A nurse is reinforcing teaching about health promotion with a group of young adult clients.
Which of the following information should the nurse include? - ANSYoung adults should receive
a dental assessment every 6 months
A nurse is caring for a client who has a prescription for a potassium supplement. The client tells
the nurse that the pill is too large to swallow and refuses to take it. The nurse offers to break the
pill into smaller pieces. The nurse is demonstrating which of the following ethical principles? -
ANSBeneficence
A client who has advanced cancer tells the nurse that they have a difficult time talking to anyone
about the illness. Which of the following actions should the nurse take to encourage therapeutic
communications? - ANSLet the client know that, as their nurse, they are available and willing to
listen
A nurse has delegated various client care tasks to the assistive personnel (AP) on the care
team. Which of the following actions by the Ap should the nurse identify as correct? -
ANSDonning a mask to measure the vital signs of a client who has pertussis
A nurse is caring for a client who is postoperative and is experiencing nausea and vomiting. The
nurse should identify which of the following findings as indication that the client has fluid volume
deficit? (Select all that apply? - ANS- cool extremities
- orthostatic hypotension
- flat neck veins
A nurse is taking notes of client information on a piece of paper while receiving report. Which of
the following actions should the nurse take to dispose of the paper? - ANSShred the paper in a
secure container
A nurse is reinforcing teaching with a client about the use of crutches. Which of the following
actions by the client indicates an understanding of the teaching? - ANSThe client advances the
unaffected leg first while climbing stairs
A nurse is providing wound care for a group of clients. Which of the following wounds should the
nurse identify as healing by secondary intention? - ANSA stage 3 pressure injury on the coccyx
A nurse is preparing to administer a topical medication to a client. Which of the following actions
should the nurse take? - ANSCompare the label of the medication container with the medication
administration record three times
, A nurse is reinforcing preoperative teaching with a client about how to turn, cough, and deep
breathe. Which of the following statements by the client indicates an understanding of the
teaching? - ANS"This can help prevent pneumonia"
A nurse is reinforcing teaching about hospice care measures with the family of a client who is
dying. Which of the following statements by a member of the client's family indicates an
understanding of the teaching? - ANS"We will keep her room cool to help her breathe better."
A nurse is planning to perform wound irrigation for a client who has a large abdominal wound.
Which of the following actions should the nurse plan to take? - ANSAdminister an analgesic 30
min before starting the procedure
A nurse is planning care for a client for a client who is disorientated and at risk for falls. Which of
the following interventions should the nurse include? (Select all that apply) - ANS- ensure that
the client is wearing nonskid slippers
- place the client in a room near the nurses' station
- reinforce teaching about how to use the call bell
A nurse is caring for a client who has an indwelling urinary catheter. Which of the following
actions should the nurse take to prevent urinary tract infections? - ANSDrain urine from the
tubing before ambulation
A nurse is collecting data from a client who has an NG tube set to low intermittent suction.
Which of the following findings indicates hypomagnesemia? - ANSPositive Chvostek's sign
A nurse is using Maslow's hierarchy of needs in assisting with discharge planning for a client.
Which of the following activities should the nurse recommend as the priority for this client? -
ANSAttend an exercise program
A nurse is caring for a client who is receiving continuous NG tube feedings. The nurse listens to
the client's bowel sounds. Which of the following actions should the nurse take? (Click on the
audio button to listen to the clip) - ANSDecrease the rate of the feeding
A nurse is reinforcing teaching about the use of crutches with a client who has a fractured right
tibia and fibula. Which of the following statements by the client indicates an understanding of the
teaching. - ANS"I will be sure to keep the crutch tips dry"
A nurse is caring for a client who has metastatic cancer and practices Catholicism. The client
asks the nurse to discuss the afterlife with them. Which of the following statements by the nurse
assists in meeting the client's spiritual needs? - ANS"Tell me what the after life means to you"
A nurse is contributing to a plan of care for a client who has a new prescription for a wrist
restraint. Which of the following actions should the nurse include in the plan? - ANSPad bony
prominences on the wrist
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