NURS Test 3

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complete proteins

contain all essential amino acids

The nurse is caring for a client with a urinary diversion. For which type of diversion should the nurse plan care for this client? 1. Incontinent urinary diversion 2. The kock pouch 3. Neobladder 4. Nephrostomy

1. incontinent urinary diversion

The nurse wants to delegate the application of a condom catheter to assistive personnel (AP). What must the nurse assess prior to delegating this task? 1. Assess whether the client has unique needs. 2. Measure the client's intake. 3. Assist the client out of bed to a chair. 4. Assess changes in the client's mobility status.

1. assess whether the client has unique needs

A client is rushed to the emergency department with what the physicians suspect to be necrosis of the urinary diversion stoma. What evidence presented by the client leads to this conclusion? 1. Black with sloughing 2. Moist stoma 3. Pink and shiny 4. Slight bleeding from stoma

1. black with sloughing

A client's urine pH is 8.0. What further assessments would be indicated for this client? (Select all that apply.) 1. Intake of fruits and vegetables 2. Intake of cranberries 3. Intake of high-protein foods 4. Symptoms of diarrhea 5. Symptoms of a urinary tract infection

1. intake of fruits and vegetables, 5. symptoms of a UTI

The nurse instructs a client on self-care for a new ostomy. Which client behaviors demonstrate that instruction has been effective? (Select all that apply.) 1. Client provides skin care and changes ostomy device. 2. Client states what items are needed to perform ostomy care. 3. Client is unable to identify changes in skin around the stoma. 4. Client does not want to do the care. 5. Client asks the spouse to learn how to perform the care.

1. client provides skin care and changes ostomy device, 2. client states what items are needed to perform ostomy care

A client has the nursing problem/diagnosis statement Risk for Impaired Skin Integrity related to immobility. Which nursing intervention should be identified for this client's problem? a. Encourage the client to eat at least 40% of meals. b. Keep linens dry and wrinkle-free. c. Restrict fluid intake. d. Turn client every 3 hours.

B. keep linens dry and wrinkle-free

A client is prescribed to have wrist restraints applied. Place in order the steps the nurse will take to apply these restraints. a. Pad bony prominences on the wrist. b. Apply the padded portion of the restraint around the wrist. c. Pull the tie of the restraint through the slit in the wrist restraint and ensure that it is not too tight. d. Attach the other end of the restraint to the movable portion of the bed frame using a half-bow knot.

1. A, 2. B, 3. C, 4. D

The nurse is caring for a client who has pulmonary fibrosis. Of the following teaching priorities, which will take the highest priority? 1. Client will be able to set up and administer a nebulizer treatment by the end of the day. 2. Client will have increased activity level by the end of the week. 3. Client will be able to do activities of daily living (ADLs) without shortness of breath in 3 days. 4. Client will have a positive attitude about the diagnosis by the end of the month.

1. client will be able to set up and administer a nebulizer treatment by the end of the day

The nurse is instructing a client on ways to manage stress urinary incontinence. What should be included in this client's teaching? (Select all that apply.) 1. Limit intake of caffeine. 2. Limit intake of alcohol. 3. Increase intake of citrus juices. 4. Limit evening fluid intake. 5. Increase intake of beverages with artificial sweeteners.

1. limit intake of caffeine, 2. limit intake of alcohol, 4. limit evening fluid intake

The nurse is creating a teaching plan for a client recovering from total hip replacement surgery. What should the nurse include in this client's plan? (Select all that apply.) 1. The content to be included 2. The outcome for the teaching 3. The approaches used to teach the content 4. The evaluation of the effectiveness of teaching 5. The amount of time needed to cover the content

1. content included, 2. outcome for teaching, 3. approaches used to teach content, 5. amount of time needed to cover content

A client tells the nurse about the need to get up several times throughout the night to void. The nurse suspects the client is experiencing nocturia due to which factor? 1. Decrease in bladder tone 2. Decrease in blood supply 3. Decrease in number of nephrons 4. Decrease in cardiac output

