N1 Exams

The nurse is caring for a client diagnosed with irritable bowel syndrome (IBS) who is experiencing diarrhea. What medication would the nurse expect to administer?

loperamide (Imodium)

The nurse is listening for bowel sounds in a postoperative patient. The bowel sounds are slow, as they are heard only every 3 to 4 minutes. The patient asks the nurse why this is happening. The best response from the nurse would be which of the following?

"Anesthesia during surgery and pain medication after surgery may slow peristalsis in the bowel"

A client has functional urinary incontinence. Which instruction by the nurse to the client and family helps meet an expected outcome for this condition?

"Buy slacks with elastic waistbands that are easy to pull down"

The nurse is assessing a client who reports severe knee pain after a fall. Which question does the nurse ask to determine the radiation of the pain?

"Does the pain move to another area from your knee?"

The nurse has educated a client on Paget's disease. Which statement by the client indicates good understanding of causative factors?

"I may have a genetic predisposition"

Which statements said by patients indicate that the nurse's teaching regarding prevention of acid-base imbalances is successful? (Select all that apply.)

"I shall take my insulin on time each day" "My aspirin is on a high shelf away from children" "I have reliable transportation to dialysis sessions"

Which statements by a female client indicate that instruction in ways to prevent urinary tract infection (UTI) was understood? Select all that apply.

"I should avoid tub baths and take showers instead" "I should drink 8-10 glasses of fluid per day"

A client is prescribed alendronate (Fosamax). Which statement indicates that the client understands teaching about this drug?

"I should take this drug with a full glass of water"

The nurse is caring for a client with perineal excoriation caused by diarrhea from acute gastroenteritis. Which client statement indicates that additional teaching about perineal care is needed?

"I will clean my rectal area thoroughly with toilet paper after each stool and then apply aloe vera gel"

The nurse is instructing a client diagnosed with osteoarthritis. Which of the following statements indicates that the client understands these instructions?

"I will need to lose weight; my doctor says about 20 pounds"

The nurse is providing discharge teaching for a client following a liver transplant. Which statement by the client indicates that additional teaching is needed?

"If I develop an infection, I should stop taking the steroid preparation"

A nurse is teaching a group of businesspeople about disease transmission. He knows that he needs to *reeducate* when one of the participants states which of the following?

"If I don't feel sick, then I don't have to worry about transmitted diseases"

An older adult client tells the nurse that her granddaughter has chickenpox. The client is afraid to visit because she is afraid of getting shingles from her granddaughter. What is the nurse's best response?

"If you already had chickenpox, you can safely visit your granddaughter"

Which dietary adjustments does the nurse recommend to an older adult client asking what changes she should institute to prevent or manage constipation?

"Include plenty of fiber"

A mother overhears two nurses discussing the incubation period for a measles outbreak. The mother asks the nurses why it is important to know this. The nurses' reply would include which statement about the incubation period?

"It describes a period when the child might be contagious"

A client is diagnosed with primary bone sarcoma of the leg and is scheduled for tumor removal. The client expresses fear of loss of function. Which is the nurse's best response?

"It is normal to feel this way"

A nurse educator is teaching a module on proper body mechanics during employee orientation. Which of the following statements by a newly hired nurse indicates the need for *further* teaching?

"My line of gravity should fall outside my base of support"

After being diagnosed, a client asks the nurse "What is pyelonephritis?" The nurse should respond

"Pyelonephritis is a common infection that needs to be treated to prevent complications"

A 15-year-old patient complains of left ankle pain after being tackled while playing football. He asks the nurse what tests he need to have to determine if he has a strain or fracture. How should the nurse reply?

"Sprains, strains, and fractures have similar symptoms at first; you will need an xray of the joint to be certain"

The nurse is caring for a client who has undergone a kidney transplant. The client asks the nurse what will happen when his body realizes that the kidney is not "his." What is the nurse's best response?

"The immune system will try to destroy the kidney if we don't suppress it"

While caring for a patient preparing for a kidney transplant, the nurse knows that the patient understands teaching on immunosuppression when she states which of the following?

"The medications I take will help prevent my body from attacking my new kidney"

A patient who was diagnosed with senile dementia has become incontinent of urine. The patient's daughter asks the nurse why this is happening. The best response by the nurse is:

"The patient is losing sphincter control due to dementia"

The client who has ulcerative colitis is scheduled for an ileostomy. When the client asks the nurse what to expect related to bowel function and care after surgery, what response should the nurse make?

