220 Exam 3
Which of the following foods is/ are not recommended for a patient who is on a soft or low-residue diet? A.Raw fruits and vegetables. B.Bananas C.Milk D.Eggs
A.Raw fruits and vegetables.
A nurse is caring for a client receiving dextrose 5% in 0.9% sodium chloride IV at 120 mL/hr. Which of the following statements by the client should alert the nurse to suspect fluid overload? (select all that apply) A. "I feel lightheaded" B. "I feel as though my heart is racing." C. "I feel a little short of breath." D. "The nurse technician told me that my blood pressure was 150 over 90." E. "I think my ankles are less swollen."
B. "I feel as though my heart is racing." C. "I feel a little short of breath." D. "The nurse technician told me that my blood pressure was 150 over 90."
Whereas __[1]__ provides calories, __[2]__ serve a role in regulating body processes. Select from the key words below to fill-in-the blanks. Key Words: Macronutrients Micronutrients Fiber Vitamins Minerals Electrolytes
Macronutrients Micronutrients
a nurse is caring for a nondiabetic client who has a new prescription for a fasting blood glucose check. The nurse checks the client's blood glucose and it is 67 mg/dL. which of the following actions should the nurse take next? document the client's blood glucose level report the client's blood glucose level to the provider provide the client with a 15g carbohydrate snack recheck the blood sugar in 15 min
provide the client with a 15g carbohydrate snack
A nurse is caring for a female client who has a prescription for a clean catch urine specimen. Which of the following statements by the client demonstrates an understanding of how to provide a urine specimen? "I need to wipe from front to back with a sanitary wipe." "I should place the urine sample cup in the refrigerator." "I will begin the urination process in the specimen cup." "I will urinate in the urine tray for the nurse to collect."
"I need to wipe from front to back with a sanitary wipe."
A nurse is teaching a patient about the urinary system structures. Order the follow of urine. 1.Kidney 2.Bladder 3.Urethra 4.Ureters
1.Kidney 2.Urteters 3.Bladder 4.Urethra
a nurse is helping a client calculate how many net carbohydrates they consumed in their last meal. the client's food had a total of 72g of carbohydrates and 9g of fiber. how many net carbohydrates did the client consume? 81 63 8 72
63
A nurse on a medical-surgical unit is caring for a group of clients. For which of the following clients should the nurse expect a prescription for fluid restriction? A. A client who has a new diagnosis B. A client who has heart failure C. A client who is receiving treatment for diabetic ketoacidosis D. A client who has abdominal ascites
B. A client who has heart failure
The nurse is caring for a patient receiving total parenteral nutrition (TPN). Which action will the nurse take? A.Take down a running bag of TPN after 36 hours. B.Run lipids for no longer than 24 hours. C.Wear a sterile mask when changing the central venous catheter dressing. D.Clean injection port with alcohol 5 seconds before and after use.
C.Wear a sterile mask when changing the central venous catheter dressing.
A nurse is caring for a client who has a history of irritable bowel syndrome and reports that their last bowel movement was 5 days ago. The nurse should identify this as which of the following types of altered elimination pattern? Encopresis Diarrhea Fecal incontinence Constipation
Constipation
A nurse is caring for a client with suspected dehydration. For which of the following findings should the nurse monitor this client? Oral temperature of 97.5F Light yellow urine Dry mucous membranes Diaphoresis
Dry mucous membranes
A nurse is planning care for a client who reports blood in their stool. Which of the following tests should the nurse anticipate the provider ordering? Fecal occult blood test Stool culture Flexible sigmoidoscopy endoscopic retrograde cholangiopancreatography (ERCP)
Fecal occult blood test
A nurse is planning care for a client who has a new colostomy. Which of the following complications should the nurse plan to monitor for? Hernia Gastroesophageal reflux disease Crohn's disease Ulcerative colitis
Hernia
The involuntary loss of a moderate amount of urine usually without warning due to hyperreflexia of the detrusor muscle, usually from spinal cord dysfunction.
