A nurse is reviewing the medical record of a client who is postoperative. Which of the following
findings should the nurse identify as a complication of surgery? - ANS WBC count of
15,000/mm3
A nurse is caring for a client who is 2 hr postoperative following an amputation of the foot.
Which of the following actions should the nurse take first? - ANS Check the incisional dressing
A nurse is reinforcing teaching with a client who is taking levothyroxine. Which of the following
statements by the client indicates an understanding of the teaching? - ANS "The medication
should be taken before I eat breakfast every morning."
A nurse is caring for a client undergoing testing for multiple sclerosis. Which of the following
findings should the nurse expect? - ANS Muscle spasticity
A nurse in a clinic is collecting data from a client who had hyperthyroidism and has been taking
methimazole for 4 weeks. Which of the following statements bu the client indicates a therapeutic
response of the medication? - ANS "I have gained 3 pounds since my last appoint."
A nurse is reinforcing discharge teaching with a client who has leukemia and is receiving
chemotherapy. Which of the following statements should the nurse include in the teaching? -
ANS "You should place your toothbrush in hydrogen peroxide overnight."
A nurse in a health clinic is reinforcing teaching with a client who has tuberculosis (TB) about
transmission of the disease. Which of the following client statements indicates an understanding
of the teaching? - ANS "I inhaled the infected droplets that were in the air."
A nurse is assisting in the plan of care for a client who had a recent left hemispheric stroke.
Which of the following actions should the nurse include in the plan? - ANS Use simple verbal
cues when directing tasks.
A nurse is delegating the task of repositioning a client who is in skeletal traction to an assistive
personnel (AP). Which of the following instructions should the nurse give the AP? - ANS Allow
the weights to hang freely.
A nurse is caring for a client who is postoperative following a transurethral resection of the
prostate (TURP) and is receiving continuous bladder irrigation. The nurse notes decreased
output from the urethral catheter. Which of the following provider prescriptions should the nurse
expect? - ANS Irrigate the urethral catheter with 0.9% sodium chloride
, A nurse is collecting data from an older adult client who has several concerns. Which of the
following concerns should the nurse recognize as a normal change associated with aging? -
ANS "My food tastes bland even after I add seasoning"
A nurse is caring for a client who has an intestinal obstruction and reports a new onset of
nausea. The client has an NG tube set as low intermittent suction and is receiving continuous IV
infusion of 0.9% sodium chloride. Which of the following actions should the nurse take first? -
ANS Check for kinks in the NG tube
A nurse is reinforcing teaching with a client who has chronic kidney disease about disease
management. Which of the following statements by the client indicates an understanding of the
teaching? - ANS "I will limit my daily intake of protein"
A nurse is assisting with the care of a client who had a stroke and is unable to speak. The nurse
should identify that the client's injury occurred in which of the following lobes of the brain? (You
will find hot spots to select in the artwork below. Select only the hot spot that corresponds to
your answer.) - ANS Frontal lobe
A nurse is caring for a client who is 24 hr postoperative following an abdominal surgery. Which
of the following findings requires immediate attention from the nurse? - ANS Oxygen saturation
of 88%
A nurse is repositioning a client who has lower back pain. Which of the following positions is
appropriate for the client? - ANS Semi fowler's with knees flexed
A nurse is caring for a client following a thyroidectomy. Which of the following findings should
alert the nurse to the possibility of parathyroid gland injury? - ANS Muscle twitching
A nurse is caring for a client who has neutropenia. Which of the following nursing interventions
should the nurse implement? - ANS Limit visitors to healthy adults
A nurse is contributing to the plan of care to promote a restful night's sleep for a client who has
Alzheimer's disease. Which of the following interventions should the nurse include in the plan? -
ANS Offer a small snack at bedtime
A nurse is reinforcing teaching with a client about increasing dietary fiber. The nurse should
recommend which of the following foods as the best source of fiber? - ANS 1/2 cup cooked
kidney beans
A home health nurse is caring for a client who has COPD. The client tells the nurse that he
becomes short of breath while eating despite the use of home oxygen. Which of the following
instructions should the nurse include? - ANS Drink beverages at the end of meals
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