At the community health fair, a nurse is asked by one of the residents about the influenza vaccine. The nurse responds to the resident that the influenza vaccine is recommended for individuals who are:
A.
A nurse is preparing a room for a patient with tuberculosis. The specific aspect for this tier of Standard Precautions that is different that tier 1 is that the care should include:
D.
A nurse is preparing a teaching plan for patients about the hepatitis B virus. The nurse informs them that this virus may be transmitted by:
C.
A nurse is working on a unit with a number of patients who have infectious diseases. One of the most important methods for reducing the spread of microorganisms is:
C.
The assignment today for a nurse includes a patient with tuberculosis. In caring for a patient on droplet precautions, the nurse should routinely use:
D.
A nurse is caring for a patient who has a large abdominal wound that requires a sterile saline soak and dressing. While performing the care, the nurse drops the saline-soaked 4x4 gauze near the wound on the patient's abdomen. The nurse:
D.
A nurse is checking the laboratory results of a male patient admitted to the medical unit. The nurse is alerted to the presence of an infectious process based on the finding of:
A.
The individual most at risk for a latex allergy is the patient with a history of:
C.
A nurse is working with a patient who has a deep laceration to the right lower extremity. To reduce a possible reservoir of infection, the nurse:
A.
A nurse implements droplet precautions for the patient with:
C.
A patient who has had a transplant will require what type of isolation?
C.
For a patient with hepatitis A, the nurse is aware that the disease is transmitted through
D.
A sign that is indicative of a systemic infection resulting from a wound is:
B.
There are small open wounds on the hands of the nurse. The nurse's most appropriate action is:
C.
A nurse is aware that older adults are more susceptible to infection as a result of:
B.
A nurse is working on a pediatric unit and assessing the vital signs of an infant admitted for gastroenteritis. The nurse expects that the vital signs are normally the following:
B.
While working in an extended care facility, a nurse expects the vital signs of anolder adult patient to be:
D.
A student nurse is taking vital signs for her assigned patients on the surgical unit. The student is aware that a patient's body temperature may be reduced after:
A.
While working in an emergency department, a nurse is carefully monitoring the vital signs of the patients who have been admitted. The nurse is alert to the potential for a decrease in a patient's pulse rate as a result of:
C.
A patient is being treated for hyperthermia. The nurse anticipates that the patient's response to this condition will be:
A.
Several friends have gone on a ski trip and have been exposed to very cold temperatures. One of the individuals appears to be slightly hypothermic. The best initial response by the nurse in the ski lodge is to give this individual:
a. Soup
b. Coffee
c. Cocoa
d. Brandy
a
When checking the temperature of a patient, a nurse notes that he is febrile. An antipyretic medication is ordered. The nurse prepares to administer:
D.
A nurse has been assigned a number of different patients in the long-term care unit. When taking vital signs, the nurse is alert to the greater possibility of tachycardia for the patient with:
D.
While reviewing the vital signs taken by the aide this morning, a nurse notes that one of the patients is hypotensive. The nurse will be checking to see if the patient is experiencing:
B.
Vital sign measurements have been completed on all assigned patients. The nurse will need to immediately report a finding of:
B.
A nurse is preparing to take vital signs for the patients on the acute care unit. A tympanic temperature assessment is indicated for the patient:
B.
Blood pressure monitoring is being conducted on a cardiac care unit. The nurse is determining whether an automatic blood pressure device is indicated for use. This device is selected for the patient with:
C.
A 34-year-old patient has gone to a physician's office for an annual physical examination. The nurse is completing the vital signs before the patient is seen by the physician. The nurse alerts the physician to a finding of:
D.
A nurse is assigned to the well-child center that is affiliated with the acute care facility. A mother takes her 1 1/2-year-old son to the center for his immunizations. The nurse assesses the child's pulse rate by checking the:
A.
A nurse determines that a patient's pulse rate is significantly lower than it has been during the past week. The nurse reassess and finds that the pulse rate is still 46 beats per minute. The nurse should first:
D.
The most important sign of heat stroke is:
A.
The most accurate temperature measurement for an adult patient experiencing tachypnea and dyspnea is:
C.
A nurse should insert a rectal thermometer into the adult patient:
C.
A patient is determined to have an intermittent fever. This is supported by which of the following observations?
C.
