1. A.example of a process standard on a med-surg unit is:

2. Nail and foot care are essential in meeting basic hygiene needs of clients. Important assessments by the nurse in this area include:

3. A seventh grader lost consciousness after being hit in the head with a basketball. In the emergency room his vital signs are stable, and he demonstrates no neurologic deficit. He will not be admitted to the hospital. It is most important that you advise his mother to:

4. A serious complication of a total hip replacement is displacement of the prosthesis. What is the primary sign of displacement?

5. The nurse who was not promoted then went to the utility room and slammed several cupboard doors while looking for Kleenex. This behavior exemplifies:

6. A nurse observes a client sitting alone and talking. When asked, the client reports that he is 'talking to the voices.' The nurse's next action should be:

7. When preparing insulin for IV administration, the nurse identifies which kind of insulin to use?

8. A client's membranes have just ruptured spontaneously. Which of the following nursing actions should take priority?

9. A 2-year-old child diagnosed with HIV comes to a clinic for immunizations. Which of the following vaccines should the nurse expect to administer in addition to the scheduled vaccines?

10. A 2-year-old toddler is hospitalized with epiglottitis. In assessing the toddler, the nurse would expect to find:

11. There are many types of torts that can be committed against clients. They include all of the following except:

12. The intent of the Patient Self Determination Act (PSDA) of 1990 is to:

13. During surgery, it is found that a client with adenocarcinoma of the rectum has positive peritoneal lymph nodes. What is the next most likely site of metastasis?

14. What is pica?

15. A 28-year-old multigravida has class II heart disease. At her prenatal visit at 34 weeks' gestation, all of the following observations are made. Which would require intervention?

16. Which of the following statements by a client indicates adequate preparation for magnetic resonance imaging?

17. The physician has ordered that ampicillin 250 mg IV be given over 30 minutes. The medication is diluted as recommended in 10 mL in the volume control chamber of a set that has a tubing of 12 mL. Which nursing measure is most accurate considering these facts?

18. For a client with suspected appendicitis, the nurse should expect to find abdominal tenderness in which quadrant?

19. A 35-year-old client is admitted to the hospital for elective tubal ligation. While the nurse is doing preoperative teaching, the client says, The anesthesiologist said she was going to give me balanced anesthesia. What exactly is that?"The best explanation for the nurse to give the client would be that balanced anesthesia:"

20. The nurse should teach a client in the Emergency Department, who has suffered an ankle sprain, to:

21. Which of the following home-care strategies is most likely to negatively impact the body image of a client with Cushing's syndrome?

22. A client is given an opiate drug for pain relief following general anesthesia. The client becomes extremely somnolent with respiratory depression. The physician is likely to order the administration of:

23. A 30-year-old client is exhibiting auditory hallucinations. In working with this client, the nurse would be most effective if the nurse:

24. Which of the following is responsible for laws mandating the reporting of certain infections and diseases?

25. A 26-year-old female client presents at 10 weeks' gestation. She currently is a G3 1-0-1-1. Her mother and grandmother have heart disease. Her grandmother also has insulin-dependent diabetes. The client's previous delivery was a term female infant weighing 9 lb 13 oz. The client is 5 ft 6 inches tall and her current weight is 130 lb. Based on her history, she is at risk for developing diabetes in pregnancy. Which of the following factors places her at risk for gestational diabetes?