Can someone help… i appear to keep getting mixed answers so can i…

Can someone help… i appear to keep getting mixed answers so can i please get the right answers only…. Thank you in advance.

8. A nurse is assisting in the plan of care for a client who is dehydrated and is receiving IV fluid replacement. Which of the following interventions should the nurse contribute to the plan of care?
A. Check for neck vein distention
B. Limit oral fluids prior to bedtime.
C. Monitor pulse pressure every 6 hrs
D. Offer oral fluids every 4 hrs.

9. A nurse is caring for a young adult client who has testicular cancer and expresses concern about their sexual functions following an orchiectomy of the involved testicle. Which of the following responses should the nurse make?
A. The removal of a single testicle will not prevent your from having an erection.
B. You should focus on recovering from your cancer right now
C. I am sure any partner will understand that you have no control over this.
D. There are other ways to express intimacy besides intercourse.

10.A nurse is collecting data from a client who has hyperthyroidism and is taking propylthiouracil. Which of the following statements by the client indicates the medication is effective?
Ans: I have less oily skin

11.A nurse is planning care for a client who is receiving radiation therapy to treat cancer and reports a change in the taste of food. Which of the following interventions should the nurse include in the plan of care?
A. Provide three large meals daily.
B. Add honey to sweeten fruit smoothies.
C. Heat food before serving.
D. Offer artificial saliva frequently.

12.A nurse working the night shift is caring for an older adult client who has dementia and is at risk for falls. Which of the following actions should the nurse take?
A. Raise all four side rails while the client is in bed.
B. Move the overbid table away from the bed.
C. Leave the television on in the client’s room,.
D. Apply a motion sensor mat to the client’s bed.

13.A nurse is reinforcing teaching with a client about increasing her intake of fiber. Which of the following foods should the nurse encourage the client to eat?
A. Yogurt
B. Pears
C. Cheese
D. Eggs

14.A nurse is reviewing the medical recored of a client who reports his urine is red-orange. The nurse should identify that which of the following medications can cause this adverse effect?
A. Isoniazid
B. Rifampin
C. Furosemide
D. Metoprolol

15.A nurse is caring for a cline tin hospice are who is dying. The client partner expresses concern that the client is sleeping more than in the previous week. Which of the following is an appropriate response by the nurse?
A. Encourage your partner to wake up to interact with family members.
B. I will call the provider to discuss your concerns.
C. I can ask the provider to prescribe a medication that will minimize drowsiness
D. Sitting quietly near the bedside can provide comfort and support.

16.A nurse is reinforcing teaching with a client who is postoperative following a tympanoplasty. Which of the following information should the nurse include?
A. Plan to shampoo hair in 1 week
B. Resume exercising in 10 days C. Close mouth when sneezing
D. Drink fluids through a straw

17.A nurse is reinforcing discharge teaching about dietary changes with a client who has a new colostomy. Which of the following foods should the nurse recommend?
A. Bananas
B. Broccoli
C. Asparagus
D. Grapes

18.A nurse is caring for a client who has diabetes mellitus. Which of the following laboratory results should the nurse report to the provider?
A. Fasting blood glucose 70 mg/dL
B. Glycosylated hemoglobin 5.2%
C. Urine negative for bilirubin
D. Urine positive for ketones

19.A nurse is caring for an older adult client who has heart failure. Which of the following findings should the nurse report to the provider?
A. Chest x-ray showing cardiomegaly
B. Potassium level 4.5 mEq/L
C. PaCO255 mm Hg
D. Urinary output of 1,000 mL in 12 hr

20.A nurse is caring for a client who has diabetic neuropathy of the lower extremities and has a new prescription for a heating pad. The prescription reads. “Apply to the left foot for 20 mins”. Which of the following actions should the nurse take?
A. Apply the heating pad as prescribed by the provider
B. Complete semmes-Weinstein monofilament testing following treatment.
C. Clarify the prescription with provider
D. Observe the skin 10 min after the start of treatment.

