Test 3 Prep U's
A client with chronic obstructive pulmonary disease (COPD) requires low flow oxygen. How will the oxygen be administered? A. nasal cannula B. Venturi mask C. partial rebreather mask D. simple oxygen mask
A
A client's primary care provider has informed the nurse that the client will require thoracentesis. The nurse should suspect that the client has developed which disorder of lung function? A. Pleural effusion B. Tachypnea C. Wheezes D. Pneumonia
A
A novice nurse is using the assessment technique of auscultation. What assessment finding can the nurse obtain with this method? A. Presence of peristalsis B. Size of the liver C. Skin temperature D. Pupil reaction
A
A nurse collects a clean-catch specimen from a client at a health care facility. Which statement describes a clean-catch urine sample? A. a sample of urine that is considered sterile B. a sample of urine collected over a period of 24 hours C. a sample of fresh urine collected in a clean container D. a sample of urine collected in a sterile environment
A
A urinalysis has been ordered for a client. When is the best time for the client to provide a urine sample? A. first thing in the morning B. evening C. before bedtime D. afternoon
A
The nurse is caring for a client who has a percutaneous tracheostomy (PCT) following a skydiving accident. Which oxygen delivery device will the nurse select? A. tracheostomy collar B. face tent C. nasal cannula D. simple mask
A
A client is suspected of having a disease process affecting the functional unit of the kidney. Which stucture is most likely involved? A. Glomerulus B. Bowman's capsule C. Nephron D. Loop of Henle
C
The nurse is delegating hygiene care to the unlicensed assistive personnel (UAP) for a client with hypoxia. In which position will the nurse tell the UAP to place the client? A. lithotomy B. Trendelenburg C. high Fowler D. supine
C
The nurse is caring for a client admitted for a mild exacerbation of asthma who has been prescribed portable oxygen at 2 L/min. What delivery device will the nurse select to apply oxygen to the client? A. face tent B. tracheostomy collar C. nasal cannula D. simple mask
C
What is an advantage of using an external condom catheter for a male client who has frequent episodes of urinary incontinence? A. The client can apply it himself with minimal supervision. B. It collects urine into a drainage bag without the risk of infection associated with indwelling urinary catheters. C. A sterile urine specimen can be obtained from the drainage bag tubing. D. It can be left in place for a long period of time.
B
Which teaching about the oxygen analyzer is important for the nurse to provide to a client using oxygen? A. It decreases dry mucous membranes via delivering small water droplets. B. It determines whether the client is getting enough oxygen. C. It prescribes oxygen concentration. D. It regulates the amount of oxygen received.
B
The nurse is conducting a respiratory assessment of a client age 71 years who has been recently admitted to the hospital unit. Which assessment finding should the nurse interpret as abnormal? A. vesicular breath sounds audible over peripheral lung fields B. resonance on percussion of lung fields C. fine crackles to the bases of the lungs bilaterally D. respiratory rate of 18 breaths per minute
C
The nurse should assess for respiratory depression before and after the administration of which drugs? A. Antibiotics and antivirals B. Proton-pump inhibitors C. Opioid analgesics D. Diuretics
C
The health care provider has ordered a 24-hour urine specimen collection for a client. Which nursing action is appropriate? Select all that apply. A. Teach client to void only one time per hour. B. Discard first urine just before starting the test, then collect urine thereafter. C. Ask client to void for the last time at exactly the 24-hour mark. D. Place urine in staff refrigerator. Have client label own urine collection.
