nclex question (sata)

[futurern34]

Which of the following should the nurse expect to be part of the care plan for a Crohn's patient?

a. Lactulose therapy

b. High fiber diet

c. high protein milkshake

d. Antidiarreheal medication

e. Coticosteriod therapy

Feel free to post more sata's:specs:

[patri]

Denial

Anger

Bargaining

Depression

Acceptance

[futurern34]

Denial

Anger

Bargaining

Depression

Acceptance

Correcto!!

[Me2006]

A 46 year old male client is being discharged after a thyroidectomy. Which of the following discharge instructions would be appropriate for this client?

A: Report signs and symptoms of hypoglycemia

B: Take thyroid replacement medication as ordered

C: Watch for changes in body functioning, such as lethargy, restlessness, sensitivity to cold, and dry skin, and report these changes to the physician

D: Recognize the signs of dehydration

E: Avoid all OTC meds

F: carry injectable dexamethasone at all times

B AND C are the correct answers

[Me2006]

The nurse receives a change-of-shift report for a 76-year-old client who had a total hip replacement. The client is not oriented to time, place, or person and is attempting to get out of bed and pull out an I.V. line that's supplying hydration and antibiotics. The client has a vest restraint and bilateral soft wrist restraints. Which action by the nurse would be appropriate?

Select all that apply:

1. Assess and document the behavior that requires continued use of restraints.

2. Tie the restraints in quick-release knots.

3. Tie the restraints to the side rails of the bed.

4. Ask the client if he needs to go to the bathroom and provide range-of-motion exercises every 2 hours.

5. Position the vest restraints so that the straps are crossed in the back.

1,2, 4 are the correct asnwers

[patri]

"The nurse receives a change-of-shift report for a 76-year-old client who had a total hip replacement. The client is not oriented to time, place, or person and is attempting to get out of bed and pull out an I.V. line that's supplying hydration and antibiotics. The client has a vest restraint and bilateral soft wrist restraints. Which action by the nurse would be appropriate?

Select all that apply:

1. Assess and document the behavior that requires continued use of restraints.

2. Tie the restraints in quick-release knots.

3. Tie the restraints to the side rails of the bed.

4. Ask the client if he needs to go to the bathroom and provide range-of-motion exercises every 2 hours.

5. Position the vest restraints so that the straps are crossed in the back."

I don't get 4 as an answer bcoz the client is not oriented so how can we ask the client?

[diana2520]

"the nurse receives a change-of-shift report for a 76-year-old client who had a total hip replacement. the client is not oriented to time, place, or person and is attempting to get out of bed and pull out an i.v. line that's supplying hydration and antibiotics. the client has a vest restraint and bilateral soft wrist restraints. which action by the nurse would be appropriate?

select all that apply:

1. assess and document the behavior that requires continued use of restraints.

2. tie the restraints in quick-release knots.

3. tie the restraints to the side rails of the bed.

4. ask the client if he needs to go to the bathroom and provide range-of-motion exercises every 2 hours.

5. position the vest restraints so that the straps are crossed in the back."

i don't get 4 as an answer bcoz the client is not oriented so how can we ask the client?

thats the reason why you would ask him if he wants to go to the bathroom because he is not oriented. in other words hes a little confused so you have to offer him .., normally you dont ask ppl if they have to go to the bathroom, we all go by ourselves... but if someone is not oriented to the place...we have to help them out .