Nursing EXAM Questions and Answers Latest Updated 2023 Rated A+, Exams of Nursing

Download Nursing EXAM Questions and Answers Latest Updated 2023 Rated A+ and more Exams Nursing in PDF only on Docsity! Nursing EXAM Questions and Answers Latest Updated 2023 Rated A+ 1) A client enters the emergency department confused, twitching, and having seizures. His family states he recently was placed on corticosteroids for arthritis and was feeling better and exercising daily. Upon assessment, he has flushed skin, dry mucous membranes, an elevated temperature, and poor skin turgor. His serum sodium level is 172 mEq/L. Which interventions would the health care provider likely prescribe? Select all that apply. 1. Monitor the vital signs. 2. Monitor intake and output. 3. Increase water intake orally. 4. Monitor the electrolyte levels. 5. Provide a sodium-reduced diet. 6. Administer sodium replacements. 2) The nurse is monitoring a client receiving glipizide (Glucotrol). Which outcome indicates an ineffective response from the medication? 1. A decrease in polyuria 2. A decrease in polyphagia 3. A fasting plasma glucose of 100 mg/dL 4. A glycosylated hemoglobin level of 12% 6) A client is admitted to the hospital with a diagnosis of major depression. During the admission interview, the nurse determines that a major concern is the client's altered nutrition related to poor nutritional intake. Which nursing intervention related to altered nutrition should be the initial choice? 1. Weigh the client three times per week, before breakfast. 2. Explain to the client the importance of a good nutritional intake. 3. Report the nutritional concern to the psychiatrist and obtain a nutritional consult as soon as possible. 4. Offer the client several small, frequent meals daily, and schedule brief nursing interactions with the client during these times. 7) A client received 20 units of NPH insulin subcutaneously at 8:00 am. The nurse should check the client for a potential hypoglycemic reaction at which time? 1. 5:00 pm 2. 10:00 am 3. 11:00 am 4. 11:00 pm 8) An emergency department nurse is caring for an older client who may have been physically abused by her caregiver. In planning care for the client, the nurse makes a priority of: A) Notifying the police department B) Obtaining psychiatric help for the caregiver C) Contacting adult protective services to investigate the situation D) Telling the caregiver that he or she is not allowed to care for the client 9) A nurse responds to an external disaster in a large city involving an explosion at a shopping mall. Numerous victims require treatment. Which victim will the nurse attend to first? A) A victim with multiple bruises who is alert and oriented B) A victim who has sustained multiple lacerations with minor bleeding C) A victim who is alert and wandering around yelling that he cannot see D) A victim with a crush injury to the abdomen who has no pulse or blood pressure assistance regarding your request" 13) The nurse has made an error in documentation of dose administered of an opioid pain medication in the client's record. The nurse draws 1 mg from the vial and another RN witnesses wasting of the remaining 1 mg. When scanning the medication, the nurse entered into the MAR that 2 mg of hydromorphone was administered instead of the actual dose administered, which was 1 mg. The nurse should take which actions to correct the MAR? Select all that apply: 1. complete and file an occurrence report 2. right-click on the entry and modify it to reflect the correct information 3. document the correct information and end with the nurse's signature and title 4. obtain a cosignature from the RN who witnessed the waste of the remaining 1 mg 5. document in a nurse's note in the client's record detailing the corrected information. 14) Which identifies accurate nursing documentation notations? Select all that apply: 1. The client slept through the night 2. Abdominal wound dressing is dry and intact without drainage 3. The client seemed angry when awakened for vital sign measurement 4. The client appears to become anxious when it is time for respiratory treatments 5. The client's left lower medial leg wound is 3cm in length without redness, drainage, or edema 15) A nursing instructor delivers a lecture to nursing students regarding the issue of client's rights and asks a nursing student to sustained. The client, although reluctant, tells the nurse in confidence that her son frequently hits her if supper is not prepared on time when he gets home from work. Which is the most appropriate nursing response? 