RN Comprehensive Predictor 2019 Form A&B
1. A nurse is providing teaching about the gastrostomy tube feedings to the parents of a school age child. Which of the following instructions should the nurse take?
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RN Comprehensive Predictor 2019 Form A&B
1. A nurse is providing teaching about the gastrostomy tube feedings to the parents of a school age child. Which of the following instructions should the nurse take?
A. Administer the feeding over 30 min.
B. Place the child in as supine position after the feeding.
C. Charge the feeding bag and tubing every 3 days.
D. Warm the formula in the microwave prior to administration.
2. A nurse is administering digoxin 0.125 mg Po to an adult client. For which of the following findings should the nurse report to the provider? A. Potassium level 4.2 mEq/L.
B. Apical pulse 58/min.
C. Digoxin level 1 ng/ml.
D. Constipation for 2 days.
3. A nurse is caring for a client who is comatose and has advance directives that indicate the client does not want life-sustaining measures. The client’s family want the client to have life-sustaining measures. Which of the following action should the nurse take?
A. Arrange for an ethics committee meeting to address the family’s concerns.
B. Support the family’s decision and initiate life-sustaining measures.
C. Complete an incident report.
D. Encourage the family to contact an attorney.
4. A nurse is caring for a client who wears glasses. Which of the following actions should the nurse take? A.
Store the glasses in a labeled case.
B. Clean the glasses with hot water.
C. Clean the glasses with a paper towel.
D. Store the glasses on the bedside table.
5. A nurse is teaching a group of newly licensed nurses about measures to take when caring for a client who is on contact precautions. Which of the following should the nurse include in the teaching?
A. Remove the protective gown after the client’s room.
B. Place the client in a room with negative pressure.
C. Wear gloves when providing care to the client.
D. Wear a mask when changing the linens in the client’s room.
6.A nurse is planning on care for a client who is recovering from an acute myocardial infarction that occurred 3 days ago. Which of the following instructions should the nurse include? A. Perform an ECG every 12 hr.
B. Place the client in a supine position while resting.
C. Draw a troponin level every 4hr.
D. Obtain a cardiac rehabilitation consultation.
7. The nurse is reviewing the medical record of a client who is requesting combination oral contraceptives.
Which of the following conditions in the client’s history is a contradiction to the use of oral
contraceptives? A. Hyperthyroidism. B. Thrombophlebitis.
C. Diverticulosis.
D. Hypocalcemia.
8 A nurse is caring for a client who request the creation of a living will. Which of the following actions should the nurse take?
A. Schedule a meeting between the hospital ethics committee and the client.
B. Evaluate the client’s understanding of life-sustaining measures.
C. Determine the client’s preferences about post mortem care.
D. Request a conference with the client’s family.
9.A nurse is caring for an adolescent who has sickle-cell anemia. Which of the following manifestations indicates acute chest syndrome and should be immediately reported to the provider? A. Substernal
retractions.
B. Hematuria.
C. Temperature 37.9 C (100.2 F).
D. Sneezing.
10.A nurse is preforming a gastric lavage for a client who has upper gastrointestinal bleeding. Which of the
.following action should the nurse take?
A. Instill 500 ml of solution through the NG tube.
B. Insert a large-bore NG tube.
C. Use a cold irrigation solution.
D. Instruct the client to lie on his right side.
11. A nurse is providing care for a client who is in the advance stage of amyotrophic lateral
sclerosis. (ALS). Which of the following referrals is the nurse’s priority?
A. Psychologist.
B. Social worker.
C. Occupational therapist.
D. Speech-language pathologist.
12.A nurse is reviewing the laboratory results of a client who has rheumatoid arthritis. Which of the following findings should the nurse report to the provider? A. WBC count 8,000/mm3.
B. Platelets 150,000/mm3.
C. Aspartate aminotransferase 10 units/L.
D. Erythrocyte sedimentation rate 75 mm/hr
13. A nurse is caring for a client who has generalized petechiae and ecchymoses. The nurse should expect a prescription for which of the following laboratory tests? A. Platelet count.
