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Questions 158

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Question 1 of 5

A client has begun to exhibit signs of alcohol withdrawal. Her blood pressure has risen from 120/60 to 190/100, pulse is increased from 88 to 110 bpm, and she is irritable and agitated and has gross motor tremors of the hands. The nurse notifies the doctor. The nurse can anticipate that the doctor will order which of the following?

Correct Answer: B

Rationale: This answer is incorrect. Benzodiazepines are drugs of choice for alcohol withdrawal. This answer is correct. The drug has a sedative effect, is safe, and has an anticonvulsant effect. This answer is incorrect. Amitriptyline is an antidepressant. This answer is incorrect. Chlorpromazine is most effective in psychotic disorders.

Question 2 of 5

A 2-year-old child will undergo a cardiac catheterization tomorrow to evaluate his ventricular septal defect. Based on his developmental stage, the nurse:

Correct Answer: B

Rationale: A toddler is not capable of conceptualizing about the inside of his body and is concerned about body intactness; therefore, diagrams would not be useful. Also, the previous evening is too far from the procedure for the toddler to remember the instructions. A simple explanation the morning of the procedure is the best developmental strategy to use, because it focuses on the toddler's need for parental support, body intactness, and short attention span. A relationship between the nurse and the child needs to develop. Also, misinformation may be given to the child if the parents explain the procedure to the child. The parents are the child's support system and need to be there to strengthen the child.

Question 3 of 5

A 37-year-old client has been taking antipsychotic medication for the past 10 days. The nurse observes her walking with a shuffling gait and postural rigidity and notes a masklike expression on her face. Which side effect is this client exhibiting?

Correct Answer: B

Rationale: This answer is incorrect. Dystonia refers to severe, painful muscle contractions. This answer is correct. Parkinsonism commonly occurs approximately 1-2 weeks after initiation of antipsychotic drug therapy. Traditional signs are masklike facies, postural rigidity, shuffling gait, and resting tremor. This answer is incorrect. Tardive dyskinesia is characterized by involuntary muscle movements of the face, jaw, and tongue. This answer is incorrect. Akathisia is motor restlessness.

Question 4 of 5

The client is prescribed albuterol (Proventil) for asthma. Which side effect should the nurse monitor for?

Correct Answer: B

Rationale: Albuterol, a beta-agonist, stimulates the sympathetic nervous system, causing tremors as a common side effect. Tachycardia (not bradycardia), hypertension, and diarrhea are more likely than hypotension or constipation.

Question 5 of 5

A client in the family planning clinic asks the nurse about the most likely time for her to conceive. The nurse explains that conception is most likely to occur when:

Correct Answer: B

Rationale: Conception is most likely during ovulation triggered by a surge in luteinizing hormone (LH). Low estrogen thin endometrium or low progesterone are not associated with ovulation.

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