A nurse in a provider's clinic is caring for a client who has heart failure. The nurse is evaluating
the client's understanding of the teaching.
Select the 3 client statements that indicate an understanding of the teaching. - ANS "I know to
call my doctor if I gain 3 pounds or more in 2 days"
"I am eating fewer potato chips and more fruit for snacks"
"I am limiting my sodium intake to 2 grams daily"
A nurse is assisting with admitting a client to a health care facility. A nurse is assisting in the
care of a client who is being placed on transmission-based precautions. Which of the following
actions should the nurse plan to take when caring for this client?
Select all that apply. - ANS -Wear an N95 mask when caring for the client
-Place a trash can for soiled linens inside the client's room
-Place the client in a negative airflow room
-Perform hand hygiene before leaving the client's room
A nurse is caring for a client who had a spinal cord injury and has paraplegia. Click to highlight
the findings below that that require intervention by the nurse. - ANS -Passive range-of-motion
exercises to lower extremities performed once daily
-Plantar flexion contractures noted bilaterally
-Left heel has 1.3 cm x 1.3 cm (0.5 in x 0.5 in) area of Non blanchable erythema; skin is intact
Assisting With the Care of a Client Who Reports an Extended Period of Constipation. Based on
the client's clinical findings, which of the following actions should the nurse take? - ANS -Assist
the client to a left side-lying position with the right knee flexed
-Administer a cleansing enema
, -Auscultate the client's bowel sounds
-Perform a manual digital examination of the client's rectum
A nurse is caring for a client in a medical-surgical unit. After reviewing the findings, which of the
following actions should the nurse plan to take?
Select the 3 actions that the nurse should plan to take. - ANS -Administer analgesic prior to
planned activities
-Assist the client to dangle their legs at the bedside prior to standing
-Delegate the application of sequential compression devices to assistive personnel
A nurse is caring for a client who is postoperative following abdominal surgery. Click to highlight
the findings the nurse should report to the provider. - ANS -Urinary output
-Reported pain level
-Vital signs
A nurse is assisting in the care of a client. When prioritizing care for the client, the nurse should
first - ANS -first, plan a turning and positioning schedule
-second, apply a hydrocolloid dressing to the client's sacrum
-third, request a prescription for a pressure redistribution bed
A nurse is assisting with caring for a female client who has a newly placed ileostomy. Complete
the following sentence by using the lists of options. The nurse should first address
the___________ followed by the ______________ - ANS -Color of the stoma
-Skin condition around the stoma
A client who has advanced cancer tells the nurse that they have a difficult time talking to
anyone about the illness. Which of the following actions should the nurse take to encourage