B. Potassium level.
C. Creatine clearance.
D. Prealbumin.
14. A nurse is caring for a client following application of a cast. Which of the following actions should the nurse take first?
A. Place an ice pack over the cast.
B. Palpate the pulse distal to the cast.
C. Teach the client to keep the cast clean and dry.
D. Position the casted extremity on a pillow.
15. A nurse is caring for a client who has vision loss. Which of the following actions should the nurse take? (Select all that apply)
A. Keep objects in the client’s room in the same place.
B. Ensure there is high-wattage lighting in the client’s room.
C. Approach the client from the side.
D. Allow extra time for the client to perform tasks.
E. Touch the client gently to announce presence.
16. A nurse is caring for a client who is newly diagnosed with pancreatic cancer and has questions about the disease. To research the nurse should identify that which of the following electronic database has the most
comprehensive collection of nursing (Unable to read) articles?
A. MEDLINE
B. CINAHL.
C. ProQuest.
D. Health Source.
17. A nurse in an emergency department is assessing newly admitted client who is experiencing drooling and hoarseness following a burn injury. Which of the following should actions should the nurse take first?
A. Obtain a baseline ECG.
B. Obtain a blood specimen for ABG analysis.
C. Insert an 18-gauge IV catheter.
D. Administer 100% humidified oxygen.
18. A nurse is planning care for a client who has unilateral paralysis and dysphagia following a right hemispheric stroke. Which of the following interventions should the nurse include in the plan?
A. Place food on the left side of the client’s mouth when he is ready to eat.
B. Provide total care in performing the client’s ADLs.
C. Maintain the client on bed rest.
D. Place the client’s left arm on a pillow while he is sitting.
19. A nurse is caring for a client who is in a seclusion room following violent behavior. The client continues to display aggressive behavior. Which of the following actions should the nurse take?
A. Confront the client about this behavior.
B. Express sympathy for the client’s situation.
C. Speak assertively to the client.
D. Stand within 30 cm (1 ft) of the client when speaking with them.
20. A nurse is caring for a client who is receiving brachytherapy for treatment of prostate cancer. Which of the following actions should the nurse take?
A. Cleanse equipment before removal from the client’s room.
B. Limit the client’s visitors to 30 min per day.
C. Discard the client’s linens in a double bag.
Discard the radioactive source in a biohazard bag
21. A nurse is assessing a client who has left-sided heart failure. Which of the following should the nurse identify as a manifestation of pulmonary congestion?
A. Frothy, pink sputum.
B. Jugular vein distention.
C. Weight gain.
D..Bradypnea
22. A nurse is caring for a client who is in labor and requires augmentation of labor. Which of the following conditions should the nurse recognize as a contraindication to the use of oxytocin.
A. Diabetes mellitus.
B. Shoulder presentation.
C. Postterm with oligohydramnios. (I think Maternal Newborn Chapter 15 page 100)
D. Chorioamnionitis
23. A nurse is assessing a client who has left-sided heart failure. Which of the following should the nurse identify as a manifestation of pulmonary congestion?
A. Frothy, pink sputum.
D. Jugular vein distention.
E. Weight gain.
Bradypnea
24. A nurse is caring for a 5-month-old infant who has manifestations of severe dehydration and a prescription for paternal fluid therapy. The guardian asks. “What are the indications that my baby needs an IV?” Which of the following responses should the nurse make?
A. “Your baby needs an IV because she is not producing any tears”
B. “Your baby needs an IV because her fontanels are budging”
C. “Your baby needs an IV because she is breathing slower than normal”
D. “Your baby needs an IV because her heart rate is decreasing”
25. A nurse is providing teaching to a client who has heart failure and a new prescription for furosemide. Which of the following statements should the nurse make?
