1. A nurse is performing a home safety assessment for a client who is receiving supplemental oxygen. Which of the following observations should the nurse
... [Show More] identify as proper safety protocol?
-The client uses a wool blanket on their bed.
-The client identifies the location of a fire extinguisher.
-The client stores an extra oxygen tank on its side under their bed.
-The client has a weekly inspection checklist for oxygen equipment.
-The client should be able to identify the location of fire extinguishers in the home and be aware of how to use them.
2. A nurse is teaching a client and his family how to care for the client's tracheostomy at home. Which of the following instructions should the nurse include in the teaching?
-Remove the outer cannula cautiously for routine cleaning.
-Use tracheostomy covers when outdoors.
-Use sterile techniques when performing tracheostomy care at home.
-Cleanse irritated skin with full-strength hydrogen peroxide.
-Tracheostomy covers protect the client airway from cold air, dust, and other airborne particles.
3. A home health nurse is performing a follow-up visit for a client who has a gastronomy tube through which they receive intermittent feedings and medications. The client has recently developed diarrhea. Which of the following findings should the nurse identify as a possible cause of diarrhea?
-The client is receiving formula at room temperature.
-The feedings infuse at a slow, continuous drip over 8 hr each night.
-The clients caregiver washes out the feeding bag with warm water once every 24 hr.
-The clients caregiver flushes the tubing with water before and after administering medications.
-Feeding bags should be washed out after each feeding and replaced with a new feeding bag every 24 hr to prevent bacterial contamination. The nurse should reinforce this information with the clients caregiver to avoid future contamination.
4. A nurse is assessing a client who reports increased pain following physical therapy. Which of the following questions should the nurse ask when assessing the quality of the client's pain?
-Is your pain constant or intermittent?
-What would you rate your pain as, on a scale of 0 to 10?
-Does the pain radiate?
-Is your pain sharp or dull?
-Asking the client whether the pain is sharp, dull, crushing, throbbing, aching, burning, electric-like, or shooting helps determine the quality of the pain.
5. A nurse is talking with an older client who is contemplating retirement. The client states, "I keep thinking about how much I enjoy my job. I'm not sure I want to retire." Which of the following responses should the nurse make?
-You would have so much more time to spend with your family.
-You should consider getting a part-time job or doing volunteer work.
-Lets talk about how the change in your job status will affect you.
-Why wouldn't you want to retire and relax?
-This response is therapeutic because the nurse is encouraging the client to verbalize feelings about the life transition of retirement. [Show Less]