"The stoma will require that you wear a collection device at all times"

The mother of a 16-year-old client diagnosed with Ewing's sarcoma expresses concern that her son seems to be angry at everyone in the family. How does the nurse respond?

"This is a normal stage in the grieving process"

During preoperative assessment, the client tells the nurse about taking NSAIDs for years. What question is most important for the nurse to ask?

"When was the last time you took your NSAID?"

A 16-year-old was hospitalized 3 weeks ago. He has been confined to bed throughout his hospital stay because of a crushed pelvis. His parents tell the nurse" our soon is just staring off into space; he won't talk to us. We are worried because he has not even listened to his ipod, watched tv, or played his video games for 2 days. That is so unlike him." What is the best response the nurse can make?

"Your son had a major injury and his immobility might be causing him to feel isolated and depressed"

The physician is going to order a hypotonic intravenous solution for a client with cellular dehydration. The nurse would expect which fluid to be administered?

0.45 % sodium chloride

When the nurse walks into the patient's room, she notices fire coming for the patient's trash can. Rank the following actions in the order they should be performed by the nurse: 1. Activate the fire alarm 2. Move the patient out of the room 3. Close all doors and windows 4. Put out the fire using the proper extinguisher

2-1-3-4

Considering normal developmental and physical maturation in children, for which age would a goal of "Achieves bowel control by the end of this month" be most realistic?

3 years

The nurse, caring for a client recovering from surgery, is monitoring the urine output and will notify the surgeon if the output falls below:

30 mL/hr

The nurse recognizes that the leading cause of death for the otherwise health 1-year-old is:

Accidental injury

A nursing student that immediately informs her clinical instructor after she realizes that she has administered the wrong dose of medication to a patient is best described professionally as:

Accountable

A nurse enters a client's room and finds that the wastebasket is on fire. The nurse immediately assists the client out of the room. What is the next nursing action?

Activate the fire alarm

A 28-year-old female client presents at the emergency department with a rapid onset of fever and chills, with flank pain, pyuria, nausea, vomiting, and headache. Laboratory results indicate bacteriuria, WBCs, and casts. What condition should the nurse suspect?

Acute pyelonephritis

During a surgical procedure, the client's body temperature spikes to a dangerous level. Which of the following will be done to help this client?

Administer a Dantrolene infusion

A patient is admitted to the hospital with tuberculosis. Which precautions must the nurse institute when caring for this patient?

Airborne transmission

Although a nurse may not agree, the nurse recognizes that a terminally ill client has the legal right to:

All answers listed Competent clients have the right to refuse treatment. This includes life-saving hydration and nutrition. Physician-assisted suicide is legal in the state of Oregon, and it is legally a client's decision to declare a DNR status or to sign an organ donor card.

Which action by the nurse shows an understanding of the principle of self-determination?

Allowing a postoperative client decide to take medication with fruit juice rather than water

Which of the following would the nurse identify as age-related changes in immunologic function that occur in the older adult? (Select all that apply.)

Alternated nutrition intake Failure of immune system to differentiate self from nonself Increased hematuria

Antiembolic stockings (thromboembolic device [TED] hose) are ordered for the client on bed rest following surgery. The nurse explains to the client that the primary purpose for the TEDs is to:

Apply external pressure

Which aspect of restraint use can the nurse delegate to the nursing assistive personnel?

Applying and removing the restraints

The parents of a newborn question the nurse about the need for vaccinations: "Why does our baby need all those shots? He's so small, and they have to cause him pain." The nurse can explain to the parents that which of the following are true about vaccinations? (Select all that apply.)

Are part of primary prevention for system disorders Help protect individuals and communities Are recommended by the CDC

While teaching a health promotion group of adults, the nurse notices one person who is clutching his throat with both hands. What should the nurse do first?

Ask "are you choking?"

Twenty minutes after a client has received a preoperative injection of atropine and midazolam (Versed), the client tells the nurse that he must be allergic to the medication because his mouth is dry and his heart seems to be beating faster than normal. What is the nurse's priority action?

Assess the client's pulse and blood pressure

A nurse is completing a physical assessment on a client who has osteoarthritis. Which of the following physical manifestations may the nurse expect to find?

Atrophy

A nurse who is teaching a group of adults ages 20-40 years old about safety is going to ensure that which topic is a priority?

Automobile crashes/MVA

What action is most important in limiting the nurse's risk of back injuries?

