1 :

Hint : Support orientation and clarity.

Correct Answers:

  • Face the client when speaking to them.


Rationale :
💥For clients with moderate vision impairment, facing them while speaking ensures that nonverbal cues such as facial expressions and lip movements can assist in comprehension. 💥It also helps orient the client spatially and reinforces verbal communication. 💥Maintaining this respectful and direct communication approach supports client safety, confidence, and engagement.

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2 :

Hint : Manages airway interventions.

Correct Answers:

  • Respiratory therapist


Rationale :
✅A respiratory therapist possesses the specialized training necessary for managing airway interventions, including tracheostomy care. ✅This professional can assess airway patency, perform suctioning, and assist with ventilator settings or humidification systems. ✅Their involvement ensures that the client receives expert care tailored to respiratory support and airway maintenance.

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3 :

Hypertension

Osteoarthritis

Hyperlipidemia

Client works as a construction worker.

Day 1

Furosemide 40 mg PO QD

Naproxen 250 mg PO BID

Lovastatin 20 mg PO QD

6 months later:

Client reports ringing in both ears

Client states they are having difficulty hearing the television

 6 months later

Audiometer test with hearing loss at 39 dB

A nurse is caring for a client.


A nurse is reviewing a client's medical record. Select the 3 findings that place the client at risk for hearing impairment.


Answer Options

Hint : Noise + drug toxicity risk.

Correct Answers:

  • Occupation
  • Furosemide
  • Naproxen


Rationale :
💥A construction worker is often exposed to prolonged loud noise, a primary risk factor for noise-induced hearing loss due to continuous auditory damage. 💥Furosemide is known to be ototoxic, particularly with long-term use or in high doses, and can lead to sensorineural hearing impairment. 💥Naproxen, a nonsteroidal anti-inflammatory drug (NSAID), has ototoxic potential and can cause symptoms such as tinnitus or diminished hearing over time.

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4 :

Hint : Main function = absorbs water.

Correct Answers:

  • It absorbs liquid to form stool-


Rationale :
✅The primary function of the large intestine is to absorb water and electrolytes from indigestible food residue, allowing the conversion of liquid chyme into formed stool. ✅This process facilitates normal bowel elimination and contributes to fluid balance in the body.

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5 :

Hint : Reduces serum potassium.

Correct Answers:

  • Sodium polystyrene


Rationale :
💥Sodium polystyrene sulfonate is a potassium-exchange resin used to lower elevated serum potassium levels by promoting potassium elimination via the gastrointestinal tract. 💥In a client with a critical potassium level of 6.8 mEq/L, this medication helps prevent life-threatening cardiac arrhythmias by rapidly reducing hyperkalemia.

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6 :

Hint : Location: sigmoid = LLQ.

Correct Answers:

  • "You will have a stoma in your left lower abdomen"


Rationale :
✅A sigmoid colostomy involves diverting the sigmoid colon to the abdominal surface, typically on the left lower quadrant. ✅This location aligns with the anatomical path of the sigmoid colon and allows for the excretion of formed stool. ✅Teaching clients about the stoma's position prepares them for self-care and appliance management postoperatively.

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7 :

Hint : Increases UTI risk.

Correct Answers:

  • "l will need to wipe my perineal area from back to front after urination:'


Rationale :
💥Wiping from back to front increases the risk of introducing fecal bacteria, such as E. coli, into the urinary tract, which can lead to infection. 💥Proper perineal hygiene—wiping from front to back—is essential to preventing urinary tract infections, especially in female clients who have a shorter urethra.

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8 :

Hint : Indicates fluid concentration.

Correct Answers:

  • Dark-colored urine


Rationale :
✅Dehydration results in decreased fluid volume and concentrated urine, which appears dark amber or brownish. ✅This finding is a key clinical indicator of reduced hydration status and is often accompanied by other symptoms such as dry mucous membranes, tachycardia, and low urine output.

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9 :

Hint : Neuro loss of bladder control.

Correct Answers:

  • Reflex incontinence


Rationale :
💥Reflex incontinence occurs due to neurological impairment, such as spinal cord injury, which disrupts voluntary control of bladder function. 💥Clients with this condition often experience involuntary loss of urine without awareness of bladder fullness, as the reflex arc remains intact but conscious sensation and control are absent.

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10 :

Hint : Signals impaired perfusion.

Correct Answers:

  • The stoma is pale in color


Rationale :
✅A pale stoma may indicate impaired blood flow or ischemia, which requires immediate evaluation by the provider. ✅A healthy stoma should appear moist and pink or red, reflecting adequate perfusion. ✅Pale or dusky appearances can be early signs of tissue compromise following stoma formation.

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Total Questions: 10

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