RN Fundamentals Online Practice 2019 B Questions And Answers |Guarantee A+ Score A

RN Fundamentals Online Practice 2019 B (2) Questions And Answers |Guarantee A+ Score A home health nurse is completing an admission assessment of an older adult client who has their caregiver present. Which of the following findings should the nurse identify as a potential indication of elder abuse?

• The caregiver is the client's financial power of attorney.
• The client is in a wheelchair with the wheels locked.
• The client reports receiving a full bath twice each week.
• The caregiver insists on remaining in the room.

{{Correct Ans- D. The caregiver insists on remaining in the room.

A caregiver who refuses to leave the room during an admission assessment can be an indication of potential mistreatment of the client who is receiving care. The nurse should evaluate the client for additional signs of potential mistreatment throughout the admission assessment.

A middle adult client tells the nurse, "I feel so useless now that my children do not need me anymore." Which of the following responses should the nurse make?

• "Most people are happy when their children grow up and leave home."
• "You should be proud that your children are becoming independent."
• "Maybe you should consider why you are feeling useless."
• "People in middle adulthood often find satisfaction in nurturing and guiding young

people." {{Correct Ans- D. "People in middle adulthood often find satisfaction in nurturing and guiding young people."

According to Erik Erikson, the task of middle adulthood is generativity versus self- absorption and stagnation. The focus of this task is on offering support and guidance to future generations. The nurse should explore opportunities for mastering the developmental tasks of this stage with the client, such as volunteering and mentoring young people.

A nurse is reviewing practice guidelines with a group of newly licensed nurses. Which of the following interventions should the nurse include that is within the scope of RN practice?

• Insert an implanted port.
• Close a laceration with sutures.
• Place an endotracheal tube.
• Initiate an enteral feeding through a gastrostomy tube.

{{Correct Ans- D. Initiate an enteral feeding through a gastrostomy tube.

It is within the RN scope of practice for nurses to initiate enteral feedings through nasoenteric, gastrostomy, and jejunostomy tubes.

A nurse is preparing a heparin infusion for a client who was admitted to the facility with deep vein thrombosis. The prescription reads 25,000 units of heparin in 0.9% sodium chloride 250 mL to infuse as 800 units/hr. At what rate should the nurse set the infusion pump? (Round the answer to the nearest whole number. Use a leading zero if it applies. Do not use a trailing zero) {{Correct Ans- 25,000units/2500mL = 800units/hr/x Cross multiply. 800 x 250 = 200,000 200,000 divided by 25,000 = 8

• mL/hr

A nurse is caring for a client who reports pain. When documenting the quality of the clients pain on an initial assessment, the nurse should record which of the following client statements?

• "I'm having mild pain."
• "The pain is like a dull ache in my stomach."
• "I notice that the pain gets worse after I eat."
• "The pain makes me feel nauseous."

{{Correct Ans- B. "The pain is like a dull ache in my stomach."

The client is describing the quality of the pain, which is how the pain feels in the client's own words.

A nurse is caring for a client who is receiving 24 hour urine collection. Which of the following statements by the client indicates an understanding of the teaching?

• "I had a bowel movement, but I was able to save the urine."
• "I have a specimen in the bathroom from about 30 minutes ago."
• "I flushed what I urinated at 7:00 a.m. and have saved all urine since."
• "I drink a lot, so I will fill up the bottle and complete the test quickly."

{{Correct Ans- C. "I flushed what I urinated at 7:00 a.m. and have saved all urine since."

For a 24-hr urine collection, the client should discard the first voiding and save all subsequent voidings.

A nurse is completing an admission assessment for a client who reports vomiting and diarrhea for the past 3 days. Which of the following findings should the nurse expect?

• Neck vein distention
• Urine specific gravity 1.010
• Rapid heart rate
• Blood pressure 144/82 mm Hg

{{Correct Ans- C. Rapid heart rate

Tachycardia indicates fluid volume deficit, which is an expected finding for a client who has had vomiting and diarrhea for 3 days.

A nurse is teaching a client whose left leg is in a cast about using crutches. Which of the following statements should the nurse identify as an indication that the client understands the teaching?

• "When descending stairs, I will first shift my weight to my right leg."
• "I should place my crutches 12 inches in front and to the side of each foot."
• "As I sit down, I will hold one crutch in each hand."
• "I will make sure the shoulder rests are snug against my armpits."

{{Correct Ans- A. "When descending stairs, I will first shift my weight to my right leg."

To descend stairs, the client should first shift his body weight to his right, unaffected leg.

A nurse in an acute care facility is preparing a discharge summary for a client who is transferring to a long term care facility. Which of the following documentation should the nurse include?

• Client flow sheet
• Acuity ratings