Question 1 What document should be in guiding the care of this client? Advance Directives Question 2 You are the of a health care team that consists of one licensed practical/vocational nurse, one nursing assistant, a nursing student and yourself. To whom is it appropriate to assign complete care for Yourself Question 4 As the nurse takes a history of a 3-year-old with neuroblastoma, what comments by the parents require follow-up and are consistent with the diagnosis? "Clothes are becoming tighter across her abdomen." Question 5 A 16-year-old presents to the emergency department. The triage nurse finds that this teenager is legally married and signed the consent form for treatment. What would be the appropriate INITIAL action by the nurse? Assess and treat in the same manner as any adult client Question 6 A newly admitted elderly client is severely dehydrated. When planning care for this client, which one of the following is an appropriate task for an Unlicensed Assistive Personnel (UAP)? Report output of less than 30 ml/hr Question 7 The nurse is assessing a 4-year-old for possible rheumatic fever. Which of the following would the nurse suspect is related to this diagnosis? Exposure to strep throat in daycare last month Question 8 When the nurse becomes aware of feeling reluctant to interact with a manipulative client, the BEST action by the nurse is to Discuss the feeling of reluctance with an objective peer or supervisor Question 9 A client is being treated for paranoid schizophrenia. When the client became loud and boisterous, the nurse immediately placed him in seclusion as a precautionary measure. The client willingly complied. The nurse's action May result in charges of unlawful seclusion and restraint ice pack Question 10 A client has been admitted to the Coronary Care Unit with a Myocardial Infarction. Which of the following nursing diagnosis should have PRIORITY? Pain related to ischemia Question 11 The nurse manager who is responsible for hiring professional nursing staff is required to comply with the Americans with Disabilities Act. The provisions of the law require the nurse manager to Provide reasonable accommodations for disabled individuals Question 12 The mother of a school-aged child in a long leg cast asks the nurse how to relieve itching inside the cast. Which of the following is appropriate for the nurse to suggest as a remedy? Applying an over the area of the cast that is affected Question 13 Which of the following BEST describes the application of time management strategies in the role of the nurse manager? Setting daily goals to prioritize work Question 14 The clinic nurse assesses a toddler with a tentative diagnosis of neuroblastoma. Symptoms the nurse observes that suggest this problem include Abdominal mass and weakness Question 15 A fifteen-year-old client has been placed in a Milwaukee Brace. Which one of the following statements from the client indicates the need for additional teaching? "I will only have to wear this for six months." Question 16 The nurse manager has been using a decentralized block scheduling plan to staff the nursing unit. However, staff have asked for many changes and exceptions to the schedule over the past few months. The manager considers self-scheduling knowing that Team morale will improve Question 17 A client is admitted to the emergency room following an acute asthma attack. Which of the following assessments would be expected by the nurse? Diffuse expiratory wheezing Question 18 The nurse manager hears a physician loudly criticizing one of the staff nurses in the hearing of others. The employee does not respond to the physician's complaints. The nurse manager's FIRST action should be Request an immediate private meeting with the physician and staff nurse Question 19 A client voluntarily admits herself to the hospital due to suicidal ideation. The client has been on the unit for two days and is now demanding to be released. The MOST appropriate action is for the nurse to Discuss with the client the decision to leave and prepare for her discharge Question 20 A client is admitted with condition? (IE). Which symptom would alert the nurse to a complication of this Heart murmur Question 21 A nurse admits a premature infant who has respiratory distress syndrome. In planning care, nursing actions are based on the fact that the MOST likely cause of this problem stems from the infant's inability to Maintain alveolar surface tension Question 22 An 18-year-old client is admitted to intensive care from the emergency room following a diving accident. The injury is suspected to be at the level of the 2nd cervical vertebrae. The nurse's PRIORITY assessment should be Respiratory function Question 23 The nurse is caring for a client who was successfully resuscitated from a pulseless dysrhythmia. Which of the following assessments is CRITICAL for the nurse to include in the plan of care? Hourly urine output Question 24 The nurse admitting a 5-month-old who vomited nine times in the past six hours should observe for signs of Metabolic alkalosis Question 25 A child is injured on the school playground and appears to have a fractured leg. The FIRST action the school nurse should take is Assess the child and the extent of the injury