Answer to Question 1
ANS: 4
The nurse evaluates success by observing the client's performance of each expected behavior. Feedback indicating success in this situation is the client drinking 240 mL of fluid five or six times during the shift. This would be a fluid intake of 1200-1440 mL, meeting the objective of at least 1000 mL during the designated time period. Voiding at least 1000 mL is not the objective. The objective is to have the client drink at least 1000 mL. Verbalizing abdominal comfort with-out pressure is not an evaluation of the objective regarding specific fluid intake. Having adequate intake and output is not accurate feedback indicating success. The term adequate is not quanti-fied.
Answer to Question 2
ANS: 4
The number of persons being taught, the need for privacy, the room temperature, the room light-ing, noise, the room ventilation, and the room furniture are important factors when choosing the setting. The ideal setting helps the client focus on the learning task. Knowing the specific ages of all the people involved is not as important as providing an environment conducive to learning. It is not necessary to know the names of employees who are married to teach individuals how to take their blood pressure. Whether an employee has high blood pressure should not be as im-portant to the teacher as providing an environment conducive to learning. Having high blood pressure may be a motivating factor for employees to learn how to take their blood pressure, be-cause of its personal relevance.
The nurse uses a noninvasive bladder ultrasound to measure the client’s bladder volume.
Use face cradle covers to prevent the client’s skin from touching the face cradle upholstery.
Testing the Achilles tendon reflex with client in a supine position
Position the client
The focal lengths of the objective and the eyepiece in a microscope are 0.29 cm