B,C
What is the most important risk factor in pulmonary disease? A. air pollution from vehicles B. dangerous chemicals in the workplace C. active and passive cigarette smoke D. loss of the ozone layer of the atmosphere
C
When a nurse observes that an older client's skin is dry and shiny and his nails are thickened, the nurse determines that the client is most likely experiencing A. Anemia B. Malnutrition C. Poor tissue perfusion D. Congestive heart failure
C
Which catheter would the nurse use to drain a client's bladder for short periods (5 to 10 minutes)? A. Foley catheter B. suprapubic catheter C. straight catheter D. indwelling urethral catheter
C
Which is the test that would provide an accurate measurement of the kidney's excretion of creatinine? A. clean-catch specimen B. intermittent specimen C. 24-hour specimen D. random specimen
C
The nurse is caring for a client who reports burning upon urination, and an ongoing sense of needing to urinate. Which urine characteristics does the nurse anticipate? A. light yellow, clear B. strongly aromatic, amber C. cloudy, foul odor D. clear, dark amber
C
A child is admitted to the pediatric division with an acute asthma attack. The nurse assesses the lung sounds and respiratory rate. The mother asks the nurse, "Why is his chest sucking in above his stomach? The nurse's most accurate response is: A. "He is using his chest muscles to help him breathe." B. "He will require additional testing to determine the cause." C. "His lung muscles are swollen so he is using abdominal muscles." D. "His infection is causing him to breathe harder."
A
A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client? A. flow meter B. oxygen analyzer C. nasal cannula D. nasal strip
A
A client has been put on oxygen therapy because of low oxygen saturation levels in the blood. What should the nurse use to regulate the amount of oxygen delivered to the client? A. flow meter B. oxygen analyzer C. nasal strip D. nasal cannula
A
A client is admitted to a hospital unit with scleroderma. The nurse is unfamiliar with this condition. What is the nurse's best source of information about this condition? A. The nursing and medical literature B. The client C. The client's chart D. The client's physician
A
A client who uses portable home oxygen states, "I still like to smoke cigarettes every now and then." What is the appropriate nursing response? A. "You should never smoke when oxygen is in use." B. "An occasional cigarette will not hurt you." C. "I understand; I used to be a smoker also." D. "Oxygen is a flammable gas."
A
A client with a history of advanced liver disease comes to the emergency department (ED) with dehydration. White blood cell count shows elevation in bands and neutrophils. When preparing to catheterize the client, what color urine does the nurse anticipate will drain? A. dark brown, cloudy B. reddish-brown, clear C. aromatic, green D. clear, light yellow
A
A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing: A. bronchiolitis. B. a bronchospasm. C. bronchiectasis. D. bronchitis.
B
A client has a cerebrovascular accident and is incontinent of bowel and bladder. Incontinence of urine in this client is related to a: A. cystocele. B. neurogenic bladder. C. overactive bladder. D. enuresis.
B
A client reports an episode of losing control of urination when a bathroom wasn't close by. The client states, "I'm worried this means that I'm starting to lose control of my bladder." What is the appropriate nursing response? A. "This only happened one time, so it is nothing to worry about." B. "Let's review your medication history and whether you consume bladder irritants." C. "I agree; please make an appointment with your health care provider." D. "I suggest that you invest in incontinence undergarments."
B
A nurse auscultates the lungs of a client with asthma. Which lung sound is characteristic of this condition? A. Vesicular sounds B. Crackles C. Wheezes D. Bronchial sounds
C
A woman is reporting bladder urgency. It is most important to assess: A. vitamin supplements. B. exercise. C. caffeine intake. D. weight.
C
Oxygen and carbon dioxide move between the alveoli and the blood by: A. hyperosmolar pressure. B. negative pressure. C. diffusion. D. osmosis.
C
Upon auscultation of the client's lungs, the nurse hears loud, high-pitched sounds over the larynx. What term will the nurse use in documentation to describe this breath sound? A.Adventitious B. Vesicular C. Bronchovesicular D. Bronchial
D
It is a red air-quality day in the city. This means the air is stagnant, with high pollution levels and high humidity. Which client is most likely to experience shortness of breath? A. Young adult without disease B. Middle-age adult with hypertension C. Teenager with contact dermatitis D. Child with asthma
D
The nurse is auscultating the lungs of a client and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds? A. They are low-pitched, soft sounds heard over peripheral lung fields. B. They are soft, high-pitched discontinuous (intermittent) popping lung sounds. C. They are medium-pitched blowing sounds heard over the major bronchi. D. They are loud, high-pitched sounds heard primarily over the trachea and larynx.
A
The nurse is caring for a client who has been prescribed humidified oxygen at 6 L/minute. Which type of liquid will the nurse gather to set up the humidifier? A. distilled water B. tap water C. normal saline D. mineral oil
A
The nurse is caring for an older adult client on home oxygen who has dentures but has quit wearing them stating that the dentures irritate the gums. What nursing action is appropriate? A. Check the fit of the oxygen mask. B. Increase the flow of oxygen. C. Discontinue oxygen therapy until the client is reassessed by the healthcare provider. D. Contact the oxygen supplier to request an oxygen tent.
A
A 70-year-old client who has four children and six grandchildren states that she "wets" herself when she sneezes or laughs. She reports that sometimes this also occurs when rising from a sitting to standing position. Which type of incontinence does the nurse anticipate? A. stress B. total C. reflect D. urge
A
In which client should the nurse prioritize assessments for respiratory depression? A. A client taking opioids for cancer pain B. A client taking a beta-adrenergic blocker for hypertension C. A client taking insulin for type 1 diabetes D. A client taking antibiotics for a urinary tract infection
A
The nurse is inserting a urinary catheter into a 63-year-old male client and encounters resistance. What is the most likely cause of the resistance? A. The client has an enlarged prostate. B. The diameter of the catheter is too large. C. The nurse failed to deflate the retention balloon after pretesting it for integrity. D. The client has an occult abscess in the urethra.
A
To determine the quality of oxygenation, the nurse performs the physical assessment, the arterial blood gas test, and pulse oximetry. What is the purpose of the pulse oximetry test? A. Monitor the pressure of oxygen dissolved in plasma. B. Monitor the amount of oxygen saturation in the blood. C. Calculate the pressure of carbon dioxide dissolved in plasma. D. Measure the volume of air exhaled or inhaled over time.
B
A woman informs the nurse that when she is experiencing stress it is difficult to void, and wonders why this happens. What is the nurse's best explanation? A. "You require greater privacy to void." B. "You might have a neurologic condition." C. "Stress causes the muscles to become tense." D. "What medications are you taking?"
C
The nurse is attempting to insert a urinary catheter into a female client's bladder and realizes the catheter has been inserted into the vagina. Which action is most appropriate? A. Leave the catheter in place as a marker and attempt to insert a new sterile catheter directly above the misplaced catheter. B. Immediately remove the catheter from the vagina, contact the health care provider, and anticipate a prescription for prophylactic antibiotics. C. Remove the catheter from the vagina and attempt to insert it into the bladder. D. Ask the client to bear down until the catheter is expelled.
A
When collecting a urine sample from a client for examination, the nurse notes that the sample appears reddish-brown in color. What could cause this variation in color of the urine? A. blood B. infection C. stasis D. dehydration
A
A client is diagnosed with frequent urinary tract infections. What would be an appropriate question for the nurse to ask the client? A. "Are you on any type of special diet at home?" B. "How frequently do you urinate each day?" C. "Are you on any blood pressure medications?" D. "How often do you have a bowel movement?"
B
The nurse is demonstrating oxygen administration to a client. Which teaching will the nurse include about the humidifier? A. "It measures the percentage of delivered oxygen to determine whether the client is getting the amount prescribed." B. "This is a gauge used to regulate the amount of oxygen that a client receives." C. "The humidifier prescribes the concentration of oxygen." D. "Small water droplets come from this, thus preventing dry mucous membranes."
D
The nurse is preparing to catheterize a client who is incontinent of urine following bladder surgery. What fact should the nurse keep in mind when performing catheterization? A. Pathogens introduced into the bladder remain in the bladder. B. A normal bladder is as susceptible to infection as an injured one. C. The external opening to the urethra should always be sterilized. D. The bladder normally is a sterile cavity.
D
The nurse is working with a client who requires continence training. Which client teaching about pelvic floor muscle exercises (Kegel exercises) will the nurse include? A. Relax muscles for at least 5 minutes between Kegels. B. Loosen the internal muscles used to prevent or interrupt urination. C. Perform these exercises two times daily for a week. D. Keep muscles contracted for at least 10 seconds.
D
The nurse is teaching the client with a pulmonary disorder about deep breathing. The client asks, "Why is it important to start by breathing through my nose, then exhaling through my mouth?" Which appropriate response would the nurse give this client? A. "Breathing through your nose first will warm, filter, and humidify the air you are breathing." B. "We are concerned about you developing a snoring habit, so we encourage nasal breathing first." C. "If you breathe through the mouth first, you will swallow germs into your stomach." D. "Breathing through your nose first encourages you to sit up straighter to increase expansion of the lungs during inhalation."
A
When reviewing data collection on a client with a cardiac output of 2.5 L/minute, the nurse inspects the client for which symptom? A. Rapid respirations B. Weight loss C. Increased urine output D. Mental alertness
A
Which dietary guideline would be appropriate for the older adult homebound client with advanced respiratory disease who informs the nurse that she has no energy to eat? A. Eat smaller meals that are high in protein. B. Eat one large meal at noon. C. Contact the physician for nutrition shake. D. Snack on high-carbohydrate foods frequently.
A
Which medication is administered in the home or the hospital to relieve inflammation in the lung tissue? A. Corticosteroids B. Expectorants C. Antibiotics D. Bronchodilators
A
Which piece of client information is subjective? A. Generalized myalgia or muscle pain B. A temperature of 102°F (38.9°C) C. Alert and oriented to person and place but not time or situation D. Ptosis, a drooping of the eyelid, on the right side E. Leukoplakia on the client's oral mucosa
A
birth. The client voices concern to the nurse. What information should be provided to the client? A. The birth can cause perineal swelling. B.Catheterization is necessary for 1 week. C. A urinary tract infection results from the birth process. D. A neurogenic bladder results from local anesthesia.
A
A client vomits as a nurse is inserting his oropharyngeal airway. What would be the most appropriate intervention in this situation? A. Leave the airway in place and promptly notify the health care provider for further instructions. B. Immediately remove the airway, rinse the client's mouth with sterile water, and report this to the health care provider. C. Suction the client's mouth through the oropharyngeal airway to prevent aspiration. D. Remove the airway, turn the client to the side, and provide mouth suction, if necessary.
D
A client who was prescribed CPAP reports nonadherence to treatment. What is the priority nursing intervention? A. Explain the use of a BiPAP mask instead of a CPAP mask. B. Document outcomes of modifications in care. C. Contact the health care provider to report the client's current status. D. Ask the client what factors contribute to nonadherence.
D
A client with a history of chronic obstructive pulmonary disease (COPD) has been ordered oxygen at 3 L/min as needed for treatment of dyspnea. What delivery mode is most appropriate to this client's needs? A. Simple mask B. Nonrebreather mask C. Partial rebreather mask D. Nasal cannula
D
A client with chronic obstructive pulmonary disease (COPD) requires low flow oxygen. How will the oxygen be administered? A. enturi mask B. partial rebreather mask C. simple oxygen mask D. nasal cannula
D
A nurse is caring for a client with a hemodialysis access site. Which action should the nurse take? A. Perform venipuncture below the access site to obtain a blood sample for laboratory testing. B. Measure the client's blood pressure on the arm above the access site. C. Administer an IV on the arm high above the access site. D. Auscultate over the access site with the bell of a stethoscope, listening for a bruit or vibration.
D
The nurse is caring for a postoperative client who has a prescription for meperidine 75 mg intramuscularly (IM) every 4 hours as needed for pain. Before and after administering meperidine, the nurse would assess which most important sign? A. Orthostatic blood pressure B. Respiratory rate and depth C. Urinary intake and output D. Apical pulse
B
The nurse schedules a pulmonary function test to measure the amount of air left in a client's lungs at maximal expiration. What test does the nurse order? A. Total lung capacity (TLC) B. Residual Volume (RV) C. Forced Expiratory Volume (FEV) D. Tidal volume (TV)
B
A nurse is volunteering at a day camp. A child is stung by a bee and develops wheezing in the upper airways. The child is experiencing: A. bronchitis. B. bronchiolitis. C. bronchiectasis. D. a bronchospasm.
