A nurse is providing teaching to a client who has AIDS. Which of the following statements by the client indicates an understanding of the teaching?
"I
... [Show More] should clean my toothbrush in the dishwasher once a month."
"I should eat more fresh fruit and vegetables."
"I will avoid drinking a glass of cold liquid that has been standing for 30 minutes."
"I will take my temperature once a day."
I will take my temperature once a day.
A nurse is providing teaching to a client who has asthma about the use of a metered-dose inhaler. The nurse should identify that which of the following client actions indicates an understanding of the teaching?
Breathing in rapidly while administering the medication
Washing the plastic case and cap of the inhaler in the dishwasher
Holding breath for 10 seconds after inhaling
Waiting 15 seconds between puffs, if two puffs are required
Holding breathe 10 secs after inhaling
A nurse is reviewing the laboratory findings of a client who developed chest pain 6 hr ago. The nurse should identify which of the following findings as an indication of a myocardial infarction (MI)?
Creatine kinase (CK-MB) 85 units/L
High-density lipoprotein (HDL) 65 mg/dL
Alanine aminotransferase (ALT) 28 units/L
Troponin I 8 ng/mL
Troponin 18
A nurse is caring for a client who had a nephrostomy tube inserted 12 hr ago. Which of the following findings should the nurse report to the provider?
The client's urinary output has increased.
The client reports back pain.
The client's urine color is red tinged.
The client's BUN is 18 mg/dL.
The client reports back pain
A nurse is providing discharge teaching about infection prevention to a client who has AIDS. Which of the following statements by the client indicates understanding of the teaching?
"I will eat a salad at least once each day to increase my intake of vitamin K."
"I can work in my flower garden as long as I wear gardening gloves to cover my skin."
"I will no longer floss my teeth after brushing my teeth."
"I can sip on a glass of juice for at least 2 hours before I should discard it."
I will no longer floss my teeth after brushing
A nurse is providing discharge teaching to a client who is postoperative following a modified radical mastectomy. Which of the following instructions should the nurse include?
Flex the affected arm when ambulating.
Numbness can occur along the inside of the affected arm.
Begin active range-of-motion exercises 1 day after surgery.
Dress in clothing that fits snugly.
numbness can occur along the inside of the affected arm
A nurse is providing postoperative teaching for a client who had a total knee arthroplasty. Which of the following instructions should the nurse include?
Flex the foot every hour when awake.
Place a pillow under the knee when lying in bed.
Lower the leg when sitting in a chair.
Ensure the leg is abducted when resting in bed.
Flex the foot every hour when awake
A nurse is providing education to a client who is at risk for osteoporosis. Which of the following instructions should the nurse include?
Begin taking glucosamine supplements.
Walk for 30 min four times per week.
Jog for 15 min two times per week.
Avoid taking over-the-counter calcium supplements.
walk for 30 mins 4x a week
A nurse is providing preoperative teaching for a client who is scheduled for a mastectomy. Which of the following statements should the nurse make?
"You should accept your body image change before discharge."
"It is important for you to look at the incisional site when the dressings are removed."
"I will refer you to community resources that can provide support."
"The scar will remain red and raised for many years after surgery."
I will refer you to community resources that can provide support
A nurse is caring for a client who has hypothyroidism. Which of the following manifestations should the nurse expect?
Constipation
Insomnia
Tachycardia
Diaphoresis
constipation
A nurse is caring for a client who has terminal cancer. The client tells the nurse, "I wish I could stop these treatments. I am ready to die." Which of the following statements should the nurse make?
"Discontinuing with the treatments is your choice if it is your wish to do so."
"Your daughter is named as your health care surrogate. I will ask her if you can stop them."
"I will call your spiritual advisor to come in, so you can discuss this with them."
"Next time you have an oncology appointment, you should ask the oncologist."
discontinuing treatments is your choice
A nurse at an urgent care clinic is caring for a client who is experiencing an anaphylactic reaction. After ensuring a patent airway, which of the following nursing interventions is the priority?
