A nurse is assessing a client who is receiving enteral feeding via an NG tube. The client has
developed hyperosmolar dehydration. Which of the following actions should the nurse take
when administering the client’s findings?
a. Switch to a lactose-free formula.
A nurse is providing discharge teaching to a client who has a new ostomy. Which of the
following instructions should the nurse include?
a. Empty your ostomy pouch when it is half full
A nurse is teaching the parents of a school-age child who has sickle cell anemia about
managing the disease at home which of the following instructions should the nurse include?
A nurse is teaching about Safe Handling of formula to a client who is postpartum and chooses to
bottle feed her newborn. Which of the following statements by the client indicates an
understanding of the teaching?
a. I should boil tap water for 2 minutes and call it before I mix it with powdered
formula
A nurse is assessing a child who is post-operative following a tonsillectomy. Which of the
following findings should the nurse identify as the priority?
a. Frequent swallowing
A nurse is teaching a client who is pregnant about non-stress testing. Which of the following
statements by the client indicates an understanding of the teaching?
A nurse is monitoring a client who is receiving a transfusion of packed RBC's. The client reports
chills, headaches, low back pain, and a feeling of tightness in his chest. The nurse should
identify that the client has developed which of the following types of transfusion reactions?
a. Acute hemolytic
A nurse is caring for a client who is in the latent phase of Labor and reports severe back pain.
The vaginal examination reveals that the cervix is dilated two centimeters, 25% effaced and -2
station. Which of the following interventions should the nurse implement?
A nurse is teaching about how to suppress lactation with a client who is postpartum and bottle
feeding her newborn. Which of the following instructions should the nurse include in the
1. Request the provider prescribe a pudendal nerve block
a. During this test, I will punch a button if the baby moves
a. Apply cold compresses too painful areas
a. I will avoid crushing this medication
teaching?
a. You should wear a snug fitting bra continuously for 72 hours
A nurse is preparing to administer medication to a client. What are the following identifiers
should the nurse use to identify the client?
a. Room number
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