Exhibits

The nurse is reviewing the chart.

Select the condition from the choices below to fill in each blank in the following sentence.

Based on the client's history and physical, the nurse notes that this postpartum client is most at risk for developing
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Answer and Explanation

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

Based on the client's history and physical, the nurse notes that this postpartum client is most at risk for developing thromboembolism

Rationale

Prolonged immobility during labor and instrumental delivery are risk factors for venous thromboembolism (VTE) due to stasis of blood flow in the lower extremities. In addition, epidural anesthesia can contribute to venous stasis by impairing mobility and reducing the ability to feel discomfort or urgency to move.

The immediate postpartum period, especially after a prolonged labor and delivery, poses an increased risk of VTE due to hypercoagulability and vascular damage.

Nursing Test Bank

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Correct Answer is ["B","D"]

Explanation

Rationale

A. This is generally a good practice for clients who may have difficulty ambulating to the bathroom due to their condition. It promotes safety and reduces the risk of falls, especially during episodes of dyspnea.

B. A supine position can increase venous return to the heart and exacerbate symptoms of heart failure by increasing preload. This can lead to increased pulmonary congestion and respiratory distress. Therefore, this observation requires immediate intervention.

C. Providing a low sodium diet aligns with managing heart failure by reducing fluid retention and workload on the heart. This observation does not require immediate intervention unless there are specific dietary restrictions or concerns.

D. In heart failure, fluid restriction is often necessary to prevent fluid overload and exacerbation of symptoms. Having a full pitcher of water accessible to the client could lead to excessive fluid intake, which is concerning and requires immediate intervention.

E. A saline lock allows access for intravenous medications or fluids if needed. Its presence does not necessarily indicate a need for immediate intervention unless it is not functioning properly or if there are signs of infection or infiltration.

A. Pickled olives. B. Fruits without sauce. C. Fresh or frozen vegetables without sauce. D. Cottage cheese. E. Canned soup.

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

Explanation

Rationale

A. High in sodium due to pickling, which is not suitable for someone with hypertension.

B. Recommended because fresh fruits are low in sodium and high in potassium and other nutrients beneficial for managing blood pressure.

C. Recommended because they are low in sodium and rich in potassium, fiber, and nutrients that support cardiovascular health.

D. Cottage cheese is high in sodium and should be avoided or consumed in moderation.

E. Generally high in sodium, which should be limited or avoided in the diet of someone with hypertension.

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Exhibits The nurse is reviewing the chart. Select the condition from the choices below to fill in each blank in the following sentence. Based on the client's history and physical, the nurse notes that this postpartum client is most at risk for developing dropdown

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A client is admitted with an exacerbation of heart failure secondary to chronic obstructive pulmonary disease (COPD). Which observation(s) by the nurse require immediate intervention to reduce the likelihood of harm to this client? Select all that apply.

Correct Answer is ["B","D"]

Explanation

When conducting diet teaching for a client who was diagnosed with hypertension, which food(s) should the nurse encourage the client to eat? Select all that apply.

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

Explanation

The parent of a 7-month-old brings the infant to the clinic because the skin in the diaper area is excoriated and red, but there are no blisters or bleeding. The parent reports no evidence of watery stools. Which nursing intervention should the nurse implement?

A young adult is brought to the emergency department after taking a handful of drugs. The client is unresponsive, so an endotracheal tube (ETT) is inserted. How should the nurse determine if the ETT is correctly placed? Select all that apply.

An older adult client with dementia who is refusing to allow an unlicensed assistive personnel (UAP) to assist in bathing, is becoming increasingly agitated and stating the UAP "wants to hurt me and tie me up." Which approach should the nurse use with the client?

A parent brings their 2-month-old infant to the clinic to receive the recommended primary vaccines. Which instruction should the nurse provide the parent about care of the infant after the injections?

A client is admitted to the mental health unit for feelings of depression secondary to a positive HIV report. To provide a safe milieu for this client, which action should the nurse take?

Exhibits

The nurse is reviewing the chart.

Select the condition from the choices below to fill in each blank in the following sentence.

Based on the client's history and physical, the nurse notes that this postpartum client is most at risk for developing
dropdown