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NEW QUESTION # 289
Pregnant women with diabetes often have problems related to the effectiveness of insulin in controlling their glucose levels during their second half of pregnancy. The nurse teaches the client that this is due to:
- A. Decreased estrogen levels
- B. Increased human placental lactogen levels
- C. Decreased progesterone levels
- D. Decreased glomerular filtration and increased tubular absorption
Answer: B
Explanation:
(A) There is a rise in glomerular filtration rate in the kidneys in conjunction with decreased tubular glucose reabsorption, resulting in glycosuria. (B) Insulin is inhibited by increased levels of estrogen. (C) Insulin is inhibited by increased levels of progesterone. (D) Human placental lactogen levels increase later in pregnancy. This hormonal antagonist reduces
insulin's effectiveness, stimulates lipolysis, and increases the circulation of free fatty acids.
NEW QUESTION # 290
The nurse has been assigned a client who delivered a 6- lb, 12-oz baby boy vaginally 40 minutes ago. The initial assessment of greatest importance for this client would be:
- A. Character of the fundus
- B. Amount of IV fluid to be infused
- C. Length of her labor
- D. Type of episiotomy
Answer: A
Explanation:
The length of labor has little bearing on the fourth stage of labor. The type of labor and delivery is significant. (B) The type of episiotomy will affect the client's comfort level. However, the nurse's assessment and implementations center on prevention of hemorrhage during the fourthstage of labor. The amount of bleeding from the episiotomy or hematoma formation is of higher priority than the type of episiotomy. (C) The amount of IV fluid to be infused is a nursing function to be attended to; however, it is lower in priority than determining if hemorrhaging is occurring. (D) Character of the fundus would be the priority nursing assessment because changes in uterine tone may identify possible postpartum hemorrhage.
NEW QUESTION # 291
A female client plans to bottle-feed her newborn. Her physician has ordered bromocriptine (Parlodel) to suppress lactation. Which of the following instructions about bromocriptine should be given by the nurse?
- A. Bromocriptine stimulates the production of prolactin.
- B. Her blood pressure must be stable before starting bromocriptine.
- C. Bromocriptine is generally taken for 5 days.
- D. Hypertension is a primary side effect.
Answer: B
Explanation:
Explanation/Reference:
Explanation:
(A) Bromocriptine inhibits the secretion of prolactin. (B) Hypotension is a side effect of this drug; hypertension is not. (C) Bromocriptine is generally taken for 14 days. (D) The administration of bromocriptine is delayed at least 4 hours postpartum and given only when the client's blood pressure is stable, because it can cause hypotension and syncope.
NEW QUESTION # 292
In healthcare settings, nurses must be familiar with primary, secondary, and tertiary levels of care. As a nurse in the community, which of the following interventions might be a primary prevention strategy?
- A. Teaching fifth-grade children the harmful effects of substance abuse
- B. Counseling a client with post-traumatic stress disorder
- C. Referring a client who has been on a detoxification unit to a rehabilitation center
- D. Crisis intervention with an intoxicated teenager whose mother just committed suicide
Answer: A
Explanation:
Explanation
(A) The teenager is already coping ineffectively and requires early detection and treatment, which is secondary prevention. (B) The client must be sent to a rehabilitation unit, which requires tertiary prevention. (C) Reducing the incidence of disease through education supports primary prevention. (D) A client with identified symptoms of post-traumatic stress disorder requires intervention by treatment.
NEW QUESTION # 293
A 7-year-old girl has been diagnosed with juvenile arthritis and has been placed on daily aspirin. Which statement made by the parent indicates a need for further teaching?
- A. "I give her aspirin on a regular schedule every day."
- B. "Her gums have been bleeding frequently. Maybe she is brushing too hard."
- C. "One sign of aspirin toxicity can be ringing in the ears."
- D. "My daughter takes her aspirin with her meals."
