CONCEPT-BASED ASSESSMENT
ONLINE PRACTICE A LEVE 2
QUESTIONS WITH CORRECT ANSWERS
Abjhospicebjnursebjisbjcaringbjforbjabjpreschoolerbjwhobjhasbjabjterminalbjillness.bjOnebjofbjt
hebjchild'sbjparentsbjtellsbjthebjnursebjthatbjitbjisbjtoobjdifficultbjtobjcopebjanybjlongerbjandbjha
sbjdecidedbjtobjmovebjoutbjofbjthebjhouse.bjWhichbjofbjthebjfollowingbjresponsesbjshouldbjth
ebjnursebjmake?bj-bjANS--
A:bj"Let'sbjtalkbjaboutbjabjfewbjwaysbjyoubjhavebjdealtbjwithbjstressbjinbjthebjpast."bjRationale
:bjThisbjstatementbjbybjthebjnursebjcombinesbjtwobjtherapeuticbjresponses,bjactivebjlistenin
gbjandbjfocusing.bjUsedbjtogether,bjthesebjtechniquesbjfacilitatebjcommunicationbjbybjlettin
gbjthebjparentbjknowbjone'sbjfeelingsbjarebjheardbjandbjtakenbjseriously,bjwhichbjconveysbja
cceptancebjandbjrespect.bjTherefore,bjthebjparentbjfeelsbjthebjnursebjvalidatesbjthebjconcer
nsbjandbjbecomesbjcomfortablebjaskingbjthebjnursebjsensitivebjquestionsbjaboutbjthebjchild.
Abjnursebjisbjteachingbjabjclientbjwaysbjtobjpreventbjosteoporoticbjfracturesbjduebjtobjosteop
orosis.bjWhichbjofbjthebjfollowingbjinformationbjshouldbjthebjnursebjincludebjinbjthebjteachin
g?bj-bjANS--
A:bj"Maintainbjbonebjhealthbjbybjeatingbjfruits,bjvegetables,bjandbjprotein."bjRationale:bjThe
bjnursebjshouldbjinstructbjthebjclientbjthatbjthebjbestbjwaybjtobjmaintainbjbonebjhealthbjandbjb
onebjremodelingbjisbjbybjeatingbjfruits,bjvegetables,bjandbjprotein.
Abjnursebjisbjteachingbjabjclientbjwhobjhasbjhypothyroidismbjaboutbjtakingbjlevothyroxine.bj
Whichbjofbjthebjfollowingbjstatementsbjshouldbjthebjnursebjmake?bj-bjANS--
B:bj"Thisbjmedicationbjcausesbjadversebjeffectsbjifbjthebjdosagebjisbjtoobjhighbjorbjtoobjlow."b
jRationale:bjThebjnursebjshouldbjinstructbjthebjclientbjthatbjlevothyroxine,bjinbjthebjrightbjdos
age,bjdoesbjnotbjtypicallybjcausebjadversebjeffects.bjIfbjthebjdosagebjisbjtoobjlow,bjthebjmanif
estationsbjofbjhypothyroidismbjwillbjrecur.bjIfbjthebjdosagebjisbjtoobjhigh,bjthebjmanifestation
sbjofbjhyperthyroidismbjwillbjoccur.
Abjnursebjinbjanbjemergencybjdepartmentbjisbjassessingbjabjpreschoolerbjwhobjhasbjsevere
bjdehydrationbjasbjabjresultbjofbjgastroenteritisbjandbjisbjreceivingbjisotonicbjIVbjfluids.bjWhic
hbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjidentifybjasbjanbjindicationbjthatbjthebjtreat
mentbjisbjeffective?bj-bjANS--
D:bjBriskbjskinbjturgorbjRationale:bjThebjnursebjshouldbjexpectbjthebjchildbjtobjhavebjbriskbjs
kinbjturgorbjifbjfluidbjreplacementbjtherapybjisbjeffective.
