Capstone Fundamentals Assessment
client with dysphagia, which interventions include in plan ANS have the client seat upright for 1 hr
following meals
Assessing Infussion IV site, client reports pain, site is red, warmth.
What the nurse do ANS Disontinue Infussion
Routine abdominal assessment. action by the nurse ANS perform palpitation after ascultation
teachin new nurses about immunity. Include in the teaching ANS The body produces antibodies in
response to an antigen with active immunity
Risk factors for older adults that increase risk of developing infections ANS Lowered immune system
function
Teaching Meter dose Inhaler. What instructions teach ANS Inhale medication deeply for 3-5 seconds
a nurse is performing a focused assessment on a client who has a history of COPD and is experiencing
dyspnea, which of the findings should the nurse expect? ANS flaring of the nostrils
a nurse is teaching a client about the correct use of a cane, what should the nurse include? (SATA) ANS
ensure the cane has a rubber cap
hold the can on the stronger side
flex the elbow slightly when using the cane
use a quad cane for increased support
, 1. a nurse is teaching a group of assistive personal about the expected integumentary changes in older
adults, which should the nurse include: ANS a. decreased in elasticity
1. a nurse in a provider's office is assessing a client who reports a decrease in the effectiveness of their
arthritis medication. which of the following client information should the nurse identify as a contributing
factor to the decrease in the medication's effectiveness? ANS a. the client has a history of recurring
bowel inflammation
1. a nurse is monitoring a client who has been receiving intermittent enteral feedings, what should the
nurse identify as an intolerance to the feeding? ANS a. Nausea
1. a nurse is assisting a client who signed an informed consent form for surgery but has since expressed
doubts about the need for surgery, which of the following statements should the nurse make? ANS The
surgeon will answer your questions before surgery
A nurse is preparing to administer meperidine 35mg IM to an adolescent who is preoperative. Available
in meperidine 50mg how much should the nurse administer? (Round the to the tenth ANS 0.7 mg
1. a nurse is documenting client care, which of the following entries should the nurse identify as an
example of implementation of client care? ANS a. contacted the provider to report client findings
1. a nurse is assisting with meal planning for a client who has been prescribed a mechanical soft diet. the
nurse should instruct the client to avoid which of the following foods? ANS a. Orange slices
1. a nurse is teaching about measures to promote sleep with insomnia, what statement indicates
understanding? ANS a. I should reduce my fluid intake to 2 hours before bedtime
1. a nurse is assessing the pain level of a client who has dementia and difficulty communicating, which
pain assessment technique should the nurse use? ANS a. Behavioral indicators
client with dysphagia, which interventions include in plan ANS have the client seat upright for 1 hr
following meals
Assessing Infussion IV site, client reports pain, site is red, warmth.
What the nurse do ANS Disontinue Infussion
Routine abdominal assessment. action by the nurse ANS perform palpitation after ascultation
teachin new nurses about immunity. Include in the teaching ANS The body produces antibodies in
response to an antigen with active immunity
Risk factors for older adults that increase risk of developing infections ANS Lowered immune system
function
Teaching Meter dose Inhaler. What instructions teach ANS Inhale medication deeply for 3-5 seconds
a nurse is performing a focused assessment on a client who has a history of COPD and is experiencing
dyspnea, which of the findings should the nurse expect? ANS flaring of the nostrils
a nurse is teaching a client about the correct use of a cane, what should the nurse include? (SATA) ANS
ensure the cane has a rubber cap
hold the can on the stronger side
flex the elbow slightly when using the cane
use a quad cane for increased support
, 1. a nurse is teaching a group of assistive personal about the expected integumentary changes in older
adults, which should the nurse include: ANS a. decreased in elasticity
1. a nurse in a provider's office is assessing a client who reports a decrease in the effectiveness of their
arthritis medication. which of the following client information should the nurse identify as a contributing
factor to the decrease in the medication's effectiveness? ANS a. the client has a history of recurring
bowel inflammation
1. a nurse is monitoring a client who has been receiving intermittent enteral feedings, what should the
nurse identify as an intolerance to the feeding? ANS a. Nausea
1. a nurse is assisting a client who signed an informed consent form for surgery but has since expressed
doubts about the need for surgery, which of the following statements should the nurse make? ANS The
surgeon will answer your questions before surgery
A nurse is preparing to administer meperidine 35mg IM to an adolescent who is preoperative. Available
in meperidine 50mg how much should the nurse administer? (Round the to the tenth ANS 0.7 mg
1. a nurse is documenting client care, which of the following entries should the nurse identify as an
example of implementation of client care? ANS a. contacted the provider to report client findings
1. a nurse is assisting with meal planning for a client who has been prescribed a mechanical soft diet. the
nurse should instruct the client to avoid which of the following foods? ANS a. Orange slices
1. a nurse is teaching about measures to promote sleep with insomnia, what statement indicates
understanding? ANS a. I should reduce my fluid intake to 2 hours before bedtime
1. a nurse is assessing the pain level of a client who has dementia and difficulty communicating, which
pain assessment technique should the nurse use? ANS a. Behavioral indicators
