Assessment findings for a client following a colectomy for familial polyposis include an ileostomy bag that contains a large amount of fecal liquid and an IV infusion of dextrose 5% in lactated Ringer's infusing at a rate of 100 mL/hour. Which assessment is most

Urinary output.

Serum electrolytes.

Peristomal skin integrity.

Skin turgor.

Answer and Explanation

The Correct Answer is B

A.   While monitoring urinary output is important, it is not the most critical assessment in this context.
B.   Monitoring serum electrolytes is crucial because the large amount of fecal liquid output from the ileostomy can lead to significant electrolyte imbalances.
C.   Peristomal skin integrity is important but is secondary to the immediate risk of electrolyte imbalances.
D.   Skin turgor is important for assessing hydration status, but monitoring electrolytes is more directly related to the immediate postoperative care.

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Correct Answer is B

Explanation

A. This is an open-ended question, not closed-ended.

B. A closed-ended question like "Does your pain occur when walking short distances?" is specific and allows the nurse to understand the triggers and pattern of the pain, which is important for assessing unstable angina.
C. "When did you first notice the pain in your chest?" is also a relevant question but less specific to understanding the current pattern and triggers of the pain.
D. "How do you feel when the pain becomes noticeable?" is open-ended and less specific in identifying triggers and patterns of the pain.

A. Case Manager B. Occupational Therapist C. Speech Therapist D. Respiratory Therapist E. Chief Nursing Officer F. Medical Assistant G. Pharmacy Technician H. Physical Therapist

Correct Answer is ["A","B","C","H"]

Explanation

A. A case manager can coordinate the overall care plan, ensuring the client receives appropriate services and support during recovery and discharge planning.
B. An occupational therapist can help the client regain the ability to perform activities of daily living (ADLs) and improve fine motor skills affected by the stroke.
C. A speech therapist can assist the client with speech and language difficulties, as well as swallowing issues that may have resulted from the stroke.
D. A respiratory therapist is typically involved if there are respiratory issues, which are not indicated in this case.
E. A chief nursing officer provides leadership and oversight roles, and not direct patient care.
F. A medical assistant is typically involved in basic clinical tasks but not in specialized stroke recovery.
G. A pharmacy technician fills prescriptions but doesn’t directly participate in client rehabilitation.
H. A physical therapist can help the client improve strength, balance, and mobility, which are often impaired after a

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Assessment findings for a client following a colectomy for familial polyposis include an ileostomy bag that contains a large amount of fecal liquid and an IV infusion of dextrose 5% in lactated Ringer's infusing at a rate of 100 mL/hour. Which assessment is most

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

While completing an admission assessment for a client with unstable angina, which closed ended questions should the nurse ask about the client's chest pain?

Correct Answer is B

Explanation

Correct Answer is ["A","B","C","H"]

Explanation

The nurse wants to teach the client about the long-term phase symptoms of rape-trauma syndrome. What symptoms are consistent with long-term rape trauma? Select all that apply.

The charge nurse observes a new nurse preparing to irrigate an intravenous catheter. The new nurse is attaching an 18-gauge needle. Which action should the charge nurse take?

When entering the room of a sedated postoperative client, which assessment requires immediate intervention by the nurse?

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During discharge teaching, an overweight client with heart failure (HF) is asked to make a grocery list for the nurse to review. What food choice(s) included on the client's list should the nurse encourage? Select all that apply.

A client who underwent cardiac stent placement four days ago arrives to the emergency department reporting a sudden onset of chest pressure and shortness of breath. Which action should the nurse take next?

A client is admitted to a medical unit with a diagnosis of gastritis and chronic heavy alcohol abuse. Which medication should the nurse administer to prevent the development of Wernicke's syndrome?

The nurse initiates the procedure to remove a client's peripherally inserted central catheter (PICC) when a code blue is called for another client in the unit who collapsed in the hallway while ambulating with the unlicensed assistive personnel (UAP). Which action should the nurse take?