Abjnursebjisbjcaringbjforbjabjclientbjwhobjhasbjleftbjhemiparesisbjfollowingbjabjstroke.bjWhichbj
ofbjthebjfollowingbjactionsbjshouldbjthebjnursebjtake?bj-bjANS--
B:bjEncouragebjthebjclientbjtobjusebjwide-
gripbjutensilsbjwhenbjeatingbjwithbjthebjrightbjhand.bjRationale:bjThebjnursebjshouldbjencour
agebjthebjclientbjwhobjhasbjhemiparesisbjtobjusebjwide-
gripbjutensilsbjwhenbjeatingbjwithbjthebjrightbjhand,bjwhichbjcanbjaccommodatebjabjweakbjgr
aspbjandbjencouragebjindependencebjinbjeating.
,Abjnursebjisbjteachingbjaboutbjherbalbjsupplementsbjwithbjabjgroupbjofbjnewlybjlicensedbjnur
ses.bjWhichbjofbjthebjfollowingbjherbalbjsupplementsbjshouldbjthebjnursebjincludebjinbjthebjte
achingbjforbjtreatingbjhyperlipidemia?bj-bjANS--
D:bjGarlicbjRationale:bjThebjnursebjshouldbjincludebjthatbjgarlicbjcanbjhelpbjimprovebjcholes
terolbjlevels,bjwhichbjthenbjhelpsbjtobjreducebjthebjbuildupbjofbjplaquebjinbjthebjarteries.bjForb
jsomebjclients,bjitbjcanbjalsobjhelpbjlowerbjbloodbjpressure
Abjnursebjisbjadmittingbjabjclientbjwhobjhasbjanbjacutebjbacterialbjwoundbjinfectionbjandbjabjt
emperaturebjofbj39.8°bjCbj(103.6°bjF).bjWhichbjofbjthebjfollowingbjactionsbjshouldbjthebjnurs
ebjtake?bj-bjANS--
D:bjSetbjthebjtemperaturebjofbjthebjclient'sbjroombjtobj22.2°bjCbj(72°).bjRationale:bjThebjnurs
ebjshouldbjsetbjthebjtemperaturebjofbjthebjclient'sbjroombjatbj21°bjCbjtobj27°bjCbj(70°bjFbjtobj8
0°bjF).bjThisbjpromotesbjabjreductionbjinbjthebjclient'sbjfeverbjwithoutbjcausingbjshivering.bjB
ybjcombiningbjnonpharmacologicalbjinterventionsbjwithbjantipyretics,bjthebjnursebjcanbjredu
cebjthebjclient'sbjfever.
Abjnursebjisbjplanningbjcarebjforbjabjclientbjwhobjhadbjsurgerybjforbjosteomyelitisbjfrombjabjpa
stbjmusculoskeletalbjtraumabjtobjthebjlowerbjleg.bjWhichbjofbjthebjfollowingbjinterventionsbjs
houldbjthebjnursebjincludebjinbjthebjplanbjofbjcare?bj-bjANS--
C:bjCheckbjforbjparesthesiabjofbjthebjaffectedbjleg.bjRationale:bjThebjnursebjshouldbjinclude
bjinbjthebjinterventionsbjtobjcheckbjforbjparesthesia,bjsuchbjasbjabjtinglingbjsensationbjofbjtheb
jlegbjandbjfoot,bjwhichbjcanbjindicatebjmanifestationsbjofbjneurovascularbjcompromisebjorbjc
ompartmentbjsyndrome.
Abjnursebjisbjassessingbjthebjeyesbjandbjearsbjofbjabj2-year-oldbjtoddlerbjatbjabjwell-
childbjvisit.bjWhichbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjreportbjtobjthebjprovider
?bj-bjANS--
B:bjPresencebjofbjstrabismusbjRationale:bjThebjnursebjshouldbjrecognizebjthatbjthebjpresen
cebjofbjstrabismus,bjorbjcrossingbjofbjthebjeyes,bjshouldbjdisappearbjbybj4bjmonthsbjofbjage.b
jIfbjthisbjisbjnotbjcorrectedbjbybj4bjtobj6bjyearsbjofbjage,bjitbjcanbjleadbjtobjamblyopia;bjtherefor
e,bjthebjnursebjshouldbjreportbjthisbjfindingbjtobjthebjprovider.
