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Questions 149

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Question 1 of 5

A burn client is in the acute phase of burn care. The nurse assesses jugular vein distention, edema, urine output of 20 cc in 2 hours, and crackles on auscultation. Which order would the nurse anticipate from the physician?

Correct Answer: A

Rationale: Signs of fluid overload (JVD, edema, low urine output, crackles) suggest the need for furosemide (Lasix) to reduce excess fluid and prevent pulmonary edema.

Question 2 of 5

The client arrives in the emergency department after a motor vehicle accident. Nursing assessment findings include BP 68/34, pulse rate 130, and respirations 18. Which is the client's most appropriate priority nursing diagnosis?

Correct Answer: B

Rationale: The vital signs indicate hypovolemic shock, making fluid volume deficit the priority nursing diagnosis.

Question 3 of 5

The doctor has prescribed a diet high in vitamin B12 for a client with pernicious anemia. Which foods are good sources of B12?

Correct Answer: A

Rationale: Vitamin B12 is found in animal products like meat, eggs, and dairy, essential for treating pernicious anemia due to impaired B12 absorption.

Question 4 of 5

The nurse is assessing a client with suspected diverticulitis. Which of the following findings would the nurse expect?

Correct Answer: B

Rationale: fever and left lower quadrant pain are common in diverticulitis due to inflammation in the sigmoid colon

Question 5 of 5

A nurse is preparing to mix and administer chemotherapy. What equipment would be unnecessary to obtain?

Correct Answer: C

Rationale: Chemotherapy requires protective equipment (gloves, gown, Luer lok tubing to prevent leaks), but a surgical hat cover is unnecessary unless in a sterile field, which isn't typical for chemo administration.

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