Which nursing implication is appropriate for a client undergoing a paracentesis?

• A.Have the client void before the procedure.
• B.Keep the client NPO.
• C.Observe the client for hypertension following the procedure.
• D.Place the client on the right side following the procedure.

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A 32-year-old male client is a marketing representative. His job requires him to have a tremendous amount of energy during the day. He frequently uses cocaine to sustain his energy level. Lately he has increased his use of cocaine and even experimented with crack cocaine. Realizing he can no longer continue this destructive behavior, he is seeking treatment for cocaine addiction. In planning nursing care for the client's inpatient stay, which expected outcome is most appropriate?

• A.He will attend four consecutive group educational sessions on substance abuse.
• B.He will name activities that he would most likely be involved in posttreatment.
• C.He will meet with his family in counseling sessions and discuss his feelings.
• D.He will be able to deal with his feelings through participation in group therapy sessions.

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A client is experiencing muscle weakness and lethargy. His serum K+ is 3.2. What other symptoms might he exhibit?

• A.Tetany
• B.Dysrhythmias
• C.Numbness of extremities
• D.Headache

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In evaluating the laboratory results of a client with severe pressure ulcers, the nurse finds that her albumin level is low. A decrease in serum albumin would contribute to the formation of pressure ulcers because:

• A.The proteins needed for tissue repair are diminished.
• B.The iron stores needed for tissue repair are inadequate.
• C.A decreased serum albumin level indicates kidney disease.
• D.A decreased serum albumin causes fluid movement into the blood vessels, causing dehydration.

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A female client has a chest tube placed. It is accidentally pulled out of the intrapleural space when she is ambulating. The first action the nurse should take is to:

• A.Instruct the client to cough deeply to re-expand her lung
• B.Put on sterile gloves and replace the tube
• C.Apply a petrolatum dressing over the site
• D.Auscultate the lung to determine if she needs the tube replaced

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