Applying oxygen via face mask
Placing the client in Fowler's position
Administering epinephrine
Initiating an IV infusion of 0.9% sodium chloride
applying oxygen via face mask
A nurse is reviewing the medical record of a client who is taking warfarin for chronic atrial fibrillation. Which of the following values should the nurse identify as a desired outcome for this therapy?
INR 1
INR 2.5
aPTT 45 seconds
aPTT 90 seconds
inr 2.5
A nurse is teaching a client about the use of transcutaneous electrical nerve stimulation (TENS) for the management of bone cancer pain. The nurse should explain that applying a TENS unit to the painful area has which of the following effects?
Electrically generated feelings of heat
Cryotherapy for painful areas
A tingling sensation replacing the pain
Realignment of energy flow through meridians
A tingling sensation replacing the pain
A nurse is assessing a client who has diabetes insipidus. Which of the following findings should the nurse expect?
Low urine specific gravity
Hypertension
Bounding peripheral pulses
Hyperglycemia
Low urine specific gravity
A nurse is providing teaching to a client who has stage II cervical cancer and is scheduled for brachytherapy. Which of the following instructions should the nurse include?
"You will have an implant placed twice each month for the duration of the treatment."
"You should remain at least 6 feet away from others between treatments."
"You should expect to have blood in your urine for a few days after treatment."
"You will need to stay still in the bed during each treatment session."
You will need to stay still in the bed during each treatment session."
prostate (TURP) and notes clots in the client's indwelling urinary catheter and a decrease in urinary output.
Remove the client's indwelling urinary catheter.
Irrigate the indwelling urinary catheter.
Clamp the indwelling urinary catheter.
Apply traction to the indwelling urinary catheter.
Irrigate the indwelling urinary catheter
A nurse is assessing a client's hydration status. Which of the following findings indicates fluid volume overload?
Warm, moist skin
Distended neck veins
Dark amber, odiferous urine
Orthostatic hypotension
Distended neck veins
A nurse on a medical-surgical unit is reviewing the medical record of an older adult client who is receiving IV fluid therapy. Which of the following client information should indicate to the nurse that the client requires re-evaluation of the IV therapy prescription? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)
Blood pressure
Prescribed medications
Oxygen saturation
BUN
BUN
A nurse is assessing for compartment syndrome in a client who has a short leg cast. Which of the following findings should the nurse identify as a manifestation of this condition?
Bounding pedal pulse
Capillary refill less than 2 seconds
Pain that increases with passive movement
Areas of warmth on the cast
Pain that increases with passive movement
A nurse is providing teaching to a client who takes ginkgo biloba as an herbal supplement. Which of the following statements should the nurse make?
"Ginkgo biloba relieves nausea for people who have vertigo."
"Taking ginkgo biloba will help relieve your joint pain."
"Ginkgo biloba can cause an increased risk for bleeding."
"Taking ginkgo biloba decreases the risk of migraine headache."
"Ginkgo biloba can cause an increased risk for bleeding."
A nurse is caring for an older adult client who has dementia and requires acute care for a respiratory infection. The client is agitated and is attempting to remove their IV catheter. Which of the following actions should nurse take to avoid restraining the client?
Check on the client every 2 hr.
Provide a quiet environment with no distractions.
Turn on the television in the client's room.
Keep the client occupied with a manual activity.
Keep the client occupied with a manual activity.
A nurse is assessing a client who is at risk for the development of pernicious anemia resulting from peptic ulcer disease. Which of the following images depicts a condition caused by pernicious anemia?
picture of tongue kind of white/yellow
picture of tongue pink with distinct wrinkles
picture of tongue very red
picture of normal looking tongue
This image depicts glossitis, which can indicate pernicious anemia. Glossitis, a smooth red tongue, is also a manifestation of deficiencies in vitamin B6, zinc, niacin, or folic acid. (pic showing 1.5 teeth)
A nurse is providing teaching to a client who has a new prescription for psyllium. Which of the following information should the nurse include in the teaching?
Drink 240 mL (8 oz) of water after administration.
Expect results in 4 to 6 hr.
Take this medication before meals to increase appetite.
Reduce dietary fiber intake to improve medication absorption.
Drink 240 mL (8 oz) of water after administration.
A nurse is planning care for a client who has a sealed radiation implant for cervical cancer. Which of the following interventions should the nurse include in the plan of care?
