A nurse is working with a client who experiences constipation. The nurse
recognizes that additional education is needed when the client states the following:
a) "I should plan for routine physical activity to help improve my bowel habits."
,b) "I plan to drink at least 1,500ml of fluids per day to help promote a regular
bowel movement."
c) "Fiber is a really important aspect of my diet that I should plan to incorporate
more often."
d) "I plan to take my stimulant laxative every day for at least the next 6 months to
make sure it's working." - ANSWER- d) "I plan to take my stimulant laxative
every day for at least the next 6 months to make sure it's working."
Which of the following does not need to be irrigated?
Colostomy
Ileostomy - ANSWER- Ileostomy
A patient with a long-standing history of diabetes mellitus is voicing concerns
about kidney disease. The patient asks the nurse where urine is formed in the
kidney. The nurse's response is the:
Bladder
Kidney
Nephron
Ureter - ANSWER- Nephron
Which physiologic factor can place an 83 year old client at risk for acute kidney
injury?
Decline in glomerular function
Decreased abdominal muscle control
Loss of urinary sphincter control
,Consumption of caffeine - ANSWER- Decline in glomerular function
The nurse identifies the diagnosis Impaired Urinary Elimination in an older adult
client admitted after a stroke. Impaired Urinary Elimination places the patient at
risk for which complication?
A nurse is caring for an elderly client who has nearly fallen twice while getting out
of bed to go to the bathroom. The nurse has instructed the client not to get up
without assistance. The client tells the nurse about feeling a need to get to the
bathroom when the urge to void occurs and feeling a need to rush. Which strategy
should the nurse utilize to minimize the client's risk of falling?
a) Obtain an order for an indwelling catheter
b) Require that a family member stay with the client
c) Check on the client every 2 hours and offer toileting assistance
d) Obtain an order for restraints to prevent injury - ANSWER- c) Check on the
client every 2 hours and offer toileting assistance
Which body fluid lies in the spaces between the cells?
Interstitial
Intracellular
Intravascular
, Transcellular - ANSWER- Interstitial
On assessment of a patient with acute renal failure, the nurse finds the following:
distended neck veins, cool and pale skin, and crackles in the lungs. The nurse
should suspect the patient is experiencing
A senior student nurse delegates the task of intake and output to a new nursing
assistant. The student will verify that the nursing assistant understands the task of
I&O when the nursing assistant states:
a) "I will record the amount of all voided urine."
b) "I will not count liquid stools as output."
c) "I will not record a café mocha as intake."
d) "I will notate perspiration and record it as a small or large amount." -
ANSWER- a) "I will record the amount of all voided urine."
A nurse is planning care for a client with hypernatremia. Which action should the
nurse anticipate including in the plan of care?
Implement fluid restriction
Increase salt intake
Administer hypotonic IV solution
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