Health Promotion

The nurse is assisting with the development of a tool in the electronic medical record to prompt providers to screen appropriate individuals for hypothyroidism. The nurse provides which characteristics to the informatics team to include in the tool? Select all that apply.

The nurse is planning care for a patient returning from surgery for a colon resection and ileal pouch-anal anastomosis. Which interventions does the nurse employ to prevent surgical site infection? Select all that apply.

The full-term neonate is born via normal spontaneous vaginal delivery (NSVD). The neonate cries at the perineum and maintained flexion against gravity but is noted to be bluish gray. Which intervention is appropriate?

The 3-week-old neonate has failed to return to birth weight due to projectile vomiting partially-digested breast milk after most feedings. Upon assessment, an olive-shaped mass is palpated in the upper right abdominal quadrant. The nurse anticipates which diagnosis?

Place the nursing interventions for a 16-year-old patient in the hospital for severe malnutrition and depression with a history of falls in order from highest priority to lowest priority.

The nurse is the first responder to a motor vehicular accident involving the injury of a 40-year-old male. Which action is the highest priority?

The nurse is involved in a motor vehicular accident in which a minor injury from the seatbelt was sustained. Which action does the nurse take first in helping the other victims?

A local celebrity is admitted to hospital following rupture of the appendix. The charge nurse submits an incident report if which individual accesses the patient’s chart?

The nurse delegates a pre-prandial blood sugar check to the unlicensed assistive personnel who fails to perform it before the patient’s food tray arrives and the patient eats breakfast. Who is most at fault?

Which task is most appropriate for the nurse to delegate to an unlicensed assistive personnel (UAP)?

The patient from India tells the nurse that, in addition to his conventional medical treatment, he would also like to be treated according to the principles of Ayurvedic medicine. The nurse plans care based on which understanding of the focus of Ayurvedic medicine?

The nurse is assigned to care for a patient who speaks minimal English but is fluent in Farsi. Which is the best practice for the nurse to take when communicating with this patient?

The nurse is providing discharge instructions and education to a patient with stomach cancer who is interested in alternative/complementary medicine. Which low-risk therapies does the nurse include in the discussion? Select all that apply.

The patient reports an interest in using a herbal supplement to help with his depression. The nurse discusses herbal supplements with the patient based on which understanding of the nurse’s role in alternative and complementary medicine?

The nurse attempts, but is unable, to contact the provider to clarify a prescription that is much higher than the normal dosage. Which action by the nurse is appropriate?

Which patient is triaged as first to be treated following a hurricane?

The charge nurse is making patient assignments for an unlicensed assistive personnel, a registered nurse, and a licensed vocational/practical nurse. Which patient is the most appropriate assignment for the LVN/LPN?

The patient with cervical cancer has an implanted sealed internal radiation device. The nurse provides which instruction to the patient?

Which tool is most effective for promoting safety when ambulating an elderly patient who is a fall risk?

The nurse is the first responder to a 3-year-old male who is with his mother, having recently ingested a large quantity of household cleaner. The patient is unconscious but is hemodynamically stable and breathing. An ambulance has already been called. Which action by the nurse is appropriate?

The nurse is supervising the care of a patient with a wound infected with methicillin-resistant staphylococcus aureus (MRSA). Which action by the student nurse would prompt the nurse to intervene?

Which characteristic of a home is most effective at preventing falls in the elderly patient?

A unit has experienced a significant rise in the incidence of hospital-acquired urinary tract infections (UTIs). Which action item will be most effective to reduce the incidence of hospital-acquired UTIs?

The nurse is supervising the care of a diabetic patient with stomach cancer. After surgery, the patient is placed on total parenteral nutrition (TPN). Which information does the nurse provide the nursing student about the TPN?

The nurse is caring for a patient receiving total parenteral nutrition (TPN). The nurse most closely assesses for which complication in this patient? 

The nurse is most vigilant for signs of which complication in a patient receiving total parenteral nutrition (TPN)?

The patient with tears of the right medial meniscus asks the nurse about the use of therapeutic massage. Which response by the nurse is appropriate?

Which patient is most at risk for developing a decubitus ulcer?

Which explanation of the mechanism of action of the cutaneous stimulation method in reducing pain is correct?

The nurse is providing dietary education for a patient with chronic alcoholism complicated by iron deficiency anemia and Wernicke encephalopathy. Which statement by the patient indicates a need for further teaching?

The provider orders that the patient transition to a full liquid diet. Which new item is the patient now allowed to have?

The nurse is teaching a nursing student about hand washing. Which statement by the nursing student indicates understanding of the teaching?

Which statement by the patient indicates an understanding of the nurse’s teaching about Buck’s traction?

During a lumbar puncture, which event warrants immediate intervention by the nurse?

Which statement by the patient who has recently undergone a radical mastectomy indicates they understand teaching by the nurse?

Which statement by a patient newly diagnosed with type 1 diabetes mellitus indicates understanding of the nurse’s discharge teaching?

Which food is best for a patient with hypokalemia?

Which nursing intervention will be most effective in preventing the spread of Clostridium difficile between patients?

Which patient is at the highest risk for falls?

Which statement by the patient with systolic heart failure indicates an understanding of discharge teaching?

A person in the hospital pulls out a firearm and starts shooting patients and staff at random in the emergency department. Which action by the nurse is most appropriate?

A cesarean section is the only safe method of delivery for the fetus when the pregnant woman has which condition? 

A patient with severe chronic obstructive pulmonary disorder (COPD) is receiving 3 liters per minute of oxygen via nasal canal. Which oxygen saturation indicates respiratory support is adequate?

A patient presents to the ER after having impaled his hand with a nail from a pneumatic nail gun at work. His friend removed the nail at the scene. Which statement indicates the patient understands the teaching provided by the nurse?

Which statement by the patient indicates a need for further teaching regarding postoperative care for a total hip arthroplasty?

Which statement by the patient’s spouse indicates an understanding of the teaching about bipolar disorder?

The nurse is caring for a 62-year-old female who was recently diagnosed with glaucoma. The patient is given docusate. Which of the following is the primary reason for giving the patient a stool softener?

The nurse is counseling the parents of a 7-year-old child who are concerned because of a strong family history of type 2 diabetes mellitus. The nurse instructs the parents that the initial screening for type 2 diabetes mellitus will occur at which time? 

The patient is being treated for obsessive-compulsive disorder with medication and behavioral therapy. At a follow-up visit, the patient reports near complete resolution of symptoms. The nurse anticipates discussing which treatment plan?  

The nurse instructs parents on which type of diet to decrease the risk for lead poisoning in their children?