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Questions 227

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Extract:


Question 1 of 5

A client has been taking alprazolam (Xanax) for 3 days. Nursing assessment should reveal which expected effect of the drug?

Correct Answer: A

Rationale: Tranquilization, numbing of emotions. The anti-anxiety drugs produce tranquilizing effects and may numb the emotions.

Question 2 of 5

The nurse is caring for a client who underwent a mastectomy 24 hours ago. Which of the following interventions should the nurse prioritize?

Correct Answer: A

Rationale: Encouraging arm exercises prevents lymphedema and restores mobility post-mastectomy. Dependent positioning (
B) increases edema, heating pads (
C) risk tissue damage, and fluid restriction (
D) is unnecessary and harmful.

Question 3 of 5

A client refuses to take the medication prescribed because the client prefers to take self-prescribed herbal preparations. What is the initial action the nurse should take?

Correct Answer: B

Rationale: Respect for differences is demonstrated by incorporating traditional cultural practices for staying healthy into professional prescriptions and interventions. The challenge for the health care provider is to understand the client's perspective. 'Culture care preservation or maintenance refers to those assistive, supporting, facilitative or enabling professional actions and decisions that help people of a particular culture to retain and/or preserve relevant care values to that they can maintain their well-being, recover from illness or face handicaps and/or death.'

Question 4 of 5

A 76-year-old client is admitted to a long-term care facility with Alzheimer's-type dementia. The client has been wearing the same dirty clothes for several days. The nurse contacts the family and asks them to bring in clean clothing. Which intervention would best prevent further regression in the client's personal hygiene?

Correct Answer: A

Rationale: Clients with Alzheimer's-type dementia tend to fluctuate in their capabilities. Encouraging self-care to the extent possible helps increase the client's orientation and promotes a trusting relationship with the nurse. Making the client assume responsibility for physical care is unreasonable. Assigning a staff member to take over the client's physical care restricts the client's independence. Accepting the client's desire to go without bathing promotes poor hygiene.

Extract:

A patient regains consciousness and has expressive aphasia.


Question 5 of 5

As a part of the long-range planning, the nurse should:

Correct Answer: A

Rationale: Positive feedback encourages progress in expressive aphasia recovery.

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