21.A nurse is reinforcing teaching with a client who has a new colostomy. Which of the following statements by the client indicates an understanding of the teaching?

A. I should avoid broccoli and chewing gum
B. I should place an aspirin in the pouch to eliminate odor. C. I should clean around the stoma with moisturizing soap
D. I should decrease the amount of fresh fruit in my diet.

22.A nurse is collecting data from a client who has a newly placed colostomy. Which of the following findings should indicate to the nurse the client has accepted their new altered body images?
A. Accepts that sexual activity will decrease
B. Prefers not to look at the stoma site
C. Denies feelings of sadness about the stony
D. Participates in performing ostomy care

23.A nurse is reviewing the laboratory data of a client who is scheduled for a liver biopsy. Which of following values should the nurse report to the provider?
A. Ammonia 55 mcg/dL
B. Bilirubin 1.0 mg/dL
C. Aspartate aminotransferase 34 units/L
D. Platelets 60.000/mm3

24.A nurse is assisting with the plan of care for a client who requires contact precautions. Which of the following interventions should the nurse include in the plan?
A. Wear an N95 mask when entering the room.
B. Use an alcohol swab to clean the temperature probe before removing it from
the roof,
C. Keep a stethoscope at the client’s bedside for the duration of her hospital
stay.
D. Remove personal protective equipment immediately after leaving the client’s
room.

25.A nurse is caring for a client who has a prescription for propranolol for the treatment of atrial fibrillation. Which of the following actions should the nurse take?
A. Request a dosage increase if the apical heart rate is less than 60/min
B. Administer the medication with an antacid.
C. Withhold the medication if the systolic blood pressure is less than 90 mm Hg
D. Instruct the client to expect increased hair growth

26.A nurse is reinforcing teaching about dietary modifications to help control blood pressure with a client who has hypertension. Which of the following food choices by the client indicates an understanding of the teaching?
A. Beef bouillon with crackers
B. A ham sandwich on rye bread
C. Pork sausage with sautéed peppers
D. Broiled cod with broccoli

27.A nurse is reinforcing teaching with a client about heart disease prevention. Which of the following client statements indicates an understanding of the teaching?
A. I will improve my LDL cholesterol by raising it from 100 to 130
B. I will try to maintain my blood pressure around 116/72
C. I will increase my dairy intake by drinking whole milk with every meal
D. I will exercise by walking twice a week for 25 minutes

28.A nurse is reinforcing teaching about a transcutaneous electrical nerve stimulation (TENS)unit for a client who has a herniated intervertebral disk. Which of the following statements by the client indicates an understanding of the teaching?
A. I should adjust the TENS unit until I feel a tingling sensation.
B. The TENS unit administer a continuous dose of pain medication
C. The TENS unit should be applied at least 8 inches from the actual site of my
pain
D. I will need to charge the TENS unit for 2 hours each day

29.A nurse is reviewing a client’s medical record. Which of the following findings is the priority for the nurse to report?
A. A clients range of ear pain as 5 on a scale from 0 to 10
B. Abnormal hepatoiminodiacetic acid (HIDA) scan
C. Urine output 200 mL/8 hr
D. Potassium level 6.2 mEq/L

30.A nurse is reinforcing teaching about decreasing risk of osteoporosis to a client who is postmenopausal. Which of the following instruction should the nurse include?
A. Increase daily intake of vitamin E.
B. Add a weight-bearing exercise regimen.
C. Take calcium carbonate supplements once a day with breakfast
D. Limit vitamin D intake.

31.A nurse is caring for a client who has COPD with copious secretions. Which of the following action should the nurse take?
A. Administer high-flow oxygen
B. Limit fluid intake
C. Place the client in prone position
D. Perform postural drainage

32.A nurse is collecting data from a client who had a long arm cast applied 2 hr ago. Which of the following findings of the affected extremity the nurse report to the provider immediately?
A. The client reports increased pain at the area of the fracture
B. The client’s fingers are cool to the touch.
C. The client’s capillary refill is 3 seconds
D. The client reports severe itching under the cast

33.A nurse is reinforcing teaching with a client who has diabetes mellitus about reducing the risk for a stroke. Which of the following statement by the client indicates an understanding of the teaching?
A. Having a Toal cholesterol level below 200 mg/dL. Increase my risk for a stroke.
B. My provider might prescribe a glucocorticoid regimen to decrease my risk for a stroke.
C. My risk for a stroke increase if HbA1c level is 6 percent or less.
D. I can decrease my risk for a stroke by losing excess weight.

