders is characterized by writhing, twisting movements of the face and limbs?
Which of the following nursing actions is most effective when evaluating a kinetic family drawing?
A client who is immobilized secondary to traction is complaining of constipation. Which of the following medications should the nurse expect to be ordered?
When a client informs the nurse that he is experiencing hypoglycemia, the nurse provides immediate intervention by providing:
Ashley and her boyfriend Chris, both 19 years old, are transported to the Emergency Department after being involved in a motorcycle accident. Chris is badly hurt, but Ashley has no apparent injuries, though she appears confused and has trouble focusing on what is going on around her. She complains of dizziness and nausea. Her pulse is rapid, and she is hyperventilating. The nurse should assess Ashley’s level of anxiety as:
A client has been diagnosed with Disseminated Intravascular Coagulation (DIC) and transferred to the medical intensive care unit (ICU) subsequent to an acute bleeding episode. In the ICU, continuous Heparin drip therapy is initiated. Which of the following assessment findings indicates a positive response to Heparin therapy?
A client with Kawasaki disease has bilateral congestion of the conjunctivae, dry cracked lips, a strawberry tongue, and edema of the hands and feet followed by desquamation of fingers and toes. Which of the following nursing measures is most appropriate to meet the expected outcome of positive body image?
A client is complaining of difficulty walking secondary to a mass in the foot. The nurse should document this finding as:
When the nurse is determining the appropriate size of an oropharyngeal airway to insert, what part of a client’s body should she measure?
A safety measure to implement when transferring a client with hemiparesis from a bed to a wheelchair is:
A client who is experiencing infertility says to the nurse, “I feel I will be incomplete as a man/woman if I cannot have a child.” Which of the following nursing diagnoses is likely to be appropriate for this client?
Which of the following nursing diagnoses might be appropriate as Parkinson’s disease progresses and complications develop?
James returns home from school angry and upset because his teacher gave him a low grade on an assignment. After returning home from school, he kicks the dog. This coping mechanism is known as:
A 20-year-old obese female client is preparing to have gastric bypass surgery for weight loss. She says to the nurse, “I need this surgery because nothing else I have done has helped me to lose weight.” Which response by the nurse is most appropriate?
Which of the following organs of the digestive system has a primary function of absorption?
All of the following factors, when identified in the history of a family, are correlated with poverty except:
A 10-month-old child is brought to the Emergency Department because he is difficult to awaken. The nurse notes bruises on both upper arms. These findings are most consistent with:
A client, age 28, was recently diagnosed with Hodgkin’s disease. After staging, therapy is planned to include combination radiation therapy and systemic chemotherapy with MOPP— nitrogen mustard, vincristine (Onconvin), prednisone, and procarbazine. In planning care for this client, the nurse should anticipate which of the following side effects to contribute to a sense of altered body image?
The nurse observes bilateral bruises on the arms of an elderly client in a long-term care facility. Which of the following questions should the nurse ask this client?
A chemical reaction between drugs prior to their administration or absorption is known as:
The client’s lab culture report is negative for a suspected infection. A test that can correctly identify those who do not have a given disease is:
The nurse should teach parents of small children that the most common type of first-degree burn is:
Fat emulsions are frequently administered as a part of total parenteral nutrition. Which statement is true regarding fat emulsions?
A client is 36 hours post-op a TKR surgery. 270 cc’s of sero-sanguinous accumulates in the surgical drains. What action should the nurse take?
If Ms. Barrett’s distance vision is 20/30, which of the following statements is true?
Which of the following statements by a client with spinal cord injury indicates a need for further teaching by the nurse regarding bowel management?
A nurse is administering an antibiotic to a 4 year old girl, who does not have an identification bracelet. What action should the nurse take?
A client needs to rapidly achieve a therapeutic plasma drug concentration of a medication. Rather than wait for steady state to be achieved, the physician might order:
A client has experienced a CVA with right hemiparesis and is ready for discharge from the hospital to a long-term care facility for rehab. To provide optimal continuity of care, the nurse should do all of the following except:
Which direction given to the nursing assistant is most likely to accomplish the task of getting a urine specimen delivered to the lab immediately after collection?
