Nokea
A nurse in a mental health facility is caring for a client who expresses anxiety about exercising in the outdoor courtyard. The nurse promises to walk with the client in the courtyard each day. Which of the following ethical principles is the nurse demonstrating?
- A. Justice
- B. Fidelity
- C. Autonomy
- D. Nonmaleficence
Correct Answer: B
Rationale: Fidelity involves keeping promises and maintaining trust. By committing to walk with the client, the nurse upholds this principle, fostering a supportive relationship.
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A nurse is reinforcing teaching with a client who has a new prescription for lisinopril. Which of the following statements should the nurse include?
- A. You should increase your intake of potassium-rich foods.
- B. You might develop a dry cough while taking this medication.
- C. You should take this medication at bedtime.
- D. You need to limit your fluid intake while taking this medication.
Correct Answer: B
Rationale: Lisinopril can cause a persistent dry cough, a common side effect. Potassium intake, bedtime dosing, or fluid limits aren't specific concerns.
A nurse is caring for a client who is postoperative following a lumbar laminectomy. Which of the following actions should the nurse take?
- A. Encourage the client to ambulate with a straight back.
- B. Instruct the client to avoid turning at the waist.
- C. Allow the client to sit in a chair for 2 hr at a time.
- D. Apply a heating pad to the surgical site.
Correct Answer: B
Rationale: Avoiding waist turning prevents strain on the surgical site. Ambulation should allow natural posture, prolonged sitting risks stiffness, and heating pads may increase swelling.
A nurse is caring for a client who is postoperative following a spinal fusion. Which of the following actions should the nurse take?
- A. Encourage the client to ambulate with a back brace.
- B. Instruct the client to twist at the waist when turning.
- C. Apply a heating pad to the surgical site.
- D. Allow the client to sit for 2 hr at a time.
Correct Answer: A
Rationale: A back brace supports ambulation, promoting stability. Twisting risks injury, heating pads may increase swelling, and prolonged sitting strains the spine.
A nurse is reinforcing teaching with a client who has a new prescription for metformin. Which of the following statements by the client indicates an understanding of the teaching?
- A. I should take this medication on an empty stomach.
- B. I might need to check my blood sugar more often.
- C. I can stop taking this medication if I lose weight.
- D. I should avoid drinking alcohol while taking this medication.
Correct Answer: B,D
Rationale: Metformin requires frequent glucose monitoring and alcohol avoidance to prevent lactic acidosis. It's taken with food, and stopping needs provider approval.
A nurse is reinforcing teaching with a client who has a new prescription for nitroglycerin sublingual tablets. Which of the following instructions should the nurse include?
- A. Keep the tablets in a dark, airtight container.
- B. Take one tablet every 15 min for chest pain.
- C. You might feel a tingling sensation under your tongue.
- D. You should swallow the tablet with water.
Correct Answer: C
Rationale: Nitroglycerin causes a tingling sensation, indicating absorption. Tablets are kept in dark containers, taken every 5 minutes for pain, and not swallowed.