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One year after being discharged from the burn trauma unit, a client with a history of 40% full-thickness burns is admitted with bone pain and muscle weakness. Which intervention should the nurse include in this client's plan of care?
Encourage progressive active range of motion.
Explain the need for skin exposure to sunlight without sunscreen.
Teach the need for dietary and supplemental vitamin D.
Instruct the client in the use of muscle strengthening exercises.
Correct Answer:
C. Teach the need for dietary and supplemental vitamin D.
Explanation of Correct Answer
C. Teach the need for dietary and supplemental vitamin D
Clients with extensive burn injuries often experience impaired vitamin D synthesis due to destruction of skin, which is necessary for converting sunlight into active vitamin D. This deficiency can lead to bone pain and muscle weakness from osteomalacia. The priority intervention is ensuring adequate vitamin D intake through diet and supplements to restore bone health and correct metabolic deficiencies
The nurse recognizes an issue and formulates a corresponding clinical question while tending to the client. Next, the nurse intends to gather evidence so that the decision-making process in response to the problem and clinical question is evidence-based. When gathering evidence, which consideration is most important?
Frequency that the problem occurs.
Relevance to the situation
Past experience with similar problems
Related personal values.
Correct Answer:
B. Relevance to the situation.
Explanation of Correct Answer
B. Relevance to the situation
In evidence-based practice, the priority is to gather evidence that directly applies to the client’s specific problem and clinical question. Relevant evidence ensures that interventions are targeted, appropriate, and effective in addressing the current issue, leading to improved outcomes. Other factors, such as frequency, past experience, or personal values, may provide context but are not as critical as using evidence that is most relevant to the situation at hand.
After working with a very demanding client, an unlicensed assistive personnel (UAP) tells the nurse, "I have had it with that client. I just can't do anything that pleases him. I'm not going in there again." The nurse should respond by saying
He has a lot of problems. You need to have patience with him.
I will talk with him and try to figure out what to do.
He is scared and taking it out on you. Let's talk to figure out what to do.
Ignore him and get the rest of your work done. Someone else can take care of him for the rest of the day.
Correct Answer C: He is scared and taking it out on you. Let's talk to figure out what to do.
Explanation:
This response acknowledges the UAP’s frustration, provides insight into the client’s behavior, and invites collaboration to problem-solve. It maintains professionalism, supports the UAP emotionally, and keeps the focus on delivering quality client care.
Why Other Options Are Wrong:
A) He has a lot of problems. You need to have patience with him.
This is dismissive and minimizes the UAP’s feelings without offering constructive support or a solution.
B) I will talk with him and try to figure out what to do.
Although supportive, this excludes the UAP from problem-solving and misses an opportunity to teach conflict resolution strategies.
D) Ignore him and get the rest of your work done. Someone else can take care of him for the rest of the day.
This is unprofessional and neglectful, as it avoids the problem and compromises the continuity of patient care.
A 35 year-old client with sickle cell crisis is talking on the telephone but stops as the nurse enters the room to request something for pain. The nurse should
Administer a placebo
Encourage increased fluid intake
Administer the prescribed analgesia
Recommend relaxation exercises for pain control
Correct Answer C. Administer the prescribed analgesia
Explanation:
C. Administer the prescribed analgesia
Clients experiencing a sickle cell crisis suffer from severe pain caused by vascular occlusion and tissue ischemia. The appropriate nursing action is to promptly administer the prescribed analgesic as ordered, usually opioids. Pain management is the priority in a crisis to reduce suffering, prevent complications, and support mobility and oxygenation. Although fluids and relaxation techniques are helpful adjuncts, they do not replace the immediate need for pharmacological pain relief.
Why Other Options Are Incorrect:
A. Administer a placebo
Administering a placebo is unethical and violates patient trust. It disregards the real physiological pain associated with sickle cell crisis and undermines therapeutic communication.
B. Encourage increased fluid intake
Hydration is important in sickle cell management because it reduces blood viscosity and helps prevent further sickling. However, it does not address the client’s immediate need for pain control. Fluids are supportive but not the primary action when pain is acute and severe.
D. Recommend relaxation exercises for pain control
Relaxation and distraction techniques can assist in coping with pain, but they are supplemental methods. They are inappropriate as the sole response during a crisis when the client requires prompt pharmacological intervention to relieve intense pain.
A client diagnosed with calcium kidney stones has a history of gout. A new prescription for aluminum hydroxide (Amphogel) is scheduled to begin at 0730. Which client medication should the nurse bring to the healthcare provider's attention
Allopurinol (Zyloprim)
Aspirin, low dose
Furosemide (Lasix)
Enalapril (Vasotec)
Correct Answer A. Allopurinol (Zyloprim)
Explanation:
Aluminum hydroxide (Amphogel) is an antacid that binds phosphate in the gut, but it can also interfere with the absorption of other oral medications if given at the same time. Allopurinol, used for gout, is one of the drugs whose absorption can be reduced by concurrent administration with antacids, decreasing its effectiveness. The nurse should notify the healthcare provider so administration times can be adjusted to prevent drug interactions.
Why Other Options Are Wrong:
B. Aspirin, low dose
Aspirin can worsen gout by affecting uric acid excretion, but the immediate concern here is not the aspirin–Amphogel interaction.
C. Furosemide (Lasix)
Loop diuretics can increase uric acid levels and worsen gout, but there is no direct absorption interaction with Amphogel.
D. Enalapril (Vasotec)
An ACE inhibitor does not have a significant interaction with Amphogel. The bigger concern is monitoring renal function, but not absorption issues.
