RSNG2121 Exam Preparations Solutions, Questions With Answers Best RATED A+ 2023 Updates, Exams of Nursing

Download RSNG2121 Exam Preparations Solutions, Questions With Answers Best RATED A+ 2023 Updates and more Exams Nursing in PDF only on Docsity! RSNG2121 Exam Preparations Solutions, Questions With Answers Best RATED A+ 2023 Updates Question 1 See full question 47s A client with diabetes mellitus has a foot ulcer. The physician orders bed rest, a wet-to- damp dressing change every shift, and blood glucose monitoring before meals and at bedtime. Why are wet-to-damp dressings used for this client? You Selected: • They debride the wound and promote healing by secondary intention. Correct response: • They debride the wound and promote healing by secondary intention. Explanation: Remediation: Add a Note Question 2 See full question 45s A health care provider (HCP) has been exposed to hepatitis B through a needlestick. Which drug should the nurse anticipate administering as postexposure prophylaxis? You Selected: • hepatitis B immune globulin Correct response: • hepatitis B immune globulin Explanation: Remediation: Add a Note Question 3 See full question 59s The nurse is evaluating the laboratory results of a client who was recently admitted to the hospital. Which result indicates the presence of inflammation? You Selected: • leukocytosis Correct response: • leukocytosis Explanation: Remediation: Add a Note Question 4 See full question 35s The nurse is admitting a child who has been diagnosed with bacterial meningitis to the pediatric unit. The nurse should implement which type of isolation? You Selected: • droplet precautions Correct response: • droplet precautions Explanation: Remediation: Add a Note Question 5 See full question 2m 1s Interferon alfa-2b has been prescribed to treat a client with chronic hepatitis B. The nurse should assess the client for which common adverse effects? You Selected: • flulike symptoms Correct response: • flulike symptoms Explanation: Remediation: Add a Note Question 6 See full question 19s The client with acute lymphocytic leukemia (ALL) is at risk for infection. What action should the nurse take? Correct response: • a peripheral site and all lumens of the VAD Explanation: When an infection is suspected from a VAD, blood cultures should be drawn peripherally and from all lumens of the VAD to determine the source of the infection. If the number of organisms is greater from the VAD than in the peripheral culture, the source is determined to be the VAD. Remediation: Add a Note Question 9 See full question 26s Which nursing intervention is most appropriate for a client with multiple myeloma? You Selected: • Preventing bone injury Correct response: • Preventing bone injury Explanation: Remediation: Add a Note Question 10 See full question 26s An oncology clinic nurse is reinforcing prevention measures for oropharyngeal infections to a client receiving chemotherapy. Which statement by the client indicates that teaching was successful? You Selected: • "I clean my teeth gently several times per day." Correct response: • "I clean my teeth gently several times per day." Explanation: Remediation: Add a Note Question 11 See full question 2m 26s A nurse assesses a client in the physician's office. Which assessment findings support a suspicion of systemic lupus erythematosus (SLE)? You Selected: • Facial erythema, pericarditis, pleuritis, fever, and weight loss Correct response: • Facial erythema, pericarditis, pleuritis, fever, and weight loss Explanation: Remediation: Add a Note Question 12 See full question 37s A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? You Selected: • Hypercalcemia Correct response: • Hypercalcemia Explanation: Remediation: Add a Note Question 13 See full question 4s When caring for a client with diabetes insipidus, the nurse expects to administer: You Selected: • vasopressin. Correct response: • vasopressin. Explanation: Remediation: Add a Note Question 14 See full question 18s A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? You Selected: • Hypotonic saline Correct response: • Hydrocortisone Explanation: Emergency treatment for acute adrenal insufficiency (addisonian crisis) is I.V. infusion of hydrocortisone and saline solution. The client is usually given a dose containing hydrocortisone 100 mg I.V. in normal saline every 6 hours until blood pressure returns to normal. Insulin isn't indicated in this situation because adrenal insufficiency is usually associated with hypoglycemia. Potassium isn't indicated because these clients are usually hyperkalemic. The client needs normal — not hypotonic — saline solution. Remediation: Add a Note Question 15 See full question 2m 47s Which factor is most important to assess when determining the impact of the cancer diagnosis and treatment modalities on a long-term survivor's quality of life? You Selected: • evidence of disease Correct response: • individual values and beliefs Explanation: Individuals with cancer have various cultural values and beliefs that help them cope with the cancer experience. Quality of life cannot be evaluated solely by quantifiable factors such as employability, functional status, or evidence of disease. It must be evaluated by the survivors within the context of their subjective and individual values and beliefs. • decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. Explanation: Remediation: Add a Note Question 3 See full question 34s A client with metastatic cancer of the liver tells the nurse about being concerned about the prognosis. The nurse should: You Selected: • place emphasis on providing symptomatic and comfort measures. Correct response: • place emphasis on providing symptomatic and comfort measures. Explanation: Remediation: Add a Note Question 4 See full question 1m 36s A client with bladder cancer has gross hematuria. The client’s hemoglobin is 8.0 g/dL (80 g/L), and the health care provider (HCP) prescribes a unit of packed blood cells. The client has an existing intravenous infusion of normal saline using a 19-gauge needle. To administer the packed red blood cells, the nurse should: You Selected: • attach the packed cells to the existing 19G IV of normal saline solution using Y tubing. Correct response: • attach the packed cells to the existing 19G IV of normal saline solution using Y tubing. Explanation: Remediation: Add a Note Question 5 See full question 2m 12s Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply. You Selected: • Initial dilated and comprehensive eye exam at the time of diabetes diagnosis is recommended by the American and Canadian Diabetes Associations. • Good control of blood glucose levels helps prevent or delay complications. Correct response: • Good control of blood glucose levels helps prevent or delay complications. • Initial dilated and comprehensive eye exam at the time of diabetes diagnosis is recommended by the American and Canadian Diabetes Associations. Explanation: Remediation: Add a Note Question 6 See full question 56s The nurse teaches the client to report signs and symptoms of which potential complication after hypophysectomy? You Selected: • hypopituitarism Correct response: • hypopituitarism Explanation: Remediation: Add a Note Question 7 See full question 53s A client from a Mediterranean country is admitted with thalassemia, jaundice, splenomegaly, and hepatomegaly. Which should be the primary focus of nursing care for this client? You Selected: • Decrease cardiac demands by promoting rest. Question 13 See full question 35s For a client newly diagnosed with radiation-induced thrombocytopenia, the nurse should include which intervention in the care plan? You Selected: • Inspecting the skin for petechiae once every shift Correct response: • Inspecting the skin for petechiae once every shift Explanation: Remediation: Add a Note Question 14 See full question 51s A nurse is caring for a client with multiple myeloma. Which laboratory value is the nurse most likely to see? You Selected: • Hypercalcemia Correct response: • Hypercalcemia Explanation: Remediation: Add a Note Question 15 See full question 46s A