The nurse counts the client's pulse rate and anticipates a faster rate in which of the following clients?
1. The sleeping client
2. The sedated client
3. The client with a fever
4. The client with hypothyroidism
4
Rationale: The client with a fever will be expected to have a higher pulse rate as a result of the increased metabolic rate that accompanies a high temperature. The remaining clients would be expected to have a lower-than-baseline pulse rate.
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The nurse is caring for an elderly client with a nursing diagnosis of Fluid Volume Deficit. Which of the following actions would yield the best indicator of the effectiveness of the nursing plan of care?
1. Pinch the skin on the back of the hand, and time how long it takes to return to normal. 2. Pinch the skin on the sternum, and time how long it takes to return to normal 3. Monitor the client's white blood cell count. 4. Monitor the client's intake and output.
A hospice patient's surgical procedure to reduce the size of his tumor in an effort to relieve pain will be classified as:
A) Diagnostic B) Laparoscopic C) Curative D) Palliative
Binge eating in anorexia nervosa is usually followed by purging. A mental health nurse knows that purging is defined as what?
A) Use of laxatives on a daily basis B) Evacuation of the digestive tract by eating until you vomit C) Overuse of diuretics until fluid volume depletion occurs D) Evacuation of the digestive tract by self-induced vomiting or excessive use of laxatives and diuretics
A client is to have a venipuncture to obtain a blood sample to check ammonia levels. The nurse:
A. Uses prewarmed test tubes B. Keeps the specimen out of the light C. Does not use a tourniquet during the procedure D. Places the samples on ice before sending them to the laboratory