Answer: B
Explanation:
Section: Questions Set E
Explanation:
(A) Aspirin should not be given on an empty stomach because it is irritating to the mucosa. (B) Bleeding from decreased clotting capacity may be caused by aspirin toxicity. (C) A regular schedule of aspirin administration is important to maintain a satisfactory drug level in the body. (D) Aspirin toxicity may affect cranial nerve VIII, leading to tinnitus (ringing in the ears).
NEW QUESTION # 294
A post-lung surgery client is placed on a chest tube drainage system. When explaining to the family how the system works, the nurse states that the water-seal bottle of a three-bottle chest drainage system serves which of the following purposes?
- A. Preventing air from entering the chest upon inspiration
- B. Collection bottle for drainage
- C. Pressure regulator
- D. Preventing accumulation of blood around the heart
Answer: A
Explanation:
Explanation
(A) There is a separate collection bottle for drainage as part of a chest drainage system. (B) In a three-bottle chest drainage system, one bottle serves only as a pressure regulator. (C) Mediastinal chest tubes prevent accumulation of blood around the heart immediately following heart surgery. (D) The purpose of the water-seal bottle in any chest drainage setup is to allow air out of the chest, but not back in. This negative pressure promotes lung expansion.
NEW QUESTION # 295
The physician prescribes a medical regimen of isoniazid, rifampin, and vitamin B6 for a tuberculosis client.
The nurse instructs the client that B6 is given because it:
- A. Reduces peripheral neuropathy
- B. Improves nutritional status
- C. Increases activity of rifampin
- D. Increases activity of isoniazid
Answer: A
Explanation:
Explanation
(A) Vitamin B6does not enhance the activity of isoniazid. (B) Vitamin B6does not enhance the activity of rifampin. (C) A vitamin alone does not improve nutritional status. (D) Isoniazid leads to Vitamin B6deficiency, which is manifested as peripheral neuropathy.
NEW QUESTION # 296
The nurse is teaching a client how to perform monthly testicular self-examination (TSE) and states that it is best to perform the procedure right after showering. This statement is made by the nurse based on the knowledge that:
- A. The scrotum will be softer and more relaxed after a warm shower, making the testicles easier to palpate
- B. The client is more likely to remember to perform the TSE when in the nude
- C. The examination will be less painful at this time
- D. When the scrotum is exposed to cool temperatures, the testicles become large and bulky
Answer: A
Explanation:
Explanation
(A) Nudity is not a trigger for reminding males to perform TSE. (B) Testicles become more firm when exposed to cool temperatures, but not large and bulky. (C) The testicles will be lower and more easily palpated with warmer temperatures. A protective mechanism of the body to protect sperm production is for the scrotum to pull closer to the body when exposed to cooler temperatures. (D) The examination should not be painful.
NEW QUESTION # 297
A male client is started on IV anticoagulant therapy with heparin. Which of the following laboratory studies will be ordered to monitor the therapeutic effects of heparin?
- A. Hemoglobin
- B. Partial thromboplastin time
- C. Red blood cell (RBC) count
- D. Prothrombin time
Answer: B
Explanation:
Explanation
(A) Partial thromboplastin time is used to monitor the effects of heparin, and dosage is adjusted depending on test results. It is a screening test used to detect deficiencies in all plasma clotting factors except factors VII and XIII and platelets. (B) Hemoglobin is the main component of RBCs. Its main function is to carry O2from the lungs to the body tissues and to transport CO2back to the lungs. (C) RBC count is the determination of the number of RBCs found in each cubic millimeter of whole blood. (D) PT is used to monitor the effects of oral anticoagulants, e.g., coumarintype anticoagulants.
NEW QUESTION # 298
The primary focus of nursing interventions for the child experiencing sickle cell crisis is aimed toward:
- A. Providing pain relief
- B. Maintaining an adequate level of hydration
- C. Preventing infection
- D. O2 therapy
Answer: B
Explanation:
Section: Questions Set D
Explanation:
(A) Maintaining the hydration level is the focus for nursing intervention because dehydration enhances the sickling process. Both oral and parenteral fluids are used. (B) The pain is a result of the sickling process.
