In providing discharge teaching for the client after a modified radical mastectomy, the nurse should instruct the client that she might need to modify or avoid which of the following activities?
  A. Shampooing her dog.
  B. Caring for her tropical fish.
  C. Working in her rose garden.
  D. Taking a late-evening swim.

A client with iron-deficiency anemia is prescribed liquid iron supplements. The nurse teaches the client's about how to take this drug. Which of the following statements by the client indicates that the education is effective?
  A. "I will report any black stools to the physician. "
  B. "I will dilute the medication and drink it with a straw. "
  C. "I will check my gums for any bleeding. "
  D. "I can use antidiarrheal drugs if I develop diarrhea. \

A 24-year-old primipara decides to breast-feed her baby but says, "I'm worried that I won't be able to breast-feed my baby because my breasts are so small. " Which of the following is appropriate response by the nurse?
  A. Because her breasts are small, she will have to feed the baby more often.
  B. Breast size poses no influence on a woman's ability to breast-feed a baby.
  C. Breast milk can be enhanced by occasional formula feeding.
  D. The woman's motivation to breast-feed is less important than breast size.

The nurse plans to administer an injection of heparin to a client. Which of the following techniques for heparin administration is appropriate?
  A. Selects a 1.5-inch, 21-gauge needle for the injection.
  B. Makes the injection into the deltoid muscle.
  C. Applies gentle pressure to the site for 5 to 10 seconds after the injection.
  D. Aspirates with the plunger to check for entry into the blood vessel before injecting the heparin.

The nurse evaluates the client's understanding of myasthenia gravis. The nurse would judge that the client has formed a realistic concept of her condition when she says
  A. "By taking medication and pacing activities, I will live longer, but ultimately the disease will cause my death. "
  B. "By taking medication and pacing activities, my fatigue will be relieved, but I should expect occasional periods of muscle weakness. "
  C. "By taking medication and pacing activities, my symptoms will be controlled and eventually the disease will be cured. "
  D. "By taking medication and pacing activities, I should be able to control the disease and enjoy a healthy lifestyle. \

The nurse is caring for a client in an acute manic state. What's the most effective nursing action for this client?
  A. Assigning him to group activities.
  B. Reducing his stimulation.
  C. Assisting him with self-care.
  D. Helping him express his feelings.

The nurse instructs the female client concerning hormone replacement therapy for menopausal symptoms. Which of the following points should the nurse include in the client's teaching plan?
  A. Estrogen therapy eliminates the need for supplemental calcium intake.
  B. Estrogen therapy can reduce the risk of menopausal bone loss.
  C. The risk of uterine cancer is decreased after menopause.
  D. Smoking is associated with a later onset of menopause.

Which of the following symptoms would the nurse most likely observe in a client with cholecystitis from cholelithiasis?
   A. Black stools.
   B. Decreased white blood cell count.
   C. Nausea after ingestion of high-fat foods.
   D. Elevated temperature of 103°F(39.4℃).

Pancrelipase (Viokase), an enzyme replacement, has been prescribed for a client with chronic pancreatitis. The nurse evaluates the client's understanding of how to take this drug. Which of the following statements indicates the client has adequate knowledge?
  A. "The enzyme mixture should be taken after each meal. "
  B. "The enzyme mixture should be stored in the refrigerator to keep it fresh. "
  C. "I should be careful not to inhale the powder when mixing it with food. "
  D. "I should chew the capsule thoroughly. \

Which of the following laboratory tests should be monitored closely by the nurse while the client is receiving heparin therapy?
  A. International normalized ratio (INR).
  B. Activated partial thromboplastin time (APTT).
  C. Prothrombin time (PT).
  D. Thrombin time.

David, a hyperkinetic 5-year-old, exhibits signs of extreme restlessness, short attention span, and impulsiveness. In order to alter the child's milieu that would likely be most therapeutic for him, what could the nurse do?
  A. Define behaviors of the child that will be acceptable and those that will be unacceptable.
  B. Allow the child freedom to choose activities in which to participate and other children with whom to associate.
  C. Increase the child's sensory stimulation and activity.
  D. Limit the child's opportunities to display anger and frustration.

During the evening shift on the day of the client's surgery, the nurse notices that the nasogastric tube drains 500 mL of green-brown fluid. What should the nurse do?
  A. Record the amount of drainage on the client's chart.
  B. Irrigate the tube with normal saline solution.
  C. Call the physician immediately.
  D. Increase the intravenous infusion rate.