A. “Taking furosemide can cause your potassium levels to be high”
B. “Eat foods that are high in sodium”
C. “Rise slowly when getting out of bed”
D. “Taking furosemide can cause you to be overhydrated”
26. A nurse is creating a plan of care for a newly admitted client who has obsessive-compulsive disorder. Which of the following interventions should the nurse take? A. Allow the client enough time to perform rituals.
B. Give the client autonomy in scheduling activities.
C. Discourage the client from exploring irrational fears.
D. Provide negative reinforcement for ritualistic behaviors.
27. A nurse is caring for a client who has depression and reports taking ST. John’s wort along with citalopram. The nurse should monitor the client for which of the following conditions as a result of an interaction between these substances?
A. Serotonin syndrome
B. Tardive dyskinesia
C. Pseudo parkinsonism.
D. Acute dystonia.
28. A nurse is assessing a client who is receiving packed RBCs. Which of the following findings indicate fluid overload?
A. Low back pain.
B. Dyspnea.
C. Hypotension.
D. Thready pulse.
29. A nurse is calculating a client’s expected date of delivery. The client’s last menstrual period began on April
. Using Nagele’s rule, what date should the nurse determine to be the client’s expected delivery
date? (Use mmdd format.)
0119 date
30. A nurse is discussing group treatment and therapy with a client. The nurse should include which of the following as being a characteristic of a therapeutic group? A. The group is organized in an autocratic structure.
B. The group encourages members to focus on a particular issue. (Mental Health Chapter 8 Page 42)
C. The group must be led by a licensed psychiatrist.
D. The group encourages clients to form dependent relationships.
31. A nurse manger is reviewing documentation with a newly licensed nurse. Which of the following notations by the newly licensed nurse indicates an understanding of the teaching.
UNSURE IF ON THE REPORT
A. “OOB with assistance for breakfast”
B. “Given 2 mg MSO4 IM for report of pain”
C. “Dressing changed qd”
D. “Administered 8 u regular insulin sq.”
32. A nurse is preparing to administer eye drops to a school-age child. Identify the actions the nurse should take. (Move the steps into the box on the right, placing them in the order of performance. Use all the steps.)
1. Apply pressure to the lacrimal punctum.
2. Ask the child to look upward.
3. Pull the lower eyelid downward.
4. Instill the drops of medication.
5. Place the child in a sitting position.
5 2 3 4 1
33. A nurse is caring for a client who speaks a language different from the nurse. Which of the following should the nurse take?
A. Request an interpreter of a different sex from the client.
B. Request a family member or friend to interpret information for the client.
C. Direct attention toward the interpreter when speaking to the client.
D. Review the facility policy about the use of an interpreter.
34. A nurse is caring for a client who is in labor and is receiving oxytocin. Which of the following findings indicates that the nurse should increase the rate of infusion?
ON THE REPORT needs double checking A. Urine output 20 ml/hr.
B. Montevideo units constantly 300 mm Hg.
C. FHR pattern with absent variability.
D. Contractions every 5 min that last 30 seconds.
35.A public health nurse is managing several projects for the community. Which of the following interventions should the nurse identify as a primary prevention strategy?
A. Teaching parenting skills to expectant mothers and their partners.
B. Conducting mental health screenings at the local community center. C. Referring client who have obesity to community exercise programs.
D. Providing crisis intervention through a mobile counseling unit.
36. A nurse is preparing to administer an autologous blood product to a client. Which of the following actions should the nurse take to identify the client?
A. Match the client’s blood type with the type and cross match specimens.
B. Confirm the provider’s prescription matches the number on the blood component.
C. Ask the client to state the blood type and the date of their last blood donation.
D. Ensure that the client’s identification band matches the number on the blood unit.
37. A nurse is performing physical therapy for a client who has Parkinson’s disease. Which of the
following statements by the client indicates the need for a referral to physical therapy?
A. “I have been experiencing more tremors in my left arm than before”
B. “I noticed that I am having a harder time holding on to my toothbrush”
C. “Lately, I feel like my feet are freezing up, as they are stuck to the ground”
D. “Sometimes, I feel I am making a chewing motion when I’m not eating”
38. A nurse is reviewing laboratory data for a client who has chronic kidney disease. Which of the following findings should the nurse expect? A. Increased creatine.
