NUR 623 Exam: Questions And Answers Best Rated A+ Guaranteed Success Latest Update/2023 Ve, Exams of Nursing

Download NUR 623 Exam: Questions And Answers Best Rated A+ Guaranteed Success Latest Update/2023 Ve and more Exams Nursing in PDF only on Docsity! NUR 623 Exam: Questions And Answers Best Rated A+ Guaranteed Success Latest Update/2023 Verified Answers 1 A nurse is teaching staff members about the legal terminology used in child abuse. What definition of battery should the nurse include in the teaching? 2 4 View Topics Stats Issue with this question? Which nursing interventions require a nurse to wear gloves? (Select all that apply.) 1 The application of force to another person without lawful justification. Correct3 Confidence: Nailed it 1130037135 Battery means touching in an offensive manner or actually injuring another person. Battery refers to actual bodily harm rather than threats of physical or psychological harm. Battery refers to harm against persons instead of property. Behaving in a way that a reasonable person with the same education would not is the definition of negligence. Maligning a person's character while threatening to do bodily harm. of students nationwide answered this question correctly.65% A legal wrong committed by one person against property of another. Behaving in a way that a reasonable person with the same education would not. Giving a back rub. Cleaning a newborn immediately after delivery. Correct2 Emptying a portable wound drainage system. Correct3 A health care provider prescribes a standard walker (pick- up walker with rubber tips on all four legs). The nurse identifies what clinical findings that indicate the client is capable of using a standard walker? 1 2 3 View Topics Stats Issue with this question? To prevent footdrop in a client with a leg cast, the nurse should: Strong upper arm strength and non–weight bearing on the affected extremity Correct4 Confidence: Pretty sure 1130049055 A walker with four rubber tips on the legs requires more upper body strength than a rolling walker. A client who is non–weight bearing on the affected extremity is able to use a standard walker . A rolling walker is more appropriate for a client with weak upper arm strength and impaired stamina who is less able to lift up and move a walker with four rubber tips. A client with unilateral paralysis is not a candidate for a standard walker; the client must be able to grip and lift the walker with both upper extremities and move the walker forward. A rolling walker is more appropriate for this client. A client with kyphosis is less able to lift up and move a of students nationwide answered this question correctly.62% Weak upper arm strength and impaired stamina Weight bearing as tolerated and unilateral paralysis Partial weight bearing on the affected extremity and kyphosis 1 Encourage complete bed rest to promote healing of the foot. 2 Place the foot in traction. Support the foot with 90 degrees of flexion. 4 Place an elastic stocking on the foot to provide support. Correct3 View Topics Stats Issue with this question? What should the nurse include in dietary teaching for a client with a colostomy? 1 2 3 Confidence: Nailed it 1130049079 The diet should be adjusted to include foods that result in manageable stools. Correct4 of students nationwide answered this question correctly.64% To prevent footdrop (plantar flexion of the foot due to weakness or paralysis of the anterior muscles of the lower leg) in a client with a cast, the foot should be supported with 90 degrees of flexion. Bed rest can cause footdrop, and 45 degrees is not enough flexion to prevent footdrop . Applying an elastic stocking for support also will not prevent footdrop; a firmer support is required. Test-Taking Tip: On a test day, eat a normal meal before going to school. If the test is late in the morning, take a high-protein snack with you to eat 20 minutes before the examination. The brain works best when it has the glucose necessary Liquids should be limited to 1 L per day. Non-digestible fiber and fruits should be eliminated. A formed stool is an indicator of constipation. impairment. Legally, who is responsible for the child's injury? 1 Health care provider, because this decision took precedence over the nurse's concern 2 Nurse, because failure to further question the health care provider about the child's status placed the child at risk Correct3 Health care provider, because of total responsibility for the child's health and treatment regimen 4 View Topics Stats Issue with this question? On the third postoperative day following a below-the-knee amputation, a client is refusing to eat, talk, or perform any rehabilitative activities. What is the best initial approach that the nurse should take when interacting with this client? 1 2 3 Neither, because high fevers are common in children and the health care provider had little cause for concern Confidence: Nailed it 1130045532 Acknowledge that the client's withdrawal is an expected and necessary part of initial grieving. Correct4 It is the nurse's responsibility to foresee potential harm and prevent risks by acting as a client advocate. This is not acceptable as a rationale for inaction. The nurse and health care provider share interdependent roles in the assessment and care of clients. High temperatures are common in children but are nonetheless a valid cause for concern. of students nationwide answered this question correctly.71% Explain why there is a need to increase activity. Emphasize that with a prosthesis, there will be a return to the previous lifestyle. Appear cheerful and non-critical regardless of the client's response to attempts at intervention. View Topics Stats Issue with this question? Confidence: Pretty sure 1130049034 The withdrawal provides time for the client to assimilate what has occurred and integrate the change in body image. The client is not ready to hear explanations about why there is a need to increase activity until assimilation of the surgery has occurred. Emphasizing a return to the previous lifestyle does not acknowledge that the client must grieve; it also does not allow the client to express any feelings that life will never be the same again. In addition, it may be false reassurance. The client might feel that the nurse has no comprehension of the situation or understanding of feelings if the nurse appears cheerful and noncritical regardless of the client's response to attempts at intervention. of students nationwide answered this question correctly.68% View Topics Stats Issue with this question? A nurse identifies that an older adult has not achieved the desired outcome from a prescribed proprietary medication. When assessing the situation, the client shares that the medication is too expensive and the prescription was never filled. What is an appropriate nursing response? 2 Encourage the client to acquire the medication over the internet. Correct3 Inform the health care provider of the inability to afford the medication. 4 Suggest that the client purchase insurance that covers prescription medications. Confidence: Nailed it 1130039631 of students nationwide answered this question correctly.65% Ask the pharmacist to provide a generic form of the medication. Incorrect1 Although water flushes some microorganisms from the skin, without friction it has minimal value. Test-Taking Tip: Answer the question that is asked. Read the situation and the question carefully, looking for key words or phrases. Do not read anything into the question or apply what you did in a similar situation during one of your clinical experiences. Think of each question as being an ideal, yet realistic, situation. 1 The health care provider needs to be aware of the reason for the client's lack of response to the medication so that an alternate treatment plan or financial assistance can be arranged (e.g., go to The National Council on the Aging web site [BenefitsCheckUpRx] to establish whether the client is eligible for assistance from any community, state, or federal programs or from the drug company). A health care provider may prefer the proprietary form of the medication. To ask the pharmacist to provide a generic form of the medication is unsafe. To recommend that the client obtain a generic form of the medication is not within the legal role of the nurse, unless the health care provider documents that this is acceptable. Medications purchased over the internet may be illegally imported, counterfeit, expired, or contaminated and therefore should be avoided. Although some prescription insurance plans may help to reduce the cost of some medications, the A client with heart failure is on a drug regimen of digoxin (Lanoxin) and furosemide (Lasix). The client dislikes oranges and bananas. Which fruit should the nurse encourage the client to eat? 2 Grapes Correct3 Apricots 4 Cranberries View Topics Stats Issue with this question? What is the best nursing intervention to minimize perineal edema after an episiotomy? Correct1 Applying ice packs Offering warm sitz baths 3 Confidence: Just a guess 1135007872 Incorrect2 Apples Incorrect1 Lasix is potassium depleting; apricots have more than 440 mg of potassium per 100 g. Apples have about 80 to 110 mg of potassium per 100 g. Grapes have about 80 to 160 mg of potassium per 100 g, depending on the variety. Cranberries have about 65 mg of potassium per 100 g. of students nationwide answered this question correctly.58% A client newly diagnosed with myasthenia gravis is concerned about fluctuations in physical condition and generalized weakness. When caring for this client it is most important for the nurse to plan to: Correct1 Space activities throughout the day 2 3 View Topics Stats Issue with this question? An older client's colonoscopy reveals the presence of extensive diverticulosis. What type of diet should the nurse encourage the client to follow? Correct2 High-fiber 3 High-protein 4 Low-carbohydrate Have a family member stay at the bedside to give the client support Incorrect4 Confidence: Just a guess 1140387132 Spacing activities encourages maximum functioning within the limits of the client's strength and endurance. Bed rest and limited activity may lead to muscle atrophy and calcium depletion. Teaching the limitations imposed by the disorder is necessary for lifelong psychological adjustment, but does not address the client's concerns at this time. Having a member of the family stay and give the client support should be permitted if requested by the client or family, but does not address the concerns voiced by the client. of students nationwide answered this question correctly.64% Low-fat Incorrect1 Restrict activities and encourage bed rest Teach the client about limitations imposed by the disorder 1 Fiber promotes passage of residue through the intestine, thereby preventing constipation. Constipation causes straining at stool; this increases intraluminal pressure, which can precipitate diverticulitis or perforation of diverticulum. The other diets are not indicated for diverticulosis. View Topics Stats Issue with this question? The nurse teaches a client who developed degenerative joint disease of the vertebral column positioning techniques, including turning from back to side, keeping the spine straight. The nurse explains that the least effort will be exerted if the client crosses the arm over the chest and: 1 Correct2 Bends the top knee to the side to which the client is turning 3 Crosses the ankles while