A nurse is assisting with the care of a client.
The vital signs indicate abnormalities.
Which of the following actions should the nurse take?

Administer IV fluids as prescribed.

Place the client in a supine position.

Monitor for signs of infection.

Notify the provider about abnormal findings.

Answer and Explanation

The Correct Answer is D

Choice A rationale

Administering IV fluids as prescribed can be essential for maintaining fluid balance, but it does not directly address abnormal vital signs unless they are linked to hypovolemia. The nurse should prioritize identifying the cause of the abnormalities first, and then proceed with interventions aimed at stabilization and correction.

Choice B rationale

Placing the client in a supine position can exacerbate certain conditions, such as respiratory distress or hypoxia. While position changes may be needed in specific cases, this is not a primary action for addressing abnormal vital signs unless positional changes are directly implicated.

Choice C rationale

Monitoring for signs of infection is an important ongoing care strategy, especially when abnormal findings suggest potential sepsis. However, it alone does not resolve immediate concerns with abnormal vital signs and must be paired with communication and treatment strategies.

Choice D rationale

Promptly notifying the provider about abnormal findings ensures that the client's condition is evaluated comprehensively. Providers can order additional assessments or interventions to address potential underlying issues, thereby preventing clinical deterioration.

Nursing Test Bank

Quiz #1: RN Exams Pharmacology Exams Quiz #2: RN Exams Medical-Surgical Exams Quiz #3: RN Exams Fundamentals Exams Quiz #4: RN Exams Maternal-Newborn Exams Quiz #5: RN Exams Anatomy and Physiology Exams Quiz #6: RN Exams Obstetrics and Pediatrics Exams Quiz #7: RN Exams Fluid and Electrolytes Exams Quiz #8: RN Exams Community Health Exams Quiz #9: RN Exams Promoting Health across the lifespan Exams Quiz #10: RN Exams Multidimensional care Exams

Get 100+ Naxlex Exit Exams for $79 Try Naxlex NCLEX-RN (14 Day Free-Trial)

Naxlex Comprehensive Predictor Exams

Quiz #1: Naxlex RN Comprehensive online practice 2019 B with NGN Quiz #2: Naxlex RN Comprehensive Predictor 2023 Quiz #3: Naxlex RN Comprehensive Predictor 2023 Exit Exam A Quiz #4: Naxlex HESI Exit LPN Exam Quiz #5: Naxlex PN Comprehensive Predictor PN 2020 Quiz #6: Naxlex VATI PN Comprehensive Predictor 2020 Quiz #8: Naxlex PN Comprehensive Predictor 2023 - Exam 1 Quiz #10: Naxlex HESI PN Exit exam Quiz #11: Naxlex HESI PN EXIT Exam 2

Free Nursing Study Resources

Correct Answer is A

Explanation

Choice A rationale

Cottage cheese is a complete protein, containing all nine essential amino acids. These are vital for tissue repair, enzyme synthesis, and immune function. It is also highly digestible, making it ideal for individuals with compromised health.

Choice B rationale

Oatmeal lacks all essential amino acids, particularly lysine. Although it is a healthy carbohydrate source and rich in soluble fiber, it does not qualify as a complete protein for this context.

Choice C rationale

Cooked spinach, while high in vitamins and iron, is deficient in essential amino acids like methionine. It supports general health but does not fulfill the criteria for complete proteins.

Choice D rationale

Whole wheat bread provides incomplete protein, missing essential amino acids like lysine. While nutritionally beneficial as a complex carbohydrate, it is not suitable for teaching about complete proteins.

A. The client has inspiratory stridor. B. The client reports a sore throat. C. The client's temperature is 38.6°C (101.4°F). D. The client's sputum has streaks of blood.

Correct Answer is A

Explanation

Choice A rationale

Inspiratory stridor reflects airway obstruction, potentially life-threatening following bronchoscopy. Causes include vocal cord edema or laryngospasm. Prompt intervention ensures airway patency and oxygenation. Audible stridor indicates urgent escalation.

Choice B rationale

Sore throat is anticipated due to irritation from the bronchoscope. This resolves without treatment, differentiating it from alarming symptoms like respiratory difficulty.

Choice C rationale

Post-bronchoscopy fever is common due to airway manipulation. Low-grade fever under 38.6°C does not necessitate urgent evaluation unless persistent or accompanied by other symptoms.

Choice D rationale

Bloody sputum results from mucosal trauma during the procedure. Minimal streaking is benign and resolves spontaneously. It does not indicate complications. .

View Question and Answer

Whether you are a student looking to ace your exams or a practicing nurse seeking to enhance your expertise , our nursing education contents will empower you with the confidence and competence to make a difference in the lives of patients and become a respected leader in the healthcare field.

Visit Naxlex, invest in your future and unlock endless possibilities with our unparalleled nursing education contents today

A nurse is assisting with the care of a client.The vital signs indicate abnormalities.Which of the following actions should the nurse take?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is reinforcing teaching about complete proteins with a client who has AIDS.Which of the following foods should the nurse include in the teaching?

Correct Answer is A

Explanation

A nurse is assisting with the care of a client who had a bronchoscopy 12 hours ago.Which of the following findings should the nurse report to the provider?

Correct Answer is A

Explanation

A nurse is assisting with the transfer of a client from a medical-surgical unit to an intensive care unit following a change in status.Which of the following information should the nurse include in the transfer documentation? (Select all that apply.)

A nurse is reinforcing teaching with a client who is to begin taking lansoprazole.Which of the following statements by the client indicates an understanding of the teaching?

A nurse is transporting a client who has pneumonia and is on droplet precautions to radiology.Which of the following safety measures should the nurse take while transporting the client?

A nurse is collecting data from a client who has a newly placed colostomy.Which of the following findings should indicate to the nurse the client has accepted their new altered body image?

A nurse is preparing to administer enoxaparin 1.5 mg/kg subcutaneously to a client who weighs 175 lb. How many mg should the nurse administer? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero.)

A nurse is caring for a client who has anorexia related to AIDS.Which of the following laboratory values should the nurse monitor to confirm the client's nutritional intake is adequate?

A nurse is assisting with the care of an 18-year-old client who is at their provider's office for an annual physical.The client inquires about cancer examinations that they should have.Which of the following examinations should the nurse recommend?

A nurse at an urgent care clinic is contributing to the plan of care for a client following a near drowning while attempting to walk across a frozen pond.Which of the following interventions should the nurse recommend?

A nurse is assisting with the care of a client.
The vital signs indicate abnormalities.
Which of the following actions should the nurse take?