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Questions 149

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Question 1 of 5

A client is admitted to the unit 2 hours after an injury with second-degree burns to the face, trunk, and head. The nurse would be most concerned with the client developing what?

Correct Answer: B

Rationale: Laryngeal edema is a critical concern with facial and head burns due to the risk of airway obstruction.

Question 2 of 5

The nurse is preparing to administer a dose of regular insulin to a client based on a sliding scale. The client’s blood glucose is 320 mg/dL. The sliding scale orders 6 units of regular insulin for a blood glucose of 301–350 mg/dL. Which of the following actions should the nurse take?

Correct Answer: A

Rationale: the sliding scale indicates 6 units for a blood glucose of 320 mg/dL, so the dose is correct

Question 3 of 5

The nurse is assessing a client who is 36 hours postpartum. Which of the following findings would indicate a need for further evaluation?

Correct Answer: D

Rationale: a temperature of 100.4°F may indicate infection, such as endometritis, and requires further evaluation

Question 4 of 5

A client is admitted to the surgical unit following a transurethral prostatectomy (TURP). The nurse administers a B&O suppository to help prevent bladder spasms. The nurse would observe the client for:

Correct Answer: C

Rationale: Belladonna and opium (B&O) suppositories can cause nausea and vomiting as side effects. These are more immediate concerns than dependence or the other symptoms.

Question 5 of 5

The nurse is preparing to admit a client from the emergency department with tuberculosis. Which of the following should the nurse anticipate in caring for this client? Select all that apply.

Correct Answer: C, D, E, F

Rationale: Tuberculosis requires airborne precautions, standard precautions, negative airflow rooms, and N95/PAPR use due to respiratory transmission. Fall precautions are not specific, and droplet precautions are incorrect.

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