Name: Score:

Year and Section: Date:

Read the instruction very carefully and choose the best answer. Encircle your BEST
answer =) Strictly No Erasure Guys.

Daily walks relieve symptoms of intermittent

claudication, although the exact mechanism is
unclear. Anaerobic exercise may exacerbate
these symptoms. Clients with chronic arterial
occlusive disease must reduce daily fat intake to
30% or less of total calories. The client should
limit dietary cholesterol because hyperlipidemia
is associated with atherosclerosis, a known
cause of arterial occlusive disease. However,
HDLs have the lowest cholesterol concentration,
so this client should eat foods that raise HDL
levels.
45. A physician orders gastric decompression for
a client with small bowel obstruction. The nurse
should plan for the suction to be:
A. low pressure and intermittent
B. low pressure and continuous
C. high pressure and continuous
D. high pressure and intermittent
ANS: A Gastric decompression is typically low pressure
and intermittent. High pressure and continuous
gastric suctioning predisposes the gastric
mucosa to injury and ulceration.
46. Which nursing diagnosis is most appropriate
for an elderly client with osteoarthritis?
A. Risk for injury
B. Impaired urinary elimination
C. Ineffective breathing pattern
D. Imbalanced nutrition: less than body
requirements
ANS: A In osteoarthritis, stiffness is common in large,
weight bearing joints such as the hips. This joint
stiffness alters functional ability and range of
motion, placing the client at risk for falling and
injury. Therefore, client safety is in jeopardy.
Osteoporosis doesn’t affect urinary elimination,
breathing, or nutrition.
47. Parathyroid hormone (PTH) has which
effects on the kidney?
A. Stimulation of calcium reabsorption and
phosphate excretion
B. Stimulation of phosphate reabsorption and
calcium excretion
C. Increased absorption of vit D and excretion of
vit E
D. Increased absorption of vit E and excretion of
Vit D ANS: A PTH stimulates the kidneys to reabsorb calcium
and excrete phosphate and converts vit D to its
active form: 1 , 25 dihydroxyvitamin D. PTH
doesn’t have a role in the metabolism of Vit E.
48. A visiting nurse is performing home
assessment for a 59-yr old man recently
discharged after hip replacement surgery. Which
home assessment finding warrants health
promotion teaching from the nurse?
A. A bathroom with grab bars for the tub and
toilet
B. Items stored in the kitchen so that reaching
up and bending down aren’t necessary
C. Many small, unsecured area rugs
D. Sufficient stairwell lighting, with switches t the
top and bottom of the stairs
ANS: C
The presence of unsecured area rugs poses a
hazard in all homes, particularly in one with a
resident at high risk for falls.
49. A client with autoimmune thrombocytopenia
and a platelet count of 800/uL develops epistaxis
and melena. Treatment with corticosteroids and
immunoglobulins has been unsuccessful, and
the physician recommends a splenectomy. The
client states, “I don’t need surgery—this will go
away on its own.” In considering her response to
the client, the nurse must depend on the ethical
principle of:
A. beneficence
B. autonomy
C. advocacy
D. justice
ANS: B
Autonomy ascribes the right of the individual to
make his own decisions. In this case, the client
is capable of making his own decision and the
nurse should support his autonomy. Beneficence
and justice aren’t the principles that directly
relate to the situation. Advocacy is the nurse’s
role in supporting the principle of autonomy.
50. Which of the following is t he most critical
intervention needed for a client with myxedema
coma?
A. Administering and oral dose of levothyroxine
(Synthroid)
B. Warming the client with a warming blanket
C. Measuring and recording accurate intake and
output
D. Maintaining a patent airway
ANS: D
Because respirations are depressed in
myxedema coma, maintaining a patent airway is
the most critical nursing intervention. Ventilatory
support is usually needed. Thyroid replacement
will be administered IV. Although myxedema
coma is associated with severe hypothermia, a
warming blanket shouldn’t be used because it
may cause vasodilation and shock. Gradual
warming blankets would be appropriate. Intake
and output are very important but aren’t critical
interventions at this time.
MEDICAL-SURGICAL PART2 51. Because diet and exercise have failed to
control a 63 yr-old client’s blood glucose level,
the client is prescribed glipizide (Glucotrol). After
oral administration, the onset of action is:A. 15
to 30 minutes
B. 30 to 60 minutes
C. 1 to 1 ½ hours
D. 2 to 3 hours
ANS: A Glipizide begins to act in 15 to 30 minutes. The other options are incorrect. 52.
