Nokea
You are serving as the preceptor for a newly graduated nurse. As you observe the new nurse for their application of body mechanics principles into client care, you observe that the nurse spreads her legs apart during a transfer with a client. What should you do?
- A. Advise the nurse that the legs must be close together for stability during lifting and transfers.
- B. Advise the nurse that the legs should be one in front of the other and not spread apart during a transfer.
- C. Validate the nurse's competency in terms of the application of body mechanics principles during a transfer.
- D. Validate the nurse's competency in terms of the application of ergonomics principles during a transfer.
Correct Answer: C
Rationale: Spreading the legs apart during a transfer provides a wide base of support, which is a correct body mechanics principle , ensuring stability and reducing injury risk.
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A client who has had a laparoscopic cholecystectomy receives discharge instructions from the nurse. Which statement indicates that the client has understood the instructions?
- A. I need to maintain a low-fat diet for the next 6 months
- B. I can remove the dressing from my incision tomorrow and take a shower
- C. I can anticipate some nausea for several days after surgery
- D. I can return to work in 4 to 6 weeks
Correct Answer: B
Rationale: Removing the dressing and showering the day after a laparoscopic cholecystectomy is standard, as incisions are small. A low-fat diet may be advised but not for a fixed 6 months, nausea is not expected, and return to work is typically sooner.
The nurse notes that the client admitted after fainting is receiving olanzapine. Which disorder or condition should the nurse suspect the client is experiencing?
- A. Schizophrenia
- B. Dementia disorder
- C. Personality disorder
- D. Major depressive disorder
Correct Answer: A
Rationale: Olanzapine is an atypical antipsychotic medication used in the management of manifestations associated with psychotic disorders. It is the first-line treatment for schizophrenia, targeting both the positive and the negative symptoms. None of the remaining options are indicated uses for this medication.
The nurse is preparing a teaching plan for a 45-year-old client recently diagnosed with type 2 diabetes mellitus. What is the first step in this process?
- A. Establish goals.
- B. Assess the client's learning needs.
- C. Set priorities of learning needs.
- D. Select teaching strategies.
Correct Answer: B
Rationale: Assessing the client's learning needs is the first step to tailor education to their knowledge level, preferences, and barriers, ensuring effective teaching.
A client is admitted with a diagnosis of acute pancreatitis. The nurse should expect the client to report which of the following symptoms?
- A. Pain radiating to the right shoulder.
- B. Epigastric pain radiating to the back.
- C. Right lower quadrant pain.
- D. Diffuse lower abdominal pain.
Correct Answer: B
Rationale: Acute pancreatitis typically causes epigastric pain that radiates to the back due to pancreatic inflammation.
A client experiencing low back pain asks the nurse which type of exercise will strengthen the lower back muscles. Which exercise should the nurse encourage the client to participate in to best strengthen the lower back muscles?
- A. Tennis
- B. Diving
- C. Canoeing
- D. Swimming
Correct Answer: D
Rationale: Walking and swimming are very beneficial in strengthening back muscles for the client with low back pain. The other options involve twisting and pulling of the back muscles, which is not helpful to the client experiencing back pain.