Prep U: basic physical needs
4. Which would be the most appropriate measure for preventing the development of a paralytic ileus in a client who has undergone renal surgery?
Continue IV fluid therapy. Offer 3 to 4 oz (90 to 120 mL) of a carbonated beverage periodically. Encourage the client to ambulate every 2 to 4 hours. Encourage use of a stool softener.
10. Which nursing action best addresses the outcome: The client will be free from falls?
Install a monitoring system to help the client in an emergency situation. Encourage use of grab bars and railings in the bathroom and halls Use large muscle group when transfer client from bed to chair. Place emergency contact's telephone number in a prominent place.
8. A child has a nasogastric (NG) tube inserted by the nurse to administer a continuous feeding. Which of the following actions should the nurse take before starting the NG feeding on the child? Select all that apply.
Heat the formula in a microwave. Verify the physician's order. Check placement of the NG tube. Prepare a 24-hour supply of formula. Assess for bowel sounds.
2. A client who's dehydrated has urinary incontinence and excoriation in the perineal area. Which action would be a priority?
Applying moist, warm compresses to the client's groin Keeping the perineal area clean and dry Maintaining a fluid intake of 1 L/day Offering the client the urinal every 3 hours
9. The nurse understands that client position is important when treating dyspnea. What position would be contraindicated for a client who has dyspnea?
Contour Orthopneic Fowler's Supine
5. The nurse instructs the unlicensed assistive personnel (UAP) on how to provide oral hygiene for clients who cannot perform this task for themselves. Which technique should the nurse ask the UAP to incorporate into the client's daily care?
Use a soft toothbrush to brush the client's teeth after each meal. Assess the oral cavity each time mouth care is given and record observations. Swab the client's tongue, gums, and lips with a soft foam applicator every 2 hours. Rinse the client's mouth with mouthwash several times a day.
6. A nurse is caring for an elderly client with a pressure ulcer on the sacrum. When teaching the client about dietary intake, which foods should the nurse emphasize?
Whole grain products Legumes and cheese Lean meats and low-fat milk Fruits and vegetables
7. The nurse is planning care for a client on complete bed rest. The plan of care should include all except:
maintaining the client in the supine position. use of thromboembolic disease support (TED) hose. turning every 2 hours. passive and active range-of-motion exercises.
3. The family members of a client who is near death from colon cancer ask the nurse what to expect if the client becomes dehydrated. What should the nurse should tell them?
The health care provider (HCP) will make the decision regarding hydration therapy. Dehydration is expected during the dying process. Hydration is used only in extreme situations of dehydration. Dehydration may prolong the dying process.