Exhibits

A nurse on an antepartum unit is caring for a client who is at 15 weeks of gestation and has hyperemesis gravidarum. Which of the following findings should the nurse report to the provider? (Click on the "Exhibit" button for additional information about the client. There are three tabs that contain separate categories of data.)

Hgb

Urinalysis results

Intake

Temperature

Answer and Explanation

The Correct Answer is B

A. Hgb: A hemoglobin level of 11.1 mg/dL is lower than normal, indicating anemia, which could be concerning but might not be the most urgent issue compared to other findings.
B. Urinalysis results: Positive urine ketones indicate ketonuria, which is significant in the context of hyperemesis gravidarum and may reflect severe dehydration or malnutrition. This finding should be reported to the provider.
C. Intake: The client’s intake of 50% of the meal without emesis is a relevant detail but does not indicate a severe immediate issue compared to the urinalysis results.
D. Temperature: A temperature of 37.2° C (99° F) is slightly elevated but not extremely concerning in this context compared to other findings like ketonuria.

Nursing Test Bank

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Correct Answer is B

Explanation

A. "Your doctor has been performing this surgery for a long time now." While this statement aims to reassure the client by emphasizing the doctor's experience, it does not address the client's feelings or encourage further discussion about their fears.
B. "Would it help you to talk more with me about how you feel?" This is a therapeutic response that encourages the client to express their feelings and concerns, showing empathy and providing an opportunity for the client to discuss their fears in more detail.
C. "I have prayed for you and everything is going to be fine." While this statement may be comforting to some, it can be inappropriate and may not address the client's specific fears or promote open communication. It also assumes the client's belief system, which might not be the same as the nurse's.
D. "Why are you afraid to have surgery all of a sudden?" This response can be perceived as dismissive and might make the client feel judged or misunderstood. It does not encourage a supportive discussion about the client's fears.

A. Verapamil B. Lithium C. Sumatriptan D. Prednisone.

Correct Answer is C

Explanation

A. Verapamil Verapamil is used as a preventive treatment for cluster headaches, not for aborting an acute attack.
B. Lithium Lithium is used for cluster headache prevention, not for immediate pain relief.
C. Sumatriptan Sumatriptan is effective in aborting acute cluster headache attacks.
D. Prednisone Prednisone can be used as a short-term preventive measure but is not typically used to abort an acute headache.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who states, "The doctor says I need to have surgery to replace the bones in my knee and I'm terrified." Which of the following therapeutic responses should the nurse make?

Correct Answer is B

Explanation

A nurse is caring for a client who is experiencing a cluster headache. The nurse should plan to administer which of the following medications to abort the headache and manage the client's pain?

Correct Answer is C

Explanation

A nurse is preparing to administer fentanyl 100 mcg via IV bolus to a client who is postoperative and is currently receiving 0.9% sodium chloride by continuous IV infusion. Which of the following actions should the nurse take?

A nurse is assessing a client who has an ankle fracture of the right foot and is at risk for complex regional pain syndrome (CRPS). The nurse should identify that which of the following findings is a manifestation of CRPS?

A nurse is planning care for a client who has a Clostridium difficile infection. Which of the following interventions should the nurse include in the plan of care? (Select all that apply.)

A nurse manager is planning an in-service for a group of staff nurses about documentation guidelines in The Joint Commission's National Patient Safety Goals. Which of the following examples should the nurse manager include when discussing error-prone abbreviations?

A nurse is caring for a client who requires partial assistance with ADLs. Which of the following actions should the nurse take?

A nurse is providing teaching to a client who has chronic pain related to osteoarthritis. Which of the following instructions should the nurse include?

A nurse is preparing to apply a bed alarm for a client who is at risk for falls and attempts to get out of bed without assistance. After explaining the procedure to the client, which of the following actions should the nurse take next?