NLN NACE Adult Health (Care of the Adult Client)

A nurse is caring for a 72-year-old client transitioning from acute care to a skilled nursing facility. Which intervention best supports a safe transition of care?

• ASend a verbal report only when the receiving nurse calls
• BProvide a written medication reconciliation list and a SBAR handoff to the receiving faci…
• CWait until the client arrives to discuss the plan of care
• DSend the discharge summary by mail within 7 days

Which client should the nurse assess FIRST after receiving the shift report?

• AA client with stable angina scheduled for a stress test in 4 hours
• BA client with new-onset confusion and an oxygen saturation of 86% on room air
• CA client with chronic low back pain rating discomfort 4/10
• DA client awaiting discharge teaching for newly diagnosed hypertension

A nurse is delegating tasks to an unlicensed assistive personnel (UAP). Which task is appropriate to delegate?

• AInitial assessment of a newly admitted client with chest pain
• BTeaching a client how to use a glucometer
• CRecording vital signs on a stable post-operative client every 4 hours
• DAdjusting the rate of an IV pump for a client receiving heparin

A client is to receive a unit of packed red blood cells. The nurse confirms the unit with another RN at the bedside. What is the most important verification step?

• AConfirm the client's name and room number
• BCompare the client's name, MRN, ABO/Rh type, and unit number against the blood bank tag a…
• CVerify the client's blood pressure is within normal range
• DEnsure the IV tubing is primed with dextrose 5% in water

A nurse is preparing to start an IV on a client with end-stage renal disease whose left arm has a functioning AV fistula. Which site should the nurse select?

• AA vein in the left forearm distal to the fistula
• BA vein in the right forearm
• CThe antecubital vein in the left arm
• DA vein at the fistula site itself

A client with C. difficile infection is admitted. Which precautions should the nurse implement?

• AStandard precautions only
• BContact precautions with soap and water for hand hygiene
• CDroplet precautions with surgical mask
• DAirborne precautions in a negative-pressure room

A nurse is caring for a client with active pulmonary tuberculosis. Which type of mask is required when entering the room?

• ASurgical mask
• BN95 respirator (fit-tested)
• CPowered air-purifying respirator only
• DSimple cloth face covering

A client has a written advance directive indicating no cardiopulmonary resuscitation. The client is now unresponsive with no pulse. The family demands resuscitation. What is the nurse's best action?

• ABegin CPR because the family requested it
• BHonor the advance directive and notify the provider; offer family support
• CWait for the family to contact a lawyer
• DBegin CPR but stop after 5 minutes

Before a client signs informed consent for a surgical procedure, the nurse's primary responsibility is to:

• AExplain the risks and benefits of the procedure
• BWitness the client's signature and confirm the client understands the discussion held wit…
• CSign the consent on the client's behalf
• DEnsure the spouse signs if the client is anxious

A nurse discovers that a colleague has been documenting medications as administered without giving them. What is the nurse's most appropriate action?

• AConfront the colleague at the next break
• BReport the finding to the nurse manager and complete an incident report
• CIgnore it because it is not directly the nurse's responsibility
• DTell the family of the affected client immediately

A client receiving home oxygen therapy is being discharged. Which safety teaching is MOST essential?

• AIncrease oxygen flow rate during shortness of breath
• BAvoid open flames, smoking, and petroleum-based products near oxygen
• CStore the oxygen tank lying horizontally near a heater
• DDiscontinue oxygen during sleep to conserve the supply

A nurse is performing a sterile dressing change. Which action breaks sterile technique?

• AHolding sterile gloved hands above the waist
• BTurning her back to the sterile field briefly to retrieve supplies
• CConsidering the 1-inch outer border of the sterile field nonsterile
• DPouring sterile saline without touching the bottle to the basin

A nurse is screening a 75-year-old client at risk for falls. Which intervention is MOST evidence-based for fall prevention?

• AApply soft wrist restraints at night
• BKeep the client in a low bed with bed alarm and ensure call light is within reach
• CPlace a sedative on the medication list
• DRestrict ambulation to once per shift

Which finding requires immediate notification of the provider in a client with a continuous bladder irrigation after TURP (transurethral resection of the prostate)?

• APink-tinged urine output
• BBright red bleeding with clots and bladder spasms
• CUrine output of 200 mL per hour
• DMild discomfort at the catheter site

A nurse is caring for a client with a chest tube to closed water-seal drainage. Which finding is expected and normal?

• AContinuous bubbling in the water-seal chamber
• BTidaling (fluid rising and falling with respirations) in the water-seal chamber
• CClamping the tube during ambulation
• DStripping the tubing every hour to maintain patency

A nurse working in a long-term care facility notes that a 78-year-old resident has unexplained bruises and reports being 'pushed' by a staff member. What is the nurse's first action?