1. decrease in bladder tone

The nurse serves as an educator of other healthcare personnel. In what capacity will this nurse participate in education? (Select all that apply.) 1. Preceptor of new graduate nurses 2. Instructing a part of the critical care course 3. Clinical instruction of nursing students 4. One-to-one teaching of clients 5. Teaching grandparents how to care for children

1. preceptor of new grad nurses, 2. instructing part of the critical care course, 3. clinical instruction of nursing students

An older client needs to access the Internet to complete a post hospitalization survey and update health information but the client does not have a computer and would not know how to use one. What should the nurse do? (Select all that apply.) 1. Suggest the client learn how to use a computer through classes held at a local library. 2. Provide times for the client to attend basic computer use classes through the community learning center. 3. Document that the client is resistant to instruction. 4. Notify the physician that the client will not be adhering to medical instruction as planned. 5. Identify the client as being noncompliant with instruction.

1. suggest the client learn how to use a computer through classes held at local library, 2. provide times for client attend basic computer classes through community learning center

bathing water temp

106-110 degrees

A client who is on seizure precautions experiences a seizure while ambulating in the room. What should the nurse include in this client's documentation? (Select all that apply.) 1. Who assisted the client back to bed 2. Location of the seizure 3. Duration of the seizure 4. Status of airway and use of oxygen 5. Who discovered the client

2. location of seizure, 3. duration of seizure, 4. status of airway and use of oxygen

The nurse is preparing a teaching plan for a client. Which information should the nurse omit from the plan? 1. Content outline 2. Name of the nurse 3. Teaching methods 4. Learning outcomes

2. name of the nurse

The nurse explains the use, how it works, and the rationale for an incentive spirometer that a client needs to use after surgery. When mastering the use of this device, the client will demonstrate learning in which of Bloom's domains? 1. Cognitive 2. Psychomotor 3. Affective 4. Imitation

2. psychomotor

Which nursing problem/diagnosis statement would be appropriate for a client who has a retention catheter if the drainage bag is found lying on the floor? 1. Risk for Impaired Skin Integrity related to catheter placement 2. Risk for Infection related to improper handling 3. Self-Care Deficit related to presence of a retention catheter 4. Risk for Incontinence related to an obstruction

2. risk for infection related to improper handling

The nurse has completed closed irrigation of a client's retention catheter. What specific information should the nurse document about this procedure? 1. Number of mL of solution used to inflate the balloon of the catheter 2. Abnormal drainage, such as blood clots, pus, or mucous shreds 3. Location of the draining bag 4. Technique used to conduct the irrigation

2. abnormal drainage such as blood clots, pus, or mucous shreds

The nurse is assessing a client's learning needs. On which elements should the nurse focus? (Select all that apply.) 1. Nurse's own knowledge 2. Client's age 3. Client's understanding of health problem 4. Sensory acuity 5. Learning style

2. client's age, 3. client's understanding of health problem, 4. sensory acuity, 5. learning style

A client prescribed new medications and a low-fat diet for a heart problem is concerned about understanding all of the new information. Which nursing problem/diagnosis statement should be used to guide this client's care? 1. Health-Seeking Behavior 2. Deficient Knowledge 3. Noncompliance 4. Risk for Myocardial Infarction

2. deficient knowledge

A client recovering from a transurethral resection of the prostate with a three-way indwelling catheter expresses the need to urinate. Which action should the nurse take to help this client? 1. Deflate and then reinflate the balloon. 2. Irrigate the catheter. 3. Reposition the catheter. 4. Retape the catheter to the abdomen.

2. irrigate the catheter

A client has been admitted with incontinence. What should the nurse expect to assess in this client? 1. Client is wearing cotton undergarments. 2. Leakage of urine occurs when client laughs. 3. Leakage of urine occurs when talking with the client. 4. The skin of the client is clear without discoloration.

