Nursing Elites

1. The client with systemic sclerosis (Scleroderma) is experiencing Raynaud's phenomenon. What assessment finding does the nurse anticipate?

• A. Excessive heartburn
• B. Cyanosis of the lips
• C. Excess wrinkled skin
• D. Cold and purple nailbeds

Correct answer: D

Rationale:

2. What evaluation indicates successful progress on the client goal of increasing daily physical activity?

• A. The client reports decreased social interaction
• B. The client reports more nonsteroidal anti-inflammatory drug (NSAID) use
• C. The client reports a fall
• D. The client reports less fatigue walking up stairs

Correct answer: D

Rationale: The correct answer is D because reporting less fatigue when walking up stairs indicates improved physical endurance, showing progress in increasing daily activity. Choices A, B, and C are incorrect because decreased social interaction, increased NSAID use, and experiencing a fall are not indicators of successful progress in increasing daily physical activity.

3. What is a negative effect of immobility on the musculoskeletal system?

• A. Pressure injury
• B. Contractures
• C. Glucose intolerance
• D. Incontinence

Correct answer: B

Rationale: Contractures are a negative effect of immobility on the musculoskeletal system.

4. Which of the following would be the most appropriate goal for an elderly client with a nursing diagnosis of risk for injury after hip surgery?

• A. Client will increase mobility by the time of discharge from hospital
• B. Client will demonstrate effective breathing pattern when ambulating throughout hospital stay
• C. Client will increase activity tolerance by discharge from the hospital
• D. Client will remain free from falls throughout their hospital stay

Correct answer: D

Rationale:

5. The client has been asked to perform weight-bearing exercises three times a week. The client admits to not doing the recommended exercises. What is the most appropriate response by the nurse?

• A. I walk 3 miles every day. Would you like to join me?
• B. Tell me more about your experience with these exercises.
• C. My dad never exercised. He fell and broke his hip. Is that your goal?
• D. You should be doing these exercises.

Correct answer: B

Rationale: The most appropriate response by the nurse is to ask the client to elaborate on their experience with the exercises. By doing so, the nurse can gain insight into any barriers the client may be facing and work together to find solutions to improve adherence. Choice A is not appropriate as it doesn't address the client's situation. Choice C is not relevant and may induce fear in the client. Choice D is directive and does not promote open communication or understanding of the client's perspective.

Similar Questions