A client reports difficulty sleeping at night, which interferes with daily functioning. Which intervention should the nurse suggest to this client?

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Question 1 of 9

A client reports difficulty sleeping at night, which interferes with daily functioning. Which intervention should the nurse suggest to this client?

Correct Answer: A

Rationale: The correct answer is A: Avoid beverages containing caffeine. Caffeine is a stimulant that can interfere with sleep, making it difficult for the client to fall asleep at night. Taking sleep medication regularly (choice B) may not address the root cause of the sleep difficulty and can lead to dependency. Watching television in bed (choice C) can actually stimulate the brain and hinder relaxation before sleep. Advising the client to take several naps during the day (choice D) can disrupt the sleep-wake cycle further. Therefore, recommending the avoidance of caffeine-containing beverages is the most appropriate intervention to help the client improve their ability to sleep at night and function better during the day.

Question 2 of 9

A client with hypertension is being educated by a healthcare professional about lifestyle changes. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer: B

Rationale: The correct answer is B: 'I should consume foods low in sodium.' This statement indicates an understanding of managing hypertension. Excessive sodium intake can lead to increased blood pressure, so reducing sodium consumption is crucial in hypertension management to prevent complications. Choices A, C, and D are incorrect. Consuming foods low in potassium is not typically recommended for hypertension management as potassium-rich foods like fruits and vegetables can be beneficial. Consuming foods high in saturated fats and cholesterol can be detrimental to cardiovascular health and should be limited in individuals with hypertension.

Question 3 of 9

Indicate true or false: (Adapted: Which statement is true about IV solutions?)

Correct Answer: A

Rationale: Hypotonic solutions (e.g., 0.45% saline) shift fluid into cells, replacing intracellular loss (e.g., dehydration), making this true ideal for cellular rehydration. Smaller veins aren't ideal for irritating solutions (e.g., potassium); larger veins dilute and tolerate them better, reducing phlebitis making this false. Adapting the true/false format, 'hypotonic solutions should replace intracellular loss' stands as true, supported by fluid dynamics in nursing. Both being true fails due to the vein statement. Neither true ignores the hypotonic role. The first statement's accuracy aligns with IV therapy principles, guiding nurses in fluid management, making it the correct choice.

Question 4 of 9

A client has a new prescription for a low-fat diet. Which of the following foods should be recommended?

Correct Answer: C

Rationale: When following a low-fat diet, it is essential to choose foods that are low in fat. Chicken breast is a lean protein source that is low in fat, making it a suitable option for a low-fat diet. Bacon, whole milk, and cheese are higher in fat content and should be avoided or limited in a low-fat diet. Bacon is high in saturated fat, whole milk contains significant amounts of fat, including saturated fat, and cheese is also high in fat. Therefore, these options are not ideal for a low-fat diet.

Question 5 of 9

The physician has ordered Stadol (butorphanol) for a post-operative client. The nurse knows that the medication is having its intended effect if the client:

Correct Answer: A

Rationale: Being asleep 30 minutes post-Stadol indicates effective pain relief and sedation, its intended effect post-op extra food, urine output, or less nausea aren't primary goals. Nurses monitor response, ensuring rest and pain control, critical for recovery in surgical care.

Question 6 of 9

The best position for examining the rectum is:

Correct Answer: C

Rationale: Knee-chest provides optimal access and visibility for rectal exams.

Question 7 of 9

A client with hyperkalemia is being taught about dietary management. Which of the following statements by the client indicates an understanding of the teaching?

Correct Answer: B

Rationale: Correct! Hyperkalemia is a condition characterized by high levels of potassium in the blood. To manage hyperkalemia, it is essential to decrease the intake of potassium-rich foods since excess potassium can worsen the condition. By understanding the need to decrease potassium-rich foods, the client shows comprehension of the dietary management required for hyperkalemia. Choice A is incorrect because increasing potassium-rich foods would exacerbate hyperkalemia. Choice C is incorrect since increasing sodium-rich foods is unrelated to managing hyperkalemia and could potentially lead to other health issues. Choice D is incorrect as decreasing sodium-rich foods is not the primary focus when managing hyperkalemia.

Question 8 of 9

Tympanic temperature is taken from John, A client who was brought recently into the ER due to frequent barking cough. The temperature reads 37.9 Degrees Celsius. As a nurse, you conclude that this temperature is

Correct Answer: D

Rationale: Tympanic temp of 37.9°C is normal (36.6-38°C) e.g., high-normal from cough stress. Not high (>38°C), low (<36.6°C), or low-end. Nurses interpret this e.g., monitor trends in acute cases, per standard ranges.

Question 9 of 9

The nurse is caring for clients in a rural health clinic and wants to promote illness prevention. Which action should the nurse take?

Correct Answer: A

Rationale: In a rural clinic, illness prevention primary prevention aims to stop disease before it starts, critical where access lags. Providing accident prevention education, like safe tractor use or fall risks, targets common rural hazards, reducing injuries proactively. Screening for hypertension is secondary, detecting issues, not preventing them. Referring chronic cases to specialists or teaching diabetic diets is tertiary, managing existing conditions, not averting onset. Accident prevention fits rural needs data shows higher injury rates in such areas empowering clients with knowledge to avoid harm. The nurse's action aligns with nursing's preventive role, addressing environmental and lifestyle risks unique to the setting, enhancing community health by tackling root causes before they escalate, a practical step given limited rural resources.

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