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Question 1 of 5

A client recently lost a child due to poisoning. The client tells the nurse, 'I don't want to make any new friends right now.' This is an example of which of the following indicators of stress?

Correct Answer: C

Rationale: Avoiding new social connections reflects a sociocultural stress response, altering relationships due to grief. The other indicators involve different stress manifestations. Psychosocial Integrity

Question 2 of 5

When performing an assessment on the client with emphysema, the nurse finds that the client has a barrel chest. The alteration in the client's chest is due to:

Correct Answer: B

Rationale: Clients with emphysema develop a barrel chest due to the trapping of air in the lungs, causing them to hyperinflate. Answers C and D are common in those with emphysema but do not cause the chest to become barrel shaped. Answer A does not occur in emphysema.

Question 3 of 5

Which of these clients is at greatest risk for the complications associated with osteoporosis?

Correct Answer: C

Rationale: The 70-year-old postmenopausal woman has multiple risk factors: age, immobility, corticosteroid use, and alcohol consumption, maximizing osteoporosis complication risk.

Question 4 of 5

The practical nurse is caring for a client with newly diagnosed infective endocarditis. Which assessment finding by the nurse is the most concerning?

Correct Answer: A

Rationale: Pain and pallor in one foot suggest an embolic event, a serious complication of infective endocarditis that could lead to tissue ischemia or infarction, requiring urgent intervention. Knee pain, splinter hemorrhages, and mild fever are less immediately threatening.

Question 5 of 5

The home health nurse reviews the serum laboratory test results for a client with seizures. The phenytoin level is 27 mcg/mL. The client makes which statement that may indicate the presence of dose-related drug toxicity and prompt the nurse to notify the supervisory registered nurse?

Correct Answer: A

Rationale: A phenytoin level of 27 mcg/mL is above the therapeutic range (10-20 mcg/mL), indicating potential toxicity. Unsteadiness when walking suggests neurological toxicity, such as ataxia, which requires immediate reporting. Nocturia, metallic taste, and gingival hyperplasia are less urgent or unrelated.

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