Question: A patient with heart failure has been ordered to reduce her sodium intake in order to better control her condition. Which best explains why reduction in sodium intake will affect symptoms of heart failure? Answer: D.  Too much sodium intake is associated with fluid retention Rationale:  Fluid retention is a risk for patients with […]

Question: A 41-year-old patient is being seen at the primary care clinic for a physical exam. The patient is overweight and wants to talk to the nurse about losing weight. Choose the alternative that best explains the calculation of BMI. Answer: C.  BMI is a calculation of body fat that is based on weight and […]

Question: A physician has ordered calorie counts for a patient who needs to lose weight. Which best describes how the nurse would instruct the client in this process? Answer: B. “This method teaches you common amounts of calories in foods and you keep track of what you eat every day.” Rationale:  Calorie counting is a […]

Question:  A nurse is caring for a client who is at high risk of dehydration. Which parameter would the nurse use for assessment if this patient were to become dehydrated? Answer:  A. Orthostatic hypotension Rationale:  A patient who is dehydrated may exhibit several clinical signs that indicate that the nurse needs to intervene to help […]

Question: A patient with lung disease has decided to receive palliative care at home. The patient does not want his mother to be nearby while he is recovering, even though his wife has asked him to reconsider. Which response from the nurse would best support this patients choice? Answer: A.  “Your family is responsible for […]

Question: A palliative care nurse is counseling a patient who is suffering from cancer. Which statement by the patient indicates that more education is needed about the treatment he receives through palliative care? Answer: D. “I can receive palliative care for my side effects of chemo, but my cancer pain has to be treated differently.” […]

Question: A nurse who is caring for a patient with chronic pain and recommends the patient undergoes relaxation therapy as part of pain management. How would relaxation therapy work in this situation? Answer: C.  Relaxation decreases anxiety, which can cause muscle tension and contribute to pain Rationale:  Relaxation exercises are useful in helping patients to […]

Question: A nurse is preparing to apply thigh-high anti-embolism stockings to a patient with a history of DVT. The nurse notes that the patients legs have different measurements. Which response from the nurse is appropriate? Answer: B.  Choose antiembolism stockings of different sizes Rationale:  Before applying antiembolism stockings, the nurse must measure the size of […]

Question: A patient has suffered a bruise on her elbow from being assisted in bed for repositioning. Which best describes how the nurse can prevent this injury from becoming a point of skin breakdown? Answer: A. Encourage the patient to increase fluid intake Rationale:  A patient with mobility impairments may be at risk of skin […]

Question: A nurse is caring for a patient with reduced mobility following hip surgery. Which best describes how the nurse would intervene to prevent skin breakdown from immobility? Answer: A.  Use padding and cushions under the heels and other bony prominences Rationale: Skin breakdown is a consequence of immobility; a patient who moves very little […]