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1. A nurse is performing tracheostomy care for a client who is postoperative
following a laryngectomy. Which of the following actions should the
nurse take when suctioning the client's airway?
Withdraw the catheter if the client begins coughing.
Apply suction for 10 seconds.
Advance the catheter 2 cm (0.8 in) after resistance is met.
Use medical asepsis when performing the procedure.
2. A nurse is preparing to administer a long-acting insulin to a client who has
diabetes mellitus. Which of the following actions should the nurse plan to
take first?
Teach the client reportable adverse effects from the medication.
Check the insulin dose with another licensed nurse
Administer the insulin at a 90° angle.
Clean the insertion site.
3. A nurse is caring for an older adult client in the PACU following general
anesthesia. Which of the following findings should the nurse report to
the provider?
Urine output 120 mL in 4 hr
Systolic blood pressure 12 mm Hg lower than the preoperative level
Audible stridor
Normal sinus rhythm with an occasional premature ventricular contraction
4. A nurse is preparing to administer diazepam 0.3 mg/kg IV bolus to a toddler
who weighs 22 lb and is experiencing a grand mal seizure. Available is
diazepam solution for injection 5 mg/mL. How many mL should the nurse
administer? (Round the answer to the nearest tenth. Use a leading zero if it
applies. Do not use a trailing zero.) 0.6
5. A charge nurse is planning an educational session for staff nurses about
working with parents whose terminally ill children are candidates for
donating their organs. Which of the following information should the
nurse plan to include?
Choosing to donate organs can delay the timing of the child's funeral.
The family can have the child an open casket without fearing that the organ donation
might disfigure the childs body
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