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1.Ask the physician for an order to begin intravenous fluid replacement. 2.Ask the physician to order a chest x-ray. 3.Assess the urine for osmolality. 4.Ask the physician for an order for a brain scan. 40.A client is diagnosed with severe hyponatremia. The nurse realizes this client will most likely need which of the following precautions implemented?
1.Seizure2.Infection3.Neutropenic 4.High-risk fall 41.When analyzing an arterial blood gas report of a client with COPD and respiratory acidosis, the nurse anticipates that compensation will develop through which of the following mechanisms? 1.The kidneys retain bicarbonate 2.The kidneys excrete bicarbonate 3.The lungs will retain carbon dioxide 4.The lungs will excrete carbon dioxide 42.A nurse is monitoring an older adult client who is receiving IV fluid therapy. Which of the following assessment findings should the nurse recognize as an adverse effect of excess fluid therapy? (select all that apply) a. Edema b. Oliguria c. Crackles in lungs d. Jugular venous distention 43. The nurse notices that the client is experiencing an unusually large amount and significant degree of stress and is concerned. Which is the priority assessment area the nurse must address while working with this client? a. b. c. d. The client’s primary emotional needs What else is happening in the client’s life How the stress has influenced the client’s activities of daily living Determining whether the client is thinking about harming self or others 44. The Health Insurance Portability and Accountability Act of 1996 (HIPAA) providesclients basic rights pertaining to their medical records. The nurse is aware that which statement reflects a violation of HIPAA? 1.Two RN’s discussing client conditions in the nursing report room at the change of shift 2.Allowing nursing students to review client charts before caring for clients to whom they are assigned 3.Posting daily nursing care information along with the medical condition of the client on a message board in the client’s room 4.Releasing client information regarding terminal illness to family when the client has given permission for information to be shared
45. The nurse, while working with a client to support and assess spirituality should do which of the following first? 1.Refer the client to the agency chaplain 2.Assist the client to use faith to get well 3.Provide a variety of religious literature 4.Determine the client’s personal belief system 6 46. The nurse teaching a health awareness class identifies which situation as being the highest risk factor for the development of a deep vein thrombosis (DVT)? a. Pregnancy b. Inactivity c. Aerobic exercise d. Tight clothing 47.A woman experiences the loss of a very early–term pregnancy. Her friends do not mention the loss, and someone suggests to her that she can “always try again.” The woman feels confusion over her sadness and stops talking about it with others. What type of grief response is she most likely experiencing?