166: A charge nurse is observing a newly licensed nurse perf
166: A charge nurse is observing a newly licensed nurse perform… 166: A charge nurse is observing a newly licensed nurse perform suctioning for a client who has a tracheostomy. For which of the following actions by the newly licensed nurse should the charge nurse intervene?Ans: Applies suction during catheter removal Auscultates breath sounds Suctions for 30 seconds Oxygenates with 100% oxygen 167: A nurse is planning care for four clients. Which of the following tasks should the nurse as the charge nurse to reassign to an RN?Ans: Administering a subcutaneous insulin injection Providing discharge teaching about home IV medication therapy Collecting a sputum culture Removing an NG tube 168: A nurse is discussing risk factors for child abuse with members of a parenting group. The nurse should identify which of the following findings as a characteristic of perpetrators of child abuse?Ans: Rigid expectations of behavior High self-esteem Laissez-faire leadership style Self-blame for financial problems 169: A nurse is collecting data from a client who is taking tranylcypromine and reports ingestion of tyramine-rich foods. The nurse should monitor the client for which of the following findings as an adverse effect of the medication?Ans: Hypertension Hyperglycemia Tinnitus Hematuria 170: A nurse is contributing to the plan of care for a client who is pregnant and reports having trouble sleeping. Which of the following instructions should the nurse include in the plan of care?Ans: “Use a transcutaneous electrical nerve stimulator.” ”Obtain a prescription for pramipexole.” ”Lie on your left side with your top leg forward.” ”Soak in a bathtub of hot water each night.” 171: A nurse is monitoring a client’s lower extremity following the placement of a cast earlier in the day. Which of the following findings should the nurse identify as manifestations of compartment syndrome? (Select all that apply)Ans: Sensation of tingling Pale-colored toes Pain relieved by analgesia Decreases skin turgor Diminished capillary refill 172: A nurse nis caring for a client who is unable to perform ADLs and wears dentures. Which of the following actions should the nurse take when providing denture care?Ans: Remove the lower dentures before the upper dentures. Use a circular motion to cleanse the biting surface of the dentures. Place a towel in the sink when cleaning the dentures. Store the dentures in a dry denture cup on the bedside table after cleaning. 173: A nurse is reinforcing teaching with a client’s family about home oxygen use via nasal cannula. Which of the following statements by a family member indicates an understanding of the teaching?Ans: ”We will frequently check the top oh his ears for sores.” ”We can use petroleum jelly to keep his nares moist.” ”We can turn the oxygen up to 10 when he has trouble breathing.” ”We will need to remove the nasal cannula when he is eating.” 174: A nurse is caring for a client who is postoperative following abdominal surgery and has a wound evisceration. Which of the following actions should the nurse take?Ans: Hold gently direct pressure on the protruding organ. Place the client’s knees in an extended position. Cover the wound with sterile, saline-soaked gauze. Raise the head of the bed to a 450 angle. 175: A nurse is reviewing the medical record of a client who is at 37 weeks of gestation and has HELLP syndrome. Which of the following laboratory findings should the nurse expect?Ans: BUN 20 mg/dL Hemoglobin 12 g/dL WBC count 18,000/mm3 Platelet count 77,000/mm3 176: A nurse is caring for a client who has Graves’ disease. Which of the following findings should indicate to the nurse that the client is developing a thyroid storm?Ans: Tachycardia Respiratory depression Hypotension Neck pain 177: A nurse is making a follow-up call to a client who has a new prescription for an ACE inhibitor to treat hypertension. The client reports lightheadedness upon standing. Which of the following statements should the nurse make?Ans: “Restrict your daily fluid intake.” ”Sit back down for a few minutes when this occurs.” ”Take a daily potassium supplement.” ”Discontinue this medication if this occurs again.” 178: A nurse is caring for a client who has an indwelling catheter with a urinary drainage system. Which of the following actions should the nurse take?Ans: Secure the tubing with adhesive tape to the lower abdomen. Instruct the client to hold the drainage bag at waist height when ambulating. Collect a sterile specimen from the urinary drainage bag. Coil the tubing on the bed above the collection bag. 179: A nurse is administering pancrelipase to a child who has cystic fibrosis. Which of the following outcomes should the nurse expect as a therapeutic effect of the treatment?Ans: Reduced fat in the stools Improved respiratory function Improved absorption of vitamins B and C Decreased sodium excretion 180: A nurse is caring for a client who is 1 day postoperative following a total hip arthroplasty and is receiving heparin subcutaneously. Which of the following adverse effects of the medication should the nurse report to the provider?Ans: Bradycardia Epistaxis Weight gain AnorexiaHealth Science Science Nursing RNSG 1341
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