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Extract:


Question 1 of 5

A client is complaining of difficulty walking secondary to a mass in the foot. The nurse should document this finding as:

Correct Answer: D

Rationale: Morton's neuroma is a benign mass in a digital nerve of the foot, causing pain and difficulty walking. The other conditions involve different foot pathologies. Basic Care and Comfort

Question 2 of 5

A 28-year-old client is being treated with acute pelvic inflammatory disease. Which of the following positions will afford the most comfort for this client?

Correct Answer: C

Rationale: Semi-Fowler's position reduces pelvic pressure and promotes comfort in clients with pelvic inflammatory disease.

Question 3 of 5

The nurse is assessing a client with suspected dehydration. Which of the following findings would support this diagnosis?

Correct Answer: B

Rationale: Dehydration causes tachycardia and hypotension due to reduced blood volume. Moist mucous membranes (
A) and clear urine (
C) indicate hydration, and weight gain (
C) suggests fluid retention, not dehydration.

Question 4 of 5

A client with chronic renal failure has a serum potassium level of 6.8 mEq/L. What should the nurse assess first?

Correct Answer: D

Rationale: The nurse should assess the client's cardiac rhythm using electrocardiography because an elevated serum potassium level may lead to a life-threatening cardiac arrhythmia. The client's blood pressure may change, but only as a result of the arrhythmia.
Therefore, the nurse should assess blood pressure later. The nurse also can delay assessing respirations and temperature because these aren't affected by the serum potassium level.

Extract:

Mr. Lou, 65 years old, with liver cirrhosis was ordered neomycin enema


Question 5 of 5

Mr. Lou, 65 years old, with liver cirrhosis was ordered neomycin enema for which of the following goals?

Correct Answer: B

Rationale: Neomycin enemas reduce ammonia-producing bacteria, improving consciousness in hepatic encephalopathy.

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