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Questions 149

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Question 1 of 5

A client with tuberculosis who has been on combined therapy with rifampin and isoniazid asks the nurse how long he will have to take medication. The nurse should tell the client that:

Correct Answer: C

Rationale: Standard treatment for active tuberculosis involves 6 months of combined therapy with rifampin and isoniazid to ensure complete eradication.

Question 2 of 5

The nurse is caring for a client who has verbalized the desire to commit suicide. He has a detailed, concrete plan in place. The nurse places the client on suicide precautions, which include assigning the client a 24-hour sitter. The client becomes angry and refuses the sitter. Which action by the nurse is the most appropriate?

Correct Answer: C

Rationale: A detailed suicide plan indicates high risk. Assigning a sitter despite refusal ensures safety, as patient consent is secondary to preventing harm.

Question 3 of 5

The nurse is caring for a client in intensive care with a diagnosis of traumatic brain injury. The client is found to be restless, complains of extreme nausea, and is weak on the left arm and leg. Which is the best response by the nurse?

Correct Answer: B

Rationale: Elevating the head to 30 degrees reduces intracranial pressure in traumatic brain injury, addressing symptoms like nausea and restlessness.

Question 4 of 5

A diabetic multigravida is scheduled for an amniocentesis at 32 weeks gestation to determine the L/S ratio and phosphatidyl glycerol level. The L/S ratio is 1:1 and the presence of phosphatidylglycerol is noted. The nurse's assessment of this data is:

Correct Answer: C

Rationale: An L/S ratio of 1:1 indicates immature fetal lungs, increasing the risk of respiratory distress syndrome, despite the presence of phosphatidylglycerol.

Question 5 of 5

A client weighing 150 pounds has received burns over 50% of his body at 1200 hours. Using the Parkland formula, calculate the expected amount of fluid that the client should receive by 2000 hours.

Correct Answer: B

Rationale: Parkland formula: 4 mL × kg × % TBSA. Weight = 150 lb ÷ 2.2 = 68 kg. 4 × 68 × 50 = 13,600 mL total. Half (6,800 mL) is given in the first 8 hours (1200 to 2000).

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