turning and keeps both legs of students nationwide answered this question correctly.63% Confidence: Nailed it 1140355302 Flexes the bottom knee to the side the client wishes to turn Incorrect4 Putting the upper arm and leg toward the side to which the client is turning uses body weight to facilitate turning; the spine is kept straight. Using the overbed table to pull up will result in twisting the spinal column. This is unsafe; an overbed table has wheels and is not a stable object. Crossing the ankles while turning with both legs straight can be done if another person were turning the client; when turning alone in this position, the client will have no leverage and turning probably will result in twisting the spinal column. Flexing the bottom knee to the side to which the client wishes to turn will interfere with turning because the bent leg becomes an obstacle and provides a force opposite to the leverage needed to turn. STUDY TIP: Laughter is a great stress reliever. Watching a short program that makes you laugh, reading something funny, or sharing humor with friends helps of students nationwide answered this question correctly.55% Tofu products increase protein without increasing vitamin D because, unlike milk products, tofu does not contain vitamin D. Eggnog contains milk and should be avoided. Cottage cheese, a milk product, contains vitamin D, which should be avoided. Powdered whole milk contains vitamin D and should be avoided. Uses the overbed table to pull the upper body up to assist with turning straight View Topics Stats Issue with this question? Confidence: Nailed it 1140401566 A client was recently diagnosed with a cancerous lesion of the mouth. What should the nurse ask when analyzing the client's need for health education in relation to this health problem? 1 3 "How frequently are you seeing the dentist?" Correct4 "Have you noticed any change in your appetite?" View Topics Stats Issue with this question? A nurse is teaching a class about hepatitis, specifically hepatitis A. Which food should the nurse explain most likely will remain contaminated with the hepatitis A virus after being cooked? "Do feel like your gums are inflamed?" Incorrect2 Confidence: Just a guess 1140433493 Problems involving the oral cavity often result in nutritional problems. The question "Have you noticed any change in your appetite?" will elicit more information. An inability to sleep usually is not a characteristic symptom of cancer of the oral cavity; it may occur after the diagnosis because of worry or fear. Gum infections usually are not an early problem after diagnosis of oral cancer. Lesions of the oral cavity do not tend to cause major dental problems. Test-Taking Tip: If the question asks for an immediate action or response, all of the answers may be correct, so base your selection on identified priorities for of students nationwide answered this question correctly.58% Incorrect1 "Are you having difficulty sleeping?" View Topics Stats Issue with this question? Confidence: Pretty sure 1135028812 Dependent edema around the area of feet and ankles often indicates right sided heart failure or venous insufficiency. The nurse should assess for pitting edema by pressing firmly for several seconds then release to assess for any depression left on the skin. The grading of 1+ to 4+ characterizes the severity of the edema. A grade of grade of 4+ indicates an 8 mm depression. A grade of 1+ indicates a 2 mm depression. A grade of 2 + indicates a 4 mm depression. A grade of 3+ indicates a 6 mm depression. of students nationwide answered this question correctly.68% A mother whose newborn infant son has a cleft lip and palate asks how to feed her baby because he has difficulty suckling. What information should the nurse provide concerning safe feeding technique for this infant? 1 2 Correct4 View Topics Stats Issue with this question? A client who has been in a coma for two months is being maintained on bed rest. The nurse concludes that to prevent the effects of shearing force, the head of the bed should be maintained at an angle of: "Try using a soft nipple with an enlarged opening so he can get the milk through a chewing motion." Incorrect3 Confidence: Pretty sure 1140359907 Cleft lip and palate, a congenital defect, prevents the infant from creating a tight seal with the lips to facilitate suckling. As a result, the infant swallows large amounts of air when feeding. The mother should be taught to provide frequent rest periods and to burp the infant often to expel excess air in the stomach. Infants with cleft lip and palate should be held upright during feedings. Newborn infants cannot chew and do not make chewing movements. of students nationwide answered this question correctly.63% "Because he tires easily, it's best to have him lying in bed while he is being fed." "Hold him in a horizontal position and feed him slowly to help prevent aspiration." "Give him brief rest periods and frequent burpings during feedings so he can get rid of swallowed air." Correct1 3 60 degrees 4 90 degrees 45 degrees Incorrect2 30 degrees Correct4 1 Discharge planning for an ambulatory client with Parkinson disease (PD) includes recommending equipment for home use that will help with activities of daily living. To foster independence, the nurse should promote the use of: 2 Side rails for the bed 3 Trapeze above the bed 4 Crutches for ambulation Donning elastic stockings before getting out of bed provides support and promotes venous return; applying stockings while the legs are horizontal ensures that the stockings are in place before dependent edema occurs. Although leg exercises are helpful, this will not provide continuous support for the veins. Sitting with the knees flexed promotes venous