A nurse is providing care for a client who is scheduled for a total laryngectomy. Which of the following is the nurse's priority intervention?

Show the client how to use an artificial larynx.

Arrange a support session for the client.

Demonstrate the use of esophageal speech.

Determine the client's reading ability.

Answer and Explanation

The Correct Answer is D

A.   Showing the client how to use an artificial larynx is an important aspect of post-laryngectomy care, but determining the client's reading ability takes precedence as it will significantly impact communication options.
B.   Arranging a support session is important for emotional support, but assessing the client's reading ability is more immediate in addressing communication needs.
C.   Demonstrating the use of esophageal speech is relevant, but understanding the client's reading ability is a priority before exploring communication alternatives.

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Correct Answer is C

Explanation

A. Sterile gloves are not necessary for a tap water enema; clean, non-sterile gloves are sufficient.

B. Lubricating the tip of the rectal tube is appropriate to ease insertion and enhance client comfort.
C. Placing the client into a left Sims' position facilitates optimal administration of a tap water enema.
D. Lowering, not raising, the enema bag will allow for a slower flow and may reduce cramping.

A. Frequency of previous vital sign measurement B. Effectiveness of the last dose of pain medication C. Number of family members who have visited D. Time of the client's last bath

Correct Answer is B

Explanation

A. The frequency of previous vital sign measurements may be important but is not the most critical information to communicate during a transfer.
B. The effectiveness of the last dose of pain medication is crucial information for the receiving facility to manage the client's pain appropriately.
C. The number of family members who have visited is important for emotional support but may not be the priority for the receiving facility.
D. The time of the client's last bath is relevant but may not be as critical as information related to pain management during the hand-off report.

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A nurse is providing care for a client who is scheduled for a total laryngectomy. Which of the following is the nurse's priority intervention?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is preparing to administer a tap water enema to a client. Which of the following actions should the nurse take?

Correct Answer is C

Explanation

A nurse in an acute care facility is preparing to transfer a client to a long-term care facility. Which of the following information should the nurse include in the hand-off report?

Correct Answer is B

Explanation

A nurse is teaching a client how to self-administer daily low-dose heparin injections. Which of the following factors is most likely to increase the client's motivation to learn?

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