A nurse is teaching a client who has urolithiasis (renal calculi). The nurse should explain that which of the following conditions can increase the risk for renal calculi?
Answer Choices:
Dehydration
Protein in the urine
Obesity
Iron deficiency
Answer: Dehydration
A nurse is caring for a client who has borderline personality disorder (BPD). The client says, “Why don’t you shut up already? I can read it myself, you know!” Which of the following responses should the nurse give?
Answer Choices:
“I don’t like it when you address me with that tone of voice.”
“We do this every day. Why are you so angry with me this morning?”
“I know you can, but are you going to read it or not?”
“Fine. Here is the schedule, and I will expect you to be on time to your therapies.”
Answer: “I know you can, but are you going to read it or not?”
A nurse is caring for a client who has end-stage renal disease (ESRD). Which of the following are expected findings? (Select all that apply).
Answer Choices:
Hypotension
Pruritus
Slurred speech
Bone pain
Bradypnea
Answer: Hypotension, Pruritus, Bone pain
A nurse is assessing a client who is admitted with hyperthyroidism. The client reports weight loss, increased appetite, increased perspiration, fatigue, menstrual irregularity, and restlessness. Which of the following actions should the nurse take to prevent a thyroid crisis?
Answer Choices:
Observe the client carefully for signs of hypocalcemia.
Keep the client NPO.
Provide a quiet, low-stimulus environment.
Administer aspirin as prescribed for any sign of hyperthermia.
Answer: Provide a quiet, low-stimulus environment.
For each potential provider’s prescription, specify anticipated, nonessential, or contraindicated.
Answer Choices:
Prepare client for surgery
Administer aspirin for abdominal pain
Test stools for occult blood
Initiate continuous ECG monitoring
Insert NG tube, attach to suction
Administer 1 unit PRBC
Initiate IV fluids
Answer: Prepare client for surgery – Anticipated
Administer aspirin for abdominal pain – Contraindicated
Test stools for occult blood – Anticipated
Initiate continuous ECG monitoring – Nonessential
Insert NG tube, attach to suction – Anticipated
Administer 1 unit PRBC – Anticipated
Initiate IV fluids – Anticipated
A nurse is providing discharge teaching for a client who is to perform peritoneal dialysis at home. Which of the following information should the nurse include?
Answer Choices:
“You should avoid foods high in fiber.”
“You should warm the dialysate in a microwave oven before instillation.”
“You should expect redness at the catheter exit site.”
“You should anticipate pain the first week during the inflow of dialysate.”
Answer: “You should expect redness at the catheter exit site.”
A nurse is admitting a client to the mental health unit. Based on the notes, diagnostic results, medications, and history, which interventions should the nurse include in the plan?
Answer Choices:
Educate the client about the need for hemodialysis
Withhold next dose of lithium
Discuss contraception with the client
Notify the provider of potential medication interactions
Administer prochlorperazine
Set up a dietary consult for a low-sodium diet
Answer: Withhold next dose of lithium, Notify the provider of potential medication interactions, Administer prochlorperazine, Set up a dietary consult for a low-sodium diet
A nurse is reviewing the laboratory findings of a client who has a new diagnosis of Graves’ disease. The nurse should anticipate which of the following laboratory values to be elevated?
Answer Choices:
Calcium
Triiodothyronine (T3)
Thyroid-stimulating hormone
Phosphorus
Answer: Triiodothyronine (T3).
A nurse is caring for a client who has diabetic ketoacidosis. Which of the following manifestations should the nurse expect?
Answer Choices:
Blood glucose level below 40 mg/dL
Malignant hypertension
Acetone odor to breath
Cheyne-Stokes breathing
Answer: Acetone odor to breath
A nurse is providing discharge teaching to a client who had a bilateral orchiectomy. The nurse should instruct the client to expect which of the following symptoms?
Answer Choices:
Hot flashes
Increased libido
Increased muscle mass
Hypoglycemia
Answer: Hot flashes.
A nurse is providing teaching to a client about measures to prevent urinary tract infections (UTIs). Which of the following client statements indicates a need for further teaching?
Answer Choices:
“I will need to empty my bladder regularly and completely.”
“I need to drink 8 cups of liquid each day.”
“I will need to wipe my perineal area from back to front after urination.”
“I will need to drink apple cider vinegar each day.”
Answer: “I will need to drink apple cider vinegar each day.”