PNU 211-Nurse is caring for a client who is postoperative following a total knee arthroplasty.
194: A nurse is caring for a client who is postoperative following a total knee arthroplasty. The client reports a pain level of 6 on a scale from 0 to 10. Which of the following mediations should thye nurse administer?
Ans: Celecoxib
Oxycodone
Acetaminophen
Ibuprofen
195: A nurse is caring for a client who has a chest tube that was inserted 4 days ago. Which of the following findings should the nurse report to the charge nurse?
Ans: Blood pressure 110/70 mm Hg
Fluctuation in the water seal chamber with respiration
400 mL of drainage in the collection chamber within 4 hr
Respiration rate 16/min
196: A nurse is caring for a client who is in bed and begins experiencing a tonic-clonic seizure. Which of the following actions should the nurse take?
Ans: Lower the side rails of the bed when the seizure begins.
Restrain the client’s arms and legs to prevent injury.
Measure the duration of the seizure.
Insert an oral airway into the client’s mouth.
197: A nurse is caring for a client who has a chlamydial infection and a new prescription for doxycycline. The client reports nausea and vomiting after starting the medication. Which of the following recommendations should the nurse make?
Ans: Take the medication with an antacid.
Take the medication and then lay down for 30 min.
Take the medication with crackers.
Take the medication with calcium fortified orange juice.
198: A nurse is reinforcing teaching with the parents of a child who has a new diagnosis of Wilms’ tumor. Which of the following information should the nurse include in the teaching?
Ans: ”Your child will not require further treatment after removal of the tumor.”
”You should give your child captopril 200 mg PO daily.”
”You should not palpate your child’s abdomen prior to surgery.”
”Your child should have surgery in 7 to 10 days to remove the tumor.”
199: A nurse delegates a task to an assistive personnel (AP) and the AP refuses to complete the assigned task. Which of the following actions should he nurse take?
Ans: Assign the task to another AP.
Perform the task on behalf of the AP.
Report the AP to the risk manager.
Discuss the AP’s concerns about performing the task.
200: A nurse is reinforcing dietary teaching with a client who is 12 weeks of gestation. Which of the following statements should the nurse make?
Ans: ”Limit your caffeine intake to 700 milligrams per day.”
”Consume 600 micrograms of folic acid per day.”
”Increase your dietary intake by 500 calories per day.”
”Eat 40 milligrams of protein-rich foods per day.”
201: A nurse is caring for a client who has clostridium difficile. When applying a cover gown, which of the following techniques should the nurse use?
Ans: Tuck the glove cuffs under the gown sleeves.
Tie the gown with the gloves on.
Push the gown sleeves up to the elbows.
Apply the gown before the gloves.
202: A nurse is collecting data from a client who is taking an oral contraceptive. Which of the following findings is a contraindication for the use of oral contraceptives?
Ans: Gastroesophageal reflux disease
History of mononucleosis 1 year ago
Irregular menstrual cycles
Headaches with aura
203: A nurse is caring for a 3-year-old child who has acute bacterial conjunctivitis of the right eye and has been prescribed bacitracin ophthalmic ointment. Which of the following actions should the nurse take?
Ans: Wipe any excess medication from the inner canthus outward.
Gently massage the eyelid to facilitate absorption of the medication.
Place an occlusive dressing on the affected eye to prevent the spread of infection.
Instruct guardian to apply erythromycin ophthalmic ointment every morning for 14 days.
204: A nurse is contributing to the plan of care for a client who had prolonged exposure to cold weather and has a core body temperature of 32.50 C (90.50 F). Which of the following data is the priority for the nurse monitor?
Ans: Pain sensation
Muscle strength
Heart rhythm
Urinary output
205: A nurse is reviewing the plan of care for a group of clients. The nurse should identify that informed consent is required for which of the following procedures?
Ans: Irrigation of a wound with antibiotic solution
Placement of a central venous catheter
Administration of an iron injection using z-track technique
Insertion of a nasogastric tube
206: A nurse is reinforcing teaching with a newly licensed nurse about transcribing medication prescriptions. Which of the following prescriptions should the newly licensed nurse identify is an accurate transcription?
Ans: Heparin 500 U subcutaneous every 8 hr
MgSO4 10 g PO daily
Doxazosin .5 mg PO at bedtime
Lorazepam 0.5 mg PO PRN at bedtime
207: A nurse is transcribing a client’s prescription for erythromycin 500 mg four times per day. Which of the following information should the nurse clarify with the provider?
Ans: Route
Dosage
Medication
Time
208: A nurse is caring for a client who delivered a newborn by cesarean birth 1 day ago. The client requests nonpharmacological interventions to manage pain when changing positions. Which of the following responses should the nurse make?
Ans: “You should use patterned-paced breathing when changing positions.”
”You should change positions as little as possible.”
”You can apply counterpressure to your back with each position change.”
”You can splint the incision with a pillow when changing positions.”
209: A nurse is giving change-of-shift report on a group of clients. Which of the following statements should the nurse make? (Select all that apply)
Ans: “The client in room 204 has a new prescription for IV gentamicin.”
”The client in room 203 will undergo surgery at 0900 tomorrow.”
”The client in room 205 is scheduled for a dressing change at 1800.”
”The client in room 205 has had several visitors today.”
”The client in room 204 received some pain medicine earlier today.”
210: A nurse is obtaining a capillary blood specimen to measure a client’s blood glucose. Which of the following actions should the nurse take?
Ans: Massage the client’s finger away from the puncture site.
Apply sterile gloves.
Hold the lancet at 45o angle.
Allow the antiseptic to dry before puncturing.
211: A nurse is reinforcing teaching with a client who is scheduled to have a colonoscopy in 1 week. Which of the following client statements indicates an understanding of the teaching?
Ans: “I’ll have my friend drive me home after the procedure.”
”I will follow a full-liquid diet the day before the procedure.”
”I can expect rectal bleeding for a week after the procedure.”
”This procedure will take place while I’m under general anesthesia.”
212: A nurse is reinforcing discharge teaching with a client who has COPD and reports problems with maintaining adequate nutrition. Which of the following instructions should the nurse include?
Ans: “Drink at least 240 milliliters of water during each meal.”
”Perform pulmonary hygiene 1 hour before meals.”
”Lie down for 30 minutes after eating.”
”Self-administer oxygen through your nasal cannula at 6 milliliter per minute during meals.”
Complete Answer:
