When performing pin care, which of the following would be most appropriate? Select all that apply.

Use aseptic technique.

Use an applicator only once.

Gently remove crusts around pin sites.

Clean the site, working toward the pin.

Obtain culture if purulent drainage.

Answer and Explanation

Correct Answer : A,B,D,E

When performing pin care, the nurse should use aseptic technique and obtain a culture if purulent drainage is present. The applicator should be used only once, and the site should be cleaned, working toward the pin. Crusts around the pin site should not be removed as this can cause trauma to the site and increase the risk of infection.

Choice C, Gently remove crusts around pin sites is not appropriate as this can cause trauma to the site and increase the risk of infection.

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Correct Answer is C

Explanation

Measure abdominal girth according to a set routine. Abdominal enlargement is a common finding in clients with cirrhosis, which is a condition characterized by liver scarring and impaired liver function. Measuring abdominal girth regularly is an important nursing intervention to monitor the progression of abdominal distention and to identify potential complications such as ascites, which is an accumulation of fluid in the abdomen.

Choice A, reporting the condition to the physician immediately, may be necessary if the abdominal enlargement is sudden or accompanied by other symptoms such as severe pain or shortness of breath.

Choice B, providing the client with nonprescription laxatives, is not indicated for abdominal enlargement in clients with cirrhosis.

Choice D, asking the client about food intake, is not relevant to the assessment of abdominal enlargement in clients with cirrhosis.

A. Painless hematuria. B. Frequency. C. Urinary retention. D. Fever.

Correct Answer is A

Explanation

Painless hematuria. Painless hematuria, the presence of blood in the urine without any accompanying pain, is the most common initial symptom of a malignant tumor of the bladder. Frequency, choice B, urinary retention, choice C, and fever, choice D, may also be associated with bladder cancer but are not typically the initial symptoms.

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When performing pin care, which of the following would be most appropriate? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

When performing a physical examination on a client with cirrhosis, a nurse notices that the abdomen is enlarged. Which of the following interventions should the nurse consider?

Correct Answer is C

Explanation

A nurse is reviewing the history along with physical examination of a client with a suspected malignant tumor of the bladder. Which finding would the nurse identify as the most common initial symptom?

Correct Answer is A

Explanation

Which of the following interventions would be appropriate for a client who has undergone surgery for a liver disorder and has started shivering?

A client is diagnosed with carpal tunnel syndrome. Which of the following assessment findings would the nurse expect?

The nurse is caring for a client with Guillain-Barré syndrome. Which assessment finding would indicate the need for oral suctioning?

The nursing instructor is facilitating a discussion with a group of nursing students about common signs and symptoms of diabetes which include the 3 P's. What are the three P's of hyperglycemia? (SATA).

A client is suspected of having acromegaly. What definitive diagnostic testing is the most reliable for confirming acromegaly?

The nurse is caring for a young woman who is struggling with weight loss issues without apparent physical cause. Which is the most likely nursing assessment for this nutritional disorder in which normal body weight is not maintained?

Which nursing instruction is correct to provide the client following a barium enema?

The nurse is reviewing a client's history which reveals that the client has had an oversecretion of growth hormone (GH) that occurred before puberty. The nurse interprets this as which of the following?