FB Q & A #4 for NLE - A client hospitalized with pneumonia has thick, tenacious secretions.

To help
liquefy these secretions, the nurse should: a. turn the client every 2 hours b. elevate the head of the bed
30... degrees c. encourage increased fluid intake d. maintain a cool room temperature

FB Q & A #6 for NLE - An elderly client with tuberculosis has difficulty coughing up secretions
for a sputum specimen. Which nursing action is appropriate? a. spray the oropharynx with saline
b. ask the client to drink a warm liquid c. force fluids for the next 8 hours d. raise the head of the
bed to at least 45 degrees

FB Q & A #15 for NLE - The nurseis teaching a client who will be discharged
soon how to change a sterile dressing on the right leg. During the teaching
session, the nurse noticesredness, swelling, and induration at the wound site.
What do these signs suggest? a. infection
b. dehiscence
c. hemorrhage
d. evisceration

FB Q & A #14 for NLE - The nurse administers furosemide (Lasix) to treat a
client with heart failure. Which adverse effect must the nurse watch for most
carefully?
a. increase in blood pressure
b. increase in blood volume
c. low serum potassium level
d. high serum sodium level

FB Q & A #13 for NLE - The nurseshould be prepared to manage complications

after abdominal aortic aneurysm resection. Which of the following complications
is most common postoperatively?
a. renal failure
b. hemorrhage and shock
c. graft occlusion
d. enteric fistula

FBQ & A #11 for NLE - A client has been admitted for meningitis. Inreviewing
the laboratory analysis of cerebrospinal fluid (CSF), the nurse would expect to
note
a. high protein
b. clear color
c. elevated sedimentation rate
d. increased glucose

FB
Q & A #6 for NLE - An elderly client with tuberculosis has
difficulty coughing up secretions for a sputum specimen. Which nursing
action is appropriate?
a. spray the oropharynx with saline

FB Q & A #4 for NLE - A client hospitalized with pneumonia has thick,

tenacious secretions. To help liquefy these secretions, the nurse should:
a. turn the client every 2 hours
b. elevate the head of the bed 30... degrees
c. encourage increased fluid intake
d. maintain a cool room temperature

-Answer: C

Rationale: Increasing the client's intake of oral or I.V. fluids helps liquefy thick,
tenacious secretions and ensures adequate hydration. Turning the client every 2
hours would decrease pooling of secretions but wouldn't liquefy them. Elevating
the head of the bed would reduce pressure on the diaphragm and ease breathing
but wouldn't liquefy secretions. Maintaining a cool room temperature would
increase the client's comfort but wouldn't liquefy secretions.

FB Q & A #10 for NLE - For a

client with a head injury whose neck has been stabilized, the preferred bed
position is:
a. trendelenburg's
b. 30-degree head elevation
...c. flat
d. side-lying

FB Q & A #9 for NLE - A client complains of vertigo. The nurse anticipates that
the client may have a problem with which portion of the ear?
a. external ear
b. middle ear
c. inner ear
d. tympanic membrane

FB Q & A #8 for NLE - The nurse is caring for a client who requires intracranial
pressure (ICP) monitoring. The nurse should be alert for what major
complication of ICP monitoring?
a. coma
b. infection
c. high blood pressure
d. apnea

-Answer: B

Rationale: The catheter for measuring ICP is inserted through a burr hole into a
lateral ventricle of the cerebrum, thereby creating a risk of infection. Coma, high
blood pressure, and apnea are late signs of increased ICP.

FB Q & A #7 for NLE - The nurse is removing a fecal impaction on a75 year-old
client. It is most important that the nurse remember that:
a. the procedure be done prior to the bath
b. family members should be taught the procedure
c. cardiac dysrhythmias can result during the process
d. increased dietary fiber can minimi...ze such problem

FB Q & A #6 for NLE - An elderly client with tuberculosis has difficulty

coughing up secretions for a sputum specimen. Which nursing action is
appropriate?
a. spray the oropharynx with saline
b. ask the client to drink a warm liquid
c. force fluids for the next 8 hours
d. raise the head of the bed to at least 45 degree...s

-The correct answer is D: Raise the head of the bed to at least 45 degrees

Rationale: Placing the client in semi or high fowler’s position will promote lung
expansion and effective coughing. While drinking liquids helps to loosen
secretions over time, they should not be given when collecting a specimen.
Spraying the throat with saline may cause irritation and coughing and reduce
oxygenation.
FB Q & A #5 for NLE - To evaluate a client's chief complaint, the nurse
performs deep palpation. The purpose of deep palpation is to assess which of the
following?

FB Q & A #4 for NLE - A client

hospitalized with pneumonia has thick, tenacious secretions. To help liquefy
these secretions, the nurse should:
a. turn the client every 2 hours
b. elevate the head of the bed 30
... degrees
c. encourage increased fluid intake
d. maintain a cool room temperature

B Q & A #3 for NLE - Whenmonitoring a client's central venous pressure (CVP),

the nurse knows that anormal CVP measurement is:
a. 2 cm water
b. 1 mm Hg
c. 10 mm Hg
d. 5 cm water

-Rationale for Question Number 2 - The client should be encouraged to force

fluids
to prevent renal calculi formation. Sodium should be encouraged to replace
losses in urine. Restricting potassium isn't necessary in hyperparathyroidism.

-Answer for Question #2 - Letter C

Rationale for Question #1 - In SIADH, the posterior pituitary gland produces

excess antidiuretic hormone (vasopressin), which decreases water excretion by
the kidneys. This, in turn, reduces the serum sodium level, causing
hyponatremia. In SIADH, the serum creatinine level isn't affected by the
client's fluid status and re...mains within normal limits. Typically, the
hematocrit and BUN level decrease.

-Answer for Question #1 - Letter A

FB Q & A #12 for NLE - The nurse would teach a client with Raynaud's phenomenon that it is most
important to:
a. stop smoking
b. keep feet dry
c. reduce stress
d. avoid caffeine
-Answer is Letter A: Stop smoking The most important teaching for this client is to stop
smoking. The question is asking what is the most important teaching. The others tend to be done
less frequently than smoking and are less of a threat.