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Questions 149

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Question 1 of 5

The nurse is at the nurses' station charting when a physician comes up and says, 'Since you are already logged into the computer, I need you to look up some labs on a client.' The client is not cared for by this nurse. Which response by the nurse is most appropriate?

Correct Answer: D

Rationale: Accessing a client's lab results without authorization violates HIPAA, as the nurse is not assigned to the client. The charge nurse can ensure proper access.

Question 2 of 5

The nurse is formulating a plan of care for a client with a goiter. The priority nursing diagnosis for the client with a goiter is:

Correct Answer: D

Rationale: A goiter can compress the trachea, posing a risk for airway obstruction, making ineffective airway clearance the priority nursing diagnosis.

Question 3 of 5

The nurse is caring for a client who will have a pulmonary function test (PFT) performed as an outpatient following hospital discharge. Which should the nurse include in his teaching on the procedure? Select all that apply.

Correct Answer: D,E

Rationale: Smoking cessation for 6-8 hours and withholding bronchodilators for 4-6 hours ensure accurate PFT results. Other instructions are unnecessary or incorrect.

Question 4 of 5

A client is admitted to the surgical unit following a transurethral prostatectomy (TURP). The nurse administers a B&O suppository to help prevent bladder spasms. The nurse would observe the client for:

Correct Answer: C

Rationale: Belladonna and opium (B&O) suppositories can cause nausea and vomiting as side effects. These are more immediate concerns than dependence or the other symptoms.

Question 5 of 5

Which of the following roommates would be most suitable for the client with myasthenia gravis?

Correct Answer: A

Rationale: Hypothyroidism poses no infection risk, unlike pyelonephritis or bronchitis.

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