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Questions 164

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Question 1 of 5

A client has a serum glucose of 385 mg/dl. Which of these orders would the nurse question first?

Correct Answer: C

Rationale: Regular insulin is the only insulin that can be given by the intravenous route. Humulin N is not suitable for IV administration, making this the priority order to question.

Question 2 of 5

A client with schizophrenia is experiencing auditory hallucinations and is admitted for evaluation and treatment. A suitable activity for a client with schizophrenia who is experiencing auditory hallucinations is:

Correct Answer: D

Rationale: Taking a walk with the nurse provides distraction and support, reducing focus on hallucinations. Group activities or solitary tasks (B,
C) may be overwhelming or less therapeutic.

Question 3 of 5

The nurse is preparing the sterile field and supplies for a wet-to-damp dressing change. Which of the following actions by the nurse would require follow-up?

Correct Answer: D

Rationale: Using saline from a bottle opened 30 hours ago risks contamination, as sterile solutions are typically discarded after 24 hours. Keeping the field in view and placing gauze appropriately maintain sterility.

Question 4 of 5

The nurse talking with a client with polycythemia vera. Which of the following statements by the client would require follow-up?

Correct Answer: D

Rationale: Iron supplements can worsen polycythemia vera by increasing red blood cell production. Hydration, aspirin, and phlebotomy are appropriate management strategies.

Question 5 of 5

An adult asks the nurse what could be causing him to have a black tongue and black stools. The following items are in the client's history. Which is most likely to be causing his symptoms?

Correct Answer: A

Rationale: Bismuth subsalicylate commonly causes black tongue and stools, a harmless side effect, unlike the other options.

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