Extract:

Question 1 of 5

A client has polycystic kidney disease. The client asks the nurse, 'How did I get these fluid-filled bubbles on my kidneys? I have not had any X-ray type tests.' How should the nurse respond to help the client understand risk factors for this disease process?

Correct Answer: C

Rationale: Polycystic kidney disease is primarily genetic, with a higher incidence among blood relatives due to autosomal dominant or recessive inheritance patterns.

Question 2 of 5

You are serving as the supervisory nurse for a home healthcare agency in the community. You are doing an admission assessment for a 76 year old male client who resides with his elderly wife. Which of the following assessments would indicate that the couple needs some education relating to home safety?

A. The client has refrigerated foods labelled with an expiration date. B. You assess that the home is free of scatter rugs that many use to protect the feet against hard floors. C. The client uses the FIFO method for insuring food safety. D. The client assures you that the smoke alarm batteries are replaced annually to insure that they work.

Correct Answer: B

Rationale: The absence of scatter rugs is a safety feature, not a concern requiring education. Labeled foods , FIFO method , and annual smoke alarm battery replacement are all safe practices. However, the question implies a need for education, and B is the least directly related to a safety deficit, but no clear safety issue is present in the options provided.

Question 3 of 5

Your client is receiving phototherapy. What nursing intervention would you implement for this client?

A. Placing the client in the Trendelenburg position B. Monitoring the color of the stools C. Using a Hoyer lift for patient transfers D. Monitoring the arterial blood gases

Correct Answer: B

Rationale: Phototherapy, often used for jaundice, can affect stool color (e.g., green or loose stools in infants). Monitoring stool color helps assess treatment effects and complications.

Question 4 of 5

The nurse is caring for a client with a diagnosis of peptic ulcer disease. When monitoring the client for possible gastrointestinal perforation, the nurse identifies the importance of what assessment data?

A. Slow, strong pulses B. Increase in bowel sounds C. Positive guaiac stool tests D. Sudden, severe abdominal pain

Correct Answer: D

Rationale: Sudden, severe abdominal pain is a sign of perforation. When perforation occurs, the pulse will more likely be weak and rapid. The nurse may be unable to hear bowel sounds at all. Positive guaiac stool results indicate the presence of bleeding but are not necessarily indicative of perforation.