34.A nurse is monitoring a cline two has nasogastric (NG) tube set to intermittent suction to manage a mechanical intestinal obstruction. Which of the following findings should the nurse report?
A. Bile-colored drainage from the NG tube
B. Potassium 4.2 mEq/L
C. Abdominal distention
D. BUN 16 mg/dL

36.A nurse working in a provider’s office is caring for a client who received penicillin G potassium 15 min ago to treat strap throat. Which of the following is the priority finding the nurse should report to the provider?
A. Nausea
B. Arthralgia
C. Hypotension
D. Abdominal pain

37.A nurse is collecting data from a client who began taking captopril 2 days ago. Which of the following findings should the nurse report to the provider immediately?
A. Lip selling
B. Metallic taste
C. Joint aches
D. Dizziness

38.A nurse is caring for a client who has dysphagia and left-sided weakness following a stroke. Which of the following actions should the nurse take when assisting the client with feeding?
A. Instruct the client to place their chin to their chest when swallowing
B. Position the client upright for 5 min after eating
C. Offer the client sick foods such as peanut butter
D. Place food on the affected side of the cline’t mouth

39.A nurse is reinforcing teaching with a client who has ovarian cancer an all receive chemotherapy through a peripherally inserted central catheter (PICC) line. Which of the following statements by the client indicates an understanding of the teaching?
A. I will monitor my temperature for fever while I have this device.
B. It’s okay to get the device wet when I shower.
C. I will ear an arm immobilizer to prevent dislodgment of this device
D. I should pull the dressing away from the insertion site when I change it.

40.A nurse is assisting with care of a cline two has a closed-chest tube drainage system. Which of the following actions should the nurse take?
A. Monitor for at least 150 mL of drainage every hour.
B. Pin the tubing to the client’s bed sheets
C. Clamp the tube for 30 min every 8 hr
D. Replace the unit when the drainage cancer is full

41.A nurse is collecting date from a client who is 2 days postoperative following a colon resection. Which of the following findings indicates the need for nursing intervention?
A. Serosanguineous drainage on the wound dressing
B. Oxygen saturation 95%
C. Mild abdominal pain when coughing 30 min after receiving pain medication
D. Dark brown drainage in the NG tube

42.A nurse is caring for a client who is visually impaired. Which delivering the client’s meal tray. Which of the following actions should the nurse take?
A. Provide the client with small-handled adaptive utensils
B. Arrange for a assistance personnel to fee the client
C. Describe the food placement as though the plate were a clock.
D. Discourage conversations during the client’s mealtime.

43.A nurse is reinforcing teaching with a client who is starting to take metformin extended release. Which of the following instruction should the nurse include in the instructions?
A. Chew the medication before swallowing
B. Expect muscle pain while taking this medication
C. Take the medication with breakfast
D. Monitor blood glucose while taking this medication

45.A nurse is receiving change-of-shift report about the care of four clients. Which of the following clients should the nurse see first?
A. A client who displays increased confusion over the past 4 hr
B. A client who has a blood pressure of 138/88 mm Hg
C. A client who reports a pain level of 4 on a scale of 0 to 10
D. A client who has a blood glucose level of 128 mg/dL

46.A nurse is assisting in the care of a client whose cardiac monitor suddenly displays ventricular tachycardia. Which of the following is the priority nursing action?
A. Determine palpable pulse
B. Perform immediate defibrillation
C. Provide pulmonary ventilation
D. Begin chest compressions

