RN Comprehensive Online Practice 2026 B

A nurse is working triage in an emergency department during a local disaster. Which of the following clients should the nurse recommend for discharge?

A client who has cellulitis and is receiving oral antibiotics can safely continue this treatment at home.

A rural community health nurse is developing a plan to improve health care delivery for migrant farmworkers. To identify health services data for this minority group, the nurse should gather information from which of the following sources?

World Health Organization

Department of Agriculture

National Institutes of Health

Agency for Healthcare Research and Quality

Agency for Healthcare Research and Quality

A nurse receives a request from a client to review the information in their medical record. Which of the following responses should the nurse give?

According to HIPAA, the nurse is responsible for following the facility's policy when providing the client with access to the medical record.

A nurse is interviewing a client who is now without housing due to a natural disaster. After ensuring the client's safety, which of the following actions should the nurse take first?

Determine the client's perception of the personal effect of the crisis.

Give the client information about available community resources for shelter.

Suggest the client obtain mental health counseling.

Assist with contacting individuals from the client's support system.

Determine the client's perception of the personal effect of the crisis.

A nurse at a mental health clinic is caring for four clients. The nurse should recognize which of the following clients is using dissociation as a defense mechanism?

A client states that they did not get a job promotion because the boss did not like them.

A client who is shorter than average is verbally assertive with coworkers.

A client who was abused as a child describes the abuse as if it happened to someone else.

A client forgets to buy their partner a birthday gift after a disagreement.

A client who was abused as a child describes the abuse as if it happened to someone else

A nurse is providing teaching about improving nutrition for a client who has multiple sclerosis. Which of the following instructions should the nurse include?

"A speech pathologist will be performing a swallowing study for you."

"You should rest before eating a meal."

"You should restrict foods that are high in vitamin D."

"Reduce your intake of dietary fiber."

"Thicken your beverages before drinking."

"A speech pathologist will be performing a swallowing study for you."

"You should rest before eating a meal."

"Thicken your beverages before drinking."

A nurse is assessing a client who has decreased visual acuity due to cataracts. The nurse should identify that which of the following physiological changes is the cause for the client's visual loss?

Increased opacity of the lens

Deterioration of the macula

An increase in the intraocular pressure

Vitreous hemorrhage

Increased opacity of the lens

A charge nurse is planning an educational session for staff nurses about working with parents whose children have a terminal illness and are candidates for donating their organs. Which of the following information should the nurse plan to include?

The family can have the child in an open casket without fearing that the organ donation might disfigure the child's body.

Choosing to donate organs can delay the timing of the child's funeral.

The nurse should introduce the option of organ donation to the parents when first discussing the child's impending death.

The family should understand that an autopsy is mandatory prior to organ donation.

The family can have the child in an open casket without fearing that the organ donation might disfigure the child's body.

A nurse is planning care for a client who has rheumatoid arthritis (RA). Which of the following interventions should the nurse include in the plan?

Increase the client's dietary iron intake.

Administer opioid analgesia.

Encourage the client to take a cool sponge bath each morning.

Restrict the client's intake of foods high in purines.

Increase the client's dietary iron intake.

A nurse is completing a home health visit with a client who has hemianopsia. Which of the following information should the nurse review with the client to promote safety in the home?

Use scanning technique when ambulating.

Secure extension cords under carpeting.

Set water heater to 54.4° C (130° F).

Change positions every 4 hr.

Use scanning technique when ambulating.

A nurse is planning care for a client who has a deficit with cranial nerve (CN) II. Which of the following actions should the nurse plan to take?

Evaluate the client's ability to swallow.

Clear objects from the client's walking area.

Ask the client to restate directions.

Keep the client resting in bed.

Clear objects from the client's walking area.

A charge nurse overhears two staff nurses in the hallway discussing the nutritional status of a client who has anorexia nervosa. Which of the following actions should the charge nurse take?

Tell the nurses to stop the discussion.

Document the incident in the client's medical record.

Advise the nurses that they are being insubordinate.

Apologize to the client for the nurses' actions.