Avoid manual lifting by using assistive devices as often as possible

A patient comes to the clinic with a complaint of painful, itchy feet. On interview, the patient tells the nurse that he is a college student living in a dormitory apartment that he shares with five other students. The nurse plans to teach the patient to

Avoid sharing razors and other personal items

Which set of assessment data is consistent for a patient with severe infection that could lead to system failure?

BP 90/48 P 112 beats/min RR 26 breaths/min Urine output 240 mL in past 24 hr

The nurse is caring for a patient who is being discharged home after a splenectomy. What information on immune function needs to be included in this patient's discharge planning?

Basic infection control techniques

A client is about to start taking celecoxib (Celebrex) to treat osteoarthritis symptoms. The nurse should instruct the client to watch for and report which of the following possible indications of a serious reaction to this drug?

Black, tarry stools

A client is surprised to learn that his acute pain is caused by a kidney stone. The nurse should instruct the client that the most common type of renal calculi is composed of:

Calcium

A client with hypocalcemia is taking supplemental vitamin D. When the client asks the purpose of this therapy, what explanation should the nurse give?

Calcium is absorbed in the intestines only under the influence of activated vitamin D

The nurse is having difficulty reading the prescribed dosage on a handwritten order for a pain medication. The most appropriate action to ensure the client's safety and to minimize legal issues is for the nurse to:

Call the health care provider to clarify the order

Before the nurse brings the client to the operating room (OR) for knee surgery, the client reports to the nurse that he did not mark the operative knee with the surgeon. What is the priority action of the nurse?

Call the surgeon to mark the site with client before transfer to the OR

A client presents with dyspnea, pruritus, and localized swelling of the forearm after being stung by a bee. What is the priority nursing intervention?

Check the tongue for swelling and listen for stridor

A patient is brought to the emergency department after inhaling mercury. The nurse should be alert for which acute adverse effects associated with mercury inhalation?

Chest pain, pneumonitis, and inflammation of the mouth

A client with renal calculi is advised to restrict calcium in the diet. The nurse determines that the client understands the restriction when the client states to avoid which types of foods?

Chocolate, smoked fish, and low-fat milk

The nurse assesses an area of drainage on the dressing of a postanesthesia care client's surgical wound. Which of the following should the nurse do?

Circle the area and mark it with the date and time

When turning a client, the nurse notices a reddened area on the coccyx. What skin care interventions should the nurse use on this area?

Clean the area with mild soap, dry, and add a protective moisturizer

The nurse notes that the electrical cord on an IV infusion pump is cracked. Which action by the nurse is best?

Clearly label the pump and send it for repair

Which client is at highest risk of compromised immunity?

Client who just had surgery

Which client does the nurse assess first at the start of the nursing shift?

Client who reports increased pain and swelling after an arthroscopy

A client is experiencing an acute attack of gout. The nurse should be prepared to provide which of the following medications as prescribed?

Colchicine

The nurse is preparing to administer medications to a patient with rheumatoid arthritis (RA). The nurse explains to the patient that the goal of medication treatments for RA is to

Control inflammation

A nurse is caring for a client admitted for acute inflammation of the ankle. The provider diagnoses an acute attack of gout and orders colchicine (Colsalide) 2 mg IV now, then 0.5 mg every 6 hr. The nurse should know that the purpose of colchicine is to:

Decreased joint inflammation

A client has been on prolonged bed rest, and the nurse is observing for signs associated with immobility. In assessment of the client, the nurse is alert to a(n):

Decreased peristalsis

A nurse's use of ethical responsibility can be best seen in which of the following nursing actions?

Delivery of competent care

A nurse is preparing a client for an IV pyelogram. What measures should the nurse employ?

Determine whether the client is allergic to shellfish

An immobilized client is suspected of having atelectasis. This is assessed by the nurse upon auscultation as:

Diminished breath sounds

A client, scheduled for a colonoscopy, is provided with a polyethylene glycol solution to ingest the day before the test. Which of the following should the nurse instruct the client about this solution?

Drink 8 oz. of the solution every 10 minutes until totally consumed

A client is demonstrating signs of the inflammatory response. The nurse would assess which of the following in this client? (Select all that apply.)

Edema Heat Erythema Pain

An 8-month-old infant is hospitalized with severe diarrhea. The nurse knows that the major problem associated with severe diarrhea is:

Electrolyte and fluid loss

The nurse is caring for a client with fluid volume excess who has edematous skin. Which of the following is an appropriate nursing consideration for this client?

