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Questions 227

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Extract:


Question 1 of 5

A nurse is assessing a patient who has been receiving morphine for pain management. Which of the following findings indicates a need for immediate intervention?

Correct Answer: C

Rationale: A respiratory rate of 10 breaths per minute indicates respiratory depression, a life-threatening side effect of morphine, requiring immediate intervention (e.g., naloxone). Drowsiness, constipation, and nausea are expected but less urgent.

Question 2 of 5

A nurse is caring for a patient with chronic heart failure. Which of the following interventions should the nurse include in the plan of care? (Select all that apply)

Correct Answer: A,C,D,E

Rationale: Daily weight tracks fluid status, diuretics reduce overload, fluid restriction prevents exacerbation, and activity improves cardiac function. High-sodium diets worsen heart failure.

Extract:

Marie is a 5-year-old girl is admitted with a diagnosis of Acute Lymphoblastic Leukemia.


Question 3 of 5

Incidence of Leukemia is higher in children. Pathophysiology of infection in Leukemia is due primarily to:

Correct Answer: C

Rationale: Elevated WBC with impaired function (neutropenia) predisposes to infections in leukemia.

Extract:


Question 4 of 5

What interpersonal relief behavior is Ashley using?

Correct Answer: B

Rationale: Somatizing involves expressing emotional conflict, like Ashley's severe anxiety, through physical symptoms such as dizziness and nausea. The other behaviors do not match her presentation. Psychosocial Integrity

Extract:

Francis' serum K+ level is 3.8 mEq/L. Potassium chloride 40 mEq has been prescribed to be added to the first liter of IV fluid.


Question 5 of 5

The nurse should

Correct Answer: C

Rationale: Ketoacidosis means high blood glucose. Insulin is expected to be administered to lower the blood glucose level. Insulin transports potassium back to the cell, so potassium IV is usually given prophylactically with insulin.

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