Which part on the wave deflection corresponds to ventricular muscle repolarization in the following ECG graph?
 
 A. A
 B. B
 C. C
 D. D

A client is at risk for developing a pressure ulcer. The first warning of an impending pressure ulcer is when pressure applied to skin it turns
  A. whitish.
  B. yellowish.
  C. bluish.
  D. reddish.

Emergency restraints or seclusion may be implemented without a physician's order under which of the following conditions?
  A. When a written order will be obtained from the primary physician within 1 hour.
  B. If a voluntary client wants to leave against medical advice.
  C. When a minor child is out of control.
  D. Never.

A voluntary client in a health care facility decides to leave the unit before treatment is complete. To detain the client, the nurse refuses to return the client's personal effects. This is an example of which of the following?
  A. False imprisonment.
  B. Violation of confidentiality.
  C. Limit setting.
  D. Slander.

The development of laryngeal cancer is most clearly linked to which of the following factors?
  A. High-fat, low-fiber diet.
  B. Alcohol and tobacco use.
  C. Low socioeconomic status.
  D. Overuse of artificial sweeteners.

The nurse is evaluating the effectiveness of airway suctioning. Which of the following outcome criteria is most appropriate?
  A. Respirations unlabored.
  B. Decreased mucus production.
  C. Hollow sound on chest percussion.
  D. Breath sounds clear on auscultation.

Which of the following interventions would likely be most effective for the client to use at home when managing the discomfort of rhinoplasty the initial 2 days after surgery?
  A. Applying ice compresses.
  B. Applying warm, moist compresses.
  C. Lying in a prone position.
  D. Blowing the nose gently.

Assertive behavior involves which of the following elements?
  A. Expressing an air of superiority.
  B. Saying what is on your mind at the expense of others.
  C. Avoiding unpleasant situations and circumstances.
  D. Standing up for your rights while respecting the rights of others.

When preparing to give a neonate the first feeding by nipple, the nurse uses a 5 mL feeding of sterile water first. Which of the following is the reason for doing so?
  A. Ensure that the neonate has the energy to take oral feedings.
  B. Ensure that the mother will be able to feed the neonate.
  C. Ascertain the patency of the neonate's esophagus.
  D. Determine if the neonate can retain the feeding.

Which of the following nursing diagnoses would be most appropriate when teaching the mother of a toddler?
  A. Activity intolerance.
  B. Risk for injury.
  C. Delayed growth and development.
  D. Impaired mobility.

The nurse is caring for a child with leukemia. Which of the following should the nurse priority pay more attention to?
  A. Preventing injury.
  B. Monitoring the child's platelet count.
  C. Monitoring the child's temperature.
  D. Encouraging increased fluid intake.

A 9-year-old child is in diabetes. The nurse offers to meet with the mother and the child's teacher before school to discuss the teacher's responsibilities in relation to the child's diabetes. Which of the following would the nurse expect to discuss in this meeting?
  A. How to perform a glucometer test.
  B. How to give an insulin injection.
  C. Signs and symptoms of hypoglycemia.
  D. The American Diabetic Association (ADA) diet.

A 10-month-old girl with bronchitis is taken out of the 30% oxygen tent for breakfast because she refuses to eat unless in a high chair. During the feeding, the nurse notes that the child's respiratory rate has increased, she is becoming more irritable, and she is using accessory muscles to breathe. Which of the following should be the nurse's first action?
  A. Perform postural drainage then complete the feeding.
  B. Suction the child's nose with a bulb syringe.
  C. Discontinue the feeding and place the child back in the tent.
  D. Assess the pulse rate and respirations and notify the physician.

The most common symptom associated with bladder cancer is
  A. burning on urination.
  B. frequent infections.
  C. painless hematuria.
  D. decreasing urine output.

One-year-old Susan, the second child to have sickle cell disease in a family of five children, is admitted to the hospital with sickle cell crisis. When preparing the plan of care for her, which of the following treatments would the nurse most likely expect to include in the plan?
  A. Intravenous fluid therapy.
  B. Fast-acting anticoagulant therapy.
  C. Parenteral iron therapy.
  D. Exchange transfusion.

Which one of the following nursing interventions should be included in a plan of care for a client with a T tube?
  A. Maintain client in a supine position while T tube is in place.
  B. Keep T tube clamped except for during mealtimes.
  C. Inspect skin around the T tube daily for irritation.
  D. Irrigate the T tube every 4 hours to maintain patency.