Elevate an edematous part to a position higher than the heart's level

For the patient with no healthcare coverage who is seeking medical care, the emergency department staff members decide whether to provide care or transport to a public facility based on which law, enacted by Congress in 1986 and updated in 2003?

Emergency Medical Treatment and Active Labor Act (EMTALA)

To promote respiratory function in the immobilized client, the nurse should:

Encourage deep breathing and coughing every hour

The nurse suspects a 3-year-old child who is coughing vigorously has aspirated a small object. Which action should the nurse take first?

Encourage the child to continue coughing

You are caring for a patient who has suffered a spinal cord injury. You are concerned about the patient's elimination status. As the nurse, your primary concern is to:

Establish a bowel and bladder program for the client

A patient has asked the nurse to explain her laboratory results. The nurse informs the patient that he must first assist another patient to the bathroom and then he will explain the results. The nurse assists the other patient to the bathroom and then returns to explain the results to the patient. What moral principle has the nurse displayed?

Fidelity

The nurse is using the Braden Scale to determine a client's risk for developing a pressure ulcer. Which of the following areas are assessed with this scale?

Friction and shear

While you are admitting an adult patient, he asks you whether he should create an advance directive. To provide him adequate information to make an informed decision, you should tell the patient which of the following? Select all that apply.

He may change his advance directive by telling his physician or by making changes in writing An advance directive will ensure he gets as much or as little care as he wishes

A nurse is reviewing a metabolic panel laboratory report of a client on diuretic therapy for congestive heart failure. The report is as follows: sodium, 142 mEq/L; potassium, 2.5 mEq/L; calcium, 8.5 mEq/L; and chloride, 98 mEq/L. Which of the following electrolyte disturbances should the nurse report to the physician?

Hypokalemia

The nurse is admitting an older adult with decompensated congestive heart failure. The nursing assessment reveals adventitious lung sounds, dyspnea, and orthopnea. The nurse should question which doctor's order?

IV 500 mL of 0.9% NaCl at 125 mL/hr

The nurse is reviewing the results of a laboratory test to measure the amount of immunoglobulins in a client's blood. Which of the following should have the highest value?

IgG

The nurse instructs a client to use good handwashing and cover her nose and mouth when sneezing. These efforts will reduce others' exposure to molecules that can elicit an immune response or:

Immunogens

The mother of a newborn baby is concerned that the baby will develop illnesses from being around so many people. The nurse should explain that the baby has immunity that is present at birth or:

Innate immunity

The patient's laboratory report today indicates severe hypokalemia, and the nurse has notified the physician. Nursing assessment indicates that heart rhythm is regular. What is the most important nursing intervention for this patient now?

Institute fall precautions due to potential postural hypotension and weak leg muscles

Which body fluid lies in the spaces between the body cells?

Interstitial

A nurse is teaching a client who is about to start therapy with alendronate (Fosamax) to treat osteoporosis. Which of the following adverse effects should the nurse instruct the client to report? (Select all that apply)

Jaw pain Blurred vision Dysphagia

A 37-year-old male client presents at the emergency department with excruciating pain that comes in waves, nausea, vomiting, and chills. The nurse suspects the client has kidney stones. What test would be ordered to confirm or rule out this condition?

KUB flat place of the abdomen

A 50-year-old woman had a surgical repair of a fracture of her right tibia 2 days ago. She has been using crutches for ambulation and must remain non-weight-bearing on her right leg, but must learn to use the steps leading into her house. The nurse should instruct the woman to:

Lead with the left leg when going up steps, and lead with the right leg when going down steps

The nurse is completing a physical assessment with a client. Which of the following findings could be caused by impaired immune function in the client?

Leg rash

Which of the following is *false* regarding state licensure laws?

Licensure is not necessary if the individual has completed training

A patient has received a radiation implant. The patient is weak and needs help even to turn in bed. Which action should the nurse take when caring for this patient?

Limit the amount of time spent with the patient

An elderly client tells the nurse that he has been having increasing difficulty walking and he has reduced range of motion in both hips. The nurse suspects that which of the following is occurring with this client?

Loss of elasticity of the ligaments and tendons

A client is seeking medical attention for pain in the knee that occurred during a recent sports activity. The nurse realizes that the client will most likely have which of the following diagnostic tests?

MRI

Upon initial assessment of a 75-year-old patient, you identify bruises and scratches on the patient's arms, legs, and trunk in various stages of healing. You notify your supervisor when you suspect the patient may be a victim of physical abuse. You are complying with which of the following state laws?

