Question:-A nurse is assessing a client who has been taking antacids frequently for gastrointestinal distress. The assessment findings include drowsiness,
... [Show More] muscle weakness, bradycardia, and hypotension. Which of the following electrolyte imbalance should the nurse suspect?
a. hypophosphatemia
b. hypochloremia
c. hypomagnesemia
d. hypernatremia {{Correct Ans- c
The nurse should indentify that frequent ingestion of antacids adn laxatives that contain Mg can cause hypermangesemia. Malinfestations include hypotension, bradycardia, absent deep tendon reflexes, weak skeletal muscle ctxs, ECG changes, lethargy, and drowsiness that can progress to coma.
Question:-A nurse is assessing a client who ahs developed type 1 herpes simplex virus. Which of the following image should the nurse identify as this type of viral infection?
a. oral resin or thrush on the oral mucous membrane
b. rash which consists of blisters on one side of the body
c. cold sore on lips
d. rash between toes {{Correct Ans- c
Herpes simplex virus infection is a common viral infection in adults. The nurse should identify that this iamge indicates the type 1 herpes simplex viral infection because the infection causes a recurring cold sore.
Question:-A nurse is planning care for a client who has pneumonia. Which of the following interventions should the nurse include in the plan?
a. direct the client to perform IS Q2H.
b. titrate O2 to maintain the client's O2 saturation level at 90%.
c. teach the client how to cough up secretions.
d. maintain the client in a low-Flower's position. {{Correct Ans- c
The nurse should instruct the client how to cough and breathe deeply to expel productive secretions and clear the airway for optimal breathing.
Question:-a nurse is teaching a client who has asthma about using metered-dose inhaler. which of the following client statements incdicates an understanding of the teaching?
a. 'I'll roll the canister b/w my palms a few times before using it.'
b. 'I'll take a deep breath and blow it out before I inhale the medication.
c. 'I'll hold the mouthpiece 3 inches in front of my mouth before depressing the canister.'
d. 'I'll hold my breath for up to 5 seconds after inhaling the medications.' {{Correct Ans- b
The cilent should take a deep breath while sitting or standing then exhale forcefully when prparing to self-administer the inhalant meds.
Question:-a nurse is teaching a female adult client who is obese about disease management. which of the following informaiton should the nurse include in the teaching?
a. average body fat for women is 15%.
b. obesity can cause osteoporosis.
c. morbid obesity is measures as a BMI over 40.
d. coronary artery disease increase with a waist size of 81.28 cm (32 in). {{Correct Ans- c
The nurse should instruct the client that the expected reference range for a healthy weight is a BMI of 25 or less. A client who has a BMI of 40 or greater is consdered morbidly obese.
Question:-a nurse is planing care for a client who has chemotherapy-induced anemia and is starting epoetin. which of the follwoing interventions should the nurse include the plan?
a. shake the medication vial prior to drawing up the medication.
b. withhold epoein if Hgb is < 9 g/dL.
c. initiate contact isolation.
d. monitor for HTN. {{Correct Ans- d
The nurse should monitor the client's blood pressure while receiving epoetin to identify and terat HTN. HTN and cardiovascular events, such as MI and stroke, are adverse effects of epoetin.
Question:-a nurse is teaching about food care w/ a group of older adults who have T1DM. which of the following information should the nurse include in the teaching?
a. soak feet daily to soften calluses.
b. apply a heating pad to the feet to improve circulation.
c. choose sandals w/ open toes to wear in the summer.
d. trim toenails straight across to prevent ingrown toenails. {{Correct Ans- d
The nurse should instruct the clients to trim toenails straight across to prevent ingrown toenails that increase the risk for tissue breakdown and infection.
Question:-a nurse is providing discharge planning for a client who has GDM. which of the following interventions should the nurse identify as the priority?
a. determine the client's knwoledge regarding GDM.
b. explaing hte effects of GDM on the pregnancy and fetus w/ the client.
c. discuss dietary meal plans for GDM w/ the client.
d. tell the client about manifestation of hypoglycemia {{Correct Ans- a
The first action the nurse should take when using the nursing process is to assess the client. it is important for the nurse to determine the client's kowledge level re: the disease process. this provides the nurse w/ info re: where to start w/ the client teaching process.
Question:-a nurse is teaching a client who has TB about taking rifampin. which of the following instructions should hte nurse include?
a. 'expect this med to give your urine a greenish tinge.'
b. 'do not drink alcohol while taking this med.'
c. 'take this med w/ food.'
d. 'take a stool softener for the duration of therapy w/ this med' {{Correct Ans- b
The nurse should instruct the client that rifampin could cause liver damage. alcohol intensifies this risk.
rifampin is contraindicated for clients who have livere disease or consume alcohol in excess.
Question:-a nurse has arrived at the site of an accident where a client has sustained a traumatic amputation of the big toe. Identify the sequence of steps the nurse should take to terat the MSK trauma.
a. apply direct pressure w/ layers of dry cloth.
b. call 911 and examine the amputation site.
c. place the toe in a bag and place the bag in 1 part ice and 3 parts water.
d. elevate extremity above the client's heart. [Show Less]