ELSEVIER ADAPTVE QUIZING
### Question 7
For a pregnant client with type 1 diabetes, which action is most likely to reduce the risks of disease-related complications?
– Monitor and control blood glucose levels.
– Limit pregnancy weight gain to an average of 25 pounds.
– Plan an elective cesarean section delivery.
– Attend all prenatal office visits.
### Question 8
Which action would the nurse take first for a client who is in active labor and experiences sudden vaginal bleeding and increased uterine tone without relaxation between contractions?
– Transport the client for a cesarean birth.
– Check the perineum for rupture of membranes.
– Change the underpad and position the client on her left side.
– Assess the fetal heart rate, uterine activity, and blood pressure.
### Question 9
Which is the priority nursing action when a loop of umbilical cord protrudes from the vagina after rupture of a client’s membranes?
– Monitoring the fetal heart rate.
– Covering the cord with a saline dressing.
– Checking intensity and duration of contractions.
– Holding the presenting part away from the cord.
### Question 10
A client at 36 weeks’ gestation has gained 5 lb (2.3 kg) in the previous week and has a pronounced increase in blood pressure. Which is the initial intervention upon admission of the client to the high-risk unit?
– Preparing for an imminent cesarean birth.
– Providing a dark, quiet room with minimal stimuli.
– Initiating intravenous (IV) furosemide to promote diuresis.
– Administering calcium gluconate to lower the blood pressure.
### Question 11
Which orders are appropriate for a client with mild preeclampsia? Select all that apply. One, some, or all responses may be correct.
– Daily weight.
– Side-lying bed rest.
– 2g/day sodium diet.
– Monitor deep tendon reflexes.
– Glucose tolerance test.
### Question 12
Which postpartum client is at the highest risk for disseminated intravascular coagulation (DIC)?
– Gravida III with twins.
– Gravida V with endometriosis.
– Gravida II who had a 9-lb baby.
– Gravida I who has had an intrauterine fetal death.
### Question 13
A client who has missed two menstrual periods arrives at the prenatal clinic with vaginal bleeding and one-sided lower quadrant pain. Which condition would the nurse suspect?
– Placenta previa.
– Ectopic pregnancy.
– Incomplete abortion.
– Rupture of a graafian follicle.
### Question 14
A postpartum client is being treated with subcutaneous enoxaparin for deep vein thrombosis of the left calf. Which client cue is of most concern to the nurse?
– Dyspnea.
– Pulse rate of 62 beats/min.
– Blood pressure of 136/88 mm Hg.
– Positive Homan sign in the left leg.
### Question 15
When caring for a woman with a probable tubal pregnancy, which clinical manifestation requires immediate intervention?
– Abdominal distention.
– Intermittent abdominal contractions.
– Dull, continuous upper-quadrant abdominal pain.
– Sudden onset of knifelike pain in one of the lower quadrants.
### Question 16
While providing care for a client who sustained a severe head injury in an accident, the nurse observes the client is constantly passing urine and dehydrated. Which condition would the nurse suspect as the cause of the client’s condition?
– Decreased secretion of aldosterone.
– Decreased secretion of antidiuretic hormone.
– Decreased secretion of parathyroid hormone.
– Decreased secretion of atrial natriuretic peptide.
### Question 17
When evaluating the condition of a client with burns to the upper body, which finding would alert the nurse of a potential respiratory obstruction?
– Deep breathing.
– Hoarse quality to the voice.
– Pink-tinged, frothy sputum.
– Rapid abdominal breathing.
### Question 18
When providing care for a client during the first few hours after admission to the burn unit with full-thickness burns of the trunk and head, which goal is the nurse’s priority during the emergent phase of this injury?
– Preventing pain.
– Managing leukopenia.
– Preventing infection.
– Managing fluid loss.
### Question 19
Which action by the nurse is best when a client who experienced a myocardial infarction 2 days ago has a temperature of 100.2°F (37.9°C)?
– Auscultate the chest for diminished breath sounds.
– Encourage coughing and deep breathing every hour.
– Record the temperature reading and continue to monitor it.
– Suspect an infection and notify the health care provider immediately.