D
A nurse will use a bladder scanner to assess a client with urinary frequency. How should the nurse best prepare the client for this procedure? A. Have the client rest for 15 minutes before the assessment. B. Assess the client's need for analgesia. C. Administer a diuretic, as ordered. D. Position the client in a supine position.
D
A sterile urine specimen for culture and sensitivity has been ordered for a client who has an indwelling urinary catheter. How should the nurse obtain this specimen? A. Discontinue the indwelling catheter and insert an intermittent catheter to obtain the sterile specimen. B. Empty the collection bag, wait 30 minutes, and then collect the contents of the collection bag. C. Collect a urine specimen from the collection bag first thing in the morning, or a few hours after the client receives a diuretic. D. Withdraw several milliliters of urine from the port on the collection tubing, using a syringe and needle.
D
The health care provider has ordered a Foley catheter for a 48-year-old male client who is in traction with leg fractures. The client refuses, stating "I don't want something placed internally into me." What is the appropriate nursing response? A. "This is the only option for catheterization." B. "You will have to ambulate to the bathroom to urinate." C. "Foley catheters do not hurt, and I will be careful placing it." D. "Let me talk to your health care provider about a condom catheter."
D
Use of an indwelling urinary catheter leads to the loss of bladder tone. False True
True
Which statement should the nurse convey to the mother of a 3-year-old son who has not achieved urinary continence? A. Daytime continence is usually not achieved by boys until age 5. B. Boys may walk by 1 year and should be continent by 3 years. C. Incontinence after the age of 3 years is not normal. D. Boys may take longer for daytime continence than girls.
D
The nurse is preparing discharge teaching for a client who has chronic obstructive pulmonary disease (COPD). Which teaching about deep breathing will the nurse include? A. "Inhale slowly over three seconds, purse your lips, contract abdominal muscles, and exhale slowly." B. "Take in a little air over 10 seconds, hold your breath 15 seconds, and exhale slowly." C. "Take in a large volume of air over 5 seconds and hold your breath as long as you can before exhaling." D. "Take in a small amount of air very quickly and then exhale as quickly as possible."
A
The nurse is caring for an older adult client on home oxygen who has dentures but has quit wearing them stating that the dentures irritate the gums. What nursing action is appropriate? A. Contact the oxygen supplier to request an oxygen tent. B. Increase the flow of oxygen. C. Discontinue oxygen therapy until the client is reassessed by the healthcare provider. D. Check the fit of the oxygen mask.
D
The nurse is preparing to insert an indwelling urinary catheter into a female client's bladder. The nurse has opened the sterile catheterization tray using sterile technique, donned sterile gloves and has opened all sterile supplies. Arrange the following steps in the correct order. A. Advance the catheter until there is a return of urine. B. Discard used supplies. C. Insert the lubricated catheter into the urethra. D. Clean each labial fold, then the area directly over the meatus. E. Inflate the balloon with the correct amount of sterile saline
D, C, A, E, B
The nurse is caring for a 14-year-old client who has just delivered a baby. The client reports living with an aunt and having no other family around. The delivery was uncomplicated and the newborn is healthy. Which would be the primary nursing diagnosis for this client?A. Ineffective Breastfeeding B. Risk for Loneliness C. Ineffective Infant Feeding Pattern D. Risk for Impaired Parenting E. Acute Pain
D
A client with no prior history of respiratory illness has been admitted to a postoperative unit following foot surgery. What intervention should the nurse prioritize in an effort to prevent postoperative pneumonia and atelectasis during this time of reduced mobility following surgery? A. oropharyngeal suctioning twice daily B. administration of inhaled corticosteroids C. educating the client on the use of incentive spirometry D. educating the client on pursed-lip breathing techniques
C
A nurse assessing a client's respiratory effort notes that the client's breaths are shallow and 8 per minute. Shortly after, the client's respirations cease. Which form of oxygen delivery should the nurse use for this client? A. Nasal cannula B. Oxygen tent C. Ambu bag D. Oxygen mask
C
A nurse is caring for an asthmatic client who requires a low concentration of oxygen. Which delivery device should the nurse use in order to administer oxygen to the client? A. simple mask B. face tent C. nasal cannula D. nonrebreather mask
C
A nurse is reading a journal article about pollutants and their effect on an individual's respiratory function. Which problem would the nurse most likely identify as an effect of exposure to automobile pollutants? A. Bronchiectasis B. Atelectasis C. Bronchitis D. Croup
C
Which statement by a nurse best indicates an accurate understanding of the different types of assessments? A. "The physician informs the nurse of which type of assessment to perform for each client." B. "It is up to the nurse to decide which assessment to perform." C. "The purpose for the assessment offers guidance for which type and how much data to collect." D. "How much time the nurse has and how the client is feeling determine which type of assessment to perform."
C
The nurse is assessing a 3-week-old infant who has not gained weight since birth. The infant's bowel sounds are present in all quadrants and breath sounds are clear to auscultation. The infant's mother reports that the child cries much of the night but sleeps better in the daytime. The mother reports that the child only breastfeeds about four times in a 24-hour period and that the mother doesn't seem to have much milk. Which nursing diagnosis would be of highest priority for this client? A. Impaired Comfort B. Ineffective Breastfeeding C. Readiness for Enhanced Parenting D. Disturbed Sleep Pattern E. Risk for Impaired Parenting
B
The nurse is auscultating the lungs of a client and detects normal vesicular breath sounds. What is a characteristic of vesicular breath sounds? A. They are loud, high-pitched sounds heard primarily over the trachea and larynx. B. They are low-pitched, soft sounds heard over peripheral lung fields. C. They are medium-pitched blowing sounds heard over the major bronchi. D. They are soft, high-pitched discontinuous (intermittent) popping lung sounds.
B
The nurse is caring for a client with a prescription for a midstream urine specimen. The nurse would provide which information to the client? A. "Void into the specimen hat in the toilet bowl." B. "Void a small amount, stop, and discard it." C. "Save all urine for the next 24 hours." D. "You will have a catheter put in to collect the urine."
B
The nurse is catheterizing a male urinary bladder, and urine leaks out of the meatus around the catheter. Which actions would the nurse perform next? Select all that apply. A. If underfill is suspected, attempt to push the catheter further into the bladder. B. Increase the size of the indwelling catheter. C. Make sure the smallest sized catheter with a 10-mL balloon is used. D. Consider an evaluation for urinary tract infection. E. Assess the client for diarrhea. F. Ensure that the correct amount of solution was used to inflate the balloon.
C, D, F
The nurse is gathering subjective data from a client during an interview after a suicide attempt. Which assessment data gathered by the nurse would be documented as subjective data? Select all that apply. A. Ecchymosis on upper left arm B. Clothes unkempt and hair greasy C. Client states, "I am in pain." D. Blood pressure 140/82 mm Hg E. Client states, "I feel so sad all of the time."
C, E
A client's BUN test results are significantly elevated. When reviewing the client's history, which finding is consistent with BUN elevation other than renal compromise? A. The client is lactose intolerant. B. The client is dehydrated. C. The client is on a low protein diet. D. The client has a history of osteoarthritis.
B
A nurse drains the bladder of a client by inserting a catheter for 5 minutes. What type of catheter would the nurse use in this instance? A. retention catheter B. intermittent urethral catheter C. indwelling urethral catheter D. Foley catheter
B
During data collection, the nurse auscultates low-pitched, soft sounds over the lungs' peripheral fields. Which appropriate terminology would the nurse use to describe these lung sounds when documenting? A. Bronchovesicular B. Crackles C. Vesicular D. Bronchial
C
The health care provider prescribes a long-term continuous drainage system to monitor a chronically ill client. What type of catheter would best suit this client's needs? A. external catheter B. intermittent urethral catheter C. suprapubic catheter D. indwelling urethral catheter
C
While providing care to a client admitted to the health care facility, the client states that she has "a burning sensation when urinating." After further questioning, the nurse inspects the client's perineal area. Which sign/symptom would the nurse document as an abnormal finding? A. Absence of discharge B. Moist perineal skin C. Reddened perineal skin D. Presence of smegma
C
A client at the health care facility has been diagnosed with total urinary incontinence. How could the nurse describe the condition of the client? A. loss of small amount of urine when intra-abdominal pressure rises B. need to void is perceived frequently, with short-lived ability to sustain control of flow D. loss of urine control because a toilet is not accessible E. loss of urine without any identifiable pattern or warning
E
An older adult client was recently placed on home oxygen. The client's caregiver reports that the client now refuses to leave the house. What teaching will the nurse provide the caregiver? Select all that apply. A. "Remove the oxygen for times when the client wants to leave the house." B. "Give the client time to adjust." C. "Continued socialization with others is important." D. "Invite friends and family to the client's house." E. "Discuss with the client switching to a portable oxygen device."
