Nokea
A nurse is assisting with the care of a client who has a recent diagnosis of a chronic condition and is exhibiting findings of ineffective coping. Which of the following actions should the nurse take first?
- A. Determine if the client has a support system.
- B. Schedule a mental health consult for the client.
- C. Provide the client with information about coping strategies.
- D. Encourage the client to attend a support group.
Correct Answer: A
Rationale: Assessing the support system first identifies resources to address ineffective coping.
You may also like to solve these questions
A nurse is caring for an older adult client who has a hearing aid. Which of the following actions should the nurse take when the client reports hearing a whistling sound from the hearing aid?
- A. Soak the hearing aid in warm water.
- B. Decrease the volume on the hearing aid.
- C. Clean the hearing aid with isopropyl alcohol.
- D. Turn the hearing aid off for 5 min.
Correct Answer: B
Rationale: Whistling (feedback) often indicates high volume; decreasing it resolves the issue.
A nurse is collecting data from a client who reports an inability to cope because of their recent job loss. Which of the following actions should the nurse take?
- A. Tell the client to think about something else.
- B. Ask the client to describe their support system.
- C. Ask the client why they're unable to cope.
- D. Tell the client that everything will be okay.
Correct Answer: B
Rationale: Assessing the support system identifies resources to help the client cope.
A nurse is caring for a client who is postoperative and is preparing to walk for the first time in several days. Which of the following instructions should the nurse give the client to prevent orthostatic hypotension?
- A. Use your incentive spirometer.
- B. Dangle your legs over the side of the bed.
- C. Increase your intake of protein.
- D. Perform regular isometric exercises.
Correct Answer: B
Rationale: Dangling legs helps acclimate the body to positional changes, reducing hypotension risk.
A nurse is checking for proper placement of a feeding tube. Which of the following methods is the most reliable for verification of tube placement?
- A. Verify the bilirubin level of the tube contents.
- B. Auscultate for air insufflation.
- C. Request a chest x-ray.
- D. Check the pH level of gastric contents.
Correct Answer: C
Rationale: A chest x-ray is the gold standard for confirming feeding tube placement.
A nurse is preparing to administer ampicillin to a school-age child who weighs 55 lb. The provider prescribes 50 mg/kg/day in 4 equal doses. Available is ampicillin oral suspension 125 mg/5 mL. How many ml should the nurse administer with each dose?
- A. 12.5 mL (calculated: 55 lb = 25 kg, 50 mg/kg = 1250 mg/day, 1250 mg / 4 doses = 312.5 mg/dose, 312.5 mg / 125 mg/5 mL = 12.5 mL)
Correct Answer: A
Rationale: Calculation confirms 12.5 mL per dose is correct.