Question

A nurse is providing teaching for the family of a client who has Alzheimer's disease. Which of the following statements should the nurse include?

Answer 1

Correct Answers:

"Provide the client with structured activities to fill their time."

Rationale :

Clients with Alzheimer's benefit from structured activities as they reduce confusion and anxiety. A predictable routine promotes engagement and minimizes agitation. Overstimulation should be avoided.

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Answer 2

Correct Answers:

The client advances the weaker leg forward to the cane.

Rationale :

Proper use of a quad cane involves advancing the weaker leg first to provide stability. This technique helps maintain balance while walking. Incorrect positioning can lead to falls.

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Answer 3

Rationale :

To assess for a positive Chvostek's sign, the nurse should tap on the facial nerve just anterior to the ear and below the zygomatic bone (cheekbone). A positive response (twitching of the facial muscles) indicates hypocalcemia, which can occur after a thyroidectomy due to possible damage to the parathyroid glands leading to hypoparathyroidism.

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Answer 4

Correct Answers:

Clear items from the client's surrounding area_

Rationale :

Ensuring a safe environment prevents injury during a seizure. Hard or sharp objects should be removed to reduce the risk of trauma. Protecting the airway is also important.

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Answer 5

Correct Answers:

Instruct the client not to bend the affected leg

Rationale :

After a cardiac catheterization through the femoral artery, bending the leg can increase the risk of bleeding at the insertion site. The client should remain in a supine position to prevent complications.

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Answer 6

Correct Answers:

Inability to exhale retained carbon dioxide

Rationale :

Asthma leads to air trapping due to bronchoconstriction, making it difficult to exhale CO₂. This results in hyperinflation and respiratory distress. Proper management focuses on airway relaxation.

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Answer 7

Correct Answers:

Administer oxygen at 2 L/min.

Rationale :

Clients with emphysema rely on low oxygen levels to drive respiration, so oxygen should be administered cautiously. High-flow oxygen can suppress their breathing. Controlled oxygen therapy prevents complications.

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Answer 8

Correct Answers:

HCO₃ 18 mEq/L (21 to 28 mEq/L)

Rationale :

Metabolic acidosis is characterized by low bicarbonate (HCO₃) levels. The kidneys are unable to maintain acid-base balance, leading to acidic blood pH. Compensation occurs through respiratory mechanisms.

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Answer 9

Correct Answers:

Flush the PICC line with 0.9% sodium chloride after medication administration.

Rationale :

Flushing the PICC line prevents clot formation and maintains patency. Sodium chloride helps clear the line between medications. Using improper flushing techniques can lead to occlusion.

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Answer 10

Correct Answers:

Place the client in the dorsal recumbent position,

Rationale :

Positioning the client correctly facilitates a smooth catheter removal process and reduces discomfort. The client should be monitored for urinary retention post-removal.

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RN ATI Adult MedSurg~2023 IV

No.

1 : A nurse is providing teaching for the family of a client who has Alzheimer's disease. Which of the following statements should the nurse include?

2 : A nurse is teaching a client who has left-sided weakness how to use a quad cane. Which of the following client actions indicates an understanding of the teaching?

4 : A nurse is caring for a client who is experiencing a seizure. Which of the following actions should the nurse take first?

5 : A nurse is caring for a client immediately following a cardiac catheterization through the right femoral artery. Which of the following actions should the nurse take?

6 : A nurse is caring for a client who is experiencing an acute asthma attack. Which of the following should the nurse identify as a contributing factor to the client's manifestations?

7 : A nurse is caring for a client who has emphysema. Which of the following interventions should the nurse include in the client's plan of care?

8 : A nurse is reviewing the arterial blood gas report of a client who is in metabolic acidosis. Which of the following findings should the nurse expect?

9 : A nurse is planning care for a client who requires insertion of a peripherally inserted central catheter (PICC) line. Which of the following actions should the nurse plan to take?

10 : A nurse is caring for a postoperative client who has an indwelling urinary catheter. Which of the following actions should the nurse take when removing the catheter?

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