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A nurse in the urgent care facility is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. Which objective findings should the nurse expect? (Select three options that apply.)

Pale yellow urine

Flat neck veins

Hypotension

Poor skin turgor

Bradycardia

Answer and Explanation

Correct Answer : B,C,D

A. Pale yellow urine would not be expected, as dehydration often leads to concentrated, dark urine.

B. Flat neck veins are a sign of dehydration and decreased fluid volume.

C. Hypotension is expected with dehydration due to a drop in circulating blood volume.

D. Poor skin turgor is a common indicator of dehydration as the skin loses elasticity.

E. Bradycardia is not expected; rather, tachycardia is more common in dehydration as the body tries to compensate for fluid loss.

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Correct Answer is "{\"xRanges\":[89.96875,99.96875],\"yRanges\":[232.87109375,242.87109375]}"

Explanation

The posterior tibial pulse is typically palpated just behind the medial malleolus, which is the bony prominence on the inner side of the ankle. To locate this pulse, one should place their fingers in the groove between the medial malleolus and the Achilles tendon.

While checking the client's medication administration record, it was determined the client

A. Recommend a psychiatric consult B. Proceed with the exam by completing invasive aspects first. C. Stay with the client at all times to provide assistance. D. Use a relaxed manner and reassure the client as necessary.

Correct Answer is D

Explanation

A. Recommending a psychiatric consult is premature and not appropriate for routine anxiety during an assessment.

B. Starting with invasive aspects may increase the client's anxiety. Instead, the nurse should ease the client into the exam.

C. Staying with the client at all times may not be necessary and could make the client feel more uncomfortable.

D. Using a relaxed manner and reassuring the client can help reduce anxiety and make the physical assessment more comfortable.

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A nurse in the urgent care facility is assessing a client who reports frequent vomiting and diarrhea for the past 3 days. Which objective findings should the nurse expect? (Select three options that apply.)

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Naxlex Comprehensive Predictor Exams

A nurse is assessing a client's peripheral circulation. In which of the following locations should the nurse palpate to assess the posterior tibial pulse? (Selectable areas, or "Hot Spots," are outlined in the artwork below. Select only the outlined area that corresponds to your answer.)

Correct Answer is "{\"xRanges\":[89.96875,99.96875],\"yRanges\":[232.87109375,242.87109375]}"

Explanation

The nurse is preparing to conduct a physical assessment on a client who appears uncomfortable and slightly anxious. Which action is the most appropriate for the nurse to take?

Correct Answer is D

Explanation

A nurse is preparing to administer lidocaine 50 mg IV bolus. Available is lidocaine 200 mg/mL. How many mL should the nurse administer per dose? (Round the answer to the nearest tenth. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is assessing for cyanosis in a client who has dark skin. Which part of the body should the nurse examine to identify cyanosis in this client?

In caring for a quadriplegic client which action would the nurse implement to prevent skin breakdown?

The nurse is collecting a medical history on a 34-year old client. The client reports: "I take oral antibiotics whenever she gets a sore throat, because she cannot afford to lose any time at work". What is the nurse's best response?

The nurse is preparing to assess the sinuses of an adult client using direct percussion. Which technique is the most appropriate for this assessment?

Upon auscultating a client's lungs, the nurse notes there is a low-pitched, continuous respiratory sound that has a snoring quality. How should the nurse interpret and document the findings?