1. A community health nurse is evaluating eligibility for home assistance for a client who is quadriplegic. Which of the following actions should the nurse perform first?
a. Determine the client's living situation.
b.
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1. A community health nurse is evaluating eligibility for home assistance for a client who is quadriplegic. Which of the following actions should the nurse perform first?
a. Determine the client's living situation.
b. Problem solved with the client.
c. Offer community resources to the client.
d. Assist the client with decision-making.
2. A nurse is discussing care with a newly licensed nurse for a client who practices Orthodox Judaism. Which of the following meals suggestions by the newly licensed nurse indicates a need for further teaching?
a. Chicken breast and boiled potatoes.
b. Carrot sticks and cottage cheese.
c. Grilled cheese an Apple sauce. d. Roast beef and ice cream.
3. A nurse is preparing to auscultate a client apical pulse at the point of maximal impulse (PMI). the nurse should place the diaphragm of the stethoscope at which of the following locations
a. Within the angle of Louis.
b. 5th intercostal space at the left midclavicular line.
c. Second intercostal space to the right of the sternum.
d. Over the xyphoid process.
4. A nurse is caring for a client who is receiving a blood transfusion at 125 mL/hour and develops a hemolytic reaction. Which of the following actions should the nurse perform?
a. Infuse 0.9% sodium chloride IV.
b. Administer an anti-pyretic.
c. Decrease the infusion rate to 75 mL/hour.
d. Place the client in a left lateral position
5. A nurse is planning care for a client who is prescribed a cane for ambulation. Which of the following nursing actions should the nurse include in the plan of care?
a. Remind the client to place the cane on the unaffected side.
CONTINUED..........
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