Abjnursebjisbjteachingbjabjclientbjwhobjhasbjatherosclerosisbjaboutbjself-
care.bjWhichbjofbjthebjfollowingbjinstructionsbjshouldbjthebjnursebjincludebjinbjthebjteaching?
bj-bjANS--
C:bjIncreasebjfiberbjintakebjtobjatbjleastbj30bjgbjperbjday.bjRationale:bjThebjnursebjshouldbjin
structbjthebjclientbjtobjincreasebjdailybjfiberbjintakebjtobjatbjleastbj30bjg.bjFiberbjassistsbjinbjth
ebjeliminationbjofbjlipidsbjandbjminimizesbjthebjdevelopmentbjofbjatherosclerosis.
Abjnursebjisbjassessingbjabjclientbjwhobjhasbjasbjanbjulcerbjduebjtobjperipheralbjvascularbjdis
ease.bjWhichbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjidentifybjasbjanbjindicationbjth
atbjthebjclientbjhasbjabjvenousbjulcerbjratherbjthanbjanbjarterialbjulcer?bj-bjANS--
B:bjDiscolorationbjandbjedemabjofbjthebjrightbjanklebjRationale:bjThebjnursebjshouldbjidentif
ybjthatbjmanifestationsbjofbjperipheralbjvenousbjdiseasebjincludebjdiscolorationbjandbjedem
abjofbjthebjankle,bjresultingbjfrombjvenousbjhypertension.
, Abjnursebjisbjprovidingbjdischargebjteachingbjtobjabjclientbjwhobjisbjpostoperativebjfollowingb
jabjtransurethralbjresectionbjofbjthebjprostatebj(TURP)bjforbjtreatmentbjofbjbenignbjprostaticbj
hyperplasia.bjWhichbjofbjthebjfollowingbjinstructionsbjshouldbjthebjnursebjincludebjinbjthebjte
aching?bj-bjANS--
D:bj"PerformbjKegelbjexercisesbjseveralbjtimesbjthroughoutbjthebjday."bjRationale:bjThebjnu
rsebjshouldbjinstructbjthebjclientbjonbjthebjperformancebjofbjKegelbjexercises,bjorbjtightening
bjandbjthenbjrelaxingbjthebjurinarybjsphincter,bjtobjassistbjthebjclientbjinbjregainingbjurinarybjc
ontrolbjandbjeliminatebjdribblingbjorbjthebjleakagebjofbjurine.bjThebjnursebjshouldbjencourag
ebjthebjclientbjtobjperformbjthesebjexercisesbjseveralbjtimesbjeachbjday.
Abjnursebjisbjassessingbjabjclientbjwhobjhasbjleft-
sidedbjheartbjfailure.bjWhichbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjexpect?
bj(Selectbjallbjthebjapply.)bj-bjANS--A:bjNocturia
C:bjDyspnea
D:bjHackingbjcoughbjRationale:bjLeft-
sidedbjheartbjfailurebjcausesbjoliguriabjduringbjthebjdaybjandbjnocturiabjduringbjsleepingbjho
urs,bjpulmonarybjmanifestations,bjsuchbjasbjdyspnea,bjorthopnea,bjcrackles,bjandbjwheeze
s,bjandbjabjhackingbjcoughbjthatbjworsensbjatbjnightbjandbjeventuallybjproducesbjfrothybjspu
tum.
Abjnursebjisbjassessingbjabjclientbjwhobjisbj1bjhourbjpostoperativebjfollowingbjabjtransurethra
lbjresectionbjofbjthebjprostatebj(TURP)bjforbjtreatmentbjofbjbenignbjprostaticbjhyperplasia.bjF
orbjwhichbjofbjthebjfollowingbjassessmentbjfindingsbjshouldbjthebjnursebjnotifybjthebjprovider
?bj-bjANS--
C:bjThebjcatheterbjtubingbjhasbjmultiplebjredbjclots.bjRationale:bjThebjnursebjshouldbjidentify
bjthatbjthebjpresencebjofbjmultiplebjredbjclotsbjinbjthebjcatheterbjtubingbjorbjdrainagebjthatbjisbj
ketchup-
likebjarebjmanifestationsbjofbjpostoperativebjbleeding.bjThebjnursebjshouldbjnotifybjthebjprov
iderbjandbjprovidebjhandbjirrigationbjofbjthebjbladderbjperbjproviderbjprescription.
