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A nurse is admitting a client following care in the ED for an intentional overdose of
opioids. The client states "I feel so alone. No one can help me." Which of the following
responses by the nurse is therapeutic?
A. Lets finish your admission and then talk about your feelings.
B. How come you feel that no one can help you when you are receiving help now?
C. Why do you feel that no one can help you?
D. I would like to sit and talk with you.
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D. I would like to sit and talk with you.
A nurse is caring for a client who has MS. Which of the following should the nurse
expect ?
A. Drooping eye lids
B. Loss of cognitive function
,C. Fluctuations on BP
D. Ineffective cough
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B. Loss of cognitive function
A nurse is reviewing the medical record of a client who has postmenopausal
osteoporosis and a prescription for raloxifene. Which of the following findings in the
clients medical record should the nurse identify as a contraindication to receiving this
medication?
A. Breast cancer
B. History of DVT
C. Allergy to calcitonin
D. Current diagnosis of cholecystitis.
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B. History of DVT
Which intervention are most appropriate for caring for a client in alcohol withdrawal?
(select all that apply)
A. Monitor VS
B. Provide a safe environment
C. Address hallucinations therapeutically
D. Provide stimulation in the environment
E. Provide reality orientation as appropriate
F. Maintain NPO status
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, A. Monitor VS
B. Provide a safe environment
C. Address hallucinations therapeutically
E. Provide reality orientation as appropriate
A client was brought to the emergency department after a fall. The client is taken to
the operating room to receive
a right hip prosthesis. In the immediate postoperative period, what health education
should the nurse emphasize?
A. "Make sure you don't bring your knees close together."
B. "Try to lie as still as possible for the first few days."
C. "Try to avoid bending your knees until next week."
D. "Keep your legs higher than your chest whenever you can.
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A. "Make sure you don't bring your knees close together."
A nurse is assessing a client who has a sudden onset of severe back pain of unknown
origin. Which of the following questions should the nurse ask to encourage discussion
with the client?
A. Does the medication you're taking relieve the pain?
B. Can you point to where the pain is the worse?
C. What do you think caused the onset of your pain?
D. Changing positions makes your pain worse, right?
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B. Can you point to where the pain is the worse?
, A nurse is caring for a client who is 3 days post op following a right total hip
arthroplasty. While transferring to a chair, the client cries out in pain. The nurse should
assess the client for which of the following manifestations of dislocation of the hip
prosthesis?
A. Bulging in the area over the surgical incision
B. Shortening of the right leg
C. Sensation of warmth over the surgical incision
D. Pallor following elevation of the right leg
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B. Shortening of the right leg
The nurse witnessed a vehicle hit a pedestrian. The victim is dazed and tries to get up.
A leg appears fractured. Which intervention should the nurse take?
A. Try to reduce the fracture manually.
B. Assist the victim to get up and walk to the sidewalk.
C. Leave the victim for a few moments to call an ambulance.
D. Stay with the victim and encourage him or her to remain still.
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D. Stay with the victim and encourage him or her to remain still.
A hospitalized client with a history of alcohol abuse tells the nurse, "I am leaving now.
I have to go. I don't want to any more treatment. I have things that i have to do right
away." The client has not been discharges and is scheduled for an important
diagnostic test to be performed in 1 hours. After the nurse discusses the clients
concerns with client, the client dresses and begins to walk out the hospital room.
What action should the nurse take?
A. Call the nursing supervisor