A nurse is instructing a person who had a left CVA and right lower extremity hemiparesis to use a quad cane. Which of the following is the most appropriate gait sequence?
A 55 year-old female asks a nurse the following, “Which mineral/vitamin is the most important to prevent progression of osteoporosis. The nurse should state:
Which of the following symptoms is not indicative of autonomic dysreflexia in the client with a spinal cord injury?
A nurse is assessing a 18 year-old female who has recently suffered a TBI. The nurse notes a slower pulse and impaired respiration. The nurse should report these findings immediately to the physician, due to the possibility the patient is experiencing which of the following conditions?
A nurse teaching a patient with COPD pulmonary exercises should do which of the following?
A client admitted to the medical nursing unit has classic symptoms of tuberculosis (TB) and tests positive on the purified protein derivative (PPD) skin test. Several months later, the nurse who cared for the client also tests positive on an annual TB skin test for work. The most likely course of treatment if the chest X-ray (CXR) is negative is to:
A patient that has delivered a 8.2 lb. baby boy 3 days ago via c-section, reports white patches on her breast that aren’t going away. Which of the following medications may be necessary?
A nurse has just started on the 7PM surgical unit shift. Which of the following patients should the nurse check on first?
Which of the following developmental milestones for a 6-month-old child should be screened by the nurse during a routine office visit?
The nurse provides a postoperative client with an analgesic medication and darkens the room before the client goes to sleep for the night. The nurse’s actions:
When an elder client asks the nurse whether he will be capable of sexual activity in old age, the best response by the nurse is:
In hanging a parenteral IV fluid that is to be infused by gravity, rather than with an infusion pump, the nurse notes that the IV tubing is available in different drop factors. Which tubing is a microdrop set?
A patient has fallen off a bicycle and fractured the head of the proximal fibula. A cast was placed on the patient’s lower extremity. Which of the following is the most probable result of the fall?
After group therapy, the female victim of intimatepartner violence confides to the nurse that she does not feel in any immediate danger. Which of the following statements about victims of domestic violence is true?
A nurse runs into the significant other of a patient with end stage AIDS crying during her smoke break. Which of the following is most appropriate action for the nurse to take?
A patient is complaining of severe chest pain during a stress test. Which of the following medications is the most appropriate to relieve this discomfort?
A nurse is covering a pediatric unit and is responsible for a 15 year-old male patient on the floor. The mother of the child states, “I think my son is sexually interested in girls.” The most appropriate course of action of the nurse is to respond by stating:
A two-year old has been in the hospital for 3 weeks and seldom seen family members due to isolation precautions. Which of the following hospitalization changes is most like to be occurring?
The nurse supporting a family who has just experienced a sudden and unexpected death needs to know:
The nurse seeks to assess the renal function of an elderly client who is about to receive a nephrotoxic medication. Which of the following labs provides the best indicator for renal function?
The physician wants to know if a client is tolerating his total parenteral nutrition. Which of the following laboratory tests is likely to be ordered?
A mother of a newborn notices a nurse placing liquid in her baby’s eyes. Which of the following is an inaccurate statement about the need for eyedrops following birth?
If your patient is acutely psychotic, which of the following independent nursing interventions would not be appropriate?
The nurse assesses a client for physiological risk factors for falls. The nurse should conclude that the client is not at risk if which of the following is discovered?
A central venous pressure reading of 11cm/H(2)0 of an IV of normal saline is determined by the nurse caring for the patient. The patient has a diagnosis of pericarditis. Which of the following is the most applicable:
The mother of a newborn child is very upset. The child has a cleft lip and palate. The type of crisis this mother is experiencing is:
The ICU nurse caring for a client who has just been declared brain dead can expect to find evidence of the client’s wishes regarding organ donation:
A nurse has been ordered to set-up Buck’s traction on a patient’s lower extremity due to a femur fracture. Which of the following applies to Buck’s traction?
A nurse is performing a screening on a patient that has been casted recently on the left lower extremity. Which of the following statements should the nurse be most concerned about?
