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NEW QUESTION 300
The initial treatment for a client with a liquid chemical burn injury is to:
- A. Irrigate the area with neutralizing solutions
- B. Inject calcium chloride into the burned area
- C. Flush the exposed area with large amounts of water
- D. Apply lanolin ointment to the area
Answer: C
Explanation:
Explanation
(A) In the past, neutralizing solutions were recommended, but presently there is concern that these solutions extend the depth of burn area. (B) The use of large amounts of water to flush the area is recommended for chemical burns. (C) Calcium chloride is not recommended therapy and would likely worsen the problem. (D) Lanolin is of no benefit in the initial treatment of a chemical injury and may actually extend a thermal injury.
NEW QUESTION 301
A 64-year-old client is admitted to the hospital with benign prostatic hypertrophy (BPH). He has a history of adult-onset diabetes and hypertension and is scheduled to undergo a resection of the prostate. When recording his health history, the nurse asks about his chief complaint. The most serious symptom that may accompany BPH is:
- A. Decreased force of the urinary stream
- B. Acute urinary retention
- C. Increased frequency of urination
- D. Hesitancy in starting urination
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Acute urinary retention requires urgent medical attention. If measures such as a warm tub bath or warm tea do not occur after 6 hours, the client should go to the ED for catheterization. (B, C, D) This choice is a symptom of BPH, but it is not serious or life threatening.
NEW QUESTION 302
A client is diagnosed with organic brain disorder. The nursing care should include:
- A. Challenging educational programs
- B. Detailed explanations of procedures
- C. Long, extended family visits
- D. Organized, safe environment
Answer: D
Explanation:
(A) A priority nursing goal is attending to the client's safety and well-being. Reorient frequently, remove dangerous objects, and maintain consistent environment. (B) Short, frequent visits are recommended to avoid overstimulation and fatigue. (C) Short, concise, simple explanations are easier to understand. (D) Mental capability and attention span deficits make learning difficult and frustrating.
NEW QUESTION 303
A client takes warfarin (Coumadin) 15 mg po daily. To evaluate the medication's effectiveness, the nurse should monitor the:
- A. partial thromboplastin time (PTT)
- B. PTT-C
- C. prothrombin time (PT)
- D. Fibrin split products
Answer: C
Explanation:
Explanation
(A) PT evaluates adequacy of extrinsic clotting pathway. Adequacy of warfarin therapy is monitored by PT.
(B) PTT evaluates adequacy of intrinsic clotting pathway. Adequacy of heparin therapy is monitored by PTT.
(C) There is no such laboratory test. (D) Fibrin split products indicate fibrinolysis. This is a screening test for disseminated intravascular coagulation. Heparin therapy may increase fibrin split products.
NEW QUESTION 304
A 23-year-old female client is brought to the emergency room by her roommate for repeatedly making superficial cuts on her wrists and experiencing wide mood swings. She is very angry and hostile. Her medical diagnosis is adjustment disorder versus borderline personality disorder. The client comments to the nurse, "Nobody in here seems to really care about the clients. I thought nurses cared about people!" The client is exhibiting the ego defense mechanism:
- A. Sublimation
- B. Rationalization
- C. Reaction formation
- D. Splitting
Answer: D
Explanation:
(A) Reaction formation is the development and demonstration of attitudes and/or behaviors opposite to what an individual actually feels. The client's comment does reveal her anger and hostility. (B) Rationalization, another ego defense mechanism, is offering a socially acceptable or seemingly logical explanation to justify one's feelings, behaviors, or motives. The client's comment does not reflect rationalization. (C) Splitting, the viewing of people or situations as either all good or all bad, is frequently used by persons experiencing a disruption in self-concept. This ego defense mechanism is reflective of the individual's inability to integrate the positive and negative aspects of self. (D) Sublimation, the channeling of socially unacceptable impulses and behaviors into more acceptable patterns of behavior, is another ego defense mechanism. The client's comment reveals that she is not engaging in sublimation.
NEW QUESTION 305
A newborn infant is exhibiting signs of respiratory distress. Which of the following would the nurse recognize as the earliest clinical sign of respiratory distress?
