Professional Documents
Culture Documents
1. The client is admitted to the unit after a motor vehicle accident with a
temperature of 102°F rectally. The nurse is aware that the most likely
explanation for the elevated temperature is:
❍ A. There was damage to the hypothalamus.
❍ B. He has an infection from the abrasions to the head and face.
❍ C. He will require a cooling blanket to decrease the temperature.
❍ D. There was damage to the frontal lobe of the brain.
3. The nurse notes the patient care assistant looking through the personal
items of the client with cancer. Which action should be taken by the
registered nurse?
Answer B is correct. The best action at this time is to report the incident
to the charge nurse. Further action might be needed, but it should be
determined by the charge nurse. Answers A, C, and D are incorrect
because notifying the police is overreacting at this time, and monitoring
or ignoring the situation is an inadequate response.
4. The doctor has ordered 80mg of furosemide (Lasix) two times per
day. The nurse notes the patient’s potassium level to be 2.5meq/L. The
nurse should:
❍ A. Administer the Lasix as ordered
❍ B. Administer half the dose
❍ C. Offer the patient a potassium-rich food
❍ D. Withhold the drug and call the doctor
Answer B is correct. Skin irritation can occur if the TENS unit is used
for prolonged periods of time. To prevent skin irritations, the client
should change the location of the electrodes often. Electrocution is not a
risk because it uses a battery pack; thus, answer A is incorrect. Answer
C is incorrect because the unit should not be used on sensitive areas of
the body. Answer D is incorrect because no creams are to be used
with the device.
6. The nurse is assessing the client admitted for possible oral cancer. The
nurse identifies which of the following as a late-occurring symptom of
oral cancer?
❍ A. Warmth
❍ B. Odor
❍ C. Pain
❍ D. Ulcer with flat edges
7. The nurse is caring for the client who has been in a coma for 2
months. He has signed a donor card, but the wife is opposed to the idea
of organ donation. How should the nurse handle the topic of organ
donation with the wife?
❍ A. Contact organ retrieval to come talk to the wife
❍ B. Tell her that because her husband signed a donor card, the hospital
has the right to take the organs
upon the death of her husband
❍ C. Drop the subject until a later time
❍ D. Refrain from talking about the subject until after the death of her
husband
9. The home health nurse is planning for the day’s visits. Which client
should be seen first?
❍ A. The 78-year-old who had a gastrectomy 3 weeks ago with a PEG
tube
❍ B. The 5-month-old discharged 1 week ago with pneumonia who is
being treated with amoxicillin liquid suspension
❍ C. The 50-year-old with MRSA being treated with Vancomycin via a
PICC line
❍ D. The 30-year-old with an exacerbation of multiple sclerosis being
treated with cortisone via a centrally
placed venous catheter
Answer D is correct. The priority client is the one with multiple sclerosis
who is being treated with cortisone via the central line. This client is at
highest risk for complications. MRSA, in answer C, is methicillin-
resistant staphylococcus aureas. Vancomycin is the drug of choice and
can be administered later, but its use must be scheduled at specific times
of the day to maintain a therapeutic level. Answers A and B are incorrect
because these clients are more stable.
Question # 11. The client with AIDS tells the nurse that he has been
using acupuncture to help with his pain. The nurse should question the
client regarding this treatment because acupuncture:
A. Uses pressure from the fingers and hands to stimulate the energy
points in the body
B. Uses oils extracted from plants and herbs
C. Uses needles to stimulate certain points on the body to treat pain
D. Uses manipulation of the skeletal muscles to relieve stress and pain
Question # 13. The nurse witnesses the nursing assistant hitting the
client in the long-term care facility. The nursing assistant can be charged
with:
A. Assault
B. Tort
C. Negligence
D. Malpractice
Answer A is correct. The first client to be seen is the one who recently
returned from surgery. The other clients in answers B, C, and D are
more stable and can be seen later.
Question No. 20:-A rape victim comes on 4th day for contraception. The
best method is
A:-high dose oestrogens
B:-high dose progestogens
C:-combination of estrogen and progesterone
D:-CuT
Correct Answer:- Option-D