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A nurse is evaluating a nursing student's understanding of positioning clients. Which of the following statements indicates a need for further teaching?

Positioning a client in good body alignment and changing the position regularly (every 3 hours) and systematically are essential aspects of nursing practice.

"Frequent change in position helps to prevent muscle discomfort, undue pressure resulting in pressure ulcers, damage to superficial nerves and blood vessels, and contractures."

"Any position, correct or incorrect, can be detrimental if maintained for a prolonged period."

"For all clients, it is important to assess the skin and provide skin care before and after a position change.

Answer and Explanation

The Correct Answer is A

This statement indicates a need for further teaching because it is not accurate. Positioning a client in good body alignment and changing the position regularly are essential aspects of nursing practice, but the position should be changed more frequently than every 3 hours. It is generally recommended to reposition clients at least every 2 hours to prevent pressure ulcers and other complications. The other options (Frequent change in position helps to prevent muscle discomfort, undue pressure resulting in pressure ulcers, damage to superficial nerves and blood vessels, and contractures; Any position, correct or incorrect, can be detrimental if maintained for a prolonged period; and For all clients, it is important to assess the skin and provide skin care before and after a position change) are accurate statements and do not indicate a need for further teaching.

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Correct Answer is C

Explanation

Turning, deep breathing, and coughing exercises are important for clients recovering from surgery as they help prevent the development of pneumonia. After surgery, clients may have difficulty taking deep breaths and coughing due to pain or discomfort. This can lead to the accumulation of mucus in the lungs, increasing the risk of pneumonia. By performing these exercises, clients can help clear their lungs and reduce their risk of developing this complication. While these exercises may also help prevent other complications such as thrombophlebitis, the primary reason for performing them is to prevent pneumonia.

A. Questioning a medication order that does not appear to meet the client's needs for pain management. B. Practicing nursing in a culturally competent fashion. C. Exhibiting a willingness to try alternate methods of addressing a client's care needs. D. Waiting for the medical team to determine the focus of the client's supportive care. E. Listening with empathy to a client who has recently been diagnosed.

Correct Answer is ["A","C","E"]

Explanation

The manager observed the nurse performing actions that demonstrate critical thinking, including questioning a medication order that does not appear to meet the client's needs for pain management, exhibiting a willingness to try alternate methods of addressing a client's care needs, and listening to empathy to a client who has recently been diagnosed. These actions show that the nurse is able to think critically and make informed decisions based on the needs of the client.

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A nurse is evaluating a nursing student's understanding of positioning clients. Which of the following statements indicates a need for further teaching?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client recovering from surgery asks the nurse why turning, deep breathing, and coughing exercises need to be done. How should the nurse respond?

Correct Answer is C

Explanation

The nurse manager has determined that a new staﬀ nurse is demonstrating characteristics of a critical thinker. Which of the following did the manager observe the nurse perform? Select all that apply.

Correct Answer is ["A","C","E"]

Explanation

Which of the following is marked rhythmic waxing and waning of respirations from very deep to very shallow breathing and temporary apnoea?

A nurse is providing care for a client who has recently been diagnosed with type 1 diabetes mellitus. To focus on aﬀective learning with this client, the nurse should use which of the following interventions?

The nurse has been caring for a client for several days and has assessed that he has been eating poorly during his hospitalization. Which nursing measure should the nurse implement to assist the client in improving his nutritional intake?

A discharge goal for a client is to have improved mobility. Which outcome statement did the nurse write appropriately?

A client is prescribed a diuretic for swelling of the lower extremities. The nurse should teach the client about the eﬀect of the medication on the client's urinary output.

A client needs a test to determine the amount of residual urine. The nurse realizes that this assessment is used for which reason(s)? Select all that apply.

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The nurse is collecting equipment to administer a unit of packed red blood cells. Which IV ﬂuid should be used to initiate the IV for this transfusion?