Analgesics or narcotics will be used for symptom relief, but the underlying cause of the pain will be resolved with hydration. (C) Serious bacterial infections may result owing to splenic dysfunction. This is true at all times, not just during the acute period of a crisis. (D) O2 therapy is used for symptomatic relief of the hypoxia resulting from the sickling process. Hydration is the primary intervention to alleviate the dehydration that enhances the sickling process.
NEW QUESTION # 299
To appropriately monitor therapy and client progress, the nurse should be aware that increased myocardial work and O2 demand will occur with which of the following?
- A. Positive inotropic therapy
- B. Increase in balance of myocardial O2 supply and demand
- C. Negative chronotropic therapy
- D. Afterload reduction therapy
Answer: A
Explanation:
(A)
Inotropic therapy will increase contractility, which will increase myocardial O2 demand.
(B)
Decreased heart rate to the point of bradycardia will increase coronary artery filling time. This should be used cautiously because tachycardia may be a compensatory mechanism to increase cardiac output. (C) The goal in the care of the MI client with angina is to maintain a balance between myocardial O2 supply and demand. (D) Decrease in systemic vascular resistance by drug therapy, such as IV nitroglycerin or nitroprusside, or intra-aortic balloon pump therapy, would decrease myocardial work and O2 demand.
NEW QUESTION # 300
An 82-year-old former restaurant owner walks to the nursing station and states, "I have to go. The restaurant opens at 11 am." Which response by the nurse is the most appropriate?
- A. "You once owned a restaurant. Tell me about it."
- B. "Go back to your room. You do not own a restaurant."
- C. "You are in the hospital now. Calm down."
- D. "It is snowing outside. The restaurant is closed."
Answer: A
Explanation:
Explanation/Reference:
Explanation:
(A) This response cuts off communication with the client. It does not address her feelings. (B) Reality orientation frequently does not work alone. Feelings must be addressed. Telling a client to calm down is frequently ineffective. (C) Reminiscence is used here to reorient and recall past pleasant events. Talking about the restaurant will allay anxiety. (D) This response may confirm to the client that she indeed does still own a restaurant, buying into her confusion. Her feelings and anxiety require nursing intervention.
NEW QUESTION # 301
In assessing the nature of the stool of a client who has cystic fibrosis, what would the nurse expect to see?
- A. Blood-tinged stools
- B. Dark brown stools
- C. Steatorrhea stools
- D. Clay-colored stools
Answer: C
Explanation:
Section: Questions Set B
Explanation:
(A) Clay-colored stools indicate dysfunction of the liver or biliary tract. (B) In the early stages of cystic fibrosis, fat absorption is primarily affected resulting in fat, foul, frothy, bulky stools. (C) Dark brown stools indicate normal passage through the colon. (D) Blood-tinged stools indicate dysfunction of the gastrointestinal (GI) tract.
NEW QUESTION # 302
During burn therapy, morphine is primarily administered IV for pain management because this route:
- A. Avoids causing additional pain from IM injections
- B. Delays absorption to provide continuous pain relief
- C. Allows for discontinuance of the medication if respiratory depression develops
- D. Facilitates absorption because absorption from muscles is not dependable
Answer: D
Explanation:
Explanation/Reference:
Explanation:
(A) Absorption would be increased, not decreased. (B) IM injections should not be used until the client is hemodynamically stable and has adequate tissue perfusion. Medications will remain in the subcutaneous tissue with the fluid that is present in the interstitial spaces in the acute phase of the thermal injury. The client will have a poor response to the medication administered, and a "dumping" of the medication can occur when the medication and fluid are shifted back into the intravascular spaces in the next phase of healing. (C) IV administration of the medication would hasten respiratory compromise, if present. (D) The desire to avoid causing the client additional pain is not a primary reason for this route of administration.
