A nurse is caring for a client who is restrained to each extremity. Which of the following assessments should the nurse perform first?

Elimination needs

Comfort level

Skin integrity

Peripheral pulses.

Answer and Explanation

The Correct Answer is D

When a client is restrained to each extremity, it is important for the nurse to assess the client’s peripheral pulses first to ensure that circulation is not compromised.

Choice A, Elimination needs, is important but not the first priority in this situation.

Choice B, Comfort level, is also important but not the first priority in this situation.

Choice C, Skin integrity, is important but not the first priority in this situation.

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Correct Answer is C

Explanation

“This test will provide information about the function of your liver.” An alanine aminotransferase (ALT) test measures the level of ALT in the blood, which is an enzyme found primarily in the liver.

Elevated levels of ALT can indicate liver damage or disease.

Choice A, “This test will indicate if you are at risk for developing blood clots,” is not correct as an ALT test does not provide information about blood clot risk.

Choice B, “This test will determine if your heart is performing properly,” is not correct as an ALT test does not provide information about heart function.

Choice D, “This test is used to check how your kidneys are working,” is not correct as an ALT test does not provide information about kidney function.

A. Apply a bath blanket between the client and a cooling blanket. B. Place ice packs on the client's neck and behind the knees. C. Give the client a sponge bath using an alcohol-water solution. D. Cover the client with heavy blankets after shivering subsides.

Correct Answer is A

Explanation

A nurse should apply a bath blanket between the client and a cooling blanket when caring for a client who has a high fever.
This can help regulate the temperature of the environment and make it more comfortable for the patient.
Choice B is wrong because placing ice packs on the client’s neck and behind the knees is not recommended as it can cause further problems.
Choice C is wrong because giving the client a sponge bath using an alcohol-water solution is not recommended.
Choice D is wrong because covering the client with heavy blankets after the shivering subsides is not recommended as it can increase body temperature.

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A nurse is caring for a client who is restrained to each extremity. Which of the following assessments should the nurse perform first?

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for a client who is scheduled to have his alanine aminotransferase (ALT) level checked. The client asks the nurse to explain the laboratory test. Which of the following is an appropriate response by the nurse?

Correct Answer is C

Explanation

A nurse is caring for a client who has a high fever. Which of the following actions should the nurse take?

Correct Answer is A

Explanation

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