Tell the nurses to stop the discussion.

A nurse is providing discharge instructions to a client following a total hip arthroplasty. Which of the following instructions should the nurse include?

Maintain the hip at an angle greater than 90°.

Place a pillow under the knees when lying down.

Minimize the use of a walker.

Install a raised toilet seat at home.

install a raised toilet seat at home.

During an 8-week postpartum examination, a client reports feeling fatigued, lethargic, no interest in usual activities, sleeping all the time, and a feeling of worthlessness. Which of the following questions should the nurse ask the client first?

"Have you had any thoughts about hurting yourself or the baby?"

A nurse is planning teaching about allowable foods for a client who has a history of uric acid-based urinary calculi formation. Which of the following foods should the nurse include in the teaching?

Chicken

Liver

Red wine

Lentils

Lentils

A nurse is assessing a client following a vaginal delivery and notes heavy lochia and a boggy fundus. Which of the following medications should the nurse expect to administer?

Magnesium sulfate

Nalbuphine

Oxytocin

Terbutaline

oxytocin

A nurse is providing preoperative teaching to a client who is scheduled for insertion of an implanted port. Which of the following client statements should the nurse recognize as an indication of understanding the teaching?

My port will be flushed before and after each dose of medication

A nurse is teaching about total parenteral nutrition (TPN) and IV lipid emulsions with a client who has an extensive burn injury. Which of the following information should the nurse include?

"TPN is a way to provide vitamins and minerals without increased calories."

"You will receive fingersticks for blood glucose testing."

"Taking TPN can increase the risk of developing a latex allergy."

"This type of nutrition is more effective than eating by mouth."

You will receive fingersticks for blood glucose testing

A nurse is preparing a sterile field in order to insert an indwelling urinary catheter for a male client. Which of the following techniques should the nurse use to maintain surgical aseptic technique?

Don sterile gloves after opening the lubricant packet.

Advance the catheter 2.5 cm (1 in) further after flash or urine begins to flow.

Cleanse the meatus with a new cotton ball with antiseptic 3 times.

Clean the penis with the nondominant hand.

cleanse the meatus with a new cotton ball with antiseptic 3 times

A nurse is reviewing the ABG results of a client who has COPD. The results include a pH of 7.3 (7.35 to 7.45), PaO2 56 mm Hg (80 to 100 mm Hg), PaCO2 54 mm Hg (35 to 45 mm Hg), HCO3- 26 mEq/L (21 to 28 mEq/L), and SaO2 87%. Which of the following is the correct interpretation of these values?

Uncompensated respiratory acidosis

A nurse is caring for a newborn who has herpes simplex virus (HSV). Which of the following isolation precautions should the nurse initiate?

contact

A nurse is caring for a client who is 4 hr postpartum and has a boggy uterus with heavy lochia. Which of the following actions should the nurse take first?

Administer oxygen.

Obtain a CBC.

Initiate an infusion of oxytocin.

Massage the uterus to expel clots.

Massage the uterus to expel clots.

A nurse is providing discharge teaching to a new parent about car seat safety. Which of the following statements should the nurse include in the teaching?

Secure the retainer clip at the level of your baby's armpits

A nurse is caring for a client who has COPD and becomes extremely short of breath. Which of the following interventions by the nurse requires completion of an incident report?

Increasing oxygen via nasal cannula to 6 L/min

Elevating the head of the client's bed to 45°

Administering a PRN bronchodilator via nebulizer

Encouraging the client to cough and deep breathe

Increasing oxygen via nasal cannula to 6 L/min.

A nurse is teaching a client who is to start taking misoprostol and currently is on long-term therapy with NSAIDs for arthritis. The nurse should provide the client with which of the following information?

This medication coats stomach ulcers so that they can heal.

Increase intake of fluids and fiber to prevent constipation.

Complete a serum pregnancy test before taking the medication.

Take a magnesium-containing antacid along with this medication.

Complete a serum pregnancy test before taking the medication

A nurse is caring for a client who has acute blood loss following a trauma. The client refuses a blood transfusion that might potentially save their life. Which of the following actions should the nurse take first?

