A nurse is caring for a client.

Exhibits

Complete the following sentence by using the list of options

The client is at risk for developing
_
as evidenced by the client's
_

Answer and Explanation

The Correct Answer is {"dropdown-group-1":"A","dropdown-group-2":"C"}

Infection (Option 1): The patient's WBC count has decreased from 8,000/mm³ (normal range) to 4,000/mm³ (below normal), indicating leukopenia. This puts the client at increased risk for infections, especially since they are undergoing chemotherapy, which can further suppress the immune system.

WBC count (Option 2): The decreased WBC count is a direct indicator of the risk for infection, as a low white blood cell count reduces the body’s ability to fight off infections.

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Correct Answer is B

Explanation

A. Light bleeding from the stoma can be normal in the early postoperative period, but it should be monitored.

B. A dark-colored stoma can indicate ischemia or compromised blood supply, which is a critical finding that requires immediate reporting to the provider.

C. Slight protrusion of the stoma is typically expected and not a cause for concern.

D. Small amounts of liquid stool from the stoma are normal in the immediate postoperative period and do not need to be reported.

A. Request a prescription renewal from the provider every 36 hr. B. Make sure two fingers fit under the restraints. C. Check the client's range of motion every 6 hr. D. Secure the restraints with a square knot.

Correct Answer is B

Explanation

A. Restraint prescriptions typically need to be renewed at least every 24 hours, not every 36 hours, to comply with regulatory standards.

B. Ensuring that two fingers fit under the restraints is essential to confirm that they are not too tight, allowing for circulation and comfort while still securing the client.

C. Checking the client's range of motion should occur more frequently than every 6 hours; ideally, it should be assessed more regularly to prevent complications.

D. Restraints should be secured using a quick-release knot, not a square knot, to ensure they can be removed easily in an emergency.

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A nurse is caring for a client. Exhibits Complete the following sentence by using the list of options The client is at risk for developing ___ as evidenced by the client's ___

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is collecting data from a client who is 2 days postoperative following the placement of a colostomy. Which of the following findings should the nurse report to the provider?

Correct Answer is B

Explanation

A nurse is caring for a client who is confused and has a prescription for wrist restraints. Which of the following actions should the nurse take?

Correct Answer is B

Explanation

A nurse is caring for an adult client who has a developmental disability. The client requires an emergency appendectomy, and the staff cannot reach the appointed guardian. Which of the following is an appropriate action for the nurse to take?

A nurse is preparing to obtain a capillary blood specimen from a client. Which of the following actions should the nurse take? (Select all that apply.)

A nurse is caring for a client who refuses their morning dose of antihypertensive medication. The client tells the nurse. "I'm not going to take this medication because it makes me sick and dizzy." Which of the following actions should the nurse take first?

A nurse is caring for a client who has a new prescription for a belt restraint. Which of the following actions should the nurse take?

A nurse is caring for a client and observes a nurse from another unit reviewing the client's medical record. Which of the following actions should the nurse take?

A home health nurse is reinforcing teaching about dietary needs with the child of a client. They state. "I don't know what to do because they're not eating." Which of the following responses should the nurse make?

A nurse is collecting data from a client who is immobile and has a potential deep-vein thrombosis. Which of the following findings should the nurse report to the provider?

A nurse is caring for a client.

Exhibits

Complete the following sentence by using the list of options

The client is at risk for developing
_
as evidenced by the client's
_