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Questions 149

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Extract:


Question 1 of 5

A client has accidentally splashed a toxic (although not caustic) substance in his right eye and the nurse must flush the eye. Which of the following steps are correct? Select all that apply.

Correct Answer: B,C,D,E

Rationale: Correct eye irrigation includes syringe 0.5 inch above eye (
B), flushing 5 minutes (
C), holding eyelid open (
D), and using a basin (E). Head down (
A) is incorrect; tilt toward affected side.

Question 2 of 5

A client complains of sharp, stabbing pain in the right lower quadrant that is graded as level 8 on a scale of 10. The nurse knows that pain of this severity can best be managed using:

Correct Answer: D

Rationale: Morphine sulfate is the most effective for severe, acute pain due to its strong opioid properties.

Question 3 of 5

An ICU nurse is caring for a client receiving total parenteral nutrition (TPN) via IV. The client's infusion ended 2 hours ago and the pharmacy has not yet sent another bag. The client is diaphoretic, tachycardic, and states he feels weak, dizzy, and fatigued. The nurse suspects

Correct Answer: D

Rationale: Abrupt cessation of TPN can cause hypoglycemia due to persistent insulin secretion, leading to diaphoresis, tachycardia, weakness, and dizziness.

Question 4 of 5

A client weighing 150 pounds has received burns over 50% of his body at 1200 hours. Using the Parkland formula, calculate the expected amount of fluid that the client should receive by 2000 hours.

Correct Answer: B

Rationale: Parkland formula: 4 mL × kg × % TBSA. Weight = 150 lb ÷ 2.2 = 68 kg. 4 × 68 × 50 = 13,600 mL total. Half (6,800 mL) is given in the first 8 hours (1200 to 2000).

Question 5 of 5

The home health nurse is scheduled to visit four clients. Which client should she visit first?

Correct Answer: A

Rationale: The AIDS client with fever and cough may have an acute infection like pneumonia, requiring urgent assessment.

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