Reflex
a nurse is preparing to assist with feeding a client who is at risk for aspiration. which of the following actions should the nurse take? position the client upright at a 45* angle turn on the television per the client's request avoid allowing the client to drink until meal is finished cut the client's food into small bites
cut the client's food into small bites
a nurse is caring for a client whose provider prescribed a heart-healthy diet. which of the following information shouuld the nurse include for the client regarding heart-healthy diets? (select all that apply) "you should limit saturated fats in your diet" "you should increase sodium intake to your taste" "eat foods with whole grains in your new diet" "it's important to eat larger portions of fruits and vegetables" "limiting high calorie food intake will promote adherence to your new diet" "continue to avoid skim milk and lean meats"
" you should limit saturated fats in your diet" "eat foods with whole grains in your new diet" "it's important to eat larger portions of fruits and vegetables" "limiting high-calorie food intake will promote adherence to your new diet"
A nurse is evaluating a client's bladder training program. Which of the following statements by the client indicates the bladder training was successful? "I am having accidents daily." "I am voiding a small amount when I visit the bathroom." "I continue to visit the bathroom every hour." "I am experiencing less than one urinary accidents per week."
"I am experiencing less than one urinary accidents per week."
A nurse is providing information to a client about what may happen if their urinary tract infection (UTI) is not treated. Which of the following statements by the client indicates an understanding of the information? "I can develop a kidney infection called pyelonephritis." "I might have urinary retention." "I might become incontinent." "I can develop functional incontinence."
"I can develop a kidney infection called pyelonephritis."
A nurse is teaching a client about foods that can irritate the bladder. Which of the following statements by the client indicates an understanding of the teaching? "I will still be able to drink chocolate milk." "I should avoid fruits that are acidic." "I will to switch from regular soda to diet soda." "I can still use jalapeno peppers when cooking.:
"I should avoid fruits that are acidic."
A nurse is educating a client about a new ileostomy. Which of the following statement by the client indicates an understanding of the teaching? "My ileostomy has an internal reservoir that collects waste," "My ileostomy is allowing my colon time to heal from the surgery" "My ileostomy must be accessed with a catheter to drain the waste." "My ileostomy is designed to be a permanent solution."
"My ileostomy is allowing my colon time to heal from the surgery"
a nurse is caring for a client who states, "i feel like i don't have to eat a vaired diet when I take my multivitamin." which of the following responses should the nurse make? "if taken four or more days a week, a multivitamin provides all the nutrients you need" "as long as you take a multivitamin daily, you do not need to eat a vaired diet each day" "a multivitamin should not be used in place of a nutritious diet" "as long as the multivitamin isn't generic, it can replace unhealthy dietary choices"
"a multivitamin should not be used in place of a nutritious diet"
a nurse is caring for a client who states, "i only eat a diet high in protien and carbohydrates." which of the following responses should the nurse make? "make sure to get eough servings of red meat in your diet daily" "your diet is varied but should also be high in calorie intake" "a varied diet should be high in protein and carbohydrate consumption" "a nutritious diet should include carbohydrates, protien, fiber, and healthy fats"
"a nutritious diet should include carbohydrates, protein, fiber, and healthy fats"
a nurse is discussing macronutrients with a client. which of the following statements should the nurse make? "macronutrients include vitamins and minerals, which your body needs a large amount of" "macronutrients include carbohydrates, proteins, and fats, which make up the majority of a person's diet" "macronutrients include carbohydrates and fats, which your body needs very little of" "while essential, macronutrients should be limited to weekly consumption"
"macronutrients include carbohydrates, protiens, and fats, which make up the majority of a person's diet"
a nurse is caring for a client who is prescribed a lwo glycemic index diet. the client states, "i don't understand what this means" which of the following responses should the nures make? (select all that apply) "they glycemic index of a food relates to its ability to increase the bloood glucose level" "you should eat foods such as whole grains, fruits, and vegetables" "consuming white bread will increase your blood glucose level slowly" "try to limit or avoid potatoes due to their glycemic index" "foods with a high glycemic index will cause yuour blood glucose to increase rapidly"
"the glycemic index of a food relates to its ability to increase the blood glucose level" "you should eat foods such as whole grains, fruits and vegetables" "try to limit or avoid potatoes due to their high glycemic index" "foods with high glycemic index will cause your blood glucose to increase rapidly"
A nurse is providing postoperative instructions for a client who had a kidney stone removal and placement of a nephrostomy tube. Which of the following statements by the client indicates an understanding of the instructions? "This tube will keep my ureters open in case of another stone." "This tube will remain permanently because I can't empty my bladder." "This tube goes directly into my bladder." "this tube is only temporary."
