Nokea
A nurse is assisting a client who is postoperative following a total hip arthroplasty into a supine position. Which of the following actions is appropriate to prevent hip dislocation?
- A. Place a sandbag to the lateral calf.
- B. Place a wedge pillow between the legs.
- C. Place a trochanter roll against the thigh.
- D. Place a footboard on the bed.
Correct Answer: B
Rationale: Placing a wedge pillow between the legs maintains hip abduction, preventing adduction and reducing the risk of dislocation after hip arthroplasty.
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A nurse is reinforcing teaching with a client who has gastroesophageal reflux disease (GERD) about minimizing the effects of reflux during sleep. Which of the following client statements indicates an understanding of the teaching?
- A. I can have 6 ounces of alcohol before bed to help me sleep.
- B. I will have a snack 1 hour before going to bed.
- C. I should elevate the head of the bed.
- D. I will sleep on my stomach with my head flat.
Correct Answer: C
Rationale: Elevating the head of the bed helps reduce acid reflux by keeping stomach acid from flowing back into the esophagus during sleep.
A nurse is caring for a client who has benign prostatic hyperplasia (BPH). Which of the following findings should the nurse expect?
- A. Difficulty starting the flow of urine.
- B. Painful urination.
- C. Urge incontinence.
- D. Critically elevated prostate-specific antigen (PSA) level.
Correct Answer: A
Rationale: Difficulty starting urine flow is common in BPH due to prostate enlargement obstructing the urethra.
A nurse is preparing to administer digoxin 1 mg PO to a client. The amount available is digoxin 0.5 mg/tablet. How many tablets should the nurse administer? (Round to the nearest whole number. Use a leading zero if it applies. (Do not use a trailing zero))
Correct Answer: 2 tablets
Rationale: 1 mg ÷ 0.5 mg/tablet = 2 tablets. The nurse should administer 2 tablets.
A nurse is caring for a client who has a new diagnosis of urolithiasis. Which of the following risk factors should the nurse identify as contributing to this diagnosis?
- A. High-purine diet.
- B. Low levels of serum calcium.
- C. Female gender.
- D. Drinking large quantities of fluids.
Correct Answer: A
Rationale: A high-purine diet increases uric acid, forming crystals and stones, contributing to urolithiasis.
An adult client newly diagnosed with type 2 diabetes mellitus asks a nurse to explain how he developed the condition. Which of the following responses should the nurse make?
- A. Your body will continue producing too much insulin without medicine to counteract it.
- B. Your body doesn't process glucose well.
- C. Your body's hemoglobin is not binding to the sugar you consume.
- D. Your body's immune system has destroyed cells in your pancreas.
Correct Answer: B
Rationale: Type 2 diabetes involves insulin resistance, where the body cannot process glucose effectively, leading to elevated blood glucose levels.