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Adult Health Exam 1

What action should the nurse implement in caring for a client following an electroencephalogram (EEG)?

    A. Monitor the client's vital signs every 4 hours

    B. Assess the client's lower extremities for sensation

    C. Instruct the client to maintain bed rest

    D. Wash any paste from the client's hair and scalp

Correct Answer: D
Rationale: The correct action the nurse should implement after an EEG is to wash any paste from the client's hair and scalp. This is crucial to prevent irritation and infection at the EEG site. Monitoring vital signs every 4 hours is not specifically indicated after an EEG. Assessing the client's lower extremities for sensation is unrelated to caring for a client post-EEG. While rest may be recommended after the procedure, there is no standard requirement for a specific duration of bed rest.

The client is 4 hours post-operative from a cesarean section and complains of gas pain and bloating. What non-pharmacological intervention can the nurse provide?

  • A. Encourage the client to ambulate
  • B. Apply a heating pad
  • C. Provide a carbonated beverage
  • D. Teach relaxation techniques

Correct Answer: A
Rationale: The correct answer is to encourage the client to ambulate. Early ambulation helps alleviate gas pain and bloating by promoting gastrointestinal motility and reducing the accumulation of gas in the abdomen. Applying a heating pad may provide comfort for some types of pain but is not specifically effective for gas pain. Providing a carbonated beverage can actually worsen gas pain due to the introduction of more gas into the digestive system. Teaching relaxation techniques may be beneficial for overall comfort but may not directly address the gas pain and bloating experienced post-cesarean section.

During a manic episode, what is the most appropriate intervention to implement first for a client with bipolar disorder?

  • A. Engage the client in a quiet activity
  • B. Provide a structured environment with minimal stimulation
  • C. Monitor the client continuously
  • D. Adjust the lighting and noise levels

Correct Answer: B
Rationale: During a manic episode, individuals with bipolar disorder may experience sensory overload and agitation. Providing a structured environment with minimal stimulation is the most appropriate initial intervention as it can help reduce overwhelming sensory input and promote a sense of calm. Engaging the client in a quiet activity (Choice A) may not be effective if the environment is still overstimulating. Continuous monitoring (Choice C) is important but may not be the first intervention needed. Adjusting lighting and noise levels (Choice D) can be helpful but may not address the core issue of sensory overload and agitation during a manic episode.

The client with chronic kidney disease (CKD) is being educated about dietary modifications. Which dietary restriction should the nurse emphasize the most?

  • A. Limit intake of high-fiber foods
  • B. Restrict protein intake
  • C. Avoid dairy products
  • D. Increase fluid intake

Correct Answer: B
Rationale: The most crucial dietary restriction to emphasize for a client with chronic kidney disease (CKD) is to restrict protein intake. By restricting protein intake, the workload on the kidneys is reduced, which helps slow the progression of CKD. While high-fiber foods are generally beneficial, they may need to be limited in some individuals with CKD due to potassium concerns, making choice A less critical. Avoiding dairy products may be necessary in some cases to control phosphorus levels, but it is not as vital as restricting protein intake. Increasing fluid intake is essential for kidney health, but it is not the most critical dietary modification for clients with CKD.

The healthcare provider is providing discharge instructions to a client with chronic heart failure. Which dietary recommendation is most appropriate?

  • A. Increase fluid intake.
  • B. Follow a low-sodium diet.
  • C. Follow a high-protein diet.
  • D. Increase sodium intake.

Correct Answer: B
Rationale: The most appropriate dietary recommendation for a client with chronic heart failure is to follow a low-sodium diet. This helps manage the condition by reducing fluid retention and the workload on the heart. High fluid intake can lead to fluid overload and exacerbate heart failure symptoms. While protein is important for overall health, a high-protein diet is not specifically indicated for chronic heart failure. Increasing sodium intake is contraindicated in heart failure as it can worsen fluid retention and increase the workload on the heart.

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