An older client's spouse reports to the nurse that there has been a behavior change in the client for the past several days. The client was recently seen by the healthcare provider at the clinic and was treated for seasonal allergies and insomnia. Which action is most important for the nurse to implement?

Encourage the client to engage in social activities.

Review medications for drug and food interactions.

Appraise light sensitivity, tiredness, and dizzy spells.

Observe carefully for extrapyramidal symptoms (EPS).

Answer and Explanation

The Correct Answer is B

A. Encouraging social activities may benefit the client in the long term but does not directly address the immediate concern of the reported behavior change.

B. Reviewing medications for drug and food interactions is crucial, especially since the behavior change could be related to new medications or combinations that the client was prescribed. This assessment can help identify any adverse effects or interactions affecting the client's mental status.

C. Appraising for light sensitivity, tiredness, and dizzy spells is important but does not directly address the most pressing concern of behavioral changes which could be medication-related.

D. Observing for extrapyramidal symptoms (EPS) is important if the client is on antipsychotic medication, but the more immediate step is to ensure that medications are not contributing to the behavior change.

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Correct Answer is B

Explanation

A. Hematocrit levels provide information about hydration status and blood volume but are not directly related to infection or immune response.

B. The neutrophil count is crucial in assessing the body's response to infection; elevated levels would indicate an ongoing infection, which is relevant in the presence of purulent drainage.

C. Serum blood glucose levels are important for overall health, especially in diabetic patients, but they do not provide immediate information about infection status.

D. Serum albumin is a measure of nutritional status and can indicate healing capacity, but it does not directly assess the presence or severity of infection.

A. Increase ventilator tidal volume. B. Decrease expiratory flow time. C. Decrease expiratory pressure. D. Increase rate of ventilation.

Correct Answer is D

Explanation

A. Increasing the ventilator tidal volume could improve the client's ventilation but may not adequately address the severe hypercapnia indicated by the elevated PaCO2.

B. Decreasing expiratory flow time is not a priority and may not improve ventilation effectively.

C. Decreasing expiratory pressure does not directly address the underlying problem of carbon dioxide retention.

D. Increasing the rate of ventilation is the most appropriate intervention to improve carbon dioxide elimination and correct the acid-base imbalance indicated by the low pH and high PaCO2.

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Naxlex Comprehensive Predictor Exams

While caring for a client with a full thickness burn covering 40% of the body surface area (BSA), the nurse observes purulent drainage at the wound. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

Correct Answer is B

Explanation

Correct Answer is D

Explanation

A client is being treated for syndrome of inappropriate antidiuretic hormone (SIADH). On examination, the client has a weight gain of 4.4 lbs (2 kg) in 24 hours and an elevated blood pressure. Which intervention should the nurse implement first?

The nurse caring for a child with mononucleosis can expect the child to exhibit which symptoms?

Exhibits The nurse starts the albuterol nebulizer as prescribed. Which should the nurse assess after the albuterol nebulizer treatment is complete? Select all that apply.

A child who weighs 55 lb receives a prescription for cefotaxime 150 mg/kg/day IV in divided doses every 6 hours. How many mg should the nurse administer each day? (Enter numerical value only.)

After a scheduled downtime, the computer documentation system fails to restart. Which action should the nurse take first?

An adult client was diagnosed with stage IV lung cancer three weeks ago. The client's spouse approaches the nurse and asks how to know that the spouse's death is imminent because their two adult children want to be there when the client dies. Which is the best response by the nurse?

Exhibits Which client statement(s) require(s) follow up teaching by the nurse? Select all that apply.

Which instruction should the nurse provide to a client who is preparing to have a cystoscopy?