The correct procedure for auscultating the client's abdomen for bowel sounds would include
  A. palpating the abdomen first to determine correct stethoscope placement.
  B. encouraging the client to cough to stimulate movement of fluid and air through the abdomen.
  C. placing the client on the left side to aid auscultation.
  D. listening for 5 minutes in all four quadrants to confirm absence of bowel sounds.

Which of the following would be an appropriate expected outcome of nursing care for the client with ulcerative colitis?
  A. The client experiences decreased frequency of constipation.
  B. The client accepts that an ileostomy will be necessary.
  C. The client maintains an ideal body weight.
  D. The client verbalizes the importance of restricting fluids.

Which of the following signs or symptoms would be of least importance when the nurse evaluates the client for postoperative peripheral nerve damage?
  A. Pain.
  B. Bleeding.
  C. Altered sensation.
  D. Pulselessness.

Which pregnancy-related physiologic change would place the client with a history of cardiac disease at the greatest risk for developing severe cardiac problems?
  A. Decreased heart rate.
  B. Decreased cardiac output.
  C. Increased plasma volume.
  D. Increased blood pressure.

Mr. W is with bipolar disorder, manic phase, with a nursing diagnosis of Imbalanced nutrition: less than body requirements. In order to help the client meet recommended daily allowances of nutrients, which of the following nursing interventions should be included in the plan of care?
   A. Tell the client to sit alone at mealtime so that he won't be distracted by others.
   B. Teach the client about proper nutrition.
   C. Give the client half of a meat and cheese sandwich between meals.
   D. Inform the client that snacks are available only if he eats properly at mealtime.

A client exhibits confusion and severe memory loss. At 11:30 AM, he tells the nurse that he is going to work and proceeds to walk toward the door. Which of the following actions should be the nurse take?
  A. Remind him that he retired from his job 10 years ago.
  B. Tell him that she'll accompany him for a short walk outdoors.
  C. Divert his attention toward the dining room where lunch is being served.
  D. Tell him that he does not have to go to work today.

A woman seeking help at a community mental health center complains of fatigue, sensitivity to criticism, decreased libido, and feeling self-conscious. She also has aches and pains. A nursing diagnosis for this client might include
  A. Delayed growth and development.
  B. Ineffective role performance.
  C. Posttrauma syndrome.
  D. Chronic low self-esteem.

The parents of a neonate with a cleft lip are shocked when they see their child for the first time. In order to help the parents accept their infant's anomaly, which of the following should be included in the neonate's plan of care?
  A. Reassuring them that surgery will correct the defect.
  B. Encouraging the parents to visit more frequently.
  C. Showing them pictures of babies before and after corrective surgery.
  D. Allowing them to complete their grieving process before seeing the infant again.

Which nursing diagnosis would the nurse anticipate as having the highest priority for the client with gestational diabetes in labor?
  A. Risk for infection related to invasive procedures during labor.
  B. Risk for injury to fetus related to the effects of diabetes on uteroplacental functioning.
  C. Deficient knowledge related to lack of information about care during labor.
  D. Interrupted family processes related to diabetes increasing the client's risk of complications.

Which of the following is the most important aspect of nursing care in the postpartum period?
  A. Supporting the mother's ability to successfully feed and care for her neonate.
  B. Providing group discussions on infant care.
  C. Monitoring the normal progression of lochia.
  D. Involving the family in the teaching.

After a gastrectomy, the client will have a nasogastric tube in place for several days postoperatively. The nurse explains to the client that the nasogastric tube is for which of the following reasons?
   A. Prevent excessive pressure on suture lines.
   B. Prevent the development of ascites.
   C. Provide enteral feedings in the immediate postoperative period.
   D. Enable administration of antacids to promote healing of the anastomosis.

The clinic nurse is instructing a group of parents about emergency treatment for accidental poisoning and injury. Which of the following statements by one of the mothers indicates that she needs further instruction?
   A. "I should flush my child's eye with room temperature tap water for 15 to 20 minutes if a caustic material gets into it. "
   B. "I should save the emesis if my child vomits. "
   C. "I should call the poison control center if there are any symptoms. "
   D. "I should give 2 to 5 teaspoons of clear fluids after administering ipecac. \

If none of the following bed positions is contraindicated, which position would be preferred for the client with hypovolemic shock?
  A. Supine.
  B. Semi-Fowler's.
  C. Trendelenburg's.
  D. Supine with the legs elevated 15 degrees.

