A nurse is reinforcing teaching with a client who has an electrolyte imbalance. Which of the following foods should the nurse include as the lowest in potassium?
- A. Cantaloupe
- B. Orange juice
- C. Sweet potato
- D. Baked chicken breast
Correct Answer: D
Rationale: Baked chicken breast has the lowest potassium content compared to the other options, which are potassium-rich.
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The client has a new diagnosis of diabetes mellitus and is refusing to learn how to self-administer insulin.
A nurse is caring for a client who has a new diagnosis of diabetes mellitus and is refusing to learn how to self-administer insulin. Which of the following responses should the nurse make?
- A. You will suffer serious health issues if you don't take your medication.
- B. Have you considered how your decision to refuse medication will affect your family?
- C. I'd like to hear your thoughts about giving yourself this medication.
- D. Why don't you want to learn how to give yourself your medication?
Correct Answer: C
Rationale: Exploring the client's thoughts promotes understanding and respects autonomy.
A nurse is reviewing laboratory findings for three clients. Which of the following laboratory results should the nurse expect for a client who has pancreatitis?
- A. Elevated ammonia
- B. Elevated lipase
- C. Prolonged PT/INR
- D. Decreased albumin
Correct Answer: B
Rationale: Elevated lipase is a specific marker of pancreatitis.
A nurse is caring for a client who has dementia. Which of the following findings should the nurse expect?
- A. Memory loss that disrupts ADLs
- B. Acute onset of confusion
- C. Illusions
- D. Catatonia
Correct Answer: A
Rationale: Memory loss disrupting ADLs is a hallmark of dementia.
A nurse is reinforcing teaching with a client about the use of budesonide for asthma management. Which of the following statements by the adolescent indicates an understanding of the teaching?
- A. I should use my inhaler when I have an asthma attack.
- B. I will rinse my mouth and gargle with water after each inhaler treatment.
- C. I will take my inhaler treatment before each meal and at bedtime.
- D. I should use my inhaler before exercising.
Correct Answer: B
Rationale: Rinsing the mouth after budesonide (a corticosteroid) prevents oral thrush, indicating understanding.
The client is expressing suicidal ideations.
A nurse is collecting data from a client who is expressing suicidal ideations. Which of the following questions is the nurse's priority?
- A. Do you have a plan for harming yourself?
- B. Has anyone in your family ever died by suicide?
- C. Do you have someone to discuss your feelings with?
- D. Can you tell me about the stresses in your life?
Correct Answer: A
Rationale: Assessing a plan determines immediate risk, the priority in suicide assessment.
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