"this tube is only temporary."
a nurse is caring for a client who has a new prescription for parenteral nutrition. the client states, "i am scared that i will be on this therapy for the rest of my life" which of the following responses should the nurse make? "there is a good chance you will have to be on this therapy for the rest of your life" "parenteral nutrition is very common and should not interefere with your daily activities" "this type of nutrition can be lifelong, but it can also be temporary depending on how your nutritional needs change" "i am sure you will need parenteral nutrition temporarily"
"this type of nutritoin can be life long, but it can also be temporary depending on how your nutritional needs change"
a nurse is caring for a client who has a high phosphorus level. which of the following instructions regarding food should the nurse provide? "you should eat white bread." "you can drink 2 cups of milk per day" "you should limit broccoli to 3 cups per week" "you can have four servings of oatmeal per week"
"you should eat white bread"
a nurse is caring for a client who has a new prescription for a clear liquid diet. the client asks the nurse, "how long will i have to be on this type of diet?" which of the following responses should the nurse make? "you will be on this diet as long as the provider feels you need to be" "you might be on this diet for a week or two" "you should not be on this diet for more than a few days" "you should speak with the provider about your concern"
"you should not be on this diet for more than a few days"
A nurse is teaching a newly licensed nurse about urinary retention. Which of the following clients should the nurse include as having an increased risk for this condition? A client has an enlarged uterus A client who experiences frequent urinary tract infections A client who has an enlarged prostate A client who has chronic hypertension
A client who has an enlarged prostate
Ais conducting an in-service education program about the complications of IV therapy. Which of the following statements by an attendee indicates an understanding of the manifestations of infiltration? (Select all that apply) A. "The temperature around the IV site is cooler." B. "The rate of the infusion increases." C. "The skin at the IV site is red." D. "The IV dressing is damp." E. "The tissue around the venipuncture site is swollen."
A. "The temperature around the IV site is cooler." D. "The IV dressing is damp." E. "The tissue around the venipuncture site is swollen."
A nurse is delivering an enteral feeding to a client who has an NG tube in place for intermittent feedings. When the nurse pours water into the syringe after the formula drains from the syringe, the client asks the nurse why the water is necessary. Which of the following responses should the nurse make? A. "Water helps clear the tube so it doesn't get clogged." B. "Flushing helps make sure the tube stays in place." C. "This will help you get enough fluids." D. "Adding water makes the formula less concentrated."
A. "Water helps clear the tube so it doesn't get clogged."
A nurse on a medical-surgical unit is caring for a group of clients. The nurse should identify that which of the following clients is at risk for hypovolemia? A. A client who has nasogastric suctioning B. A client who has chronic constipation C. A client who has syndrome of inappropriate antidiuretic hormone D. A client who took a toxic dose of sodium bicarbonate antacids.
A. A client who has nasogastric suctioning
A nurse is caring for a client in a long-term care facility who is receiving enervate feedings via an NG tube. Which of the following actions should the nurse completely prior to administering the tube feeding? (select all that apply) A. Auscultate bowel sounds B. Assist the client to an upright position C. Test the pH of gastric aspirate D. Warm the formula to body temperature. E. Discard any residual gastric contents.
A. Auscultate bowel sounds B. Assist the client to an upright position C. Test the pH of gastric aspirate
A client who has an indwelling catheter reports a need to urinate. Which of the following actions should the nurse take? A. Check to see whether the catheter is patent B. Reassure the client that it is not possible for them to urinate C. Recatheterize the baller with a larger-gauge catheter D. Collect a urine specimen for analysis
A. Check to see whether the catheter is patent
A nurse is caring for a client who has a prescription for a 24-hr urine collection. Which of the following actions should the nurse take? A. Discard the first voiding B. Keep the urine in a single container at room temperature C. Dispose of the last voiding D. Ask the client to urinate into the toilet, stop midstream, and finish urinating into the specimen container.
