QUESTIONS & ANSWERS LATEST UPDATE
2024/2025 WITH VERIFIED ANSWERS GRADED A+
A nurse is caring for a client who has a leg cast and is returning to demonstrate
on the proper use of crutches while climbing stairs. Identify the sequence the
client should follow when demonstrating crutch use.
- Brings the crutches and the affected leg up to the stair
- Places body weight on the crutches
- Shifts weight from the crutches to the unaffected leg
- Advances the unaffected leg onto the stair - answer-- Places body weight on
the crutches
- Advances the unaffected leg onto the stair
- Shifts weight from the crutches to the unaffected leg
- Brings the crutches and the affected leg up to the stair
A nurse is caring for a client who has hypothyroidism. Which of the following
manifestations should the nurse expect?
- Constipation
- Insomnia
- Tachycardia
,- Diaphoresis - answer-- Constipation
RATIONALE: Smoking cessation is an important lifestyle modification to
prevent athersclerosis.
- Maintain an appropriate weight
RATIONALE: Preventing obesity through diet and exercise can help to prevent
atherosclerosis.
- Eat a low-fat diet
RATIONALE: Eating a low-fat diet decreases LDL cholesterol and can prevent
atherosclerosis.
The nurse is providing preoperative teaching for a client who is scheduled for a
mastectomy. Which of the following statements should the nurse make?
- "You should accept your body image before discharge."
- "It is important for you to look at the incisional site when the dressings are
removed."
- "I will refer you to community resources that can provide support."
,- "The scar will remain red and raised for many years after surgery." - answer--
"I will refer you to community resources that can provide support."
RATIONALE: The nurse should provide the client with support resources,
including community programs, to assist the client with acceptance of body
changes.
A nurse is assessing a client while suctioning the client's tracheostomy tube.
Which of the following findings should indicate to the nurse the client is
experiencing hypoxia?
- The client starts to cough
- The client's heart rate increases
- The client is diaphoretic
- The client's blood pressure decreases - answer-- The client's heart rate
increases
RATIONALE: Hypoxia related to suctioning can cause the client's heart rate to
increase. If this occurs, the nurse should discontinue the suctioning and
manually oxygenate the client with 100% oxygen. The nurse should instruct the
client to take 3 or 4 deep breaths prior to suctioning to reduce the risk for
hypoxia.
A nurse is providing follow-up care for a client who sustained a compound
fracture 3 weeks ago. The nurse should recognize that an expected finding for
which of the following laboratory values is a manifestation of osteomyelitis
and should be reported to the provider?
- Sedimentation rate
- Hematocrit
, - Calcium
- Acid phosphatase - answer-- Sedimentation rate
RATIONALE: An increased sedimentation rate occurs when a client has any
type of inflammatory process, such as osteomyelitis.
A nurse is providing instructions to a client who has type 2 diabetes mellitus
and a new prescription for metformin. Which of the following statements by
the client indicates an understanding of the teaching?
- "I will monitor my blood sugar carefully because the medication increases the
secretion of insulin."
- "I should take this medication with a meal."
- "I can expect to gain weight while taking this medication."
- "While taking this medication, I will experience flushing of my skin." - answer-
- "I should take this medication with a meal."
RATIONALE: The client should take metformin with or immediately following
meals to improve absorption and to minimize GI distress.
A nurse is performing a dressing change for a client who is recovering from a
hemicolectomy. When removing the dressing, the nurse notes that a large part
of the bowel is protruding through the abdomen. Which of the following
actions should the nurse take first?
- Place the client in a supine position
- Measure vital signs
- Cover the wound with a sterile, saline-moistened dressing