clinical nurse specialist (CNS) is orienting a new graduate registered nurse to an oncology unit where blood product transfusions are frequently administered. In discussing ABO compatibility, the CNS presents several hypothetical scenarios. The new graduate knows that the greatest likelihood of an acute hemolytic reaction would occur when giving: You Selected: • O-negative blood to an O-positive client. Correct response: • A-positive blood to an A-negative client. Explanation: An acute hemolytic reaction occurs when there is an ABO or Rh incompatibility. For example, giving A blood to a B client would cause a hemolytic reaction. Likewise, giving Rh-positive blood to an Rh-negative client would cause a hemolytic reaction. It's safe to give Rh-negative blood to an Rh-positive client if there is a blood type compatibility. O- negative blood is the universal donor and can be given to all other blood types. AB clients can receive either A or B blood as long as there isn't an Rh incompatibility. Remediation: Add a Note Question 16 See full question 32s A client is admitted to the health care facility for evaluation for Addison's disease. Which laboratory test result best supports a diagnosis of Addison's disease? You Selected: • Blood urea nitrogen (BUN) level of 12 mg/dl (0.7 mmol/L) Correct response: • Serum potassium level of 5.8 mEq/L (5.8 mmol/L) Explanation: Addison's disease decreases the production of aldosterone, cortisol, and androgen, causing urinary sodium and fluid losses, an increased serum potassium level, and hypoglycemia. Therefore, an elevated serum potassium level of 5.8 mEq/L best supports a diagnosis of Addison's disease. A BUN level of 12 mg/dl and a blood glucose level of 90 mg/dl are within normal limits. In a client with Addison's disease, the serum sodium level would be much lower than 134 mEq/L, a nearly normal level. Remediation: Add a Note Question 17 See full question 1m A nurse should perform which intervention for a client with Cushing's syndrome? You Selected: • Explain that the client's physical changes are a result of excessive corticosteroids. Correct response: • Explain that the client's physical changes are a result of excessive corticosteroids. Explanation: Remediation: Add a Note Question 18 See full question 1m 3s A nurse is assessing a client with possible osteoarthritis. The most significant risk factor for primary osteoarthritis is: You Selected: • age. Correct response: • age. Explanation: Remediation: Add a Note Question 19 See full question 44s The client with acute leukemia and the health care team establish mutual client outcomes of improved tidal volume and activity tolerance. Which measure would be least likely to promote these outcomes? You Selected: • lying in bed and taking deep breaths Correct response: • lying in bed and taking deep breaths Explanation: Remediation: Add a Note Question 20 See full question 26s To combat the most common adverse effects of chemotherapy, a nurse should prepare to do which of the following? Add a Note Question 6 See full question 35s Which combination of adverse effects should a nurse monitor for when administering I.V. insulin to a client with diabetic ketoacidosis? You Selected: • Hypocalcemia and hyperkalemia Correct response: • Hypokalemia and hypoglycemia Explanation: Blood glucose needs to be monitored in clients receiving I.V. insulin because of the risk of hyperglycemia or hypoglycemia. Hypoglycemia might occur if too much insulin is administered. Hypokalemia, not hyperkalemia, might occur because I.V. insulin forces potassium into cells, thereby lowering the plasma level of potassium. Calcium and sodium levels aren't affected by I.V. insulin administration. Remediation: Add a Note Question 7 See full question 6s At what age is an individual most at risk for acquiring acute lymphocytic leukemia (ALL)? You Selected: • 4 to 12 years Correct response: • 4 to 12 years Explanation: Remediation: Add a Note Question 8 See full question 15s A 32-year-old woman recently diagnosed with Hodgkin's disease is admitted for staging by undergoing a bone marrow aspiration and biopsy. To obtain more information about the client's nutrition status, the nurse should review the results of which test? You Selected: • albumin level Correct response: • albumin level Explanation: Remediation: Add a Note Question 9 See full question 12s A client is being admitted with a nursing home–acquired pneumonia. The unit has four empty beds in semiprivate rooms. The room that would be most suitable for this client is the one with a: You Selected: • 45-year-old client with abdominal hysterectomy. Correct response: • 60-year-old client admmitted for investigation of transient ischemic atttacks. Explanation: The client with a possible transient ischemic attack is the only client who has not had surgery and is not immunocompromised. The client with a recent surgery and incision should not be exposed to a client with infection. Clients with cancer or alcoholic cirrhosis are very susceptible to infection, and it would not be safe to expose them to a client with a respiratory infection. Remediation: Add a Note Question 10 See full question 34s Which of the following actions most clearly demonstrates a nurse’s commitment to social justice? You Selected: • Lobbying for an expansion of Medicare eligibility and benefits. Correct response: • Lobbying for an expansion of Medicare eligibility and benefits. Explanation: Add a Note Question 11 See full question 22s Four clients injured in an automobile accident enter the emergency department at the same time. The triage nurse evaluates them immediately. The nurse should assign the highest priority to the client with the: You Selected: • maxillofacial injury and gurgling respirations. Correct response: • maxillofacial injury and gurgling respirations. Explanation: Remediation: Add a Note Question 12 See full question 16s A nurse medicates a client with another client's morning medicines. What is the best action by the nurse upon realizing the error? You Selected: • Assess the patient for the medications' effects. Correct response: • Assess the patient for the medications' effects. Explanation: Remediation: Add a Note Question 13 See full question 23s A client with acute kidney failure is placed on fluid restriction of 1000 mL of fluid over a 24-hour period. What is the priority nursing action? You Selected: • Divide the fluids equally among the three 8-hour nursing shifts. Correct response: Explanation: Remediation: Add a Note Question 19 See full question 22s Following a simple mastectomy, the nurse is totaling the amount of drainage in 24 hours from a suction drain in the incision. The nurse notes there is 200 mL of serosanguinous drainage for the first 24 hours. The nurse should: You Selected: • document the findings. Correct response: • document the findings. Explanation: Remediation: Add a Note Question 20 See full question 19s A nurse is planning staffing for a nursing unit in which the primary need of the clients is learning how to manage their health problems. Which combination is the ideal mix of staff for this unit? You Selected: • three registered nurses (RNs) Question 1 See full question 28s A client with stage II ovarian cancer undergoes a total abdominal hysterectomy and bilateral salpingo-oophorectomy with tumor resection, omentectomy, appendectomy, and lymphadenectomy. During the second postoperative day, which assessment finding requires immediate intervention? You Selected: • Shallow breathing and increasing lethargy Correct response: • Shallow breathing and increasing lethargy Explanation: Remediation: Add a Note Question 2 See full question 23h 2m 10s A client is scheduled for a right lower lobectomy for lung cancer. During the admission assessment, the client asks for information about a living will and advance directive. The nurse knows that the client understands teaching about the living will and advanced directive when he says: You Selected: • "The advance directive allows me to state my health care wishes while I'm still able to do so." Correct response: • "The advance directive allows