Geri Exam 1 Questions and Correct
Answers
An elderly diabetic client is admitted to the hospital with a chronic non-healing ulcer. The nurse inspects
the color of the ulcer and measures its diameter daily. The nurse finds that the ulcer does not have an
odor. The client is taking antibiotics prescribed by the primary healthcare provider. What are the
evaluative measures in relation to the ulcer in this case? Select all that apply.
1. Color of the ulcer
2. Diameter of the ulcer
3. Diabetes
4. Odor in the ulcer
5. Antibiotics - correct answers:color of the ulcer, diameter of the ulcer, and odor of the ulcer
What should the nurse know about evaluation in the nursing process?
1. Evaluation is dynamic and ever changing.
2. Evaluation occurs at particular intervals set by the nurse.
3. Evaluation process should not involve the caregivers.
4. Evaluation process is done in a nursing process - correct answers:1. Evaluation is dynamic and ever
changing
A client has limited mobility as a result of a recent knee replacement. The nurse identifies that he has
altered balance and assists him in ambulation. The client uses a walker presently as part of his therapy.
The nurse notes how far the client is able to walk and then assists him back to his room. Which of the
following is an evaluative measure?
1. Uses walker during ambulation
2. Presence of altered balance
3. Limited mobility in lower extremities
4. Observation of distance client is able to walk - correct answers:Observation of distance client is able to
walk
,Final step in the nursing process - correct answers:Evaluation
A nurse is caring for a client with pneumonia. According to the client's care plan, a reduction of
respiratory rate (RR) from 33 breaths per minute to 20 breaths per minute (bpm), reduced cough, and
reduced sputum production in two days would indicate successful intervention. On the first day the
nurse finds that cough has reduced following nebulization and the RR is 25 bpm. What should the
nurse's evaluation be?
1. The client's condition is deteriorating.
2. The client can be discharged to home to continue treatments.
3. The client needs continued nebulization therapy.
4. The client needs to be transferred to the ICU immediately. - correct answers:The client needs
continued nebulization therapy
A client is recovering from surgery for removal of an ovarian tumor. It is 1 day after her surgery. Because
she has an abdominal incision and dressing and a history of diabetes, the nurse has selected a nursing
diagnosis of risk for infection. Which of the following is an appropriate goal statement for the diagnosis?
1. Client will remain afebrile to discharge.
2. Client's wound will remain free of infection by discharge.
3. Client will receive ordered antibiotic on time over next 3 days.
4. Client's abdominal incision will be covered with a sterile dressing for 2 days. - correct answers:Client's
wound will remain free of infection by discharge
A nurse is caring for a 40-year-old client undergoing chemotherapy. The client complains of vomiting.
Which statement is an appropriate goal statement for the client's problem?
1. The client will stop vomiting in 2 hours.
2. Antiemetic should be administered every 6 hours.
3. The client may develop a side-effect of the antiemetic medication.
4. The client will not vomit again. - correct answers:The client will stop vomiting in 2 hours
A nurse is assessing a client at home post splenectomy. The client tells the nurse that he realizes that
strain on the incision site could cause tearing of the stitches. Nevertheless, the nurse finds that some of
the client's stitches are pulled out. What should be the most appropriate nursing action?
1. Advise the client to maintain complete bed rest for at least a month.
, 2. Immediately make arrangements for admission of the client to the hospital.
3. Report to the caregiver that the client is not following the instructions given.
4. Ask if the client understands which activities can cause strain at the incision site. - correct answers:Ask
if the client understands which activities can cause strain at the incision site
An elderly client who has been taking thyroxine for hypothyroidism is diagnosed with dementia. What
should the nurse do in revising the care plan for hypothyroidism?
1. Do not make any changes.
2. Increase the dose of thyroxine.
3. Ask the caregiver to monitor administration of the thyroxine.
4. Advise the caregiver to admit the client to a nursing home. - correct answers:Ask the caregiver to
monitor administration of the thyroxine
A client has a nursing diagnosis of fractured ankle. As a part of the care plan, the nurse plans to assist the
client to walk and provides instruction about the use of crutches. Later, the nurse finds that the client is
already able to walk with the crutches. What should the nurse do now?
1. Help the client walk.
2. Discontinue the current interventions and develop new ones.
3. Instruct the client to walk without support.
4. Demonstrate the use of crutches instead of instructing. - correct answers:Discontinue the current
interventions and develop new ones
A nurse is preparing a client for discharge from the hospital. One of the important outcome measures
before discharge is that the client's surgical wound is aseptic. What is the most probable evaluative
measure in this case?