stasis and the formation of thrombophlebitis. Warm soaks resolve inflammation; they do not prevent the development of thrombophlebitis. Raised toilet seat Correct1 A raised toilet seat will reduce strain on the back muscles and make it easier for the client to rise from the seat without injury. The client is not bedridden and will not need side rails for the bed or a trapeze above the bed. Clients with Parkinson disease have poor balance and a propulsive gait, which makes it unsafe to use crutches. STUDY TIP: Develop a realistic plan of study. Do not set rigid, unrealistic goals. of students nationwide answered this question correctly.54% Apply warm soaks to the legs daily Put on elastic stockings before arising View Topics Stats Issue with this question? A client's serum albumin value is 2.8 g/dL. Which food selected by the client indicates that the nurse's dietary teaching is successful? 1 2 4 View Topics Stats Issue with this question? A nurse in a rehabilitation center teaches clients with Confidence: Pretty sure 1140399052 Sliced turkey Correct3 Confidence: Nailed it 1140407477 This client's serum albumin value indicates severe depletion of visceral protein stores; the expected range for serum albumin is 3.5 to 5.5 g/dL. White meat turkey (two slices 4 × 2 × 1/4 inch) contains approximately 28 g of protein. A 4 oz serving of beef broth contains approximately 2.4 g of protein. A 6 oz serving of mixed fruit contains approximately 0.5 g of protein. A 3 oz serving of spinach salad contains approximately 9 g of protein. of students nationwide answered this question correctly.51% Beef broth Fruit salad Spinach salad dietary regimen. The nurse should become informed about the cultural eating patterns of clients so that foods containing the essential nutrients that are part of these dietary patterns may be included in the diet. Fluid retention is only one component of weight gain; growth of the fetus, placenta, breasts, and uterus also contributes to weight gain. The need for calories and nutrients increases during pregnancy. Pregnancy diets are not specific; they are composed of the essential nutrients. View Topics Stats Issue with this question? A nurse is providing dietary teaching for a client with celiac disease. Which foods should the nurse teach the client to avoid when following a gluten-free diet? (Select all that apply.) 3 Rice 4 Corn of students nationwide answered this question correctly.61% Confidence: Nailed it 1140387198 Oats Correct2 Rye Correct1 Wheat Correct5 Rye should be avoided because it is irritating to the gastrointestinal mucosa. Oats should be avoided because they are irritating to the gastrointestinal mucosa. Products containing wheat should be avoided because they are irritating to the gastrointestinal mucosa. Gluten is not found in rice; therefore, it does not have to be avoided. Gluten is not found in corn; therefore, it does not have to be avoided. STUDY TIP: Becoming a nursing student automatically increases stress levels because of the complexity of the information to be learned and applied and because of new constraints on time. One way to decrease stress associated with school is to become very organized so that assignment deadlines or tests do not come as sudden surprises. By following a consistent plan for studying and completing assignments, you can stay on top of requirements and of students nationwide answered this question correctly.48% View Topics Stats Issue with this question? A client is experiencing stomatitis as a result of chemotherapy. Which nursing action is most appropriate when caring for this client? 2 Use karaya powder to decrease irritation. 3 Increase fluid intake to compensate for accompanying diarrhea. 4 Provide meticulous skin care of the abdomen with an antiseptic. View Topics Stats Issue with this question? A nurse is monitoring a client with renal failure for signs of fluid excess. Which finding does the nurse identify as inconsistent with fluid excess? Confidence: Just a guess 1130044741 Confidence: Nailed it 1140390833 Provide frequent saline mouthwashes. Correct1 Saline mouthwashes are soothing to the oral mucosa and help clean the mouth, minimizing infection. Stomatitis refers to the oral cavity; karaya is used to protect the skin around a stoma created on the abdomen. Stomatitis does not cause diarrhea or fluid loss. The abdomen is not involved; stomatitis is an inflammation of the oral mucosa. of students nationwide answered this question correctly.61% View Topics Stats Issue with this question? Which alternative therapy may be beneficial for the nurse to discuss with a client who has terminal bone cancer? 2 Radiotherapy 3 Bariatric therapy 4 Radioactive implants View Topics Confidence: Nailed it 1140402651 Confidence: Pretty sure 1135200792 of students nationwide answered this question correctly.64% Biofeedback Correct1 Biofeedback provides information about changes in body function; clients can learn to use this to control a variety of body responses, including pain. Radiotherapy is a part of standard medical regimens. Bariatrics is a type of therapy that focuses on the correction of obesity; it encompasses prevention, control, and treatment of the problem, which involves medications and surgery. Placement of radioactive sources into or in contact with tissues (brachytherapy) is part of standard medical treatment for cancer. of students nationwide answered this question correctly.55% The pelvis is elevated by actions involving the unaffected upper extremities and unaffected leg. Turning toward the operative side is not permitted because it causes adduction of the leg and can lead to dislocation of the femoral head. Flexing both knees while slowly lifting the pelvis puts pressure on the operative hip, which is contraindicated because it may dislocate the prosthesis. Lifting only with the arms requires strength; the use of both heels puts pressure on the operative hip, which may dislocate the prosthesis. Stats Issue with this question? A nurse reviews the prescribed treatment with the parents of an infant born with bilateral clubfeet. Which parental statement indicates to the nurse that further education is required? 