me to state my health care wishes while I'm still able to do so." Explanation: Remediation: Add a Note Question 3 See full question 21s A client with rheumatoid arthritis has been on aspirin therapy for an extended time. Which assessment is the most important for the nurse to obtain? You Selected: • Hearing Correct response: • Hearing Explanation: Remediation: Add a Note Question 4 See full question 42s A group of nursing assistants hired for the medical-surgical floors are attending hospital orientation. Which topic should the educator cover when teaching the group about caring for clients with diabetes mellitus? You Selected: • Assessing the client experiencing a hypoglycemic reaction Correct response: • Obtaining, reporting, and documenting fingerstick glucose levels Explanation: Remediation: Add a Note Question 5 See full question 26s A client in sickle cell crisis has been hospitalized during her pregnancy. After giving discharge instructions, the nurse determines the client needs further teaching when she makes which statement? You Selected: • “I will need to take an iron supplement even if my laboratory values are normal.” Correct response: • “I will need to take an iron supplement even if my laboratory values are normal.” Explanation: Remediation: Add a Note Question 6 See full question 32s Nonsteroidal anti-inflammatory drugs (NSAIDs) are commonly used in the treatment of musculoskeletal conditions. It is important for the nurse to remind the client to: You Selected: • take NSAIDs with food. Correct response: • take NSAIDs with food. Explanation: Remediation: Add a Note Question 7 See full question 25s • measuring urine output hourly Explanation: Remediation: Add a Note Question 12 See full question 39s Which information should the nurse include when developing a teaching plan for a client newly diagnosed with type 2 diabetes mellitus? Select all that apply. You Selected: • Good control of blood glucose levels helps prevent or delay complications. • Monitoring carbohydrate intake should be the sole nutritional focus. • Initial dilated and comprehensive eye exam at the time of diabetes diagnosis is recommended by the American and Canadian Diabetes Associations. Correct response: • Good control of blood glucose levels helps prevent or delay complications. • Initial dilated and comprehensive eye exam at the time of diabetes diagnosis is recommended by the American and Canadian Diabetes Associations. Explanation: Remediation: Add a Note Question 13 See full question 47s When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which physiologic functions? You Selected: • bleeding tendencies Correct response: • bleeding tendencies Explanation: Remediation: Add a Note Question 14 See full question 33s The nurse evaluates that the client correctly understands how to report signs and symptoms of bleeding when the client says: You Selected: • "Ecchymoses are large, purple skin bruises." Correct response: • "Ecchymoses are large, purple skin bruises." Explanation: Remediation: Add a Note Question 15 See full question 30s A client is about to undergo bone marrow aspiration of the sternum. What should the nurse tell the client? You Selected: • "You may feel a solution being wiped over your entire front from your neck down to your navel and out to your shoulders." Correct response: • "You will feel a pulling type of discomfort for a few seconds." Explanation: As the bone marrow is being aspirated, the client will feel a suction or pulling type of sensation or discomfort that lasts a few seconds. A systemic premedication may be given to decrease this discomfort. A small area over the sternum is cleaned with an antiseptic. It is unnecessary to paint the entire anterior chest. The local anesthetic is injected through the subcutaneous tissue to numb the tissue for the larger-bore needle that is used for aspiration and biopsy. After the needle is removed, pressure is held over the aspiration site for 5 to 10 minutes to achieve hemostasis. A small dressing is applied; a large pressure dressing, such as an Ace bandage, would restrict the expansion of the lungs and is not used. Remediation: Add a Note • Red, open sores on the oral mucosa Explanation: Remediation: Add a Note Question 22 See full question 21s A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous? You Selected: • Nonmobile mass with irregular edges Correct response: • Nonmobile mass with irregular edges Explanation: Remediation: Add a Note Question 23 See full question 39s A nurse is caring for a client who is receiving chemotherapy and has a platelet count of 30,000/mm3. Which statement by the client indicates a need for additional teaching? You Selected: • "I take a stool softener every morning." Correct response: • "I floss my teeth every morning." Explanation: A client with a platelet count of 30,000/mm3 is at risk for bleeding and shouldn't floss his teeth. Flossing may increase the risk of bleeding in a client with a platelet count less than 40,000/mm3. Using an electric razor is appropriate because doing so helps minimize the risk of cutting when shaving. Taking a stool softener helps decrease potential trauma to the GI tract that may cause bleeding. Removing throw rugs from the house helps prevent falls, which could lead to uncontrolled bleeding. Remediation: Add a Note Question 24 See full question 15s After receiving chemotherapy for lung cancer, a client's platelet count falls to 98,000/?l. What term should the nurse use to describe this low platelet count? You Selected: • Thrombocytopenia Correct response: • Thrombocytopenia Explanation: Remediation: Add a Note Question 25 See full question 5s Which type of white blood cell (WBC) is the most numerous? You Selected: • Neutrophil Correct response: • Neutrophil Explanation: Remediation: Add a Note Question 26 See full question 21s A client is diagnosed with megaloblastic anemia caused by vitamin B12 deficiency. The physician begins the client on cyanocobalamin (Betalin- 12), 100 mcg I.M. daily. Which substance influences vitamin B12 absorption? You Selected: • Intrinsic factor Correct response: • Intrinsic factor Explanation: Remediation: Add a Note Question 27 See full question 20s A client with anemia has been admitted to the medical-surgical unit. Which assessment findings are characteristic of iron deficiency anemia? You Selected: • Dyspnea, tachycardia, and pallor Correct response: • Dyspnea, tachycardia, and pallor Explanation: Remediation: Add a Note Question 28 See full question 17s During a follow-up visit to the physician, a client with hyperparathyroidism asks the nurse to explain the physiology of the parathyroid glands. The nurse states that these glands produce parathyroid hormone (PTH). PTH maintains the balance between calcium and: You Selected: • phosphorus. Correct response: • phosphorus. Explanation: Remediation: Add a Note Question 29 See full question 17s A nurse is assessing a client with hyperthyroidism. What findings should the nurse expect? You Selected: • Weight loss, nervousness, and tachycardia Explanation: Remediation: Add a Note Question 35 See full question 23s A client with multiple sclerosis is taking baclofen. Which sign indicates the drug is having the intended outcome? The client: You Selected: • has relief from muscle spasms. Correct response: • has relief from muscle spasms. Explanation: Remediation: Add a Note Question 36 See full question 1m 5s The nurse should assess the client with hypothyroidism for: You Selected: • decreased activity due to fatigue. Correct response: • decreased activity due to fatigue. Explanation: Remediation: Add a Note Question 37 See full question 51s A client who is in the end-stages of cancer is increasingly upset about receiving chemotherapy. Which approach by the nurse would likely be most helpful in gaining the client's cooperation? You Selected: • Tell the client how the treatment can be expected to help. Correct response: • Tell the client how the treatment can be expected to help. Explanation: Remediation: Add a Note Question 38 See full question 36s The client with hepatitis A is experiencing fatigue, weakness, and