### Question 20
When assessing a 75-year-old client, which finding by the nurse would be most important to report to the health care provider?
– Decreased lung sounds at bases.
– Kyphosis with barrel-shaped chest.
– Oxygen saturation at rest 93%.
– Expiratory wheezes bilaterally.
### Question 21
When a client who experienced a myocardial infarction suddenly develops a heart rate of 120 beats/minute, which action would the nurse take first?
– Offer reassurance.
– Check blood pressure.
– Call for an electrocardiogram (ECG).
– Activate the hospital rapid response team.
### Question 22
When admitting a client with acute coronary syndrome (ACS) to the telemetry unit after cardiac catheterization and percutaneous intervention (PCI), which action would the nurse take first?
– Attach the cardiac monitor.
– Auscultate the heart sounds.
– Check the intravenous fluid rate.
– Assess alertness and orientation.
### Question 23
When preparing to admit a near-drowning victim to the emergency department, which action by the nurse has the highest priority?
– Obtain equipment for nasogastric tube insertion to decompress the stomach.
– Prepare the endotracheal intubation tray for insertion of an artificial airway.
– Have warming blankets and hyperthermia machine available to warm the client.
– Call for laboratory personnel to be in the emergency department to draw blood.
### Question 24
When assigned the care of a client arriving in the emergency department with possible acute coronary syndrome, which prescribed action would the nurse take first?
– Ask the client about level of intensity of the chest pain.
– Draw blood for troponin and creatine kinase MB.
– Obtain a 12 lead electrocardiogram (ECG).
– Notify the cardiac catheterization laboratory about the client.
### Question 25
Which nursing action has the highest priority when providing care for a client who has had an acute myocardial infarction (MI)?
– Prevent nausea and vomiting.
– Monitor for cardiac dysrhythmias.
– Use prescribed medication to lower fever.
– Teach about the phases of cardiac rehabilitation.
### Question 26
Which action would the nurse take first when responding to an apnea monitor alarm that signifies a 10-second cessation of respirations?
– Assess for changes in skin color.
– Use tactile stimuli on the chest or extremities.
– Check the monitor for signs of a malfunction.
– Resuscitate with a face mask and an Ambu bag.
### Question 27
Which problem would be the most difficult for the nurse to manage when meeting the needs of an extensively burned client 3 days after admission?
– Weaning of potent opioids like morphine for severe pain to prevent addiction.
– Changing and debriding wounds to prevent infection.
– Beginning a discussion related to alteration in body image.
– Turning and positioning the client every 30 to 60 minutes to prevent contracture development.
### Question 28
Which action would the nurse anticipate implementing when providing care for a client with acute respiratory distress syndrome who is intubated and on mechanical ventilation?
– Deflate the endotracheal tube cuff hourly.
– Schedule a change in ventilator tubing every 24 hours.
– Determine need for suctioning based on client assessments.
– Leave fraction of inspired oxygen (FiO2) at the highest setting as the client oxygenation improves.
### Question 29
Which physiologic response to bronchiolitis would the nurse expect to observe on the pediatric intensive care unit? Select all that apply. One, some, or all responses may be correct.
– Wheezing.
– Bradycardia.
– Sternal retractions.
– Nasal flaring.
– Prolonged expiratory phase.
### Question 30
Which client between the ages of 25 and 55 years would the nurse assess first?
– Male client with a hemoglobin of 15.9 (160 mmol/L).
– Female client on warfarin with an international normalized ratio (INR) of 7.5.
– Female client taking daily calcium supplements with a serum calcium level of 9.4 (2.35 mmol/L).
– Male client with a blood urea nitrogen (BUN) of 20 (7.1 mmol/L) and a creatinine of 1 (96 mcmol/L).
### Question 31
A client with chronic obstructive pulmonary disease (COPD) is breathing rapidly and using accessory muscles of respiration. The nurse auscultates the lungs and hears crackles and wheezes. Which action would the nurse take?
– Encourage the client to take slow, deep breaths and administer 5 L/min oxygen per nasal cannula.
