A client who has been blinded as result of an injury informs the rehabilitation staff that she plans to return to her counseling practice and will continue to work on a full-time basis. This client is demonstrating which aspect of values clarification? 1. Choosing 2. Prizing 3. Acting 4. Clarifying ANSWER Correct Answer: 3 […]
The nurse has delegated the making of unoccupied beds to unlicensed assistive personnel. What should the nurse assess regarding client safety once the beds are completed? 1. Folding of the top sheet 2. Direction of the pillow 3. Call light being readily available 4. Presence of mitered corners ANSWER Correct Answer: 3 Rationale 1: […]
The nurse recognizes that the older adult’s tendency to take smaller steps with feet kept closer together will most likely: 1. Increase the client’s risk of injury resulting from falls 2. Result in less stress on the client’s knees, hips, and ankles 3. Decrease the amount of energy the client expends on movement 4. Allow […]
A client has been on prolonged bed rest, and the nurse is observing for signs associated with im-mobility. In assessment of the client, the nurse is alert to a(n): 1. Increased blood pressure 2. Decreased heart rate 3. Increased urinary output 4. Decreased peristalsis ANSWER ANS: 4 Immobility causes gastrointestinal disturbances such as decreased […]
The greatest barrier to a 3-year-old client’s ability to self-assess her pain is: 1. A limited vocabulary 2. Increased separation anxiety 3. Reluctance to talk to strangers 4. Inability to grasp the concept of pain ANSWER ANS: 1 Young children who have not developed full vocabularies have difficulty verbally describing and expressing pain to […]
The nurse is caring for a cognitively impaired client who has experienced a painful procedure. The nurse is most effective in determining the client’s pain medication needs when using which of the following assessment methods? 1. Medicating the client with the as-needed (prn) analgesic as often as ordered 2. Utilizing the pain face scale to […]
Which of the following statements made by a nurse best reflects an understanding of the thera-peutic value of perceived client control? 1. “The client was very interested in the information about support groups.” 2. “The client fell right to sleep when I told her the procedure was canceled.” 3. “Research has shown that clients are […]
A 64-year-old male client has been scheduled to undergo surgery for a total knee replacement. The client would like to be able to use his own blood for the surgery, if needed. The nurse explains that there are several advantages to the client’s having an autologous infusion, but there are some drawbacks as well. Which […]
The order is for eye medication, ii gtt OD. The nurse administers: 1. 2 mL to the right eye 2. 2 drops to the left eye 3. 2 drops to the right eye 4. 2 drops to both eyes ANSWER ANS: 3 ii = 2; gtt = drops. OD = right eye. gtt is […]
The nurse is identifying outcomes for an older client prone to injuries. Which outcome should the nurse identify as appropriate for this client? 1. The client will demonstrate an understanding of all limitations. 2. The client will establish a buddy system. 3. The client will make uninformed choices when addressing health issues. 4. The client […]
