Solutions
1) Based on knowledge of total body fluids, a nurse
is especially watchful for a fluid volume deficit in
an infant. Why would the nurse do this? Correct
Answers Infants have more total body fluid and
ECF than adults.
1) Which body fluid is the fluid within the cells,
constituting about 70% of the total body water?
Correct Answers Intracellular fluid (ICF)
A client asks a nurse if it is possible to contract a
disease by donating blood. How would the nurse
respond? Correct Answers "There is no way you
can contract a disease by giving blood."
A client asks a nurse to explain a living will. What is
the nurse's best answer? Correct Answers It lists
specific instructions for health care provisions.
A client has a physician's order for NPO (nothing by
mouth) following abdominal surgery to repair a
bowel obstruction. The client has a nasogastric
tube inserted to low intermittent suction. The client
requires intravenous therapy for what purpose?
Correct Answers Replace fluid and electrolytes
,A client has a severe abdominal injury with
damage to the liver and colon from a motorcycle
crash. What type of pain will predominate? Correct
Answers Visceral pain
A client has an order for a narcotic analgesic every
three to four hours and he received his last dose
three hours earlier. Which of the following actions
is most appropriate for the nurse to take in
response to the client's request for pain medication
on his first postoperative day? Correct Answers
Provide the client with pain medication
A client has an order to restrict fluids. What is one
comfort measure nurses can implement for this
client to alleviate a common problem? Correct
Answers Oral hygiene
A client has been taught how to do Kegel
exercises. What statement by the client indicates a
need for further information? Correct Answers "I
will contract the muscles in my abdomen and
thighs."
A client has been taught relaxation exercises
before beginning a painful procedure. What
chemicals are believed to be released in the body
during relaxation to relieve pain? Correct Answers
Endorphins
,A client has had a head injury affecting the brain
stem. What is located in the brain stem that may
affect respiratory function? Correct Answers
Respiratory center
A client has had frequent watery stools (diarrhea)
for an extended period of time. The client also has
decreased skin turgor and dark urine. Based on
these data, which nursing diagnosis would be
appropriate? Correct Answers Deficient Fluid
Volume
A client has sought care because of insomnia that
has been increasing in severity and frequency in
recent months. What questions should the nurse
include in an assessment of this client's health
problem? Select all that apply. Correct Answers
-"Do you smoke?"
-"What medications are you currently taking?"
-"Do you have a consistent routine around getting
ready for bed and going to bed?"
-"How would you characterize your mood lately?"
A client having acute pain tells the nurse that her
pain has gradually reduced, but that she fears it
could recur and become chronic. What is a
characteristic of chronic pain? Correct Answers
Chronic pain has far-reaching effects on the client.
, A client in his 40s has asked the nurse how much
sleep he should be getting in order to maximize his
health and well-being. How should the nurse
respond? Correct Answers "Most adults need
between seven and nine hours, but everyone is
different."
A client in the emergency department is diagnosed
with a myocardial infarction (heart attack). The
client describes pain in his left arm and shoulder.
What name is given to this type of pain? Correct
Answers Referred pain
A client is admitted to the health care facility with
complaints of pain on urination that is secondary to
a urinary tract infection (UTI). The nurse
documents this finding as which of the following?
Correct Answers Dysuria
A client is diagnosed with a terminal illness. Who is
usually responsible for deciding what, when, and
how the client should be told? Correct Answers
Physician
A client is diagnosed with narcolepsy. Which of the
following is a characteristic of this disorder?
Correct Answers Uncontrollable desire to sleep