Explore the client's reasons for refusing the treatment.

A parent tells the nurse that their newborn consistently spits up when being bathed. Which of the following should the nurse advise the parent to do?
Switch the newborn's formula.

Wait at least 4 hr after a feeding to bathe the newborn.

Bathe the newborn before a feeding.

Feed the newborn less before a bath.

Bathe the newborn before a feeding.

A nurse is caring for a client who is at 37 weeks of gestation and is experiencing abruptio placentae. Which of the following findings should the nurse expect?

Fundal height of 40 cm (15.7 in)

Hyperactive deep tendon reflexes

Painless, bright red vaginal bleeding

Persistent uterine contractions

persistent uterine contractions.

A nurse is caring for four clients at the beginning of a shift. After receiving change-of-shift report, which of the following clients should the nurse attend to first?

confusion and has been attempting to get out of bed

A nurse is assessing a client for compartment syndrome. Which of the following findings should the nurse expect?

Shortened femoral neck

Dark brown urine

Edema

Fever

edema

A nurse is assessing a toddler who has sickle cell anemia. Which of the following findings should the nurse should identify as a manifestation of vaso-occlusive crisis?

Hematuria

Hyperglycemia

Hearing loss

Diminished reflexes

hematuria

A nurse is caring for a client who has chronic headaches and reports taking as many as 10 acetaminophen capsules per day. Which of the following assessment findings indicate the client may be experiencing an acetaminophen toxicity?

Blurred vision

Abdominal tenderness

Hypotension

Decreased urine output

Abdominal tenderness

A nurse on an inpatient mental health unit is monitoring a visit between a client who has a history of aggressive behavior and the client's partner. Which of the following observations should the nurse identify as an indication for potential violence?

The client is pacing around the chair in which their partner is sitting.

A nurse is preparing a sterile field to perform a sterile dressing change. Which of the following interventions should the nurse use to maintain surgical sterile technique?

maintain sterile objects within the line of vision

A nurse is caring for a client who was diagnosed with diabetic ketoacidosis (DKA). The client is prescribed an insulin drip and an IV infusion of 0.9% sodium chloride. Which of the following laboratory values should the nurse report first to the provider?

Potassium level 3.2 mEq/L (3.5 to 5 mEq/L)

Sodium level 132 mEq/L (136 to 145 mEq/L)

Blood pH level 7.29 (7.35 to 7.45)

Blood glucose 300 mg/dL (74 to 106 mg/dL)

Potassium level 3.2 mEq/L

A nurse is caring for a client who had a stroke 6 hr ago. Which of the following interventions should the nurse implement to reduce the risk of increased intracranial pressure (ICP)?

Place the client in a quiet environment.

A nurse is preparing to transfer a client from the ICU to the medical floor. The client was recently weaned from mechanical ventilation following a pneumonectomy. Which of the following information should the nurse include in the change-of-shift report?

The last time the provider evaluated the client

The frequency in which the client presses the call button

The time of the client's last dose of pain medication

The client's most recent ventilator settings

the time of the client's last dose of pain medication

A nurse is caring for a client who is in active labor and receiving oxytocin. The FHR pattern shows moderate variability with accelerations. Which of the following actions should the nurse take?

Document and continue to monitor.

A nurse is caring for a toddler who has infectious gastroenteritis. Which of the following actions should the nurse take?

Include chicken broth in the toddler's diet.

Offer the toddler flavored gelatin.

Initiate oral rehydration therapy for the toddler.

Feed the toddler the BRAT diet.

initiate oral rehydration therapy (ORT) for the toddler.

A nurse is caring for a client who is prescribed ketorolac 15 mg IV. Which of the following laboratory findings would require the nurse to withhold the medication and notify the provider?

Elevated hemoglobin

Decreased sodium

Elevated creatinine

Decreased WBC count

Elevated creatinine

A case manager is reviewing the medical records of several clients. For which of the following clients should the nurse request an interprofessional care conference?