Nail and foot care are essential in meeting basic hygiene needs of clients. Important assessments by the nurse in this area include:
Mrs. Owens is the 81-year-old mother of Jonathan, who is 54 years old. Jonathan has had schizophrenia since he was 16 years old. Which of Mrs. Owens’s concerns is likely to predominate?
A successful resolution of the nursing diagnosis Negative Self-Concept (related to unrealistic selfexpectations) is when the client can:
A nurse is caring for a client with an elevated cortisol level. The nurse can expect the client to exhibit symptoms of:
All of the following are clinical manifestations indicating male climacteric except:
Which of the following nursing diagnoses is most appropriate for the client experiencing acute pancreatitis?
A physician orders a serum creatinine for a hospitalized client. The nurse should explain to the client and his family that this test:
The parents of a 2-year-old child ask the nurse how they can teach their child to quit taking toys away from other children. Which of the following statements by the nurse offers the parents the best explanation of their child’s behavior?
The chemotherapeutic agent 5-fluorourcacil (5-FU) is ordered for a client as an adjunct measure to surgery. Which statement about chemotherapy is true?
With a breech presentation, the nurse must be particularly alert for which of the following?
The nurse is turning a client who has a new prosthetic hip. Which position should be avoided to prevent injury to the new prosthetic hip?
Which type of exercises might be prescribed to strengthen the pelvic floor muscles of a client with urinary incontinence?
What are the implications for a client with renal insufficiency who wants to start a low-carbohydrate (CHO) diet?
Which of the following home-care strategies is most likely to negatively impact the body image of a client with Cushing’s syndrome?
When assessing a client in the Emergency Department whose membranes have ruptured, the nurse notes that the fluid is a greenish color. What is the cause of this greenish coloration?
When a client wishes to improve her appearance by removing excess skin from her face and neck, the nurse should provide teaching regarding which of the following procedures?
Which of the following statements by a client indicates adequate understanding of preparation for electroencephalography?
In administering NSAID adjunctive therapy to an elderly client with cancer, the nurse must monitor:
In infants and children, the side effects of firstgeneration over-the counter (OTC) antihistamines, such as diphenhydramine (Benedryl) and hydroxyzine (Atarax), can include:
A client expresses anxiety about having magnetic resonance imaging performed. Which of the following is an appropriate response by the nurse?
The nurse is using Cognitive-Behavioral methods of pain control and knows that the these methods can be expected to do all the following except:
Which is an appropriate outcome for the nursing diagnosis of Body Image Disturbance for a client with anorexia nervosa?
A female prostitute enters a clinic for treatment of a sexually transmitted disease. This disease is the most prevalent STD in the United States. The nurse can anticipate that the woman has which of the following?
In the United States, several definitions of death are currently being used. The definition that uses apnea testing and pupillary responses to light is termed:
The school nurse is conducting health screenings on schoolchildren. During the screening, she identifies a child with the behavioral characteristics of attention deficit disorder. Which of the following behaviors is consistent with this disorder?
Local anesthetics block the conduction of pain impulses to the spinal cord. Their duration of action:
A day care center has asked the nurse to provide education for parents regarding safety in the home. What type of preventive care does this represent?
Referral for client education in the community can be accomplished through all of the following except:
Which of the following factors can impact an individual’s ability to give informed consent?
The advanced directive in a client’s chart is dated August 12, 1998.The client’s daughter produces a Power of Attorney for Health Care, dated 2003, which contains different care direction(s). The nurse is supposed to:
Which of the following vaccines are not part of the regular schedule of immunizations for children?
Hearing screening of prematurely born infants is an effective means of identifying disease and is an example of:
A client is having psychological counseling for problems communicating with his mother. Which model of stress is the most useful in reference to this stressor?
A neighbor telephones the nurse to tell her that her child has erythema infectiosum and asks for information. The nurse knows that another name for the disorder is:
A client goes to the mental health center for difficulty concentrating, insomnia, and nightmares. The client reports being raped as a child. The nurse should assess the client for further signs of:
A client asks the nurse if all donor blood products are cross-matched with the recipient to prevent a transfusion reaction. Which of the following always requires cross-matching?
The nurse is preparing to administer IV Vancomycin to a client. Which of the following nursing actions
should be taken first?
