Tüm alıştırma soruları

A nurse is caring for a client who recently received an intravenous dose of morphine for severe postoperative pain. During the reassessment, the nurse notes that the client is difficult to arouse, has pinpoint pupils, and has a respiratory rate of 8 breaths per minute. Which of the following actions should the nurse take first?

A nurse is preparing to administer an intermittent enteral tube feeding to a client via a percutaneous endoscopic gastrostomy (PEG) tube. Place the following nursing actions in the correct sequence to ensure safe administration.

An older adult client is admitted to the medical-surgical floor with severe bilateral lower extremity edema associated with chronic venous insufficiency. What is the most appropriate action by the nurse to manage the client's swelling and promote comfort?

A registered nurse is caring for a client at 38 weeks gestation in active labor. Fifteen minutes ago, the client received a continuous lumbar epidural infusion for pain management. The nurse assesses the client and notes that her blood pressure has decreased from 124/78 mmHg to 92/54 mmHg. Simultaneously, the external fetal monitor displays recurrent, gradual decreases in the fetal heart rate (FHR) that begin after the peak of the uterine contractions and return to the baseline only after the contractions have ended.

Which of the following actions should the nurse perform first?

A nurse is conducting hourly rounds on an inpatient dual-diagnosis unit and discovers a client unresponsive with cyanotic lips, pinpoint pupils, and a respiratory rate of 6 breaths per minute. The client has a documented history of severe opioid use disorder. Arrange the following nursing actions in the correct order of priority.

A client with acute decompensated heart failure is receiving continuous intravenous (IV) infusions of milrinone at $0.5 \text{ mcg/kg/min}$ and heparin at $1,200 \text{ units/hr}$ through a double-lumen central venous catheter (CVC). The client's morning serum potassium level is $2.6 \text{ mEq/L}$. The healthcare provider prescribes a single dose of potassium chloride (KCl) $40 \text{ mEq}$ in $100 \text{ mL}$ of $0.9\%$ sodium chloride to infuse intravenously over $4 \text{ hours}$. The nurse consults a parenteral drug reference and notes that KCl is physically incompatible with both milrinone and heparin at the Y-site. Which action is the most appropriate for the nurse to take?

An 82-year-old resident in a long-term care facility receives continuous enteral nutrition via a percutaneous endoscopic gastrostomy (PEG) tube. The nursing staff observes that the resident has recently developed sudden-onset confusion, frequent bowel incontinence, and worsening sacral erythema. Which action by the registered nurse demonstrates safe practice regarding the client's basic care and comfort?

A nurse is preparing to remove and dispose of bed linens heavily soiled with feces from a client diagnosed with a Clostridioides difficile (C. diff) infection. Arrange the following actions in the correct sequence to ensure safe handling of infectious materials.

A nurse at an outpatient wellness center is creating a targeted health promotion initiative to increase influenza vaccination compliance among older adult clients. In what order should the nurse perform the following actions?

An orthopedic nurse is reviewing postoperative orders for a client who underwent a right total hip arthroplasty using a posterolateral approach. To minimize the risk of prosthesis dislocation, which interventions should the nurse include in the daily care plan? Select all that apply.

A community health nurse is conducting a follow-up assessment on a 24-year-old client who was prescribed pre-exposure prophylaxis (PrEP) for HIV prevention 3 months ago. The client states, "I take my medication every single day as prescribed, so I have stopped using condoms during sexual encounters." Which of the following is the most appropriate response by the nurse?

A nurse assumes care for a client who is 4 hours postoperative following a right-sided pneumonectomy for bronchogenic carcinoma. The client has no chest tube in place. Current vital signs are: heart rate 112/min, respiratory rate 24/min, blood pressure 118/76 mm Hg, and SpO2 93% on 3 L/min of oxygen via nasal cannula. The nurse observes the client lying in the left lateral decubitus position with the head of the bed elevated 30 degrees. Assessment reveals absent breath sounds on the right side and a trachea that is deviated slightly to the right. Which intervention should the nurse implement FIRST to reduce the client's risk for sudden physiological decompensation?

A 72-year-old individual is receiving treatment on the medical-surgical floor for right-sided bacterial pneumonia. The client exhibits shallow breathing, generalized weakness, and expresses feeling exhausted from continuous coughing. What is the most appropriate action for the registered nurse to take?

While transporting a prepared intravenous bag of doxorubicin to a client's room, an oncology nurse accidentally drops the bag on the floor, causing it to rupture and spill the antineoplastic solution into the hallway. Which of the following actions should the nurse take first?

A nurse is caring for a client receiving intravenous (IV) fluids. The client suddenly develops shortness of breath, a cough, and crackles in the lung bases. Arrange the following nursing actions in the priority order they should be performed.

A nurse is instructing a client who is non-weight-bearing on the left leg due to a fractured tibia on how to safely ascend a flight of stairs using crutches. Arrange the following steps of a three-point gait in the correct sequential order.

A nurse is assessing a client who is postoperative and at risk for hemorrhage. Which of the following clinical findings indicate the client is developing early hypovolemic shock? Select all that apply.

A nurse is preparing to administer a large-volume cleansing enema to an adult client to relieve constipation. Arrange the following procedural steps in the correct chronological order from first to last.

A nurse is caring for a client receiving total parenteral nutrition (TPN) via a central venous catheter (CVC). During a tubing change, the CVC accidentally disconnects from the injection cap. The client suddenly gasps, reports sharp chest pain, and exhibits dyspnea with cyanosis. Arrange the following risk-reduction actions in the chronological order the nurse must perform them to manage this complication.

A nurse is preparing to administer a prescribed intravenous (IV) piggyback dose of a reconstituted antibiotic. The client has a continuous primary IV infusion of $0.9\%$ sodium chloride running via an electronic infusion pump. Arrange the following steps in the correct chronological order to safely prepare and initiate the secondary IV piggyback infusion. All steps must be used.