A female patient complains of abdominal discomfort. Watery stool has been leaking from her rectum. This could be a sign of_______?
B. Vowel Movement
C. Fecal Impaction
A patient with a crush injury to her right arm calls the nurse and requests pain medicine, which the nurse administers as ordered. An hour later, the patient is still complaining of intense pain. Which of the following actions does the nurse take next?
A. Tell the patient that she can have more medication in three hours.
B. Tell the patient that this is to be expected with a crush injury.
C. Ask the patient to describe the pain in quality and intensity.
D. Offer the patient a distraction, such as television or a magazine.
The nurse at the daycare center observes children playing on the playground. The nurse is MOST concerned if which of the following is observed?
A. One child tries to pull another off the swing.
B. A 3-year-old is leaning forward with mouth open, tongue protruding, and drooling.
C. A 2-year-old is crying, tugging at his ear, and hugging a stuffed animal.
D. Two children are fighting over a ball.
A patient with a diagnosis of lung cancer is receiving chemotherapy and reports nausea and loss of appetite resulting in decreased food intake. What should the healthcare provider recommend to promote adequate nutrition? Advise the patient to_______?
A. Eat small meal throughout the day.
B. Only eat when feeling hungry.
C. Eat large meal but less frequently throughout the day.
D. Eat only favorite food to increase appetite.
The nurse performs discharge teaching for a client with a left leg cast who will be using crutches to ambulate. Which of the following statements, if made by the patient to the nurse, would require further teaching?
A. “I will put all of my body weight on the handholds and keep it off my armpits.”
B. “When going up stairs, I will first lift my bad leg and then my good one.”
C. “I will remember not to scratch inside the cast.”
D. “When going down stairs, I will follow my bad leg with my good leg.”
The nurse cares for a ninety-two year-old patient whose wife recently passed away. Which of the following statements, if made by the patient to the nurse, requires further investigation?
A. “Without my wife, life is so tasteless. I keep asking God why this happened to me.”
B. “Sometimes I think I feel my wife’s presence in the house. It makes me feel better to think she’s still looking after me.”
C. “Since her death, I just haven’t felt like eating much.”
D. “I gave away my favorite watch to my nephew the other day. I wanted him to have it, in case I’m not around for much longer.”
A six-year-old boy with a casted left leg rings his call bell. Which of the following statements, if made by the nurse, requires an immediate intervention?
A. “My leg feels funny.”
B. “Can you give me a ruler so I can scratch my leg inside my cast?”
C. “The edge of the cast is hurting my skin.”
D. “My leg itches.”
The nurse teaches a 20-year-old female how to perform SBE (self breast exams). Which of the following instructions, if given by the nurse, is INCORRECT?
A. “Remember that breast tissue may feel tender at times, and this is normal.”
B. “The best time to perform your SBE is at the end of the month.”
C. “The first position you will use to inspect your breasts is to stand with your arms at your sides.”
D. “Use your index, pointer, and ring fingers to firmly palpate the breast in a circular motion.”
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