A nurse is assisting with he care of a client following a left femoral cardiac angiography. Thee nurse should place a sandbag on the client over which of
... [Show More] the following areas?
- CORRECT ANSWER left groin
A nurse is reviewing the lab results of a client who is postoperative and has a respiratory rate of 7/min. The arterial blood gas ABG values include:
pH 7.22
PaCO2 68 mm Hg
base excess -2
PaO2 78 mm Hg
oxygen saturation 80%
Bicarbonate 28 mEq/L. - CORRECT ANSWER respiratory acidosis
A nurse is reinforcing discharge instructions with a client who has hepatitis A. Which of the following statements by the client indicates an understanding of the teaching?
- CORRECT ANSWER I will abstain from sexual intercourse
A nurse notes a small section of bowel protruding from the abdominal incision of a client who is postoperative. After calling for assistance which of the following actions should the nurse take first?
- CORRECT ANSWER cover the clients wound with a moist sterile dressing
Based on a clients recent history a nurse suspects that a client is beginning menopause. Which of the following questions should the nurse ask the client to help confirm the client is experiencing manifestations of menopause?
- CORRECT ANSWER Do you sleep well at night
A nurse collecting data from a client who has manifestations of appendicitis. Where should the nurse palpate to monitor for pain at Mcburneys point?
- CORRECT ANSWER Mcburneys point is found between the naval and the anterior iliac crest (left lower)
A nurse is reinforcing teaching about excercise with a client who has type 1 diabetes mellitus. Which of the following statements by the client indicates an understanding of the teaching?
- CORRECT ANSWER I should avoid injecting insulin into my thigh if I am going to go running
A nurse is caring for a client who is postoperative following a tracheostomy and has copies and tenacious secretions. Which of the following is an acceptable method for the nurse to use to thin the clients secretions?
- CORRECT ANSWER provide humidified oxygen
A nurse is reviewing the lab results of a client who is taking cyclosporine following a kidney transplant. Which of the following lab findings should the nurse identify as the most important to report to the provider?
- CORRECT ANSWER increase in serum creatinine
A nurse is reinforcing discharge teaching on actions that improve gas exchange to a client diagnosed with emphysema. Which of the following instructions should be included in the teaching?
- CORRECT ANSWER breath in through nose and out through pursed lips
A nurse is contributing to the plan of care for a client who has a spinal cord injury at level C8 who is admitted for comprehensive rehabilitation. Which of the following long term goals is appropriate with regard to the clients mobility?
- CORRECT ANSWER propel a wheelchair equipped with knobs on the wheels
A nurse is reinforcing teaching about an esophagogastrodudenscopy with a client who has upper gastric pain. Which of the following statements should the nurse include in the teaching
?
- CORRECT ANSWER you will remain NPO for 8 hours before the procedure
A nurse is checking for paradoxical blood pressure on a client who has constrictive pericarditis. Which of the following findings should the nurse expect?
- CORRECT ANSWER drop is systolic BP more than 10 mm Hg on inspiration
A nurse is assisting in the care of a client who is 2 hours postoperative following a wedge resection of the left lung and has a chest tube to section. Which of the following is the priority finding the nurse should report to the provider?
- CORRECT ANSWER abdomen is distended
A nurse is reinforcing teaching with a client who is postoperative after having an ileostomy established. Which of the following instructions should the nurse include in the teaching? - CORRECT ANSWER avoid medications in a capsule or enteric form
A nurse is caring for a client after a radical dissection. To which of the following should the nurse give priority in the immediate postoperative period?
- CORRECT ANSWER ineffective airway clearance related to thick copious secretions
A nurse is caring for a client scheduled for coronary artery bypass grafting who reports he is no longer certain he wants to have the procedure. Which of the following responses should the nurse make?
- CORRECT ANSWER Bypass surgery must be very frightening for you
A nurse is assisting with the care of a client who has diabetes insipidus. The nurse should monitor the client for which of the following manifestations?
- CORRECT ANSWER hypotension
A nurse is collecting data from a client who has emphysema. Which of the following findings should the nurse expect?
- CORRECT ANSWER dyspnea, barrel chest, clubbing of the fingers, shallow respirations
A nurse is assisting with thee care of a client who is postoperative and has a closed wound drainage system in place. Which of the following actions should the nurse take?
- CORRECT ANSWER fully recollapse the reservoir after emptying it
A nurse is caring for a Client who has Alzheimers disease. The nurse discovers the client entering the room of another client who comes upset and frightened. Which of the following actions should the nurse take?
