PrepU Review - Quiz 4

**A woman age 76 years has informed the nurse that she has begun using over-the-counter laxatives because her friend told her it was imperative to have at least one bowel movement daily. How should the nurse best respond to this client's statement?

"Actually, people's bowel patterns can vary a lot and some people don't tend to go every day."

**A nurse is conducting a health history interview for an office client who is having problems with urinary control. What would be an appropriate interview question to collect further data?

"How have you handled this problem?"

**A client who is scheduled for a bronchoscopy has arrived at the clinical facility. When preparing for the test, the client reports feeling hungry and asks the nurse when he will be able to eat. What information should be provided by the nurse?

"You will not be able to eat or drink until your gag reflex has returned."

**The nurse is caring for an older adult client suspected of having a urinary tract infection. The nurse should assess for what finding specifically associated with the development of this condition in the older adult?

Acute confusion

The proliferation of Clostridium difficile causes:

Antibiotic-associated diarrhea

**The nurse is performing a respiratory assessment for a client and hears a high-pitched, harsh "blowing" sound, with sound on expiration being longer than inspiration. How will the nurse document this finding?

Bronchial breath sounds

The nurse is assessing a client with lung cancer. What manifestations may suggest that the client has chronic hypoxia?

Clubbing

**During his stay in the hospital, a male client has established a pattern of maintaining urinary continence during the day, but he is experiencing incontinence at night. What intervention should the nurse implement in this client's care?

Condom catheter

**When the nurse observes a newborn infant demonstrating an irregular abdominal breathing pattern, with a respiratory rate of 50 breaths/minute with occasional pauses in breathing of 5-second durations. What is the most appropriate action by the nurse?

Continue to assess the infant

**The home care nurse visits a client who has dyspnea. The nurse notes the client has pitting edema in his feet and ankles. Which additional assessment would the nurse expect to observe?

Crackles in the lower lobes

The nurse auscultates a client with soft, high-pitched popping breath sounds on inspiration. The nurse documents the breath sounds heard as:

Crackling

The client reports experiencing abdominal pain. The nurse auscultates the client's abdomen and hears gurgling sounds. What additional information does the nurse assess about the gurgling sound?

Frequency

**A postoperative client is reporting abdominal distention and pressure related to intestinal gas. The nurse performs a physical assessment. What percussion sound is consistent with excess flatus trapped in the intestine?

Hyperresonance

**The student nurse is preparing a presentation on how to perform a physical assessment on the abdomen. Place the assessment steps in the correct order.

Inspection Auscultation Percussion Palpation

The nurse is obtaining a pulse oximetry reading for a client admitted with exacerbation of chronic obstructive pulmonary disease (COPD). When observing a reading of 89%, what action should the nurse perform?

No action is required, because this may be normal for the client

**The nurse has entered a client's room to empty the client's urine collection bag at the end of a busy shift. The nurse realizes that the client's urine output is 75 mL over the past 8 hours. The nurse would recognize that the client is experiencing:

Oliguria

**A client with urine retention related to a complete prostatic obstruction requires a urinary catheter to drain the bladder. Which type of catheter is most appropriate for a client that has an obstructed urethra?

Suprapubic catheter

**A nurse is providing education to an older adult client concerning ways to prevent constipation. Which diet choices would support that the education was successful? Select all that apply.

hot tea with meals a turkey sandwich with whole-grain bread prune juice with breakfast