B. Increased hemoglobin.
C. Increased bicarbonate.
D. Increased calcium.
39. A nurse is administering a scheduled medication to a client. The client reports that the medication appears different than what they take at home. Which of the following responses should the nurse take?
A. “Did the doctor discuss with you that there was a change in this medication?”
B. “I recommend that you take this medication as prescribed”
C. “Do you know why this medication is being prescribed to you?”
D. “I will call the pharmacist now to check on this medication”
40 A nurse is teaching at a community health fair about electrical fire prevention. Which of the following information should the nurse include in the teaching? A. Use three pronged grounded plugs.
B. Cover extension cords with a rug.
C. Check the tingling sensations around the cord to ensure the electricity is working.
D. Remove the plug from the socket by pulling the cord.
41. A charge nurse is recommending postpartum client discharge following a local disaster. Which of the following should the nurse recommend for discharge?
A. A 42-year-old client who has preeclampsia and a BP of 166/110 mm Hg.
B. A 15-year-old client who delivered via emergency cesarean birth 1 day ago.
C. A client who received 2 units of packed RBCs 6 hr. ago for a postpartum hemorrhage.
D. A client who delivered precipitously 36 hr. ago and has a second-degree perineal laceration.
42. A nurse in a provider’s office is reviewing the laboratory results of a group of clients. Which to
report?
A. Herpes simplex.
B. Human papillomavirus
C. Candidiasis
D. Chlamydia
43. A nurse is providing discharge teaching for a group of clients. The nurse should recommend a referral to adietitian
A. A client who has a prescription for warfarin and states “I will need to limit how much spinach I eat”.
B. A client who has gout and states, “I can continue to eat anchovies on my pizza.”
C. A client who has a prescription for spironolactone and states “I will reduce my intake of foods
that contain potassium”.
D. A client who has (Unable to read) and states “I’ll plan to take my calcium carbonate with a full glass of water”.
44. A nurse is preparing to measure a temperature of an infant. Which of the following action should the nurse take?
A. Place the tip of the thermometer under the center of the infant’s axilla.
B. Pull the pinna of the infant’s ear forward before inserting the probe.
C. Insert the probe 3.8 cm (1.5in) into the infant’s rectum.
D. Insert the thermometer in front of the infant’s tongue.
45. A nurse in a pediatric clinic is teaching a newly hired nurse about the varicella rooster. Which of the following information should the nurse include?
A. Children who have varicella are contagious until vesicles are crusted.
B. Children who have varicella should receive the herpes zoster vaccination.
C. Children who have varicella should be placed in droplet precaution.
D. Children who have varicella are contagious 4 days before the first vesicle eruption.
46.A nurse is reviewing the laboratory report of a client who has been having lithium carbonate for the past 12 months. The nurse notes a lithium level of 0.8 mEq/L. Which of the following orders from the provider should the nurse expect?
A. Withhold the next dose.
B. Increase the dosage.
C. Discontinue the medication.
D. Administer the medication.
47. A nurse is caring for a client who has fibromyalgia and requests pain medication. Which of the following medications should the nurse administer?
A.
B. Pregabali C. n
Lorazepa
D.
m
Colchicin e Codeine.
48. A nurse is caring for a client who is to receive a transfusion of packed RBCs. Which of the following actions should the nurse take?
A. Prime IV tubing with 0.9% sodium chloride.
B. Use a 24-gauge IV
C. catheter Obtain filter less IV tubing.
D. Place blood in the warmer for 1 hr.
49. A nurse is caring for a toddler who has acute lymphocytic leukemia. In which of the following should the toddler participate?
A. Looking at alphabet flashcards.
B. Playing with a large plastic truck.
C. Use scissors cut out paper shapes.
D. Watching a cartoon in the dayroom.
50. A nurse is caring for a client who has chronic pancreatitis. Which of the following dietary recommendations should the nurse make?