- A. Cyanosis
- B. Sternal and subcostal retractions
- C. Decreased respirations
- D. Increased respirations
Answer: B
Explanation:
Explanation
(A) Cyanosis is a late clinical sign of respiratory distress. (B) Rapid respirations are normal in a newborn. (C) The newborn has to exert an extra effort for ventilation, which is accomplished by using the accessory muscles of ventilation. The diaphragm and abdominal muscles are immature and weak in the newborn. (D) Decreased respirations are a late clinical sign. In the newborn, decreased respirations precede respiratory failure.
NEW QUESTION 306
The nurse is admitting a client with folic acid deficiency anemia. Which of the following questions is most important for the nurse to ask the client?
- A. "Do you drink alcohol on a regular basis?"
- B. "Do you take aspirin on a regular basis?"
- C. "Do you eat red meat?"
- D. "Have your stools been normal?"
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Aspirin does not affect folic acid absorption. (B) Folic acid deficiency is strongly associated with alcohol abuse. (C) Because folic acid is a coenzyme for single carbon transfer purines, calves liver or other purines are the meat sources. (D) Folic acid does not affect stool character.
NEW QUESTION 307
Plans for the care of a client with an ulcer caused by emotional problems need to take into consideration that:
- A. There is no real psychological basis for his illness
- B. He is unable to participate in planning his care
- C. The disorder is a threat to his physical well-being
- D. His priority needs are limited to medical management
Answer: C
Explanation:
Section: Questions Set D
Explanation:
(A) There may be a medical emergency that takes top priority; however, the basis of the problem is emotional.
(B) The problem is a physical manifestation of an emotional conflict. (C) The bleeding ulcer can be life threatening. (D) For lifestyle change to occur, the client must participate in the planning of his care so that he is committed to changes that will have positive results.
NEW QUESTION 308
In planning daily care for a client with multiple sclerosis, the nurse would take into consideration that multiple sclerosis:
- A. Has unpredictable remissions and exacerbations
- B. Becomes progressively debilitating without remission
- C. Responds quickly to antimicrobial therapy
- D. Is rapidly fatal
Answer: A
Explanation:
Explanation
(A) Multiple sclerosis eventually becomes debilitating, but it is characterized by remission of symptoms. (B) Remissions and exacerbations are unpredictable with multiple sclerosis. The client experiences progressive dysfunction after each exacerbation episode. (C) Multiple sclerosis is usually slowly progressive. (D) Multiple sclerosis is an autoimmune disease. Antimicrobial therapy has no effect on its course.
NEW QUESTION 309
The nurse notes hyperventilation in a client with a thermal injury. She recognizes that this may be a reaction to which of the following medications if applied in large amounts?
- A. Povidone-iodine
- B. Neosporin sulfate
- C. Mafenide acetate
- D. Silver sulfadiazine
Answer: C
Explanation:
Section: Questions Set A
Explanation:
(A) The side effects of neomycin sulfate include rash, urticaria, nephrotoxicity, and ototoxicity. (B) The side effects of mafenide acetate include bone marrow suppression, hemolytic anemia, eosinophilia, and metabolic acidosis. The hyperventilation is a compensatory response to the metabolic acidosis. (C) The side effects of silver sulfadiazine include rash, itching, leukopenia, and decreased renal function. (D) The primary side effect of povidone-iodine is decreased renal function.
NEW QUESTION 310
A pregnant client is at the clinic for a third trimester prenatal visit. During this examination, it has been determined that her fetus is in a vertex presentation with the occiput located in her right anterior quadrant. On her chart this would be noted as:
- A. Right occipitoposterior
- B. LOA
- C. Right sacroanterior
- D. Right occipitoanterior
Answer: D
Explanation:
Explanation
(A) The fetus in the right occipitoposterior position would be presenting with the occiput in the maternal right posterior quadrant. (B) Fetal position is defined by the location of the fetal presenting part in the four quadrants of the maternal pelvis. The right occipitoanterior is a fetus presenting with the occiput in mother's right anterior quadrant. (C) The fetus in right sacroanterior position would be presenting a sacrum, not an occiput. (D) The fetus in left occipitoanterior position would be presenting with the occiput in the mother's left anterior quadrant.