A. Discard the first voiding
A nurse is reviewing factors that increase the risk of Urinary Tract Infections (UTIs) with a client who has recurrent UTIs. Which of the following facts should the nurse include? (select all that apply) A. Frequent sexual intercourse B. Lowering of testosterone levels C. Wiping from front to back to coal the perineum D. Location of the urethra closer to the anus E. Frequent Catheterization
A. Frequent sexual intercourse D. Location of the urethra closer to the anus E. Frequent Catheterization
A nurse is reviewing the laboratory tests results for a client who has an elevated temperature. The nurse should identify which of the following findings is a manifestation of dehydration? (select all that apply) A. Hct 55% B. Blood osmolarity 260 mOsm/kg C. Blood sodium 150 mEq/L D. Urine specific gravity 1.035 E. Blood creatinine 0.6 mg/dL
A. Hct 55% C. Blood sodium 150 mEq/L D. Urine specific gravity 1.035
A nurse in a senior center is counseling a group of older adults about their nutritional needs and considerations. Which of the following information should the nurse include? (select all that apply) A. Older adults are more prone to dehydration than younger adults are. B. Older adults need the same amount of most vitamins and minerals as younger adults do. C. Many older men and women need calcium supplementation D. Older adults need more calories than they did when they were younger. E. Older adults should consume a diet low in carbohydrates
A. Older adults are more prone to dehydration than younger adults are. B. Older adults need the same amount of most vitamins and minerals as younger adults do. C. Many older men and women need calcium supplementation
A nurse is preparing to insert an NG tube for a client who requires gastric decompression. Which of the following actions should the nurse person before beginning the procedure? (Select all that apply) A. Review a signal the client can use if feeling any distress B. Lay a towel across the client's chest C. Administer oral pain medication D. Obtain a Dobhoff tube for insertion E. Have a petroleum-based lubricant available
A. Review a signal the client can use if feeling any distress B. Lay a towel across the client's chest
A nurse is preparing to administer a cleaning edema to an adult client in preparation for a diagnostic procedure. Which of the following steps should the nurse take? (select all that apply?) A. Warm the enema solution prior to instillation B. Position the client on the left side with the right leg flexed forward C. Lubricate the rectal tube or nozzle D. Slowly insert the rectal tube about 5 cm (2 in) E. Hang the enema container 61 cm (24in) about the client's anus.
A. Warm the enema solution prior to instillation B. Position the client on the left side with the right leg flexed forward C. Lubricate the rectal tube or nozzle
Which skills does the nurse teach a patient with a new colostomy before discharge from the hospital? (select all that apply). A.How to change the pouch. B.How to determine whether the colostomy is healing appropriately. C.How to empty the pouch. D.How to open and close the pouch. E.How to irrigate the colostomy.
A.How to change the pouch. B.How to determine whether the colostomy is healing appropriately. C.How to empty the pouch. D.How to open and close the pouch.
A nurse is demonstrating how to insert an IV catheter. Which of the following statements by a nurse viewing the demonstration indicated understanding of the procedure? A. "I will thread the needle all the way into the vein until the hub rests against the insertion site after I see a flashback of blood." B. "I will insert the needle into the client's skin at an angle of 10 to 30 degrees with the bevel up." C. I will apply pressure approximately 1.2 inches below the insertion site prior to removing the needle." D. "I will choose a vein in the antecubital fossa for IV insertion due to its size and easily accessible location."
B. "I will insert the needle into the client's skin at an angle of 10 to 30 degrees with the bevel up."
A nurse is planning care for a client who has dehydration which of the following actions should the nurse include? A. Administer antihypertensive on schedule B. Check the client's weight each morning C. Notify the provider of a urine output greater than 30mL/hr D. Encourage independent ambulation four times a day.
B. Check the client's weight each morning
While a nurse is administering a cleansing edema, the client reports abdominal cramping. Which of the following actions should the nurse take? A. Have the client hold their breath B. Clamp the enema tubing C. Remind the client that cramping ins common at this time D. Raise the level of the enema fluid container
B. Clamp the enema tubing
A nurse is teaching a client who reports stress urinary incontinence. Which of the following instruction should the nurse include? (select all that apply). A. Limit total daily fluid intake. B. Decrease or avoid caffeine. C. Take calcium supplements D. Avoid drinking alcohol E. Use the Crede maneuver
B. Decrease or avoid caffeine. D. Avoid drinking alcohol
A nurse is preparing to initiate a bladder-retraining program for a client who has incontinence. Which of the following actions should the nurse take? (select all that apply) A. Restrict the client's intake of fluids during the daytime B. Have the client record urination times C. Gradually increase the urination times D. Remind the client to hold urine until the next scheduled urination time. E. Provide a sterile container for urine.
