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[单项选择]The nurse is caring a client in an acute care mental health program. The client refuses his morning dose of an oral antipsychotic medication and believes he’s being poisoned. What should the nurse do
A. Crushing the medication and putting it in his food.
B. Consulting with the physician about a plan of care.
C. Administering the medication by injection.
D. Omitting the dose and trying again the next day.
[单项选择]A family member is caring for a client diagnosed with Alzheimer’s disease. Which of the following is most likely to cause the caregiver depression and role strain
A. The caregiver had a close relationship with the client before diagnosis of the illness.
B. The caregiver has no formal support, such as a visiting nurse or day care worker.
C. The caregiver understands the full reality of the disease and its inevitable progression.
D. The caregiver feels unable to control the client and unable to cope with caregivin
[单项选择]The nurse is caring for a client with cholelithiasis. Which sign indicates obstructive jaundice
A. Straw-colored urine.
B. Reduced hematocrit.
C. Clay-colored stools.
D. Elevated urobilinogen in the urin
[单项选择]The nurse is caring for a client with otosclerosis scheduled to undergo a stapedectomy. The client asks the nurse when her hearing will improve. Which response by the nurse is most appropriate
A. Your hearing may not improve but you’ll no longer be bothered by tinnitus.
B. Your hearing may be dramatically improved right after surgery.
C. You may notice improved hearing within 1 to 2 weeks.
D. Your hearing may improve 3 to 6 weeks after surgery.
[单项选择]A client with stress incontinence asks the nurse what kind of diet she should follow at home. Which of the following diet regime would most likely be recommended by the nurse
A. Avoid alcohol and caffeine.
B. Decrease fluid intake.
C. Increase intake of fruit juice.
D. Avoid milk products.
[单项选择]The nurse is caring for a client whom she suspects is paranoid. How would the nurse confirm this assessment()
A. Indirect questioning.
B. Direct questioning.
C. Lead-in sentences.
D. Open-ended sentences.
[单项选择]The nurse is caring for a client undergoing a cystoscopy to diagnose bladder cancer. Following the test, the client returns to his room. Which signs should alert the nurse to a potential complication()
A. Chills and tachycardia.
B. Urinary frequency and burning on urination.
C. Dizziness and fainting.
D. Pink-tinged urine and bladder spasms.
[单项选择]The nurse is caring for a client diagnosed with body dysmorphic disorder. When the client verbalizes disapproval of her physical features, the nurse should()
A. encourage verbalizations about fears and stressful life situations.
B. agree with the client because she feels a specific physical feature is awful.
C. ignore the comment and talk about less threatening issues.
D. compliment the client on her appearance.
[单项选择]The nurse is caring for a client with an exacerbation of ulcerative colitis. Which of the following nursing measures should be included in the plan of care
A. Encourage regular use of antidiarrheal medications.
B. Incorporate frequent rest periods into the client’s schedule.
C. Have the client maintain a high-fiber diet.
D. Wear a gown when providing direct client car
[单项选择]The nurse is caring for a client with mild active bleeding from placenta previ
A. a. Which of the following observations indicates that an emergency cesarean section may be necessary Increased maternal blood pressure of 150/90 mmHg.B. Decreased amount of vaginal bleeding.C. Fetal heart rate of 80 beats per minute.D. Maternal heart rate of 65 beats per minut
[单项选择]The nurse is caring for a client who is experiencing auditory hallucinations. What would be most critical for the nurse to assess
A. Possible hearing impairment.
B. Family history of psychosis.
C. Content of the hallucinations.
D. Possible sella turcica tumors.
[单项选择]The nurse is caring for a client with acute pulmonary edem
A. a. To immediately promote oxygenation and relieve dyspnea, which of the following interventions is appropriate Administer oxygen.B. Have the client take deep breaths and cough.C. Place the client in high Fowler’s position.D. Perform chest physiotherapy.
[单项选择]The nurse is caring for a client who complains of chronic pain. Given this complaint, why would the nurse simultaneously evaluate both general physical and psychosocial problems
A. Depression is commonly characterized by pain disorders and somatic complaints.
B. Combining evaluations will save time and allow for quicker delivery of health care.
C. Most insurance plans won’t cover evaluation of both as separate entities.
D. The physician doesn’t have the training to evaluate for psychosocial considerations.
[单项选择]The nurse is caring for a client during the fourth stage of labor. Which of the following nursing interventions would be LEAST appropriate
A. Catheterization to protect the bladder from trauma.
B. Perineal assessments for swelling and bleeding.
C. Vital signs and fundal checks every 15 minutes.
D. Time with the neonate to initiate breast-feedin
[单项选择]The nurse is caring for a client with bipolar disorder in a manic state. Which of the following nursing interventions should be included in the plan of care
A. Allowing the client to exhibit hyperactive, demanding, manipulative behavior without setting limits.
B. Listening attentively with a neutral attitude and avoiding power struggles.
C. Offering high-calorie meals and strongly encouraging the client to finish all food.
D. Insisting that the client remain active through the day so that he’ll sleep at night.
[单项选择]The nurse is caring for a client with acute osteomyelitis in the right tibi
A. a. Which of the following measures is most appropriate when repositioning the client’s leg Hold the leg by the ankle when repositioning to avoid touching the tibia.B. Support the leg above and below the affected area when positioning.C. Have the client move the leg by himself to decrease pain.D. Apply warm moist compresses to the leg before repositionin
[单项选择]The nurse is caring for a client hospitalized on numerous occasions for complaints of chest pain and fainting spells, which she attributes to her deteriorating heart condition. No relatives or friends report ever actually seeing a fainting spell. After undergoing an extensive cardiac, pulmonary, GI, and neurologic workup, she’s told that all test results are completely negative. The client remains persistent in her belief that she has a serious illness. What diagnosis is appropriate for this client
A. Exhibitionism.
B. Somatoform disorder.
C. Degenerative dementia.
D. Echolali
[单项选择]The nurse is caring for a client who exhibits magical thinking. Which of the following best describes magical thinking
A. Strong positive and negative feelings that cause conflict.
B. Returning to an earlier developmental stage.
C. Meaningless repetition of words.
D. The belief that thoughts or wishes can control other people or events.
[单项选择]The nurse is caring for a client who exhibits signs of somatization. Which of the following statements is most relevant
A. Clients with somatization are cognitively impaired.
B. Anxiety rarely coexists with somatization.
C. Somatization exists when medical evidence supports the symptoms.
D. Clients with somatization often have lengthy medical records.