B. "Place a pillow between your knees while lying in bed to prevent hip
dislocation."
(The client's affected hip joint following a hemiarthroplasty (partial hip
replacement) is at risk of dislocation for 6 months to a year following the
A 73-year-old female client had a procedure. Hip precautions to prevent dislocation include placing a pillow
hemiarthroplasty of the left hip yesterday the knees to maintain abduction of the hips (B). Clients should be instructe
due to a fracture resulting from a fall. In avoid bending at the waist (A), to seek assistance for both standing and w
reviewing hip precautions with the client, until they are stable on a walker or cane (C), and to take pain medication 2
which instruction should the nurse include minutes prior to physical therapy sessions, rather than waiting until the pa
in this client's teaching plan? is high after their therapy.)
A. "In 8 weeks you will be able to bend at
the waist to reach items on the floor."
B. "Place a pillow between your knees
while lying in bed to prevent hip
dislocation."
C. "It is safe to use a walker to get out of
bed, but you need assistance when
walking."
D. "Take pain medication 30 minutes after
your physical therapy sessions."
, A. "It is important that you continue your medication while learning to med
(The prolonged practice of meditation may lead to reduced need for
antihypertensive medications. However, the medications must be continue
An adult male client with a history of while the physiologic response to meditation is monitored. (B) is not as im
hypertension tells the nurse that he is as continuing the medication. The HCP should be informed, but permissio
tired of taking antihypertensive required to mediate (C). Although, it is true that the complimentary therapy
medications and is going to try spiritual be effective (D), it is essential that the client continue with antihypertensive
meditation instead. What should be the mediations until the effect of mediation can be measured.)
nurse's first response?
A. It is important that you continue your
medication while learning to meditate.
B. Spiritual meditation requires a time
commitment of 15 to 20 minutes daily.
C. Obtain your healthcare provider's
permission before starting meditation.
D. Complementary therapy and western
medicine can be effective for you.
, A. Inquire about the source and type of pain
(Different cultural groups often have their own terms for health conditions.
Americans clients may refer to pain as "the miseries." Based on understan
An African-American grandmother tells this term, the nurse should conduct a focused assessment on the source a
the nurse that her 4-year-old grandson is of pain (A). (B, C, and D) are important, but do not focus on "miseries" (pa
suffering with "miseries." Based on this
statement, which focused assessment
should the nurse conduct?
A. Inquire about the source and type of
pain.
B. Examine the nose for congestion and
discharge.
C. Take vital signs for temperature
elevation.
D. Explore the abdominal area for
distention.
, A. Determine the etiology of the problem.
(Before planning care, the nurse should determine the etiology, or cause,
problem (A), because this will help determine (B, C, and D). )
After completing an assessment and
determining that a client has a problem,
which action should the nurse perform
next?
A. Determine the etiology of the problem.
B. Prioritize nursing care interventions.
C. Plan appropriate interventions.
D. Collaborate with the client to set goals.