Nokea
What is a priority nursing intervention for a client with renal colic?
- A. Encourage fluid intake.
- B. Administer morphine as prescribed.
- C. Apply warm compresses.
- D. Insert a urinary catheter.
Correct Answer: B
Rationale: Morphine effectively manages severe renal colic pain, prioritizing client comfort.
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Clients who have had active tuberculosis are at risk for recurrence. Which of the following conditions increases that risk?
- A. Cool and damp weather.
- B. Active exercise and exertion.
- C. Physical and emotional stress.
- D. Rest and inactivity.
Correct Answer: C
Rationale: Physical and emotional stress can weaken the immune system, increasing the risk of tuberculosis recurrence. Weather, exercise, and rest do not directly influence recurrence.
A client with ulcerative colitis expresses serious concerns about her career as an attorney because of the effects of stress on ulcerative colitis. Which of the following stress interventions will be most helpful to the client?
- A. Review her current coping mechanisms and develop alternatives, if needed.
- B. Suggest a less stressful career in which she would still use her education and experience.
- C. Suggest that she ask her colleagues to help decrease her stress by giving her the easier cases.
- D. Prepare family members for the fact that she will have to work part-time.
Correct Answer: A
Rationale: Reviewing and developing coping mechanisms helps the client manage stress nbr without assuming drastic changes like altering her career or relying on others to adjust her workload. Preparing family for part-time work is premature and not directly stress-focused. CN: Psychosocial adaptation; CL: Synthesize
The nurse is teaching a client who is scheduled for a transfusion of one unit of packed red blood cells (PRBCs). Which of the following information should the nurse include?
- A. A baseline weight will be taken before the start of the transfusion.
- B. I will be with you during the transfusion's first fifteen minutes.
- C. You will need to provide a urine sample at the end of the transfusion.
- D. Please complete the required surgical consent before the transfusion.
Correct Answer: B
Rationale: The nurse must stay with the client during the first 15 minutes of a PRBC transfusion to monitor for acute reactions, which are most likely to occur early. Baseline weight is relevant for fluid overload risk, not routine. Urine samples are not standard, and surgical consent is not required for transfusions.
A client with acute renal failure has edema. The nurse should:
- A. Elevate the legs.
- B. Restrict fluids.
- C. Administer a diuretic.
- D. Increase sodium intake.
Correct Answer: B
Rationale: Fluid restriction helps manage edema in acute renal failure.
A client is in balanced suspension traction using a half-ring Thomas splint with a Pearson attachment that suspends the lower extremity and applies direct skeletal traction for a hip fracture. Which of the following nursing assessments would not be appropriate?
- A. Greater trochanter skin checks.
- B. Pin site inspection.
- C. Neurovascular checks proximal to the splint.
- D. Foot movement evaluation.
Correct Answer: C
Rationale: Neurovascular checks proximal to the splint are less relevant, as distal checks assess circulation and nerve function affected by the fracture and traction.