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Questions 148

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Extract:


Question 1 of 5

A client is admitted to the emergency room with a gunshot wound to the right arm. After dressing the wound and administering the prescribed antibiotic, the nurse should:

Correct Answer: C

Rationale: Immobilizing the arm with a splint prevents further tissue damage and promotes healing, which is a priority after initial wound care and antibiotic administration. Checking for allergies should have been done prior to administering antibiotics, and pain management, while important, is secondary to stabilization.

Question 2 of 5

The nurse is assisting a client who is to undergo a thoracentesis. Which of the following is the optimal position for the procedure?

Correct Answer: D

Rationale: The upright position leaning forward (
D) maximizes lung expansion and access to pleural fluid during thoracentesis.

Question 3 of 5

Which assignment should not be performed by the nursing assistant?

Correct Answer: D

Rationale: Administering an enema is an invasive procedure requiring clinical judgment, which is beyond the scope of a nursing assistant's responsibilities.

Question 4 of 5

The nurse is developing a plan of care for a client with an ileostomy. The priority nursing diagnosis is:

Correct Answer: A

Rationale: Fluid volume deficit is the priority due to the risk of dehydration from high ileostomy output, which can lead to electrolyte imbalances and other complications.

Question 5 of 5

A client with rheumatoid arthritis is beginning to develop flexion contractures of the knees. The nurse should tell the client to:

Correct Answer: A

Rationale: Lying prone with feet hanging over the mattress edge promotes knee extension, helping to prevent or reduce flexion contractures in rheumatoid arthritis.

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