NEW QUESTION # 303
Two hours after the second injection of haloperidol, a client complains to the nurse of a stiff neck and inability to sit still. He is experiencing symptoms consistent with:
- A. Akathisia and parkinsonism
- B. Parkinsonism and dystonia
- C. Dystonia and akathisia
- D. Neuroleptic malignant syndrome
Answer: C
Explanation:
Explanation
(A) Stiff neck is consistent with a dystonic reaction, but the client has no symptoms of drooling, shuffling gait, or pill-rolling movements characteristic of parkinsonism. (B) Stiff neck is consistent with a dystonic reaction, and inability to sit still with varying degrees of psychomotor agitation is characteristic of akathisia. (C) The client has symptoms of dystonia but not of parkinsonism. (D) The client has none of the characteristic symptoms of neuroleptic malignant syndrome: hyperpyrexia, generalized muscle rigidity, mutism, obtundation, agitation, sweating, increased blood pressure and pulse.
NEW QUESTION # 304
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. Diluted carbonated drinks
- B. Fruit juices
- C. Regular formulas mixed with electrolyte solutions
- D. Soy-based, lactose-free formula
Answer: D
Explanation:
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 # 305
A 28-year-old woman was admitted to the hospital for a thyroidectomy. Postoperatively she is taken to the postanesthesia care unit for several hours. In preparing for the client's return to her room, which nursing measure best demonstrates the nurse's thorough understanding of possible postthyroidectomy complications?
- A. Narcotics are readily available and administered when the client returns to her room to prevent excruciating pain.
- B. A tracheostomy set, O2, and suction are available at the bedside.
- C. Dressings are placed at the bedside for dressing changes, which are to be done every 2 hours to best detect postoperative bleeding.
- D. The nurse should instruct the client as soon as possible on alternative means of communication.
Answer: B
Explanation:
(A) Dressing changes are done as necessary for bleeding. However, frequently, post-thyroidectomy bleeding may not be visible on the dressing, but blood may drain down the back of the neck by gravity. (B) Narcotics are administered for acute pain as necessary. They are not necessarily given on return of the client to her room. (C) The most serious postthyroidectomy complication is ineffective airway and breathing pattern related to tracheal compression and edema. A tracheostomy set, O2, and suction should be available at bedside for at least the first 24 hours postoperatively. (D) Impaired verbal communication may occur due to laryngeal edema or nerve damage, but most commonly, it occurs due to endotracheal intubation. The client is usually able to communicate but is hoarse.
NEW QUESTION # 306
After several days, an IDDM client's serum glucose stabilizes, and the registered nurse continues client teaching in preparation for his discharge. The nurse helps him plan an American Diabetes Association diet and explains how foods can be substituted on the exchange list. He can substitute 1 oz of poultry for:
- A. Two slices of bacon
- B. One frankfurter
- C. One ounce of ham
- D. One-fourth cup dry cottage cheese
Answer: D
Explanation:
Section: Questions Set F
Explanation:
(A) A frankfurter is a high-fat meat on the diabetic exchange list. (B) Ham is a medium-fat meat on the diabetic exchange list, unless it is a center-cut slice. (C) One strip of bacon equals onefatexchange rather than ameatexchange. Dietary substitutions should occur within exchange lists and not between exchange lists. (D) Diabetic meat-exchange lists are categorized into lean meat foods, medium-fat meats, and high-fat meats.
Cottage cheese (dry, 2% butterfat), one-fourth cup, can substitute for one lean-meat exchange.
NEW QUESTION # 307
Assessment of severe depression in a client reveals feelings of hopelessness, worthlessness; inability to feel pleasure; sleep, psychomotor, and nutritional alterations; delusional thinking; negative view of self; and feelings of abandonment. These clinical features of the client's depression alert the nurse to prioritize problems and care by addressing which of the following problems first:
- A. Impaired thinking
- B. Rest and activity impairment
- C. Possible harm to self
- D. Nutritional status
Answer: C
Explanation:
(A) Anorexia and weight loss are problems that need attention in severe depression, but they can be addressed secondary to immediate concerns. (B) Impaired thinking and confusion are problems in severe depression that are addressed with administration of medication, through group and individual psychotherapy, and through activity therapy as motivation and interest increase. (C) Possible harm to self as with suicidal ideation; a suicide plan, means to execute plan; and/or overt gestures or an attempt must be addressed as an immediate concern and safety measures implemented appropriate to the risk of suicide. (D) Rest and activity impairment may take time and further assessment to determine client's sleep pattern and amount of psychomotor retardation with the more immediate concern for safety present.
