Exam 10: How to Take and Pass Tests

A 73-year-old man receives hydralazine (Apresoline) 20 mg PO at 0800. When the nurse checks his blood pressure at 0900, she obtains a reading of 72/44 mm Hg. The client has been taking this same dose of medication for 3 years. The nurse finds all of the following data in the client's chart. Identify the finding that is most significant for producing the client's current blood pressure.

Based on accepted standards of care for documentation, identify the element that the nurse should avoid placing in the client's medical record.

After eye surgery, a client is alert and oriented and has eye patches over both eyes. Select the action by the nurse that would have the highest priority in preventing injury to this client.

A 24-year-old woman comes to the family planning clinic with dysuria, purulent vaginal drainage, and perineal pruritus and has a positive culture for a sexually transmitted disease (STD). Identify the STD that the nurse is required to report to the public health department.

During a "Health Promotion" class at a senior citizen center, one of the elderly attendees asks the nurse teaching the class, "I know older persons fall frequently. What types of fractures are most common in people in our age group?" Select the type of fracture the elderly most often experience.

Select the instructions by the clinic nurse that are most effective in preventing back injury for a client with chronic low back pain.

Identify the instructions about the care of urinary system the nurse should give to a 44-year-old hospitalized woman who has an indwelling urinary catheter and IV who insists on going to the smoking room for a cigarette every few hours.

Identify the discharge instructions by the nurse that best help prevent potential complications related to the pacemaker for a 65-year-old man who received an implanted ventricular demand pacemaker for treatment of a complete AV block secondary to an anterior myocardial infarction.

A 15-year-old girl is brought by her mother to the pediatric clinic because she has not yet started her menstrual cycles and shows minimal physical development typical of puberty. When the diagnosis of delayed puberty is made, the girl begins to cry, stating, "Everybody at school makes fun of me because I'm so flat." Select the response by the nurse that best addresses the girl's concerns.

While climbing over a barbed wire fence, a 22-year-old man received a deep laceration on his arm and hand. After washing and dressing the laceration with an antibiotic ointment, the emergency department nurse notes that the client has had all his immunizations, with his last tetanus at age 18 for another injury. Select the action that should be taken by the nurse at this time.

A particularly vocal staff nurse on a busy obstetrical unit has been complaining to the other nurses about the unit manager's preferential treatment of the night-shift nurses. Select the action the unit manager should take to resolve this problem that best demonstrates the use of the assertive approach to conflict resolution.

Identify the action by the nurse that is most appropriate when caring for a client hospitalized with chronic schizophrenia who has been taking clozapine (Clozaril) for the past 2 weeks.

At the family planning clinic, a 19-year-old woman who has recently become HIV positive is given counseling by the clinic nurse. Identify the instructions by the nurse that are most effective in preventing the transmission of HIV during sexual intercourse.

During her routine annual physical examination, a 48-year-old woman tells the nurse that she worries about her health all the time, spends 8 to 10 hours at the health center every week, and has spent a larger than usual amount of money on cosmetics over the past 6 months. Select the most appropriate response by the nurse to this client.