Nokea
A nurse is preparing to reinforce teaching with a client who has expressive aphasia. Which of the following actions should the nurse plan to take?
- A. Provide the teaching without expecting the client to respond.
- B. Determine the client's ability to use a communication board.
- C. Speak with a loud voice while providing the information.
- D. Avoid the use of facial gestures during the instructions.
Correct Answer: B
Rationale: A communication board aids clients with expressive aphasia in responding, enhancing understanding.
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A nurse is contributing to a community center's in-service program about early detection of breast cancer. Which of the following recommendations should the nurse make for female clients who do not have a family history of breast cancer?
- A. You should start receiving mammograms as early as age 40.
- B. You should receive a breast ultrasound every 3 years after age 50.
- C. You should receive a breast examination from your provider each year after age 30.
- D. You should start performing monthly breast self-examinations at age 35.
Correct Answer: A
Rationale: Guidelines recommend mammograms starting at 40 for average-risk women.
A nurse is preparing to provide tracheostomy care to a client who has a chronic tracheostomy. In which order should the nurse complete the following steps? (Move the steps placing them in the order of performance. Use all the steps.)
- A. Wipe the inside of the inner cannula with a folded pipe cleaner.
- B. Unlock and remove the inner cannula.
- C. Scrub the inside and outside of the inner cannula with a small brush
- D. Cleanse the stoma site with 0.9% sodium chloride solution.
- E. Pour 2.54 cm (1 in) of 0.9% sodium chloride solution into the sterile basin.
Correct Answer: E,B,C,A,D
Rationale: E: Prepare solution. B: Remove cannula. C: Scrub cannula. A: Wipe cannula. D: Cleanse stoma ensures sterile technique.
A nurse is reinforcing teaching with a client about the use of a quad cane. Which of the following statements by the client indicates an understanding of the teaching?
- A. I will move the cane forward 18 inches.
- B. I will hold the cane on my stronger side.
- C. I should wear shoes with smooth soles to help slide my weak leg forward.
- D. I should move my stronger leg forward before moving my weaker leg.
Correct Answer: B
Rationale: Holding the cane on the stronger side provides optimal support and balance for the weaker side.
A nurse is preparing to perform a fecal occult blood test of stool specimens for a client. Which of the following actions should the nurse plan to take?
- A. Wear sterile gloves when handling the stool specimen.
- B. Have the client defecate into a bedpan that contains a small amount of water.
- C. Repeat the test three times using the same stool specimen.
- D. Ensure that the stool specimen does not contain urine.
Correct Answer: D
Rationale: Urine can contaminate the specimen, affecting the accuracy of the fecal occult blood test.
A nurse is caring for a client who has insomnia. Which of the following actions should the nurse take?
- A. Administer prescribed diuretics in the evening
- B. Provide the client with snug-fitting nightwear
- C. Keep the door to the client's room closed
- D. Use overhead lighting when checking equipment
Correct Answer: C
Rationale: Closing the door reduces noise, promoting sleep; other options may disrupt it.