1 2 3 1 A fter surgery for a fractured hip, a client states, "I don't remember when I have ever been so uncomfortable." The nurse should: "We'll have to have the baby fitted with prosthetic devices before he'll be able to walk." Correct4 Most children with bilateral clubfeet are eventually able to walk without much difficulty. Prosthetic devices generally are not indicated. Serial casting with cast changes every week is usually successful. If serial casting is not effective, surgical intervention may be necessary. Test-Taking Tip: Monitor questions that you answer with an educated guess or changed your answer from the first option you selected. This will help you to analyze your ability to think critically. "We'll have to start serial casting right away." "The casts will have to be changed every week." "The baby may have to have surgery if the problem's not fixed in a few months." View Topics Stats Issue with this question? A nurse is evaluating a client's response to fluid replacement therapy. Which clinical finding indicates adequate tissue perfusion to vital organs? Confidence: Nailed it 1140397102 2 Central venous pressure reading of 2 mm Hg 3 Baseline pulse rate of 120 that decreases to 110 beats/min within a 15-minute period 4 Baseline blood pressure of 50/30 that increases to 70/40 mm Hg within a 30-minute period View Topics Stats Issue with this question? A preschooler is admitted with a diagnosis of acute glomerulonephritis. The child's history reveals a 5-lb weight gain in 1 week and periorbital edema. How can the nurse obtain the most accurate information on the status of the child's edema? Weighing daily 2 Observing body changes 3 Measuring intake and output Urinary output of 30 mL in an hour Correct1 Confidence: Nailed it 1143260284 A urinary output rate of 30 mL/hour is considered adequate for perfusion of the kidneys, heart, and brain. A central venous pressure reading of 2 mm Hg indicates hypovolemia. A baseline pulse rate of 120 that decreases to 110 beats/min within a 15-minute period and a baseline blood pressure of 50/30 that increases to 70/40 mm Hg within a 30-minute period indicate improvement but not necessarily of students nationwide answered this question correctly.69% Correct1 4 Monitoring electrolyte values Weight monitoring is the most useful means of assessing fluid balance and changes in the edematous state; 1 L of fluid weighs about 2.2 lb. Visual inspection is subjective and generally inaccurate. Measuring intake and output is not as accurate as daily weights; fluid may be trapped in the third compartment. Monitoring of electrolyte values is unreliable; they may or may not be altered with of students nationwide answered this question correctly.71% 4 View Topics Stats Issue with this question? A hospitalized 7-year-old boy wakes up crying because he has wet his bed. It is most appropriate for the nurse to: 1 3 Take the child to the bathroom and change his pajamas 4 Remind the child to call the nurse next time to avoid the need to change his pajamas Sweet potatoes Confidence: Pretty sure 1138380987 Change the child's bed while he changes his pajamas Correct2 Strawberries contain 88 mg of vitamin C (ascorbic acid) per cup. One banana contains 12 mg of ascorbic acid. One cup of green beans contains 21 mg of ascorbic acid. One baked sweet potato contains 25 mg of ascorbic acid. Test-Taking Tip: Have confidence in your initial response to an item because it more than likely is the correct answer. of students nationwide answered this question correctly.74% Allow the child to change his bed and pajamas View Topics Stats Issue with this question? Confidence: Pretty sure 1143238946 Changing the child's bed while the child changes his pajamas will not call attention to the accident and will minimize the child's embarrassment. The child would probably be unable to change the bed without assistance; failure to complete the task might add to his embarrassment. Taking the child to the bathroom to change his pajamas and reminding the child to call a nurse next time will only add to the child's embarrassment. Test-Taking Tip: Try putting questions and answers in your own words to test of students nationwide answered this question correctly.65% What intervention is included in the nursing care plan for a 4-month-old infant with tetralogy of Fallot and heart failure? 2 Positioning the child flat on the back 3 Encouraging nutritional fluids often. 4 Measuring the head circumference daily. View Topics Stats Issue with this question? A client who has intermittently been having painful, swollen knee and wrist joints during the past three months is diagnosed with rheumatoid arthritis. What type of diet should the nurse expect the health care provider to prescribe? 1 Salt-free, low-fiber diet 2 High-calorie, low-cholesterol diet Confidence: Nailed it 1140407837 Providing small, frequent feedings. Correct1 Small, frequent feedings with adequate rest periods in between may improve the infant's intake at each feeding; infants with tetralogy of Fallot become extremely fatigued while suckling. Positioning the child with the head elevated facilitates respiration; an infant cardiac seat, similar to a car seat, helps maintain the child in the semi-Fowler position. As a means of reducing the cardiac workload, excessive fluids usually are not offered, and fluids may even be restricted. The head circumference is not an important assessment for infants with congenital heart disease; daily head measurements should be taken for infants with hydrocephaly. of students nationwide answered this question correctly.66% 1 A client is admitted to the hospital for the medical management of burns over 18% of the body's surface. What should the nurse teach the client to help manage pain during dressing changes? 