The nurse is assessing a client in the acute care setting who has had a history of osteoarthritis. The client states that they have been taking ibuprofen four times a day for over five months and their pain continues to be poorly controlled despite all of their efforts. What is another assessment finding the nurse might anticipate for this client?

Increased urinary output.

Increased heart rate.

Decreased heart rate.

Hypoglycemia.

Answer and Explanation

The Correct Answer is B

A. Increased urinary output is incorrect because NSAIDs like ibuprofen can cause kidney damage, leading to fluid retention and decreased urine output, not increased output.
B. Increased heart rate is correct. Long-term NSAID use can cause gastrointestinal (GI) irritation and ulcers, which may lead to occult blood loss and anemia. Anemia can result in tachycardia (increased heart rate) as the body compensates for decreased oxygen delivery. C. Decreased heart rate is incorrect because anemia and pain typically cause tachycardia, not bradycardia.
D. Hypoglycemia is incorrect because NSAIDs do not significantly impact blood glucose levels.

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Correct Answer is B

Explanation

A. Ensuring valid conclusions when analyzing data is part of the initial assessment rather than the purpose of a partial assessment.
B. Reassessing previously detected problems to note any changes is correct because partial assessments are conducted to monitor the client's progress and detect any new or worsening symptoms.
C. Crisis intervention is not the primary purpose of a partial assessment unless a crisis is evident.
D. Identifying strengths and limitations in lifestyle and health status is a component of the initial comprehensive assessment rather than the partial assessment.

A. Review the client's blood work for sodium and bicarbonate levels. B. Assess the client for signs and symptoms of peptic ulcer disease. C. Assess the client's nutritional status. D. Assess the client for other signs and symptoms of liver disease.

Correct Answer is D

Explanation

A. Reviewing sodium and bicarbonate levels is not the most immediate action. While these lab values may provide useful information, they do not directly assess the suspected condition.
B. Assessing for peptic ulcer disease is incorrect because a tight, distended abdomen with visible arterioles (caput medusae) is more indicative of liver disease, such as cirrhosis or portal hypertension, rather than a gastric ulcer.
C. Assessing the client’s nutritional status may be important, but it is not the priority in this situation. Malnutrition can be a consequence of liver disease, but the nurse should first focus on identifying the underlying condition.
D. Assessing the client for other signs and symptoms of liver disease is correct. A distended abdomen and visible arterioles suggest possible ascites and portal hypertension, both of which are common in liver disease. Further assessment for jaundice, hepatic encephalopathy, or changes in liver enzyme levels would be appropriate.

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Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse has completed the comprehensive health assessment of a client who has been admitted for the treatment of community-acquired pneumonia. Following the completion of this assessment, why does the nurse periodically perform a partial assessment of the client?

Correct Answer is B

Explanation

The nurse is inspecting a new client's abdomen and notes the presence of a tight, distended abdomen and visible arterioles on the abdominal skin surface. What would the nurse do next?

Correct Answer is D

Explanation

A nurse has completed the client's initial assessment and is preparing to identify abnormal data and the client's strengths. Which of the following is required to successfully complete this phase of the nursing process?

A client has come into the clinic with complaints of anorexia for one month with a noted 20-pound weight loss in the past six weeks. The nurse notes mild edema to the lower extremities, thin, dry hair, and brittle nails. What deficiency are these findings most likely related to?

While assessing a client's abdomen, the nurse observes sharp pains and involuntary reflex guarding on expiration. What complication does the nurse suspect based on these findings?

Which of the following statements indicate that the student nurse understands the importance of documenting the initial assessment data?

A nurse is preparing to examine the chest, extremities, and peripheral pulses of a client who has low back pain. What is the best position to place this client in to assure they are comfortable for the exam?

After teaching a group of students about changes in body weight due to aging, the instructor determines that the students have understood the teaching when they state which of the following?

The nurse is assessing vital signs on a client admitted to the medical-surgical unit. What is the correct technique for assessing the radial pulse?