Abjnursebjisbjteachingbjabjclientbjwhobjhasbjgastroesophagealbjrefluxbjdiseasebjaboutbjways
bjtobjpreventbjreflux.bjWhichbjofbjthebjfollowingbjinformationbjshouldbjthebjnursebjincludebjinbj
thebjteaching?bj-bjANS--
D:bjPlanbjtobjfinishbjeatingbjatbjleastbj3bjhrbjbeforebjbedtime.bjRationale:bjThebjnursebjshould
bjencouragebjthebjclientbjnotbjtobjeatbjanythingbjatbjleastbj3bjhrbjbeforebjbedtimebjtobjpreventb
jreflux.
Abjnursebjisbjprovidingbjteachingbjforbjabjclientbjwhobjhasbjabjnewbjdiagnosisbjofbjbenignbjpro
staticbjhyperplasiabj(BPH).bjWhichbjofbjthebjfollowingbjinstructionsbjshouldbjthebjnursebjincl
udebjtobjpromotebjelimination?bj-bjANS--
B:bj"Voidbjasbjsoonbjasbjyoubjfeelbjthebjurge."bjRationale:bjThebjnursebjshouldbjinstructbjabjcl
ientbjwhobjhasbjBPHbjonbjmeasuresbjtobjpreventbjdistensionbjofbjthebjbladderbjandbjurinarybj
retention.bjEncouragingbjthebjclientbjtobjvoidbjasbjsoonbjasbjthebjurgebjdevelopsbjdecreases
bjthebjriskbjofbjbladderbjdistension.
ONLINE PRACTICE A LEVE 2
QUESTIONS WITH CORRECT ANSWERS
Abjhospicebjnursebjisbjcaringbjforbjabjpreschoolerbjwhobjhasbjabjterminalbjillness.bjOnebjofbjt
hebjchild'sbjparentsbjtellsbjthebjnursebjthatbjitbjisbjtoobjdifficultbjtobjcopebjanybjlongerbjandbjha
sbjdecidedbjtobjmovebjoutbjofbjthebjhouse.bjWhichbjofbjthebjfollowingbjresponsesbjshouldbjth
ebjnursebjmake?bj-bjANS--
A:bj"Let'sbjtalkbjaboutbjabjfewbjwaysbjyoubjhavebjdealtbjwithbjstressbjinbjthebjpast."bjRationale
:bjThisbjstatementbjbybjthebjnursebjcombinesbjtwobjtherapeuticbjresponses,bjactivebjlistenin
gbjandbjfocusing.bjUsedbjtogether,bjthesebjtechniquesbjfacilitatebjcommunicationbjbybjlettin
gbjthebjparentbjknowbjone'sbjfeelingsbjarebjheardbjandbjtakenbjseriously,bjwhichbjconveysbja
cceptancebjandbjrespect.bjTherefore,bjthebjparentbjfeelsbjthebjnursebjvalidatesbjthebjconcer
nsbjandbjbecomesbjcomfortablebjaskingbjthebjnursebjsensitivebjquestionsbjaboutbjthebjchild.
Abjnursebjisbjteachingbjabjclientbjwaysbjtobjpreventbjosteoporoticbjfracturesbjduebjtobjosteop
orosis.bjWhichbjofbjthebjfollowingbjinformationbjshouldbjthebjnursebjincludebjinbjthebjteachin
g?bj-bjANS--
A:bj"Maintainbjbonebjhealthbjbybjeatingbjfruits,bjvegetables,bjandbjprotein."bjRationale:bjThe
bjnursebjshouldbjinstructbjthebjclientbjthatbjthebjbestbjwaybjtobjmaintainbjbonebjhealthbjandbjb
onebjremodelingbjisbjbybjeatingbjfruits,bjvegetables,bjandbjprotein.