2 Progressive muscle relaxation 3 Active range-of-motion exercises 4 Important elements of wound care View Topics Stats Issue with this question? A nurse is providing dietary instruction to a client with cardiovascular disease. Which dietary selection by the client indicates the need for further instruction? Whole milk with oatmeal 2 Garden salad with olive oil 3 Tuna fish with a small apple Confidence: Nailed it 1140392960 Deep breathing exercises Correct1 Deep breathing exercises are an effective intervention in controlling pain; this is a positive coping skill. Muscle relaxation techniques generally include muscle contraction and then relaxation, which may increase the pain. Active range-of- motion exercises may increase the pain. Understanding important aspects of wound care will not reduce pain; health teaching should be initiated before, not of students nationwide answered this question correctly.72% Correct1 4 Soluble fiber cereal with skim milk Although oatmeal is a soluble fiber, whole milk is high in saturated fat and should be avoided. Olive oil contains unsaturated fat. Most fish have a low fat content; fruit does not contain fat. Soluble fiber helps to lower cholesterol; skim milk does 3 4 View Topics Stats Issue with this question? A nurse is caring for a client with a diagnosis of renal calculi secondary to hyperparathyroidism. Which type of diet should the nurse explore with the client when providing discharge information? 1 3 High phosphorus 4 High alkaline ash 90 degrees Confidence: Nailed it 1140408697 Low calcium Correct2 Shearing force occurs when two surfaces move against each other; when the bed is at an angle greater than 30 degrees, the torso tends to slide and cause this phenomenon. Forty- five, 60, and 90 degrees will raise the head of the bed too high, and the client will slide down in the bed, causing shearing forces. of students nationwide answered this question correctly.77% 60 degrees Low purine View Topics Stats Issue with this question? Confidence: Nailed it 1140395902 Calcium and phosphorus are components of these stones; foods high in calcium and phosphorus should be avoided. Low purine and high alkaline ash diets are indicated for clients with gout. Foods high in phosphorus must be avoided. Test-Taking Tip: Be aware that information from previously asked questions may help you respond to other examination questions. of students nationwide answered this question correctly.68% A nurse provides dietary teaching about a low-sodium diet for a client with hypertension. Which nutrient selected by the client indicates an understanding about foods that are low in natural sodium? 1 2 4 View Topics Stats Issue with this question? A 1-day-old infant with an imperforate anus undergoes a pull-through procedure with an anoplasty. What should postoperative nursing care include? 1 Fruits Correct3 Confidence: Nailed it 1143238976 Fruits contain less natural sodium than do other foods. Milk is higher in natural sodium than is fruit. Meat is higher in natural sodium than is fruit. Vegetables are higher in natural sodium than is fruit. of students nationwide answered this question correctly.51% Milk Meat Vegetables Withholding oral feedings for several days A client drank 7.5 oz of orange juice, 6 oz of tea, and 8 oz of eggnog. How many milliliters of fluid were consumed by the client? Record your answer using a whole number. mL View Topics Stats 1130045978 Confidence: Nailed it One ounce (oz) equals approximately 30 mL. The client drank a total of 21.5 oz; multiply 21.5 × 30, which yields 645 mL. 59%of students nationwide answered this question correctly. Issue with this question? A client with a history of chronic obstructive pulmonary disease (COPD) is admitted with acute bronchopneumonia. The client is in moderate respiratory distress. The nurse should place the client in what position to enhance comfort? 1 2 3 1 A severely dehydrated infant with gastroenteritis is admitted to the pediatric unit. Nothing-by-mouth (NPO) status is prescribed. The parents ask why their baby cannot be fed. The nurse explains that this is necessary to: High-Fowler's position using the bedside table as an arm rest Correct4 High Fowler's position elevates the clavicles and helps the lungs to expand, thus easing respirations. The other options do not promote more comfortable breathing. Side lying position with head elevated 45 degrees Sim's position with head elevated 90 degrees Semi-Fowler's position with legs elevated 1 3 Determine the cause of the diarrhea 4 Prevent perianal irritation from the diarrhea Allow the intestinal tract to rest Correct2 Withholding food reduces the need for intestinal activity, which rests the intestines and minimizes diarrhea and the loss of fluid. Although intravenous therapy will be started for rehydration and to correct electrolyte imbalances, this is not the reason Correct electrolyte imbalances 2 3 4 View Topics Stats Issue with this question? A client has a hiatal hernia. The client is 5 feet 3 inches tall and weighs 140 pounds. When the nurse discusses prevention of esophageal reflux, what should be included? 