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Questions 158

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Question 1 of 5

A client with a history of seizure disorder is admitted with complaints of breakthrough seizures. The nurse should give priority to:

Correct Answer: A

Rationale: Administering anticonvulsants is the priority to control breakthrough seizures and prevent status epilepticus.

Question 2 of 5

Which of the following findings would necessitate discontinuing an IV potassium infusion in an adult with ketoacidosis?

Correct Answer: A

Rationale: Adequate renal flow of 30 mL/hr is a necessity with potassium infusions because potassium is excreted renally. Because potassium level will decrease during correction of diabetic ketoacidosis, potassium will be infused even if plasma levels of potassium are normal. A small T wave is normal and desired on the electrocardiogram. A tall, peaked T-wave could indicate overinfusion of potassium and hyperkalemia. Glucose levels of <200 are desirable.

Question 3 of 5

The nurse is caring for a client with a history of Addison’s disease. Which finding indicates a potential adrenal crisis?

Correct Answer: A

Rationale: Adrenal crisis in Addison’s disease causes hypotension (e.g., 90/60 mmHg) due to cortisol and aldosterone deficiency, leading to shock. Weight gain, normal sodium, and normal heart rate are not indicative.

Question 4 of 5

An 8-year-old boy has been diagnosed with hemophilia. Which of the following diagnostic blood studies is characteristically abnormal in this disorder?

Correct Answer: A

Rationale: Partial thromboplastic time measures activity of thromboplastin, which depends on the intrinsic clotting factors deficient in children who are hemophiliacs. Platelet counts are normal in hemophilia. Hemophilia does not affect the complete blood count. Bleeding times are normal in hemophiliacs. They measure the time interval for the bleeding from small superficial wounds to cease.

Question 5 of 5

The nurse is performing an assessment on a client with a history of a tension pneumothorax. Which finding is most concerning?

Correct Answer: A

Rationale: Tracheal deviation in a tension pneumothorax indicates mediastinal shift from increased intrathoracic pressure, a life-threatening emergency requiring immediate attention.

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