The nurse is performing a physical examination on a 58-year-old adult client. The nurse will most likely find that the client of this age is experiencing which one of the following physiological changes related to normal aging? 1. Palpable thyroid lobes 2. Decreased skin turgor 3. Reduced pupillary reaction 4. Increased range of joint motion […]
A nurse is observed conducting an assessment interview for a newly admitted client. Which of the following would require immediate follow-up by the nurse’s mentor? 1. Conducting the interview with the client’s boyfriend present 2. Stopping the interview to answer a page from the nursing station 3. Frequently checking the time while waiting for the […]
The nurse is considering using the NANDA nursing diagnosis Impaired Physical Mobility in the care plan of a newly admitted client. In order to make this problem statement more individual, the nurse should take which action? 1. Include what mobility is impaired. 2. Use Level 1, 2, 3, or 4 to describe immobility. 3. Describe […]
The nurse recognizes the importance of an accurate, thorough physical assessment and health history. Which of the following facets of care are directly dependent on the database of infor-mation collected? (Select all that apply.) 1. Identification of client likes and dislikes 2. Support of the nurse-client relationship 3. Selection of client-centered interventions 4. Revision of […]
A client in isolation ambulates with assistance to the bathroom. After toileting, what should the unlicensed assistive personnel do? 1. Assist the client with hand washing. 2. Assist the client back to bed. 3. Change the client’s bed. 4. Leave the client’s room. ANSWER Correct Answer: 1 Rationale 1: The client should utilize good […]
A nurse is working in a clinic whose emphasis is on cost control, customer satisfaction, health promotion, and preventive services. This represents which type of system? 1. Managed care 2. Case management 3. Differentiated practice 4. Patient-focused care ANSWER Correct Answer: 1 Rationale 1: Managed care describes a health care system whose goals are […]
Which of the following interview questions will best determine a client’s readiness for enhanced spiritual well-being? 1. “Are you a religious person?” 2. “Are you satisfied with your life?” 3. “To whom do you turn when you have a problem to deal with?” 4. “Do you tend to rely on prayer during times of personal […]
The nurse identifies that the client is unable to cough to produce a sputum specimen, and the cli-ent’s secretions must be suctioned. Which suctioning route is preferred for obtaining this speci-men? 1. Nasopharyngeal 2. Nasotracheal 3. Oropharyngeal 4. Orotracheal ANSWER ANS: 2 Nasotracheal suctioning is the preferred route for obtaining a sputum specimen when […]
A nurse who performs a skin assessment while bathing an immobile client would be displaying: 1. Efficiency 2. Leadership 3. Organization 4. Effectiveness ANSWER ANS: 1 Effective use of time means doing the right things, whereas efficient use of time means doing things right. The nurse is showing efficiency by combining various nursing activities—in […]
The nurse is performing a physical examination on a 40-year-old adult client. The nurse will most likely find that the client of this age is experiencing which one of the following physiological changes related to normal aging? 1. Decreased hearing acuity 2. Decreased sense of smell 3. Decreased strength of abdominal muscles 4. Decreased function […]
