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Questions 149

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Question 1 of 5

A client at a psychiatric hospital tells the nurse that he does not want to join the others for dinner in the dining room because he already ate. The nurse is aware this client has been diagnosed with avoidant personality disorder. The best response from the nurse is to

Correct Answer: D

Rationale: Avoidant personality disorder involves social withdrawal due to fear of rejection. Gently encouraging participation while providing support (walking with the client) promotes socialization without confrontation.

Question 2 of 5

Which nursing assessment indicates that involutional changes have occurred in a client who is 3 days postpartum?

Correct Answer: A

Rationale: A firm fundus 3 finger widths below the umbilicus by day 3 postpartum indicates normal uterine involution, as the uterus shrinks progressively after delivery.

Question 3 of 5

The nurse in the ER has received report of four clients en route to the emergency department. Which client should the nurse see first? A client with:

Correct Answer: A

Rationale: Third-degree burns to the face and neck with singed nasal hairs suggest airway burns, a life-threatening condition requiring immediate airway assessment and management.

Question 4 of 5

The nurse is preparing to transfer a client from the ED to the orthopedic unit. She knows that adhering to the hospital policy for client handoffs best ensures which of the following?

Correct Answer: C

Rationale: Proper handoffs ensure continuity of care by transferring critical information accurately between care teams.

Question 5 of 5

The nurse is caring for a client who is postoperative day 1 following a craniotomy. Which of the following positions should the nurse place the client in?

Correct Answer: B

Rationale: semi-Fowler’s position with the head elevated 30° reduces intracranial pressure and promotes venous drainage

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