A client with dysphagia is eating breakfast and suddenly slumps over. What should the nurse do first?

Call the rapid response team.

Move the client to the bed.

Call the primary care provider.

Assess client for unresponsiveness.

Answer and Explanation

The Correct Answer is D

This is because the nurse should always follow the ABC (airway, breathing, circulation) priority when dealing with a client who suddenly slumps over. The nurse should check if the client is conscious and breathing before calling for help or moving the client.

Choice A is wrong because calling the rapid response team should not be done before assessing the client’s condition and ensuring a patent airway.

Choice B is wrong because moving the client to the bed may cause further harm or aspiration if the client has food in the mouth or airway.

Choice C is wrong because calling the primary care provider is not a priority action in this situation. The nurse should first assess and stabilize the client before notifying the provider.

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Correct Answer is D

Explanation

Diminished breath sounds in a client admitted with pneumonia. This is because diminished breath sounds indicate a worsening of the respiratory condition and a possible complication of pneumonia, such as atelectasis or pleural effusion.

The healthcare provider should be notified immediately to assess the client and order appropriate interventions.

Choice A is wrong because a report of joint pain by a client who recently started taking arthritis medication is not an urgent finding.

Joint pain is a common symptom of arthritis and may take some time to improve with medication.

The nurse should monitor the client’s pain level and administer analgesics as prescribed.

Choice B is wrong because report of decreased appetite and difficulty sleeping is not an immediate concern.

These are nonspecific symptoms that may be related to stress, anxiety, depression, or other factors.

The nurse should explore the possible causes of these symptoms and provide emotional support and education to the client.

Choice C is wrong because a weight loss of two pounds in a client admitted to congestive heart failure is not a critical finding.

Weight loss may indicate a reduction of fluid retention, which is a desired outcome for clients with heart failure.

The nurse should monitor the client’s weight daily and report any significant changes to the health care provider.

Normal ranges for weight, appetite, sleep, joint pain, and breath sounds vary depending on the individual’s age, gender, height, activity level, medical history, and other factors.

A. Age of the client. B. Viscosity of the solution. C. Amount of adipose tissue over the muscle. D. Quantity of the solution to be administered.

Correct Answer is C

Explanation

The proper length of the needle to administer a subcutaneous injection depends on the amount of adipose tissue over the muscle.

The needle should be long enough to reach the subcutaneous layer but not so long that it penetrates the muscle. The needle gauge and length vary depending on the patient’s size and the injection site

Choice A is wrong because the age of the client does not determine the needle length.

However, age may affect the amount of adipose tissue and muscle mass, which are factors to consider when choosing a needle length.

Choice B is wrong because the viscosity of the solution does not determine the needle length. However, viscosity may affect the needle gauge, which is the diameter of the needle.

Thicker solutions may require larger gauge needles to allow easier flow.

Choice D is wrong because the quantity of the solution does not determine the needle length.

However, quantity may affect the syringe size, which is the volume of medication that can be held by the syringe.

The syringe size should match the prescribed dose as closely as possible to ensure accuracy and ease of measurement.

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A client with dysphagia is eating breakfast and suddenly slumps over. What should the nurse do first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

Which client assessment should a nurse immediately report to the health care provider?

Correct Answer is D

Explanation

Which criterion should a nurse use to determine the proper length of the needle to administer a subcutaneous (subcut) medication?

Correct Answer is C

Explanation

A nurse identifies that a medication is ordered for the client as twice the regular dosage. What action should the nurse take?

Which serum laboratory test result should the nurse expect for a client diagnosed with Imbalanced Nutrition: Less than Body Requirements?

The nurse talks with a client who is a widower of six years and who misses his wife. What is the best statement by the nurse to encourage the client to express his feelings?

Which outcome is expected for a client who has a diagnosis of constipation? The client:.

Which statement, if made by a client diagnosed with sleep disturbance, should a nurse evaluate as correct understanding of the plan of care to improve sleep patterns?

Which statement made by a client taking nitroglycerin as needed (prn) indicates understanding of the instructions for safe use of this drug?

The nurse is assessing a client presenting with diazepam intoxication. What signs and symptoms are consistent with benzodiazepine intoxication? Select all that apply.

A nurse is performing a health history. What communication techniques should the nurse use? Select all that apply.