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Questions 158

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Extract:


Question 1 of 5

A pregnant client during labor is irritable and feels the urge to vomit. The nurse should recognize this as the:

Correct Answer: C

Rationale: The transition stage is characterized by irritability, nausea, and strong contractions as the cervix completes dilation.

Question 2 of 5

The nurse is caring for a client in labor. The fetal monitor shows early decelerations. The nurse should:

Correct Answer: C

Rationale: Early decelerations are benign caused by fetal head compression during contractions and do not indicate fetal distress. Continuing to monitor the fetal heart rate is appropriate. Repositioning oxygen or notifying the physician are unnecessary unless other abnormalities occur.

Question 3 of 5

The nurse is caring for a client with a diagnosis of postpartum depression. Which symptom is most likely to be present?

Correct Answer: A

Rationale: Postpartum depression is characterized by persistent sadness and low mood. Fever uterine tenderness and foul-smelling lochia suggest infection not depression.

Question 4 of 5

The nurse is providing dietary instructions for a client with iron-deficiency anemia. Which food is a poor source of iron?

Correct Answer: A

Rationale:
Tomatoes are a poor source of iron compared to legumes, dried fruits, and nuts, which are rich in iron.
Tomatoes provide vitamin C, which aids iron absorption, but lack significant iron content.

Question 5 of 5

The nurse is caring for a client with a spinal cord injury at C5. Which complication is the client at greatest risk for?

Correct Answer: A

Rationale: A C5 spinal cord injury impairs diaphragm function (innervated by C3–C5), placing the client at greatest risk for respiratory depression due to weak respiratory muscles. The other complications are risks but less immediate.

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