Tüm alıştırma soruları

A palliative care nurse conducts a home visit for an older adult client with end-stage heart failure. The client's adult daughter, who serves as the primary caregiver, appears tearful and profoundly fatigued. The daughter's spouse privately states to the nurse, "She refuses to leave her father's side, even to sleep or eat with our children. Our family is falling apart." When approached by the nurse, the daughter states, "Nobody else can care for him correctly. If he dies while I am resting, I will never forgive myself." Which of the following is the priority nursing action?

A client arrives at the medical unit after undergoing a diagnostic lumbar puncture. To decrease the risk of a post-dural puncture headache, which action is most important for the nurse to implement?

A home health nurse is conducting an initial evaluation for an older adult client with newly diagnosed heart failure. The client recently immigrated and speaks limited English. The client's adult children, who are fluent in English, answer all the nurse's questions and state, "We will manage all the medications, cooking, and medical decisions for our parent, as is our cultural tradition." Which action is the priority for the nurse to take?

A client is receiving cardiac monitoring on a telemetry unit three days after an intentional medication overdose. During the first two days of admission, the client was withdrawn, tearful, and refused to eat. On the morning of the third day, the nurse notes the client is fully dressed, appears highly energized, and exhibits a bright affect. The client approaches the nurse, offers a valuable piece of personal jewelry, and states, "Thank you for everything; I finally know exactly how to fix all my problems." Which behavioral intervention should the nurse implement first?

A nurse is preparing to reposition a bedridden client who is receiving continuous enteral tube feedings. Which of the following actions is most appropriate for the nurse to take?

A nurse is interacting with several clients across different clinical settings and utilizes various therapeutic communication techniques to facilitate psychosocial care. Match each nursing statement with the specific therapeutic communication technique it demonstrates.

A 24-year-old client is preparing for the removal of a thoracostomy (chest) tube, which was placed three days ago for a primary spontaneous pneumothorax. Current clinical assessments indicate symmetrical chest excursion and full lung re-expansion on the morning radiograph. To safely reduce the risk of procedural complications and prevent atmospheric air entry into the pleural space, arrange the following nursing actions in the correct chronological sequence.

The nurse receives the shift report for four clients on a medical-surgical unit. Which client should the nurse assess first?

The healthcare provider prescribes $40\text{ mEq}$ of intravenous (IV) potassium chloride for a client whose morning laboratory results reveal a serum potassium level of $2.5\text{ mEq/L}$. The client currently has a continuous transfusion of packed red blood cells (PRBCs) running through a single-lumen peripheral IV catheter. Which of the following actions should the nurse take to safely administer the medication?

A palliative care nurse is caring for an alert and oriented client with end-stage liver disease. The client's extended family privately requests that the nurse avoid discussing the poor prognosis with the client, stating that in their culture, discussing death brings bad luck and destroys hope. Shortly after, the client asks the nurse, "Am I dying?" Which of the following are appropriate nursing actions? Select all that apply.

A nurse is preparing to ambulate a client who has multiple sclerosis and resulting right leg weakness using a standard (non-rolling) pickup walker. Arrange the nurse's actions and instructions in the correct chronological sequence.

A nurse is caring for a Native American client admitted with an acute exacerbation of chronic obstructive pulmonary disease (COPD). The client is receiving continuous oxygen therapy via nasal cannula. The client's family arrives and requests to perform a traditional smudging ceremony in the client's room, which involves burning small amounts of dried sage for spiritual purification. Which of the following is the most appropriate action by the nurse?

A nurse is evaluating a client who has experienced severe, persistent vomiting for the past three days. Which of the following acid-base imbalances should the nurse anticipate as a direct physiological consequence of this condition?

A client presents to the primary care clinic pacing rapidly, wringing their hands, and hyperventilating. The client states, "My business partner just stole everything we had and vanished! I'm completely ruined. I can't think, I don't know how I'm going to tell my family." Which of the following initial nursing interventions are appropriate for this client? Select all that apply.

A nurse is caring for a client who is recovering from open abdominal surgery. The client coughs forcefully, reports a "popping" sensation, and the nurse observes a wound evisceration. In what order should the nurse perform the following actions? Arrange the steps from first to last.

A nurse in an inpatient psychiatric unit is caring for a client with schizophrenia who is actively experiencing distressing auditory hallucinations. Which of the following nursing interventions should the nurse include in the client's plan of care? (Select all that apply.)

A client admitted with a pulmonary embolism has a new prescription for a continuous intravenous heparin infusion at $18\text{ units/kg/hr}$. The client weighs $187\text{ lbs}$. The pharmacy dispenses a premixed bag containing $25,000\text{ units}$ of heparin in $500\text{ mL}$ of $0.9\%$ sodium chloride. At what rate in $\text{mL/hr}$ should the nurse program the infusion pump? (Round the final answer to the nearest whole number.)

A nurse is preparing to administer a prescribed intravenous (IV) piggyback medication to a client who is currently receiving a continuous IV infusion of 0.9% sodium chloride. What is the priority nursing action before attaching the secondary IV tubing to the primary line?

A client has just returned to the medical-surgical unit after undergoing a percutaneous liver biopsy. To minimize the risk of post-procedure hemorrhage, which of the following positions should the nurse assist the client into?

A nurse is developing a post-procedure plan of care for a 54-year-old client who has just returned to the medical-surgical unit following a flexible bronchoscopy with a transbronchial biopsy under conscious sedation. Which of the following nursing actions should be included to reduce the risk of potential complications? Select all that apply.