The nurse is caring for a client with severe diarrhea. The nurse monitors the client
closely, understanding that this client is at risk for developing which acid-base disorder?
- CORRECT ANSWER-Metabolic acidosis
A 2-year-old child is diagnosed with constipation due to encopresis. Which description is
a characteristic of this disorder? - CORRECT ANSWER-The infrequent and difficult
passage of dry stools
The nurse is caring for a client with acute pancreatitis and a history of alcoholism and is
monitoring the client for complications. Which data should be indicative of paralytic
ileus? - CORRECT ANSWER-Inability to pass flatus
The nurse is caring for a child with a diagnosis of intussusception. Which manifestation
should the nurse expect to note in this child? - CORRECT ANSWER-Blood and mucus
in the stools
The nurse is collecting data on an infant with a diagnosis of suspected Hirschsprung's
disease. Which question to the mother will most specifically elicit information regarding
this disorder? - CORRECT ANSWER-"Does your infant have foul-smelling, ribbon-like
stools?"
The nurse is monitoring a newborn with a suspected diagnosis of imperforate anus. The
nurse understands that which is unassociated with this disorder? - CORRECT
ANSWER-The passage of currant jelly-like stools
After several diagnostic tests, a client is diagnosed with diabetes insipidus. The nurse
understands that which signs/symptoms are indicative of this disorder? - CORRECT
ANSWER-Excessive thirst and urine output
The nurse is admitting a client to the nursing unit who has returned from the
postanesthesia care unit following prostatectomy. The client has a three-way Foley
catheter with continuous bladder irrigation. The nurse should maintain the flow rate of
the continuous bladder infusion to maintain which urine output characteristic? -
CORRECT ANSWER-Pale yellow or slightly pink
The nurse is caring for a client diagnosed with Parkinson's disease who is prescribed
benztropine mesylate (Cogentin) daily. The nurse reinforces instructions to both the
client and the spouse regarding the side effects of this medication and the need to
report which side effect if it occurs? - CORRECT ANSWER-Inability to urinate
, A client with cancer has undergone a total abdominal hysterectomy and has a Foley
catheter in place. The nurse should expect to note which type of urinary drainage
immediately following this surgery? - CORRECT ANSWER-Blood tinged
The nurse is reviewing the health records of assigned clients. The nurse should plan
care knowing that which client is at risk for fluid volume deficit? - CORRECT ANSWER-
The client with a colostomy
The nurse is inserting an indwelling urinary catheter into the urethra of a client. As the
nurse inflates the balloon, the client complains of discomfort. Which is the appropriate
nursing action? - CORRECT ANSWER-Aspirate the fluid, advance the catheter further,
and reinflate the balloon.
A long-term care nurse notes that a female client has leakage of urine when sneezing,
coughing, or laughing. The nurse reports that this client has which type of incontinence?
- CORRECT ANSWER-Stress incontinence
A client with complaints of mild shortness of breath and weakness comes to the medical
clinic. The nurse reviews the client's chart and immediately contacts the health care
provider about which life-threatening finding? Refer to chart. - CORRECT ANSWER-
Potassium level
A client has been diagnosed with functional incontinence. Which interventions are
appropriate to care for this type of incontinence? Select all that apply. - CORRECT
ANSWER-1. Schedule toileting every 2 hours.
2. Modify clothing for easy removal.
3. Assess environment for obstacles.
4. Set up schedule of cues such as mealtimes, awakening, and bedtime.
The nurse is assisting in the care of a client who had an ileostomy created a few days
ago. Owing to the normally high output of drainage from this type of ostomy, the nurse
monitors the client for which sign? - CORRECT ANSWER-Metabolic acidosis
A clinic nurse has given a client the materials needed to test the stool for occult blood
as part of a routine screening for colorectal cancer. When the client asks the nurse
whether there are any special precautions that must be followed in doing this test, the
nurse tells the client to avoid eating which food for at least a day before performing the
test? - CORRECT ANSWER-Red meat
The nurse reviews the record of a 3-week-old infant and notes that the health care
provider has documented a diagnosis of suspected Hirschsprung's disease. The nurse
understands that which manifestation led the mother to seek health care for the infant? -
CORRECT ANSWER-Foul-smelling, ribbon-like stools
A client who has calcium phosphate kidney stones tells the nurse, "Tell me what I can
do, so that I never have this pain again." Which instructions should the nurse plan to