A client who has a history of two prior miscarriages and has ruptured membranes at 38 weeks of gestation

A client who has diabetes mellitus and has had repeated hospitalizations for diabetic ketoacidosis

A client who has alcohol use disorder and has decided to start attending Alcoholics Anonymous meetings

A client who was admitted for dehydration and is receiving a continuous IV infusion

diabetes mellitus and has had repeated hospitalizations for diabetic ketoacidosis

A nurse is caring for an older adult client in a PACU following general anesthesia. Which of the following findings should the nurse report to the provider?

Audible stridor.

A community health nurse is performing triage tagging following a mass casualty incident. On which of the following clients should the nurse place a black tag?

A client who has significant head trauma and agonal respirations.

A nurse is performing tracheostomy care for a client who is postoperative following a laryngectomy. Which of the following actions should the nurse take when suctioning the client's airway?

Apply suction for 10 seconds.

Use medical asepsis when performing the procedure.

Advance the catheter 2 cm (0.8 in) after resistance is met.

Withdraw the catheter if the client begins coughing.

apply suction for 10 seconds

Male client who has diagnosis of chronic obstructive pulmonary disease (COPD) and inability to care for self at home admitted to facility. Client has a productive cough with thick, white sputum. Mild wheezing noted on inspiration and expiration, decreased chest vibration noted. Caregiver voices concern that the client is losing weight and not eating well.

cough, prealbumin result, and BMI

A nurse is caring for a client in a long-term care facility. Which of the following client findings should the nurse identify as unexpected for a client who has COPD?

lung sounds and palpation findings are unexpected for a client who has COPD. Clients who have COPD often have adventitious lung sounds during inspiration and expiration, but crackles are not typically present, and chest vibrations, or fremitus, are typically decreased.

A nurse is caring for a client in a long-term care facility.Complete the following sentence by using the lists of options.

ung sounds due to their risk for pneumonia.

A nurse is caring for a client in a long-term care facility. Select the 2 provider orders the nurse should anticipate.

a dietary consult and to administer a bronchodilator 30 min before each meal. The nurse should consult with a dietitian

The nurse has reviewed the Provider Prescriptions from 3 Days Ago, 0820. For each alteration below, click to specify the nursing intervention that would be appropriate for the care of the client. Choose the most likely response for the dropdown(s) in the table below by choosing from the lists of options.

obtaining a provider order for oral nutrition supplements

activity intolerance is to pace the client's activities throughout the day and provide rest periods

shake the medication well

The nurse has reviewed the Nurses' Notes and Vital Signs from Today, 0805. Click to highlight the findings that indicate the client is progressing as expected. To deselect a finding, click on the finding again.

ambulating in the hall, decreased shortness of breath, mild wheezing bilaterally on inspiration, drinking prescribed oral supplements, an increase in the client's current weight, and the client's respiratory rate

A nurse is preparing to administer a blood transfusion to a client. Which of the following procedures should the nurse follow to ensure proper client identification?

Ask the client to state their blood type prior to beginning blood administration.

Compare information on the blood product to the informed consent form.

Verify the client and blood product information with another licensed nurse.

Check the client's blood type and crossmatch it against the provider's orders.

verify the client and blood product information with another licensed nurse.

A nurse is caring for a client who has a prescription for warfarin. Which of the following laboratory values should the nurse review before administering this medication?

Partial thromboplastin time (PTT)

International normalized ratio (INR)

Platelet count

Erythrocyte sedimentation rate (ESR)

INR

A nurse is caring for a client who is postoperative after receiving moderate (conscious) sedation. The client suddenly becomes restless and reports feeling lightheaded. Which of the following actions should the nurse take?

Check the client's oxygen saturation level.

A nurse is initiating discharge planning for a client who had a stroke and is experiencing right-sided weakness. Which of the following actions should the nurse take first?

Ask a social worker to identify the client's insurance eligibility for rehabilitation services.

Provide the client with a list of community resources.

Request a referral for the client to receive physical therapy.

