1- A 59-year-old male client is brought to the emergency room where he is assessed to have a Glasgow
Coma Scale of 3. Based on this assessment, howshould the nurse characterize the client’s condition?
a. The client has increased intracranial pressure
b. He has a good prognosis for recovery
c. This client is conscious, but is not oriented to time and place
d. He is in a coma, and has a very poor prognosisCorrect D
2- At a community health fair, a 50-year-old woman tells the nurse that she has anannual physical exam that
includes a clinical breast exam and an annual mammogram. How should the nurse respond?
a. Encourage the woman to explore her fears about breast cancer.
b. Ask the woman if she also performs monthly breast self- exams.
c. Commend the woman for adhering to the recommended cancer detectionguidelines.
d. Advise the woman that mammograms are only needed every two years ather age.
Correct B
3- Which assessment finding should indicate to the nurse that a client with arterialhypertension is
experiencing a cardiac complication?
a. Complaints of an occipital headache
b. A palpable dorsal is pedis pulse bilaterally
c. Complaints of shortness of breath on exertion
d. A blood pressure of 160/90Correct
C
4- A college student who is diagnosed with a vaginal infection and vulva irritationdescribes the vaginal
discharge as having a “cottage cheese” appearance.
Which prescription should the nurse implement first?
a. Cleanse perineum with warm soapy water 3 times per day
b. Instill the first dose of nystatin (Mycostatin) vaginally per applicator
c. Perform glucose measurement using a capillary blood sample
d. Obtain a blood specimen for sexually transmitted disease (STDs)Correct B
5- A client in acute renal failure has serum potassium of 7.5 mEq/L. Based on thisfinding, the nurse should
anticipate implementing which action?
a. Administer an IV of normal saline rapidly and NPH insulsubcutaneously.
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