Which of the following values indicates the correct pulse pressure for a patient with a blood pressure of 170/90? a. 80
b. 170
c. 260
d. Value not known based on the information given
a
For a patient who is experiencing a febrile state, the nurse should:
A.
A nurse anticipates that bradycardia will be evident if a patient is:
B.
A nurse anticipates that a patient with hypertension will be receiving:
A.
To determine the arterial blood flow to a patient's feet, the nurse should assess the:
D.
A nurse anticipates an increase in blood pressure for the patient who is:
D.
Pre-hypertension is classified as an average of repeated readings of:
B.
A nurse is assessing a patient's nail beds. AN expected finding is indicated by:
D.
A young adult woman arrives at the family planning center for a physical examination. For this patient with mature breasts, the nurse expects to find that the:
C.
A nurse has checked the medical record and found that a patient has anemia. The presence of anemia is accompanied by the nurse's finding of:
A.
A patient with asthma has gone to an urgent care center for treatment. On auscultation of the lungs, a nurse hears rhonchi. These sounds are described as:
D.
A patient is admitted to a medical center with a peripheral vascular problem. A nurse is performing the initial assessment of the patient. While assessing the lower extremities, the nurse is alert to venous insufficiency as indicated by:
B.
A nurse is performing a complete neurological assessment on a patient after a cerebrovascular accident (CVA/stroke). To assess cranial nerve III, the nurse:
A.
Student nurses are practicing neurological assessment and determination of cranial nerve functioning. To assess cranial nerve X, the student nurse should ask the patient to:
C.
While completing a physical examination, a nurse assesses and reports that a patient has petechiae. The nurse has found:
A.
A nurse reviews a chart and sees that a patient who has been admitted to the unit this morning has a hyperthyroid disorder. The nurse anticipates that an examination of the eyes will reveal:
A.
In preparation for an examination of the internal ear, a nurse anticipates that the color of the ear drum should appear:
D.
A patient with a history of smoking and alcohol abuse has gone to a clinic for a physical examination. Based on this history, the nurse is particularly alert during an examination of the oral cavity to the presence of:
B.
A patient in a physician's office has an increased anteroposterior diameter of the chest. The nurse should inquire specifically about the patient's history of:
D.
When auscultating a patient's chest, a nurse hears what appears to be an S3 sound. This is an expected finding if the patient is:
C.
A patient in a medical center has been prescribed bed rest for a prolonged period of time. There is a possibility that the patient may have developed phlebitis. The nurse assess for the presence of this condition by:
B.
When teaching a 45-year-old patient in the gynecologist's office about breast cancer, a nurse includes information on recommendations for screening. The patient is informed that a woman her age should have:
A.
A patient has been experiencing some lightheadedness and loss of balance over the past few weeks. A nurse wants to check the patient's balance while waiting for the patient to over other laboratory tests. The nurse administers the:
D.
Screenings are being conducted at the junior high school for scoliosis. A nurse is observing the students for the presence of:
B.
While reviewing a medical record, a nurse notes that a patient has suspected pancreatitis. The nurse assess the patient for:
C.
An 80-year-old woman is being assessed by a nurse in an extended care facility. The nurse is assessing the genitalia of this patient and suspects that there may be malignancy present. The nurse's suspicion is due to the found of :
B.
A screening for osteoporosis is being conducted at an annual health fair. To determine the risk factors for osteoporosis, a nurse is assessing individuals for:
A.
A patient in rehabilitation facility has experienced a cerebrovascular accident (CVA/stroke) that has left the patient with an expressive aphasia. The nurse anticipates that this patient will:
B.
A peripheral pulse that is easily palpable and normal in tension is documented as:
A.
To assess a patient's visual fields, a nurse should:
C.
A nurse exerts downward pressure on the thigh. This assessment is determining the muscle strength of the:
C.
Light palpation involves depressing the part being examined:
A.
A nurse teaches the male patient that he should notify a health care provider if he finds the following during a testicular self-examination:
D.
A nurse manager observes a new nurse on the unit performing a patient assessment. The new nurse's assessment should be interrupted if the manager observes the nurse:
C.
A nurse assesses a patient's skin and documents that vesicles are present. This observation is based on the nurse finding:
D.
A nurse is assessing a patient's level of consciousness using the Glasgow Coma Scale. The following findings are documented: Eyes open to speech, responses are oriented, localized pain is noted. The score for this patient is:
