471 Final

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A client who has undergone surgery and radiation therapy to treat oral cancer reports persistent dry mouth. What will the nurse teach this client about managing this symptom? A. Use saliva substitutes, especially when eating dry foods. B. This condition is common but is temporary. C. Use lozenges and hard candies to prevent dry mouth. D. This indicates a complication of therapy.

After change-of-shift report, which client does the nurse plan to assess first? A. Young adult who had a tracheostomy tube removed at the end of the last shift B. Adult who has severe xerostomia associated with radiation therapy C. Middle-aged adult who is describing oral pain after a partial glossectomy D. Older adult who has lost 10 pounds (4.5 kg) secondary to stomatitis

The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? A. Acyclovir (Zovirax) B. Diphenhydramine (Benadryl) C. Nystatin (Mycostatin) D. Tetracycline syrup (Sumycin syrup)

The nurse teaches a client who is recovering from acute kidney disease to avoid which type of medication? A. Nonsteroidal anti-inflammatory drugs (NSAIDs) B. Angiotensin-converting enzyme (ACE) inhibitors C. Opiates D. Calcium channel blockers

When assisting with dietary protein needs for a client on peritoneal dialysis, the nurse recommends that the client select which food? A. Eggs B. Ham C. Eggplant D. Macaroni

Which of the following is the best indicator of an excessive response to diuretic therapy? 1. Elevated BUN & HCT & an 8 pound weight loss in 24 hours 2. Elevated BUN & HCT & an 8 pound weight gain in 24 hours 3. Decreased BUN & HCT & an 8 pound weight loss in 24 hours 4. Decreased BUN & HCT & an 8 pound weight gain in 24 hours

A 45 y.o. diagnosed with fluid volume overload due to acute kidney dysfunction is placed on a 1000 mL fluid restriction per 24-hour period. The client asks the nurse, "Why is there such a severe fluid restriction when I already have dry lips and mouth?" Which response by the nurse is best? 1. "The doctor ordered the fluid restriction, so you must comply with those orders." 2. "Your kidneys are not able to eliminate extra fluid right now, so fluid intake has to be limited to protect your heart & lungs from being overloaded with fluid." 3. "You probably drank too much fluid before you got sick, so you can't compare your usual intake to your limitations now that your kidneys are not working." 4. "Too much fluid will cause your heart to fail & your lungs to fill up with water, which could be fatal."

nAn adult client in the clinic complains of a cough, fever, nausea, & vomiting for 3 days. Exam reveals dry tongue & oral mucosa & concentrated urine. The client also reports feeling weak & dizzy. Which vital sign measurement would provide the best indicator of current fluid status? 1. Temperature 2. Respiratory rate & depth 3. BP & pulse in lying & standing positions 4. Pulse oximetry reading at rest

A client has been admitted to the medical intensive care unit with a diagnosis of diabetes insipidus (DI) secondary to lithium overdose. Which medication is used to treat the DI? A. Desmopressin (DDAVP) B. Dopamine hydrochloride (Intropin) C. Prednisone D. Tolvaptan (Samsca)

A client has been diagnosed with mild gastroesophageal reflux disease and asks the nurse about nonpharmacologic treatments to prevent symptoms. What does the nurse tell this client? A. "Avoid caffeine-containing foods and beverages." B. "Eat three meals each day and avoid snacking between meals." C. "Peppermint lozenges help to reduce stomach upset." D. "Sleep on your left side with a pillow between your knees."

A client has been diagnosed with terminal gastric cancer and is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Pain control is a major component of the care provided by hospice and its staff members." B. "What has your provider told you about participating in hospice?" C. "I can speak to your provider about requesting adequate pain medication." D. "You don't want to become too dependent on pain medication and become an addict."

A client has been discharged home after surgery for gastric cancer, and a case manager will follow up with the client. To ensure a smooth transition from the hospital to the home setting, which information provided by the hospital nurse to the case manager is given the highest priority? A. Schedule of the client's follow-up examinations and x-ray assessments B. Information on family members' progress in learning how to perform dressing changes C. Copy of the diet plan prepared for the client by the hospital dietitian D. Detailed account of what occurred during the client's surgical procedure

A client has returned from a captopril renal scan. Which teaching does the nurse provide when the client returns? A. "Arise slowly and call for assistance when ambulating." B. "I must measure your intake and output." C. "We must save your urine because it is radioactive." D. "I must attach you to this cardiac monitor."

A client has undergone a radical neck dissection for cancer and is being discharged home while undergoing radiation therapy. Which is likely to be the most important aspect of this client's outpatient care? A. Dental care B. Infection prevention C. Nutrition services D. Support group for cancer survivors

A client is admitted to the hospital with elevated serum amylase and lipase levels and a decreased calcium level. Which gastrointestinal health problem is indicated by these laboratory findings? A. Acute pancreatitis B. Cirrhosis C. Crohn's disease D. Diarrhea

A client is being discharged with propylthiouracil (PTU). Which statement by the client indicates a need for further teaching by the nurse? A. "I can return to my job at the nursing home." B. "I must call if my urine is dark." C. "I must faithfully take the drug every 8 hours." D. "I need to report weight gain."

A client is experiencing bleeding related to peptic ulcer disease (PUD). Which nursing intervention is the highest priority? A. Starting a large-bore IV B. Administering IV pain medication C. Preparing equipment for intubation D. Monitoring the client's anxiety level

A client is scheduled for a colonoscopy. What does the nurse tell the client to do before the procedure is performed? A. "Begin a clear liquid diet 12 to 24 hours before the test." B. "Do not eat or drink anything for 12 hours before the test." C. "Give yourself tap water enemas until the fluid returns are clear." D. "You will have to drink a contrast liquid 2 hours before the test."

A client is scheduled to be discharged after a gastrectomy. The client's spouse expresses concern that the client will be unable to change the surgical dressing adequately. What is the nurse's highest priority intervention? A. Providing both oral and written instructions on changing the dressing and on symptoms of infection that must be reported to the provider B. Asking the provider for a referral for home health services to assist with dressing changes C. Asking the spouse whether other family members could be taught how to change the dressing D. Trying to determine specific concerns that the spouse has regarding dressing changes

A client presents to the emergency department with a history of adrenal insufficiency. The following laboratory values are obtained: Na+ 130 mEq/L, K+ 5.6 mEq/L, and glucose 72 mg/dL. Which is the first request that the nurse anticipates? A. Administer insulin and dextrose in normal saline to shift potassium into cells. B. Give spironolactone (Aldactone) 100 mg orally. C. Initiate histamine2 (H2) blocker therapy with ranitidine for ulcer prophylaxis. D. Obtain arterial blood gases to assess for peaked T waves.

A client who had been hospitalized with pancreatitis is being discharged with home health services. The client is severely weakened after this illness. Which nursing intervention is the highest priority in conserving the client's strength? A. Limiting the client's activities to one floor of the home B. Instructing the client to take an as-needed (PRN) sleeping medication at night C. Arranging for the client to have a nutritional consult to assess the client's diet D. Asking the health care provider for a request for PRN nasal oxygen

A client who is admitted with urolithiasis reports "spasms of intense flank pain, nausea, and severe dizziness." Which intervention does the nurse implement first? A. Administer morphine sulfate 4 mg IV. B. Begin an infusion of metoclopramide (Reglan) 10 mg IV. C. Obtain a urine specimen for urinalysis. D. Start an infusion of 0.9% normal saline at 100 mL/hr.

A client who was previously diagnosed with a urinary tract infection (UTI) and started on antibiotics returns to the clinic 3 days later with the same symptoms. When asked about the previous UTI and medication regimen, the client states, "I only took the first dose because after that, I felt better." How does the nurse respond? A. "Not completing your medication can lead to return of your infection." B. "That means your treatment will be prolonged with this new infection." C. "This means you will now have to take two drugs instead of one." D. "What you did was okay; however, let's get you started on something else."

A client with a recently created vascular access for hemodialysis is being discharged. In planning discharge instructions, which information does the nurse include? A. Avoiding venipuncture and blood pressure measurements in the affected arm ` B. Modifications to allow for complete rest of the affected arm C. How to assess for a bruit in the affected arm D. How to practice proper nutrition

A client with an endocrine disorder says, "I can't, you know, satisfy my wife anymore." What is the nurse's best response? A. "Can you please tell me more?" B. "Don't worry. That is normal." C. "How does she feel?" D. "Should I make an appointment with a counselor?"

A client with chronic kidney disease asks the nurse about the relationship between the disease and high blood pressure. What is the nurse's best response? A. "Because the kidneys cannot get rid of fluid, blood pressure goes up." B. "The damaged kidneys no longer release a hormone that prevents high blood pressure." C. "The waste products in the blood interfere with other mechanisms that control blood pressure." D. "This is a compensatory mechanism that increases blood flow through the kidneys in an effort to get rid of some of the waste products."

A client with chronic kidney disease reports chest pain. The nurse notes tachycardia and low-grade fever. Which additional assessment is warranted? A. Auscultate for pericardial friction rub. B. Assess for crackles. C. Monitor for decreased peripheral pulses. D. Determine if the client is able to ambulate.

A client with diabetes insipidus (DI) has dry lips and mucous membranes and poor skin turgor. Which intervention does the nurse provide first? A. Force fluids B. Offer lip balm C. Perform a 24-hour urine test D. Withhold desmopressin acetate (DDAVP)

A client with iatrogenic Cushing's syndrome is a resident in a long-term care facility. Which nursing action included in the client's care would be best to delegate to unlicensed assistive personnel (UAP)? A. Assist with personal hygiene and skin care. B. Develop a plan of care to minimize risk for infection. C. Instruct the client on the reasons to avoid overeating. D. Monitor for signs and symptoms of fluid retention.

A client with pheochromocytoma is admitted for surgery. What does the nurse do for the admitting assessment? A. Avoids palpating the abdomen B. Monitors for pulmonary edema with a chest x-ray C. Obtains a 24-hour urine specimen on admission D. Places the client in a room with a roommate for distraction

A client with syndrome of inappropriate antidiuretic hormone is admitted with a serum sodium level of 105 mEq/L. Which request by the health care provider does the nurse address first? A. Administer infusion of 150 mL of 3% NaCl over 3 hours. B. Draw blood for hemoglobin and hematocrit. C. Insert retention catheter and monitor urine output. D. Weigh the client on admission and daily thereafter.

A client with these assessment data is preparing to undergo a computed tomography scan with contrast: Which medication does the nurse plan to administer before the procedure? A. Acetylcysteine (Mucosil) B. Metformin (Glucophage) C. Captopril (Capoten) D. Acetaminophen (Tylenol)

A client with type 1 diabetes arrives in the emergency department breathing deeply and stating, "I can't catch my breath." The client's vital signs are: T 98.4° F (36.9° C), P 112 beats/min, R 38 breaths/min, BP 91/54 mm Hg, and O2 saturation 99% on room air. Which action does the nurse take first? A. Check the blood glucose. B. Administer oxygen. C. Offer reassurance. D. Attach a cardiac monitor.

A client, who is a mother of two, has autosomal dominant polycystic kidney disease (ADPKD). Which statement by the client indicates a need for further education about her disease? A. "By maintaining a low-salt diet in our house, I can prevent ADPKD in my children." B. "Even though my children don't have symptoms at the same age I did, they can still have ADPKD." C. "If my children have the ADPKD gene, they will have cysts by the age of 30." D. "My children have a 50% chance of inheriting the ADPKD gene that causes the disease."

After receiving change-of-shift report about these four clients, which client does the nurse attend to first? A. Client with acute adrenal insufficiency who has a blood glucose of 36 mg/dL B. Client with diabetes insipidus who has a dose of desmopressin (DDAVP) due C. Client with hyperaldosteronism who has a serum potassium of 3.4 mEq/L D. Client with pituitary adenoma who is reporting a severe headache

After receiving change-of-shift report on these clients, which client does the nurse plan to assess first? A. Young adult client with acute pancreatitis who is dyspneic and has a respiratory rate of 34 to 38 breaths/min B. Adult client admitted with cholecystitis who is experiencing severe right upper quadrant abdominal pain C. Middle-aged client who has an elevated temperature after undergoing endoscopic retrograde cholangiopancreatography D. Older adult client who is receiving total parenteral nutrition after a Whipple procedure and has a glucose level of 235 mg/dL

An older adult woman who reports a change in bladder function says, "I feel like a child who sometimes pees her pants." What is the nurse's best response? A. "Have you tried using the toilet at least every couple of hours?" B. "How does that make you feel?" C. "We can fix that." D. "That happens when we get older."

An older female client is diagnosed with gastric cancer. Which statement made by the client's family demonstrates a correct understanding of the disorder? A. "This may be related to her recurring ulcer disease." B. "This is probably curable with surgery." C. "Gastric cancer has a strong genetic component." D. "Thank goodness she won't have to undergo surgery."

As a result of being treated with radiation for oral cancer, a client is experiencing xerostomia. What community resource does the nurse suggest for this client's care? A. Dentist B. Occupational therapist C. Psychiatrist D. Speech therapist

The RN has just received change-of-shift report. Which of the assigned clients should be assessed first? A. Client with chronic kidney failure who was just admitted with shortness of breath B. Client with kidney insufficiency who is scheduled to have an arteriovenous fistula inserted C. Client with azotemia whose blood urea nitrogen and creatinine are increasing D. Client receiving peritoneal dialysis who needs help changing the dialysate bag

The charge nurse on the medical-surgical unit is making client assignments for the shift. Which client is the most appropriate to assign to an LPN/LVN? A. Client with Cushing's syndrome who requires orthostatic vital signs assessments B. Client with diabetes mellitus who was admitted with a blood glucose of 45 mg/dL C. Client with exophthalmos who has many questions about endocrine function D. Client with possible pituitary adenoma who has just arrived on the nursing unit

The nurse caring for four diabetic clients has all of these activities to perform. Which is appropriate to delegate to unlicensed assistive personnel (UAP)? A. Perform hourly bedside blood glucose checks for a client with hyperglycemia. B. Verify the infusion rate on a continuous infusion insulin pump. C. Monitor a client with blood glucose of 68 mg/dL for tremors and irritability. D. Check on a client who is reporting palpitations and anxiety.

The nurse educates a group of women who have had frequent urinary tract infections (UTIs) about how to avoid recurrences. Which client statement shows a correct understanding of what the nurse has taught? A. "I should be drinking at least 1.5 to 2.5 liters of fluids every day." B. "It is a good idea for me to reduce germs by taking a tub bath daily." C. "Trying to get to the bathroom to urinate every 6 hours is important for me." D. "Urinating 1000 mL on a daily basis is a good amount for me."

The nurse has just received change-of-shift report on the endocrine unit. Which client does the nurse see first? A. Client with type 1 diabetes whose insulin pump is beeping "occlusion" B. Newly diagnosed client with type 1 diabetes who is reporting thirst C. Client with type 2 diabetes who has a blood glucose of 150 mg/dL D. Client with type 2 diabetes with a blood pressure of 150/90 mm Hg

The nurse has placed a nasogastric (NG) tube in a client with upper gastrointestinal (GI) bleeding to administer gastric lavage. The client asks the nurse about the purpose of the NG tube for the procedure. What is the nurse's best response? A. "Saline goes down the tube to help clean out your stomach." B. "Medication goes down the tube to help clean out your stomach." C. "The provider requested the tube to be placed just in case it was needed." D. "We'll start feeding you through it once your stomach is cleaned out."

The nurse is assessing a client who had abdominal surgery yesterday. What method provides the most accurate data about resumption of peristalsis in the client? A. Asking the client whether he or she has passed flatus (gas) B. Auscultating bowel sounds in all abdominal quadrants C. Counting the number of bowel sounds in each abdominal quadrant D. Observing the abdomen for symmetry and distention

The nurse is caring for a client diagnosed with esophageal cancer who is experiencing diarrhea after conventional esophageal surgery. The nurse anticipates that the health care provider will request which medication to manage diarrhea? A. Loperamide (Imodium) B. Mesalamine (Pentasa) C. Minocycline (Minocin) D. Pantoprazole (Protonix)

The nurse is caring for a client who has just returned to the surgical unit after a radical nephrectomy. Which assessment information alarms the nurse? A. Blood pressure is 98/56 mm Hg; heart rate is 118 beats/min. B. Urine output over the past hour was 80 mL. C. Pain is at a level 4 (on a 0-to-10 scale). D. Dressing has a 1-cm area of bleeding.

The nurse is caring for a client with a hiatal hernia who had an open fundoplication yesterday. Which task does the nurse delegate to unlicensed assistive personnel (UAP)? A. Using a pillow to support the incision when the client coughs Q B. Adjusting the position of the nasogastric (NG) tube C. Assessing the level of postoperative pain using a 0-to-10 scale D. Giving the client sips of water once bowel sounds are heard

The nurse is caring for an older adult male client who reports stomach pain and heartburn. Which symptom is most significant in determining whether the client's ulceration is gastric or duodenal in origin? A. Pain occurs 1½ to 3 hours after a meal, usually at nighT B. Pain is worsened by the ingestion of food C. The client has a malnourished appearance. D. The client is a man older than 50 years.

The nurse is instructing a client who will undergo a suppression test. Which statement by the client indicates that teaching was effective? A. "I am being tested to see whether my hormone glands are hyperactive." B. "I am being tested to see whether my hormone glands are hypoactive." C. "I am being tested to see whether my kidneys work at all." D. "I will be given more hormones as a trigger."

The nurse is providing discharge teaching to a client with diabetes about injury prevention for peripheral neuropathy. Which statement by the client indicates a need for further teaching? A. "I can break in my shoes by wearing them all day." B. "I need to monitor my feet daily for blisters or skin breaks." C. "I should never go barefoot." D. "I should quit smoking."

The nurse is questioning a female client with a urinary tract infection (UTI) about her antibiotic drug regimen. Which statement by the client indicates a need for further instruction? A. "I take my medication only when I have symptoms." B. "I always wipe front to back." C. "I don't use bubble baths and other scented bath products." D. "I try to drink 3 liters of fluid a day."

The nurse is reinforcing the instructions on swallowing provided by the speech-language pathologist to a client diagnosed with esophageal cancer. Which instruction to the client is the highest priority? A. Place food at the back of the mouth as you eat. B. Do not be overly concerned with tongue or lip movements. C. Before swallowing, tilt the head back to straighten the esophagus. D. Do not attempt to reach food particles that are on the lips or around the mouth.

The nurse is teaching a client about how to monitor therapy effectiveness for syndrome of inappropriate antidiuretic hormone. What does the nurse tell the client to look for? A. Daily weight gain of less than 2 pounds B. Dry mucous membranes C. Increasing heart rate D. Muscle spasms

The nurse is teaching a client about maintaining a proper diet to prevent an endocrine disorder. Which food does the nurse suggest after the client indicates a dislike of fish? A. Iodized salt for cooking B. More red meat C. More green vegetables D. Salt substitute for cooking

The nurse is teaching a client with peptic ulcer disease about the prescribed drug regimen. Which statement made by the client indicates a need for further teaching before discharge? A. "Nizatidine (Axid) needs to be taken three times a day to be effective." B. "Taking ranitidine (Zantac) at bedtime should decrease acid production at night." C. "Sucralfate (Carafate) should be taken 1 hour before and 2 hours after meals." D. "Omeprazole (Prilosec) should be swallowed whole and not crushed."

The nurse is teaching a client with type 2 diabetes about the importance of weight control. Which comment by the client indicates a need for further teaching? A. "I should begin exercising for at least an hour a day." B. "I should monitor my diet." C. "If I lose weight, I may not need to use the insulin anymore." D. "Weight loss can be a sign of diabetic ketoacidosis."

The nurse manager for the medical-surgical unit is making staff assignments. Which client will be most appropriate to assign to a newly graduated RN who has completed a 6-week unit orientation? A. Client with chronic hypothyroidism and dementia who takes levothyroxine (Synthroid) daily B. Client with follicular thyroid cancer who has vocal hoarseness and difficulty swallowing C. Client with Graves' disease who is experiencing increasing anxiety and diaphoresis D. Client with hyperparathyroidism who has just arrived on the unit after a parathyroidectomy

The nurse should encourage fluids every 2 hours for older adult clients because of a decrease in which factor? A. Antidiuretic hormone (ADH) production B. General metabolism C. Glucose tolerance D. Ovarian production of estrogen

The nurse working during the day shift on the medical unit has just received report. Which client does the nurse plan to assess first? A. Young adult with epigastric pain, hiccups, and abdominal distention after having a total gastrectomy B. Adult who had a subtotal gastrectomy and is experiencing dizziness and diaphoresis after each meal C. Middle-aged client with gastric cancer who needs to receive omeprazole (Prilosec) before breakfast D. Older adult with advanced gastric cancer who is scheduled to receive combination chemotherapy

The school nurse is counseling a teenage student about how to prevent kidney trauma. Which statement by the student indicates a need for further teaching? A. "I can't play any type of contact sports because my brother had kidney cancer." B. "I avoid riding motorcycles." C. "I always wear pads when playing football." D. "I always wear a seat belt in the car."

To prevent pre-renal acute kidney injury, which person is encouraged to increase fluid consumption? A. Construction worker B. Office secretary C. Schoolteacher D. Taxicab driver

What is a common gastrointestinal problem that older adults experience more frequently as they age? A. Decreased hydrochloric acid B. Excess lipase production C. Increased liver enzymes D. Increased peristalsis

When caring for a client 24 hours after a nephrectomy, the nurse notes that the client's abdomen is distended. Which action does the nurse perform next? A. Check vital signs. B. Notify the surgeon. C. Continue to monitor. D. Insert a nasogastric (NG) tube.

When caring for a client with nephrotic syndrome, which intervention should be included in the plan of care? A. Administering angiotensin-converting enzyme (ACE) inhibitors to decrease protein loss B. Administering heparin to prevent deep vein thrombosis (DVT) C. Providing antibiotics to decrease infection D. Providing transfusion of clotting factors

When caring for a client with oral cancer who has developed stomatitis as a complication of radiation and chemotherapy, which action does the nurse delegate to the home health aide? A. Provide oral care using disposable foam swabs. B. Inspect the oral mucosa for evidence of oral candidiasis. C. Instruct the client on how to use nystatin (Mycostatin) oral rinses. D. Assist the client in making appropriate dietary choices.

When caring for a client with polycystic kidney disease, which goal is most important? A. Preventing progression of the disease B. Performing genetic testing C. Assessing for related causes D. Consulting with the dialysis unit

When taking the health history of a client with acute glomerulonephritis (GN), the nurse questions the client about which related cause of the problem? A. Recent respiratory infection B. Hypertension C. Unexplained weight loss D. Neoplastic disease

Which age-related change can cause nocturia? A. Decreased ability to concentrate urine B. Decreased production of antidiuretic hormone C. Increased production of erythropoietin D. Increased secretion of aldosterone

Which client does the charge nurse assign to an experienced LPN/LVN working on the adult medical unit? A. A 32-year-old who needs a nasogastric tube inserted for gastric acid analysis B. A 36-year-old who needs teaching about an endoscopic retrograde cholangiopancreatography C. A 40-year-old who will need administration of IV midazolam hydrochloride (Versed) during an upper endoscopy D. A 46-year-old who was recently admitted with abdominal cramping and diarrhea of unknown causes

Which clinical manifestation indicates the need for increased fluids in a client with kidney failure? A. Increased blood urea nitrogen (BUN) B. Increased creatinine level C. Pale-colored urine D. Decreased sodium level

Which condition may predispose a client to chronic pyelonephritis? A. Spinal cord injury B. Cardiomyopathy C. Hepatic failure D. Glomerulonephritis

Which diagnostic results lead the nurse to suspect that a client may have gallbladder disease? A. Increased white blood cell (WBC) count, visualization of calcified gallstones, edema of the gallbladder wall B. Decreased WBC count, visualization of calcified gallstones, increased alkaline phosphatase C. Increased WBC count, visualization of noncalcified gallstones, edema of the gallbladder wall D. Decreased WBC count, visualization of noncalcified gallstones, increased alkaline phosphatase

Which finding in the first 24 hours after kidney transplantation requires immediate intervention? A. Abrupt decrease in urine output B. Blood-tinged urine C. Incisional pain D. Increase in urine output

Which gland releases catecholamines? A. Adrenal B. Pancreas C. Parathyroid D. Thyroid

Which is the best referral that the nurse can suggest to a client who has been newly diagnosed with diabetes? A. American Diabetes Association B. Centers for Disease Control and Prevention C. Health care provider office D. Pharmaceutical representative

Which of the following is an appropriate client instruction regarding DKA prevention? A. Check your blood glucose 4 times a day & have regular HgA1C tests. B. If ill, take your insulin and drink clear liquids with CHO.C. Call 911 for emergency assistance if you blood glucose is over 300 mg/dl. D. Use a dipstick to assess for ketones in your urine daily.

Which of the following signs and symptoms is least likely in HHS? A.Abdominal pain B.Confusion C.Polyuria D.Polydipsia

Which practice does the nurse include when teaching a client about proper oral care? A. Perform self-examination of the mouth every week, and report any unusual findings. B. Brush the teeth daily and floss as needed. C. Use drugs that reduce the flow of saliva unless lesions are present. D. Getting daily sun exposure is essential to maintain good health.

Which urinary assessment information for a client indicates the potential need for increased fluids? A. Increased blood urea nitrogen B. Increased creatinine C. Pale-colored urine D. Decreased sodium

While working in the outpatient procedure unit, the RN is assigned to these clients. Which client does the nurse assess first? A. A 51-year-old who recently had an endoscopic retrograde cholangiopancreatography (ERCP) B. A 54-year-old who is ready for discharge following a colonoscopy C. A 58-year-old who has just arrived for basal gastric secretion and gastric acid stimulation testing D. A 60-year-old with questions about an endoscopic ultrasound examination

nA diabetic patient has developed an altered level of consciousness. Your first treatment choice would be to: a)Administer quick-acting carbohydrates by mouth b)Administer 50% glucose intravenously c)Administer the regular dose of insulin d)Administer on half of the usual insulin dose

nMrs. A. has a serum glucose of 800 mg/dl and her urine is positive for ketones. Which of the following would you also expect to see? a)A large urine output b)Decreased serum osmolality c)Metabolic alkalosis d)Elevated central venous pressure

nThe nurse is helping a client who was recently placed on a low sodium diet to choose foods for lunch. Which lunch menu would be best for this client? 1. Grilled chicken sandwich on white bread, apple, salad, & iced tea 2. Bologna sandwich on wheat bread, canned fruit cocktail, salad, and a soda 3. Canned ham and bean soup, fresh fruit salad, pickles, and a diet soda 4. Fast food cheeseburger, grapes, fresh pineapple, & tomato juice

nYour patient asks what is the difference between Glucophage & insulin. The most appropriate response would be: a)"Glucophage helps the insulin in your body work better." b)"Glucophage helps the pancreas produce insulin." c)"Glucophage is like an oral insulin." d)"Glucophage binds with the sugar in the blood to make it lower."

A client with a urinary tract infection is prescribed trimethoprim/sulfamethoxazole (Bactrim). What information does the nurse provide to this client about taking this drug? (Select all that apply.) A. "Be certain to wear sunscreen and protective clothing." B. "Drink at least 3 liters of fluids every day." C. "Take this drug with 8 ounces of water." D. "Try to urinate frequently to keep your bladder empty." "You will need to take all of this drug to get the benefits."

A, B, C

Which clients are at risk for acute kidney injury (AKI)? (Select all that apply.) A. Football player in preseason practice B. Client who underwent contrast dye radiology C. Accident victim recovering from a severe hemorrhage D. Accountant with diabetes E. Client in the intensive care unit on high doses of antibiotics F. Client recovering from gastrointestinal influenza

A, B, C, E, F

A client has undergone the Whipple procedure (radical pancreaticoduodenectomy) for pancreatic cancer. Which precautionary measures does the nurse implement to prevent potential complications? (Select all that apply.) A. Check blood glucose often. B. Check bowel sounds and stools. C. Ensure that drainage color is clear. D. Monitor mental status. E. Place the client in the supine position.

A, B, D

The nurse is observing a co-worker who is caring for a client with a nasogastric tube following esophageal surgery. Which actions by the co-worker require the nurse to intervene? (Select all that apply.) A. Checking tube placement every 12 hours B. Keeping the bed flat C. Placing the client upright when taking sips of water D. Providing mouth care every 8 hours E. Securing the tube

A, B, D

What information will the nurse provide to a client who is scheduled for extracorporeal shock wave lithotripsy? (Select all that apply.) A. "Your urine will be strained after the procedure." B. "Be sure to finish all of your antibiotics." C. "Immediately call the health care provider if you notice bruising." D. "Remember to drink at least 3 liters of fluid a day to promote urine flow." E. "You will need to change the incisional dressing once a day."

A, B, D

For which clients scheduled for a computed tomography (CT) scan with contrast does the nurse communicate safety concerns to the health care provider? (Select all that apply.) A. Client with an allergy to shrimp B. Client with a history of asthma C. Client who requests morphine sulfate every 3 hours D. Client with a blood urea nitrogen of 62 mg/dL and a creatinine of 2.0 mg/dL E. Client who took metformin (Glucophage) 4 hours ago

A, B, D, E

Which clients with an indwelling urinary catheter does the nurse reassess to determine whether the catheterization needs to be continued or can be discontinued? (Select all that apply.) A. Three-day postoperative client B. Client in the stepdown unit C. Comatose client with careful monitoring of intake and output (I&O) D. Incontinent client with perineal skin breakdown E. Incontinent older adult in long-term care

A, B, E

The nurse is preparing the room for the client returning from a thyroidectomy. Which items are important for the nurse to have available for this client? (Select all that apply.) A. Calcium gluconate B. Emergency tracheotomy kit C. Furosemide (Lasix) D. Hypertonic saline E. Oxygen F. Suction

A, B, E, F

While managing care for a client with chronic kidney disease, which actions does the registered nurse (RN) plan to delegate to unlicensed assistive personnel (UAP)? (Select all that apply.) A. Obtain the client's pre-hemodialysis weight. B. Check the arteriovenous (AV) fistula for a thrill and bruit. C. Document the amount the client drinks throughout the shift. D. Auscultate the client's lung sounds every 4 hours. E. Explain the components of a low-sodium diet.

A, C

An older adult client diagnosed with stress incontinence is prescribed the medication oxybutynin (Ditropan). Which side effects does the nurse tell the client to expect? (Select all that apply.) A. Dry mouth B. Increased blood pressure C. Increased intraocular pressure D. Constipation E. Reddish-orange urine color

A, C, D

The nurse assists a client with acute kidney injury (AKI) to modify the diet in which ways? (Select all that apply.) A. Restricted protein B. Liberal sodium C. Restricted fluids D. Low potassium E. Low fat

A, C, D

The nurse is teaching a group of older adult women about the signs and symptoms of urinary tract infection (UTI). Which concepts does the nurse explain in the presentation? (Select all that apply.) A. Dysuria B. Enuresis C. Frequency D. Nocturia E. Urgency F. Polyuria

A, C, D, E

Which assessment findings does the nurse expect in a client with kidney cancer? (Select all that apply.) A. Erythrocytosis B. Hypokalemia C. Hypercalcemia D. Hepatic dysfunction E. Increased sedimentation rate

A, C, D, E

The nurse is instructing a client on measures to maintain effective oral health. Which measures does the nurse include in the client's teaching plan? (Select all that apply.) A. Regular dental checkups B. Use of mouthwashes containing alcohol C. Ensuring that dentures are slightly loose-fitting D. Managing stress as much as possible E. Eating a balanced diet

A, D, E

A client admitted with hyperthyroidism is fidgeting with the bedcovers and talking extremely fast. What does the nurse do next? A. Calls the provider B. Encourages the client to rest C. Immediately assesses cardiac status D. Tells the client to slow down

A client awaiting kidney transplantation states, "I can't stand this waiting for a kidney, I just want to give up." Which statement by the nurse is most therapeutic? A. "I'll talk to the health care provider and have your name removed from the waiting list." B. "You sound frustrated with the situation." C. "You're right, the wait is endless for some people." D. "I'm sure you'll get a phone call soon that a kidney is available."

A client being treated for hyperthyroidism calls the home health nurse and mentions that his heart rate is slower than usual. What is the nurse's best response? A. Advise the client to go to a calming environment. B. Ask whether the client has increased cold sensitivity or weight gain. C. Instruct the client to see his health care provider immediately. D. Tell the client to check his pulse again and call back later.

A client had a parathyroidectomy 18 hours ago. Which finding requires immediate attention? A. Edema at the surgical site B. Hoarseness C. Pain on moving the head D. Sore throat

A client has a long-term history of Crohn's disease and has recently developed acute gastritis. The client asks the nurse whether Crohn's disease was a direct cause of the gastritis. What is the nurse's best response? A. "Yes, Crohn's disease is known to be a direct cause of the development of chronic gastritis." B. "We know that there can be an association between Crohn's disease and chronic gastritis, but Crohn's does not directly cause acute gastritis to develop." C. "What has your doctor told you about how your gastritis developed?" D. "Yes, a familial tendency to inherit Crohn's disease and gastritis has been reported. Have your other family members been tested for Crohn's disease?"

A client has a routine sigmoidoscopy with a tissue biopsy. What complication is the nurse looking for in a postprocedure assessment? A. Excessive diarrhea B. Heavy bleeding C. Nausea and vomiting D. Severe rectal pain

A client has been diagnosed with hypothyroidism. What medication is usually prescribed to treat this disorder? A. Atenolol (Tenormin) B. Levothyroxine sodium (Synthroid) C. Methimazole (Tapazole) D. Propylthiouracil

A client has been diagnosed with terminal esophageal cancer. The client is interested in obtaining support from hospice, but expresses concern that pain management will not be adequate. What is the nurse's best response? A. "Haven't you received adequate pain management in the hospital?" B. "Would you like me to get a nurse from hospice to come talk with you?" C. "Do you want me to call the hospital chaplain to explain hospice to you?" D. "Talk to your health care provider about hospice services."

A client has developed acute pancreatitis after also developing gallstones. Which is the highest priority instruction for this client to avoid further attacks of pancreatitis? A. "You may need a surgical consult for removal of your gallbladder." B. "See your health care provider immediately when experiencing symptoms of a gallbladder attack." C. "If you have a gallbladder attack and pain does not resolve within a few days, call your health care provider." D. "You'll need to drastically modify your alcohol intake."

A client has just been diagnosed with diabetes. Which factor is most important for the nurse to assess in the client before providing instruction about the disease and its management? A. Current lifestyle B. Educational and literacy level C. Sexual orientation D. Current energy level

A client has just been diagnosed with pancreatic cancer. The client's upset spouse tells the nurse that they have recently moved to the area, have no close relatives, and are not yet affiliated with a church. What is the nurse's best response? A. "Maybe you should find a support group to join." B. "Would you like me to contact the hospital chaplain for you?" C. "Do you want me to try to find a therapist for you?" D. "Do you have any friends whom you want me to call?"

A client has undergone a partial glossectomy for cancer. What community resource does the nurse refer the client to when dressing supplies will be needed at home? A. Oral Cancer Foundation B. American Cancer Society (ACS) C. Client Advocate Foundation D. American Medical Supply Foundation

A client has undergone a transsphenoidal hypophysectomy. Which intervention does the nurse implement to avoid increasing intracranial pressure (ICP) in the client? A. Encourages the client to cough and deep-breathe B. Instructs the client not to strain during a bowel movement C. Instructs the client to blow the nose for postnasal drip D. Places the client in the Trendelenburg position

A client in the outpatient clinic tells the nurse about experiencing heartburn and nighttime coughing episodes. Which action does the nurse take first? A. Teach the client about antacid effects and side effects. B. Ask the client about medications and dietary intake. C. Suggest that the client sleep with the head elevated 6 inches. D. Tell the client to avoid drinking alcohol late in the evening.

A client is admitted to the hospital with severe right upper quadrant (RUQ) abdominal pain. Which assessment technique does the nurse use for this client? A. Assesses the abdomen in the following sequence: inspection, palpation, percussion, auscultation B. Examines the RUQ of the abdomen last C. Has the client lie in a supine position with legs straight and arms at the sides D. Views the abdomen by looking directly down while standing over the client's abdominal area

A client is hesitant to talk to the nurse about genitourinary dysfunction symptoms. What is the nurse's best response? A. "Don't worry, no one else will know." B. "Take your time. What is bothering you the most?" C. "Why are you hesitant?" D. "You need to tell me so we can determine what is wrong."

A client is hospitalized for pituitary function testing. Which nursing action included in the client's plan of care will be most appropriate for the RN to delegate to the LPN/LVN? A. Assess the client for clinical manifestations of hypopituitarism. B. Inject regular insulin for the growth hormone stimulation test. C. Palpate the thyroid gland for size and firmness. D. Teach the client about the adrenocorticotropic hormone stimulation test.

A client is receiving immune-suppressive therapy after kidney transplantation. Which measure for infection control is most important for the nurse to implement? A. Adherence to therapy B. Handwashing C. Monitoring for low-grade fever D. Strict clean technique

A client newly diagnosed with diabetes is not ready or willing to learn diabetes control during the hospital stay. Which information is the priority for the nurse to teach the client and the client's family? A. Causes and treatment of hyperglycemia B. Causes and treatment of hypoglycemia C. Dietary control D. Insulin administration

A client presents to the emergency department with acute adrenal insufficiency and the following vital signs: P 118 beats/min, R 18 breaths/min, BP 84/44 mm Hg, pulse oximetry 98%, and T 98.8° F oral. Which nursing intervention is the highest priority for this client? A. Administering furosemide (Lasix) B. Providing isotonic fluids C. Replacing potassium losses D. Restricting sodium

A client recently admitted with hyperparathyroidism has a very high urine output. Of these actions, what does the nurse do next? A. Calls the health care provider B. Monitors intake and output C. Performs an immediate cardiac assessment D. Slows the rate of IV fluids

A client who has been diagnosed recently with esophageal cancer states, "I'm not comfortable going to my father's birthday lunch at our family-owned restaurant because I'm afraid I'll choke in public." What is the nurse's best response? A. "I understand your concerns, but you can't give up your normal activities. You should go anyway and try not to worry about it." B. "Could you perhaps invite everyone over to cook at your home? That will allow you to be together and be more relaxed." C. "Why not take one of your antianxiety pills before going? That will keep you from worrying about everything so much." D. "You need to talk to your doctor about your concerns. The doctor may recommend that you join a support group for cancer survivors."

A client with gastroesophageal reflux disease has undergone a laparoscopic Nissen fundoplication (LNF). What will the nurse include in postoperative home care instructions? A. "Consume carbonated beverages if you experience stomach upset." B. "Remain on a soft diet for about a week and avoid raw fruits and vegetables." C. "You may resume running and weight lifting if you wish." D. "You may stop taking your anti-reflux medications after 1 week."

A client with newly diagnosed irritable bowel syndrome (IBS) reports having five to six loose stools daily. What is the common psychological client response to this gastrointestinal health problem? A. Acceptance B. Embarrassment C. Euphoria D. Grief

A client with peptic ulcer disease (PUD) asks the nurse whether licorice and slippery elm might be useful in managing the disease. What is the nurse's best response? A. "No, they probably won't be useful. You should use only prescription medications in your treatment plan." B. "These herbs could be helpful. However, you should talk with your provider before adding them to your treatment regimen." C. "Yes, these are known to be effective in managing this disease, but make sure you research the herbs thoroughly before taking them." D. "No, herbs are not useful for managing this disease. You can use any type of over-the-counter drugs though. They have been shown to be safe."

A client with peptic ulcer disease asks the nurse whether a maternal history of gastric cancer will cause the client to develop gastric cancer. What is the nurse's best response? A. "Yes, it is known that a family history of gastric cancer will cause someone to develop gastric cancer." B. "If you are concerned that you are at high risk, I recommend speaking to your provider about the possibility of genetic testing." C. "Have you spoken to your health care provider about your concerns?" D. "I wouldn't be too concerned about that as long as your diet limits pickled, salted, and processed food."

A client with type 1 diabetes mellitus received regular insulin at 7:00 a.m. The client should be monitored for hypoglycemia at which time? A. 7:30 a.m. B. 11:00 a.m. C. 2:00 p.m. D. 7:30 p.m.

A male client being treated for bladder cancer has a live virus compound instilled into his bladder as a treatment. What instruction does the nurse provide for postprocedure home care? A. "After 12 hours, your toilet should be cleaned with a 10% solution of bleach." B. "Do not share your toilet with family members for the next 24 hours." C. "Please be sure to stand when you are urinating." D. "Your underwear worn during the procedure and for the first 12 hours afterward should be bagged and discarded."

Family members of a client diagnosed with hyperthyroidism are alarmed at the client's frequent mood swings. What is the nurse's response? A. "How does that make you feel?" B. "The mood swings should diminish with treatment." C. "The medications will make the mood swings disappear completely." D. "Your family member is sick. You must be patient."

In type 1 diabetes, insulin injections are necessary to maintain which action between insulin and glucose? A. Glucose intolerance B. Homeostasis C. Insulin intolerance D. Negative feedback

The RN is caring for a client who has just had a kidney biopsy. Which action does the nurse perform first? A. Obtain blood urea nitrogen (BUN) and creatinine. B. Position the client supine. C. Administer pain medications. D. Check urine for hematuria.

The RN is working with unlicensed assistive personnel (UAP) in caring for a group of clients. Which action is best for the RN to delegate to UAP? A. Assessing the vital signs of a client who was just admitted with blunt flank trauma and hematuria B. Assisting a client who had a radical nephrectomy 2 days ago to turn in bed C. Helping the provider with a kidney biopsy for a client admitted with acute glomerulonephritis D. Palpating for bladder distention on a client recently admitted with a ureteral stricture

The admission assessment for a client with acute gastric bleeding indicates blood pressure 82/40 mm Hg, pulse 124 beats/min, and respiratory rate 26 breaths/min. Which admission request does the nurse implement first? A. Type and crossmatch for 4 units of packed red blood cells. B. Infuse lactated Ringer's solution at 200 mL/hr. C. Give pantoprazole (Protonix) 40 mg IV now and then daily. D. Insert a nasogastric tube and connect to low intermittent suction.

The charge nurse is making client assignments for the day shift. Which client is best to assign to an LPN/LVN? A. Client who has just returned from having a kidney artery angioplasty B. Client with polycystic kidney disease who is having a kidney ultrasound C. Client who is going for a cystoscopy and cystourethroscopy D. Client with glomerulonephritis who is having a kidney biopsy

The client is taking fludrocortisone (Florinef) for adrenal hypofunction. The nurse instructs the client to report which symptom while taking this drug? A. Anxiety B. Headache C. Nausea D. Weight loss

The nurse anticipates that a client who develops hypotension and oliguria post nephrectomy may need the addition of which element to the regimen? A. Increase in analgesics B. Addition of a corticosteroid C. Administration of a diuretic D. Course of antibiotic therapy

The nurse expects that which client will be discharged to the home environment first? A. Older obese adult who has had a laparoscopic cholecystectomy B. Middle-aged thin adult who has had a laparoscopic cholecystectomy C. Middle-aged thin adult with a heart murmur who has had a traditional cholecystectomy D. Older obese adult with chronic obstructive pulmonary disease (COPD) who has had a traditional cholecystectomy

The nurse has just taken change-of-shift report on a group of clients on the medical-surgical unit. Which client does the nurse assess first? A. Client taking repaglinide (Prandin) who has nausea and back pain B. Client taking glyburide (Diabeta) who is dizzy and sweaty C. Client taking metformin (Glucophage) who has abdominal cramps D. Client taking pioglitazone (Actos) who has bilateral ankle swelling

The nurse is assessing a client for endocrine dysfunction. Which comment by the client indicates a need for further assessment? A. "I am worried about losing my job because of cutbacks." B. "I don't have any patience with my kids. I lose my temper faster." C. "I don't seem to have any stressors now." D. "My weight has been stable these past few years."

The nurse is assessing a client who comes to the emergency department with acute abdominal pain. The nurse notes a bulging, pulsating mass when inspecting the abdomen. Which action by the nurse is correct? A. Auscultate the abdomen to determine the presence of bowel sounds. B. Notify the provider about this finding immediately. C. Palpate the client's abdomen to determine the outlines of the mass. D. Question the client about recent stool habits.

The nurse is educating a group of older adults about screening for colorectal cancer. Which statement by a group member indicates the need for further clarification about these guidelines? A. "A barium enema every 5 years is a screening option." B. "I will need to have a routine colonoscopy every 5 years." C. "My routine flexible sigmoidoscopy every 5 years is OK." D. "The 'virtual' colonoscopy every 5 years is acceptable."

The nurse is providing discharge teaching to a client with newly diagnosed diabetes. Which statement by the client indicates a correct understanding about the need to wear a MedicAlert bracelet? A. "If I become hyperglycemic, it is a medical emergency." B. "If I become hypoglycemic, I could become unconscious." C. "Medical personnel may need confirmation of my insurance." D. "I may need to be admitted to the hospital suddenly."

The nurse is reviewing admitting requests for a client admitted to the intensive care unit with perforation of a duodenal ulcer. Which request does the nurse implement first? A. Apply antiembolism stockings. B. Place a nasogastric (NG) tube, and connect to suction. C. Insert an indwelling catheter, and check output hourly. D. Give famotidine (Pepcid) 20 mg IV every 12 hours.

The nurse is teaching a client about dietary choices to prevent dumping syndrome after gastric bypass surgery. Which statement by the client indicates a need for further teaching? A. "I will need to avoid sweetened fruit juice beverages." B. "I can eat ice cream in moderation." C. "I cannot drink alcohol at all." D. "It is okay to have a serving of sugar-free pudding."

The nurse is teaching a client about the correct procedure for a 24-hour urine test for creatinine clearance. Which statement by the client indicates a need for further teaching? A. "I should keep the urine container cool in a separate refrigerator or cooler." B. "I should not eat any protein when I am collecting urine for this test." C. "I won't save the first urine sample." D. "To end the collection, I must empty my bladder, adding it to the collection."

The nurse is teaching a client about the manifestations and emergency treatment of hypoglycemia. In assessing the client's knowledge, the nurse asks the client what he or she should do if feeling hungry and shaky. Which response by the client indicates a correct understanding of hypoglycemia management? A. "I should drink a glass of water." B. "I should eat three graham crackers." C. "I should give myself 1 mg of glucagon." D. "I should sit down and rest."

The nurse is teaching a client with a neurogenic bladder to use intermittent self-catheterization for bladder emptying. Which client statement indicates a need for further clarification? A. "A small-lumen catheter will help prevent injury to my urethra." B. "I will use a new, sterile catheter each time I do the procedure." C. "My family members can be taught to help me if I need it." D. "Proper handwashing before I start the procedure is very important."

The nurse is teaching a client with diabetes about proper foot care. Which statement by the client indicates that teaching was effective? A. "I should go barefoot in my house so that my feet are exposed to air." B. "I must inspect my shoes for foreign objects before putting them on." C. "I will soak my feet in warm water to soften calluses before trying to remove them." D. "I must wear canvas shoes as much as possible to decrease pressure on my feet."

The nurse practitioner is performing an abdominal assessment on a newly admitted client. In which order should the nurse proceed with assessment technique? A. Auscultation, percussion, palpation, inspection B. Inspection, auscultation, percussion, palpation C. Palpation, percussion, inspection, auscultation D. Percussion, auscultation, palpation, inspection

The nurse receives the change-of-shift report on four clients. Which client does the nurse decide to assess first? A. A 26-year-old admitted 2 days ago with urosepsis with an oral temperature of 99.4° F (37.4° C) B. A 28-year-old with urolithiasis who has been receiving morphine sulfate and has not voided for 8 hours C. A 32-year-old admitted with hematuria and possible bladder cancer who is scheduled for cystoscopy D. A 40-year-old with noninfectious urethritis who is reporting "burning" and has estrogen cream prescribed

The nurse suspects that which client is at highest risk for developing gallstones? A. Obese male with a history of chronic obstructive pulmonary disease B. Obese female on hormone replacement therapy C. Thin male with a history of coronary artery bypass grafting D. Thin female who has recently given birth

The nurse wishes to reduce the incidence of hospital-acquired acute kidney injury. Which question by the nurse to the interdisciplinary health care team will result in reducing client exposure? A. "Should we filter air circulation?" B. "Can we use less radiographic contrast dye?" C. "Should we add low-dose dobutamine?" D. "Should we decrease IV rates?"

To best determine how well a client with diabetes mellitus is controlling blood glucose, which test does the nurse monitor? A. Fasting blood glucose B. Glycosylated hemoglobin (HbA1c) C. Oral glucose tolerance test D. Urine glucose level

What is the appropriate range of urine output for the client who has just undergone a nephrectomy? A. 23 to 30 mL/hr B. 30 to 50 mL/hr C. 41 to 60 mL/hr D. 50 to 70 mL/hr

When assessing a client with acute glomerulonephritis, which finding causes the nurse to notify the provider? A. Purulent wound on the leg B. Crackles throughout the lung fields C. History of diabetes D. Cola-colored urine

When caring for a client with acute kidney injury and a temporary subclavian hemodialysis catheter, which assessment finding does the nurse report to the provider? A. Mild discomfort at the insertion site B. Temperature 100.8° F C. 1+ ankle edema D. Anorexia

Which client does the charge nurse on the adult medical unit assign to an RN who has floated from the outpatient gastrointestinal (GI) unit? A. A 38-year-old who needs discharge instructions after having an endoscopic retrograde cholangiopancreatography (ERCP) B. A 40-year-old who needs laxatives administered and effectiveness monitored before a colonoscopy C. A 43-year-old recently admitted with nausea, abdominal pain, and abdominal distention D. A 50-year-old with epigastric pain who needs conscious sedation during a scheduled endoscopy procedure

Which clinical manifestation in a client with pyelonephritis indicates that treatment has been effective? A. Decreased urine output B. Decreased white blood cells in urine C. Increased red blood cell count D. Increased urine specific gravity

Which factor is an indicator for a diagnosis of hydronephrosis? A. History of nocturia B. History of urinary stones C. Recent weight loss D. Urinary incontinence

Which instruction by the nurse will help a client with chronic kidney disease prevent renal osteodystrophy? A. Consuming a low-calcium diet B. Avoiding peas, nuts, and legumes C. Drinking cola beverages only once daily D. Increasing dairy products enriched with vitamin D

Which laboratory test is the best indicator of kidney function? A. Blood urea nitrogen (BUN) B. Creatinine C. Aspartate aminotransferase (AST) D. Alkaline phosphatase

Which medication is most effective in slowing the progression of kidney failure in a client with chronic kidney disease? A. Diltiazem (Cardizem) B. Lisinopril (Zestril) C. Clonidine (Catapres) D. Doxazosin (Cardura)

Which nursing action is best for the charge nurse to delegate to an experienced LPN/LVN? A. Retape the nasogastric tube for a client who has had a subtotal gastrectomy and vagotomy. B. Reinforce the teaching about avoiding alcohol and caffeine for a client with chronic gastritis. C. Document instructions for a client with chronic gastritis about how to use "triple therapy." D. Assess the gag reflex for a client who has arrived from the postanesthesia care unit after a laparoscopic gastrectomy.

Which percussion technique does the nurse use to assess a client who reports flank pain? A. Place outstretched fingers over the flank area and percuss with the fingertips. B. Place one hand with the palm down flat over the flank area and use the other fisted hand to thump the hand on the flank. C. Place one hand with the palm up over the flank area and cup the other hand to percuss the hand on the flank. D. Quickly tap the flank area with cupped hands.

Which sign or symptom, when assessed in a client with chronic glomerulonephritis (GN), warrants a call to the health care provider? A. Mild proteinuria B. Third heart sound (S3) C. Serum potassium of 5.0 mEq/L D. Itchy skin

Which statement by a client with diabetic nephropathy indicates a need for further education about the disease? A. "Diabetes is the leading cause of kidney failure." B. "I need less insulin, so I am getting better." C. "My blood sugar may drop really low at times." D. "I must call my provider if the urine dipstick shows protein."

Which statement is true about hormones and their receptor sites? A. Hormone activity is dependent only on the function of the receptor site. B. Hormones need a specific receptor site to work. C. Hormones need to be plasma-bound to activate the receptor site. D. Hormone stores are available for activation until needed.

n The nurse is counseling a patient who is about to receive opioids to manage cancer pain. It is important to include the fact that tolerance will not develop to which of the following opioid effects? ¨a. Sedation ¨b. Respiratory Depression ¨c. Urinary retention ¨d. Constipation

nMr. E. received a dose of regular insulin sub q for an elevated morning blood glucose level. The nurse tells Mr. E. that this medication will begin to act within: a)A few minutes b)1/2 to 1 hour c)2 to 4 hours d)6 to 8 hours

nYou are assigned to a Type II diabetic patient who is having a colon resection. What effect on the blood glucose would you expect with this surgery? a)The patient will most likely need supplemental insulin b)The patient will most likely have good control if the amount of carbohydrates in the diet is increased c)The glucose level will most likely not be affected d)The glucose control will remain stable with stress management techniques

When caring for a client with a left forearm arteriovenous fistula created for hemodialysis, which actions must the nurse take? (Select all that apply.) A. Check brachial pulses daily. B. Auscultate for a bruit every 8 hours. C. Teach the client to palpate for a thrill over the site. D. Elevate the arm above heart level. E. Ensure that no blood pressures are taken in that arm.

B, C

The nurse in the urology clinic is providing teaching for a female client with cystitis. Which instructions does the nurse include in the teaching plan? (Select all that apply.) A. Cleanse the perineum from back to front after using the bathroom. B. Try to take in 64 ounces of fluid each day. C. Be sure to complete the full course of antibiotics. D. If urine remains cloudy, call the clinic. E. Expect some flank discomfort until the antibiotic has worked.

B, C, D

When assessing a client with acute pyelonephritis, which findings does the nurse anticipate will be present? (Select all that apply.) A. Suprapubic pain B. Vomiting C. Chills D. Dysuria E. Oliguria

B, C, D

Which factors place a client at risk for gastrointestinal (GI) problems? (Select all that apply.) A. Eating a high-fiber diet B. Smoking a half-pack of cigarettes per day C. Socioeconomic status D. Some herbal preparations E. Use of nonsteroidal anti-inflammatory drugs (NSAIDs)

B, C, D

A 49-year-old woman comes to the emergency department with reports of black tarry stools that started 2 weeks ago. In taking a gastrointestinal (GI) history, which questions does the nurse ask that pertain to Gordon's Functional Health Patterns? (Select all that apply.) A. "Are you having any difficulty having sex? How frequently do you have sex?" B. "Do you have any difficulty chewing or swallowing?" C. "Do you have pain, diarrhea, gas, or any other problems? Do any specific foods cause these symptoms for you?" D. "What is your usual bowel elimination pattern? Frequency? Character?" E. "When was your last colonoscopy?"

B, C, D, E

A client diagnosed with stress incontinence is started on propantheline (Pro-Banthine). What interventions does the nurse suggest to alleviate the side effects of this anticholinergic drug? (Select all that apply.) A. Take the drug at bedtime. B. Encourage increased fluids. C. Increase fiber intake. D. Limit the intake of dairy products. E. Use hard candy for dry mouth

B, C, E

The nurse is caring for a client with esophageal cancer who has received photodynamic therapy using porfimer sodium (Photofrin). What instructions does the nurse include in teaching the client about porfimer sodium? (Select all that apply.) A. Avoid sunlight for 2 weeks. B. Cover all exposed body areas. C. Follow a clear liquid diet for 3 to 5 days after the procedure. D. Monitor for hypertension. E. Tissue particles may be found in the sputum.

B, C, E

Which interventions are helpful in preventing bladder cancer? (Select all that apply.) A. Drinking 2½ liters of fluid a day B. Showering after working with or around chemicals C. Stopping the use of tobacco D. Using pelvic floor muscle exercises E. Wearing a lead apron when working with chemicals F. Wearing gloves and a mask when working around chemicals and fumes

B, C, F

The nurse is assessing a client with gastroesophageal reflux disease (GERD). Which findings does the nurse expect to observe? (Select all that apply.) A. Blood-tinged sputum B. Dyspepsia C. Excessive salivation D. Flatulence E. Regurgitation

B, D, E

Which signs and symptoms indicate rejection of a transplanted kidney? (Select all that apply.) A. Blood urea nitrogen (BUN) 21 mg/dL, creatinine 0.9 mg/dL B. Crackles in the lung fields C. Temperature of 98.8° F (37.1° C) D. Blood pressure of 164/98 mm Hg E. 3+ edema of the lower extremities

B, D, E

nA problem with using methadone for relief of cancer pain is that: ¨a. it is a stronger agent and patients are more likely to become addicted. ¨b. the long half-life allows dangerous levels to accumulate. ¨c. methadone is more costly and requires a controlled-substances prescription. ¨d. methadone is associated with more side effects.

nThe most severe complication of diabetic ketoacidosis (DKA) is: a)Confusion b)Hemorrhage c)Tetany d) Shock

A client with type 2 diabetes who is taking metformin (Glucophage) is seen in the diabetic clinic. The fasting blood glucose is 108 mg/dL, and the glycosylated hemoglobin (HbA1C) is 8.2%. Which action does the nurse plan to take next? A. Instruct the client to continue with the current diet and metformin use. B. Discuss the need to check blood glucose several times every day. C. Talk about the possibility of adding rapid-acting insulin to the regimen. D. Ask the client about current dietary intake and medication use.

A 32-year-old female with a urinary tract infection (UTI) reports urinary frequency, urgency, and some discomfort upon urination. Her vital signs are stable except for a temperature of 100° F. Which drug does the health care provider prescribe? A. Nitrofurantoin (Macrodantin) after intercourse B. Estrogen (Premarin) C. Trimethoprim/sulfamethoxazole (Bactrim) D. Phenazopyridine (Pyridium) with intercourse

A 53-year-old postmenopausal woman reports "leaking urine" when she laughs, and is diagnosed with stress incontinence. What does the nurse tell the client about how certain drugs may be able to help with her stress incontinence? A. "They can relieve your anxiety associated with incontinence." B. "They help your bladder to empty." C. "They may be used to improve urethral resistance." D. "They decrease your bladder's tone."

A client admitted to the medical unit with a history of vomiting and diarrhea and an increased blood urea nitrogen requires 1 liter of normal saline infused over 2 hours. Which staff member should be assigned to care for the client? A. RN who has floated from pediatrics for this shift B. LPN/LVN with experience working on the medical unit C. RN who usually works on the general surgical unit D. New graduate RN who just finished a 6-week orientation

A client diagnosed with acalculous cholecystitis asks the nurse how the gallbladder inflammation developed when there is no history of gallstones. What is the nurse's best response? A. "This may be an indication that you are developing sepsis." B. "The gallstones are present, but have become fibrotic and contracted." C. "This type of gallbladder inflammation is associated with hypovolemia." D. "This may be an indication of pancreatic disease."

A client diagnosed with hyperpituitarism resulting from a prolactin-secreting tumor has been prescribed bromocriptine mesylate (Parlodel). As a dopamine agonist, what effect does this drug have by stimulating dopamine receptors in the brain? A. Decreases the risk for cerebrovascular disease B. Increases the risk for depression C. Inhibits the release of some pituitary hormones D. Stimulates the release of some pituitary hormones

A client expresses fear and anxiety over the life changes associated with diabetes, stating, "I am scared I can't do it all and I will get sick and be a burden on my family." What is the nurse's best response? A. "It is overwhelming, isn't it?" B. "Let's see how much you can learn today, so you are less nervous." C. "Let's tackle it piece by piece. What is most scary to you?" D. "Other people do it just fine."

A client has been discharged to home after being hospitalized with an acute episode of pancreatitis. The client, who is an alcoholic, is unwilling to participate in Alcoholics Anonymous (AA), and the client's spouse expresses frustration to the home health nurse regarding the client's refusal. What is the nurse's best response? A. "Your spouse will sign up for the meetings only when he is ready to deal with his problem." B. "Keep mentioning the AA meetings to your spouse on a regular basis." C. "I'll get you some information on the support group Al-Anon." D. "Tell me more about your frustration with your spouse's refusal to participate in AA."

A client has hyperparathyroidism. Which incident witnessed by the nurse requires the nurse's intervention? A. The client eating a morning meal of cereal and fruit B. The physical therapist walking with the client in the hallway C. Unlicensed assistive personnel pulling the client up in bed by the shoulders D. Visitors talking with the client about going home

A client has recently developed acute sialadenitis. Which intervention does the nurse include in this client's care? A. Applying cold compresses B. Avoiding the use of fruit or citrus-flavored candy C. Massaging the salivary gland D. Keeping the head of the bed at 10 degrees when the client is lying down

A client has suspected alterations in antidiuretic hormone (ADH) function. Which diagnostic test does the nurse anticipate will be requested for this client? A. Adrenocorticotropic hormone (ACTH) suppression test B. Chest x-ray C. Cranial computed tomography (CT) D. Renal sonography

A client is experiencing an attack of acute pancreatitis. Which nursing intervention is the highest priority for this client? A. Measure intake and output every shift. B. Do not administer food or fluids by mouth. C. Administer opioid analgesic medication. D. Assist the client to assume a position of comfort.

A client is hospitalized with a possible disorder of the adrenal cortex. Which nursing activity is best for the charge nurse to delegate to an experienced nursing assistant? A. Ask about risk factors for adrenocortical problems. B. Assess the client's response to physiologic stressors. C. Check the client's blood glucose levels every 4 hours. D. Teach the client how to do a 24-hour urine collection.

A client is in the emergency department for an inability to void and for bladder distention. What is most important for the nurse to provide to the client? A. Increased oral fluids B. IV fluids C. Privacy D. Health history forms

A client is scheduled to undergo kidney transplant surgery. Which teaching point does the nurse include in the preoperative teaching session? A. "Your diseased kidneys will be removed at the same time the transplant is performed." B. "The new kidney will be placed directly below one of your old kidneys." C. "It is essential for you to wash your hands and avoid people who are ill." D. "You will receive dialysis the day before surgery and for about a week after."

A client with Cushing's disease begins to laugh loudly and inappropriately, causing the family in the room to be uncomfortable. What is the nurse's best response? A. "Don't mind this. The disease is causing this." B. "I need to check the client's cortisol level." C. "The disease can sometimes affect emotional responses." D. "Medication is available to help with this."

A client with an inoperable esophageal tumor is receiving swallowing therapy. Which task does the home health nurse delegate to an experienced home health aide? A. Teaching family members how to determine whether the client is obtaining adequate nutrition B. Assessing lung sounds for possible aspiration when the client is swallowing clear liquids C. Reminding the client to use the chin-tuck technique each time the client attempts to swallow D. Instructing family members about symptoms that may indicate a need to call the provider

A client with end-stage kidney disease has been put on fluid restrictions. Which assessment finding indicates that the client has not adhered to this restriction? A. Blood pressure of 118/78 mm Hg B. Weight loss of 3 pounds during hospitalization C. Dyspnea and anxiety at rest D. Central venous pressure (CVP) of 6 mm Hg

A client with hypothyroidism is being discharged. Which environmental change may the client experience in the home? A. Frequent home care B. Handrails in the bath C. Increased thermostat setting D. Strict infection-control measures

A client with type 2 diabetes has been admitted for surgery, and the health care provider has placed the client on insulin in addition to the current dose of metformin (Glucophage). The client wants to know the purpose of taking the insulin. What is the nurse's best response? A. "Your diabetes is worse, so you will need to take insulin." B. "You can't take your metformin while in the hospital." C. "Your body is under more stress, so you'll need insulin to support your medication." D. "You must take insulin from now on because the surgery will affect your diabetes."

A cognitively impaired client has urge incontinence. Which method for achieving continence does the nurse include in the client's care plan? A. Bladder training B. Credé method C. Habit training D. Kegel exercises

A diabetic client has a glycosylated hemoglobin (HbA1C) level of 9.4%. What does the nurse say to the client regarding this finding? A. "Keep up the good work." B. "This is not good at all." C. "What are you doing differently?" D. "You need more insulin."

A newly admitted client who is diabetic and has pyelonephritis and prescriptions for intravenous antibiotics, blood glucose monitoring every 2 hours, and insulin administration should be cared for by which staff member? A. RN whose other assignments include a client receiving chemotherapy for renal cell carcinoma B. RN who is caring for a client who just returned after having renal artery balloon angioplasty C. RN who has just completed preoperative teaching for a client who is scheduled for nephrectomy D. RN who is currently admitting a client with acute hypertension and possible renal artery stenosis

After receiving change-of-shift report on the urology unit, which client does the nurse assess first? A. Client post radical nephrectomy whose temperature is 99.8° F (37.6° C) B. Client with glomerulonephritis who has cola-colored urine C. Client who was involved in a motor vehicle crash and has hematuria D. Client with nephrotic syndrome who has gained 2 kg since yesterday

An RN and LPN/LVN are caring for a group of clients on the medical-surgical unit. Which client will be the best to assign to the LPN/LVN? A. Client with Graves' disease who needs discharge teaching after a total thyroidectomy B. Client with hyperparathyroidism who is just being admitted for a parathyroidectomy C. Client with infiltrative ophthalmopathy who needs administration of high-dose prednisone (Deltasone) D. Newly diagnosed client with hypothyroidism who needs education about the use of thyroid supplements

An intensive care client with diabetic ketoacidosis (DKA) is receiving an insulin infusion. The cardiac monitor shows ventricular ectopy. Which assessment does the nurse make? A. Urine output B. 12-lead electrocardiogram (ECG) C. Potassium level D. Rate of IV fluids

An older client with an elevated serum calcium level is receiving IV furosemide (Lasix) and an infusion of normal saline at 150 mL/hr. Which nursing action can the RN delegate to unlicensed assistive personnel (UAP)? A. Ask the client about any numbness or tingling. B. Check for bone deformities in the client's back. C. Measure the client's intake and output hourly. D. Monitor the client for shortness of breath.

Discharge teaching has been provided for a client recovering from kidney transplantation. Which information indicates that the client understands the instructions? A. "I can stop my medications when my kidney function returns to normal." B. "If my urine output is decreased, I should increase my fluids." C. "The anti-rejection medications will be taken for life." D. "I will drink 8 ounces of water with my medications."

The certified Wound, Ostomy, and Continence Nurse or enterostomal therapist teaches a client who has had a cystectomy about which care principles for the client's post-discharge activities? A. Nutritional and dietary care B. Respiratory care C. Stoma and pouch care D. Wiping from front to back (asepsis)

The nurse and the dietitian are planning sample diet menus for a client who is experiencing dumping syndrome. Which sample meal is bestfor this client? A. Chicken salad on whole wheat bread B. Liver and onions C. Chicken and rice D. Cobb salad with buttermilk ranch dressing

The nurse finds a client vomiting coffee-ground emesis. On assessment, the client has blood pressure of 100/74 mm Hg, is acutely confused, and has a weak and thready pulse. Which intervention is the nurse's first priority? A. Administering a histamine2 (H2) antagonist B. Initiating enteral nutrition C. Administering intravenous (IV) fluids D. Administering antianxiety medication

The nurse is assessing a client who has come to the emergency department with acute abdominal pain. The client is very thin and the nurse observes visible peristaltic movements when inspecting the abdomen. What does the nurse suspect? A. Acute diarrhea B. Aortic aneurysm C. Intestinal obstruction D. Pancreatitis

The nurse is assessing a client's alcohol intake to determine whether it is the underlying cause of the client's attacks of pancreatitis. Which question does the nurse ask to elicit this information? A. "Do you usually binge drink?" B. "Do you tend to drink more on holidays or weekends?" C. "Tell me more about your alcohol intake." D. "Estimate how many episodes of binge drinking you do in a week."

The nurse is caring for a postoperative client who had a radical neck dissection, and the client is describing throbbing pain in the head. The nurse anticipates that the health care provider will request which medication for this client? A. Diphenhydramine (Benadryl) B. Midazolam (Versed) intravenously C. Morphine sulfate intravenously D. Oxycodone plus acetaminophen (Percocet, Tylox)

The nurse is educating a female client about hygiene measures to reduce her risk for urinary tract infection. What does the nurse instruct the client to do? A. "Douche—but only once a month." B. "Use only white toilet paper." C. "Wipe from front to back." D. "Wipe with the softest toilet paper available."

The nurse is instructing an older adult female client about interventions to decrease the risk for cystitis. Which client comment indicates that the teaching was effective? A. "I must avoid drinking carbonated beverages." B. "I need to douche vaginally once a week." C. "I should drink 2½ liters of fluid every day." D. "I will not drink fluids after 8 PM each evening."

The nurse is providing discharge instructions to a client on spironolactone (Aldactone) therapy. Which comment by the client indicates a need for further teaching? A. "I must call the provider if I am more tired than usual." B. "I need to increase my salt intake." C. "I should eat a banana every day." D. "This drug will not control my heart rate."

The nurse is providing instructions to a client who has a history of stomatitis. Which instructions does the nurse include in the client's teaching plan? A. Encourage the client to eat acidic foods to decrease bacteria. B. Mouth care should be performed twice daily. C. Rinse the mouth with warm saline or sodium bicarbonate. D. Use a medium-bristled toothbrush for oral care.

The nurse is reviewing the medical record for a client with polycystic kidney disease who is scheduled for computed tomographic angiography with contrast: H and P: Polycystic kidney diseaseDiabetesHysterectomyAbdomen distendedNegative edema Med: GlyburideMetforminSynthroid Dx findings: BUN 26 mg/dLCreatinine 1.0 mg/dLHbA1c 6.9%Glucose 132 mg/dL Which intervention is essential for the nurse to perform? A. Obtain a thyroid-stimulating hormone (TSH) level. B. Report the blood urea nitrogen (BUN) and creatinine. C. Hold the metformin 24 hours before and on the day of the procedure. D. Notify the provider regarding blood glucose and glycosylated hemoglobin (HbA1c) values.

The nurse is reviewing the medication history for a client diagnosed with gastroesophageal reflux disease who has been prescribed esomeprazole (Nexium) once daily. The client reports that the drug doesn't completely control the symptoms. The nurse contacts the provider to discuss which intervention? A. Adding a second proton pump inhibitor medication B. Increasing the dose of esomeprazole C. Changing to a twice-daily dosing regimen D. Switching to omeprazole (Prilosec)

The nurse is teaching a client about thyroid replacement therapy. Which statement by the client indicates a need for further teaching? A. "I should have more energy with this medication." B. "I should take it every morning." C. "If I continue to lose weight, I may need an increased dose." D. "If I gain weight and feel tired, I may need an increased dose."

The nurse is teaching a client how to prevent recurrent chronic gastritis symptoms before discharge. Which statement by the client demonstrates a correct understanding of the nurse's instruction? A. "It is okay to continue to drink coffee in the morning when I get to work." B. "I will need to take vitamin B12 shots for the rest of my life." C. "I should avoid alcohol and tobacco." D. "I should eat small meals about six times a day."

The nurse is teaching a client how to provide a clean-catch urine specimen. Which statement by the client indicates that teaching was effective? A. "I must clean with the wipes and then urinate directly into the cup." B. "I will have to drink 2 liters of fluid before providing the sample." C. "I'll start to urinate in the toilet, stop, and then urinate into the cup." D. "It is best to provide the sample while I am bathing."

The nurse is teaching a client with gallbladder disease about diet modification. Which meal does the nurse suggest to the client? A. Steak and French fries B. Fried chicken and mashed potatoes C. Turkey sandwich on wheat bread D. Sausage and scrambled eggs

The nurse receives report on a client with hydronephrosis. Which laboratory study does the nurse monitor? A. Hemoglobin and hematocrit (H&H) B. White blood cell (WBC) count C. Blood urea nitrogen (BUN) and creatinine D. Lipid levels

The nurse suspects that a client may have acute pancreatitis as evidenced by which group of laboratory results? A. Deceased calcium, elevated amylase, decreased magnesium B. Elevated bilirubin, elevated alkaline phosphatase C. Elevated lipase, elevated white blood cell count, elevated glucose D. Decreased blood urea nitrogen (BUN), elevated calcium, elevated magnesium

The nurse visualizes blood clots in a client's urinary catheter after a cystoscopy. What nursing intervention does the nurse perform first? A. Administer heparin intravenously. B. Remove the urinary catheter. C. Notify the health care provider. D. Irrigate the catheter with sterile saline.

The outpatient clinic nurse is caring for a recovering client who had a colonoscopy. The client asks for a drink. How does the nurse respond to this request? A. "After I hear bowel sounds, you can have a drink." B. "Twenty minutes after the procedure was completed, you may have some liquids." C. "When you are able to pass flatus (gas), you can have a drink." D. "You can have fluids when you get home and are settled."

These data are obtained by the RN who is assessing a client who had a transsphenoidal hypophysectomy yesterday. What information has the most immediate implications for the client's care? A. Dry lips and oral mucosa on examination B. Nasal drainage that tests negative for glucose C. Client report of a headache and stiff neck D. Urine specific gravity of 1.016

When a client with diabetes returns to the medical unit after a computed tomography (CT) scan with contrast dye, all of these interventions are prescribed. Which intervention does the nurse implement first? A. Give lispro (Humalog) insulin, 12 units subcutaneously. B. Request a breakfast tray for the client. C. Infuse 0.45% normal saline at 125 mL/hr. D. Administer captopril (Capoten).

When caring for a client who had a nephrostomy tube inserted 4 hours ago, which is essential for the nurse to report to the health care provider? A. Dark pink-colored urine B. Small amount of urine leaking around the catheter C. Tube that has stopped draining D. Creatinine of 1.8 mg/dL

When caring for a client with uremia, the nurse assesses for which symptom? A. Tenderness at the costovertebral angle (CVA) B. Cyanosis of the skin C. Nausea and vomiting D. Insomnia

When performing bladder scanning to detect residual urine in a female client, the nurse must first assess which factor? A. Abdominal girth B. Presence of urinary infection C. History of hysterectomy D. Hematuria

Which action does the postanesthesia care unit (PACU) nurse perform first when caring for a client who has just arrived after a total thyroidectomy? A. Assess the wound dressing for bleeding. B. Give morphine sulfate 4 to 8 mg IV for pain. C. Monitor oxygen saturation using pulse oximetry. D. Support the head and neck with sandbags.

Which action is correct when drawing up a single dose of insulin? A. Wash hands thoroughly and don sterile gloves. B. Shake the bottle of insulin vigorously to mix the insulin. C. Pull back plunger to draw air into the syringe equal to the insulin dose. D. Recap the needle and save the syringe for the next dose of insulin.

Which assessment finding alarms the nurse immediately after a client returns from the operating room for cystoscopy performed under conscious sedation? A. Pink-tinged urine B. Urinary frequency C. Temperature of 100.8° F D. Lethargy

Which client does the nurse identify as being at highest risk for acute adrenal insufficiency resulting from corticosteroid use? A. Client with hematemesis, upper epigastric pain for the past 3 days not relieved with food, and melena B. Client with right upper quadrant pain unrelieved for the past 2 days, dark-brown urine, and clay-colored stools C. Client with shortness of breath and chest tightness, nasal flaring, audible wheezing, and oxygen saturation of 85% for the second time this week D. Client with three emergency department visits in the past month for edema, shortness of breath, weight gain, and jugular venous distention

Which explanation best assists a client in differentiating type 1 diabetes from type 2 diabetes? A. Most clients with type 1 diabetes are born with it. B. People with type 1 diabetes are often obese. C. Those with type 2 diabetes make insulin, but in inadequate amounts. D. People with type 2 diabetes do not develop typical diabetic complications.

Which factor represents a sign or symptom of digoxin toxicity? A. Serum digoxin level of 1.2 ng/mL B. Polyphagia C. Visual changes D. Serum potassium of 5.0 mEq/L

Which food does the nurse instruct a client undergoing chemotherapy for oral cancer with secondary stomatitis to avoid? A. Broiled fish B. Ice cream C. Salted pretzels D. Scrambled eggs

Which information suggests that a client with diabetes may be in the early stages of kidney damage? A. Elevation in blood urea nitrogen (BUN) B. Oliguria C. Microalbuminuria D. Painless hematuria

Which instruction does the nurse give a client who needs a clean-catch urine specimen? A. "Save all urine for 24 hours." B. "Use the sponges to cleanse the urethra, and then initiate voiding directly into the cup." C. "Do not touch the inside of the container." D. "You will receive an isotope injection, then I will collect your urine."

Which laboratory result indicates that fluid restrictions have been effective in treating syndrome of inappropriate antidiuretic hormone (SIADH)? A. Decreased hematocrit B. Decreased serum osmolality C. Increased serum sodium D. Increased urine specific gravity

Which negative feedback response is responsible for preventing hypoglycemia during sleep in nondiabetic clients? A. Alpha cells of the pancreas B. Beta cells of the pancreas C. Glucagon release D. Insulin release

Which nursing activity illustrates proper aseptic technique during catheter care? A. Applying Betadine ointment to the perineal area after catheterization B. Irrigating the catheter daily C. Positioning the collection bag below the height of the bladder D. Sending a urine specimen to the laboratory for testing

Which of these clients with diabetes does the endocrine unit charge nurse assign to an RN who has floated from the labor/delivery unit? A. A 58-year-old with sensory neuropathy who needs teaching about foot care B. A 68-year-old with diabetic ketoacidosis who has an IV running at 250 mL/hr C. A 70-year-old who needs blood glucose monitoring and insulin before each meal D. A 76-year-old who was admitted with fatigue and shortness of breath

Which substance, produced in the stomach, facilitates the absorption of vitamin B12? A. Glucagon B. Hydrochloric acid C. Intrinsic factor D. Pepsinogen

Which type of incontinence benefits from pelvic floor muscle (Kegel) exercise? A. Functional B. Overflow C. Stress D. Urge

Which type of thyroid cancer often occurs as part of multiple endocrine neoplasia (MEN) type II? A. Anaplastic B. Follicular C. Medullary D. Papillary

While assisting a client during peritoneal dialysis, the nurse observes the drainage stop after 200 mL of peritoneal effluent drains into the bag. What action should the nurse implement first? A. Instruct the client to deep-breathe and cough. B. Document the effluent as output\ C. Turn the client to the opposite side. D. Re-position the catheter.

nBreakthrough pain differs from end-of-dose pain in that: ¨a. it occurs immediately before the next dose is scheduled. ¨b. it occurs midway through the dosing interval. ¨c. it can occur at any time during the dosing interval. d.it occurs immediately after a dose is given.

nMrs. D., a client with diabetes, has many questions about dietary control of her disease. The nurse should teach the client that the percentage of calories that should be derived from carbohydrates is: a)about 10% b)about 25% c)about 60% d)about 80%

The nurse is caring for a client diagnosed with aphthous ulcers. The nurse instructs the client to avoid which foods? (Select all that apply.) A. Apples B. Bananas C. Cheese D. Nuts E. Potatoes

C, D, E

A client arrives at the emergency department with acute abdominal pain in the left lower quadrant. In which order does the nurse examine and assess the client's left lower quadrant (LLQ), left upper quadrant (LUQ), right lower quadrant (RLQ), and right upper quadrant (RUQ)? A. LLQ, RLQ, LUQ, RUQ B. LUQ, LLQ, RUQ, RLQ C. RLQ, LLQ, RUQ, LUQ D. RUQ, LUQ, RLQ, LLQ

A client had a computed tomography (CT) scan with contrast dye 8 hours ago. Which nursing intervention is the priority for this client? A. Maintaining bedrest B. Medicating for pain C. Monitoring for hematuria D. Promoting fluid intake

A client has been placed on enzyme replacement for treatment of chronic pancreatitis. In teaching the client about this therapy, the nurse advises the client not to mix enzyme preparations with foods containing which element? A. Carbohydrates B. High fat C. High fiber D. Protein

A client has undergone conventional esophageal surgery. The client's diet has been advanced to semi-solid, and feedings are well tolerated. The client reports experiencing diarrhea about 1 hour after each meal. What is the priority nursing intervention to help prevent further diarrhea? A. Ensure that the client takes adequate amounts of fluids with meals. B. Advance the diet to solid food and encourage eating as much as possible at meals. C. Give the client a dose of magnesium hydroxide (Milk of Magnesia) after each meal. D. Encourage the client to take fluids between meals rather than with meals.

A client is admitted for extracorporeal shock wave lithotripsy (ESWL). What information obtained on admission is most critical for a nurse to report to the health care provider before the ESWL procedure begins? A. "Blood in my urine has become less noticeable, so maybe I don't need this procedure." B. "I have been taking cephalexin (Keflex) for an infection." C. "I previously had several ESWL procedures performed." D. "I take over-the-counter naproxen (Aleve) twice a day for joint pain."

A client is being discharged after a minimally invasive esophagectomy. Which teaching point does the nurse consider to be of the highest priority during the predischarge teaching session? A. Instruct the client to eat three meals daily. B. Emphasize the importance of lying down after meals. C. Encourage the client to ask his or her health care provider for antidepressant medication. D. Report the presence of fever and a swollen, painful neck incision.

A client is being treated for kidney failure. Which statement by the nurse encourages the client to express his or her feelings and concerns about the risk for death and the disruption of lifestyle? A. "All of this is new. What can't you do?" B. "Are you afraid of dying?" C. "How are you doing this morning?" D. "What concerns do you have about your kidney disease?"

A client is newly diagnosed with tongue and esophageal cancer. Which response to the diagnosis does the nurse expect the client to have? A. Anxiety from knowing that, as a result of cancer and surgery, ingestion of food by mouth might become impossible B. Concern about getting an infection caused by invasive procedures C. Fear about the chance of aspiration after surgery D. Depression about changes in the face and neck after surgery

A client is referred to a home health agency after a transsphenoidal hypophysectomy. Which action does the RN case manager delegate to the home health aide who will see the client daily? A. Document symptoms of incisional infection or meningitis. B. Give over-the-counter laxatives if the client is constipated. C. Set up medications as prescribed for the day. D. Test any nasal drainage for the presence of glucose.

A client is referred to a home health agency after being hospitalized with overflow incontinence and a urinary tract infection. Which nursing action can the home health RN delegate to the home health aide (unlicensed assistive personnel [UAP])? A. Assisting the client in developing a schedule for when to take prescribed antibiotics B. Inserting a straight catheter as necessary if the client is unable to empty the bladder C. Teaching the client how to use the Credé maneuver to empty the bladder more fully D. Using a bladder scanner (with training) to check residual bladder volume after the client voids

A client is scheduled for a cystoscopy later this morning. The consent form is not signed, and the client has not had any preoperative medication. The nurse notes that the provider visited the client the day before. What action does the nurse take? A. Asks the client to sign the informed consent B. Cancels the procedure C. Asks the client's spouse to sign the form D. Notifies the department and the provider

A client is taking methimazole (Tapazole) for hyperthyroidism and would like to know how soon this medication will begin working. What is the nurse's best response? A. "You should see effects of this medication immediately." B. "You should see effects of this medication within 1 week." C. "You should see full effects from this medication within 1 to 2 days." D. "You should see some effects of this medication within 2 weeks."

A client recently admitted with new-onset type 2 diabetes will be discharged with a self-monitoring blood glucose machine. When is the besttime for the nurse to explain to the client the proper use of the machine? A. Day of discharge B. On admission C. When the client states readiness D. While performing the test in the hospital

A client who is 6 months pregnant comes to the prenatal clinic with a suspected urinary tract infection (UTI). What action does the nurse take with this client? A. Discharges the client to her home for strict bedrest for the duration of the pregnancy B. Instructs the client to drink a minimum of 3 liters of fluids, especially water, every day to "flush out" bacteria C. Recommends that the client refrain from having sexual intercourse until after she has delivered her baby D. Refers the client to the clinic nurse practitioner for immediate follow-up

A client with Cushing's disease says that she has lost 1 pound. What does the nurse do next? A. Auscultates the lungs for crackles B. Checks urine for specific gravity C. Forces fluids D. Weighs the client

A client with a possible adrenal gland tumor is admitted for testing and treatment. Which nursing action is most appropriate for the charge nurse to delegate to the nursing assistant? A. Assess skin turgor and mucous membranes for hydration status. B. Discuss the dietary restrictions needed for 24-hour urine testing. C. Plan ways to control the environment that will avoid stimulating the client. D. Remind the client to avoid drinking coffee and changing position suddenly.

A client with acute cholecystitis is admitted to the medical-surgical unit. Which nursing activity associated with the client's care will be bestfor the nurse to delegate to unlicensed assistive personnel (UAP)? A. Assessing dietary risk factors for cholecystitis B. Checking for bowel sounds and distention C. Determining precipitating factors for abdominal pain D. Obtaining the admission weight, height, and vital signs

A client with gastric cancer is scheduled to undergo surgery to remove the tumor once 5 pounds of body weight has been regained. The client is not drinking the vanilla-flavored enteral supplements that have been prescribed. Which is the highest priority nursing intervention for this client? A. Explain to the client the importance of drinking the enteral supplements prescribed. B. Ask the client's family to try to persuade the client to drink the supplements. C. Inform the client that a nasogastric tube may be necessary if he or she fails to comply. D. Ask the client if a change in flavor would make the supplement more palatable.

A client with oral cancer is depressed over the diagnosis and tells the nurse of plans to have a radical neck dissection. What is the nurse's best reaction? A. Listen to the client and then explain that it is normal to feel depressed about the diagnosis. B. Explain the grieving process and listen to what the client has to say. C. Suggest that the client talk with friends and family and seek their support. Listen to the client's concerns and feelings, and then suggest that the client join a community group of cancer survivors

A client with oral carcinoma has a priority problem of risk for airway blockage related to obstruction by the tumor. At the beginning of the shift, which action will the nurse take first? A. Suction the client's oral secretions to clear the airway. B. Place the client on humidified oxygen per nasal cannula. C. Assist the client to an upright position to facilitate breathing. D. Assess the respiratory effort and quantities and types of oral secretions.

A client with pyelonephritis has been prescribed urinary antiseptic medication. What purpose does this medication serve? A. Decreases bacterial count B. Destroys white blood cells C. Enhances the action of antibiotics D. Provides comfort

A client with thyroid cancer has just received 131I ablative therapy. Which statement by the client indicates a need for further teaching? A. "I cannot share my toothpaste with anyone." B. "I must flush the toilet three times after I use it." C. "I need to wash my clothes separately from everyone else's clothes." D. "I'm ready to hold my newborn grandson now."

After a colonoscopy, a client reports severe abdominal pain. The nurse obtains these data: temperature 100.2° F (37.9° C), pulse 122 beats/min, blood pressure 100/45 mm Hg, respirations 44 breaths/min, and O2 saturation 89%. Which request from the health care provider does the nurse implement first? A. Give cefazolin (Ancef) 500 mg IV. B. Infuse normal saline at 200 mL/hr. C. Give morphine sulfate 2 mg IV. D. Provide oxygen at 6 L/min per nasal cannula.

An older adult woman confides to the nurse, "I am so embarrassed about buying adult diapers for myself." How does the nurse respond? A. "Don't worry about it. You need them." B. "Shop at night, when stores are less crowded." C. "Tell everyone that they are for your husband." D. "That is tough. What do you think might help?"

During discharge teaching for a client with kidney disease, what does the nurse teach the client to do? A. "Drink 2 liters of fluid and urinate at the same time every day." B. "Eat breakfast and go to bed at the same time every day." C. "Check your blood sugar and do a urine dipstick test." D. "Weigh yourself and take your blood pressure."

How does the drug desmopressin (DDAVP) decrease urine output in a client with diabetes insipidus (DI)? A. Blocks reabsorption of sodium B. Increases blood pressure C. Increases cardiac output D. Works as an antidiuretic hormone (ADH) in the kidneys

In reviewing the health care provider admission requests for a client admitted in a hyperglycemic-hyperosmolar state, which request is inconsistent with this diagnosis? A. 20 mEq KCl for each liter of IV fluid B. IV regular insulin at 2 units/hr C. IV normal saline at 100 mL/hr D. 1 ampule NaHCO3 IV now

One of the nurse's roles is talking to adult clients about urinary and sexual hygiene. Which words does the nurse use when referring to the client's reproductive body parts? A. Children's terms that are easily understood B. Slang words and terms that are heard "socially" C. Technical and medical terminology D. Words that the client uses

The RN has just received change-of-shift report on the medical-surgical unit. Which client will need to be assessed first? A. Client with Hashimoto's thyroiditis and a large goiter B. Client with hypothyroidism and an apical pulse of 51 beats/min C. Client with parathyroid adenoma and flank pain due to a kidney stone D. Client who had a parathyroidectomy yesterday and has muscle twitching

The charge nurse is making client assignments for the medical-surgical unit. Which client will be best to assign to an RN who has floated from the pediatric unit? A. Client in Addisonian crisis who is receiving IV hydrocortisone B. Client admitted with syndrome of inappropriate antidiuretic hormone (SIADH) secondary to lung cancer C. Client being discharged after a unilateral adrenalectomy to remove an adrenal tumor D. Client with Cushing's syndrome who has elevated blood glucose and requires frequent administration of insulin

Which clients with long-term urinary problems does the nurse refer to community resources and support groups? (Select all that apply.) A. A 32-year-old with a cystectomy B. A 44-year-old with a Kock pouch C. A 48-year-old with urinary calculi D. A 78-year-old with urinary incontinence E. An 80-year-old with dementia

A. B . D

The health care provider requests phenazopyridine (Pyridium) for a client with cystitis. What does the nurse tell the client about the drug? A. "It will act as an antibacterial drug." B. "This drug will treat your infection, not the symptoms of it." C. "You need to take the drug on an empty stomach." D. "Your urine will turn red or orange while on the drug."