2. leakage of urine occurs when client laugs

A client is prescribed a 1,600-calorie diet. Of this diet, 30% of the intake should be protein, 20% fat, and 50% carbohydrates. How many grams of carbohydrates should the client ingest every day? Calculate to the nearest whole number.

200 grams, (1,600 x 0.50= 800--- 800/4= 200)

The nurse realizes that which client is at risk for difficulty in urinary elimination? 1. A client who had bladder cancer and now has a newly created ileal conduit 2. A 25-year-old female client with low self-esteem 3. An 80-year-old male reporting frequent urination at night 4. The client with hypertension who takes a diuretic every day for blood pressure

3. an 80-year-old male reporting frequent urination at night

A client needs a test to determine the amount of residual urine. The nurse realizes that this assessment is used for which reason(s)? (Select all that apply.) 1. Evaluate the glomerular filtration rate 2. Determine the extent of renal failure 3. Determine the amount of retained urine after voiding 4. Determine the need for medications 5. Evaluate fluid volume status

3. determine amount of retained urine after voiding, 4. determine need for medications

A client needs discharge teaching regarding the use of a walker before going home however the client's room is small and adjacent to a soda machine and small lounge area. In planning a teaching session, which is the best thing the nurse can do? 1. Wait until just prior to discharge, then do the teaching in the hospital lobby. 2. Close the door to the client's room and make sure there is no clutter on the floor before the teaching session begins. 3. Take the client to a larger area (treatment room, for example) for teaching, then evaluate on the way back to the client's room. 4. Make sure a physical therapist is available to do the teaching and can see the client before discharge.

3. take the client to a larger area (treatment room) for teaching, then evaluate on the way back to the client's room

The nurse is identifying outcomes for a client with the nursing problem/diagnosis statement Stress Urinary Incontinence. Which outcome would be related to sphincter incompetence? 1. The client will empty the bladder with each void. 2. The client will improve incontinence within 1 month. 3. The client will perform eight squeezes three times a day. 4. The client will stop the flow of urine when voiding.

3. the client will perform 8 squeezes 3x a day

A client with an incision necessitating a complex dressing change is being discharged and will require continued dressings at home. Which statement by the client indicates a need to postpone teaching? 1. "It's going to take time for me to understand this whole thing." 2. "Let's make sure my spouse is around before you start explaining." 3. "I wish my doctor would have explained this more in depth." 4. "I'm feeling nauseous but go ahead and start anyway."

4. "I'm feeling nauseous but go ahead and start anyway"

The nurse is caring for a client with diabetes. What should the nurse include as foot care for this client? a. Cut toenails in a rounded shape and file. b. Dry toes thoroughly. c. Wash feet with water at a temperature of 90-98.6°F. d. Inspect feet thoroughly once a week.

B. dry toes thoroughly

The nurse is working with a group of older clients through a community senior citizens center. In which way should the nurse support these clients' health literacy? 1. Provide information written at a third-grade level. 2. Use a variety of approaches when teaching 3. Provide information with pictures. 4. Ensure ample time for teaching.

4. ensure ample time for teaching

The nurse is applying an external urinary device to a client. Before attaching the device to the drainage bag, what should the nurse do? 1. Perform hand hygiene. 2. Document the client's tolerance of the procedure. 3. Instruct the client about the drainage system. 4. Ensure that the condom is not twisted.

4. ensure that the condom is not twisted

A client's results from a urinalysis are as follows: pH 5.2, gross cloudiness, WBC 10-15, glucose negative, specific gravity 1.012, and protein negative. How should the nurse interpret the results? 1. Dehydration 2. Diabetic ketoacidosis 3. Trauma 4. Urinary tract infection

4. urinary tract infection

A client with an indwelling urinary catheter is prescribed to receive sterile normal saline bladder irrigation at 100 mL/hr. After an 8-hour shift the nurse measures the client's output as being 1425 mL. What is the client's urine output for the 8-hour shift? Calculate to the nearest whole number.