47.A nurse is collecting data from a client who underwent a thyroidectomy 4 hr ago,.which of the following findings indicates a complication of the procedure?
A. Tingling of the fingers
B. Soreness at the incision site
C. Report of sore throat
D. Serosanguineous drainage on the dressing

48.A nurse is reinforcing discharge teaching with a client who had an excision biopsy of the left breast. Which of the following instructions should the nurse include?
A. Expect numbness to last for up to 4 months
B. Use bandages to absorb bleeding at the incision site.
C. Apply an ice pack to the incision site to treat discomfort
D. Refrain from wearing a bra for 10 days after the surgery

49.A nurse is collecting data from a client who has peritonitis. Which of the following should the nurse expect?
A. Peripheral edema
B. Decreased respirations
C. Polyuria
D. Absent bowel sounds

50.A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease. Which of the following dietary instructions should the nurse include?
A. Limit meals to three per day with no snacking in between
B. Chew food thoroughly
C. Drink carbonated beverages with meals
D. Use a straw when drinking liquids

51.A nurse is reinforcing teaching with a client about menopause. Which of the following statements by the client indication an understanding of the teaching?
A. I should expect to have an increased risk for breast cancer
B. I will need hormone replacement therapy for the rest of my life
C. I should use a vaginal douche to prevent dryness.
D. The use of black cohosh will decrease vaginal bleeding

52.A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease. Which of the following dietary instruction should the nurse include?
A. Limit meals to three per day with no snacking in between
B. Chew food thoroughly
C. Drink carbonated beverages with meals
D. Use a straw when drinking liquids

53.A nurse is preparing a client for a colposcopy following an abnormal papanicolaus (pap) test. Which of the following actions should the nurse take?
A. Reinforce teaching that the procedure involves dilation of the cervix
B. Instruct the client to avoid sexual intercourse until the cervix is healed
C. Place the client in the sims position
D. Insert a tampon following the procedure

54.A nurse is assisting with the development of the plan of care for a client who has a low WBC count. Which of the following interventions should the nurse include?
A. Obtain the client’s rectal temperature every 4 hr
B. Encourage the client to eat a low-protein diet
C. Prohibit fresh flowers in the client’s room
D. Initiate airborne precautions for the client

55.A nurse is reinforcing teaching with a female client who has a history of urinary tract infection. Which of the following instructions should the nurse include?
A. Urinate before and after sexual intercourse
B. Increase milk consumption to make the urine more alkaline
C. Use a vaginal douche once a week
D. Empty the bladder at least every 6 hr

56.A nurse is caring for a client who has prescription for a sequential compression device (SCD). Which of the following actions should the nurse take when applying the SCD?
A. Ensure pressure of the device is at 25 mm Hg
B. Place each sleeve under each leg with the opening at the calf
C. Ensure two fingers fit between the leg and the sleeve
D. Wrap excess tubing to the side of each leg.

57.A nurse is caring for a client who has bladder cancer and is 1 day postoperative following placement of an ill conduit. Which of the following information should the nurse report to the provider? (Click on the “exhibit” button for additional information about the client. There are three tabs that contain separate categories of data)
A. Stoma color
B. Bowel sounds
C. Platelet count
D. Urine output

58.A nurse is collecting data about immunizations from a 65 year old client who has no identified risk factors for disease. The nurse should identify the client’s need for which of the following immunizations?
A. Inactivated polio virus
B. Herpes zoster
C. Human papiloma virus
D. Measles, mumps and rubella

59.A nurse is reinforcing teaching with a client about colorectal cancer. Which of the following risk factors should the nurse include?
A. Chronic constipation
B. Duodenal ulcer
C. Ulcerative colites
D. Biliary colic

60.A nurse is assisting with transfer of a client from a medical-surgical unit to an intensive care unit following a change in status. Which of the following information should the nurse include in the transfer documentation? ( Select all that apply)
A. Current medication prescriptions
B. Primary health problem
C. Number of family members who have visited
D. Scheduled times for dressing changes
E. Admission vital signs from 1 week ago

