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Questions 164

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Extract:


Question 1 of 5

After the shift report in a labor and delivery unit which of these clients would the nurse check first?

Correct Answer: D

Rationale: This client has an actual complication. The others present with findings of potential complications. The adolescent’s symptoms suggest a serious condition, possibly pulmonary edema or fetal demise, requiring immediate assessment.

Question 2 of 5

A client, admitted to the unit because of severe depression and suicidal threats, is placed on suicidal precautions. The nurse should be aware that the danger of the client committing suicide is greatest

Correct Answer: B

Rationale: Suicide potential is often increased when there is an improvement in mood and energy level. At this time ambivalence is often decreased and a decision is made to commit suicide.

Question 3 of 5

What principle of HIV disease should the nurse keep in mind when planning care for a newborn who was infected in utero?

Correct Answer: B

Rationale: The infant is very susceptible to infections. HIV compromises the immune system, increasing susceptibility to opportunistic infections.

Question 4 of 5

The nurse is preparing a client with a deep vein thrombosis (DVT) for a Venous Doppler evaluation. Which of the following would be necessary for preparing the client for this test?

Correct Answer: D

Rationale: This is a non-invasive procedure and does not require preparation other than client education.

Question 5 of 5

As adult is admitted with bleeding esophageal varices, and a triple-lumen nasogastric tube is inserted and the balloons inflated. What should the nurse keep at the bedside because the client has this tube?

Correct Answer: C

Rationale: Scissors are kept at the bedside to cut and release the tube if the balloons cause airway obstruction or excessive pressure, a critical safety measure for triple-lumen tubes like the Sengstaken-Blakemore.

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