The nurse caring for a client with acute leukemia who is immunosuppressed is diligent about protecting the patient from infection. When visitors come in, in addition to having them put on neutropenic isolation, the registered nurse prohibits them from bringing a:

New pajama.

Well-done meat.

Beautiful potted plant.

A new iPad from the online store

Answer and Explanation

The Correct Answer is C

A. New pajamas are generally not a risk for infection and do not pose a significant threat to an immunosuppressed patient.
B. Well-done meat is safe for consumption and does not pose an infection risk in this context.
C. A potted plant can harbor soil-borne bacteria and fungi, posing a risk of infection to immunosuppressed patients and should be avoided.
D. A new iPad from the online store is unlikely to introduce infection and does not pose a significant risk.

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Correct Answer is D

Explanation

A. Refusing to leave home can be a sign of anxiety or other issues but is not specific to confabulation.
B. Reminiscing about the past is a normal behavior and does not indicate confabulation.
C. Compulsive and ritualistic behaviors are more related to obsessive-compulsive disorders rather than confabulation.
D. Confabulation involves making up stories to fill in memory gaps and is a coping mechanism seen in some clients with dementia.

A. Decrease in the urinary output from 50 mL to 30 mL per hour. B. Increase in the heart rate from 88 to 110/min. C. Decrease in the respiratory rate from 20 to 16/min. D. Increase in the temperature from 37.5° C (99.5° F) to 38.6° C (101.5° F).

Correct Answer is B

Explanation

A. A decrease in urinary output can be a sign of decreased blood volume but is less immediate than changes in heart rate.
B. An increase in the heart rate is a common compensatory response to hypovolemia as the body attempts to maintain adequate perfusion to vital organs.
C. A decrease in the respiratory rate is not typically associated with hypovolemic shock; rather, respiratory rate may increase due to compensatory mechanisms.
D. An increase in temperature is not a specific indicator of hypovolemic shock; it could be related to infection or inflammation rather than immediate hypovolemia.

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The nurse caring for a client with acute leukemia who is immunosuppressed is diligent about protecting the patient from infection. When visitors come in, in addition to having them put on neutropenic isolation, the registered nurse prohibits them from bringing a:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

A nurse is caring for an older adult client who has dementia and handles anxiety by confabulating. The nurse should recognize confabulation when the client

Correct Answer is D

Explanation

A nurse is caring for a client who returns to the nursing unit from the recovery room after a sigmoid colon resection for adenocarcinoma. The client had an episode of intraoperative bleeding. Which finding indicates to the nurse that the client may be developing hypovolemic shock?

Correct Answer is B

Explanation

A nurse on a medical-surgical unit is caring for four clients who are 24 to 36 hr postoperative. Which of the following surgical procedures places the client at risk for deep-vein thrombosis?

A nurse in the emergency department is caring for a client who has extensive partial and full-thickness burns of the head, neck, and chest. While planning the client's care, the nurse should identify which of the following risks as the priority for assessment and intervention?

A nurse is caring for a client who has chemotherapy-induced peripheral neuropathy. The nurse should expect the client to report having experienced which of the following symptoms?

A clinic nurse is performing a physical assessment on a client who has systemic lupus erythematosus (SLE). Which of the following findings should the nurse expect?

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A nurse is caring for a client who has a new diagnosis of myasthenia gravis. For which of the following manifestations should the nurse monitor?

A nurse is caring for a client who is receiving a unit of packed red blood cells. Fifteen minutes following the start of the transfusion, the nurse notes that the client is febrile, with chills and red-tinged urine. Which of the following transfusion reactions should the nurse suspect?