625 mL. . Need to subtract the total output from the bladder irrigant for the 8 hours. To determine the bladder irrigant received, you multiple 100mL by 8 hours to get 800 mL total. Then, you do 1425 mL (total output)- 800= 625mL

A client has received an oil retention enema. At which time should the nurse instruct the client that the enema will take effect? a. 1-3 hours b. 10-20 minutes c. 5-10 minutes d. 10-15 minutes

A. 1-3 hours

The nurse is assessing an older client. Which finding should cause the nurse to be concerned about the client's safety? a. Alteration in olfactory status b. Blood pressure 138/88 mm Hg c. Applies medication for a skin rash Ambulates without assistive devices

A. alteration in olfactory status

The nurse has completed care with a client who has a new ostomy. What should the nurse document about the care provided? (Select all that apply.) a. Any change in stoma size b. Condition of the skin around the stoma c. Amount and type of drainage d. Client's response to the procedure e. Degree of bowel sounds after care provided

A. any change in stoma size, B. condition of skin around stoma, C. amount and type of drainage, D. client's response to procedure

The nurse is planning instruction for a client who is underweight. What should be included in this teaching? (Select all that apply.) a. Discuss factors contributing to inadequate nutrition and weight loss. b. Discuss ways to manage, minimize, or alter the factors contributing to malnourishment. c. Discuss principles of a well-balanced diet and high-and low-calorie foods. d. Provide information about community agencies that can assist in providing food. e. Provide information about ways to increase calorie intake.

A. discuss factors contributing to inadequate nutrition and weight loss, B. Discuss ways to manage, minimize, or alter factors contributing to malnourishment, D. provide information about community agencies that can assist in providing food, E. provide information about ways to increase calorie intake

The nurse is planning an educational program for community members on ways to improve nutritional intake. What information should the nurse include about carbohydrate digestion and metabolism? (Select all that apply.) a. Enzymes are needed to digest carbohydrates. b. The breakdown of carbohydrates results in simple sugars. c. Carbohydrates are a major source of body energy. d. The simple sugar glucose provides a readily available source of energy. e. Pancreatic amylase enhances the use of glucose by the body cells.

A. enzymes are needed to digest carbs, B. the breakdown of carbs results in simple sugars, C. carbs are a major source of body energy, D. the simple sugar glucose provides a readily available source of energy

A client has occasional bouts of constipation and asks the nurse what can be done to prevent these episodes in the future. What should the nurse instruct the client to do? (Select all that apply.) a. Establish a regular exercise regimen. b. Include high-fiber foods, such as vegetables, fruits, and whole grains, in the diet. c. Maintain fluid intake of 2000-3000 mL a day. d. Do not ignore the urge to defecate. e. Use over-the-counter medications to treat constipation.

A. establish a regular exercise regimen, B. include high-fiber foods (vegetables, fruits, whole grains), C. maintain fluid intake of 2000-2000mL a day, D. don't ignore urge to defecate

During an assessment, the nurse notes that a client's stool is black. Which medication should the nurse consider as causing this client's change in stool color? a. Iron b. Aspirin c. Antacids Antibiotics

A. iron, B. aspirin

The nurse is appointed to be a member of a committee whose focus is to identify and address workplace safety issues. Which issues should the nurse recommend for analysis by this committee? (Select all that apply.) a. Lifting clients b. Inadequate lighting c. Bending and walking d. Exposure to infectious agents e. Exposure to hazardous medications

A. lifting clients, C. bending and walking, D. exposure to infectious agents, E. exposure to hazardous medications

The nurse is instructing a client on foods that are considered complete proteins. What will the nurse include in these instructions? (Select all that apply.) a. Meat b. Gelatin c. Eggs d. Chicken e. Fish

A. meat, C. eggs, D. chicken, E. fish

The nurse is preparing to provide a morning bath to a client diagnosed with dementia. What can the nurse do to ensure a positive bathing experience for the client? (Select all that apply.) a. Move slowly. b. Be flexible. c. Help the client feel in control. d. Avoid stopping once the bath is started. e. Be prepared.

