Which of the following statements made by a nurse most reflects a need for additional instruc-tion on areas of client care requiring nursing documentation? 1. “The fact that the client refused the prescribed antidepressant medication was noted in his chart.” 2. “I provided a detailed description of the dressing change in the client’s chart in […]
A client with a family history of cancer is discussing the effects of free radicals on body cells and tissue. Which of the following responses is the most therapeutic answer to the client’s question, “What can I do to protect against free radicals?” 1. “Eat foods like blueberries, oranges, almonds, and carrots; they fight free […]
Although a nurse may not agree, the nurse recognizes that a terminally ill client has the legal right to: 1. Seek passive euthanasia in some states 2. Sign an organ donor pledge statement 3. Refuse DNR (do not resuscitate) status 4. Refuse treatment in the form of food and water ANSWER ANS: 4 Competent […]
A client hospitalized for injuries from a motor vehicle crash is diagnosed with higher brain death. What findings support this client’s diagnosis? 1. Episodic coughing 2. No cephalic reflexes 3. Not breathing spontaneously 4. Inconsistent cardiac function on the heart monitor 5. Electroencephalogram showed no activity for 30 minutes ANSWER Correct Answer: 2, 3, […]
The nurse recognizes that which of the following clients present at the annual July 4th marathon is at greatest risk for hyperthermia and the resulting heatstroke? 1. A 34-year-old running for the first time in the July 4th marathon who is sweating profusely 2. A 16-year-old volunteer, with type 1, insulin-dependent diabetes, who is checking […]
The nurse who is discussing safe sex with a group of teenage students must realize that safe sex practice includes: (Select all that apply.) 1. Having sex with only partners you know well 2. Willingness to resist peer pressure to have sex 3. Insisting upon the use of barrier protective devices 4. An understanding that […]
Which nursing diagnosis would be appropriate for a client who has a retention catheter if the drainage bag is found lying on the floor? 1. Risk for Impaired Skin Integrity related to catheter placement 2. Risk for Infection related to improper handling 3. Self-Care Deficit related to presence of a retention catheter 4. Risk for […]
Which of the following statements is the most appropriate response to a client’s statement, “I thought you could tell I was in pain”? 1. “How do you express a need for pain medication if not by asking?” 2. “I’m so very sorry; may I get you your pain medication right now? 3. “I don’t think […]
The nurse is evaluating teaching provided to a client about home safety. Which observation indicates that teaching has been effective? 1. Smoke alarm functioning with new batteries installed 2. Scatter rugs located in the kitchen and bathroom only 3. Cord for a space heater stretched across a hallway 4. Light bulbs burned out in the […]
A home health client lives alone in a small apartment and has only one phone, which is a land line. What safety recommendation might the visiting home health nurse make for this particular client? 1. Suggest that the client move to a nursing home or assisted living dwelling. 2. Recommend that the client be enrolled […]