61.A nurse is collecting data from a client prior to administering bydrochlorothiaxige for mild hypertension. Which of the following findings should the nurse identify as a contraindication to administering the medications?
A. 2 + pedal edema
B. History of GERD
C. Allergy to shellfish
D. Potassium 2.8 mEq/L

62.A nurse is caring for a cline who has a terminal illness and is in the active phase of dying. The client refuses further hydration and nourishment. Which of the following actions should the nurse take?
A. Provide regular oral care for the client with a moist swab.
B. Request a prescription for IV fluids
C. Explain the importance of oral hydration to the client
D. Ask the client’s health care surrogate for permission to withhold nourishment

63.A nurse is caring for a client who has returned to the unit following a cardiac catheterization using a feral approach. Which of the following methods should the nurse use to monitor for complication?
A. Palpitate the client’s brachial pulses and compare bilaterally.
B. Palpate the client’s pedal pulses and compare bilaterally
C. Check for jugular vein distention while the client is supine
D. Check the client’s blood pressure while the client lies supine, sits and stands.

64.A nurse reinforcing teaching about foot are with a client who has diabetes mellitus. Which of the following client statement s indicates understanding of the teaching?
A. I should round the corners of my toenails with a nail file to prevent ingrown nails
B. I should apply a heating pad to my feet every night to help with circulation
C. I should put lotion between my toes every day to prevent dryness and
cracking
D. I should use my wrist to test the temperature of the water before bathing.

65.A nurse is contributing to the plan of care for a client who has disuse syndrome following cast removal from a lower extremity. Which of the following referrals should the nurse include in the plan of care?
A. Occupational therapist
B. Dietitian
C. Herbalist
D. Social worker

66.A nurse is collecting data from a client who had a left hemispheric stroke. Which of the following findings should the nurse report to the provider immediately?
A. Right sided weakness
B. Difficulty speaking
C. Inability to follow direction
D. A change in pupil size

67.A nurse is caring for a client who is experiencing muscle spasms and has a new prescription for an aquathermia pad. Which of the following actions should the nurse take?
A. Use safety pins to secure the pad in place.
B. Cover the pad prior to use
C. Fill the pad with sterile water
D. Apply the pad for 45 min at a time

68.A nurse is reinforcing teaching about risk factors for colorectal cancer with a client. Which of the following risk factors should the nurse include in the teach? ( select all that apply)
A. Physical inactivity
B. Hight-fiber diet
C. Family history of colorectal cancer
D. History of diabetes mellitus
E. Age over 50 year

69.A nurse is caring for an older adult client who has stomatitis due to poorly fitting dentures. Which of the following actions should the nurse take?
A. Offer the client hot beverages to drink
B. Provide the client with a high-protein diet
C. Rinse the client’s mouth twice daily with an alcohol based mouthwash
D. Increase the client’s fluid intake to 2,000mL daily

70.A nurse is caring for a client who is in skin traction. Which of the following actions should the nurse take?
A. Ensure the weights hang freely from the client’s bed.
B. Maintain 6.8 kg (15 lb) of weight for the client’s skin traction
C. Inspect the client’s skin every 12 hr for signs of breakdown
D. Loosen the ropes of the pulleys when repositioning the client in bed.

71.A nurse is collecting data from an older adult client. Which of the following findings should indicates to the nurse that the client has a bladder infection?
A. Temperature 37.3 C (99.1 F)
B. Changed mental status
C. WBC count 9,000/mm3
D. Diminished reflexes

72.A nurse is preparing to assist with the administration of peritoneal dialysis to a client. In which order should the nurse take the following steps?(move the steps into the box on the right. Placing them in the order of performance. Use all the steps)
A. Prime the client’s catheter tubing with dialysate solution
B. Measure the client’s abdominal girth
C. Infuse dialysate solution into the client peritoneal cavity
D. Record the client’s vital signs
E. Open the client’s drainage tubing after 10 in of dwell time.