a general feeling of malaise. The client tires rapidly during morning care. The most appropriate goal for this client is to: You Selected: • gradually increase activity tolerance. Correct response: • gradually increase activity tolerance. Explanation: Remediation: Add a Note Question 39 See full question 1m 31s Which goal is a priority for the diabetic client who is taking insulin and has nausea and vomiting from a viral illness or influenza? You Selected: • obtaining adequate food intake Correct response: • obtaining adequate food intake Explanation: Add a Note Question 40 See full question 21s The client with an open femoral fracture was discharged to home and reports having a fever, night sweats, chills, restlessness, and restrictive movement of the fractured leg. The nurse should interpret these findings as the client may be experiencing: You Selected: • osteomyelitis. Correct response: • osteomyelitis. Explanation: Remediation: Add a Note Question 41 See full question 13s A nurse is caring for a client with bronchogenic carcinoma. Which nursing intervention takes highest priority? You Selected: • Removing pulmonary secretions Correct response: • Removing pulmonary secretions Explanation: Remediation: Add a Note Question 42 See full question 1m 21s A client has been receiving chemotherapy for cancer treatment. The client is competent and has been actively involved in decisions regarding care; however, the client has now decided to refuse treatment. What should the nurse do when the client refuses the next dose of chemotherapy? You Selected: • Document the client’s choice and offer to discuss feelings about the chemotherapy. Correct response: • Document the client’s choice and offer to discuss feelings about the chemotherapy. Explanation: Question 48 See full question 10s A nurse is administering an IV antineoplastic agent when the client says, “My arm is burning by the IV site.” What should the nurse do first? You Selected: • Stop infusing the medication. Correct response: • Stop infusing the medication. Explanation: Add a Note Question 49 See full question 42s Before supper, an adult client who has type-2 diabetes and requires insulin tells the nurse about having tremors, being weak and anxious. The nurse should: You Selected: • have the client drink a glass of milk or orange juice. Correct response: • have the client drink a glass of milk or orange juice. Explanation: Remediation: Add a Note Question 50 See full question 16s The nurse is receiving results of a blood glucose level from the laboratory over the telephone. The nurse should: You Selected: • write down the results, read back the results to the caller from the laboratory, and receive confirmation from the caller. When a nurse removes an I.V. from an client with acquired immunodeficiency syndrome (AIDS), blood splashes into her eyes. What should the nurse do next? You Selected: • Rinse her eyes with water, report the incident, and go to Employee Health. Correct response: • Rinse her eyes with water, report the incident, and go to Employee Health. Explanation: Remediation: Add a Note Question 2 See full question 2m 18s A client with primary diabetes insipidus is ready for discharge on desmopressin (DDAVP). Which instruction should the nurse provide? You Selected: • "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." Correct response: • "You may not be able to use desmopressin nasally if you have nasal discharge or blockage." Explanation: Remediation: Add a Note Question 3 See full question 19s A nurse has just been trained in how to use and care for a new blood glucose monitor. Which nursing intervention demonstrates proper use of a blood glucose monitor? You Selected: • Calibrating the machine after installing a new battery Correct response: • Calibrating the machine after installing a new battery Explanation: Remediation: Add a Note Question 4 See full question 14s A nurse is caring for a client who complains of lower back pain. Which instruction should the nurse give to the client to prevent back injury? You Selected: • "Stand close to the object you're lifting." Correct response: • "Stand close to the object you're lifting." Explanation: Remediation: Add a Note Question 5 See full question 4m 4s A client has a total hip replacement. Which of the following client statements indicates a need for further teaching before discharge? You Selected: • "I can't wait to take a tub bath when I get home." Correct response: • "I can't wait to take a tub bath when I get home." Explanation: Remediation: Add a Note Question 6 See full question 18s The nurse is developing a plan of care for a client who has joint stiffness due to rheumatoid arthritis. Which measure will be the most effective in relieving stiffness? You Selected: • a warm shower before performing activities of daily living Correct response: • a warm shower before performing activities of daily living Explanation: Remediation: Correct response: • local joint pain Explanation: Remediation: Add a Note Question 13 See full question 1m 28s A client has a testicular nodule that is highly suspicious for testicular cancer. A laboratory test that supports this diagnosis is: You Selected: • increased AFP. Correct response: • increased AFP. Explanation: Remediation: Add a Note Question 14 See full question 1m 15s Which indicator is the best for determining whether a client with Addison's disease is receiving the correct amount of glucocorticoid replacement? You Selected: • skin turgor Correct response: • daily weight Explanation: Measuring daily weight is a reliable, objective way to monitor fluid balance. Rapid variations in weight reflect changes in fluid volume, which suggests insufficient control of the disease and the need for more glucocorticoids in the client with Addison’s disease. Nurses should instruct clients taking oral steroids to weigh themselves daily and to report any unusual weight loss or gain. Skin turgor testing does supply information about fluid status, but daily weight monitoring is more reliable. Temperature is not a direct measurement of fluid balance. Thirst is a nonspecific and very late sign of weight loss. Remediation: Add a Note Question 15 See full question 53s The client with Addison's disease should anticipate the need for increased glucocorticoid supplementation when? You Selected: • having oral surgery Correct response: • having oral surgery Explanation: Remediation: Add a Note Question 16 See full question 35s The nurse understands that the client who is undergoing induction therapy for leukemia needs additional instruction when the client makes which statement? You Selected: • "I cannot wait to get home to my cat!" Correct response: • "I cannot wait to get home to my cat!" Explanation: Remediation: Add a Note Question 17 See full question 10s Which is a priority assessment for the client in shock who is receiving an IV infusion of packed red blood cells and normal saline solution? You Selected: • anaphylactic reaction Correct response: • anaphylactic reaction Explanation: Remediation: Add a Note Question 18 See full question 51s The nurse is evaluating the outcome of therapy for a client with osteoarthritis. Which outcome indicates the goals of therapy have been met? You Selected: • joint range of motion improved Correct response: • joint range of motion improved Explanation: Remediation: Add a Note Question 19 See full question 28s The nurse is encouraging an unlicensed assistive personnel (UAP) to interact with a dying client and family. The nurse should help the UAP understand that: You Selected: • when health care personnel do not understand their own feelings about death and dying, they often avoid the client. Correct response: • when health care personnel do not understand their own feelings about death and dying, they often avoid the client. Explanation: Add a Note Question 20 See full question 2m 31s When starting the client’s intravenous infusion line, the nurse applies a tourniquet and selects the site for inserting the needle. When should the nurse remove the tourniquet? You Selected: You Selected: • Pituitary carcinoma Correct