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Questions 163

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Question 1 of 5

A client indicates to the nurse a desire to become pregnant. The client drinks 1-2 glasses of wine on weekends. BMI is 32 kg/m². Which teachings should the nurse reinforce as part of proper preconception health care for this client? Select all that apply.

Correct Answer: A,B,D,E

Rationale:
To optimize preconception health: Avoid undercooked meat to prevent toxoplasmosis; limit alcohol to minimal or none to avoid fetal alcohol syndrome; rubella vaccine prevents congenital rubella syndrome; and folic acid reduces neural tube defects. A BMI of 32 is obese and should be reduced for healthier pregnancy outcomes.

Question 2 of 5

The nurse is caring for a client who had a right modified radical mastectomy 4 hours ago. The nurse should place the client in the

Correct Answer: C

Rationale: Semi-Fowler position with the right arm elevated promotes drainage and reduces edema post-mastectomy. High Fowler may strain the incision, and supine without elevation (B,
D) increases edema risk.

Question 3 of 5

The parent of a 7-month-old reports that the child has been crying and vomiting with a distended belly for the past 4 hours. The infant is now lying quietly in the parent's arms with a pulse of 200/min and respirations of 60/min. Which of the following components of SBAR (situation, background, assessment, recommendation/read back) communication is most important for the nurse to report?

Correct Answer: C

Rationale: The infant's lethargy with tachycardia (200/min) and tachypnea (60/min) are critical, suggesting a serious condition like intussusception or volvulus, requiring urgent reporting. Duration , perceived improvement , and laxative suggestion are less critical.

Question 4 of 5

The nurse is discussing child safety with the parents of a 12-month-old child who is just beginning to walk. Which statement by the parents indicates a need for further instruction?

Correct Answer: D

Rationale: Using a mobile walker is unsafe for a walking 12-month-old due to fall and injury risks, requiring further teaching. Fenced pools , stair gates , and lowered crib mattresses are appropriate safety measures.

Question 5 of 5

The physician has recommended that the client increase the amount of dietary iron. The nurse knows that the client understands the recommendation when the client selects which foods?

Correct Answer: C

Rationale: Roast beef is high in iron, suitable for increasing dietary iron. Other options lack significant iron sources.

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