73.A nurse is caring for a client who is 2 days postoperative following abdominal surgery. The nurse auscultates hypoactive bowel sounds and the client reports cramping abdominal pain. Which of the following actions should the nurse take first?
A. Administer a glycerin suppository
B. Offer an analgesic medication
C. Ambulate the client in the hallway
D. Request the client to be NPO

74.A nurse is caring for a client who has an indwelling urinary catheter. Which of the following actions should the nurse take?
A. Use clean technique to collect urine specimens from the drainage system
B. Empty urine from the drainage bag every 12 hr
C. Secure he catheter tubing to the client’s thigh
D. Apply topical antimicrobial ointment to the client’s urinary meatus following
catheter care.

75.A nurse is caring for a client who is 8 hr postoperative following left hip arthroplasty. Which of the following laboratory values indicates the nurse should notify the provider?
A. Potassium 3.6 mEq/L
B. Blood glucose 98 mg/dL
C. Hemoglobin 8.6 g/dL
D. Bun 18 mg/dL

76.A nurse is caring for a client who has been admitted with Addison’s disease. For which of the following laboratory findings should the nurse plan to monitor and report to the provider?
A. Sodium 140 mEq/L
B. Potassium 3.8 mEq/L
C. Bun 15 mg/dL
D. Glucose 55 mg/dL

77.A nurse is caring for a client who is postoperative following a right radical mastectomy. Which of the following actions should the nurse take to prevent the development of lymphedema?
A. Obtain blood pressure readings using the client’s right arm B. Keep both arms below the level of the alien’s heart
C. Use the client’s left arm to obtain blood samples
D. Limit range of motion exercise with the affected arm.

78.A nurse is preparing to administer subcutaneous enoxaparin. In which order should the nurse perform the following steps? (Move the steps into the box on the right. Placing them in the order of performance. Use all the steps)
A. Locate the injection site 5 cm (2 in) to the right or left of the umbilicus
B. Check the medication administration record to verify the client’s allergies
C. Pinch clean skin at the injection site and dart the needle into the skin fold at a
90 angle.
D. Ensure an air bubble is present in the profiled enoxaparin syringe
E. Slowly inject the medication into the site without aspirating.

79.A nurse is collecting data from a client who is African-American. Which of the following area should the nurse check to determine the presence of pallor?
A. Pinna of the ear
B. Abdomen
C. Antecubital space
D. Conjunctiva

80.A nurse is caring for a client who is postoperative following an appendectomy. Which of the following information should the nurse include when documenting in the electronic medical record?
A. Abdominal wound dry. Without redness
B. Client status unchanged throughout shift
C. Incision healing well
D. Client received an adequate amount of fluid

81.A nurse is caring for a cite who is 24 hr postoperative following abdominal surgery. The client received an opioid analgesic 1 hr ago and now reports a pain level of 2 on a scale of 0 to 10. Which of the following actions should the nurse take?
A. Reposition the client
B. Maintain the client on bed rest
C. Apply a warm, moist compress to the incision area. D. Administer an additional dose of pain medication.

82. A nurse is reinforcing teaching about immunization with an older adult client. Which of the following instruction should the nurse include?
A. Your should receive one dose of the pneumococcal vaccine.
B. You should receive the hepatitis A vaccine every 10 year
C. You should receive the live, attenuated influenza vaccine every other year
D. You should receive the human papillomavirus vaccine.

83.A nurse is monitoring a client who is receiving a transfusion of of packed RBCs. Which of the following findings should the nurse identify as an indication that the client should receive diphenhydramine?
A. Urticaria
B. Pulmonary congestion
C. Jugular vein distention
D. Vomiting

84.A nurse is caring for a client who is experiencing a generalized tonic- clonic seizure. Which of the following actions should the nurse take?
A. Place the client in the prone position
B. Insert a tongue blade into the client’s mouth
C. Apply restraints to the client
D. Administer an IV bolus of lorazepam

85.A nurse is prioritizing care for four clients following change-of-shift report. Which of the following clients should the nurse attend to first?
A. A client who sustained a head injury 2 days ago and has a decreased level of consciousness
B. A client who has diverticulitis and a temperature of 38.3 C (100.9 F)
C. A client who has a prescription for a sputum specimen to be obtained before
breakfast
D. A client who has Alzheimer’s disease and requires assistance to the
bathroom.