A. move slowly, B. be flexible, C. help client feel in control

An older client tells the nurse that in order to have a daily bowel movement, the client uses laxatives most days of the week. What should the nurse tell this client? (Select all that apply.) a. Normal patterns of elimination are different for everyone. b. Increase fiber intake to 20-35 grams a day. c. Engage in enjoyable exercise. d. Ignore the urge to have a bowel movement. e. Drink six to eight glasses of fluid daily.

A. normal patterns of elimination are different for everyone, B. increase fiber intake to 20-35 grams a day, C. engage in enjoyable exercise, E. drink 6-8 glasses of fluid daily

The nurse wants to assess a client during the morning bath. What will the nurse be able to assess during this time? (Select all that apply.) a. Skin status b. Financial status c. Psychosocial needs d. Learning needs e. Physical conditions

A. skin status, C. psychological needs, D. learning needs, E. physical conditions

The client's lab studies reveal a normal serum albumin with a prealbumin of 10. How should the nurse interpret the significance of these readings? a. The client has had recent protein malnutrition. b. The client is now relatively well nourished with malnutrition 6-8 months ago. c. The client is at risk for development of malabsorption syndromes. d. Carbohydrate malnutrition has occurred over the last 6 months.

A. the client has had recent protein malnutrition

The nurse is assigning feedings of an older client who is at risk for aspiration to assistive personnel (AP). What feeding techniques should the nurse instruct the AP to use? (Select all that apply.) a. Thicken all fluids. b. Use the chin-tuck method. c. Place the client in a seated position. d. Focus on food preferences. e. Keep the head of the bed at a 30-degree angle.

A. thicken all fluids, B. use chin-tuck method, C. place client in seated position, D. focus on food preferences

Type of care: changes of clothes (drainage, soiled gown), frequent bathing, as required by client

As-needed prn care

A connection on a client's intravenous solution was dislodged and solution saturated the client's gown and bed linens. The nurse will provide which type of hygienic care to the client? a. Hour-of-sleep care b. As-needed care c. Early-morning care d. Morning care

B. As-needed care

The nurse has assigned administration of tube feeding to a specially unlicensed trained assistive personnel (UAP). What action should be taken by the nurse in regard to this delegation? a. Order the equipment to give the feeding. b. Check the tube for placement. c. Set up the equipment and mix the feeding. d. Regulate the rate of the feeding.

B. check the tube for placement

The nurse is caring for the stoma of a client who has a colostomy. Which action is the most appropriate? a. Apply pressure over the stoma. b. Clean the stoma and pat dry. c. Dilate the stoma. d. Scrub the stoma.

B. clean the stoma and pat dry

What nursing problem/diagnosis statement should the nurse select as appropriate to address bowel evacuation for a client who is on bed rest? a. Bowel Incontinence b. Constipation c. Diarrhea d. Disturbed Body Image

B. constipation

A client is prescribed to receive a cleansing enema. What should the nurse instruct the client prior to administering this enema? a. Hold the solution for a short time. b. Lie in the left lateral position. c. Lie in the right lateral position. d. Take fast breaths through the nose.

B. lie in the left lateral position

A client is prescribed seizure precautions. What can the nurse safely assign to assistive personnel (AP) to complete when implementing the precautions? a. Placing a tongue blade at the head of the bed b. Padding the client's bed c. Installing oxygen d. Checking the oral suction apparatus

B. padding client's bed

The nurse is caring for a client who is confused and wanders. Which alternative to a restraint can the nurse use for this client? a. Assign this client to the farthest room from the nurses' station. b. Place a rocking chair in the client's room. c. Pull up all of the side rails on the bed. d. Wedge pillows against the side rails on the bed.

