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Questions 149

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Question 1 of 5

A young adult patient constantly seeks attention from the nurses, stomping away from the nurses’ station and pouting when her requests are refused. Which of the following responses by the nurse is MOST appropriate?

Correct Answer: B

Rationale: reward nonseeking attention behaviors by giving the patient unsolicited attention

Question 2 of 5

Which cephalic presentation is most common during delivery of a neonate?

Correct Answer: A

Rationale: Vertex presentation (
A), with the head flexed and occiput leading, is the most common (95%) during delivery.

Question 3 of 5

The charge nurse is making assignments for the day shift. One of the nurses is 5 months pregnant. Which of the following clients is the most appropriate assignment for this expectant nurse?

Correct Answer: C

Rationale: Pneumonia is less likely to pose a risk to a pregnant nurse compared to shingles, measles (both vaccine-preventable and highly contagious), or C. difficile (requiring strict contact precautions).

Question 4 of 5

A client is 2 days post-operative colon resection. After a coughing episode, the client's wound eviscerates. Which nursing action is most appropriate?

Correct Answer: C

Rationale: Covering the eviscerated wound with a sterile saline-soaked dressing keeps the protruding organs moist and prevents infection until surgical repair.

Question 5 of 5

A newly admitted client has sickle cell crisis. He is complaining of pain in his feet and hands. The nurse's assessment findings include a pulse oximetry of 92. Assuming that all the following interventions are ordered, which should be done first?

Correct Answer: C

Rationale: A pulse oximetry of 92 indicates hypoxemia, so administering oxygen is the priority to improve oxygenation and prevent further sickling.

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