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Questions 158

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Question 1 of 5

A client with a history of pancreatitis is admitted with complaints of nausea. The nurse should give priority to:

Correct Answer: A

Rationale: Antiemetics relieve nausea in pancreatitis, improving comfort and preventing dehydration.

Question 2 of 5

A 19-year-old client fell off a ladder approximately 3 ft to the ground. He did not lose consciousness but was taken to the emergency department by a friend to have a scalp laceration sutured. The nurse instructs the client to:

Correct Answer: C

Rationale: Confusion, nausea, or vomiting may indicate increasing intracranial pressure from a possible head injury, requiring immediate evaluation.

Question 3 of 5

A school-age child with asthma is ready for discharge from the hospital. His physician has written an order to continue the theophylline given in the hospital as an oral home medication. Immediately prior to discharge, he complains of nausea and becomes irritable. His vital signs were normal except for tachycardia. What first nursing actions would be essential in this situation?

Correct Answer: B

Rationale: Nausea, tachycardia, and irritability are all symptoms of theophylline toxicity. The physician should be notified immediately so that a serum theophylline level can be ordered.

Question 4 of 5

In the client with a diagnosis of coronary artery disease, the nurse would anticipate the complication of bradycardia with occlusion of which coronary artery?

Correct Answer: A

Rationale: Sinus bradycardia and atrioventricular (AV) heart block are usually a result of right coronary artery occlusion. The right coronary artery perfuses the sinoatrial and AV nodes in most individuals. Occlusion of the left main coronary artery causes bundle branch blocks and premature ventricular contractions. Occlusion of the circumflex artery does not cause bradycardia. Sinus tachycardia occurs primarily with left anterior descending coronary artery occlusion because this form of occlusion impairs left ventricular function.

Question 5 of 5

The home care nurse is preparing a teaching plan for a client with deficiencies in folic acid. Which foods will increase the clients' folic acid level?

Question Image

Correct Answer: A, B, D

Rationale: Folic acid-rich foods include broccoli (
A), cabbage (
B), and dried fruit (
D). Chicken (
C), white bread (E), and milk (F) are low in folate.

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