The nurse admits an immunocompromised client who has contracted herpes simplex stomatitis. The nurse anticipates that the health care provider will request which medication? A. Acyclovir (Zovirax) Correct B. Diphenhydramine (Benadryl) C. Nystatin (Mycostatin) D. Tetracycline syrup (Sumycin syrup)

The nurse has these client assignments. Which client does the nurse encourage to consume 2 to 3 liters of fluid each day? A. Client with chronic kidney disease B. Client with heart failure C. Client with complete bowel obstruction D. Client with hyperparathyroidism

The nurse is attempting to position a client having an acute attack of pancreatitis in the most comfortable position possible. In which position does the nurse place this client? A. Supine, with a pillow supporting the abdomen B. Up in a chair between frequent periods of ambulation C. High-Fowler's position, with pillows used as needed D. Side-lying position, with knees drawn up to the chest

The nurse is caring for a client recently diagnosed with type 1 diabetes mellitus who has had an episode of acute pancreatitis. The client asks the nurse how he developed diabetes when the disease does not run in the family. What is the nurse's best response? A. "The diabetes could be related to your obesity." B. "What has your doctor told you about your disease?" C. "Do you consume alcohol on a frequent basis?" D. "Type 1 diabetes can occur when the pancreas is destroyed by disease."

The nurse is caring for a client with hypercortisolism. The nurse begins to feel the onset of a cold but still has 4 hours left in the shift. What does the nurse do? A. Asks another nurse to care for the client B. Monitors the client for cold-like symptoms C. Refuses to care for the client D. Wears a facemask when caring for the client

The nurse is caring for clients on a renal/kidney medical-surgical unit. Which drug, requested by the health care provider for a client with a urinary tract infection (UTI), does the nurse question? A. Bactrim B. Cipro C. Noroxin D. Tegretol

The nurse is monitoring a client with gastric cancer for signs and symptoms of upper gastrointestinal bleeding. Which change in vital signs is most indicative of bleeding related to cancer? A. Respiratory rate from 24 to 20 breaths/min B. Apical pulse from 80 to 72 beats/min C. Temperature from 98.9° F to 97.9° F D. Blood pressure from 140/90 to 110/70 mm Hg

The nurse is performing discharge teaching for a client after a nephrectomy for renal cell carcinoma. Which statement by the client indicates that teaching has been effective? A. "Because renal cell carcinoma usually affects both kidneys, I'll need to be watched closely." B. "I'll eventually require some type of renal replacement therapy." C. "I'll need to decrease my fluid intake to prevent stress to my remaining kidney." D. "My remaining kidney will provide me with normal kidney function now."

The nurse is preparing to instruct a client with chronic pancreatitis who is to begin taking pancrelipase (Cotazym). Which instruction does the nurse include when teaching the client about this medication? A. Administer pancrelipase before taking an antacid. B. Chew tablets before swallowing. C. Take pancrelipase before meals. D. Wipe your lips after taking pancrelipase.

The nurse is reviewing orders for a client with possible esophageal trauma after a car crash. Which request does the nurse implement first? A. Give total parenteral nutrition (TPN) through a central venous catheter. B. Administer cefazolin (Kefzol) 1 g intravenously. C. Obtain a computed tomography (CT) scan of the chest and abdomen. D. Keep the client nothing by mouth (NPO) for possible surgery.

The nurse is reviewing the laboratory test results for a client admitted with a possible pituitary disorder. Which information has the mostimmediate implication for the client's care? A. Blood glucose 125 mg/dL B. Blood urea nitrogen (BUN) 40 mg/dL C. Serum potassium 5.2 mEq/L D. Serum sodium 110 mEq/L

The nurse is teaching a client about pelvic muscle exercises. What information does the nurse include? A. "For the best effect, perform all of your exercises while you are seated on the toilet." B. "Limit your exercises to 5 minutes twice a day, or you will injure yourself." C. "Results should be visible to you within 72 hours." D. "You know that you are exercising correct muscles if you can stop urine flow in midstream."

The nurse is teaching a client who is scheduled for a neobladder and a Kock pouch. Which client statement indicates a correct understanding of these procedures? A. "If I restrict my oral intake of fluids, the adjustment will be easier." B. "I must go to the restroom more often because my urine will be excreted through my anus." C. "I need to wear loose-fitting pants so the urine can flow into my ostomy bag." D. "I will have to drain my pouch with a catheter."

The nurse is teaching the importance of a low purine diet to a client admitted with urolithiasis consisting of uric acid. Which statement by the client indicates that teaching was effective? A. "I am so relieved that I can continue eating my fried fish meals every week." B. "I will quit growing rhubarb in my garden since I'm not supposed to eat it anymore." C. "My wife will be happy to know that I can keep enjoying her liver and onions recipe." D. "I will no longer be able to have red wine with my dinner."

The nurse is working with the dietitian to plan a menu for a client who has persistent difficulty swallowing. What is a suitable breakfast selection for this client? A. Scrambled eggs and toast B. Oatmeal and orange juice C. Puréed fruit and English muffin D. Cream of wheat and applesauce

The nurse prepares a teaching session regarding lifestyle changes needed to decrease the discomfort associated with a client's hiatal hernia. Which change does the nurse recommend to this client? A. Eat only two or three meals daily. B. Sleep flat in a left side-lying position. C. Drink tea instead of coffee. D. Avoid working while bent over the computer.

The nurse reviews a medication history for a client newly diagnosed with peptic ulcer disease (PUD) who has a history of using ibuprofen (Advil) frequently for chronic knee pain. The nurse anticipates that the health care provider will request which medication for this client? A. Bismuth subsalicylate (Pepto-Bismol) B. Magnesium hydroxide (Maalox) C. Metronidazole (Flagyl) D. Misoprostol (Cytotec)

The nurse reviews the vital signs of a client diagnosed with Graves' disease and sees that the client's temperature is up to 99.6° F. After notifying the health care provider, what does the nurse do next? A. Administers acetaminophen B. Alerts the Rapid Response Team C. Asks any visitors to leave D. Assesses the client's cardiac status completely

What does the nurse teach a client to do to decrease the risk for urinary tract infection (UTI)? A. Limit fluid intake. B. Increase caffeine consumption. C. Limit sugar intake. D. Drink about 3 liters of fluid daily.

What effect can starting a dose of levothyroxine sodium (Synthroid) too high or increasing a dose too rapidly have on a client? A. Bradycardia and decreased level of consciousness B. Decreased respiratory rate C. Hypotension and shock D. Hypertension and heart failure

When caring for a client who receives peritoneal dialysis (PD), which finding does the nurse report to the provider immediately? A. Pulse oximetry reading of 95% B. Sinus bradycardia, rate of 58 beats/min C. Blood pressure of 148/90 mm Hg D. Temperature of 101.2° F (38.4° C)

When caring for a client with hemorrhage secondary to kidney trauma, the nurse provides volume expansion. Which element does the nurse anticipate will be used? A. Fresh-frozen plasma B. Platelet infusions C. 5% dextrose in water D. Normal saline solution (NSS)

When planning an assessment of the urethra, what does the nurse do first? A. Examine the meatus. B. Note any unusual discharge. C. Record the presence of abnormalities. D. Don gloves.

When preparing a client for nephrostomy tube insertion, it is essential for the nurse to monitor which factor before the procedure? A. Blood urea nitrogen (BUN) and creatinine B. Hemoglobin and hematocrit (H&H) C. Intake and output (I&O) D. Prothrombin time (PT) and international normalized ratio (INR)

Which assessment finding represents a positive response to erythropoietin (Epogen, Procrit) therapy? A. Hematocrit of 26.7% B. Potassium within normal range C. Absence of spontaneous fractures D. Less fatigue

Which client assessment information is correlated with a diagnosis of chronic gastritis? A. Anorexia, nausea, and vomiting B. Frequent use of corticosteroids C. Hematemesis and anorexia D. Treatment with radiation therapy

Which client does the nurse manager on the medical unit assign to an experienced LPN/LVN? A. A 42-year-old with painless hematuria who needs an admission assessment B. A 46-year-old scheduled for cystectomy who needs help in selecting a stoma site C. A 48-year-old receiving intravesical chemotherapy for bladder cancer D. A 55-year-old with incontinence who has intermittent catheterization prescribed

Which goal for a client with diabetes will best help to prevent diabetic nephropathy? A. Heed the urge to void. B. Avoid carbohydrates in the diet. C. Take insulin at the same time every day. D. Maintain glycosylated hemoglobin (HbA1c).

Which nursing action can the home health nurse delegate to a home health aide who is making daily visits to a client with newly diagnosed type 2 diabetes? A. Assist the client's spouse in choosing appropriate dietary items. B. Evaluate the client's use of a home blood glucose monitor. C. Inspect the extremities for evidence of poor circulation. D. Assist the client with washing the feet and applying moisturizing lotion.

Which nursing intervention or practice is most effective in helping to prevent urinary tract infection (UTI) in hospitalized clients? A. Encouraging them to drink fluids B. Irrigating all catheters daily with sterile saline C. Recommending that catheters be placed in all clients D. Periodically re-evaluating the need for indwelling catheters

Which problem excludes a client hoping to receive a kidney transplant from undergoing the procedure? A. History of hiatal hernia B. Presence of diabetes and glycosylated hemoglobin of 6.8% C. History of basal cell carcinoma on the nose 5 years ago D. Presence of tuberculosis

Which set of assessment findings indicates to the nurse that a client may have acute pancreatitis? A. Absence of jaundice, pain of gradual onset B. Absence of jaundice, pain in right abdominal quadrant C. Presence of jaundice, pain worsening when sitting up D. Presence of jaundice, pain worsening when lying supine

Which staff member does the charge nurse assign to a client who has benign prostatic hyperplasia and hydronephrosis and needs an indwelling catheter inserted? A. RN float nurse who has 10 years of experience with pediatric clients B. LPN/LVN who has worked in the hospital's kidney dialysis unit until recently C. RN without recent experience who has just completed an RN refresher course D. LPN/LVN with 5 years of experience in an outpatient urology surgery center

Which technique does the nurse use to obtain a sterile urine specimen from a client with a Foley catheter? A. Disconnect the Foley catheter from the drainage tube and collect urine directly from the Foley. B. Remove the existing catheter and obtain a sample during the process of inserting a new Foley. C. Use a sterile syringe to withdraw urine from the urine collection bag. D. Clamp the tubing, attach a syringe to the specimen, and withdraw at least 5 mL of urine.

nWhich of the following statements should not be included in an education program for the elderly about prevention of dehydration during hot weather? 1. "Observe your urine and immediately drink more fluid if it starts getting darker." 2. "Keep a variety of fluids in your home & drink them frequently throughout the day." 3. "Popsicles, gelatin, & ice cream, provide fluid intake as well as liquids you drink." 4. "Use your thirst as a guide to the amount of fluid you should be drinking."

nThe preferred route of opioid administration for patients with mild to moderate pain is: ¨a. oral. ¨b. subcutaneously. ¨c. intramuscularly. ¨d. intravenously.

nWhen asked the significance of tolerance, the nurse's best response is that: ¨a. this means that more drug may be needed to produce the same effect after opioids have been used for over 1-2 weeks. ¨b. addiction to opioids is developing and the drugs should be discontinued ¨c. the patient needs less amount of drug to produce the same effect. ¨d. organ toxicity has occurred and the drug should be discontinued.

nWhich is the goal of cancer pain management? ¨a. To reduce pain to a level agreed upon between the patient and the providers. ¨b. To completely alleviate pain. ¨c. To make the patient comfortable with the least amount of medication. ¨d. To use pain relief measures until pain reaches a score of 7 out of 10.

nWhich of the following clients is at highest risk for developing fluid volume deficit? 1. A 76-y.o. who has had an NG tube to low suction following cancer surgery 2. A thin 55-y.o. who smokes & takes steroids for COPD 3. A 1 y.o. being treated in the clinic for a runny nose & ear infection 4. A 30 y.o. jogging in 50 degree weather

nA cancer patient with a history of alcohol abuse is taking acetaminophen for pain. What organ function is a risk for toxicity from this particular combination? ¨a. Sensory ¨b. Liver ¨c. Kidney ¨d. Cardio-respiratory

nWhich of the following ABG values would be most likely to be those of a patient suffering from Diabetic Ketoacidosis (DKA)? a)Low pH, high CO2, high HCO3 b)Low pH, low CO2, low HCO3 c)High pH, low CO2, high HCO3 d)High pH, high CO2, low HCO3

nWhich is the most important component of the pain assessment in a cancer patient? ¨a.The most recent CT scan interpretation. ¨b. The dosage of opioids required to relieve the pain. ¨c.The patient's description of his pain. ¨d. The serum tumor marker levels

471 Final

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