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Question 1 of 5

A gravida III para II is admitted to the labor unit. Vaginal exam reveals that the client's cervix is 8 cm dilated, with complete effacement. The priority nursing diagnosis at this time is:

Correct Answer: B

Rationale: At 8 cm dilation with complete effacement, the client is in advanced labor, and the risk of precipitate delivery is high, posing a potential for injury.

Question 2 of 5

A client with frequent urinary tract infections asks the nurse how she can prevent the reoccurrence. The nurse should teach the client to:

Correct Answer: B

Rationale: Voiding every 3 hours prevents urine stasis, reducing the risk of bacterial growth and urinary tract infections.

Question 3 of 5

A client has been placed on the drug valproic acid (Depakene). Which would indicate to the nurse that the client is experiencing an adverse reaction to this medication?

Correct Answer: C

Rationale: Lethargy is a common adverse reaction to valproic acid, indicating potential toxicity or side effects, requiring further evaluation.

Question 4 of 5

The nurse is caring for a client with epilepsy who is to receive Dilantin 100 mg IV push. The client has an IV of D51/2NS infusing at 100 mL/hr. When administering the Dilantin, the nurse should first:

Correct Answer: C

Rationale: Dilantin is incompatible with dextrose solutions (D51/2NS), causing precipitation. Flushing with normal saline ensures compatibility and prevents complications.

Question 5 of 5

The nurse is teaching the client with AIDS regarding needed changes in food preparation. Which statement indicates that the client understands the nurse's teaching?

Correct Answer: B

Rationale: Thoroughly cooking meat reduces the risk of foodborne infections, which is critical for clients with AIDS due to their weakened immune systems.

Similar Questions

The nurse is assisting a client with diverticulosis to select appropriate foods. Which food should be avoided?
The nurse is making assignments for the day. The staff consists of an RN, an LPN, and a nursing assistant. Which client could the nursing assistant care for?
The nurse is preparing to hang a unit of blood on a client. The blood has been checked off with two RNs and the pre-infusion vitals recorded. The nurse is at the bedside monitoring the infusion. Shortly after beginning the infusion, the pump alarm sounds. The IV has infiltrated. No blood has yet reached the client. The client is a hard stick, and the nurse realizes that a line cannot be placed within the time frame to begin the infusion. Which action by the nurse is correct?
The nurse is discharging a client with asthma who has a prescription for zafirlukast (Accolate). Which comment by the client would indicate a need for further teaching?
The client has a nitroprusside drip infusing at 0.3 mcg/kg/min. The concentration is 50 mg nitroprusside in 250 mL D5W. The client weighs 70 kg. What will the IV infusion rate be?

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