Arrange for the delivery of prescribed medications to the client's home.

request a referral for the client to receive physical therapy

A nurse in an emergency department is caring for a client who is experiencing ongoing seizures. The client is prescribed intravenous bolus phenytoin. Which of the following actions should the nurse take when administering this infusion?

Dilute the medication with dextrose 5% in water to reduce irritation.

Flush the line with 0.9% sodium chloride before and after administration.

Use a central venous access device for administration.

Withhold the medication until the client stops actively seizing.

flush the line with 0.9% sodium chloride before and after administration

A nurse on a medical-surgical unit is caring for a client prior to a surgical procedure. Which of the following findings should indicate to the nurse that the client has the ability to sign the informed consent?

The client is able to accurately describe the upcoming procedure.

An RN is planning care for a group of clients and is working with a licensed practical nurse (LPN) and an assistive personnel (AP). Which of the following tasks should the RN delegate to the LPN?

insertion of a nasogastric (NG) tube

A nurse is caring for a 16-year-old female in the emergency department. Click to highlight the findings that require immediate follow-up. To deselect a finding, click on the finding again.

When recognizing cues, the nurse should expect that the assessment findings of decreased urine that is dark yellow, capillary refill greater than 3 seconds, and poor skin turgor require immediate follow-up according to the urgent versus non-urgent priority setting framework. These findings are associated with dehydration and should be reported to the provider.

A nurse is caring for a 16-year-old female in the emergency department. For each client finding, click to specify if the finding is consistent with anorexia nervosa or borderline personality disorder. There must be at least 1 selection in every row. There does not need to be a selection in every column.

When analyzing cues, the nurse should recognize that the client's findings of amenorrhea, hypotension, hypokalemia, and distorted body image are consistent with anorexia nervosa, especially in the acute phase of treatment when dehydration is present. The client's behavioral findings of emotional lability and rapid mood swings may be present with a client who has borderline personality disorder.

A nurse is assisting with the care of a 16-year-old female in the emergency department. Drag words from the choices below to fill in each blank in the following sentence.

acute kidney injury and cardiac dysrhythmias.

A nurse is assisting with the care of a 16-year-old female in the emergency department. Select the 2 orders or prescriptions that the nurse should anticipate.

initiate IV fluids and cardiac monitoring.

The nurse has reviewed the Provider Orders on Day 1 at 1100. Complete the following sentence by using the lists of options.

When taking action, the nurse should plan to stay with the client during meals and for 1 hr after to help ensure sufficient caloric consumption.

The nurse has reviewed the Laboratory Results on Day 2 at 0530, Vitals Signs on Day 2 at 0630, and Nurses' Notes on Day 2 at 0730. Click to highlight the findings that show an improvement of the client's condition. To deselect a finding, click on the finding again

blood pressure of 98/68 mm Hg, a heart rate of 70/min, elastic skin turgor, moist mucous membranes, and a respiratory rate of 18/min

A nurse on a medical-surgical unit is caring for a client who has a new diagnosis of terminal cancer. The client tells the nurse that they would like to go home to be with loved ones. Which of the following actions should the nurse take?

Make a referral for social services.

Explain the process of leaving the facility against medical advice.

Contact the facility chaplain to visit with the client.

Encourage the client to continue with inpatient care.

Make a referral for social services.

A nurse on an inpatient mental health unit is planning care for a client who is experiencing active suicidal ideations. Which of the following interventions should the nurse include in the plan of care?

Observe the client every 15 min.

Provide the client with a brightly lit environment.

Ensure the client fully swallows each medication with every dose.

Assign the client to a room farther away from the nurses' station.

Ensure the client fully swallows each medication with every dose.

A nurse is planning care for a client who is receiving hemodialysis via an established arteriovenous (AV) fistula in the right arm. Which of the following interventions should the nurse include in the client's plan of care?

Notify the provider if a thrill is palpated at the fistula.

Discourage range-of-motion exercises in the affected extremity.

Auscultate the affected extremity for a bruit.

Perform venipuncture in the affected extremity.

Auscultate the affected extremity for a bruit.

