90 QUESTIONS AND CORRECT DETAILED ANSWERS
WITH RATIONALES
A nurse is planning care to decrease psychosocial health issues for a client
who is starting dialysis treatments for chronic kidney disease. Which of the
following intervention should the nurse include in the plan?
- Remind the client that dialysis treatments are not difficult to incorporate
into daily
- Inform the client that dialysis will result in a cure
- Tell a client that it is possible to return to similar previous levels of activity
- Begin health promotion teaching during the first dialysis treatment -
Answer:-- Tell a client that it is possible to return to similar previous levels of
activity
RATIONALE: The nurse should help the client develop realistic goals and
activities to have a productive life.
A nurse is planning care for a client who is postoperative following a
laparotomy and has a closed-suction drain. Which of the following actions
should the nurse take to manage the drain?
- Set the wall suction to 80 to 100 mmHg
,- Compress the drain reservoir after emptying
- Allow the drainage to collect on a sterile gauze dressing
- Position the drain below the bed to promote drainage -Answer:-- Compress
the drain reservoir after emptying
RATIONALE: Compressing the reservoir creates a vacuum that draws fluid out
of the wound, through the drain, and into the reservoir.
A nurse has received report on a client who is being admitted to the
emergency department.
Select the 3 findings that require follow-up by the nurse.
- GCS score
- Wound drainage
- Oxygen saturation
- Pain level
- Temperature -Answer:-- Wound drainage
RATIONALE: The nurse should apply a pressure dressing to control bleeding.
,- Oxygen saturation
RATIONALE: The client has an oxygen saturation that is less than the expected
reference level, indicating hypoxia. The nurse should plan to increase the
client's supplemental oxygen.
- Pain level
RATIONALE: The nurse should follow-up on the client's pain level.
The nurse is caring for the client.
Complete the following sentence by using the list of options.
1) The client is most likely experiencing a _____________
- Traumatic brain injury
- Hemothroax
- Ruptured spleen
2) as evidenced by the client's ________
, - Gastrointestinal findings
- GCS score
- Respiratory findings -Answer:-- Hemothorax
- Respiratory findings
RATIONALE: The client has SOB, hypoxia, diminished breath sounds, and a
decreased hematocrit. Therefore, the client is likely experiencing a
hemothorax.
The client has SOB, hypoxia, diminished breath sounds, and a decreased
hematocrit. Therefore, the client is likely experiencing a hemothorax.
The nurse is caring for the client.
Drag words from the choices below to fill in each blank in the following
sentence.
1) The nurse should first address the client's _________
- Peripheral pulses
- Temperature
- Oxygenation