Patient Data

Exhibits

The client continues to have stable neurologic assessments. The nurse provides interventions to promote client safety while in the hospital. Click to indicate which interventions promote client safety. Each column must have at least one response selected.

Initiate use of the bed alarm

Place all client belongings out of reach

Instruct the client to call before getting up

Provide a call button kept within reach

Place the client in a room near the elevator

Complete a swallow study before giving anything by mouth

Answer and Explanation

The Correct Answer is {"A":{"answers":"A"},"B":{"answers":"B"},"C":{"answers":"A"},"D":{"answers":"A"},"E":{"answers":"B"},"F":{"answers":"A"}}

Rationale:

Initiate use of the bed alarm: This alerts staff when the client attempts to get out of bed, enabling quick assistance. It is especially crucial for clients with unilateral weakness and impaired mobility after stroke. Early response helps prevent falls and related injuries.
Place all client belongings out of reach: Placing items out of reach encourages the client to stretch, reach, or attempt to get out of bed unsafely. Stroke patients may have limited strength and poor balance, making this dangerous. It increases the risk of injury and delays access to essential items.
Instruct the client to call before getting up: Teaching the client to seek assistance before attempting to ambulate minimizes the risk of unassisted movement. Stroke patients often have impaired coordination or weakness, increasing the risk of falling.
Provide a call button kept within reach: Keeping the call bell within the client’s reach promotes autonomy and timely communication with the care team. It enables the client to signal for help easily in case of urgent needs or sudden symptoms.
Place the client in a room near the elevator: A room near the elevator may expose the client to high traffic, noise, and stimulation, which can increase confusion or anxiety. For a stroke patient needing rest and monitoring, this environment is not ideal.
Complete a swallow study before giving anything by mouth: A bedside swallow evaluation identifies risk for aspiration, which is common in stroke clients with impaired speech and facial droop. Preventing oral intake until clearance protects against aspiration pneumonia and choking.

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Naxlex Comprehensive Predictor Exams

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Correct Answer is B

Explanation

Rationale:
A. Report the COVID-19 result to the local health department according to the Center for Disease Control (CDC) guidelines: Reporting is important for public health surveillance but is not the nurse’s most immediate priority. Isolation should occur first to prevent the spread of infection, especially before confirmatory test results are available.

B. Isolate the client from other clients, family, and healthcare workers not wearing proper personal protective equipment (PPE): Prompt isolation is the highest priority to prevent transmission of COVID-19. Even with a previous negative test, current symptoms suggest active infection, and precautions must be implemented immediately to protect others.

C. Notify the charge nurse the client will need assignment to the COVID-19 specified area of the facility: While communication with the charge nurse is necessary for client placement, it should follow immediate implementation of infection control measures.

D. Place the nasal swab specimen for COVID-19 directly into a biohazard bag: Proper specimen handling is critical for safety and test integrity but does not take precedence over isolating a potentially infectious client.

A. Both the sun and radiation can damage the skin because it has a rapid renewal rate. B. lonizing energy of RT penetrates to the target tumor and does not affect the skin like sun rays. C. Shielding helps to localize the entrance of RT and protects other sensitive areas. D. Special gels can be prescribed for local application to promote healing and comfort. E. Application of cold compresses after treatment decreases the skin's sensitivity.

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

Explanation

Rationale:
A. Both the sun and radiation can damage the skin because it has a rapid renewal rate:
The skin’s high cellular turnover makes it vulnerable to damage from both UV radiation and radiation therapy. Clients with fair skin are especially prone to radiation dermatitis due to lower melanin protection.

B. Ionizing energy of RT penetrates to the target tumor and does not affect the skin like sun rays: Although radiation targets deeper tissues, the skin at the entry site can still be affected. Radiation can cause localized skin damage, including dryness, erythema, or peeling.

C. Shielding helps to localize the entrance of RT and protects other sensitive areas:
Radiation therapy uses shielding and precise targeting to minimize exposure to surrounding tissues. However, the entry site of the beam still receives some exposure, making localized protection and care essential.

D. Special gels can be prescribed for local application to promote healing and comfort:
Topical agents like hydrophilic creams or corticosteroid gels may be recommended to soothe irritated skin and promote healing during radiation therapy. These help manage symptoms like dryness and inflammation.

E. Application of cold compresses after treatment decreases the skin's sensitivity: Cold compresses are not typically recommended after radiation, as they may constrict blood flow and delay healing. Instead, gentle skincare routines and prescribed topical treatments are preferred.

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Patient Data Exhibits The client continues to have stable neurologic assessments. The nurse provides interventions to promote client safety while in the hospital. Click to indicate which interventions promote client safety. Each column must have at least one response selected.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Four days after exposure to COVID-19 a client has a negative COVID-19 test result. Eight days after the negative test result, the client presents with fever, fatigue, and cough and the nurse performs a second COVID-19 test. Which action is most important for the nurse to take?

Correct Answer is B

Explanation

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

Explanation

Exhibits After two days of intensive care, the client is transferred to the telemetry floor. The floor nurse is preparing a plan of care for the client. Which modifiable risk factor(s) should the nurse include in the teaching for this client? Select all that apply.

A client who has asthma receives a new prescription for a corticosteroid inhaler. The client expresses concern about taking steroid medications. Which information should the nurse provide the client about the use of this maintenance inhaler?

Exhibits For each of the findings listed, click to indicate which are consistent with the disease process of aortic aneurysm versus gastric cancer. Each column must have at least one response option selected.

When conducting diet teaching for a client who is on a postoperative full liquid diet, which food(s) should the nurse encourage the client to eat? Select all that apply.

The nurse is conducting a visual screening of a group of older adults. Which finding should the nurse report to the healthcare provider immediately?

A client with a history of a bilateral adrenalectomy is admitted with a weak, irregular pulse, and hypotension. Which assessment finding warrants immediate intervention by the nurse?

Patient Data

Exhibits

The client continues to have stable neurologic assessments. The nurse provides interventions to promote client safety while in the hospital. Click to indicate which interventions promote client safety. Each column must have at least one response selected.