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Questions 148

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Question 1 of 5

A child with Tetralogy of Fallot is scheduled for a modified Blalock Taussig procedure. The nurse understands that the surgery will:

Correct Answer: B

Rationale: The modified Blalock-Taussig procedure creates a shunt to improve pulmonary blood flow in Tetralogy of Fallot, enhancing lung oxygenation.

Question 2 of 5

The nurse is evaluating the intake and output of a client for the first 12 hours following an abdominal cholecystectomy. Which finding should be reported to the physician?

Correct Answer: D

Rationale: Absence of stool post-cholecystectomy may indicate a complication like ileus or obstruction, requiring physician evaluation.

Question 3 of 5

Upon admission to the hospital, a client reports having 'the worst headache I've ever had.' The nurse should give the highest priority to:

Correct Answer: C

Rationale: A sudden, severe headache may indicate a serious condition like subarachnoid hemorrhage. Neuro checks are the priority to assess for neurological changes.

Question 4 of 5

The nurse is caring for a client with a cerebrovascular accident (CVA) who is complaining of being nauseated and is requesting an emesis basin. Which action would the nurse take first?

Correct Answer: C

Rationale: Turning the client to one side prevents aspiration, a risk in CVA patients with nausea due to impaired swallowing or consciousness. This is the priority before other actions.

Question 5 of 5

The physician has ordered intubation and mechanical ventilation for a client with periods of apnea following a closed head injury. Arterial blood gases reveal a pH of 7.47, PCO2 of 28, and HCO3 of 23. These findings indicate that the client has:

Correct Answer: B

Rationale: A pH of 7.47 and PCO2 of 28 indicate respiratory alkalosis, likely due to hyperventilation from the head injury.

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