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Questions 158

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Question 1 of 5

A 72-year-old client with a new colostomy is being evaluated at the clinic today for constipation. When discussing diet with the client, the nurse recognizes that which one of the following foods most likely caused this problem?

Correct Answer: C

Rationale: Fried, greasy food, such as fried chicken, will produce diarrhealike stools in individuals with all types of GI ostomies. Eggs will cause odor-producing stools in individuals with all types of GI ostomies. Tapioca and rice products will cause constipation in individuals with all types of GI ostomies. Cabbage will cause odor-producing and flatus-producing stools in individuals with all types of GI ostomies.

Question 2 of 5

Which of the following would the nurse expect to find following respiratory assessment of a client with advanced emphysema?

Correct Answer: A

Rationale: Distant breath sounds are characteristic of emphysema due to increased anteroposterior chest diameter, overdistention, and air trapping.

Question 3 of 5

A client with a history of atrial fibrillation is receiving warfarin (Coumadin). Which laboratory value should the nurse monitor closely?

Correct Answer: B

Rationale: Warfarin affects clotting, requiring monitoring of PT/INR to ensure therapeutic anticoagulation. Platelets (
A), hemoglobin (
C), and potassium (
D) are not directly affected.

Question 4 of 5

Prior to administering digoxin to a client with congestive heart failure, the nurse needs to assess:

Correct Answer: D

Rationale: Apical pulse should be measured for 1-minute prior to digoxin administration. Digoxin decreases the heart rate. Digoxin should be withheld if apical rates are <60 bpm or >120 bpm.

Question 5 of 5

The nurse is caring for a client with a diagnosis of gestational hypertension. Which symptom is most characteristic?

Correct Answer: A

Rationale: Hypertension (BP ≥140/90) is the defining symptom of gestational hypertension. Proteinuria indicates preeclampsia and fetal macrosomia or painful bleeding are unrelated.

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