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Questions 164

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Question 1 of 5

A 78-year-old client is admitted following a cerebrovascular accident. He cannot move his left arm and leg. Which finding would indicate to the nurse that the client also has homonymous hemianopia?

Correct Answer: B

Rationale: Homonymous hemianopia, a visual field defect from right brain stroke, causes left-sided vision loss, so the client misses the nurse on the left, unlike arm movement, swallowing, or speech issues.

Question 2 of 5

The nurse is talking with the parent of a 5-year-old client who is receiving morphine for pain. Which of the following statements by the parent would be a priority to follow up?

Correct Answer: D

Rationale: Assuming a playing child has no pain (
D) is incorrect, as children may play despite pain. This requires follow-up to ensure adequate pain management. Aggression (
A) and feeling punished (
B) are valid concerns but less urgent. Using the FACES scale (
C) is appropriate.

Question 3 of 5

A client with a diagnosis of HPV is at risk for which of the following?

Correct Answer: B

Rationale: The client with HPV is at higher risk for cervical and vaginal cancer related to this STI. She is not at higher risk for the cancers mentioned in answers A, C, and D, so those are incorrect.

Question 4 of 5

Because the client has hypothyroidism, the nurse expects which of the following to be present in the client?

Correct Answer: C

Rationale: Hypothyroidism slows metabolism, causing hypothermia (e.g., 96.8°F). Weight gain, not loss, slow respirations, and heavy menses are typical.

Question 5 of 5

A client admitted to the floor 3 days after a bowel resection suddenly develops chest pain and shortness of breath. Assessment of the client reveals rales, BP 160/40, and severe tachycardia. The nurse's first action should be to:

Correct Answer: C

Rationale: The symptoms suggest a pulmonary embolus, a medical emergency. Placing the client in high Fowler's position facilitates breathing. Oxygen is secondary, chest compressions are inappropriate without cardiac arrest, and sedatives could worsen respiratory distress.

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