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The nurse is caring for a client with bulimia nervosa. The nurse recognizes that the major difference in the client with anorexia nervosa and the client with bulimia nervosa is the client with bulimia:
- A. Is usually grossly overweight.
- B. Has a distorted body image.
- C. Recognizes that she has an eating disorder.
- D. Struggles with issues of dependence versus independence.
Correct Answer: C
Rationale: Clients with bulimia often recognize their eating disorder, unlike those with anorexia, who may deny the problem due to distorted body image.
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A client with osteomylitis has an order for a trough level to be done because he is taking Gentamycin. When should the nurse call the lab to obtain the trough level?
- A. Before the first dose
- B. 30 minutes before the fourth dose
- C. 30 minutes after the first dose
- D. 30 minutes before the first dose
Correct Answer: B
Rationale: Trough levels measure the lowest drug concentration and are drawn just before a dose after steady-state, typically around the fourth dose for Gentamicin.
The nurse is assessing a client with suspected diverticulitis. Which of the following findings would the nurse expect?
- A. Pain in the right upper quadrant.
- B. Fever and left lower quadrant pain.
- C. Diarrhea with bright red blood.
- D. Soft, non-tender abdomen.
Correct Answer: B
Rationale: fever and left lower quadrant pain are common in diverticulitis due to inflammation in the sigmoid colon
The nurse is conducting a physical examination of a client's abdomen. Place the examination techniques listed below (Roman numerals) in the correct sequence, from first to last.
- A. Percussion
- B. Palpation
- C. Inspection
- D. Auscultation
Correct Answer: C,D,A,B
Rationale: Abdominal exam sequence: Inspection (III) first, then auscultation (IV) before percussion (I) and palpation (II) to avoid altering bowel sounds.
A med-surg nurse is floating to the post-op floor for a few days. The float nurse sees one of the regular post-op nurses taking medication from the med cart and ingesting several pills. The float nurse should immediately
- A. inform the state board of nursing.
- B. inform the nursing supervisor who works on the post-op floor.
- C. report the nurse to human resources.
- D. confront the post-op nurse about stealing and abusing medications.
Correct Answer: B
Rationale: Reporting to the nursing supervisor ensures prompt investigation and intervention for suspected medication diversion, maintaining patient safety.
The nurse is performing discharge teaching to a client newly diagnosed with hypertension and high cholesterol. Which statement by the client indicates that the nurse's teaching was effective?
- A. I need to buy canned foods that are low in sodium.
- B. I can substitute lean sirloin for my homemade fried chicken.
- C. I will take a can of soup to work for lunch instead of eating a burger.
- D. Frozen dinners are better for me than eating in the cafeteria at work.
Correct Answer: B
Rationale: Substituting lean sirloin for fried chicken reduces fat and cholesterol. Canned foods, soups, and frozen dinners are often high in sodium, unsuitable for hypertension.