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Question 1 of 5

The nurse is performing discharge instruction for a client with an implantable permanent pacemaker. What discharge instruction is an essential part of the plan?

Correct Answer: C

Rationale: Clients with pacemakers must monitor their pulse to ensure the device is functioning correctly and to detect irregularities, making pulse-taking an essential discharge instruction.

Question 2 of 5

A home health nurse has four clients assigned for morning visits. The nurse should give priority to visiting the client with:

Correct Answer: B

Rationale: Frothy sputum in congestive heart failure suggests pulmonary edema, a life-threatening condition requiring immediate attention.

Question 3 of 5

A nurse graduated from nursing school 3 years ago. He worked at one hospital on the telemetry unit for 6 months. He then transferred to the cardiac care unit (CCU) at a teaching hospital, and has been working there for 2.5 years. According to the novice-expert model of nursing, he is considered

Correct Answer: C

Rationale: Per Benner’s model, a nurse with 2-3 years of focused experience (2.5 years in CCU) is competent, demonstrating efficiency and coordinated care.

Question 4 of 5

A nulliparous client has been admitted after 12 hours of mild contractions at home. On examination, the client is found to be fully effaced and dilated to 3 cm. Contractions are every 5 minutes and last approximately 60 seconds. The client asks the nurse approximately how long it should take to get to 10 cm dilation. Which of the following is the most appropriate response?

Correct Answer: D

Rationale: Nulliparous women progress at ~1 cm/hour in active labor. From 3 cm to 10 cm is 7 cm, so ~7 hours (
D) is expected.

Question 5 of 5

Cataracts result in opacity of the crystalline lens. Which of the following best explains the functions of the lens?

Correct Answer: C

Rationale: The lens focuses light rays onto the retina to produce a clear image.

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