NUR 311 Test with Verified Solutions
A nurse is assessing the urine on a newborn's diaper. What would be a normal
assessment finding? - ✅✅ Light in color and odorless
An older woman who is a resident of a long-term care facility has to get up and
void several times during the night. This can be the result of what physiologic
change with normal aging? - ✅✅ Diminished kidney ability to concentrate urine
After surgery, a postoperative client has not voided for eight hours. Where would
the nurse assess the bladder for distention? - ✅✅ Between the symphysis pubis
and the umbilicus
A nurse is delegating the collection of urinary output to an assistant. What should
the nurse tell the assistant to do while measuring the urine? - ✅✅ Wear gloves
when handling a client's urine.
A nurse has instructed a client at the clinic about collecting a specimen for a
routine urinalysis. The client makes the following statements. Which one indicates
a need for more teaching? - ✅✅ "I will keep the toilet paper in the specimen."
A nurse is initiating a 24-hour urine collection for a client at home. What will be
the first thing the nurse will ask the client to do at the beginning of the specimen
collection? - ✅✅ Void and discard the urine.
,An older adult woman has constant dribbling of urine. The associated discomfort,
odor, and embarrassment may support which of the following nursing diagnoses? -
✅✅ Social Isolation
A male client who has had outpatient surgery is unable to void while lying supine.
What can the nurse do to facilitate his voiding? - ✅✅ Assist him to a standing
position.
A nurse is educating a client on the amount of water to drink each day. What is the
recommended daily fluid intake for adults? - ✅✅ 8 to 10 (8-oz) glasses per day
A nurse is carrying out an order to remove an indwelling catheter. What is the first
step of this skill? - ✅✅ Wash hands and put on gloves.
A nurse has catheterized a client to obtain urine for measuring postvoid residual
(PVR) amount. The nurse obtains 40 ml of urine. What should the nurse do next? -
✅✅ Document this normal finding for postvoid residual.
A nurse is inserting an indwelling urethral catheter. What type of supplies will the
nurse need for this procedure? - ✅✅ A sterile catheterization kit or tray
A client has been taught how to do Kegel exercises. What statement by the client
indicates a need for further information? - ✅✅ "I will contract the muscles in my
abdomen and thighs."
Which body fluid is the fluid within the cells, constituting about 70% of the total
body water? - ✅✅ Intracellular fluid (ICF)
,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? - ✅✅ Infants have
more total body fluid and ECF than adults.
What is the average adult fluid intake and loss in each 24 hours? - ✅✅ 1,500 to
3500 ml
A nurse monitoring the intake and output of fluids for a client with severe diarrhea
knows that normally how much body fluid is lost via the gastrointestinal tract? -
✅✅ 300 ml
A nurse reads the laboratory report and notes that the client has hyponatremia.
What physical assessment should be made? - ✅✅ Monitor for GI symptoms.
A home care client reports weakness and leg cramps. Per order, the nurse draws
blood and requests a potassium level. What is the rationale for this request? -
✅✅ The nurse recognizes these symptoms of hypokalemia.
A client's paco2 is abnormal on an ABG report. Which of is the most likely be the
medical diagnosis? - ✅✅ Chronic obstructive pulmonary disease
Which question about fluid balance would be appropriate when conducting a
health history for a client? - ✅✅ "Describe your usual urination habits."
A client is taking a diuretic that increases her urinary output. What would be an
appropriate nursing diagnosis on which to base an educational plan? - ✅✅ Risk
for Deficient Fluid Volume
, A nurse measures a client's 24-hour fluid intake and documents the findings. To be
an accurate indicator of fluid status, what must the nurse also do with the
information? - ✅✅ Compare the total intake and output of fluids for the 24
hours.
A physician writes an order to "force fluids." What will be the first action the nurse
will take in implementing this order? - ✅✅ Explain to the client why this is
needed.
A client has an order to restrict fluids. What is one comfort measure nurses can
implement for this client to alleviate a common problem? - ✅✅ Oral hygiene
A nurse is administering a potassium supplement to a client. What will the nurse
do to disguise the taste and decrease gastric irritation? - ✅✅ Dilute it
A student is learning how to administer intravenous fluids, including accessing a
vein. Although all of the following may occur, which is the most potentially
harmful risk posed for the client when accessing the vein? - ✅✅ Infection
Which location might the nurse use to assess the condition of an insertion site for a
central venous access device? - ✅✅ Over the jugular vein
A specially trained nurse has inserted a PICC line. What would be done next? -
✅✅ Send the client to the radiology department
Cross-matching of blood is ordered for a client before major surgery. What does
this process do? - ✅✅ Determines compatibility between blood specimens
A nurse is assessing the urine on a newborn's diaper. What would be a normal
assessment finding? - ✅✅ Light in color and odorless
An older woman who is a resident of a long-term care facility has to get up and
void several times during the night. This can be the result of what physiologic
change with normal aging? - ✅✅ Diminished kidney ability to concentrate urine
After surgery, a postoperative client has not voided for eight hours. Where would
the nurse assess the bladder for distention? - ✅✅ Between the symphysis pubis
and the umbilicus
A nurse is delegating the collection of urinary output to an assistant. What should
the nurse tell the assistant to do while measuring the urine? - ✅✅ Wear gloves
when handling a client's urine.
