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Exam (elaborations)

NLN NACE Prep questions and answers 100% solved

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A nurse is caring for a client that has not voided for several hours. When percussing the client's bladder to assess for distention, the nurse should expect to hear...... - ANSWER Dullness This indicates a full bladder -Tympany means empty -Hyperrenosance is an abnormal pulmonary sound -Renosance is a vibration A client is receiving intermittent nasogastric tube feedings. A nurse should aspirate the residual stomach contents prior to administering a scheduled feeding to..... - ANSWER Determine absorption of feedings Which medication should be delivered using the z-track method? - ANSWER Iron dextran(Imferon) to prevent tissue damage A nurse is to administer medication to 2 clients sitting in the lounge with several other clients. What action by the nurse is appropriate? - ANSWER Check name bands on the clients' arms A client is to be checked for residual urine. At which time should the procedure be performed? - ANSWER Immediately after the client voids A nurse is to obtain a residual urine specimen from an elderly client whose indwelling foley catheter was just removed. What is the purpose of a residual urine specimen? - ANSWER To assess for urinary retention A nurse is caring for a client receiving intravenous therapy. What would indicate to the nurse that the intravenous infusion has infiltrated? - ANSWER Cutaneous tissue at the intravenous site is swollen -the IV catheter should be removed and a new site should be restarted Which of the following measures should a nurse include in the plan of care of a patient with hyperthyroidism? - ANSWER Keeping the client's environment cool -A client with hyperthyroidism is heat intolerant

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