response: • Pituitary carcinoma Explanation: Remediation: Add a Note Question 26 See full question 33s A client is receiving chemotherapy to treat breast cancer. Which assessment finding indicates a chemotherapy-induced complication? You Selected: • Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Correct response: • Serum potassium level of [2.6 mEq/L (2.6 mmol/L)} Explanation: Remediation: Add a Note Question 27 See full question 12s What should a male client older than age 50 do to help ensure early identification of prostate cancer? You Selected: • Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Correct response: • Have a digital rectal examination and prostate-specific antigen (PSA) test done yearly. Explanation: Remediation: Add a Note Question 28 See full question 18s A nurse is performing a home visit for a client who received chemotherapy within the past 24 hours. The nurse observes a small child playing in the bathroom, where the toilet lid has been left up. Based on these observations, the nurse modifies the client's teaching plan to include: You Selected: • chemotherapy exposure and risk factors. Correct response: • chemotherapy exposure and risk factors. Explanation: Remediation: Add a Note Question 29 See full question 14s Testicular cancer risk is highest for adolescents and men younger than age 35. To specifically address testicular cancer risk, a nurse should modify client teaching for male clients to include: You Selected: • testicular self-examination. Correct response: • testicular self-examination. Explanation: Remediation: Add a Note Question 30 See full question 19s A nurse is providing discharge teaching to a client who is immunosuppressed. Which statement by the client indicates the need for additional teaching? You Selected: • "I won't go to see my nephew right after he gets his vaccines." Correct response: • "I can eat whatever I want as long as it's low in fat." Explanation: The client requires additional teaching if he states that he can eat whatever he wants. Immunosuppressed clients should avoid raw fruit and vegetables because they may contain bacteria that could increase the risk of infection; foods must be thoroughly cooked. Avoiding people who are sick, products containing alcohol, and people who have just received vaccines are appropriate actions for an immunosuppressed client. Remediation: Add a Note Question 31 See full question 28s A nurse is teaching a client about rheumatoid arthritis. Which statement by the client indicates understanding of the disease process? You Selected: • "It will get better and worse again." Correct response: • "It will get better and worse again." Explanation: Remediation: Add a Note Question 32 See full question 15s A complete blood count is commonly performed before a client goes into surgery. What does this test seek to identify? You Selected: • Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Correct response: • Abnormally low hematocrit (HCT) and hemoglobin (Hb) levels Explanation: Remediation: Add a Note You Selected: • "Do all your chores in the morning, when pain and stiffness are least pronounced." Correct response: • "Pace yourself and rest frequently, especially after activities." Explanation: A client with osteoarthritis must adapt to this chronic and disabling disease, which causes deterioration of the joint cartilage. The most common symptom of the disease is deep, aching joint pain, particularly in the morning and after exercise and weight- bearing activities. Because rest usually relieves the pain, the nurse should instruct the client to rest frequently, especially after activities, and to pace herself during daily activities. Telling the client to do her chores in the morning is incorrect because the pain and stiffness of osteoarthritis are most pronounced in the morning. Telling the client to do all chores after performing morning exercises or in the evening is incorrect because the client should pace herself and take frequent rests rather than doing all chores at once. Remediation: Add a Note Question 39 See full question 22s A client is admitted with acute osteomyelitis that developed after an open fracture of the right femur. When planning this client's care, the nurse should anticipate which measure? You Selected: • Administering large doses of I.V. antibiotics as ordered Correct response: • Administering large doses of I.V. antibiotics as ordered Explanation: Remediation: Add a Note Question 40 See full question 25s A client is preparing for discharge from the emergency department after sustaining an ankle sprain. The client is instructed to avoid weight bearing on the affected leg and is given crutches. After instruction, the client demonstrates proper crutch use in the hallway. What additional information is most important to know before discharging the client? You Selected: • Whether the client needs to navigate stairs routinely at home Correct response: • Whether the client needs to navigate stairs routinely at home Explanation: Remediation: Add a Note Question 41 See full question 21s The nurse is assessing a middle-aged client with cancer who has lost 1 lb (0.5 kg) in 4 weeks. The client is taking ondansetron for nausea and now has a temperature of 101° F (38.3° C). The fever is indicative of: You Selected: • infection. Correct response: • infection. Explanation: Remediation: Add a Note Question 42 See full question 16s A client with diabetes is being tested for glycosylated hemoglobin. How would the nurse explain the reason for this diagnostic test? You Selected: • It determines the average blood glucose level in the previous 2-3 months. Correct response: • It determines the average blood glucose level in the previous 2-3 months. Explanation: Remediation: Add a Note Question 43 See full question 24s The nurse is caring for a client with type 2 diabetes who has been admitted with hyperglycemia. What is the most important consideration when developing a teaching plan for this client? You Selected: • Assess what the client already knows, then identify learning needs. Correct response: • Assess what the client already knows, then identify learning needs. Explanation: Remediation: Add a Note Question 44 See full question 1m 26s The nurse is caring for a client admitted for pneumonia with a history of hypertension and heart failure. The client has reported at least one fall in the last 3 months. The client may ambulate with assistance, has a saline lock in place, and has demonstrated appropriate use of the call light to request assistance. Using the Morse Fall Scale (see chart), what is this client’s total score and risk level? You Selected: • 60, high risk Correct response: • 60, high risk Explanation: Remediation: Add a Note Question 45 See full question 1m A client is receiving intravenous mannitol for treatment of a brain tumor. The client’s intracranial pressure before administration of the mannitol was 14 mm Hg. Which assessment finding indicates that the medication is attaining a therapeutic effect? You Selected: Remediation: Add a Note Question 2 See full question 39s The nurse caring for a client with diabetes realizes that the client has a higher risk of developing cataracts and should also assess the client for indications of: You Selected: • diabetic retinopathy. Correct response: • diabetic retinopathy. Explanation: Add a Note Question 3 See full question 24s The nurse is reviewing the laboratory results of a client with hypothyroidism. An expected finding is: You Selected: • decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. Correct response: • decreased thyroxine (T4) and increased thyroid-stimulating hormone (TSH) levels. Explanation: Remediation: Add a Note Question 4 See full question 42s An adolescent is to receive radioactive iodine for Graves' disease. Which statement by the client reflects the need for more teaching? You Selected: • "Taking radioactive iodine will not affect my ability to have children in the future." Correct response: • "The advantage of radioactive iodine is that I will not need future medication for my disease." Explanation: Most clients will