The nurse analyzes the electrolyte test results for a client and notes that the potassium level is 2.2 mEq/L (2.2 mmol/L). Based on the laboratory result, which ECG pattern is not expected?

Correct Answer: A

Rationale: Absent P waves are not typical in hypokalemia (2.2 mEq/L); they occur in arrhythmias like atrial fibrillation, unrelated to low potassium. Depressed ST , inverted T waves , and U waves are classic ECG signs of hypokalemia, reflecting repolarization issues. Nurses, per NCLEX, expect B, C, D, making A the outlier and correct answer.

Correct Answer: B

Rationale: The correct answer is B) Record the findings. In this scenario, a red and edematous stoma is a common post-operative finding and not indicative of an immediate complication. It is crucial for the nurse to document these observations accurately to establish a baseline for the client's condition and to monitor for any changes over time. Option A) Immediately apply ice is incorrect because applying ice to a red and edematous stoma could potentially cause further damage or complications. It is not a standard intervention for this situation. Option C) Elevate the client's buttocks is incorrect because elevating the buttocks would not directly address the redness and edema of the stoma. It is not a relevant intervention in this context. Option D) Notify the primary healthcare provider is incorrect because, in this case, the observed redness and edema of the stoma are expected post-operative findings. There is no need for immediate notification unless there are additional concerning symptoms or changes in the client's condition. Educationally, understanding the rationale behind documenting normal post-operative findings is essential for nurses to differentiate between expected and unexpected outcomes. This skill is crucial in providing quality care, ensuring accurate communication with the healthcare team, and promoting optimal client outcomes. By recording these findings, nurses can track trends, identify deviations from the norm, and intervene promptly when necessary.

Correct Answer: A

Rationale: Good communication steps , per the answer key, involve a structured process: setting the stage, assessing understanding, sharing info, gauging perspective, and planning next steps. Phone messages lack interaction, supervisor reliance shifts responsibility, and expecting coworker duty skips collaboration. This method, per AHRQ, ensures clarity and teamwork in patient care, critical for nursing assistants in long-term facilities to maintain safety and coordination.

Correct Answer: B

Rationale: Fibromyalgia is a chronic condition marked by widespread musculoskeletal pain, often accompanied by fatigue, sleep disturbances, and cognitive difficulties known as 'fibro fog.' This pain is typically diffuse, affecting multiple body areas, and is a hallmark symptom distinguishing it from other disorders. Choice A, improved energy levels, is incorrect because fibromyalgia commonly causes debilitating fatigue, not vitality. Choice C, temporary muscle stiffness, doesn't capture the persistent, widespread nature of fibromyalgia painstiffness may occur, but it's not the defining feature. Choice D, increased cognitive clarity, is the opposite of the memory and concentration issues patients experience. Choice B correctly identifies widespread musculoskeletal pain as a common, central symptom, making it a key focus for nursing assessment and management in affected individuals.

Correct Answer: B

Rationale: A quiet, dark environment best promotes rest in patients by minimizing sensory stimulation, allowing the body and mind to relax and enter a restorative state. Darkness supports melatonin production, aiding sleep, while quietness reduces arousal, key for those with sleep-rest disorders or fatigue. Choice A, bright lighting, disrupts rest by suppressing melatonin and signaling wakefulness, often used to keep patients alert, not relaxed. Choice C, frequent interruptions, fragments rest, preventing deep sleep or recovery, a common issue in busy hospital settings. Choice D, high noise levels, stimulates the nervous system, increasing stress and hindering rest, especially for sensitive patients. Choice B is the optimal answer, reflecting evidence-based nursing practices that create a conducive rest environment, essential for healing and comfort across various conditions.