The nurse is assisting a victim of spousal abuse to create a plan for escape if it becomes necessary. The nurse would recommend that the victim bring:

toys to amuse the children for 3 days.

their cell phone.

birth certificates and Social Security cards.

books and magazines.

Answer and Explanation

The Correct Answer is C

C. Bringing birth certificates and Social Security cards is essential for establishing identity and accessing necessary services, such as shelters, legal assistance, or government benefits. These documents may be needed for applying for assistance, obtaining housing, or enrolling children in school.
A. Ensuring the well-being and comfort of any children involved is important but bringing toys to amuse them for a few days may not be the highest priority when creating an escape plan from spousal abuse.
B. A cell phone can be used to call for help, contact emergency services, or reach out to trusted individuals for assistance. However, it is not the most important item.
D. Having reading materials may provide distraction and comfort during stressful times but they are not typically considered essential items for an escape plan from spousal abuse.

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Correct Answer is C

Explanation

C. Digoxin toxicity is a serious condition that can occur when there is too much digoxin in the body. It can lead to life-threatening cardiac dysrhythmias. One of the risk factors for digoxin toxicity is low blood levels of potassium, or hypokalemia.
A. Electrolyte imbalances, including hyponatremia (low sodium levels), can contribute to digoxin toxicity. However, a sodium level of 133 mg/dl alone does not directly indicate digoxin toxicity.
B. Blood glucose levels within the normal range (80-120 mg/dl) would not directly indicate digoxin toxicity.
D. Calcium levels within the normal range (8.5-10.5 mg/dl) do not directly indicate digoxin toxicity.

A. Assess breath sounds B. Monitor serum protein levels C. Assess peripheral pulses D. Monitor daily weights

Correct Answer is D

Explanation

D. Furosemide is a diuretic that works by increasing urine output, which in turn reduces fluid retention and swelling. By tracking the client's weight on a daily basis, the nurse can obtain a clear and consistent measure of how much fluid is being lost as a result of the medication.
A. Monitoring respiratory status but it may not be the most direct method for evaluating the effectiveness of furosemide in reducing peripheral edema.
B. Monitoring serum protein levels may provide information about the client's nutritional status and liver function, but it is not typically used as a direct measure of response to furosemide for peripheral edema.
C. Improvement in peripheral pulses may indicate a reduction in fluid overload and resolution of edema. However, changes in peripheral pulses may be influenced by factors other than diuresis, such as vascular disease or cardiac function.

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The nurse is assisting a victim of spousal abuse to create a plan for escape if it becomes necessary. The nurse would recommend that the victim bring:

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse should monitor the client for signs and symptoms of digoxin toxicity if the laboratory report reflects a serum:

Correct Answer is C

Explanation

The nurse is administering furosemide 40 mg PO to a client who has peripheral edema. Which method would the nurse use to best evaluate the client's response to this medication?

Correct Answer is D

Explanation

The nurse has recently set limits for a client with borderline personality disorder. The client tells the nurse, "You used to care about me. I thought you were wonderful. Now I can see that I was mistaken. You are hateful." This outburst can be assessed as:

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