seminar 3 quiz

When assessing the physical activity of clients, the nurse would be most concerned about which client?

the middle-aged computer programmer

The nurse is caring for a client utilizing a Patient Controlled Analgesia (PCA) pump that is programmed to allow a bolus dose every 10 minutes. The client is sleeping with visitors at the bedside. Which of the following instructions should the nurse give the client's visitors?

"Only the client should push the pump button."

The UAP asks the nurse what hand rolls are used for when providing client care. What is the appropriate nursing response?

"To preserve the client's functional ability to grasp and pick up objects."

The wife of a client with cancer is concerned that her husband's breakthrough doses of morphine have recently needed to be larger and more frequent in order for him to achieve pain relief. The nurse would recognize that the client is likely showing the effects of:

tolerance.

The nurse is administering medications to a client with neuropathic pain. The client asks why an antidepressant medication is prescribed when the client is not depressed. Which is the best response by the nurse?

"Antidepressants have been shown to be effective in treating and managing neuropathic pain."

A nurse is caring for a client with insomnia. Which teaching will the nurse provide to help the client improve sleep?

"Create a bedtime routine."

The nurse makes the following assessment. A middle-age client reports falling asleep frequently at his job during the day, feels like he is not getting enough sleep at night (even though the number of hours of sleep is unchanged), continues to feel tired, and is not able to think clearly. Also, the client reports his wife believes he is irritable upon awakening. Nursing interventions include teaching the client to:

use caution when driving an automobile.

The nurse is assessing a client with a history of sleep apnea who is noncompliant regarding wearing the continuous positive airway pressure (CPAP) apparatus. Which statement made by the client indicates understanding of risks related to noncompliance?

"I know if I do not wear the CPAP the oxygen in my blood may drop and damage my heart."

The nursing assistant is preparing to help the client make a lateral transfer from the bed to a stretcher. The client informs the nurse that the client is able to move onto the stretcher without the nurse's help. What is the nurse's best response?

"You are free to move onto the stretcher without assistance, but I will supervise for your safety."

The nurse uses gait belts when assisting clients to ambulate. Which client would be a likely candidate for this assistive device?

A client who has leg strength and can cooperate with the movement

A nurse attempts to relieve the pain of a client by using cutaneous stimulation. Which of the following describes usage of this technique?

A nurse applies intermittent heat and cold to a client's leg.

The nurse is applying graduated compression stockings to the legs of a postsurgical client. The client suddenly complains of sharp pain to his left leg as the nurse is unrolling the stockings. What is the nurse's most appropriate action?

Assess the client's leg for signs and symptoms of deep vein thrombosis and inform the primary care provider.

The nurse observes the sleep pattern of an obese client with cardiac disease and notes occasional periods of apnea. Which action should the nurse take?

Assess the client's vital signs and pulse oximetry.

A client has been in the hospital for the past 10 days following the development of an infection at her surgical incision site. Each morning, the client reports overwhelming fatigue and has told the nurse, "I just can't manage to get any sleep around here." How should the nurse first respond to this client's statement?

Assess the factors that the client believes contribute to the problem.

A nurse is caring for a client who has been diagnosed with a disturbed sleep pattern. Which measures should the nurse implement to promote sleep? Select all that apply.

Assisting with progressive relaxation Promoting daytime exercises Providing a back massage

The nurse is evaluating pain of several clients who had hip replacement surgery. Which client is most likely to have the greatest perceived pain?

Client who is anxious about discharge

The nurse is preparing to administer an NSAID to a client for pain relief. The nurse notices that the client is diagnosed with a bleeding disorder. What should the nurse do?

Contact the health care provider.

What type of pain will the client experience as a result of the intervention being preformed?

Cutaneous

The demonstration provided by the nurse is directed at helping the postsurgical client manage what type of pain?

Deep somatic

Which interview question would be the best choice for the nurse to use to assess for recent changes in a client's sleep-wakefulness pattern?

Do you usually go to bed and wake up about the same time each day?

A nurse is teaching a client about the beneficial effects of exercise on his body. Which education point would the nurse include in the plan? Select all that apply.

Exercise increases intestinal tone. Exercise increases efficiency of the metabolic system. Exercise increases blood flow to kidneys.

The nurse is caring for a client who reports insomnia. The client has recently moved from an area near a fire station in the inner city to the country. Which recommendation will the nurse make to facilitate sleep?

Find a phone app that plays sounds of the city.

The nurse is transferring the client from the bed to a wheelchair when the client reports dizziness. What is the next step for the nurse?

Firmly grasp the gait belt and gently lower the client into bed.

