Exhibits
Click to highlight the findings that would indicate the client is progressing as expected.
The nurse assesses the client. The client reports he was able to sleep through the night. The client notes continued numbness in his left arm, along with a tingling sensation, and is not able to move his fingers. The client reports mild nausea and has no desire to eat breakfast. There is a 1.18 in (3 cm) by 1.97 in (5 cm) area of blood noted on the bandage. The left arm is warm to touch. The client's left shoulder and collarbone are symmetric.
The client reports he was able to sleep through the night
The left arm is warm to touch. The client's left shoulder and collarbone are symmetric
The client reports mild nausea and has no desire to eat breakfast
The Correct Answer is ["A","B"]
The client reports he was able to sleep through the night: This indicates pain management may be effective, allowing the client to rest, which is a positive sign of progress.
The left arm is warm to touch: This suggests good circulation in the injured limb, which is crucial for healing.
The client’s left shoulder and collarbone are symmetric: Symmetry suggests that the alignment of the shoulder and collarbone is stable, which indicates no further dislocation or misalignment post-injury.
Nursing Test Bank
Naxlex Comprehensive Predictor Exams
Related Questions
Correct Answer is ["D","E"]
Explanation
A. While nutrition is important, it is not an immediate priority in this acute respiratory situation. Addressing airway and oxygenation issues takes precedence.
B. Vital signs are important to monitor the client's condition; however, addressing oxygenation and administering bronchodilators are more urgent to stabilize her respiratory status.
C. Although pulmonary function tests are valuable for assessing respiratory function, they are not as urgent as administering oxygen and bronchodilators in the context of acute respiratory distress. Immediate interventions to improve her breathing should be prioritized first.
D. The client has an oxygen saturation of 91%, which is below the desired level of greater than 94%. Administering oxygen will help improve her oxygen saturation levels and alleviate hypoxia, making it a priority intervention.
E. The client is experiencing an acute asthma exacerbation, as indicated by wheezing and difficulty breathing. Administering albuterol via nebulization will provide bronchodilation and improve airway patency, which is critical for the client's immediate respiratory status.
Correct Answer is ["0.75"]
Explanation
To determine the correct dosage, the nurse should use the concentration of the reconstituted solution which is 0.25 mg per 1 mL. Since the prescribed dose is 0.1875 mg, the nurse needs to calculate the volume of the reconstituted solution that contains this dose. By dividing the prescribed dose (0.1875 mg) by the concentration of the solution (0.25 mg/mL), the result is the volume to administer. Therefore, the nurse should administer 0.75 mL of the reconstituted solution.
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