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Questions 148

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Question 1 of 5

A client being treated with sodium warfarin (Coumadin) has a Protime of 120 seconds. Which intervention would be most important to include in the nursing care plan?

Correct Answer: A

Rationale: A Protime of 120 seconds indicates excessive anticoagulation, increasing the risk of bleeding, so assessing for abnormal bleeding is the most important intervention.

Question 2 of 5

The nurse is caring for a 42-year-old client who has a do not resuscitate (DNR) order on the chart. The client tells the nurse, 'I've changed my mind about the DNR. I would like to cancel that and be given whatever care is needed to keep me alive.' Which response by the nurse is correct?

Correct Answer: A

Rationale: A DNR can be revoked by the client at any time. Notifying the provider ensures the change is documented and followed.

Question 3 of 5

A infant weighs 7 pounds at birth. The expected weight by 1 year should be:

Correct Answer: D

Rationale: Infants typically triple their birth weight by 1 year, so a 7-pound infant should weigh approximately 21 pounds.

Question 4 of 5

Cystic fibrosis is an exocrine disorder that affects several systems of the body. The earliest sign associated with a diagnosis of cystic fibrosis is:

Correct Answer: D

Rationale: Meconium ileus, a bowel obstruction at birth, is often the earliest sign of cystic fibrosis in newborns.

Question 5 of 5

A client has been receiving cyanocobalamine (B12) injections for the past six weeks. Which laboratory finding indicates that the medication is having the desired effect?

Correct Answer: D

Rationale: Increased reticulocyte count indicates effective B12 therapy for anemia.

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