Abjnursebjisbjteachingbjabjclientbjwhobjhasbjhypothyroidismbjaboutbjtakingbjlevothyroxine.bj
Whichbjofbjthebjfollowingbjstatementsbjshouldbjthebjnursebjmake?bj-bjANS--
B:bj"Thisbjmedicationbjcausesbjadversebjeffectsbjifbjthebjdosagebjisbjtoobjhighbjorbjtoobjlow."b
jRationale:bjThebjnursebjshouldbjinstructbjthebjclientbjthatbjlevothyroxine,bjinbjthebjrightbjdos
age,bjdoesbjnotbjtypicallybjcausebjadversebjeffects.bjIfbjthebjdosagebjisbjtoobjlow,bjthebjmanif
estationsbjofbjhypothyroidismbjwillbjrecur.bjIfbjthebjdosagebjisbjtoobjhigh,bjthebjmanifestation
sbjofbjhyperthyroidismbjwillbjoccur.
Abjnursebjinbjanbjemergencybjdepartmentbjisbjassessingbjabjpreschoolerbjwhobjhasbjsevere
bjdehydrationbjasbjabjresultbjofbjgastroenteritisbjandbjisbjreceivingbjisotonicbjIVbjfluids.bjWhic
hbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjidentifybjasbjanbjindicationbjthatbjthebjtreat
mentbjisbjeffective?bj-bjANS--
D:bjBriskbjskinbjturgorbjRationale:bjThebjnursebjshouldbjexpectbjthebjchildbjtobjhavebjbriskbjs
kinbjturgorbjifbjfluidbjreplacementbjtherapybjisbjeffective.
Abjnursebjisbjcaringbjforbjabjclientbjwhobjhasbjleftbjhemiparesisbjfollowingbjabjstroke.bjWhichbj
ofbjthebjfollowingbjactionsbjshouldbjthebjnursebjtake?bj-bjANS--
B:bjEncouragebjthebjclientbjtobjusebjwide-
gripbjutensilsbjwhenbjeatingbjwithbjthebjrightbjhand.bjRationale:bjThebjnursebjshouldbjencour
agebjthebjclientbjwhobjhasbjhemiparesisbjtobjusebjwide-
gripbjutensilsbjwhenbjeatingbjwithbjthebjrightbjhand,bjwhichbjcanbjaccommodatebjabjweakbjgr
aspbjandbjencouragebjindependencebjinbjeating.
,Abjnursebjisbjteachingbjaboutbjherbalbjsupplementsbjwithbjabjgroupbjofbjnewlybjlicensedbjnur
ses.bjWhichbjofbjthebjfollowingbjherbalbjsupplementsbjshouldbjthebjnursebjincludebjinbjthebjte
achingbjforbjtreatingbjhyperlipidemia?bj-bjANS--
D:bjGarlicbjRationale:bjThebjnursebjshouldbjincludebjthatbjgarlicbjcanbjhelpbjimprovebjcholes
terolbjlevels,bjwhichbjthenbjhelpsbjtobjreducebjthebjbuildupbjofbjplaquebjinbjthebjarteries.bjForb
jsomebjclients,bjitbjcanbjalsobjhelpbjlowerbjbloodbjpressure
Abjnursebjisbjadmittingbjabjclientbjwhobjhasbjanbjacutebjbacterialbjwoundbjinfectionbjandbjabjt
emperaturebjofbj39.8°bjCbj(103.6°bjF).bjWhichbjofbjthebjfollowingbjactionsbjshouldbjthebjnurs
ebjtake?bj-bjANS--
D:bjSetbjthebjtemperaturebjofbjthebjclient'sbjroombjtobj22.2°bjCbj(72°).bjRationale:bjThebjnurs
ebjshouldbjsetbjthebjtemperaturebjofbjthebjclient'sbjroombjatbj21°bjCbjtobj27°bjCbj(70°bjFbjtobj8
0°bjF).bjThisbjpromotesbjabjreductionbjinbjthebjclient'sbjfeverbjwithoutbjcausingbjshivering.bjB
ybjcombiningbjnonpharmacologicalbjinterventionsbjwithbjantipyretics,bjthebjnursebjcanbjredu
cebjthebjclient'sbjfever.
