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Which descriptions warrant additional follow-up by the nurse? (Select all that apply.).

Solid with red streaks.

Formed but soft.

Brown liquid.

Tarry appearance.

Multiple hard pellets.

Answer and Explanation

Correct Answer : A,D,E

The descriptions that warrant additional follow-up by the nurse are choices A, D, and E.
Solid with red streaks may indicate blood in the stool1.
A tarry appearance may indicate bleeding in the upper digestive tract1.
Multiple hard pellets may indicate constipation1.

Choice B is not an answer because brown liquid stool is not necessarily a cause for concern.

Choice C is not an answer because formed but soft stool is considered normal.

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Correct Answer is A

Explanation

Guided imagery involves creating a specific imagined reality for yourself.

These techniques can be self-taught or guided by a professional.

The more you’re able to use your imagination and engage your senses, the greater the benefits 1.

Choice B is not the answer because motivational phrases may not be as effective as positive external places in reducing chronic pain through guided imagery.

Choice C is not the answer because tranquil sounds may not be as effective as positive external places in reducing chronic pain through guided imagery.

Choice D is not the answer because emotional reflection may not be as effective as positive external places in reducing chronic pain through guided imagery.

A. Abdominal girth. B. Breath sounds. C. Bowel sounds. D. Vital signs.

Correct Answer is D

Explanation

Prior to performing digital removal of a fecal impaction, it is important for the nurse to assess the client’s vital signs.

This includes checking the client’s blood pressure, pulse rate, respiratory rate, and temperature.

These measurements can provide important information about the client’s overall health status and can help the nurse determine if it is safe to proceed with the procedure.

Choice A is not correct because abdominal girth is not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

Choice B is not correct because breath sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

Choice C is not correct because bowel sounds are not the most important assessment for the nurse to perform prior to performing digital removal of a fecal impaction.

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Which descriptions warrant additional follow-up by the nurse? (Select all that apply.).

Nursing Test Bank

Naxlex Comprehensive Predictor Exams

The nurse is using guided imagery with a client who is experiencing chronic pain. What should the nurse direct the client's attention on during the session?

Correct Answer is A

Explanation

Prior to performing digital removal of a fecal impaction, what is the most important assessment for the nurse to perform?

Correct Answer is D

Explanation

The healthcare provider prescribes ear drops to an adult client with an ear infection. Which exacting should the nurse follow?

While changing the dressing of a client with a leg ulcer, the nurse observes a red, tender, and swollen wound at the site of the lesion. Before reporting this finding to the healthcare provider, the nurse should note which of the client's laboratory values?

A client arrives at the emergency department (ED) with severe right upper quadrant pain. To assess the quality of the client's pain, which approach should the nurse use?

After a long bed rest, a client with a Foley catheter and wrist restraints has repeatedly removed the antibiotic (G) tube and NG tube. At checking the restraints, which action is most important for the nurse to take?

A client arrives at the emergency department (ED) with severe right upper quadrant pain. To assess the quality of the client's pain, which approach should the nurse use?

An older woman with end-stage heart disease is hospitalized for severe heart failure. She is alert and requests that no heroic measures be implemented if her breathing stops. What actions should the nurse take first?

The nurse is preparing to give an emergency sedative injection to an agitated client. Which action by the nurse is inappropriate?

The nurse is teaching a client how to self-administer subcutaneous heparin injections. Which instruction should the nurse include?