A client with pneumonia is receiving
supplemental oxygen, 2 L/min via nasal cannula.
The client’s history includes chronic obstructive
pulmonary disease (COPD) and coronary artery
disease. Because of these findings, the nurse
closely monitors the oxygen flow and the client’s
respiratory status. Which complication may arise
if the client receives a high oxygen
concentration?
A. Apnea B. Anginal pain C. Respiratory alkalosis D. Metabolic acidosis ANS: A
Hypoxia is the main breathing stimulus for a
client with COPD. Excessive oxygen
administration may lead to apnea by removing
that stimulus. Anginal pain results from a
reduced myocardial oxygen supply. A client with
COPD may have anginal pain from generalized
vasoconstriction secondary to hypoxia; however,
administering oxygen at any concentration
dilates blood vessels, easing anginal pain.
Respiratory alkalosis results from alveolar
hyperventilation, not excessive oxygen
administration. In a client with COPD, high
oxygen concentrations decrease the ventilatory
drive, leading to respiratory acidosis, not
alkalosis. High oxygen concentrations don’t
cause metabolic acidosis.
53. A client with type 1 diabetes mellitus has
been on a regimen of multiple daily injection
therapy. He’s being converted to continuous
subcutaneous insulin therapy. While teaching
the client bout continuous subcutaneous insulin
therapy, the nurse would be accurate in telling
him the regimen includes the use of:
A. intermediate and long-acting insulins
B. short and long-acting insulins
C. short-acting only
D. short and intermediate-acting insulins
ANS: C
Continuous subcutaneous insulin regimen uses
a basal rate and boluses of short-acting insulin.
Multiple daily injection therapy uses a
combination of short-acting and intermediate or
long-acting insulins.
54. a client who recently had a cerebrovascular
accident requires a cane to ambulate. When
teaching about cane use, the rationale for
holding a cane on the uninvolved side is to:
A. prevent leaning
B. distribute weight away from the involved side
C. maintain stride length
D. prevent edema
ANS: B
Holding a cane on the uninvolved side
distributes weight away from the involved side.
Holding the cane close to the body prevents
leaning. Use of a cane won’t maintain stride length or prevent edema. 55. A client with a
history of an anterior wall
myocardial infarction is being transferred from
the coronary care unit (CCU) to the cardiac step-
down unit (CSU). While giving report to the CSU
nurse, the CCU nurse says, “His pulmonary
artery wedge pressures have been in the high
normal range.” The CSU nurse should be
especially observant for:
A. hypertension
B. high urine output
C. dry mucous membranes
D. pulmonary crackles
ANS: D
High pulmonary artery wedge pressures are
diagnostic for left-sided heart failure. With left-
sided heart failure, pulmonary edema can
develop causing pulmonary crackles. In left-
sided heart failure, hypotension may result and
urine output will decline. Dry mucous
membranes aren’t directly associated with
elevated pulmonary artery wedge pressures.
56. The nurse is caring for a client with a
fractures hip. The client is combative, confused,
and trying to get out of bed. The nurse should:
A. leave the client and get help
B. obtain a physician’s order to restrain the client
C. read the facility’s policy on restraints
D. order soft restraints from the storeroom
ANS: B
It’s mandatory in most settings to have a
physician’s order before restraining a client. A
client should never be left alone while the nurse
summons assistance. All staff members require
annual instruction on the use of restraints, and
the nurse should be familiar with the facility’s
policy.
57. For the first 72 hours after thyroidectomy
surgery, the nurse would assess the client for
Chvostek’s sign and Trousseau’s sign because
they indicate which of the following?A.
hypocalcemia
B. hypercalcemia
C. hypokalemia
D. Hyperkalemia
ANS: A The client who has undergone a thyroidectomy
is t risk for developing hypocalcemia from
inadvertent removal or damage to the
parathyroid gland. The client with hypocalcemia
will exhibit a positive Chvostek’s sign (facial
muscle contraction when the facial nerve in front
of the ear is tapped) and a positive Trousseau’s
sign (carpal spasm when a blood pressure cuff
is inflated for few minutes). These signs aren’t
present with hypercalcemia, hypokalemia, or
Hyperkalemia.
