NCLEX Questions, ATI NCLEX-RN Practice Questions Questions, NCLEX-RN Questions, Nurselytic

Questions 158

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Question 1 of 5

A two-year-old is being evaluated for hearing loss. Which finding in the child's history is likely to be a significant factor?

Correct Answer: D

Rationale: Meningitis treated with garamycin (gentamicin) is a significant risk factor for hearing loss as gentamicin is ototoxic and meningitis can damage auditory nerves. The other factors are less directly associated with hearing impairment.

Question 2 of 5

The nurse is caring for a client following a laryngectomy. The nurse can best help the client with communication by:

Correct Answer: A

Rationale: A pad and pencil allow immediate, effective communication for a client post-laryngectomy, who cannot speak due to removal of the voice box.

Question 3 of 5

The nurse is caring for a client with scalding burns across the face, neck, upper half of the anterior chest, and entire right arm.

Correct Answer: 32

Rationale: Rule of nines: face (4.5%), neck (4.5%), upper half anterior chest (9%), right arm (9%) = 4.5 + 4.5 + 9 + 9 = 27%. The closest answer is 32% (
C), possibly due to rounding or partial overlap.

Question 4 of 5

At 12 hours postvaginal delivery, a female client is without complications. Which of the following assessment findings would warrant further nursing interventions?

Correct Answer: B

Rationale: Bradycardia of 50-70 bpm may be considered normal postpartally because the heart compensates for the decreased resistance in the pelvis. The uterus is displaced from the midline by a full bladder. This condition could lead to a boggy uterus and increased risk of postpartal hemorrhage; therefore, the bladder should be kept empty. Re-establishment of normal bowel function is delayed into the first postpartum week. A postpartum woman's oral temperature may go as high as 100.4°F within 24 hours of delivery resulting from muscular exertion, dehydration, and hormonal changes.

Question 5 of 5

A mother came to the pediatric clinic with her 17-month-old child. The mother would like to begin toilet training. What should the nurse teach her about implementing toilet training?

Correct Answer: B

Rationale: Giving her toys will distract her and interfere with toilet training because of inappropriate reinforcement. A child-sized toilet seat or training potty gives a child a feeling of security. She should use words that are age appropriate for the child. Children should be praised for cooperative behavior and/or successful evacuation.

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