All practice questions

A public health nurse is designing a comprehensive community health initiative aimed at reducing the burden of type 2 diabetes mellitus in a disproportionately affected urban neighborhood. Which of the following planned interventions is the best example of a secondary prevention strategy?

A client recovering from abdominal surgery reports a pain level of 8 on a 0-to-10 scale. The healthcare provider has ordered $2 \text{ mg}$ of morphine sulfate to be administered via intravenous push over 4 minutes. The client currently has a continuous infusion of $0.9\% \text{ sodium chloride}$ running at $75 \text{ mL/hr}$ through a peripheral catheter. The nurse accesses the injection port closest to the client. Which technique represents the safest method for administering this medication?

A young adult client is brought to the emergency department experiencing a severe asthma exacerbation. Initially, the client is restless, using accessory muscles to breathe, and has loud, widespread expiratory wheezes. The initial arterial blood gas (ABG) reveals a pH of $7.48$, $\text{PaCO}_2$ of $30\text{ mm Hg}$, and $\text{PaO}_2$ of $64\text{ mm Hg}$. One hour later, following continuous bronchodilator therapy, the nurse notes that the client has become drowsy and the wheezing is now barely audible. A repeat ABG shows a pH of $7.31$, $\text{PaCO}_2$ of $54\text{ mm Hg}$, and $\text{PaO}_2$ of $56\text{ mm Hg}$. Which of the following interventions should the nurse anticipate implementing? Select all that apply.

An older adult client is recovering on the surgical unit 48 hours after a right below-the-knee amputation. The nurse is updating the client's daily care plan. Which interventions should be included to promote comfort and prevent complications? Select all that apply.

A nurse is receiving a handoff report for a client who is receiving total parenteral nutrition (TPN) via a dedicated lumen of a central venous catheter (CVC). Which of the following actions should the nurse include in the client's plan of care? (Select all that apply)

A pediatric clinic nurse is planning care for a healthy 2-month-old infant presenting for a routine well-child visit. Which intervention should the nurse implement as a primary prevention strategy appropriate for this client?

A nurse is caring for a client who sustained a severe traumatic brain injury and is receiving mechanical ventilation. The client's continuous intracranial pressure (ICP) reading is $24\text{ mm Hg}$. The most recent arterial blood gas (ABG) results reveal a $\text{pH}$ of $7.31$, a $\text{PaCO}_2$ of $56\text{ mm Hg}$, a $\text{PaO}_2$ of $88\text{ mm Hg}$, and an $\text{HCO}_3^-$ of $24\text{ mEq/L}$. To reduce the risk of secondary brain injury, which action should the nurse implement first?

A nurse is performing wound care for a client and removes an abdominal dressing that is completely saturated with blood and purulent drainage. Which of the following is the most appropriate action for the nurse to take when disposing of the soiled dressing?

A community health clinic nurse assesses a 15-year-old who requests testing for a sexually transmitted infection. Upon physical examination, the nurse discovers multiple varying stages of bruising across the client's torso. The adolescent tearfully admits the injuries were inflicted by their primary caregiver but begs the nurse to keep it a secret. Which action is the most appropriate response by the nurse to uphold ethical and legal standards?

A registered nurse (RN) on a medical-surgical unit is preparing to delegate the insertion of a straight urinary catheter for a client with acute urinary retention to a licensed practical/vocational nurse (LPN/VN). Arrange the following steps of the delegation process in the correct chronological order according to national delegation guidelines. (Place the first step at the top and the final step at the bottom.)

An older adult client with advanced Alzheimer's disease is admitted for severe dehydration. The client continuously attempts to pull out their peripheral intravenous (IV) line despite the implementation of multiple non-restrictive safety measures. The healthcare provider has prescribed bilateral soft wrist restraints. Arrange the following nursing actions in the correct sequence of execution from first to last.

While coordinating client care assignments and evaluating clinical protocols on a busy telemetry unit, the charge nurse observes several interactions involving transmission-based precautions. Which of the following actions by the nursing staff demonstrate appropriate adherence to infection control guidelines? Select all that apply.

An older adult with advanced dementia is receiving continuous enteral nutrition through a newly placed gastrostomy tube. The client appears disoriented and repeatedly attempts to grasp and remove the tubing. Which action should the nurse take first to maintain the safety of the medical device?

During a routine assessment on the maternal-newborn unit, the registered nurse monitors a client who experienced an uncomplicated spontaneous vaginal birth earlier in the shift. To accurately evaluate for hemorrhage, the nurse implements quantitative blood loss (QBL) measurement protocols. The nurse collects the used chux pads and peripads and places them on a scale. The scale displays a total weight of $1,240\text{ g}$. The standard dry weight of these identical items is $315\text{ g}$.

Calculate the client's quantified blood loss in milliliters ($\text{mL}$).

A nurse is reviewing safety protocols for the administration of intravenous (IV) medications and continuous infusions. Which of the following practices should the nurse implement to ensure client safety? Select all that apply.

An ambulatory client who recently started taking oral lisinopril for hypertension contacts the clinic to report several new symptoms. Which of the following client reports requires the most immediate intervention by the nurse?

A client requires a large-volume cleansing enema to relieve severe constipation. In what chronological sequence should the nurse perform the steps of this procedure?

A critical care nurse is managing a client receiving continuous renal replacement therapy. The client becomes increasingly restless and repeatedly attempts to disconnect the dialysis lines. After unsuccessful alternative interventions, the healthcare provider prescribes bilateral soft wrist restraints. Which actions by the nurse indicate appropriate management of the restraints? Select all that apply.

A nurse is caring for a client who is receiving continuous total parenteral nutrition (TPN) via a multilumen central venous catheter. Which of the following actions should the nurse include in the client's plan of care? Select all that apply.

A nurse is preparing a client for a bedside thoracentesis to treat a large pleural effusion. Which actions must the nurse perform to prevent procedural errors and ensure client safety? Select all that apply.