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Questions 148

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Question 1 of 5

A 5-month-old infant is admitted to the ER with a temperature of 103.6°F and irritability. The mother states that the child has been listless for the past several hours and that he had a seizure on the way to the hospital. A lumbar puncture confirms a diagnosis of bacterial meningitis. The nurse should assess the infant for:

Correct Answer: B

Rationale: Tenseness of the anterior fontanel indicates increased intracranial pressure, a critical finding in bacterial meningitis in infants.

Question 2 of 5

An end-of-life client receiving home hospice care states he no longer wants to eat. The nurse should

Correct Answer: C

Rationale: In hospice care, respecting the client’s autonomy is key. Accepting the decision to stop eating and focusing on comfort aligns with end-of-life care principles.

Question 3 of 5

Which diet is associated with an increased risk of colorectal cancer?

Correct Answer: C

Rationale: A diet high in fat and refined carbohydrates increases the risk of colorectal cancer due to prolonged intestinal transit time and exposure to carcinogenic metabolites.

Question 4 of 5

The nurse is monitoring a client’s EKG strip and notes coupled premature ventricular contractions greater than 10 per minute. The nurse should expect to administer which of the following?

Correct Answer: D

Rationale: Lidocaine is the drug of choice for frequent premature ventricular contractions (PV
C) occurring in excess of 6-10 per minute; for coupled PVCs or for a consecutive series of PVCs that may result in ventricular tachycardia

Question 5 of 5

The client delivered a 9-pound infant two days ago. An effective means of managing discomfort from an episiotomy is:

Correct Answer: C

Rationale: Sitz baths relieve episiotomy pain by promoting circulation and healing.

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