86.A nurse is reinforcing teaching with a client who is taking oxybutynin. The nurse should tell the client that the medication will have which of the following effects?
A. Increases venous return to the heart
B. Relaxes the muscles of the bladder
C. Relaxes the muscles of the colon
D. Increases tissues perfusion in the lungs

87.A nurse is reviewing the laboratory report of a client who has cancer and is experiencing anorexia. Which of the following laboratory values should indicate to the nurse that the client is experiencing malnutrition?
A. Hematocrit 45%
B. WBC count 6,000/mm3
C. Prealbumin 10.5 mg/dL
D. Bun 15 mg/dL

88.A charge nurse is observing a newly licensed nurse care for a client who is at risk for falls. Which of the following findings would the nurse identify as a risk factor for falls?
A. Instructs the client to wear their own socks to the bathroom
B. Attaches the call light to the side rail of the clients bed
C. Keeps the client’s bed in the low position
D. Positions the bedside table close to the client

89.A nurse in a long-term care facility is providing care for a client who’s Alzheimer’s disease and is agitated. Which of the following interventions should the nurse implement?
A. Isolate the client in their room
B. Apply bilateral wrist restraints to the client
C. Administer a prescribed oral dose of trazodone to the client
D. Encourage the client to ambulate with a staff member.

90.A nurse is reinforcing teaching with a client who is to begin taking lansoprazole. Which of the following statement by the clients indicates an understanding of the teaching?
A. I should report episodes of diarrhea
B. I should take the medication following a meal
C. I should chew the capsule thoroughly
D. I should expect the medication to cause indigestion.

91.An occupational health nurse is interpreting the results of a tuberculin skin test for a group of clients who received the test 48 hr ago. Which of the following clients should the nurse identify as having a positive test result?
A. A client whose injection site is ecchymotic
B. A client whose injection site is firm and measures 3 mm (0.1 in)
C. A client whose injection site has a elevated area measuring 15 mm (0.6 in)
D. A client whose injection site is scabbed

92.A nurse is performing tracheostomy care for a client who has a chronic tracheostomy. Which of the following actions should the nurse take?
A. Apply suction pressure while inserting the catheter into the trachea.
B. Suction the client for 20 seconds with each pass
C. Sanitize around the stoma with providone-iodine
D. Allow space for one finger to be placed under the tube lies.

93.A nurse is collecting data from a client who has gastroenteritis with diarrhea and vomiting. Which of the following laboratory values should alert the nurse that the client is at risk for fluid volume deficit?
A. Potassium 4.5 mEq/L
B. Creatinine 1.1 mg/dL
C. Sodium 140 mEq/L
D. Hematocrit 56 mg/dL

94.A nurse is reviewing the results a client’s Facal occult blood screening test. Which of the following findings from the client’s history should the nurse identify as potentially causing a false-positive result?
A. The client takes ibuprofen for headaches
B. The client consumed citrus juice 3 days before the test
C. The client has a history of breast cancer
D. The client had a hemorrhoidectomy 1 year ago.

95.A nurse is reinforcing discharge teaching with the partner of a cline who requires tracheal suctioning. Which of the following statements by the partner indicate an understanding of the teaching?

A. I will wrap the suction catheters in a clean towel to be used again at a later time
B. I will suction for less than 15 seconds while inserting the suction catheter.
C. I will suction the mouth before inserting the suction catheter into the
tracheostomy
D. I will set the suction pressure dial between 80 and 120

96.A nurse is caring for a client who has Parkinson’s disease. The client displays difficulty using utensil while eating at mealtime. For which of the following interdisciplinary team members should the nurse recommend a referral?
A. Speech therapist
B. Physical therapist
C. Recreational therapist
D. Occupational therapist

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