need lifelong thyroid replacement after treatments with radioactive iodine. Most clients are treated as outpatients. To reduce the risk of exposure to radioactivity to others, clients are advised to avoid public places for at least 1 day and maintain a prudent distance from others for 2 to 3 days. Additionally, clients are advised to avoid close contact with pregnant women and children for 5 to 11 days. The use of radioiodine to treat Graves’ disease has not been found to affect long-term fertility. Clients are taught not to share food, utensils, and towels. Use of a private bathroom is desirable. Clients are also instructed to flush the toilet more than one time after each use. Remediation: Add a Note Question 5 See full question 34s Because of steroid excess after a bilateral adrenalectomy, the nurse should assess the client for: You Selected: • delayed wound healing. Correct response: • delayed wound healing. Explanation: Remediation: Add a Note Question 6 See full question 44s A nurse observes a nursing assistant bending over a bed as she helps an obese client sit up. The nurse discusses her observations with the nursing assistant to reinforce the need for proper body mechanics. Which response indicates that the nursing assistant understands these principles? Select all that apply. You Selected: • "I need to keep my back straight and lift with my thigh muscles." • "I should bend at the knees, keep my back straight, then pull the client up." • "After letting the bed up,grasp the drawsheet, and pull the client up." Correct response: • "I need to keep my back straight and lift with my thigh muscles." • "I should ask the client to help as much as possible." Explanation: When moving a client, a nurse is least likely to hurt herself if she holds her back straight and lifts with her thigh muscles. Standing at the client's side places undue stress on the nurse's back. The nurse should encourage the client to help as much as possible to minimize her risk of injury. Remediation: Add a Note Question 7 See full question 25s Which instruction about insulin administration should a nurse give to a client? You Selected: • "Always follow the same order when drawing the different insulins into the syringe." Correct response: • "Always follow the same order when drawing the different insulins into the syringe." Explanation: Remediation: Add a Note Question 8 See full question 40s A female client with hyperglycemia who weighs 210 lb (95 kg) tells the nurse that her husband sleeps in another room because her snoring keeps him awake. The nurse notices that the client has large hands and a hoarse voice. Which disorder would the nurse suspect as a possible cause of the client's hyperglycemia? You Selected: • Acromegaly Correct response: Question 13 See full question 1m 21s The client with an above-the-knee amputation is to be fitted with a functioning prosthesis. The nurse has been teaching the client how to care for the residual limb. Which behavior would demonstrate that the client has an understanding of proper residual limb care? The client: You Selected: • washes and dries the residual limb daily. Correct response: • washes and dries the residual limb daily. Explanation: Remediation: Add a Note Question 14 See full question 7m 19s A client has a C7 spinal cord injury. Which would be the most important nursing intervention during the acute stage of the injury? You Selected: • Maintain a patent airway. Correct response: • Maintain a patent airway. Explanation: Remediation: Add a Note Question 15 See full question 1m 52s A client with type 1 diabetes mellitus asks the nurse about taking ginseng at home. How should the nurse respond to the client? You Selected: • "Taking ginseng will increase the risk of hypoglycemia." Correct response: • "Taking ginseng will increase the risk of hypoglycemia." Explanation: Remediation: Add a Note Question 16 See full question 17s What are important nursing priorities on the first postoperative day for a client who has had an open reduction and internal fixation (ORIF) after a right hip fracture? You Selected: • Supporting the leg to maintain adduction, ensuring adequate pain control, and maintaining bed rest Correct response: • Assessing the neurovascular status in the right leg, providing pain control, encouraging position changes, and early ambulation Explanation: Assessing the neurovascular status, including circulation and innervation, is very important postoperatively. Control of pain is also a priority. Maintaining the integrity of the skin through frequent turns and ambulation will prevent pressure ulcers. Correct postoperative positioning involves maintaining the leg in a neutral position and preventing adduction. Bed rest can result in immobility consequences. Assessing skin integrity and nutritional status is positive, but maintaining bedrest is incorrect. Reorienting frequently will not prevent disorientation, and the nurse would not restrict pain measures. Remediation: Add a Note Question 17 See full question 17s A nurse is caring for a client with type 1 diabetes who is light headed, begins sweating profusely, and loses consciousness. Which action should the nurse take? You Selected: • Raise the client’s legs. Correct response: • Administer an IV bolus of 50% dextrose. Explanation: The client is most likely experiencing hypoglycemia and needs glucose. Giving fluids to an unconscious client is contraindicated. Insulin will further decrease glucose levels. Raising the client’s legs will not reverse hypoglycemia. Remediation: Add a Note Question 18 See full question 35s A client is brought to the emergency department with a painful swollen ankle. Which of the following is the nurse’s most appropriate action? You Selected: • Elevate the ankle Correct response: • Elevate the ankle Explanation: Remediation: Add a Note Question 19 See full question 24s A client is being discharged following an open reduction and internal fixation of the left ankle, and is to wear a non–weight-bearing cast for 2 weeks. What should the nurse teach the client to do when using crutches? You Selected: • Keep leg dependent when sitting. Correct response: • Maintain two to three finger widths between the axillary fold and underarm piece grip. Explanation: The nurse instructs the client to maintain two finger widths between the axillary fold and the underarm piece grip of the crutches to prevent pressure on the brachial plexus. The client is advised to use the three-point gait; in the four-point and two point-gait there is partial weight bearing of both feet. The client is also advised to keep the affected leg elevated when sitting to prevent swelling, and to use the arms, not the axillae, to maintain balance and support. Remediation: Correct response: • Tachycardia Explanation: Remediation: Add a Note Question 6 See full question 10s A nurse should expect to administer which medication to a client with gout? You Selected: • Colchicine Correct response: • Colchicine Explanation: Remediation: Add a Note Question 7 See full question 1m 2s A client with hyperparathyroidism declines surgery and is to receive hormone replacement therapy with estrogen and progesterone. Which instruction is most important for the nurse to include in the client's teaching plan? You Selected: • "Maintain a moderate exercise program." Correct response: • "Maintain a moderate exercise program." Explanation: Remediation: Add a Note Question 8 See full question 1m 9s A client with a history of Addison's disease and flulike symptoms accompanied by nausea and vomiting over the past week is brought to the facility. His wife reports that he acted confused and was extremely weak when he awoke that morning. The client's blood pressure is 90/58 mm Hg, his pulse is 116 beats/minute, and his temperature is 101° F (38.3° C). A diagnosis of acute adrenal insufficiency is made. What should the nurse expect to administer by I.V. infusion? You Selected: • Hydrocortisone Correct response: • Hydrocortisone Explanation: Remediation: Add a Note Question 9 See full question 30s A diet plan is developed for a client with gouty arthritis. The nurse