Mandatory Reporting Law

Arterial blood gas levels are obtained for the client. If the client's results are pH 7.48, CO2 42 mm Hg, and HCO3 32 mEq/L, the client is exhibiting which one of the following acid-base imbalances?

Metabolic alkalosis

Identify the appropriate intervention(s) for a patient with hypovolemia. (Select all that apply)

Monitor I&O daily Encourage fluid intake Monitor electrolyte balance

When a client's serum sodium level is 120 mEq/L, the priority nursing assessment is to monitor the status of which body system?

Neurological

The nurse is concerned that a client will develop an overwhelming infection because which of the following laboratory values is low?

Neutrophils

The nurse is caring for a client who has had conscious (minimal) sedation. What is the primary advantage of this type of anesthesia?

No respiratory support is needed

The nurse is completing preoperative teaching for a client, and it becomes apparent that the client does not understand the surgery that will be performed. What is the priority action for the nurse?

Notify the surgeon and document the finding

A primary prevention tool used for colon cancer screening is

Occult blood testing

Which client is at greatest risk for dehydration?

Older adult client with cognitive impairment

When encouraging a fitness program for older adults, what must the nurse consider?

Older adults at risk for falling should do activities that maintain or improve balance

A client who has just been transferred to the postanesthesia care unit (PACU) from surgery is very restless and confused. What is the nurse's first action?

Orient the client and remain with him or her

Which factor(s) in the patient's past medical history place(s) him at risk for falling? (Selected all that apply)

Orthostatic hypotension Dizziness

A client is being evaluated for generalized skeletal pain and pain in the hips, ribs, and feet. The nurse observes that the client walks with a waddling gait. Because of this information, which of the following should the nurse suspect is occurring with this client?

Osteomalacia

The nurse is teaching a group of community members at the senior center about osteoporosis. Which of the following clinical manifestations should the nurse instruct as not being related to this disorder?

Pain

What type of immunity is provided by IV administration of immunoglobulin G?

Passive

A nurse is caring for a 25-year-old male quadriplegic patient. Which of the following treatments would the nurse perform to decrease the risk of joint contracture and promote joint mobility?

Passive ROM

Which is the most commonly reported incident in hospitals?

Patient falls

A client is hospitalized with urinary retention, has an indwelling catheter, and is getting IV fluids. Which intervention does the nurse add to the care plan to address the priority problem for this this client?

Perform catheter care per policy every shift

A patient is receiving an IV infusion of lactated Ringer's solution and 40 mEq of KCl at 100 mL/hr. When assessing the IV site, the nurse notes swelling, erythema, and warmth. There is a palpable cord along the vein, and the infusion is sluggish. The patient is complaining of pain at the site. The nurse would recognize these findings to be consistent with which of the following?

Phlebitis

The nurse is collecting a 24-hour urine specimen from a client with an indwelling urinary catheter. How should the nurse collect this specimen?

Place the catheter bag on ice and empty regularly into the collection bottle, which is also kept on ice

The nurse has taught the client to perform deep-breathing and coughing exercises. The nurse determines that the client needs more teaching when the client is observed doing which activity? (Select all that apply).

Placing both hands vertically and lightly on either side of the incision Use gentle coughing efforts that sound like clearing the throat

A 5-year-old child is brought into the clinic after being stung by an insect. The child appears to be going into anaphylactic shock. Which nursing action is of highest priority?

Position the child's head to maintain an open airway

The nurse assessed four patients at the beginning of the shift. Which finding should the nurse report most urgently to the physician?

Positive Chvostek's sign in patient with acute pancreatitis

The Joint Commission's national Speak Up campaign encourages patients to become active and informed participants on the healthcare team. The goal is to:

Prevent healthcare errors

The nurse should instruct the postoperative client that antiembolic stockings are used to:

Promote venous return

To enhance meeting the psychosocial needs of a client on transmission-based precautions, the nurse should place highest priority on which of the following?

Providing the client with diversional activities to enhance sensory input

What would be the most appropriate goal for a frail, elderly patient with a nursing diagnosis of risk for injury after hip surgery?

Remain free from injury or falls throughout hospital stay

Which of the following is the principal site for regulation of fluid and electrolyte balance?

Renal system

Prior to drug administration, the nurse reviews the seven rights, which includes right patient, right medication, right time, right dose, right education, right documentation, and right

Route

The cardiac nurse wants to know about the best practices to prevent pneumonia after open-heart surgery. What does the nurse do first?

