The nurse instructs an unlicensed assistive personnel (UAP) to turn an immobilized older client with an indwelling urinary catheter every two hours.
What additional action should the nurse instruct the UAP to perform each time the client is turned?

Offer the client oral fluids.

Feed the client a snack.

Assess the breath sounds.

Empty the urinary drainage bag.

Answer and Explanation

The Correct Answer is D

Choice A rationale
Offering the client oral fluids is important for hydration, but it may not be appropriate for all patients, especially those with certain medical conditions or those who are NPO (nothing by mouth)7.
Choice B rationale

Feeding the client a snack can help maintain energy levels, but it may not be appropriate for all patients, especially those with dietary restrictions or those who are NPO7.
Choice C rationale
Assessing breath sounds is an important part of respiratory assessment, but it is not typically within the scope of practice for unlicensed assistive personnel (UAP). This task should be performed by a licensed nurse.
Choice D rationale
Emptying the urinary drainage bag is an appropriate task for a UAP to perform each time the client is turned. This helps ensure accurate measurement of urinary output and prevents infection by keeping the bag below the level of the bladder.

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Correct Answer is C

Explanation

Choice A rationale
While the sensitivity of genetic markers can influence the choice of treatment, it is not the primary pathophysiological process involved in BRCA1 and BRCA2 genetic testing. The main purpose of these tests is to identify genetic mutations that increase the risk of developing certain types of cancer.
Choice B rationale
BRCA1 and BRCA2 do play a role in protecting mature, functioning breast and ovarian cells. However, this is not the primary reason for conducting BRCA1 and BRCA2 genetic testing. The main purpose of these tests is to identify mutations that increase cancer risk.
Choice C rationale

This is the correct answer. Mutations in BRCA1 or BRCA2 can significantly increase a person’s risk for developing breast and ovarian cancer. Therefore, identifying these mutations through genetic testing can help determine a person’s cancer risk.
Choice D rationale
While inherited mutations in BRCA1 and BRCA2 can influence the prognosis of breast cancer, the primary purpose of BRCA1 and BRCA2 genetic testing is to identify mutations that increase cancer risk, not to determine prognosis.

A. Avoid exposure to large crowds. B. Call the crisis hotline if feeling lonely. C. Do not take any over-the-counter medications. D. Follow a high carbohydrate, low fat, low protein diet.

Correct Answer is C

Explanation

Choice A rationale
While avoiding exposure to large crowds can help prevent infections, especially for patients with compromised immune systems, it is not the most crucial information for a patient with liver damage due to an overdose of acetaminophen.
Choice B rationale
While emotional support is important for patients dealing with health issues, calling a crisis hotline if feeling lonely is not the most crucial information for a patient with liver damage due to an overdose of acetaminophen.
Choice C rationale
This is the most crucial information for the patient. Acetaminophen is found in many over-the- counter medications, and further intake could exacerbate liver damage.
Choice D rationale
While a balanced diet is important for overall health, following a high carbohydrate, low fat, low protein diet is not the most crucial information for a patient with liver damage due to an overdose of acetaminophen.

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The nurse instructs an unlicensed assistive personnel (UAP) to turn an immobilized older client with an indwelling urinary catheter every two hours. What additional action should the nurse instruct the UAP to perform each time the client is turned?

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The nurse is preparing a client with breast cancer for BRCA1 and BRCA2 genetic testing. Which pathophysiological process should the nurse use to support client teaching?

Correct Answer is C

Explanation

A male adult is admitted due to an overdose of acetaminophen. After being transferred to the mental health unit, the patient is informed that he has liver damage. What is the most crucial information for the nurse to include in the patient’s discharge plan?

Correct Answer is C

Explanation

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The nurse instructs an unlicensed assistive personnel (UAP) to turn an immobilized older client with an indwelling urinary catheter every two hours.
What additional action should the nurse instruct the UAP to perform each time the client is turned?