When asking an older adult client about abdominal pain, the client reports, "I don't want to be a bother because nothing hurts too much." The nurse notes that the client grimaces and splints the abdomen when moving. What is the appropriate nursing action?

Gently mention that the client appears to be experiencing pain that can be treated.

A client reports periodic difficulty falling asleep. Which teaching will the nurse provide? Select all that apply.

Go on a daily walk. Decrease caffeine intake. Adhere to a regular schedule for waking and going to sleep.

A client had a mild stroke with residual left-sided weakness. While teaching the client about walking with the cane, the nurse will offer which instruction?

Hold your cane on the right side.

A factory worker has a work schedule involving rotating work hours between days, evenings, and nights. The client tells the nurse about being a "morning person" and not being sleeping well when working the night shift. Which information will the nurse teach the client about sleep hygiene?

Modify the sleep environment to simulate quiet and darkness.

For the last 3 weeks, a nurse in a long-term care facility has administered a sedative hypnotic to a client who complains of insomnia. The client does not seem to be responding to the drug and is now lying awake at night. What is the most likely explanation?

Most sedative hypnotics lose their effect after 1 or 2 two weeks of administration.

A postoperative client who has been receiving morphine for pain management is exhibiting a depressed respiratory rate and is not responsive to stimuli. Which drug has the potential to reverse the respiratory-depressant effect of an opioid?

Naloxone

The nurse is administering oxycodone to a client. To which category of analgesics does this belong?

Opioid

The nurse is assisting a client from the bed into a wheelchair. What is a recommended guideline for this procedure?

Raise the head of the bed to a sitting position.

A client is worried and states, "I just know I won't be able to sleep before my surgery." What sleeping pattern would the nurse anticipate?

The client will likely not be able to sleep.

A client has been admitted to a post-surgical unit with a patient-controlled analgesia (PCA) system. Which statement is true of this medication delivery system?

The dose that is delivered when the client activates the machine is preset.

A nurse implements cutaneous stimulation for a client as part of a strategy for pain relief. Which nursing action exemplifies the use of this technique?

The nurse gives the client a massage before bed.

A nurse is assisting client from a bed to a wheelchair. Which nursing action is appropriate?

The nurse uses assistive devices when lifting more than 35 lb (16 kg) of client weight.

A newly admitted client states to the nurse, "I average about 5.5 hours of sleep per night." What determination of this client's sleep patterns does the nurse discuss with the client?

They are sleep deprived to some degree.

A 38-year-old client is in an outpatient clinic reporting chronic back pain. As the nurse reviews the chart, the nurse notices that the client has required escalating doses of hydromorphone to treat this pain. The client tells the nurse that "the old dose just doesn't work anymore." What term best describes this client's situation?

Tolerance

A client with chronic pain uses a machine to monitor his physiologic responses to pain. The unit transforms the data into a visual display and through seeing the pain responses, the client is taught to regulate his physiologic response and control pain through relaxation, imagery, or breathing exercises. This technique for pain control is known as:

biofeedback.

A 45-year-old man is interested in starting an exercise program. The nurse informs him that exercise does not:

decrease appetite.

A client has voiced concerns about her inability to fall asleep. When reviewing her history, what information would the nurse expect to find? Select all that apply.

drinks coffee with all meals history of hyperthyroidism smokes 1 pack of cigarettes daily

When moving a client up in bed with the assistance of another caregiver, the nurse should:

have the client fold the arms across the chest.

Which body system effects would the nurse state as occurring due to immobility? Select all that apply.

increased cardiac workload increased risk for renal calculi Increased risk for electrolyte imbalance

The nurse observes an older adult client walks walking with knees slightly flexed and body leaning. What does the nurse identify the client is demonstrating?

is demonstrating a common gait for the older adult.

When logrolling a client, the nurse should use supportive devices in turning the client in order to:

maintain the natural alignment of the client's body.

A nurse is caring for a client with an amputated limb. The client tells the nurse that he has a burning sensation in his amputated limb. How should the nurse document this pain?

phantom pain

The client being seen in the employee wellness clinic reports difficulty sleeping for the past several months. The most important assessment the nurse could make is:

reviewing the client's sleep diary for the past 2 weeks.

The nurse is planning care for a client with a nursing diagnosis of Activity Intolerance. What assessment finding would cause the nurse the most concern?

shortness of breath after walking up five stairs

The nurse has been educating the client about how to use a walker safely. The nurse knows that the education has been effective when the client:

steps into the walker when walking.

Who is the authority on the presence and extent of pain experienced by a client?

the client

A nurse is discussing sleep with a group of orienting unlicensed personnel. The nurse explains that the older adults can have issues with physical safety in relation to the sleep patterns because:

they may be disoriented on awakening.