A nurse is teaching a group of clients with a diagnosis of Schizophrenia who are nearing discharge from a residential care facility. An essential topic to include is:
How many temporary teeth should the nurse expect to find in a 5-year-old client’s mouth?
The emergency triage nurse should perform which action upon receiving the history that a client has a severe cough, fever, night sweats, and body wasting?
While walking in the hallway of an acute care unit of the hospital, the nurse overhears the change of shift report. The nurse should:
One day postoperative, the client complains of dyspnea, and his respiratory rate (RR) is 35, slightly labored, and there are no breath sounds in the lower-right base. The nurse should suspect:
During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis?
The nurse is teaching a client about sleep and gives background information on normal sleep patterns. Which of the following substances promotes sleep?
A client’s central venous access device (CVAD) becomes infected. Why might the physician order antibiotics to be given through the line rather than through a peripheral IV line?
When questioning an elder about suspected abuse, the nurse should keep the questions:
A complication of total parenteral nutrition (TPN) is the development of cholestasis. What is this condition?
A client and his family facing the end stage of a terminal illness might be best served by:
What happens if folic acid is given to treat anemia without determining its underlying cause?
Which of the following statements by a client indicates adequate understanding of preparation for a lipoprotein fractionation test?
Which instruction should be given in a health education class regarding testicular cancer?
The nurse has completed client teaching about introducing solid foods to an infant. To evaluate teaching, the nurse asks the mother to identify an appropriate first solid food. Which of the following is an appropriate response?
Melissa Smith came to the Emergency Department in the last week before her estimated date of confinement complaining of headaches, blurred vision, and vomiting. Suspecting PIH, the nurse should best respond to Melissa’s complaints with which of the following statements?
Appropriate nursing strategies to assist a client in maintaining a sense of self include:
When working with multicultural populations, the nurse should consider all of the following when planning care for a client with an altered sexuality pattern except:
When teaching a client about anti-retroviral therapy for human immunodeficiency virus (HIV), the PN should emphasize:
A hospital discharge planning nurse is making arrangements for a client who has an epidural catheter for continuous infusion of opioids to be placed in a long-term care facility. The family prefers a facility in its neighborhood to facilitate visiting. The neighborhood facility has never cared for a client with this type of need. What is the most appropriate action by the discharge planning nurse?
A preschooler has successfully completed the test item “counts 5 blocks” on the Denver II test. This pass is evidence of which of the following developmental concepts?
Incidences of child abuse apperar to be higher in the African-American community and might be explained by:
The nurse is transferring a client from a wheelchair to the bed. Which is the correct procedure?
A client’s postoperative pain seems to be getting worse instead of better. When the nurse asks the client, “Why do you think it’s getting worse?” the client replies, “My wife died last month. It’s all I can think about.” The nurse must now consider:
Which of the following foods present a problem for a client diagnosed with Celiac Disease?
A Roman Catholic client is preparing to have magnetic resonance imaging. He wants to wear his metal crucifix pendant while he is receiving the test. Which of the following is an appropriate response by the nurse?
A client had a colostomy done one day ago. Which of the following is an abnormal finding when assessing the stoma?
Which physiologic mechanism best describes the function of the sodium-potassium pump?
An Rh-negative woman with previous sensitization has delivered an Rh-positive fetus. Which of the following nursing actions should be included in the client’s care plan?
After breast reconstruction secondary to breast cancer, the nurse should recognize which of the following expected client outcomes as evidence of a favorable response to nursing interventions related to disturbed body image?
A client describes her cervical mucus as clear, thin, and elastic. Upon examination, the nurse demonstrates that the cervical mucus can be stretched 8–10 cm. The nurse correctly documents the finding as:
A client is admitted with a diagnosis of Multiple Drug Use. The nurse should plan care based on knowledge that:
Which of the following statements by a client with gastroesophageal reflux disease (GERD) indicates adequate understanding?
A client with major head trauma is receiving bolus enteral feeding. The most important nursing order for this client is:
When suctioning a client, what is the usual amount of time the nurse should spend for each suction pass?
Which of the following lab values is elevated first after a client has a myocardial infarction?
TESTED 02 May 2026