Peterstudies

1. A nurse is caring for a client who is postprocedure following a lumbar puncture and reports a throbbing headache when sitting upright. Which of the following actions should the nurse take? (Select all that apply). A. Use the Glasgow Coma Scale when assessing the client. B. Assist the client to a supine position. C. Administer an opioid medication. D. Encourage the client to increase fluid intake. E. Instruct the client to perform deep breathing and coughing exercises.: B. Assist the cl...

1. A nurse is caring for a client who has a WBC count of 20,000/mm3. Which of the following WBC abnormalities is consistent with the findings? A. Neutropenia B. Leukocytosis C. Left shift D. Leukopenia: B. Leukocytosis (WBC count greater than 10,000/mm3 , which indicate inflammation or infection.) 2. A nurse is reviewing the laboratory findings of a client who has measles. The nurse should expect an increase in which of the following types of WBCs? A. Neutrophils B. Basophils C. Lymp...

1. A nurse in an emergency department is preparing to perform an ocular irrigation for a client. Which of the following actions should the nurse plan to take? a. Assess the client's visual acuity prior to irrigation b. Have the client turn their head toward the unaffected eye c. Hold the irrigator syringe 3.81 cm (1.5 in) above the eye d. Perform the irrigation with sterile water for irrigation: d. Perform the irriga- tion with sterile water for irrigation 2. A nurse is preparing to admini...

1. A nurse is reviewing the health history of a client who has diabetes mellitus type 2. Which of the following are risk factors for hyperglycemic hyperosmolar state (HHS)? (Select all that apply) A. Evidence of recent myocardial infarction B. BUN 35 mg/dL C. Takes a calcium channel blocker D. Age 77 years E. Daily insulin injections: a,b,c,d 2. A nurse is assessing a client who has diabetic ketoacidosis and ketones in the urine. The nurse should expect which of the following findings? (...

1. A nurse is assisting with the care of a client who has a femur fracture and is in skeletal traction. Which of the following actions should the nurse take: Ensure the client's weights are hanging freely from the bed. 2. A nurse in a provider's office is reinforcing teaching with a client who has anemia and has been taking ferrous gluconate for several weeks. Which of the following instructions should the nurse include?: Take this medication between meals 3. A nurse in a provider's office ...

1. The nurse is providing discharge teaching for a client who is postoperative following a laparoscopic cholecystectomy. Which of the following instruc- tions should the nurse include?: -Resume a diet of choice -Cleanse the puncture site using mild soap and water -Report nausea and vomiting to the surgeon 2. A nurse is reviewing risk factors with a client who has cholecystitis. The nurse should identify that which of the following as a risk factor for cholecystitis?: Obesity 3. A nurse is co...

1. A nurse in an emergency department is preparing to perform an ocular irrigation for a client. Which of the following actions should the nurse plan to take? a. Assess the client's visual acuity prior to irrigation b. Have the client turn their head toward the unaffected eye c. Hold the irrigator syringe 3.81 cm (1.5 in) above the eye d. Perform the irrigation with sterile water for irrigation: d. Perform the irriga- tion with sterile water for irrigation 2. A nurse is preparing to admini...

1. Glascow Coma Scale (GCS): eye opening, verbal response, motor response 2. Romberg test: performed once with eyes open and with eyes closed - assess balance and motor function 3. normal ICP: 10-15 mmhg 4. signs of increased ICP: irritability (EARLY SIGN) restlessness headache pupil abnormalities 5. interventions for ICP: - avoid suctioning - hyperventilate pts - maintain HOB 30 - spread out nursing activities - decrease stimuli 6. Late finding of ICP: cushing's triad 7. lumbar pu...

1. A nurse is monitoring a client who is receiving two units packed RBC's. Which of the following manifestation indicates a hemolytic transfusion reac- tion? a) back pain b) Hypertension c) Chills d) bradycardia: a) back pain 2. A nurse is planning care for a client who has a full-thickness burns on the lower extremities. Which of the following interventions should the nurse include? a) Limit visitation time for client's children to 40 minutes per day b) clean the equipment in the c...

1. A nurse is taking an adult client's temp rectally/ What action should the nurse take? A. Rotate the probe if any resistance is met as the thermometer is inserted. B. Insert the probe to aim at the client's pelvic area. C.Dip the probe about 0.58 cm (2 in) into a tube of lubricant. D.Insert the probe about 1.27 cm (0.5 in) into the client's anus.: Insert the probe about 1.27cm into the client's anus 2. A nurse is auscultating a client's apical pulse to listen to the S1 and S2 heart...