A nurse is teaching self-administration of insulin to a client who has a new prescription for a short-acting and intermediate-acting insulin. Which of the following actions by the client indicates an understanding of the teaching?

Withdraws the intermediate-acting insulin before the short-acting insulin

Injects the insulin into the deltoid muscle

Inserts the needle at a 30° angle

Pinches the skin prior to injecting the insulin

Pinches the skin prior to injecting the insulin

A nurse is preparing to assist with a thoracentesis for a client who has pleurisy. Which of the following actions should the nurse plan to perform?

Perform pulmonary function tests following the procedure.

Instruct the client to avoid coughing during the procedure.

Place the client on bed rest for 24 hr after the procedure.

Administer a bowel preparation the night before the procedure.

instruct the client to avoid coughing during the procedure.

A nurse is assessing a client who has a chest tube. Which of the following findings should the nurse expect?

Drainage of 125 mL/hr

Drainage system located above the client's chest level

Continuous bubbling in the water-seal chamber

Occlusive dressing on the insertion site

occlusive dressing on the insertion site

A nurse is caring for a client who had a cerebrovascular accident and is experiencing expressive aphasia. Which of the following actions should the nurse take to assist the client to communicate their needs to health care providers?

Speak to the client loudly when updating plan of care.

Use flashcards with pictures.

Provide orientation to time, place, and person.

Provide detailed explanations of upcoming procedures.

Use flashcards with pictures

A nurse is assessing a newborn who is 3 days old. Click to highlight the findings that require follow up. To deselect a finding, click on the finding again.

When recognizing cues, the nurse should identify that a temperature of 36.4° C (97.5° F) is below the expected reference range. Hypothermia can lead to the occurrence of hypoglycemia and respiratory distress. The newborn breastfeeding for short intervals, nipple discomfort, and a weight loss of greater than 10% of birth weight can indicate inadequate transfer of breastmilk, which can result in hypoglycemia. The presence of mild tremors can be a manifestation of hypoglycemia.

A nurse is caring for a client in a clinic. Click to highlight the findings that require follow-up. To deselect a finding, click on the finding again.

postmenopausal bleeding that is heavy and consistent in flow, low back pain, pelvic pressure, and watery discharge that has an odor require follow-up.Abnormal uterine bleeding, especially postmenopausal bleeding, is a cause for concern and could indicate a gynecological condition. It is important for the nurse to collect data regarding the amount and appearance of vaginal discharge and bleeding.

A nurse is caring for a client in a clinic. For each client risk factor, click to specify if the risk factor is consistent with endometrial cancer or cervical cancer. Each risk factor may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

family history of colon cancer, never being pregnant, obesity, postmenopausal age, and past medical history of type 2 diabetes mellitus are risk factors consistent with endometrial cancer.

The risk factor that could contribute to cervical cancer is the client's weight.

The nurse has reviewed the Nurses' Notes from Week 2, Day 1, 0845. Complete the following sentence by using the lists of options.

excessive bleeding and infection due to an endometrial biopsy.

The nurse has reviewed the Nurses' Notes from Week 2 and Week 3, and Diagnostic Results from Week 2. The nurse is planning to provide discharge teaching for the client.For each potential client instruction, click to specify if the instruction should be included or not included for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

When generating solutions, the nurse should expect to include reporting an elevated temperature to the client's provider, abstaining from sexual intercourse for 6 weeks after surgery, and avoiding strenuous activity

Instructions that inform the client they are able to bathe after surgery or that they should expect continued vaginal bleeding that is similar to a period after surgery should not be included.

The nurse has reviewed the Nurses' Notes from Week 3, Day 3, 0945. Which of the following responses should the nurse make?

tell them more about their concerns.

The nurse has reviewed the Nurses' Notes from Week 6, Day 1, 1000. Click to highlight the findings that indicate the client is progressing as expected. To deselect a finding, click on the finding again

no pelvic pain, vaginal bleeding, urinary urgency or dysuria, and a surgical incision site that is clean, dry, and intact with no erythema, swelling, or drainage

A nurse is preparing to transfer a client who has had a stroke to a rehabilitation facility. The client's caregiver tells the nurse they are concerned about the level of care the client will receive. Which of the following actions should the nurse take?