NEW QUESTION 311
When teaching a mother of a 4-month-old with diarrhea about the importance of preventing dehydration, the nurse would inform the mother about the importance of feeding her child:
- A. Soy-based, lactose-free formula
- B. Fruit juices
- C. Diluted carbonated drinks
- D. Regular formulas mixed with electrolyte solutions
Answer: A
Explanation:
Section: Questions Set A
Explanation:
(A) Diluted fruit juices are not recommended for rehydration because they tend to aggravate the diarrhea. (B) Diluted soft drinks have a high-carbohydrate content, which aggravates the diarrhea. (C) Soy-based, lactose- free formula reduces stool output and duration of diarrhea in most infants. (D) Regular formulas contain lactose, which can increase diarrhea.
NEW QUESTION 312
Diabetes mellitus is a disorder that affects 3.1 out of every 1000 children younger than 20 years old. It is characterized by an absence of, or marked decrease in, circulating insulin. When teaching a newly diagnosed diabetes client, the nurse includes information on the functions of insulin:
- A. Catabolism and hyperglycemia
- B. Transport of glucose into body cells and storage of glycogen in the liver
- C. Glycogenolysis and facilitation of glucose use for energy
- D. Glycogenolysis and catabolism
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Lack of insulin causes glycogenolysis, catabolism, and hyperglycemia. (B) Insulin promotes the conversion of glucose to glycogen for storage and regulates the rate at which carbohydrates are used by cells for energy. (C) Insulin is anabolic in nature. (D) Glucose stimulates protein synthesis within the tissue and inhibits the breakdown of protein into amino acids.
NEW QUESTION 313
A 79-year-old client with Alzheimer's disease is exhibiting significant memory impairment, cognitive impairment, extremely impaired judgment in social situations, and agitation when placed in a new situation or around unfamiliar people. The nurse should include the following strategy in the client's care:
- A. Encourage the client to attend all structured activities on the unit, whether she wants to or not.
- B. Ask the client to go to an activity once. If she gives no response right away, change the question around, asking the same thing.
- C. Maintain routines and usual structure and adhere to schedules.
- D. Give the client two or three choices to decide what she wants to do.
Answer: C
Explanation:
Explanation/Reference:
Explanation:
(A) Alzheimer's clients cope poorly with changes in routine because of memory deficits. Schedule changes cause confusion and frustration, whereas adhering to schedules is helpful and supports orientation. (B) Insisting that the client go to all unit activities may antagonize her and increase her agitation because of cognitive impairments. It may be better to allow the client time for calming down or distraction rather than to insist that she attend every activity. (C) When repeating a question, allow time first for a response; then use the same words the second time to avoid further confusion. (D) The nurse should avoid giving several choices at once. Cognitively impaired clients will become more frustrated with making decisions.
NEW QUESTION 314
A client is admitted to the hospital with diabetic ketoacidosis.
The emergency room nurse should anticipate the administration of:
- A. Humulin U
- B. Humulin R
- C. Humulin L
- D. Humulin N
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Intermediate-acting insulin is not indicated in an emergency. (B) Regular insulin is rapid acting and indicated in an emergency situation. (C) Long-acting insulin is not indicated in an emergency situation. (D) Intermediate-acting insulin is not indicated in an emergency situation.
NEW QUESTION 315
A 40-year-old client is admitted to the hospital for tests to diagnose cancer. Since his admission, he has become dependent and demanding to the nursing staff. The nurse identifies this behavior as which defense mechanism?
- A. Regression
- B. Displacement
- C. Denial
- D. Projection
Answer: A
Explanation:
Explanation
(A) Denial is the disowning of consciously intolerable thoughts. (B) Displacement is the referring of a feeling or emotion from one person, object, or idea to another. (C) Regression is returning to an earlier stage of development. (D) Projection is attributing one's own thoughts, feelings, or impulses to another person.
NEW QUESTION 316
A client is admitted to the hospital for an induction of labor owing to a gestation of 42 weeks confirmed by dates and ultrasound. When she is dilated 3 cm, she has a contraction of 70 seconds. She is receiving oxytocin.
