Which of the following actions by the nurse would indicate the need for remedial education in the removal of an indwelling catheter? 1. Draping the female client between the thighs 2. Obtaining a specimen before removal 3. Cutting the catheter to deflate the balloon 4. Checking the client’s output for 24 hours after removal […]
A client reports that an adolescent family member has started a vegan diet. Which additions to meals should the nurse recommend to help ensure that the adolescent does not become deficient in calcium? 1. Tofu 2. Soybeans 3. Brewer’s yeast 4. Raisins 5. Okra ANSWER Correct Answer: 1, 2, 4 Rationale 1: Calcium deficiency […]
While caring for a client who is approaching death, the nurse notices the client’s facial expression of extreme sadness. What should the nurse do? 1. Leave the client alone. 2. Provide physical care to increase comfort. 3. Acknowledge the client’s expression, and ask whether the client would like to talk about her feelings. 4. Offer […]
A client asks what changes can be made to dietary intake to reduce the effects of stress. What changes should the nurse encourage the client to make? 1. Reduce sugar intake. 2. Eliminate excess salt. 3. Reduce caffeine intake. 4. Avoid vitamin supplements. 5. Follow a low-fat eating plan. ANSWER Correct Answer: 1, 2, […]
The nurse is identifying care goals for a client who is prone to getting hurt. Which care goal should the nurse select for this client? 1. Assess the client’s mental status. 2. Keep the client dependent on the staff for all care. 3. Make all choices for the client. 4. Remain free from injury. […]
The nurse is caring for a client who is recovering from surgery. Which intervention should the nurse implement to decrease the client’s possibility of developing hypercalcemia? 1. Measure vital signs every 4 hours. 2. Assist the client to turn, cough, and deep breathe every 2 hours. 3. Assist the client to ambulate around the room […]
An appendectomy is appropriately documented by the nurse as: 1. Diagnostic surgery 2. Palliative surgery 3. Ablative surgery 4. Reconstructive surgery ANSWER ANS: 3 Ablative surgery is the excision or removal of a diseased body part, such as an appendectomy. Diagnostic surgery is surgical exploration that allows the health care provider to confirm a […]
The nurse is discussing safety issues with the mother of three children. Which of the following statements has the greatest possibility for decreasing the potential for injury among the children? 1. “Where do you see a need for safety improvements in your home?” 2. “Keep all toxic liquids capped and stored out of reach of […]
A nursing diagnosis of Enhanced readiness for spiritual well-being has been formulated for a particular family. Which of the following data clusters would support this diagnosis? 1. The family visits different congregations, the parents have been reflecting on their own spiritual upbringings, and the children are questioning rituals of their friends and friends’ families. 2. […]
The Medicaid insurance program is best described as: 1. Acute care hospital insurance for the older adult population 2. A funded health care program for older and disabled persons 3. A state-regulated health care program for persons of low income 4. A fee-for-service insurance plan that supports preventive health care ANSWER ANS: 3 Medicaid […]