58. In a client with enteritis and frequent
diarrhea, the nurse should anticipate an acid-
base imbalance of:
A. respiratory acidosis
B. respiratory alkalosis
C. metabolic acidosis
D. metabolic alkalosis
ANS: C
Diarrhea causes a bicarbonate deficit. With loss
of the relative alkalinity of the lower GI tract, the
relative acidity of the upper GI tract
predominates leading to metabolic acidosis.
Diarrhea doesn’t lead to respiratory acid-base
imbalances, such as respiratory acidosis and
respiratory alkalosis. Loss of acid, which occurs
with severe vomiting, may lead to metabolic
alkalosis.
59. When caring for a client with the nursing
diagnosis Impaired swallowing related to
neuromuscular impairment, the nurse should:
A. position the client in a supine position
B. elevate the head of the bed 90 degrees
during meals
C. encourage the client to remove dentures
D. encourage thin liquids for dietary intake
ANS: B
The head of the bed must be elevated while the
client is eating. The client should be placed in a
recumbent position—not a supine position—
when lying down to reduce the risk of aspiration.
Encourage the client to wear properly fitted
dentures to enhance his chewing ability.
Thickened liquids, not thin liquids, decrease
aspiration risk.
60. A nurse is caring for a client who has a
tracheostomy and temperature of 39º C. which
intervention will most likely lower the client’s
arterial blood oxygen saturation?
A. Endotracheal suctioning
B. Encouragement of coughing
C. Use of cooling blanket
D. Incentive spirometry
ANS: A Endotracheal suctioning secretions as well as
gases from the airway and lowers the arterial
oxygen saturation (SaO2) level. Coughing and
incentive spirometry improve oxygenation and
should raise or maintain oxygen saturation.
Because of superficial vasoconstriction, using a
cooling blanket can lower peripheral oxygen
saturation readings, but SaO2 levels wouldn’t be
affected.
61. A client with a solar burn of the chest, back,
face, and arms is seen in urgent care. The
nurse’s primary concern should be:A. fluid
resuscitation
B. infection
C. body image
D. pain management
ANS: D
With a superficial partial thickness burn such as
a solar burn (sunburn), the nurse’s main concern
is pain management. Fluid resuscitation and
infection become concerns if the burn extends to
the dermal and subcutaneous skin layers. Body
image disturbance is a concern that has a lower priority than pain management. 62.
Which statement is true about crackles?
A. They’re grating sounds.
B. They’re high-pitched, musical squeaks.
C. They’re low-pitched noises that sound like
snoring.
D. They may be fine, medium, or course.
ANS: D
Crackles result from air moving through airways
that contain fluid. Heard during inspiration and
expiration, crackles are discrete sounds that
vary in pitch and intensity. They’re classified as
fine, medium, or coarse. Pleural friction rubs
have a distinctive grating sound. As the name
indicates, these breath sounds result when
inflamed pleurae rub together. Continuous, high-
pitched, musical squeaks, called wheezes, result
when air moves rapidly through airways
narrowed by asthma or infection or when an
airway is partially obstructed by a tumor or
foreign body. Wheezes, like gurgles, occur on
expiration and sometimes on inspiration. Loud,
coarse, low-pitched sounds resembling snoring
are called gurgles. These sounds develop when
thick secretions partially obstruct airflow through
the large upper airways.
63. A woman whose husband was recently
diagnosed with active pulmonary tuberculosis
(TB) is a tuberculin skin test converter.
Management of her care would include:
A. scheduling her for annual tuberculin skin
testing
B. placing her in quarantine until sputum
cultures are negative
C. gathering a list of persons with whom she has
had recent contact
D. advising her to begin prophylactic therapy
with isoniazid (INH)
Individuals who are tuberculin skin test
converters should begin a 6-month regimen of
an antitubercular drug such as INH, and they
should never have another skin test. After an
individual has a positive tuberculin skin test,
subsequent skin tests will cause severe skin
reactions but won’t provide new information
about the client’s TB status. The client doesn’t
have active TB, so can’t transmit, or spread, the
bacteria. Therefore, she shouldn’t be
quarantined or asked for information about
recent contacts.