Search for evidence to answer the question

A toddler who has not had surgery before is being prepared for a surgical procedure. The child's mother expresses concern about the child's psychological adaptation to surgery. While planning for postoperative care, the nurse recognizes that the child is likely to have which greatest concern based on age?

Separation from parents

The process of digestion is important for every living organism for the purpose of nourishment. Where does most digestion take place in the body?

Small intestine

The nurse, after reviewing a client's immunization history, realizes that which of the following pathogen toxoids would not be given to an individual to develop an immune response?

Snake toxin

Which of the following actions represents proper body mechanics for nurses providing care as well as teaching patients about safe body movements? (Select all that apply)

Stand with the body in alignment and erect posture Use a wide base of support with your feed at shoulder width Keep objects close to your body when carrying them

A client is being admitted to a health care facility. Which type of precautions will the nurse implement at this time?

Standard

A patient in the emergency department is angry, yelling, cursing, and waving his arms when the nurse comes to the treatment cubicle. Which action(s) by the nurse is (are) advisable?

Stay between the patient and the door; keep the door open

What would the nurse identify as a safety hazard in an infant?

Suffocation in the crib

A client is diagnosed with osteoarthritis. The nurse would *not* expect to find which of the following during assessment?

Symmetrical joint involvement

A client is prescribed trimethoprim-sulfamethoxazole (Bactrim) for a urinary tract infection. Which of the following instructions would *not* be appropriate for this medication?

Take with an antacid

A nurse is developing a plan of care for an older adult who is at risk for falls. Which of the following actions should the nurse plan to include in the plan? (Selected all that apply)

Teach about balance and strengthening exercises Providing information about home safety checks Locking beds and wheelchairs during transfers Placing a bedside table within the client's reach

The nurse is preparing a consent form for a client to sign before a procedure. Which of the following statements explains a characteristic of informed consent?

The client does not need to give consent if the situation is an emergency

During a routine screening, a client has a positive response to intradermal injection of purified protein derivative (PPD or Mantoux test). The nurse draws which conclusion about this result?

The client has been infected with TB and has developed a cellular (T cell) response to the tubercle bacillus

A nurse is preparing to transfer a client from lying in bed to sitting in a chair. When identifying the safest method of transfer, which of the following is most important for the nurse to determine?

The client's current weight-bearing status

Which of the following is an example of a nurse violating the Health Insurance Portability and Accountability Act (HIPAA) of 1996?

The nurse asks the unit clerk to look up lab values for her relative recently admitted to the hospital

A client has a history of being treated for ulcerative colitis. The nurse realizes that a life-threatening complication of this disorder is:

Toxic megacolon

A client is admitted with severe diarrhea. Arterial blood gas (ABG) results are pH 7.33; PaCO 2 42; HCO 3 - 20. The nurse concludes this client has which acid-base imbalance?

Uncompensated metabolic acidosis

A nurse forgets to administer a client's diuretic and the client experiences an episode of pulmonary edema. The charge nurse would consider the medication error to constitute negligence because the situation contains which element?

Unintentional failure to perform a health care procedure

A patient hospitalized in a long-term rehabilitation facility is immobile and requires mechanical ventilation with a tracheostomy. She has a pressure area on her coccyx measuring 5 cm by 3 cm. The area is covered with 100% eschar. What would the nurse identify this as?

Unstageable pressure ulcer

A client has a reduction in immune function. What is the nurse's priority action for this client?

Wash hands before entering the room

The nurse records a patient's hourly urine output from an indwelling catheter as follows:0700: 36 mL 0800: 45 mL 0900: 85 mL1000: 62 mL1100: 50 mL1200: 48 mL1300: 94 mL1400: 78 mL1500: 60 mL. The nurse can conclude that the patient's urine output should be described as which of the following?

Within normal limits

A client is admitted for treatment of various poorly healing, infected leg ulcers. The nurse recognizes that the client's nutritional history is of primary importance since:

Wound healing and infection prevention are negatively impacted by poor nutrition

A home health nurse is reviewing the medication list of an older adult client who reports falling a couple of times over the past week. Which of the following medications should the nurse suspect is contributing to the client's falls?

alprazolam (Xanax)

The nurse it talking to the unlicensed assistive personnel about moving a patient in bed. The nurse knows the unlicensed assistive personnel understands the concept of mobility and proper moving techniques when he/she states, "Patients must

be moved correctly in bed to prevent shearing"

The nurse would suspect that a client who frequently uses which medication is at risk for developing metabolic alkalosis?

calcium carbonate (Tums)