A nurse is preparing a client for a physical assessment. The client appears anxious about the assessment. Which statement by the nurse would be most appropriate?

"This is nothing to worry about. It won't hurt you."

"Let me tell you what I'll be doing. It should not be painful."

"Some of the examination may be painful, but will be gentle."

"I have to do this, so just relax and it won't last long."

Answer and Explanation

The Correct Answer is B

The most appropriate statement by the nurse would be to explain the procedure to the client and reassure them that it should not be painful. This can help alleviate the client's anxiety and make them feel more comfortable and informed about the assessment.

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Correct Answer is A

Explanation

The nursing process consists of five phases: assessment, diagnosis, planning, implementation, and evaluation. During the assessment phase, the nurse gathers information about the client's health status and needs. In this scenario, the nurse is conducting a dressing change and notes a new area of skin breakdown. This observation is part of the assessment phase of the nursing process, as the nurse is gathering information about the client's condition. The other phases of the nursing process involve analyzing the information gathered during assessment (diagnosis), developing a plan of care (planning), carrying out interventions (implementation), and evaluating the eﬀectiveness of care (evaluation).

A. To determine the need for medications B. To evaluate ﬂuid volume status C. To evaluate the glomerular filtration rate D. To determine the amount of retained urine after voiding. E. To determine the extent of renal failure

Correct Answer is ["A","D"]

Explanation

A test to determine the amount of residual urine is used to measure the amount of urine that remains in the bladder after voiding. This assessment can be used for several reasons, including to determine the need for medications that can help improve bladder emptying and to evaluate the amount of retained urine after voiding. Retained urine can increase the risk of urinary tract infections and other complications. This test is not typically used to evaluate ﬂuid volume status, glomerular filtration rate, or the extent of renal failure.

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A nurse is preparing a client for a physical assessment. The client appears anxious about the assessment. Which statement by the nurse would be most appropriate?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While conducting a dressing change, the nurse notes a new area of skin breakdown that was caused by the tape used to secure the dressing. In which phase of the nursing process is the nurse working?

Correct Answer is A

Explanation

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.

Correct Answer is ["A","D"]

Explanation

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