The nurse encounters resistance when inserting the tubing into a client's
rectum for a tap water enema. What action should the nurse implement?
Ask the
... [Show More] client to relax and run a small amount of fluid into the rectum.
The nurse is discussing dietary preferences with a client who adheres to a
vegan diet. Which dietary supplement should the nurse encourage the client to
include in the dietary plan?
Vitamin B12.
An older client who is able to stand but not to ambulate receives a
prescription to be mobilized into a chair as tolerated during each day.What is
the best action for the nurse to implement when assisting the client from the
bed to the chair?
Place a transfer belt around the client, assist to stand, and pivot to a chair that is
placed at a right angle to the bed.
A male client with an infected wound tells the nurse that he follows a
macrobiotic diet. Which type of foods should the nurse recommend that the
client select from the hospital menu?
Combination of plant proteins to provide essential amino acids.
A 4-year-old boy who is scheduled for a tonsillectomy and adenoidectomy asks
the nurse, "Will it hurt to have my tonsils and adenoids taken out?" Which
response is best for the nurse to provide?
"It may hurt but we'll give you medicine to help you feel better."When the nurse enters a client's room to do an initial assessment, the client
shouts, "Get out of my room! I'm tired of being bothered!" How should the
nurse respond?
"What is concerning you this morning?"
Which statement correctly identifies a written learning objective for a client
with peripheral vascular disease?
Upon discharge, the client will list three ways to protect the feet from injury.
The nurse is providing passive range of motion (ROM) exercises to the hip
and knee for a client who is unconscious.
After supporting the client's knee with one hand, what action should the nurse
take next?
Cradle the client's heel.
While preparing to insert a rectal suppository in a male adult client, the nurse
observes that the client is holding his breath while bearing down. What action
should the nurse implement?
Instruct the client to take slow deep breaths and stop bearing down.
What action should the nurse implement when adding sterile liquids to a
sterile field?
Consider the sterile field contaminated if it becomes wet during the procedure.
When assessing a client with a nursing diagnosis of fluid volume deficit, the
nurse notes that the client's skin over the sternum "tents" when gently
pinched. Which action should the nurse implement?
Continue the planned nursing interventions to restore the client's fluid volume.A client is admitted to the hospital with intractable pain. What instruction
should the nurse provide the unlicensed assistive personnel (UAP) who is
preparing to assist this client with a bed bath?
Take measures to promote as much comfort as possible.
The nurse is preparing to irrigate a client's indwelling urinary catheter using
an open technique. What action should the nurse take after applying gloves?
Draw up the irrigating solution into the syringe.
The nurse is administering an intermittent infusion of an antibiotic to a client
whose intravenous (IV) access is an antecubital saline lock. After the nurse
opens the roller clamp on the IV tubing, the alarm on the infusion pump
indicates an obstruction. What action should the nurse take first?
Reposition the client's arm.
What intervention should the nurse include in the plan of care for a client who
is being treated with an Unna’s paste boot for leg ulcers due to chronic venous
insufficiency?
Check capillary refill of toes on lower extremity with Unna's paste boot.
A client is admitted with a stage four pressure ulcer that has a black,
hardened surface and a light-pink wound bed with a malodorous green
drainage. Which dressing is best for the nurse to use first?
Wet to moist dressing. [Show Less]