NEW QUESTION # 308
A 5-year-old child cries continually in her bed. Her parents have been unsuccessful in assisting her in expressing her feelings. Which activity should the nurse provide the child to assist her in expressing her feelings?
- A. Puppets
- B. Books with colorful pictures
- C. Music
- D. Riding toys
Answer: A
Explanation:
(A) Books increase cognition, assist with fine motor skills, and augment language development. (B) Music provides auditory stimulation and large-muscle activity. (C) Riding toys provide large-muscle activity. (D) Puppets allow expression of feelings and fears that otherwise could not be directly communicated.
NEW QUESTION # 309
A 45-year-old male client was admitted to a chemical dependency treatment center following legal problems related to alcohol abuse. He states, "I know that alcohol is a problem for some people, but I can stop whenever I want to. I'm never sick or miss work, and no one can complain about me." During the initial assessment, the best response by the nurse would be:
- A. "If you can stop drinking when you want to, why don't you stop?"
- B. "I understand it took strength to admit yourself to the unit, and I will do my part to help you to stay alcohol- free."
- C. "It's good that you can stop drinking when you want to."
- D. "The fact is you are an alcoholic or you wouldn't be here."
Answer: B
Explanation:
Explanation
(A) Direct confrontation initially is nontherapeutic and may result in the client becoming frustrated and wanting to leave. (B) A positive, supportive attitude builds trust, and identifying positive strength raises self-esteem. Offering help allows the client to feel that he is not alone in dealing with problems. (C) Asking the client why or to give an explanation for his behavior puts him in a position of having to justify his behavior to the nurse. (D) Giving approval or placing a value on feelings or a behavior may limit the client's freedom to behave in a way that may displease another. This response may lead to seeking praise instead of progress.
NEW QUESTION # 310
The nurse is caring for a laboring client. Assessment data include cervical dilation 9 cm; contractions every 1-2 minutes; strong, large amount of "bloody show." The most appropriate nursing goal for this client would be:
- A. Maintain client's privacy.
- B. Assist with assessment procedures.
- C. Provide strategies to maintain client control.
- D. Enlist additional caregiver support to ensure client's safety.
Answer: C
Explanation:
(A) Privacy may help the laboring client feel safer, but measures that enhance coping take priority. (B) The frequency of assessments do increase in transition, but helping the client to maintain control and cope with this phase of labor takes on importance. (C) This laboring client is in transition, the most difficult part of the first stage of labor because of decreased frequency, increased duration and intensity, and decreased resting phase of the uterine contraction. The client's ability to cope is most threatened during this phase of labor, and nursing actions aredirected toward helping the client to maintain control. (D) Safety is a concern throughout labor, but helping the client to cope takes on importance in transition.
NEW QUESTION # 311
A 25-year-old client believes she may be pregnant with her first child. She schedules an obstetric examination with the nurse practitioner to determine the status of her possible pregnancy. Her last menstrual period began May 20, and her estimated date of confinement using Naegele's rule is:
- A. January 3
- B. March 27
- C. February 27
- D. February 1
Answer: C
Explanation:
Section: Questions Set A
Explanation:
(A) March 27 is a miscalculation. (B) February 1 is a miscalculation. (C) February 27 is the correct answer. To calculate the estimated date of confinement using Naegele's rule, subtract 3 months from the date that the last menstrual cycle began and then add 7 days to the result. (D) January 3 is a miscalculation.
NEW QUESTION # 312
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