1. "Oh, really? I will discuss this situation with your son" 2. "Lets talk about ways you can manage your time to prevent this from happening" 3. "Do you have any friends who could help you out until you resolve these issues with your son?" 4. "As a nurse, I am legally bound to report abuse. I will stay with you while you give the report and help find a safe place for you to stay" 18) The nurse calls the primary hc provider regarding a new medication prescription, because the dosage prescribed is higher than the recommended dosage. The nurse is unable to locate the primary hc provider, and the medication is due to be administered. Which action should the nurse take? 1. contact the nursing supervisor 2. administer the dose prescribed 3. hold the medication until the primary hc provider can be contacted 4. administer the recommended does until the primary hc provider can be located 19) The nurse employed in a hospital is waiting to receive a report from the lab from the fax machine. The fax machine activates and the nurse expects the report, but instead receives a sexually oriented photo. Which is the most appropriate nursing action? 1. call the police 2. cut up the photo and throw it away 3. call the nursing supervisor and report the occurrence 4. call the lab and ask for the name of the individual who sent the photo 20) The nurse is assigned to care for 4 clients. In planning client rounds, which client should the nurse assess first? 1. a post-op client preparing for discharge with a new medication 22) A nursing graduate is attending an agency orientation regarding the nursing model of practice implemented in the hc facility. The nurse is told that the nursing model is a team nursing approach. The nurse determines that which scenario is characteristic of the team- based model of nursing practice? 1. each staff member is assigned a specific task for a group of clients 2. a staff member is assigned to determine the client's needs at home and begin discharge planning 3. a single RN is responsible for providing care to a group of 6 clients with the help of assistive personnel 4. an RN leads 2 licensed practical nurses (LPNs) and 3 APs in providing care to a group of 12 clients 23) The nurse has received the assignment for the day shift. After making initial rounds and checking all of the assigned clients, which client should the nurse plan to care for first? 1. a client who is ambulatory demonstrating steady gait 2. a post-op client who has just received an opioid pain med 3. a client scheduled for PT for their first crutch- walking session 4. a client with a WBC count of 14,000 mm and a temp of 38.4 C 24) The nurse is giving a bed bath to an assigned client when an AP enters the client's room and tells the nurse another assigned client is in pain and needs pain meds. Which is the most appropriate nursing action? 1. finish the bed bath and then administer the pain med to the other client 2. ask the AP to find out when the last pain med was given to the client 3. ask the AP to tell the client in pain the med will be administered as soon as the bed bath is done 4. cover the client, raise the side rails, tell the client you'll return soon, and give the pain med to the other client 28) The nurse employed in a LTC facility is planning assignments for the clients in a nursing unit. The nurse needs to assign 4 clients and has a LPN and 3 APs on a nursing team. Which client would the nurse most appropriately assign to the LPN? 1. a client who requires a bed bath 2. an older client requiring frequent ambulation 3. a client who needs hourly vital sign measurements 4. a client requiring abdominal wound irrigations and dressing changes every 3 hours 29) The charge nurse is planning the assignment for the day. Which factors should the nurse remain mindful of when planning the assignment? Select all that apply: 1. the acuity level of the clients 2. specific responses from the staff 3. the clustering of the rooms on the unit 4. the number of anticipated client discharges 5. client needs and worker needs and abilities 30) The nurse is caring for a client with heart failure. On assessment, the nurse notes that the client is dyspneic, and crackles are audible on auscultation. What additional manifestations would the nurse expect to note in this client if excess fluid volume is present? 1. weight loss and dry skin 2. flat neck and hand veins and decreased urinary output 3. an increase in bp and increased respirations 4. weakness and decreased central venous pressure (CVP) 31) The nurse reviews a client's record and determines that the client is at risk for developing a K+ deficit if which situation is documented? 