Académique Documents
Professionnel Documents
Culture Documents
The nurse would evaluate that the client understands his home care
instructions after scleral buckling for a detached retina if he says his
activity should include:
a. Avoiding abrupt movements of the head
b. Exercising the eye muscles each day
c. Turning the entire head rather than just the eyes for sight
d. Avoiding activities requiring good depth perception
15. The nurse notes that the client’s urinary appliance contains
yellow urine with large amounts of mucus. How would the nurse
best interpret these data?
a. The client is developing an infection of the urinary tract
b. The mucus is caused by elevated levels of glucose in the urine
c. These findings are normal for a client with an ileal
conduit
d. There is irritation of the stoma
16. Which of the following assessments would be important for the
nurse to make to determine whether or not a client is recovering as
expected from spinal anesthesia?
a. Level of consciousness
b. Rate and depth of respirations
c. Rate of capillary refill in the toes
d. Degree of response to pinpricks in the legs and toes
18. The nurse has instructed the client about the correct positioning
of his leg and hip following hip replacement surgery. Which of the
following statements indicate that the client has understood these
instructions?
a. I may cross my legs as long as I keep my knees extended
b. I should avoid bending over to tie my shoes
c. I can sit in any chair that I find comfortable
d. I should avoid any unnecessary walking for about 3 months
after my surgery
20. An autograft is taken from the client’s left leg. The nurse should
care for the donor site by:
a. Covering it with an occlusive dry dressing
b. Keeping the site clean and dry
c. Applying a pressure dressing
d. Wrapping the extremity with an elastic bandage
21. Which of the following categories of medications would the
nurse anticipate being included in the conservative management of
a client with a herniated lumbar disk?
a. Muscle relaxant
b. Sedatives
c. Tranquilizers
d. Parenteral analgesics
27. Nursing measures for the client who has had an MI include
helping the client to avoid activity that results in Valsalva’s
maneuver. Valsalva’s maneuver may cause cardiac dysrhythmias,
increased venous pressure, increased intrathoracic pressure and
thrombi dislodgement. Which of the following actions would help
prevent Valsalva’s maneuver? Have the client:
a. Assume a side-lying position
b. Clench her teeth while moving in bed
c. Drink fluids through a straw
d. Avoid holding her breath during activity
31. A client has stress incontinence has been given a pamphlet that
describes Kegel exercises. Which of the following statements
indicates to the nurse that the client has understood the
instructions contained in the pamphlet?
a. I should perform these exercises every evening
b. It will probably take a year before the exercises are effective
c. I can do these exercises sitting up, lying down or
standing
d. I need to tighten my abdominal muscles to do these exercises
correctly
35. Which of the following nutrients provides a little over half of the
energy needed during sleep?
a. Protein
b. Carbohydrate
c. Fat
d. Water
36. An anticipated outcome for the client after cataract removal
surgery would include which of the following?
a. The client states her vision is clear
b. The client states her infection is under control
c. The client describes methods to prevent an increase in
intraocular pressure
d. The client states she is able to administer parenteral pain
medication
38. The nurse notes the following assessment findings regarding the
client’s peripheral vascular status: cramping leg pain relieved by
rest; cool, pale feet; and delayed capillary refilling. Based on these
data, the nurse would make a nursing diagnosis of:
a. Impaired skin integrity
b. Impaired gas exchange
c. Ineffective peripheral tissue perfusion
d. Impaired physical mobility
39. The client with urinary tract infection is given a prescription for
trimethoprim (Bactrim-DS) for her infection. Which of the following
statements would indicate that she understands the principles of
antibiotic therapy?
a. I’ll take the pills until I feel better and keep the rest for
recurrences
b. I’ll take all the pills then return to my doctor
c. I’ll take the pills until the symptoms go away then reduce the
dose to one pill a day
d. I’ll take all the pills then have the prescription renewed once
41. When bandaging the burned client’s hand, the nurse should
make certain that:
a. The bandage is free of elastic
b. The hand and finger surfaces do not touch
c. The hand and fingers are not elevated above heart level
d. The bandage material is moistened with sterile normal saline
solution
42. The nurse is caring for a client who has a history of aplastic
anemia. Which of the following data from the nursing history
indicates that the anemia is not being managed effectively?
a. Pallor of skin and mucous membranes
b. Heart rate of 68 bpm, bounding pulse
c. Blood pressure of 146/90 mm Hg
d. Poor skin turgor
43. A client is learning about caring for her ileostomy. Which of the
following statements would indicate that she understands how to
care for her ileostomy pouch?
a. I’ll empty my pouch when it’s about one-third full
b. I can take my pouch off at night
c. I should change my pouch immediately after lunch
d. I must apply a new pouch system every day
45. Which of the following symptoms would the nurse most likely
observe in a client with cholecystitis from cholelithiasis?
a. Black stools
b. Nausea after ingestion of high fat foods
c. Elevated temperature of 103 F (39.4 C)
d. Decreased WBC count
46. Pain control is an important nursing goal for the client with
pancreatitis. Which of the following medications would the nurse
plan to administer in this situation?
a. Meperidine hydrochloride (Demerol)
b. Cimetidine (Tagamet)
c. Morphine sulfate
d. Codeine sulfate
49. After the client returns from surgery for a deviated nasal
septum, the nurse would anticipate placing her in what position?
a. Supine
b. Left side-lying
c. Semi-Fowler’s
d. Reverse Trendelenburg’s