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A nurse is reinforcing discharge instructions to a client who is postoperative from a hip arthroplasty. Which of the following statements by the client indicates a correct understanding of the teaching?
- A. I will avoid wearing socks on my feet.
- B. I will avoid performing leg exercises.
- C. I will avoid crossing my legs for the first 3 months after surgery.
- D. I will avoid lying on the side of my surgery when I get home.
Correct Answer: C
Rationale: Avoiding crossing the legs for the first 3 months after surgery helps prevent dislocation of the hip joint and promotes proper healing.
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A nurse is assisting with the care of a client who has hypocalcemia. For which of the following signs should the nurse monitor?
- A. Kernig's sign.
- B. Brudzinski's sign.
- C. Chvostek's sign.
- D. Cullen's sign.
Correct Answer: C
Rationale: Chvostek's sign, facial muscle twitching when tapping the facial nerve, is a clinical sign of hypocalcemia.
A nurse is collecting data from a client who has peripheral arterial disease (PAD). Which of the following findings should the nurse expect?
- A. Warm extremities.
- B. Darkened skin color near extremities.
- C. Intermittent claudication.
- D. Edema.
Correct Answer: C
Rationale: Intermittent claudication, pain or cramping in the legs during exercise that subsides with rest, is a hallmark symptom of PAD due to reduced blood flow.
A nurse in a clinic is collecting data from a client who has cystitis. Which of the following findings should the nurse expect?
- A. Suprapubic tenderness.
- B. Proteinuria.
- C. Generalized edema.
- D. Oliguria.
Correct Answer: A
Rationale: Suprapubic tenderness is common in cystitis due to bladder wall irritation and inflammation.
A nurse is contributing to the plan of care for a client who has urolithiasis. Which of the following interventions should the nurse include in the plan?
- A. Tell the client to expect a decrease in urine output.
- B. Provide the client a high protein diet.
- C. Maintain the client on bed rest.
- D. Encourage the client to drink 3 L of fluids per day.
Correct Answer: D
Rationale: Encouraging the client to drink 3 L of fluids per day helps flush out stones, prevent new stone formation, and reduce urinary concentration.
A nurse is collecting data from a client who has right-sided heart failure. Which of the following findings should the nurse expect?
- A. Frothy sputum.
- B. Orthopnea.
- C. Dyspnea.
- D. Peripheral edema.
Correct Answer: D
Rationale: Peripheral edema is a common finding in right-sided heart failure due to blood backup in systemic circulation, causing fluid accumulation in tissues.