1. sustained tissue damage 2. requires nasogastric suction 3. has a history of Addison's disease 4. uric acid level of 9.4 mg/dl (557 mcmol/L) 32) The nurse reviews a client's electrolyte lab report and notes the client's K+ level is 2.5 mEq/L (2.5 mmol/L). Which patterns should the nurse watch for on the ECG as a result of the lab value? Select all that apply: 1. U waves 2. absent P waves 3. inverted T waves home D) A client who had a seizure at 2 a.m. and was treated with intravenous (IV) diazepam (Valium) and phenytoin (Dilantin) 36) The nurse is planning care for an assigned client. The nurse should include info in the plan of care about the prevention of HIV for which individuals specifically at risk? 1. lesbian persons 2. men-who-have-sex-with-men (MSM) 3. women-who-have-sex-with-women (WSW) 4. Female-To-Male (FTM) transgender persons 37) Which therapeutic communication technique is most helpful when working with transgender persons? 1. using open-ended questions 2. using their first name to address them 3. using pronouns associated with birth sex 4. anticipating the client's needs and making suggestions 38) Which special population should be targeted for breast cancer screening by way of mammography? Select all that apply: 1. male-to-female (MTF) 2. female-to-male (FTM) 3. men-who-have-sex-with-men (MSM) 4. women-who-have-sex-with-men (WSM) 5. women-who-have-sex-with-women (WSW) 39) The nurse is volunteering with an outreach program to provide basic healthcare for homeless people. Which finding, if noted, should be addressed first? 1. BP 154/72 2. visual acuity of 20/200 in both eyes 3. random blood glucose level of 206 4. complaints of pain associated with numbness 3. Metformin 4. Beclomethasone 41) The nurse is completing the admission assessment for a client who is intellectually disabled. Which part of the client encounter may require more time to complete? 1. the history 2. the physical assessment 3. the nursing plan of care 4. the readmission risk assessment 42) The nurse working in a correctional facility is caring for a new prisoner. The client asks about health risks associated with living in a prison. How should the nurse respond? 1. "health care is very limited in the prison setting" 2. "living in a prison isn't different than living at home" 3. "living in a prison can predispose a person to different health conditions" 4. "living in a prison is similar to living in a condominium complex or dorm" 43) A nurse working in a community outreach program for foster children plans care knowing that which health conditions are common in this population? Select all that apply: 1. asthma 2. claustrophobia 3. sleep problems 4. bipolar disorder 5. aggressive behavior 47) Which action by the nurse will best facilitate adherence to the treatment regimen for a client with a chronic illness? 1. arranging for home health care 2. focusing on managing a single illness at a time 3. communicating with one provider only to avoid confusion for the client 4. allowing the client to teach a support person about their treatment regimen 48) The nurse hears a client calling out for help, hurries down the hallway to the client's room, and finds the client lying on the floor. The nurse performs an assessment, assists the client back to bed, notifies the health care provider of the incident, and completes an incident report. Which statement should the nurse document on the incident report? 1. The client fell out of bed. 2. The client climbed over the side rails. 3. The client was found lying on the floor. 4. The client became restless and tried to get out of bed. 49) A client is brought to the ED by emergency medical services (EMS) after being hit by a car. The name of the client is unknown, and the client has sustained a severe head injury and multiple fractures and is unconscious. An emergency craniotomy is required. Regarding informed consent for the surgical procedure, which is the best action? 1. obtain a court order for the surgical procedure 2. ask the EMS team to sign the informed consent 3. transport the victim to the operating room for surgery 4. call the police to identify the client and notify the family hospital policy on floating 4. submit a written protest to nursing administration, and then call the hospital lawyer 52) As a nurse is providing care, the client suddenly experiences a tonic-clonic seizure. The nurse would immediately: A) Call the physician B) Turn the client to the side C) Restrain the client's limbs D) Insert an airway in the client's mouth 53) A nurse is providing care to a client with a closed chest tube drainage system. When the nurse assists the client in turning onto his side, the chest tube is accidentally dislodged from the insertion site. The nurse must immediately: A) Contact the physician B) Reinsert the chest tube C) Turn the client onto his back D) Apply pressure over the chest tube insertion site 54) A nurse is suctioning a client through a tracheostomy tube. During the procedure, the client begins to cough, and the nurse notes an audible wheeze. The nurse tries to remove the suction catheter from the client's trachea but is unable to do so. After immediately disconnecting the suction source from the catheter, which intervention does the nurse implement next? A) Calling a code B) Administering an inhaled bronchodilator 57) A client is diagnosed with cancer and is told that surgery followed by chemotherapy will be necessary. The client states to the nurse, "I have read a lot about complementary therapies. Do you think I should try any?" The nurse should respond by making which appropriate statement? 