Keep a lead-lined container in the client's room.
Limit each visitor to 1 hr per day.
Place a dosimeter badge on the client.
Remove soiled linens from the client's room each day.
Keep a lead-lined container in the client's room.
A nurse is receiving report on a client who is postoperative following an open repair of Zenker's diverticulum. The nurse should anticipate the surgical incision to be in which of the following locations? (You will find hot spots to select in the artwork below. Select only the hot spot that corresponds to your answer.)
A:neck
B:upper quadrant area
C: middle abdomen
D: lower abdomen
A:neck
A nurse is caring for a client who is 4 hr postoperative following an open reduction internal fixation of the right ankle. Which of the following assessment findings should the nurse report to the provider?
Extremity cool upon palpation
Serosanguineous drainage on the dressing
Capillary refill of 2 seconds
Client report of discomfort when moving toes
Extremity cool upon palpation
A nurse is assessing heart sounds of a client who reports substernal precordial pain. Identify which of the following sounds the nurse should document in the client's medical record by listening to the audio clip. (Click on the audio button to listen to the clip.)
Murmur
S4
Pericardial friction rub
Ventricular gallop
Pericardial friction rub
A nurse is reviewing the medical record of a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?
Facial butterfly rash
Bradycardia
Esophagitis
Interstitial fibrosis
Facial butterfly rash
A nurse is providing teaching to a client who has end-stage kidney disease and is waiting for a kidney transplant. Which of the following information should the nurse provide?
Kidney donation must come from a living donor.
Immunosuppressive therapy is necessary until the donated kidney begins producing urine.
Hemodialysis is sometimes required following surgery.
Kidney transplant recipients can resume their regular diet following surgery.
Hemodialys is sometimes required following surgery
A home health nurse is providing teaching to a client who has a stage 1 pressure injury on the greater trochanter of his left hip. Which of the following instructions should the nurse include in the teaching?
Clean the wound daily with an antiseptic.
Use a donut-shaped pillow when sitting in a chair.
Change position every hour.
Massage the area two times daily.
Change position every hour.
A nurse is providing teaching to a client who has hypertension and a new prescription for verapamil. Which of the following information should the nurse include in the teaching?
"Take this medication on an empty stomach."
"Eczema is an immediate expected adverse effect of this medication."
"Increase fiber intake to avoid constipation."
"Monitor your blood pressure monthly."
"Increase fiber intake to avoid constipation."
A nurse is teaching a family about the care of a parent who has a new diagnosis of Alzheimer's disease. Which of the following information should the nurse include in the teaching?
Position tabletop clocks with multi-colored backgrounds throughout the home.
Explain how to complete a task while having the client do the task.
Place a calendar on the wall with days and weeks included.
Create complete outfits and allow the client to select one each day.
Create complete outfits and allow the client to select one each day
A nurse is caring for a client who has a pneumothorax and a closed-chest drainage system. Which of the following findings is an indication of lung re-expansion?
The chest tube is draining serosanguineous fluid at 65 mL/hr.
The client tolerates gentle milking of the tubing.
Bubbling in the water seal chamber has ceased.
There is tidaling in the water seal chamber.
Bubbling in the water seal chamber has ceased.
A nurse is assessing a client who has advanced lung cancer and is receiving palliative care. The client has just undergone thoracentesis. The nurse should expect a reduction in which of the following common manifestations of advanced cancer?
Dyspnea
Hemoptysis
Mucus production
Dysphagia
Dyspnea
A nurse is administering packed RBCs to a client. Which of the following assessment findings indicates a hemolytic transfusion reaction?
Anorexia and jaundice
Bronchospasm and urticaria
Hypertension and bounding pulse
Low back pain and apprehension
Low back pain and apprehension
A nurse is planning care for a client who is postoperative following a laparotomy and has a closed-suction drain. Which of the following actions should the nurse take to manage the drain?
Set the wall suction to 80 to 100 mm Hg.
Compress the drain reservoir after emptying.
Allow the drainage to collect on a sterile gauze dressing.
Position the drain below the bed to promote drainage.
Compress the drain reservoir after emptying. [Show Less]