1 2 Teaching how to cough to expectorate bronchial secretions effectively Confidence: Nailed it 1140358036 Communication is a priority; it facilitates interaction, limits anxiety, and promotes safety. A nasogastric tube can cause trauma to the suture lines; total parenteral nutrition may be used. Demonstrating how to care for a permanent laryngeal stoma is done postoperatively as the client begins to accept the laryngectomy. After a laryngectomy the client cannot cough; expectoration occurs through the of students nationwide answered this question correctly.64% Establishing a means for communicating postoperatively Explaining that there will be a feeding tube postoperatively Demonstrating how to care for a permanent laryngeal stoma "Increase your intake of fat with each meal." "Lie down after eating to help your digestion." 4 "Reduce your caloric intake to foster weight reduction." Correct3 Weight reduction decreases intraabdominal pressure, thereby decreasing the tendency to reflux into the esophagus. Fats decrease emptying of the stomach, extending the period that reflux can occur; fats should be decreased. Lying down after eating increases the pressure against the diaphragmatic hernia, increasing symptoms. Drinking several glasses of fluid during each meal will increase pressure; fluid should be discouraged with meals. Test-Taking Tip: Do not read too much into the question or worry that it is a "trick." If you have nursing experience, ask yourself how a classmate who is "Drink several glasses of fluid during each of your meals." View Topics Stats Issue with this question? A client suffered an injury to the leg as a result of a fall. X- ray films indicate an intertrochanteric fracture of the femur. The client will be placed in Buck's traction until surgery is performed. When considering the client's plan of care, the nurse recalls that the primary purpose of Buck's traction is to: 1 3 Maintain abduction of the leg 4 Eliminate rotation of the femur View Topics Stats Issue with this question? of students nationwide answered this question correctly.52% Confidence: Nailed it 1140355314 Immobilize the fracture Correct2 Confidence: Nailed it 1140409028 A continuous pull on the lower extremity keeps bone fragments from moving and causing further trauma, pain, and edema. The fracture will be reduced by surgery; Buck's traction is a temporary measure before surgery. Moving the leg away from the midline will not keep the leg in alignment; it is not the purpose of Buck's traction. External rotation of the femur may still occur with Buck's traction. of students nationwide answered this question correctly.62% Reduce the fracture E Correct4 Vitamin E hinders the oxidative breakdown of structural lipid membranes in body tissues, which is caused by free radicals in the cells. Vitamin A assists in the formation of visual purple needed for night vision. Vitamin C is used for formation of collagen, which is important for maintaining capillary strength, promoting wound healing, and resisting infection. Vitamin B1 is necessary for protein and fat metabolism and for functioning of the nervous system. of students nationwide answered this question correctly.59% View Topics Stats Issue with this question? A client with a history of a pulmonary embolus is to receive 3 mg of warfarin (Coumadin) daily. The client has blood drawn twice weekly to ascertain that the international normalized ratio (INR) stays within a therapeutic range. The nurse provides dietary teaching. Which food selected by the client indicates that further teaching is necessary? 1 3 Sweet potatoes 4 Cheese sandwich 1 Confidence: Nailed it 1140402606 Spinach salad Correct2 Dark green, leafy vegetables are high in vitamin K. Influencing the level of vitamin K alters the activity of warfarin because vitamin K acts as a catalyst in the liver for the production of blood-clotting factors and prothrombin. The intake of foods containing vitamin K must be consistent to regulate the warfarin dose so that the INR remains within the therapeutic range. Eggs contain protein and are permitted on the diet. Yellow vegetables contain vitamin A and are permitted on the diet. Dairy products containing protein and bread supplying carbohydrates are permitted on the diet. Poached eggs A client who recently experienced a brain attack (CVA) and who has limited mobility complains of constipation. What is most important for the nurse to determine when collecting information about the constipation? Presence of distention 2 Incorrect1 A client who is recuperating from a spinal cord injury at the T4 level wants to use a wheelchair. What should the nurse teach the client to do in preparation for this activity? Correct1 Push-ups to strengthen arm muscles 2 Leg lifts to prevent hip contractures 3 Balancing exercises to promote equilibrium View Topics Stats Issue with this question? A back brace is prescribed for a client who had a laminectomy. What instruction should the nurse include in the teaching plan? Correct1 Apply the brace before getting out of bed Put the brace on while in the sitting position 3 Confidence: Pretty sure 1140355306 Incorrect2 Quadriceps-setting exercises to maintain muscle tone Incorrect4 Arm strength is necessary for transfers and activities of daily living and for use of crutches or a wheelchair. Equilibrium is not a problem. The client does not have neurological control of the other activities. of students nationwide answered this question correctly.48% Use the brace when the back begins to feel tired 4 Wear the brace when performing twisting exercises Appling the brace before getting out of bed is done while in the supine position before the body is subjected to the force of gravity in a vertical position. Anatomical landmarks are easier to locate for correct application of the brace, and intraabdominal organs have not shifted toward the pelvic floor by gravity. The brace should be applied while in the supine position, not the sitting position. The brace View Topics Stats Issue with this question? A nurse teaches a client with calcium-based renal calculi about foods that can be eaten on a low-calcium diet (400 mg/day). The nurse concludes that the teaching was effective when the client selects what food items from the menu? (Select all that apply.) 