Abjnursebjisbjplanningbjcarebjforbjabjclientbjwhobjhadbjsurgerybjforbjosteomyelitisbjfrombjabjpa
stbjmusculoskeletalbjtraumabjtobjthebjlowerbjleg.bjWhichbjofbjthebjfollowingbjinterventionsbjs
houldbjthebjnursebjincludebjinbjthebjplanbjofbjcare?bj-bjANS--
C:bjCheckbjforbjparesthesiabjofbjthebjaffectedbjleg.bjRationale:bjThebjnursebjshouldbjinclude
bjinbjthebjinterventionsbjtobjcheckbjforbjparesthesia,bjsuchbjasbjabjtinglingbjsensationbjofbjtheb
jlegbjandbjfoot,bjwhichbjcanbjindicatebjmanifestationsbjofbjneurovascularbjcompromisebjorbjc
ompartmentbjsyndrome.
Abjnursebjisbjassessingbjthebjeyesbjandbjearsbjofbjabj2-year-oldbjtoddlerbjatbjabjwell-
childbjvisit.bjWhichbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjreportbjtobjthebjprovider
?bj-bjANS--
B:bjPresencebjofbjstrabismusbjRationale:bjThebjnursebjshouldbjrecognizebjthatbjthebjpresen
cebjofbjstrabismus,bjorbjcrossingbjofbjthebjeyes,bjshouldbjdisappearbjbybj4bjmonthsbjofbjage.b
jIfbjthisbjisbjnotbjcorrectedbjbybj4bjtobj6bjyearsbjofbjage,bjitbjcanbjleadbjtobjamblyopia;bjtherefor
e,bjthebjnursebjshouldbjreportbjthisbjfindingbjtobjthebjprovider.
Abjnursebjisbjteachingbjabjclientbjwhobjhasbjatherosclerosisbjaboutbjself-
care.bjWhichbjofbjthebjfollowingbjinstructionsbjshouldbjthebjnursebjincludebjinbjthebjteaching?
bj-bjANS--
C:bjIncreasebjfiberbjintakebjtobjatbjleastbj30bjgbjperbjday.bjRationale:bjThebjnursebjshouldbjin
structbjthebjclientbjtobjincreasebjdailybjfiberbjintakebjtobjatbjleastbj30bjg.bjFiberbjassistsbjinbjth
ebjeliminationbjofbjlipidsbjandbjminimizesbjthebjdevelopmentbjofbjatherosclerosis.
Abjnursebjisbjassessingbjabjclientbjwhobjhasbjasbjanbjulcerbjduebjtobjperipheralbjvascularbjdis
ease.bjWhichbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjidentifybjasbjanbjindicationbjth
atbjthebjclientbjhasbjabjvenousbjulcerbjratherbjthanbjanbjarterialbjulcer?bj-bjANS--
B:bjDiscolorationbjandbjedemabjofbjthebjrightbjanklebjRationale:bjThebjnursebjshouldbjidentif
ybjthatbjmanifestationsbjofbjperipheralbjvenousbjdiseasebjincludebjdiscolorationbjandbjedem
abjofbjthebjankle,bjresultingbjfrombjvenousbjhypertension.
