1. While working in an outpatient clinic, the nurse receives several messages. Which one should be prioritized for a return call? A mother mentions her five-day-old infant's umbilical stump is dry and firm. mother reports that her four-day-old infant's fontanel feels slightly raised while sleeping. A mother states her 3-day-old infant’s circumcision site has a yellowish discharge A father says his two-day-old baby flailed her arms and then curled them back in after the crib was bumped

2. Parents ask what causes their son’s hemophilia. What is the best response by the nurse? The mother passes the gene to her son Both parents carry a recessive gene for the condition The father transmits the trait to his son Each daughter has a 50% chance of inheriting the gene from the mother

3. During a routine check-up, what developmental milestone should a nurse expect in a 6-month-old infant? Using a pincer grasp. Able to sit with support Has tripled birth weight Posterior fontanel is still present

4. A 48-year-old patient with an endotracheal tube needs suctioning. Which describes the correct technique? Insert the catheter four inches, suction for 30 seconds while twirling the catheter out. Give supplemental oxygen before inserting the catheter and suction while withdrawing it using a gentle back-and-forth movement Tell the patient about the process, begin suction during insertion, and twist the catheter out. Advance the catheter until resistance is felt, pull back slightly, then suction intermittently while withdrawing.

5. A woman visits the mental health clinic due to a fear of heights. What defense mechanisms are typically involved in phobias? Projection and displacement. Sublimation and internalization Rationalization and intellectualization. Reaction formation and symbolization

6. A client at eight weeks pregnant tests positive for syphilis. What should be the nurse's main teaching focus? Avoid all medications to protect the baby from harm Take the full course of penicillin as prescribed. Refrain from sexual contact during pregnancy Keep the identity of sexual partners confidential

7. What is the nurse’s understanding about passive range-of-motion exercises for an elderly client who has been immobile? They increase muscle strength They should be performed through full motion in all joints. They are performed up to the point of pain. They help maintain the ability to perform daily self-care tasks

8. A 65-year-old client is scheduled for colon surgery. He completed a bowel prep the night before but has passed soft brown stool this morning. How should the nurse interpret this? The bowel is not yet adequately cleansed. The client ate food after midnight. This is a normal finding prior to surgery This stool was the last residue left in the colon

9. Which physical findings are expected in a newborn with fetal alcohol syndrome? Large for gestational age with hydrocephalus and facial abnormalities. Low birth weight, small head, and flat cheekbones Small head and low weight with excessive sucking reflex. Normal head size with low weight and breathing problems

10. Which side effects should the nurse closely monitor for in a client receiving IM hydromorphone (Dilaudid)? Increased sensitivity to light and constipation Low blood pressure and suppressed breathing Involuntary muscle movements and double vision. Dry mouth and ringing in the ears.

11. A 66-year-old diabetic client refuses to check her blood sugar and uses urine testing instead. Why is blood glucose monitoring preferred? Older adults may have a higher threshold for glucose in the kidneys It’s less expensive and easier to perform at home Urine tests often produce false positives Color changes on strips are interpreted differently by individuals

12. . A pregnant client at 32 weeks gestation is scheduled for an ultrasound. Which client statement indicates proper understanding of the procedure? The test can help determine the baby’s age. It will assess how mature the baby's lungs are It shows spinal cord issues. It checks for early blood disorders in the fetus.

13. A child with head lice is being treated with 1% Kwell shampoo. What should the nurse teach the parents? Use the shampoo every other day for one week Clean belongings normally with soap and water Repeat the shampoo treatment in 7 to 10 days. A single treatment removes both lice and eggs

14. The nurse supervises an LPN giving an enema. Which action is most critical for patient safety? Hang the enema bag 20 inches above the anus Warm the solution to a safe temperature Insert the tube six inches into the rectum. Position the client on the left side with the knee bent

15. An 18-month-old is admitted with laryngotracheobronchitis (croup). What early signs should the nurse expect? Deep breathing and slow heart rate Fever with decreased respiratory rate Wheezing on exhalation and chest retractions Stridor while inhaling and increased restlessness

16. A client on chlorpromazine reports restlessness, insomnia, and hand tremors. What do these symptoms indicate? They are minor side effects that lessen with time. They are the intended effects of the medication They are extrapyramidal symptoms. They suggest the dose should be raised.

17. Which nursing diagnosis is most appropriate for a client with a tracheostomy? Difficulty communicating due to inability to speak. Ineffective airway clearance due to increased secretions Risk for skin breakdown at tracheostomy site Pain caused by surgical incision

18. Which diet is most suitable for a client with low parathyroid function? Rich in phosphorus High in calcium Low in sodium Low in potassium.

19. Why is internal fetal monitoring used for a woman in active labor? To monitor how labor is progressing To assess the strength of contractions To evaluate fetal oxygenation To decide if oxytocin is needed

20. A mentally challenged client is being discharged with a prescription for warfarin. What should be the nurse’s FIRST action? Teach a family member how to manage the medication. Assess how well the client understands the medication Prepackage the pills for easier use Ask the client to demonstrate giving themselves the medication