Following discharge teaching, a male client with duodenal ulcer tells the nurse the he will drink plenty of
dairy products, such as milk, to help coat
... [Show More] and protect his ulcer. What is the best follow-up action by the
nurse?
• Review with the client the need to avoid foods that are rich in milk and cream
2. A male client with hypertension, who received new antihypertensive prescriptions at
his last visit returns to the clinic two weeks later to evaluate his blood pressure (BP).
His BP is 158/106 and he admits that he has not been taking the prescribed
medication because the drugs make him “feel bad”. In explaining the need for
hypertension control, the nurse should stress that an elevated BP places the client at
risk for which pathophysiological condition?
• Stroke secondary to hemorrhage
3. The nurse observes an unlicensed assistive personnel (UAP) positioning a newly
admitted client who has a seizure disorder. The client is supine and the UAP is
placing soft pillows along the side rails. What action should the nurse implement?
• Instruct the UAP to obtain soft blankets to secure to the side rails instead of
pillows.
4. An adolescent with major depressive disorder has been taking duloxetine (Cymbalta)
for the past 12 days. Which assessment finding requires immediate follow-up?
• Describes life without purpose
5. A 60-year-old female client with a positive family history of ovarian cancer has
developed an abdominal mass and is being evaluated for possible ovarian cancer.
Her Papanicolau (Pap) smear results are negative. What information should the nurse
include in the client’s teaching plan?
• Further evaluation involving surgery may be needed
6. A client who recently underwear a tracheostomy is being prepared for discharge to
home.
Which instructions is most important for the nurse to include in the discharge plan?
• Teach tracheal suctioning techniques
7. In assessing an adult client with a partial rebreather mask, the nurse notes that the
oxygen reservoir bag does not deflate completely during inspiration and the client’s
respiratory rate is 14 breaths / minute. What action should the nurse implement?
• Document the assessment data
• Rational: reservoir bag should not deflate completely during inspiration and the
client’s respiratory rate is within normal limits.
8. During shift report, the central electrocardiogram (EKG) monitoring system alarms.
Which client alarm should the nurse investigate firs?
• Respiratory apnea of 30 seconds
9. During a home visit, the nurse observed an elderly client with diabetes slip and fall.
What action should the nurse take first?
• Check the client for lacerations or fracture [Show Less]