B. place rocking chair in client's room

The nurse is discussing different types of ostomy appliances with a client with a new ostomy. During this discussion, the nurse should keep in mind that an ostomy appliance should do which of the following? (Select all that apply.) a. Be changed daily b. Protect the skin c. Collect stool d. Control odor e. Be open, so the client can empty it sporadically throughout the day

B. protect the skin, C. cool stool, D. control odor

The nurse is assigning activities regarding fecal elimination to assistive personnel (AP). Which activity can AP safely perform to meet a client's fecal elimination needs? a. Provide a fracture pan to a client on bed rest. b. Provide a client who has a fecal impaction and prolapsed rectum with a cleansing enema. c. Change a client's ostomy device. d. Irrigate a client's ostomy.

B. provide a client who has fecal impaction and prolapsed rectum with a cleansing enema

The nurse notes that the tube-fed client has shallow breathing and dusky color. The feeding is running at the prescribed rate. What should the nurse do first? a. Place the client in high Fowler position. b. Turn off the tube feeding. c. Assess the client's lung sounds. d. Assess the client's bowel sounds.

B. turn off the tube feeding

18.5-24.9 is normal ________

BMI

A client who has not been bathed for several days does not want to get into the tub for a morning bath. What should the nurse do? a. Assign assistive personnel the task of giving the client a bath. b. Skip the client's bath and document "refused" in the medical record. c. Ask the client the usual way bathing occurs at home. d. Tell the client that a bath is needed and ignore the client's comment.

C. ask client the usual way bathing occurs at home

The nurse has assigned the making of unoccupied beds to assistive personnel. What should the nurse assess regarding client safety once the beds are completed? a. Folding of the top sheet b. Direction of the pillow c. Call light being readily available d. Presence of mitered corners

C. call light being readily available

The client is weighed each month while residing in the long-term care facility. This month the client weighs 110 lb (50 kg). The nurse compares this weight to the last 3 months' results and discovers the client has lost 22 lb (10 kg). There has been no attempt to lose this weight. How should the nurse interpret this weight loss? a. No malnutrition b. Mild malnutrition c. Moderate malnutrition d. Severe malnutrition

C. moderate malnutrition

The nurse is preparing to assess a client who has a history of falls. Which methods should the nurse use to assess this client's risk for injury? (Select all that apply.) a. Cognitive awareness b. Mobility c. Nursing history d. Physical examination e. Marital status

C. nursing history, D. physical examination

The nurse is admitting an older client to the care area. What can the nurse do to promote a safe environment for the client? a. Keep clutter to a minimum in the client's room. b. Have the client wear terry-cloth slippers. c. Provide adequate lighting. d. Turn off alarms to reduce noise.

C. provide adequate lighting

The nurse is preparing to bathe a client on the first postoperative day. Which nursing intervention should take priority? a. Apply lotion to the extremities. b. Change the water when it becomes cold. c. Raise side rails when gathering supplies. d. Remove the soiled dressing during the bath.

C. raise side rails when gathering supplies

A client is prescribed bed rest with bathroom privileges. Which types of bath would be appropriate for this client? (Select all that apply.) a. Shower b. Tub bath c. Self-help bed bath d. Therapeutic bath e. Partial bath

C. self-help bath, D. therapeutic bath

The nurse notices that the client's continuous open-system tube-feeding set is almost empty. What action should the nurse take? a. Add tube feeding to the set. b. Discontinue the feeding and hang a closed system bag. c. Wash out the set and add new feeding. d. Flush the set with clear carbonated soda and discontinue.

C. wash out set and add new feeding

After ambulating a client to the bathroom, the assistive personnel did not reattach the client's bed safety-monitoring device, and the client fell out of bed. What should the nurse document? a. Client fell out of bed; bed safety-monitoring device malfunctioning. b. Client fell out of bed; client removed leg band of bed safety-monitoring device. c. Client fell out of bed; no observable injuries. d. Client fell out of bed; bed safety-monitoring device not activated.

