Nokea
Which nursing action is most helpful for reducing or eliminating feedback from the client's hearing aid?
- A. Repositioning the hearing aid within the ear
- B. Cleaning the hearing aid with a soft cloth
- C. Replacing the battery in the hearing aid
- D. Turning down the volume in the hearing aid
Correct Answer: A
Rationale: Repositioning corrects improper fit, reducing feedback noise.
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Which activity should the client who underwent a stapedectomy avoid for the next 6 months?
- A. Listening to music
- B. Flying in an airplane
- C. Driving an automobile
- D. Singing in the choir
Correct Answer: B
Rationale: Pressure changes during flying can disrupt healing after a stapedectomy.
The nurse is caring for clients on a medical unit. After the shift report, which client should the nurse assess first?
- A. The 34-year-old client who is quadriplegic and cannot move his arms.
- B. The elderly client diagnosed with a CVA who is weak on the right side.
- C. The 78-year-old client with pressure ulcers who has a temperature of 102.3°F.
- D. The young adult who is unhappy with the care that was provided last shift.
Correct Answer: C
Rationale: Fever in a client with pressure ulcers suggests infection, requiring urgent assessment. Quadriplegia, weakness, and dissatisfaction are less acute.
Before the examination can be completed, which type of eye medication would the nurse instill in the client's eye to dilate the pupil and temporarily paralyze the ciliary muscle?
- A. Pilocarpine (Pilocar)
- B. Dipivefrin (Propine)
- C. Gentamicin (Genoptic)
- D. Cyclopentolate solution (Cyclogyl)
Correct Answer: D
Rationale: Cyclopentolate is a cycloplegic agent that dilates the pupil and paralyzes the ciliary muscle for retinoscopy.
The nurse is caring for a client who has developed stage IV pressure ulcers on the left trochanter and coccyx. Which collaborative problem has the highest priority?
- A. Impaired cognition.
- B. Altered nutrition.
- C. Self-care deficit.
- D. Altered coping.
Correct Answer: B
Rationale: Altered nutrition is critical in stage IV ulcers to support wound healing. Cognition, self-care, and coping are secondary in advanced wounds.
The nurse is teaching the client diagnosed with atopic dermatitis. Which information should the nurse include in the teaching?
- A. Discuss skin care using hydrating lotions and minimal soap.
- B. Tell the client the methods of treating secondary infection.
- C. Explain there are no adverse effects to using topical corticosteroids daily.
- D. Warn the client inhaled allergens have been linked to exacerbations.
Correct Answer: A
Rationale: Hydrating lotions and minimal soap reduce atopic dermatitis flares. Secondary infections, corticosteroid risks, and allergens are secondary teaching points.