Exam 3 Flash Cards

The nurse is caring for a group of clients. Which client is most likely to have a serum phosphorus level of 2.0 mg/dL?

A client with a history of alcoholism

The nurse is reviewing the results of a client's serum laboratory studies. Which result indicates a deficiency of protein intake?

Albumin, 2.6 mg/dL

A seriously ill client in the hospital tells the nurse that he thinks he has lost some of his ability to hear over the past few days. The nurse reviews the medications the client is currently receiving. Which medications are known to be ototoxic?

Aspirin Furosemide (Lasix) Gentamycin (Garamycin)

The nurse is told that an assigned client is suspected of having methicillin-resistant Staphylococcus aureus (MRSA). Which precautions should the nurse institute during the care of the client?

Wear a gown and gloves.

A pregnant woman has tested positive for human immunodeficiency virus (HIV). The nurse reinforces information to the client about HIV and determines that additional counseling is necessary when the client makes which statement?

"Breast-feeding after delivery is best for my baby."

A client who has undergone a barium enema is being readied for discharge from the ambulatory care unit. Which statement by the client indicates understanding of the discharge instructions?

"I should take a laxative and my stool should return to normal color."

A mother tells the pediatrician's office nurse that she is concerned because her children must let themselves into the house after school each day while she is at work. The nurse should explore with the mother which suggestion to decrease the children's sense of isolation and fear?

"You should seek community after-school programs or activities for your children."

Abdominal ultrasonography is prescribed for a client who is pregnant. The nurse provides information to the client regarding the procedure and makes which statement?

"You will be positioned on your back and turned slightly to one side with your head elevated."

A client has been admitted for urinary tract infection and dehydration. The nurse determines that the client has received adequate volume replacement if the blood urea nitrogen (BUN) level drops to which value?

15 mg/dL

The nurse is assigned to the care of a client with an unsealed internal radiation source. During an 8-hour shift, the nurse plans the care to avoid spending more than how much time in the client's room?

30 minutes

The prescription reads to infuse an insulin drip at 12 mL/hr. There are 100 units regular insulin in 250 mL of normal saline. How many units of insulin will the client receive per hour?

4.8 Units

The nurse is reinforcing instructions to a client and family regarding home care following cataract removal from the left eye. The nurse should provide the client with which instruction regarding positioning in the postoperative period?

Do not sleep on the left side.

Which information should the nurse include when reinforcing client teaching regarding ostomy care? Select all that apply.

Empty pouch when 1/3 to ½ full. The stoma should be moist and pink to red. The skin barrier should be within 1/16 to 1/8 inch of the stoma. Change the appliance about every 3 days, or sooner if it is leaking effluent.

The nurse is making a worksheet and listing the tasks that need to be performed for assigned adult clients during the shift. The nurse writes on the plan to check the intravenous (IV) of an assigned client who is receiving fluid replacement therapy how frequently?

Every hour

The nurse is caring for a client who is on airborne precautions. The nurse notes that the client is scheduled for a magnetic resonance imaging (MRI) test. Which nursing action would be most appropriate in preparing the client for the test?

Place a surgical mask on the client for transport and for contact with other individuals.

A client uses the call system to notify the nurse to say that "the IV hurts and my left hand is swollen." The nurse assesses the site and determines infiltration has occurred. In order of priority, which actions should the nurse take? Arrange the actions in the order they should be performed. All options must be used.

Stop the infusion. Remove the intravenous catheter. Apply a compress to the site. Notify the registered nurse to start a new IV on the right extremity.

The nurse is preparing a continuous intravenous (IV) infusion at the medication cart. As the nurse goes to attach the distal end of the IV tubing to a needleless device, the tubing drops and hits the top of the medication cart. Which is the appropriate action by the nurse?

Change the IV tubing.

The nurse is encouraging an older incontinent client's participation in recreational therapy. What nursing intervention should the nurse consider performing first?

Change the client's soiled disposable brief.

The nurse is assisting in the preparation of a client for a blood transfusion. Which item is the most important for the completion of the identification process?

Identification bracelet

A client with methicillin-resistant Staphylococcus aureus (MRSA) needs to be placed on contact precautions, and the licensed practical nurse (LPN) in charge asks a newly licensed LPN to initiate contact precautions. Which action by the new LPN would indicate the need to review the procedure for contact precautions?

Wears a gown when caring for the client and removes the gown immediately after leaving the client's room