3 5 View Topics of students nationwide answered this question correctly.62% Confidence: Nailed it 1140374351 Chocolate pudding Incorrect2 Roast beef with mashed potato Correct4 Baked chicken Correct1 Baked chicken is relatively low in calcium. Roast beef and mashed potato have moderate amounts of calcium. Pudding is made with milk and is high in calcium. Cheese is high in calcium. Ice cream is made with milk and is high in calcium. of students nationwide answered this question correctly.58% client feels tired. Twisting exercises are contraindicated because they exert excessive pressure on the operative site. Salmon loaf with cheese sauce Vanilla ice cream with chocolate syrup G4, T1, P1, A1, L3 4 G4, T2, P1, A1, L1 View Topics 1 130043540 Four pregnancies = G (gravida ) 4. One pregnancy that ended at 38 weeks = T (term) 1. One pregnancy that ended at 32 weeks = P (preterm) 1. One pregnancy that ended at 18 weeks = A (abortion) 1. One set of twins and a singleton = L (living) 3. of students nationwide answered this question correctly.60% Stats Issue with this question? The health care provider prescribes a low-fat, 2-gram sodium diet for a client with hypertension. The nurse should explain that the purpose of restricting sodium is to: 1 2 Correct3 View Topics Stats Issue with this question? Cause fluid to move toward the interstitial compartment Incorrect4 1140375795 Confidence: Just a guess Sodium absorbs water in the kidneys' renal tubules. When dietary intake of sodium is decreased, water is not reabsorbed and edema is reduced. A decrease in sodium will prevent the reabsorption of water. Furosemide stimulates the loop of Henle to inhibit the reabsorption of sodium and chloride at the proximal and distal tubules. Adequate hydration is the major factor that diminishes the thirst response. A low- sodium diet will help move fluid from the interstitial compartment to the intravascular compartment. 68%of students nationwide answered this question correctly. Confidence: Nailed it Chemically stimulate the loop of Henle Diminish the thirst response of the client Prevent reabsorption of water in the distal tubules A client has 4 ounces of apple juice, 6 ounces of tea, and 240 mL of chicken broth. The nurse calculates that the client ingested how many mL of fluid? Record your answer using a whole number. mL View Topics Stats Issue with this question? 1135006418 Confidence: Pretty sure 540 mL is a correct calculation. 4 ounces apple juice x 30 mL/ounce = 120 mL, 6 oz tea x 30 mL/ounce = 180 mL, and 240 mL chicken broth provide a total of 540 mL that the client has ingested. 64%of students nationwide answered this question correctly. View Topics Stats Issue with this question? A client has cholelithiasis with possible obstruction of the common bile duct. What should be determined about the client's nutritional status before surgery is scheduled? Correct1 Is the client deficient in vitamins A, D, and K? 2 Does the client eat adequate amounts of dietary fiber? Does the client consume excessive amounts of protein? 4 Are the client's levels of potassium and folic acid increased? 1 Confidence: Nailed it 1140399033 of students nationwide answered this question correctly.57% Incorrect3 Bile promotes the absorption of fat-soluble vitamins; an obstruction of the common bile duct limits the flow of bile to the duodenum. Knowing if the client eats adequate amounts of dietary fiber is not relevant to the situation. Knowing if the client consumes excessive amounts of protein is unnecessary; however, protein is desirable for wound healing. An increase in potassium and folic acid are not expected. A client with a fecal impaction has the urge to defecate but is unable to do so. Flatulence may occur as a result of immobility, not just obstruction. Anorexia may occur with an impaction but also may be caused by other conditions. The frequency of bowel movements varies for individuals; it may be normal for this individual not to have a bowel movement for several days. A client who is to receive radiation therapy for cancer says to the nurse, "My family said I will get a radiation burn." What is the nurse's best response? 1 "Your skin will look like a blistering sunburn." Correct2 "A localized skin reaction usually occurs." 3 "A daily application of an emollient will prevent a burn." View Topics Stats Issue with this question? A nurse hired to work in a metropolitan hospital provides services for a culturally diverse population. One of the nurses on the unit says it is the nurses' responsibility to discourage "these people" from bringing all that "home medicine stuff" to their family members. Which response by the recently hired nurse is most appropriate? 1 "Hospital policies should put a stop to this." 2 "Everyone should conform to the prevailing culture." Correct3 "Nontraditional approaches to health care can be beneficial." Confidence: Nailed it 1140402633 "Your family must have had experience with radiation therapy." Incorrect4 Radiodermatitis occurs three to six weeks after the start of treatment. The word "burn" should be avoided because it may increase anxiety. Emollients are contraindicated; they may alter the calculated x-ray route and injure healthy tissue. The response about the client's family does not address the client's concern. of students nationwide answered this question correctly.68%