1) "I would try anything that I could if I had cancer." 2) "You need to ask your health care provider about it." 3) "No, because it will interact with the chemotherapy." 4) "Let's talk more about the different forms of complementary therapies." 59) The nurse is preparing to assist a client of Orthodox Jewish faith with eating lunch. A kosher meal is delivered to the client. Which nursing action is appropriate when assisting the client with the meal? 1) Unwrapping the eating utensils for the client 2) Replacing the plastic utensils with metal utensils 3) Carefully transferring food from the paper plates to glass plates 4) Allowing the client to unwrap the utensils and prepare his own meal for eating 60) The nurse is caring for a group of clients who are taking herbal medications at home. Which client should be given instructions in regard to avoiding the use of herbal medications? 1) A 60-year-old male client with rhinitis 2) A 24-year-old male client with a lower back injury 3) A 10-year-old female with a urinary tract infection 4) A 45-year-old female client with a history of migraine headaches 64) An antihypertensive medication has been prescribed for a client with hypertension. The client tells the nurse that she would like to take an herbal substitute to help lower her blood pressure. Which statement by the nurse is most important to provide the client? 1) "Herbal substances are not safe and should never be used." 2) "I will teach you how to take your blood pressure so that it can be monitored closely." 3) "You will need to talk to your health care provider (HCP) before using an herbal substance." 4) "If you take an herbal substance, you will need to have your blood pressure checked frequently." 65) A nursing student is asked to identify the practices and the beliefs of the Amish society. Which should the student identify? Select all that apply. 1) Many choose not to have health insurance. 2) They believe that health is a gift from God. 3) The authority of women is equal to that of men. 4) They remain secluded and avoid helping others. 5) They use both traditional and alternative health care, such as healers, herbs, and massage. 6) Funerals are conducted in the home without an eulogy, flower decorations, or any other display. Caskets are plain and simple, without adornment. 66) Which is a recommended guideline for safe computerized charting? 1) Passwords to the computer system should only be changed if lost. 2) Computer terminals may be left unattended during client-care activities. 3) Accidental deletions from the computerized file need to be reported to the nursing manager or supervisor. 4) Copies of printouts from computerized files should be kept on a clipboard at the nurses' station for other nurses to access. 69) The nurse arrives at work and is told to report (float) to the pediatric unit for the day because the unit is understaffed and needs additional nurses to care for the clients. The nurse has never worked in the pediatric unit. Which is the appropriate nursing action? 1) Call the hospital lawyer. 2) Call the nursing supervisor. 3) Refuse to float to the pediatric unit. 4) Report to the pediatric unit and identify tasks that can be safely performed 70) The nurse enters a client's room and notes that the client's lawyer is present and that the client is preparing a living will. The living will requires that the client's signature be witnessed, and the client asks the nurse to witness the signature. Which is the appropriate nursing action? 1) Decline to sign the will. 2) Sign the will as a witness to the signature only. 3) Call the hospital lawyer before signing the will. 4) Sign the will, clearly identifying credentials and employment agency. 71) The nurse observes that a client received pain medication an hour ago from another nurse, but the client still has severe pain. The nurse has previously observed this same occurrence. Based on the nurse practice act, the observing nurse should plan to take which action? 1) Report the information to the police. 2) Call the impaired nurse organization. 3) Talk with the nurse who gave the medication. 4) Report the information to a nursing supervisor. 