Refer the client and caregiver to a social worker for assistance and a follow-up meeting.

Reassure the client's caregiver that the same provider will provide care at the new facility.

Facilitate an interdisciplinary conference at the new facility for the caregiver.

Tell the caregiver that the rehabilitation facility has an excellent client care record.

facilitate an interdisciplinary conference at the new facility for the caregiver.

A nurse is teaching a client who has a new prescription for methylphenidate. Which of the following instructions should the nurse include in the teaching?

"You will see the full effect of this medication after 2 weeks."


"Monitor for weight gain while taking this medication."


"Take this medication in the morning."


"Drink 1 to 3 cups of caffeinated beverages each day to enhance the effect of this medication."

Take this medication in the morning

A nurse is preparing a parenting seminar addressing adolescent issues. The nurse should plan to include which of the following expected changes associated with adolescent development?

The onset of estrogen and androgen secretions occur during adolescence.

Adolescents have a need for recognition and acceptance related to self-image.

A fear of death increases during adolescent years.

The need for sleep decreases during adolescent years.

Adolescents have a need for recognition and acceptance related to self-image.

A nurse is caring for a newborn. Complete the following sentence by using the lists of options.

respiratory rate and heart rate

A nurse manager is assisting with the orientation of a newly licensed nurse. Which of the following actions by the nurse requires the nurse manager to intervene?

Notifies the health department of a client's diagnosis of chlamydia

Tells the hospital chaplain a client's diagnosis

Reports suspected child maltreatment to social services

Informs the provider about a client's suicide plan

tells the hospital chaplain a client's diagnosis

A nurse is assessing a 2-month-old infant during a well-baby examination. Which of the following actions should the nurse take to assess the infant's rooting reflex?

Stroke the infant's cheek.

Turn the infant's head to one side.

Tap on the bridge of the infant's nose.

Depress the infant's tongue.

stroke the infant's cheek to assess the rooting reflex,

A nurse is preparing to insert an indwelling urinary catheter for a client. The nurse should assess the client for which of the following conditions prior to starting the procedure?

assess the client for a latex allergy prior to the insertion of an indwelling urinary catheter due to the risk of an allergic reaction.

A nurse in an emergency department is assessing a client who reports taking methylenedioxymethamphetamine (MDMA). Which of the following findings should the nurse expect?

Lethargy

Cough

Bradycardia

Diaphoresis

Diaphoresis

A nurse is providing colostomy care for a client using a two-piece pouching system. Which of the following actions should the nurse take?

Empty the pouch when it's 1/3 to 1/2 full. 

Cut the skin barrier opening 0.6 cm (0.24 in) larger than the stoma.

Cleanse the skin at the stoma site with povidone-iodine for 15 seconds.

Dampen the skin before applying the skin barrier and ostomy pouch.

empty the client's pouch when it becomes 1/3 to 1/2 full.

A home health nurse is evaluating a school-age child who has cystic fibrosis. The nurse should initiate a request for a high-frequency chest compression vest in response to which of the following parent statements?

"My child has only a small amount of mucus after percussion therapy

A nurse is providing education to the guardian of a school-age child who has asthma. Which of the following statements by the guardian indicates an understanding of the teaching?

"I will record an average of three readings from my child's peak expiratory flow meter."

"I will administer aspirin to my child to treat pain or fever."

"I will make sure my child receives a yearly influenza immunization."

"I will place carpet in my child's bedroom to control allergens."

