Questions and Verified Answers |100%
Correct| Grade A- Nightingale
Which action can be assigned to the unlicensed assistive personnel
(UAP)? - ANSWER Measure the client's urinary output.
What is the best initial response by the nurse? - ANSWER
Describe the location and type of pain you are having
Based on the nurse's assessment, which assessment data supports the
decision to administer pain medication as the first intervention? (Select
all that apply. One, some, or all options may be correct.) - ANSWER
Pain rating of 6/10 - Heart rate of 102 beats/minute - Blood pressure of
132/76 mmHg
,Which action should the nurse implement first? - ANSWER
Administer an analgesic.
Which interventions are important to include in the client's plan of care
while receiving multiple immunosuppressants? (Select all that apply.
One, some, or all options may be correct.) - ANSWER
Instruct client to wear a mask when walking in the halls. - Instruct
visitors that fresh flowers should not be taken into the room. - Monitor
immunosuppression drug levels regularly.
Which intervention should the nurse ensure is included in the plan of
care during the immediate postoperative period?
a. Monitor Judy's urinary output hourly using an urimeter.
b. Assess Judy's surgical incision every shift.
c. Monitor Judy's nasogastric tube every 4 hours.
d. Encourage Judy to use the incentive spirometer daily. - ANSWER
a
Which is the priority nursing assessment during the first 24-hour
postoperative period? - ANSWER Vital signs
,The nurse is teaching the patient about fluid management between
dialysis treatments. Which instruction by the nurse is the most accurate?
- ANSWER Limit fluids in between treatments to
minimize the amount of fluid that needs to be removed during dialysis.
Which expected outcome should be included in the nurse's teaching
plan? - ANSWER Client will avoid canned and
processed foods.
The nurse assesses the dialysis graft. Which assessment should be
reported to the healthcare provider (HCP) immediately? (Select all that
apply. One, some, or all options may be correct.) - ANSWER
Yellow, purulent drainage from graft incision site. - Absence of a thrill
over the graft site. - Capillary refill >10 seconds in the hand where the
graft is placed.
Which intervention should the nurse ensure has been include in the
client's plan of care? (Select all that apply. One, some, or all options may
be correct.)
, A. Instruct lab personnel to obtain blood specimens from the dual-lumen
catheter.
B. Perform sterile dressing changes at the dual-lumen catheter site.
C. Empty and record the drainage from the graft tubing regularly.
D. Regularly rotate IV insertion sites above and below the graft site.
E. Assess Judy's distal pulses and circulation in the arm with the access -
ANSWER B. Perform sterile dressing changes at the dual
lumen catheter site - E. Assess the client's distal pulses and circulation in
the arm with the access.
The nurse documents the assessment of the arteriovenous (AV) graft.
Which documentation best describes a properly functioning AV graft? -
ANSWER Thrill present and palpated
The client asks the nurse to clarify what palliative care involves. Which
explanation provides the client the best education regarding palliative
care? (Select all that apply. One, some, or all options may be correct.) -
ANSWER Palliative care provides relief from symptoms
including pain. - Palliative care supports holistic care and improves
quality of life. -