72) A client has died, and the nurse asks a family member about the funeral arrangements. The family member refuses to discuss the issue. Which is the appropriate nursing action? 1) Show acceptance of feelings. 2) Provide information needed for decision areas on both of the client's arms and buttocks. The nurse asks the client how the bruises were sustained. The client, although reluctant, tells the nurse in confidence that her daughter frequently hits her if she gets in the way. Which is the appropriate nursing response? 1) "I have a legal obligation to report this type of abuse." 2) "I promise I won't tell anyone, but let's see what we can do about this." 3) "Let's talk about ways that will prevent your daughter from hitting you." 4) "This should not be happening. If it happens again, you must call the emergency department." 75) The nurse is recording a nursing hands-off (end-of-shift) report for a client. Which information needs to be included? 1) As-needed medications given that shift 2) Normal vital signs that have been normal since admission 3) All of the tests and treatments the client has had since admission 4) Total number of scheduled medications that the client received on that shift 76) The nurse is planning the client assignments for the day. Which is the most appropriate assignment for the unlicensed assistive personnel (UAP)? 1) A client who requires wound irrigation 2) A client who requires frequent ambulation 3) A client who is receiving continuous tube feedings 4) A client who requires frequent vital signs after a cardiac catheterization 77) The nurse employed in a long-term care facility is planning the client assignments for the shift. Which client should the nurse assign to the unlicensed assistive personnel (UAP)? 1) A client who requires a 24-hour urine collection statement by the new nurse indicates a need for further teaching? Select all that apply 1) "An event is termed a mass casualty when it overwhelms local medical capabilities" 2) "Mass casualty events do not require an increase in the number of staff that are needed." 3) "A mass casualty event occurs only within the health care facility and could endanger staff." 4) "A mass casualty event occurs if a fight between visitors occurs in the emergency department." 5) "Mass casualty events may require the collaboration of many local agencies to handle the situation." 81) The nurse is attending an agency orientation meeting about the nursing model of practice implemented in the facility. The nurse is told that the nursing model is a team nursing approach. The nurse understands that which is a characteristic of this type of nursing model of practice? 1) A task approach method is used to provide care to clients. 2) Managed care concepts and tools are used when providing patient care. 3) Nursing staff are led by the nurse when providing care to a group of clients. 4) A single registered nurse is responsible for providing nursing care to a group of clients. 82) A client experiences a cardiac arrest. The nurse leader quickly responds to the emergency and assigns clearly defined tasks to the work group. In this situation, the nurse is implementing which leadership style? 1) Autocratic 2) Situational 3) Democratic 4) Laissez-faire . 83) The nurse has delegated several nursing tasks to staff members. Which is the nurse's primary responsibility after the delegation of the tasks? 85) The nurse who is caring for a client with kidney failure notes that the client is dyspneic, and crackles are heard on auscultation of the lungs. Which additional signs/symptoms should the nurse expect to note in this client? 1) Rapid weight loss 2) Flat hand and neck veins 3) A weak and thready pulse 4) An increase in blood pressure 86) The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at risk for a potassium deficit? 1) The client with Addison's disease 2) The client with metabolic acidosis 3) The client with intestinal obstruction 4) The client receiving nasogastric suction 87) The nurse reviews a client's electrolyte results and notes a potassium level of 5.5 mEq/L. The nurse understands that a potassium value at this level would be noted with which condition? 1) Diarrhea 2) Traumatic burn 3) Cushing's syndrome 4) Overuse of laxatives 88) The nurse is reading the HCP's progress notes in the client's record and sees that the HCP has documented "insensible fluid loss of approximately 800 mL daily." Which client is at risk for this loss? 1) Client with a draining wound 2) Client with a urinary catheter 3) Client with a fast respiratory rate 4) Client with a nasogastric tube to low suction 89) The nurse is reviewing the health records of assigned clients. The nurse should plan care knowing that which client is at the least likely risk for the development of third-spacing? 1) The client with sepsis