64. The nurse is caring for a client who ahs had
an above the knee amputation. The client
refuses to look at the stump. When the nurse
attempts to speak with the client about his
surgery, he tells the nurse that he doesn’t wish
to discuss it. The client also refuses to have his
family visit. The nursing diagnosis that best
describes the client’s problem is:
A. Hopelessness
B. Powerlessness
C. Disturbed body image
D. Fear
MEDICAL-SURGICAL NURSING Part 1 1. After a cerebrovascular accident, a 75 yr
old
client is admitted to the health care facility. The
client has left-sided weakness and an absent
gag reflex. He’s incontinent and has a tarry
stool. His blood pressure is 90/50 mm Hg, and
his hemoglobin is 10 g/dl. Which of the following
is a priority for this client?
a. checking stools for occult blood
b. performing range-of-motion exercises to the
left side
c. keeping skin clean and dry
d. elevating the head of the bed to 30 degrees
ANS: D
Because the client’s gag reflex is absent,
elevating the head of the bed to 30 degrees
helps minimize the client’s risk of aspiration.
Checking the stools, performing ROM exercises,
and keeping the skin clean and dry are
important, but preventing aspiration through
positioning is the priority.
2. The nurse is caring for a client with a
colostomy. The client tells the nurse that he
makes small pin holes in the drainage bag to
help relieve gas. The nurse should teach him
that this action:
a. destroys the odor-proof seal
b. wont affect the colostomy system
c. is appropriate for relieving the gas in a
colostomy system
d. destroys the moisture barrier seal
ANS: A Any hole, no matter how small, will destroy the
odor-proof seal of a drainage bag. Removing the
bag or unclamping it is the only appropriate
method for relieving gas.
3. When assessing the client with celiac
disease, the nurse can expect to find which of
the following?
a. steatorrhea
b. jaundiced sclerae
c. clay-colored stools
d. widened pulse pressure
ANS: A because celiac disease destroys the absorbing
surface of the intestine, fat isn’t absorbed but is
passed in the stool. Steatorrhea is bulky, fatty
stools that have a foul odor. Jaundiced sclerae
result from elevated bilirubin levels. Clay-colored
stools are seen with biliary disease when bile
flow is blocked. Celiac disease doesn’t cause a
widened pulse pressure.
4. A client is hospitalized with a diagnosis of chronic glomerulonephritis. The client
mentions that she likes salty foods. The nurse should warn her to avoid foods containing
sodium because:
a. reducing sodium promotes urea nitrogen
excretion
b. reducing sodium improves her glomerular
filtration rate
c. reducing sodium increases potassium
absorption
d. reducing sodium decreases edema
ANS: D
Reducing sodium intake reduces fluid retention.
Fluid retention increases blood volume, which
changes blood vessel permeability and allows
plasma to move into interstitial tissue, causing
edema. Urea nitrogen excretion can be
increased only by improved renal function.
Sodium intake doesn’t affect the glomerular
filtration rate. Potassium absorption is improved
only by increasing the glomerular filtration rate; it
isn’t affected by sodium intake.
5. The nurse is caring for a client with a cerebral
injury that impaired his speech and hearing.
Most likely, the client has experienced damage
to the:
a. frontal lobe
b. parietal lobe
c. occipital lobe
d. temporal lobe
AN:S D
The portion of the cerebrum that controls speech
and hearing is the temporal lobe. Injury to the
frontal lobe causes personality changes,
difficulty speaking, and disturbance in memory,
reasoning, and concentration. Injury to the
parietal lobe causes sensory alterations and
problems with spatial relationships. Damage to
the occipital lobe causes vision disturbances.
6. The nurse is assessing a postcraniotomy
client and finds the urine output from a catheter
is 1500 ml for the 1st hour and the same for the
2nd hour. The nurse should suspect:
a. Cushing’s syndrome
b. Diabetes mellitus
c. Adrenal crisis d. Diabetes insipidus ANS: D
Diabetes insipidus is an abrupt onset of extreme
polyuria that commonly occurs in clients after
brain surgery. Cushing’s syndrome is excessive
glucocorticoid secretion resulting in sodium and
water retention. Diabetes mellitus is a
hyperglycemic state marked by polyuria,
polydipsia, and polyphagia. Adrenal crisis is
undersecretion of glucocorticoids resulting in
profound hypoglycemia, hypovolemia, and
hypotension.
7. The nurse is providing postprocedure care for
a client who underwent percutaneous lithotripsy.