1. The absence of redness or tenderness at the site of the incision
2. The client identifying the symptoms of wound infection
3. The client's caregiver identifying the signs of wound infection
4. The client reporting no fever three days after surgery - correct answers:The absence of redness or
tenderness at the site of the incision
Answers
An elderly diabetic client is admitted to the hospital with a chronic non-healing ulcer. The nurse inspects
the color of the ulcer and measures its diameter daily. The nurse finds that the ulcer does not have an
odor. The client is taking antibiotics prescribed by the primary healthcare provider. What are the
evaluative measures in relation to the ulcer in this case? Select all that apply.
1. Color of the ulcer
2. Diameter of the ulcer
3. Diabetes
4. Odor in the ulcer
5. Antibiotics - correct answers:color of the ulcer, diameter of the ulcer, and odor of the ulcer
What should the nurse know about evaluation in the nursing process?
1. Evaluation is dynamic and ever changing.
2. Evaluation occurs at particular intervals set by the nurse.
3. Evaluation process should not involve the caregivers.
4. Evaluation process is done in a nursing process - correct answers:1. Evaluation is dynamic and ever
changing
A client has limited mobility as a result of a recent knee replacement. The nurse identifies that he has
altered balance and assists him in ambulation. The client uses a walker presently as part of his therapy.
The nurse notes how far the client is able to walk and then assists him back to his room. Which of the
following is an evaluative measure?
1. Uses walker during ambulation
2. Presence of altered balance
3. Limited mobility in lower extremities
4. Observation of distance client is able to walk - correct answers:Observation of distance client is able to
walk
,Final step in the nursing process - correct answers:Evaluation
A nurse is caring for a client with pneumonia. According to the client's care plan, a reduction of
respiratory rate (RR) from 33 breaths per minute to 20 breaths per minute (bpm), reduced cough, and
reduced sputum production in two days would indicate successful intervention. On the first day the
nurse finds that cough has reduced following nebulization and the RR is 25 bpm. What should the
nurse's evaluation be?
1. The client's condition is deteriorating.
2. The client can be discharged to home to continue treatments.
3. The client needs continued nebulization therapy.
4. The client needs to be transferred to the ICU immediately. - correct answers:The client needs
continued nebulization therapy
A client is recovering from surgery for removal of an ovarian tumor. It is 1 day after her surgery. Because
she has an abdominal incision and dressing and a history of diabetes, the nurse has selected a nursing
diagnosis of risk for infection. Which of the following is an appropriate goal statement for the diagnosis?
1. Client will remain afebrile to discharge.
2. Client's wound will remain free of infection by discharge.
3. Client will receive ordered antibiotic on time over next 3 days.
4. Client's abdominal incision will be covered with a sterile dressing for 2 days. - correct answers:Client's
wound will remain free of infection by discharge
A nurse is caring for a 40-year-old client undergoing chemotherapy. The client complains of vomiting.
Which statement is an appropriate goal statement for the client's problem?
1. The client will stop vomiting in 2 hours.
2. Antiemetic should be administered every 6 hours.
3. The client may develop a side-effect of the antiemetic medication.
4. The client will not vomit again. - correct answers:The client will stop vomiting in 2 hours
A nurse is assessing a client at home post splenectomy. The client tells the nurse that he realizes that
strain on the incision site could cause tearing of the stitches. Nevertheless, the nurse finds that some of
the client's stitches are pulled out. What should be the most appropriate nursing action?
1. Advise the client to maintain complete bed rest for at least a month.
, 2. Immediately make arrangements for admission of the client to the hospital.
3. Report to the caregiver that the client is not following the instructions given.
4. Ask if the client understands which activities can cause strain at the incision site. - correct answers:Ask
if the client understands which activities can cause strain at the incision site
An elderly client who has been taking thyroxine for hypothyroidism is diagnosed with dementia. What
should the nurse do in revising the care plan for hypothyroidism?
1. Do not make any changes.
2. Increase the dose of thyroxine.
3. Ask the caregiver to monitor administration of the thyroxine.
4. Advise the caregiver to admit the client to a nursing home. - correct answers:Ask the caregiver to
monitor administration of the thyroxine
A client has a nursing diagnosis of fractured ankle. As a part of the care plan, the nurse plans to assist the
client to walk and provides instruction about the use of crutches. Later, the nurse finds that the client is
already able to walk with the crutches. What should the nurse do now?
1. Help the client walk.
2. Discontinue the current interventions and develop new ones.
3. Instruct the client to walk without support.
4. Demonstrate the use of crutches instead of instructing. - correct answers:Discontinue the current
interventions and develop new ones
A nurse is preparing a client for discharge from the hospital. One of the important outcome measures
before discharge is that the client's surgical wound is aseptic. What is the most probable evaluative
measure in this case?
1. The absence of redness or tenderness at the site of the incision
2. The client identifying the symptoms of wound infection
3. The client's caregiver identifying the signs of wound infection
4. The client reporting no fever three days after surgery - correct answers:The absence of redness or
tenderness at the site of the incision
