a) Insomnia.
b) Headache.
c) Anxiety.
d) Orthostatic hypotension.
Q.2.A client with a history of polysubstance abuse is admitted to the facility. He complains of nausea and vomiting 24 hours after admission. The nurse who assesses the client notes piloerection, pupillary dilation, and lacrimation. The nurse suspects that the client is going through withdrawal from which substance?
a) Alcohol
b) Cannabis
c) Cocaine
d) Opioids
Q.3.A client who is 32 weeks pregnant presents to the emergency department with bright red bleeding and no abdominal pain. A nurse should first:
a) perform a pelvic examination.
b) assess the client's blood pressure.
c) assess the fetal heart rate.
d) order a stat hemoglobin and hematocrit.
Q.4.A nurse is assessing a woman in labor. Her cervix is dilated 8 cm. Her contractions are occurring every 2 minutes. She's irritable and in considerable pain. What type of breathing should the nurse instruct the woman to use during the peak of a contraction?
a) Deep breathing
b) Shallow chest breathing
c) Deep, cleansing breaths
d) Chest panting
Q.5.After being treated with heparin therapy for thrombophlebitis, a multiparous client who delivered 4 days ago is to be discharged on oral warfarin (Coumadin). After teaching the client about the medication and possible effects, which of the following client statements indicates successful teaching?
a) "I can take two aspirin if I get uterine cramps."
b) "Protamine sulfate should be available if I need it."
c) "I should use a soft toothbrush to brush my teeth."
d) "I can drink an occasional glass of wine if I desire."
Q.6.A client's gestational diabetes is poorly controlled throughout her pregnancy. She goes into labor at 38 weeks and givesbirth. Which priority intervention should be included in the care plan for the neonate during his first 24 hours?
a) Administer insulin subcutaneously.
b) Administer a bolus of glucose I.V.
c) Provide frequent early feedings with formula.
d) Avoid oral feedings.
Q.7.A client with a past medical history of ventricular septal defect repaired in infancy is seen at the prenatal clinic. She is complaining of dyspnea with exertion and being very tired. Her vital signs are 98, 80, 20, BP 116/72. She has + 2 pedal edema and clear breath sounds. As the nurse plans this client's care, which of the following is her cardiac classification according to the New York Heart Association Cardiac Disease classification?
a) Class I.
b) Class II.
c) Class III.
d) Class IV.
Q.8.The American Cancer Society recommends routine screening to detect colorectal cancer. Which screening test for colorectal cancer should a nurse recommend?
a) Carcinoembryonic antigen (CEA) test after age 50
b) Proctosigmoidoscopy after age 30
c) Annual digital examination after age 40
d) Barium enema after age 20
Q.9.A client has a nasogastric tube inserted at the time of abdominal perineal resection with permanent colostomy. This tube will most likely be removed when the client demonstrates:
a) Absence of nausea and vomiting.
b) Passage of mucus from the rectum.
c) Passage of flatus and feces from the colostomy.
d) Absence of stomach drainage for 24 hours.
Q.10.The best indicator that the client has learned how to give an insulin self-injection correctly is when the client can:
a) Perform the procedure safely and correctly.
b) Critique the nurse's performance of the procedure.
c) Explain all steps of the procedure correctly.
d) Correctly answer a posttest about the procedure.
Q.11.A client has a herniated disk in the region of the third and fourth lumbar vertebrae. Which nursing assessment finding most supports this diagnosis?
a)Hypoactive bowel sounds
b)Severe lower back pain
c)Sensory deficits in one arm
d)Weakness and atrophy of the arm muscles
Q.12.The client with a hearing aid does not seem to be able to hear the nurse. The nurse should do which of the following?
a)Contact the client's audiologist.
b)Cleanse the hearing aid ear mold in normal saline.
c)Irrigate the ear canal.
d)Check the hearing aid's placement.
Q.13.The physician ordered I.V. naloxone (Narcan) to reverse the respiratory depression from morphine administration. After administration of the naloxone the nurse should:
a)Check respirations in 5 minutes because naloxone is immediately effective in relieving respiratory depression.
b)Check respirations in 30 minutes because the effects of morphine will have worn off by then.
c)Monitor respirations frequently for 4 to 6 hours because the client may need repeated doses of naloxone.
d)Monitor respirations each time the client receives morphine sulfate 10 mg I.M.
Q.14.When caring for a client after a closed renal biopsy, the nurse should?
a)Maintain the client on strict bed rest in a supine position for 6 hours.
b)Insert an indwelling catheter to monitor urine output.
c)Apply a sandbag to the biopsy site to prevent bleeding.
d)Administer I.V. opioid medications to promote comfort.
Q.15.A nurse is caring for a client who required chest tube insertion for a pneumothorax. To assess for pneumothorax resolution, the nurse can anticipate that the client will require:
a)monitoring of arterial oxygen saturation (SaO2).
b)arterial blood gas (ABG) studies.
c)chest auscultation.
d)a chest X-ray
Answer And Rational
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