QUESTION 1
A arse s caring for an older adut clant Click to Nighlight the findings that require Immediate fallow-up Te
Gesaloct a finding. click on the finding again.
[ T
0945 Gereral AR (VA8 ACCTATYING e et eI 1 CheT, eapresg
cConceen over mrmary and thought process, apoecte. and self care
AR i staten, “My wibling and | Fured b ot Pme for my panent
Adult child accompanying parent reports cognitive and physical W ITOUET Tt ok e Bt 4t ot (Re
dediine in the client, expressing cancern over memory loss, (odey.
siged over 1o e
thought processes, appetite,
and selfcare. Adult child states,
“My sibling and | hred help at home for my parent. We thought Clant makes
that might help, but it has not. | found the title to the car today, 0kBRSO,
o 1 epnts viewing TP 4 g ane)
TG Up “ONCE Or (RCE Per Mg o 5 to the bathroom.
sgned over to me.*
Chent makes poor eye contact. speaks in a monotone voice. and P
has a lack of facial expression. Atect Chwnt sy, “Why dan's you just ieawe ma | am of o e *
Client reports sleeping 7 h 4 night and getting up “ance or twice
per night to o to the bathroom " Client reports not wanting to
wat anymare. Client's child reports their parent has lost about &
b in the past month,
1030
Client found stting in waiting room, head in hands. Chent says.
“Why don't you just leave me? | am of no use.”
QUESTION 2
Anurse is preparing to administer vancomycin IV to an adult client. The client asks the nurse if the medication can be given 2 hr earlier. Which of
‘the following statements should the nurse make?
0 " can start the medication 30 minutes earfier.”
@ "I can adjust the time and scheduie for when its convenient for you.*
Ot caninfuse the medication at 3 faser rate”
e "I have up to 2 hours after the usual schedule time to give you this medication,”
,QUESTION 3
Anurse s caring for a client who has end-stage kidney disease. The client’s adult child asks the nurse about becoming a living kidney donor for
their parent. Which of the following conditions in the child's medical history should the nurse identify as a contraindication to the procedure?
D R R R R R R I S RN B N N SN S
© amputation
@ osteoarthvitis
O Hyperensin
© primary gascoma
QUESTION 4
A st 5 CArg1O 8 75 year 0l Chant who is drmitted £0 (e edical Compiete the diagram by dragging from the choices below to specify
Surgeal uni WRAT CONGItion the client is most likely experiencing. 2 Actions the nurse
NOuld take (6 address that condition, and 2 parameters the nurse
[T TR e P Y Should monitor te assess the cent's pragress.
Today
0700
Received change of shift report. Chent 1s 2 days postoperative
followsng a hysterectomy and they have not yet ambulated with
physical therapy due to sgnificant postoperative pain. Per
change of shift report, pain medications have been adjusted
and pain has improved. Client currently reports pain level as 2
an a scale of 010 10,
0900
Ambulating in hallway with the assistance of physical therapy.
1000
Return 1o bed with siderails up x 2, but not wearing sequential
compression devices because they “hurt 100 much.* Applied
antiembolism stockings.
Cliont notified nurse that nght leg; is warm and painful
Assessment 1 unilateral rght exteemity g and
warmth below the knee. Prowder noufied
, QUESTION 5
A nurse i caring for an clder adult cient. Click to highlight the findings that require immediate follow-up. To
deselect a finding. click on the finding again.
BhoR1 el DRR RN T )
Nurses’ Notes
0945: General | Adult child accomparying parwnit reports decine in clien, expressing
concern over memory and thought process. appetite, and self-care.
Adutt
child states.
Adult child accompanying parent reports cognitive and physical ‘We thought that would help but it has not.
decline in the client, expressingconcern over memory loss, today. signed over to me."
thought processes, appetite, and seif-care. Adult child states,
"My sibling and | hired help at home for my parent. We thought
that might help, but it has not. | found the title to the car today,
signedover to me.”
Client makes poor eye contact, speaks in a monotone voice, and
has a lack of facial expression.
Client reports sleeping 7 hr a night and getting up *once or twice
per night to go to the bathroom." Client reports not wanting to
eat anymore. Client's child reports their parent has lost about 8
Ibin the past month.
1030
Client found sitting in waiting
room, head in hands. Client says,
“Why don't you just leave me? | am of no use.”
QUESTION 6
Anurse is providing preoperative teaching to an older adult client who is scheduled for surgery. Which of the following actions should the nurse
take to promote learning?
Q Speak loudly when addressing the dient
‘ ° Connect new information with the chent's past experiences.
Q Present the information to the chent using abstract concepts.
0 Use a 12-point font when printing written materials for the dient