- CORRECT ANSWER attempt to determine what the client was looking for
A nurse is reinforcing teaching about a tonometry examination with a client who has manifestations of glaucoma. Which of the following statements should the nurse include in the teaching?
- CORRECT ANSWER this test will measure the intraocular pressure of the eye
A nurse is collecting data from a client who has open angle glaucoma. Which of the following findings should the nurse expect?
- CORRECT ANSWER loss of peripheral vision
A nurse in a providers office is reinforcing teaching with a client who has anemia and has been taking ferrous gluconate for several weeks. Which of the following instructions should the nurse include?
- CORRECT ANSWER take this medication between meals
A nurse is collecting data from a client who has scleroderma. Which of the following findings should the nurse expect?
- CORRECT ANSWER hardened skin
A nurse is checking the suction control chamber of a clients chest tube and notes that there is no bubbling in the suction control chamber. Which of the following actions should the nurse take?
- CORRECT ANSWER verify that the suction regulator is on
A nurse is caring for a client scheduled for a bone marrow biopsy. The client expresses fear about the procedure and asks the nurse if thee biopsy will hurt. Which of the following responses should the nurse make? - CORRECT ANSWER the biopsy can be uncomfortable but we will try to keep you as comfortable as possible
A nurse is assisting in the plan of care for a client who had removal if the pituitary gland. Which of the following actions should the nurse include in the plan?
- CORRECT ANSWER change the nasal drip pad as needed
A nurse is caring for a client with severe burns to both lower extremities. The client is scheduled for an escharotomy and wants to know what the procedure involves. Which of the following statements is appropriate for the nurse to make?
- CORRECT ANSWER large incisions will be made in the burned tissue to improve circulation
A nurse is reviewing the plan of care for a client who has cellulitis of the leg. Which of the following interventions should the nurse recommend?
- CORRECT ANSWER wash daily with an antibacterial soap
A nurse is caring for a client who has a temp of 103.5 and has a prescription for a hypothermia blanket. The nurse should monitor the client for which of the following adverse effects of the hypothermia blanket?
- CORRECT ANSWER shivering
A nurse is reinforcing preop teaching for a client who is scheduled for surgery and is to take hydroxyzine preop. Which of the following effects of the medication should the nurse include in the teaching?
- CORRECT ANSWER decreasing anxiety, controlling emesis, reducing the amount of narcotics needs for pain relief
A nurse is collecting data from a client who has acute gastroenteeritis. Which of the following data collection findings should the nurse identify as the priority?
- CORRECT ANSWER potassium of 2.5 mEq/L
A nurse is caring for a client who is being evaluated for endometerial cancer. Which of the following findings should the nurse expect the client to report?
- CORRECT ANSWER abnormal vaginal bleeding
A nurse is reinforcing teaching with a client who has a new presicprion for epoetin alfa. The nurse should reinforce to the client to take which of the following dietary supplements with this medication?
- CORRECT ANSWER iron
A nurse is caring for an older adult client who has dysphasia and left sided weakness following a stroke. Which of the following actions should the nurse take?
- CORRECT ANSWER add thicker to fluids
A nurse is caring or a client who has heart failure and has been taking digoxin 0.25 mg daily. The client refuses breakfast and reports nausea. Which of the following actions should the nurse take first?
- CORRECT ANSWER check the clients vital signs
A nurse is caring for a client who asks why she is being preceived aspirin 325 mg daily following a MI. The nurse should instruct the client that aspirin is prescribed for clients who have coronary artery disease for which of the following effects?
- CORRECT ANSWER to prevent blood clotting
A nurse is caring for a client who has a spinal cord injury at T4. The nurse should recognize that the client is at risk for autonomic dysreflexia. Which of thee following interventions should thee nurse take to prevent autonomic dysreflexia?
- CORRECT ANSWER prevent bladder distention
A nurse is caring for a client who is 12 hours postoperative following a transurethral resection of the prostate TURP and has a 3 way urinary Catheter with a continuous irrigation. The nurse notes there has not been any urinary output in the last hour. Which of the following actions should the nurse perform first?
- CORRECT ANSWER determine the latency of the tubing
A nurse is caring for a client who is difficult to arrouse and very sleepy for several hours following a general tonic clonic seizure. Which of the following descriptions should the nurse use when documenting this finding in the medical record?
- CORRECT ANSWER postical phase
A nurse is assisting with the care of a client who has a femur fracture and is in skeletal traction. Which of the following actions should the nurse take?
- CORRECT ANSWER [Show Less]