Nokea
When assisting a client with range-of-motion exercises, which movements should be carried out on the client's elbows? Select all that apply.
- A. Supination.
- B. Flexion.
- C. Circumduction
- D. Pronation
- E. Extension.
- F. Hyperextension.
Correct Answer: A,B,D,E
Rationale: Elbow range-of-motion includes flexion (B), extension (E), supination (A), and pronation (D). Circumduction (C) is not possible at the elbow, and hyperextension (F) is not a standard motion for this joint.
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A client has surgery scheduled in 2 weeks. He decides to donate his own blood ahead of time to be stored and used in case he needs a blood transfusion during his surgery. This type of blood donation is referred to as
- A. an allogeneic donation.
- B. an xenogeneic donation.
- C. an autologous donation.
- D. a directed donation.
Correct Answer: C
Rationale: Autologous donation involves donating one’s own blood for personal use during surgery, reducing transfusion risks.
The nurse finds a client smoking marijuana in the hospital and tells her that no smoking or use of drugs is allowed in the facility. The client responds by shouting, 'What business is it of yours? Leave me alone!' Which of the following initial responses is the best for the nurse to use to defuse the situation?
- A. It's my business because I'm your nurse.'
- B. If you don't put that out immediately, I will call security.'
- C. You are violating the facility policies and the law!'
- D. I'm sorry, but I have to ask you again to put out your marijuana cigarette.'
Correct Answer: D
Rationale: A calm, polite request to stop (D) de-escalates the situation while reinforcing the rule. Other responses (A, B, C) are confrontational and likely to escalate the client's agitation.
A client is admitted with a possible bowel obstruction. Which question during the nursing history is least helpful in obtaining information regarding this diagnosis?
- A. Tell me about your pain.'
- B. What does your vomit look like?'
- C. Describe your usual diet.'
- D. Have you noticed an increase in abdominal size?'
Correct Answer: C
Rationale: Diet history is less directly related to diagnosing a bowel obstruction compared to pain, vomiting characteristics, or abdominal distension, which are hallmark symptoms.
A client confides in the nurse that a close friend recently died from pancreatic cancer. The client asks what the risk factors are for pancreatic cancer. The nurse should respond with
- A. Being a female of Asian descent is linked to an increased risk of pancreatic cancer.'
- B. Drinking two or fewer alcoholic beverages per week is linked to an increased risk of pancreatic cancer.'
- C. Past history of acute pancreatitis before age 20 is linked to an increased risk of pancreatic cancer.'
- D. Cigarette smoking is linked to an increased risk for pancreatic cancer.'
Correct Answer: D
Rationale: Cigarette smoking is a well-established risk factor for pancreatic cancer, increasing risk through carcinogenic exposure.
The nurse is aware that the best way to prevent post-operative wound infection in the surgical client is to:
- A. Administer a prescribed antibiotic
- B. Wash her hands for 2 minutes before care
- C. Wear a mask when providing care
- D. Ask the client to cover her mouth when she coughs
Correct Answer: B
Rationale: Hand washing is the most effective measure to prevent postoperative wound infections.