The nurse is caring for a group of patients on the medical-surgical unit.
The nurse delegates some duties to the unlicensed assistive personnel
(UAP). Which patient should the nurse instruct the UAP to provide care
for first?
-A post-surgical patient who needs help with ambulation
-A 71-year-old female who requires oral care after breakfast
-A 75-year-old bedbound man with an episode of urinary incontinence
-An 81-year-old female who requires routine morning hygiene care -
ANSWER A 75-year-old bedbound man with an episode of urinary
incontinence
The mother of a 2-month-old infant is concerned about the frequency of
her infant's bowel movements.
Which response by the nurse addresses the mother's concern?
-"Some control of defecation begins at this stage."
-"Infant bowel movement patterns change at this age."
-"Meconium is usually passed in the first 24 hours of life."
-"Infant bowel habits are similar to adult habits." - ANSWER "Infant
bowel movement patterns change at this age."
A patient diagnosed with bowel obstruction is scheduled for surgical
resection of the bowel.
Which nursing action is most appropriate for this patient?
-Preparing instruction on care and cleaning of the ostomy pouch
-Preparing needed preoperative instructions
-Preparing information on chemotherapy and/or radiation therapy
-Preparing for the administration of an enema - ANSWER -Preparing
needed preoperative instructions
At 5 feet 10 inches and 320 pounds, a female patient has been advised
to lose weight for her overall health and to help with a recent problem of
, incontinence. The patient asks, "How will this help with my
incontinence?"
Which explanation by the nurse is appropriate?
-"Weight loss can reduce stress incontinence caused by increased
pressure on the bladder as a result of obesity."
-"Obesity causes the bladder to empty at a predictable volume due to an
inability to sense when the bladder is full."
-"People who are overweight often have diabetes. One of the clinical
manifestations of diabetes is overproduction of urine."
-"Obesity causes a lack of normal detrusor muscle activity. This leads to
overfilling of the bladder and frequent leaks of small amounts of urine." -
ANSWER "Weight loss can reduce stress incontinence caused by
increased pressure on the bladder as a result of obesity."
The nurse is admitting a patient in the emergency department for acute
diarrhea.
Which is the priority assessment question the nurse should ask?
-"Have you had any incontinence with the diarrhea?"
-"What amount of fluid do you drink each day?"
-"How often are you having diarrhea?"
-"What time of day do you usually have a bowel movement?" -
ANSWER -"How often are you having diarrhea?"
The nurse is caring for an older male with urinary problems. The patient
has been ordered to have an ultrasonic bladder scan. The patient asks,
"What is the purpose of the test?"
How should the nurse reply?
"To look for bladder infection"
"To see how much pressure is in the urethra"
"To look at how much urine is passed per second.
"To see how much you empty your bladder" - ANSWER "To see how
much you empty your bladder"
The nurse is providing dietary teaching to a patient with chronic
constipation.
The nurse delegates some duties to the unlicensed assistive personnel
(UAP). Which patient should the nurse instruct the UAP to provide care
for first?
-A post-surgical patient who needs help with ambulation
-A 71-year-old female who requires oral care after breakfast
-A 75-year-old bedbound man with an episode of urinary incontinence
-An 81-year-old female who requires routine morning hygiene care -
ANSWER A 75-year-old bedbound man with an episode of urinary
incontinence
The mother of a 2-month-old infant is concerned about the frequency of
her infant's bowel movements.
Which response by the nurse addresses the mother's concern?
-"Some control of defecation begins at this stage."
-"Infant bowel movement patterns change at this age."
-"Meconium is usually passed in the first 24 hours of life."
-"Infant bowel habits are similar to adult habits." - ANSWER "Infant
bowel movement patterns change at this age."
A patient diagnosed with bowel obstruction is scheduled for surgical
resection of the bowel.
Which nursing action is most appropriate for this patient?
-Preparing instruction on care and cleaning of the ostomy pouch
-Preparing needed preoperative instructions
-Preparing information on chemotherapy and/or radiation therapy
-Preparing for the administration of an enema - ANSWER -Preparing
needed preoperative instructions
At 5 feet 10 inches and 320 pounds, a female patient has been advised
to lose weight for her overall health and to help with a recent problem of
, incontinence. The patient asks, "How will this help with my
incontinence?"
Which explanation by the nurse is appropriate?
-"Weight loss can reduce stress incontinence caused by increased
pressure on the bladder as a result of obesity."
-"Obesity causes the bladder to empty at a predictable volume due to an
inability to sense when the bladder is full."
-"People who are overweight often have diabetes. One of the clinical
manifestations of diabetes is overproduction of urine."
-"Obesity causes a lack of normal detrusor muscle activity. This leads to
overfilling of the bladder and frequent leaks of small amounts of urine." -
ANSWER "Weight loss can reduce stress incontinence caused by
increased pressure on the bladder as a result of obesity."
The nurse is admitting a patient in the emergency department for acute
diarrhea.
Which is the priority assessment question the nurse should ask?
-"Have you had any incontinence with the diarrhea?"
-"What amount of fluid do you drink each day?"
-"How often are you having diarrhea?"
-"What time of day do you usually have a bowel movement?" -
ANSWER -"How often are you having diarrhea?"
The nurse is caring for an older male with urinary problems. The patient
has been ordered to have an ultrasonic bladder scan. The patient asks,
"What is the purpose of the test?"
How should the nurse reply?
"To look for bladder infection"
"To see how much pressure is in the urethra"
"To look at how much urine is passed per second.
"To see how much you empty your bladder" - ANSWER "To see how
much you empty your bladder"
The nurse is providing dietary teaching to a patient with chronic
constipation.
