A client is admitted during the acute phase of a stroke. The nurse observes that the client is restless and unable to follow instructions. Which instruction(s) should the nurse provide the unlicensed assistive personnel (UAP) who is assisting with the care of the client? Select all that apply.

Keep the room brightly lit while providing care.

Minimize verbal interaction with the client.

Monitor for change in speech.

Avoid dropping side rails or abruptly closing the door.

Report any change in level of consciousness.

Answer and Explanation

Correct Answer : C,D,E

Choice A reason: Keeping the room brightly lit while providing care may help with orientation but is not a specific instruction related to stroke care.

Choice B reason: Minimizing verbal interaction with the client is not advisable. Communication is essential in assessing the client's neurological status.

Choice C reason: Monitoring for change in speech is important as speech difficulties can indicate a worsening of the stroke or other neurological issues.

Choice D reason: Avoiding dropping side rails or abruptly closing the door helps minimize unnecessary stimulation and agitation, which can be beneficial for a client experiencing a stroke.

Choice E reason: Reporting any change in level of consciousness is critical as it can indicate changes in the client's condition that require immediate medical attention.

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Correct Answer is A

Explanation

Choice A reason: Low fat yogurt is a good source of calcium and vitamin D, which are important nutrients for postmenopausal women to maintain bone health and prevent osteoporosis.

Choice B reason: Mixed berries are healthy and high in antioxidants, but they do not specifically provide the nutrients that postmenopausal women need most for bone health.

Choice C reason: Carrots are high in beta-carotene but are not a primary source of calcium or vitamin D.

Choice D reason: Beets are nutritious but do not offer the specific benefits of calcium and vitamin D needed by postmenopausal women.

A. Catheter tubing. B. The client's bed. C. Urinary meatus. D. Client's bladder.

Correct Answer is A

Explanation

Choice A reason: The catheter tubing is the most likely reservoir for the infection as it can harbor bacteria and introduce them into the urinary tract when not managed properly.

Choice B reason: The client's bed is an unlikely reservoir for the infection as it does not have direct contact with the urinary system.

Choice C reason: The urinary meatus is part of the normal flora but is not the primary reservoir for the infection in this scenario.

Choice D reason: The client's bladder is the site of the infection, not the reservoir that introduced the bacteria.

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A client is admitted during the acute phase of a stroke. The nurse observes that the client is restless and unable to follow instructions. Which instruction(s) should the nurse provide the unlicensed assistive personnel (UAP) who is assisting with the care of the client? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is providing a nutrition class to a group of postmenopausal clients. Which food should the nurse emphasize to this group?

Correct Answer is A

Explanation

A client's catheter bag was left on the client's bed for a prolonged period of time, and the client develops a urinary tract infection (UTI). In evaluating the cause of the infection, which should the nurse identify as the infection reservoir?

Correct Answer is A

Explanation

A female client is taking alendronate, a bisphosphonate, for postmenopausal osteoporosis. The client tells the nurse that she is experiencing jaw pain. How should the nurse respond?

The nurse is preparing to administer a formula feeding by nasogastric tube (NGT) to a 2-month-old. Which intervention should the nurse implement?

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A client with deep vein thrombosis (DVT) is receiving a continuous heparin IV infusion. The client now has tarry, black diarrhea and reports abdominal pain. Which actions should the nurse implement? Select all that apply.

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A client with osteomyelitis from a compound fracture of the left tibia has an open draining wound and is admitted with possible methicillin-resistant Staphylococcus aureus (MRSA) infection. Which interventions should the nurse include in the plan of care? Select all that apply.