Samenvatting

53) A nurse is in an ER caring for client of multiple wounds due to a motor vehicle crash. Which of the
following interventions are appropriate? Select all that apply
a) Apply direct pressure to bleeding wounds
b) Clean rest last rations and abrasions with hydrogen peroxide
c) Cover wounds with a sterile dressing
d) Administer 650 mg aspirin PO as needed for pain
e) Determine date of last tetanus toxoid vaccination.
54) The nurses reviewing clients admission laboratory results. Which of the findings required further
evaluation?
a) Sodium 138
b) Creatinine 1.8
c) Hemoglobin 15
d) Potassium 4.2
55) A nurse is providing teaching for a client has a new prescription for methadone. Which of the phone
following client statements indicates need for further teaching?
a) I understand the methadone tends to slow my breathing
b) I understand the methadone may cause me to have difficulty sleeping
c) I will avoid alcohol while I’m taking this medication
d) I’ll change positions gradually especially from lying down to standing
12 of 28
56) Which of the following client is appropriate for the nurse to refer to speech therapy for swallowing
evaluation?
a) Premature infant with a poor suck reflex and failure to thrive
b) An older adults who has difficulty taking in fluids
c) Adolescent who anorexia who is cachectic
d) A middle aged adults was gastroesophageal reflux disease
57) A nurse is caring for a group of clients. Which of the following client should nurse assess first?
a) A client whose benign prostatic hyperplasia and is unable to urinate
b) The client was heart failure and report shortness of breath while ambulating
c) A client who is open cholecystectomy and has green drainage from the T-tube
d) A client whose abdominal pain and is vomiting coffee ground emesis
58) A nurse is taking a medication history from client was type II diabetes mellitus is scheduled for an
arteriogram. Which of the following medications to the nurses instruct the client to discontinue 48 hrs
prior to the procedure?
a) Atorvastatin
b) Digoxin
c) Nifedipine
d) Metformin
59) The nurses assessing client with posttraumatic stress disorder. Which of the following findings to the
nurse expect to find?
a) Dependence on family and friends
b) Loss of interest in usual activities
c) Ritualistic behavior
d) Passive aggressive behavior
60) A nurse working in a long-term care facility is caring for an older adult client has dementia. The clients
often agitated and frequently wanders the halls. Which of the following intervention should the nurse
include in the plan of care?
a) Give the client several choices when scheduling activities.
b) Confront the client regarding unacceptable behavior
c) Maintain Nutritional requirements by offering finger foods
d) Stimulate the client by leaving the television on throughout the da

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