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Questions 149

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Extract:


Question 1 of 5

A nurse is working with an immobile client and doing passive range-of-motion (ROM) exercises on his legs. The client states the exercise is too painful and does not want to continue. The nurse should

Correct Answer: D

Rationale: Pain during ROM exercises may indicate injury. Stopping the exercise prevents harm, with further assessment or pain management to follow.

Question 2 of 5

The nurse’s INITIAL priority when managing a physically assaultive client is to

Correct Answer: C

Rationale: most important priority in the nursing management of an assaultive client is to maintain milieu safety by restoring the client’s self-control; a quick assessment of situation, psychological intervention, chemical intervention, and possibly physical control are important when managing the physically assaultive client

Question 3 of 5

An elderly client is returned to her room after an open reduction and internal fixation of the left femoral head after a fracture. It is MOST important for the nursing care plan to include that the client

Correct Answer: D

Rationale: prevents respiratory complications due to immobility following surgery

Question 4 of 5

Which of the following is the primary focus of cognitive behavioral therapy (CBT)?

Correct Answer: D

Rationale: CBT focuses on identifying and correcting automatic thoughts (
D) to change behavior. Rewards (
A), underlying causes (
B), and social effects (
C) are secondary.

Question 5 of 5

The clinic record for a client reads: gravida 3, para 2. The admitting nurse is most correct to confirm which prenatal history?

Correct Answer: B

Rationale: Gravida 3, para 2 indicates three pregnancies and two births after 20 weeks’ gestation, regardless of outcome (live or stillbirth).

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