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?

Bradycardia.

Bigeminal.

Dysrhythmia.

Tachycardia.

Answer and Explanation

The Correct Answer is D

The client would most likely exhibit tachycardia, which is an abnormally fast heart rate. Fever and infection can both cause an increase in heart rate as the body tries to fight oﬀ the infection. Severe pain can also cause an increase in heart rate due to the body's stress response. Therefore, it is likely that the client would have a fast pulse rate, or tachycardia.

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Free Nursing Study Resources

Correct Answer is ["C","D"]

Explanation

If a visitor in the dining room at the hospital has a forceful cough, the nurse should first allow the visitor to continue coughing. Coughing is a natural reﬂex that helps clear the airway of foreign objects or mucus. The nurse should also assess the eﬀectiveness of the cough. If the cough is weak or ineﬀective, further intervention may be necessary.

Starting cardiopulmonary resuscitation (CPR) or performing the Heimlich maneuver would only be appropriate if the visitor is choking and unable to breathe. Assisting the client to a sitting position on the ﬂoor may not be necessary and could potentially cause harm.

A. Hallucinations at the onset of sleep B. Sleep apnea C. A lack of rapid eye movement (REM) sleep D. The urge to move the legs when trying to sleep E. Sudden attacks of sleep

Correct Answer is ["A","B","E"]

Explanation

During an assessment of a client diagnosed with narcolepsy, the nurse should anticipate the following findings: Hallucinations at the onset of sleep, Sleep apnea, and Sudden attacks of sleep ². These are common symptoms of narcolepsy. The other options (A lack of rapid eye movement (REM) sleep and The urge to move the legs when trying to sleep) are not directly related to narcolepsy.

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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?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While in the dining room at the hospital, the nurse notes a visitor has forceful coughs. Which actions would the nurse take to assist this visitor? Select all that apply:

Correct Answer is ["C","D"]

Explanation

A nurse is conducting an assessment on a client diagnosed with narcolepsy. The nurse should anticipate which of the following findings? Select all that apply.

Correct Answer is ["A","B","E"]

Explanation

While conducting a dressing change, the nurse notes a new area of skin breakdown that was caused by the tape used to secure the dressing. In which phase of the nursing process is the nurse working?

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