A. Coffee with creamer.
B. Lettuce with sliced avocados.
C. Broiled skinless chicken breast with brown rice.
D. Warm toast with margarine.
51. A nurse is preparing to assess a 2-week-old newborn. Which of the following actions should the nurse plan to take?
A. Obtain the newborn’s body temperature using a tympanic thermometer.
B. (Unable to read) FACES pain scale.
C. Auscultate the newborn’s apical pulse for 60 seconds.
D. Measure the newborn’s head circumference over the eyebrows and below the occipital prominence.
(NOT)
52. A nurse is caring for a client who is at 38 weeks gestation, is in active labor, and has ruptured membrane. Which of the following actions should the nurse take?
A. Insert an indwelling urinary catheter.
B. Apply fetal heart rate monitor.
C. Initiate fundal massage.
D. Initiate an oxytocin IV infusion.
53. A nurse is assessing a client who is 30 min postoperative following an arterial thrombectomy. Which of the following findings should the nurse to report?
A. Chest pain
B. Muscle spasms.
C. Cool, moist skin.
D. Incisional pain.
54. A nurse is completing an incident report after a client fall. Which of the following competencies of Quality
and Safety Education for Nurse is the use demonstrating? A
B. Patient (Unable to read)
C. Evidence based practice.
D. Informatics.
. Quality improvement.
55. A nurse is talking with another nurse on the unit and smells alcohol on her breath. Which of the following actions should the nurse take?
A. Confront the nurse about the suspected alcohol use.
B. Inform another nurse on the unit about the suspected alcohol use.
C. Ask the nurse to finish administering medications and then go home.
D. Notify the nursing manager about the suspected alcohol use.
56. A nurse is caring for a client who has diaper dermatitis. Which of the following actions should the nurse take?
A. Apply zinc oxide ointment to the irritated area.
B. (Unable to read)
C. Wipe stool from the skin using store bought baby wipes.
D. Apply talcum powder to the irritated area.
66. A nurse is reviewing the facility’s safety protocols considering newborn abduction with the parent of anewborn. Which of the following statements indicates an understanding of the teaching?
A. “Staff will apply identification band after first
C. “I can remove my baby’s identification band as long as she is in my room”
D. “I can leave my baby in my room while I walk in the hallway”
57. A nurse is receiving a telephone prescription from a provider for a client who requires additional medication for pain control. Which of the following entries should the nurse make in the medical record?
A. “Morphine 3 mg SQ every 4 hr. PRN for pain.”
B. “Morphine 3 mg Subcutaneous (Unable to read)
C. “Morphine 3.0 mg sub q every 4 hr. PRN for pain.”
D. “Morphine 3 mg SC q 4 hr. PRN for pain.”
58. A nurse realizes that the wrong medication has been administered to a client. Which of the
following actions should the nurse take first? A. Notify the provider.
B. Report the incident to the nurse manager.
C. Monitor vital signs.
D. Fill out an incident report.
59. A nurse is providing teaching to a client who is experiencing preterm contractions and dehydration. Which of the following statements should the nurse make?
A. “Dehydration is treated with calcium supplements”
B. “Dehydration can increase the risk of preterm labor”
C. “Dehydration associated gastroesophageal reflux”
D. “Dehydration is caused by a decreased hemoglobin and hematocrit”
60. A nurse is receiving a change-of-shift report for an adult female client who is postoperative. Which of the following client information should the nurse report?
A. (Unable to read)
B. (Unable to read)
C. Answer might be lower platelets.
D. (Unable to read)
61. A nurse manager is developing a protocol for an urgent care clinic that often cares for clients who do not speak the same language as clinical staff. Which of the following instructions should the nurse include?
A. Use the client’s children to provide interpretation.
B. (Answer was the nurse was going to do the interpretation)
C. Offer client’s translation services for a nominal fee.
D. Evaluate the clients’ understanding at regular intervals.
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