B. Have the client record urination times C. Gradually increase the urination times D. Remind the client to hold urine until the next scheduled urination time.
A nurse is assessing a client who has had diarrhea for 4 days. Which of the following findings should the nurse expect? (select all that apply) A. Bradycardia B. Hypotension C. Elevated temperature D. Poor skin turgor E. Peripheral edema
B. Hypotension C. Elevated temperature D. Poor skin turgor
A nurse is caring for a client who is at high risk for aspiration. Which of the following actions should the nurse take? A. Give the client thin liquids B. Instruct the client to tuck their chin when swallowing C. Have the client use a straw D. Encourage the client to lie down and rest after meals
B. Instruct the client to tuck their chin when swallowing
A nurse is providing dietary teaching for a client who reports constipation. Which of the following foods should the nurse recommend? A. Macaroni and cheese B. One medium apple with skin C. One cup of plain yogurt D. Roast chicken and white rice
B. One medium apple with skin
A nurse is caring for a client who is receiving continuous enteral feedings. Which of the following nursing interventions is the highest priority when the nurse suspects aspiration of the feeding? A. Auscultate breath sounds. B. Stop the feeding C. Obtain a chest x-ray D. Initiate oxygen therapy
B. Stop the feeding
A nurse is preparing to instill an enteral feeding for a client who has a NG tube in place. Which of the following actions is the nurse's highest assessment priority before performing this procedure? A. Check how long the feeding container has been open. B. Verify the placement of the NG tube C. confirm that the client does not have diarrhea D. Make sure the client is alert and oriented
B. Verify the placement of the NG tube
When providing care for a patient who is receiving TPN, the nurse should include all of the following except: A.Wear sterile gloves and a mask during dressing and tubing changes. B.Clean the port throughly before administering IV push medications into the TPN line. C.Mointor the patient's blood glucose levels. D.Have the patient turn their head to the opposite side of the central line dressing and place face mask on patient.
B.Clean the port throughly before administering IV push medications into the TPN line.
The nurse is planning care for a group of stable patients. Which task will the nurse assign to the nursing assistive personnel? A.Measuring the patient's risk for aspiration B.Measuring capillary blood glucose level C.Measuring nasoenteric tube for insertion D.Measuring pH in gastrointestinal aspirate
B.Measuring capillary blood glucose level
A nursing student is performing a colostomy irrigation. When would the nurse intervene? A.Student cleans, rinses, and dries the skin and applies a new drainage pouch. B.Student hangs the prepared irrigation container on the bed rail. C.Student encourages the patient to walk for 30 to 45 minutes for secondary evacuation. D.Student puts 500 to 1000 mL of lukewarm water in the container.
B.Student hangs the prepared irrigation container on the bed rail.
A nurse is performing an admission assessment on a. client who has hypovolemia due to vomiting and diarrhea. The nurse should expect which of the following findings? (select all that apply) A. Distended neck veins B. Hyperthermia C. Tachycardia D. Syncope E. Decreased skin turgor
C. Tachycardia D. Syncope E. Decreased skin turgor
A nurse is caring for a client who requires a low-residue diet. The nurse should expect to see which of the following foods on the client's meal tray? A. Cooked barley B. Pureed broccoli C. Vanilla custard D. Lentil Soup
C. Vanilla custard
A patient expresses concerns over having black stool. The fecal occult test is negative. Which response by the nurse is most appropriate? A."Are you under a lot of stress?" B."This is probably a false negative; we should rerun the test." C."Do you take iron supplements?" D."You should schedule a colonoscopy as soon as possible."
C."Do you take iron supplements?"
A nurse is caring for an 8-year-old patient who is embarrassed about urinating in bed at night. Which intervention should the nurse suggest to reduce the frequency of this occurrence? A."Empty your bladder completely before going to bed." B."Set your alarm clock to wake you every 2 hours, so you can get up to void." C."Drink your nightly glass of milk earlier in the evening." D."Line your bedding with plastic sheets to protect your mattress."
