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Questions 149

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Question 1 of 5

A client with a history of abusing barbiturates abruptly stops taking the medication. The nurse should give priority to assessing the client for:

Correct Answer: B

Rationale: Abrupt cessation of barbiturates can cause withdrawal symptoms like tachycardia and diarrhea due to central nervous system hyperactivity.

Question 2 of 5

A client who served three tours of duty in Afghanistan has been diagnosed with posttraumatic stress disorder (PTSD). Which of the following signs and symptoms does the nurse expect the client to exhibit? Select all that apply.

Correct Answer: A,B,C,E

Rationale: PTSD symptoms include recurring flashbacks (
A), detachment (
B), anger (
C), and nightmares (E). Hyperacute memory (
D) is not typical, and excessive sleeping (F) is less common than insomnia in PTSD.

Question 3 of 5

When caring for a ventilator-dependent client who is receiving tube feedings, the nurse can help prevent aspiration of gastric secretions by:

Correct Answer: B

Rationale: Elevating the head of the bed 30-45° reduces the risk of aspiration in ventilator-dependent clients.

Question 4 of 5

A nurse is preparing to administer a MMR vaccine to a 35-year-old male. The nurse should

Correct Answer: D

Rationale: MMR is an intramuscular vaccine, requiring a 90-degree angle injection (typically deltoid). Dorsogluteal is not preferred, and pinching is for subcutaneous injections.

Question 5 of 5

The nurse has taken the blood pressure of a client hospitalized with methicillin-resistant staphylococcus aureus (MRSA). Which action by the nurse indicates an understanding regarding the care of clients with MRSA?

Correct Answer: A

Rationale: Leaving the stethoscope in the room prevents MRSA transmission, as it avoids contaminating other areas or clients.

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