A client presents to the emergency department (ED reporting abdominal pain. The nurse observes the client's right cheek and eye are bruised and suspects possible domestic violence. Which approach is best for the nurse to use when interviewing the client?

Share personal values to put the client at ease.

Get the most difficult questions over with first.

Ask questions in a vague, non-specific format.

Begin with questions that are less sensitive in nature.

Answer and Explanation

The Correct Answer is D

A.   Share personal values to put the client at ease: Sharing personal values may not be appropriate and could potentially alienate the client or make them feel judged.
B.   Get the most difficult questions over with first: Starting with difficult questions may increase the client's defensiveness and resistance to sharing information.
C.   Ask questions in a vague, non-specific format: Being vague may not elicit the necessary information and could lead to misunderstandings or incomplete responses.
D.   Begin with questions that are less sensitive in nature: Starting with less sensitive questions helps build rapport and trust with the client before addressing more sensitive topics like domestic violence. It allows the client to feel more comfortable and may increase the likelihood of obtaining accurate information.

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Correct Answer is ["B","C","D"]

Explanation

A. Giving a bolus of 1,000 mL 0.9% sodium chloride is typically used to treat hypovolemia or electrolyte imbalances, which are not indicated by the patient's current lab values or clinical
situation.
B. Repeating the blood gas in 1 hour is a reasonable order as it would provide information on whether the patient's respiratory status is improving following interventions for ventilator-associated pneumonia.
C. Placing the client in a prone position can improve oxygenation in patients with respiratory distress by redistributing lung perfusion, making it a suitable intervention for this patient with diminished breath sounds and crackles.
D. Performing endotracheal suctioning would help clear secretions, which may be contributing to the patient's diminished breath sounds and crackles, and is consistent with the care for a patient with pneumonia.
E. A chest x-ray now would typically be ordered if there was a suspicion of a new onset condition such as a pneumothorax or pleural effusion, which is not indicated by the patient's current presentation.
F. Administering an inhaled corticosteroid is generally used for long-term management of chronic respiratory conditions and is not typically used for acute management of ventilator-associated pneumonia.

A. Difficulty staying asleep. B. Blood pressure 130/80 mm Hg. C. Dark yellow urine. D. Serum creatinine 1.6 mg/dL (141.44 μmol/L).

Correct Answer is D

Explanation

A. Difficulty staying asleep may indicate a sleep disorder or psychological stress but is not directly related to the client's diabetes mellitus or hypertension.
B. Blood pressure of 130/80 mm Hg is within the normal range for adults and does not require further follow-up unless there are specific concerns related to the client's medical history.
C. Dark yellow urine may indicate dehydration, which could be related to the client's diabetes mellitus and hypertension. However, it is not as concerning as the elevated serum creatinine
level.
D. Serum creatinine level of 1.6 mg/dL (141.44 μmol/L) is elevated above the normal range for both females and males. This finding suggests impaired kidney function, which is a significant concern for a client with a history of type 2 diabetes mellitus and hypertension. Further follow- up and evaluation are necessary to assess kidney function and determine appropriate
interventions.

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A client presents to the emergency department (ED reporting abdominal pain. The nurse observes the client's right cheek and eye are bruised and suspects possible domestic violence. Which approach is best for the nurse to use when interviewing the client?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Exhibits Based on the assessment and blood gas results, which 3 orders should the nurse expect from the healthcare provider?

Correct Answer is ["B","C","D"]

Explanation

The nurse is caring for a client with a history of type 2 diabetes mellitus and hypertension who arrives at the clinic for a scheduled visit. Which finding requires further follow-up by the nurse? Creatinine: Female: [0.5 to 1.1 mg/dL (44 to 97 μmol/L)] Male: [0.6 to 1.2 mg/dL (53 to 106 μmol/L)]

Correct Answer is D

Explanation

Exhibits Which interventions are indicated to promote positive outcomes for the client? Select all that apply.

The nurse places an opioid patch on the chest of a client with intractable pain who also has obstructive sleep apnea (OSA). Which intervention is most important for the nurse to implement before leaving the client?

The nurse administers an antibiotic to a client with a respiratory tract infection. To evaluate the medication's effectiveness, what laboratory value(s) should the nurse monitor? Select all that apply.

A client with 50% full-thickness burns has received fluid resuscitation for the past 24 hours. Which assessment warrants immediate intervention by the nurse?

A client is being discharged home after being treated for heart failure (HF. Which instruction should the nurse include in this client's discharge teaching plan?

A client who recently received a prescription for ramelteon to treat sleep deprivation reports experiencing several side effects since taking the drug. Which side effect should the nurse report to the healthcare provider?

A client is being discharged home after being treated for heart failure (HF. Which instruction should the nurse include in this client's discharge teaching plan?