• AConfront the staff member privately
• BDocument the findings, report to the supervisor and adult protective services per state l…
• CWait until next week's care conference to discuss
• DTell the family but not document anything

A nurse is reviewing the metabolic regulation of a client with type 2 diabetes who is NPO for surgery. Which insulin adjustment is most appropriate per typical perioperative protocols?

• AHold all insulin while NPO
• BHold short-acting insulin and reduce or hold long-acting insulin per protocol; monitor bl…
• CDouble the usual long-acting insulin dose to prevent hyperglycemia
• DGive the usual mealtime insulin doses regardless of NPO status

A client with dementia is wandering on the unit. Which environmental accommodation is BEST?

• AApply a vest restraint
• BProvide a structured walking schedule, clear signage, and door alarms with a wandering-pr…
• CPlace the client in seclusion
• DLock the client in the room

A nurse is using the SBAR format to call a provider about a deteriorating client. Which statement belongs in the 'Assessment' section?

• A'Mr. K was admitted yesterday for pneumonia.'
• B'I think he is becoming septic — temp 39.4 °C, HR 122, BP 88/54, SpO2 89%.'
• C'I would like a blood culture and a 1-liter NS bolus.'
• D'Hi Dr. Lee, I'm calling about Mr. K in room 412.'

A nurse is documenting in the electronic health record. Which entry meets legal documentation standards?

• A'Client appears comfortable; tolerated procedure well.'
• B'14:25 — Pain rated 6/10 RUQ, sharp; morphine 4 mg IV given. 14:55 — Pain 2/10, denies na…
• C'Client is doing fine, no concerns.'
• D'Family seems upset; nurse handled it.'

A 65-year-old client asks about cancer screening recommendations. Per current USPSTF guidelines, which screening is recommended for the average-risk adult of this age?

• AAnnual chest X-ray for lung cancer
• BColorectal cancer screening (colonoscopy or stool-based test) through age 75
• CAnnual prostate-specific antigen (PSA) screening for all men
• DWhole-body MRI every 2 years

Which immunization is recommended annually for adults age 65 and older?

• ATetanus-diphtheria-pertussis (Tdap)
• BInactivated influenza vaccine
• CMeasles-mumps-rubella (MMR)
• DHepatitis B series

A client with newly diagnosed hypertension asks about lifestyle changes. Which DASH diet recommendation should the nurse emphasize?

• AIncrease processed meats and canned soups
• BReduce sodium to less than 2,300 mg/day (ideally <1,500 mg) and increase fruits, vegetabl…
• CEliminate all carbohydrates
• DDrink alcohol with every meal

An 80-year-old client lives alone and reports difficulty preparing meals. Which support service is the MOST appropriate referral?

• AInpatient psychiatric admission
• BMeals on Wheels and a home health social work consult
• CLong-term acute care hospital
• DSkilled nursing facility for ventilator care

A nurse is teaching a client newly diagnosed with COPD. Which lifestyle change has the GREATEST impact on slowing disease progression?

• ASmoking cessation
• BSleeping with the head of the bed flat
• CIncreasing dairy intake
• DAvoiding all physical activity

A client with newly diagnosed type 2 diabetes asks about lifestyle changes. Which goal is MOST appropriate?

• AAchieve weight loss of 5-10% of body weight and 150 minutes of moderate exercise per week
• BEliminate all dietary fat
• CAvoid all carbohydrates indefinitely
• DEngage in vigorous exercise daily without medical clearance

Which assessment finding suggests an aging adult is having difficulty maintaining independence with activities of daily living (ADLs)?

• ADifficulty managing finances
• BDifficulty bathing and dressing without assistance
• CDriving to the supermarket
• DCooking simple meals occasionally

A client with stage 3 chronic kidney disease (eGFR 45) asks about diet. Which teaching is MOST appropriate?

• AIncrease potassium-rich foods like bananas and oranges
• BLimit sodium to <2,300 mg/day, moderate protein, and avoid excessive potassium and phosph…
• CDrink unlimited fluids to flush kidneys
• DTake over-the-counter NSAIDs daily for back pain

A nurse is teaching breast self-awareness. Which finding warrants urgent provider evaluation?

• ASoft, mobile cyst that fluctuates with menstrual cycle
• BHard, fixed lump with skin dimpling and nipple retraction
• CSlight breast tenderness during menstruation
• DMild fibrocystic changes that resolve mid-cycle

Which family/caregiver education topic is MOST important for a client newly diagnosed with Alzheimer disease?

• AHow to perform IV administration at home
• BCaregiver burnout, safety modifications, routine and structure, and respite resources
• CHow to administer chemotherapy at home
• DInsulin dosing schedules

A 68-year-old client with osteoarthritis asks about exercise. Which recommendation is MOST appropriate?

