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The client reports feeling stress.
A nurse is collecting data from a client who reports feeling stress. Which of the following should the nurse identify as an external stressor?
- A. Recurring urinary tract infections
- B. A recent move to a new city
- C. Report of feeling depressed
- D. Lack of nutritional knowledge
Correct Answer: B
Rationale: A recent move is an external stressor, unlike internal health or knowledge factors.
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A nurse is assisting with the care of a client who is receiving a spinal epidural to treat a herniated disc. Which of the following findings should the nurse identify as an indicator of unrelieved pain?
- A. Difficulty swallowing
- B. Constipation
- C. Urinary retention
- D. Clenched teeth
Correct Answer: D
Rationale: Clenched teeth indicate ongoing pain despite the epidural.
The client reports manifestations of depression.
A nurse is collecting data from a client who reports manifestations of depression. Which of the following findings should the nurse identify as a risk factor for suicide?
- A. The client is married and has children.
- B. The client has a strong religious affiliation.
- C. The client recently received a pay raise at work.
- D. The client has a history of chronic back pain.
Correct Answer: D
Rationale: Chronic pain increases suicide risk due to persistent distress.
A nurse is reinforcing teaching with a client who has a new prescription for epinephrine auto-injector PRN. The nurse should reinforce with the client that the medication can help treat which of the following manifestations?
- A. Hand tremors
- B. Shortness of breath
- C. Nausea
- D. Hyperglycemia
Correct Answer: B
Rationale: Epinephrine treats shortness of breath in anaphylaxis.
A nurse is reinforcing teaching with a client who is scheduled for an intravenous pyelogram. Which of the following statements by the client indicates an understanding of the teaching?
- A. I can have a meal up to 2 hours before the procedure.
- B. I should limit my fluid intake for 2 days after the procedure.
- C. I do not need to sign a consent form before this procedure.
- D. I will feel a warming sensation after the injection of the dye.
Correct Answer: D
Rationale: A warming sensation is expected with IVP dye injection, indicating understanding.
A nurse is reinforcing teaching about the side effects of metoprolol. Which of the following client statements indicates an understanding of the teaching?
- A. I need to be careful when standing up from bed.
- B. I should limit my intake of leafy green vegetables.
- C. I should expect some weight loss.
- D. I may experience loss of taste.
Correct Answer: A
Rationale: Metoprolol can cause orthostatic hypotension, requiring caution when standing.