should advise the client to limit his intake of: You Selected: • organ meats. Correct response: • organ meats. Explanation: Remediation: Add a Note Question 10 See full question 1m 25s A client with muscle weakness and an abnormal gait is being evaluated for muscular dystrophy. Which test or finding confirms muscular dystrophy? You Selected: • Muscle biopsy Correct response: • Muscle biopsy Explanation: Remediation: Add a Note Question 11 See full question 1m 7s A client with arterial insufficiency undergoes below-knee amputation of the right leg. Which action should the nurse include in the postoperative care plan? You Selected: • Elevating the stump for the first 24 hours Correct response: • Elevating the stump for the first 24 hours Explanation: Remediation: Add a Note Question 12 See full question 1m A client with osteoarthritis asks for information concerning activity and exercise. When assisting the client, which concept should be included? You Selected: • Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. Correct response: • Exercising at least 1 hour after awakening allows the client to participate in exercise after some of the morning-related stiffness has subsided. Explanation: Remediation: Add a Note Question 13 See full question 34s A client undergoes a total hip replacement. Which statement made by the client indicates to the nurse that the client requires further teaching? You Selected: • "I don't know if I'll be able to get off that low toilet seat at home by myself." • “I need to make sure that I eat my meals and snacks on time after I take my insulin.” Correct response: • “I need to make sure that I eat my meals and snacks on time after I take my insulin.” • “If I monitor and control my blood glucose levels carefully, there is less likelihood of suffering long-term complications.” • “If I exercise more than is normal, there is a risk that I might become hypoglycemic.” Explanation: Remediation: Add a Note Question 18 See full question 2m 13s A client with diabetes mellitus has a prescription for 5 units of U-100 regular insulin and 25 units of U-100 isophane (NPH) insulin to be taken before breakfast. At about 4:30 p.m. (1630), the client experiences headache, sweating, tremor, pallor, and nervousness. What is the most probable cause of these signs and symptoms? You Selected: • The client is experiencing hyperglycemia. Correct response: • The isophane (NPH) insulin is peaking. Explanation: Headache, sweating, tremor, pallor, and nervousness typically result from hypoglycemia, an insulin reaction in which serum glucose level drops below 70 mg/dl (3.88 mmol/L). Isophane (NPH) insulin typically peaks at 4-12 hours after administration. However, hypoglycemia may occur 4 to 18 hours after administration of isophane (NPH) insulin suspension or insulin zinc suspension, both of which are intermediate-acting insulins. Although hypoglycemia may occur at any time, it usually precedes meals. Hyperglycemia, in which serum glucose level is above 180 mg/dl (10 mmol/L), causes such early manifestations as fatigue, malaise, and drowsiness. Intravenous insulin can cause an acute shift in potassium levels leading to hypokalemia, but these signs and symptoms would include muscle weakness and muscle cramps. Remediation: Add a Note Question 19 See full question 1m 27s The nurse is checking the laboratory results of an adult client with type 1 diabetes (see chart). What laboratory result indicates a problem that should be managed? You Selected: • blood glucose Correct response: • blood glucose Explanation: Remediation: Add a Note Question 20 See full question 45s The nurse is caring for an adult with a grade III compound fracture of the right femur; the client has been placed in skeletal traction. The intended outcome of the traction is to: You Selected: • reduce and immobilize the fracture. Question 50 See full question 20s When a client demonstrates the technique for self-administering NPH insulin, which action indicates that the client needs additional teaching? You Selected: • pulling back on the syringe plunger as soon as the needle is in subcutaneous tissue The wife of a client with end-stage acquired immunodeficiency syndrome (AIDS) is caring for her husband at home. The hematologist recommends hospice care and the couple agrees. During the initial admission visit, the hospice nurse provides information to the client and his family about an advance directive. During the next day's visit, the client states that since he and his wife filled out the advance directive form, he feels abandoned by his physician. Which statement by the hospice nurse best addresses the client's concerns? You Selected: • "Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so he will be able to provide it if you can't tell him yourself." Correct response: • "Your physician will continue to care for you. The advance directive simply puts in writing the care you want, so he will be able to provide it if you can't tell him yourself." Explanation: Remediation: Add a Note Question 2 See full question 47s A nurse preparing to discharge a child with leukemia observes a family member who has a cold sharing a meal with the child. How should the nurse approach the situation? You Selected: • Offer a face mask to the person with the cold and use this as an opportunity for further teaching. Correct response: • Offer a face mask to the person with the cold and use this as an opportunity for further teaching. Explanation: Remediation: Add a Note Question 3 See full question 1m 51s A client with lymphoma tells the nurse that he's found an overseas holistic physician who can cure him with coffee enemas. What should the nurse say? You Selected: • "You should ask your physician if this is a helpful approach." Correct response: • "You should ask your physician if this is a helpful approach." A nurse is assessing a woman who is receiving the second administration of chemotherapy for breast cancer. When obtaining this client’s health history, the nurse should ask the client which question? You Selected: • "Have you had nausea or vomiting?" Correct response: • "Have you had nausea or vomiting?" Explanation: Remediation: Add a Note Question 10 See full question 20s A client with rheumatoid arthritis tells the nurse, “I know it is important to exercise my joints so that I will not lose mobility, but my joints are so stiff and painful that exercising is difficult.” Which response by the nurse would be most appropriate? You Selected: • "Take a warm tub bath or shower before exercising. This may help with your discomfort." Correct response: • "Take a warm tub bath or shower before exercising. This may help with your discomfort." Explanation: Remediation: Add a Note Question 11 See full question 4m 36s The client in balanced suspension traction is transported to surgery for closed reduction and internal fixation of a fractured femur. What should the nurse do when transporting the client to the operating room? You Selected: • Send the client on the bed with extra help to stabilize the traction. Correct response: • Send the client on the bed with extra help to stabilize the traction. Explanation: Remediation: Add a Note Question 12 See full question 51s The client with type 1 diabetes mellitus says, "If I could just avoid what you call carbohydrates in my diet, I guess I would be okay." What is the best response by the nurse? You Selected: • "A person with diabetes should monitor their eating of proteins, fats, and carbohydrates." Correct response: • "A person with diabetes should monitor their eating of proteins, fats, and carbohydrates." Explanation: Remediation: Add a Note Question 13 See full question 1m 15s Vasopressin is administered to the client with diabetes insipidus because it: You Selected: • increases release of insulin from the pancreas. Correct response: • increases tubular reabsorption of water. Explanation: The major characteristic of diabetes insipidus is decreased tubular reabsorption of water due to insufficient amounts of antidiuretic hormone (ADH). Vasopressin is administered to the client with diabetes insipidus because