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Extract:


Question 1 of 5

A patient with cirrhosis is experiencing ascites. Which of the following interventions should the nurse implement?

Correct Answer: B

Rationale: Diuretics reduce fluid overload in ascites, as prescribed. High-sodium diets worsen fluid retention, fluid restriction is typically 1–1.5 liters, and supine positioning may impair breathing.

Question 2 of 5

An adult is on long-term aspirin therapy and complains of tinnitus. Which interpretation by the nurse is accurate?

Correct Answer: D

Rationale: Tinnitus is a sign of aspirin toxicity (salicylism), indicating a minor overdose. It's not an expected effect, and GI bleed would present with other symptoms like melena.

Extract:

Miss Helen Roller is admitted following a diagnosis of congestive heart failure. She tells you she is unable to wash herself without assistance because of shortness of breath. You notice she also has difficulty walking to the bathroom unassisted for the same reason.


Question 3 of 5

Which of the following nursing diagnosis is most important?

Correct Answer: B

Rationale: Activity intolerance due to shortness of breath is the most pressing issue affecting her daily functioning.

Extract:


Question 4 of 5

A nurse is delegating tasks to a nursing assistant. Which of the following tasks is appropriate to delegate?

Correct Answer: C

Rationale: Assisting with ambulation is within a nursing assistant’s scope, promoting safety and mobility. Medication administration, sterile procedures, and care planning require licensed nurse skills.

Question 5 of 5

The nurse is evaluating the growth and development of a toddler with AIDS. The nurse would anticipate finding that the child has

Correct Answer: D

Rationale: Delay in achievement of most developmental milestones. The majority of children with AIDS have neurological involvement, leading to developmental delays and potential loss of milestones.

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