Tiêu đề RECALLS 4 (NP4) - STUDENT COPY ✅

4 | Page Prepared by: GARCIA, RHYAN P. ROMAN, HANNAH GISELLA C. Crackles in the lungs D. Dry mucous membranes 62. Nurse Mallow is caring for a post-op client freshly endorsed from the OR department. Which assessment requires immediate attention? A. Urine output of 30 mL/hr B. Pain level of 7/10 C. Absent bowel sounds D. Restlessness and confusion 63. Nurse Mallow is documenting care in the electronic health record (EHR). Which statement made by her would be correct? A. “Client appears to be in pain.” B. “Client states, ‘I feel pain in my stomach.’” C. “Client was comfortable.” D. “Severe abdominal pain noted.” 64. A client is prescribed metoprolol. Which of the following should Nurse Mallow assess before administration? A. Respiratory rate B. Heart rate C. Temperature D. Oxygen saturation 65. A client is prescribed heparin. Which lab test should Nurse Mallow monitor? A. PT B. INR C. aPTT D. Platelet count SITUATION: Sucrose, a student nurse, is currently in her hospital rotation with her clinical instructor. She is mindful that her clinical instructor’s license is at stake whenever she performs patient care as a nursing student. 66. Student nurse Sucrose is caring for a client with a nasogastric tube. Which action is appropriate? A. Check placement using auscultation B. Flush the tube with 30 mL of air before feeding C. Keep the head of the bed elevated at 30–45 degrees during feeding D. Position the client flat to promote comfort 67. Asked by her clinical instructor, Sucrose would be correct when she selects among the options is appropriate when administering a subcutaneous injection? A. Insert the needle at a 45-degree angle B. Aspirate before injecting the medication C. Use a 1.5-inch needle D. Massage the site after injection 68. Alongside a ward nurse, Sucrose is reviewing discharge instructions for a client on prednisone. Which statement by Sucrose indicates a need for further teaching? A. “The client needs to take this medication with food.” B. “The client can stop the medication when he feels better.” C. “The client must monitor for signs of infection.” D. “The client might notice weight gain while on this medication.” 69. A client with hypertension is prescribed lisinopril. Which side effect should Sucrose teach the client to report? A. Persistent dry cough B. Increased appetite C. Constipation D. Bradycardia 70. Sucrose is correct when she chooses this method to verify nasogastric tube placement. A. Auscultate over the stomach while injecting air B. Check the pH of gastric aspirate C. Rely on the client’s report of discomfort D. Observe for bubbling at the tube insertion site 71. A client with type 2 diabetes is prescribed metformin. Which lab value should the Sucrose, alongside the ward nurse, should monitor closely? A. Blood glucose B. Liver enzymes C. Serum creatinine D. Hemoglobin 72. A client receiving chemotherapy reports mouth sores and difficulty eating. What is Sucrose’s primary teaching? A. Provide lemon glycerin swabs for oral care B. Encourage the client to drink hot tea C. Suggest bland, soft foods and perform frequent mouth care D. Recommend mouthwash with alcohol to kill bacteria 73. Sucrose would be correct when she chooses among the options—What is the nurse’s role in informed consent? A. Explaining the risks and benefits of a procedure B. Witnessing the client’s signature and ensuring they understand the procedure C. Deciding if the procedure is necessary for the client D. Discussing alternative treatments with the client 74. A client post-thyroidectomy develops tingling in the fingers and around the mouth. After the situation has been resolved, the clinical instructor asks Sucrose what the priority action in such a case would be. Sucrose would be correct when she answers ______________. A. Administer calcium gluconate B. Reassure the client this is normal after surgery C. Increase fluid intake D. Encourage deep breathing exercises SITUATION: Kaveh is a bedside nurse who dreams of flying abroad to support his dreams of becoming an architect. Before he can accomplish this goal, he needs to have at least 1 year's worth of hospital experience. 75. Nurse Kaveh is preparing to administer IV potassium chloride. Which action is correct? A. Administer as a rapid IV push B. Dilute in an appropriate IV solution and infuse slowly C. Inject directly into the central line without dilution D. Give undiluted through a peripheral IV 76. A client with pneumonia is prescribed antibiotics. Which finding indicates the treatment is effective? A. Increased sputum production B. Decreased white blood cell count C. Decreased breath sounds D. Increased respiratory rate 77. Nurse Kaveh is caring for a client with a new colostomy. Which statement indicates effective teaching? A. “I will change the bag once a week.” B. “I will clean the stoma with alcohol pads.” C. “I will expect my stoma to be bright red and moist.” D. “I will apply lotion around the stoma to prevent skin breakdown.” 78. Nurse Kaveh is caring for a client with acute pancreatitis. Which assessment finding requires immediate attention? A. Epigastric pain radiating to the back B. Bluish discoloration around the umbilicus C. Nausea and vomiting D. Elevated serum amylase 79. Nurse Kaveh is preparing to administer medications via a nasogastric tube. What should the nurse do first? A. Flush the tube with 60 mL of water B. Verify tube placement C. Crush all medications together D. Mix medications with enteral feeding solution 80. A client receiving total parenteral nutrition (TPN) suddenly develops dyspnea and chest pain. What is the priority action? A. Slow down the TPN infusion rate B. Notify the healthcare provider immediately C. Place the client in the Trendelenburg position on the left side D. Check the client’s blood glucose level 81. A client has a prescription for lisinopril. Which finding requires immediate action? A. Blood pressure of 110/70 mmHg B. Serum potassium of 6.2 mEq/L C. Heart rate of 80 bpm D. Presence of a dry cough 82. A client with heart failure is prescribed digoxin. Which of the following indicates digoxin toxicity? A. Heart rate of 80 bpm B. Yellow-green vision C. Increased appetite D. Weight gain of 2 pounds in one week 83. Nurse Kaveh finds that a client’s IV site is red, warm, and swollen. Upon checking the patient’s history, the client was