A client needs a test to determine the amount of residual urine. The nurse realizes that this assessment is used for which reason(s)? Select all that apply.

To determine the need for medications

To evaluate ﬂuid volume status

To evaluate the glomerular filtration rate

To determine the amount of retained urine after voiding.

To determine the extent of renal failure

Answer and Explanation

Correct Answer : A,D

A test to determine the amount of residual urine is used to measure the amount of urine that remains in the bladder after voiding. This assessment can be used for several reasons, including to determine the need for medications that can help improve bladder emptying and to evaluate the amount of retained urine after voiding. Retained urine can increase the risk of urinary tract infections and other complications. This test is not typically used to evaluate ﬂuid volume status, glomerular filtration rate, or the extent of renal failure.

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Correct Answer is B

Explanation

Cheyne-Stokes respiration is an abnormal pattern of breathing characterized by progressively deeper, and sometimes faster, breathing followed by a gradual decrease that results in a temporary stop in breathing called apnea. The pattern repeats, with each cycle usually taking 30 seconds to 2 minutes ². It is marked by rhythmic waxing and waning of respirations from very deep to very shallow breathing and temporary apnea ¹.

A. "These exercises prevent thrombophlebitis." B. "The doctor ordered the exercises." C. "These exercises help prevent pneumonia." D. "All surgical clients must do these exercises." E. The correct answer and explanation is:

Correct Answer is C

Explanation

Turning, deep breathing, and coughing exercises are important for clients recovering from surgery as they help prevent the development of pneumonia. After surgery, clients may have difficulty taking deep breaths and coughing due to pain or discomfort. This can lead to the accumulation of mucus in the lungs, increasing the risk of pneumonia. By performing these exercises, clients can help clear their lungs and reduce their risk of developing this complication. While these exercises may also help prevent other complications such as thrombophlebitis, the primary reason for performing them is to prevent pneumonia.

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A client needs a test to determine the amount of residual urine. The nurse realizes that this assessment is used for which reason(s)? Select all that apply.

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which of the following is marked rhythmic waxing and waning of respirations from very deep to very shallow breathing and temporary apnoea?

Correct Answer is B

Explanation

A client recovering from surgery asks the nurse why turning, deep breathing, and coughing exercises need to be done. How should the nurse respond?

Correct Answer is C

Explanation

During a home visit, the nurse explains the procedures for preventing infection in a central venous access device to the spouse who watches while the nurse hooks the client to the medication infusion. Which role is the nurse performing at this time?

While performing a bed bath, the nurse notes an area of tissue injury on the client's sacral area. The wound presents as a shallow open ulcer with a red-pink wound bed and partial thickness loss of dermis. What is the correct name of this wound?

A nurse is providing care for a client who has recently been diagnosed with type 1 diabetes mellitus. To focus on aﬀective learning with this client, the nurse should use which of the following interventions?

A client visits a health care facility reporting loss of appetite following a prolonged illness. How should the nurse document the client's condition?

Which is an example of a closed-ended question or statement?

A nurse is assessing a client who has a fever, an infection of a ﬂank incision, and is in severe pain. Which type of pulse rate would the client most likely exhibit?

During a particularly heated staﬀ meeting regarding staﬀ assignments, the nurse manager makes this comment: "When you all can come to a decision, let me know and we'll move on from there." This leader is best identified as which of the following?

A nurse is taking care of a client who just lost her husband to a terminal illness. The client is refusing to believe that the loss is happening. Which of Kubler-Ross's stages of grieving is the client experiencing?