C."Drink your nightly glass of milk earlier in the evening."
The nurse is responsible for the care of a postoperative patient with a thoracotomy. Which action should the nurse delegate to the nursing assistive personnel (NAP)? A.Planning activities for periods when the patient has the most energy. B.Monitoring cardiorespiratory response to activity. C.Encouraging, monitoring, and recording nutrition-al intake. D.Instructing the patient to alternate rest and activity periods.
C.Encouraging, monitoring, and recording nutrition-al intake.
The nurse is assessing a patient and finds crackles in the lung bases and neck vein distention. Which action will the nurse take first? A.Increase fluids. B.Offer calcium-rich foods. C.Raise head of bed. D.Administer diuretic.
C.Raise head of bed.
After a nasogastric tube is inserted, which assessment finding is cause for greatest concern? A.Gastric contents have a coffee-ground appearance. B.The patient reports that the tube is irritating nose and throat feels sore. C.The patient demonstrates coughing and cannot speak clearly. D.Gastric fluid is bright red and has small clots.
C.The patient demonstrates coughing and cannot speak clearly.
A nurse is caring for a client reports occasionally having dark, tea-colored urine at home. the nurse identifies that which of the following activities can contribute to this finding? Attending a yoga class Consuming alcohol Drinking 2,000 mL of fluid in a day Consuming fish for dinner
Consuming alcohol
A nurse is teaching a client about diagnostic urinary testing. Which of the following should the nurse include in the teaching about cystometric testing? Cystometric testing measures bladder capacity, pressure, and final capacity when the urge to urinate begins. Cystometric testing measures urine speed and volume Cystometric testing measures bladder pressure when urinary leakage occurs. Cystometric testing measures electrical activity of the muscles and nerves of the bladder and sphincters
Cystometric testing measures bladder capacity, pressure, and final capacity when the urge to urinate begins.
During new employee orientation, a nurse is explaining how to prevent IV infections. Which of the following statements by an orientee indicates understanding of the preventive strategies? A. "I will leave the IV catheter in place after the client completes the course of IV antibiotics." B. "As long as I am working with the same client, I can use the same IV catheter for my second insertion attempt." C. "If my client needs to use the rest room, it would be safer to disconnect his IV infusion as long as I clean the injection port thoroughly with an antiseptic swab." D. "I will replace any IV catheter when I suspect contamination during insertion."
D. "I will replace any IV catheter when I suspect contamination during insertion."
A nurse is preparing a presentation about basic nutrients for a group of high school athletes. She should explain that which of the following nutrients provides the body with the most energy? A. Fat B. Protein C. Glycogen D. Carbohydrates
D. Carbohydrates
A nurse is collecting data from a client who is receiving IV therapy and reports pain in the arm, chills, and "not feeling well." The nurse notes warmth, edema, induration, and red streaking on the client's arm close to the IV insertion site. Which of the following actions should the nurse plan to take first? A. Obtain a specimen for culture B. Apply a warm compress C. Administer analgesics D. Discontinue the infusion
D. Discontinue the infusion
A nurse is caring for a client who will person a fecal occult blood testing at home. Which of the following information should be included when explaining the procedure to the client? A. Eating more protein is optimal prior to testing B. One stool specimen is sufficient for testing. C. A red color change indicates a positive test. D. The specimen cannot be contained with urine
D. The specimen cannot be contained with urine
When caring for an elderly patient who has a potential or actual alteration in nutrition, the nurse should: A.Assess the patient's visual acuity. B.Determine whether the patient wears dentures. C.Assess the patient's financial resources. D.All of the above.
D.All of the above.
To obtain a clean-voided urine specimen from a female patient, what should the nurse teach the patient to do? A.Cleanse the urethral meatus from the area of most contamination to least. B.Initiate the first part of the urine stream directly into the collection cup. C.Drink fluids 5 minutes before collecting the urine specimen. D.Hold the labia apart while voiding into the specimen cup.
D.Hold the labia apart while voiding into the specimen cup.