During the first 48 to 72 hours of fluid resuscitation therapy after a major burn injury, the intravenous infusion rate will be adjusted by evaluating which of the following observation?
   A. Daily body weight.
   B. Hourly urine output.
   C. Hourly urine specific gravity.
   D. Hourly body temperature.

A client diagnosed with schizoaffective disorder is suffering from schizophrenia with elements of which of the following disorders?
  A. Thought disorder.
  B. Amnestic disorder.
  C. Personality disorder.
  D. Mood disorder.

A client who was found huddled in her apartment by the police is admitted to the clinic. The client stares toward one corner of the room and seems to be responding to something not visible to others. She appears hyperalert and scared. Which of the following conclusion by the nurse is most appropriate according to the situation?
  A. Nothing is wrong because the client isn't a threat to society.
  B. The client is malingering.
  C. The client may be hallucinating.
  D. The client is suicidal.

A 15-year-old girl with anorexia refuses to eat in a mental health unit. Which of the following statements is the best response from the nurse?
  A. "Why do you think you're fat? You're underweight. Here--look in the mirror. "
  B. "You really look terrible at this weight. I hope you'll eat. "
  C. "You don't have to eat. It's your choice. "
  D. "I hope you'll eat your food by mouth. Tube feedings and IV lines can be uncomfortable. \

An 20-month-old with acquired immunodeficiency syndrome (AIDS) is seen in the clinic for health maintenance. Which of the following vaccines would the nurse anticipate administering to this toddler?
  A. Diphtheria-tetanus-acellular pertussis.
  B. Varicella.
  C. Measles, mumps, and rubella.
  D. Hemophilus influenza.

The nursing care plan for a client after gynecologic surgery includes nursing orders intended to help reduce the risk of thrombophlebitis. Which is not appropriate among the following nursing interventions?
  A. Ambulate the client.
  B. Massage the client's legs.
  C. Have the client wear elasticized stockings.
  D. Have the client perform range-of-motion exercises in bed.

A client with recurred cancer is planned to take internal radiation treatment with a radium implant. The client tells the nurse that she is concerned about being radioactive and has been having nightmares about the treatment. What would be a reasonable explanation for the nurse to give to the client?
  A. "Careful shielding prevents the area above your waist from radioactivity. "
  B. "These nightmares indicate that you're in the denial phase of accepting the diagnosis. "
  C. "The radioactive material is controlled and stays with the source; once the material is removed, no radioactivity will remain. "
  D. "The radioactivity will gradually decrease, and you will be discharged when the radioactive material reaches its half-life. \

To assess the client's dorsalis pedis pulse, the nurse should palpate the
  A. medial surface of the ankle.
  B. lateral surface of the ankle.
   C. ventral aspect of the top of the foot.
   D. medial aspect of the dorsum of the foot.

A client diagnosed with tuberculosis is taking the prescribed chemotherapy of isoniazid, rifampin, and pyrazinamide. The nurse should evaluate the client for signs of which of the following commonly occurring toxicities?
  A. Ototoxicity.
  B. Nephrotoxicity.
  C. Optic neuritis.
  D. Hepatotoxieity.

After determining that a pregnant client is Rh-negative, the physician orders an indirect Coombs'test. What's the purpose of performing this test on a pregnant client?
  A. To determine the fetal blood Rh factor.
  B. To determine the maternal blood Rh factor.
  C. To detect maternal antibodies against fetal Rh-positive factor.
  D. To detect maternal antibodies against fetal Rh-negative factor.

After the nurse has taught the parents of a 5-year-old boy who has leukemia how to talk with their child about death and dying, which of the following would indicate that the parents have age-appropriate expectations about their child's reaction to his impending death?
  A. "He is too young to understand what is happening to him. "
  B. "He might think he can cause his death because he has misbehaved. "
  C. "He will accept his death as caused by his disease. "
  D. "He will understand how much his siblings will miss him. \

Which of the following nursing measures would the nurse institute to help reduce eyelid edema in a child with nephrotic syndrome?
  A. Instill eye drops every 8 hours.
  B. Limit the child's television watching.
  C. Apply cool compresses to the child's eyes.
  D. Elevate the head of the child's bed.