D. client fell out of bed; bed safety-monitoring device not activated

The client has a body mass index (BMI) of 30. How should the nurse interpret this finding? a. The client is underweight b. The client is malnourished c. The client is normal d. The client is overweight

D. client is overweight

Assistive personnel are assigned the task of feeding breakfast to older clients with alterations in mobility and orientation. What instruction should the nurse include in this delegation? a. Breakfast should be completed quickly so that baths may begin. b. Give fluids before and after each bite of solid foods. c. Stand to the left of right-handed clients during feeding. d. Engage the client in conversation during the meal.

D. engage client in conversation during the meal

A client with an upper gastrointestinal disorder is experiencing seeping of liquid stool, anorexia, abdominal distention, and nausea and vomiting. Which should the nurse suspect the client is experiencing? a. Constipation b. Diarrhea c. Trapped flatus d. Fecal impaction

D. fecal impaction

A client is being transferred from an acute care facility to a long-term care facility. What information should the nurse provide to the long-term care facility about the client's medications? a. Nothing, as the medications all need to be reordered at the long-term care facility. b. Have the client's medication prescriptions filled before going to the long-term care facility. c. Instruct the client to tell the nurses at the long-term care facility what medications are prescribed. d. Inform the nurse at the long-term care facility what medications the client is prescribed, and document that this information was provided.

D. inform nurse at long-term care what medication client is prescribed and document info

The nurse is bathing a client with Alzheimer disease. Which should the nurse remember to do during this bath? a. Help the client into a bathtub b. Place the client in the shower c. Complete the bath as quickly as possible d. Keep the body covered and wash one area at a time

D. keep the body covered and wash one area at a time

After eating dinner, a client asks for help to get to the bathroom because of an extreme urge to defecate. The nurse realizes that the client has experienced which physiological function of the colon? a. Flatus b. Gastrocolic reflex c. Haustral churning d. Peristalsis

D. peristalsis

Assistive personnel are caring for a client's ears. What information should be reported to the nurse? a. Excessive earwax b. Loud talking c. Presence of a hearing aid d. Presence of any drainage

D. presence of any drainage

The nurse is preparing to provide morning care to a client. What should the nurse explain to the client as the reason for a daily bath? a. Assess skin integrity b. Develop a nurse-client relationship c. Moisturize the skin d. Stimulate circulation

D. stimulate circulation

The nurse plans to provide foot care to a client. Which action should be taken to ensure for the client's safety? a. Cut off any calluses b. Soak the feet for 30 minutes c. Apply lotion between the toes d. Use water at 106-110°F

D. use water at 106-110 degrees

Type of care: elimination, washing face and hands, oral care

PM care

The nurse is planning care for an older client. Which safety hazard should the nurse take into consideration when planning this care? a. Burns b. Drowning c. Poisoning d. Suffocation

a. burns

The nurse is creating a teaching poster about the most recent National Patient Safety Goals. Which information should be included to reduce the risk of healthcare-associated infections? a. Post the guidelines for hand hygiene b. List the chemicals used to clean the floors c. Identify when the client rooms are cleaned each day d. Explain the different types of transmission-based precautions

a. post guidelines for hand hygiene

adolescent nutrition is at risk for....

anorexia and bulimia

partial bath

bed rest with bathroom privileges

alcohol can reduce risk of....

cardiovascular disease, strokes, dementia, diabetes, osteoporosis

People with diabetes tend to have _______ skin

dry

Type of care: urinal or bed pan, washing face or hands, oral care (cleaning denture)

early morning care

over 40.0 is what?

extreme obesity

vitamin A, D, E, K are ______ soluble

fat

serum transferrin indicates _____________ level

iron

Ca, P, Mg, Na, K, Cl, S are _________________________

macrominerals

less than 16 is what?

malnourished

Type of care: after breakfast, elimination, bath or shower, perineal care, back massage, oral and hair and nail care

morning care

Type of care: assessing skin status, psychological needs, learning needs, physical needs

morning care

30-30.9 is what?

obese

26-29.9 is what?

overweight

serum albumin indicates _______________ level

protein

pre-albumin changes _____________ and indicates overall nutritional problem

slowly

16-18.5 is what?

underweight

vitamin B and C are _________ soluble

water


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