A nurse is preparing to collect a urinalysis using a raegent strip. The nurse should identify that the reagent strip can detect substance that are consistent with which of the following conditions. Diabetes Colon Cancer Pancreatitis Pregnancy
Diabetes
A nurse is preparing to insert a nasogastric tube into a client for decompression. Which of the following actions should the nurse perform first? Measure the tube from the client's ear to the xiphiod Insert the tube while the client takes sips of water Connect the nasogastric tube to suction. Ensure the client is a sitting position
Ensure the client is a sitting position
The loss of urine due to factors that interfere with responding to the need to urinate, such as cognitive, mobility, and environmental barriers.
Functional
A nurse is caring for a client who has constipation. Which of the following diets should the nurse encourage the client to follow? Low fat High protein High fiber Low carbohydrate
High fiber
The two periods of life during which growth is more rapid and energy requirements are higher in __[1]__ and __[2]__. Select from the key words below to fill-in-the blanks. Key Words: Infants Toddlers School-Aged Adolescents Adults Older Adults
Infants Adolescents
A nurse is caring for has constipation and requires an enema. Which of the following actions should the nurse take when administering the enema solution." Instruct the client to lie on their right side with their left leg pulled to their chest. Instruct the client to lie on their left side with their right leg pulled up to their chest. Instruct the client to lie on their left side with both legs pulled up to their chest. Instruct the client to lie on their right side with both legs pulled up to their chest.
Instruct the client to lie on their left side with their right leg pulled up to their chest.
A nurse is educating a client who has paraplegia about urinary catheter use. Which of the following catheter types should the nurse include in the teaching to help facilitate urinary elimination for this client?" Suprapubic catheter Indwelling catheter Condom catheter Intermittent catheter
Intermittent catheter
A nurse is caring for an older adult client who is experiencing urinary leakage. Which of the following is an expected age-related change that can contribute to this occurrence? Reduced blood supply Loss of kidney tissue loss of nephrons Loss of bladder tone
Loss of bladder tone
A nurse is reviewing a client's list of medications and supplements. Which of the following medication classifications increases the risk of constipation. Magnesium-containing antacids Antibiotics Narcotic pain medications Beta Blockers
Narcotic pain medications
a nurse is assessing a client who has an indwelling urinary catheter and determine that the catheter is in place and functioning properly. The nurse should expect which of the following findings?" Dark yellow, cloudy urine Pale yellow, clear urine Urine with a strong odor Urine with a slight red tint
Pale yellow, clear urine
A nurse if caring for a client who has a colostomy and does not wear a colostomy pouch. Which of the following actions should the nurse anticipate performing on this client to maintain expected bowel functions? Administer an enema Administer a laxative Perform colostomy irrigation Insert a rectal tube
Perform colostomy irrigation
A nurse is caring for a client who is receiving enteral tube feedings due to dysphagia. What positioning of the bed should the patient be in
Semi-fowler's
A nurse is reviewing urinary laboratory results. Which finding will cause the nurse to follow up? Urine output of 80 mL/hr Specific gravity of 1.036 Protein level of 2 mg/100 mL pH of 6.4
Specific gravity of 1.036
The loss of small amounts of urine from increased abdominal pressure without bladder muscle contraction with laughing, sneezing, or lifting.
Stress
The nurse is caring for a client who is receiving antibiotic treatment for a urinary tract infection and is experiencing diarrhea. Which of the following should the nurse identify as a potential causes of the diarrhea? The antibiotic dose is not correct, and the provider should be alerted. The antibiotic interferes with the client's ability to absorb nutrients The antibiotic eliminates the healthy gastrointestinal bacteria, allowing harmful bacteria to grow The antibiotic decreases a client's immunity level, resulting in diarrhea
The antibiotic eliminates the healthy gastrointestinal bacteria, allowing harmful bacteria to grow
A nurse is caring for a client who has a prescription for a vitamin K injection. The nurse should identify that vitamin K is naturally produced in which of the following locations in the body? The small intestine The large intestine The esophagus The stomach
The large intestine
A nurse is reviewing the primary function of the urinary tract with a group of newly licensed nurses. Which of the following information should the nurse include? The urinary tract regulates the production of red blood cells. The urinary tract produces hormones for blood pressure regulation The urinary tract keeps bones strong The urinary tract eliminates waste and excess fluid from the body
The urinary tract eliminates waste and excess fluid from the body
Active transport requires energy in contrast to passive transport, which does not require energy. True/False?
