The client is admitted to the nurse's unit with a diagnosis of heart failure. His heart is not pumping eﬀectively, which is resulting in edema and coarse crackles in his lungs. The term for this condition is:

Myocardial Infarction.

Atelectasis.

Fluid volume deficit.

Fluid volume excess.

Answer and Explanation

The Correct Answer is D

Heart failure is a condition in which the heart is unable to pump blood eﬀectively, leading to a buildup of ﬂuid in the body. This can result in edema (swelling) and ﬂuid accumulation in the lungs, causing coarse crackles when breathing. The term for this condition is ﬂuid volume excess, which refers to an excessive amount of ﬂuid in the body.

Myocardial infarction is a heart attack, atelectasis is a collapse of lung tissue, and ﬂuid volume deficit refers to a lack of ﬂuid in the body.

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Correct Answer is D

Explanation

The number "+3" in this documentation represents the pulse amplitude. Pulse amplitude refers to the strength or force of the pulse and is typically measured on a scale of 0 to 4+. A "+3" pulse is considered to be full or strong, indicating good blood ﬂow to the area being palpated.

A. Disturbed Sleep Pattern related to difficulty staying asleep B. Disturbed Thought Processes related to chronic insomnia C. Risk for injury related to somnambulism D. Risk for Impaired Gas Exchange related to sleep apnea

Correct Answer is C

Explanation

The priority nursing diagnosis for this client should be Risk for injury related to somnambulism. Somnambulism, also known as sleepwalking, can put the client at risk for injury as they may engage in activities while not fully conscious. The client's report of falling asleep while driving and almost being involved in an accident further highlights the potential risk for injury. It is important for the nurse to address this risk and develop a plan to ensure the client's safety.

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The client is admitted to the nurse's unit with a diagnosis of heart failure. His heart is not pumping eﬀectively, which is resulting in edema and coarse crackles in his lungs. The term for this condition is:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse palpates the pulse of a client and documents the following: 6/6/12 pulse 85 and regular, 3+ and equal in radial, popliteal, and dorsalis pedis. What does the number "+3" represent?

Correct Answer is D

Explanation

The client who has sleep apnoea reports falling asleep while driving, almost being involved in an accident, and frequent episodes of sleepwalking. What nursing diagnosis should be a priority for this client?

Correct Answer is C

Explanation

The nurse has performed an assessment of a client scheduled for discharge to be cared for by the family. Which situation would the nurse question regarding discharge of this client to be cared for by the family?

A nurse is conducting a lung assessment on a client suspected of having pneumonia. Which finding should the nurse report to the physician immediately?

A nurse is caring for a client in the introductory (orientation) phase of the nurse-client relationship. Which of the following communication techniques should the nurse use during this phase?

A client with a terminal illness without an advance directive stops breathing and does not have a heartbeat. What should the nurse do?

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The nurse instructs the client on mind-body therapies. Which mind-body therapy is used when the client pictures themselves lying on a beach with the sounds of waves, the cries of seagulls, and the warmth of the sun during periods of stress?

A client has been diagnosed with diabetes mellitus and must learn how to do his own finger stick blood sugar analysis as part of his treatment. The client has been sullen and uncommunicative since receiving the diagnosis. How can the nurse best increase the client's motivation to learn?

A client needs a test to determine the amount of residual urine. The nurse realizes that this assessment is used for which reason(s)? Select all that apply.