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Question 1 of 5

A priority nursing diagnosis for a child being admitted from surgery following a tonsillectomy is:

Correct Answer: C

Rationale: Post-tonsillectomy, the risk of bleeding and aspiration is a priority due to the surgical site in the throat.

Question 2 of 5

The nurse is caring for a client following the removal of a central line catheter when the client suddenly develops dyspnea and complains of substernal chest pain. The client is noticeably confused and fearful. Based on the client's symptoms, the nurse should suspect which complication of central line use?

Correct Answer: B

Rationale: Sudden dyspnea, chest pain, and confusion post-central line removal suggest an air embolus, a serious complication requiring immediate intervention.

Question 3 of 5

A 46-year-old male has been placed under therapeutic hypothermic care after a myocardial infarction (MI). The nurse correctly explains to the family,

Correct Answer: C

Rationale: Therapeutic hypothermia post-MI slows metabolism, reducing cerebral oxygen demand and protecting the brain from ischemic injury.

Question 4 of 5

A client with bacterial pneumonia is admitted to the pediatric unit. What would the nurse expect the admitting assessment to reveal?

Correct Answer: A

Rationale: High fever is a hallmark of bacterial pneumonia due to the body's response to infection.

Question 5 of 5

A client with advanced Alzheimer's disease has been prescribed haloperidol (Haldol). What clinical manifestation suggests that the client is experiencing side effects from this medication?

Correct Answer: B

Rationale: Haloperidol, an antipsychotic, can cause extrapyramidal side effects like tremors, which are common and indicate a neurological side effect.

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