C,D,E
During data collection the nurse may validate data by which method? Select all that apply. A. Referring to textbooks, journals, and research reports B. Using cues from one source C. Checking the consistency of cues D. Clarifying the client's statements E. Seeking consensus among colleagues about inferences
A, C, D, E
A client comes to a health care facility reporting abdominal pain and vomiting. The client's spouse informs the nurse that the client went out for dinner the previous night. The report that the client went out for dinner the previous night is example of data from which type of source? A. Primary B. Teritiary C. Secondary D. Quaternary
C
A client is preparing to give a clean-catch specimen. Which instruction will the nurse provide? A. Collect the first urine expelled. B. Collect the entire urinary output. C. After the initial stream is initiated, collect the sample. D. Wait until the void is almost over to collect a specimen.
C
A client returns to the telemetry unit after an operative procedure. Which diagnostic test will the nurse perform to monitor the effectiveness of the oxygen therapy ordered for the client? A. peak expiratory flow rate B. spirometry C. pulse oximetry D. thoracentesis
C
A client in a long-term care facility becomes confused and disoriented at night and is incontinent during these periods of confusion due to the inability to find the commode. During the day, the client does not experience confusion and is continent. What type of incontinence is this client experiencing during the nighttime hours? A. reflex incontinence B. transient incontinence C. stress incontinence D. functional incontinence
D
A client reports to the nurse that after delivering a baby, she loses small amounts of urine each time she sneezes or laughs hard. Which type of incontinence does the nurse anticipate? A. reflex B. total C. urge D. stress
D
The nurse educator is presenting a lecture on clients at risk for developing urinary tract infections (UTIs). Which response made by the staff nurse would indicate to the educator a need for further teaching? A."I will make sure to teach my clients with diabetes mellitus to control their glucose level to help prevent a UTI." B. "A woman using an intrauterine device for contraceptive reason is at risk for developing a UTI." C. "Due to the physiologic changes with aging, the elderly are at risk for developing a UTI." D. "Having sexual relationships does not put a woman at risk for developing a UTI."
D
The nurse educator is presenting a lecture on the respiratory and cardiovascular systems. Which response given by the nursing staff would indicate to the educator that they have an understanding of cardiac output? A. "If the client's stroke volume is 80 mL and heart rate is 80 beats per minute, then the cardiac output is 6.0 L/minute." B. "If the client's stroke volume is 60 mL and heart rate is 60 beats per minute, then the cardiac output is 3.2 L/minute." C. "If the client's stroke volume is 70 mL and heart rate is 70 beats per minute, then the cardiac output is 4.7 L/minute." D. "If the client's stroke volume is 50 mL and heart rate is 50 beats per minute, then the cardiac output is 2.5 L/minute."
D
The nurse is assessing a client for changes in health condition. After listening to the client's lungs for adventitious breath sounds, the nurse also checks the client's latest white blood cell count. The nurse is gathering which type of data when looking up the lab value? A. Secondary B. Primary C. Subjective D. Objective
D
A nurse is caring for a client who has an infant age 4 months. The client informs the nurse that she has been experiencing a sudden loss of urine whenever she laughs; this is causing embarrassment to her. Which type of urinary incontinence is this client experiencing? A. urge incontinence B. stress incontinence C. functional incontinence D. reflex incontinence
B