, Abjnursebjisbjprovidingbjdischargebjteachingbjtobjabjclientbjwhobjisbjpostoperativebjfollowingb
jabjtransurethralbjresectionbjofbjthebjprostatebj(TURP)bjforbjtreatmentbjofbjbenignbjprostaticbj
hyperplasia.bjWhichbjofbjthebjfollowingbjinstructionsbjshouldbjthebjnursebjincludebjinbjthebjte
aching?bj-bjANS--
D:bj"PerformbjKegelbjexercisesbjseveralbjtimesbjthroughoutbjthebjday."bjRationale:bjThebjnu
rsebjshouldbjinstructbjthebjclientbjonbjthebjperformancebjofbjKegelbjexercises,bjorbjtightening
bjandbjthenbjrelaxingbjthebjurinarybjsphincter,bjtobjassistbjthebjclientbjinbjregainingbjurinarybjc
ontrolbjandbjeliminatebjdribblingbjorbjthebjleakagebjofbjurine.bjThebjnursebjshouldbjencourag
ebjthebjclientbjtobjperformbjthesebjexercisesbjseveralbjtimesbjeachbjday.
Abjnursebjisbjassessingbjabjclientbjwhobjhasbjleft-
sidedbjheartbjfailure.bjWhichbjofbjthebjfollowingbjfindingsbjshouldbjthebjnursebjexpect?
bj(Selectbjallbjthebjapply.)bj-bjANS--A:bjNocturia
C:bjDyspnea
D:bjHackingbjcoughbjRationale:bjLeft-
sidedbjheartbjfailurebjcausesbjoliguriabjduringbjthebjdaybjandbjnocturiabjduringbjsleepingbjho
urs,bjpulmonarybjmanifestations,bjsuchbjasbjdyspnea,bjorthopnea,bjcrackles,bjandbjwheeze
s,bjandbjabjhackingbjcoughbjthatbjworsensbjatbjnightbjandbjeventuallybjproducesbjfrothybjspu
tum.
Abjnursebjisbjassessingbjabjclientbjwhobjisbj1bjhourbjpostoperativebjfollowingbjabjtransurethra
lbjresectionbjofbjthebjprostatebj(TURP)bjforbjtreatmentbjofbjbenignbjprostaticbjhyperplasia.bjF
orbjwhichbjofbjthebjfollowingbjassessmentbjfindingsbjshouldbjthebjnursebjnotifybjthebjprovider
?bj-bjANS--
C:bjThebjcatheterbjtubingbjhasbjmultiplebjredbjclots.bjRationale:bjThebjnursebjshouldbjidentify
bjthatbjthebjpresencebjofbjmultiplebjredbjclotsbjinbjthebjcatheterbjtubingbjorbjdrainagebjthatbjisbj
ketchup-
likebjarebjmanifestationsbjofbjpostoperativebjbleeding.bjThebjnursebjshouldbjnotifybjthebjprov
iderbjandbjprovidebjhandbjirrigationbjofbjthebjbladderbjperbjproviderbjprescription.
Abjnursebjisbjteachingbjabjclientbjwhobjhasbjgastroesophagealbjrefluxbjdiseasebjaboutbjways
bjtobjpreventbjreflux.bjWhichbjofbjthebjfollowingbjinformationbjshouldbjthebjnursebjincludebjinbj
thebjteaching?bj-bjANS--
D:bjPlanbjtobjfinishbjeatingbjatbjleastbj3bjhrbjbeforebjbedtime.bjRationale:bjThebjnursebjshould
bjencouragebjthebjclientbjnotbjtobjeatbjanythingbjatbjleastbj3bjhrbjbeforebjbedtimebjtobjpreventb
jreflux.
Abjnursebjisbjprovidingbjteachingbjforbjabjclientbjwhobjhasbjabjnewbjdiagnosisbjofbjbenignbjpro
staticbjhyperplasiabj(BPH).bjWhichbjofbjthebjfollowingbjinstructionsbjshouldbjthebjnursebjincl
udebjtobjpromotebjelimination?bj-bjANS--
B:bj"Voidbjasbjsoonbjasbjyoubjfeelbjthebjurge."bjRationale:bjThebjnursebjshouldbjinstructbjabjcl
ientbjwhobjhasbjBPHbjonbjmeasuresbjtobjpreventbjdistensionbjofbjthebjbladderbjandbjurinarybj
retention.bjEncouragingbjthebjclientbjtobjvoidbjasbjsoonbjasbjthebjurgebjdevelopsbjdecreases
bjthebjriskbjofbjbladderbjdistension.
