1. A nurse is caring for a group of clients. Which of the following clients should the nurse identify as having an increased risk of aspiration while eating? (select all that apply)

A client who has lactose intolerance

A client who is 4 hr postoperative following a leg amputation with general anesthesia

A client who has had radiation therapy for head and neck cancer

A client who has had prolonged diarrhea

A client who has had a cerebrovascular accident

2. The nurse prepares to transfer a client with stroke who has left sided weakness from the bed to the wheelchair. With the client dangling on the side of the bed, where should the nurse position the wheelchair?

At a right angle to the client's right leg

At a right angle to the clients left leg

At ninety degrees to the clients left leg

Directly in front of the client

3. A nurse is caring for a client who requests prescription pain medication. Which of the following actions should the nurse perform first?

Review the effects of the pain medication

Reposition the client

Administer the medication

Determine the location of the pain

5. A charge nurse is making client care assignments. Which of the following tasks should the nurse delegate to assistive personnel (AP)? (select all that apply)

Explain oral hygiene to a client receiving chemotherapy?

Assist a client to ambulate using a gait belt

Educate a client who has hypertension about a low sodium diet

Bathe a client who had an amputation 2 days ago

Feed a client who had a stroke 3 months ago

6. A nurse is caring for a client who has a prescription for a clear liquid diet. Which of the following foods should the nurse allow the client to have?

Milkshake

Orange juice

Grape juice

Pudding

7. A nurse is completing the initial admission assessment and history for a client. Which of the following is the priority action for the nurse to take?

Teach the client about the diagnosis

Develop a plan of care for the client

Document the client's allergies in the electronic medical record

Provide a schedule of visiting hours to the client's family

8. A nurse is caring for a client that refuses treatment and asks to be discharged from the hospital against medical advice. The nurse notifies the client's health care provider (HCP), who tells the nurse to restrain the client, if necessary, to keep the client from leaving the hospital. The nurse understands that restraining this client would be considered which type of tort by the nurse?

Negligence

False imprisonment

Assault

malpractice

9. A charge nurse is teaching a new nurse how to initiate intravenous (IV) access on a client. Which of the following actions by the new nurse indicates an understanding of the teaching?

Shaves the selected insertion site with a razor blade or sharp razor prior to the procedure

Applies the tourniquet 1 inch above the selected insertion site

Washes hands with soap and water before the procedure

Applies sterile gloves prior to inserting IV catheter

10. The nurse is bathing a client with nausea and vomiting when the client begins to cry. Which action by the nurse is therapeutic at this time?

Continue bathing the client and say nothing

Stop the bath, cover the client and allow the client private time

Call the healthcare provider to report the signs of depression

Stop the bath, cover the client, and sit with the client

11. The home care nurse assesses the client's environment for potential hazards. Which observation requires the nurse to counsel the client and the family about the potential for injury?

Dash can next to the clients' favorite chair

Extension cord tucked away between the sitting area and wall

Stairway that leads to bedrooms

Fluorescent light bulbs in every table lamp





13. A nurse is caring for a client with a normal grief reaction following the loss of spouse. Which of the following findings should the nurse expect?

Insomnia

Diarrhea

Hypertension

Chest discomfort

14. A nurse is preparing an educational program for a group of newly licensed nurses about client confidentiality. The nurse should explain that nurses may share a client's protected health information with which of the following groups?

Health care team members caring for the client

The facility's administration

Clergy affiliated with the facility

The client's immediate family members