The nurse notices that the client’s continuous open system tube-feeding set is almost empty. What action should the nurse take? 1. Add tube feeding to the set. 2. Discontinue the feeding and hang a closed system bag. 3. Wash out the set and add new feeding. 4. Flush the set with clear carbonated soda and […]
Date: September 20th, 2020
The response to stress for older adults may be manifested differently than in younger adults. The nurse recognizes that. For the older adult client, the nurse is aware that: 1. Losses are more stress-provoking 2. Anxiety disorders are most prevalent 3. Psychosocial factors are the greatest threats 4. Timing of stress-inducing events is not significant […]
Date: September 20th, 2020
A client sustained a significant loss of blood after a motor vehicle accident. The nurse notes that the client’s urine output has decreased and suspects that which hormones have influenced this client’s fluid balance? 1. Aldosterone 2. Angiotensin 3. Antidiuretic hormone 4. Estrogen 5. Progesterone ANSWER Correct Answer: 1, 2, 3 Rationale 1: Aldosterone […]
Date: September 20th, 2020
A client diagnosed with congestive heart failure has been treated for many years with intravenous furosemide (Lasix). What sensory impairment should the nurse assess in this client? 1. Loss of ability to taste 2. Hearing loss 3. Vision loss 4. Loss of ability to smell ANSWER Correct Answer: 2 Rationale: Furosemide (Lasix) does not […]
Date: September 20th, 2020
The nurse is concerned that an older client with a retention catheter is developing a urinary tract infection. What assessment finding caused this concern? 1. Elevated blood pressure 2. Elevated heart rate 3. Confusion 4. Leg pain ANSWER Correct Answer: 3 Rationale 1: Elevated blood pressure is not a sign of urinary tract infection. […]
Date: September 20th, 2020
During the morning bath of a client, the nurse identifies areas of erythema below the client’s breasts. What should the nurse do to enhance comfort and healing for the client? 1. Wash the skin carefully. 2. Apply alcohol-free lotion. 3. Wash the area without soap. 4. Remove hair in the area. ANSWER Correct Answer: […]
Date: September 20th, 2020
Which of the following statements made by a client with benign prostatic hypertrophy (BPH) during an admissions interview reflects the best understanding of the long-term effects of this condition? 1. “I usually get up 3 to 4 times a night to urinate.” 2. “My health care provider prescribed some medication that has helped.” 3. “At […]
Date: September 20th, 2020
The nurse is discussing nail care with a group of teenage girls. Which of the following statements made by one girl in the audience requires immediate follow-up by the nurse? 1. “My mother tells me that toe rings will cause me to develop calluses.” 2. “It’s expensive buying new shoes just because your feet keep […]
Date: September 20th, 2020
A nurse who is caring for postoperative clients on a surgical unit knows that for 24 to 48 hours postoperatively, clients who have undergone general anesthesia may experience: 1. Colitis 2. Stomatitis 3. Paralytic ileus 4. Gastrocolic reflex ANSWER ANS: 3 Any surgery that involves direct manipulation of the bowel temporarily stops peristalsis. This […]
Date: September 20th, 2020
Which of the following statements best reflects a client’s healthy sense of identity? 1. “My name is Susan.” 2. “My children are my world.” 3. “I’m looking for my perfect job.” 4. “I’m happiest when I get to exercise regularly.” ANSWER ANS: 4 Identity involves the internal sense of individuality, wholeness, and consistency of […]
Date: September 20th, 2020