• AAvoid all exercise to prevent joint damage
• BEngage in low-impact aerobic activity (walking, swimming) and strength training
• CRun 5 miles daily
• DLift heavy weights to build joint cushioning

Which adult should receive the shingles (recombinant zoster) vaccine according to CDC guidelines?

• AAll adults age 50 and older (and immunocompromised adults 19+)
• BOnly adults with a history of chickenpox under age 30
• COnly adults receiving live vaccines
• DOnly adults with active shingles outbreak

A 70-year-old client asks about pneumococcal vaccination. Per current ACIP guidelines, which is the recommended approach?

• ANo pneumococcal vaccination after age 65
• BReceive PCV20 (or PCV15 followed by PPSV23) as recommended by ACIP for adults 65+
• CReceive only the influenza vaccine
• DWait until age 80 to consider pneumococcal vaccination

A client describes binge drinking on weekends. The nurse uses the CAGE questionnaire. What does each letter assess?

• ACalories, Alcohol, Glucose, Exercise
• BCut-down, Annoyed, Guilty, Eye-opener
• CCardiac, Anemia, Glucose, Eosinophils
• DCancer, Allergy, Genetics, Edema

An adult client requests information about vitamin D supplementation. Which statement is accurate?

• AAll adults need 50,000 IU daily
• BMost adults benefit from 600-800 IU daily; older adults may need higher doses if deficient
• CVitamin D should never be supplemented
• DVitamin D is only obtained from sunlight

A 75-year-old client with mild cognitive impairment is admitted. Which intervention BEST supports orientation and reduces delirium risk?

• ARestrict visitors to reduce stimulation
• BProvide a clock, calendar, familiar objects, hearing aids/glasses, and consistent caregiv…
• CUse sedating medications nightly
• DKeep the room dark all day

A nurse is caring for a client with Parkinson disease. Which finding is consistent with this neurological disorder?

• AResting tremor, bradykinesia, rigidity, and postural instability
• BSudden unilateral facial droop and slurred speech
• CBilateral ascending paralysis
• DSevere headache with photophobia and stiff neck

A nurse is providing end-of-life care to a client on hospice. The client is restless and grimacing. Vital signs: HR 110, BP 90/56, RR 24. Which intervention is MOST appropriate?

• AWithhold opioids to avoid hastening death
• BAdminister prescribed opioid analgesic and reassess pain every 15-30 minutes
• CIncrease IV fluids to 200 mL/hr
• DInitiate full-code resuscitation orders

A primary caregiver of a spouse with advanced dementia reports exhaustion, disrupted sleep, and feelings of resentment. Which nursing diagnosis is MOST appropriate?

• AFluid volume excess
• BCaregiver role strain
• CActivity intolerance
• DDisturbed body image

A client with stage 4 metastatic cancer states, 'I don't see the point of any more treatment.' What is the nurse's BEST response?

• A'You should keep fighting for your family's sake.'
• B'Tell me more about what you are feeling.'
• C'Don't worry, the next treatment will work.'
• D'I'll let the doctor know you are giving up.'

A nurse is assessing a client with a stage 3 pressure injury. Which feature defines stage 3?

• AIntact skin with non-blanchable redness
• BPartial-thickness loss with exposed dermis (shallow crater, no slough)
• CFull-thickness skin loss with visible adipose (subcutaneous fat) but no exposed muscle, t…
• DFull-thickness loss with exposed bone, tendon, or muscle

A nurse is implementing pressure injury prevention for a bedridden client. Which intervention is MOST evidence-based?

• AReposition every 4 hours and use a regular foam mattress
• BReposition at least every 2 hours, use a pressure-redistributing surface, and assess skin…
• CMassage reddened areas vigorously
• DApply heat lamps to reddened skin

A nurse is assessing the developmental needs of a 78-year-old client. Per Erikson's stages, what is the central psychosocial task at this stage?

• AIdentity vs. role confusion
• BIntimacy vs. isolation
• CGenerativity vs. stagnation
• DEgo integrity vs. despair

A client experiences sudden left-sided weakness, facial droop, and slurred speech. The nurse calls a stroke alert. What is the priority diagnostic test?

• ALumbar puncture
• BNon-contrast CT scan of the head
• CEchocardiogram
• DChest X-ray

A client recovering from a left-sided ischemic stroke has homonymous hemianopia. Which intervention is MOST appropriate?

• APlace all items on the client's left (affected) side
• BApproach from and place items on the unaffected (right) side initially; teach scanning to…
• CCover the affected eye to reduce confusion
• DRestrict the client to bed

A client experiencing depression after a recent loss states, 'I'd be better off dead.' What is the nurse's PRIORITY action?

• AReassure the client and change the subject
• BDirectly assess for suicide plan, intent, and means; ensure safety
• CWait until family arrives to discuss
• DDocument and address it during discharge planning