The nurse's first intervention should be to:
- A. Turn off the IV oxytocin
- B. Check FHT
- C. Prepare for the delivery because the client is probably in transition
- D. Notify the attending physician
Answer: A
Explanation:
(A) FHT should be monitored continuously with an induction of labor; this is an accepted standard of care. (B) The physician should be notified, but this is not the first intervention the nurse should do. (C) The standard of care for an induction according to the Association of Women's Health, Obstetric, and Neonatal Nurses and American College of Obstetrics and Gynecology is that contractions should not exceed 60 seconds in an induction. Inductions should simulate normal labor; 70-second contractions during the latent phase (3 cm) are not the norm. The next contractions can be longer and increase risks to the mother and fetus. (D) Contractions lasting 60-90 seconds during transition are typical; this provides a good distractor. The nurse needs to be knowledgeable of the phases and stages of labor.
NEW QUESTION 317
When assessing fetal heart rate status during labor, the monitor displays late decelerations with tachycardia and decreasing variability. What action should the nurse take?
- A. Report to physician or midwife.
- B. Continue monitoring because this is a normal occurrence.
- C. Decrease IV fluids.
- D. Turn client on right side.
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) This is not a normal occurrence. Late decelerations need prompt intervention for immediate infant recovery. (B) To increase O2 perfusion to the unborn infant, the mother should be placed on her left side.
(C) IV fluids should be increased, not decreased. (D) Immediate action is warranted, such as reporting findings, turning mother on left side, administering O2, discontinuing oxytocin (Pitocin), assessing maternal blood pressure and the labor process, preparing for immediate cesarean delivery, and explaining plan of action to client.
NEW QUESTION 318
The nurse discovers that a 78-year-old client who received hydralazine (Apresoline) 20 mg 45 minutes ago has a blood pressure of 70/40 mm Hg. The client has been on this dose of the medication for 3 years. Which of the following data is most likely significant in relation to the cause of the low blood pressure?
- A. Serum potassium 3.3
- B. Pedal pulses 11 (weak)
- C. Twenty-four-hour intake 1000 mL/day for past 2 days
- D. Pulse rate 150 bpm
Answer: C
Explanation:
Explanation
(A, D) Decreased pulse volume and increased pulse rate are signs of an acute hypotensive episode. (B) Inadequate fluid volume when taking vasodilators can result in a drop in blood pressure when vasodilation starts to physiologically occur as an action of the drug. (C) A potassium level of 3.3 would not be associated with a significant drop in blood pressure.
NEW QUESTION 319
The nurse assesses a postoperative mastectomy client and notes that breath sounds are diminished in both posterior bases. The nurse's action should be to:
- A. Obtain arterial blood gases
- B. Increase O2 from 2-3 L/min
- C. Encourage coughing and deep breathing each hour
- D. Remove the postoperative dressing to check for bleeding
Answer: C
Explanation:
Section: Questions Set G
Explanation:
(A) Decreased or absent breath sounds are frequently indicators of postoperative atelectasis. (B) Arterial blood gases are not indicated because there is no other information indicating impendingdanger. (C) Increasing O2 rate is not indicated without additional information. (D) Removing the dressing is not indicated without additional information.
NEW QUESTION 320
A child receiving chemotherapeutic drugs experiences a loss of appetite directly related to the therapy.
Which of the following strategies should be most effective in encouraging the child to eat?
- A. Offer the child smaller meals more frequently than usual, and include as many of her favorite foods as possible.
- B. Offer the child a diet with a wider variety of foods and with more seasoning than her usual diet.
- C. Schedule procedures immediately after eating so that the child will not be tired or in pain at mealtime.
- D. Provide a well-balanced diet at usual times, and restrict dessert if the child fails to eat well.
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) Because the child's appetite is capricious at best, regular servings may be overwhelming. Praise the child for what is eaten. (B) The child will soon learn that procedures follow meals and may play with food rather than eat it to avoid or delay the procedure. (C) Young children usually do not like highly seasoned foods and may need the security of usual foods. Such a change may actually increase anorexia. (D) Small servings appear more achievable to the child, and the inclusion of favorite foods can add a sense of security.
NEW QUESTION 321
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