I will make sure my child receives a yearly influenza immunization

A nurse is caring for an adolescent who is nonbinary and has requested staff use their pronouns during their stay. Which of the following actions should the nurse take?

clarify the adolescent's pronouns with each new staff member involved in care

A nurse is preparing to perform an intermittent urinary catheterization for a client who has urinary retention. Which of the following images indicates the catheter the nurse should use?

straight urinary catheter,

A nurse on a mental health unit is caring for a client. For each nursing action, click to specify if the nursing action is anticipated or contraindicated for the client. There must be at least 1 selection in every row. There does not need to be a selection in every column.

initiating suicide precautions, encouraging the client to attend group therapy, and frequently offering high-calorie snacks are anticipated. The client should be encouraged to attend individual and group therapy Frequent high-calorie and high-protein snacks can increase the client's intake allowing the client to sleep with their hands out of view is contraindicated due to the risk of self-harm

A nurse is planning care for a client who has a new prescription for a continuous IV infusion of 0.45% sodium chloride with 20 mEq/L potassium chloride at 150 mL/hr. Which of the following interventions should the nurse include in the plan of care?

Contact the provider to clarify the infusion rate.

Monitor the client's LDL and triglyceride levels.

Insert an 18-gauge or larger peripheral IV catheter.

Check the client's BUN and creatinine levels.

Check the client's BUN and creatinine levels

A nurse is caring for a client admitted to the emergency department.For each potential assessment finding, click to specify if the finding is consistent with schizophrenia or bipolar I disorder. Each finding may support more than 1 disease process or none at all. There must be at least 1 selection in every column. There does not need to be a selection in every row.

When analyzing cues, the nurse should recognize that the client's speech, delusions, and social interactions are manifestations of both schizophrenia and bipolar I disorder. The client manifests pressured speech by their rapid and unorganized communication. Grandiose delusions are exhibited with the client's declaration of, "I am divine." Social impairment is demonstrated with the client's violent and threatening behavior. Dependency is not a feature of either schizophrenia or bipolar I disorder.

A nurse is developing a client education program about osteoporosis for older adult clients. The nurse should include which of the following variables as a risk factor for osteoporosis?

Sedentary lifestyle

Obesity

Estrogen dominance

Acromegaly

Sedentary lifestyle.

A nurse is caring for a male client in the emergency department. Complete the diagram by dragging from the choices below to specify what condition the client is most likely experiencing, 2 actions the nurse should take to address that condition, and 2 parameters the nurse should monitor to assess the client's progress.

nurse's priority hypotheses is that this client is most likely experiencing acute pancreatitis.

It is important to generate solutions and take actions that will reduce the client's pain. Therefore, the nurse should request for a prescription for an opioid analgesic and place the client on NPO status to rest the pancreas to reduce pancreatic enzyme secretion. To evaluate these interventions the nurse should monitor the client's serum calcium and glucose levels.

A nurse is caring for a client on a medical-surgical unit. Which of the following interventions should the nurse include in the client's plan of care to reduce environmental stress?

Assign the client to a room away from the nurses' station.

A nurse is providing teaching to a client who has peripheral arterial disease. Which of the following client actions indicates an understanding of the teaching?

Elevates the feet above the level of the heart when resting

Warms feet with a heating pad while sleeping

Applies lubricating lotion to feet

Trims toenails with a rounded edge

should use a lubricating lotion on the feet to prevent dry, cracked skin.

A nurse is caring for a client who has active tuberculosis (TB). Which of the following actions should the nurse plan to take to prevent the transmission of the disease?

Wear a surgical mask while providing care for the client.

Restrict visitors from entering the client's room during hospitalization.

Have the client wear a surgical mask while being transported outside the room.

Initiate contact precautions for the client upon admission.

Have the client wear a surgical mask while being transported outside the room.

A nurse is providing teaching to the guardians of a newborn about measures to prevent sudden unexpected infant death (SUID). Which of the following guardian statements indicates an understanding of the teaching?

strong correlation between exposure to cigarette smoke and the occurrence of SUID.

A nurse is assessing an infant who is postoperative following placement of a ventriculoperitoneal (VP) shunt due to hydrocephaly. Which of the following findings should the nurse report to the provider?

Irritability when being held

Anterior fontanel is level and soft

Urine output 2 mL/kg/hr

Heart rate 122/min

The nurse should recognize that irritability is a manifestation of increased intracranial pressure, which is an indication that the VP shunt is malfunctioning. This finding should be reported to the provider immediately.