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QUESTIONS AND ANSWERS
QUESTIONS ANSWERS
An older adult client with a long history of B. Assist client to an upright position
chronic obstructive pulmonary disease
(COPD) is admitted with progressive
shortness of breath and a persistent cough.
She is anxious and is complaining of a dry
mouth. Which intervention should the
nurse implement?
A. Administer a prescribed sedative
B. Assist client to an upright position
C. Encourage client to drink water
D. Apply a high flow venturi mask
A client with multiple sclerosis (MS) is A. Provide assistance to bedside
admitted to the medical unit, The client commode\
reports fatigue, muscle weakness, and C. Schedule frequent rest periods.
diplopia. Which action should the nurse E. Teach to patch one eye while walking
implement to reduce the clients risk for
falls? SATA
A. Provide assistance to bedside commode
B. Provide frequent rest periods.
C. Offer to assist with warm baths in the
morning
D. Monitor pulse ox during activities
E. Teach to patch one eye while walking
A client arrives to the ED following a B. Chest tube insertion
motor vehicle collision, The nurse observes
the client experiencing increasing dyspnea
and notes absent breath sounds on the left
side, which procedure should the nurse
,prepare for the client?
A. Bronchoscopy
B. Chest tube insertion
C. Endotracheal intubation
D. Pulmonary function test
Following a transurethral resection of the B. Drink 3 liters of water each day
prostate (TURP) a client is discharged
from the hospital with an indwelling
urinary catheter, Which instruction is most
important for the nurse to include in the
discharge teaching plan?
A. Eliminate all spicy foods from your diet
B. Drink 3 liters of water each day
C. Clamp the catheter when taking a
shower
D. Avoid driving a car for 2 weeks
An adult woman with Graves disease is C. Maintain a paten intravenous site
admitted with severe dehydration and
malnutrition, She is currently restless and
refusing to eat. Which action is most
important for the nurse to implement?
A. Teach client relaxation techniques
B. Determine the clients food preferences
C. Maintain a patent Intravenous site
D. Keep room temperature cool
A client tells the clinic nurse about A. Obtain a specimen of urethral
experiencing burning on urination, and drainage for culture
assessment reveals that the client had
sexual intercourse four days ago with a
person who was a casual acquaintance,
Which action should the nurse implement?
A. Obtain a specimen of urethral drainage
for culture
B. Observe the perineal area for a chancre
like lesion
C. Identify all sexual partners in the last
four days.
D. Assess for perineal itching erythema
and excoriation
The nurse is caring for a client admitted to A Lumbar puncture
the hospital with a tentative diagnosis of
bacterial meningitis, which diagnostic
procedure should the nurse prepare the
client for?
A. Lumbar puncture
B. Skull radiography
, C. MRI
D. CT
An older adult client with long term type 2 A. Sensation in feet and legs
DM is seen in the clinic for a routine health B. Skin condition of lower extremities
assessment, which assessment would the C. Visual acuity
nurse complete to determine if a patient D. Serum Creatinine and blood urea
with type 2 DM is experiencing long term nitrogen (BUN)
complications? SATA
A. Sensation in feet and legs
B. Skin condition of lower extremities
C. Visual acuity
D Serum creatinine and blood urea
nitrogen (BUN)
E. Signs of respiratory tract infection
The nurse assesses a client with cirrhosis B. Hypoalbuminemia that results in
and finds 4+ pitting edema of the feet and decreased colloidal oncotic pressure
legs, and massive ascites, Which Hypoalbuminemia that results in a
mechanism contributes to edema and decreased colloidal oncotic pressure,
ascites in a client with cirrhosis? this is correct, in cirrhosis liver damage
A. Decreased portacaval pressure with leads to decreased synthesis of albumin,
greater collateral circulation Albumin plays a crucial role in
B. Hypoalbuminemia that results in maintaining colloidal oncotic pressure
decreased colloidal oncotic pressure and when it is decreased
C. Decreased renin angiotensin response (hypoalbuminemia) fluid is more likely
related to an increase in renal blood flow to leak out of blood vessels resulting n
D. Hyperaldosteronism causing an edema, the same mechanism contributes
increased sodium absorption in renal tubes to the development of ascites in the
abdominal cavity.
D: Incorrect hyperaldosteronism is
characterized by an excess of
aldosterone a hormone that regulates
sodium and water balance in cirrhosis
sodium retention is often related to
other mechanisms such as portal
hypertension and hypoalbuminemia
rather than hyperaldosteronism.
C. Cirrhosis is more commonly
associated with an activated renin
angiotensin aldosterone system, leading
to increased sodium and water
retention, the increased renin
angiotensin response is a compensatory
mechanism to maintain perfusion in the