– Place the client in a side-lying position and perform chest physiotherapy using clapping and vibration.
– Raise the head of the bed to a high-Fowler position and administer 2 L/min oxygen per nasal cannula.
– Assist the client in assuming a position of comfort and perform postural drainage.
### Question 32
A client with renal failure receives prescriptions for vitamin D and calcium supplements. The client asks the nurse, “Why do I need to take these?” The nurse explains that, with renal failure,
there is:
– An inability to activate and use circulating vitamin D.
– A tendency to store, rather than excrete, vitamin D.
– A dietary need for increased calcium and vitamin D.
– An inability to metabolize and excrete calcium.
### Question 33
Which finding would the nurse expect in the history of a client with chronic pyelonephritis?
– Weight gain.
– Hypertension.
– Hyperkalemia.
– Hypocalcemia.
### Question 34
When performing a neurologic assessment for a client with type 1 diabetes who is 24 hours postoperative, which is the priority nursing action?
– Assessing level of consciousness.
– Obtaining a fasting blood glucose level.
– Testing deep tendon reflexes of the legs.
– Evaluating size and reactivity of the pupils.
### Question 35
A client with a chest tube in place is receiving mechanical ventilation. When providing care for this client, which action is the priority?
– Ensure the integrity of the client’s ventilator settings.
– Check the volume of the client’s chest tube drainage.
– Maintain the client in a high-Fowler position.
– Verify the position of the chest tube.
### Question 36
Which clinical cue would the nurse anticipate finding in a client with right-sided heart failure?
– Pallor.
– Warm, dry skin.
– Shortness of breath.
– Peripheral edema.
### Question 37
When caring for a 10-year-old client with hemophilia A, which action would the nurse take to decrease trauma to the client’s joints?
– Administering an iron supplement.
– Encouraging active range-of-motion exercises.
– Providing factor VIII replacement therapy.
– Limiting the client’s intake of dietary protein.
### Question 38
When assessing a client after a closed reduction of a fractured wrist and application of a cast, which action would the nurse take first if the client exhibits symptoms of compartment syndrome?
– Check the temperature of the cast.
– Notify the health care provider immediately.
– Ask about the client’s last tetanus immunization.
– Perform a neurologic examination of the affected arm.
### Question 39
When caring for a client with Guillain-Barré syndrome, which intervention is the priority?
– Providing for adequate ventilation.
– Monitoring for changes in level of consciousness.
– Preventing development of complications of immobility.
– Teaching the client and family about the disease process.
### Question 40
Which nursing intervention is the priority when preparing to move a client into the lithotomy position for a gynecologic examination?
– Having the client void.
– Drape the client carefully.
– Provide support for the feet.
– Raise the legs simultaneously.
### Question 41
When a client with multiple trauma is admitted to the intensive care unit, which finding would alert the nurse to abdominal injury?
– Chest pain.
– Absent bowel sounds.
– Increased heart rate.
– Increased blood pressure.
### Question 42
When providing care for a client who experienced a cerebrovascular accident (CVA) and is at risk for aspiration, which intervention would the nurse implement?
– Providing frequent oral care.
– Instructing the client to use a straw.
– Placing the client in a side-lying position.
– Keeping the head of the bed elevated to 45 degrees.
### Question 43
A client with diabetes mellitus reports palpitations and sweating and has a blood glucose level of 65 mg/dL. Which intervention is the priority?
– Administer oxygen.
– Obtain a serum glucose level.
– Give the client 4 oz (118 mL) of fruit juice.
– Notify the health care provider immediately.
### Question 44
Which action would the nurse take first when responding to the monitor alarm indicating ventricular tachycardia?
– Assessing the client’s airway.
– Preparing for immediate defibrillation.
– Palpating for a pulse.
– Starting cardiopulmonary resuscitation (CPR).
### Question 45
Which action would the nurse take when a postpartum client is diagnosed with postpartum depression?
– Reassure the client this is normal for new mothers.
– Teach the client the signs and symptoms of postpartum psychosis.
– Encourage the client to schedule an appointment with her health care provider.
– Instruct the client to get more rest and sleep whenever the baby sleeps.