A nurse is assessing a female client who has pneumonia. The nurse should identify which of the following findings increases the client's risk of skin breakdown?

Receiving bronchodilator medication

Weight loss of 2.8 kg (6.2 b)

Hemoglobin 17 g/dl (12 to 16 g/dL)

Wearing an oxygen device

Answer and Explanation

The Correct Answer is B

Indicates an increased risk of skin breakdown. This is because significant weight loss can lead to muscle wasting and reduced subcutaneous tissue, making the skin more vulnerable.

Bronchodilators, hemoglobin level and oxygen device do not relate directly to skin breakdown

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Correct Answer is C

Explanation

Kale is high in vitamin K, which can antagonize the effects of warfarin. Warfarin works by inhibiting vitamin K-dependent clotting factors, so consuming large amounts of vitamin K-rich foods like kale can reduce the anticoagulant effect of warfarin, leading to a decrease in the INR.

Orange juice, beef stew and yogurt have no interactions with warfarin.

A. "Are you afraid of needles that will be used during the procedure?" B. "Let's discuss your concerns about this procedure." C. "Tell me why you are scared to have this procedure." D. "After this procedure, you will feel much better."

Correct Answer is B

Explanation

This response acknowledges the client's fear and invites them to express their concerns, allowing the nurse to address them effectively and provide necessary information or support.
A. This response focuses specifically on the fear of needles and may not address the client's overall apprehension about the procedure or their specific concerns.
C. This response directly asks the client to articulate their fears, which can help the nurse understand the specific reasons behind their anxiety and tailor their support and education accordingly.
D. While this response attempts to offer reassurance, it may come across as dismissive of the client's current fears and may not effectively address their concerns or provide the support they need before undergoing the procedure.

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A nurse is assessing a female client who has pneumonia. The nurse should identify which of the following findings increases the client's risk of skin breakdown?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is teaching a client who has a new prescription for warfarin about foods that affect the INR. The nurse should include in the teaching that which of the following foods interacts with this medication?

Correct Answer is C

Explanation

A nurse is caring for a client who has a herniated disc and is scheduled for a peripheral nerve block. The client tells the nurse, "I am afraid to have this procedure." Which of the following responses should the nurse make?

Correct Answer is B

Explanation

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