True
Excessive oral intake of fluids is the most common cause of hypervolemia. True/False?
True
Surgical patients as well as those who are receiving chemotherapy and certain types of medications may experience alterations in nutrition secondary to these therapies. True/ False?
True
A nurse is caring for a group of clients who are at risk for an alteration in urinary elimination. Which of the following groups should the nurse identify as being at an increased risk? (select all that apply) Uncircumcised infants School-aged children Middle adults Older adults Young Adults
Uncircumcised infants School-aged children Older adults
A nurse is caring for a client who has a stone in their right ureter that is obstructing the flow of urine. Which of the following urinary diversion should the nurse anticipate the client will need? Urostomy Continent cutaneous reservoir Ureteral stent Neobladder
Ureteral stent
Inability to stop urine flow long enough to reach the bathroom due to an overactive detrusor muscle with increased bladder pressure.
Urge
A nurse is planning care for a client who has an order for urinalysis. Which of the following tests should the nurse anticipate being ordered if the presence of white blood cells is detected on urinalysis? Urine culture Bladder scan 24-hour urine Stool culture
Urine culture
A nurse is assessing a client who has stress incontinence. Which of the following findings should the nurse expect who this client? Urine leakage prior to reaching the toilet Urine leakage following coughing Urine leakage as a result of nerve damage Urine leakage due to not reaching the toilet in time from a physical impairment
Urine leakage following coughing
a nurse is caring for a client who has renal disease and must limit potassium intake. which of the following foods should the nurse instruct the client to avoid because they are high in potassium? (select all that apply) potatoes bananas dried beans spinach tomatoes
bananas dried beans spinach tomatoes
a nurse is caring for a client who reports having daily constipation. which of the following information should the nurse provide to the client regarding fiber intake? (select all that apply) increasing daily fiber intake can help alleviate the issue of constipation eating more whole grain can promote regular bowel movements consume 10g of fiber per day foods such as white rice increase fiber intake decreasing daily fiber intake can help alleviate digestive discomfort
increasing daily fiber intake can help alleviate the issue of constipation eating more whole grains can promote regular bowel movements
a nurse is caring for a client who is receiving tube feedings via PEG. Which of the following actions should the nurse implement in order to help prevent the client from aspirating? keep the client's head elevated to at least 30* for a minimum of 1 hr after a feeding verify the initial tube placement with an x-ray after the first feeding check the client's tube feeding tolerance every 12 hr check the pH of the gastric contents each day
keep the client's head elevated to at least 30* for a minimum of 1 hr after a feeding
a nurse is preparing to measure a nasogastric tube for insertion. the nurse recalls that the client's xyphoid process should be used as the last place of measurement. which of the following landmarks should the nurse measure before the xyphoid process? measure from the bottom of the ear measure from the tip of the chin measure from the bottom of the jaw line mresure from the tip of the nose to the earlobe
measure from the tip of the nose to the earlobe
a nurse is assessing a client who is experiencing digestive issues. which of the following findings should the nurse expect? (select all that apply) nausea abdominal pain diarrhea reports of bloating reports of excessive salivation
nausea abdominal pain diarrhea reports of bloating
a nurse is assessing a client's hair and notes that it is brittle. which of the following should the nurse determine about the client's nutritional intake? the client is not getting enough vitamin A the client has insufficient protein in their diet the client needs more vitamin D form sun exposure the client needs to eat five servings of fruits and vegetables daily
the client has insufficent protein in their diet
a nurse is caring for a client who routinely eats a regular diet and is scheduled to have surgery with sedation in the morning. the nurse receives a new NPO diet prescription for the client. which of the following should the nurse identify as the rationale for the provider's prescription? the client is at risk for aspiration due to the upcoming surgery the client is at risk for dysphagia due to the upcoming surgery the nutrients consumed as a part of the regular diet will interact with the sedation used in the procedure the client reports having a drink a few sips of water before the procedure
the client is at risk for aspiration due to the upcoming surgery
a nurse is reviewing a client's medical record and notes that their BMI is 25.5. how should the nurse interpret this finding? the client is overweight the client is underweight the client's BMI is within normal range the client is obese
the client is overweight