After the nurse witnesses a preoperative client signing the surgical consent form, the nurse signs the form as a witness. Which is (are) the legal implication(s) of the nurse's signature on the client's surgical consent form? Select all that apply.
The client is competent to sign the consent without impairment of judgment
Verifies that the client understands the procedure that is being performed
The client voluntarily grants permission for the procedure to be done.
The surgeon has explained to the client why the surgery is necessary
The client understands the risks and benefits associated with the procedure.
Correct Answers:
A. The client is competent to sign the consent without impairment of judgment. C. The client voluntarily grants permission for the procedure to be done.
Explanation of Correct Answers
A. The client is competent to sign the consent without impairment of judgment
By witnessing the signature, the nurse affirms that the client appeared mentally competent and not under the influence of sedatives or coercion at the time of signing.
C. The client voluntarily grants permission for the procedure to be done
The nurse’s witness signature confirms that the client signed the consent form willingly and without force, ensuring voluntariness.
A client returns to the mental health clinic for assistance with an anxiety reaction that is manifested by a rapid heartbeat, sweating, shaking, and nausea while driving over the bay bridge. Which action in the treatment plan should the nurse implement?
Recommend that the client avoid driving over the bridge.
Teach the client to listen to music or audio books while driving
Tell the client to drive over the bridge until fear is manageable
Encourage the client to have the spouse drive in stressful places
Correct Answer:
B. Teach the client to listen to music or audio books while driving.
Explanation of Correct Answer
B. Teach the client to listen to music or audio books while driving.
This strategy uses distraction and relaxation techniques, which are evidence-based interventions for anxiety management. Music or audio books can shift attention away from physical symptoms and fearful thoughts, lowering anxiety levels and making stressful situations more tolerable. It helps the client cope while still engaging in the activity, rather than avoiding it.
Why Other Options Are Incorrect
A. Recommend that the client avoid driving over the bridge
Avoidance reinforces anxiety and prevents the client from overcoming fear. It increases dependence and perpetuates the phobia rather than treating it.
C. Tell the client to drive over the bridge until fear is manageable
This form of “flooding” exposure can overwhelm the client, worsening anxiety and possibly causing harm. Gradual, supportive exposure is more therapeutic.
D. Encourage the client to have the spouse drive in stressful places
Having another person assume control fosters dependency and reinforces avoidance behaviors, which do not build coping skills or long-term independence.
The nurse is instructing a 65 year-old female client diagnosed with osteoporosis. The most important instruction regarding exercise would be to
Exercisinge do weight bearing activities
Exercise to reduce weight
Avoid exercise activities that increase the risk of fracture
Exercise to strengthen muscles and thereby protect bones
Correct Answer A: Exercise doing weight bearing activities
Explanation:
For clients with osteoporosis, weight-bearing exercises such as walking, light jogging, or low-impact aerobics are most effective. These activities stimulate bone formation, slow bone loss, and improve bone strength. Exercise is a cornerstone of osteoporosis management and helps reduce fracture risk when done safely.
Why Other Options Are Wrong:
B) Exercise to reduce weight
Weight reduction is not the priority for osteoporosis management and excessive weight loss can actually worsen bone fragility.
C) Avoid exercise activities that increase the risk of fracture
While avoiding high-risk activities is important, this instruction is incomplete and does not address the need for therapeutic weight-bearing exercise.
D) Exercise to strengthen muscles and thereby protect bones
Muscle strengthening is helpful but weight-bearing exercise is more directly effective for increasing bone density, making it the most important instruction.
A client was just taken off the ventilator after surgery and has a nasogastric tube draining bile-colored liquids. Which nursing measure will provide the most comfort to the client
Allow the client to melt ice chips in the mouth
Provide mints to freshen the breath
Perform frequent oral care with a tooth sponge
Swab the mouth with glycerin swabs
Correct Answer C: Perform frequent oral care with a tooth sponge
Explanation:
Clients with nasogastric (NG) tubes often experience dry mouth, throat irritation, and discomfort. The safest and most effective intervention is frequent oral care with a tooth sponge or soft toothbrush, which cleans secretions, moistens the mouth, and provides comfort without increasing aspiration risk.
Why Other Options Are Wrong:
A) Allow the client to melt ice chips in the mouth
Not appropriate since the client is NPO (nothing by mouth) with an NG tube, as this increases aspiration risk.
B) Provide mints to freshen the breath
Mints are not safe because the client is NPO and they could increase the risk of choking or aspiration.
D) Swab the mouth with glycerin swabs
Glycerin swabs may actually dry the oral mucosa further and are not recommended for routine oral care in NG tube patients.
When providing diet teaching for a client with cholecystitis, which types of food choices should the nurse recommend to the client
High protein
Low fat
Low sodium
High carbohydrate
Correct Answer B. Low fat
Explanation:
Cholecystitis is inflammation of the gallbladder, often triggered by gallstones that obstruct bile flow. Fat stimulates the gallbladder to contract, which can worsen pain and symptoms. A low-fat diet helps reduce gallbladder stimulation and prevents exacerbations. Clients should avoid fried foods, rich gravies, creamy sauces, and high-fat dairy products.
Why Other Options Are Wrong:
A. High protein
Excess protein is not required for cholecystitis management and may increase metabolic demand on the liver, which is often stressed in gallbladder disease.
C. Low sodium
A low-sodium diet is recommended for conditions like hypertension, heart failure, or renal disease, but it is not specifically required for cholecystitis.
D. High carbohydrate
A high-carbohydrate diet is not recommended since it can contribute to weight gain and metabolic imbalance. Balanced nutrition is important, but fat restriction is the priority.
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