Questions and Answers
QUESTION 1
The nurse is discharging an adult woman who was hospitalized for 5 days
for treatment of pneumonia. While the nurse is reviewing the prescribed
medications, the client appears anxious. What action is most important for
the nurse to implement?
A. Encourage client to take PRN antianxiety drug.
B. Include a family member in teaching session.
C. Provide written instructions that are easy to follow.
D. Instruct the client to repeat the medication plan.
*Correct Answer: C. Provide written instructions that are easy to
follow. *
*Rationale: * Discharge instructions can be overwhelming and not fully
understood or remembered. Simple written instructions are likely to
enhance the client's understanding and ultimately her compliance with the
medication regimen. While an anxiolytic may be needed, it is not the best
intervention to ensure medication regimen compliance. Including family is
not as reliable as providing written instructions. Having the client repeat
,information reinforces understanding but does not ensure they will
remember later .
QUESTION 2
Which assessment finding is most significant in determining the level of
assistance a client needs with personal care?
A. 2+ pitting edema of lower extremities.
B. Red rash in groin and under breasts.
C. Firm abdomen with hypoactive bowel sounds.
D. Disorientation to time, place, and person.
*Correct Answer: D. Disorientation to time, place, and person. *
*Rationale: * A client who is disoriented requires assistance with personal
care. The nurse should further assess the amount of direction and
assistance they will need. Edema, rash, and bowel sounds have less impact
on the client's ability for self-care than disorientation .
QUESTION 3
, A client presses the call bell and requests pain medication for a severe
headache. To assess the quality of the client's pain, which approach should
the nurse use?
A. Ask the client to describe the pain.
B. Observe body language and movement.
C. Identify effective pain relief measures.
D. Provide a numeric pain scale.
*Correct Answer: A. Ask the client to describe the pain. *
*Rationale: * Pain quality (e.g., sharp, burning, throbbing, dull) is best
determined by the client's subjective description. A numeric scale measures
intensity, not quality. Facial expressions and vital signs are objective cues
but do not replace the client's verbal report of the pain character .
QUESTION 4
The nurse is reviewing the diagnostic tests prescribed for a client with a
positive skin test. Which subjective findings reported by the client supports
the diagnosis of tuberculosis?
A. Bark
1-200 no links