Tüm alıştırma soruları

A nurse in an ambulatory care clinic is designing a health promotion plan for a 50-year-old male client. The client has a body mass index (BMI) of $31 \text{ kg/m}^2$ and a strong family history of cardiovascular disease. His medical history is significant only for osteoarthritis of the right knee resulting from a remote sports injury. Which of the following nursing interventions represent secondary prevention strategies for this client? (Select all that apply.)

An 84-year-old client with advanced dementia, left-sided hemiplegia from a previous stroke, and a stage 3 sacral pressure injury is receiving continuous enteral feeding via a nasogastric (NG) tube. The client has become acutely restless, is repeatedly pulling at their soiled incontinence brief, and requires immediate perineal care. Which action by the nurse represents the safest integration of basic care and comfort principles?

A nurse is caring for a client who is 4 days postoperative following a median laparotomy. The client coughs forcefully and reports a 'giving way' sensation in the abdomen. The nurse inspects the incision and observes bowel loops protruding through the open wound. In what order should the nurse perform the following actions to minimize the risk of tissue necrosis and physiological decompensation?

An ambulatory care nurse is guiding a sedentary adult client through the development of a personalized physical activity plan to reduce the risk of chronic disease. In what order should the nurse complete the following actions? Arrange the steps from first to last.

A client who recently underwent a mechanical aortic valve replacement is receiving a continuous intravenous infusion of unfractionated heparin via a single-lumen peripherally inserted central catheter (PICC). The client is diagnosed with a healthcare-associated systemic infection, and the healthcare provider prescribes an intermittent intravenous infusion of vancomycin $1,000\text{ mg}$ to run over $90$ minutes. The nurse notes from the pharmacological reference that heparin and vancomycin are physically incompatible at the Y-site. What is the priority nursing action to safely administer the prescribed vancomycin?

A client who has been experiencing constipation for several days is prescribed a large-volume cleansing enema. To best facilitate the flow of the enema solution by gravity into the descending colon, which position should the nurse assist the client into?

An occupational health nurse at a manufacturing facility is compiling a report on the outcomes of a recently implemented workplace wellness program. The nurse is categorizing the initiatives based on the levels of disease prevention. Which of the following activities should the nurse classify as secondary prevention?

The healthcare provider prescribes a continuous intravenous infusion of sodium nitroprusside at a rate of $3 \text{ mcg/kg/min}$ for a client experiencing a hypertensive crisis. The client weighs $198 \text{ lbs}$. The medication is supplied as $50 \text{ mg}$ of sodium nitroprusside mixed in $250 \text{ mL}$ of 5% dextrose in water (D5W). What is the appropriate infusion rate in $\text{mL/hr}$? (Record your answer as a whole number.)

A community health RN is establishing a home management plan for an 80-year-old client with late-stage Parkinson's disease. The client's spouse reports that the client has become increasingly fatigued, struggles to manipulate eating utensils, and recently developed sudden episodes of urinary incontinence. Which action by the nurse best addresses the client's health and self-care needs?

A nurse is preparing to administer a scheduled intravenous (IV) antibiotic via a secondary line. The client currently has a continuous primary IV infusion of 0.45% sodium chloride with 20 mEq of potassium chloride running. Which action must the nurse prioritize before attaching the secondary tubing to the primary IV line?

While working at a community homeless shelter, a nurse evaluates a resident who abruptly stopped drinking heavy amounts of liquor two days ago. The resident is currently experiencing profuse sweating, coarse hand tremors, and agitated visual hallucinations. Which of the following actions should the nurse take? (Select all that apply)

A client in cardiogenic shock is prescribed a continuous intravenous (IV) infusion of dobutamine at a rate of $5 \text{ mcg/kg/min}$. The client weighs $80 \text{ kg}$. The pharmacy provides a premixed IV bag containing $500 \text{ mg}$ of dobutamine in $250 \text{ mL}$ of $5\%$ dextrose in water (D5W). At what rate, in $\text{mL/hr}$, should the nurse program the electronic infusion pump?

A nurse is preparing to administer a new intravenous (IV) push medication to a client who is already receiving a continuous IV fluid infusion. To ensure client safety and reduce the risk of an adverse event, which action must the nurse take before administering the medication?

A client with acute decompensated heart failure is receiving a continuous intravenous (IV) infusion of milrinone through a dedicated 20-gauge peripheral catheter. The healthcare provider prescribes a STAT dose of furosemide 40 mg IV push. The client currently has no other venous access. Which action by the nurse is the safest and most appropriate?

A nurse is directing the care of an 80-year-old client who is 48 hours post-operative following a right total hip arthroplasty (posterior approach). The client, who has no history of cognitive impairment, has become increasingly restless, is pulling at their indwelling urinary catheter, and has had two episodes of bowel incontinence. Which intervention is most appropriate for the nurse to include in the client's basic care and comfort plan?

A nurse is planning care for an older adult client who is completely bedridden following an ischemic stroke. The plan includes interventions to maintain skin integrity, promote comfort, and ensure proper body alignment. Which of the following nursing actions are appropriate to include in the client's care plan? Select all that apply.

A nurse is providing discharge teaching to a client with an opioid use disorder who will be initiating home induction of buprenorphine/naloxone therapy. To prevent precipitated withdrawal and ensure maximum medication absorption, the nurse should instruct the client to perform the administration steps in which order? Arrange the items from first to last.

A mental health nurse is guiding a client through cognitive restructuring to manage chronic stress related to a major life transition. Arrange the nursing actions in the appropriate sequential order for this intervention. (Place the first action at the top and the final action at the bottom.)

A home hospice nurse arrives for a scheduled visit to a client with end-stage amyotrophic lateral sclerosis (ALS). The client's spouse, who is the primary caregiver, is crying and states, "I just cannot do this anymore." The client's sibling, who recently arrived from out of town, is standing in the room arguing loudly, "You are completely neglecting my brother!" The client is awake in bed and visibly distressed by the interaction. Which of the following is the priority nursing action?

A registered nurse is evaluating a client who is 2 hours postpartum following a forceps-assisted vaginal delivery of a macrosomic infant. The client's uterine fundus is firm, midline, and one centimeter below the umbilicus, with scant rubra lochia on the perineal pad. The client reports severe, unremitting pelvic and vaginal pain that is unrelieved by ibuprofen. The client's current heart rate is 114 beats/min and blood pressure is 102/64 mm Hg. Which of the following actions should the nurse take? (Select all that apply.)