In this procedure, an ultrasonic probe inserted
through a nephrostomy tube into the renal pelvis
generates ultra-high-frequency sound waves to
shatter renal calculi. The nurse should instruct
the client to:
a. limit oral fluid intake for 1 to 2 weeks
b. report the presence of fine, sandlike particles
through the nephrostomy tube.
c. Notify the physician about cloudy or foul-
smelling urine
d. Report bright pink urine within 24 hours after
the procedure
ANS: C
The client should report the presence of foul-
smelling or cloudy urine. Unless contraindicated,
the client should be instructed to drink large
quantities of fluid each day to flush the kidneys.
Sand-like debris is normal because of residual
stone products. Hematuria is common after
lithotripsy.
8. A client with a serum glucose level of 618
mg/dl is admitted to the facility. He’s awake and
oriented, has hot dry skin, and has the following
vital signs: temperature of 100.6º F (38.1º C),
heart rate of 116 beats/minute, and blood
pressure of 108/70 mm Hg. Based on these
assessment findings, which nursing diagnosis
takes the highest priority?
a. deficient fluid volume related to osmotic
diuresis
b. decreased cardiac output related to elevated
heart rate
c. imbalanced nutrition: Less than body
requirements related to insulin deficiency
d. ineffective thermoregulation related to
dehydration
ANS: A A serum glucose level of 618 mg/dl indicates
hyperglycemia, which causes polyuria and
deficient fluid volume. In this client, tachycardia
is more likely to result from deficient fluid volume
than from decreased cardiac output because his
blood pressure is normal. Although the client’s
serum glucose is elevated, food isn’t a priority
because fluids and insulin should be
administered to lower the serum glucose level.
Therefore, a diagnosis of Imbalanced Nutrition:
Less then body requirements isn’t appropriate. A
temperature of 100.6º F isn’t life threatening,
eliminating ineffective thermoregulation as the
top priority.
9. Capillary glucose monitoring is being
performed every 4 hours for a client diagnosed
with diabetic ketoacidosis. Insulin is
administered using a scale of regular insulin
according to glucose results. At 2 p.m., the client
has a capillary glucose level of 250 mg/dl for
which he receives 8 U of regular insulin. The
nurse should expect the dose’s:
a. onset to be at 2 p.m. and its peak at 3 p.m.
b. onset to be at 2:15 p.m. and its peak at 3 p.m.
c. onset to be at 2:30 p.m. and its peak at 4 p.m.
d. onset to be at 4 p.m. and its peak at 6 p.m.
ANS: C
Regular insulin, which is a short-acting insulin,
has an onset of 15 to 30 minutes and a peak of
2 to 4 hours. Because the nurse gave the insulin
at 2 p.m., the expected onset would be from
2:15 to 2:30 p.m. and the peak from 4 p.m. to 6 p.m. 10. A client with a head injury is
being monitored
for increased intracranial pressure (ICP). His
blood pressure is 90/60 mmHG and the ICP is
18 mmHg; therefore his cerebral perfusion
pressure (CPP) is:
a. 52 mm Hg
b. 88 mm Hg
c. 48 mm Hg
d. 68 mm Hg
ANS: A CPP is derived by subtracting the ICP from the
mean arterial pressure (MAP). For adequate
cerebral perfusion to take place, the minimum
goal is 70 mmHg. The MAP is derived using the
following formula:
MAP = ((diastolic blood pressure x 2) + systolic
blood pressure) / 3
MAP = ((60 x2) + 90) / 3
MAP = 70 mmHg
To find the CPP, subtract the client’s ICP from
the MAP; in this case , 70 mmHg – 18 mmHg =
52 mmHg.
11. A 52 yr-old female tells the nurse that she
has found a painless lump in her right breast
during her monthly self-examination. Which
assessment finding would strongly suggest that
this client’s lump is cancerous?
a. eversion of the right nipple and a mobile mass
b. nonmobile mass with irregular edges
c. mobile mass that is oft and easily delineated
d. nonpalpable right axillary lymph nodes
ANS: B
Breast cancer tumors are fixed, hard, and poorly
delineated with irregular edges. Nipple retraction
—not eversion—may be a sign of cancer. A
mobile mass that is soft and easily delineated is
most often a fluid-filled benigned cyst. Axillary
lymph nodes may or may not be palpable on
initial detection of a cancerous mass.
12. A Client is scheduled to have a descending
colostomy. He’s very anxious and has many
questions regarding the surgical procedure, care
of stoma, and lifestyle changes. It would be most
appropriate for the nurse to make a referral to
which member of the health care team?
a. Social worker
b. registered dietician
c. occupational therapist
d. enterostomal nurse therapist
ANS: D
An enterostomal nurse therapist is a registered
nurse who has received advance education in
an accredited program to care for clients with
stomas. The enterostomal nurse therapist can
assist with selection of an appropriate stoma
site, teach about stoma care, and provide
emotional support.
