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A client with a family history of cardiac disease is seeking information to control risk factors. Which lifestyle modification is most important for the nurse to encourage?
- A. Smoking cessation.
- B. Regular exercise.
- C. Low-fat diet.
- D. Stress reduction.
Correct Answer: A
Rationale: Smoking is a major cardiac risk factor.
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A confused older adult client is having trouble sleeping at night and is sometimes found wandering in the hallway. Which nursing intervention should the nurse implement first?
- A. Administer a PRN sedative prescription.
- B. Leave the door to the client’s room open slightly.
- C. Apply wrist restraints to prevent wandering.
- D. Provide a back rub at bedtime.
Correct Answer: B
Rationale: Back rub addresses agitation non-pharmacologically.
A child has experienced several episodes of vomiting. After the nurse reviews the need to provide only clear liquids, the parent of the child reports making clear liquid popsicles out of flavored gelatin for the child. Which information should the nurse obtain about the popsicles?
- A. How many popsicles are available.
- B. The color and flavor of gelatin used.
- C. If the popsicles are completely frozen.
- D. Whether they contain pulp or fruit.
Correct Answer: C
Rationale: Pulp or fruit ensures clear liquid compliance.
An older adult female client tells the clinic nurse about frequently awakening during the night and not being able to go back to sleep. What action(s) should the nurse suggest to the client to help improve sleep?
- A. Ask the healthcare provider for a mild sedative for bedtime.
- B. Take an afternoon nap to make up for missed sleep.
- C. Drink a mixture of warm water, whiskey, and honey at bedtime.
- D. Establish a regular time for going to bed and getting up.
- E. Avoid drinking caffeinated beverages late in the day.
Correct Answer: D,E
Rationale: Regular schedule and avoiding caffeine improve sleep.
A 64-year-old female client with a 3-day history of cough and chest pain is admitted for presumed pneumonia. The client has a history of type 2 diabetes mellitus and takes insulin glargine 17 units in the morning and 17 units in the evening. Which of the following actions should the nurse take to prevent medication errors?
- A. Double check all dosage calculations.
- B. nusually large or small doses.
- C. Compare the medication label to the order.
- D. Use at least 2 client identifiers before administering a dose.
- E. Involve and educate clients in medication administration.
- F. Document all medication in the electronic record as soon as it is given.
Correct Answer: A,C,D,E.F
Rationale: Verification and documentation ensure safety.
A client who had emergency gallbladder surgery yesterday is getting ready for discharge. The client speaks very little English. When teaching wound care, which method should the nurse use to evaluate the client’s understanding of self-care at home?
- A. Have the client demonstrate prescribed wound care.
- B. After each instruction, ask if the client understands.
- C. Have an interpreter repeat the wound care instructions.
- D. Provide written instructions in the client’s native language.
Correct Answer: A
Rationale: Demonstration confirms skill.