A client with an excessive alcohol intake has a reduced amount of antidiuretic hormone (ADH). The nurse anticipates the client will exhibit: 1. Hematuria 2. An increased blood pressure 3. Dry mucous membranes 4. A low serum sodium level ANSWER ANS: 3 Alcohol inhibits the release of ADH, resulting in increased water loss in […]
The nurse is caring for a 6-year-old child who is scheduled for outpatient surgery. Piaget’s theory of cognitive development suggests that the nurse can help the child cope with the stressors of this hospital experience best by: 1. Arranging for the parents to be with the child until the anesthetic takes affect 2. Explaining the […]
Which statement best reflects the major limitation of the team nursing model? 1. “The team really needed an extra pair of hands today.” 2. “It complicates things when you have a different team each day.” 3. “Getting our two new admissions stabilized took up all of my time today.” 4. “My nursing assistants need to […]
The nurse recognizes which of the following client outcomes as being a result of ineffective pain management? (Select all that apply.) 1. Client expressing feelings of despair and hopelessness 2. Inability to self-ambulate distance from bed to bathroom 3. Stage 1 pressure ulcer development on coccyx and left hip 4. Client rating pain as 4 […]
The nurse is discussing different types of ostomy appliances with a client with a new ostomy. During this discussion, the nurse should keep in mind that an ostomy appliance should 1. be changed daily. 2. protect the skin. 3. collect stool. 4. control odor. 5. be open, so the client can empty it sporadically throughout […]
An order is written for 80 mg of a medication in elixir form. The medication is available in 80 mg/tsp strength. The nurse prepares to administer: 1. 2 mL 2. 5 mL 3. 10 mL 4. 15 mL ANSWER ANS: 2 The nurse should first change the household measurement to a metric equivalent (5 […]
A 73-year-old female client with Parkinson’s syndrome was prescribed levodopa when other therapies had failed. The client is alarmed that her urine has become dark brown and is concern. The nurse explains to the client that one of the side effects of this medication is that it may cause: 1. Her urine to become dark […]
Related to Problem Oriented Medical Record (POMR) documentation, which of the following statements made by a nurse reflects the greatest need for additional instruction on the proper management of a resolved client problem? 1. “His surgery corrected the mobility problem, so I drew a line through it and dated it.” 2. “The client’s problem list […]
The nurse is assessing a client with a history of chronic obstructive pulmonary disease. When as-sessing for the presence of air hunger, the nurse should: 1. Monitor the client’s pulse oximetry reading 2. Measure the movement of air by counting respirations 3. Auscultate breath sounds both anteriorly and posteriorly 4. Observe for the elevation of […]
The nurse is interviewing a client who is concerned about the possibility of contracting the human immunodeficiency virus (HIV) from unprotected sex with a known IV drug user. The nurse knows that if the client is infected: 1. The client’s life expectancy is 3 to 5 years 2. There are no effective treatment modalities 3. […]