13. Ottorrhea and rhinorrhea are most commonly seen with which type of skull
fracture?
a. basilar
b. temporal
c. occipital
d. parietal
ANS: A Ottorrhea and rhinorrhea are classic signs of
basilar skull fracture. Injury to the dura
commonly occurs with this fracture, resulting in
cerebrospinal fluid (CSF) leaking through the
ears and nose. Any fluid suspected of being
CSF should be checked for glucose or have a
halo test done.
14. A male client should be taught about
testicular examinations:
a. when sexual activity starts
b. after age 60
c. after age 40
d. before age 20
ANS: D
Testicular cancer commonly occurs in men
between ages 20 and 30. A male client should
be taught how to perform testicular self-
examination before age 20, preferably when he
enters his teens.
15. Before weaning a client from a ventilator,
which assessment parameter is most important
for the nurse to review?
A. fluid intake for the last 24 hours
B. baseline arterial blood gas (ABG) levels
C. prior outcomes of weaning
D. electrocardiogram (ECG) results
ANS: B
Before weaning a client from mechanical
ventilation, it’s most important to have a baseline
ABG levels. During the weaning process, ABG
levels will be checked to assess how the client is
tolerating the procedure. Other assessment
parameters are less critical. Measuring fluid
volume intake and output is always important
when a client is being mechanically ventilated.
Prior attempts at weaning and ECG results are
documented on the client’s record, and the
nurse can refer to them before the weaning
process begins.
16. The nurse is speaking to a group of women
about early detection of breast cancer. The
average age of the women in the group is 47.
Following the American Cancer Society (ACS)
guidelines, the nurse should recommend that
the women:
A. perform breast self-examination annually
B. have a mammogram annually
C. have a hormonal receptor assay annually
D. have a physician conduct a clinical evaluation
every 2 years
ANS: B
According to the ACS guidelines, “Women older
than age 40 should perform breast self-
examination monthly (not annually).” The
hormonal receptor assay is done on a known
breast tumor to determine whether the tumor is estrogen- or progesterone-dependent. 17.
When caring for a client with esophageal
varices, the nurse knows that bleeding in this
disorder usually stems from:
A. esophageal perforation
B. pulmonary hypertension
C. portal hypertension
D. peptic ulcers
ANS: C
Increased pressure within the portal veins
causes them to bulge, leading to rupture and
bleeding into the lower esophagus. Bleeding
associated with esophageal varices doesn’t
stem from esophageal perforation, pulmonary
hypertension, or peptic ulcers.
18. A 49-yer-old client was admitted for surgical
repair of a Colles’ fracture. An external fixator
was placed during surgery. The surgeon
explains that this method of repair:
A. has very low complication rate
B. maintains reduction and overall hand function
C. is less bothersome than a cast
D. is best for older people
ANS: B
Complex intra-articular fractures are repaired
with external fixators because they have a better
long-term outcome than those treated with
casting. This is especially true in a young client.
The incidence of complications, such as pin tract
infections and neuritis, is 20% to 60%. Clients
must be taught how to do pin care and assess
for development of neurovascular complications.
19. A client is hospitalized with a diagnosis of
chronic renal failure. An arteriovenous fistula
was created in his left arm for hemodialysis.
When preparing the client for discharge, the
nurse should reinforce which dietary instruction?
A. “Be sure to eat meat at every meal.”
B. “Monitor your fruit intake and eat plenty of
bananas.”
C. “Restrict your salt intake.”
D. “Drink plenty of fluids.”
ANS: C
In a client with chronic renal failure, unrestricted
intake of sodium, protein, potassium, and fluids
may lead to a dangerous accumulation of
electrolytes and protein metabolic products,
such as amino acids and ammonia. Therefore,
the client must limit his intake of sodium, meat
(high in Protein), bananas (high in potassium),
and fluid because the kidneys can’t secrete
adequate urine.
20. The nurse is caring for a client who has just
had a modified radical mastectomy with
immediate reconstruction. She’s in her 30s and
has tow children. Although she’s worried about
her future, she seems to be adjusting well to her
diagnosis. What should the nurse do to support
her coping?
A. Tell the client’s spouse or partner to be