it has pressor and ADH activities. Vasopressin works to increase the concentration of the urine by increasing tubular reabsorption, thus preserving up to 90% water. Vasopressin is administered to the client with diabetes insipidus because it is a synthetic ADH. The administration of vasopressin results in increased tubular reabsorption of water, and it is effective for emergency treatment or daily maintenance of mild diabetes insipidus. Vasopressin does not decrease blood pressure or affect insulin production or glucose metabolism, nor is insulin production a factor in diabetes insipidus. Remediation: Add a Note Question 14 See full question 22s The nurse should institute which measure to prevent transmission of the hepatitis C virus to health care personnel? You Selected: • decreasing contact with blood and blood-contaminated fluids Correct response: • decreasing contact with blood and blood-contaminated fluids Explanation: Remediation: Add a Note Question 15 See full question 15s The nurse is administering packed red blood cells (PRBCs) to a client. The nurse should first: You Selected: • stay with the client during the first 15 minutes of infusion. Correct response: • stay with the client during the first 15 minutes of infusion. Explanation: Remediation: Add a Note Question 16 See full question 12s When a client is diagnosed with aplastic anemia, the nurse should assess the client for changes in which physiologic functions? You Selected: Explanation: Remediation: Add a Note Question 21 See full question 34s The nurse is teaching a client with osteoporosis about taking alendronate sodium. The nurse emphasizes that the client is to take the medication: You Selected: • with a full glass of juice and then rest for 30 minutes. Correct response: • with a full glass of water and remain upright for 30 minutes. Explanation: Clients are instructed to take alendronate on arising, 30 minutes before eating, with a full glass of water. Because it can cause severe esophageal irritation, the client must remain upright for 30 minutes after administration. Taking alendronate with food or juice significantly reduces absorption. Remediation: Add a Note Question 22 See full question 21s A client with iron-deficiency anemia is prescribed liquid iron supplements. The nurse evaluates the client’s understanding of how to take this drug. Which statement indicates the client has adequate knowledge? You Selected: • ”I will dilute the medication and drink it with a straw.” Correct response: • ”I will dilute the medication and drink it with a straw.” Explanation: Remediation: Add a Note Question 23 See full question 18s A nurse is administering daunorubicin to a patient with lung cancer. Which situation requires immediate intervention? You Selected: • The I.V. site is red and swollen. Correct response: • The I.V. site is red and swollen. Explanation: Remediation: Add a Note Question 24 See full question 11s A client tells the nurse that she has found a painless lump in her right breast during her monthly self-examination. Which assessment finding would strongly suggest that this client's lump is cancerous? You Selected: • Nonmobile mass with irregular edges Correct response: • Nonmobile mass with irregular edges Explanation: Remediation: Add a Note Question 25 See full question 27s A nurse is assessing a client with multiple myeloma. The nurse should keep in mind that clients with multiple myeloma are at risk for: You Selected: • pathologic bone fractures. Correct response: • pathologic bone fractures. Explanation: Remediation: Add a Note Question 26 See full question 1m 10s Which finding should a nurse identify as requiring further investigation? You Selected: • White blood cell (WBC) count of 7,000/?l Correct response: • Platelet count of 115,000/?l Explanation: A platelet count of 115,000/?l is abnornal and requires further investigation. Normal values are 150,000 to 300,000 platelets/?l; 5,000 to 10,000 WBCs/?l; 4.5 to 5.5 million RBCs/?l; and an average hematocrit of 45%. Remediation: Add a Note Question 27 See full question 18s An incoherent client with a history of hypothyroidism is brought to the emergency department by the rescue squad. Physical and laboratory findings reveal hypothermia, hypoventilation, respiratory acidosis, bradycardia, hypotension, and nonpitting edema of the face and pretibial area. Knowing that these findings suggest severe hypothyroidism, the nurse prepares to take emergency action to prevent the potential complication of: You Selected: • myxedema coma. Correct response: • myxedema coma. Explanation: Remediation: Add a Note Question 28 See full question 15s • inability to perform active movement and pain with passive movement. Explanation: Remediation: Add a Note Question 34 See full question 1m 25s Which statement by a staff nurse on the orthopedic floor indicates the need for further staff education? You Selected: • "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device." Correct response: • "The client is receiving physical therapy twice per day, so he doesn't need a continuous passive motion device." Explanation: Remediation: Add a Note Question 35 See full question 10s Which client is at highest risk for colorectal cancer? You Selected: • the client who has been treated for Crohn's disease for 20 years Correct response: • the client who has been treated for Crohn's disease for 20 years Explanation: Remediation: Add a Note Question 36 See full question 1m 19s A client with a large goiter is scheduled for a subtotal thyroidectomy to treat thyrotoxicosis. Saturated solution of potassium iodide (SSKI) is prescribed preoperatively for the client. The expected outcome of using this drug is that it helps: You Selected: • slow progression of exophthalmos. Correct response: • reduce the vascularity of the thyroid gland. Explanation: SSKI is frequently administered before a thyroidectomy because it helps decrease the vascularity of the thyroid gland. A highly vascular thyroid gland is very friable, a condition that presents a hazard during surgery. Preparation of the client for surgery includes depleting the gland of thyroid hormone and decreasing vascularity. SSKI does not decrease the progression of exophthalmos, and it does not decrease the body’s ability to store thyroxine or increase the body’s ability to excrete thyroxine. Remediation: Add a Note Question 37 See full question 13s The nurse should assess the client with hypothyroidism for: You Selected: • decreased activity due to fatigue. Correct response: • decreased activity due to fatigue. Explanation: Remediation: Add a Note Question 38 See full question 28s Angiotensin-converting enzyme (ACE) inhibitors may be prescribed for the client with diabetes mellitus to reduce vascular changes and possibly prevent or delay development of: You Selected: • cerebrovascular accident. Correct response: • renal failure. Explanation: Renal failure frequently results from the vascular changes associated with diabetes mellitus. ACE inhibitors increase renal blood flow and are effective in decreasing diabetic nephropathy. Chronic obstructive pulmonary disease is not a complication of diabetes, nor is it prevented by ACE inhibitors. Pancreatic cancer is neither prevented by ACE inhibitors nor considered a complication of diabetes. Cerebrovascular accident is not directly prevented by ACE inhibitors, although management of hypertension will decrease vascular disease. Remediation: Add a Note Question 39 See full question 15s A 25-year-old client taking hydroxychloroquine for rheumatoid arthritis reports difficulty seeing out of the left eye. What does this finding indicate? You Selected: • possible retinal degeneration Correct response: • possible retinal degeneration Explanation: Remediation: Add a Note Question 40 See full question 53s A client who has had a lumbar laminectomy with a spinal fusion is sitting in a chair. Which is the correct position for this client's feet? You Selected: • on the floor with the feet flat Correct response: • on the floor with the feet flat Explanation: Remediation: Add a Note Question 41 See full question 1h 1m 56s