Term 1 of 814
While changing a client's chest tube dressing, the nurse notes a crackling sensation when gentle
pressure is applied to the skin at the insertion site. What is the best action for the nurse to take?
Report the client's jaw pain to the healthcare provider.
Measure the area of swelling and crackling.
Explore the client's reasons for wanting to be discharged.
Recompress the wound suction device and secure to plug
Term 2 of 814
When five family members arrive at the hospital, they all begin asking the nurse questions
regarding the prognosis of their critically ill mother. What intervention should the nurse implement
first?
Ask the client if she has had any recent thoughts of harming herself
A 10-year-old who is receiving chemotherapy and the infusion pump is beeping
Provide a family tour of the preoperative unit one week before the surgery is scheduled
Ask the family to identify a specific spokesperson
Term 3 of 814
A client with severe full-thickness burns is scheduled for an allografting procedure. Which
information should the nurse provide the client
Avoid all isometric exercises, but walk regularly
Human source grafts require monitoring for signs of graft rejection
Advise the UAP to resume positioning the client on schedule
Add equal amounts of water and feeding to a feeding bag and infuse at 50ml/hour
,Term 4 of 814
A 13 years-old client with non-union of a comminuted fracture of the tibia is admitted with
osteomyelitis. The healthcare provider collects home aspirate specimens for culture and
sensitivity and applies a cast to the adolescent's lower leg. What action should the nurse
implement next?
Bivalve the cast for distal compromise
Encourage screening for a peptic ulce
Administer antiemetic agents
Begin parenteral antibiotic therapy
Term 5 of 814
A client with arthritis has been receiving treatment with naproxen and now reports ongoing
stomach pain, increasing weakness, and fatigue. Which laboratory test should the nurse monitor
Monitor heart, lung, and kidney function.
Notify healthcare provider of serum amylase and lipase levels.
Review client's abdominal ultrasound findings.
Contact the regional organ procurement agency
Hemoglobin
Overlook the client's behavior.
Term 6 of 814
A young adult male was admitted 36 hours ago for a head injury that occurred as the result of a
motorcycle accident. In the last 4 hours, his urine output has increased to over 200 ml/H. Before
reporting the finding to the healthcare provider, which intervention should the nurse implement?
Document the extend of the bruising in the medical record
Evaluate the urine osmolality and the serum osmolality values.
Establish a structured routine for the client to follow
Explain the reason for using only non-narcotics.
,Term 7 of 814
A client admitted with an acute coronary syndrome (ACS) receives eptifibatide, a glycoprotein
(GP) IIB IIIA inhibitor, which important finding places the client at greatest risk?
Current diagnosis of hepatitis B
Contact the regional organ procurement agency
Unresponsive to painful stimuli
Respiratory apnea of 30 seconds
Term 8 of 814
A male client reports to the clinic nurse that he has been feeling well and is often "dizzy" his
blood pressure is elevated. Based on this findings, this client is at a greatest risk for which
pathophysiological condition?
36%
Furosemide
Stroke
Maternal pulse rate of 162 beats per min
, Term 9 of 814
The nurse is developing an educational program for older clients who are being discharged with
new antihypertensive medications. The nurse should ensure that the educational materials include
which characteristics? Select all that apply
-Contains a list with definitions of unfamiliar terms
-Uses common words with few Syllables
-Uses pictures to help illustrate complex ideas
Document the assessment data
Rational: reservoir bag should not deflate completely during inspiration and the client's
respiratory rate is within normal limits.
-Weigh the client and report any weight gain.
-Report any client complaint of pain or discomfort.
-Note and report the client's food and liquid intake during meals and snacks
Maintain both lower extremities elevated on pillows
Term 10 of 814
In determine the client position for insertion of an indwelling urinary catheter, it is most important
for the nurse to recognize which client condition?
What food does your baby usually eat in a normal day?
Orthopnea
Contraction pattern
Deltoid
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