A nurse has instructed a client at the clinic about collecting a specimen for a
routine urinalysis. The client makes the following statements. Which one indicates
a need for more teaching? - ✅✅ "I will keep the toilet paper in the specimen."
A nurse is initiating a 24-hour urine collection for a client at home. What will be
the first thing the nurse will ask the client to do at the beginning of the specimen
collection? - ✅✅ Void and discard the urine.
,An older adult woman has constant dribbling of urine. The associated discomfort,
odor, and embarrassment may support which of the following nursing diagnoses? -
✅✅ Social Isolation
A male client who has had outpatient surgery is unable to void while lying supine.
What can the nurse do to facilitate his voiding? - ✅✅ Assist him to a standing
position.
A nurse is educating a client on the amount of water to drink each day. What is the
recommended daily fluid intake for adults? - ✅✅ 8 to 10 (8-oz) glasses per day
A nurse is carrying out an order to remove an indwelling catheter. What is the first
step of this skill? - ✅✅ Wash hands and put on gloves.
A nurse has catheterized a client to obtain urine for measuring postvoid residual
(PVR) amount. The nurse obtains 40 ml of urine. What should the nurse do next? -
✅✅ Document this normal finding for postvoid residual.
A nurse is inserting an indwelling urethral catheter. What type of supplies will the
nurse need for this procedure? - ✅✅ A sterile catheterization kit or tray
A client has been taught how to do Kegel exercises. What statement by the client
indicates a need for further information? - ✅✅ "I will contract the muscles in my
abdomen and thighs."
Which body fluid is the fluid within the cells, constituting about 70% of the total
body water? - ✅✅ Intracellular fluid (ICF)
,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? - ✅✅ Infants have
more total body fluid and ECF than adults.
What is the average adult fluid intake and loss in each 24 hours? - ✅✅ 1,500 to
3500 ml
A nurse monitoring the intake and output of fluids for a client with severe diarrhea
knows that normally how much body fluid is lost via the gastrointestinal tract? -
✅✅ 300 ml
A nurse reads the laboratory report and notes that the client has hyponatremia.
What physical assessment should be made? - ✅✅ Monitor for GI symptoms.
A home care client reports weakness and leg cramps. Per order, the nurse draws
blood and requests a potassium level. What is the rationale for this request? -
✅✅ The nurse recognizes these symptoms of hypokalemia.
A client's paco2 is abnormal on an ABG report. Which of is the most likely be the
medical diagnosis? - ✅✅ Chronic obstructive pulmonary disease
Which question about fluid balance would be appropriate when conducting a
health history for a client? - ✅✅ "Describe your usual urination habits."
A client is taking a diuretic that increases her urinary output. What would be an
appropriate nursing diagnosis on which to base an educational plan? - ✅✅ Risk
for Deficient Fluid Volume
, A nurse measures a client's 24-hour fluid intake and documents the findings. To be
an accurate indicator of fluid status, what must the nurse also do with the
information? - ✅✅ Compare the total intake and output of fluids for the 24
hours.
A physician writes an order to "force fluids." What will be the first action the nurse
will take in implementing this order? - ✅✅ Explain to the client why this is
needed.
A client has an order to restrict fluids. What is one comfort measure nurses can
implement for this client to alleviate a common problem? - ✅✅ Oral hygiene
A nurse is administering a potassium supplement to a client. What will the nurse
do to disguise the taste and decrease gastric irritation? - ✅✅ Dilute it
A student is learning how to administer intravenous fluids, including accessing a
vein. Although all of the following may occur, which is the most potentially
harmful risk posed for the client when accessing the vein? - ✅✅ Infection
Which location might the nurse use to assess the condition of an insertion site for a
central venous access device? - ✅✅ Over the jugular vein
A specially trained nurse has inserted a PICC line. What would be done next? -
✅✅ Send the client to the radiology department
Cross-matching of blood is ordered for a client before major surgery. What does
this process do? - ✅✅ Determines compatibility between blood specimens
